Psychological factors may impacton postmenopausal women fracture risk

Anxiety and osteoporosis are common diseases and major public health problems. The association between  anxiety levels and bone loss was poorly investigated, thus we aimed to explore whether anxiety severity could be considered as an independent fracture risk. In a setting of postmenopausal women we measured anxiety levels by Hamilton Anxiety Rating Scale (HAMA), depressive symptoms by Beck Depression Inventory and evaluated quality of life by the 36-Item Short Form Health Survey (SF-36) questionnaire. Women with higher anxiety levels showed lower BMD at lumbar spine and femoral neck, and exhibited a poorer quality of life after grouping our population in tertiles of HAMA score. Anxiety levels were predictive of reduced BMD after correcting for other known clinical risk of fractures

Quality of life in postmenopausal women: which role for vitamin D?

Quality of life (QoL) represents a dramatic issue in an aging population. Vitamin D has been consistently associated with several diseases. Thus, vitamin D may be considered a hallmark of health status. Our aim was to investigate whether vitamin D could be a determinant of self-perceived quality of life. The 36-Item Short Form Health Survey (SF-36) for quality of life, the Hamilton Anxiety Rating Scale (HAM-A), the Beck Depression Inventory II edition (BDI-II), in addition with multiple clinical risk factors for fractures and FRAX score, BMD at lumbar spine and femoral neck, were evaluated in a group of 177 postmenopausal women referring to an outpatients clinic for the prevention of osteoporosis. Serum levels of vitamin D [25(OH)D], indicative of vitamin D status, were detected by high-performance liquid chromatography. Scores of each dimension of the SF-36 were significantly related with the measurements of anxiety and depression by HAM-A and BDI-II respectively. Moreover role emotional, vitality, general health and bodily pain were significantly associated with vitamin D status. However, at a stepwise multiple regression analysis the physical component summary, obtained from SF-36, was not independently predicted from vitamin D. In conclusion we found an association between vitamin D status and QoL, thus we suggest physicians to consider vitamin D levels as a marker of QoL. Further studies testing the impact of vitamin D administration in improving QoL over time are needed

Vitamin D status is associated with anxiety levels in postmenopausal women evaluated for osteoporosis

Vitamin D status has been previously associated with a wide range of acute and chronic diseases. The nervous system express vitamin D receptors and thus vitamin D may be involved in mental health. Poor data exist about the correlation between vitamin D and anxiety levels.Our aim was to investigate the association of vitamin D status with anxiety severity. A group of 177 postmenopausal women (mean age 65.5±8.22 yr.) referring to an outpatients clinic for the prevention of osteoporosis were evaluated. Severity of perceived anxiety symptoms was measured by the Hamilton Anxiety rating scale (HAMA). Depression levels were also evaluated using the Beck Depression Inventory-second edition scale (BDI-II). 25(OH)D serum levels, indicative of vitamin D status, were detected by high-performance liquid chromatography. 25(OH)D levels were significantly related HAMA-score (r=-0.15, p=0.04); particularly a deep association was observed between 25(OH)D levels and somatic symptoms (r=-0.195, p=0.009). HAMA score was associated with BDI-II score (r=0.487, p=<0.001); HAMA psychic symptom score was also related with age and time since menopause (r=0.149, p=0.039 and r=0.222, p=0.003, respectively). At a multiple regression analysis, after correcting for age and depression levels, 25(OH)D was predictive of HAMA score (β =-0,05961, p= 0.02, SE=-2.206), but the strength of association was lost further correcting for time since menopause. In conclusion, in a setting of postmenopausal women, we observed a significant association between anxiety levels and serum 25(OH)D concentrations irrespective of age and depression levels

Quality of life and psychological functioning in postmenopausal women undergoing aromatase inhibitor treatment for early breast cancer.

IntroductionAromatase inhibitors (AIs) dramatically increased breast cancer (BC) survival, leading to enhanced attention to their long-term consequences on psychological functioning. Conflicting data has been examined regarding the association between AIs administration and the clinical psychological features in BC survivors (BCSs).PurposeAs psychological symptoms often occur in such chronic diseases, our study aimed at exploring anxious and depressive symptoms and the perceived quality of life (QoL) in BCSs assessed for osteoporosis.MethodsThe total sample consisted of a clinical sample of 51 outpatient postmenopausal women, diagnosed with BC, and a control group composed of 51 healthy postmenopausal women. All recruited participants were evaluated through the clinical gold standard interview and completed the following self-rating scales: the Hamilton Anxiety Rating Scale, Beck Depression Inventory II edition, and 36-Item Short Form Health Survey, which were administered at baseline and after 6 months in BCSs in AIs treatment, compared with controls. Moreover, all participants were assessed for vitamin D status, bone mineral density (BMD) and subclinical vertebral fractures. Data regarding age, age at menopause, body mass index (BMI), smoking habits and alcohol consumption was collected.ResultsBCSs (n = 51) showed higher anxious and depressive symptoms, and lower perceived QoL vs. controls (n = 51) (pConclusionsThe improvement of clinical psychological features and perceived QoL was associated with AIs treatment in women being treated with, for early breast cancer. Further studies are needed to obtain a deeper comprehension of the correlation between clinical psychological and physical features in BCSs

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

The coffee rust crises in Colombia and Central America (2008–2013): impacts, plausible causes and proposed solutions

Coffee rust is a leaf disease caused by the fungus, Hemileia vastatrix. Coffee rust epidemics, with intensities higher than previously observed, have affected a number of countries including: Colombia, from 2008 to 2011; Central America and Mexico, in 2012-13; and Peru and Ecuador in 2013. There are many contributing factors to the onset of these epidemics e.g. the state of the economy, crop management decisions and the prevailing weather, and many resulting impacts e.g. on production, on farmers' and labourers' income and livelihood, and on food security. Production has been considerably reduced in Colombia (by 31 % on average during the epidemic years compared with 2007) and Central America (by 16 % in 2013 compared with 2011-12 and by 10 % in 2013-14 compared with 2012-13). These reductions have had direct impacts on the livelihoods of thousands of smallholders and harvesters. For these populations, particularly in Central America, coffee is often the only source of income used to buy food and supplies for the cultivation of basic grains. As a result, the coffee rust epidemic has had indirect impacts on food security. The main drivers of these epidemics are economic and meteorological. All the intense epidemics experienced during the last 37 years in Central America and Colombia were concurrent with low coffee profitability periods due to coffee price declines, as was the case in the 2012-13 Central American epidemic, or due to increases in input costs, as in the 2008-11 Colombian epidemics. Low profitability led to suboptimal coffee management, which resulted in increased plant vulnerability to pests and diseases. A common factor in the recent Colombian and Central American epidemics was a reduction in the diurnal thermal amplitude, with higher minimum/lower maximum temperatures (+0.1 °C/-0.5 °C on average during 2008-2011 compared to a low coffee rust incidence period, 1991-1994, in Chinchiná, Colombia; +0.9 °C/-1.2 °C on average in 2012 compared with prevailing climate, in 1224 farms from Guatemala). This likely decreased the latency period of the disease. These epidemics should be considered as a warning for the future, as they were enhanced by weather conditions consistent with climate change. Appropriate actions need to be taken in the near future to address this issue including: the development and establishment of resistant coffee cultivars; the creation of early warning systems; the design of crop management systems adapted to climate change and to pest and disease threats; and socio-economic solutions such as training and organisational strengthening. (Résumé d'auteur

Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the \u201cDelirium Day\u201d study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors

Drug Prescription and Delirium in Older Inpatients: Results From the Nationwide Multicenter Italian Delirium Day 2015-2016

Objective: This study aimed to evaluate the association between polypharmacy and delirium, the association of specific drug categories with delirium, and the differences in drug-delirium association between medical and surgical units and according to dementia diagnosis. Methods: Data were collected during 2 waves of Delirium Day, a multicenter delirium prevalence study including patients (aged 65 years or older) admitted to acute and long-term care wards in Italy (2015-2016); in this study, only patients enrolled in acute hospital wards were selected (n = 4,133). Delirium was assessed according to score on the 4 "A's" Test. Prescriptions were classified by main drug categories; polypharmacy was defined as a prescription of drugs from 5 or more classes. Results: Of 4,133 participants, 969 (23.4%) had delirium. The general prevalence of polypharmacy was higher in patients with delirium (67.6% vs 63.0%, P =.009) but varied according to clinical settings. After adjustment for confounders, polypharmacy was associated with delirium only in patients admitted to surgical units (OR = 2.9; 95% CI, 1.4-6.1). Insulin, antibiotics, antiepileptics, antipsychotics, and atypical antidepressants were associated with delirium, whereas statins and angiotensin receptor blockers exhibited an inverse association. A stronger association was seen between typical and atypical antipsychotics and delirium in subjects free from dementia compared to individuals with dementia (typical: OR = 4.31; 95% CI, 2.94-6.31 without dementia vs OR = 1.64; 95% CI, 1.19-2.26 with dementia; atypical: OR = 5.32; 95% CI, 3.44-8.22 without dementia vs OR = 1.74; 95% CI, 1.26-2.40 with dementia). The absence of antipsychotics among the prescribed drugs was inversely associated with delirium in the whole sample and in both of the hospital settings, but only in patients without dementia. Conclusions: Polypharmacy is significantly associated with delirium only in surgical units, raising the issue of the relevance of medication review in different clinical settings. Specific drug classes are associated with delirium depending on the clinical setting and dementia diagnosis, suggesting the need to further explore this relationship