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1.
Plast Reconstr Surg ; 146(2): 423-435, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740600

RESUMO

Plastic surgery patients span the nutritional spectrum from generally healthy, nutritionally competent patients to inherently catabolic, nutritionally deficient, and chronic wound patients. Therefore, plastic and reconstructive surgery affords the opportunity to investigate the impact of nutrition across a heterogeneous patient population following a wide variety of procedures. Although patients may be nutritionally deficient in certain vitamins warranting perioperative repletion, other supplements have the potential to benefit all patients, regardless of nutritional status. Despite these putative benefits, there is a dearth of information regarding nutritional optimization, with the limited, available literature focusing mostly on herbal supplements and their potential side effects. A significant barrier to supplement use is the lack of education and available supporting information regarding the indications, contraindications, and physiology of these adjuncts. The goal of this article is to provide a comprehensive, evidence-based review of available nutritional supplements that can be considered for the plastic surgery patient in the perioperative period to optimize surgical outcomes while minimizing risk. Prospective, well-designed studies using validated, high-quality supplements will be critical in determining the significance that perioperative supplementation can have for surgical outcomes. Until well-done prospective studies are performed, the supplement, dose, and duration should be determined on an individual, patient-per-patient basis at the discretion of the operating surgeon.


Assuntos
Medicina Baseada em Evidências/métodos , Desnutrição/dietoterapia , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Humanos , Desnutrição/complicações , Desnutrição/diagnóstico , Estado Nutricional , Complicações Pós-Operatórias/etiologia
2.
PLoS One ; 15(7): e0232998, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32609719

RESUMO

OBJECTIVES: The study tried to determine if malnutrition (underweight, stunting, wasting, overweight) and enamel defects (enamel hypoplasia, hypomineralized second molar, amelogenesis imperfecta, fluorosis) were associated with early childhood caries (ECC). The study also examined whether malnutrition was associated with the presence of enamel defects in 0-5-year-old children. METHODS: The study was a secondary analysis of primary data of a cross-sectional study assessing the association between maternal psychosocial health and ECC in sub-urban Nigerian population collected in December 2018 and January 2019. One hundred and fifty nine children were recruited. Exploratory variables were malnutrition and enamel defects. The outcome variables were the prevalence of ECC in 0-2-year-old, 3-5-year-old, and 0-5-year-old children. Multivariable Poisson regression analysis was used to determine the associations, and socioeconomic status, oral hygiene status, and frequency of in-between-meals sugar consumption were adjusted for. The adjusted prevalence ratios, 95% confidence intervals, and p values were calculated. RESULTS: The prevalence of ECC was 2.1% in 0-2-year-old children and 4.9% in 3-5-year-old children. In adjusted models, underweight, stunting, and wasting/overweight were not significant risk indicators for ECC in either age group. 0-2-year-old children who had amelogenesis imperfecta (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. 3-5-year-old children who had hypoplasia (p = 0.004), amelogenesis imperfecta (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. 0-5-year-old children with hypoplasia (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. There were significant associations between various types of malnutrition and various types of enamel defects. CONCLUSION: Although different types of malnutrition were associated with enamel defects, and enamel defects were associated with ECC, malnutrition was not associated with ECC. Further studies are needed to clarify the association between malnutrition and genetically and toxin-induced enamel defects.


Assuntos
Cárie Dentária/epidemiologia , Esmalte Dentário/patologia , Desnutrição/epidemiologia , Criança , Pré-Escolar , Cárie Dentária/complicações , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Desnutrição/complicações , Nigéria , Prevalência , Fatores de Risco , População Urbana/estatística & dados numéricos
3.
Nutr. hosp ; 37(3): 422-431, mayo-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-193846

RESUMO

INTRODUCTION: malnutrition is commonly associated with, and worsens the prognosis of heart failure. The management of chronic heart failure and its complications based only on the application of pharmacologic guidelines is incomplete. The benefits of interventions to improve nutritional status may be limited by the multifactorial nature of malnutrition. The objective of the present study was to determine whether nutritional advice and nutritional supplementation can improve the nutritional status of patients with chronic heart failure. METHODS: we performed a randomized clinical trial on an intention-to-treat basis with blinded observers. We divided a sample of 76 patients into 2 groups: one that received structured advice combined with nutritional supplements for 12 weeks (test group), and one that received treatment as usual (control group). The outcome measure was nutritional status as evaluated using the Subjective Global Assessment and the Mini Nutritional Assessment tools. After 12 weeks of treatment the test group received a leaflet that served as a reminder. No further interventions were applied in either group. Patients were followed for 1 year. RESULTS AND CONCLUSION: at 3 months of follow-up nutritional status improved 4-fold in the test group, whereas no change was observed in the control group. At 9 months nutritional status in the intervention group had improved 2-fold with respect to the baseline visit, whereas no differences were recorded in the control group. Differences in mortality and length of stay at 1 year did not reach statistical significance


INTRODUCCIÓN: la desnutrición se asocia comúnmente con la insuficiencia cardíaca y empeora su pronóstico. El tratamiento de la insuficiencia cardíaca crónica basado exclusivamente en la aplicación de las guías clínicas farmacológicas resulta insuficiente. Los beneficios de las intervenciones para mejorar el estado nutricional pueden quedar enmascarados por el carácter multifactorial de la desnutrición. El objetivo del estudio fue determinar si el asesoramiento nutricional más suplementos nutricionales puede mejorar el estado nutricional de los pacientes con insuficiencia cardiaca. MÉTODO: ensayo clínico aleatorizado basado en la intención de tratar con evaluadores sometidos a enmascaramiento. Una muestra de 76 pacientes en 2 grupos: uno que recibió asesoramiento estructurado más suplementos nutricionales durante 12 semanas (grupo de intervención) y otro que siguió el tratamiento habitual (grupo de control). El parámetro del resultado fue el estado nutricional evaluado utilizando como herramientas la Valoración Global Subjetiva y el Mini Nutritional Assesment. Después de 12 semanas de tratamiento, el grupo de intervención recibió a modo de recuerdo un folleto informativo. No se aplicaron más intervenciones en ninguno de los grupos. Se siguió a los pacientes durante 1 año. RESULTADOS Y CONCLUSIÓN: a los 3 meses de seguimiento, el estado nutricional mejoró cuatro veces en el grupo de intervención, mientras que no se observó ningún cambio en el grupo de control. A los 9 meses, el estado nutricional en el grupo de intervención había mejorado 2 veces con respecto a la visita inicial, mientras que no se registraron diferencias en el grupo de control. Las diferencias de mortalidad y estancia hospitalaria al cabo de 1 año no alcanzaron la significación estadística


Assuntos
Humanos , Insuficiência Cardíaca/dietoterapia , Avaliação Nutricional , Estado Nutricional , Qualidade de Vida , Prognóstico , Desnutrição/complicações , Suplementos Nutricionais
4.
Gerokomos (Madr., Ed. impr.) ; 31(2): 76-80, jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193887

RESUMO

OBJETIVO: Las personas de la tercera edad frágiles son un colectivo en riesgo de sufrir desnutrición. El objetivo de este estudio fue describir el estado nutricional de una residencia asistida de 136 plazas y analizar su relación con otras variables. MÉTODOS: Estudio observacional descriptivo transversal sobre una muestra de 113 personas. Se recogieron las variables composición corporal del residente, estado de deterioro cognitivo, nutricional, tipo de desnutrición y alimentación (tipo de dieta, tratamiento nutricional, disfagia, anorexia y dependencia en la alimentación). Se realizaron comparaciones de medias mediante la prueba de la t de Student y comparación de proporciones mediante c2 de Pearson. RESULTADOS: El riesgo de desnutrición encontrada fue del 31% (n = 35); de ellos, el 22% (n = 25) presentaba desnutrición según Gasull. El 92% (104) de los participantes del estudio presentaban algún síntoma o patología y solamente 18 (15,9%) personas no padecían deterioro cognitivo. El 65,5% (74) seguía una dieta basal/diabética y el 35,4% (48) necesitaba ayuda para comer. El deterioro cognitivo moderado-elevado y las dietas terapéuticas obtuvieron mayor proporción de casos de desnutrición según Gasull. CONCLUSIÓN: El estado nutricional de la residencia se puede relacionar con la mayor complejidad que presentan los residentes (alto porcentaje de ellos con deterioro cognitivo moderado y grave y/u otras patologías) y con la calidad en la asistencia. La falta de asociación de desnutrición con el resto de las variables analizadas nos lleva a apoyar la hipótesis de que son múltiples factores los que interfieren en el estado nutricional de los adultos mayores


OBJECTIVE: elderly fragile people are a group at risk for malnutrition. Because of this, the study aimed to describe the nutritional status of an assisted residence of 136 beds and analyze the relationship between malnutrition and other variables. METHODS: descriptive, observational, cross-sectional study on a sample of 113 people. Variables collected were body composition of resident, nutritional and cognitive impairment, type of malnutrition and feeding (type of diet, nutritional therapy, dysphagia, anorexia, and eating dependence). Comparison of means using the Student T test and compared proportions using Chi-square of Pearson were made. RESULTS: The risk of malnutrition found was 31% (n = 35), of them, 22% (n = 25) of total residents were classified as Gasull malnutrition. 92% (104) of the participants of the study showed some symptoms or disease and only 18 (15.9%) were not suffering from cognitive impairment. The 65.5% (74) was at basal/diabetic diet and the 35.4% (48) needed help to eat. Moderate-high cognitive impairment and therapeutic diets showed a positive correlation with malnutrition according to Gasull cases. CONCLUSION: Nutritional state of the residence may be related with greater resident complexity (high percentage of them with moderate and severe cognitive impairment and/or other illnesses) and with the quality of assistance. The lack of association of malnutrition with the rest of the variables analyzed, leads us to support the hypothesis that multiple factors interfere in the nutritional status of elder adults


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Estado Nutricional/fisiologia , Desnutrição/complicações , Desnutrição/epidemiologia , Casas de Saúde , Disfunção Cognitiva/psicologia , Idoso Fragilizado/psicologia , Desnutrição/dietoterapia , Desnutrição/psicologia , Estudos Transversais/métodos , Composição Corporal , Antropometria , Valor Nutritivo
5.
Medicine (Baltimore) ; 99(22): e20261, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481393

RESUMO

BACKGROUND: This study will assess the effect of high-quality nursing intervention (HQNI) on anxiety and depression in patients with chronic heart failure companied malnutrition (CHFM). METHODS: We will retrieve electronic databases from the respective dates to February 29, 2020 without language and publication status restrictions: Cochrane Library, Web of Science, MEDLINE, EMBASE, Scopus, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All potential randomized controlled trials (RCTs), which examined the effect of HQNI on anxiety and depression in patients with CHFM will be included. Two team members will separately perform article retrieval, duplicates excluding, scanning, data collection, and study quality assessment. In addition, this study will carry out data analysis by RevMan 5.3 software. RESULTS: This study will provide high-quality synthesis and/or descriptive analysis of the latest evidence to assess the effect of HQNI on anxiety and depression in patients with CHFM. CONCLUSION: The findings of this study will exert evidence to judge whether or not HQNI is effective on anxiety and depression in patients with CHFM. REGISTRATION NUMBER: INPLASY202040069.


Assuntos
Ansiedade/enfermagem , Depressão/enfermagem , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/psicologia , Desnutrição/complicações , Humanos , Metanálise como Assunto , Qualidade da Assistência à Saúde , Revisões Sistemáticas como Assunto
6.
PLoS One ; 15(6): e0232200, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497066

RESUMO

Schizophrenia is a debilitating disorder affecting just under 1% of the population. While the symptoms of this disorder do not appear until late adolescence, pathological alterations likely occur earlier, during development in utero. While there is an increasing literature examining transcriptome alterations in patients, it is not possible to examine the changes in gene expression that occur during development in humans that will develop schizophrenia. Here we utilize three distinct rodent developmental disruption models of schizophrenia to examine potential overlapping alterations in the transcriptome, with a specific focus on markers of interneuron development. Specifically, we administered either methylazoxymethanol acetate (MAM), Polyinosinic:polycytidylic acid (Poly I:C), or chronic protein malnutrition, on GD 17 and examined mRNA expression in the developing hippocampus of the offspring 18 hours later. Here, we report alterations in gene expression that may contribute to the pathophysiology of schizophrenia, including significant alterations in interneuron development and ribosome function.


Assuntos
Perfilação da Expressão Gênica , Crescimento e Desenvolvimento , Esquizofrenia/genética , Animais , Comportamento Animal , Modelos Animais de Doenças , Feminino , Crescimento e Desenvolvimento/efeitos dos fármacos , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Desnutrição/complicações , Acetato de Metilazoximetanol/farmacologia , Poli I-C/farmacologia , Gravidez , Ratos , Ratos Sprague-Dawley , Esquizofrenia/etiologia , Esquizofrenia/fisiopatologia
7.
Geroscience ; 42(4): 1089-1092, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32578073

RESUMO

The unprecedented COVID-19 pandemic is rapidly and unpredictably evolving and the majority of deaths are occurring in older people. A partial description of the magnitude of the scenario is provided by numbers and statistics, which probably underestimate the ongoing tragedy. In the present opinion paper, we have focused our attention on the evidence of the relationship among malnutrition, immunosenescence, and the higher morbidity and mortality in elderly patients. In particular, we propose the intriguing hypothesis that correction of nutritional deficits may attenuate the age-dependent alterations of the innate and adaptive immune system which participate in the increased susceptibility and worse outcome observed in the elderly COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Imunossenescência/fisiologia , Desnutrição/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Idoso , Humanos , Pandemias , Fatores de Risco
8.
Am J Clin Nutr ; 112(2): 251-256, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32559276

RESUMO

Coronavirus disease 2019 (COVID-19) continues to ravage health and economic metrics globally, including progress in maternal and child nutrition. Although there has been focus on rising rates of childhood wasting in the short term, maternal and child undernutrition rates are also likely to increase as a consequence of COVID-19 and its impacts on poverty, coverage of essential interventions, and access to appropriate nutritious foods. Key sectors at particular risk of collapse or reduced efficiency in the wake of COVID-19 include food systems, incomes, and social protection, health care services for women and children, and services and access to clean water and sanitation. This review highlights key areas of concern for maternal and child nutrition during and in the aftermath of COVID-19 while providing strategic guidance for countries in their efforts to reduce maternal and child undernutrition. Rooted in learnings from the exemplars in Global Health's Stunting Reduction Exemplars project, we provide a set of recommendations that span investments in sectors that have sustained direct and indirect impact on nutrition. These include interventions to strengthen the food-supply chain and reducing food insecurity to assist those at immediate risk of food shortages. Other strategies could include targeted social safety net programs, payment deferrals, or tax breaks as well as suitable cash-support programs for the most vulnerable. Targeting the most marginalized households in rural populations and urban slums could be achieved through deploying community health workers and supporting women and community members. Community-led sanitation programs could be key to ensuring healthy household environments and reducing undernutrition. Additionally, several COVID-19 response measures such as contact tracing and self-isolation could also be exploited for nutrition protection. Global health and improvements in undernutrition will require governments, donors, and development partners to restrategize and reprioritize investments for the COVID-19 era, and will necessitate data-driven decision making, political will and commitment, and international unity.


Assuntos
Saúde da Criança , Infecções por Coronavirus , Saúde do Lactente , Recém-Nascido , Desnutrição , Saúde Materna , Estado Nutricional , Pandemias , Pneumonia Viral , Criança , Transtornos da Nutrição Infantil/prevenção & controle , Pré-Escolar , Coronavirus , Infecções por Coronavirus/complicações , Características da Família , Abastecimento de Alimentos , Saúde Global , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Desnutrição/complicações , Desnutrição/prevenção & controle , Pneumonia Viral/complicações , Pobreza
9.
J Appl Oral Sci ; 28: e20190489, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401939

RESUMO

Some conditions consolidated as risk factors for oropharyngeal dysphagia have already been identified in other diseases, such as neurological. Studies on cardiovascular diseases concentrate in individuals in the postoperative period; thus, it is unknown if these same factors occur in individuals hospitalized for clinical or surgical treatment of these diseases. Objective to correlate predictive risk factors for oropharyngeal dysphagia in individuals with cardiovascular disease admitted at a reference cardiology hospital. Methodology This is a retrospective clinical study. Medical records of 175 individuals hospitalized for clinical and/or surgical treatment at a reference cardiology hospital from January to June 2017, attendants of the Speech-Language Pathology and Nutrition team, were analyzed. Of these, 100 records were included in the study: 41 females and 59 males (mean age 67.56 years). Deaths and individuals from 0 to 18 years were excluded. Stroke, malnutrition, age and prolonged orotracheal intubation were considered predictive risk factors for oropharyngeal dysphagia. Mann-Whitney test and Fisher's test were used for statistical analysis. Results Stroke (OR=2.93 p=0.02), malnutrition (OR=2.89 p=0.02) and prolonged orotracheal intubation (OR=3.94 p=0.02) were statistically significant predictors for oropharyngeal dysphagia within this population. Age below 80 years was not significant (p=0.06), but within octogenarians, significance was found (p=0.033). Conclusion Stroke, malnutrition, prolonged orotracheal intubation and age > 80 years are predictive risk factors for oropharyngeal dysphagia in adult population with cardiovascular diseases.


Assuntos
Doenças Cardiovasculares/complicações , Transtornos de Deglutição/etiologia , Intubação Intratraqueal/efeitos adversos , Desnutrição/complicações , Acidente Vascular Cerebral/complicações , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Adulto Jovem
11.
PLoS Negl Trop Dis ; 14(5): e0008328, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32407313

RESUMO

The dual burden of enteric infection and childhood malnutrition continues to be a global health concern and a leading cause of morbidity and death among children. Campylobacter infection, in particular, is highly prevalent in low- and middle-income countries, including Bangladesh. We examined longitudinal data to evaluate the trajectories of change in child growth, and to identify associations with Campylobacter infection and household factors. The study analyzed data from 265 children participating in the MAL-ED Study in Mirpur, Bangladesh. We applied latent growth curve modelling to evaluate the trajectories of change in children's height, as measured by length-for-age z-score (LAZ), from age 0-24 months. Asymptomatic and symptomatic Campylobacter infections were included as 3- and 6-month lagged time-varying covariates, while household risk factors were included as time-invariant covariates. Maternal height and birth order were positively associated with LAZ at birth. An inverse association was found between increasing age and LAZ. Campylobacter infection prevalence increased with age, with over 70% of children 18-24 months of age testing positive for infection. In the final model, Campylobacter infection in the preceding 3-month interval was negatively associated with LAZ at 12, 15, and 18 months of age; similarly, infection in the preceding 6-month interval was negatively associated with LAZ at 15, 18, and 21 months of age. Duration of antibiotic use and access to treated drinking water were negatively associated with Campylobacter infection, with the strength of the latter effect increasing with children's age. Campylobacter infection had a significant negative effect on child's growth and this effect was most powerful between 12 and 21 months. The treatment of drinking water and increased antibiotic use have a positive indirect effect on linear child growth trajectory, acting via their association with Campylobacter infection.


Assuntos
Infecções por Campylobacter/epidemiologia , Deficiências do Desenvolvimento/etiologia , Características da Família , Desnutrição/epidemiologia , Adolescente , Adulto , Antropometria , Bangladesh/epidemiologia , Bioestatística , Infecções por Campylobacter/complicações , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Desnutrição/complicações , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
12.
Anesth Analg ; 130(6): 1524-1533, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32384342

RESUMO

Anesthetists are increasingly faced with the challenge of delivering perioperative care to frail older people. Patients with frailty undergoing surgical intervention are at a significantly increased risk of perioperative complications, mortality, and longer length of stay. Moreover, frailty is often associated with multimorbidity and a range of geriatric syndromes including functional dependency, cognitive impairment, and malnutrition which further increases risk and complexity of care. There is a growing body of evidence that prehabilitation-intervention delivered during the preoperative period to improve overall health and function-can improve postoperative outcomes for patients undergoing surgery. However, whether this vulnerable population stand to benefit from prehabilitation is less clear. We review the evidence for prehabilitation for patients with frailty including whether the risks associated with and outcomes from surgery can be modified through comprehensive geriatric assessment.


Assuntos
Delírio/prevenção & controle , Fragilidade/cirurgia , Avaliação Geriátrica/métodos , Complicações Cognitivas Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , Idoso , Disfunção Cognitiva/complicações , Delírio/diagnóstico , Idoso Fragilizado , Fragilidade/terapia , Humanos , Tempo de Internação , Desnutrição/complicações , Multimorbidade , Complicações Cognitivas Pós-Operatórias/diagnóstico , Período Pós-Operatório , Cuidados Pré-Operatórios , Fatores de Risco , Resultado do Tratamento , Populações Vulneráveis
13.
PLoS One ; 15(5): e0232541, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384130

RESUMO

Early infection from enteropathogens is recognised as both a cause and effect of infant malnutrition. Specifically, evidence demonstrates associations between growth shortfalls and Campylobacter infection, endemic across low-income settings, with poultry a major source. Whilst improvements in water, sanitation and hygiene (WASH) should reduce pathogen transmission, interventions show inconsistent effects on infant health. This cross-sectional, formative study aimed to understand relationships between infant Campylobacter prevalence, malnutrition and associated risk factors, including domestic animal husbandry practices, in rural Ethiopia. Thirty-five households were visited in Sidama zone, Southern Nations, Nationalities and Peoples' region. Infant and poultry faeces and domestic floor surfaces (total = 102) were analysed for presumptive Campylobacter spp. using selective culture. Infant anthropometry and diarrhoeal prevalence, WASH facilities and animal husbandry data were collected. Of the infants, 14.3% were wasted, 31.4% stunted and 31.4% had recent diarrhoea. Presumptive Campylobacter spp. was isolated from 48.6% of infant, 68.6% of poultry and 65.6% of floor surface samples. Compared to non-wasted infants, wasted infants had an increased odds ratio (OR) of 1.41 for a Campylobacter-positive stool and 1.81 for diarrhoea. Positive infant stools showed a significant relationship with wasting (p = 0.026) but not stunting. Significant risk factors for a positive stool included keeping animals inside (p = 0.027, OR 3.5), owning cattle (p = 0.018, OR 6.5) and positive poultry faeces (p<0.001, OR 1.34). Positive floor samples showed a significant correlation with positive infant (p = 0.023), and positive poultry (p = 0.013, OR 2.68) stools. Ownership of improved WASH facilities was not correlated with lower odds of positive stools. This formative study shows a high prevalence of infants positive for Campylobacter in households with free-range animals. Findings reaffirm contaminated floors as an important pathway to infant pathogen ingestion and suggest that simply upgrading household WASH facilities will not reduce infection without addressing the burden of contamination from animals, alongside adequate separation in the home.


Assuntos
Infecções por Campylobacter/epidemiologia , Campylobacter , Desnutrição/complicações , Animais , Animais Domésticos/microbiologia , Campylobacter/isolamento & purificação , Infecções por Campylobacter/etiologia , Infecções por Campylobacter/transmissão , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Desnutrição/epidemiologia , Desnutrição/microbiologia , Prevalência , Fatores de Risco , População Rural
14.
PLoS One ; 15(5): e0232764, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365092

RESUMO

OBJECTIVE: This study aimed to explore the association between malnutrition, clinical parameters, and health-related quality of life in elderly hospitalized patients with Parkinson's disease (PD). METHODS: Cross-sectional study of 92 hospitalized elderly patients with PD (mean age 73.6 ± 6.7 years) without dementia. The Mini Nutritional Assessment (MNA) was used to evaluate nutritional status. Motor impairment and non-motor symptoms burden (Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS], Non-Motor Symptoms Questionnaire, and Hoehn & Yahr staging), depression (Becks Depression Inventory-II), and health-related quality of life (PD quality of life Questionnaire-39) were assessed. RESULTS: Every second patient was malnourished or at risk of malnutrition. In the multivariable analysis, male gender, longer disease duration, higher Hoehn & Yahr and depression were associated with total MNA score. Besides non-motor symptoms and motor impairment, malnutrition was an independent predictor of poor health-related quality of life. In the multivariate analysis, malnutrition had a statistically significant effect on emotional well-being, mobility, social support, stigmatization, and cognition. The strongest association was found between malnutrition and emotional well-being. CONCLUSION: Elderly male persons with longer PD duration and higher disease stages are more likely to be malnourished or at risk for malnutrition. Malnutrition was mainly associated with poor emotional well-being, suggesting that treatment of depression and anxiety beside diet and physical activity can help improving nutrition status in these subjects. The MNA should not be used independent of other measures of cognition and depression in people with advanced PD.


Assuntos
Hospitalização , Desnutrição/complicações , Doença de Parkinson/complicações , Qualidade de Vida , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Avaliação Nutricional , Prevalência
16.
PLoS One ; 15(4): e0231859, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32339181

RESUMO

INTRODUCTION: Addressing malnutrition is one of the key components of HIV care among people living with HIV. Since 2010, a nutritional program has been implemented to address malnutrition amongst HIV patients in Ethiopia, with patients enrolled in the program for 3 months (for mild acute malnutrition) and 6 months (for severe acute malnutrition). However, utilisation and effectiveness of the nutritional programs remain unexplored. This study aimed to examine individual level determinants and contextual factors influencing the effectiveness of the nutritional program in the Tigray region of Ethiopia. METHODS AND SETTING: The study employed a mixed-methods approach involving quantitative and qualitative research methods. In the quantitative phase of the study, records from 1757 adult patients, including socio-demographic characteristics, clinical and nutritional program outcomes were retrieved from three selected hospitals in the Tigray region, Ethiopia. Logistic regression analysis was used to identify the individual demographic and socioeconomic, clinical and immunological, and anthropometric and nutritional determinants of nutritional outcomes. The qualitative study included 33 individual interviews with adult patients, health providers, and program managers. Interview data were analysed using a framework analysis approach. RESULTS: Amongst study participants, 55.3% (95% CI = 53.2‒57.4) recovered from malnutrition, 19% (95% CI, 17.3‒20.7) did not complete the program, and 21% (95% CI = 19.7‒23.4) completed the program but failed to recover from malnutrition. In the multivariable logistic regression analysis, those who were: living in urban areas (AOR = 1.44, 95% CI = 1.05‒1.97), employed (AOR = 1.39, 95% CI = 1.01‒1.93), attending Shul (AOR = 4.6, 95% CI = 3.15‒6.71) and Lemlem Karl (AOR = 2.5, 95% CI = 1.69‒3.71) hospitals, in clinical stages II (AOR = 2.49, 95% CI = 1.59‒3.91) and III (AOR = 1.46(1.02‒2.07), on ART for less than six months (AOR = 1.61, 95% CI = 1.09‒2.39), anaemic (AOR = 1.77, 95% = 1.29‒2.41), and diagnosed with severe acute malnutrition at enrolment (AOR = 6.43, 95% CI = 4.69‒8.3); were less likely to complete the program. Results for those who completed the program indicated that urban residence, (AOR = 1.46, 95% CI = 1.4‒2.91), attending Shul (AOR = 2.92, 95% CI = 2.04‒4.19) and Lemlem Karl (AOR = 1.49, 95% CI 1.05‒2.11) hospitals, having bedridden functional status (AOR = 0.36, 95% CI = 0.15‒0.83), advanced WHO clinical stage (WHO clinical stage IV) (AOR = 0.52, 95% CI = 0.28‒0.98) and severe malnutrition at enrolment (AOR = 4.25, 95% CI = 3.02‒5.98)) predicted non-response to the nutritional program. Qualitative interviews revealed that the taste and perceived side effects of the nutritional supplement provided as part of the nutritional program, sharing/selling practices, religious and sociocultural issues, distance and poor access to the health services were barriers to program utilisation. Nutritional counselling and health service-related factors such as a previous enrolment in the program and positive experience in the health service were enablers of program utilisation. CONCLUSION: There was a clear nexus between contextual factors such as distance, quality of health service and sociocultural factors, and individual patient characteristics with the effectiveness of the nutritional program. Taking individual and contextual factors into consideration in program design, planning and implementation is essential if the nutritional program in HIV care services is to achieve its goal in addressing malnutrition amongst people living with HIV.


Assuntos
Assistência à Saúde , Infecções por HIV/patologia , Apoio Nutricional , Avaliação de Programas e Projetos de Saúde , Adulto , Emprego , Etiópia/epidemiologia , Feminino , Abastecimento de Alimentos , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Desnutrição/complicações , Desnutrição/epidemiologia , Desnutrição/patologia , Pessoa de Meia-Idade , Razão de Chances , Índice de Gravidade de Doença , População Urbana
17.
PLoS One ; 15(4): e0231777, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298381

RESUMO

BACKGROUND: Malnutrition in critically ill patients is linked with significant mortality and morbidity. However, it remains controversial whether nutrition therapy protocols are effective in improving clinical outcomes. The present study aimed to evaluate the effectiveness of a surgical ICU nutrition protocol, and to compare the hospital mortality, hospital LOS, and ICU LOS of protocol and non-protocol groups. METHODS: A randomized controlled trial was conducted at the Surgical ICU, Siriraj Hospital. The nutrition administration of the control group was at the discretion of the attending physicians, whereas that of the intervention group followed the "Siriraj Surgical ICU Nutrition Protocol". Details of the demographic data, nutritional data, and clinical outcomes were collected. RESULTS: In all, 170 patients underwent randomization, with 85 individuals each in the protocol and non-protocol groups. More than 90% of the patients in both groups were at risk of malnutrition, indicated by a score of ≥ 3 on the Nutritional Risk Screening 2002 tool. The average daily calories of the 2 groups were very similar (protocol group, 775.4±342.2 kcal vs. control group, 773.0±391.9 kcal; p = 0.972). However, the median time to commence enteral nutrition was shorter for the protocol group (1.94 days) than the control group (2.25 days; p = 0.503). Enteral nutrition was provided within the first 48 hours to 53.7% of the protocol patients vs. 47.4% of the control patients (p = 0.589). In addition, a higher proportion of the protocol patients (36.5%) reached the 60% calorie-target on Day 4 after admission than that for the non-protocol group (25.9%; p = 0.136). All other clinical outcomes and nutrition-related complications were not significantly different. CONCLUSIONS: The implementation of the nutrition protocol did not improve the feeding effectiveness or clinical outcomes as compared to usual nutrition management practices of the Surgical ICU.


Assuntos
Estado Terminal/mortalidade , Nutrição Enteral , Nutrição Parenteral , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Nutrição Enteral/métodos , Nutrição Enteral/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Desnutrição/complicações , Desnutrição/mortalidade , Desnutrição/prevenção & controle , Pessoa de Meia-Idade , Nutrição Parenteral/métodos , Nutrição Parenteral/estatística & dados numéricos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo
18.
Medicine (Baltimore) ; 99(16): e19799, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311995

RESUMO

INTRODUCTION: Wernicke's encephalopathy (WE) is a severe neuropsychiatric disorder, which results from a nutritional deficiency of thiamine. The occurrence of WE is rarely reported in patients with cerebral infarction, who often have complications of malnutrition. Cerebral infarction is a neurological disease, patients with cerebral infarction may show symptoms such as disturbance of consciousness and gait instability, which is difficult to differentiate from WE. Thus, early recognition and differential diagnosis of WE are important. We report a rare case of cerebral infarction patient who developed WE due to malnutrition and parenteral nutrition. PATIENT CONCERNS: A 65-year-old woman was admitted to our hospital with cerebral infarction. She had lost 15 kg of weight in the past month or so and was diagnosed with malnutrition. In order to correct malnutrition, parenteral nutrition and intravenous glucose without thiamine were administered. Cognitive dysfunction, laloplegia, sleep rhythm inversion, somnolence and bilateral lower limbs weakness were presented 20 days after admission. DIAGNOSIS: Brain magnetic resonance imaging confirmed the diagnosis of WE. INTERVENTIONS: The patient was given thiamine and nutrition support therapy. OUTCOMES: The patient's cognitive impairment, laloplegia and sleep condition improved within 4 days. Neurological status continued to improve and physical activity recovered gradually within 2 weeks. She received rehabilitation training when her condition was relatively stable, and her muscle strength of limbs and physical function gradually improved. CONCLUSION: Infarction-related malnutrition may result in nutrient deficiency-related neurological complications, such as WE. Thus, it is important to pay close attention to the nutritional status of patients with cerebral infarction. In addition, early recognition and differential diagnosis of WE in patients with infarction-related malnutrition are necessary, early treatment of replete thiamine supplementation and nutrition support therapy can reduce the risk of WE and improve the prognosis.


Assuntos
Infarto Cerebral/complicações , Desnutrição/complicações , Tiamina/administração & dosagem , Complexo Vitamínico B/administração & dosagem , Encefalopatia de Wernicke/etiologia , Idoso , Feminino , Humanos , Injeções Intramusculares , Nutrição Parenteral , Encefalopatia de Wernicke/diagnóstico por imagem , Encefalopatia de Wernicke/tratamento farmacológico
20.
PLoS One ; 15(3): e0229979, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155194

RESUMO

BACKGROUND: While physical frailty and malnutrition/obesity (parameters easily measured by a nurse) are not the same, older persons who are malnourished/obese are more likely to be frail and there is a potential overlap between these conditions. The objective was to examine the relationship between gait speed (GS) and body mass index (BMI) in men and women aged 75 years and older. DESIGN: Cross-sectional analysis. SETTING, PARTICIPANTS: Data from the Aging Multidisciplinary Investigation (AMI), a French prospective cohort study with participants randomly selected from the farmer Health Insurance rolls. MEASUREMENTS: Usual GS was measured over a 4 meters-track. BMI was categorized using clinical cut-points for European populations: (e.g, <20.0 kg/m2; 20.0-24.9 kg/m2; 25.0-29.9 kg/m2; 30.0-34.9 kg/m2; ≥35.0 kg/m2). RESULTS: The current analyses were performed in 449 participants. Mean age was 81 years. Being malnourished/obese was significantly associated with slow GS. Unadjusted and age-adjusted models showed that underweight, overweight and obesity statuses were significantly associated with slow GS for both women (0.83m/s [0.61; 1.04], 0.87m/s [0.72; 1.02], 0.70 m/s [0.41; 0.98], respectively) and men (0.83m/s [0.61; 1.04], 1.11m/s [1.03; 1.20], 0.97m/s [0.75; 1.19], respectively). CONCLUSION: Malnourished/obese are associated with slow GS in older persons. These variables could be contributed at comprehensively and complementarily assessing the older person.


Assuntos
Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Desnutrição/complicações , Sobrepeso/complicações , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Índice de Massa Corporal , Estudos Transversais , Feminino , Fragilidade/etiologia , Fragilidade/fisiopatologia , Humanos , Masculino , Desnutrição/fisiopatologia , Sobrepeso/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Velocidade de Caminhada/fisiologia
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