•69% of the caregivers consider caregiving as a source of self-fulfillment.•Spouse functional limitations were associated with a higher burden.•Caregivers with a higher SOC-13 reported a ...significantly lower burden.•In our study, SOC did not appear to be merely the inverse of depression.
Caregiving is often associated with burden and chronic stress. Sense of coherence (SOC) may help the caregivers in coping with their stress and was identified as a positive factor for health outcomes and quality of life. We aimed to study the links between SOC, burden, depression and positive affects among caregivers of frail older patients.
Seventy-nine spousal caregivers were recruited via the geriatric outpatient clinic. Data collected: Zarit Burden Inventory, SOC-13, Geriatric Depression Scale, Caregiver Reaction Assessment (CRA), sleep, time of supervision, Katz Index, Global Deterioration Scale and Neuropsychiatric Inventory. Analyses: Caregiver’s characteristics were analyzed by burden severity and SOC level. Multivariable logistic regressions were used in order to identify the variable that best predict caregiver burden and high SOC.
The mean age was 79.4±5.3; 53% were women. Among care-recipient, 82% had cognitive impairment and the median Katz Index was 3. Caregivers with a high SOC and an older age reported a lower burden (Odds Ratio (OR) 0.18, 95% confidence interval (CI) 0.04–0.65 and OR 0.87, 95% CI 0.76–0.98, respectively). A higher burden was associated with patient functional limitations (OR 8.69, 95% CI 2.28–40.46).
Having a high sense of coherence seems to be a protective factor against the burden. To support caregivers, health providers should recognize the expertise of the caregivers and the meaningfulness of this care situation.
Several modifiers of the effects of multimorbidity have been identified mostly in terms of negative modifiers that increase the risk of adverse outcomes such as disability, depressive symptoms, ...impaired cognition, lower level of education,... ...the components of ICF allow to capture the individual's functional status (both in terms of impairments and capabilities) and can accommodate determinants of frailty and other modifiers of the effects of multimorbidity (both in terms of barriers and facilitators).
Evidence suggests that nutritional status during fetal development and early life leaves an imprint on the genome, which leads to health outcomes not only on a person as an adult but also on his ...offspring. The purpose of this study is to bring forth an overview of the relevant parameters that need to be collected to assess the long-term and transgenerational health outcomes of famine. A literature search was conducted for the most pertinent articles on the epigenetic effects of famine. The results were compiled, synthesized and discussed with an expert in genetics for critical input and validation. Prenatal and early life exposure to famine was associated with metabolic, cardiovascular, respiratory, reproductive, neuropsychiatric and oncologic diseases. We propose a set of parameters to be collected in disaster settings to assess the long-term outcomes of famine: PALTEM (parameters to assess long-term effects of malnutrition).
We organized this study in order to investigate differences in serum inflammatory profiles and circulating serum pneumoproteins between smokers with and without chronic obstructive pulmonary disease ...(COPD).
Patients aged 35-70 years with COPD and a smoking history ≥10 pack-years (cases, n=38) and 38 participants with the same smoking history without COPD (controls) were included in a comparative study conducted as part of a population-based cross-sectional study with 2,388 individuals in northwestern Russia. Cases and controls were matched for age and smoking history. Airflow obstruction (AO) was defined using forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <0.70 and/or FEV1/FVC < lower limit of the normal cut-off values. Patients at risk for COPD were reassessed using a standardized diagnostic work-up protocol. Several parameters, among which four inflammatory biomarkers the high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF-α) levels and two pneumoproteins surfactant protein D (SP-D) and Clara cell secretory protein 16 (CC16), were measured in the peripheral blood. Systemic inflammation was defined as at least 2 or more elevated biomarker levels.
Out of all smokers, 57.9% with normal spirometry and 36.8% with COPD did not have systemic inflammation, whereas 44.7% of the patients with COPD and 5.3% of the patients without AO demonstrated at least two elevated biomarker levels. No difference in age, gender, and smoking history, environmental and occupational exposure was found between the non-inflamed and the inflamed smokers. Of all risk factors studied, only COPD was associated with systemic inflammation odds ratio (OR) 11.42, 95% confidence interval (CI): 2.13-58.84.
Our study describes the systemic inflammatory network pattern associated with COPD and how it differs from the pattern in smokers with normal lung function. Systemic inflammation is not present in all smokers with COPD; in contrast, some non-obstructed smokers are characterized by systemic inflammation. From this perspective, smoking itself could be seen as a disease and studied accordingly.
NCT02307799.
Abstract
Background: Ageing people show increasing morbidity, dependence and vulnerability.
Objectives: To compare the relationships of different measures of multimorbidity with dependence ...(operationalized as disability) and vulnerability (operationalized as frailty).
Method: A cross-sectional analysis within the BELFRAIL cohort (567 subjects aged ≥ 80). Multimorbidity was measured using a disease count (DC), the Charlson comorbidity index (CCI) and the cumulative illness rating scale (CIRS), respectively. Associations with disability (based on activities of daily living) and frailty (defined by the Fried frailty criteria) were assessed using bivariable and multivariable analyses. Net reclassification improvement (NRI) values were calculated to compare the abilities of the DC, CCI and CIRS to identify patients with disability or frailty.
Results: Disability was associated with the DC (crude odds ratio, OR: 2.1; 95% confidence interval, CI: 1.4-3.4), CCI (crude OR: 1.8; 95% CI: 1.2-2.7) and CIRS (crude OR: 4.0; 95% CI: 2.5-6.5); only the association with CIRS was independent of age, sex, chronic inflammation, impaired cognition and frailty (adjusted OR: 3.2; 95% CI: 1.7-5.8). Frailty was associated with CCI (crude OR: 2.4; 95% CI: 1.2-4.6) and CIRS (crude OR: 2.6; 95% CI: 1.3-5.3); adjusted for age, sex, chronic inflammation, impaired cognition and disability. These associations were not statistically significant. The NRIs demonstrated a similar ability of the DC, CCI, and CIRS to identify patients with disability or frailty, respectively.
Conclusion: The associations of different measures of multimorbidity with disability and frailty differ but their ability to identify patients with disability or frailty is similar. Generally, multimorbidity scores incompletely reflect dependence and vulnerability in this age group.
Paediatric palliative care (PPC) aims to improve children's quality of life, but this outcome is rarely measured in clinical care. PPC is provided in Belgium through six transmural paediatric liaison ...teams (PLTs) ensuring continuity of care for children with life-limiting or life-threatening conditions (LLC/LTC). This study aims to measure the quality of life (QoL) of children with LLC/LTC followed-up by PLTs and the QoL of their parents.
During interviews, an original socio demographic questionnaire, the Children palliative outcome scale-version 2 (CPOS-2), the Fragebogen für Kinder und Jugendliche zur Erfassung der gesundheitsbezogenen Lebensqualität (KINDL) and the Quality of life in life-threatening Illness-Family caregiver (QOLLTI-F) were filled in by PLT members. Statistics were used to investigate significant differences between scores. Results were discussed and interpreted with six PLTs.
73 children aged 1-18 were included in the study. Especially for items focusing on emotional items, children reported their QoL as higher than their parents did. The QoL scores were not significantly associated with the child's condition's severity.
This study provides, for the first time, an overview of the QoL of children and parents followed-up by PLTs in Belgium.
vitamin D deficiency is a well-known cause of bone loss and fractures but its association, especially among the oldest old, with muscle weakness is less obvious.
to investigate the relationship ...between 25-hydroxyvitamin D (25-OHD) and muscle performance in persons aged 80 years and older.
baseline results of the Belfrail study, a prospective, population-based cohort study were used to study balance, grip strength and gait speed in relation to 25-OHD serum levels in 367 subjects.
a sufficient 25-OHD serum level of 30 ng/ml or more was found in 12.8% of the population. The prevalence of vitamin deficiency (20-29 ng/ml), insufficiency (10-19 ng/ml) and severe insufficiency (<10 ng/ml) was 21.5, 33 and 32.7%, respectively. No significant relation between balance, gait speed and grip strength, and serum 25-OHD was detected neither in bivariate analysis nor after adjustment for age, gender, level of education, institutionalisation, smoking status, body mass index, co-morbidity, level of activity, season, CRP, renal function, serum calcium parathyroid hormone levels, vitamin D intake and use of loop or thiazide diuretics.
in this cohort of octogenarians vitamin D deficiency was highly prevalent. We could not confirm the findings of previous studies showing an association between serum 25-OHD and physical performance in elderly.
The prevalence of chronic obstructive pulmonary disease (COPD) varies in different countries, while the cut-off for airflow obstruction (AO) is still contested. No COPD prevalence data based on the ...Global Lung Initiative (GLI) 2012 equations are available in Russia.
This study aims to assess AO prevalence by the GLI lower limit of normal (GLI-LLN) and the fixed cut-off, to identify AO risk factors and to assess the diagnostic value of respiratory symptoms in north-western Russia.
In a north-western Russian population-based sample of 2,974 adults aged 35-70 years, data on socio-demographics, smoking, occupational exposures and respiratory symptoms were collected, and spirometry was performed before and after bronchodilator (BD) administration.
The AO prevalence was 6.8% (95% CI 5.8-7.9) based on the fixed and 4.8% (95% CI 3.9-5.7) based on the GLI-LLN cut-off. 22.5% of the participants with post-BD AO had a positive bronchodilator test, and 1% showed a paradoxical BD response. Of the environmental factors studied, only smoking was independently associated with AO (odds ratio 2.47, 95% CI 1.60-3.82). The positive predictive value of respiratory symptoms for AO was 11% based on the fixed and 8% based on the GLI-LLN cut-off.
In a sample of adults in north-western Russia, the AO prevalence by the GLI-LLN cut-off was lower than that by the fixed cut-off. The predictive value of respiratory symptoms was low.
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