Charlson Comorbidity Index does not predict long-term mortality in elderly subjects with chronic heart failure

Methods: long-term mortality after 12-year follow-up in 125 subjects with CHF and 1,143 subjects without CHF was studied. Comorbidity was evaluated using CCI.Findings: in elderly subjects stratified for CCI (1-3 and >= 4), mortality was higher in non-CHF subjects with CCI >= 4 (52.4% versus 70%, P < 0.002) but not in those with CHF (75.9% versus 77.6%, P = 0.498, NS). Cox regression analysis on 12 years mortality indicated that both CCI (HR = 1.15; 95% CI = 1.01-1.31; P = 0.035) and CHF (HR = 1.27; 95% CI = 1.04-8.83; P = 0.003) were predictive of mortality. When Cox analysis was performed by selecting the presence and the absence of CHF, CCI was predictive of mortality in the absence but not in the presence of CHF.Conclusion: CCI does not predict long-term mortality in elderly subjects with CHF

Physical activity is inversely related to drug consumption in elderly patients with cardiovascular events

Abstract Elderly patients with cardiovascular events are characterized by high drug consumptions. Whether high drug consumptions are related to physical activity is not known. In order to examine whether physical activity is related to drug consumption in the elderly, patients older than 65 years (n = 250) with a recent cardiovascular event were studied. Physical activity was analyzed according to the Physical Activity Scale for the Elderly (PASE) score and related to drug consumption. PASE score was 72.4 ± 45.0 and drug consumption was 8.3 ± 2.2. Elderly patients with greater comorbidity took more drugs (8.7 ± 2.1) and are less active (PASE = 64.4 ± 50.6) than patients with Cumulative Illness Rating Scale severity score higher than 1.8 than those with a score lower than 1.8 (76.3 ± 41.4, p < 0.05, and 8.0 ± 2.0, p = 0.006, respectively). Multivariate analysis correlation confirmed that PASE score is negatively associated with drug consumption (β = −0.149, p = 0.031), independently of several variables including comorbidity. Thus, physical activity is inversely related to drug consumption in elderly patients with cardiovascular events. This inverse relationship may be attributable to the high degree of comorbidity observed in elderly patients in whom poor level of physical activity and high drug consumption are predominant

Role of permanent atrial fibrillation (AF) on long-term mortality in community-dwelling elderly people with and without chronic heart failure (CHF)

Permanent AF is characterized by an increased mortality in elderly subjects with CHF. Moreover, AF increased the risk of mortality also in elderly subjects without CHF. Thus, we examined long-term mortality in community-dwelling elderly people with and without CHF. A total of 1332 subjects aged 65 and older were selected from the electoral rolls of Campania, a region of southern Italy. The relationship between AF and mortality during a 12-year follow-up in 125 subjects with CHF and in 1.143 subjects without CHF were studied. Elderly subjects showed a higher mortality in those with respect to those without AF (72.1% vs. 51.8%; p &lt; 0.01). Similarly, elderly subjects without CHF showed a higher mortality in those with respect to those without AF (61.8% vs. 49.8%; p &lt; 0.05). In contrast, elderly subjects with CHF showed a similar mortality in those with respect to those without AF (74.7% vs. 82.4%; p = 0.234). Multivariate analysis shows that AF was predictive of mortality in all elderly subjects (Hazard Risk = HR = 1.39, 95% confidence interval (CI) = 1.25-2.82; p &lt; 0.001). When the analysis was conducted considering the presence and the absence of CHF, AF was strongly predictive of mortality in elderly subjects without CHF (HR = 1.95, 95% CI = 1.25-4.51; p &lt; 0.001) but not in those with CHF (HR = 1.12, 95% CI = 0.97-3.69; p = 0.321). We concluded that AF is able to predict long-term mortality in elderly subjects. Moreover, AF is strongly predictive of long-term mortality in the absence but not in the presence of CHF. (C) 2011 Elsevier Ireland Ltd. All rights reserved

Mortality and heart rate in the elderly: role of cognitive impairment

Mortality related to heart rate ( HR) increase in the elderly has not yet been well established. To ascertain the relationships among cognitive impairment ( CI), mortality, and HR increase, the authors prospectively studied a random sample of elderly subjects stratified according to presence or absence of CI. Elderly subjects randomly selected in 1991 ( n = 1332) were followed up for 12 years. Mortality was established in 98.1% of the subjects. When HR was stratified in quartiles (&lt; 69,70-75,76-80, and &gt; 80 bpm), mortality was linearly associated with increased HR in all ( from 47.7 to 57.0; r(2) = .43, p = .019) and in subjects without ( from 41.7 to 51.1%; r(2) = .50, p = .043) but not in those with CI ( from 57.5 to 66.1; r(2) = .20, p = .363). Cox regression analysis, adjusted for several variables, shows that HR doesn't predict mortality in all subjects ( RR 0.69; 95% CI = 0.27-1.73) or in those with CI ( RR 0.91; 95% CI = 0.81-1.02). In contrast, HR predicts mortality in subjects without CI ( RR 1.10; 95% CI = 1.00-1.22). Hence, HR increase is a predictor of mortality in elderly subjects without CI. However, when considering all elderly subjects and those with CI, HR increase seems to have no effect on mortality. Thus, CI should be considered when focusing on HR increase as risk factor for mortality in the elderly

Waist circumference but not body mass index predicts long-term mortality in elderly subjects with chronic heart failure

OBJECTIVESTo examine whether waist circumference (WC) and body-mass index (BMI) can predict long-term mortality in elderly subjects with and without chronic heart failure (CHF).DESIGNLongitudinal evaluation with a 12-year follow-up.SETTINGCampania, a region of southern Italy.PARTICIPANTSOne thousand three hundred thirty-two subjects aged 65 and older selected from the electoral rolls of Campania.MEASUREMENTSThe relationship between WC or BMI and mortality during a 12-year follow-up in 125 subjects with and 1,143 subjects without CHF.RESULTSMortality increased as WC increased in elderly subjects without CHF (from 47.8% to 56.7%, P=.01), and the increase was even greater in patients with CHF (from 58.1% to 82.0%, P=.01). In contrast, mortality decreased as BMI increased in elderly subjects without CHF (from 53.8% to 46.1%, P0 =.046) but not in those with CHF. According to Cox regression analysis, BMI protected against long-term mortality in the absence but not in the presence of CHF. In the absence of CHF, WC was associated with a 2% increased risk of long-term mortality for each 1-cm greater WC (Hazard Ratio (HR)=1.02, 95% confidence interval (CI)=1.01-1.03; P &lt;.001), versus 5% increased in the presence of CHF (HR=1.06, 95% CI=1.02-1.10; P &lt;.001).CONCLUSIONWC, but not BMI, is predictive of long-term mortality in elderly individuals with CHF and to a lesser extent in those without CHF

Osteoarthritis and mortality: A prospective cohort study and systematic review with meta-analysis

Objectives: Osteoarthritis (OA) is a leading cause of disability, but the relationship with premature mortality remains uncertain. We aimed to investigate the relationship between OA and mortality from any cause and from cardiovascular disease (CVD). Methods: Electronic literature databases searches were conducted to identify prospective studies comparing mortality in a sample of people with and without OA. Risk of all-cause and CVD mortality were summarized using adjusted hazard ratios (HRs) for joint specific (hand, hip, and knee) and joint non-specific OA. New data from the Progetto Veneto Anziani (PRO.V.A.) study were also included. Results: From the PRO.V.A. study (N 1⁄4 2927), there was no significant increase in mortality risk for participants with any joint OA (N 1⁄4 1858) compared to non-OA (all-cause, HR 1⁄4 0.95, 95% CI: 0.77–1.15 and CVD, HR 1⁄4 1.12, 95% CI: 0.82–1.54). On meta-analysis, seven studies (OA 1⁄4 10,018/non-OA 1⁄4 18,541), with a median 12-year follow-up, reported no increased risk of any-cause mortality in those with OA (HR 1⁄4 1.10, 95% CI: 0.97–1.25). After removing data on hand OA, a significant association between OA and mortality was observed (HR 1⁄4 1.18, 95% CI: 1.08–1.28). There was a significant higher risk of overall mortality for (1) studies conducted in Europe, (2) patients with multi-joint OA; and (3) a radiological diagnosis of OA. OA was associated with significantly higher CVD mortality (HR 1⁄4 1.21, 95% CI: 1.10–1.34). Conclusions: People with OA are at increased risk of death due to CVD. The relationship with overall mortality is less clear and may be moderated by the presence of hand OA

Working with the enemy, relations between Italian partisans and the British forces (1943-1945)

The Italo-British relationship during the Second World War has been the object of constant scrutiny and enquiry over the course of the years, especially as far as the relation between the Italian Resistance and British forces during the Italian campaign of 1943-1945 is concerned. Many have pointed out that the British actions were moved by political reasons, such as the fear of a possible Communist takeover after the war.According to this interpretation, this led to a general hostility in the British war machine towards Italians. Others have pointed out how this analysis is fundamentally flawed, as it focuses only on the political aspect of the relationship and does not account for the good relations that often Italian partisans and British forces were able to build in the field. However, both interpretations seem to exist independently of each other and the debate has reached a stale point over the course of the last few decades.Through the critical re-examination of three main topics (interactions on the field,propaganda and partisan disarmament) this thesis aims at filling the gulf between these two historiographical branches. The analysis is not only focused on British or Italian actions but also how these actions influenced the perception of each other. This point of view allows for a nuanced approach that considers representation and selfrepresentation as two key interpretative tools. Moreover, the elements unearthed in this way can be also evaluated against the historiography and public memory that followed the war, in order to frame elements of longue durée which may have influenced the representation of the Italo-British relationship in the future.The Italo-British relationship during the Second World War has been the object of constant scrutiny and enquiry over the course of the years, especially as far as the relation between the Italian Resistance and British forces during the Italian campaign of 1943-1945 is concerned. Many have pointed out that the British actions were moved by political reasons, such as the fear of a possible Communist takeover after the war.According to this interpretation, this led to a general hostility in the British war machine towards Italians. Others have pointed out how this analysis is fundamentally flawed, as it focuses only on the political aspect of the relationship and does not account for the good relations that often Italian partisans and British forces were able to build in the field. However, both interpretations seem to exist independently of each other and the debate has reached a stale point over the course of the last few decades.Through the critical re-examination of three main topics (interactions on the field,propaganda and partisan disarmament) this thesis aims at filling the gulf between these two historiographical branches. The analysis is not only focused on British or Italian actions but also how these actions influenced the perception of each other. This point of view allows for a nuanced approach that considers representation and selfrepresentation as two key interpretative tools. Moreover, the elements unearthed in this way can be also evaluated against the historiography and public memory that followed the war, in order to frame elements of longue durée which may have influenced the representation of the Italo-British relationship in the future

DVT hospitalized elderly: Risk factors and complications [La TVP nell'anziano ospedalizzato: Fattori di rischio e complicanze]

La trombosi venosa profonda (TVP) è una flebotrombosi, cioè la formazione di un trombo in una vena profonda, prevalentemente negli arti inferiori. Segni non specifici possono includere dolore, gonfiore, arrossamento, calore e gonfiore delle vene superficiali 1. L’embolia polmonare, una complicanza potenzialmente pericolosa per la vita, è causata dal distacco (embolizzazione) di un coagulo che viaggia verso i polmoni 2. La TVP e l’embolia polmonare costituiscono un unico processo patologico noto come tromboembolia venosa 1 2. La sindrome post-trombotica, un’altra complicanza, contribuisce in modo significativo ai costi sanitari se si considera che ogni anno nei pazienti anziani in Italia l’embolia polmonare e la sua causa principale, la trombosi venosa profonda, sono responsabili di circa 500 000 ricoveri ospedalieri

SLE for the carbon dioxide + trans-1,3,3,3-tetrafluoropropene

A built experimental set-up was employed for the estimation of the solid-liquid equilibria of alternative refrigerants systems. The behavior of carbon dioxide + 1,3,3,3-tetrafluoropropene (CO2 + R1234ze(E)) was measured down to temperatures of 160.0 K. The results obtained for the mixtures were interpreted by means of the Schröder equation