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1.
PLoS One ; 15(2): e0227939, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32023265

RESUMEN

Severe acute malnutrition (SAM) affects over 16.6 million children worldwide. The integrated Community Case Management (iCCM) strategy seeks to improve essential health by means of nonmedical community health workers (CHWs) who treat the deadliest infectious diseases in remote rural areas where there is no nearby health center. The objective of this study was to assess whether SAM treatment delivered by CHWs close to families' locations may improve the early identification of cases compared to outpatient treatment at health facilities (HFs), with a decreased number complicated cases referred to stabilization centers, increased anthropometric measurements at admission (closer to the admission threshold) and similarity in clinical outcomes (cure, death, and default). The study included 930 children aged 6 to 59 months suffering from SAM in the Kita district of the Kayes Region in Mali; 552 children were treated by trained CHWs. Anthropometric measurements, the presence of edema, and other medical signs were recorded at admission, and the length of stay and clinical outcomes were recorded at discharge. The results showed fewer children with edema at admission in the CHW group than in the HF group (0.4% vs. 3.7%; OR = 10.585 [2.222-50.416], p = 0.003). Anthropometric measurements at admission were higher in the CHW group, with fewer children falling into the lowest quartiles of both weight-for-height z-scores (20.2% vs. 31.5%; p = 0.002) and mid-upper arm circumference (18.0% vs. 32.4%; p<0.001), than in the HF group. There was no difference in the length of stay. More children in the CHW group were cured (95.9% vs. 88.7%; RR = 3.311 [1.772-6.185]; p<0.001), and there were fewer defaulters (3.7% vs. 9.8%; RR = 3.345 [1.702-6.577]; p<0.001) than in the HF group. Regression analyses demonstrated that less severe anthropometric measurements at admission resulted in an increased probability of cure at discharge. The study results also showed that CHWs provided more integrated care, as they diagnosed and treated significantly more cases of infectious diseases than HFs (diarrhea: 36.0% vs. 18.3%, p<0.001; malaria: 41.7% vs. 19.8%, p<0.001; acute respiratory infection: 34.8% vs. 25.2%, p = 0.007). The addition of SAM treatment in the curative tasks that the CHWs provided to the families resulted in earlier admission and more integrated care for children than those associated with HFs. CHW treatment also achieved better discharge outcomes than standard community treatment.


Asunto(s)
Agentes Comunitarios de Salud , Composición Familiar , Hospitalización , Desnutrición/terapia , Alta del Paciente , Enfermedad Aguda , Brazo/anatomía & histología , Estatura , Peso Corporal , Preescolar , Femenino , Instituciones de Salud , Humanos , Masculino , Malí , Modelos Teóricos
2.
Hosp Pract (1995) ; 48(sup1): 17-25, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32046544

RESUMEN

Cancer occurs most frequently in patients aged 65 and older. With the increasing age of the world's population, there will be a significant increase in cancer diagnoses in older adults. Aging imposes a wide variety of physiological responses, comorbidities, and ailments, but older patients are less represented in clinical studies. Specific needs of older patients with cancer often go under-recognized and consequently unmet. In this review, common diagnoses that can affect the outcomes of this population, including frailty, malnutrition, and delirium, are discussed. Areas that need further research to improve the care of geriatric cancer patients, particularly in the hospital settings, are also identified.


Asunto(s)
Delirio/epidemiología , Fragilidad/epidemiología , Evaluación Geriátrica/métodos , Desnutrición/epidemiología , Neoplasias/epidemiología , Neoplasias/terapia , Anciano , Anciano de 80 o más Años , Envejecimiento , Comorbilidad , Delirio/diagnóstico , Delirio/terapia , Anciano Frágil , Fragilidad/diagnóstico , Fragilidad/terapia , Humanos , Desnutrición/diagnóstico , Desnutrición/terapia , Obesidad/epidemiología , Factores de Riesgo
3.
Medicine (Baltimore) ; 99(1): e18506, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895785

RESUMEN

BACKGROUND: Whether the occurrence of refeeding syndrome (RFS), a metabolic condition characterized by electrolyte shifts after initiation of nutritional therapy, has a negative impact on clinical outcomes remains ill-defined. We prospectively investigated a subgroup of patients included in a multicentre, nutritional trial (EFFORT) for the occurrence of RFS. METHODS: In this secondary analysis of a randomized-controlled trial investigating the effects of nutritional support in malnourished medical inpatients, we prospectively screened patients for RFS and classified them as "RFS confirmed" and "RFS not confirmed" based on predefined criteria (i.e. electrolyte shifts, clinical symptoms, clinical context, and patient history). We assessed associations of RFS and mortality within 180 days (primary endpoint) and other secondary endpoints using multivariable regression analysis. RESULTS: Among 967 included patients, RFS was confirmed in 141 (14.6%) patients. Compared to patients with no evidence for RFS, patients with confirmed RFS had significantly increased 180-days mortality rates (42/141 (29.8%) vs 181/826 (21.9%), adjusted odds ratio (OR) 1.53 (95% CI 1.02 to 2.29), P < .05). Patients with RFS also had an increased risk for ICU admission (6/141 (4.3%) vs 13/826 (1.6%), adjusted OR 2.71 (95% CI 1.01 to 7.27), P < .05) and longer mean length of hospital stays (10.5 ±â€Š6.9 vs 9.0 ±â€Š6.6 days, adjusted difference 1.57 days (95% CI 0.38-2.75), P = .01). CONCLUSION: A relevant proportion of medical inpatients with malnutrition develop features of RFS upon hospital admission, which is associated with long-term mortality and other adverse clinical outcomes. Further studies are needed to develop preventive strategies for RFS in this patient population.


Asunto(s)
Pacientes Internos/estadística & datos numéricos , Desnutrición/mortalidad , Apoyo Nutricional/efectos adversos , Síndrome de Realimentación/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Desnutrición/terapia , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Síndrome de Realimentación/etiología , Factores de Riesgo , Tasa de Supervivencia
7.
Bull Cancer ; 107(1): 61-71, 2020 Jan.
Artículo en Francés | MEDLINE | ID: mdl-31564476

RESUMEN

INTRODUCTION: There is a growing interest in diets and their effects on cancer prognosis. In 2014, a report from the World Cancer Research Fund on diet and women with a history of breast cancer did not demonstrate a major effect on breast cancer prognosis. The aim of this literature review was to provide an update of knowledge in this area. METHODS: Randomized trials, prospective cohorts and meta-analyses published between 2012 and 2018 examining the impact of diet on recurrence risk and/or mortality after breast cancer were included, to achieve the objective. We evaluated study quality (according to Haute Autorité de Santé criteria) and the studied diets were categorized: macronutrients, micronutrients and selective foods. RESULTS: We selected eighteen articles that met levels of evidence 1 to 3. For macronutrients, a low-fat diet was associated with better survival. With regard to micronutrients, a diet rich in phytœstrogen reduced the risk of cancer recurrence. Finally, the adoption of a healthy diet was not associated with an improved prognosis for breast cancer but with an improvement in overall survival and risk of death from cardiovascular disease. DISCUSSION: This review suggests that nutrition influences the prognosis of breast cancer. Nevertheless, the level of evidence of the results was insufficient to make recommendations. Ultimately, a healthy and balanced diet could be encouraged in order to reduce global mortality.


Asunto(s)
Neoplasias de la Mama/mortalidad , Estado Nutricional , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/dietoterapia , Neoplasias de la Mama/patología , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/prevención & control , Culinaria , Dieta con Restricción de Grasas , Medicina Basada en la Evidencia , Ayuno , Femenino , Alimentos/efectos adversos , Humanos , Inflamación , Desnutrición/complicaciones , Desnutrición/dietoterapia , Desnutrición/terapia , Metaanálisis como Asunto , Micronutrientes/administración & dosificación , Nutrientes/administración & dosificación , Política Nutricional , Apoyo Nutricional , Fitoestrógenos/uso terapéutico , Pronóstico , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Riesgo
8.
World Neurosurg ; 133: e173-e179, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31493604

RESUMEN

BACKGROUND: Preoperative malnutrition is associated with increased postoperative complication rate and hospital length of stay. However, the degree to which these risks can be mitigated by nutritional consultation has not been well described. To address this, we sought to determine if a preoperative nutrition consult was associated with decreased 30-day complication rate and hospital length of stay. METHODS: Adult patients who underwent neurosurgical intervention for spinal metastases at a tertiary care institution between 2008 and 2016 were retrospectively reviewed. Stepwise multivariable linear regression analyses were used to identify associations with 30-day complication rate and hospital length of stay. RESULTS: Among 95 patients who met inclusion criteria, the average length of stay was 8.9 days and 40 patients (42.1%) experienced one or more postoperative complications. On multivariable analysis, 30-day complication rates were higher in patients with the absence of a preoperative nutrition consult, a Modified Charlson Comorbidity Index score of greater than 2 points, greater operative blood loss, and malnutrition (Nutritional Risk Index score <97.5). Furthermore, hospitalization duration was increased with the absence of a nutrition consult, malnutrition, congestive heart failure, and prior systemic therapy in the multivariable analysis. CONCLUSIONS: On multivariable analysis, receipt of a preoperative nutrition consult was associated with both decreased 30-day complication rate and shorter hospitalization. We therefore posit that greater implementation of nutritional counseling may help to decrease complication rates and expedite discharge in patients undergoing surgical intervention for spinal metastases.


Asunto(s)
Apoyo Nutricional , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/métodos , Neoplasias de la Columna Vertebral/secundario , Anciano , Comorbilidad , Femenino , Humanos , Tiempo de Internación , Masculino , Desnutrición/complicaciones , Desnutrición/terapia , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/cirugía
9.
Support Care Cancer ; 28(1): 373-380, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31049672

RESUMEN

BACKGROUND/OBJECTIVES: The assessment of nutritional status and the quality of life in patients with gastric cancer has become one of the important goals of current clinical treatment. The purpose of this study was to assess the nutritional status in hospitalized gastric cancer patients by using patient-generated subjective global assessment (PG-SGA) and to analyze the influence of nutritional status on the patients' quality of life (QOL). METHODS: We reviewed the pathological diagnosis of gastric cancer for 2322 hospitalized patients using PG-SGA to assess their nutritional status and collected data on clinical symptoms, the anthropometric parameters (height, weight, body mass index (BMI), mid-arm circumference (MAC), triceps skin-fold thickness (TSF), and hand-grip strength (HGS). We also collected laboratory data (prealbumin, albumin, hemoglobin) within 48 h after the patient was admitted to the hospital. The 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) was used for QOL assessment in all patients. RESULTS: By using PG-SGA, we found 80.4% of the patients were malnourished (score ≥ 4) and 45.1% of the patients required urgent nutritional support (score ≥ 9). In univariate analysis, old age (> 65 years, p < 0.001), female (p = 0.007), residence in a village (p = 0.004), a lower level of education (p < 0.001), and self-paying (p < 0.001) were indicated as risk factors of patients with gastric cancer to be suffering from severe malnutrition. There was a negative correlation between PG-SGA and various nutritional parameters (p < 0.05). The quality of life was significantly different in gastric cancer patients with different nutritional status (p < 0.01). CONCLUSION: Malnutrition of hospitalized patients with gastric cancer in China is common and seriously affects the patients' quality of life. The nutritional status should be evaluated in a timely manner and reasonable nutritional intervention should be provided as soon as possible. The PG-SGA was fit for using as a clinical nutrition assessment method, being worthy of clinical application.


Asunto(s)
Hospitalización/estadística & datos numéricos , Estado Nutricional/fisiología , Calidad de Vida , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Peso Corporal/fisiología , China/epidemiología , Estudios Transversales , Femenino , Fuerza de la Mano/fisiología , Humanos , Masculino , Desnutrición/epidemiología , Desnutrición/etiología , Desnutrición/terapia , Persona de Mediana Edad , Evaluación Nutricional , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Gástricas/complicaciones , Encuestas y Cuestionarios
10.
Surg Clin North Am ; 99(6): 1083-1094, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31676049

RESUMEN

Patients with ulcerative colitis and Crohn's disease often present to surgery malnourished and on combination immunosuppression. These factors affect operation selection and postoperative outcomes. Corticosteroids have a well-established detrimental effect on postoperative outcomes, whereas the impact of biologic agents is more controversial. In a patient exposed to these medications, and in the presence of other risk factors, temporary intestinal diversion is likely the best choice. Enteral nutrition may help optimize malnourished patients at high risk of adverse postoperative outcomes.


Asunto(s)
Corticoesteroides/uso terapéutico , Productos Biológicos/uso terapéutico , Colectomía/métodos , Colitis Ulcerosa/tratamiento farmacológico , Enfermedad de Crohn/tratamiento farmacológico , Progresión de la Enfermedad , Toma de Decisiones Clínicas , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/cirugía , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/cirugía , Nutrición Enteral/métodos , Femenino , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/cirugía , Masculino , Desnutrición/terapia , Periodo Preoperatorio , Pronóstico , Resultado del Tratamiento
11.
Rev Med Suisse ; 15(670): 2046-2051, 2019 Nov 06.
Artículo en Francés | MEDLINE | ID: mdl-31696680

RESUMEN

Stroke is the most common acute neurological disease in the world. Approximately 16 000 strokes occur each year in Switzerland. In the older population, the stroke outcomes are related to high risk of malnutrition due to neurological deficits impacting oral feeding. Therefore, systematic screening of malnutrition is required upon admission to hospital. Then, assessment of the nutritional status by a specialist should be initiated before deciding on individualised nutritional strategy. Rehabilitation is complex and must be done in multidisciplinary team to provide optimal care to the patients.


Asunto(s)
Desnutrición/etiología , Desnutrición/terapia , Evaluación Nutricional , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/complicaciones , Anciano , Hospitalización , Humanos , Desnutrición/diagnóstico , Estado Nutricional , Accidente Cerebrovascular/epidemiología , Suiza/epidemiología
12.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(9): 555-562, nov. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-184378

RESUMEN

Introducción: La prevalencia de la desnutrición relacionada con la enfermedad en el hospital varía del 20 al 50%. La utilización de herramientas de cribado debe ser el primer paso en la prevención y el tratamiento de los pacientes en riesgo de desnutrición o desnutridos. Objetivos: Implantar un método de cribado nutricional al ingreso en el ámbito de un hospital terciario. Métodos: La Unidad de Nutrición elaboró un protocolo de detección precoz del riesgo nutricional y eligió el NRS 2002 como herramienta de cribado. El protocolo fue aprobado por la Comisión de Protocolos y Procedimientos del hospital y difundido en la intranet. El NRS 2002 se incluyó en el programa de prescripción de dietas para su realización por parte del personal de enfermería de las unidades de hospitalización y como sistema de comunicación directo con la Unidad de Nutrición. Se diseñaron 3 fases para la implantación: fase de pilotaje, fase de implantación y fase de consolidación. Resultados: En la fase de pilotaje se implantó el NRS 2002 en 2 unidades de hospitalización para monitorizar el software. La fase de implantación se realizó en las mismas unidades y se verificaron todos los protocolos de actuación relacionados con el mismo. La fase de consolidación consistió en ir ampliando sucesivamente las unidades de hospitalización con el protocolo implantado. Conclusiones: La implantación de un cribado nutricional al ingreso hospitalario es un proceso largo y complejo, con la implicación de muchos estamentos. El programa informático ha posibilitado que la realización del mismo sea rápido, sencillo y automatizado, y que el resultado del cribado llegue inmediatamente al personal de enfermería de la unidad de Nutrición y se activen los protocolos de actuación de la misma


Introduction: Prevalence of disease-related malnutrition in hospitals ranges from 20%-50%. Use of nutritional screening tools should be the first step in the prevention and treatment of patients at risk of malnutrition and/or undernourished. Aims: To implement a nutritional screening tool at admission to a tertiary hospital. Methods: The nutrition unit prepared a protocol for early detection of nutritional risk and selected the NRS 2002 as screening tool. The protocol was approved by the hospital committee of protocols and procedures and disseminated through the intranet. NRS 2002 was included in the diet prescription software to be implemented by the nursing staff of the hospital wards and as a direct communication system with the nutrition unit. Three phases were designed: pilot phase, implementation phase, and consolidation phase. Results: The pilot phase, NRS 2002 was implemented in 2 hospital units to monitor software. The implementation phase was carried out in the same units, and all action protocols related to it were verified. The consolidation phase consisted of sequential extension of the protocol to the other hospital units. Conclusions: Implementation of nutritional screening at hospital admission is a long and complex process that requires involvement of many stakeholders. Computer software has allowed for a rapid, simple, and automatic process, so that the results of the screening are immediately available to the nursing staff of the nutrition unit and activate the nutritional protocols when required


Asunto(s)
Humanos , Anciano , Desnutrición/prevención & control , Desnutrición/terapia , Diagnóstico Precoz , Hospitales Universitarios , Desnutrición/diagnóstico , Programas de Detección Diagnóstica/normas , Indicadores de Morbimortalidad , Tiempo de Internación
13.
PLoS Med ; 16(10): e1002934, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31613883

RESUMEN

BACKGROUND: Recent data suggest that case fatality from severe acute malnutrition (SAM) in India may be lower than the 10%-20% estimated by the World Health Organization (WHO). A contemporary quantification of mortality and recovery from acute malnutrition in Indian community settings is essential to inform policy regarding the benefits of scaling up prevention and treatment programmes. METHODS AND FINDINGS: We conducted a cohort study using data collected during a recently completed cluster-randomised controlled trial in 120 geographical clusters with a total population of 121,531 in rural Jharkhand and Odisha, eastern India. Children born between October 1, 2013, and February 10, 2015, and alive at 6 months of age were followed up at 9, 12, and 18 months. We measured the children's anthropometry and asked caregivers whether children had been referred to services for malnutrition in the past 3 months. We determined the incidence and prevalence of moderate acute malnutrition (MAM) and SAM, as well as mortality and recovery at each follow-up. We then used Cox-proportional models to estimate mortality hazard ratios (HRs) for MAM and SAM. In total, 2,869 children were eligible for follow-up at 6 months of age. We knew the vital status of 93% of children (2,669/2,869) at 18 months. There were 2,704 children-years of follow-up time. The incidence of MAM by weight-for-length z score (WLZ) and/or mid-upper arm circumference (MUAC) was 406 (1,098/2,704) per 1,000 children-years. The incidence of SAM by WLZ, MUAC, or oedema was 190 (513/2,704) per 1,000 children-years. There were 36 deaths: 12 among children with MAM and six among children with SAM. Case fatality rates were 1.1% (12/1,098) for MAM and 1.2% (6/513) for SAM. In total, 99% of all children with SAM at 6 months of age (227/230) were alive 3 months later, 40% (92/230) were still SAM, and 18% (41/230) had recovered (WLZ ≥ -2 standard deviation [SD]; MUAC ≥ 12.5; no oedema). The adjusted HRs using all anthropometric indicators were 1.43 (95% CI 0.53-3.87, p = 0.480) for MAM and 2.56 (95% CI 0.99-6.70, p = 0.052) for SAM. Both WLZ < -3 and MUAC ≥ 11.5 and < 12.5 were associated with increased mortality risk (HR: 3.33, 95% CI 1.23-8.99, p = 0.018 and HR: 3.87, 95% CI 1.63-9.18, p = 0.002, respectively). A key limitation of our analysis was missing WLZ or MUAC data at all time points for 2.5% of children, including for two of the 36 children who died. CONCLUSIONS: In rural eastern India, the incidence of acute malnutrition among children older than 6 months was high, but case fatality following SAM was 1.2%, much lower than the 10%-20% estimated by WHO. Case fatality rates below 6% have now been recorded in three other Indian studies. Community treatment using ready-to-use therapeutic food may not avert a substantial number of SAM-related deaths in children aged over 6 months, as mortality in this group is lower than expected. Our findings strengthen the case for prioritising prevention through known health, nutrition, and multisectoral interventions in the first 1,000 days of life, while ensuring access to treatment when prevention fails.


Asunto(s)
Desnutrición/mortalidad , Desnutrición/terapia , Desnutrición Aguda Severa/mortalidad , Desnutrición Aguda Severa/terapia , Antropometría , Cuidadores , Edema/complicaciones , Femenino , Estudios de Seguimiento , Geografía , Política de Salud , Accesibilidad a los Servicios de Salud , Humanos , India/epidemiología , Lactante , Masculino , Prevalencia , Modelos de Riesgos Proporcionales , Ensayos Clínicos Controlados Aleatorios como Asunto , Riesgo , Servicios de Salud Rural , Población Rural , Resultado del Tratamiento
14.
J Stroke Cerebrovasc Dis ; 28(12): 104405, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31570264

RESUMEN

BACKGROUND: Malnutrition in patients hospitalized with a stroke have been assessed using different nutritional screening methods but there is a paucity of data linking risk of malnutrition to clinical outcomes using a validated tool. AIMS: To identify the prevalence of malnutrition risk in patients after a stroke and assess the predictive value of the Malnutrition Universal Screening Tool (MUST) on clinical outcomes. PATIENTS AND METHODS: Using data from electronic records and the Sentinel Stroke National Audit Programme (January 2013 and March 2016), patients aged more than 18 years with confirmed stroke admitted to a tertiary care stroke unit were assessed for risk of malnutrition. The association between malnutrition risk and clinical outcomes was investigated and adjusted for confounding variables. RESULTS: Of 1101 patients, 66% were screened at admission. Most patients (n = 571, 78.5%) were identified as being at low risk, 4.1% (n = 30) at medium risk, and 17.4% (n = 126) at high risk of malnutrition. Compared with low risk, patients with medium or high risk of malnutrition were more likely to have a longer hospital stay (IRR 1.30, 95% confidence interval [CI] 1.07, 1.58), and had greater risk of mortality (10.9% versus 3.5%, 95% CI .03, .13). CONCLUSIONS: Prevalence of malnutrition assessed by MUST in patients after a stroke was relatively low, but nearly a third of patients were not screened. Patients classified as being at medium or high risk of malnutrition were more likely to experience negative outcomes. Early identification of this population may improve outcome if appropriate care is provided.


Asunto(s)
Desnutrición/diagnóstico , Evaluación Nutricional , Estado Nutricional , Accidente Cerebrovascular/diagnóstico , Anciano , Anciano de 80 o más Años , Diagnóstico Precoz , Registros Electrónicos de Salud , Femenino , Humanos , Tiempo de Internación , Masculino , Desnutrición/mortalidad , Desnutrición/fisiopatología , Desnutrición/terapia , Auditoría Médica , Persona de Mediana Edad , Admisión del Paciente , Valor Predictivo de las Pruebas , Pronóstico , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Factores de Tiempo , Reino Unido/epidemiología
15.
Rev Lat Am Enfermagem ; 27: e3198, 2019 Oct 14.
Artículo en Portugués, Inglés, Español | MEDLINE | ID: mdl-31618391

RESUMEN

OBJECTIVE: to evaluate the clinical and nutritional evolution of elderly patients receiving home enteral nutritional therapy. METHOD: retrospective cohort observational study. Data collection was performed through the analysis of clinical and nutritional records. The demographic, nutritional and clinical variables were analyzed. The sample consisted of elderly patients using home enteral nutritional therapy via the probe or the stomach. For the statistical analysis, the Statistical Package for the Social Sciences program was used, adopting the level of significance of 5%. RESULTS: the sample was 218 participants, with a mean age of 76 ± 10.12 years, of which 54.1% were female. The main morbidity was the stroke sequelae. Malnutrition was the nutritional diagnosis and the overall subjective assessment, the main instrument of nutritional evaluation. The route of administration of the most prevalent diet was the nasoenteric/nasogastric tube, however, after one year of follow-up, gastrostomy became the main route. It was observed the predominance of general condition maintenance and the most prevalent clinical outcome was death. CONCLUSION: the majority of patients in home enteral nutrition therapy presented maintenance and / or improvement of clinical and nutritional status. Therefore, this therapy may contribute to a better clinical and nutritional evolution.


Asunto(s)
Nutrición Enteral/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Estado Nutricional , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Femenino , Gastrostomía/estadística & datos numéricos , Evaluación Geriátrica/estadística & datos numéricos , Humanos , Intubación Gastrointestinal/estadística & datos numéricos , Masculino , Desnutrición/terapia , Estudios Retrospectivos , Resultado del Tratamiento
16.
PLoS Med ; 16(10): e1002950, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31661490

RESUMEN

BACKGROUND: Global warming is predicted to indirectly result in more undernutrition by threatening crop production. Whether temperature rise could affect undernutrition directly is unknown. We aim to quantify the relationship between short-term heat exposure and risk of hospitalization due to undernutrition in Brazil. METHODS AND FINDINGS: We collected hospitalization and weather data for the hot season (the 4 adjacent hottest months for each city) from 1,814 Brazilian cities during 1 January 2000-31 December 2015. We used a time-stratified case-crossover design to quantify the association between heat exposure and hospitalization due to undernutrition. Region-specific odds ratios (ORs) were used to calculate the attributable fractions (AFs). A total of 238,320 hospitalizations for undernutrition were recorded during the 2000-2015 hot seasons. Every 1°C increase in daily mean temperature was associated with a 2.5% (OR 1.025, 95% CI 1.020-1.030, p < 0.001) increase in hospitalizations for undernutrition across lag 0-7 days. The association was greatest for individuals aged ≥80 years (OR 1.046, 95% CI 1.034-1.059, p < 0.001), 0-4 years (OR 1.039, 95% CI 1.024-1.055, p < 0.001), and 5-19 years (OR 1.042, 95% CI 1.015-1.069, p = 0.002). Assuming a causal relationship, we estimate that 15.6% of undernutrition hospitalizations could be attributed to heat exposure during the study period. The AF grew from 14.1% to 17.5% with a 1.1°C increase in mean temperature from 2000 to 2015. The main limitations of this study are misclassification of different types of undernutrition, lack of individual temperature exposure data, and being unable to adjust for relative humidity. CONCLUSIONS: Our study suggests that global warming might directly increase undernutrition morbidity, by a route other than by threatening food security. This short-term effect is increasingly important with global warming. Global strategies addressing the syndemic of climate change and undernutrition should focus not only on food systems, but also on the prevention of heat exposure.


Asunto(s)
Calentamiento Global , Hospitalización , Calor , Desnutrición/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Contaminación del Aire/análisis , Brasil/epidemiología , Niño , Preescolar , Ciudades , Clima , Estudios Cruzados , Exposición a Riesgos Ambientales/análisis , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , Estaciones del Año , Temperatura , Adulto Joven
17.
Ned Tijdschr Geneeskd ; 1632019 09 13.
Artículo en Holandés | MEDLINE | ID: mdl-31556503

RESUMEN

Optimal nutrition is an important condition for optimal recovery from illness, both in and outside the hospital setting. In addition, in developed countries hospital-related malnutrition remains a major problem which can lead to complications, longer hospital stays and increased costs. The EFFORT study investigated if individualised nutritional support targeted at reaching protein and caloric goals, would reduce the risk of adverse outcomes. Achieving optimal nutrition is difficult due to illness-induced anorexia, inadequate education of medical doctors and little financial incentive. Guidelines focus on protein and energy, negating those illness-induced anorexia and individual patient aspects such as taste, portion size and eating habits. Although the EFFORT study showed benefit on the composite and individual endpoints, we should point out that the intervention group received standard care. Malnutrition needs multidisciplinary and transmural care including physiotherapy/exercise. As such, a more holistic approach is needed; optimal care as described by the EFFORT study should be the standard.


Asunto(s)
Hospitalización , Desnutrición/terapia , Apoyo Nutricional , Proteínas en la Dieta/administración & dosificación , Ingestión de Energía , Humanos , Desnutrición/complicaciones , Desnutrición/etiología , Estado Nutricional , Apoyo Nutricional/métodos , Atención Dirigida al Paciente
19.
Zhen Ci Yan Jiu ; 44(6): 451-3, 2019 Jun 25.
Artículo en Chino | MEDLINE | ID: mdl-31368271

RESUMEN

OBJECTIVE: To investigate the clinical effect of acupuncture at Sifeng (EX-UE10) combined with Wang's Baochi Pills in the treatment of pediatric malnutrition, so as to provide a more effective method for pediatric malnutrition. METHODS: A total of 201 children with malnutrition were randomly divided into combined treatment group (n=102) and control (Baochi Pill) group (n=99). The children in the combined treatment group were treated by acupuncture stimulation of Sifeng (EX-UE10, till no more yellowish-white effusion out) and oral administration of Wang's Baochi Pills, and those in the control group treated by oral administration of Wang's Baochi Pills only. The course of treatment was one month for both groups. The integral score of symptom was assessed according to the main symptoms as body weight and height and food-intake, and to the secondary symptoms including mentality, agitation, sleep, hair gloss, susceptibility to cold, hydrosis, abdominal distension, and susceptibility to diarrhea or constipation. The therapeutic effect was assessed by consulting the "Criteria for Diagnosis and Therapeutic Effect Evaluation of Syndromes/Illnesses of Traditional Chinese Medicine (TCM)" and "TCM Professional Criteria of the People's Republic of China for Diagnosis and Therapeutic Effect Evaluation of Syndromes/Diseases of TCM Pediatric". RESULTS: After the treatment, the total symptom scores of both groups were significantly decreased in comparison with their own pre-treatment (P<0.05), and the scores of total symptom after the treatment and the 1st, 2nd and 3rd follow-up surveys were obviously lower in the combined treatment group than in the control group (P<0.05). Of the 99 and 102 cases in the control and combined treatment groups, 47 and 59 were cured, 39 and 37 experienced improvement in their symptoms, and 13 and 6 failed, with the effective rate being 86.87% (86/99) and 94.11%(96/102), respectively. The effective rate of the combined treatment was evidently higher than that of the simple medication (P<0.05). CONCLUSION: Acupuncture of Sifeng (EX-UE10) combined with Wang's Baochi Pills is better than administration of Wang's Baochi Pills alone in the therapeutic effect for pediatric malnutrition.


Asunto(s)
Terapia por Acupuntura , Desnutrición , Administración Oral , Niño , China , Humanos , Desnutrición/terapia , Medicina China Tradicional
20.
Cancer Control ; 26(1): 1073274819863767, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31364396

RESUMEN

Oncology inpatients are at high risk of malnutrition. Identification of at risk patients by nutrition screening requires a practical and easy to use tool. The aim of this study was to determine the validity of the Bach Mai Boston Tool (BBT) compared to a 'gold standard' full nutrition assessment using the Patient-Generated Subjective Global Assessment (PG-SGA). A cross-sectional study was conducted on 270 oncology inpatients from January to December 2016. Cohen's Kappa, sensitivity, specificity and ROC analyses were performed. 270 inpatients were included in this study with a mean age of 56.3 ± 12.1 years old. Of these patients, 51.8% were male, and 74.1% had gastrointestinal cancer. The mean body mass index of patients was 20.6 ± 3.0 kg/m2. The PG-SGA tool identified 146 (54.1%) malnourished patients, while the BBT identified 105 (39.9%) malnourished patients. The BBT had a medium consistency, with a Kappa value of 0.6. Using a cut-off point of ≥ 4, the BBT had a sensitivity of 87.7% and a specificity of 72.6%. On the other hand, a BBT with a cut-off point ≥ 5 resulted in a sensitivity of 67.1%, a specificity of 94.4%, and an AUC of 0.81. The BBT is a practical, informative and valid tool for detecting malnutrition in hospitalized oncology patients. We recommend using a cut-off point of 4 for screening the risk of malnutrition for oncology inpatients.


Asunto(s)
Detección Precoz del Cáncer/métodos , Pacientes Internos/estadística & datos numéricos , Oncología Médica/métodos , Neoplasias/diagnóstico , Evaluación Nutricional , Anciano , Estudios Transversales , Femenino , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/terapia , Humanos , Masculino , Desnutrición/diagnóstico , Desnutrición/terapia , Persona de Mediana Edad , Neoplasias/terapia , Estado Nutricional , Curva ROC
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