Sensitization symptoms are associated with psychological and cognitive variables in COVID-19 survivors exhibiting post-COVID pain.

OBJECTIVE: To investigate the association between demographic, clinical, psychological, cognitive, and health-related variables and the Central Sensitization Inventory (CSI) in previously hospitalized COVID-19 survivors exhibiting "de novo" post-COVID pain. METHODS: Seventy-seven (n = 77) COVID-19 survivors with "de novo" post-COVID pain completed demographic (age, height, and weight), clinical (duration and intensity of the pain), psychological (depressive/anxiety levels and sleep quality), cognitive (catastrophizing and kinesiophobia levels), and health-related quality of life variables as well as the CSI. A multivariable correlation analysis was conducted to determine the association between variables, and a stepwise multiple linear regression model was performed to identify CSI predictors. RESULTS: Patients were assessed a mean of 6.0 (SD 0.8) months after hospital discharge. Twenty-six (33.7%) individuals showed indications of sensitization-associated symptoms (CSI score ≥40 points). The CSI score was positively associated with pain intensity (r: 0.371), anxiety (r: 0.784), depressive (r: 0.709), catastrophizing (r: 0.620), and kinesiophobia (r: 0.359) levels (all, p < 0.001). The stepwise regression analysis revealed that 60.2% of CSI was explained by anxiety levels and pain intensity. CONCLUSION: This study found that psychological and cognitive variables were associated with the CSI score in previously hospitalized COVID-19 survivors with "de novo" post-COVID pain. Anxiety levels and the intensity of pain symptoms were independently associated with CSI score suggesting a significant overlap with psychological construct. The "de novo" post-COVID pain association with CSI may indicate changes in the pain processing important for managing the pain.

Prevalence of Neuropathic Component in Post-COVID Pain Symptoms in Previously Hospitalized COVID-19 Survivors.

Objectives: To investigate the prevalence of neuropathic pain symptoms and to analyze the correlation between neuropathic symptoms with pain-related, psychological, and cognitive variables in COVID-19 survivors exhibiting "de novo" post-COVID pain. Methods: Seventy-seven (n = 77) previously hospitalized COVID-19 survivors presenting with post-COVID pain completed demographic (such as age, height, and weight), pain-related (the duration and intensity of pain), psychological (depressive/anxiety levels), and cognitive (catastrophizing and kinesiophobia) variables. The Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire was also assessed. After conducting multivariable correlation analyses, a stepwise multiple linear regression model was performed to identify S-LANSS predictors. Results: Participants were assessed a mean of 6.0 (SD 0.8) months after hospital discharge. Nineteen (24.6%) exhibited neuropathic pain symptoms (S-LANSS score≥12 points). The S-LANSS score was positively associated with the duration of post-COVID pain (r: 0.262), anxiety levels (r: 0.275), and kinesiophobia level (r: 0.291) (all, P < 0.05). The stepwise regression analysis revealed that 12.8% of the S-LANSS variance was just explained by kinesiophobia. Conclusion: This study found that almost 25% of previously hospitalized COVID-19 survivors with "de novo" post-COVID pain reported a neuropathic pain component. The presence of neuropathic pain symptomatology was associated with more anxiety and kinesiophobia, but only kinesiophobia level was significantly associated explaining 12.8% of the variance of the S-LANSS score.

Differential characteristics of cases of patients diagnosed with pneumonia and delayed discharge for non-clinical reasons in Northern Spain.

BACKGROUND: Delayed discharge for non-clinical reasons is related to a failure to plan for discharge and a lack of availability of intermediate care resources as an alternative to acute hospitalisation. The literature concerning the relationship with pneumonia is scarce. At present, the coronavirus pandemic is a new cause of complicated pneumonias that can further affect the functionality of the most fragile patients. OBJECTIVE: The aim of this study was to understand what characteristics are typical of patients affected by pneumonia, compared with other cases of delayed discharge. METHODS: A cross-sectional study was conducted. All cases of delayed discharge were studied at the hospitalisation units of a general university hospital in Northern Spain from 2007 to 2015. In order to compare the differential characteristics of the groups of patients with pneumonia with the total Student's T-test and Pearson's chi-square test (χ²) were used. RESULTS: 170 patients were identified with a diagnosis of pneumonia and delayed discharge for non-clinical reasons during the study period. These cases accumulated a total of 4790 days of total stay, of which 1294 days corresponded to the prolonged stay. The mean age of the patients was 80.23 years. The mean DRG weight was 2.28 [SD 0.579], and 14.12% of patients with pneumonia and delayed discharge died. So, patients with pneumonia were older (P = .001), less complex (P = .001) and suffered greater deaths compared with the remaining patients (P = .001). CONCLUSIONS: The sum of these factors has to do with comorbidities and complications associated with ageing and the characteristics of conditions such as aspiration pneumonia.

Morphological abnormalities in Acartia lilljeborgii Giesbrecht (1889) (Copepoda, Calanoida) in a tropical estuary under industrial development.

Morphological abnormalities in crustaceans have been registered and several are attributed to pollution and others anthropogenic activities. This study reports for the first time a temporal record of the amount and variety of morphological abnormalities in Acartia lilljeborgii, in an impacted neotropical estuary. The specimens were obtained from Suape port area, Northeast Brazil, between May 2009 and September 2010 using a 300 µm plankton net. Seven types of abnormalities were observed in one of the terminal spines of the prosome, but no temporal variation of abnormalities was found in our study. The deformities were registered in 85.7% of samples and they were found in up to 10% of the individuals (3.2 ± 2.9%). The proportion of females with abnormalities was greater than for males, in opposite to most previous reports. Due to its high distribution and abundance in part of the neotropical Atlantic coastal area, A. lilljeborgii has the potential to be used as a bioindicator of environmental conditions, although the reasons of the abnormality occurrences should be accurately investigated.

Slaying the New Dragons that Threaten Peace: Renewing the UN's 'Systemic Issues' Agenda.

The United Nations' systemic issues agenda concerns the terrain of economic engagement among nations and peoples of the world, the terreain which underpins international cooperation and peace. In the twenty-first century, this agenda must contend with inequities in access to decision-making, policy inconsistencies in the rules among different areas such as trade and finance, and curtailing vulnerabilities arising from the excessive dominance of financial logic in economic decision-making.

Trophic dynamics (Dissolved Inorganic Nitrogen-DIN and Dissolved Inorganic Phosphorus-DIP) in tropical urban estuarine systems during periods of high and low river discharge rates.

This paper focused on the use of the biogeochemical LOICZ (Land Ocean Interactions in the Coastal Zone) to investigate the dynamics of DIN and DIP nutrients among three highly urbanized tropical estuaries (Barra das Jangadas (BJ), Recife (RE) and Timbó (TB)), located in the northeastern region of Brazil. The input data were obtained through in situ measurements (2007) and governmental agency databases (2001-2007). The balances of the non-conservative elements showed that the RE and TB systems alternated between sources and sinks during the observation periods (0.2-0.8 mmoles DIP m-2 d-1 and 0.1-10 mmoles DIN m-2 d-1). The metabolism rates in the systems indicated that the BJ system was autotrophic during the two observation periods (10-26 mmoles C m-2 d-1), while the RE system was heterotrophic (9-12 mmoles C m-2 d-1). The river discharge rates observed during the period 2001-2007 showed averages ranging from 9.4±3.8 to 18.4±7.7 m3s-1. Measurements of the trophic status in the RE system during 2007 characterized the system as eutrophic, thereby demonstrating high levels of chlorophyll-a and inorganic nutrients. The applications of balance sheets modeling proved to be very useful toward understanding the dynamics of estuarine systems dominated by large urban centers.

Living with a peripherally inserted central catheter: the perspective of cancer outpatients-a qualitative study.

PURPOSE: The aim of this study was to describe the experience of using a peripherally inserted central catheter (PICC) in cancer sufferers receiving outpatient treatment. METHODS: A qualitative, phenomenological study was performed. Purposeful sampling methods were used. Data collection methods included semi-structured interviews and researcher field notes. Thematic analysis was used to analyze data. The study was conducted following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: Eighteen patients (61% women, mean age 58 years) participated. They spent a mean duration of 155 days with the line in place. Two themes were identified with different subgroups. The theme "Living with a PICC line," including the subthemes "Benefits" and "Disadvantages," displays how the implantation is experienced by patients in a dichotomous manner. This highlighted both the beneficial and negative aspects of the implantation. The second theme was "Adapting to life with the catheter" and comprised three subthemes: "Advantages," "Lifestyle modifications," and "Overall assessment of the peripherally inserted central catheter," which shows how patients gradually accept the catheter by adapting their lifestyle. CONCLUSIONS: Over time, most patients considered having a PICC line to be a positive experience that they would recommend to other patients, as they found that it did not alter their quality of life. These results can be applied in Oncology Units for developing specific protocols for patients.

Does Jacobson's relaxation technique reduce consumption of psychotropic and analgesic drugs in cancer patients? A multicenter pre-post intervention study.

BACKGROUND: Cancer patients often suffer from emotional distress as a result of the oncological process. The purpose of our study was to determine whether practice of Jacobson's relaxation technique reduced consumption of psychotropic and analgesic drugs in a sample of cancer patients. METHODS: This was a multicenter pre-post intervention design. Participants were 272 patients aged over 18 years attending 10 Spanish public hospitals with oncological pathologies and anxiety symptoms. The intervention consisted of a protocol of abbreviated progressive muscle relaxation training developed by Bernstein and Borkovec. This was followed up by telephone calls over a 1-month period. The intervention was performed between November 2014 and October 2015. Sociodemographic variables related to the oncological process, mental health variables, and intervention characteristics were measured. RESULTS: A reduction in the consumption of psychotropic and analgesic drugs was observed throughout the follow-up period. Improvement was observed throughout the 4-week follow-up for all the parameters assessed: anxiety, relaxation, concentration, and mastery of the relaxation technique. CONCLUSIONS: The practice of abbreviated Jacobson's relaxation technique can help to decrease the consumption of psychotropic and analgesic drugs. Patients experienced positive changes in all the evaluated parameters, at least during the 1-month follow-up. To confirm these findings, additional long-term studies are needed that include control groups. TRIAL REGISTRATION: ISRCTN 81335752 , DOI 10.1186/ISRCTN81335752 17. Date of registration: 22/11/2016 (retrospectively registered).

Coping with the hospital environment during the COVID-19 pandemic: A qualitative study of the survivors' perspective during their stay at the ICU and inpatient ward.

The COVID-19 pandemic has significantly affected the clinical practice of healthcare professionals. This study aimed to explore the perspectives of COVID-19 survivors regarding the healthcare they received during their stay in the Intensive Care Unit (ICU) and the inpatient COVID-19 ward. A qualitative case-study approach was implemented. Participants were recruited using non-probabilistic purposeful sampling strategy. Inclusion criteria included patients aged ≥18 years who received follow-up from the Pulmonology service at a Hospital in de North of Spain, were diagnosed with COVID-19 and bilateral pneumonia, and were admitted to the ICU before being transferred to a COVID-19 inpatient ward. Data was collected through in-depth interviews and researchers' field notes, and thematic analysis was performed. Techniques such as credibility, transferability, dependability, and confirmability were employed to ensure the trustworthiness of the data. A total of 25 individuals (six women) were included in the study. Three main themes emerged from the analysis: common challenges faced in both units, coping with the hospital stay, and developing strategies. Findings highlighted the need to improve information dissemination, individualize care, and enhance direct patient interaction. Moreover, the study shed light on the psychological impact of hospitalization and ICU experience, including feelings of loneliness, confinement, and the lack of memories from the ICU stay, as well as the influence of care and healthcare language. Finally, strategies such as keeping the mind occupied and maintaining self-discipline were identified as crucial during hospitalization. These findings provide valuable insights for healthcare professionals in delivering care to individuals with COVID-19 in the ICU and hospital ward settings.

Finding the needle in a haystack: Evaluation of ecotoxicological effects along the continental shelf break during the Brazilian mysterious oil spill.

Oceanic oil spills present significant ecological risks that have the potential to contaminate extensive areas, including coastal regions. The occurrence of the 2019 oil spill event in Brazil resulted in over 3000 km of contaminated beaches and shorelines. While assessing the impact on benthic and beach ecosystems is relatively straightforward due to direct accessibility, evaluating the ecotoxicological effects of open ocean oil spills on the pelagic community is a complex task. Difficulties are associated with the logistical challenges of responding promptly and, in case of the Brazilian mysterious oil spill, to the subsurface propagation of the oil that impeded remote visual detection. An oceanographic expedition was conducted in order to detect and evaluate the impact of this oil spill event along the north-eastern Brazilian continental shelf. The pursuit of dissolved and dispersed oil compounds was accomplished by standard oceanographic methods including seawater polycyclic aromatic hydrocarbons (PAHs) analysis, biomass stable carbon isotope (δ13C), particulate organic carbon to particulate organic nitrogen (POC:PON) ratios, nutrient analysis and ecotoxicological bioassays using the naupliar phase of the copepod Tisbe biminiensis. Significant ecotoxicological effects, reducing naupliar development by 20-40 %, were indicated to be caused by the presence of dispersed oil in the open ocean. The heterogeneous distribution of oil droplets aggravated the direct detection and biochemical indicators for oil are presented and discussed. Our findings serve as a case study for identifying and tracing subsurface propagation of oil, demonstrating the feasibility of utilizing standard oceanographic and ecotoxicological methods to assess the impacts of oil spill events in the open ocean. Ultimately, it encourages the establishment of appropriate measures and responses regarding the liability and regulation of entities to be held accountable for oil spills in the marine environment.

Evaluating Sensitization-associated, Neuropathic-like Symptoms and Psychological Factors in Patients With Interstitial Lung Disease.

The aims of this study were to phenotype pain in patients with interstitial lung disease (ILD) by investigating the association between sensitization-associated symptoms with quality of life, anxiety/depression, pain catastrophizing, and kinesiophobia levels and identifying those risk factors explaining the variance of quality of life in individuals with ILD and pain. One hundred and thirty-two (38.6% women, mean age: 70, standard deviation: 10.5 years) patients with ILD completed clinical (age, sex, height, weight), psychological (Hospital Anxiety and Depression Scale [HADS] and the Pittsburgh Sleep Quality Index), and health-related quality of life (EQ-5D-5L) variables, as well as the Central Sensitization Inventory (CSI), the Self-Report Leeds Assessment of Neuropathic Symptoms (S-LANSS), Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia (TSK-11) questionnaires. The prevalence of sensitization-associated symptomatology (CSI), neuropathic-like features (S-LANSS), anxiety symptoms, depressive symptoms, or poor sleep was 20.5%, 23.5%, 23.6%, 22.9%, or 51.6%. Significant associations between CSI, S-LANSS, HADS-A, HADS-D, Pain Catastrophizing Scale, TSK-11, and EQ-5D-5L (.220 < r < .716) were found. The regression analysis revealed that CSI, TSK-11, and HADS-D explained 44.8% of the variance of EQ-5D-5L (r2 adjusted: .448). This study found the presence of sensitization-associated and neuropathic-like symptoms as well as other central nervous system-derived symptoms, such as anxiety, depression, poor sleep, pain catastrophizing, and kinesiophobia in 25% of ILD patients with pain. Sensitization-associated symptoms, depression, and kinesiophobia were associated with a worse quality of life. These findings would support that individuals with ILD can exhibit different pain phenotypes, including nociplastic-like pain phenotype based on self-reported measurements. PERSPECTIVE: Pain in patients with ILD can fulfill features of different phenotypes, including nociplastic pain, when sensory, emotional, and cognitive mechanisms are involved at the same time.

Daily variability of pH and temperature in seawater from a near-pristine oceanic atoll, Southwest Atlantic.

The study of pH and temperature variability in reef environments, and the underlying processes that control this variability, is of great importance for ocean acidification research. Therefore, in the reef environment of Rocas Atoll, we conducted continuous monitoring of pH and temperature and periodic sampling of carbonate chemistry, and we hypothesize that seawater temperature is not the determining factor in the daily variability of pH at this atoll. Our results showed that the seawater of the atoll presented a high daily variability in pH, [H+], and temperature. The cycles of variations occurred primarily with a periodicity of ∼24 h, related to the daily light cycle, and secondarily with a periodicity of ∼12 h, associated with the semi-diurnal tidal cycles of the atoll. The results indicate that the relative balance of net organic carbon metabolism is the main process modulating carbonate chemistry on the atoll throughout the day.

Association of Kinesiophobia with Catastrophism and Sensitization-Associated Symptoms in COVID-19 Survivors with Post-COVID Pain.

Pain symptoms after the acute phase of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are present in almost 50% of COVID-19 survivors. The presence of kinesiophobia is a risk factor which may promote and perpetuate pain. This study aimed to investigate variables associated with the presence of kinesiophobia in a sample of previously hospitalized COVID-19 survivors exhibiting post-COVID pain. An observational study was conducted in three urban hospitals in Spain, including one hundred and forty-six COVID-19 survivors with post-COVID pain. Demographic (age, weight, height), clinical (intensity and duration of pain), psychological (anxiety level, depressive level, sleep quality), cognitive (catastrophizing), sensitization-associated symptoms, and health-related quality of life variables were collected in 146 survivors with post-COVID pain, as well as whether they exhibited kinesiophobia. Stepwise multiple linear regression models were conducted to identify variables significantly associated with kinesiophobia. Patients were assessed a mean of 18.8 (SD 1.8) months after hospital discharge. Kinesiophobia levels were positively associated with anxiety levels (r: 0.356, p < 0.001), depression levels (r: 0.306, p < 0.001), sleep quality (r: 0.288, p < 0.001), catastrophism (r: 0.578, p < 0.001), and sensitization-associated symptoms (r: 0.450, p < 0.001). The stepwise regression analysis revealed that 38.1% of kinesiophobia variance was explained by catastrophism (r2 adj: 0.329, B = 0.416, t = 8.377, p < 0.001) and sensitization-associated symptoms (r2 adj: 0.381, B = 0.130, t = 3.585, p < 0.001). Kinesiophobia levels were associated with catastrophism and sensitization-associated symptoms in previously hospitalized COVID-19 survivors with post-COVID pain. Identification of patients at a higher risk of developing a higher level of kinesiophobia, associated with post-COVID pain symptoms, could lead to better therapeutic strategies.

Secondary production of Acartia tonsa Dana, 1849 and A. lilljeborgii Giesbrecht, 1889 in an Amazonian estuary (Brazil).

The dynamics of the copepods A. tonsa and A. lilljeborgii were described for the first time in the Taperaçu Estuary. The acartiids were collected using plankton nets (200 µm) in June 2012, March 2013 (rainy season) and September 2012 and 2013 (dry season). The oscillations in rainfall and the fluctuations in hydrological variables influenced the abundance, biomass, and production of both A. tonsa (17 ± 23 to 8501 ± 13,248 ind.m-3; 16,385.29 mg.C.m-3; 0.09 ± 0.21 to 355.17 ± 590.84 mg.C.m-3.d-1) and A. lilljeborgii (14 ± 11 to 1470 ± 1591 ind.m-3; 22,398.40 mg.C.m-3; 177.99 ± 263.13 mg.C.m-3.d-1) with clear monthly, seasonal, and spatial patterns. The high levels of production observed may be related to the presence of waters rich in particulate organic material derived from the adjacent mangrove forests. This material is consumed by a number of copepod species, in particular A. tonsa and A. lilljeborgii, favoring the development and reproduction of both species which are characterized by high rates of productivity in the study estuary. The present results indicate that the biomass and productivity in equatorial mangrove estuaries may be relatively high in comparison with the levels observed in other coastal systems around the world and that earlier stages of both species have a great relevance for biomass and production in Amazonian estuaries.

Surgical vs. transcatheter aortic valve replacement in patients over 75 years with aortic stenosis: sociodemographic profile, clinical characteristics, quality of life and functionality.

Background: Aortic valve stenosis (AVS) affects 25% of the population over 65 years. At present, there is no curative medical treatment for AVS and therefore the surgical approach, consisting of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR), is the treatment of choice. Methodology: The aim of this study was to analyze the sociodemographic and clinical characteristics, quality of life and functionality of a sample of patients with AVS over 75 years of age, who underwent TAVR or SAVR, applying standard clinical practice. A prospective multicenter observational study was conducted in two hospitals of the Spanish National Health System. Data were collected at baseline, 1, 6 months and 1 year. Results: In total, 227 participants were included, with a mean age of 80.6 [SD 4.1]. Statistically significant differences were found in terms of quality of life, which was higher at 1 year in patients who underwent SAVR. In terms of functionality, SAVR patients obtained a better score (p < 0.01). However, patients who underwent TAVR began with a worse baseline situation and managed to increase their quality of life and functionality after 1 year of follow-up. Conclusion: The individualized choice of TAVR or SAVR in patients with AVS improves patients' quality of life and function. Moreover, the TAVR procedure in patients with a worse baseline situation and a high surgical risk achieved a similar increase in quality of life and functionality compared to patients undergoing SAVR with a better baseline situation.

Quantification and classification of the main environmental impacts on a Halodule wrightii seagrass meadow on a tropical island in northeastern Brazil.

Multiple stress mechanisms have caused a worldwide decrease in seagrasses, which are vulnerable to environmental and/or anthropogenic pressure. The loss of seagrass meadows of Halodule wrightii is reported for the littoral of Itamaracá Island (Northeastern Brazil). The present study identified the main anthropogenic factors that negatively influenced over the abundance and distribution of seagrass meadows between July and September 2007 at the Jaguaribe and Pilar Beaches, Eastern littoral of Itamaracá. Anthropogenic impact included the discharge of untreated sewage through fluvial channels, urban and commercial development along the coast, the anchoring of motorized and non-motorized boats, diverse fishing techniques and the dumping of solid waste. The data indicates that the Pilar is an environment with a higher impact index (71.43%) when compared with the Jaguaribe (57.14%), standing out the number of boats with a central motor, the total number of boats, the presence of shellfish gatherers and coastal urban development. The present study reinforces the need for defining management and conservation measures for this ecosystem, which has high ecological and economic value.

Evidence for enhanced primary production driving significant CO2 drawdown associated with the Atlantic ITCZ.

The intense rainfall associated with the Intertropical Convergence Zone (ITCZ), a narrow zone of confluence of the northeast and southeast trades, can significantly alter sea surface salinity, the chemistry of inorganic C and the resulting sea-air CO2 exchange in the tropics. We have analyzed extensive underway data collected from 2008 until 2014 and recorded by an autonomous CO2 system installed on a commercial ship that crosses the central tropical Atlantic (5°S to 15°N, 18°W to 36°W) to disentangle the effects of the ITCZ over the carbonate system there. Based on statistically significant linear co-variance of sea surface fugacity of CO2 (fCO2sw) and sea surface salinity in the areas affected by the ITCZ, we calculated CO2 drawdown rates associated with the impact of the ITCZ in the central tropical Atlantic ranging from 0.11 ± 0.02 to 2.35 ± 0.08 mmol m-2 d-1. These were calculated by comparing the observed fCO2sw with that expected without surface seawater carbonate system dilution and increase in gas transfer caused by the ITCZ. The observed decrease in fCO2sw associated with the freshening caused by the ITCZ is much larger than expected from thermodynamics alone. 59.1 ± 4.1 % of the total observed CO2 drawdown associated with the ITCZ cannot be explained by abiotic processes. Instead, we found significant negative correlations between underway sea surface salinity and remote-sensed chlorophyll a in the areas affected by the ITCZ. Different to other tropical oceanic basins, the tropical Atlantic receives large amounts of continental dust originated from Africa. Wet dust deposition driven by the ITCZ appears associated with the interannual variability of the CO2 drawdown associated with the ITCZ. Fertilization driven by the ITCZ seems to enhance primary production in the otherwise oligotrophic tropical Atlantic, thus significantly lowering CO2 emissions to the atmosphere.

Patient deaths during the period of prolonged stay in cases of delayed discharge for nonclinical reasons at a university hospital: a cross sectional study.

Background: Delayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care. Methods: A descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007-2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student's T test and Pearson's chi-square test (χ 2) were used. Results: A total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital.