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Riba-Llena I.,Autonomous University of Barcelona | Nafria C.,Autonomous University of Barcelona | Filomena J.,Parc Sanitari Pere Virgili | Tovar J.L.,Nephrology Service | And 7 more authors.
Journal of Cerebral Blood Flow and Metabolism | Year: 2016

High blood pressure accelerates normal aging stiffness process. Arterial stiffness (AS) has been previously associated with impaired cognitive function and dementia. Our aims are to study how cognitive function and status (mild cognitive impairment, MCI and normal cognitive aging, NCA) relate to AS in a community-based population of hypertensive participants assessed with office and 24-hour ambulatory blood pressure measurements. Six hundred ninety-nine participants were studied, 71 had MCI and the rest had NCA. Office pulse pressure (PP), carotid-femoral pulse wave velocity, and 24-hour ambulatory PP monitoring were collected. Also, participants underwent a brain magnetic resonance to study cerebral small-vessel disease (cSVD) lesions. Multivariate analysis-related cognitive function and cognitive status to AS measurements after adjusting for demographic, vascular risk factors, and cSVD. Carotid-femoral pulse wave velocity and PP at different periods were inversely correlated with several cognitive domains, but only awake PP measurements were associated with attention after correcting for confounders (beta = 0.22, 95% confidence interval (CI) 0.41, 0.03). All ambulatory PP measurements were related to MCI, which was independently associated with nocturnal PP (odds ratio (OR) = 2.552, 95% CI 1.137, 5.728) and also related to the presence of deep white matter hyperintensities (OR = 1.903, 1.096, 3.306). Therefore, higher day and night ambulatory PP measurements are associated with poor cognitive outcomes. © The Author(s) 2015. Source


Cobo M.R.,Parc Sanitari Pere Virgili | Egea P.T.,University of Barcelona | Gaju R.T.,Generalitat de Catalonia
Index de Enfermeria | Year: 2015

Nowadays, in the region on Catalonia, there is an opportunity to reform social and health care model in the medium term care hospitals in order to protect and improve the quality of care and its sustainability. Due to financial crisis and limited resources in providing health care attention, nurse managers can focus to analyze their particular government practices in the organizations. So, nurse managers can explore theory of governability in their centre: guarantee transparency, accountability, place in a structure of acute hospitals, and role respecting stakeholders interests. Furthermore, all these principles exposed can be explored, measured and compared their results with level of nursing quality care in the medium term care hospitals in Catalonia. © 2015 Fundación Index. Source


Odden M.C.,Oregon State University | Yee L.M.,University of Washington | Arnold A.M.,University of Washington | Sanders J.L.,University of Pittsburgh | And 6 more authors.
Journal of the American Geriatrics Society | Year: 2014

Objectives To determine the contribution of gradations of subclinical vascular disease (SVD) to the likelihood of longer survival and to determine what allows some individuals with SVD to live longer. Design Cohort study. Setting Cardiovascular Health Study. Participants Individuals born between June 30, 1918, and June 30, 1921 (N = 2,082; aged 70-75 at baseline (1992-93)). Measurements A SVD index was scored as 0 for no abnormalities, 1 for mild abnormalities, and 2 for severe abnormalities on ankle-arm index, electrocardiogram, and common carotid intima-media thickness measured at baseline. Survival groups were categorized as 80 and younger, 81 to 84, 85 to 89, and 90 and older. Results A 1-point lower SVD score was associated with 1.22 greater odds (95% confidence interval = 1.14-1.31) of longer survival, independent of potential confounders. This association was unchanged after adjustment for intermediate incident cardiovascular events. There was suggestion of an interaction between kidney function, smoking, and C-reactive protein and SVD; the association between SVD and longer survival appeared to be modestly greater in persons with poor kidney function, inflammation, or a history of smoking. Conclusion A lower burden of SVD is associated with longer survival, independent of intermediate cardiovascular events. Abstinence from smoking, better kidney function, and lower inflammation may attenuate the effects of higher SVD and promote longer survival. © 2014, The American Geriatrics Society. Source


Rodriguez-Pardo D.,Hospital Universitari Vall dHebron | Almirante B.,Hospital Universitari Vall dHebron | Bartolome R.M.,Hospital Universitari Vall dHebron | Pomar V.,Hospital de la Santa Creu i Sant Pau | And 9 more authors.
Journal of Clinical Microbiology | Year: 2013

Prospective hospital-based surveillance for Clostridium difficile-associated disease (CDAD) was conducted in Barcelona (Spain) to describe the epidemiology of this condition and investigate the risk factors for an unfavorable outcome. All patients diagnosed with CDAD during 2009 were included. Using logistic regression modeling, we analyzed the potential risk factors associated with recurrent and complicated CDAD, defined as a need for colectomy or death within 30 days. There were 365 episodes of CDAD, yielding an incidence of 22.5 cases/105 person-years, 1.22 cases/103 hospital discharges, and 1.93 cases/104 patient-days. The main PCR ribotypes identified were 241 (26%), 126 (18%), 078 (7%), and 020 (5%). PCR ribotype 027 was not detected. Among the 348 cases analyzed, 232 (67%) patients were cured, 63 (18%) had a recurrence of CDAD, and 53 (15%) developed complicated CDAD. Predictors of complicated CDAD were continued use of antibiotics following CDAD diagnosis (odds ratio [OR], 2.009; 95% confidence interval [CI], 1.012 to 3.988; P=0.046), Charlson comorbidity index score (OR, 1.265; 95% CI, 1.105 to 1.449; P=0.001), and age (OR, 1.028; 95% CI, 1.005 to 1.053; P=0.019). A leukocyte count of>15×103 cells/ml (OR, 2.277; 95% CI, 1.189 to 4.362; P=0.013), continuation of proton pump inhibitor (PPI) use after CDAD diagnosis (OR, 2.168; 95% CI, 1.081 to 4.347; P=0.029), and age (OR, 1.021; 95% CI, 1.001 to 1.041; P=0.036) were independently associated with higher odds of recurrence. The incidence of CDAD in Barcelona during 2009 was on the lower end of the previously described range for all of Europe. Our analysis suggests that the continuation of non-C. difficile antibiotics and use of PPIs in patients diagnosed with CDAD are associated with unfavorable clinical outcomes. Copyright © 2013, American Society for Microbiology. Source


Escarrabill J.,Hospital Clinic | Cleries X.,Parc Sanitari Pere Virgili | Sarrado J.J.,Institute Destudis Of La Salut
Atencion Primaria | Year: 2015

Aim To determine the relevance level of non-technical skills of those professionals dedicated to the healthcare of patients with chronic diseases, from an analysis of home care professionals. Design Quantitative and qualitative research conducted in 2 phases: 1. st from November 2010 to March 2011 and 2. nd from December 2012 to August 2013. Setting Health Region of Barcelona city. Participants During the 1. st phase, 30 professionals from homecare teams (3 from Primary Care and 3 from Hospitals). In 2. nd phase, 218 professionals from 50 Primary Healthcare Centres and 7 home care programmes. Method Purposive sampling in was used in the1st phase, and randomized sampling in the 2. nd phase. Likert scales and focus group were used. Results A total of 19 skill categories were identified in the 1. st phase. In the 2. nd phase 3 metacategories were established: comprehensive patient-centered care, interprofessional organization, and inter-health care fields and interpersonal skills. Conclusions It is necessary to improve and secure the professionals relationships between levels of healthcare, continuity of healthcare, biopsychosocial model and holistic attention to patients and relatives, looking at emotions, expectations, feelings, beliefs and values. It is essential to design and implement continuing training in transferable skills in every healthcare centre, through active methodologies. © 2013 Elsevier España, S.L.U. All rights reserved. Source

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