Psychosocial and cognitive multimorbidity and health-related quality of life and symptom burden in older adults with atrial fibrillation: The systematic assessment of geriatric elements in atrial fibrillation (SAGE-AF) cohort study

BackgroundDepression, anxiety, and cognitive impairments occur in up to 40 % of adults with AF and are associated with poorer health-related quality of life (HRQoL) and higher symptom burden. However, it is unknown how often these impairments co-occur, or multimorbidity, and how multimorbidity effects HRQoL and symptom burden.MethodsPatients with AF age ≥65 years with a CHA₂DS₂VASC risk score ≥ 2 and eligible for oral anticoagulation therapy were recruited from five clinics in a prospective cohort study. Participants completed validated measures of depression (PHQ9) and anxiety (GAD7), cognitive impairment (MoCA), and HRQOL and AF symptom burden (AFEQT). Multinomial logistic regression was used.ResultsParticipants (N = 1244, 49 % female) were on average 76 ± 7 years; 86 % were non-Hispanic white. Approximately 35 % of participants had 1 impairment, 17 % had 2 impairments and 8% had 3 impairments; 39 % had none of the 3 impairments examined. Compared to participants with no impairments, patients with 1, 2 and 3 impairments had higher odds of poor HRQoL (adjusted OR [AOR] = 1.77, 95 % CI 1.21, 2.60; AOR = 6.64, 95 % CI 4.43, 9.96; and AOR = 7.50, 95 % CI 4.40, 12.77, respectively) and those with 2 and 3 impairments had higher odds of high symptom burden (AOR = 3.69 95 % CI 2.22, 6.13; and AOR = 5.41 95 % CI 2.85, 10.26).ConclusionsPsychosocial/cognitive multimorbidity is common among older adults with AF and is associated with poor HRQoL and high symptom burden. Clinicians might consider incorporating psychosocial and cognitive screens into routine care as this may identify a high-risk population.     

Should I care for my mum or for my kid? Sandwich generation and depression burden in Italy

Setting and objectiveIn Italy, over the last decades, elderly care has been mostly provided by family members, especially adult offspring, and in particular daughters. This paper investigates the relationship between informal caregiving and mental distress among Italians aged 35–59, with a focus on gender effect and parenthood responsibilities.DataThe dataset is the European Health Interview Survey (EHIS), second wave, year 2015. As far as it is known, the Italian EHIS has not been used for studies on ageing and caregiving.MethodsUsing selected subsamples, a Propensity Score Matching between caregivers and non-caregivers aged 35–59 is implemented, with the aim of measuring the difference in level of depression, if any, between the two groups.ResultsFindings show that women providing their frail relatives with informal care are less likely to suffer from mental distress compared to non-carers. However, results change radically if they have children aged less than 15 at home, and a higher probability of being depressed is detected for women overwhelmed by the double responsibility of assisting both dependent relatives and their own children. Results are not significant for men.     

浙江省宁波市手足口病经济负担调查研究

目的 评估宁波市手足口病经济负担。 方法 选取国家疾病监测信息报告管理系统中2011年宁波市报告的手足口病例,进行问卷调查和病历回顾,收集病例就医过程、相关费用和医疗保险等信息,估算手足口病例经济负担。 结果 共调查手足口病轻症病例106例,重症病例58例,死亡病例6例。2011年宁波市手足口病总体经济负担为3635.1万元,其中直接经济负担2181.2万元,间接经济损失1453.9万元。轻症、重症、死亡病例直接费用的中位数分别为1581、7419和21 533元,直接医疗费用的中位数分别为1431、6977和17 224元。参加至少一种医疗保险的病例占32.9%,医疗保险可为轻症、重症病例分别减轻38.2%和29.1%的直接医疗费用。 结论 手足口病给患者和社会均造成了较重的经济负担。提高医疗保险覆盖率、减少轻症病例住院比例将有助于减轻患者经济负担;控制和降低发病率,才能有效减轻手足口病对社会的经济负担。     

Immunity to gastrointestinal nematodes: a story of immune modulation

Infections with gastrointestinal nematodes are some of the most prevalent infections in the world today. Despite the fact that antihelminthic drugs are generally regarded as safe, efficient and are widely available, the level of infection remains as high or, in some cases, even higher than 50 years ago. It is clear that immune-mediated resistance to infection in mouse models is mediated by a T-helper 2-type immune response. Gastrointestinal nematodes are powerful modulators of the immune response, and as such, they may have the potential to affect the outcome of concurrent infections with other parasites, bacteria or viruses. Importantly, they also appear to have the ability to influence the development of allergic reactions and modulate the effects of vaccination.     

Characteristics of Patients Infected with Norovirus GII.4 Sydney 2012, Hong Kong,China

Norovirus GII.4 Sydney 2012 has spread globally since late 2012. We report hospitalization of patients infected with this strain skewed toward infants and young children among 174 cases during August 2012–July 2013 in Hong Kong, China. This group had higher fecal viral load (≈10-fold) than did older children and adults.     

医院就诊患者肠道寄生虫感染状况调查

目的 了解医院就诊患者肠道寄生虫感染情况及临床特点,为健康状态的评估和采取有效防控措施提供依据.方法 对2010～2011年39 671例在广西医科大学第一附属医院就诊患者进行肠道寄生虫的病原学检查,并分析阳性患者的感染情况.结果 共查出感染者5 751例,总感染率为14.50％.检出8种寄生虫,感染率分别为华支睾吸虫5.96％、蛔虫0.45％、鞭虫0.24％、钩虫2.46％、溶组织内阿米巴0.82％、人芽囊原虫3.91％、蓝氏贾第鞭毛虫0.65％、人毛滴虫0.09％.男性感染率为16.78％,女性为10.77％,男性显著高于女性(P＜0.001); 30～岁组感染率最高,为24.19％;感染者大多有不良饮食习惯和或卫生习惯；感染者临床表现复杂多样、无特异性.结论 医院就诊患者土源性线虫感染率较低,但华支睾吸虫和人芽囊原虫感染率较高,是今后防治的重点,除早期诊断和药物治疗患者外,还应加强宣教工作力度,提高人群的疾病预防意识.     

Plasma oxidized high-density lipoprotein and glycated apolipoprotein A-I concentrations in ST-segment elevation myocardial infarction patients with stress hyperglycaemia or high thrombus burden

Abstract

Background: High-density lipoprotein (HDL) particles exert many beneficial actions that may help protect against cardiovascular disease. However, recent work has demonstrated that HDL can be oxidized and glycated under certain circumstances and may become pro-atherogenic. The present study investigated the impact of oxidized high-density lipoprotein (ox-HDL) and glycated apolipoprotein A-I (gly-ApoA-I) in patients presenting with ST-elevation myocardial infarction (STEMI).

Methods: We assessed 55 consecutive patients with STEMI. Patients were divided into: (1) a stress hyperglycaemia (SH) and a no SH group; and (2) a high thrombus burden (HTB) group and a low thrombus burden (LTB) group. Meanwhile, 48 healthy volunteers were recruited as controls. Plasma ox-HDL and gly-ApoA-I concentrations were measured on admission and 7?days after admission.

Results: Higher concentrations of ox-HDL and gly-ApoA-I were found in the STEMI group than in the control group on admission and at d7. Further subgroup analysis showed that ox-HDL and gly-ApoA-I were higher in the SH group than in the no SH group at both time points; the HTB group had higher ox-HDL and ox-HDL/HDL-C levels than the LTB group on admission and at d7. However, gly-ApoA-I and the relative intensity of ApoA-I glycation showed no significant differences between the HTB and LTB groups.

Conclusions: The present data indicate that: (1) SH is associated with increased plasma concentrations of ox-HDL and gly-ApoA-I and therefore aggressive treatment is recommended; and (2) that ox-HDL and ox-HDL/HDL-C were higher in the HTB group and may be used to quantify thrombus burden.     

Correlates of psychological distress in study partners of older people with and without mild cognitive impairment (MCI) – the Sydney Memory and Ageing Study

Objectives: Psychological effects of supporting someone with mild cognitive impairment (MCI) are often overlooked. We aimed to establish correlates of psychological distress in study partners of individuals with and without nonclinical MCI.Methods: Demographic, psychosocial and health measures were obtained cross-sectionally from 714 participants (39% MCI) and study partners of a longitudinal community-based study on cognitive aging. Study partners (i.e. family members/friends) were categorized as providing support with instrumental everyday activities or not. Psychological distress was measured by the Kessler psychological distress scale. Multiple hierarchical regressions examined determinants of psychological distress within Pearlin's stress process model.Results: Psychological distress was generally low and not associated with MCI or whether study partners provided support or not. Instead, distress was greater if participants were male irrespective of study partners’ sex and if study partners reported negative reactions to participants’ behavioral symptoms, felt burdened by providing support and showed worse coping abilities; overall explaining 37% variance. Self-rated disability and aspects of health-related quality of life explained additional 7%.Conclusion: Objective impairment measures were not associated with distress in partners or supporters. However, study partners’ appraisals of functional and behavioral symptoms were linked to increased distress even in this very mildly affected community cohort.