Deprivation is an independent predictor of 1-year mortality in outpatients with chronic obstructive pulmonary disease

Deprivation is linked to increased incidence in a number of chronic diseases but its relationship to chronic obstructive pulmonary disease (COPD) is uncertain despite suggestions that the socioeconomic gradient seen in COPD is as great, if not greater, than any other disease (Prescott and Vestbo).1 There is also a need to take into account the confounding effects of malnutrition which have been shown to be independently linked to increased mortality (Collins et al).2 The current study investigated the influence of social deprivation on 1-year survival rates in COPD outpatients, independently of malnutrition. 424 outpatients with COPD were routinely screened for malnutrition risk using the ‘Malnutrition Universal Screening Tool’; ‘MUST’ (Elia),3 between July and May 2009; 222 males and 202 females; mean age 73 (SD 9.9) years; body mass index 25.8 (SD 6.3) kg/m2. Each individual's deprivation was calculated using the index of multiple deprivation (IMD) which was established according to the geographical location of each patient's address (postcode). IMD includes a number of indicators covering economic, housing and social issues (eg, health, education and employment) into a single deprivation score (Nobel et al).4 The lower the IMD score, the lower an individual's deprivation. The IMD was assigned to each outpatient at the time of screening and related to1-year mortality from the date screened. Outpatients who died within 1-year of screening were significantly more likely to reside within a deprived postcode (IMD 19.7±SD 13.1 vs 15.4±SD 10.7; p=0.023, OR 1.03, 95% CI 1.00 to 1.06) than those that did not die. Deprivation remained a significant independent risk factor for 1-year mortality even when adjusted for malnutrition as well as age, gender and disease severity (binary logistic regression; p=0.008, OR 1.04, 95% CI 1.04 to 1.07). Deprivation was not associated with disease-severity (p=0.906) or body mass index, kg/m2 (p=0.921) using ANOVA. This is the first study to show that deprivation, assessed using IMD, is associated with increased 1-year mortality in outpatients with COPD independently of malnutrition, age and disease severity. Deprivation should be considered in the targeted management of these patients.

The influence of deprivation domains on malnutrition risk in outpatients with chronic obstructive pulmonary disease

Deprivation assessed using the Index of Multiple Deprivation (IMD) has been shown to be an independent risk factor for both malnutrition and mortality in outpatients with chronic obstructive pulmonary disease (COPD) (Collins et al., 2010a, b). IMD consists of a range of different deprivation domains, although it is unclear which ones are most closely linked to malnutrition. The aim of the current study was to investigate whether the relationship between malnutrition and deprivation was a general one, affecting all domains in a consistent manner, or specific, affecting only certain domains.

Nutritional support and functional capacity in chronic obstructive pulmonary disease: A systematic review and meta-analysis

Currently there is confusion about the value of using nutritional support to treat malnutrition and improve functional outcomes in chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to clarify the effectiveness of nutritional support in improving functional outcomes in COPD. A systematic review identified 12 RCTs (n = 448) in stable COPD patients investigating the effects of nutritional support [dietary advice (1 RCT), oral nutritional supplements (ONS; 10 RCTs), enteral tube feeding (1 RCT)] versus control on functional outcomes. Meta-analysis of the changes induced by intervention found that whilst respiratory function (FEV(1,) lung capacity, blood gases) was unresponsive to nutritional support, both inspiratory and expiratory muscle strength (PI max +3.86 SE 1.89 cm H(2) O, P = 0.041; PE max +11.85 SE 5.54 cm H(2) O, P = 0.032) and handgrip strength (+1.35 SE 0.69 kg, P = 0.05) were significantly improved, and associated with weight gains of ≥ 2 kg. Nutritional support produced significant improvements in quality of life in some trials, although meta-analysis was not possible. It also led to improved exercise performance and enhancement of exercise rehabilitation programmes. This systematic review and meta-analysis demonstrates that nutritional support in COPD results in significant improvements in a number of clinically relevant functional outcomes, complementing a previous review showing improvements in nutritional intake and weight.

Clinical and economic outcomes of nutrition interventions across the continuum of care

Optimal nutrition across the continuum of care plays a key role in the short- and long-term clinical and economic outcomes of patients. Worldwide, an estimated one-quarter to one-half of patients admitted to hospitals each year are malnourished. Malnutrition can increase healthcare costs by delaying patient recovery and rehabilitation and increasing the risk of medical complications. Nutrition interventions have the potential to provide cost-effective preventive care and treatment measures. However, limited data exist on the economics and impact evaluations of these interventions. In this report, nutrition and health system researchers, clinicians, economists, and policymakers discuss emerging global research on nutrition health economics, the role of nutrition interventions across the continuum of care, and how nutrition can affect healthcare costs in the context of hospital malnutrition.

The effectiveness of dietary counselling versus oral nutrition supplements in improving nutritional intake in malnourished patients with Chronic Obstructive Pulmonary Disease (COPD)

The evidence for nutritional support in COPD is almost entirely based on oral nutritional supplements (ONS) yet despite this dietary counseling and food fortification (DA) are often used as the first line treatment for malnutrition. This study aimed to investigate the effectiveness of ONS vs. DA in improving nutritional intake in malnourished outpatients with COPD. 70 outpatients (BMI 18.4 SD 1.6 kg/m2, age 73 SD 9 years, severe COPD) were randomised to receive a 12-week intervention of either ONS or DA (n 33 ONS vs. n 37 DA). Paired t-test analysis revealed total energy intakes significantly increased with ONS at week 6 (+302 SD 537 kcal/d; p = 0.002), with a slight reduction at week 12 (+243 SD 718 kcal/d; p = 0.061) returning to baseline levels on stopping supplementation. DA resulted in small increases in energy that only reached significance 3 months post-intervention (week 6: +48 SD 623 kcal/d, p = 0.640; week 12: +157 SD 637 kcal/d, p = 0.139; week 26: +247 SD 592 kcal/d, p = 0.032). Protein intake was significantly higher in the ONS group at both week 6 and 12 (ONS: +19.0 SD 25.0 g/d vs. DA: +1.0 SD 13.0 g/d; p = 0.033 ANOVA) but no differences were found at week 26. Vitamin C, Iron and Zinc intakes significantly increased only in the ONS group. ONS significantly increased energy, protein and several micronutrient intakes in malnourished COPD patients but only during the period of supplementation. Trials investigating the effects of combined nutritional interventions are required.

The effect of deprivation and disease-severity on malnutrition risk in chronic obstructive pulmonary disease (COPD)

Deprivation has previously been shown to be an independent risk factor for the high prevalence of malnutrition observed in COPD (Collins et al., 2010). It has been suggested the socioeconomic gradient observed in COPD is greater than any other chronic disease (Prescott & Vestbo, 1999). The current study aimed to examine the infl uence of disease severity and social deprivation on malnutrition risk in outpatients with COPD. 424 COPD outpatients were screened using the ‘Malnutrition Universal Screening Tool’ (‘MUST’). COPD disease severity was recorded in accordance with the GOLD criteria and deprivation was established according to the patient’s geographical location (postcode) at the time of nutritional screening using the UK Government’s Index of Multiple Deprivation (IMD). IMD ranks postcodes from 1 (most deprived) to 32,482 (least deprived). Disease severity was posi tively associated with an increased prevalence of malnutrition risk (p < 0.001) both within and between groups, whilst rank IMD was negatively associated with malnutrition (p = 0.020), i.e. those residing in less deprived areas were less likely to be malnourished. Within each category of disease severity the prevalence of malnutrition was two-fold greater in those residing in the most deprived areas compared to those residing in the least deprived areas. This study suggests that deprivation and disease severity are independent risk factors for malnutrition in COPD both contributing to the widely variable prevalence of malnutrition. Consideration of these issues could assist with the targeted nutritional management of these patients.

Temas de historia argentina y americana, 2005, n° 6 (número completo)

Imágenes de la periferia. Las exploraciones de Juan Francisco de Aguirre y su historia y geografía de las Provincias del Río de la Plata / Liliana M. Brezzo -- Las exposiciones internacionales en la ciudad de Buenos Aires durante los festejos del Centenario / Florencia Casiraghi de Pryor -- Raúl A. Molina y la historia de la Virgen de Luján / Jorge Juan Cortabarría -- Las visitas a la provincia carmelitana de San Alberto de México en el siglo XVII / María de Lourdes Lascurain de Doucet -- Sobre marinos y funcionarios en el Río de la Plata, conflictos y necesidades (1760-1800) / Guillermo Andrés Oyarzábal -- La Revolución Mexicana y la diplomacia argentina (1910-1913). Los prolegómenos de la mediación del ABC / Ricardo Weinmann -- Documentos -- Necrológicas -- Reseñas Bibliográficas

Manejo del ganado cunícola

El conejo es un animal herbivoro que se conoce de la antigüedad. Las civilizaciones mas antiguas como la china griega, egipcia e hindu, criaban conejos desde épocas muy remotas. De Grecia el conejo paso a España, en donde ya existia una buena cantidad de estos animales, razón por la que muchos autores han llegado a considerarla como " La tierra del conejo", significado en hebreo· del vocablo hispanja, de donde se deriva como tal el nombre de España. Es aceptado· que de España, el conejo paso al resto de Europa, en tanto en América, el conejo se conocia desde antes de la llegada de los colonizadores españoles, es asi como los indios Azteca de México, tenían . en gran consideración estos pequeños mamiferos, que entre otras cosas representaban la fecundidad y el nexo de lo conocido con lo inexplicable La utilidad que el hombre ha dado al conejo inicialmente ha sido como fuente de alimento, posteriormente utilizó sus pieles para confeccion ar vestimentas. En la actualidad el conejo tiene diversas utilidades en las diferentes ramas de la ciencia podemos encontrarlo como animal experimental a nivel de laboratorios, como vientres receptores temporales de embriones de ganado vacuno (En el caso de la coneja) para su posterior trasplante a las vacas, En la extraccion de suero sanguineo, para fabricar medio de cultivo y fabricar vacunas etc. No cabe duda que este anima, ha sido y sigue siendo de gran utilidad para el hombre por lo que se necesita de sus habitos y su conducta, para llevar a cabo una buena explotación y obtener así el mayor provecho y beneficio posible.

Nota sobre los límites faunísticos de los mares argentinos.

Discusión de límites zoogeográficos marinos con el objetivo de ser utilizados en la preparación de un catálogo de animales marinos. (PDF tiene 9 paginas.)

Sobre los peces del territorio de Río Negro.

Breve excursión en 1936 por tercera vez a la zona del río Negro correspondiente a Viedma para efectuar nuevos estudios sobre lampreas y larvas, coleccionar peces propios del río, de la desembocadura y marinos, y aumentar los datos de ecología de la región.

Nombres de moluscos en la obra de Ateneo de Náucratis

[ES] El léxico griego relativo a los animales marinos constituye un campo muy extenso, al que en pocas ocasiones han dedicado su interés los estudiosos de la antigüedad. En el presente artículo ofrecemos un acercamiento a uno de los grupos que lo constituyen, el de los moluscos, junto con un intento de identificación de todas aquellas especies que lo permiten, partiendo de la obra de Ateneo de Náucratis y completando su información con otros datos obtenidos de Aristóteles, Eliano, Opiano y Plinio el viejo.

Liberación de compuestos al medio circundante durante la supervivencia a bajas temperaturas en Vibrio harveyi

Vibrio harveyi es considerado como una de las especies más relevantes del género Vibrio debido a su capacidad para infectar peces marinos e invertebrados. Estudios previos han demostrado que la respuesta de V. harveyi ante condiciones ambientales adversas (p.e. disminución de la temperatura) es su entrada en el denominado estado Viable No Cultivable (VNC), representando este estado una estrategia de supervivencia para algunas bacterias no diferenciadas. Se ha estudiado la respuesta de este microorganismo durante su incubación a bajas temperaturas (4˚C) utilizando como soporte tanto agua de mar como sobrenadantes recogidos en experiencias de superviviencia previas. V. harveyi presenta un patrón similar durante su incubación en agua de mar como en fases tempranas de estudio en sobrenadantes. Sin embargo, en fases tardías de estudio se ha comprobado que se retrasa su entrada en el estado VNC. Estos resultados sugieren que estas poblaciones podrían liberan compuestos al medio para favorecer su supervivencia bajo condiciones ambientales adversas.

Gillraker analysis and speciation in the thread herring genus Opisthonema

ENGLISH: The thread herrings, genus Opisthonema, family Clupeidae, are marine fishes that occur only in tropical and subtropical waters off both coasts of the American continent. The genus is composed of one Atlantic species and four Pacific species. Opisthonema oglinum (LeSueur), the single species in the western Atlantic Ocean, occurs from Brazil to Massachusetts, at Bermuda, and throughout the West Indies. Opisthonema libertate (Günther), Opisthonema bulleri (Regan), and Opisthonema medirastre, new species, are Pacific coastal species which occur together from Peru to Mexico (with at least one occasionally in California). Opisthonema berlangai, new species, is confined to the vicinity of the Galapagos Islands. SPANISH: Los arenques de hebra, género Opisthonema, familia Clupeidae, son peces marinos que se encuentran sólo en aguas tropicales y subtropicales cerca a ambas costas del continente americano. El género está compuesto de una especie en el Atlántico y de cuatro en el Pacifico. Opisthonema oglinum (LeSueur), única especie que medra el Océano Atlántico occidental, se encuentra del Brasil a Massachusetts, en Bermuda, y las Indias Occidentales. Opisthonema libertate (Günther), Opisthonema bulleri (Regan), y Opisthonema medirastre, especie nueva, son especies costaneras del Pacífico que aparecen entremezcladas del Perú a México (ocasionalmente por lo menos una de ellas en California). Opisthonema berlangai, especie nueva, está confinada a la vecindad de las Islas Galápagos.