Changes in Muscle Contractile Properties after Cold- or Warm-Water Immersion Using Tensiomyography: A Cross-Over Randomised Trial.

Muscle contractile properties in clinical practice are often measured using either subjective scales or high-cost, inaccessible equipment. In this randomised cross-over study, we aimed to explore the use of tensiomyography (TMG) to assess changes in muscle contractile properties after cold- and warm-water immersion. The muscle contractile properties of the biceps femoris (BF) were assessed using TMG in 12 healthy active men (mean age 23 ± 3 years, Body Mass Index 22.9 ± 1.3 kg/m2) before and after a 20-min warm- or cold-water immersion over a period of 40 min. Muscle displacement (Dm) and contraction time (Tc) were registered as the main variables of the study. There was a significant condition by time interaction for Dm (p < 0.01). Post hoc analysis showed that, compared to the baseline, there was an increase in Dm 40 min after warm-water immersion (p < 0.01) and a decrease at 10 min after cold-water immersion (p < 0.01). No significant effect was found for Tc. Our results indicate that muscle contractile properties are affected by water temperature and time after the immersion; therefore, these factors should be taken into account when water-immersion is used as a recovery strategy.

Factors for persistence of MRSA carriage one year after initial detection in individuals from various healthcare institutions / Factores de persistencia de la colonización por SARM un año más tarde de la detección inicial de portadores en distintos centros sanitarios

Introduction and objective: We studied the natural history of patients with chronic stable illnesses that are colonized by Methicillin Resistant Staphylococcus aureus (MRSA). The aim was to determine the persistence colonization 1 year after. Moreover, we intended to disclose factors that predict MRSA persistence. Material and methods: A multicentric, prospective observational study was designed. Patients from an acute-care hospital and 4 long-term healthcare facilities were included. Demographic, clinical and microbiological data (nasal and skin swabs) were obtained every 3 months during a year. MRSA carriers were decolonized with nasal mupirocin. Results: Among the 699 screened patients, 114 MRSA carriers were identified. MRSA carriage persisted in 59.4% of those who completed the follow-up. Baseline factors associated to MRSA persistence were heart failure, comorbidities, antibiotics, and ulcers. At one year: LTHF, underweight, Barthel<60, and ulcers (the two latest were independent predictors). Persistence was not associated to decolonization. Conclusion: Our study disclosed a high MRSA persistence rate and identified several associated factors (both at baseline and one year later). This information may be useful to identify individuals at high-risk of being MRSA carriers at hospital admission

Introducción y objetivo: Se estudió la evolución natural de los pacientes con enfermedades crónicas que son colonizados por Staphylococcus aureus resistente a la meticilina (SARM) para determinar la persistencia de colonización al año, e identificar factores predictores de persistencia. Material y métodos: Estudio multicéntrico, prospectivo y observacional. Se incluyeron los ingresados en un hospital y los 4 centros sociosanitarios de referencia, recogiendo datos estadísticos, clínicos y microbiológicos (muestras nasales y cutáneas), trimestralmente durante un año. Los portadores recibieron mupirocina. Resultados: Se identificaron 114 portadores de SARM entre los 699 ingresados. Fueron portadores persistentes el 59,4% de aquellos que completaron el seguimiento. Los factores basales asociados a la persistencia fueron la insuficiencia cardíaca, las comorbilidades, la antibioterapia y las úlceras. Al año: CSS, bajo peso, índice de Barthel<60, y úlceras (estos 2 últimos de forma independiente). Persistencia y descolonización no estuvieron estadísticamente relacionados. Conclusión: Se detectó una elevada persistencia de SARM al año, independientemente asociada a dependencia funcional y úlceras. Esta información es útil para detectar el riesgo de ser portador de SARM desde su ingreso

Factors for persistence of MRSA carriage one year after initial detection in individuals from various healthcare institutions.

INTRODUCTION AND OBJECTIVE: We studied the natural history of patients with chronic stable illnesses that are colonized by Methicillin Resistant Staphylococcus aureus (MRSA). The aim was to determine the persistence colonization 1 year after. Moreover, we intended to disclose factors that predict MRSA persistence. MATERIAL AND METHODS: A multicentric, prospective observational study was designed. Patients from an acute-care hospital and 4 long-term healthcare facilities were included. Demographic, clinical and microbiological data (nasal and skin swabs) were obtained every 3 months during a year. MRSA carriers were decolonized with nasal mupirocin. RESULTS: Among the 699 screened patients, 114 MRSA carriers were identified. MRSA carriage persisted in 59.4% of those who completed the follow-up. Baseline factors associated to MRSA persistence were heart failure, comorbidities, antibiotics, and ulcers. At one year: LTHF, underweight, Barthel<60, and ulcers (the two latest were independent predictors). Persistence was not associated to decolonization. CONCLUSION: Our study disclosed a high MRSA persistence rate and identified several associated factors (both at baseline and one year later). This information may be useful to identify individuals at high-risk of being MRSA carriers at hospital admission.

Use of Telehealth as a New Model for Following Intermittent Claudication and Promoting Patient Expertise.

BACKGROUND: A change in healthcare systems is needed, due to the increased prevalence of chronic diseases. Patient empowerment improves results in terms of patient quality of life (QoL) and satisfaction. INTRODUCTION: We have developed a telehealth program Control Telehealth Claudication Intermittent (CONTECI) for patients with peripheral arterial disease (PAD), aimed at enhancing patient satisfaction and QoL, while improving health system efficiency. MATERIALS AND METHODS: We conducted a randomized clinical trial of patients with PAD, at the intermittent claudication stage. Study subjects were randomized into either (1) an intervention arm (IA), which utilized our CONTECI program for promoting patient self-management, or (2) a control arm (CA), utilizing the familiar system of in-person patient visits. All patients were followed up at 1 year. RESULTS: The trial included 150 patients, 75 in each arm. Complications were diagnosed more quickly in the IA (7.85 days standard deviation (SD) 9.95 vs. 53.89 days SD 41.56; p = 0.016) compared with the CA. Rest pain decreased (1.4% vs. 8.4%; p = 0.05) in the IA group, as did the number of scheduled visits-decreased by 95.95%-and the number of emergency visits (p = 0.017). QoL scores in IA patients improved from baseline (67.87 vs. 72.25; p = 0.047), as did patient satisfaction (67.36 vs. 76.78; p = 0.03). DISCUSSION: Telemedicine can improve health results and aid communication and visit scheduling. Our e-Health programs are financially viable. CONCLUSIONS: Self-management using the CONTECI telehealth program is feasible for patients with PAD. The program promotes patient expertise, encourages proactivity, increases QoL and satisfaction with disease control, and improves health resource use, with no evidence of clinical inferiority to conventional practices.

[Individual and ecological factors related to the geographical variability of psychological distress among small areas: a multilevel analysis in Catalonia, Spain]. / Factores individuales y del entorno asociados a la variabilidad geográfica de los trastornos psicológicos entre areas pequeñas: un análisis multinivel.

BACKGROUND: To know the geographic distribution of the prevalence of psychological distress is important for mental health services planning. This study is aimed at identifying the individual factors and those related to the area of residence which may explain the geographic variability of psychological distress (by healthcare districts) in Catalonia. METHODS: The data was taken from the 1994 Catalonian Health Survey and from the 1996 Catalonia population statistics. The prevalence of psychological distress is estimated by age and sex and by healthcare district. In a two-level logic regression model, a study is made of the relationship between the individual variables (first level: health survey n = 12,455) and those of the area of residence (second level: the healthcare district, n = 46) to the geographic distribution of the prevalence of psychological distress. RESULTS: The significant variables at individual level are in men: age (45-64 years OR: 0.63 y > 64 years OR: 0.22), working status (no work OR: 1.60), number of chronic diseases (CD) (CD = 1 OR: 1.75 CD = 2 OR: 2.06 CD = 3-5 OR: 3.36 and CD > 5 OR: 8.9). In women: age (25-44 years OR: 0.63 45-64 years OR: 0.45 and > 64 years OR: 0.32), working status (no work OR: 1.30), number of chronic diseases (CD = 1 OR: 1.75 CD = 2 OR: 2.44 CD = 3-5 OR: 4.09 and CD > 5 OR: 11.14), and also the kind of parental household in women (single-parental OR: 1.42). The variables at the level of the area of residence are in migration (men OR: 1.55 and women OR: 1.68) and unemployment (men OR: 1.07 and women OR: 1.06). CONCLUSIONS: The individual factors do not suffice to explain the geographical variability of the prevalence of psychological distress, but the characteristics of the area of residence are also important.

Factores individuales y del entorno asociados a la variabilidad geográfica de los trastornos psicológicos entre áreas pequeñas: un análisis multinivel / Individual and ecological factors related to the geographical variability of psychological distress among small areas: a multilevel analysis in Catalonia, Spain

Fundamento: Para planificar las necesidades de servicios sanitarioses fundamental conocer la distribución de la morbilidad portrastornos psicológicos en el territorio así como los factores que ladeterminan. El objetivo es identificar los factores que pueden explicarla variabilidad geográfica de estos trastornos en Cataluña.Métodos: Los datos proceden de la Encuesta de Salud de l994 yde la estadística de población de l996 para Cataluña. Se estima la prevalenciade trastornos psicológicos por edad y sexo y por sector sanitario.En un modelo de regresión logística a dos niveles se estudia laasociación entre las variables individuales (primer nivel: Encuestade Salud n=12.455) y las de la zona de residencia (segundo nivel: elsector sanitario, n= 46) con la prevalencia de trastornos psicológicos.Resultados: Las variables individuales que influyen en las diferenciasentre sectores son: la edad (45-64 años OR:0,63 y >64 años:OR:0,22), la situación laboral (no trabaja OR:1,60) y el número detrastornos crónicos (TC) (TC=1 OR: 1,75 TC=2 OR: 2,06 TC=3-5OR:3,36 y TC>5 OR: 8,9) en hombres. En las mujeres, además deestas variables (edad 25-44 años OR: 0,63 45-64 años OR:0,45 y >64años OR: 0,32 la situación laboral no trabaja OR:1,30 y el número detrastornos crónicos (TC) TC=1 OR: 1,75 TC=2 OR: 2,44 TC=3-5OR:4,09 y TC>5 OR: 11,14), influye el tipo de hogar (monoparentalOR: 1,42). Las variables a nivel de la zona de residencia son la proporciónde inmigración (hombres OR:1,55 y mujeres OR:1,68) y dedesempleo (hombres OR:1,07 y mujeres OR:1,06).Conclusiones: Los factores individuales no son suficientes paraexplicar la variabilidad geográfica de la prevalencia de los trastornospsicológicos, ya que también influyen las características de la zonade residencia

Background: To know the geographic distribution of the prevalenceof psychological distress is important for mental healthservices planning. This study is aimed at identifying the individualfactors and those related to the area of residence which may explainthe geographic variability of psychological distress (by healthcaredistricts) in Catalonia.Methods: The data was taken from the 1994 Catalonian HealthSurvey and from the 1996 Catalonia population statistics. The prevalenceof psychological distress is estimated by age and sex and byhealthcare district. In a two-level logic regression model, a study ismade of the relationship between the individual variables (first level:health survey n=12,455) and those of the area of residence (secondlevel: the healthcare district, n=46) to the geographic distribution ofthe prevalence of psychological distress.Results: The significant variables at individual level are in men:age (45-64 years OR:0,63 y >64 years OR: 0,22), working status (nowork OR:1,60) , number of chronic diseases (CD) (CD=1 OR: 1,75CD=2 OR: 2,06 CD=3-5 OR:3,36 and CD>5 OR: 8,9). In women:age (25-44 years OR: 0,63 45-64 years OR:0,45 and >64 years OR:0,32), working status (no work OR:1,30), number of chronic diseases(CD=1 OR: 1,75 CD=2 OR: 2,44 CD=3-5 OR:4,09 and CD>5OR: 11,14), and also the kind of parental household in women (single-parental OR: 1,42). The variables at the level of the area of residenceare inmigration (men OR:1,55 and women OR:1,68) andunemployment (men OR:1,07 and women OR:1,06).Conclusions: The individual factors do not suffice to explain thegeographical variability of the prevalence of psychological distress,but the characteristics of the area of residence are also important