How to Manage Frail Older Adults in the Community? Proposal of a Health Promotion Program Experienced in a City of 16,638 Inhabitants in France.

BACKGROUND: Health promotion programs could prevent and delay frailty and functional decline. However, in practice, the planning and establishment of such a program is a challenge for health care providers. We report an experimental model of screening and management for frail elderly conducted in Cugnaux, city of 16,638 inhabitants in France, by the Toulouse Gerontopole and the social care service of the Cugnaux City Hall. METHODS: A frailty screening self-administered questionnaire (FiND questionnaire) was sent to community-dwelling residents of 70 years old and over of Cugnaux. The completed questionnaires were analyzed and the subjects were classed into three groups: robust, frail, mobility disability, based on their score. Frail subjects and those with mobility disability invited to undergo a frailty assessment in the premises of the town hall realized by a nurse in order to identify the causes of their frailty and propose them a personalized intervention plan (PIP). RESULTS: The FiND questionnaire was sent to the residents of Cugnaux of 70 years old and over (n=2,003). After two mailings, 860 (42.9%) completed questionnaires were received. Mean age of the responders was 79.0 ± 6.2 years and 59.6% women (n= 511). According to the questionnaires analysis, 393 (45.7%) were robust, 212 (24.6%) frail, 240 (27.9%) had a mobility disability and 15 (1.7%) could not be classified due to missing data. 589 (68.5%) subjects accepted to be contacted by the Gerontopole nurse. The assessment by the nurse was proposed to frail subjects and those with mobility disability (n=313). Until 31 December 2016, 136 patients have been evaluated. The mean age was 80.1±5.4 and most patients were women (69.9%). The mean ADL score was 5.8±0.5 and the IADL showed a mean score of 6.9±1.7. According to Fried definition of frailty, 76 patients (55.9%) were pre-frail, and 35 (25.7%) frail. Concerning the frailty domains identified, 75 patients (55.1%) showed the alteration of physical performance, 70 (51.5%) thymic disorders and 46 (33.8%) sensory disorders. Preventive interventions proposed in the PIP were mostly physical interventions (86.8%, n=118) followed by cognitive (61.8%, n=84) and nutritional (39.7%, n=54) interventions. DISCUSSION: This project shows the feasibility to implement a care model in the community. It permitted a large identification of frail elderly people in the city population, insuring their assessment and clinical follow up to maintain their capacities and referring them to social services.

Percepción subjetiva del paso del tiempo en el enfermo y el cuidador primario en Cuidados Paliativos hospitalarios / No disponible

Objetivos: estudiar la percepción subjetiva del paso del tiempo en enfermos hospitalizados en una Unidad de Cuidados Paliativos (UCP) y sus cuidadores primarios. Averiguar el grado de concordancia entre la percepción temporal de ambos. Explorar factores personales, clínicos y psicosociales que pueden estar relacionados con dicha percepción. Método: estudio descriptivo llevado a cabo en la Unidad de Cuidados Paliativos del Hospital Santa Caterina de Girona desde el 1 de mayo de 2005 al 31 de mayo de 2006. Participan 96 pacientes ingresados con enfermedad terminal y sus cuidadores primarios. Resultados: el 41,7% de los enfermos refiere una percepción subjetiva del paso del tiempo «largo» o «muy largo» mientras que un 28,1% lo considera «corto» o «muy corto». La percepción temporal en los enfermos está relacionada con la edad y la valoración de la calidad de la relación con el cuidador primario, siendo las personas mayores y las que refieren una buena relación con el cuidador las que perciben un paso del tiempo más rápido. Por el contrario, la percepción subjetiva del paso del tiempo en enfermos es independiente del sexo, de los días de ingreso en la UCP, del grado de dependencia funcional para las actividades básicas de la vida diaria (ABVD), de la gravedad de la enfermedad y la proximidad a la muerte, y de comunicar experiencias subjetivas positivas y/o negativas durante la jornada. En referencia a los cuidadores primarios, la mayoría encuentran el tiempo «ni corto ni largo» (39,6%). No se observa relación entre la percepción del paso del tiempo del cuidador primario y las horas de estancia en el hospital, los días de ingreso, el grado de dependencia funcional del enfermo para las ABVD, el informar de experiencias subjetivas positivas y/o negativas y la calidad de la relación enfermo-cuidador primario. Contrariamente, la percepción subjetiva del paso del tiempo del cuidador estuvo relacionada con la gravedad de la enfermedad y la proximidad a la muerte, percibiéndose el tiempo más largo a medida que se agrava la situación del enfermo. Las percepciones subjetivas del paso del tiempo del enfermo y del cuidador primario no están relacionadas. Enfermos y cuidadores primarios perciben el paso del tiempo de forma distinta, pasando algo más largo para los enfermos que para sus cuidadores primarios. Conclusiones: en general, los enfermos ingresados en una UCP perciben el paso del tiempo ligeramente más lento que sus cuidadores primarios, quedando pendiente para posteriores análisis valorar aquellos factores que modulan dicha percepción. Las percepciones del paso del tiempo de enfermos y cuidadores primarios no están relacionadas, percibiendo ambos el paso del tiempo en el hospital de forma diferente. A pesar de estas divergencias, otros aspectos psicosociales como una buena relación entre ambos, pueden influir en su percepción de la situación, convirtiendo así los hechos en más agradables y positivos. Es posible que se considere un hecho positivo simplemente la presencia y asistencia de un cuidador primario con el que se tenga una buena relación. En este sentido, integrando en nuestra atención sanitaria, recursos ambientales y técnicas terapéuticas destinadas a mejorar la relación enfermo-cuidador, podríamos facilitar en un futuro un mayor bienestar para el enfermo y para su cuidador primario en esta etapa difícil que es el final de la vida (AU)

Objectives: to study the subjective perception of the passing of time among patients hospitalized in a Palliative Care Unit (PCU) and their primary caregivers. To find out agreement extent between perceived time in both. To explore personal, clinical, and psychosocial factors that may be related to this perception. Method: a descriptive study carried out in the Palliative Care Unit at Hospital Santa Caterina in Girona from May 1st 2005 to May 31st 2006. Ninety-six terminally ill patients and their primary caregivers took part in the survey. Results: in 41.7% of patients the subjective perception of the passage of time was described as «long» or «very long», while 28.1% considered it «short» or «very short». Time perception in patients was related to age and quality of the relationship with primary caregivers, with older people and those having a good relationship with their caregiver experiencing a faster passage of time. In contrast, the subjective perception of the passage of time in patients is unrelated to sex, days in a PCU, functional dependence for basic activities of daily living (BADL), seriousness of illness, and proximity of death, as well as the communication of positive and/or negative events during the day. Regarding primary caregivers, most of them find that time is «neither short nor long» (39.6%). No connection was observed between perceived passage of time in primary caregivers and hours in the hospital, days in the PCU, extent of functional dependence for BADL, communication of positive and/or negative events, and quality of patient-caregiver relationship. On the contrary, the subjective perception of the passage of time in caregivers was related to seriousness of illness and proximity of death, with time being perceived as longer with patient worsening. The subjective perceptions of the passage of time in patients and primary caregivers are unrelated. Patients and primary caregivers perceive the passage of time in a different way - time is longer for patients versus primary caregivers. Conclusions: in general, patients in a PCU perceive the passage of time as slightly slower when compared to their primary caregivers, leaving for a later analysis an evaluation of factors modulating this perception. The perceptions of the passage of time in patients and primary caregivers are unrelated, and both perceive the passage of time in hospital in a different way. In spite of these divergences other psychosocial aspects, such as a good relationship between both, may influence their perception. Thus, everything may become more pleasant and positive. It is possible that the simple fact of having a good relationship with the caregiver can be positively considered. In this sense, integrating in our healthcare system environmental resources and therapeutical techniques aimed at improving the relationship between patients and caregivers may improve wellbeing for both patients and primary caregivers at the end of life (AU)

Efectos del modelado por parte de familia, pareja y amigos en la conducta de fumar de jóvenes universitarios / Model effect of family, partner and friends in smoking behavior of university students

El objetivo del presente trabajo es estudiar la relación entre el consumo de tabaco de familiares, pareja y amigos, y la conducta de fumar en una muestra de estudiantes universitarios (n = 122; 38,9 por ciento hombres y 61,1 por ciento mujeres). Los resultados obtenidos muestran que, en comparación con los no fumadores, los sujetos fumadores suelen tener padre y/o madre y/o amigos también fumadores mientras que no se aprecian diferencias en el caso de pareja y hermanos. Atendiendo al sexo de los sujetos, en los varones únicamente se observan diferencias entre el estatus de consumo del sujeto y el de la madre, mientras que en las jóvenes esta diferencia se aprecia en ambos progenitores. Se constata la influencia del entorno social de manera que los fumadores suelen tener a su alrededor un mayor número de familiares y amigos que también fuman (AU)

¿Piensan los estudiantes fumadores en las consecuencias de su hábito? / Do the smoker student think about the consequences of their habit?

No disponible

Rotavirus identification in jejunal juice and stools of acute and chronic forms of infantile gastroenteritis.

1. The present study investigates, by means of a combined enzyme immunoassay for rotaviruses and adenoviruses (EIARA), the occurrence of rotaviruses in stools and jejunal juices from 31 children with acute diarrhea and 18 with chronic diarrhea. 2. Stools from 8 acute cases contained rotaviruses (26%). In two of these cases rotaviruses were also detected in the jejunal juice. 3. In the chronic diarrhea group we identified rotaviruses in the stools of one patient and in the jejunal juice of another. 4. Some of the electropherotypes of the rotaviruses identified showed different patterns of RNA migration. 5. Abnormalities of the jejunal mucosa were characterized in 6 acute rotavirus-positive cases. No morphological or functional abnormalities of the intestinal mucosa were observed in the chronic diarrhea rotavirus-positive cases.

Rotavirus identification in jejunal juice and stools of acute and chronic forms of infantile gastroenteritis

The present study investigates, by means of a combined enzyme immunoassay for rotaviruses and adenoviruses (EIARA), the occurrence of rotaviruses in stools and jejunal juices from 31 children with acute diarrhea and 18 with chronic diarrhea. Stools from 8 acute cases contained rotaviruses (26%). In two of these cases rotaviruses were also detected in the jejunal juice. In the chronic diarrhea group we identified rotaviruses in the stools of one patient and in the jejunal juice of another. Some of the electropherotypes of the rotaviruses identified showed different patterns of RNA migration. Abnormalities of the jejunal mucosa were characterized in 6 acute rotavirus-positive cases. No morphological or functional abnormalities of the intestinal mucosa were observed in the chornic diarrhea rotavirus-positive cases

Culture supernatants of Campylobacter jejuni induce a secretory response in jejunal segments of adult rats.

Culture supernatants of four Campylobacter jejuni strains induced a net sodium secretory flux (plasma-lumen) and an impaired glucose transport in perfused jejunal segments of adult rats in vivo.