Correction: Machine Learning Model for Predicting Mortality Risk in Patients With Complex Chronic Conditions: Retrospective Analysis

[This corrects the article DOI: 10.2196/52782.].

Machine Learning Model for Predicting Mortality Risk in Patients With Complex Chronic Conditions: Retrospective Analysis

Background

The health care system is undergoing a shift toward a more patient-centered approach for individuals with chronic and complex conditions, which presents a series of challenges, such as predicting hospital needs and optimizing resources. At the same time, the exponential increase in health data availability has made it possible to apply advanced statistics and artificial intelligence techniques to develop decision-support systems and improve resource planning, diagnosis, and patient screening. These methods are key to automating the analysis of large volumes of medical data and reducing professional workloads.

Objective

This article aims to present a machine learning model and a case study in a cohort of patients with highly complex conditions. The object was to predict mortality within the following 4 years and early mortality over 6 months following diagnosis. The method used easily accessible variables and health care resource utilization information.

Methods

A classification algorithm was selected among 6 models implemented and evaluated using a stratified cross-validation strategy with k=10 and a 70/30 train-test split. The evaluation metrics used included accuracy, recall, precision, F1-score, and area under the receiver operating characteristic (AUROC) curve.

Results

The model predicted patient death with an 87% accuracy, recall of 87%, precision of 82%, F1-score of 84%, and area under the curve (AUC) of 0.88 using the best model, the Extreme Gradient Boosting (XGBoost) classifier. The results were worse when predicting premature deaths (following 6 months) with an 83% accuracy (recall=55%, precision=64% F1-score=57%, and AUC=0.88) using the Gradient Boosting (GRBoost) classifier.

Conclusions

This study showcases encouraging outcomes in forecasting mortality among patients with intricate and persistent health conditions. The employed variables are conveniently accessible, and the incorporation of health care resource utilization information of the patient, which has not been employed by current state-of-the-art approaches, displays promising predictive power. The proposed prediction model is designed to efficiently identify cases that need customized care and proactively anticipate the demand for critical resources by health care providers.

Evaluating Person-Centred Integrated Care to People with Complex Chronic Conditions: Early Implementation Results of the ProPCC Programme

Introduction

The evaluation of integrated care programmes for high-need high-cost older people is a challenge. We aim to share the early implementation results of the ProPCC programme in the North-Barcelona metropolitan area, in Catalonia, Spain.

Methods

We analysed the intervention with retrospective data from May 2018 to December 2021 by describing the cohort complexity and by showing its 6-months pre-post impact on time spent at home and resources used: primary care visits, emergency department visits, hospital admissions and hospital stay.

Findings

264 cases were included (91% at home; 9% in nursing homes). 6-month pre vs. 6-months post results were (mean, p-value): primary care visits 8.2 vs. 11.5 (p < 0.05); emergency department visits 1.4 vs. 0.9 (p < 0.05); hospital admissions 0.7 vs. 0.5 (p < 0.05); hospital stay 12.8 vs. 7.9 days (p < 0.05). Time spent at home was 169.2 vs.174.2 days (p < 0.05).

Conclusion

Early implementation of the ProPCC programme results in an increase in time spent at home (up to 3%) and significant reductions in emergency department attendance (-37.2%) and hospital stays (-38.3%). The increased use of primary care resources is compensated by the hospital resources savings, with a result in the average total cost of -46.3%.

The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents

BACKGROUND

Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality.

METHODS

We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death.

RESULTS

A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001).

CONCLUSIONS

Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

Severe Hypoalbuminemia at Admission Is Strongly Associated with Worse Prognosis in Older Adults with SARS-CoV-2 Infection

Serum albumin levels have been associated with prognosis in several conditions among older adults. The aim of this study is to assess the prognostic value in mortality of serum albumin in older adults with SARS-CoV-2 infection. Methods. Cohort observational study with consecutive older-adults (≥65 years old), with confirmed SARS-CoV-2 infection admitted to a university hospital between March–May 2020. A logistic regression model was fitted to assess the impact of albumin levels on in-hospital mortality adjusted by potential confounders. Results. Among a total of 840 patients admitted to the hospital, 405 (48%) were older adults with a total of 92 deaths (23%) among them. Those who died were older, had more comorbidities, higher inflammation status and lower levels of serum albumin at admission [3.10 g/dL (0.51) vs. 3.45 g/dL (0.45); p < 0.01. Serum albumin levels at admission were negatively correlated with inflammatory markers such as C-Reactive protein (Pearson Coeff −0.4634; p < 0.001) or IL-6 (Pearson’s Coeff −0.244; p = 0.006) at admission but also to other clinical outcomes such time to clinical stability (Pearson’s Coeff −0.259; p < 0.001). Severe hypoalbuminemia associated with increased risk of mortality was defined as ≤3 g/dL at admission according to the AUC/ROC analysis (0.72 95% CI 0.63–0.81) In a multivariate logistic regression model adjusting by age, inflammation, comorbidities and severity at admission severe hypoalbuminemia was a strong predictor of in-hospital mortality (OR 2.18 95% CI 1.03–4.62; p = 0.039). Conclusion. Severe hypoalbuminemia with ≤3 g/dL is an independent risk factor for mortality among older adults with SARS-CoV-2 infection. There is a consistent correlation between albumin levels and inflammatory biomarkers. Further studies are needed to determine whether the supplementation of albumin as coadjuvant treatment will have a positive impact on the prognosis of this infection.

Designing a Person-Centred Integrated Care Programme for People with Complex Chronic Conditions: A Case Study from Catalonia

INTRODUCTION

The prevalence of people with complex chronic conditions is increasing. This population's high social and health needs require person-centred integrated approaches to care.

METHODS

To collect data about experiences with the health system and identify priorities for care, we conducted 2 focus groups and 15 semi-structured interviews involving patients with multimorbidity and advanced conditions, caregivers, and representatives of patients' associations. To design the programme, we combined this information with evidence-based recommendations from local healthcare and social care professionals.

RESULTS

Patients' and caregivers' main priorities were to ensure (a) comprehension of information provided by healthcare professionals; (b) coordination between patients, caregivers, and professionals; (c) access to social services; (d) support to caregivers in managing situations; (e) perceived support throughout the healthcare process; (f) home care, when available; and (d) a patient-centred approach. These dimensions were included in 37 of 63 clinical actions of the programme to cover the whole care trajectory: identifying high needs, defining, and providing care plans, managing crises, and providing transitional care and end-of-life care.

CONCLUSION

We developed an evidence-based integrated care programme tailored to high-need patients combining input from patients, caregivers, and healthcare and social care professionals.

Prevalence and Prognostic Value of Myocardial Injury in the Initial Presentation of SARS-CoV-2 Infection among Older Adults

Myocardial involvement during SARS-CoV-2 infection has been reported in many prior publications. We aim to study the prevalence and the clinical implications of acute myocardial injury (MIN) during SARS-CoV-2 infection, particularly in older patients. The method includes a longitudinal observational study with all consecutive adult patients admitted to a COVID-19 unit between March-April 2020. Those aged ≥65 were considered as older adult group. MIN was defined as at least 1 high-sensitive troponin (hs-TnT) concentration above the 99th percentile upper reference limit with different sex-cutoff. Results. Among the 634 patients admitted during the period of observation, 365 (58%) had evidence of MIN, and, of them, 224 (61%) were older adults. Among older adults, MIN was associated with longer time to recovery compared to those without MIN (13 days (IQR 6-21) versus 9 days (IQR 5-17); p < 0.001, respectively. In-hospital mortality was significantly higher in older adults with MIN at admission versus those without it (71 (31%) versus 11 (12%); p < 0.001). In a logistic regression model adjusting by age, sex, severity, and Charlson Comorbidity Index, the OR for in-hospital mortality was 2.1 (95% CI: 1.02-4.42; p = 0.043) among those older adults with MIN at admission. Older adults with acute myocardial injury had greater time to clinical recovery, as well as higher odds of in-hospital mortality.

Drug exposure may have a substantial influence on COVID-19 prognosis among residents of long-term care facilities: an exploratory analysis

Objectives

To explore the association between drug exposure and SARS-CoV-2 prognosis among elderly people living in long-term care facilities (LTC)

Design

We carried out a cross-sectional study among old people living in LTC that had a proven SARS-CoV-2 infection, including socio-demographic data, comorbidities and drug intake at the moment of the diagnosis. The study was focused on ACE2 inhibitors, ARA-II blockers, inhaled bronchodilators, oral corticoids, platelet antiaggregants, oral anti-coagulants, statins and Vitamin D.

Results

1 306 individuals were included, with a mean age of 86.7 years, and 72.3% were females. The case fatality rate was 24.4%. Among the studied exposures platelet antiaggregants were the most prevalent (24.7%). After adjusting for propensity score, the intake of inhaled corticoids (OR 0.73; p=0.03) and statins (OR 0.65; p=0.03) were found to be protective factors of death, whereas ACE2 inhibitor showed an almost significant association (OR 0.73, p=0.07).

Conclusions

Considering the high prevalence of drug intake among elderly people, drug exposure may be an important Covid-19 disease modifier in LTC residents and should be considered when exploring prognostic risk factors associated to Covid-19.

A retrospective cohort study of risk factors for mortality among nursing homes exposed to COVID-19 in Spain

Long-term care (LTC) facilities have shown remarkably high mortality rates during the coronavirus disease 2019 (COVID-19) outbreak in many countries¹, and different risk factors for mortality have been identified in this setting^2-5. Using facilities as the unit of analysis, we investigated multiple variables covering facility characteristics and socioeconomic characteristics of the geographic location to identify risk factors for excess mortality from a comprehensive perspective. Furthermore, we used a clustering approach to detect patterns in datasets and generate hypotheses regarding potential relationships between types of nursing homes and mortality trends. Our retrospective analysis included 167 nursing homes providing LTC to 8,716 residents during the COVID-19 outbreak in Catalonia (northeast Spain). According to multiple regression analysis, COVID-19-related and overall mortality at the facility level were significantly associated with a higher percentage of patients with complex diseases, lower scores on pandemic preparedness measures and higher population incidence of COVID-19 in the surrounding population. When grouping nursing homes into eight clusters based on common features, we found higher mortality rates in four clusters, mainly characterized by a higher proportion of residents with complex chronic conditions or advanced diseases, lower scores on pandemic preparedness, being located in rural areas and larger capacity, respectively.

New Insights into the Design and Application of a Passive Acoustic Monitoring System for the Assessment of the Good Environmental Status in Spanish Marine Waters

Passive acoustic monitoring systems allow for non-invasive monitoring of underwater species and anthropogenic noise. One of these systems has been developed keeping in mind the need to create a user-friendly tool to obtain the ambient noise indicators, while at the same time providing a powerful tool for marine scientists and biologists to progress in studying the effect of human activities on species and ecosystems. The device is based on a low-power processor with ad-hoc electronics, ensuring that the system has efficient energy management, and that the storage capacity is large enough to allow deployments for long periods. An application is presented using data from an acoustic campaign done in 2018 at El Gorguel (Cartagena, Spain). The results show a good agreement between theoretical maps created using AIS data and the ambient noise level indicators measured in the frequency bands of 63 Hz and 125 Hz specified in the directive 11 of the EU Marine Strategy Framework Directive. Using a 2D representation, these ambient noise indicators have enabled repetitive events and daily variations in boat traffic to be identified. The ship noise registered can also be used to track ships by using the acoustic signatures of the engine propellers’ noise.

Different ways to present clinical cases in a classroom: video projection versus live representation of a simulated clinical scene with actors

BACKGROUND

Use of the video digital format in the classroom is a common way to present clinical cases to stimulate discussion and increase learning. A simulated live performance with actors, also in the classroom, could be an alternative way to present cases that may be more attractive to arouse students' interest and attention. The aim of the present study was to compare the learning process between a group of students who saw a clinical case as a simulated live scene in the classroom and others seeing the same clinical case projected by video.

METHOD

One hundred and thirty-one students (69 from physiotherapy and 62 from medicine) attended an interactive seminar on delirium in older people. Each group was subdivided into two groups: one saw the clinical case as a theatrical performance in the classroom (scene group; n = 68), while the other saw the same case projected on video (video group; n = 63). Before and after attending the seminar, students answered a questionnaire [four questions on theoretical knowledge of delirium (score 0-7) and two on subjective learning perception (linear scale: 0-10) (score 0-20)]. At the end, a further question was included on the usefulness of the scene or a video in the learning process (linear scale: 0-10).

RESULTS

Students in both groups (live scene and video) significantly improved in all questionnaire scores after the seminar (p = 0.001) with a large Effect Size (ES > 0.80). Students of the scene group obtained higher scores on theoretical delirium knowledge [6.41 ± 0.73 vs 5.93 ± 1.31 (p = 0.05)], subjective learning perception questions (what they thought they knew about delirium) (16.28 ± 3.51 versus 15.92 ± 2.47 (p = 0.072)], and the overall questionnaire (22.45 ± 4.15 versus 21.48 ± 2.94 (p = 0.027)] than the video group. Students of the scene group opined that live scene was very useful for learning with a mean score of 9.04 ± 1.16 (range 0-10), and opinion in the student's video group scored 8.21 ± 1.22 (p = 0.001).

CONCLUSIONS

All students improved significantly their knowledge but those who saw the theatrical performance obtained slightly better results, which suggest that this form of clinical case presentation in the classroom may be an alternative at least as effective as traditional video projections.

[Hospital-at-home Integrated Care Programme tailored to older patients with disabling acute processes: identification of prognostic factors]

INTRODUCTION

Several authors have demonstrated the efficacy of different hospital-at-home strategies in older patients. The identification of prognostic factors is key for improving the targeting process of candidates.

METHODS

We performed an analysis of a cohort of older patients attended due to disabling health crises (medical, orthopaedics, or stroke) by a hospital-at-home scheme developed in an integrated care institution over a 5-year period. Main outcomes were: health crisis resolution (discharge to Primary Care); functional resolution (relative functional gain ≥35%), and their combined variable. A logistic regression analysis was performed, including clinical variables from Comprehensive Geriatric Assessment at admission to detect factors related to favourable outcomes.

RESULTS

A total of 484 patients were included. The main characteristics were: age 84.4 (6.7), female gender 69%, baseline Barthel score 74.2 (22.6), family-private caregiver/nursing home 82%/18%, referral from hospital wards/emergency department-community in 55%/45%. The main results (for selected processes medical/orthopaedics/stroke) were: health crisis resolution 71.7/87.5/77.6%; functional resolution 72.1/84.9/73.5%; favourable crisis resolution (health crisis resolution with functional resolution) 67.1/81.6/67.3%. Favourable crisis resolution was associated with [OR (95%CI)]: orthopaedic as main diagnosis [2.00 (1.22-3.29)], Barthel score at admission higher than 40 points [2.00 (1.18-3.38)], and the absence of pressure ulcers at admission [2.80 (1.68-4.65)].

CONCLUSIONS

Patients presenting with an orthopaedic diagnosis, not having severe disability at admission, and not having pressure ulcers at admission could obtain better results on favourable crisis resolution. Suffering cognitive impairment or delirium, or being institutionalised, was not found related with less favourable results.

Serum albumin is a strong predictor of sepsis outcome in elderly patients

The incidence of sepsis is disproportionately higher in elderly adults, and age is an independent predictor of mortality. Retrospective analysis was conducted among patients admitted to the emergency department in a tertiary teaching hospital from January 2016 to June 2017. To study the prognosis determinants of sepsis among elderly patients attended in the emergency room of a tertiary care hospital. As secondary objectives, we aimed to describe the causes of sepsis, the general outcome, and the general characteristics of these patients. Two hundred thirty-five episodes data of patients admitted throughout the 15-month study period who were diagnosed with sepsis, severe sepsis or septic shock, were included. Throughout the study cohort, 51 patients (21.7%) fulfilled the criteria of severe sepsis or septic shock. All-cause mortality was 11 patients (4.7%) on day 14 and 27 (11.5%) on day 30. Prognosis factors associated with 30-day mortality were the following: albumin level < 2.6 g/dl (first quartile of the overall population), odds ratio (OR 3.26, 95% CI 12-9.41; p = 0.029), Charlson comorbidity index (OR 1.23, 95% CI 1.04-1.45; p = 0.012), C-reactive protein on admission (OR 1.04, 95% CI 0.99-1.08; p = 0.062), and non-adequacy of the initial antimicrobial therapy (OR 3.3, 95% CI 1.06-10.4; p = 0.039). Among elderly patients with sepsis, strong predictors of mortality such as albumin could be considered as part of prognosis and future potential interventions. Adequacy of antimicrobial therapy at admission must be one of the objectives in the treatment of sepsis, also in the elderly, since it is an independent predictor of mortality.

Frailty, Falls and Osteoporosis: Learning in Elderly Patients Using a Theatrical Performance in the Classroom

OBJECTIVE

To ascertain the usefulness of a simulated clinical scene with actors in the classroom (theatrical performance) as a teaching tool for the management of falls and their related injuries.

DESIGN

Experimental design of two related groups.

SETTING

Spain.

PARTICIPANTS

A group of 12 students attended a seminar in which the approach to a clinical case was made using a simulated scene with actors in the classroom (scene group); a non-scene group of 34 students attended the seminar, without a theatrical performance (the same clinical case was read and presented in a traditional manner, oral presentation).

MEASUREMENTS

Before and after the seminar, students answered a questionnaire [five questions on theoretical knowledge of falls and osteoporosis (score 0-10) and two on subjective learning perception (linear scale: 0-10) (score 0-20)]. In the scene group were two further questions included at the end on their opinion of the scene and on the seminar overall.

RESULTS

Both groups significantly improved in all questionnaire scores after the seminar (p=0.001). The scene group had a greater rise in mean points of the questionnaire before and after the seminar than the non-scene group: theoretical knowledge [3.81±1.69 versus 2.75±1.33 (p=0.033)], subjective questions [6.08±4.10 versus 4.97±2.24 (p=0.247)], and the questionnaire overall [9.89±4.98 versus 7.72±2.66 (p=0.060)]. The scene group had a very good opinion of the usefulness of the scene and of the overall opinion of the seminar: 9.08±0.95 and 9.41±0.79.

CONCLUSIONS

Theatrical performance in the classroom seems to promote better learning than classic oral presentation, providing qualitative value by adding creativity and different approaches to the teaching of medicine.

Potentially inappropriate medication among people with dementia in eight European countries

Objectives

to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European study 'RightTimePlaceCare', and to evaluate factors and adverse outcomes associated with PIM prescription.

Methods

survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries and mortality in the time between baseline and follow-up. The European Union(7)-PIM list was used to evaluate PIM prescription. Multivariate regression analysis was used to investigate factors and adverse outcomes associated with PIM prescription.

Results

overall, 60% of the participants had at least one PIM prescription and 26.4% at least two. The PIM therapeutic subgroups most frequently prescribed were psycholeptics (26% of all PIM prescriptions) and 'drugs for acid-related disorders' (21%). PwD who were 80 years and older, lived in institutional long-term care settings, had higher comorbidity and were more functionally impaired were at higher risk of being prescribed two PIM or more. The prescription of two or more PIM was associated with higher chance of suffering from at least one fall-related injury and at least one episode of hospitalisation in the time between baseline and follow-up.

Conclusions

PIM use among PwD is frequent and is associated with institutional long-term care, age, advanced morbidity and functional impairment. It also appears to be associated with adverse outcomes. Special attention should be paid to psycholeptics and drugs for acid-related disorders.

Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care

Objective

to analyse the clinical impact of a home-based Intermediate Care model in the Catalan health system, comparing it with usual bed-based care.

Design

quasi-experimental longitudinal study.

Setting

hospital Municipal de Badalona and El Carme Intermediate Care Hospital, Badalona, Catalonia, Spain.

Participants

we included older patients with medical and orthopaedic disabling health crises in need of Comprehensive Geriatric Assessment (CGA) and rehabilitation.

Methods

a CGA-based hospital-at-home Integrated Care Programme (acute care and rehabilitation) was compared with a propensity score matched cohort of contemporary patients attended by usual inpatient hospital care (acute care plus intermediate care hospitalisation), for the management of medical and orthopaedics processes. Main outcomes measures were: (a) Health crisis resolution (referral to primary care at the end of the intervention); (b) functional resolution: relative functional gain (functional gain/functional loss) ≥ 0.35; and (c) favourable crisis resolution (health + functional) = a + b. We compared between-groups outcomes using uni/multivariable logistic regression models.

Results

clinical characteristics were similar between home-based and bed-based groups. Acute stay was shorter in home group: 6.1 (5.3-6.9) versus 11.2 (10.5-11.9) days, P < 0.001. The home-based scheme showed better results on functional resolution 79.1% (versus 75.2%), OR 1.62 (1.09-2.41) and on favourable crisis resolution 73.8% (versus 69.6%), OR 1.54 (1.06-2.22), with shorter length of intervention, with a reduction of -5.72 (-9.75 and -1.69) days.

Conclusions

in our study, the extended CGA-based hospital-at-home programme was associated with shorter stay and favourable clinical outcomes. Future studies might test this intervention to the whole Catalan integrated care system.

[Prognostic value of assessment tools on elderly patients with chronic advanced disease and end of life, admitted to an intermediate care centre]

OBJECTIVE

To apply 3advanced chronic disease evaluation tools in elderly patients admitted to an intermediate and long-term care centre, and evaluate its relationship with mortality.

METHODS

The NECPAL tool, PROFUND prognostic index, and Charlson comorbidity index were applied to 87 patients.

RESULTS

The NECPAL tool identified 31 patients (35.6%) in need of palliative care, and according to the PROFUND index, 45 (54.7%) had high/very high risk of mortality (≥7 points), and according to Charlson index, 31 (35.6%) had high comorbidity (≥4 points). Of the NECPAL positive patients, 80.5% had a PROFUND index score ≥7, and 48.3% a Charlson index ≥ 4. These percentages were 34.4% and 28.5% in negative NECPAL patients (P<.001 and P≤.06, respectively). Correlations between the 3tools: quantitative (Spearman) number of responses in NECPAL with PROFUND (r=.57; P<.001); with Charlson (r=.214; P<.047) and between PROFUND and Charlson (r=.157; P=.148). Qualitative (kappa) NECPAL (positive/negative) with PROFUND (cut-off 6/7) (0.40; P<.001), and Charlson (cut-off 3/4) (0.19; P=.080) and between PROFUND and Charlson (0.08; P=.399). Mortality prediction (area under the curve): NECPAL 3 months 0.81 (95% CI: 0.62-1.00); 6 months 0.71 (95% CI: 0.53-0.89) and 12 months 0.67 (95% CI: 0.52-0.82). PROFUND 3 months 0.71 (95% CI: 0.50-0.91); 6 months 0.73 (95% CI: 0.58-0.87), and 12 months 0.69 (95% CI: 0.57-0.81). Charlson 3 months 0.72 (95% CI: 0.52-0.91); 6 months 0.62 (95% CI: 0.45-0.80), and 12 months 0.64 (95% CI: 0.50-0.78).

CONCLUSIONS

The 3tools were significantly associated with high mortality. A low concordance was found between the results of the different tools.

Prevalence of malnutrition and sarcopenia in a post-acute care geriatric unit: Applying the new ESPEN definition and EWGSOP criteria

BACKGROUNDS & AIMS

The European Society of Clinical Nutrition and Metabolism (ESPEN) consensus definition of malnutrition has been applied in hospitalized older diabetics and middle-aged patients, geriatric outpatients, and healthy elderly and young individuals. In a post-acute care setting, our aim was to assess malnutrition (ESPEN definition) and determine its relationship with sarcopenia in older in-patients deconditioned due to an acute process.

METHODS

Eighty-eight in-patients aged ≥70 years with body mass index (BMI) <30 kg/m² were included (84.1 years old; 62% women) and screened for malnutrition risk using biochemical markers and Mini-Nutritional Assessment-Short Form (MNA-SF). The ESPEN definition was applied: 1) BMI <18.5 kg/m² or 2) unintentional weight loss plus a) low BMI or b) low fat-free mass index (FFMI). European Working Group on Sarcopenia in Older People (EWGSOP) criteria were also applied.

RESULTS

Unintentional weight loss occurred in 27 (30.7%) of 88 in-patients considered "at risk" by MNA-SF. Malnutrition prevalence was 4.5%, 7.9%, and 17% using ESPEN definitions 1, 2a, and 2b, respectively; 19.3% were malnourished. Prevalence of sarcopenia was 37.5%, of which 90.9% fulfilled ESPEN malnutrition criteria, a significant association (p = 0.02). No differences in biochemical markers were observed between patients with or without malnutrition or sarcopenia.

CONCLUSIONS

ESPEN criteria constitute an appropriate tool to establish a malnutrition diagnosis in post-acute care. Sarcopenia, as defined by EWGSOP, was present in 37.5% of patients, of which 90.9% fulfilled ESPEN criteria; therefore, malnutrition was significantly related to sarcopenia. Additional work is needed to determine further implications of the ESPEN consensus definition.

[Clinical application of the "Stop walking while talking test". Relationship with geriatric assessment parameters and other tests of balance and gait]

OBJECTIVE

To assess the relationship between the Stop Walking While Talking (SWWT) test and some parameters of the geriatric assessment, as well as other tests of balance and gait.

PATIENTS AND METHODS

A prospective, observational and cross-sectional study conducted on 108 patients (62% women), with a mean age of 80.5±8.4 years. Twenty-three of them were living at home, 24 in a nursing home, and 61 in an intermediate care unit. A record was made of the Barthel index, Mini-Mental State Examination of Folstein (MMSE), comorbidity (Charlson index), the presence of previous falls, and fear of falling. Timed Up and Go (TUG), Tinetti test, and Stop Walking While Talking (SWWT) test, were performed on all the patients. Based on the results of the SWWT test patients were divided in two groups: "stoppers" and "non-stoppers". All patients were able to walk (with or without walking aids).

RESULTS

The stoppers group of patients had a mean age 82.2±8.7; Barthel index 64.6±20.7; MMSE 21.6±5.1; Charlson index 1.8±1.7, and the non-stoppers 78.5±7.6 (P=.024), 86.0±18.1 (P<.001), 24.3±4.0 (P=.004), and 1.3±1.6 (P=.130), respectively. Of the 58 stoppers patients, 39 (67.2%) had a previous fall, and 19 (32.8%) had not (P=.002); 43 (74.1%) had fear of falling, and 15 (25.9%) had not (P<0.009). Of the 63 patients with TUG>20seconds, 52 (82.5%) were stoppers and 11 (17.5%) non-stoppers. Of the 31 with TUG between 10-20seconds, 5 (16.1%) were stoppers and 26 (83.9%) non-stoppers. Of the 14 with TUG<10 seconds, 1 (7.1%) were stoppers, and 13 (92.9%) non-stoppers (P<0.0001). The score of Tinetti test in the stoppers group was 15.4±5.2, and in non-stoppers 23.9±4.6 (P<0.001).

CONCLUSIONS

Those in the stopper group were significantly older, were more dependent in activities of daily living, had greater cognitive impairment, more previous falls, had greater fear of falling, lower scores on the Tinetti test, and longer times in the TUG.

Optimized ultrasonic attenuation measures for non-homogeneous materials

In this paper the study of frequency-dependent ultrasonic attenuation in strongly heterogeneous materials is addressed. To determine the attenuation accurately over a wide frequency range, it is necessary to have suitable excitation techniques. Three kinds of transmitted signals have been analysed, grouped according to their bandwidth: narrowband and broadband signals. The mathematical formulation has revealed the relation between the distribution of energy in their spectra and their immunity to noise. Sinusoidal and burst signals have higher signal-to-noise ratios (SNRs) but need many measurements to cover their frequency range. However, linear swept-frequency signals (chirp) improve the effective bandwidth covering a wide frequency range with a single measurement and equivalent accuracy, at the expense of a lower SNR. In the case of highly attenuating materials, it is proposed to use different configurations of chirp signals, enabling injecting more energy, and therefore, improving the sensitivity of the technique without a high time cost. Thus, if the attenuation of the material and the sensitivity of the measuring equipment allows the use of broadband signals, the combination of this kind of signal and suitable signal processing results in an optimal estimate of frequency-dependent attenuation with a minimum measurement time.

[Lipid peroxidation in the lymphocyte membrane and protein oxidation in the serum of elderly people. Are they potential markers of frailty and dependence? Preliminary results]

OBJECTIVE

To study the relationships between lipid peroxidation of the lymphocyte membrane, protein oxidation and different markers of frailty and dependence.

METHODS

The sample consisted of 15 elderly patients in an intermediate and long-term care center, who had not suffered any acute process recently. The geriatric assessment included, functional capacity (Barthel and Lawton indexes), comorbidity (Charlson index), and cognitive function (Mini Mental State Examination of Folstein). The frailty was estimated by the Hospital Admission Risk Profile (high risk of frailty 4-5 points, intermediate/low 0-3 points) and Frailty Scale of Rockwood (mild frailty<6, intermediate frailty/severe≥6). Lipid peroxidation was studied by determination of conjugated dienes and trienes. Analysis of protein oxidation was performed by determining malondialdehyde bound to plasma proteins, corrected by total protein quantification.

RESULTS

Elderly patients at high risk of frailty according to Hospital Admission Risk Profile presented mean values of conjugated dienes of 7.94±1.32%, trienes of 1.75±0.51%, and malondialdehyde bound to plasma proteins of 141.9±27.3nmol/g. In the group of intermediate/low risk, these values were 4.96±2.77% (P=.035), 1.37±0.78% (P=.337) and 96.4±31.5nmol/g (P=.022), respectively. In those with intermediate/severe frailty according to the Frailty Scale of Rockwood, these values were 7.06±2.18%; 1.73±0.50% and 119.6±37.9nmol/g, respectively, and in those with mild frailty 2.56±1.48% (P=014); 0.61±0.58% (P=020) and 173.2±51.9nmol/g (P=.144), respectively. There was good correlation between the Hospital Admission Risk Profile score and malondialdehyde bound to plasma proteins (r=0.70; P=01) and between the Frailty Scale of Rockwood score and conjugated dienes (r=0.65; P=01).

CONCLUSIONS

Elderly patients with a higher degree of frailty appear to have greater levels of lipid peroxidation, which could be considered a marker of frailty.

Characterization of the complexity in short oscillating time series: An application to seismic airgun detonations

Extracting frequency-derived parameters allows for the identification and characterization of acoustic events, such as those obtained in passive acoustic monitoring applications. Situations where it is difficult to achieve the desired frequency resolution to distinguish between similar events occur, for example, in short time oscillating events. One feasible approach to make discrimination among such events is by measuring the complexity or the presence of non-linearities in a time series. Available techniques include the delay vector variance (DVV) and recurrence plot (RP) analysis, which have been used independently for statistical testing, however, the similarities between these two techniques have so far been overlooked. This work suggests a method that combines the DVV method with the recurrence quantification analysis parameters of the RP graphs for the characterization of short oscillating events. In order to establish the confidence intervals, a variant of the pseudo-periodic surrogate algorithm is proposed. This allows one to eliminate the fine details that may indicate the presence of non-linear dynamics, without having to add a large amount of noise, while preserving more efficiently the phase-space shape. The algorithm is verified on both synthetic and real world time series.

Ultrasonic characterization of GRC with high percentage of fly ash substitution

New applications of non-destructive techniques (NDT) with ultrasonic tests (attenuation and velocity by means of ultrasonic frequency sweeps) have been developed for the characterization of fibre-reinforced cementitious composites. According to new lines of research on glass-fibre reinforced cement (GRC) matrix modification, two similar GRC composites with high percentages of fly ash and different water/binder ratios will be studied. Conventional techniques have been used to confirm their low Ca(OH)(2) content (thermogravimetry), fibre integrity (Scanning Electron Microscopy), low porosity (Mercury Intrusion Porosimetry) and good mechanical properties (compression and four points bending test). Ultrasound frequency sweeps allowed the estimation of the attenuation and pulse velocity as functions of frequency. This ultrasonic characterization was correlated successfully with conventional techniques.

Does gait speed contribute to sarcopenia case-finding in a postacute rehabilitation setting?

OBJECTIVE

The European Working Group of Sarcopenia in Older People (EWGSOP) has developed an algorithm based on gait speed measurement to begin sarcopenia case-finding in clinical practice, in which a cut-off point of <0.8m/s identifies risk for sarcopenia in community-dwelling older people. The objective of this study was to assess the application of the EWGSOP algorithm in hospitalised elderly patients with impaired functional capacity.

METHODS

One hundred in-patients (aged 84.1 SD 8.5, 62% women) were prospectively studied in a postacute care geriatric unit focused on rehabilitation. Sarcopenia was assessed by corporal composition (electrical bioimpedance), handgrip strength, and physical performance (gait speed). Other measurements were Charlson index, length of stay, and functional gain at discharge and 3-month follow-up. All patients were screened by the EWGSOP algorithm and sarcopenia was confirmed according to diagnostic criteria.

RESULTS

Gait speed was <0.8m/s in all cases and 58 patients had low muscle mass, which, according to the EWGSOP-algorithm, would indicate a diagnosis of sarcopenia. No differences were observed in functional capacity between these patients and those with normal muscle mass. When decreased handgrip strength was considered, 47 of these patients met the EWGSOP criteria for severe sarcopenia. In this group, differences in functional capacity were observed at discharge (Barthel 45.2 vs. 56.3, p=0.042) and 3-month follow-up (48.3 vs. 59.8, p=0.047).

CONCLUSION

The application of the EWGSOP algorithm in hospitalised, postacute, elderly patients with low gait speed suggested that muscle strength should be considered before confirming or discarding a sarcopenia diagnosis.

Measuring predictability in ultrasonic signals: an application to scattering material characterization

In this paper, we present a novel and completely different approach to the problem of scattering material characterization: measuring the degree of predictability of the time series. Measuring predictability can provide information of the signal strength of the deterministic component of the time series in relation to the whole time series acquired. This relationship can provide information about coherent reflections in material grains with respect to the rest of incoherent noises that typically appear in non-destructive testing using ultrasonics. This is a non-parametric technique commonly used in chaos theory that does not require making any kind of assumptions about attenuation profiles. In highly scattering media (low SNR), it has been shown theoretically that the degree of predictability allows material characterization. The experimental results obtained in this work with 32 cement probes of 4 different porosities demonstrate the ability of this technique to do classification. It has also been shown that, in this particular application, the measurement of predictability can be used as an indicator of the percentages of porosity of the test samples with great accuracy.

Insomnia among patients with advanced disease during admission in a Palliative Care Unit: a prospective observational study on its frequency and association with psychological, physical and environmental factors

BACKGROUND

THE AIMS OF THIS STUDY WERE

1) to assess the frequency of insomnia among patients during admission in a Palliative Care Unit (PCU); 2) to study the association between emotional distress and insomnia, taking physical, environmental and other psychological factors into account.

METHODS

Prospective observational study including patients consecutively admitted to a PCU during eight months, excluding those with severe cognitive problems or too low performance status. Insomnia was assessed by asking a single question and by using the Sleep Disturbance Scale (SDS), and emotional distress using the Hospital Anxiety and Depression Scale (HADS). Physical, environmental and other psychological factors potentially interfering with sleep quality were evaluated. Association between insomnia and the factors evaluated was studied using univariate and multivariate regression analyses.

RESULTS

61 patients were included (mean age 71.5 years; 95% with oncological disease); 38 (62%) answered "yes" to the insomnia single question and 29 (47%) showed moderate to severe insomnia according to the SDS. 65% showed clinically significant emotional distress and 79% had nocturnal rumination. The physical symptoms most often mentioned as interfering with sleep quality were pain (69%) and dyspnoea (36%). 77% reported at least one environmental disturbance. In the univariate analysis, answering "yes" to the insomnia single question was significantly associated with higher HADS score, anxiety, nocturnal rumination, clear knowledge of the diagnosis, higher performance status and dyspnoea; moderate to severe insomnia was significantly associated with nocturnal rumination, higher performance status, environmental disturbances and daytime sleepiness. In the multivariate regression analysis, answering "yes" to the single question was associated with dyspnoea (OR 7.2 [1.65-31.27]; p = 0.009), nocturnal rumination (OR 5.5 [1.05-28.49]; p = 0.04) and higher performance status (OR 14.3 [1.62-125.43]; p = 0.017), and moderate to severe insomnia with nocturnal rumination (OR 5.6 [1.1-29.1]; p = 0.041), and inversely associated with daytime sleepiness (OR 0.25 [0.07-0.9]; p = 0.043).

CONCLUSIONS

Insomnia was highly frequent. Several physical, psychological and environmental factors seemed to influence insomnia. Within the multimodal management of insomnia, the assessment of nocturnal rumination may be of particular interest, irrespective of emotional distress. Further studies with larger sample sizes could confirm this result.

Does breathing type influence electromyographic activity of obligatory and accessory respiratory muscles?

Craniomandibular electromyographic (EMG) studies frequently include several parameters, e.g. resting, chewing and tooth-clenching. EMG activity during these parameters has been recorded in the elevator muscles, but little is known about the respiratory muscles. The aim of this study was to compare EMG activity in obligatory and accessory respiratory muscles between subjects with different breathing types. Forty male subjects were classified according to their breathing type into two groups of 20 each: costo-diaphragmatic breathing type and upper costal breathing type. Bipolar surface electrodes were placed on the sternocleidomastoid, diaphragm, external intercostal and latissimus dorsi muscles. EMG activity was recorded during the following tasks: (i) normal quiet breathing, (ii) maximal voluntary clenching in intercuspal position, (iii) natural rate chewing until swallowing threshold, (iv) short-time chewing. Diaphragm EMG activity was significantly higher in the upper costal breathing type than in the costo-diaphragmatic breathing type in all tasks (P < 0·05). External intercostal EMG activity was significantly higher in the upper costal breathing type than in the costo-diaphragmatic breathing type in tasks 3 and 4 (P < 0·05). Sternocleidomastoid and latissimus dorsi EMG activity did not show significant differences between breathing types in the tasks studied (P > 0·05). The significantly higher EMG activity observed in subjects with upper costal breathing than in the costo-diaphragmatic breathing type suggests that there could be differences in motor unit recruitment strategies depending on the breathing type. This may be an expression of the adaptive capability of muscle chains in subjects who clinically have a different thoraco-abdominal expansion during inspiration at rest.

[Geriatric assessment and factors associated with mortality in elderly patients with heart failure admitted to an acute geriatric unit]

INTRODUCTION AND OBJECTIVES

Heart failure (HF) is very prevalent in older adults, and is associated with a high mortality. The prediction of the outcome of HF and the identification of patients in advanced stages is difficult. The present work aims at identifying variables of the geriatric assessment and other clinical variables associated with an increased risk of death at one year in older adults with HF.

MATERIAL AND METHODS

Prospective study of 101 patients (mean age, 85.9 ± 6.3 years, 81% women) admitted during 2006 to an Acute Geriatric Unit, with principal diagnosis of HF. We recorded: demographic data, predisposing heart disease, main trigger of exacerbation, comorbidity, number of prescriptions at discharge and specific treatment of HF, average length-of-stay, readmissions, and mortality at one year after discharge. Geriatric assessment included: disability in basic (Barthel index) and instrumental (Lawton index) activities of daily living, cognitive function (Pfeiffer test), comorbidity (Charlson index), and geriatric syndromes.

RESULTS

In a multivariable logistic regression model, previous disability (lower Barthel index) (OR [95%CI]=1.03 [1.01-1.06]; P=.040) and higher number of re-admissions (OR [95%CI]=3.53 [1.19-10.44]; P=.023) were associated with 1-year mortality. Female sex had a protective effect (OR [95%CI]=0.15 [0.04-0.59]; P=.007).

CONCLUSIONS

Disability in the basic activities of daily living and re-admissions were associated with increased 1-year mortality in older adults, whereas female sex was protective. If confirmed in further studies, these data could reinforce the need for a systematic comprehensive geriatric assessment in older adults with HF.

[Benzodiazepine prescription in the elderly in different health care levels: characteristics and related factors]

OBJECTIVES

To determine the prevalence of benzodiazepine (BZD) prescription and the factors related to prescribing them in the elderly in the community, in an acute general hospital (AH) and in a convalescence geriatric unit (CGU).

MATERIAL AND METHODS

Retrospective study of 334 CGU inpatients discharged from an AH. A comprehensive geriatric assessment included functional and cognitive evaluation before hospitalization, at admission and at discharge from CGU (Barthel index, Lawton index and Folstein Mini-Mental State Examination), as well as comorbidity (Charlson index), polypharmacy and social situation. The percentage of benzodiazepine prescriptions at the different healthcare levels was compared and their related factors were evaluated (Chi-squared test).

RESULTS

The prevalence of benzodiazepine prescriptions in the community was 23.6%, and being female and polypharmacy were related factors to prescribing at this level. During AH admission, this proportion increased up to 38.6%, and after CGU admission decreased to 21.,9%. Factors related to prescription in AH were, being female, polypharmacy and osteoarticular-fracture related diagnosis, and in CGU, being female and polypharmacy.

CONCLUSIONS

The prevalence of benzodiazepine prescribing was high among elderly people at every healthcare level (community, AH and CGU), and polypharmacy was one of the significant factors associated with prescribing. This prescribing was increased during AH admission due to a medical or surgical process.

The pulsed to tonal strength parameter and its importance in characterizing and classifying Beluga whale sounds

A large number of the vocalization studies on mammals are based on time-frequency analysis of the produced sounds. The patterns, which are extracted from the time-frequency representations, determine the classification in the different sound categories. However, there are situations where this pattern related recognition does not allow a precise characterization of the vocalization to be obtained. In these situations, a feasible alternative, which can help by giving the dominant component of the sound, is to measure the strength of the tonal and pulsed constituent units. In this work, the use of a ratio of pulsed to tonal strength is proposed to objectively measure the distribution of energy between these two components. This pulsed to tonal ratio (PTR) can be computed with the aid of the discrete cosine transform. It is demonstrated that the PTR can be obtained with a relatively simple expression without having to go through the time- frequency representation. This work presents examples that show how the PTR can be used to distinguish between two very similar Beluga whale sounds and how to dynamically track the power distribution between the pulsed and tonal components in non-stationary signals.

[Changes in the incidence of falls in an intermediate and long-term care center]

INTRODUCTION

The characteristics of falls in older patients admitted to an institution in 2 different periods.

MATERIAL AND METHODS

We performed a prospective study of falls among inpatients admitted to an intermediate and long-term care center. Age, sex, Barthel index, main diagnoses, medication at the time of the fall, place, the shift when the fall occurred, lighting, characteristics of the floor, the use of walking aids and/or restraints, the kind of shoes worn, and activity at the moment of the fall were registered. During the first 2-year study period (period A), there were 332 beds (intermediate care and rehabilitation unit, long-term care unit, palliative care unit, psychogeriatric unit and assisted residential home). During the second 2-year period (period B), the palliative and intermediate care units were moved to another center (255 beds remaining).

RESULTS

Period A: there were 647 falls in 227 patients; the total number of patients admitted was 1387 (accumulated incidence of falls: 46.6%). Period B: there were 539 falls in 191 patients; the total number of patients admitted was 908 (accumulated incidence of falls: 59.3%). Significant differences between the two periods were found in age (79.8+/-10.6 versus 81.3 10.2) (p<0.02), the percentage of women (55.2% versus 66.4%) (p<0.001), neurological diagnoses (26.7% versus 36.1%) (p< 0.001), antidepressants (12.6% versus 16.4%), neuroleptics (10.3% versus 15.2%) (p<0.001), falls in the bedroom (39.7% versus 41.6%) (p<0.001), falls when moving from bed to chair (41.3% versus 30.8%) (p<0.001), and the use of walking aids (65.8% versus 40.5%) (p<0.001).

CONCLUSIONS

a) the incidence of falls increased in the second period of the study; b) in period A, risk factors for falls related to rehabilitation (moving from bed to chair, use of walking aids) were more frequent. In period B, risk factors related to the characteristics of psychogeriatric patients were predominant (neurological illness, use of psychotropic drugs, and c) the difference in the incidence of falls between the two study periods may be related to the distinct characteristics of the patients (case mix).

Functional decline after prolonged bed rest following acute illness in elderly patients: is trunk control test (TCT) a predictor of recovering ambulation?

Authors wanted to assess the predictive value of the trunk control test (TCT) on recovering ambulation in elderly patients who have developed walking disability. The study design was a prospective study performed in a hospital-based intermediate-care unit. Twenty-one patients (mean age 78.5+/-6.7 years) were investigated, who had developed walking disability after prolonged bed rest for an acute condition. A comprehensive geriatric assessment with functional status evaluation, based on the activities of daily living (ADL) (expressed as Barthel index=BI), and instrumental activities of daily living (IADL) (expressed as Lawton index=LI), cognitive function (Mini-Mental State Examination-Folstein=MMSE), depression (Geriatric Depression Scale=GDS) and comorbidity (Charlson comorbidity index=CCI) was performed within 72h after admission. A specialist in physical medicine and rehabilitation designed a rehabilitation program. TCT was performed in all patients before they started the program. The mean TCT score of the 21 patients was 52.7+/-22.9 (range: 0-100), while this score was 47.3+/-16.9 in the 15 patients who recovered ambulation, and 66.2+/-31.4 in the rest who did not (p=0.08). No statistically significant differences were observed either in subtotal scores of the TCT between groups. Furthermore, none of the TCT cutoff point was significantly associated with recovery. Cognitive function assessed by the MMSE was significantly better in patients who recovered, than in those who did not (23.4+/-3.9 vs. 17.8+/-5.2; p<0.02). Our conclusion is that TCT has not proved to be a predictor of recovering ambulation in elderly patients. In the present study, cognitive function was significantly associated with recovery after prolonged bed rest.

Blind detection of nonlinearities in multiple-echo ultrasonic signals

In this paper, we propose and analyze by means of simulations the use of surrogate data algorithms for blind detection of nonlinearities in multiple-echo ultrasonic signals. We assume a blind scheme so that no information about the input (emitted ultrasonic pulse) can be used. The metrics and equations that model some nonlinear situations are carefully reviewed. Also, closed form equations of the third-order metrics from a simplified second-order Volterra kernel are derived. Computer simulations show that the surrogate data technique is a potentially powerful tool for blind detection of nonlinearities in multiple-echo ultrasonic signals if adequate metrics are chosen. They also reveal interesting trade-offs among parameters that model ultrasonic systems and detection percentages.

Fetal cortisol response to intrauterine microbial colonisation identified by the polymerase chain reaction and fetal inflammation

OBJECTIVE

To determine the fetal cortisol response to intrauterine infection.

STUDY DESIGN

16s ribosomal RNA genes or the urease genes of Ureaplasma spp were identified by the polymerase chain reaction in intrauterine samples. Cord blood cortisol, interleukin 6 (IL6) and IL8 were measured in samples from 31 infants born at <32 weeks gestation.

RESULTS

13 infants (median gestation 30 weeks, birth weight 1350 g) had at least one positive intrauterine sample for microbial genes and 18 infants (31 weeks, 1320 g) did not. The cord blood cortisol concentration was significantly higher in fetuses exposed to intrauterine infection and significantly increased in fetuses/mothers presenting in preterm labour with intact membranes compared with infants delivered by elective prelabour caesarean section (p<0.05). The cord blood cortisol concentration was increased in the mothers with prelabour premature rupture of membranes but this was not significant compared with the caesarean section group. The cord blood cortisol concentration was significantly increased in the presence of chorioamnionitis or funisitis and was moderately correlated with cord blood IL6 (r = 0.64, p<0.01) and IL8 (r = 0.52, p<0.01).

CONCLUSIONS

In this study, cord blood cortisol was increased in the colonised group compared with non-colonised infants. It is unclear if infants born following prelabour premature rupture of the membranes mount an adequate anti-inflammatory response.

Using the Nottingham Health Profile (NHP) among older adult inpatients with varying cognitive function

BACKGROUND

High rates of missing, non-applicable items and insufficient reliability have been frequently reported as limitations of the generic Quality of Life questionnaires for older patients. The Nottingham Health Profile (NHP) might be more suitable as it contains easy to respond (yes/no) items covering moderate-to-severe health deterioration.

OBJECTIVES

To assess feasibility, reliability and validity of the NHP in disabled, older patients.

DESIGN

Cross-sectional study.

SETTING

Acute care hospital.

SUBJECTS

134 inpatients aged >or=65 with severe disability, abnormal cognitive function, or other persistent health problems precluding their discharge.

METHODS

The (interviewer-administered) NHP, Mini-Mental State Examination (MMSE), Barthel Index, and diagnostic information were recorded.

RESULTS

Completion rates varied from 98% of the 49 patients with normal cognition (MMSE >or=21) and 86.3% of the 51 with moderate cognitive impairment (MMSE 10-20), to 5.9% of the 34 with severe cognitive impairment (MMSE<10). Cronbach's alpha of the total NHP score was near 0.9 (0.82 and 0.87 for patients with MMSE >or= 21 and 10-20, respectively; p = 0.291). The correlation between 'Physical Mobility' of the NHP and Barthel Index was also similar in both cognitive groups (0.39 and 0.40).

CONCLUSION

Interviewer-administered NHP is suitable, reliable and valid, even in patients with moderate cognitive function.

Laterotrusive occlusal schemes and their effect on supra- and infrahyoid electromyographic activity

The objective of this study was to determine the effects of canine guidance and group function on supra- and infrahyoid electromyographic (EMG) activity. The sample included 40 healthy subjects, 20 with bilateral canine guidance and 20 with bilateral group function. Surface electrodes were used to record the integrated EMG (IEMG) activity of the left supra- and infrahyoid muscles during (1) grinding from intercuspal position to lateral edge-to-edge contact position (with canine guidance or group function), (2) static clenching in edge-to-edge lateral contact position with canine guidance or group function, and (3) grinding from lateral edge-to-edge contact position (with canine guidance or group function) to intercuspal position. IEMG activity in the suprahyoid or infrahyoid muscles was not significantly different with canine guidance or group function. Supra- and infrahyoid IEMG activity in condition 2 was significantly higher than in condition 3, which was significantly higher than in condition 1. Supra- and infrahyoid IEMG activity was not significantly different with canine guidance and group function. Supra- and infrahyoid IEMG activity during the static recording (clenching) was significantly higher than during the dynamic recordings (grinding). Activity during grinding from the lateral edge-to-edge contact position to the intercuspal position was higher than vice versa.

Breathing type and body position effects on sternocleidomastoid and suprahyoid EMG activity

The objective of this study was to determine the effects of breathing type and body position on sternocleidomastoid and suprahyoid electromyographic (EMG) activity. The sample included 18 subjects with upper costal breathing type (study group) and 15 subjects with costo-diaphragmatic breathing type (control group). All individuals had natural dentition and bilateral molar support. EMG recordings at rest and while swallowing saliva were carried out by placing surface electrodes on the left sternocleidomastoid and left suprahyoid muscles. EMG activity was recorded while standing, seated upright, and in the lateral decubitus position. Upper costal breathing type subjects showed a significantly higher suprahyoid EMG activity at rest than costo-diaphragmatic subjects in all body positions studied (mixed model with unstructured covariance matrix). In the lateral decubitus position, both breathing types showed a significantly higher sternocleidomastoid EMG activity at rest and while swallowing saliva. The suprahyoid muscles demonstrated a significantly higher EMG activity at rest as well as in the lateral decubitus position (mixed model with unstructured covariance matrix). These results are relevant because sternocleidomastoid and suprahyoid muscles play an important role in controlling the head posture and mandible dynamics. The neurophysiological mechanisms involved are discussed.