A prospective cohort study of healthcare visits and rehospitalizations after hospital discharge in community-acquired pneumonia

Background and objective: We aimed to identify the frequency of, reasons for and risk factors associated with additional healthcare visits and rehospitalizations (healthcare interactions) by patients with community-acquired pneumonia (CAP) within 30 days of hospital discharge. Methods: Observational analysis of a prospective cohort of adults hospitalized with CAP at a tertiary hospital (2007-2009). Additional healthcare interactions were defined as the visits to a primary care centre or emergency department and hospital readmissions within 30 days of discharge. Results: Of the 934 hospitalized patients with CAP, 282 (34.1%) had additional healthcare interactions within 30 days of hospital discharge: 149 (52.8%) needed an additional visit to their primary care centre and 177 (62.8%) attended the emergency department. Seventy-two (25.5%) patients were readmitted to hospital. The main reasons for additional healthcare interactions were worsening of signs or symptoms of CAP and new or worsening comorbid conditions independent of pneumonia, mainly cardiovascular and pulmonary diseases. The only independent factor associated with visits to primary care centre or emergency department was alcohol abuse (odds ratio [OR] = 1.65; 95% confidence interval [CI]: 1.03-2.64). Prior hospitalization (≤ 90 days) (OR = 2.47; 95% CI: 1.11-5.52) and comorbidities (OR = 3.99; 95% CI: 1.12-14.23) were independently associated with rehospitalization. Conclusions: Additional healthcare visits and rehospitalizations within 30 days of hospital discharge are common in patients with CAP. This is mainly due to a worsening of signs or symptoms of CAP and/or comorbid conditions. These findings may have implications for discharge planning and follow-up of patients with CAP.

A prospective cohort study of healthcare visits and rehospitalizations after hospital discharge in community-acquired pneumonia

Background and objective: We aimed to identify the frequency of, reasons for and risk factors associated with additional healthcare visits and rehospitalizations (healthcare interactions) by patients with community-acquired pneumonia (CAP) within 30 days of hospital discharge. Methods: Observational analysis of a prospective cohort of adults hospitalized with CAP at a tertiary hospital (2007-2009). Additional healthcare interactions were defined as the visits to a primary care centre or emergency department and hospital readmissions within 30 days of discharge. Results: Of the 934 hospitalized patients with CAP, 282 (34.1%) had additional healthcare interactions within 30 days of hospital discharge: 149 (52.8%) needed an additional visit to their primary care centre and 177 (62.8%) attended the emergency department. Seventy-two (25.5%) patients were readmitted to hospital. The main reasons for additional healthcare interactions were worsening of signs or symptoms of CAP and new or worsening comorbid conditions independent of pneumonia, mainly cardiovascular and pulmonary diseases. The only independent factor associated with visits to primary care centre or emergency department was alcohol abuse (odds ratio [OR] = 1.65; 95% confidence interval [CI]: 1.03-2.64). Prior hospitalization (≤ 90 days) (OR = 2.47; 95% CI: 1.11-5.52) and comorbidities (OR = 3.99; 95% CI: 1.12-14.23) were independently associated with rehospitalization. Conclusions: Additional healthcare visits and rehospitalizations within 30 days of hospital discharge are common in patients with CAP. This is mainly due to a worsening of signs or symptoms of CAP and/or comorbid conditions. These findings may have implications for discharge planning and follow-up of patients with CAP.

A prospective cohort study of healthcare visits and rehospitalizations after hospital discharge in community-acquired pneumonia

Background and objective: We aimed to identify the frequency of, reasons for and risk factors associated with additional healthcare visits and rehospitalizations (healthcare interactions) by patients with community-acquired pneumonia (CAP) within 30 days of hospital discharge. Methods: Observational analysis of a prospective cohort of adults hospitalized with CAP at a tertiary hospital (2007-2009). Additional healthcare interactions were defined as the visits to a primary care centre or emergency department and hospital readmissions within 30 days of discharge. Results: Of the 934 hospitalized patients with CAP, 282 (34.1%) had additional healthcare interactions within 30 days of hospital discharge: 149 (52.8%) needed an additional visit to their primary care centre and 177 (62.8%) attended the emergency department. Seventy-two (25.5%) patients were readmitted to hospital. The main reasons for additional healthcare interactions were worsening of signs or symptoms of CAP and new or worsening comorbid conditions independent of pneumonia, mainly cardiovascular and pulmonary diseases. The only independent factor associated with visits to primary care centre or emergency department was alcohol abuse (odds ratio [OR] = 1.65; 95% confidence interval [CI]: 1.03-2.64). Prior hospitalization (≤ 90 days) (OR = 2.47; 95% CI: 1.11-5.52) and comorbidities (OR = 3.99; 95% CI: 1.12-14.23) were independently associated with rehospitalization. Conclusions: Additional healthcare visits and rehospitalizations within 30 days of hospital discharge are common in patients with CAP. This is mainly due to a worsening of signs or symptoms of CAP and/or comorbid conditions. These findings may have implications for discharge planning and follow-up of patients with CAP.

Measuring school demand in the presence of spatial dependence. A conditional approach

Improving educational quality is an important public policy goal. However, its success requires identifying factors associated with student achievement. At the core of these proposals lies the principle that increased public school quality can make school system more efficient, resulting in correspondingly stronger performance by students. Nevertheless, the public educational system is not devoid of competition which arises, among other factors, through the efficiency of management and the geographical location of schools. Moreover, families in Spain appear to choose a school on the grounds of location. In this environment, the objective of this paper is to analyze whether geographical space has an impact on the relationship between the level of technical quality of public schools (measured by the efficiency score) and the school demand index. To do this, an empirical application is performed on a sample of 1,695 public schools in the region of Catalonia (Spain). This application shows the effects of spatial autocorrelation on the estimation of the parameters and how these problems are addressed through spatial econometrics models. The results confirm that space has a moderating effect on the relationship between efficiency and school demand, although only in urban municipalities.

Green tea catechin inhibits fatty acid synthase without stimulating carnitine Palmitoyltransferase-1 or inducing weight loss in experimental animals

Background: The enzyme fatty acid synthase (FASN) is highly expressed in many human carcinomas and its inhibition is cytotoxic to human cancer cells. The use of FASN inhibitors has been limited until now by anorexia and weight loss, which is associated with the stimulation of fatty acid oxidation. Materials and Methods: The in vitro effect of (-)-epigallocatechin-3-gallate (EGCG) on fatty acid metabolism enzymes, on apoptosis and on cell signalling was evaluated. In vivo, the effect of EGCG on animal body weight was addressed. Results: EGCG inhibited FASN activity, induced apoptosis and caused a marked decrease of human epidermal growth factor receptor 2 (HER2), phosphatidylinositol 3-kinase (PI3K)/AKT and extracellular (signal)-regulated kinase (ERK) 1/2 proteins, in breast cancer cells. EGCG did not induce a stimulatory effect on CPT-1 activity in vitro (84% of control), or on animal body weight in vivo (99% of control). Conclusion: EGCG is a FASN inhibitor with anticancer activity which does not exhibit cross-activation of fatty acid oxidation and does not induce weight loss, suggesting its potential use as an anticancer drug.

Cerimonial i prà ctica de govern a la cort dels virreis de Nà pols al segle XVII

[spa]Durante el primer tercio del siglo XVII la corte virreinal de Nápoles alcanzó un alto grado de desarrollo y madurez en su organización y su ceremonial. La prácticamente consecutiva aparición de dos importantes manuales de ceremonias, elaborados por dos ujieres mayores de los virreyes, Miguel Díez de Aux y Jusepe Renao, dan cuenta de la sofisticación ceremonial de que es protagonista una corte como la napolitana en el contexto de la monarquía hispánica de los Austrias. El segundo de estos textos, un elaborado manual de ceremonias compilado por Jusepe Renao, activo entre los años 1622 y 1637, es el punto de partida para una serie de consideraciones en torno al creciente interés por el ceremonial en ese preciso momento histórico.

Concentrar els à pats en 12 hores evita el sobrepès

L'obesitat és un dels principals factors de risc per a moltes patologies, com la diabetis de tipus II, la cirrosi no alcohòlica, les malalties cardiovasculars i diversos tipus de càncer. La major part de tractaments contra l'obesitat i de recomanacions per evitar el sobrepès se centren en la dieta, principalment en la quantitat i el contingut nutricional del menjar, i en el nombre d'àpats diaris. Però l'investigador Satchidananda Panda i els seus col·laboradors, del departament de gastroenterologia de la Universitat de Califòrnia a San Diego (EUA), han identificat un altre factor que és també molt important: el temps que passa entre el primer i l'últim àpat del dia. Segons han publicat a Cell Metabolism, aquest interval no hauria de superar les dotze hores.

Meditar és bo per al cervell

Sovint nosomconscients del plaer d'estar asseguts sense fer res, deixant vagar la ment en l'aquí i l'ara, sigui a laplatja, deixant-nos portar pel so de les onades; a lamuntanya, al costat d'un rierol, o simplementacasa.Nonomés és una experiència relaxant, que ens ajudaaequilibrar els pensaments després d'una jornada de treball i a retrobar-nos; si a més fem atenció als nostres pensaments, a algun objecte externoalanostraconsciència, estarem meditant. Etimològicament, meditació prové del llatí meditatio, que definia un tipus d'exercici intellectual. La utilitzem per descriure lapràctica d'un estat d'atenció concentrada, sigui sobreunobjecte extern, el nostrepensament,osimplement sobreel propi estat de concentració.

En què creu el nostre cervell?

Un dels monuments més vistos pels turistes que van a Barcelona és la Sagrada Família. No és excepció: qualsevol lloc que visitem sens dubte amaga un monument religiós digne de ser vist: el monestir d'El Escorial; el Sagrat Cor de París; els temples hindús d'Ellora; l'estupa budista de Boudhanath a Kàtmandu; el mur de les Lamentacions i la mesquita d'Al-Aqsa a Jerusalem... Per què totes les cultures han tingut i tenen creences religioses, al marge de l'aparent augment de persones que es declaren agnòstiques o atees? És només una construcció cultural o el nostre cervell hi té alguna cosa a veure? I si fos així, tenir creences religioses té algun valor adaptatiu?

Què hereta el cervell

Tots els animals tenen un sistema nerviós que els relaciona amb l'entorn, però el cervell humà no té parió. No només percebem l'entorn i som capaços de veure, per exemple, com surt el sol, sinó que a diferència de tota la resta d'ani- mals som capaços de percebre i gaudir de tota la bellesa d'aquesta explosió de llum i color. Tampoc no som els únics que vivim en societats organitzades, però la complexitat i la varietat de la nostra és infinitament superior. Ens comuni- quem amb els nostres congèneres, com d'una manera o una altra fan tots els mamífers, però el nostre llenguatge és capaç de crear també poesia. I colpegem pedres i pals, com la resta de primats, però les nostres mans, guiades pel cervell, també són capaces de crear obres d'art magnífiques. I raonem, som conscients de la nostra pròpia existència i hem fet florir les cultures més variades. El nostre comportament, i fins i tot la nostra forma de pensar i de percebre el món, vénen determinats per l'activitat del cervell i per anys d'evolució [...]

Els secrets de la neuroeconomia

A l'inici de la crisi financera actual (2008), la situació econòmica dels EUA s'enfonsava per la caiguda en la despesa dels consumidors d'un 6,2% el quart trimestre del 2008, xifra que va superar els càlculs del 3,8% del Govern i els del 5,4% dels analistes. L'ús de més dades objectives va reduir, però no va suprimir, l'error d'aquests. Aquell mateix any a Espanya les xifres d'atur es disparaven molt per sobre del que havia previst el Govern. El 2009, ni l'evidència constant de l'augment progressiu d'aquest no va poder canviar el discurs governamental obstinat que l'atur no arribaria a taxes tan elevades. De forma similar opera el cervell econòmic, un conjunt complex de xarxes neuronals que s'encarreguen de prendre decisions i del processament de la informació emocional i motivacional. Fins i tot amb dades reals a la seva disposició, és incapaç de no deixar-se portar per les seves pròpies expectatives [...]

Futbol, hormones a l'atac

L'esport rei mou milions de persones, com s'està veient aquest mes amb motiu de l'Eurocopa i com passa amb qualsevol gran partit. L'últim Barça-Madrid, per exemple, el van veure més de 14 milions d'espectadors a Espanya, gairebé un 30% de la població espanyola, i uns 400 milions d'espectadors a tot el món, el 5% de tota la població mundial. Per fer-nos una idea comparativa, l'última edició dels Oscar va aconseguir reunir davant de la pantalla gairebé 40 milions de nord-americans, cosa que representa només el 13% de la població d'aquest país. Hi ha qui opina que l'enorme interès i passió que desperten els esports d'equip, especialment el futbol, són exagerats; que es tracta de fenòmens acaparadors i mediàtics, i que l'incombustible recital de fons dels comentaristes esportius els diumenges a la tarda en la majoria d'emissores radiofòniques és realment antipàtic. Tanmateix, el cert és que el futbol agrada a molta gent, mou grans sumes de diners i desperta potents emocions. No hi ha dubte que constitueix un gran espectacle. Per què hi ha aquest interès gairebé universal pel futbol? A part d'aspectes culturals que emfatitzen l'atracció que sentim per aquest esport espectacle, quin és l'origen bàsic de la passió per les confrontacions esportives? Què li passa al cervell quan un juga un partit o el mira? [...]