Fumar y aumento de mortalidad en mujeres Vs hombres

Un estudio, publicado en New England Journal of Medicine, mostró que la tasa de muerte de las mujeres han igualado la de los hombres. Un análisis de los registros médicos de dos millones de mujeres en Estados Unidos reveló que quienes fuman actualmente tienen más riesgo de morir que aquéllas que fumaban durante los 1960.El estudio, publicado en New England Journal of Medicine, mostró que la tasa de muerte de las mujeres han igualado la de los hombres.La primera generación de mujeres fumadoras comenzó en los 1950 y 1960. En esos años las fumadoras tenían casi tres veces más riesgo de morir por cáncer pulmonar que las no fumadoras.Los registros de las fumadoras de hoy en día muestran que éstas tienen 25 veces más probabilidad de morir por cáncer pulmonar que las no fumadoras.El creciente riesgo de muerte quizás se debe a que ahora las mujeres comienzan a fumar antes y fuman más cigarrillos que sus antepasadas, dicen los investigadores

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Walking four times weekly for at least 15min is associated with longevity in a Cohort of very elderly people.

Maturitas. 2012 Dec 29. pii: S0378-5122(12)00400-8. doi: 10.1016/j.maturitas.2012.12.001. Abstract OBJECTIVES: This study investigated the role of walking outdoors on longevity, controlling for individual and other life-style factors as possible confounders. METHODS: A 10-year cohort study was conducted with 152 self-caring and mobile, mean age 80 years, were enrolled in the study. Information on socio-demographic characteristics, clinical and biochemical data, diet, physical activity, smoking, depression status, cognitive status and anthropometrics measurements, were obtained for all participants. Cox proportional-hazards models were used to determine independent predictors of longevity. RESULTS: During the 10-years of follow-up, 96 (63%) died. Old age, chronic diseases, smoking, depression, CD4/CD8 ratio and coffee consumption were significantly predictors of mortality. Over-all survival was highest for subjects walking at open air for 4 times weekly for at least 15min in comparison to subjects walking less than 4 times weekly (40% versus 22%). After adjusting for sex, age, education, chronic diseases, smoking, Body Mass Index and CD4/CD8 ratio, elderly people walking at open air for four times weekly had 40% decreased risk of mortality that individuals who walked less than four times weekly [relative risk (RR)=0.53; 95% confidence interval (CI)=0.32-0.88, p=0.01]. CONCLUSIONS: Findings suggest an independent and protective effect of walking on mortality and supports the encouragement of physical activity in advanced age for increasing longevity. COMMENT: Interesting especially for those of us who treat older persons (or are older persons).   While there was a clear selection bias, after all they were on average 80-years-old and there were no cancer deaths; nevertheless, we should take heart and tell our patients that the benefits of physicial activity continue into old, old age.

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Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change

Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change Michael Darmon, Eric Diconne, Bertrand Souweine, Stephane Ruckly, Christophe Adrie, Elie Azoulay, Christophe Clec'h, Maite Garrouste-Orgeas, Carole Schwebel, Dany Goldgran-Toledano, Hatem Khallel, Anne-Sylvie Dumenil, Samir Jamali, Christine Cheval, Bernard Allaouchiche, Fabrice Zeni and Jean-Francois Citation Abstract (provisional) Introduction To assess the prevalence of dysnatremia, including borderline changes in serum sodium concentration, and to estimate the impact of these dysnatremia on mortality after adjustment for confounders. Methods Observational study on a prospective database fed by 13 intensive care units (ICU). Unselected patients with ICU stay longer than 48h were enrolled over a 14-year period were included in this study. Mild to severe hyponatremia were defined as serum sodium concentration <135, <130, and <125 mmol/L respectively. Mild to severe hypernatremia were defined as serum sodium concentration >145, >150, and >155 mmol/L respectively. Borderline hyponatremia and hypernatremia were defined as serum sodium concentration between 135 and 137 mmol/L or 143 and 145 respectively. Results 11,125 patients were included in this study. Among these patients, 3,047 (27.4%) had mild to severe hyponatremia at ICU admission, 2,258 (20.3%) had borderline hyponatremia at ICU admission, 1,078 (9.7%) had borderline hypernatremia and 877 (7.9%) had mild to severe hypernatremia. After adjustment for confounder, both moderate and severe hyponatremia (subdistribution hazard ratio (sHR) 1.82, 95%CI 1.002-1.395 and 1.27, 95%CI 1.01-1.60 respectively) were associated with day-30 mortality. Similarly, mild, moderate and severe hypernatremia (sHR 1.34, 95%CI 1.14-1.57; 1.51, 95%CI 1.15-1.99; and 2.64, 95%CI 2.00-3.81 respectively) were independently associated with day-30 mortality. Conclusions One third of critically-ill patients had a mild to moderate dysnatremia at ICU admission. Dysnatremia, including mild changes in serum sodium concentration, is an independent risk factor for hospital mortality and should not be neglected.

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