The impact of HIV-related stigma on older and younger adults living with HIV disease: does age matter?

The purpose of this study was to examine the independent influence of age on levels of HIV-related stigma experienced by adults living with HIV/AIDS. To accomplish this, cross-sectional data from the Ontario HIV Treatment Network Cohort Study were used to determine whether older age is associated with overall stigma among HIV-positive adults living in Ontario, Canada (n = 960). The relationship was also tested for enacted, anticipated, and internalized stigma. Covariates included sociodemographic (e.g., gender, sexual orientation, race) and psychosocial variables (e.g., depression). Modifying effects of covariates were also investigated. Those 55 and older have significantly lower overall and internalized stigma than adults under age 40, even when accounting for gender, sexual orientation, income, time since diagnosis, depression, maladaptive coping, and social support. Age does not predict enacted or Anticipated Stigma when accounting for the demographic and psychosocial variables. A significant interaction between depression and age suggests that stigma declines with age among those who are depressed but increases to age 50 and then decreases in older age groups among those who are not depressed. Age matters when it comes to understanding stigma among adults living with HIV/AIDS; however, the relationship between age and stigma is complex, varying according to stigma type and depression level.     

Old age mortality in Japan: does the socioeconomic gradient interact with gender and age?

OBJECTIVES: There is limited knowledge concerning how the effects of socioeconomic status (SES) on mortality interact with gender and age. In addition, current studies are largely based on data from the Western nations. The validity of prior observations needs to be further evaluated. This research examines socioeconomic inequalities in old age mortality in Japan, with a special emphasis on how inequalities interact with gender and age. METHODS: Data came from a 5-wave panel study of a national probability sample of 2,200 elderly Japanese conducted between 1987 and 1999. Hazard rate models involving time-varying covariates were used to ascertain the direct and indirect effects of SES. In addition, interaction effects involving SES variables with age and gender were evaluated. RESULTS: In contrast to prior findings from the Western developed nations, there is an educational crossover effect on mortality among older men, in that, at advanced age, those with less education live longer than those with higher education. On the other hand, there is some evidence that educational differences in the risk of dying tend to converge in the 70-79 age group. More interestingly, there is a crossover in the effect of education among the 80 and older age group. DISCUSSION: The observation that educational crossover exists only among elderly men may be because of gender and SES differences in causes of death, morbidity, and health behavior. On the other hand, possible explanations for age differences in the educational crossover include selective survival and cohort effects.     

Psychological and physical activity training for older persons: who does not attend?

BACKGROUND: Interventions to promote successful aging include psychological and physical activity programs. Identification of determinants of attendance of older persons may be useful to develop strategies to improve attendance. For physical activity programs determinants of attendance have been investigated extensively. For psychological programs hardly any knowledge is available. Determinants of attendance at psychological and physical activity programs have never been investigated simultaneously. OBJECTIVE: To identify demographic, physical and psychological determinants of attendance of older subjects following multifaceted psychological training - aimed at promoting active social participation - and physical activity training and to compare the variation of these determinants between the two training programs. METHOD: 118 subjects aged 65-92 years were randomized over psychological and physical activity training. Determinants of attendance were obtained at pretest with questionnaires and performance-based tests. RESULTS: Mean attendance was 62%. Attendance was not related to type of program. Having chronic diseases facilitated attendance in the psychological training group and limited attendance in the physical activity training group. Low and high levels of Activities of Daily Living performance (ADLs) and walking endurance were related to a high attendance in the psychological training group. A low level of activities of daily living (ADL) and a low walking endurance were related to a low attendance in the physical activity training group. For both training groups, persons living with a partner had higher attendance rates than persons living alone, and persons with a low level of anxiety had higher attendance rates than persons with a moderate or a high level of anxiety. CONCLUSION: Psychological training may be more suitable for frail older persons with chronic diseases, low ADL levels and low walking endurance than physical activity training, and may help to prepare such persons for physical activity.     

Hepatitis C in 6,865 patients 65 yr or older: a severe and neglected curable disease?

BACKGROUND: Few data are available on chronic hepatitis C (CHC) in elderly patients. The aim of this study was to compare the features and severity of CHC and the efficacy/safety of antiviral therapy in patients<65, between 65 and 80, and >80 yr old, and to determine the usefulness of biochemical markers (Fibrotest-Fibrosure/ActiTest [FT-AT]) in aged patients. METHODS: This was a retrospective study with two groups of patients: Group 1: prospective cohort including all hepatitis C virus patients from our institution (N=4,182); Group 2: all consecutive patients who had FT-AT performed in France between 2002 and 2004 (N=33,738). RESULTS: A total of 6,865 patients>or=65 yr old was included (Group 1=881, Group 2=5,984). Group 1: patients>or=65 had a longer duration of and a higher age at infection, more genotype 1, and a history of transfusion (p<0.001). Among the 2,169 patients who underwent liver biopsy, bridging fibrosis (F2,F3,F4) was more frequent in patients>or=65 yr old, regardless of the duration of infection. In multivariate analysis, ages at biopsy and at infection were associated with F2,F3,F4. Discovery of CHC by a complication was more frequent in patients>or=65 yr (p<0.001). One hundred seventy patients>or=65 yr received antiviral therapy. A sustained virologic response was obtained in 45% of patients>or=65 yr treated with pegylated interferon/ribavirin. Group 2: At FT, 58% of patients>80 yr, 37% of patients between 65 and 80 yr, and 14% of patients<65 yr (p<0.001) had cirrhosis. Patients>80 yr (43%) with cirrhosis had nonelevated alanine amino transferase (ALT), compared with 31% of patients<65 yr (p<0.001). CONCLUSION: In patients>or=65 yr, CHC is more severe and presents with lower ALT than in younger patients. Treatment is effective. Biochemical markers seem particularly useful as a noninvasive alternative to liver biopsy in this population.     

Angiogenic inhibitors for older patients with advanced colorectal cancer: Does the age hold the stage?

Although major progress has been achieved in the treatment of advanced colorectal cancer (CRC) with the employment of antiangiogenic agents, several questions remain on the use of these drugs in older patients. Since cardiovascular, renal and other comorbidities are common in the elderly, an accurate assessment of the patients’ conditions should be performed before a treatment decision is made. Since most CRC patients enrolled in clinical trials testing antiangiogenic drugs were aged < 65 years, the efficacy and tolerability of these agents in elderly patients has not been adequately explored. Data suggest that patients with advanced CRC derive similar benefit from bevacizumab treatment regardless of age, but the advantage of other antiangiogenic drugs in the same class of patients appears more blurred. Literature data suggest that specific antiangiogenic-related toxicities such as hypertension or arterial thromboembolic events may be higher in the elderly than in the younger patients. In addition, it should be emphasized that the patients included in the clinical studies discussed herein were selected and therefore may not be representative of the usual elderly population. Advanced age alone should not discourage the use of bevacizumab. However, a careful patients’ selection and watchful monitoring of toxicities are required to optimize the use of antiangiogenics in this population.     

Employment and occupation effects on depressive symptoms in older Americans: does working past age 65 protect against depression?

OBJECTIVES: This article examines the effects of work status, occupational sector, and occupation type on depressive symptoms in older Americans. We partially controlled for the healthy worker selection effect by including disability as a predictor of both work status and depressive symptoms. METHODS: We analyzed a nationally representative sample of 23,247 respondents aged 65 to 88 from the National Health Interview Survey pooled over 1997 to 2000. We used structural equation models with latent variables to assess relationships between work/occupation and depressive symptoms. RESULTS: Older Americans who work had lower levels of depressive symptoms as compared to older nonworkers. Membership in several worker groups, generally higher status occupations, protected against depressive symptoms. After controlling for disability, the difference in level of depressive symptoms for workers versus nonworkers did not persist. However, workers in specific occupational sectors and types reported different levels of depressive symptoms even when we controlled for disability. DISCUSSION: The mental health benefit of working, among persons aged 65 and older, may be due to the healthy worker effect. However, the particular job sector in which older workers are employed matters. Socioeconomic status and financial versus personal motivations for working are potentially important explanations for differences.     

Lung manifestation in asymptomatic patients with primary Sj?gren syndrome: assessment with high resolution CT and pulmonary function tests.

The authors studied 37 consecutive patients with primary Sj?gren syndrome and normal chest radiographs. Thin-section CT images were analyzed using a semiquantitative grading system. The presence, distribution, and severity of 9 morphologic parameters were assessed. In 34 patients, CT findings were correlated to pulmonary function tests (PFTs). Abnormal high resolution CT (HRCT) findings were seen in 24 of 37 patients (65%): interlobular septal thickening, n = 9; micronodules, n = 9; ground glass attenuation n = 4; parenchymal cysts, n = 5. Intralobular opacities, honey combing, bronchial wall thickening, bronchiectasis, and pleural irregularities were less frequent. Both HRCT and PFTs were normal in 10 patients. Computed tomography was normal in four patients with PFTs that indicated the presence of small airway disease. High resolution CT abnormalities were found in seven patients with normal PFT. The overall correlation between HRCT and PFTs was poor. High resolution CT and PFTs appear to be sensitive for both the early detection of parenchymal abnormalities and a decreases in lung function in asymptomatic patients with primary Sj?gren syndrome. However, abnormal HRCT findings do not necessarily indicate a substantial alteration in PFTs.     

TAVR in patients with severe aortic stenosis and less than high risk: Future or present reality?

• TAVR use is growing in patients with less than high surgical risk.
• Several registries, including this one, show excellent safety with TAVR in intermediate‐risk patients compared with similar patients undergoing SAVR.
• Long‐term data from ongoing randomized trials will answer definitively if we should routinely perform TAVR in intermediate‐risk patients.

     

Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for ‘hypoglycaemia’?

Objectives Hypoglycaemia (glucose <2.2 mmol/l) is a defining feature of severe malaria, but the significance of other levels of blood glucose has not previously been studied in children with severe malaria. Methods A prospective study of 437 consecutive children with presumed severe malaria was conducted in Mali. We defined hypoglycaemia as <2.2 mmol/l, low glycaemia as 2.2–4.4 mmol/l and hyperglycaemia as >8.3 mmol/l. Associations between glycaemia and case fatality were analysed for 418 children using logistic regression models and a receiver operator curve (ROC). Results There was a significant difference between blood glucose levels in children who died (median 4.6 mmol/l) and survivors (median 7.6 mmol/l, P < 0.001). Case fatality declined from 61.5% of the hypoglycaemic children to 46.2% of those with low glycaemia, 13.4% of those with normal glycaemia and 7.6% of those with hyperglycaemia (P < 0.001). Logistic regression showed an adjusted odds ratio (AOR) of 0.75 (0.64–0.88) for case fatality per 1 mmol/l increase in baseline blood glucose. Compared to a normal blood glucose, hypoglycaemia and low glycaemia both significantly increased the odds of death (AOR 11.87, 2.10–67.00; and 5.21, 1.86–14.63, respectively), whereas hyperglycaemia reduced the odds of death (AOR 0.34, 0.13–0.91). The ROC [area under the curve at 0.753 (95% CI 0.684–0.820)] indicated that glycaemia had a moderate predictive value for death and identified an optimal threshold at glycaemia <6.1 mmol/l, (sensitivity 64.5% and specificity 75.1%). Conclusions If there is a threshold of blood glucose which defines a worse prognosis, it is at a higher level than the current definition of 2.2 mmol/l.     

Identification of asymptomatic type 2 diabetes mellitus patients with a low, intermediate and high risk of ischaemic heart disease: is there an algorithm?

Aims/hypothesis  

The leading cause of death in type 2 diabetes is cardiovascular disease (CVD). We examined the prevalence of myocardial ischaemia in type 2 diabetes patients and tried to establish an algorithm to identify patients with a high risk of ischaemic heart disease.