Association Between Hemodynamic Profile, Physical Capacity and Quality of Life in Pulmonary Hypertension

Background: No studies have described and evaluated the association between hemodynamics, physical limitations and quality of life in patients with pulmonary hypertension (PH) without concomitant cardiovascular or respiratory disease. Objective: To describe the hemodynamic profile, quality of life and physical capacity of patients with PH from groups I and IV and to study the association between these outcomes. Methods: Cross-sectional study of patients with PH from clinical groups I and IV and functional classes II and III undergoing the following assessments: hemodynamics, exercise tolerance and quality of life. Results: This study assessed 20 patients with a mean age of 46.8 ± 14.3 years. They had pulmonary capillary wedge pressure of 10.5 ± 3.7 mm Hg, 6-minute walk distance test (6MWDT) of 463 ± 78 m, oxygen consumption at peak exercise of 12.9 ± 4.3 mLO2.kg-1.min-1 and scores of quality of life domains < 60%. There were associations between cardiac index (CI) and ventilatory equivalent for CO2 (r=-0.59, p <0.01), IC and ventilatory equivalent for oxygen (r=-0.49, p<0.05), right atrial pressure (RAP) and 'general health perception' domain (r=-0.61, p<0.01), RAP and 6MWTD (r=-0.49, p<0.05), pulmonary vascular resistance (PVR) and 'physical functioning' domain (r=-0.56, p<0.01), PVR and 6MWTD (r=-0.49, p<0.05) and PVR index and physical capacity (r=-0.51, p<0.01). Conclusion: Patients with PH from groups I and IV and functional classes II and III exhibit a reduction in physical capacity and in the physical and mental components of quality of life. The hemodynamic variables CI, diastolic pulmonary arterial pressure, RAP, PVR and PVR index are associated with exercise tolerance and quality of life domains.

Depression as a Clinical Determinant of Dependence and Low Quality of Life in Elderly Patients with Cardiovascular Disease

Background:The aging process promotes a progressive increase in chronic-degenerative diseases. The effect of these diseases on the functional capacity has been well recognized. Another health parameter concerns “quality of life related to health”. Among the elderly population, cardiovascular diseases stand out due to the epidemiological and clinical impact. Usually, these diseases have been associated with others. This set of problems may compromise both independence and quality of life in elderly patients who seek cardiologic treatment. These health parameters have not been well contemplated by cardiologists.Objective:Evaluating, among the elderly population with cardiovascular disease, which are the most relevant clinical determinants regarding dependence and quality of life.Methods:This group was randomly and consecutively selected and four questionnaires were applied: HAQ, SF-36, PRIME-MD e Mini Mental State.Results:The study included 1,020 elderly patients, 63.3% women. The group had been between 60 and 97 years-old (mean: 75.56 ± 6.62 years-old). 61.4% were independent or mild dependence. The quality of life total score was high (HAQ: 88.66 ± 2.68). 87.8% of patients had a SF-36 total score > 66. In the multivariate analysis, the association between diagnoses and high degrees of dependence was significant only for previous stroke (p = 0.014), obesity (p < 0.001), lack of physical activity (p = 0.016), osteoarthritis (p < 0.001), cognitive impairment (p < 0.001), and major depression (p < 0.001). Analyzing the quality of life, major depression and physical illness for depression was significantly associated with all domains of the SF-36.Conclusion:Among an elderly outpatient cardiology population, dependence and quality of life clinical determinants are not cardiovascular comorbidities, especially the depression.

Reproducibility and Reliability of the Quality of Life Questionnaire in Patients With Atrial Fibrillation

Abstract Background: Studies have shown the impact of atrial fibrillation (AF) on the patients' quality of life. Specific questionnaires enable the evaluation of relevant events. We previously developed a questionnaire to assess the quality of life of patients with AF (AFQLQ version 1), which was reviewed in this study, and new domains were added. Objective: To demonstrate the reproducibility of the AFQLQ version 2 (AFQLQ v.2), which included the domains of fatigue, illness perception and well-being. Methods: We applied 160 questionnaires (AFQLQ v.2 and SF-36) to 40 patients, at baseline and 15 days after, to measure inter- and intraobserver reproducibility. The analysis of quality of life stability was determined by test-retest, applying the Bartko intraclass correlation coefficient (ICC). Internal consistency was assessed by Cronbach's alpha test. Results: The total score of the test-retest (n = 40) had an ICC of 0.98 in the AFQLQ v.2, and of 0.94 in the SF36. In assessing the intra- and interobserver reproducibility of the AFQLQ v.2, the ICC reliability was 0.98 and 0.97, respectively. The internal consistency had a Cronbach's alpha coefficient of 0.82, compatible with good agreement of the AFQLQ v.2. Conclusion: The AFQLQ v.2 performed better than its previous version. Similarly, the domains added contributed to make it more comprehensive and robust to assess the quality of life of patients with AF.

Production and quality of cotton fibers in relation to solar radiation

The present paper refers to a research work carried out at the Dept. of Agriculture and Horticulture of ESALQ, University of São Paulo, in Piracicaba, State of São Paulo (latitude 22º42'S, longitude 47º33' WG and altitude 546 m). Sowing at different times and using artificial cover, an attempt was made to evaluate the behavior of cultivar IAC 17 of cotton (Gossypium hirsutum L.) as to production and quality of fiber relating to incident solar radiation. Incident solar radiation, as well as insolation during the trial period, were tabulated and compared with yelds and agricultural and technological characters of fibers. The treatment under cover showed a mean level of incident solar radiation equivalent to less than 20% of that at clear sky, causing a decrease in cotton production and in the agricultural and technological characters of fibers.

Effects of environment on quality of tomato transplanting plants

In order to study the effects of shading and unshading combined with N fertilizing on tomato transplanting plants, an experiment in greenhouse conditions was carried on. It was concluded that N is important to produce healthy and strong plants. Under shading plus N fertilization, plants are taller and have high nitrate contents, while under unshading plus N fertilization, plants have higher diameter and more developed root system.

Microbial spoilage and quality of marinated dark, firm, dry meat

Estudi elaborat a partir d’una estada al Royal Veterinary and Agricultural University of Denmark entre els mesos de Març a Juny del 2006. S’ha investigat l’efecte dels envasats amb atmosferes modificades (MAP), així com la marinació amb vi tint, sobre l’evolució de la contaminació bacteriològica de carns fosques, dures i seques (DFD). Les carns DFD es troben a les canals d’animals que, abans del sacrifici, han estat exposades a activitats musculars prolongades o estrès. Les carns DFD impliquen importants pèrdues econòmiques degut a la contaminació bacteriològica i als problemes tecnològics relacionats amb la alta capacitat de retenció d’aigua. A més a més, és crític per la indústria investigar la diversitat de la contaminació bacteriana, identificar les espècies bacterianes i controlar-les. Però és difícil degut a la inhabilitat per detectar algunes bactèries en medis coneguts, les interaccions entre elles, la complexitat dels tipus de contaminació com són aigua, terra, femtes i l’ambient. La Polymerasa chain reaction- Denaturating Electrophoresis Gel (PCR-DGEE ) pot sobrepassar aquests problemes reflectint la diversitat microbial i les espècies bacterianes. Els resultants han indicat que la varietat bacteriana de la carn incrementava amb els dies d’envasat independentment del mètode d’envasat, però decreixia significativament amb el tractament de marinació amb vi tint. La DGEE ha mostrat diferències en les espècies trobades, indicant canvis en la contaminació bacteriana i les seves característiques en la carn DFD sota els diferents tractaments. Tot i que la marinació és una bona alternativa i solució a la comercialització de carn DFD , estudis de seqüenciació són necessaris per identificar les diferents tipus de bactèries.

Production and carcass quality of ten beef cattle breeds of the southwest of Europe

A sample of about 70 young bulls of each of ten beef cattle breeds reared in their typical production systems has been studied regarding growth and carcass quality traits. Breeds included were Asturiana de los Valles (AV), Asturiana de la Montaña (AM), Avileña-Negra Ibérica (A-NI), Bruna dels Pirineus (BP), Morucha (Mo), Pirenaica (Pi) and Retinta (Re) from Spain, and Aubrac (Au), Gasconne (Ga) and Salers (Sal) from France. There existed large differences between breeds and also within breeds. AV and Pi were the breeds with more muscle and less fat, whereas A-NI, Mo and Re were in the opposite side. BP and AM occupied an intermediate position. This allows to classify the Spanish breeds in three groups: AV and Pi would belong to the group of late maturity, A-NI, Mo and Re, would be early maturing breeds, whereas BP and AM, despite the small size of the last, will be of intermediate maturity. In the French populations, Au was the breed with the highest carcass weight and Ga exhibited the lowest. Sal occupied an intermediate position, showing the longer and thinner thigh. In a wide range of carcass weight, the general relationships among carcass traits have been confirmed. Animals with the better conformation were also the leaner and longer carcasses tended to be lowly associated with a poorer conformation and fatter carcasses. Bone content was clearly opposed to carcass conformation and muscle content and was associated with longer carcasses

Meat quality of ten cattle breeds of the Southwest of Europe

A sample of about 70 young bulls of each of ten beef cattle breeds reared in their typical production systems has been characterised with respect to meat quality traits. Breeds included were Asturiana de los Valles, Asturiana de la Montaña, Avileña-Negra Ibérica, Bruna dels Pirineus, Morucha, Pirenaica and Retinta from Spain, and Aubrac, Gasconne and Salers from France. As was previously showed regarding carcass traits, there exist large differences both between and within breed – systems. In general, rustic breeds tended to present darker and redder meats with higher haematin contents, whereas less precocious and more specialised breeds showed brighter meats with bigger water losses. Protein content was similar, whereas intramuscular fat presented the larger variations both between and within breeds. ICDH content was higher in the more rustic breeds, showing the predominantly oxidative character of their fibres. Texture measurements showed in general large within breed-system variations, the differences between breeds being less evident. Within breed-system, daily gain weight was positively associated with brighter and tender meats. In the range studied, increasing slaughter weight within breed did not have influence on meat quality. Conformation was related to lower water holding capacity and less dry matter and intramuscular fat, as well as to a lower haematin content giving brighter meats. The increase in fatness scores was related to an augment of toughness in meat specialised breeds, although in Avileña-Negra Ibérica breed fatness carcasses were related to more tender meats. Redness parameter a* was positively related to fatter animals and opposed to conformation, the opposite being true for the L* (lightness) parameter. There was a small trend of fatter carcasses to be related to oxidative fibres, whereas the muscular fibres of the more conformed carcasses were more glycolytic. Texture measurements maximum load, maximum stress and toughness were very closely related. Shear force was opposed to tenderness. Losses at cooking were opposed to juiciness, but only in the Spanish breeds. No consistent trends regarding relationships between carcass characteristics and tenderness could be observed. Overall acceptability was primarily related with tenderness and flavour, and later on juiciness.

Bioluminescent sensor proteins for point-of-care therapeutic drug monitoring.

For many drugs, finding the balance between efficacy and toxicity requires monitoring their concentrations in the patient's blood. Quantifying drug levels at the bedside or at home would have advantages in terms of therapeutic outcome and convenience, but current techniques require the setting of a diagnostic laboratory. We have developed semisynthetic bioluminescent sensors that permit precise measurements of drug concentrations in patient samples by spotting minimal volumes on paper and recording the signal using a simple point-and-shoot camera. Our sensors have a modular design consisting of a protein-based and a synthetic part and can be engineered to selectively recognize a wide range of drugs, including immunosuppressants, antiepileptics, anticancer agents and antiarrhythmics. This low-cost point-of-care method could make therapies safer, increase the convenience of doctors and patients and make therapeutic drug monitoring available in regions with poor infrastructure.

Validation of the IMPACT-III quality of life questionnaire in Swiss children with inflammatory bowel disease.

BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) frequently manifests during childhood and adolescence. For providing and understanding a comprehensive picture of a patients' health status, health-related quality of life (HRQoL) instruments are an essential complement to clinical symptoms and functional limitations. Currently, the IMPACT-III questionnaire is one of the most frequently used disease-specific HRQoL instrument among patients with IBD. However, there is a lack of studies examining the validation and reliability of this instrument. METHODS: 146 paediatric IBD patients from the multicenter Swiss IBD paediatric cohort study database were included in the study. Medical and laboratory data were extracted from the hospital records. HRQoL data were assessed by means of standardized questionnaires filled out by the patients in a face-to-face interview. RESULTS: The original six IMPACT-III domain scales could not be replicated in the current sample. A principal component analysis with the extraction of four factor scores revealed the most robust solution. The four factors indicated good internal reliability (Cronbach's alpha=.64-.86), good concurrent validity measured by correlations with the generic KIDSCREEN-27 scales and excellent discriminant validity for the dimension of physical functioning measured by HRQoL differences for active and inactive severity groups (p<.001, d=1.04). CONCLUSIONS: This study with Swiss children with IBD indicates good validity and reliability for the IMPACT-III questionnaire. However, our findings suggest a slightly different factor structure than originally proposed. The IMPACT-III questionnaire can be recommended for its use in clinical practice. The factor structure should be further examined in other samples.

Diabetes care in Switzerland: good, but perfectible: a population-based cross-sectional survey.

BACKGROUND: While Switzerland invests a lot of money in its healthcare system, little is known about the quality of care delivered. The objective of this study was to assess the quality of care provided to patients with diabetes in the Canton of Vaud, Switzerland. METHODS: Cross-sectional study of 406 non-institutionalized adults with type 1 or 2 diabetes. Patients' characteristics, diabetes and process of care indicators were collected using a self-administered questionnaire. Process indicators (past 12 months) included HbA1C check among HbA1C-aware patients, eye assessment by ophtalmologist, microalbuminuria check, feet examination, lipid test, blood pressure and weight measurement, influenza immunization, physical activity recommendations, and dietary recommendations. Item-by-item (each process of care indicator: percentage of patients having received it), composite (mean percentage of recommended care: sum of received processes of care / sum of possible recommended care), and all-or-none (percentage of patients receiving all specified recommended care) measures were computed. RESULTS: Mean age was 64.4 years; 59% were men. Type 1 and type 2 diabetes were reported by 18.2% and 68.5% of patients, respectively, but diabetes type remained undetermined for almost 20% of patients. Patients were treated with oral anti-diabetic drugs (50%), insulin (23%) or both (27%). Of 219 HbA1C-aware patients, 98% reported ≥ one HbA1C check during the last year. Also, ≥94% reported ≥ one blood pressure measurement, ≥ one weight measurement or lipid test, and 68%, 64% and 56% had feet examination, microalbuminuria check and eye assessment, respectively. Influenza immunization was reported by 62% of the patients.The percentage of patients receiving all processes of care ranged between 14.2%-16.9%, and 46.6%-50.7%, when considering ten and four indicators, respectively. Ambulatory care utilization showed little use of multidisciplinary care, and low levels of participation in diabetes-education classes. CONCLUSIONS: While routine processes-of-care were performed annually in most patients, diabetes-specific risk screenings, influenza immunization, physical activity and dietary recommendations were less often reported; this was also the case for multidisciplinary care and participation in education classes. There is room for diabetes care improvement in Switzerland. These results should help define priorities and further develop country-specific chronic disease management initiatives for diabetes.

Structure du temps de travail des infirmières de santé publique: effets de l'âge des patients, de la nature des prestations fournies et du lieu du contact. [Structure of work times of public health nurses: effect of the age of patients, nature of care given and location of contact].

In the framework of health services research sponsored by the Swiss National Science Foundation, a research was undertaken of the activity of the large majority of the public health nurses working in the Swiss cantons of Vaud and Fribourg (total population 700,000). During one week, 130 nurses gathered, with a specially devised instrument, data on 4165 patient visits. Studying the duration of the contacts, one has distinguished contact duration per se (DC), duration of the travel time preceding the contact (DD), and total duration in relation with the contact (DTC-addition of the first two). It was noted that the three durations increased significantly with patient age (as regard travel time, this is explained by the higher proportion of home visits in higher age groups, as compared with visits at a health center). Examined according to location of the visit, contact duration per se (without travel) is higher for visits at home and in nursing homes than for those taking place at a health center. Looked at in respect to the care given (technical care, or basic nursing care, or both simultaneously), our data show that the provision of basic nursing care (alone or with technical care) doubles contact duration (from 20 to 42-45'). The analyses according to patient age shows that, at an advanced age (beyond 80 years particularly), there is an important increase of the visits where both types of care are given. However, contact duration per se shows a significant raise with age only for the group "technical care only"; it can be demonstrated that this is due to the fact that older patients require more complex technical acts (e.g., bladder care, as compared with simpler acts such as injection). A model of the relationships between patient age and contact duration is proposed: it is because of the increase in the proportions of home visits, of visits including basic nursing care, and of more complex technical acts that older persons require more of the working time of public health nurses.

A follow-up study on the quality of alcohol dependence-related information on the web.

ABSTRACT: In order to evaluate the one-year evolution of web-based information on alcohol dependence, we re-assessed alcohol-related sites in July 2007 with the same evaluating tool that had been used to assess these sites in June 2006. Websites were assessed with a standardized form designed to rate sites on the basis of accountability, presentation, interactivity, readability, and content quality. The DISCERN scale was also used, which aimed to assist persons without content expertise in assessing the quality of written health publications. Scores were highly stable for all components of the form one year later (r = .77 to .95, p &lt; .01). Analysis of variance for repeated measures showed no time effect, no interaction between time and scale, no interaction between time and group (affiliation categories), and no interaction between time, group, and scale. The study highlights lack of change of alcohol-dependence-related web pages across one year.