Prognostic value of short-term decline of forced expiratory volume in 1 s over height cubed (FEV1/Ht3) in a cohort of adults aged 80 and over

Forced expiratory volume in 1 s over height cubed (FEV1/Ht(3)) is an FEV1 expression that uses no reference values and is independently associated with adverse outcomes in older adults. No studies have reported on the prognostic value of its decline over time in adults aged 80 and over.Query date: 2019-12-23 16:38:43status: publishe

Methods to evaluate renal function in elderly patients: a systematic literature review

CONTEXT: multiple studies of elderly patients show that the prevalence of chronic renal failure in people aged 65 years and older is dependent on the method used to calculate the glomerular filtration rate. We performed a systematic literature search with research question: What is the best method that could be applicable in clinical practice for evaluating renal function in the elderly? Studies using inulin, Cr-51-EDTA, Tc-DTPA or iohexol assays as the gold standard were included. METHODS: we searched the PubMed and EMBASE databases. Articles found were screened first by title and abstract and then by five criteria. Retained articles were scored using an adapted version of QUADAS. RESULTS: twelve articles had an identified population or subpopulation aged 65 years and older. The studies were heterogeneous with regard to the population investigated and the statistical procedures used to compare the methods and equations with the gold standard. The Cockcroft-Gault (CG) and MDRD equations and the serum cystatin C concentration produced the highest correlations with the gold standard. CONCLUSIONS: no accurate method to evaluate renal function in the elderly was found. Serum cystatin C concentration and the CG and MDRD formula might be valuable parameters, although there is insufficient evidence.Query date: 2019-12-23 16:38:43status: publishe

Infections in residents of nursing homes.

&lt;p&gt;Infectious diseases are a very common occurrence in nursing homes. While the reasons for preventing infections are the same in nursing homes and in acute hospitals, several considerations relevant to prevention of infection differ in nursing homes. Infection control measures should be based upon the particularities of the specific setting of a nursing home and its residents.&lt;/p&gt;</p

Predictive value of different expressions of forced expiratory volume in 1 second (FEV1) for adverse outcomes in a cohort of adults aged 80 and older

OBJECTIVES: Forced expiratory volume in 1 second (FEV1) is proposed as a marker of healthy ageing and FEV1 expressions that are independent of reference values have been reported to be better at predicting mortality in older adults. We assess and compare the predictive value of different FEV1 expressions for mortality, hospitalization, and physical and mental decline in adults aged 80 and older. DESIGN: Population-based, prospective, cohort study. SETTING: The BELFRAIL study, Belgium. PARTICIPANTS: A total of 501 community-dwelling adults aged 80 and older (mean age 84.7 years). MEASUREMENTS: Baseline FEV1 expressed as percent predicted (FEV1PP) and z-score (FEV1Z) using the Global Lung Function Initiative 2012 reference values; over lowest sex-specific percentile (FEV1Q), and height squared (FEV1/Ht2) and cubed (FEV1/Ht3). Mortality data until 5.1 ± 0.2 years from baseline; hospitalization data until 3.0 ± 0.25 years. Activities of daily living, battery of physical performance tests, Mini-Mental State Examination, and 15-item Geriatric Depression Scale at baseline and after 1.7 ± 0.2 years. RESULTS: Individuals in the lowest quartile of FEV1 expressions had higher adjusted risk than the rest of study population for all-cause mortality (highest hazard ratio 2.05 [95% Confidence Interval 1.50-2.80] for FEV1Q and 2.01 [1.47-2.76] for FEV1/Ht3), first hospitalization (highest hazard ratio 1.63 [1.21-2.16] for FEV1/Ht2 and 1.61[1.20-2.16] for FEV1/Ht3), mental decline (highest odds ratio 2.80 [1.61-4.89] for FEV1Q) and physical decline (only FEV1/Ht3 with odds ratio 1.93 [1.13-3.30]). Based on risk classification improvement measures, FEV1/Ht3 and FEV1Q performed better than FEV1PP. CONCLUSION: In a cohort of adults aged 80 and older, FEV1 expressions that are independent of reference values (FEV1/Ht3 and FEV1Q) were better at predicting adverse health outcomes than traditional expressions that depend on reference values, and should be used in further research on FEV1 and aging.Query date: 2019-12-23 16:38:43status: publishe

Theorizing the complexity of HIV disclosure in vulnerable populations: a grounded theory study

Background: HIV disclosure is an important step in delivering the right care to people. However, many people with an HIV positive status choose not to disclose. This considerably complicates the delivery of adequate health care. Methods: We conducted a grounded theory study to develop a theoretical model explaining how local contexts impact on HIV disclosure and what the mechanisms are that determine whether people choose to disclose or not. We conducted in-depth interviews among 23 people living with HIV, 8 health workers and 5 family and community members, and 1 community development worker in Achham, Nepal. Data were analysed using constant-comparative method, performing three levels of open, axial, and selective coding. Results: Our theoretical model illustrates how two dominant systems to control HIV, namely a community self-coping and a public health system, independently or jointly, shape contexts, mechanisms and outcomes for HIV disclosure. Conclusion: This theoretical model can be used in understanding processes of HIV disclosure in a community where HIV is concentrated in vulnerable populations and is highly stigmatized, and in determining how public health approaches would lead to reduced stigma levels and increased HIV disclosure rates.status: publishe

Prevalence of hepatitis C in drug users in Flanders: determinants and geographic differences.

The prevalence of hepatitis C and related risk factors in drug users were compared in two geographic regions in Belgium, the city of Antwerp and the mixed urban-rural area of Limburg. All 310 participants were surveyed and screened for hepatitis B, hepatitis C and HIV. Prevalence rates of anti-HCV, anti-HBc and anti-HIV were 71, 62 and 4% in Antwerp and 46, 21 and 0% in Limburg respectively. Injecting drug use, duration of injecting drug use, work as a commercial sex-worker, originating from Turkey or Northern Africa, marginalization and anti-HBc positivity were identified as independent predictors for hepatitis C infection. In this study an important difference in HCV seroprevalence among drug users in a methadone maintenance programme across two geographic regions in Belgium was demonstrated. This was explained not only by variations in drug-related risk behaviour, but also by differences in sexual risk behaviour and socio-economic status