Protective effect of COVID-19 vaccination against long COVID syndrome: A systematic review and meta-analysis

BackgroundThe relationship between coronavirus disease 2019 (COVID-19) vaccination and long COVID has not been firmly established. We conducted a systematic review and meta-analysis to evaluate the association between COVID-19 vaccination and long COVID.MethodsPubMed and EMBASE databases were searched on September 2022 without language restrictions (CRD42022360399) to identify prospective trials and observational studies comparing patients with and without vaccination before severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We also included studies reporting symptomatic changes of ongoing long COVID following vaccination among those with a history of SARS-CoV-2 infection. Odds ratios (ORs) for each outcome were synthesized using a random-effects model. Symptomatic changes after vaccination were synthesized by a one-group meta-analysis.ResultsSix observational studies involving 536,291 unvaccinated and 84,603 vaccinated (before SARS-CoV-2 infection) patients (mean age, 41.2–66.6; female, 9.0–67.3%) and six observational studies involving 8,199 long COVID patients (mean age, 40.0 to 53.5; female, 22.2–85.9%) who received vaccination after SARS-CoV-2 infection were included. Two-dose vaccination was associated with a lower risk of long COVID compared to no vaccination (OR, 0.64; 95% confidence interval [CI], 0.45–0.92) and one-dose vaccination (OR, 0.60; 95% CI, 0.43–0.83). Two-dose vaccination compared to no vaccination was associated with a lower risk of persistent fatigue (OR, 0.62; 95% CI, 0.41–0.93) and pulmonary disorder (OR, 0.50; 95% CI, 0.47–0.52). Among those with ongoing long COVID symptoms, 54.4% (95% CI, 34.3–73.1%) did not report symptomatic changes following vaccination, while 20.3% (95% CI, 8.1–42.4%) experienced symptomatic improvement after two weeks to six months of COVID-19 vaccination.ConclusionsCOVID-19 vaccination before SARS-CoV-2 infection was associated with a lower risk of long COVID, while most of those with ongoing long COVID did not experience symptomatic changes following vaccination.     

Chronic and acute effects of solvents on central nervous system functions in floorlayers

Floorlayers and age matched carpenters with long (greater than or equal to 20 years) and short (5-10 years) occupational experience were compared with respect to chronic and acute neuropsychiatric, neuropsychological, and general health effects as related to different types of solvent exposure. An increased prevalence of neuropsychiatric illness occurred among floorlayers with long occupational experience, possibly caused by high levels of exposure which were present until the 1970s. The disease appears partly reversible since, at the time of the investigation, all had essentially recovered. Some impairment of performance in psychological tests was seen, however, in this group. Visuoanalytical impairment was associated with indices of exposure to glues based on alcohols whereas contact adhesives appeared more deleterious to perceptual functions. The increased prevalence of neuropsychiatric symptoms among the floorlayers was interpreted to reflect mainly acute effects on the central nervous system.     

Chronic and acute effects of solvents on central nervous system functions in floorlayers.

Floorlayers and age matched carpenters with long (greater than or equal to 20 years) and short (5-10 years) occupational experience were compared with respect to chronic and acute neuropsychiatric, neuropsychological, and general health effects as related to different types of solvent exposure. An increased prevalence of neuropsychiatric illness occurred among floorlayers with long occupational experience, possibly caused by high levels of exposure which were present until the 1970s. The disease appears partly reversible since, at the time of the investigation, all had essentially recovered. Some impairment of performance in psychological tests was seen, however, in this group. Visuoanalytical impairment was associated with indices of exposure to glues based on alcohols whereas contact adhesives appeared more deleterious to perceptual functions. The increased prevalence of neuropsychiatric symptoms among the floorlayers was interpreted to reflect mainly acute effects on the central nervous system.     

Occurrence of Neuropsychiatric Symptoms at Low Levels of Occupational Exposure to Organic Solvents and Relationships to Health,Lifestyle, and Stress

Abstract

The objective of this study was to elucidate the effects of alcohol consumption, medical disorders, stressful life events, and solvent exposure on neuropsychiatric symptoms in a population with low levels of occupational exposure to organic solvents. The prevalence of neuropsychiatric symptoms was assessed by Questionnaire 16 (Q16) in 54 miners under notice of dismissal and 124 men in an age-matched random sample from the local population. When the Q16 results were dichotomized at six symptoms (of the 16 possible), regular use of medicine was significantly related to the Q16 score, with an adjusted odds ratio (adjOR) of 4.0, 95% confidence interval (95% CI) 1.2–13. There were also positive relationships to the number of years in work with exposure to organic solvents (adjOR 2.2 per 10 years, 95% CI 1.3–3.8), liters of pure alcohol consumed per month (adjOR 2.8,95% CI 0.78–10), and unemployment (adjOR2.4, 95% CI 0.80–7.2). The influences on neuropsychiatric symptoms of various common exposures other than occupational solvent exposure must be considered when questionnaires are used for screening or for studies of possible neurotoxic effects in solvent-exposed workers.     

新型冠状病毒感染后综合征的研究进展

新型冠状病毒(简称新冠病毒)感染后综合征(Post-COVID -19 syndrome)又称为长新冠病毒感染(Long COVID)和新冠病毒感染后状态(Post-COVID -19 condition), 是发生于新冠病毒感染急性期后的一系列症状, 以疲劳、头痛、认知障碍、肌肉骨骼疼痛、胸闷气短、抑郁失眠为主要表现, 严重影响患者的生活质量和工作能力。新冠病毒感染后综合征已引起国外医学界的重视并对其发病机制和诊疗方案进行了一系列研究。由于中国在全球疫情开始的前三年采取积极有效的疫情防控措施, 国内新冠病毒感染的病例相对较少。随着2023年初国家疫情防控政策的调整, 短时期内出现了全国范围内的大规模感染。目前, 国内新冠病毒感染急性期的救治工作已基本结束, 新冠病毒感染后综合征的诊疗将是未来各级医院工作的重点。本文对新冠病毒感染后综合征的国外研究进展进行综述, 以期为国内新冠病毒感染后综合征的诊疗工作提供参考依据。     

Physical activity and symptoms of anxiety and depression in adults with and without visual impairments: The HUNT Study

PurposeTo examine the association of leisure-time physical activity (PA) and symptoms of anxiety and depression among adults with and without self-reported visual impairment.MethodsA population-based cohort study including 34,393 participants 20–67 years of age from the second wave of the Nord-Trøndelag Health Study (HUNT2, 1995–1997) who also participated in the follow-up (HUNT3, 2006–2008). Of the participants, 3719 (10.8%) had self-reported visual impairment (SRVI). Unadjusted and fully adjusted generalized linear models were used to calculate relative risks (RR) and corresponding 95% confidence intervals (CIs) of PA with anxiety and depression symptoms (Hospital Anxiety and Depression Scale, HADS) separately for visual impairment and gender.ResultsAt follow-up, a two-folded higher prevalence of HADS-defined anxiety and depression (a score ≥ 8) was found among adults with SRVI than among adults with self-reported no visual impairment (SRNI). In adults with SRVI and SRNI, fewer depression symptoms at follow-up were significantly associated with high baseline PA scores compared with low PA scores, after adjusting for possible confounders (p < 0.05). In adults with SRNI, high baseline PA was related to fewer anxiety symptoms at follow-up compared with their less physically active counterparts, but the associations turned non-significant after adjusting for possible confounders (p > 0.05). PA was not significantly related to anxiety symptoms among adults with SRVI (p > 0.05).ConclusionsRegular PA was associated with fewer depression symptoms in adults with SRVI and SRNI, with less clear associations found for anxiety symptoms.     

A systematic review and meta-analysis on Exo-toxins prevalence in hospital acquired Pseudomonas aeruginosa isolates

IntroductionPseudomonas aeruginosa (PA) is an opportunistic pathogen that produces widespread and often overwhelming infections. Among different virulence factors, toxins are important bacterial agent which increases PA pathogenesis especially in immunocompromised patients. The aim of this meta-analysis was to determine the prevalence of exotoxin production in PA isolates in the world. Also according to the importance of drug resistance in isolates with more pathogenicity this estimation was conducted in resistant isolates.MethodsA systematic search was conducted in international database like PubMed, Scopus, Web of Science and Embase up to December 2018. Joanna Briggs Institute Checklist was used to evaluate the quality assessment of studies. Random effect model was applied to pool the prevalence data. Stata 13 software was used to analyze the data.ResultsTotal of 58 eligible studies that fulfilled the inclusion criteria of the study were selected for qualitative synthesis. Among exotoxins; the highest prevalence was related to exoT (0.83 (CI95%: 0.64–0.96)). Lowest prevalence rate was seen in exoU with estimated prevalence 0.32 (CI95%: 0.24–0.41). In Carbapenem resistance isolates exoA and exoT had the highest prevalence (1.00 (CI95%: 0.98–1.00)).ConclusionThis first meta-analysis on PA isolates with toxin potency indicated high prevalence of exotoxin production in clinical isolates of PA which is an alarming point as a clinical aspect. It was found that the ExoT has the most prevalence rate among toxins. The results of simultaneous evaluation of exotoxins and antimicrobial resistance can develop treatment policies against PA infections in hospitals and hospitalized patients.     

Clinical Presentation of COVID19 in Dementia Patients

Objective

No studies analyzing the role of dementia as a risk factor for mortality in patients affected by COVID-19. We assessed the prevalence, clinical presentation and outcomes of dementia among subjects hospitalized for COVID19 infection.

Design

Retrospective study.

Setting

COVID wards in Acute Hospital in Brescia province, Northern Italy.

Participants

We used data from 627 subjects admitted to Acute Medical wards with COVID 19 pneumonia.

Measurements

Clinical records of each patients admitted to the hospital with a diagnosis of COVID19 infection were retrospectively analyzed. Diagnosis of dementia, modalities of onset of the COVID-19 infection, symptoms of presentation at the hospital and outcomes were recorded.

Results

Dementia was diagnosed in 82 patients (13.1%). The mortality rate was 62.2% (51/82) among patients affected by dementia compared to 26.2% (143/545) in subjects without dementia (p<0.001, Chi-Squared test). In a logistic regression model age, and the diagnosis of dementia resulted independently associated with a higher mortality, and patients diagnosed with dementia presented an OR of 1.84 (95% CI: 1.09–3.13, p<0.05). Among patients diagnosed with dementia the most frequent symptoms of onset were delirium, especially in the hypoactive form, and worsening of the functional status.

Conclusion

The diagnosis of dementia, especially in the most advanced stages, represents an important risk factor for mortality in COVID-19 patients. The clinical presentation of COVID-19 in subjects with dementia is atypical, reducing early recognition of symptoms and hospitalization.

     

Exercise interventions ameliorate neuropsychiatric symptoms in dementia: A meta-analysis

ObjectivesThis meta-analysis was aimed at systematically synthesizing the effects of exercise interventions on neuropsychiatric symptoms in individuals with dementia. The possible moderators that may influence intervention effects were also examined.MethodsWe searched seven databases (PubMed, Web of Science, SCOPUS, SportDiscus, Ebsco, China National Knowledge Infrastructure, and Wanfang) for randomized clinical trials. The pooled effect sizes were computed by the standardized mean difference (SMD) from post-intervention scores using random-effects models. Potential moderators were also explored by performing subgroup analyses and meta-regression. The risk of bias for included studies was evaluated by the Cochrane Risk of Bias 2.0 Tool.ResultsA total of 22 effect sizes from 17 studies (n = 1344) fulfilled the inclusion criteria. The results indicated that exercise interventions had a small but significant effect on neuropsychiatric symptoms in dementia (SMD = −0.27, 95% CI [−0.40,−0.14], p < 0.001). Subgroup analyses showed that intervention frequency and disease severity moderated the effects. Specifically, interventions with medium-frequency (3 times/week) had a positive effect on neuropsychiatric symptoms (SMD = −0.5, 95% CI [−0.65, −0.34], p < 0.001), but not with low-frequency (1–2 times/week) (SMD = −0.07, 95% CI [−0.22, 0.08], p = 0.38) or high-frequency (4–7 times/week) (SMD = −0.11, 95% CI [−0.36, 0.14], p = 0.38). Interventions had a beneficial effect on neuropsychiatric symptoms in people with mild dementia (SMD = −0.48, 95% CI [−0.71, −0.26], p < 0.001), and moderate dementia (SMD = −0.21, 95%CI [−0.37, 0.05], p < 0.05), but not severe dementia (SMD = −0.01, 95% CI [−0.33, 0.3], p = 0.94).ConclusionsExercise interventions effectively improve neuropsychiatric symptoms in mild and moderate dementia patients. Interventions occurring three times per week were associated with significant effects. Our findings provide evidence that exercise interventions may be an accessible and effective means for improving dementia patients' neuropsychiatric symptoms.     

Factors associated with sexual assault and time to presentation

ObjectiveTo compare three non-dieting interventions that focused on lifestyle change rather than weight loss, in terms of the sustainability of improvements in lifestyle behaviors, psychological well-being and medical symptoms at 2 years.MethodIn Dunedin, New Zealand in 2002/2003, 225 obese/overweight women (BMI ≥ 28; 25–68 years) participated in a randomised, intention-to-treat trial comparing two group programs (P1, P2) and a self-guided mail-delivered program (P3). Only P1 included intensive relaxation response training. All three non-dieting interventions involved a 10-week program, followed by an eight-month support phase. Participants completed baseline, 1-year and 2-year assessments. Outcomes included behavioral, psychological and medical symptom measures and a composite success score.Results118 participants completed the 2-year follow-up. Only among P1 participants were the reductions in psychological distress and medical symptoms achieved at 1 year, also maintained at 2 years. At 2 years, P1 participants had significantly greater increases in stress management behaviors than those in P2 (p < 0.05), and significantly greater success scores than those in P3 (p < 0.05). In all three programs, mean weight was unchanged at 2 years.ConclusionInclusion of relaxation response training in a healthy lifestyle program facilitates long-term maintenance of psychological and medical symptom improvements even in the absence of weight loss.     

Symptoms,complications and management of long COVID: a review

Globally, there are now over 160 million confirmed cases of COVID-19 and more than 3 million deaths. While the majority of infected individuals recover, a significant proportion continue to experience symptoms and complications after their acute illness. Patients with ‘long COVID’ experience a wide range of physical and mental/psychological symptoms. Pooled prevalence data showed the 10 most prevalent reported symptoms were fatigue, shortness of breath, muscle pain, joint pain, headache, cough, chest pain, altered smell, altered taste and diarrhoea. Other common symptoms were cognitive impairment, memory loss, anxiety and sleep disorders. Beyond symptoms and complications, people with long COVID often reported impaired quality of life, mental health and employment issues. These individuals may require multidisciplinary care involving the long-term monitoring of symptoms, to identify potential complications, physical rehabilitation, mental health and social services support. Resilient healthcare systems are needed to ensure efficient and effective responses to future health challenges.     

The natural history of psychosomatic symptoms and their association with psychological symptoms: Observations from the Population Study of Women in Gothenburg

Objective: To study the prevalence of subjective unspecified psychological symptoms (UPS) in a cohort of middle-aged women and the development of psychosomatic symptoms over 24 years. Methods: In 1968–1969, 1462 randomly selected women, aged 38, 46, 50, 54 and 60, were recruited. A 24-year follow-up was performed in 1992–1993 (n=836). The same structured interview concerning psychological and psychosomatic symptoms was used on both occasions. Results: The prevalence of UPS was 28% in 1968–1969 and 20% in 1992–1993. Women with UPS in 1968–1969 were significantly more likely to have asthma/obstructive symptoms (34% vs 26%), headache (38% vs 22%) and abdominal symptoms (40% vs 21%), but not hypertension/high blood pressure (28% vs 28%), than women who did not report UPS. In 1992–1993, women with UPS in 1968–1969 were significantly still more likely to have asthmatic (25% vs 18%) and abdominal symptoms (44% vs 33%). Sixty-one per cent of women with UPS in 1968–1969 did not report such symptoms in 1992–1993, compared to 86% of women without UPS in 1968–1969 (p<0.001).

Conclusion: Women reporting UPS seemed to have a higher frequency of simultaneous psychosomatic symptoms than women not reporting UPS. However, having UPS was apparently unassociated with the development of psychosomatic symptoms over time. Psychosomatic symptoms in women seem to be self-limiting and decrease with time.     

Delirium Superimposed on Dementia Strongly Predicts Worse Outcomes in Older Rehabilitation Inpatients

ObjectiveDelirium superimposed on dementia (DSD) is common in many settings. Nonetheless, little is known about the association between DSD and clinical outcomes. The study aim was to evaluate the association between DSD and related adverse outcomes at discharge from rehabilitation and at 1-year follow-up in older inpatients undergoing rehabilitation.DesignProspective cohort study.SettingHospital rehabilitation unit.ParticipantsA total of 2642 patients aged 65 years or older admitted between January 2002 and December 2006.MeasurementsDementia predating rehabilitation admission was detected by DSM-III-R criteria. Delirium was diagnosed with the DSM-IV-TR. The primary outcome was that of walking dependence (Barthel Index mobility subitem score of <15) captured as a trajectory from discharge to 1-year follow-up. A mixed-effects multivariate logistic regression model was used to analyze the association between DSD and outcome, after adjusting for relevant covariates. Secondary outcomes were institutionalization and mortality at 1-year follow-up, and logistic regression models were used to analyze these associations.ResultsThe median age was 77 years (interquartile range: 71–83). The prevalence of DSD was 8%, and the prevalence of delirium and dementia alone were 4% and 22%, respectively. DSD at admission was found to be significantly associated with almost a 15-fold increase in the odds of walking dependence (odds ratio [OR] 15.5; 95% Confidence Interval [CI] 5.6–42.7; P < .01). DSD was also significantly associated with a fivefold increase in the risk of institutionalization (OR 5.0; 95% CI 2.8–8.9; P < .01) and an almost twofold increase in the risk of mortality (OR 1.8; 95% CI 1.1–2.8; P = .01).ConclusionsDSD is a strong predictor of functional dependence, institutionalization, and mortality in older patients admitted to a rehabilitation setting, suggesting that strategies to detect DSD routinely in practice should be developed and DSD should be included in prognostic models of health care.     

Self-reported symptoms and their effects on cognitive functioning in workers with past exposure to solvent-based glues: an 18-year follow-up

Objectives To examine to what extent exposure to organic solvents during the working life affects general well-being in the long term, and to explore the relationship between self-reported symptoms and cognitive functioning in previously solvent-exposed floor layers. Methods The study included 41 solvent-exposed floor layers and 40 unexposed referents participating in a longitudinal follow-up study 18 years after the baseline assessment. Symptom prevalence and level of spare time activities were studied using the same methods as in the initial study. These include a general health examination, the Q16 symptom questionnaire, and a questionnaire for spare time activities. Relationships between symptoms and cognitive functioning were analysed based on recently published data on cognitive functioning of the participants at follow-up. Results At follow-up neuropsychiatric symptoms such as need to check things, depressive mood, and abnormal fatigue, were more prevalent among floor layers, particularly the most exposed individuals, than among referents. In addition, the most highly exposed floor layers reported more concentration difficulties and irritability. Fatigue and depressive mood increased over the follow-up time in the most exposed floor layers but not in the referents. Memory difficulties, although more frequent among floor layers than among referents, had decreased in floor layers while increased in referents. Floor layers also reported some negative effects on intimate relations and activity level. Neuropsychiatric symptoms were related to poorer performance chiefly in memory tasks and tests of complex attention and perceptual speed, more seldom in visuospatial tasks. Conclusions Findings of exposure-related, long-lasting, partly deteriorating neuropsychiatric complaints indicate that general well-being later in life has been affected in floor layers with past heavy solvent exposure. We also found frequent associations between symptom prevalence and the cognitive functioning. Together with previous findings of dose-related cognitive decrements, the present results strengthen the evidence that long-term heavy occupational solvent exposure may negatively interact with the normal ageing process.     

Actions Taken by Women in Response to Intimate Partner Violence and Intimate Partner Violence Status at 1-Year Follow-Up

BackgroundIntimate partner violence (IPV) is a pervasive public health issue with significant physical and mental health sequelae. A longer duration and greater severity of abuse are associated with adverse health outcomes and increased risk of revictimization. Current research has identified a variety of strategies used by women in response to abuse, but has not established whether the use of these strategies is associated with decreased IPV over time. For this study, we analyzed the associations between the use of specific actions in response to abuse—placating, resistance, informal or formal network help-seeking, safety planning, and substance use—and IPV victimization at the 1-year follow-up.MethodsNinety-five women with past-year IPV at baseline participated in a 1-year follow-up survey measuring their use of specific actions in response to IPV and subsequent IPV status. IPV victimization at the 1-year follow-up was analyzed as a function of types of actions taken and sociodemographic variables.ResultsAmong women with past-year IPV at baseline (N = 95), 53% reported no further IPV victimization at the 1-year follow-up. In bivariate analysis, social support was associated with decreased risk of IPV victimization (odds ratio, 0.43; 95% confidence interval [CI], 0.18–0.99). In multivariable analyses, high use of placating (adjusted odds ratio, 9.40; 95% CI, 2.53–34.9), formal network help-seeking (adjusted odds ratio, 7.26; 95% CI, 1.97–26.74), and safety planning (adjusted odds ratio, 2.98; 95% CI, 1.02–8.69) strategies were associated with an increased risk of IPV victimization at the 1-year follow-up.ConclusionsOur data demonstrate that IPV exposure can change over time and that the use of specific actions in response to IPV can be indicators of risk of subsequent victimization. Abuse severity is an important potential confounder of action efficacy.     

Clinical Nutrition Research and the COVID‐19 Pandemic: A Scoping Review of the ASPEN COVID‐19 Task Force on Nutrition Research

The purpose of this scoping review by the American Society for Parenteral and Enteral Nutrition (ASPEN) Coronavirus Disease 2019 (COVID‐19) Nutrition Task Force was to examine nutrition research applicable to the COVID‐19 pandemic. The rapid pace of emerging scientific information has prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported. Of these, there were 439 articles fully abstracted, with 23 main topic areas identified across 24 article types and sourced across 61 countries and 51 specialties in 8 settings and among 14 populations. Epidemiological/mechanistic relationships between nutrition and COVID‐19 were reviewed and results mapped to the Population, Intervention, Comparator, Outcome, and Time (PICO‐T) questions. The aggregated data were analyzed by clinical stage: pre–COVID‐19, acute COVID‐19, and chronic/post–COVID‐19. Research gaps were discovered for all PICO‐T questions. Nutrition topics meriting urgent research included food insecurity/societal infrastructure and transcultural factors (pre–COVID‐19); cardiometabolic‐based chronic disease, pediatrics, nutrition support, and hospital infrastructure (acute COVID‐19); registered dietitian nutritionist counseling (chronic/post–COVID‐19); and malnutrition and management (all stages). The paucity of randomized controlled trials (RCTs) was particularly glaring. Knowledge gaps were discovered for PICO‐T questions on pediatrics, micronutrients, bariatric surgery, and transcultural factors (pre–COVID‐19); enteral nutrition, protein‐energy requirements, and glycemic control with nutrition (acute COVID‐19); and home enteral and parenteral nutrition support (chronic/post–COVID‐19). In conclusion, multiple critical areas for urgent nutrition research were identified, particularly using RCT design, to improve nutrition care for patients before, during, and after COVID‐19.     

'Reluctant pioneer': A qualitative study of doctors' experiences as patients with long COVID

BackgroundThe coronavirus disease (COVID‐19) pandemic has had far‐reaching effects upon lives, healthcare systems and society. Some who had an apparently ''mild'' COVID‐19 infection continue to suffer from persistent symptoms, including chest pain, breathlessness, fatigue, cognitive impairment, paraesthesia, muscle and joint pains. This has been labelled ''long COVID''. This paper reports the experiences of doctors with long COVID.MethodsA qualitative study; interviews with doctors experiencing persistent symptoms were conducted by telephone or video call. Interviews were transcribed and analysis conducted using an inductive and thematic approach.ResultsThirteen doctors participated. The following themes are reported: making sense of symptoms, feeling let down, using medical knowledge and connections, wanting to help and be helped, combining patient and professional identity. Experiencing long COVID can be transformative: many expressed hope that good would come of their experiences. Distress related to feelings of being ‘let down’ and the hard work of trying to access care. Participants highlighted that they felt better able to care for, and empathize with, patients with chronic conditions, particularly where symptoms are unexplained.ConclusionsThe study adds to the literature on the experiences of doctors as patients, in particular where evidence is emerging and the patient has to take the lead in finding solutions to their problems and accessing their own care.Patient and Public contributionThe study was developed with experts by experience (including co‐authors HA and TAB) who contributed to the protocol and ethics application, and commented on analysis and implications. All participants were given the opportunity to comment on findings.     

Apathy: prevalence, associated factors, and prognostic value among frail, older inpatients

ObjectivesThe association of apathy with Alzheimer disease and other dementias and caregiver burden has been examined in a number of studies; however, less is known about its relationship with delirium and mortality. We aimed to investigate the prevalence, relationship with delirium and dementia, and prognostic value of apathy in an elderly and frail inpatient population.Setting and ParticipantsThe cohort included 425 patients in acute geriatric wards and in 7 nursing homes in Helsinki (1999–2000). Demographic factors, physical functioning, diagnoses, and drugs were assessed with special reference for dementia, delirium, and apathy. Mortality was registered from central registers.ResultsOf the patients, 98 (23.1%) suffered from apathy, and it was more frequent among men (32% versus 21% women, P = .037 ). There was no difference in mean age, number of comorbidities, or in the mean number of medications between those with and without apathy; however, those with apathy had lower mean MMSE points (9.2 versus 14.0 without apathy, P < .001), more often severe dementia according to Clinical Dementia Rating, and higher dependence in activities of daily living (P = .001). Furthermore, patients with apathy were more often suffering from delirium (37.8% versus 21.1%, P ≤ .001). Mortality during the 1-year follow-up was 34.7% (n = 34) and 22.0% (n = 72) among individuals with and without apathy, respectively (P = .011). In the Cox proportional hazard model with age, gender, activities of daily living, and delirium as covariates, apathy significantly predicted mortality (HR 1.89, 95% CI 1.24 to 2.89; P = .003).ConclusionsApathy is a common and serious neuropsychiatric symptom associated with cognitive decline, delirium, and disability, and it also independently predicts mortality.     

Respiratory function in vineyard and orchard workers

A group of 174 male vineyard and orchard workers was studied for the prevalence of acute and chronic respiratory symptoms and lung function changes. In addition, 115 male control workers were studied for the prevalence of chronic respiratory symptoms. There was a significantly higher prevalence of dyspnea and chest tightness in exposed compared to control workers. In particular, exposed nonsmokers had significantly higher prevalences of dyspnea and chest tightness than controls; this was found for exposed nonsmokers with both short (≤10 years) and long (>10 years) exposure. Smokers exposed for more than 10 years had significantly higher prevalences of chronic cough, chronic phlegm, chronic bronchitis, and chest tightness than smokers with shorter exposures (p < 0.01 or p < 0.05). Workers employed for more than 10 years had higher prevalences of most of the acute (shift-related) symptoms than those workers with shorter employment; however, the differences were significant only for cough in smokers (p < 0.05). Significantly lower than predicted FVC values were measured in smokers and nonsmokers after both short and long duration of employment. Differences between measured and predicted FEV₁, FEF₅₀, and FEF₂₅ were significant for workers employed for more than 10 years. A separate analysis of individual data as a percent of predicted values demonstrated that many workers had FVC (5.2%), FEV₁ (6.3%), FEF₅₀ (27.6%), and FEF₂₅ (40.2%) lower than 70% of predicted values. These data suggest that vineyard and orchard workers may develop acute and chronic respiratory symptoms and lung function changes which are, in part, related to environmental factors and to cigarette consumption. Am. J. Ind. Med. 31:250–255, 1997. © 1997 Wiley-Liss, Inc.     

Sleep Duration and Sarcopenia: An Updated Systematic Review and Meta-Analysis

ObjectivesIn adults, short and long sleep duration has been associated with sarcopenia risk. Studies have shown that various factors, including biological and psychological factors, could be the underlying cause of the association between aberrant sleep duration and sarcopenia risk. In this study, we have qualitatively and quantitatively summarized previously published studies on sleep duration to assess the relationship between sleep duration and sarcopenia risk in adults. This would aid in enhancing our understanding of recent advancements in this field and the association between sleep duration and sarcopenia risk.DesignSystematic review and meta-analysis.Setting and ParticipantsIn this review, we included studies evaluating the association between the duration of sleep and sarcopenia in adults in observational studies.MethodsFive electronic databases (PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Web of Science) were searched to April 20, 2023, to identify studies related to sarcopenia and sleep duration. Next, we calculated the odds ratios (ORs) for sarcopenia prevalence based on the adjusted data from individual studies. Statistical analyses were performed using Stata 11.0.ResultsSarcopenia prevalence was high (18%) in adults with long sleep duration. Our results showed a significant association between short duration of sleep and high sarcopenia prevalence in older adults (OR 1.2, 95% CI 1.02-1.41, I² = 56.6%). Furthermore, a significant association was observed between all participants with long-duration sleep and high sarcopenia prevalence (OR 1.53, 95% CI 1.34-1.75, I² = 56.8%). We also observed significant heterogeneity in the adjusted ORs.Conclusions and ImplicationsThere was a correlation between sarcopenia and short or long sleep duration, especially in older adults. In adults with a long duration of sleep, sarcopenia prevalence was relatively high.