Change and predictors of quality of life in institutionalized older adults with dementia

PURPOSE: This study aims to assess the change in and predictive factors of the quality of life (QoL) of institutionalized older adults with dementia over a 20-month period. METHODS: Information was used from a follow-up study conducted over an average period of 19.61 ± 1.93 months on a sample of 274 institutionalized older adults aged 60 or over, diagnosed with dementia. Two linear regression models were built to predict change in the EQ-5D index and the quality of life in Alzheimer's disease (QOL-AD) scale, taking as independent variables: sociodemographic characteristics and measures of functional ability (Barthel Index), depression in dementia (Cornell Scale), number of chronic health problems, cognitive level (MEC, the Spanish Mini-Mental State Examination) and severity of dementia (Clinical Dementia Rating) at baseline. RESULTS: The majority of the participants were women (81.75 %) with an average age of 84.70 ± 6.51 years, single (78.15 %), with severe dementia and moderate functional dependence. There was a significant decrease on the EQ-5D, EQ-VAS and QOL-AD between baseline and follow-up scores. The main predictors of QoL of the institutionalized older adults with dementia were the number of chronic problems and baseline scores of the QoL measures. CONCLUSIONS: A significant decrease in the QoL of institutionalized older adults was observed over a 20-month period. Results suggest that interventions aimed at reducing the number of chronic medical conditions may have a beneficial effect on older adults' QoL.This study was funded by the CIEN Foundation, Carlos III Institute of Health (Ref. PI 017/09). We would like to thank the help provided by V Blaya-Novakova in language editing. The Spanish Research Group on Quality of Life and Aging is formed by: M. J. Forjaz, ENS-ISCIII; P. Martinez-Martin, CNE-ISCIII; F. Rojo-Perez, CCHS-CSIC; G. Fernandez-Mayoralas, CCHS-CSIC; B. Frades, Fundación CIEN-ISCIII; B. Leon-Salas, Fundación CIEN-ISCIII; Marina Avila, Fundación CIEN-ISCIII; M. E. Prieto-Flores, UNED; S. Martin, EULEN; I. Martinez, EULEN; C. Rodriguez-Blazquez, CNE-ISCIII; A. Ayala, ENS-ISCIII

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Change and predictors of quality of life in institutionalized older adults with dementia

Purpose This study aims to assess the change in andpredictive factors of the quality of life (QoL) of institu-tionalized older adults with dementia over a 20-monthperiod.Methods Information was used from a follow-up studyconducted over an average period of 19.61 ±1.93 monthson a sample of 274 institutionalized older adults aged 60or over, diagnosed with dementia. Two linear regressionmodels were built to predict change in the EQ-5D indexand the quality of life in Alzheimer’s disease (QOL-AD)scale, taking as independent variables: sociodemographiccharacteristics and measures of functional ability (BarthelIndex), depression in dementia (Cornell Scale), number ofchronic health problems, cognitive level (MEC, the Span-ish Mini-Mental State Examination) and severity ofdementia (Clinical Dementia Rating) at baseline.Results The majority of the participants were women(81.75 %) with an average age of 84.70 ±6.51 years,single (78.15 %), with severe dementia and moderate functional dependence. There was a significant decrease onthe EQ-5D, EQ-VAS and QOL-AD between baseline andfollow-up scores. The main predictors of QoL of theinstitutionalized older adults with dementia were thenumber of chronic problems and baseline scores of theQoL measures. Conclusions A significant decrease in the QoL of insti-tutionalized older adults was observed over a 20-monthperiod. Results suggest that interventions aimed at reducingthe number of chronic medical conditions may have abeneficial effect on older adults’ QoLThis study was funded by the CIEN Foundation, Carlos III Institute of Health (Ref. PI 017/09). We would like to thank the help provided by V Blaya-Novakova in language editing. The Spanish Research Group on Quality of Life and Aging is formed by: M. J. Forjaz, ENS-ISCIII; P. Martinez-Martin, CNE-ISCIII; F. Rojo-Perez, CCHS-CSIC; G. Fernandez-Mayoralas, CCHS-CSIC; B. Frades, Fundación CIEN-ISCIII; B. Leon-Salas, Fundación CIEN-ISCIII; Marina Avila, Fundación CIEN-ISCIII; M. E. Prieto-Flores, UNED; S. Martin, EULEN; I. Martinez, EULEN; C. Rodriguez-Blazquez, CNE-ISCIII; A. Ayala, ENS-ISCII

Estradiol and Spironolactone Plasma Pharmacokinetics Among Brazilian Transgender Women Using HIV Pre-Exposure Prophylaxis: Analysis of Potential Interactions.

Background and objectiveAn important barrier to HIV prevention among transgender women (TGW) is the concern that oral pre-exposure prophylaxis (PrEP) negatively affects the efficacy of feminizing hormone therapy (FHT). We aimed to assess the impact of PrEP on FHT pharmacokinetics (PK) among TGW from Brazil.MethodsWe performed a drug-drug interaction sub-study among TGW enrolled in a daily oral PrEP demonstration study (PrEParadas, NCT03220152). Participants had a first PK assessment (PK1) 15 days after FHT (estradiol valerate 2-6 mg plus spironolactone 100-200 mg) initiation and then started PrEP (tenofovir disoproxil fumarate 300 mg/emtricitabine 200 mg). A second PK evaluation was performed 12 weeks later (PK2). Blood samples were collected prior and after the directly observed dosing (0, 0.5, 1, 2, 4, 6, 8, and 24 hours). Pharmacokinetic parameters of estradiol, spironolactone, and metabolites were estimated by non-compartmental analysis (Monolix 2021R2, Lixoft®) and compared as geometric mean ratios (GMRs, 90% confidence interval [CI]).ResultsAmong 19 TGW who completed the substudy, median age was 26 years (interquartile range: 23-27.5). Estradiol area under the plasma concentration-time curve (AUCτ) and trough concentrations did not differ between PK1 and PK2 evaluations (GMR [90% CI]: 0.89 [0.76-1.04] and 1.06 [0.94-1.20], respectively). Spironolactone and canrenone AUCτ were statistically lower at PK2 than PK1 (0.76 [0.65-0.89] and 0.85 [0.78-0.94], respectively). Canrenone maximum concentration was also lower at PK2 than PK1 (0.82 [0.74-0.91]).ConclusionEstradiol PK was not influenced by PrEP concomitant use. The small differences observed in some spironolactone and canrenone PK parameters should not prevent the concomitant use of estradiol-based FHT and PrEP.Trial registrationThis trial (NCT03220152) was registered on July 18, 2017

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Submitted by Fábio Marques ([email protected]) on 2018-03-26T16:11:23Z No. of bitstreams: 1 ve_Emilia_Jalil_etal_INI_Lapclin_2017.pdf: 146630 bytes, checksum: 6038967edb65c8c974212141541f17c7 (MD5)Approved for entry into archive by Raquel Dinelis ([email protected]) on 2018-04-12T14:35:29Z (GMT) No. of bitstreams: 1 ve_Emilia_Jalil_etal_INI_Lapclin_2017.pdf: 146630 bytes, checksum: 6038967edb65c8c974212141541f17c7 (MD5)Made available in DSpace on 2018-04-12T14:35:29Z (GMT). No. of bitstreams: 1 ve_Emilia_Jalil_etal_INI_Lapclin_2017.pdf: 146630 bytes, checksum: 6038967edb65c8c974212141541f17c7 (MD5) Previous issue date: 2017Fundação Oswaldo Cruz.Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA.Fundação Oswaldo Cruz.Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz.Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil. / Departamento de Matemática e Estatística, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.Fundação Oswaldo Cruz.Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz.Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz.Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz.Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz.Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz.Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA.Fundação Oswaldo Cruz.Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA. / Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.Fundação Oswaldo Cruz.Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Evidence suggests that, of all affected populations, transgender women (transwomen) may have the heaviest HIV burden worldwide. Little is known about HIV linkage and care outcomes for transwomen. We aimed to estimate population-level indicators of the HIV cascade of care continuum, and to evaluate factors associated with viral suppression among transwomen in Rio de Janeiro, Brazil