Abstract
Background
Polypharmacy can be defined as using five or more medications simultaneously. “Medication-related problems”, an extension of polypharmacy, includes inappropriate prescribing, poor ...adherence, overdosage, underdosage, inappropriate drug selection, inadequate monitoring, adverse drug effects, and drug interactions. Polypharmacy and the high risk of medication-related problems among older people are associated with adverse health consequences due to drug-drug interactions, drug-disease interactions, and adverse drug effects. This study aims to assess the factors associated with polypharmacy and the high risk of medication-related problems among community-dwelling older people in the Netherlands, Greece, Croatia, Spain, United Kingdom.
Method
This longitudinal study used baseline and follow-up data from 1791 participants of the Urban Health Center European project. Polypharmacy and the risk of medication-related problems were evaluated at baseline and follow-up using the Medication Risk Questionnaire. We studied factors in the domains (a) sociodemographic characteristics, (b) lifestyle and nutrition, and (c) health and health care use. Hierarchical logistic regression analyses were used to examine the factors associated with polypharmacy and the high risk of medication-related problems.
Results
Mean age was 79.6 years (SD ± 5.6 years); 60.8% were women; 45.2% had polypharmacy, and 41.8% had a high risk of medication-related problems. Women participants had lower odds of polypharmacy (OR = 0.55;95%CI:0.42–0.72) and a high risk of medication-related problems (OR = 0.50; 95%CI:0.39–0.65). Participants with a migration background (OR = 1.67;95%CI:1.08–2.59), overweight (OR = 1.37; 95%CI:1.04–1.79) and obesity (OR = 1.78;95%CI:1.26–2.51) compared to ‘normal weight’, with lower physical HRQoL (OR = 0.96, 95%CI:0.95–0.98), multi-morbidity (OR = 3.73, 95%CI:2.18–6.37), frailty (OR = 1.69, 95%CI:1.24–2.30), visited outpatient services (OR = 1.77, 95%CI: 1.09–2.88) had higher odds of polypharmacy. The associations with the high risk of medication-related problems were similar.
Conclusions
Multiple factors in demography, lifestyle, nutrition, and health care use are associated with polypharmacy and the high risk of medication-related problems. Polypharmacy is a single element that may reflect the number of medications taken. The broader content of medication-related problems should be considered to assess the context of medication use among older people comprehensively. These provide starting points to improve interventions to reduce polypharmacy and high risk of medication-related problems. In the meantime, health professionals can apply these insights to identify subgroups of patients at a high risk of polypharmacy and medication-related problems.
Trial registration
The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952. The date of registration is 13/03/2017.
We developed a next-generation SARS-CoV-2 sequencing platform and obtained the first SARS-CoV-2 sequences from patients in Croatia at the beginning of the COVID-19 outbreak in the spring of 2020. ...Integrating the sequencing and the epidemiological data, we show that patients were infected with different SARS-CoV-2 variants belonging to different clades (mostly G and GH). This result confirms that there was widespread virus transmission early in 2020. Interestingly, we identified a unique mutation resulting in a V13I substitution in Nsp5A, the main viral protease, in a patient who had not received antiviral therapy.
Background
To compare the effectiveness between conventional (face-to-face) and online public health approaches focused on mental health, self-efficacy of health management and quality of life of ...older adults.
Design and methods
Participants will be 65+ residents of the city of Rijeka and the wider urban area and will be divided into three groups. The first group consists of participants who will be included in the conventional (face-to-face) form of public health intervention, the second group consists of participants who will be involved in online public health intervention and the third group consists of participants from the control group. A total of 450 participants will participate in a pretest-posttest non-equivalent groups design research, with 150 participants per group. A series of questionnaires will be administered to evaluate effect of the interventions on mental health, self-efficacy of health management and quality of life. Results of this research will provide insight into the effectiveness of the electronic way of implementing chronic disease self-management interventions compared to conventional (face-to-face) which can be useful to policy makers and public authorities in the organization and implementation of health policies.
Expected impact of the study for public health: This research will contribute to the definition, implementation and adaptation of future public health interventions related to mental health, selfefficacy of health management and quality of life in the context of various epidemiological situations such as the current one caused by the COVID-19 pandemic.
Overview of Iodine Intake Vasiljev, Vanja; Subotić, Alen; Marinović Glavić, Mihaela ...
Southeastern European medical journal (Online),
04/2022, Letnik:
6, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Iodine is an essential element for human health. Food is the primary source of iodine, but the iodine content of local foods depends on the iodine content of the soil. Therefore, a low iodine ...concentration in soil and water results in plants and animals with low iodine content. Numerous effects of iodine deficiency on growth and development are known as iodine deficiency disorders. Iodine deficiency has been identified as the most common cause of brain damage in the world and is linked to its effects on infant and child growth and development. Supplementation of table salt with iodine was introduced in the 20th century. Croatia was one of the first countries to introduce the supplementation of table salt with potassium iodide at a concentration of 10 mg/kg in 1953 and 25 mg/kg in 1993. In 2003, the Croatian population reached iodine sufficiency, but given the excessive salt intake (11.6 g/day) and additional sources of iodine in the diet, the question arises, are we consuming too much iodine? This article gives a short overview of iodine intake.
Aim: Falling can have serious consequences for older persons, but fear of falling is also a current problem. The aim of the study is to assess the incidence of falls and fear of falling among older ...adults, as well as to study the connection of falls and fear of falling with functional ability, body mass index (BMI) and age.Methods: The participants of this study are older persons ( > 60 years) who live in the city of Rijeka, are mobile and have no symptoms of dementia. The relationship between falls, fear of falling, body mass index (BMI) and functional ability was measured using various indicators. Assessment of physical functioning and pain relief was made using the COOP/WONCA questionnaire. Falls and fear of falling were assessed using questions with different response options.Results: The results of the study showed that participants who reported experiencing fear of falling (FoF) had a higher BMI (p = 0.018) and did not feel physically healthy (70%). Participants who lived with a partner reported experiencing FoF at a lower rate (36.4%). The most frequently reported functional problems were visual problems (46.2%) and walking difficulties (40.0%).Conclusions: A large percentage of older persons struggle with the effects of aging, which include various health problems that can increase the risk of falling and FoF. Prescription of physical activity and engaging in it could improve functional ability and have an important effect on healthy aging. This could be the starting point from which key stakeholders can plan different types of public health interventions, prescribing physical activity to maintain functional ability that enables well-being in old age.
Impulsivity, affective instability, and neglect of oneself and other people's safety as symptoms of personality dysfunction are associated with risky behaviors regarding the transmission of ...infectious diseases either sexually or by intravenous drug abuse.
The aim of this study was to analyze the association between hepatitis C virus (HCV) infection and personality dysfunction in opiate addicts on opioid substitution treatment.
This was a cross-sectional, observational investigation of patients over 18 years of age who were actively participating in opioid substitution treatment at five centers in Bosnia and Herzegovina. The occurrence of HCV infection was the primary study outcome, and personality functioning, the main independent variable, was assessed using the Severity Indices of Personality Problems (SIPP-118) questionnaire. The association between scores of personality functioning domains items and HCV infection status was determined by binary logistic regression analysis.
Patients on opioid substitution therapy with HCV infection more frequently had personality disorders (OR 2.168, 95% CI 1.161-4.05) and were treated longer than patients without HCV infection (OR 1.076, 95% CI 1.015-1.14). HCV infection was associated with lower self-respect (OR 0.946, 95% CI 0.906-0.988), decreased capacity to have enduring relationships with other people (OR 0.878, 95% CI 0.797-0.966), and lower capability to cooperate with others (OR 0.933, 95%CI 0.888-0.98). On the other hand, except for self-respect, other elements of the Identity Integration domain (enjoyment, purposefulness, stable self-image, and self-reflexive functioning), when more functional, increased the risk of HCV infection.
Our study demonstrates that opiate addicts on opioid substitution treatment have a higher risk of HCV infection if their personality is dysfunctional, especially in the aspects of self-respect, enduring relationships, and cooperativity. The risk is even higher in addicts who have an established diagnosis of any kind of personality disorder.
Older persons often have interacting physical and social problems and complex care needs. An integrated care approach in the local context with collaborations between community-, social-, and ...health-focused organisations can contribute to the promotion of independent living and quality of life. In the Urban Health Centres Europe (UHCE) project, five European cities (Greater Manchester, United Kingdom; Pallini (in Greater Athens Area), Greece; Rijeka, Croatia; Rotterdam, the Netherlands; and Valencia, Spain) develop and implement a care template that integrates health and social care and includes a preventive approach. The UHCE project includes an effect and process evaluation.
In a one-year pre-post controlled trial, in each city 250 participants aged 75+ years are recruited to receive the UHCE approach and are compared with 250 participants who receive 'care as usual'. Benefits of UHCE approach in terms of healthy life styles, fall risk, appropriate medication use, loneliness level and frailty, and in terms of level of independence and health-related quality of life and health care use are assessed. A multilevel modeling approach is used for the analyses. The process evaluation is used to provide insight into the reach of the target population, the extent to which elements of the UHCE approach are executed as planned and the satisfaction of the participants.
The UHCE project will provide new insight into the feasibility and effectiveness of an integrated care approach for older persons in different European settings.
ISRCTN registry number is ISRCTN52788952 . Date of registration is 13/03/2017.
Frailty is a pronounced symptom of aging associated with multiple comorbid states and adverse outcomes. The aim of this study was to evaluate the impact of 2 interventions, one based on prevention of ...falls and the other on prevention of loneliness, on total frailty and dimensions of frailty in urban community-dwelling elderly as well as associations with independent living.This prospective interventional study followed up 410 persons aged 75 to 95. The participants of the control and intervention groups were monitored through a public health intervention programme. The level of frailty was measured by the Tilburg Frailty Indicator (TFI) questionnaire and the factors of independent living were analyzed using validated questionnaires.After 1 year, physical frailty measured in the control group showed a statistically significant increase (r = -0.11), while in the intervention groups physical frailty did not increase (both P > .05). Psychological frailty measured after 1 year in the control group was significantly higher (r = -0.19), as well as in the group where the public health interventions to reduce loneliness were carried out (r = -0.19). Psychological frailty did not increase in the group in which public health interventions to prevent falls were carried out, and social frailty did not increase at all in the study period. The total level of frailty in the control group after 1 year was significantly increased (r = -0.19), while no increase was seen in the overall frailty in the intervention group. Multivariate analysis has shown that both interventions where independently associated with lower end frailty. Additionally, higher baseline frailty and visit to a physician in the last year were positively associated with higher end-study frailty level, while higher number of subjects in the household and higher total psychological quality of life (SF-12) were independently associated with lower end-study frailty. Only in the prevention of falls group there was no increase in restriction in the activities of daily living throughout study follow-up.Public health interventions to prevent falls and to prevent loneliness have a positive effect on the frailty and independent living of the elderly living in their own homes in an urban community.
: This study aimed to assess the association between loneliness and Health-Related Quality of Life (HR-QoL) among community-dwelling older citizens in five European countries. We characterize ...loneliness broadly from an emotional and social perspective.
: This cross-sectional study measured loneliness with the 6-item De Jong Gierveld Loneliness Scale and HR-QoL with the 12-Item Short-Form Health Survey. The association between loneliness and HR-QoL was examined using multivariable linear regression models.
: Data of 2169 citizens of at least 70 years of age and living independently (mean age = 79.6 ± 5.6; 61% females) were analyzed. Among the participants, 1007 (46%) were lonely; 627 (29%) were emotionally and 575 (27%) socially lonely. Participants who were lonely experienced a lower HR-QoL than participants who were not lonely (
≤ 0.001). Emotional loneliness std-β: -1.39; 95%-CI: -1.88 to -0.91 and social loneliness -0.95; -1.44 to -0.45 were both associated with a lower physical HR-QoL. Emotional loneliness -3.73; -4.16 to -3.31 and social loneliness -1.84; -2.27 to -1.41 were also both associated with a lower mental HR-QoL.
: We found a negative association between loneliness and HR-QoL, especially between emotional loneliness and mental HR-QoL. This finding indicates that older citizens who miss an intimate or intense emotional relationship and interventions targeting mental HR-QoL deserve more attention in policy and practice than in the past.
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