Therapy adherence in elderly of Northern Portugal

The elderly population has been growing significantly, leading to an increased prevalence of chronic diseases and consequent taking medication. The complex therapies of elderly can lead to therapy non-adherence, increasing several health risks. Aim This study aimed to estimate the prevalence of therapy adherence and associated factors. Material and Methods This cross-sectional study was based on a questionnaire, with MAT scale (measure of adherence to therapy) validated for the Portuguese population (Lima, 2001) based on the Morisky scale, applied to 52 elderly (≥65 years) from northern Portugal. To assess therapy adherence, those whose average adherence levels were ≥5, were called adherent. It was used descriptive statistics. The level of association between categories of variables was studied through the adjusted residuals (AdR) and the relationship between adherence to the therapeutic and the number of medications taken per day was studied using the Mann-Whitney U test, with a significance level of 5%. The study was approved by Ethics Committee. Results The sample consisted mainly of males elderly (61.5% vs. 38.5%), aged between 67 and 98 years (mean 82.71), and while 48.1% was between 75–84 years old. The participants shows high therapy adherence (96.2%). The non-adherent elderly are related to self-medication (AdR=4.3), with the high level of cholesterol (AdR=2.9) and chronic pain (AdR=2.9). The non-adherent elderly seem tend to take more drugs per day, although not statistically significant (P = 0.063). Conclusions This study shows that a large prevalence of elderly adhered to the therapy prescribed. Self-medication, having high cholesterol and chronic pain and higher number of different drugs per day seem related to non-adherence.info:eu-repo/semantics/publishedVersio

Polypharmacy and potentially inappropriate medication in elderly of Northern Portugal

Introduction The growing aging of population and increasing prevalence of chronic diseases require the simultaneous use of drugs, lead to the issue of polypharmacy and potentially interactions and inappropriate use. Aim To characterize polymedicated elderly and related factors, identify potentially interactions and inappropriate medication in elderly. Material and Methods This cross-sectional study was based on a questionnaire applied to 69 elderly (≥65 years) from northern Portugal. It was considered as polymedicated seniors taking ≥5 drugs. Beers list and the Delafuente classification were used to evaluate the therapeutic and possible interactions. It was used descriptive statistics and a model of binary regression, with a significance of 5%. The study was approved by Ethics Committee. Results The sample consisted mainly of males (53.6% vs. 46.4%), aged between 66 and 99 years (mean 82.01), while 65.2% have more than 80 years. However, most elderly are not polymedicated (58%), on average 4.61 different drugs are administered per day (maximum=19), antihypertensives (36.2%) and antacids (30.04%) are the most prescribed. Hypertension and depression increase the risk of polymedication eightfold (P = 0.004) and fivefold (P = 0.011) respectively. Female gender seems increase the risk of polypharmacy threefold, although not statistically significant (P = 0.102), and regarding age, the older age group (>85 years) seems reduces the risk of polypharmacy in 0.6 fold, but also not statistically significant. According with Delafuente classification, 1.4% of elderly has potentially drug interactions (Omeprazole and Iron salts). According to the list of Beers, 5.8% of seniors take drugs that classified as having some indications (hydroxyzine, amitriptyline). Conclusions Regarding polypharmacy, 42% of elderly are polymedicated with an average of about 5 different drugs per day, antihypertensives and antacids the most prescribed. Hypertension and depression are highly associated with polypharmacy. We identified one potentially drug interaction and about 6% of elderly taking drugs that classified as having some indications.info:eu-repo/semantics/publishedVersio

Characterization of medication use among the elderly of North Portugal

Aging associated with chronic comorbidities leads to Polypharmacy, but the complex therapies in elderly can lead to therapy non-adherence, increasing costs and several health risks. Objectives: To characterize medication use and related factors among northern Portuguese elderly. Methods: This cross-sectional population-based study was centered on a structured interview to 442 elderly (≥65 years), non-probabilistic sample by convenience, at home and institutions in northern Portugal. It was considered as polymedicated seniors taking ≥5 drugs daily. Beers criteria (2012) were used to evaluate the potentially inappropriate medication use. It was used descriptive statistics and univariate and multivariate statistical analysis, with a significance level of 5%. Results: The sample consisted mainly of females (56.6%), aged between 65 and 101 years (mean 76.84 ± 8.07). The prevalence of medication use was 97.3%. Most elderly are polymedicated (54.1%), on average 5.15 different drugs are administered per day. The most commonly prescribed groups were: cardiovascular drugs (82.8%), central nervous system agents (54.2%) and drugs with an effect on the digestive tract (40.9%). According to the Beers criteria, 53.5% of seniors taking potentially inappropriate medication. Polypharmacy was positively associated with living in littoral sub-region (p<0.001), having a reasonable (p=0.002) or poor health self-perception (p<0.001), self-reported chronic diseases (p<0.001) and number of doctors (p=0.003). Conclusions: Results shows a high proportion of medication use among the northern Portuguese elderly, including potentially inappropriate. The risk of polypharmacy is related to coastal region, perception of reasonably/poor health, chronic diseases and the number of doctors.info:eu-repo/semantics/publishedVersio

Relationships between social withdrawal and facial emotion recognition in neuropsychiatric disorders

Background: Emotion recognition constitutes a pivotal process of social cognition. It involves decoding social cues (e.g., facial expressions) to maximise social adjustment. Current theoretical models posit the relationship between social withdrawal factors (social disengagement, lack of social interactions and loneliness) and emotion decoding. Objective: To investigate the role of social withdrawal in patients with schizophrenia (SZ) or probable Alzheimer's disease (AD), neuropsychiatric conditions associated with social dysfunction. Methods: A sample of 156 participants was recruited: schizophrenia patients (SZ; n = 53), Alzheimer's disease patients (AD; n = 46), and two age-matched control groups (SZc, n = 29; ADc, n = 28). All participants provided self-report measures of loneliness and social functioning, and completed a facial emotion detection task. Results: Neuropsychiatric patients (both groups) showed poorer performance in detecting both positive and negative emotions compared with their healthy counterparts (p < .01). Social withdrawal was associated with higher accuracy in negative emotion detection, across all groups. Additionally, neuropsychiatric patients with higher social withdrawal showed lower positive emotion misclassification. Conclusions: Our findings help to detail the similarities and differences in social function and facial emotion recognition in two disorders rarely studied in parallel, AD and SZ. Transdiagnostic patterns in these results suggest that social withdrawal is associated with heightened sensitivity to negative emotion expressions, potentially reflecting hypervigilance to social threat. Across the neuropsychiatric groups specifically, this hypervigilance associated with social withdrawal extended to positive emotion expressions, an emotional-cognitive bias that may impact social functioning in people with severe mental illness

Differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations in Lleida, (Spain): A 6-months prospective observational study

<p>Abstract</p> <p>Background</p> <p>There are few studies comparing pharmaceutical costs and the use of medications between immigrants and the autochthonous population in Spain. The objective of this study is to evaluate whether there are differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations.</p> <p>Methods</p> <p>Prospective observational study in 1,630 immigrants and 4,154 Spanish-born individuals visited by fifteen primary care physicians at five public Primary Care Clinics (PCC) during 2005 in the city of Lleida, Catalonia (Spain). Data on pharmaceutical consumption and expenses was obtained from a comprehensive computerized data-collection system. Multinomial regression models were used to estimate relative risks and confidence intervals of pharmaceutical expenditure, adjusting for age and sex.</p> <p>Results</p> <p>The percentage of individuals that purchased medications during a six-month period was 53.7% in the immigrant group and 79.2% in the autochthonous group. Pharmaceutical expenses and consumption were lower in immigrants than in autochthonous patients in all age groups and both genders. The relative risks of being in the highest quartile of expenditure, for Spanish-born versus immigrants, were 6.9, 95% CI = (4.2, 11.5) in men and 5.3, 95% CI = (3.5, 8.0) in women, with the reference category being not having any pharmaceutical expenditure.</p> <p>Conclusion</p> <p>Pharmaceutical expenses are much lower for immigrants with respect to autochthonous patients, both in the percentage of prescriptions filled at pharmacies and the number of containers of medication obtained, as well as the prices of the medications used. Future studies should explore which factors explain the observed differences in pharmaceutical expenses and if these disparities produce health inequalities.</p

Fungal Planet description sheets: 1436–1477

Novel species of fungi described in this study include those from various countries as follows: Argentina, Colletotrichum araujiae on leaves, stems and fruits of Araujia hortorum. Australia, Agaricus pateritonsus on soil, Curvularia fraserae on dying leaf of Bothriochloa insculpta, Curvularia millisiae from yellowing leaf tips of Cyperus aromaticus, Marasmius brunneolorobustus on well-rotted wood, Nigrospora cooperae from necrotic leaf of Heteropogon contortus, Penicillium tealii from the body of a dead spider, Pseudocercospora robertsiorum from leaf spots of Senna tora, Talaromyces atkinsoniae from gills of Marasmius crinis-equi and Zasmidium pearceae from leaf spots of Smilax glyciphylla. Brazil, Preussia bezerrensis from air. Chile, Paraconiothyrium kelleni from the rhizosphere of Fragaria chiloensis subsp. chiloensis f. chiloensis. Finland, Inocybe udicola on soil in mixed forest with Betula pendula, Populus tremula, Picea abies and Alnus incana. France, Myrmecridium normannianum on dead culm of unidentified Poaceae. Germany, Vexillomyces fraxinicola from symptomless stem wood of Fraxinus excelsior. India, Diaporthe limoniae on infected fruit of Limonia acidissima, Didymella naikii on leaves of Cajanus cajan, and Fulvifomes mangroviensis on basal trunk of Aegiceras corniculatum. Indonesia, Penicillium ezekielii from Zea mays kernels. Namibia, Neocamarosporium calicoremae and Neocladosporium calicoremae on stems of Calicorema capitata, and Pleiochaeta adenolobi on symptomatic leaves of Adenolobus pechuelii. Netherlands, Chalara pteridii on stems of Pteridium aquilinum, Neomackenziella juncicola (incl. Neomackenziella gen. nov.) and Sporidesmiella junci from dead culms of Juncus effusus. Pakistan, Inocybe longistipitata on soil in a Quercus forest. Poland, Phytophthora viadrina from rhizosphere soil of Quercus robur, and Septoria krystynae on leaf spots of Viscum album. Portugal (Azores), Acrogenospora stellata on dead wood or bark. South Africa, Phyllactinia greyiae on leaves of Greyia sutherlandii and Punctelia anae on bark of Vachellia karroo. Spain, Anteaglonium lusitanicum on decaying wood of Prunus lusitanica subsp. lusitanica, Hawksworthiomyces riparius from fluvial sediments, Lophiostoma carabassense endophytic in roots of Limbarda crithmoides, and Tuber mohedanoi from calcareus soils. Spain (Canary Islands), Mycena laurisilvae on stumps and woody debris. Sweden, Elaphomyces geminus from soil under Quercus robur. Thailand, Lactifluus chiangraiensis on soil under Pinus merkusii, Lactifluus nakhonphanomensis and Xerocomus sisongkhramensis on soil under Dipterocarpus trees. Ukraine, Valsonectria robiniae on dead twigs of Robinia hispida. USA, Spiralomyces americanus (incl. Spiralomyces gen. nov.) from office air. Morphological and culture characteristics are supported by DNA barcodes

Search for supersymmetry in events with large missing transverse momentum, jets, and at least one tau lepton in 20 fb−1 of √s=8 TeV proton-proton collision data with the ATLAS detector

A search for supersymmetry (SUSY) in events with large missing transverse momentum, jets, at least one hadronically decaying tau lepton and zero or one additional light leptons (electron/muon), has been performed using 20.3fb−1 of proton-proton collision data at √s= 8 TeV recorded with the ATLAS detector at the Large Hadron Collider. No excess above the Standard Model background expectation is observed in the various signal regions and 95% confidence level upper limits on the visible cross section for new phenomena are set. The results of the analysis are interpreted in several SUSY scenarios, significantly extending previous limits obtained in the same final states. In the framework of minimal gauge-mediated SUSY breaking models, values of the SUSY breaking scale Λ below 63 TeV are excluded, independently of tan β. Exclusion limits are also derived for an mSUGRA/CMSSM model, in both the R-parity-conserving and R-parity-violating case. A further interpretation is presented in a framework of natural gauge mediation, in which the gluino is assumed to be the only light coloured sparticle and gluino masses below 1090 GeV are excluded

Massive star formation in Wolf-Rayet galaxies. V: Star formation rates, masses and the importance of galaxy interactions

(Abridged) We have performed a comprehensive analysis of a sample of 20 starburst galaxies, most of them classified as Wolf-Rayet galaxies. In this paper, the last of the series, we analyze the global properties of our galaxy sample using multiwavelength data (X-ray, FUV, optical, NIR, FIR, and radio). The agreement between our Ha-based SFR and those provided by indicators at other wavelengths is remarkable, but we consider that the new Ha-based calibration provided by Calzetti et al. (2007) should be preferred over older calibrations. The FUV-based SFR provides a powerful tool to analyze the star-formation activity in both global and local scales independently to the Ha emission. We provide empirical relationships between the ionized gas mass, neutral gas mass, dust mass, stellar mass, and dynamical mass with the B-luminosity. Although all mass estimations increase with increasing luminosity, we find important deviations to the general trend in some objects, that seem to be consequence of their particular evolutionary histories. We investigate the mass-metallicity relations and conclude that both the nature and the star-formation history are needed to understand the relationships between both properties. The majority of the galaxies follow a Schmidt-Kennicutt scaling law of star-formation that agrees with that reported in individual star-forming regions within M~51 but not with that found in normal spiral galaxies. We found a relation between the reddening coefficient and the warm dust mass indicating that the extinction is mainly internal to the galaxies. Considering all data, we found that 17 up to 20 galaxies are clearly interacting or merging with low-luminosity dwarf objects or HI clouds. We conclude that interactions do play a fundamental role in the triggering mechanism of the strong star-formation activity observed in dwarf starburst galaxies.Comment: 33 pages, 21 figures, accepted for publication by A&

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions