PREDICTORS OF HEALTH-RELATED QUALITY OF LIFE IN INFORMAL CAREGIVERS OF DEMENTIA PATIENTS IN ZAGREB, CROATIA, A CROSS SECTIONAL STUDY

We aimed to estimate health-related quality of life (HRQoL) in family-member caregivers of patients with dementia in Croatia and to assess relevant predictors. A cross-sectional study in family medicine practices in Zagreb (Health Care Center Zagreb-West) was performed in period 10/2017-9/2018 and included 131 dyads consisting of a patient with dementia and one dominant informal caregiver. Patient measures included Mini-mental-state-examination (MMSE), Barthel-index and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Caregiver measures included 36-Item Short-Form-Health-Survey (SF-36), Zarit-Burden-Interview (ZBI) and structured questionnaire regarding general information on caregiver and patient. SF-36 is a reliable instrument to estimate HRQoL . Caregiver HRQoL was higher than reported in Croatian population in physical functioning (PF), role physical (RP), general health (GH), social functioning (SF) and role emotional (RE) domains. More pronounced neuropsychiatric symptoms in patient with dementia were associated with caregiver\u27s lower HRQoL in vitality (VT) and mental health (MH) domains. Caregivers with higher caregiver burden assessed by ZBI had lower HRQoL in RP, bodily pain (BP), GH, VT, SF, RE and MH domains. In multivariate analyses, higher caregiver\u27s burden was independent predictor of lower HRQoL in RP, VT, RE and MH domains. Neuropsychiatric symptoms and use of daycare service were recognized as independent predictors of lower HRQoL (in PF, BP and GH, SF, RE domains, respectively). Neuropsychiatric symptoms and caregiver burden are associated with HRQoL in caregivers of patients with dementia. Interventions including psychological support and learning of skills necessary to tackle individual problems may help in improvement of HRQoL

PREDICTORS OF HEALTH-RELATED QUALITY OF LIFE IN INFORMAL CAREGIVERS OF DEMENTIA PATIENTS IN ZAGREB, CROATIA, A CROSS SECTIONAL STUDY

We aimed to estimate health-related quality of life (HRQoL) in family-member caregivers of patients with dementia in Croatia and to assess relevant predictors. A cross-sectional study in family medicine practices in Zagreb (Health Care Center Zagreb-West) was performed in period 10/2017-9/2018 and included 131 dyads consisting of a patient with dementia and one dominant informal caregiver. Patient measures included Mini-mental-state-examination (MMSE), Barthel-index and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Caregiver measures included 36-Item Short-Form-Health-Survey (SF-36), Zarit-Burden-Interview (ZBI) and structured questionnaire regarding general information on caregiver and patient. SF-36 is a reliable instrument to estimate HRQoL . Caregiver HRQoL was higher than reported in Croatian population in physical functioning (PF), role physical (RP), general health (GH), social functioning (SF) and role emotional (RE) domains. More pronounced neuropsychiatric symptoms in patient with dementia were associated with caregiver\u27s lower HRQoL in vitality (VT) and mental health (MH) domains. Caregivers with higher caregiver burden assessed by ZBI had lower HRQoL in RP, bodily pain (BP), GH, VT, SF, RE and MH domains. In multivariate analyses, higher caregiver\u27s burden was independent predictor of lower HRQoL in RP, VT, RE and MH domains. Neuropsychiatric symptoms and use of daycare service were recognized as independent predictors of lower HRQoL (in PF, BP and GH, SF, RE domains, respectively). Neuropsychiatric symptoms and caregiver burden are associated with HRQoL in caregivers of patients with dementia. Interventions including psychological support and learning of skills necessary to tackle individual problems may help in improvement of HRQoL

Upotreba nesteroidnih protuupalnih lijekova u bolesnika s uznapredovalim aktivnim reumatoidnim artritisom

This study aimed to determine whether patients with active rheumatoid arthritis (RA) regularly take non-steroidal anti-inflammatory drugs (NSAIDs) and to clarify whether their decision to take NSAIDs depends on disease activity, intensity of pain, or functional status. The study also aimed to identify the risk factors for gastrointestinal side effects. Over 6 months, we conducted a cross-sectional single-center study of consecutively hospitalized patients with confirmed RA. Activities of daily living, pain intensity, and disease activity were evaluated by the Health Assessment Questionnaire, visual analog scale, and disease activity score, respectively, in 28 joints. Of 73 patients diagnosed with RA, 48 (66%) regularly took NSAIDs. Compared to non-users, NSAID users used glucocorticoids less frequently. The decision to use NSAIDs was independent of disease activity, pain intensity, degree of functional impairment, or presence of gastrointestinal risk factors. However, a higher degree of functional impairment was associated with a longer duration of continuous NSAID and glucocorticoid use. NSAIDs are still relevant for RA treatment. The decision to use them is not necessarily affected by disease activity or pain intensity, but their prolonged use is required in patients with a higher degree of functional disability. NSAIDs enable exclusion of glucocorticoid use, sparing patients of glucocorticoid-related side effects.Ovo istraživanje imalo je za cilj utvrditi uzimaju li bolesnici s aktivnim reumatoidnim artritisom (RA) redovito nesteroidne protuupalne lijekove (NSAID) i razjasniti ovisi li njihova odluka o uzimanju NSAID-a o aktivnosti bolesti, intenzitetu boli ili funkcionalnom statusu. Istraživanje je također imalo za cilj utvrditi čimbenike rizika za gastrointestinalne nuspojave. Tijekom 6 mjeseci proveli smo presječnu studiju u jednom centru uzastopno hospitaliziranih bolesnika s potvrđenim RA. Svakodnevne životne aktivnosti, intenzitet boli i aktivnost bolesti procijenjeni su upitnikom za procjenu zdravlja, vizualnom analognom ljestvicom, odnosno rezultatom aktivnosti bolesti u 28 zglobova. Od 73 bolesnika s dijagnosticiranim RA njih 48 (66%) redovito je uzimalo NSAID. U usporedbi s ne-korisnicima, korisnici NSAID-a rjeđe su uzimali glukokortikoide. Odluka o primjeni NSAID-a bila je neovisna o aktivnosti bolesti, intenzitetu boli, stupnju funkcionalnog oštećenja ili prisutnosti gastrointestinalnih čimbenika rizika. Međutim, viši stupanj funkcionalnog oštećenja bio je povezan s duljim trajanjem kontinuirane primjene NSAID-a i glukokortikoida. NSAID su još uvijek relevantni za liječenje RA. Na odluku o njihovoj primjeni ne mora nužno utjecati aktivnost bolesti ili intenzitet boli, ali je njihova produljena primjena potrebna u bolesnika s višim stupnjem funkcionalne nesposobnosti. NSAID-i omogućuju isključivanje uporabe glukokortikoida, pošteđujući bolesnika nuspojava povezanih s glukokortikoidima

The associations of age, sex, and comorbidities with survival of hospitalized patients with coronavirus disease 2019: data from 4014 patients from a tertiary-center registry

Aim To investigate how age, sex, and comorbidities affect the survival of hospitalized coronavirus disease 2019 (COVID-19) patients. Methods We retrospectively analyzed the records of 4014 consecutive adults hospitalized for COVID-19 in a tertiarylevel institution from March 2020 to March 2021. Results The median age was 74 years. A total of 2256 (56.2%) patients were men. The median Charlson-comor - bidity-index (CCI) was 4 points; 3359 (82.7%) patients had severe or critical COVID-19. A significant interaction be - tween age, sex, and survival ( P <0.05) persisted after ad - justment for CCI. In patients <57 years, male sex was re - lated to a favorable (odds ration [OR] 0.50, 95% confidence interval [CI] 0.29-0.86), whereas in patients ≥57 years it was related to an unfavorable prognosis (OR 1.19, 95% CI 1.04- 1.37). Comorbidities associated with inferior survival inde - pendently of age, sex, and severe/critical COVID-19 on ad - mission were chronic heart failure, atrial fibrillation, acute myocardial infarction, acute cerebrovascular insult, history of venous thromboembolism, chronic kidney disease, ma - jor bleeding, liver cirrhosis, mental retardation, dementia, active malignant disease, metastatic malignant disease, autoimmune/rheumatic disease, bilateral pneumonia, and other infections on admission. Conclusion Among younger patients, female sex might lead to an adverse prognosis due to undisclosed reasons (differences in fat tissue distribution, hormonal status, and other mechanisms). Patient subgroups with specific co - morbidities require additional considerations during hos - pital stay for COVID-19. Future studies focusing on sex differences and potential interactions are warranted

Quality of life and burden in family member caregivers of patients with dementia

Starenjem stanovništva demencija postaje rastući globalni zdravstveni problem s posljedicama za bolesnika oboljelog od demencije, ali i članove njegove obitelji. Cilj ovog istraživanja je procijeniti kvalitetu života vezanu uz zdravlje (HRQoL po engleskom health related quality of life) i opterećenje njegovatelja članova obitelji oboljelih od demencije. Proveli smo presječno istraživanje u ambulantama obiteljske medicine u gradu Zagrebu u koje smo uključili 131 par sačinjen od neformalnog njegovatelja člana obitelji koji je dominantni njegovatelj i oboljelog od demencije. Za procjenu HRQL korišten je Short form 36 (SF-36) upitnik, a za procjenu opterećenja njegovatelja korišten je Zarit Burden Interview (ZBI). HRQL i opterećenje njegovatelja uspoređeni su međusobno te s karakteristikama njegovatelja i bolesnika. Provedena je psihometrijska validacija hrvatske verzije ZBI. SF-36 i ZBI pokazali su se kao pouzdani instrumenti za procjenu HRQL i opterećenja njegovatelja bolesnika oboljelih od demencije. HRQL u njegovatelja viša je u odnosu na hrvatsku populaciju u domenama fizičko funkcioniranje, ograničenja zbog fizičkog zdravlja, opće zdravlje, socijalno funkcioniranje i ograničenja zbog emocionalnih problema. Njegovatelji bolesnika s jače izraženim neuropsihijatrijskim simpromima u odnosu nanjegovatelje bolesnika s manje izraženim neuropsihijatrijskim simptomima imali su nižu HRQL u domenama vitalnost i mentalno zdravlje. Faktorskom analizom hrvatske verzije ZBI prepoznate su četiri dimenzije opterećenja koje smo imenovali osobno opterećenje, frustracija, sram i krivnja. Njegovatelji s većim opterećenjem imali su statistički značajno nižu HRQL u domenama ograničenje zbog fizičkog zdravlje, tjelesni bolovi, opće zdravlje, vitalnost, socijalno funkcioniranje, ograničenja zbog emocionalnih problema i mentalno zdravlje, te lošiju subjektivnu kvalitetu života. Učinjene su univarijatne i multivarijatne analize prediktora HRQL i opterećenja njegovatelja gdje se veće opterećenje pokazalo kao nezavisni prediktor niže HRQL u domenama ograničenja zbog fizičkog zdravlje, vitalnost, ograničenja zbog emocionalnih problema i mentalno zdravlje. Kao konzistentni nezavisni prediktori niže HRQL i većeg opterećenja pokazali su se i prisustvo neuropsihijatrijskih simptoma (u domenama fizičko funkcioniranje i tjelesni bolovi) i uključivanje bolesnika u program dnevne skrbi ( u domenama opće zdravlje, socijalno funkcioniranje i ograničenja zbog emocionalnih problema). Neuropsihijatrijski simptomi i opterećenje njegovatelja povezani su s HRQL. Intervencije koje uključuju individualnu psihološku podršku njegovatelju i učenje vještina kako se suočiti s problema koji su prisutni kod njega mogle bi pomoći u smanjenju opterećenja i poboljšanju kvalitete života.We aimed to estimate health-related quality-of-life (HRQL) and caregiver-burden in family-member caregivers of patients with dementia using Short-Form 36 (SF-36) and Zarit-Burden-Interview (ZBI). A cross-sectional study in family-medicine ordinations in city of Zagreb was performed in which we included 131 dyads consisting of one patient with dementia and one dominant informal caregiver. Psychometric-validation of Croatian version of ZBI was performed. SF-36 and ZBI are valid instruments to estimate HRQL and burden. Caregiver HRQL was higher than reported in Croatian population in PF, RP, GH, SF and RE domains. Neuropsychiatric-symptoms were associated with lower HRQL in VT and MF domains. Four dimensions of Croatian ZBI were recognized: personal strain, frustration, embarrassment and guilt. Caregivers with higher burden had lower HRQL in RP, BP, GH, VT, SF, RE and MH domains. In multivariate-analyses, higher burden was independent predictor of lower HRQL in RP, VT, RE and MH domains. Neuropsychiatric-symptoms and use of day-care-service were recognized as independent predictors of lower HRQL (PF, BP and GH, SF, RE domains, respectively) and higher burden. Neuropsychiatric-symptoms and caregiver-burden reflect on HRQL. Interventions including psychological support and learning of skills necessary to tackle specific individual problems may help in reduction of caregiver-burden and improvement of HRQL

Vaccine uptake in caregivers family members and patients with dementia and relationship with severity of dementia and caregiver burden: a cross-sectional study

We cross sectionally evaluated COVID-19 and seasonal flu vaccination rates among 94 dyads consisting of informal caregiver family member and non-institutionalized patient with dementia observed in family-medicine practice in Zagreb, Croatia. COVID-19 vaccination rates in caregivers (78.7%) and patients with dementia (82.9%) were significantly higher than in general population. Caregiver and patient COVID-19 vaccination status (CVS) did not correlate. Among caregivers, seasonal flu vaccination (P = 0.004) but no other investigated factors related to caregiving or dementia severity showed significant association with CVS. Among patients with dementia, CVS was significantly associated with lower number of caregiver hours dedicated per week (P = 0.017), higher caregiver SF-36 role emotional HRQoL (P = 0.017), younger patient age (P = 0.027), higher MMSE (P = 0.030), higher Barthel index (P = 0.006), absence of neuropsychiatric symptoms of agitation and aggression (P = 0.031), lower overall caregiver burden (P = 0.034), lower burden of personal strain (P = 0.023) and lower burden of frustration (P = 0.016). Caregiving and severity of dementia-related factors significantly affect patient, but not caregiver CVS

A validation of the Croatian version of Zarit Burden Interview and clinical predictors of caregiver burden in informal caregivers of patients with dementia: a cross-sectional study

Aim: To validate the Croatian version of the Zarit Burden Interview (ZBI) and to investigate the predictors of perceived burden. Methods: This cross-sectional study involved 131 dyads of one informal caregiver family member and one patient with dementia visiting primary care practices (Health Care Center Zagreb-West ; 10/2017- 9/2018). Patient-related data were collected with the Mini-Mental-State-Examination, Barthel-index, and Neuropsychiatric-Inventory-Questionnaire (NPI- Q) ; caregiver-related data with the ZBI, and general information on caregivers and patients with a structured questionnaire. Principal-axis- factoring with varimax-rotation was used for factor analysis. Results: The caregivers' mean age was 62.1±13 years. They were mostly women (67.9%) and patients' children (51.1%). Four dimensions of ZBI corresponding to personal strain, frustration, embarrassment, and guilt were assessed and explained 56% variance of burden. Internal consistency of ZBI (α=0.87) and its dimensions (α1=0.88, α2=0.83, α3=0.72, α4=0.75) was good. Stronger cognitive and functional impairment of patients was associated only with personal strain, whereas more pronounced neuropsychiatric symptoms and the need for daily care were associated with more dimensions. Longer caregiver education suppressed embarrassment and promoted guilt. Guilt was higher in younger caregivers, caregivers of female patients, patients' children, and non- retired caregivers. In multivariate analysis significant predictors of higher overall burden were male sex of the patient, higher NPI-Q, the need for daily-care services, shorter duration of caregiving, non-spouse relationship, higher number of hours caring per-week, and anxious-depressive symptoms in a caregiver. Conclusion: The Croatian version of ZBI is reliable and valid. Our data confirm that ZBI is a multidimensional construct. Caregivers may benefit from individually tailored interventions

Prognostic implications of low transferrin saturation in patients with primary myelofibrosis

OBJECTIVES: Transferrin saturation (TSAT) 20% or less is considered to represent functional iron deficiency in the context of malignant disease, phenomenon mediated through inflammatory changes of iron homeostasis. We aimed to investigate clinical and prognostic significance of low TSAT in patients with primary (PMF) and secondary myelofibrosis (SMF), malignant diseases characterized by strong inflammatory milieu. ----- METHODS: We retrospectively analyzed 87 patients with myelofibrosis and compared TSAT with disease specific parameters. ----- RESULTS: One-third of patients had TSAT ≤20%. Lower TSAT was significantly associated with Janus-kinase-2 (JAK2) mutation (P = 0.007), transfusion independency (P = 0.003), higher platelets (P = 0.004), lower mean-corpuscular-volume (P < 0.001), lower ferritin (P < 0.001), higher absolute-neutrophil-count (P = 0.027), lower absolute-lymphocyte-count (P = 0.041) and lower albumin (P = 0.018). PMF patients presenting with low TSAT (≤20%) experienced significantly shorter overall-survival (OS) (HR = 2.43; P = 0.017), whereas TSAT did not affect OS of SMF patients (HR = 1.48; P = 0.623). Low TSAT remained significantly associated with inferior OS in PMF in a series of multivariate Cox regression models comparing its properties to anemia, transfusion dependency, ferritin and Dynamic-International-Prognostic-System (DIPSS). ----- CONCLUSIONS: Low TSAT has detrimental effect on survival of PMF patients. This effect is independent of anemia and of ferritin levels that seem to be better at representing iron overload in PMF patients

The Risk of Falling and Consequences of Falling in Patients with Atrial Fibrillation Receiving Different Types of Anticoagulant

Objective: Our objective was to investigate the predictors of falls requiring a visit to the emergency department in patients with nonvalvular atrial fibrillation (AF) receiving different types of anticoagulants and to investigate the clinical consequences of falling in the same population. ----- Methods: A total of 1217 patients with nonvalvular AF from two institutions were retrospectively evaluated. Each patient underwent a physical examination, and clinical histories and medication profiles were taken from each patient at baseline. ----- Results: The median age of our cohort was 71 years; 52.3% were males, and 86.1% of patients were receiving anticoagulation at study baseline. The 5-year freedom-from-falling rate was 81.6%. The use and type of anticoagulation was not significantly associated with the risk of falling (P = 0.222), whereas higher Morse Fall Scale (MFS), CHA2DS2-VASC (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category), and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly [> 65 years], drugs/alcohol concomitantly) scores were significantly associated with a higher hazard of the first fall in univariate analyses. In the multivariate Cox regression model, MFS, older age, osteoporosis, higher levels of high-density lipoprotein cholesterol, higher diastolic blood pressure, and use of amiodarone, diuretics, or short- and medium-acting benzodiazepines were mutually independent predictors of the first fall. Of 163 patients, 93 (57%) had a bone fracture during the fall. Type of anticoagulation significantly affected survival after the first fall (P < 0.001): patients inadequately anticoagulated with warfarin had worse survival rates, and patients receiving apixaban and dabigatran had the best survival rates after the first fall. ----- Conclusion: Older patients who had comorbidities and were taking amiodarone, diuretics, or short- or medium-acting benzodiazepines had the highest risk of falls. The type and quality of anticoagulation did not seem to affect the risk of falling but did significantly affect survival after the first fall

Effect of timing of levothyroxine administration on the treatment of hypothyroidism : a three-period crossover randomized study

Aim Hypothyroidism is a common clinical problem that is successfully treated with hormone substitutes in the form of levothyroxine (LT4). LT4 is a drug with a narrow therapeutic index and is usually administered by strict rules, standardly at least half an hour before breakfast. The aim of this study was to investigate a possible effect of different timings of administration on thyroid function status and lipid profile. Methods The study included patients with the diagnosis of primary hypothyroidism, which were using a stable dose of levothyroxine. They were randomized into three different groups regarding the timing of LT4 administration in a crossover fashion. Each timing regimen lasted for at least 8 weeks ; timing regimen A—half an hour before breakfast ; timing regimen B—an hour before the main meal of the day ; timing regimen C—at bedtime (minimally 2 h after dinner). The hormones (TSH, fT3, fT4) and lipid profile (triglycerides, HDL-, LDL-, and total cholesterol) were measured before the study, at the beginning of every timing regimen and at the end of the study. Results Altogether, 84 patients finished the study. Different timings of LT4 administration were non-inferior in comparison to the standard one and between each other. Median differences in TSH level between baseline and timing regimens were: baseline vs. A = −0.017 95% C.I. (−0.400– 0.192) ; baseline vs. B = −0.325 95% C.I. (−0.562– 0.023) ; baseline vs. C = −0.260 95% C.I. (−0.475–0.000). There were no statistically significant differences in either TSH, fT4, or fT3 when compared between all three timing regimens of LT4 administration and the baseline. There were no statistically significant differences in any of the lipid profile parameters (triglycerides, HDL-, LDL-, and total cholesterol) when compared between all three timing regimens of LT4 administration and the baseline. Conclusion The three investigated timing regimens of LT4 administration were equally efficient and offer additional options regarding the treatment individualization