Background
Data are sparse regarding the value of physical activity (PA) surveillance among older adults—particularly among those with mobility limitations. The objective of this study was to examine ...longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study.
Methods and Results
Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home‐based activity data were collected by hip‐worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 SD years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84–0.96; P=0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65–0.89 P=0.001) were also associated with a lower incidence of cardiovascular events. Throughout follow‐up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85–0.96 P=0.001) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63–0.90 P=0.002) were significantly associated with lower cardiovascular event rates.
Conclusions
Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data.
Clinical Trial Registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500.
Although malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these populations. We ...present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM) in Maradi, Niger.
Children with complicated SAM hospitalized in the intensive care unit of a therapeutic feeding center, with no antibiotics in the previous 7 days, were included. A clinical examination, blood, urine and stool cultures, and chest radiography were performed systematically on admission.
Among the 311 children included in the study, gastroenteritis was the most frequent clinical diagnosis on admission, followed by respiratory tract infections and malaria. Blood or urine culture was positive in 17% and 16% of cases, respectively, and 36% had abnormal chest radiography. Enterobacteria were sensitive to most antibiotics, except amoxicillin and cotrimoxazole. Twenty-nine (9%) children died, most frequently from sepsis. Clinical signs were poor indicators of infection and initial diagnoses correlated poorly with biologically or radiography-confirmed diagnoses.
These data confirm the high level of infections and poor correlation with clinical signs in children with complicated SAM, and provide antibiotic resistance profiles from an area with limited microbiological data. These results contribute unique data to the ongoing debate on the use and choice of broad-spectrum antibiotics as first-line treatment in children with complicated SAM and reinforce the call for an update of international guidelines on management of complicated SAM based on more recent data.
Objectives
To identify novel modifiable risk factors, focusing on oral hygiene, for pneumonia requiring hospitalization of community‐dwelling older adults.
Design
Prospective observational cohort ...study.
Setting
Memphis, Tennessee, and Pittsburgh, Pennsylvania.
Participants
Of 3,075 well‐functioning community‐dwelling adults aged 70 to 79 enrolled in the Health, Aging, and Body Composition Study from 1997 to 1998, 1,441 had complete data in the data set of all variables used, a dental examination within 6 months of baseline, and were eligible for this study.
Measurements
The primary outcome was pneumonia requiring hospitalization through 2008.
Results
Of 1,441 participants, 193 were hospitalized for pneumonia. In a multivariable model, male sex (hazard ratio (HR) = 2.07, 95% confidence interval (CI) = 1.51–2.83), white race (HR = 1.44, 95% CI = 1.03–2.01), history of pneumonia (HR = 3.09, 95% CI = 1.86–5.14), pack‐years of smoking (HR = 1.006, 95% CI = 1.001–1.011), and percentage of predicted forced expiratory volume in 1 minute (moderate vs mild lung disease or normal lung function, HR = 1.78, 95% CI = 1.28–2.48; severe lung disease vs mild lung disease or normal lung function, HR = 2.90, 95% CI = 1.51–5.57) were nonmodifiable risk factors for pneumonia. Incident mobility limitation (HR = 1.77, 95% CI = 1.32–2.38) and higher mean oral plaque score (HR = 1.29, 95% CI = 1.02–1.64) were modifiable risk factors for pneumonia. Average attributable fractions revealed that 11.5% of cases of pneumonia were attributed to incident mobility limitation and 10.3% to a mean oral plaque score of 1 or greater.
Conclusion
Incident mobility limitation and higher mean oral plaque score were two modifiable risk factors that 22% of pneumonia requiring hospitalization could be attributed to. These data suggest innovative opportunities for pneumonia prevention among community‐dwelling older adults.
Early data on COVID-19 (based primarily on PCR testing) indicated a low burden in Sub-Saharan Africa. To better understand this, this study aimed to estimate the incidence rate and identify ...predictors of SARS-CoV-2 seroconversion in the two largest cities of Burkina Faso. This study is part of the EmulCOVID-19 project (ANRS-COV13).
Our study utilized the WHO Unity protocol for cohort sero-epidemiological studies of COVID-19 in general population. We conducted random sampling stratified by age group and sex. Individuals aged 10 years and older in the cities of Ouagadougou and Bobo-Dioulasso, Burkina Faso were included and surveyed at 4 time points, each 21 days apart, from March 3 to May 15, 2021. WANTAI SARS-CoV-2 Ab ELISA serological tests were used to detect total antibodies (IgM, IgG) in serum. Predictors were investigated using Cox proportional hazards regression.
We analyzed the data from 1399 participants (1051 in Ouagadougou, 348 in Bobo-Dioulasso) who were SARS-CoV-2 seronegative at baseline and had at least one follow-up visit. The incidence rate of SARS-CoV-2 seroconversion was 14.3 cases 95%CI 13.3-15.4 per 100 person-weeks. The incidence rate was almost three times higher in Ouagadougou than in Bobo-Dioulasso (Incidence rate ratio: IRR = 2.7 2.2-3.2, p < 0.001). The highest incidence rate was reported among women aged 19-59 years in Ouagadougou (22.8 cases 19.6-26.4 per 100 person-weeks) and the lowest among participants aged 60 years and over in Bobo-Dioulasso, 6.3 cases 4.6-8.6 per 100 person-weeks. Multivariable analysis showed that participants aged 19 years and older were almost twice as likely to seroconvert during the study period compared with those aged 10 to 18 years (Hazard ratio: HR = 1.7 1.3-2.3, p < 0.001). Those aged 10-18 years exhibited more asymptomatic forms than those aged 19 years and older, among those who achieved seroconversion (72.9% vs. 40.4%, p < 0.001).
The spread of COVID-19 is more rapid in adults and in large cities. Strategies to control this pandemic in Burkina Faso, must take this into account. Adults living in large cities should be the priority targets for vaccination efforts against COVID-19.
The world has high hopes of vaccination against COVID-19 to protect the population, boost economies and return to normal life. Vaccination programmes are being rolled out in high income countries, ...but the pandemic continues to progress in many low-and middle-income countries (LMICs) despite implementation of strict hygiene measures. We aim to present a comprehensive research protocol that will generate epidemiological, sociological and anthropological data about the COVID-19 epidemic in Burkina Faso, a landlocked country in West Africa with scarce resources.
We will perform a multidisciplinary research using mixed methods in the two main cities in Burkina Faso (Ouagadougou and Bobo-Dioulasso). Data will be collected in the general population and in COVID-19 patients, caregivers and health care professionals in reference care centers: (i) to determine cumulative incidence of SARS-CoV-2 infection in the Burkinabe population using blood samples collected from randomly selected households according to the WHO-recommended protocol; (ii) develop a score to predict severe complications of COVID-19 in persons infected with SARS-CoV-2 using retrospective and prospective data; (iii) perform semi-structured interviews and direct observation on site, to describe and analyze the healthcare pathways and experiences of patients with COVID-19 attending reference care centers, and to identify the perceptions, acceptability and application of preventive strategies among the population.
This study will generate comprehensive data that will contribute to improving COVID-19 response strategies in Burkina Faso. The lessons learned from the management of this epidemic may serve as examples to the country authorities to better design preventive strategies in the case of future epidemics or pandemics. The protocol was approved by the Ministry for Health (N° 2020-00952/MS/CAB/INSP/CM) and the Health Research Ethics Committee in Burkina Faso (N° 2020-8-140).
Metabolic Syndrome and the Risk of Cardiovascular Disease in Older Adults
Javed Butler, Nicolas Rodondi, Yuwei Zhu, Kathleen Figaro, Sergio Fazio, Douglas E. Vaughan, Suzanne Satterfield, Anne B. ...Newman, Bret Goodpaster, Doug Bauer, Paul Holvoet, Tamara B. Harris, Nathalie de Rekeneire, Susan Rubin, Jingzhong Ding, Stephen B. Kritchevsky, for the Health ABC Study
To assess whether metabolic syndrome (MetSyn) predicts a risk for cardiovascular events in older adults, we studied 3,035 subjects, ages 70 to 79 years. After adjustment for other risk factors, during a 6-year follow-up, MetSyn was associated with a significantly higher risk for coronary events (hazard ratio HR 1.56, 95% confidence interval CI 1.28 to 1.91), myocardial infarction (HR 1.51, 95% CI 1.12 to 2.05), and heart failure hospital stay (HR 1.49, 95% CI 1.10 to 2.00). There was a trend toward higher cardiovascular mortality (p = 0.067) and coronary mortality (p = 0.051) in patients with MetSyn. In conclusion, MetSyn is associated with significant cardiovascular risk in older adults.
The purpose of this study was to assess whether metabolic syndrome (MetSyn) predicts a higher risk for cardiovascular events in older adults.
The importance of MetSyn as a risk factor has not previously focused on older adults and deserves further study.
We studied the impact of MetSyn (38% prevalence) on outcomes in 3,035 participants in the Health, Aging, and Body Composition (Health ABC) study (51% women, 42% black, ages 70 to 79 years).
During a 6-year follow-up, there were 434 deaths overall, 472 coronary events (CE), 213 myocardial infarctions (MI), and 231 heart failure (HF) hospital stays; 59% of the subjects had at least one hospital stay. Coronary events, MI, HF, and overall hospital stays occurred significantly more in subjects with MetSyn (19.9% vs. 12.9% for CE, 9.1% vs. 5.7% for MI, 10.0% vs. 6.1% for HF, and 63.1% vs. 56.1% for overall hospital stay; all p < 0.001). No significant differences in overall mortality was seen; however, there was a trend toward higher cardiovascular mortality (5.1% vs. 3.8%, p = 0.067) and coronary mortality (4.5% vs. 3.2%, p = 0.051) in patients with MetSyn. After adjusting for baseline characteristics, patients with MetSyn were at a significantly higher risk for CE (hazard ratio HR 1.56, 95% confidence interval CI 1.28 to 1.91), MI (HR 1.51, 95% CI 1.12 to 2.05), and HF hospital stay (HR 1.49, 95% CI 1.10 to 2.00). Women and whites with MetSyn had a higher coronary mortality rate. The CE rate was higher among subjects with diabetes and with MetSyn; those with both had the highest risk.
Overall, subjects over 70 years are at high risk for cardiovascular events; MetSyn in this group is associated with a significantly greater risk.
OBJECTIVES: To identify factors associated with falling in well‐functioning older people.
DESIGN: Cross‐sectional analyses of report of falls over the past 12 months using baseline data from the ...Health, Aging and Body Composition Study.
SETTING: Clinic examinations in Pittsburgh, Pennsylvania, or Memphis, Tennessee.
PARTICIPANTS: Three thousand seventy‐five high‐functioning black and white elderly aged 70 to 79 living in the community.
MEASUREMENTS: Physical function assessed using self‐report and performance measures. Health status indicators included diseases, medication use, and body composition measures.
RESULTS: Almost one‐quarter (24.1%) of women and 18.3% of men reported at least one fall within the year before the baseline examination. Fallers were more likely to be female; white; report more chronic diseases and medications; and have lower leg strength, poorer balance, slower 400‐meter walk time, and lower muscle mass. In men, multivariate logistic regression models showed white race (adjusted odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.2–1.6), slower 6‐meter walk speed (OR = 1.1, 95% CI = 1.0–1.3), poor standing balance (OR = 1.2, 95% CI = 1.0–1.4), inability to do 5 chair stands (OR = 1.7, 95% CI = 1.3–1.9), report of urinary incontinence (UI) (OR = 1.5, 95% CI = 1.1–2.0), and mid‐quintile of leg muscle strength (OR = 0.6, 95% CI = 0.4–0.9) to be independently associated with report of falling. In women, benzodiazepine use (OR = 1.6, 95% CI = 1.0–2.6), UI (OR = 1.5, 95% CI = 1.2–1.9), and reported difficulty in rising from a chair (OR = 1.4, 95% CI = 1.2–1.6) were associated with past falls.
CONCLUSION: Falls history needs to be screened in healthier older adults. Even for well‐functioning older persons, specific correlates of falling can be identified to define those at risk.
OBJECTIVES: To identify levels of knee extensor strength that are associated with high and low risk of incident severe mobility limitation (SML) in initially well‐functioning older adults.
DESIGN: ...Prospective cohort study.
SETTING: University clinic center.
PARTICIPANTS: One thousand three hundred fifty‐five men and 1,429 women (aged 73.6±2.85) who reported no mobility limitation.
MEASUREMENTS: Unilateral knee extensor isokinetic strength of participants was obtained. Participants were followed over a median of 5.90 years for the onset of SML, defined as two consecutive reports of a lot of difficulty or inability to walk one‐quarter of a mile or climb 10 steps. Deciles of knee extension strength relative to body weight were evaluated to identify cutpoints most predictive of incident SML. Cutpoints were then compared with prevalence of having slow gait speed (<1.22 m/s) and mortality.
RESULTS: Two sex‐specific knee extension strength cutpoints were found. High and low risk of SML corresponded to less than 1.13 newton‐meters (Nm)/kg (1st decile) and more than 1.71 Nm/kg (6th decile) in men and less than 1.01 Nm/kg (3rd decile) and more than 1.34 Nm/kg (7th decile) in women, respectively. Moderate risk was defined as being between the low‐ and high‐risk cutpoints. Individuals with knee extension strength in the high‐ and moderate‐risk categories were more likely to have a gait speed less than 1.22 m/s (hazard ratio (HR)=7.00, 95% confidence interval (CI)=5.47–8.96 and HR=2.14 7.00, 95% CI=1.73–2.64, respectively) and had a higher risk of death (HR=1.77, 95% CI=1.41–2.23 and HR=1.51, 95% CI=1.24–1.84, respectively) than individuals in the low‐risk category. Adjustment for demographic factors, health behaviors, and medical conditions did not alter these associations.
CONCLUSION: Knee extensor strength cutpoints provide objective markers to identify initially well‐functioning older adults at high and low risk of future mobility limitation.
Gait speed is cross-sectionally associated with attention and psychomotor speed in older community dwellers. It is unclear if gait speed predicts decline in these cognitive domains over time.
Usual ...gait speed (m/s) over 6 m was measured at baseline in 2,776 Health, Aging and Body Composition Study participants (mean age +/- SD 73.5 +/- 2.8 years, 53% women, 37% blacks). The Digit Symbol Substitution Test (DSST) was administered at baseline and after 5 years to assess attention and psychomotor speed. We used multivariate logistic regression models to calculate the risk of DSST 5-year decline >1 SD from mean change (9 points) across quartiles of gait speed, adjusting for demographics, weight, physical activity, comorbidities, depression and Modified Mini-Mental State Examination.
After 5 years, 389 (17.1%) participants declined in DSST. Compared to those in the highest quartile of gait speed (>1.35 m/s), participants in the lowest quartile (<1.05 m/s) were more likely to decline in DSST independently of the considered covariates (OR 1.74, 95% CI 1.21-2.51, adjusted p for trend across quartiles = 0.006).
In this cohort of older community dwellers, gait speed independently predicted a decline in DSST after 5 years.
Elevated proinflammatory cytokines are associated with severity of pneumonia, but the role of preinfection cytokine levels in the predisposition to pneumonia in humans is less clear.
To ascertain ...role of preinfection inflammatory markers on susceptibility to community-acquired pneumonia (CAP).
Longitudinal analysis over 6.5 yr of a cohort that consisted of 70- to 79-yr-old well-functioning elderly individuals.
Association between preinfection tumor necrosis factor (TNF), interleukin 6 (IL-6), and C-reactive protein (CRP) levels and CAP requiring hospitalization.
Of the 3,075 participants, 161 (5.2%) developed at least one episode of CAP requiring hospitalization over a median duration of 3.3 yr. The highest tertiles of TNF (> 3.7 pg/ml) and IL-6 (> 2.4 pg/ml) were associated with increased risk of CAP, and the adjusted odds ratios were 1.6 (95% confidence interval CI, 1.02-2.7) and 1.7 (95% CI, 1.1-2.8), respectively. The adjusted risk of CAP with at least one of these markers in the highest tertile was 1.6 (95% CI, 1.1-2.3). TNF and IL-6 levels in the highest tertile had a synergistic effect (p = 0.01 for interaction), and risk of CAP for both markers in the highest tertile was 2.8 (95% CI, 1.8-4.3). An FEV(1) of 50% or less of predicted was associated with the highest risk of CAP (adjusted odds ratio, 3.6; 95% CI, 2.3-5.6). Furthermore, TNF and IL-6 levels modified risk of CAP in participants with coexisting medical conditions and history of smoking.
In the well-functioning elderly subjects, preinfection systemic levels of TNF and IL-6 were associated with higher risk of CAP requiring hospitalization in smokers and those with coexisting medical conditions.
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