Safe sexual behaviour among female partners of HIV-infected men in Rio de Janeiro, Brazil

A cross-sectional study was designed to assess safe sexual behaviour among heterosexual couples after the woman learned of her partner's infection with HIV. Female partners who had known their partners' serostatus for at least 4 weeks were eligible for participation. Couples were interviewed separately and independent predictors of safe sexual behaviour were identified using multiple logistic regression. Safe sexual behaviour was defined as no unprotected vaginal, oral, or anal intercourse. Of 328 women, 197 (60%) reported safe sexual behaviour since learning of their partners' infection. Significant independent predictors of safe sexual behaviour included older women (>30 years old) (odds ratio [OR]=1.89; 95% confidence intervals [CI]=1.01-3.51), current negative HIV serostatus (OR=2.72; 95% CI=1.50-4.94), advanced clinical stage of the index case (OR=1.96; 95% CI=1.07-3.59), longer duration of relationship (10+ years) (OR= 2.35; 95% CI=1.15-4.82), fewer sex contacts (<100) (OR=2.01; 95% CI=1.14-3.56), only one lifetime partner (OR=2.29; 95% CI=1.26-4.17), non-smoking (OR=2.67; 95% CI=1.43-4.99), not practising oral sex (OR=3.35; 95% CI=1.82-6.19) and previous HIV testing (OR=2.11; 95% CI=1.09-4.07). In addition, women who had known their partner's infection for longer were less likely to report safe sexual behaviour (P < 0.001). Our results indicate that among female partners of HIV-positive Brazilian men, learning of their partner's infection does not uniformly result in safe sexual behaviour. Counselling must emphasize disclosure of serostatus to female partners and target couples with short-term relationships, as well as those where the woman has known about her male partner's infection for a long time, because these are the least likely to maintain safe sexual behaviour.     

Changes in sexual behaviors following diagnosis with HIV: patterns and correlates among people living with HIV (PLHIV) in China

Effective secondary prevention of HIV infections requires knowledge about changes in sexual behaviors after diagnosis among people living with HIV (PLHIV), yet there is a dearth of literature assessing gender-specific patterns and correlates of such changes among heterosexual PLHIV in China. Data used in the current study were derived from a cross-sectional survey conducted from 2012 to 2013 among 1212 heterosexual sexually active PLHIV in Guangxi, China. Most participants reduced sexual frequency (71.2%), reduced or maintained the same number of sexual partners (96.6%), and increased or maintained same frequencies of condom use (80.6%). Gender difference was found in changes in sexual frequency, but not in the number of sexual partners or condom use. For males, decrease in sexual frequency was associated with having no desire to have children (OR?=?2.03, 95% CI 1.20, 3.44), being virally suppressed (OR?=?0.27, 95% CI 0.079, 0.94), and social support (OR?=?1.44, 95% CI 1.06, 1.96). Health promoting behaviors in condom use (i.e., increased or maintained same frequencies of condom use) for males was associated with being 45 years of age or older (OR?=?0.35, 95% CI 0.21, 0.61), having an HIV-negative main partner (OR?=?1.80, 95% CI 1.11, 2.92), and physical health-related quality of life (OR?=?1.02, 95% CI 1.00, 1.04). For females, decrease in sexual frequency was associated with having no desire to have children (OR?=?1.58, 95% CI 1.01, 2.47). Health promoting behaviors in condom use for females was associated with having an HIV-negative main partner (OR?=?3.24, 95% CI 1.63, 6.45) and social support (OR?=?0.75, 95% CI 0.57, 0.99).

Future intervention efforts need to target PLHIV who need extra support in making health-improvement efforts and to facilitate gender-specific behavioral changes in sexual risk reduction after HIV diagnosis.     

Sleep quality,sleep duration and sexual health among older people: Findings from the English Longitudinal Study of Ageing

ContextHow sleep quality and sexual health are associated among community-dwelling individuals remains largely unknown.ObjectiveWe examined the association of sleep disturbance and sleep duration with a range of measures assessing sexual activities, functioning and concerns in a representative sample of older people.MethodsParticipants were community-dwelling adults aged 50-90+ years from wave 6 (2012/2013) of the English Longitudinal Study of Ageing (ELSA) who reported any sexual activity in the last year. Sleep disturbance, sleep duration and sexual health were measured by self-report at wave 6. Retrospective reports of restless sleep (waves 1–6 [2002–2013]) were also examined. The association between sleep measures and sexual health was assessed using logistic regressions stratified by gender and adjusted for demographic, health and lifestyle factors with results expressed as odds ratios (OR) and 95% confidence intervals (CI).ResultsAmong both men and women disturbed sleep was associated with reported declines in sexual activity and function over the last year, and increased concern about their sexual desire, frequency of sexual activity and sexual functioning. Robust associations between high sleep disturbance and vaginal pain (OR = 1.67, 95% CI = 1.21, 2.31) and vaginal dryness (OR = 1.69, 95% CI = 1.24, 2.30) were also observed among women. Retrospective reports of restless sleep showed a dose-response relationship with reported declines in sexual health over the last year, and increased concerns about sexual expression and functioning.ConclusionsSelf-reported sleep disturbance and retrospective restless sleep were mainly associated with subjective assessments of recent declines in sexual activity and functioning, and higher levels of sexual concerns.     

Risk factors for fall in elderly with diabetes mellitus type 2

AimsDiabetes mellitus type 2 (DMT2) is a major chronic condition that also common in older people, and associated with an increased risk of falling. This study aimed to determine the risk factor of fall in elderly with DMT2.MethodsIn this cross-sectional study, 220 elderly diabetic patients who had referred to diabetes center in Kerman were chosen via convenience sampling method. To collect data, Semi-structured Fall Risk questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were used.FindingsThe mean age was estimated to be 69.82 (SD: 9.9) years. Among the participants, 38.5% suffered falls in the past one year. Good sleep quality (OR = 0.45, 95% CI = 0.1–0.85) and appropriate environment (OR = 0.6, 95% CI = 0.1–0.77) were significantly associated with a lesser odd of having recurrent falls. Gait problem (OR = 1.8, 95% CI = 1.1–4.9), balance difficulties (OR = 2.1, 95% CI = 1.24–7.12), hypotension (OR = 1.7, 95% CI = 1.2–5.6), and medication above three medicine (OR = 1.55, 95% CI = 1.12–6.34) were significantly associated with a greater odd of having recurrent falls.ConclusionIt would therefore appear that older diabetic patients would be a suitable target group for a strategy aimed at preventing falls. Early recognition of the multiple causes of falls in the older diabetic patient and prompt referral of this group of patients to a specialist falls clinic is recommend.     

Prevalence,risk factors,and management of uncontrolled hypertension among patients with diabetes: A hospital-based cross-sectional study

AimsThis research examines the prevalence of uncontrolled hypertension and associated risk factors among patients with diabetes in Saudi Arabia.MethodsA hospital-based, cross-sectional study was used in patients with diabetes and hypertension attending outpatient diabetes clinics in King Khaled Hospital and Prince Sultan Center for Health Care in Al-Kharj, Riyadh. Patients’ information, data on hypertension, type of treatment, and comorbidities were captured through electronic medical records. Uncontrolled hypertension was defined as blood pressure (BP) measurements greater than or equal to 140/90 mmHg. Antihypertensive medication use among these patients was analyzed. Multivariate analysis was performed to detect the associated factors of uncontrolled hypertension.ResultsOf 1178 outpatients‬ with diabetes who were included in the study sample, uncontrolled hypertension presented in 846 (71.8%). Most patients were on two antihypertensive medications, and the most frequently used was calcium channel blockers, followed by angiotensin-converting enzyme inhibitors. Individuals most likely to have uncontrolled hypertension were those older than 65 years (OR 1.99, 95%CI: 1.059, 3.77), male (OR = 1.51, 95%CI: 1.031, 2.22), and obese (OR = 2.39, 95%CI: 1.63, 3.504), with two (OR = 3.894, 95% CI: 2.481, 6.114) or three or more comorbidities (OR = 4.020, 95% CI: 2.510, 6.439), and with polypharmacy (OR = 1.814, 95% CI: 1.238, 2.656).ConclusionThe extent of uncontrolled hypertension among patients with diabetes in the study sample was found to be high. Age, sex, obesity, number of comorbidities, and polypharmacy are the most important correlates with increased risk of uncontrolled hypertension.     

The prevalence and risk factors for urinary incontinence among inpatients,a multicenter study from Turkey

ObjectiveTo determine the prevalence and the factors associated with urinary incontinence (UI) among inpatients in Turkey.MethodThe population of this study comprised of patients screened by the “National Prevalence Measurement of Quality of Care (LPZ)” study in 2017 and 2018. Age, gender, comorbidities, length of hospital stay, sedative medications, SARC-F score, anthropometric measurements, and care parameters such as malnutrition, falls, UI-fecal incontinence (FI), restraints, and care dependency score (CDS) were noted. The LPZ questionnaire was performed by trained researchers, and multiple logistic regression analysis was performed to determine the factors associated with UI.ResultsThe prevalence of UI was 29.4 % among 1176 inpatients, and 41.6 % in patients ≥65 years. Urinary incontinence was associated with older age (OR, 1.966, 95 % CI 1.330–2.905), female sex (OR, 2.055, 95 % CI 1.393–3.030), CDS (OR, 3.236, 95 % CI 2.080–5.035), the number of comorbidities (OR, 1.312, 95 % CI 1.106–1.556), end-of life management (OR, 3.156, 95 % CI 1.412–7.052), sedative medications (OR, 1.981, 95 % CI 1.230–3.191), and FI (OR, 12.533, 95 % CI 4.892–32.112) in all adults, where CDS (OR, 2.589, 95% CI 1.458–4.599), end-of life management (OR, 2.851, 95 % CI 1.095–7.424), sedative medications (OR, 2.529, 95 % CI 1.406–4.548), and FI (OR, 13.138, 95 % CI 4.352–39.661) were associated with UI among geriatric patients.ConclusionsThe factors associated with UI in geriatric and all adult inpatients are CDS, sedative medications, end-of life management, and FI plus older age, female sex, and comorbidities for the latter. The factors associated with UI vary in different age groups.     

Gender inequality and the risk of HIV among married couples in North India

This study investigated the distribution and determinants of HIV risks among married couples in North India. Gender inequality emerged as a potential driver of HIV risks in this region. Data collection took place in 2003 in a probability survey of 3385 couples living in India's most populous state – Uttar Pradesh – and Uttaranchal. Couples' analyses utilizing generalized estimating equations showed that compared with husbands, wives were less knowledgeable about HIV (OR = 0.31, 95% CI = 0.27–0.36), more likely to consider themselves at risk for infection (OR = 6.86, 95% CI = 4.65–10.13), and less likely to feel that a wife had the right to refuse sex with her husband (OR = 0.50, 95% CI = 0.44–0.58). The proportion of husbands reporting non-marital sex in the past year was 7.1% and transactional sex in the past year, 2.2%. Among their wives, 73.4% were unaware of their husbands' non-marital sexual behaviors and only 28.9% of husbands reported condom use during their last non-marital sexual encounter. Logistic regression analyses showed that husbands' alcohol use, husbands' mobility, and urban residence were positively associated with husbands' non-marital sexual behaviors adjusting for other covariates. The data demonstrate that HIV prevention programs among couples in North India should consider both sexual risks and gender inequalities which potentially fuel HIV spread in this region.     

The elderly and falls: Factors associated with quality of life A cross-sectional study using large-scale national data in Korea

ObjectiveTo investigate the factors of fall injury and measuring the relationship between health-related quality of life in the elderly.MethodsWe analyzed the data on 38,627 persons of aged 65 years or older who have experienced falls drawn from the Korean Community Health Survey 2011. Binomial logistic regression analysis was performed with crude and adjusted odds ratios and 95% confidence intervals.ResultsIt was found that sex (OR: 1.187), types of household (OR: 1.134), employment status (OR: 0.941), stress (OR: 1.260), comorbidities (OR: 1.308), and health-related quality of life were significantly related to falls among the elderly. Specifically, elderly women, greater stress, comorbidities, and poor health-related quality of life were strongly related to higher odds of falls.ConclusionHealth-related quality of life was significantly related with the risk of fall injuries in elderly households. Providing support for informal caregivers (e.g., friends or neighbors), not only family members could expect to positive effect.     

Predictive validity of the Brazilian version of the Tilburg Frailty Indicator for adverse health outcomes in older adults

PurposeThis study aimed to determine the predictive value of the Brazilian Tilburg Frailty Indicator (TFI) for adverse health outcomes (falls, hospitalization, disability and death), in a follow-up period of twelve months.MethodsThis longitudinal study was carried out with a sample of people using primary health care services in Rio de Janeiro, Brazil. At baseline the sample consisted of 963 people aged 60 years and older. A subset of all respondents participated again one year later (n = 640, 66.6% response rate). We used the TFI, the Katz’s scale for assessing ADL disability and the Lawton Scale for assessing IADL disability. Falls, hospitalization and death were also assessed using a questionnaire.ResultsThe prevalence of frailty was 44.2% and the mean score of the TFI was 4.4 (SD = 3.0). There was a higher risk of loss in functional capacity in ADL (OR = 3.03, CI95% 1.45–6.29) and in IADL (OR = 1.51, CI95% 1.05–2.17), falls (OR = 2.08, CI95% 1.21–3.58), hospitalization (OR = 1.83, CI95% 1.10–3.06), and death (HR = 2.73, CI95% 1.04–7.19) for frail when compared to non-frail elderly, in the bivariate analyses. Controlling for the sociodemographic variables, the frailty domains together improved the prediction of hospitalization, falls and loss in functional capacity in ADL, but not loss in functional capacity in IADL.ConclusionThe TFI is a good predictor of adverse health outcomes among elderly users of primary care services in Brazil and appears an adequate and easy to administer tool for monitoring their health conditions.     

High levels of bisexual behavior and factors associated with bisexual behavior among men having sex with men (MSM) in Nigeria

Nigerian men who have sex with men (MSM) have a high burden of HIV infection and are known to engage in bisexual behavior. This study presents the first data on characteristics and correlates of Nigerian men having sex with men and women (MSMW) in three Nigerian cities. Five hundred and fifty-seven MSM who engaged in anal sex with men completed a behavioral survey; 48.1% of these MSM also engaged in sex with women in the previous 2 months. MSMW displayed high levels of risky sexual behavior with female sex partners; casual (56.0%) and multiple female partners were common (69.0%) and 66.0% had unprotected vaginal sex. As much as 45.1% MSMW had anal sex with female partners of which 74.0% did not use protection in the 2 months prior. In bivariate analyses, bisexual behavior was associated (p<0.05) with being married or living with a women (OR 5.0, 95% CI = 2.6–9.4), less education (OR 2.0, 95% CI = 1.4–3.0), bisexual/straight identity (OR 2.3, 95% CI = 1.6–3.2), being an insertive partner (OR 3.0, 95% CI = 1.9–4.5), being HIV-negative (OR 1.6, 95% CI = 1.1–2.5), living in Lagos (OR 2.3, 95% CI = 1.7–2.2), being Muslim (OR 1.7, 95% CI = 1.1–2.5), and being away from home (OR 1.5, 95% CI = 1.0–2.1). In the multivariate model, being married to or living with a woman (AOR = 5.1; 95% CI = 2.5–10.3), bisexual/straight identity (AOR = 2.2; 95% CIs = 1.5–3.3), being an insertive partner (AOR = 3.0; 95% CI = 1.9–4.9), being away from home (AOR = 1.6; 95% CI = 1.1–2.3) and living in Lagos (AOR = 1.7; 95% CI = 1.0–2.8) remained significant (p< 0.05). High levels of bisexual behavior exist among Nigerian MSM, and these men engage in risky sexual behaviors with both male and female sex partners. While decriminalization of same-sex behavior in Nigeria will promote access to HIV prevention programs, current MSM interventions must incorporate information on safe sex with both male and female sex partners.     

Sexual Function and Aging in Racially and Ethnically Diverse Women

OBJECTIVES: To examine factors influencing sexual activity and functioning in racially and ethnically diverse middle-aged and older women.
DESIGN: Cross-sectional cohort study.
SETTING: Integrated healthcare delivery system.
PARTICIPANTS: One thousand nine hundred seventy-seven women aged 45 to 80.
MEASUREMENTS: Self-administered questionnaires assessed sexual desire, activity, satisfaction, and problems.
RESULTS: Of the 1,977 participants (876 white, 388 African American, 347 Latina, and 351 Asian women), 43% reported at least moderate sexual desire, and 60% had been sexually active in the previous 3 months. Half of sexually active participants (n=969) described their overall sexual satisfaction as moderate to high. Among sexually inactive women, the most common reason for inactivity was lack of interest in sex (39%), followed by lack of a partner (36%), physical problem of partner (23%), and lack of interest by partner (11%); only 9% were inactive because of personal physical problems. In multivariable analysis, African-American women were more likely than white women to report at least moderate desire (odds ratio (OR)=1.65, 95% confidence interval (CI)=1.25–2.17) but less likely to report weekly sexual activity (OR=0.68, 95% CI=0.48–0.96); sexually active Latina women were more likely than white women to report at least moderate sexual satisfaction (OR=1.75, 95% CI=1.20–2.55).
CONCLUSION: A substantial proportion of community-dwelling women remain interested and engaged in sexual activity into older age. Lack of a partner capable of or interested in sex may contribute more to sexual inactivity than personal health problems in this population. Racial and ethnic differences in self-reported sexual desire, activity, and satisfaction may influence discussions about sexual difficulties in middle-aged and older women.     

Asthma,COPD and comorbidities in elderly people

Co-morbidities are a significant problem in the elderly population but are rarely presented and analyzed for interdependencies among the various coexisting chronic diseases. Objective: The aim of this study was to present a profile of comorbidities in elderly patients with and without asthma and COPD. Methods: Respondents were recruited at 20 sites in Poland. Stratified random sampling from patient databases resulted in 15,973 patients older than 60 years of age. A retrospective analysis of medical history and ICD-10 codes was performed. In addition, patients underwent a spirometry test with a bronchial reversibility test and were administered questionnaires on the prevalence of chronic diseases by doctors. Results: The study population consisted of 1023 asthmatic patients, 1084 patients with COPD and 1076 control subjects without any signs of bronchoconstriction and with correct spirometry. Patients with asthma exhibited a similar distribution of cardiovascular and metabolic co-morbidities as the control group. However, asthmatic patients had a higher prevalence of arterial hypertension and depression with an odds ratio (OR) = 1.48 (95% CI: 1.38–1.62) and OR = 1.52 (95% CI: 1.44–1.68), respectively. Coronary disease (OR = 2.12; 95% CI: 1.97–2.33), cor pulmonale (OR = 3.1; 95% CI: 2.87–3.22) and heart failure (OR = 2.71; 95% CI: 2.64–3.11) were predominantly observed in patients with COPD. Patients with severe asthma exhibited a greater predisposition to cardiovascular and neuropsychiatric diseases. Conclusion: Asthma coexisted frequently with arterial hypertension and depression in elderly patients. Patients with COPD have a more exaggerated profile of coexisting diseases, specifically cardiovascular problems.     

Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study

ObjectivesThe aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS).BackgroundCHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain.MethodsThe HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs).ResultsA total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001).ConclusionsThe rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.     

Interaction of central obesity and sarcopenia on nutritional status in the community-dwelling older people

ObjectivesTo investigate the interrelationships between central obesity, sarcopenia and nutritional status in the elderly.MethodsWe enrolled 501 elderly (women: 47.5 %) with complete datasets. Biochemical and anthropometric data were measured after an overnight fast. Basic characteristics, psychosocial and behavioral factors, nutritional status, and history of chronic disease came from structured questionnaires. Central obesity was defined as waist circumference ≥ 90 cm for men, ≥ 80 cm for women. Sarcopenia was defined by the Asian consensus. Nutritional status was assessed using Mini Nutritional Assessment scores: abnormal nutritional status ≤ 23.5. Multiple logistic regression analysis was done to determine the independent factors of an abnormal nutritional status.ResultsNinety (18.0 %) participants had an abnormal nutritional status, 300 (59.9 %) had central obesity, 52 (10.4 %) sarcopenia and 3 (0.6 %) sarcopenic obesity. Central obesity (OR = 0.455, 95 % CI: 0.244-0.847) and total lymphocyte count (OR = 0.526, 95 % CI: 0.315-0.880) were negatively and sarcopenia (OR = 3.170, 95 % CI: 1.485–6.767), current smoking (OR = 4.071, 95 % CI: 1.357–12.211), and total number of chronic diseases (OR = 1.484, 95 % CI: 1.234–1.785) were positively associated with abnormal nutritional status. An analysis of the combine effects of central obesity and sarcopenia on nutritional status showed that significantly fewer participants with central obesity but not sarcopenia had abnormal nutrition than participants with sarcopenia with or without central obesity (12.8 % vs 38.5 or 65.4 %, p < 0.001).ConclusionsCentral obesity and sarcopenia were interactively associated with the nutritional status of older people living in a rural community.     

Gender and risk behaviors for HIV and sexually transmitted infections among recently released inmates: A prospective cohort study

Women in prison have a higher prevalence of HIV than men. After release from prison, former inmates have the opportunity to engage in risk behaviors for HIV and other sexually transmitted infections (STIs). We sought to assess change in risk behaviors over time and the association of gender with risk behavior in the postrelease period. In this prospective cohort study, we interviewed 200 former inmates (51 women) approximately two weeks (baseline) and three months (follow-up) after release and tested them for HIV infection at follow-up. We examined the association of gender with unprotected vaginal or anal sex in the last seven days using chi-square and Fisher's exact tests and multivariable logistic regression. At baseline, 22% of men and 41% of women reported unprotected vaginal sex (p < 0.01) and 5% of men and 8% of women reported unprotected anal sex (p = 0.51). Being younger (OR for each decade increase 0.48, 95% CI = 0.29–0.80), being gay/lesbian or being bisexual (compared with being heterosexual, OR = 4.74, 95% CI = 1.01–22.17 and OR = 3.98, 95% CI = 1.41–11.26, respectively), or reporting a drug of choice of heroin/speedballs or cocaine/crack (compared with marijuana/no drug of choice, OR = 24.00, 95% CI = 5.15–111.81 and OR = 3.49, 95% CI = 1.20–10.18, respectively) was associated with unprotected vaginal or anal sex after adjusting for race, homelessness, and hazardous drinking. At follow-up, 21% of men and 44% of women reported unprotected sex (p = 0.005), and female gender (OR = 4.42, 95% CI = 1.79–10.94) and hazardous drinking (compared with not meeting criteria for hazardous drinking, OR = 3.64, 95% CI = 1.34–9.86) were associated with unprotected sex, adjusting for race and homelessness. In this population with a high prevalence of HIV, we demonstrated persistent engagement in sexual risk behavior during the postrelease period. Enhanced efforts to promote sexual health and reduced risk behavior among both male and female current and former prison inmates are needed, including improved access to preventive care and HIV and STI screening, testing, and treatment.     

Determinants of symptom burden related to bowel preparation for colonoscopy

BackgroundSymptoms developing during bowel preparation are major concerns among subjects who refuse the procedure.AimsWe aimed to explore the determinants of symptoms occurring during preparation among patients undergoing elective colonoscopy.MethodsThis is a prospective multicenter study conducted in 10 Italian hospitals. A multidimensional approach collecting socio-demographic, clinical, psychological and occupational information before colonoscopy through validated instruments was used. Outcome was a four-category cumulative score based on symptoms occurring during preparation, according to the Mayo Clinic Bowel Prep Tolerability Questionnaire, weighted by intensity. Missing values were addressed through multiple imputation. Odds ratios (OR) and 95% confidence intervals (CI) were estimated through multivariate logistic regression models.Results1137 subjects were enrolled. Severe symptoms were associated with female sex (OR=3.64, 95%CI 1.94-6.83), heavier working hours (OR=1.13, 95% CI=1.01-1.25), previous gastrointestinal symptoms (OR=7.81, 95% CI 2.36-25.8 for high score), somatic symptoms (OR=2.19, 95% CI=1.06-4.49 for multiple symptoms), day-before regimen (OR=2.71, 95%CI 1.28-5.73). On the other hand, age ≥60 years (OR=0.10, 95% CI 0.02-0.44) and good mood (p=0.042) were protective factors. A high-risk profile was identified, including women with low mood and somatic symptoms (OR=15.5, 95%CI 4.56-52.7).ConclusionsWe identified previously unreported determinants of symptoms burdening bowel preparation and identified a particularly vulnerable phenotype. Symptoms during preparation especially impact heavier working activity.     

Sexual transmission of hepatitis B virus,hepatitis C virus,and human immunodeficiency virus type 1 infections among male transvestite comercial sex workers in Montevideo,Uruguay

Prostitution may constitute a risk behavior for infection with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). We conducted a seroepidemiologic study among 200 male transvestite commercial sex workers (CSWs) in Montevideo, Uruguay in 1999. Evidence of exposure to HBV, HCV, and HIV was found in 101 (50.5%), 13 (6.5%), and 43 (21.5%) individuals, respectively. Positivity for HIV was correlated with both HBV (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.01-4.67) and HCV (OR = 3.47, 95% CI = 0.90-12.79) infection. Predictors of infection were older age (> or = 26 years; P < 0.01) for all 3 viruses and time in CSW (> or = 5 years; P < 0.05) for HBV and HIV. Prior history of use of drugs (OR = 3.54, 95% CI = 1.09-11.52) and sexual contact with foreigners (OR = 9.2, 95% CI = 1.16-73.12) were found to be associated only with HCV infection. Sexual transmission of these viruses constitutes a significant problem among male transvestite CSWs.     

The impact of multidimensional frailty on dependency in activities of daily living and the moderating effects of protective factors

BackgroundDependency in activities of daily living (ADL) might be caused by multidimensional frailty. Prevention is important as ADL dependency might threaten the ability to age in place. Therefore, this study aimed to assess whether protective factors, derived from a systematic literature review, moderate the relationship between multidimensional frailty and ADL dependency, and whether this differs across age groups.MethodsA longitudinal study with a follow–up after 24 months was conducted among 1027 community-dwelling people aged ≥65 years. Multidimensional frailty was measured with the Tilburg Frailty Indicator, and ADL dependency with the ADL subscale from the Groningen Activity Restriction Scale. Other measures included socio-demographic characteristics and seven protective factors against ADL dependency, such as physical activity and non-smoking. Logistic regression analyses with interaction terms were conducted.ResultsFrail older people had a twofold risk of developing ADL dependency after 24 months in comparison to non-frail older people (OR = 2.12, 95% CI = 1.45–3.00). The selected protective factors against ADL dependency did not significantly moderate this relationship. Nonetheless, higher levels of physical activity decreased the risk of becoming ADL dependent (OR = 0.67, 95% CI = 0.46–0.98), as well as having sufficient financial resources (OR = 0.49, 95% CI = 0.35–0.71).ConclusionMultidimensional frail older people have a higher risk of developing ADL dependency. The studied protective factors against ADL dependency did not significantly moderate this relationship.     

The role of education on the association between disability and depressive symptoms among community-dwelling older adults: Evidence from Frailty in Brazilian Older People (Fibra) study

ObjectivesTo explore whether higher socioeconomic status attenuates the effects of depressive symptoms on disability among older adults.MethodsWe conducted a cross-sectional study based on 596 older adults, aged 65 and over, from a large city (Belo Horizonte) in Brazil. Disability was defined as limitation in activities such as Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Covariates were age, comorbidities, Body Mass Index (BMI) and grip strength. Statistical analyses were based on Ordinal Logistic Regression and calculated separately for men and women.ResultsElderly women with disability and higher education levels have similar prevalence of depressive symptoms compared to those without disability (17.9% and 16.1%, respectively), but lower compared to those disabled with lower education (37.2%). A positive gradient trend was observed for depressive symptoms across disability categories among women (OR = 2.61; 95% CI 1.52, 4.48). However, these patterns were not observed among men.ConclusionA higher level of education attenuates odds of depressive symptoms in elderly women with disability but does not eliminate it. Therefore, screening for depressive symptoms in low-educated elderly women is important in order to identify them and start early prevention care for target risk population and decrease the disability expenses for health services.     

Socioeconomic status,social relations and domestic violence (DV) against elderly people in Canada,Albania, Colombia and Brazil

PurposeTo determine whether gender, socioeconomic conditions, and/or social relations are related to recent experiences of DV in older adult populations.Materials and methodsData on socioeconomic status and social relations were collected in 2012 from 1995 community-dwelling older adults in Canada, Colombia, Brazil, and Albania. Violence experienced in the last 6 months was measured using the Hurt, Insulted, Threatened with harm, or Screamed at (HITS) scale and classified according to type (physical or psychological) and perpetrator (partner or family member). Binary logistic regression analyses were used to assess associations between experiences of violence and gender, socioeconomic conditions, and social relations.ResultsPhysical violence (by partner or family member) was reported by 0.63–0.85% of participants; the prevalence of psychological violence (by partner or family member) ranged from 3.2% to 23.5% in men and 9% to 26% in women. After adjustment for socioeconomic status, social relations, age and site, women experienced more psychological violence perpetrated by family members than did men (odds ratio (OR): 1.8; 95% CI: 1.2–2.6). Social relations, such as multifamily living arrangements and low levels of support from partners, children, and family, were associated with psychological DV. Current working status was associated with greater odds of victimization by partners among men (OR: 2.35 95% CI: 1.34–1.41), but not among women.ConclusionsGender and social relations are important determinants of experiencing violence in older adults. The findings of this study demonstrate the importance of a gender-based approach to the study of DV in older adults.