This study assesses prevalence and patients characteristics related to polypharmacy in a sample of nursing home residents.
We conducted a cross-sectional analysis on 4,023 nursing home residents ...participating to the Services and Health for Elderly in Long TERm care (SHELTER) project, a study collecting information on residents admitted to 57 nursing home in 8 countries. Data were collected using the interRAI instrument for long-term care facilities. Polypharmacy status was categorized in 3 groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs) and excessive polypharmacy (≥ 10 drugs).
Polypharmacy was observed in 2,000 (49.7%) residents and excessive polypharmacy in 979 (24.3%) residents. As compared with non-polypharmacy, excessive polypharmacy was directly associated not only with presence of chronic diseases but also with depression (odds ratio OR 1.81; 95% confidence interval CI 1.38-2.37), pain (OR 2.31; 95% CI 1.80-2.97), dyspnoea (OR 2.29; 95% CI 1.61-3.27), and gastrointestinal symptoms (OR 1.73; 95% CI 1.35-2.21). An inverse association with excessive polypharmacy was shown for age (OR for 10 years increment 0.85; 95% CI 0.74-0.96), activities of daily living disability (OR for assistance required vs independent 0.90; 95% CI 0.64-1.26; OR for dependent vs independent 0.59; 95% CI 0.40-0.86), and cognitive impairment (OR for mild or moderate vs intact 0.64; 95% CI 0.47-0.88; OR for severe vs intact 0.39; 95% CI 0.26-0.57).
Polypharmacy and excessive polypharmacy are common among nursing home residents in Europe. Determinants of polypharmacy status include not only comorbidity but also specific symptoms, age, functional, and cognitive status.
The resident deaths among Long Term Care Home (LTCH) accounted for more than 65% of total deaths in the province of Ontario, Canada, during March 29 to June 3, 2020, yet not all LTCHs were severely ...affected.
We carried out a retrospective cohort study, with case control for questions for which data allowed, with LTCH COVID-19 databases obtained from Ontario's Ministry of Long Term Care. We performed a combined temporal and spatial data analysis of COVID-19 cases and deaths among LTCH residents, identified trends, contributing factors, and early markers of LTCH outbreak severity.
Our analysis shows that for-profit LTCHs had higher death-to-bed ratio, also with an average rate of increase of death-to-bed ratio higher for for-profit homes than other types of management. We find from uni- and multi-variable analyses (linear and nonlinear) that staff infection has the strongest association with death-to-bed ratio from among the descriptor variables considered, reflecting the risk of the disease in the health region/community. We also identify a delay of up to 8 days between the trends in fatalities among individuals outside LTCHs and that of LTCH residents. We did find an association between policy change to single LTCH/staff and reduction in weekly LTCH resident death, albeit with an expected time delay of about 7-10 days.
The association between the risk of COVID-19 in the health region and the deaths among LTCH residents, and the delay between fatality among individuals residing outside and inside LTCHs suggests that fatality in a health region could be a predictor of outbreak in LTCHs within the same health region.
Objectives
To examine the relationships between protein intake from various food sources and cardiometabolic risk markers in Italian older adults.
Design
Cross-sectional study. Setting: ...Unconventional settings across Italy (e.g., exhibitions, health promotion campaigns).
Participants
People 65+ years who provided a written informed consent.
Measurements
Blood pressure (BP), blood glucose, total blood cholesterol, and anthropometric indices were assessed. Daily protein intake was estimated for 12 food items listed in a food frequency questionnaire.
Results
Three-thousand four-hundred twenty-four older adults (mean age: 72.7 ± 5.7 years; 55% women) were included in the study. Results of linear regression analysis indicated that protein intake from several food sources was negatively associated with BP, waist and hip circumferences, and waist-to-hip ratio in both sexes. Blood glucose levels were inversely associated with many protein sources in women. Positive associations were observed between some protein sources and total blood cholesterol in both men and women.
Conclusion
Our findings suggest that dietary protein is differentially associated with cardiometabolic risk factors depending on sex and food sources.
Radionuclides for radiopharmaceuticals can be produced in cyclotrons or nuclear reactors. Each of these production modes has serious issues, such as high target costs, production of long-lived wastes ...and contaminants, expensive separation. For this reason, new methods are under consideration for the production of highly pure radionuclides. The ISOL (Isotope Separation On-Line) method is the major technique for the production of radioactive ion beams for nuclear physics applications. The SPES-ISOLPHARM project at INFN-LNL (Istituto Nazionale di Fisica Nucleare-Laboratori Nazionali di Legnaro) is a feasibility study for the production of medical isotopes exploiting the ISOL method. The ongoing activities concerning a recent experiment focused on
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Ag, a study performed in collaboration with Padova and Trento Universities, is presented.
Objectives
Behavioral factors, including protein intake, influence the quantity and quality of skeletal muscle. The aim of this study was to explore the relationship between animal-derived protein ...intake and muscle mass and function in a large sample of unselected community-dwellers.
Material and Methods
The VIP (Very Important Protein) study, conducted during Expo 2015 in Milan, was a population survey aimed at assessing major health metrics in a population outside of the research setting, with a special focus on the relation between animal-derived protein intake and muscle mass and function. A brief questionnaire exploring lifestyle habits, dietary preferences and the consumption of selected foods was administered. Muscle mass was estimated by calf circumference (CC) and mid-arm muscle circumference (MAMC) of the dominant side. Muscle strength of upper and lower extremities was assessed through handgrip strength testing and repeated chair stand test, respectively.
Results
The mean age of the 1,853 participants was 50.3 years (standard deviation: 15.7; range: 18-98 years), of whom 959 (51.7%) were women. Participants in the highest tertile of protein consumption showed better performance at both the handgrip strength (p <0.001) and chair stand tests than those in the lowest tertile (p <0.01). The same results were found for CC (p <0.001) and MAMC (p <0.001). Participants with high protein intake and engaged in regular physical activity showed the higher scores in all the assessed domains.
Conclusions
The results of the VIP survey suggest an association between animal-derived protein intake and muscle mass and strength across ages. Our findings also indicate a synergistic effect of animal-derived protein intake and physical activity on muscle-related parameters.
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•Theory of pH-static titrations for metal + ligand complexation kinetics was given.•pH static titrations represent a kinetic method alternative to spectrophotometry.•The kinetics of ...Sr2++DOTA reaction at various pH and temperatures was studied.•Other used methods for kinetic measurements can give wrong results.
The theory of pH-static (or pH-stat) titrations in kinetic measurements of metal ion + ligand complex formation was resumed, and equations required to fit the experimental data were derived. This method was applied to study the kinetics of Sr2++DOTA reaction (DOTA = 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid). pH-static titrations were performed at various pH (from 4.00 to 6.00) and temperatures (5, 15, and 25 °C) and at a constant ionic strength of (Na)Cl 0.15 mol/L. The complex formation involved either a rapidly formed intermediate species which then gave the final complex, or the direct metal + ligand reaction. The corresponding equilibrium constant βos and kinetic constants kos (first order) and k (second order) were obtained. Both k and kos increased by increasing pH and temperature. Kinetic data were recorded by pH-static titrations also for Ni2++DOTA reaction, and other kinetic results were obtained by using a more commonly employed method, proposed by Kasprzyk and Wilkins S. P. Kasprzyk and R. G. Wilkins, Inorg. Chem., 1982, 21, 3349, which however appears to be theoretically incorrect. The comparison between the kinetic results for Sr2++DOTA and Ni2++DOTA reactions obtained by pH-static titrations, by the Kasprzyk/Wilkins method, and by the well-established spectrophotometric method (literature data), indicated that the Kasprzyk/Wilkins method should be used with caution as sometimes its systematic errors can be statistically relevant with respect to the typical precision of kinetic data.
Accelerator-based techniques with electromagnetic mass separation are considered among the most innovative and promising strategies to produce non-conventional radionuclides for nuclear medicine. ...Such approach was successfully used at CERN, where the dedicated MEDICIS facility was built, and at TRIUMF, where the ISAC radioactive beam facility was used to produce unconventional α-emitters. In such framework, the Legnaro National Laboratories of the Italian Institute of Nuclear Physics (INFN-LNL) proposed the ISOLPHARM project (ISOL technique for radioPHARMaceuticals), which will exploit radionuclides producible with the SPES (Selective Production of Exotic Species) ISOL (Isotope Separation On-Line) facility to develop novel radiopharmaceuticals. The ISOL technique utilizes the irradiation with a primary beam of particles/nuclei of a production target where radionuclides are produced. A radioactive ion beam is subsequently extracted from the production target unit, and transported up to an analyzing magnet, where non-isobaric contaminants are filtered out. The so-obtained purified radioactive beam is dumped onto an implantation substrate, referred as collection target. Then, the desired nuclides can be chemically harvested from the collected isobars, and the isotopically pure atom collection can be employed to radiolabel high specific activity radiopharmaceuticals. Metallic deposition targets in the form of coated metal foils were mostly used at TRIUMF and CERN. At ISOLPHARM, a different approach is under investigation which foresees the use of soluble cold-pressed collection targets, possibly facilitating the chemical purification process of the collected radionuclides. In this study, the production and characterization of some of the ISOLPHARM collection targets is presented, in particular, soluble salts (NaCl and NaNO3) and organic materials widely used for pharmaceutical tablets production are considered. All such materials proved to be potentially suitable as collection targets, since solid samples were easily produced and resulted compatible with the vacuum conditions required for the ion implantation process. Furthermore, some of the selected substrates were used for proof-of-concept deposition tests with stable silver, to prove their suitability as ISOLPHARM deposition substrates for silver-111, a promising candidate for radiotherapy. Such tests highlighted possible scenarios useful for the development of new alternative materials, as the use of insoluble organic targets.
•ISOL based techniques for the production of medical radionuclides require the use of an implantation target.•Generally, implantation targets are metallic foil, ISOLPHARM at INFN-LNL proposes saline or organic substrates.•NaCl, NaNO3, cellulosic and dextrates substrates were produced by direct compression.•All samples were characterized in terms of density, mechanical strength, disaggregation and vacuum compatibility.•Implantation depth calculations and tests with the deposition of Ag + ions were performed.
A new approach to the study of the effects on human skin of mycosporine-like amino acids (MAAs) and gadusol (Gad) incorporated in polymer gel is proposed in this work. The depth profile and ...photoprotector effects of Pluronic F127® gels containing each of the natural actives were evaluated by in vivo confocal Raman spectroscopy aiming at the analysis of the biochemical changes on human skin. Hierarchical cluster analysis (HCA) showed that the data corresponding to different depths of the skin, from surface to 4μm, and from 6 to 16μm, remained in the same cluster. In vivo Raman spectra, classified into five different layers of epidermis according to their similarities, indicated that the amount of Gad gel increased by about 26% in the outermost layer of the stratum corneum (SC) and that MAAs gel at 2μm depth was 103.4% higher than in the outermost layer of the SC. Variations in the SC of urocanic acid at 1490–1515cm−1 and 1652cm−1 and histidine at 1318cm−1 were calculated, before and after UV exposure with or without gels. With the application of gels the vibrational modes that correspond to lipids in trans conformation (1063 and 1128cm−1) increased with respect to normal skin, whereas gauche conformation (1085cm−1) disappeared. Our studies suggest that gels protected the skin against the stress of the natural defense mechanism caused by high levels of UV exposure.
•Polymer gels as delivery systems of MAA and Gad were prepared.•In vivo photoprotection of MAA and Gad was evaluated under UV exposure.•In vivo confocal Raman measurements showed biochemical changes in the human skin.•Relative concentrations of t-UCA and HIS were calculated from the Raman spectra.
Post-COVID-19 is a syndrome defined by signs and symptoms present until 12 weeks after COVID-19, lasting for more than 8 weeks, not explained by an alternative diagnosis. The present study aimed to ...assess whether the cardiovascular risk (CVR) of patients with COVID-19 correlates with symptoms and changes in respiratory function parameters in post-COVID-19. The association between CVR and the severity of acute disease was also considered.
Between 21/04/21-01/09/21, we enrolled 1,782 consecutive patients with COVID-19. We divided these subjects into (i) 4 levels, based on the severity of COVID-19 (home care; hospitalized/no oxygen therapy; hospitalized/oxygen therapy; hospitalized/NIV-ICU), (ii) 2 levels, according to CVR calculated with the European Society of Cardiology SCORE tables (low-intermediate risk; high or very high risk). All subjects underwent a 3-month follow-up considering post-COVID-19 symptoms.
In post-COVID-19 patients, high or very-high CVR was associated with (i) increased risk of hospitalization for COVID-19 (p<0.0001), (ii) higher prevalence of severe clinical manifestations and ICU admission (p<0.0001), (iii) development of post-COVID-19 (p<0.0001) and (iv) increased risk of a larger post-COVID-19 burden of disease.
We found a statistically significant association between CVR, severity of COVID-19, and post-COVID-19 syndrome three months after the end of acute disease.
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