Changes in Nutritional and Functional Status in Longer Stay Patients Admitted to a Geriatric Evaluation and Management Unit

OBJECTIVES

Malnutrition and functional decline are common in older inpatients admitted to subacute care settings. However the association between changes in nutritional status and relevant functional outcomes remains under-researched. This study examined changes in nutritional status, function and mobility in patients admitted to a Geriatric Evaluation and Management (GEM) unit who had a length of stay (LOS) longer than 21 days.

DESIGN

A prospective, observational study.

SETTING

Two GEM units at St Vincent's Hospital Melbourne, Australia.

PARTICIPANTS

Patients admitted to the GEM units who stayed longer than 21 days were included in the study.

MEASUREMENTS

Patients were assessed on admission and prior to discharge using the Subjective Global Assessment (SGA), Functional Independence Measure (FIM) motor domain and the Modified Elderly Mobility Scale (MEMS).

RESULTS

Fifty-nine patients (Mean age 84.0 ± 7 years) met the required length of stay and were included in the study. Fifty-four per cent (n=32) were malnourished on admission (SGA B/C) and 44% (n=26) were malnourished on discharge. Twenty-two per cent (n=13) improved SGA category, 75% remained stable (n=44) and 3% deteriorated (n=2) from admission to discharge. Total Motor FIM scores significantly increased from admission to discharge in both the improved (p<0.001) and stable or deteriorated (p<0.001) nutritional status groups. Subjects who improved in nutritional status had a significantly higher MEMS score at discharge (p<0.001).

CONCLUSION

On admission to the GEM unit, just over half the included patients were rated as malnourished defined by SGA category. Nearly one quarter of the sample had improved their nutritional status at the time of discharge. Improvement in nutritional status was associated with greater improvement in mobility scores. Further studies are required to investigate the effectiveness of nutrition interventions, which will inform models of care aiming to optimise nutritional, functional, and associated clinical outcomes in patients admitted to GEM units.

Forensic investigation of submersion deaths

CONTEXT

The diagnosis of the cause and the establishment of the manner of death in submersion cases are routine challenge for forensic pathologists as it presents considerable diagnostic difficulties.

OBJECTIVE

To concisely review the main questions during a submersion death investigation and to give the respective documented answers.

DATA SOURCES

The search strategy included a literature search of PubMed, Medline and Google Scholar databases, as well as a review of the cited references by the identified studies and a hand search of relevant textbooks and reference works.

CONCLUSIONS

A complete autopsy, histopathological examination and full toxicological screening are important to determine whether death indeed followed submersion in the water, or to see whether any natural disease or substance use have contributed or caused death. In ambiguous situations, the co-estimation of circumstantial evidence may be of invaluable importance toward the conclusion concerning the cause and the manner of death. The thorough forensic investigation of the submersion deaths not only serves the justice administration, but it also presents considerable benefits for the public health.

Knowledge and attitudes to sun exposure among adolescents in Korinthos, Greece

INTRODUCTION

Extended sun exposure may lead to serious health problems, and evidence of this is in the increase in skin cancer and malignant melanoma worldwide. Extended sun exposure during childhood or adolescence increases the probability of skin cancer in adulthood. The aim of the study was to identify and examine the knowledge, attitude, behaviour and beliefs of Greek adolescents (high school students) related to sun exposure and its adverse effects on health. The majority of participants (89.7%) were of Greek nationality.

METHODS

The study took place in 5 schools in the prefecture of Korinthos, and 816 of the total 925 students aged 15-18 years participated. The questionnaire was pilot tested and assessed for validity and reliability, both of which were adequate (Cronbach's alpha = 0.70 and r(s) = 0.78); SPSS 13.0 software was used for analysis.

RESULTS

Only 37.9% of participants knew that melanoma was a type of skin cancer; 50% said they did not know what melanoma was. Regarding behavior, 35.5% reported that during the last summer they went to the beach on 20 to 50 occasions, and only 50% reported that they wore a sunhat or stayed in the shade. The frequency of sunscreen use was alarmingly low, with the majority of the adolescents unfamiliar with its proper use, and 50% not using a sunscreen with sufficient sun protection factor. Television was an important source of information about protection from sun exposure, while the family was the most important provider of advice.

CONCLUSIONS

Participants' knowledge of sun exposure was insufficient and they reported risky behaviours in the summer months. Despite health promotion and community education programs focusing on sun smart strategies, these young people still associated suntans with beauty. Health promotion and education programs need to challenge such beliefs. However, as a sole approach to health promotion, teaching protective measures and appropriate ways for youth to protect themselves against the harmful effects of sunbathing may be insufficient to reduce the epidemic of skin cancer.

Poor hypertension control in Greek patients with diabetes in rural areas. The VANK study in primary care

INTRODUCTION

This study aimed to determine hypertension prevalence and levels of awareness, treatment and control of hypertension among diabetic patients using data from the VANK study.

METHODS

The sample consisted of 221 men and women (122/99) diagnosed with type 2 diabetes. Semi-structured interviews were conducted with all participants. Controlled hypertension definition was based on having a systolic blood pressure (BP) of <130 mmHg and diastolic BP of <85 mmHg in subjects taking antihypertensive medications.

RESULTS

The mean +/- SD BP was 141.6 +/- 17.4 mmHg and 81.2 +/- 9.4 mmHg for systolic and diastolic BPs, respectively. Systolic and diastolic BP was higher in men than in women. The overall prevalence of hypertension was 194/221 (87.7%). In total, 34.1% of patients (66/194) were not aware of having hypertension. Of those who were aware of having hypertension (n = 128, 65.9%), all were treated. Among those treated, only 11 persons (11/194, 5.6%) had systolic BP <130 mmHg and diastolic BP <85 mmHg. Sixty-two (38.7%) had systolic BP <140 mmHg and diastolic BP <90 mmHg.

CONCLUSION

Although all of the diagnosed hypertensive patients (n = 128) received antihypertensive drug therapy, in only 8.6% (11/128) the treatment was effective (BP <130/85 mmHg). Translating our findings into clinical practice, there is a need for aggressive treatment of hypertension from primary care physicians, as well as regular surveillance to detect developing hypertension in diabetic patients.

Smoking habits and associated factors among Greek physicians

OBJECTIVE

To investigate the smoking habits and associated risk factors among Greek physicians.

STUDY DESIGN

Cross-sectional survey of a randomly selected sample of Greek physicians.

METHODS

A national sample of 1284 physicians (718 men, 566 women) participated in the study, which was conducted between September 2003 and June 2005. Data were collected through an anonymous self-completed questionnaire. Logistic regression was used to analyse the influence of different factors on the probability of a physician being a current or former smoker.

RESULTS

Overall, 38.6% of the physicians (40% of men; 37% of women) currently smoked, 13.8% were former smokers, and 47.6% had never smoked. Eighty-three per cent of smokers reported starting smoking before the age of 25 years, with half of them during medical school (aged 19-24 years). Multivariate analyses revealed that physicians who were male, unmarried, divorced or widowed, surgeons or anaesthetists, and residents were more likely to be current smokers. Former smokers were more likely to be older, male and born in a rural area. Moreover, the odds of being a current or former smoker were significantly higher among physicians with a history of parents who smoked. The proportion of physicians who reported counselling patients (often or always) to stop smoking was lower among current smokers compared with those who never smoked or those who were former smokers (74.4% vs. 85.3% vs. 84.7%, P<0.0001).

CONCLUSIONS

The prevalence of smoking among Greek physicians is exceedingly high and similar to that of the general population. More effective interventions that reduce smoking in the medical community should be implemented immediately so that physicians will be better able to fulfil their function as role models for the general population.

Low prevalence of hepatitis C virus infection in Greek diabetic patients

AIM

To assess the prevalence of hepatitis C virus (HCV) among Greek patients with Type 1 and 2 diabetes mellitus (DM), in view of the previous reports of high prevalence, particularly in patients with elevated aminotransferase.

METHODS

We checked 423diabetic patients (183 male, 240 female, mean age: 63 years) attending our unit, recording epidemiology data, diabetes history, treatment and classification. Patients were stratified by aminotransferase values (normal or elevated). HCV screening was performed using standard techniques. Statistical analysis was done by using the Student's t-test for continuous variables and chi-square (chi2) for categorical data.

RESULTS

Antibodies against HCV (anti-HCV) were detected in seven out of 423 diabetic patients (prevalence 1.65%). There was no correlation between HCV titre and diabetes type, duration, treatment, obesity (body mass index, BMI) or glycaemic control (HbA1c). The only correlation was elevated aminotransferase values (P<0.01) Among the established risk factors for HCV transmission, only history of previous transfusion was significant (P < 0.001).

CONCLUSIONS

It remains a strong hypothesis that diabetic patients are at increased HCV infection risk, yet our findings in Greek diabetic patients were rather low. Further studies, possibly multicentre, are needed to estimate prevalence and address the question of whether a direct effect of HCV in diabetes development does actually exist.