Association between diet quality and malnutrition: pooled results from two population-based studies in older adults.

BACKGROUND: The role of diet quality on malnutrition in older adults is uncertain, due the paucity of the research conducted and the use of use of screening tools that did not consider phenotypic criteria of malnutrition. OBJECTIVE: To evaluate the association of two indices of diet quality, namely the Mediterranean Diet Adherence Screener (MEDAS) and the Alternative Healthy Eating Index (AHEI-2010), with malnutrition among community-dwelling older adults in Spain. METHODS: Cross-sectional analysis of data from 1921 adults aged ≥ 60 years from the Seniors-ENRICA-1 (SE-1) study, and 2652 adults aged ≥ 65 years from the Seniors-ENRICA-2 (SE-2) study. Habitual food consumption was assessed through a validated diet history. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM) phenotypic criteria. Statistical analyses were performed with logistic regression with adjustment for socioeconomic and lifestyle variables as well as for total energy and protein intake. RESULTS: The prevalence of malnutrition in the SE-1 study was 9.5% (95% confidence interval: 8.2 to 10.9) and 11.7% (10.5 to 13.9) in the SE-2. Adherence to the MEDAS score was associated with lower prevalence of malnutrition [pooled odds ratio for high (≥ 9 points) vs. low adherence (< 7 points): 0.64 (0.48-0.84); p-trend < 0.001]. Higher adherence to the AHEI-2010 also showed an inverse association with malnutrition (pooled odds ratio for quartile 4 vs. 1: 0.65 (0.49-0.86); p-trend 0.006). Among the individual components, higher consumption of fish and long-chain n-3 fatty acids in MEDAS and AHEI-2010, and of vegetables and nuts and legumes in AHEI-2010, and lower intake of trans-fat and sugar-sweetened beverages and fruit juice in AHEI-2010 were independently associated with lower odds of malnutrition. CONCLUSION: Adherence to high diet-quality patterns was associated with lower frequency of malnutrition among older adults. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov identifier: NCT02804672. June 17, 2016.; ClinicalTrials.gov NCT03541135. May 30, 2018.

Plant-Based Diets and Risk of Multimorbidity: The Health and Retirement Study.

BACKGROUND: Plant-based diets have gained attention due to their beneficial effects against major chronic diseases, although their association with multimorbidity is mostly unknown. OBJECTIVES: We examined the association between the healthful (hPDI) and unhealthful plant-based diet indices (uPDI) with multimorbidity among middle-aged and older adults from the United States. METHODS: Data on 4262 adults aged >50 y was obtained from the 2012-2020 Health and Retirement Study (HRS) and 2013 Health Care and Nutrition Study (HCNS). Food consumption was collected at baseline with a food frequency questionnaire and 2 PDIs were derived: the hPDI, with positive scores for healthy plant foods and reverse scores for less healthy plant foods and animal foods; and the uPDI, with only positive scoring for less healthy plant foods. Complex multimorbidity, defined as ≥3 coexistent conditions, was ascertained from 8 self-reported conditions: hypertension, diabetes, cancer, chronic lung disease, heart disease, stroke, arthritis, and depression. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: After a median follow-up of 7.8 y, we documented 1202 incident cases of multimorbidity. Compared with the lowest quartile, higher adherence to the hPDI was inversely associated with multimorbidity (HR for quartile 3: 0.77; 95% CI: 0.62, 0.96 and HR for quartile 4: 0.79; 95% CI, 0.63, 0.98; P-trend = 0.02). In addition, a 10-point increment in the hPDI was associated with a 11% lower incidence of multimorbidity (95% CI: 1, 20%). No significant associations were found for the uPDI after adjusting for sociodemographic and lifestyle factors. CONCLUSIONS: Higher adherence to the hPDI was inversely associated with multimorbidity among middle-aged and older adults. Plant-based diets that emphasize consumption of high-quality plant foods may help prevent the development of complex multimorbidity.

The Hearing Function and Ambulatory Blood Pressure in Older Adults.

OBJECTIVE: To examine the association between hearing function, assessed with pure-tone average (PTA) of air conduction thresholds, and 24-hour ambulatory blood pressure (BP) in older adults. STUDY DESIGN: Cross-sectional study. SETTING: A total of 1404 community-dwelling individuals aged ≥65 years from the Seniors-ENRICA cohort were examined. METHODS: Hearing loss was defined as PTA > 40-AudCal hearing loss decibels (dB-aHL) in the better ear for standard frequency (0.5, 1, and 2 kHz), speech frequency (0.5, 1, 2, and 4 kHz), and high frequency (3, 4, and 8 kHz). Circadian BP patterns were calculated as the percentage decline in systolic BP during the night, and participants were classified as dipper, nondipper, and riser. Ambulatory hypertension was defined as BP ≥ 130/80 mm Hg (24 hour), ≥135/85 (daytime), and ≥120/70 (nighttime) or on antihypertensive treatment. Analyses were performed with linear- and logistic-regression models adjusted for the main confounders. RESULTS: In multivariable analyses, the PTA was associated with higher nighttime systolic BP [ß coefficient per 20 dB-aHL increment standard frequency (95% confidence interval, CI): 2.41 mm Hg (0.87, 3.95); ß (95% CI) per 20 dB-aHL increment speech frequency 2.17 mm Hg (0.70, 3.64)]. Among hypertensive patients, hearing loss at standard and high-frequency PTA was associated with the riser BP pattern [odds ratio: 2.01 (95% CI, 1.03-3.93) and 1.45 (1.00-2.09), respectively]; also, hearing loss at standard PTA was linked to uncontrolled nighttime BP [1.81 (1.01-3.24)]. CONCLUSION: PTA was associated with higher nighttime BP, and hearing loss with a riser BP pattern and uncontrolled BP in older hypertensives.

Association Between Speech Reception Threshold in Noise and Multimorbidity: The UK Biobank Study.

OBJECTIVE: To investigate the association between hearing function, as approached with the functional auditory capacity, and multimorbidity. STUDY DESIGN: Cross-sectional study. SETTING: The UK Biobank was established from 2006 to 2010 in the United Kingdom. This cross-sectional analysis included 165,524 participants who provided baseline information on hearing function. METHODS: Functional auditory capacity was measured with a digit triplet test. Three categories were defined according to the speech reception threshold in noise (SRTn): normal (SRTn < -5.5 dB signal-to-noise ratio [SNR]), insufficient (SRTn ≥ -5.5 to ≤ -3.5 dB SNR) and poor hearing function (SRTn > -3.5 dB SNR). To define multimorbidity, 9 chronic diseases were considered, including chronic obstructive pulmonary disease, dementia, Parkinson's disease, stroke, cancer, depression, osteoarthritis, coronary heart disease, and diabetes; multimorbidity was defined as the coexistence of 2 or more in the same individual. Analyses were conducted using logistic models adjusted for relevant confounders. RESULTS: Among the study participants, 54.5% were women, and the mean (range) age was 56.7 (39-72) years. The prevalence of insufficient and poor hearing function and multimorbidity was 13% and 13.2%, respectively. In comparison with having a normal SRTn, the odds ratio (95% confidence interval) of multimorbidity associated with insufficient SRTn was 1.13 (1.08-1.18), and with poor SRTn was 1.25 (1.14-1.37). CONCLUSION: Insufficient and poor hearing function was associated with multimorbidity. This association suggests common biological pathways for many of the considered morbidities.

Diet Quality and Multimorbidity in Older Adults: A Prospective Cohort Study.

BACKGROUND: The role of diet quality in the accumulation of multiple chronic conditions is mostly unknown. This study examined diet quality in association with the number of chronic conditions and the rate of multimorbidity development among community-dwelling older adults. METHODS: We used data from 2 784 adults aged ≥65 years from the Seniors-ENRICA 2 cohort. Diet quality was assessed at baseline (2015-17) with the Alternate Healthy Eating Index-2010 (AHEI-2010) and the Mediterranean Diet Adherence Screener (MEDAS). Information on medical diagnoses was obtained from electronic clinical records up to 2021. RESULTS: Higher adherence to the AHEI-2010 was associated with a lower number of total chronic conditions (ß [95% CI] quartile 4 vs 1: -0.57 [-0.86 to 0.27], p trend < .001] and cardiometabolic conditions (-0.30 [-0.44 to -0.17], p trend < .001) at baseline, while higher adherence to the MEDAS was associated with a lower number of total chronic conditions (-0.30 [-0.58 to -0.02], p trend = .01) and neuropsychiatric and neurodegenerative conditions (-0.09 [-0.17 to -0.01], p trend = .01). After a median follow-up of 5.2 years (range: 0.1-6.1 years) higher adherence to the AHEI-2010 was associated with a lower increase in chronic conditions (ß [95% confidence interval] quartile 4 vs 1: -0.16 [-0.30 to -0.01], p trend = .04) and with lower rate of chronic disease accumulation. CONCLUSIONS: Higher diet quality, as measured by the AHEI-2010, was associated with a lower number of chronic health conditions and a lower rate of multimorbidity development over time.

Prospective Association Between Plasma Concentrations of Fatty Acids and Other Lipids, and Multimorbidity in Older Adults.

Biological mechanisms that lead to multimorbidity are mostly unknown, and metabolomic profiles are promising to explain different pathways in the aging process. The aim of this study was to assess the prospective association between plasma fatty acids and other lipids, and multimorbidity in older adults. Data were obtained from the Spanish Seniors-ENRICA 2 cohort, comprising noninstitutionalized adults ≥65 years old. Blood samples were obtained at baseline and after a 2-year follow-up period for a total of 1 488 subjects. Morbidity was also collected at baseline and end of the follow-up from electronic health records. Multimorbidity was defined as a quantitative score, after weighting morbidities (from a list of 60 mutually exclusive chronic conditions) by their regression coefficients on physical functioning. Generalized estimating equation models were employed to assess the longitudinal association between fatty acids and other lipids, and multimorbidity, and stratified analyses by diet quality, measured with the Alternative Healthy Eating Index-2010, were also conducted. Among study participants, higher concentrations of omega-6 fatty acids [coef. per 1-SD increase (95% CI) = -0.76 (-1.23, -0.30)], phosphoglycerides [-1.26 (-1.77, -0.74)], total cholines [-1.48 (-1.99, -0.96)], phosphatidylcholines [-1.23 (-1.74, -0.71)], and sphingomyelins [-1.65 (-2.12, -1.18)], were associated with lower multimorbidity scores. The strongest associations were observed for those with a higher diet quality. Higher plasma concentrations of omega-6 fatty acids, phosphoglycerides, total cholines, phosphatidylcholines, and sphingomyelins were prospectively associated with lower multimorbidity in older adults, although diet quality could modulate the associations found. These lipids may serve as risk markers for multimorbidity.

Duration and Quality of Sleep and Risk of Self-reported Hearing Loss: The UK Biobank Study.

OBJECTIVE: The duration and quality of sleep have been associated with multiple health conditions in adults. However, whether sleep duration and quality are associated with hearing loss (HL) is uncertain. The present study investigates the prospective association between duration and quality of sleep and HL. DESIGN: This longitudinal analysis included 231,650 participants aged 38 to 72 years from the UK Biobank cohort, established in 2006-2010 in the United Kingdom. Duration and sleep complaints (snoring at night, daytime sleepiness, sleeplessness, difficulty getting up in the morning, and eveningness preference) were self-reported. HL was self-reported at baseline and during the follow-up. RESULTS: Over a median follow-up of 4.19 (SD: 2.15) years, 6436 participants reported incident HL. In fully adjusted models, in comparison with sleeping between 7 and 8 hours a day, the adjusted hazard ratio (HR) (95% CI) associated with sleeping <7 hours a day was 1.01 (0.95 to 1.07), and for sleeping >8 hours a day was 0.98 (0.88 to 1.08). After adjustment for potential confounders, the HRs (95% confidence interval) of HL associated with having 1, 2, 3, and 4 to 5 vs. 0 sleep complaints were: 1.15 (1.05 to 1.27), 1.16 (1.05 to 1.28), 1.32 (1.19 to 1.47), and 1.49 (1.31 to 1.69), respectively; p for trend: <0.001. An increase in the number of sleep complaints was associated with higher risk of HL among participants with non-optimal sleep duration than among participants with optimal sleep duration. CONCLUSION: In this large population-based study, poor sleep quality was associated with an increased risk of HL; however, sleep duration was not associated with risk.

Prospective Association Between Plasma Amino Acids and Multimorbidity in Older Adults.

BACKGROUND: Some amino acids have been associated with aging-related disorders and risk of physical impairment. The aim of this study was to assess the association between plasma concentrations of 9 amino acids, including branched-chain and aromatic amino acids, and multimorbidity. METHODS: This research uses longitudinal data from the Seniors-ENRICA 2 study, a population-based cohort from Spain that comprises noninstitutionalized adults older than 65. Blood samples were extracted at baseline and after a follow-up period of 2 years for a total of 1 488 subjects. Participants' information was linked with electronic health records. Chronic diseases were grouped into a list of 60 mutually exclusive conditions. A quantitative measure of multimorbidity, weighting morbidities by their regression coefficients on physical functioning, was employed and ranged from 0 to 100. Generalized estimating equation models were used to explore the relationship between plasma amino acids and multimorbidity, adjusting for sociodemographics, socioeconomic status, and lifestyle behaviors. RESULTS: The mean age of participants at baseline was 73.6 (SD = 4.2) years, 49.6% were women. Higher concentrations of glutamine (coef. per mmol/l [95% confidence interval] = 10.1 [3.7, 16.6]), isoleucine (50.3 [21.7, 78.9]), and valine (15.5 [3.1, 28.0]) were significantly associated with higher multimorbidity scores, after adjusting for potential confounders. Body mass index could have influenced the relationship between isoleucine and multimorbidity (p = .016). CONCLUSIONS: Amino acids could play a role in regulating aging-related diseases. Glutamine and branched-chain amino acids as isoleucine and valine are prospectively associated and could serve as risk markers for multimorbidity in older adults.

Distribution of daily protein intake across meals and all-cause mortality in community-dwelling older adults.

Recent findings suggest that the distribution of protein intake throughout the day has an impact on various health outcomes in older adults, independently of the amount consumed. We evaluated the association between the distribution of dietary protein intake across meals and all-cause mortality in community-dwelling older adults. Data from 3225 older adults aged ≥ 60 years from the Seniors-ENRICA-1 cohort were examined. Habitual dietary protein consumption was collected in 2008-2010 and in 2012 through a validated diet history. Protein distribution across meals was calculated for each participant as the coefficient of variation (CV) of protein intake per meal, in sex-specific tertiles. Vital status was obtained from the National Death Index up to 30 January 2020. Cox proportional hazards regression was performed to determine the hazard ratios (HR) and their 95 % CI for the association between the distribution of daily protein intake across meals and all-cause mortality. Over a median follow-up of 10·6 years, 591 deaths occurred. After adjustment for potential confounders, the CV of total protein intake was not associated with all-cause mortality (HR and 95 % CI in the second and third tertile v. the lowest tertile: 0·94 (0·77, 1·15) and 0·88 (0·72, 1·08); Ptrend = 0·22). Similarly, the HR of all-cause mortality when comparing extreme tertiles of CV for types of protein were 0·89 (0·73, 1·10) for animal-protein intake and 1·02 (0·82, 1·25) for plant-protein intake. Dietary protein distribution across meals was not associated with all-cause mortality, regardless of protein source and amount, among older adults. Further studies should investigate whether this picture holds for specific causes of death.

Association of Lifestyle Behaviors With Hearing Loss: The UK Biobank Cohort Study.

OBJECTIVE: To examine the combined association of five healthy lifestyle behaviors with hearing loss (HL) in the UK Biobank cohort, established between 2006 and 2010 in the United Kingdom. METHODS: This longitudinal analysis included 61,958 participants aged 40 to 70 years from April 2007 to December 2016. The healthy behaviors examined were: never smoking, high level of physical activity, high diet quality, moderate alcohol intake, and optimal sleep. Hearing loss was self-reported at baseline and in any physical exam during the follow-up. RESULTS: Over a median follow-up of 3.9±2.5 years, 3072 (5.0%) participants reported incident HL. After adjustment for potential confounders, including age, social factors, exposure to high-intensity noise, ototoxic medication, and comorbidity, the HRs of HL associated with having 1, 2, 3, and 4 to 5 vs 0 behaviors were: 0.85 (95% CI, 0.75 to 0.96), 0.85 (95% CI, 0.75 to 0.96), 0.82 (95% CI, 0.71 to 0.94), and 0.80 (95% CI, 0.67 to 0.97), respectively (P for trend, 0.02). We estimated that the population attributable risk percent for not adhering to any five low-risk lifestyle behaviors was 15.6%. CONCLUSION: In this large study, an increasing number of healthy behaviors was associated with decreased risk of HL.

Dietary fat intake and risk of disabling hearing impairment: a prospective population-based cohort study.

PURPOSE: To examine the associations of specific dietary fats with the risk of disabling hearing impairment in the UK Biobank study. METHODS: This cohort study investigated 105,592 participants (47,308 men and 58,284 women) aged ≥ 40 years. Participants completed a minimum of one valid 24-h recall (Oxford Web-Q). Dietary intake of total fatty acids, polyunsaturated fatty acids (PUFA), saturated fatty acids (SFA), and monounsaturated fatty acids (MUFA) was assessed at baseline. Functional auditory capacity was measured with a digit triplet test (DTT), and disabling hearing impairment was defined as a speech reception threshold in noise > - 3.5 dB in any physical exam performed during the follow-up. RESULTS: Over a median follow-up of 3.2 (SD: 2.1) years, 832 men and 872 women developed disabling hearing impairment. After adjustment for potential confounders, including lifestyles, exposure to high-intensity sounds, ototoxic medication and comorbidity, the hazard ratios (HRs), and 95% confidence interval (CI) of disabling hearing function, comparing extreme quintiles of intakes were 0.91 (0.71-1.17) for total fat, 1.09 (0.83-1.44) for PUFA, 0.85 (0.64-1.13) for SFA and 1.01 (0.74-1.36) for MUFA among men. Among women, HRs comparing extreme intakes were 0.98 (0.78-1.24) for total fat, 0.69 (0.53-0.91) for PUFA, 1.26 (0.96-1.65) for SFA, and 0.91 (0.68-1.23) for MUFA. Replacing 5% of energy intake from SFA with an equivalent energy from PUFA was associated with 25% risk reduction (HR: 0.75; 95% CI: 0.74-0.77) among women. CONCLUSIONS: PUFA intake was associated with decreased risk of disabling hearing function in women, but not in men.

Diet Quality and the Risk of Impaired Speech Reception Threshold in Noise: The UK Biobank cohort.

OBJECTIVE: Previous studies have examined the association between several diet quality indexes and risk of hearing loss, based on self-reported information or on audiometry test, with inconsistent results. However, the impact of healthy diets on the capacity to listening in noise, a proxy of disability due to hearing loss, is unknown. This research assessed the prospective association between five diet quality indexes and the speech reception threshold in noise in the UK Biobank study. DESIGN: Prospective cohort with 105,592 participants aged ≥40 years. At baseline, adherence to the Mediterranean Diet Adherence Screener, the alternate Mediterranean Diet score, the Dietary Approaches to Stop Hypertension, the Alternate Healthy Eating Index-2010, and the healthful Plant-Based Diet Index were assessed. Functional auditory capacity was measured with a digit triplet test, and impairment was defined as a speech reception threshold in noise >-3.5 dB in any physical exam during the follow-up. RESULTS: Over a median follow-up of 3.2 (SD: 2.1) years, 1704 participants showed impaired speech reception threshold in noise. After adjusting for potential confounders, the hazard ratios (95% confidence interval) of impairment per 1-SD increase in the Mediterranean Diet Adherence Screener, alternate Mediterranean Diet score, Dietary Approaches to Stop Hypertension, Alternate Healthy Eating Index-2010 and healthful Plant-Based Diet Index scores were, respectively, 0.98 (0.94 to 1.03), 1.01 (0.96 to 1.06), 1.02 (0.97 to 1.07), 1.01 (0.96 to 1.06), and 1.00 (0.96 to 1.05). Results were similar when analyses were restricted to those >60 years, with British ethnicity, without chronic disease, without tinnitus or with optimal cognitive function. CONCLUSIONS: Adherence to a healthy diet did not show an association with the speech reception threshold in noise. More research is needed to identify the impact of individual foods or nutrients on this outcome.

Association Between Hearing Loss and Impaired Physical Function, Frailty, and Disability in Older Adults: A Cross-sectional Study.

Importance: Several studies have examined the association between hearing loss (HL) and physical function, with inconsistent results. Few used pure-tone thresholds and considered possible confounders in the association. Objective: To examine the association between hearing loss and impaired lower extremity function, frailty syndrome, and disability in older adults. Design, Setting, and Participants: The Seniors-ENRICA-2 is a cohort study that was established in 2015-2017 in Spain. The present study was conducted from December 2015 to June 2017. Data were analyzed from January 2, 2021, to March 10, 2021. This cross-sectional analysis included 1644 community-dwelling individuals aged 65 years or older (range, 66-91 years) of both sexes. Participants had hearing threshold measurements and data on impaired lower extremity function, frailty syndrome, and disability. Exposures: Hearing loss defined as pure-tone average greater than 40 dB HL in the better ear for standard frequency (0.5, 1, and 2 kHz), speech frequency (0.5, 1, 2, and 4 kHz), and high frequency (3, 4, and 8 kHz). Main Outcomes and Measures: Impaired lower extremity function was defined with the Short Physical Performance Battery; the frailty syndrome was defined as having at least 3 of the 5 criteria, including weakness, slow walking speed, low physical activity, exhaustion, and weight loss; and disability in instrumental activities of daily living (IADL) was evaluated with the Lawton and Brody scale. Results: Of the 1644 participants, 831 were men (50.5%); mean (SD) age was 73.8 (4.3) years. The prevalence of moderate HL was 13.6% at speech frequency. After adjustment for age, sex, lifestyle, comorbidities, impaired cognition, and social isolation, HL in standard frequency was associated with impaired lower extremity function, with an odds ratio (OR) of 2.20 (95% CI, 1.25-3.88); the corresponding estimate for the frailty syndrome was 1.85 (95% CI, 0.98-3.49) and for the IADL disability, was 2.25 (95% CI, 1.29-3.94). When considering speech frequency pure-tone average, HL was also associated with impaired function (OR, 2.59; 95% CI, 1.57-4.28), frailty syndrome (OR, 1.85; 95% CI, 1.06-3.22), and IADL disability (OR, 2.18; 95% CI, 1.32-3.60). Conclusions and Relevance: In this cross-sectional analysis of data from the Seniors-ENRICA-2 cohort study, hearing loss was associated with impaired lower extremity function, frailty syndrome, and IADL disability. It may be useful to examine this association with the mechanisms elucidated in further studies.

Chilean dentists' knowledge of hearing loss generated by occupational noise exposure / Conocimiento de odontólogos chilenos sobre la pérdida auditiva generada por exposición ocupacional al ruido

Abstract Introduction: Dentists are a population at high risk of hearing loss due to their constant exposure to instruments that can generate noise of up to 100 dB during their practice. Objective: To determine the level of knowledge of dentists working in Chile regarding hearing loss caused by exposure to noise generated by dental instruments. Materials and methods: A cross-sectional study was conducted in 114 dentists, who completed a virtual survey of 22 questions regarding the perception and level of knowledge about hearing loss due to exposure to loud noises and about national regulations on occupational noise exposure. Differences between perception and knowledge levels were evaluated taking into account the years of professional practice and the average weekly workload in dental treatment rooms. Descriptive and inferential statistics (Chi-squared test) were used for data analysis. Results: Most participants were Chilean (99.1%); 58.8% were women, and 72.8% had less than 10 years of professional experience. In addition, 97.4% were unaware of national regulations on occupational noise exposure and 50% of the sample reported having experienced hearing loss; of these, 57.9% (n = 32) associated it with their practice. Conclusions: A very low percentage of participants knew that there are regulations regarding occupational noise exposure. For this reason, it is important that, both during their training and their professional practice, dentists in Chile have greater access to information about these regulations and hearing protection measures.

Resumen Introducción. Los odontólogos son una población con un alto riesgo de desarrollar pérdida auditiva debido a la constante exposición a instrumentales que deben usar en su práctica profesional y que pueden generar ruidos de hasta 100 dB. Objetivo. Determinar el nivel de conocimiento de odontólogos laboralmente activos en Chile respecto a la pérdida auditiva causada por la exposición al ruido generado por maquinarias dentales. Materiales y métodos. Estudio transversal realizado en 114 odontólogos, quienes diligenciaron una encuesta virtual de 22 preguntas relativas a la percepción y el nivel de conocimiento sobre pérdida auditiva por exposición a ruidos fuertes y sobre la normativa nacional respecto a exposición ocupacional al ruido. Se evaluaron las diferencias entre percepción y niveles de conocimiento según los años de ejercicio profesional y la carga promedio de trabajo semanal en boxes de atención. Para el análisis de los datos se utilizó estadística descriptiva e inferencial (prueba de chi-cuadrado). Resultados. La mayoría de participantes eran chilenos (99.1%); el 58.8% fueron mujeres, y el 72.8% tenía menos de 10 años de ejercicio profesional. Además, el 97.4% desconocía las regulaciones nacionales sobre exposición ocupacional al ruido y el 50% reportó haber experimentado pérdida auditiva; de estos, 57.9% (n=32) lo asoció a su profesión. Conclusiones. Un muy bajo porcentaje de los participantes sabe que hay disposiciones sobre exposición ocupacional al ruido, por lo que es importante que, tanto en su formación, como durante su ejercicio profesional, los odontólogos en Chile tengan un mayor acceso a información relativa a estas normativas y a medidas ocupacionales de protección auditiva.

Coffee consumption and risk of hearing impairment in men and women.

BACKGROUND: Hearing loss is the fifth leading cause of disability in the world. Coffee consumption might have a beneficial effect on hearing function because of the antioxidant and anti-inflammatory properties of some of its compounds. However, no previous longitudinal study has assessed the association between coffee consumption and the risk of hearing impairment. OBJECTIVE: To assess the prospective association between coffee consumption and risk of disabling hearing impairment in middle and older men and women from the UK Biobank study. METHODS: Analytical cohort with 36,923 participants (16,142 men and 20,781 women) [mean (SD): 56.6 (7.8) years, 1.6 (1.4) cups/d, and -7.6 (1.3) dB for age, total coffee consumption and speech reception threshold in noise at baseline, respectively]. At baseline, coffee consumption was measured with 3-5 multiple-pass 24-h food records. Hearing function was measured with a digit triplet test, and disabling hearing impairment was defined as a speech reception threshold in noise > -3.5 dB in any physical exam during the follow-up. Analyses were stratified by sex and Cox regression models were used to assess the prospective association proposed. RESULTS: Over 10 years of follow-up, 343 men and 345 women developed disabling hearing impairment. Among men, compared with those who consumed <1 cup/d of coffee, those who consumed 1, and ≥2 cups/d had a lower risk of hearing impairment (hazard ratio [95% confidence interval]: 0.72 [0.54-0.97] and 0.72 [0.56-0.92], respectively; P-trend: 0.01). This association was similar for caffeinated and decaffeinated coffee, and for filtered and non-filtered coffee, and was stronger in those with obesity (hazard ratio [95% confidence interval] for consumption of ≥2 vs. <1 cups/d: 0.39 [0.21-0.74]). No association was found between coffee and hearing function among women. CONCLUSIONS: Coffee consumption was associated with lower risk of disabling hearing impairment in men but not in women. The association appeared to be independent of the coffee type and the preparation method.

Telemedicina para reducir complicaciones del embarazo y mortalidad en una zona rural de Honduras: protocolo de implementación / Telemedicine to reduce pregnancy-related complications and mortality in a rural area in Honduras: implementation protocol

OBJETIVOS: se propone un proyecto que utilice la telemedicina en el manejo obstétrico en zonas rurales de Honduras. MÉTODOS: establecer una red de telemedicina entre 8 Centros de Salud Rural y su Hospital Regional de referencia, que asesorará sobre el manejo de los embarazos de alto riesgo. Se analizarán los resultados en salud obtenidos y su impacto económico durante 24 meses mediante un enfoque de coste-efectividad. RESULTADOS: se espera que el análisis coste-efectividad del proyecto muestre una mejora de los indicadores sanitarios considerados (complicaciones obstétricas, mortalidad materna y mortalidad perinatal), junto con indicadores económicos favorables (periodo de recuperación corto, valor actual neto positivo, y tasa interna de retorno positiva). CONCLUSIONES: la implementación de una red de telemedicina en zonas rurales de Honduras tiene el potencial de ser coste-efectiva, escalarse a nivel nacional e internacional, e incluso utilizarse para cubrir necesidades de salud diferentes al manejo de embarazos de alto riesgo

OBJECTIVES: to propose a telemedicine project for the improvement of obstetric care in rural areas of Honduras. METHODS: to establish a telemedicine network between 8 Primary Care Centers and its associated Regional Hospital, which will guide them in the management of high-risk pregnancies. Health and economic outcomes will be assessed over 24 months through a cost-effectiveness approach. RESULTS: it is expected that the cost-effectiveness analysis will show an improvement in the health indicators considered (obstetric complications, maternal mortality, and perinatal mortality), as well as favourable economic indicators (a short payback period, a positive net present value, and a positive internal rate of return). CONCLUSIONS: the implementation of a telemedicine network in rural areas of Honduras has the potential of being cost-effective, scalable in national or international settings, and even of being used for health necessities other than high-risk pregnancies management

Avances en la rehabilitación auditiva con células madre / Advances in hearing rehabilitation with stem cells

Según la Organización Mundial de la Salud en el mundo hay 360 millones de personas que sufren algún tipo de pérdida auditiva discapacitante. Actualmente los tratamientos más usados para la rehabilitación de hipoacusias neurosensoriales son los aparatos electrónicos como audífonos o dispositivos implantables, tanto cocleares como osteointegrados. La presente revisión resume los avances que se han producido en la rehabilitación auditiva con células madre, y cómo éstas contribuyen en la generación de nuevas células ciliadas y neuronas auditivas. También se revisa el uso combinado con implantes cocleares, y cómo este último ayuda a la creación de redes entre las células ciliadas y las neuronas auditivas. Si bien queda un largo camino por recorrer y poder resolver algunos problemas como la implantación en la cóclea o ganglio espiral de las células o neuronas creadas exógenamente, este tipo de terapia abre una solución para una rehabilitación auditiva que en muchos casos supondría la solución definitiva para la discapacidad auditiva

There are 360 million people who suffers some kind of Hearing loss disability according to the World Health Organization (WHO). Currently, the electronic devices such as hearing aids or implantable devices both cochlear and osseointegrated, are the most useful treatments to hearing loss rehabilitation. The following review summarized both the advances that have occurred in the auditory rehabilitation with stem cells, and how they have helped in the generation of new hair cells and auditory neurons. Besides, both the combined use with cochlear implants and how it helps to create networks between the hair cells and the auditory neuron was reviewed. Although, there is a long way to go and solving some problems, such as implantation in the wall or the spiral ganglion of cells or neurons created exogenously, this kind of therapy opens a solution for a rehabilitation which would be the solution definitive for hearing impairment

Trastornos del habla en la enfermedad de parkinson. revisión / Speech disorders in parkinson's disease. review

Hasta el 90% de los pacientes con enfermedad de Parkinson presentan eventualmente trastornos del habla durante el curso de la enfermedad, que se conocen como disartria hipocinética o parkinsoniana. Este trabajo tiene como objetivo resumir y esclarecer la evidencia actual sobre dichos trastornos del habla en la enfermedad del Parkinson. Se abordarán diferentes aspectos: características, bases anatomofisiológicas, diagnóstico y tratamiento de los mismos. Como conclusión, se observa en la literatura existente que el análisis acústico podría actuar como marcador diagnóstico objetivo y no invasivo en la enfermedad de Parkinson, incluso en etapas prodrómicas. Esto facilitaría el diagnóstico y tratamiento tempranos, aumentando la calidad de vida de las personas con enfermedad de Parkinson.

Up to 90% of patients with Parkinson's disease eventually have speech disorders during the course of the disease, which are known as hypokinetic or parkinsonian dysarthria. This work aims to summarize and clarify the current evidence on speech disorders in Parkinson's disease. It deals with different aspects: characteristics, anatomophysiological bases, diagnosis and treatment of them. In conclusion, it is observed in the existing literature that acoustic analysis could act as an objective and non-invasive diagnostic marker in Parkinson's disease, even in prodromal stages. This would facilitate early diagnosis and treatment, increasing the quality of life of people with Parkinson's disease.