Factors associated with impairment in gait speed in older people with clinically normal gait. A cross-sectional study.

BACKGROUND: Health professionals commonly use gait speed in the evaluation of functional status in older people. However, only a limited number of studies have assessed gait speed in the absence of disorders of gait, using confounding factors and exclusion criteria coming from studies conducted in younger people. Our study aims to analyse which factors are associated with gait speed in older people with normal clinical gait. METHODS: An observational cross-sectional study was conducted in 119 community-dwelling residents without relevant comorbidities (Charlson index < 2), preserved function (Barthel > 85) and normal gait by visual exploration. Exclusion criteria included suffering from any illness that could modify the characteristics of gait, terminal status or the presence of an acute medical illness in the past 3 months. We used a stepwise linear regression of several variables (sociodemographic characteristics, cognition, body composition, drugs, falls, sarcopenia, frailty and physical activity) on 6-metre gait speed. RESULTS: The mean age was 78 years (range 70-96 years) and 71.4% were women. Variables that remained associated with gait speed in the multivariate final model were age (B = - 0.020, p < 0.001); gender (B = - 0.184, p < 0.001); waist-to-height ratio (B = - 0.834, p = 0.002); number of falls (B = - 0.049, p = 0.003) and the number of Fried's frailty criteria (B = - 0.064, p = 0.019). CONCLUSION: Falls, frailty and the waist-to-height ratio modify gait speed in older people with normal gait. Studies analysing the potential effect of several factors on gait speed should consider them as confounding factors.

Key Messages for a Frailty Prevention and Management Policy in Europe from the ADVANTAGE JOINT ACTION Consortium.

In the 2015 Ageing Report, the European Commission (EC) and the Economic Policy Committee stated that coping with the challenge posed by an ageing population will require determined policy action in Europe, particularly in reforming pension, health care and long-term care systems. The concern for this situation motivated the EC, the Parliament and many of the Member States (MS) to co-fund, in the 2015 call of the Third European Health Programme of the European Union 2014-2020, the first Joint Action (JA) on the prevention of frailty. ADVANTAGE JA brings together 33 partners from 22 MSs for 3 years. It aims to build a common understanding on frailty to be used in the MSs by policy makers and other stakeholders involved in the management, both at individual and population level, of older people who are frail or at risk for developing frailty throughout the European Union (EU). It is a formidable challenge but also a great opportunity for concerted action resulting in fostering effective and successful policies in frailty prevention and management in the participating MS. The Consortium has 2 years of hard work ahead to contribute to the needed change for frailty related disability free Europe. The first practical step towards this aim was the preparation of a document: the State of the Art on Frailty Report to support an overview of evidence of what works and what does not work on frailty prevention and management. Subsequently, this will be reflected in the advice that the JA will give to policy makers at MS level. Overall, these messages intend to be an instrument of added value to advocate for policy driven decisions on frailty prevention and management in the JA participating MSs and subsequently towards a frailty related disability free older population in Europe. The aim of this paper is to describe ADVANTAGE JA general structure, approach and recommendations towards a European health and social policy which will support frailty prevention in the participating MS.

Síndrome de cauda equina por hernia discal lumbar: demora quirúrgica y su relación con el pronóstico / Cauda equina syndrome secondary to lumbar disc herniation: Surgical delay and its relationship with prognosis

Objetivo. Constatar si la demora en más de 48 h en el tratamiento quirúrgico de los pacientes con síndrome de cauda equina (SCE) influyó en el resultado clínico de nuestros pacientes. Material y métodos. Estudio retrospectivo de 18 pacientes intervenidos en nuestro centro desde marzo de 2000 a enero de 2012, tras presentar SCE. Se recogió la situación clínica pre- y postoperatoria: existencia de dolor lumbar y/o ciático, alteración sensitiva en periné, déficit motor y sensitivo en extremidades inferiores y el grado de incontinencia esfinteriana (SCE completo o incompleto). Se realizó una valoración mediante el índice de discapacidad de Oswestry. Resultados. Teniendo en cuenta el inicio de los síntomas, el 44% (8 de 18) de los pacientes se intervinieron de forma precoz (menos de 48 h). Ninguno de los pacientes con SCE completo intervenidos precozmente tuvieron incontinencia urinaria residual, presentando además mayor grado de recuperación motora. De los 5 pacientes con SCE completo intervenidos de forma tardía (más de 48 h), 3 continuaron con incontinencia urinaria residual. Al final del seguimiento se obtuvo una media de 12,55 en las escala de discapacidad de Oswestry. Conclusión. Aunque no se han encontrado diferencias estadísticamente significativas, en nuestra serie hemos observado mayor recuperación motora y esfinteriana en los pacientes que fueron intervenidos antes de las 48 h (AU)

Objective. To determine whether surgical treatment delayed for more than 48 hours in patients with cauda equina syndrome (CES) influenced the clinical outcome. Material and methods. A retrospective study of 18 patients treated in our hospital from March 2000 to January 2012, after presenting with CES. The pre- and post-operative clinical status was determined: existence of back pain and/or sciatica, sensory disturbance in the perineum, sensory and motor deficits in the lower extremities, and the degree of sphincter incontinence (complete or incomplete CES). A clinical assessment was performed using the Oswestry disability index. Results. As regards the onset of symptoms, 44% (8 of 18) of patients were treated at an early stage (within 48 hours). None of the patients with complete CES operated in the early stage had urinary incontinence, and also had greater motor recovery. Of the 5 patients with complete CES who underwent delayed surgery, 3 showed residual urinary incontinence. A mean of 12.55 was obtained on the Oswestry disability index scale at the end of follow-up. Conclusion. Although no statistically significant difference was found in our study, we observed greater motor and sphincter recovery in patients who were operated on within 48 hours (AU)

Cauda equina syndrome secondary to lumbar disc herniation: Surgical delay and its relationship with prognosis. / Síndrome de cauda equina por hernia discal lumbar: demora quirúrgica y su relación con el pronóstico.

OBJECTIVE: To determine whether surgical treatment delayed for more than 48 hours in patients with cauda equina syndrome (CES) influenced the clinical outcome. MATERIAL AND METHODS: A retrospective study of 18 patients treated in our hospital from March 2000 to January 2012, after presenting with CES. The pre- and post-operative clinical status was determined: existence of back pain and/or sciatica, sensory disturbance in the perineum, sensory and motor deficits in the lower extremities, and the degree of sphincter incontinence (complete or incomplete CES). A clinical assessment was performed using the Oswestry disability index. RESULTS: As regards the onset of symptoms, 44% (8 of 18) of patients were treated at an early stage (within 48 hours). None of the patients with complete CES operated in the early stage had urinary incontinence, and also had greater motor recovery. Of the 5 patients with complete CES who underwent delayed surgery, 3 showed residual urinary incontinence. A mean of 12.55 was obtained on the Oswestry disability index scale at the end of follow-up. CONCLUSION: Although no statistically significant difference was found in our study, we observed greater motor and sphincter recovery in patients who were operated on within 48 hours.

How to design nutritional intervention trials to slow cognitive decline in apparently healthy populations and apply for efficacy claims: a statement from the International Academy on Nutrition and Aging Task Force.

Interventions are crucial as they offer simple and inexpensive public health solutions that will be useful over the long term use. A Task Force on designing trials of nutritional interventions to slow cognitive decline in older adults was held in Toulouse in September 2012. The aim of the Task Force was to bring together leading experts from academia, the food industry and regulatory agencies to determine the best trial designs that would enable us to reach our goal of maintaining or improving cognitive function in apparently healthy aging people. An associated challenge for this Task Force was to determine the type of trials required by the Public Food Agencies for assessing the impact of nutritional compounds in comparison to well established requirements for drug trials. Although the required quality of the study design, rationale and statistical analysis remains the same, the studies designed to show reduction of cognitive decline require a long duration and the objectives of this task force was to determine best design for these trials. Two specific needs were identified to support trials of nutritional interventions: 1- Risk- reduction strategies are needed to tackle the growing burden of cognitive decline that may lead to dementia, 2- Innovative study designs are needed to improve the quality of these studies.

The performance of Spanish solid waste collection.

In this paper we examine street cleaning and waste collection services in Spanish municipalities with a population exceeding 50,000. The purpose is to identify factors that influence the efficiency of these services. Three input variables (staff, vehicles and containers) and four outputs variables (tonnage, collection points, collection point density and kilometres of surface area washing) are analyzed using an analytical model based on Data Envelopment Analysis (DEA) methodology. These variables, along with non-controllable input variable (Tourist Index), were chosen because they were shown, based on a Tobit regression analysis, to have a statistically significant impact on municipality behaviour. The results obtained show that scale inefficiency was lower than pure technical efficiency, the latter is linked to service management. It was observed that the street-cleaning activity was performed more inefficiently than that of waste collection. Furthermore, it was detected that municipalities can reduce the resources used in rendering this service by 8%. Finally, an estimation using the Mann-Whitney test allows us to conclude that there is no difference between the inefficiencies observed in municipalities managed directly by town councils and those which have been transferred to private companies.

[Nutrition alterations in internal medicine. Body composition analysis with bioelectrical impedance]. / Alteraciones de la nutrición en Medicina Interna. Análisis de la composición corporal por impedancia bioeléctrica.

OBJECTIVES: To determine the prevalence of malnutrition in patients in Internal Medicine. To describe the changes of corporal composition depending on body mass index (BMI). To evaluate validity of the different screening tools for the estimation of body composition. MATERIAL AND METHODS: Prospective observational cross-sectional study of the prevalence of malnutrition in 300 patients (sample 1); these were chosen 136 patients (sample 2), classifying in four groups: BMI < 20: 30 patients; BMI = 20-25: 46 patients; BMI = 25-30: 30 patients, and BMI > 30: 30 patients. In the patients of sample 2, we carried out a protocol of nutritional evaluation with anthropometry, laboratory and bioelectrical impedance analysis. RESULTS: The prevalence of desnutrition was 9.3% and the obesity was 22.3%. In undernourished patients, the measure of body compartments with bioelectrical impedance, expressed in percentage of body weight, were: fat mass 20.5%, fat-free mass 79.4% and total body mater 58.3%. The body composition in obeses was: fat mass 40.1%, fat-free mass 60.6% and total body water 44.3%. The patients with normal BMI, the meta index (impedance at 50 kHz/BMI) was 25.9 +/- 5.21; in undernourished the index was higher (36.7) and obeses lower (15.5). The meta index (30-20) estimates desnutrition-obesity with high sensibility and specificity. The prevalence of desnutrition varies from 6% to 69% and obesity from 23% to 74%, using different methods and criterions for the estimation of body composition. CONCLUSIONS: In Internal Medicine, the overweight (BMI > 25) is the most prevalent nutritional alteration. The bioelectrical impedance analysis helps for estimation of body composition and meta index is a very useful indicator of malnutrition (desnutrition-obesity).

Alteraciones de la nutrición en Medicina Interna. Análisis de la composición corporal por impedancia bioeléctrica / Nutrition alterations in internal medicine. Body composition analysis with bioelectrical impedance

Objetivos. Determinar la prevalencia de alteraciones de la nutrición en pacientes ingresados en Medicina Interna. Describir los cambios en la composición corporal según el índice de masa corporal (IMC). Evaluar la utilidad de los diferentes métodos de medición de la composición corporal. Material y métodos. Se realizó un estudio prospectivo observacional transversal para determinar la prevalencia de malnutrición por IMC en 300 pacientes (muestra 1); de éstos se seleccionaron 136 pacientes (muestra 2), que se distribuyeron en cuatro grupos según el IMC: desnutridos (IMC 30): 30 pacientes. A todos los pacientes de la muestra 2 se les realizó un estudio de valoración nutricional con antropometría, laboratorio y análisis de impedancia bioeléctrica. Resultados. La prevalencia de desnutrición en los 300 pacientes fue del 9,3% y de la obesidad del 22,3%. El valor de los componentes corporales medidos por impedancia bioeléctrica, expresados en porcentaje del peso corporal, fue en los pacientes desnutridos: 20,5% de masa grasa, 79,4% de magro y 58,3% de agua corporal total. En los obesos: 40,1% de masa grasa, 60,6% de magro y 44,3% de agua corporal total. El índice meta (impedancia a 50 kHz/IMC) en los pacientes con IMC normal fue 25,9 ± 5,21; los desnutridos presentaron los valores más altos (36,7) y los obesos los más bajos (15,5). El índice meta (30-20) identifica desnutrición-obesidad con una alta sensibilidad y especificidad. La prevalencia de desnutrición varió entre un 6% y un 69% y la de obesidad entre un 23% y un 74%, dependiendo de los parámetros y criterios utilizados. Conclusiones. El exceso de peso (IMC > 25) fue la alteración del estado nutricional más prevalente en Medicina Interna. El análisis de impedancia bioeléctrica facilita la medición de los componentes corporales y el índice meta es un indicador muy útil de malnutrición (desnutrición-obesidad)

Objectives. To determine the prevalence of malnutrition in patients in Internal Medicine. To describe the changes of corporal composition depending on body mass index (BMI). To evaluate validity of the different screening tools for the estimation of body composition. Material and methods. Prospective observational cross-sectional study of the prevalence of malnutrition in 300 patients (sample 1); these were chosen 136 patients (sample 2), classifying in four groups: BMI 30: 30 patients. In the patients of sample 2, we carried out a protocol of nutritional evaluation with anthropometry, laboratory and bioelectrical impedance analysis. Results. The prevalence of desnutrition was 9.3% and the obesity was 22.3%. In undernourished patients, the measure of body compartments with bioelectrical impedance, expressed in percentage of body weight, were: fat mass 20.5%, fat-free mass 79.4% and total body mater 58.3%. The body composition in obeses was: fat mass 40.1%, fat-free mass 60.6% and total body water 44.3%. The patients with normal BMI, the meta index (impedance at 50 kHz/BMI) was 25.9 ± 5.21; in undernourished the index was higher (36.7) and obeses lower (15.5). The meta index (30-20) estimates desnutrition-obesity with high sensibility and specificity. The prevalence of desnutrition varies from 6% to 69% and obesity from 23% to 74%, using different methods and criterions for the estimation of body composition. Conclusions. In Internal Medicine, the overweight (BMI > 25) is the most prevalent nutritional alteration. The bioelectrical impedance analysis helps for estimation of body composition and meta index is a very useful indicator of malnutrition (desnutrition-obesity)

Fiebre y lesión muscular del pectoral mayor / Fever and pectoralis major muscle lesion

No disponible

No disponible

Odinofagia y lesiones cutáneas en paciente con metástasis cerebrales / Odinophagia and cutaneous lesions in patient with cerebral metastases

No disponible

[Tuberculosis epidemiological study in a third level hospital during 2001]. / Estudio epidemiológico de la tuberculosis en un hospital de tercer nivel en el año 2001.

OBJECTIVES: Estimate the incidence and epidemiological and clinical characteristics of Tuberculosis (TB), analyzing the influence of factors such as: HIV infection, immigration, chronic diseases and styles of life. MATERIAL AND METHODS: Retrospective study of patients who have diagnosed of active TB (microbiological results positive) and latent tuberculosis (Mantoux positive) during the year 2001 in the Gregorio Marañon Hospital. The variables include epidemiological, microbiological, clinical and therapeutic features. RESULTS: We registered 78 patients with TB at hospital, with estimated incidence in health area of 11, 14 cases per 100,000 habitants. The mean age of were 41.98 years; with 43.6% HIV infected patients and 9% immigrants. The sputum was the sample most used for the microbiological diagnosis, we detected resistance in 30% of samples analyzed. The HIV infected patients had more frequent TB from reactivation (p=0,016). The primary site of disease was pulmonary (78%). One pulmonary infiltrate was more frequent in the thoracic X-ray. The 56% of our HIV infected patients had normal thoracic X-ray (p <0,05). The treatment more common was with four drugs and the 75% of our patients fulfilled the treatment; the HIV infected patients leaves the treatment more frequent. The global mortality was 9%. CONCLUSIONS: Actually, in Madrid, the persons with HIV infection, injection drug abuse, immigration and elders in residential home were higher risk of infection for TB. For strict control of disease is need early diagnosis and supervision of treatment .

Estudio epidemiológico de la tuberculosis en un hospital de tercer nivel en el año 2001 / Tuberculosis epidemiological study ina third level hospital during 2001

Objetivos: Estimar la incidencia y características clínicoepidemiológicas de la Tuberculosis (TB), analizando la influencia de factores predisponentes como la infección VIH, la inmigración, enfermedades crónicas y hábitos de vida. Material y métodos: Se realizo un estudio retrospectivo de los pacientes diagnosticados de TB activa (confirmación microbiológica) y latente (presencia de Mantoux positivo) durante el año 2001, en el hospital Gregorio Marañón. Las variables incluidas se referían a datos epidemiológicos, bacteriológicos, clínicos y terapéuticos. Resultados: Se detectaron 78 pacientes con TB en hospital, con una incidencia estimada en el área de salud de 11,14 casos por 100.000 habitantes. La edad media fue de 41,98 años; con 43,6% pacientes VIH positivos y 9% inmigrantes. La muestra microbiológica más utilizada fue el esputo, detectándose resistencias en 30% de los casos donde se realizo. De los 78 casos revisados, 64 (82%) tenían TB activa. En los pacientes VIH fue más frecuente la TB por reactivación (p = 0,016). La localización predominante fue la pulmonar (78%). El hallazgo radiológico más frecuente fue un infiltrado pulmonar. El 56% de los pacientes VIH presentaron radiografías normales (p 0,01). La mortalidad global fue del 9%. Conclusiones: En la actualidad, en Madrid, la población con mayor riesgo de TB son los sujetos con infección VIH, drogadicción, inmigrantes y ancianos institucionalizados. Para un adecuado control de la enfermedad es necesario un diagnóstico precoz y una supervisión del tratamiento

Objectives: Estimate the incidence and epidemiological and clinical characteristics of Tuberculosis (TB), analyzing the influence of factors such as: HIV infection, immigration, chronic diseases and styles of life. Material and methods: Retrospective study of patients who have diagnosed of active TB (microbiological results positive) and latent tuberculosis (Mantoux positive) during the year 2001 in the Gregorio Marañon Hospital. The variables includes epidemiological, microbiological, clinicals and therapeutics features. Results: We were registered 78 patients with TB at hospital, with estimated incidence in health area of 11,14 cases per 100.000 habitants. The mean age of were 41,98 years; with 43,6% HIV infected patients and 9% immigrants. The sputum was the sample most used for the microbiological diagnosis, we detected resistance in 30% of samples analysed. The HIV infected patients had more frequent TB from reactivation (p=0,016). The primary site of disease was pulmonary (78%). One pulmonary infiltrate was more frequent in the thoracic X-ray. The 56% of our HIV infected patients had normal thoracic X-ray (p<0,05). The treatment more common was with four drugs and the 75% of our patients fulfilled the treatment; the HIV infected patients leaves the treatment more frequent. The global mortality was 9%. Conclusions: Actually, in Madrid, the persons with HIV infection, injection drug abuse, immigration and elders in residential home were higher risk of infection for TB. For strict control of disease is need early diagnosis and supervision of treatment

[What information do elderly patients with heart failure have about their treatment?]. / Qué información tienen los pacientes ancianos con insuficiencia cardiaca sobre su tratamiento?

INTRODUCTION: Heart failure is one of the leading cause of hospital admission because of the lack of adherence to treatment of these patients. This study was designed to know patients knowledge about heart failure. PATIENTS AND METHODS: 75 patients admitted in ward with the diagnosis of heart failure were asked about the illness and the treatment they took. RESULTS: Patients considered weight gain, dyspnea and edemas a cause of consultant to their doctors (99%). They understood as necessary the weight control to their stabilization (82%). One half of the interviewed did not consider important the control of diuresis and water ingestion. Most of the patients thought that mild physical exercise and sodium restriction could improve their physical status (85% and 100% respectively). 24% of the patients considered they could use any kind of non steroid anti-inflammatory drug. 79% of the patients knew the diuretic effect of furosemida and 70% the cardiologic effect of digoxina, all thought only just 46% recognized the use of angiotensin converse enzyme inhibitors for heart failure and blood pressure. The adverse events of these drugs were unknown (56%, 65% and 80% respectively). CONCLUSIONS: Patients with heart failure had poor information about dietary and medical treatment. This could explain the problems their have for the optimal use of effective medication, being poor patients adherence to pharmacologic and dietary therapy a common cause of exacerbation. It would be necessary to increase patients information to avoid heart failure progression and descompensation.

¿Qué información tienen los pacientes ancianos con insuficiencia cardiaca sobre su tratamiento? / What information have old patients with heart failure about their treatment?

Introducción: La insuficiencia cardiaca (IC) es uno de los principales motivos de ingreso hospitalario, viéndose favorecido este hecho por la falta de adherencia al tratamiento de los pacientes. Este estudio fue diseñado para conocer el grado de información sobre la IC con el que cuentan los pacientes. Pacientes y métodos: Se realizó entrevista personalizada a 75 pacientes ingresados con diagnóstico de IC sobre sus conocimientos sobre la enfermedad y el tratamiento que seguían. Resultados: Los pacientes consideraron motivo de consulta el aumento de peso, la disnea y los edemas (99 por ciento), entendiendo como necesario el control del peso para su estabilización (82 por ciento). Hasta un 50 por ciento no considera importante el control de la diuresis ni el de ingesta hídrica. Ven en el ejercicio físico moderado y la restricción de sal un beneficio (85 por ciento y 100 por ciento respectivamente). El 24 por ciento de los pacientes consideró que podían utilizar cualquier tipo de antiinflamatorio no esteroideo (AINEs). Un 79 por ciento de los pacientes reconocen el efecto diurético de la furosemida y un 70 por ciento atribuyen a la digoxina su efecto cardiológico, mientras que tan sólo conocen la utilidad de los Inhibidores de la Enzima Convertidora de Angiotensina (IECAs) un 46 por ciento. Los efectos secundarios de dichos fármacos son, en general, desconocidos (56 por ciento, 65 por ciento y 80 por ciento respectivamente).Conclusiones: El paciente con IC posee escasa información sobre el tratamiento y medidas higiénico-dietéticas relacionadas con su enfermedad, lo que confirma la dificultad de estos pacientes para el cuidado adecuado de su patología. Se debería incidir en este punto para evitar el reingreso de estos pacientes por IC (AU)

Introduction: Heart failure is one of the leading cause of hospital admision because of the lack of adherence to treatment of these patients. This study was designed to know patients knowledge about heart failure. Patients and methods: 75 patiens admited in ward with the diagnosis of heart failure were asked about the illness and the treatment they took. Results: Patiens considered weight gain, dyspnea and edemas a cause of consultant to their doctors (99%). They understood as necesary the weight control to their stabilization (82%). One half of the interviewed did not consider important the control of diuresis and water ingestion. Most of the patients thought that mild physical exercise and sodium restriction could improve their physical status (85% and 100% respectively). 24% of the patiens considered they could use any kind of non steroid anti-inflammatory drug. 79% of the patients knew the diuretic effect of furosemida and 70% the cardiologic effect of digoxina, all thought only just 46% recognized the use of angiotensin converse enzyme inhibitors for heart failure and blood presure. The adverse events of these drugs were unknow (56%, 65% and 80% respectively). Conclusions: Patients with heart failure had poor information about dietary and medical treatment. This could expain the problems their have for the optimal use of effective medication, being poor patients adherence to pharmacologic and dietary therapy a common cause of exacerbation. It would be necesary to increase patients information to avoid heart failure progression and descompensation (AU)

An international investigation of an outbreak of Legionnaires disease among UK and French tourists.

Five cases of legionnaires disease and one death were associated with four members of a tour group from the United Kingdom (UK) and one French tourist who all visited Spain in the spring of 1993. The UK group stayed at four hotels, one of which was also used by the French tourist. Phenotypic and genotypic comparison of isolates of Legionella pneumophila obtained from one of the UK cases and the French patient demonstrated that they were indistinguishable from each other and from environmental isolates obtained from the water supply of the hotel at which all five cases had stayed. A cohort study of the UK tour group was carried out to determine the extent of the outbreak and showed that three further members of the group had respiratory illness but were serologically negative to legionella infection. International participation in this investigation has highlighted the value of a European surveillance scheme and the benefit of microbiological collaboration between legionella reference laboratories in Europe.