Randomized trial of a multidisciplinary lifestyle intervention in HIV-infected patients with moderate-high cardiovascular risk.

OBJECTIVE: To assess the impact of a multidisciplinary lifestyle intervention on cardiovascular risk and carotid intima-media thickness (c-IMT) in HIV-infected patients with Framingham scores (FS) > 10%. DESIGN: Randomized pilot study; follow-up 36 months. METHODS: Virologically suppressed adult HIV-1-infected patients with FS >10% were randomized 1:1 to the intervention group (multidisciplinary lifestyle intervention) or control group (routine care). At baseline and months 12, 24 and 36, lipid parameters were analyzed and carotid ultrasound was performed to determine c-IMT and presence of plaques. Biomarkers were measured at baseline and month 36. The primary endpoints were lipid and FS changes at 36 months. RESULTS: Fifty-four patients were included, 27 in each arm. Median age was 50.5 years, all patients but one were men, and FS was 16.5%. Relative to controls, total and LDL cholesterol had significantly decreased in the intervention group at 24 months (p = 0.039, p = 0.011, respectively). However, no differences between groups were found at month 36 in lipid variables, neither in FS. Tobacco use decreased in the intervention group (p = 0.031). At baseline, 74.5% of patients had subclinical atherosclerosis, and at month 36, we observed a progression in c-IMT that was greater in the intervention group (p = 0.030). D-dimer increased (p = 0.027) and soluble intercellular adhesion molecule-1 decreased (p = 0.018) at 36 months. CONCLUSIONS: In this cohort of HIV-infected patients with FS>10% and a high percentage of subclinical atherosclerosis, a multidisciplinary lifestyle intervention resulted in a slight improvement in some cardiovascular risk factors and the FS during the first 2 years, but did not prevent c-IMT progression.

Timing of hepatitis B vaccination: its effect on vaccine response in health care workers.

We assessed the effect of timing and other biological variables on immune response among health care workers (HCW) vaccinated with hepatitis B vaccine. A total of 2.058 HCW received three doses and were tested for anti-HBs within 6 months. 92.2% of the HCW had evidence of seroprotection. Multivariable analysis showed that controlling for age, the estimated non-response OR associated with a delayed second dose was 2.16 (95% CI: 1.46, 3.18, p=0.004). We found a decreasing response rate with increasing age. Particular attention should be given to those HCW who are late for the second vaccine dose and to older subjects.

Prognostic factors for tobacco consumption reduction after relapse.

INTRODUCTION: It is not properly estimated the cigarette consumption after a relapse compared with the consumption before a smoking cessation therapy. The aim of this study was to know if tobacco consumption among relapsed smokers that visited a smoking cessation unit is higher or lower than consumption preceding dishabituation therapy and the related factors to this consumption change. SUBJECTS AND METHODS: 1,516 smokers who received a multicomponent program for smoking cessation have been studied. The percentage of reduction after the relapse in relation to previous consumption and the consumption difference with regard to basal variables among 994 relapsed smokers has been calculated. A logistic regression model was used in order to analyze the predictors to reduce more than 50% of previous cigarette consumption. RESULTS: Relapsed patients smoked 20.4% less than before the smoking cessation therapy. Smokers with chronic obstructive pulmonary disease, and with the age of 50 years or more, had the highest rate of reduction consumption. The best predictors for cigarette reduction were those of low nicotine dependence and being heavy smokers. CONCLUSIONS: Heavy smokers or low nicotine dependence smokers have a higher probability to reduce their cigarette consumption. Other predictor variables are age of more than 50 years, high previous consumption or previous abstinence period of more than 6 months.

Effects of partner smoking status and gender on long term abstinence rates of patients receiving smoking cessation treatment.

AIMS: To assess the effect of partner smoking status on the success of a cessation program. DESIGN: Prospective cohort. SETTING: Smoking Cessation Unit in Hospital of Bellvitge (Hospitalet de Llobregat, Barcelona). PARTICIPANTS: A total of 1516 smokers of 10 or more cigarettes who started a smoking cessation program between January 1995 and December 2001 were included. MEASUREMENTS: All patients gave information about smoking history and smoking partner status. Abstinence was determined by carbon monoxide exhaled. FINDINGS: Significant differences were found in the abstinence rates at 12 months by smoking partner status: abstinence was achieved by 28.3% of patients with smoking partner, and by 46.5% of patients without smoking partner (p<0.001). Subjects whose partner was smoking at the beginning of the program appear to be more likely to relapse than subjects without smoking partners (p<0.001) and this is more pronounced in women than in men. However no significant gender differences were found in any group of smoking partner status. CONCLUSIONS: Having a smoking partner is a determinant of relapse 1 year after the beginning of the cessation program. Interacting not just with the smoker, but also with his or her partner, could neutralize interpersonal influences making smokers more accessible to behavioural and pharmacological techniques.

Anemia in new-onset congestive heart failure inpatients admitted for acute decompensation.

BACKGROUND: Anemia may have important deleterious effects on patients with heart failure. We investigated the presence and causes of anemia among patients admitted because of new-onset congestive heart failure. The prognostic value of anemia was also evaluated. METHODS: We evaluated the presence of anemia, which was defined as hemoglobin concentrations lower than 13g/dl in men and lower than 12g/dl in women. One-year mortality and hospital readmission rates were also studied. RESULTS: A total of 103patients were included in the study. Their mean age was 78.5years and 53% were women. Mean hemoglobin levels were 12.4g/l. Forty-four patients (43%) had anemia at the time of hospital admission, 34 of them had true anemia and 10spurious anemia caused by hemodilution. Patients taking preadmission angiotensin-converting enzyme inhibitors had more severe anemia than those not taking them (p<0.01). The presence of anemia was not associated with an increase in mortality (p=0.3) or in readmission rates (p=0.1) after 1year of follow-up. CONCLUSIONS: Anemia is frequent in new-onset heart failure patients admitted for acute decompensation. However, the presence of anemia does not seem to be related to an increase in mortality or readmission in this small cohort.

Social class, education, and smoking cessation: Long-term follow-up of patients treated at a smoking cessation unit.

Our objective was to examine social class and educational differences in long-term smoking cessation success among a cohort of smokers attending a specialized smoking clinic. We studied sustained abstinence after cessation among 1,516 smokers (895 men and 621 women) treated for smoking cessation between 1995 and 2001 at a university teaching hospital in the metropolitan area of Barcelona, Spain. We calculated 1-year and long-term (up to 8-year) abstinence probabilities by means of Kaplan-Meier curves and the hazard ratio of relapse by means of Cox regression, after adjusting for other predictors of relapse. Overall abstinence probability was .277 (95% CI = .254-.301). Men and women in social classes IV-V had significant hazard ratios of relapse after long-term follow-up (men: 1.36, 95% CI = 1.07-1.72; women: 1.60, 95% CI = 1.24-2.06), as compared with patients in social classes I-II. The same independent effect was observed for education: Men and women with primary or less than primary studies had higher hazard ratios of relapse (men: 1.75, 95% CI = 1.35-2.25; women: 1.92, 95% CI = 1.51-2.46), as compared with patients with a university degree. Similar estimates were obtained after adjustment for stage of change, Fagerström score for nicotine dependence, and type of treatment. Patients of lower socioeconomic status are at higher risk of relapse, and this association is independent of other well-known predictors of relapse. Social differences have to be taken into account in the clinical setting when tailoring specific actions to treat smoking dependence.

Functional outcomes of elderly patients after the first hospital admission for decompensated heart failure (HF). A prospective study.

Congestive HF is one of the most common discharge medical diagnoses in elderly hospitalized patients. We evaluate prospectively the usefulness of a global geriatric assessment to identify changes in the functional status of patients who experience their first hospitalization for a new diagnosis of HF. The Barthel Index (BI), the Older Americans Resource Scale (OARS), the Short Portable Mental Status Questionnaire (SPMSQ), and the short form of the Mini Nutritional Assessment (short-MNA) were used to estimate functional, cognitive, and nutritional status. The Charlson score (CS) was used to measure comorbidity. Eighty-eight patients (mean age 79 years; 57% women) were finally included; their median CS score was 2.1. Prior to the index admission, their mean BI score was 91, OARS 9.8, SPMSQ 1.8 errors, and short-MNA 10.7. Twenty-four patients (27%) died during the first year of follow-up. Low preadmission BI scores were predictive of mortality (p=0.02), but not of readmission (p=0.9). After one-year of follow-up BI scores remained lower than preadmission values in 64% of the surviving patients; for OARS scores the figure was 67%. In conclusion, a previous low functional capacity is associated with higher mortality but not with HF-related hospital readmission. Admission because of a new onset HF is often followed by a sustained functional decline both for the performance of basic and instrumental activities of the daily living.

No correlation between mini-nutritional assessment (short form) scale and clinical outcomes in 73 elderly patients admitted for hip fracture.

BACKGROUND AND AIMS: Malnutrition in general and protein deficiency in particular, both upon admission and during the recovery period, may adversely influence the clinical outcome after hip fracture. This study investigates the relationship between nutritional status measured by the Mini-Nutritional Assessment short form (MNA-SF) and biological markers in elderly hip-fractured patients. METHODS: A prospective study in a university hospital. The MNA-SF nutritional scale and laboratory values (serum albumin, cholesterol, total lymphocyte count) were assessed within three days after hip fracture surgery. RESULTS: Seventy-three patients were included: 61 (84%) were women and 12 men. Mean age was 81.5+/-7.1 years. Inhospital mortality was 10%. The mean MNA-SF score was 11+/-0.5 (range 3-14); according to these values, 39 patients (53%) were at risk of malnutrition. MNA-SF scores were not significantly correlated to patients' laboratory values. Fourteen episodes of nosocomial infection were diagnosed in 11 patients, and 6 patients developed pressure ulcers during hospitalization. CONCLUSIONS: MNA-SF test scale values reflect a clinical process in post-operative hip-fractured patients which is different from serum albumin, cholesterol or lymphocyte count.

[Predisposing factors of delirium in hip fractured patients older than 84 years]. / Factores favorecedores de la aparición de cuadro confusional agudo en pacientes mayores de 84 años con fractura de fémur.

BACKGROUND AND OBJECTIVE: Our objective was to analyze those factors predisposing to delirium in patients older than 84 years who were admitted because of hip fracture. We also compared the prevalence of delirium in this population with a younger group. PATIENTS AND METHOD: One hundred and thirty patients (mean age 91.8 years) and 50 controls aged 65 to 84 years were included. RESULTS: Forty-three patients (33%) developed delirium. A poor previous functional capacity was the best marker identifying those at risk for developing delirium. Although the prevalence of delirium was higher in those older than 84 years, statistically significant differences were not reached. CONCLUSIONS: Disability prior to admission is the main risk factor predisposing to delirium during hospitalization in patients older than 84 years who are admitted because of hip fracture.

Factores favorecedores de la aparición de cuadro confusional agudo en pacientes mayores de 84 años con fractura de fémur / Predisposing factors of delirium in hip fractured patients older than 84 years

FUNDAMENTO Y OBJETIVO: Estudiar los factores favorecedores de delirium en pacientes mayores de 84 años con fractura de fémur y comparar la frecuencia de aparición con respecto a pacientes más jóvenes. PACIENTES Y MÉTODO: Se evaluó a 130 pacientes (edad media: 91,8 años) ingresados por fractura de fémur y a 50 pacientes control (entre 65 y 84 años de edad). RESULTADOS: Presentaron un episodio de delirium43 pacientes (33%). El mejor indicador para identificar riesgo de delirium es una mala capacidad funcional previa (p =0,001). Aunque el porcentaje de pacientes con delirium es superior en los mayores de84 años, no alcanza significación estadística. CONCLUSIONES: La discapacidad funcional previa es el principal factor que favorece el desarrollo de delirium en los mayores de 84años ingresados por fractura de fémur

BACKGROUND AND OBJECTIVE: Our objective was to analyze those factors predisposing to deliriumin patients older than 84 years who were admitted because of hip fracture. We also compared the prevalence of delirium in this population with a younger group. PATIENTS AND METHOD: One hundred and thirty patients (mean age 91.8 years) and 50 controls aged 65 to 84 years were included. RESULTS: Forty-three patients (33%) developed delirium. A poor previous functional capacity was the best marker identifying those at risk for developing delirium. Although the prevalence of delirium was higher in those older than 84 years, statistically significant differences were not reached. CONCLUSIONS: Disability prior to admission is the main risk factor predisposing to delirium during hospitalization in patients older than 84 years who are admitted because of hip fracture