Health and sociodemographic determinants of excess mortality in Spanish nursing homes during the COVID-19 pandemic: a 2-year prospective longitudinal study.

BACKGROUND: Age, multimorbidity, immunodeficiency and frailty of older people living in nursing homes make them vulnerable to COVID-19 and overall mortality. OBJECTIVE: To estimate overall and COVID-19 mortality parameters and analyse their predictive factors in older people living in nursing homes over a 2-year period. METHOD: Design: A 2-year prospective longitudinal multicentre study was conducted between 2020 and 2022. SETTING: This study involved five nursing homes in Central Catalonia (Spain). PARTICIPANTS: Residents aged 65 years or older who lived in the nursing homes on a permanent basis. MEASUREMENTS: Date and causes of deaths were recorded. In addition, sociodemographic and health data were collected. For the effect on mortality, survival curves were performed using the Kaplan-Meier method and multivariate analysis using Cox regression. RESULTS: The total sample of 125 subjects had a mean age of 85.10 years (standard deviation = 7.3 years). There were 59 (47.2%) deaths at 24 months (95% confidence interval, CI, 38.6-55.9) and 25 (20.0%) were due to COVID-19, mostly in the first 3 months. In multivariate analysis, functional impairment (hazard ratio, HR 2.40; 95% CI 1.33-4.32) was a significant risk factor for mortality independent of age (HR 1.17; 95% CI 0.69-2.00) and risk of sarcopenia (HR 1.40; 95% CI 0.63-3.12). CONCLUSION: Almost half of this sample of nursing home residents died in the 2­year period, and one fifth were attributed to COVID-19. Functional impairment was a risk factor for overall mortality and COVID-19 mortality, independent of age and risk of sarcopenia.

Sexual dysfunction in women with breast cancer of Northeast Brazil: a retrospective longitudinal study.

Breast cancer treatment leads to physical and psychological changes. The aim of this study was to analyze the incidence of sexual dysfunction and its risk factors in women diagnosed with breast cancer. This retrospective cohort study included women diagnosed and treated for breast cancer (exposed group, n = 90) and healthy women (non-exposed group, n = 93). Data were collected from February 2019 to October 2021 in the state of Rio Grande do Norte (Northeast Brazil), from medical records and using the Female Sexual Function Index (FSFI) questionnaire. Data were collected from medical records and using the Female Sexual Function Index (FSFI) questionnaire. Primary outcomes were analyzed using binary logistic regression. The Mann-Whitney test was used to analyze FSFI domains between groups. The exposed group had a 74% incidence of sexual dysfunction and 3.9 times increased chances of having sexual dysfunction compared with the non-exposed group (OR 3.9, CI 1.8 to 8.2, p < 0.001). Presence of comorbidities increased the chances of sexual dysfunction by 2.5 times (OR 2.5, CI 1.2 to 4.9, p = 0.009). Women diagnosed and treated for breast cancer had a higher incidence of sexual dysfunction than healthy women. Furthermore, comorbidities also increased the chances of sexual dysfunction regardless of exposure to breast cancer.

The economic impact of cancer mortality among working-age individuals in Brazil from 2001 to 2030.

BACKGROUND: About half of cancer deaths in Brazil occur among individuals of working-age (under 65 years for men, under 60 for women), resulting in a substantial economic impact for the country. We aimed to estimate the years of potential productive life lost (YPPLL) and value the productivity lost due to premature deaths from cancer between 2001 and 2015 and the projected to 2030. METHODS: We used the Human Capital Approach to estimate the productivity losses corresponding to YPPLL for cancer deaths in working age people (15-64 years). Mortality data were obtained from the Mortality Information System from 2001 to 2015 and projected between 2016 and 2030. Economic data were obtained from the Continuous National Household Sample Survey and forecasted to 2030. Productivity lost was calculated as the monetary value arising from YPPLL in Int$(2016). RESULTS: Between 2001 and 2030, a total of 2.3 million premature deaths from all cancers combined were observed and forecasted in Brazil (57% men, 43% women), corresponding to 32 million YPPLL and Int$141.3 billion in productivity losses (men: Int$102.5 billion, women: Int$38.8 billion). Between 2001 and 2030, among men, lung (Int$ 12.6 billion), stomach (Int$ 10.6 billion) and colorectal (Int$ 9.4 billion) cancers were expected to contribute to the greatest productivity losses; and among women, it will be for breast (Int$ 10.0 billion), cervical (Int$ 6.4 billion) and colorectal (Int$ 3.2 billion) cancers. CONCLUSIONS: Many preventable cancers result in high lost productivity, suggesting measure to reduce smoking prevalence, alcohol consumption, physical inactivity and inadequate diet, improving screening programs and increasing vaccination coverage for human papillomavirus and hepatitis B would have a positive impact on the economy, as well as reducing morbidity and mortality from cancer.

Sexual Dysfunction in Women with Cancer: A Systematic Review of Longitudinal Studies.

BACKGROUND: Several factors affect sexual function, including cancer development and treatment. This study summarized the risk of women with cancer of developing sexual dysfunctions. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the EMBASE, PubMed, LILACS, SciELO, CINAHL, Scopus, and Web of Science databases using the descriptors cancer, neoplasms, sexual dysfunction, sexual function, and women. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies assessed the quality of studies. RESULTS: Sixteen studies were included in this review. Women with cancer presented sexual dysfunctions in 14 out of 16 included studies. The incidence of sexual dysfunctions ranged from 30% to 80%, while the risk of developing sexual dysfunction increased 2.7- and 3.5-fold in women with cervical and breast cancer, respectively. CONCLUSION: Different cancer treatments increase the risk of developing sexual dysfunction in women, especially desire, arousal, and orgasm, leading to biopsychosocial changes in the health of this population.

Incidence and Predictive Factors of Functional Decline in Older People Living in Nursing Homes: A Systematic Review.

OBJECTIVES: To review the evidence on incidence and predictive factors of functional decline (FD) in nursing home (NH) residents. DESIGN: A systematic review of the literature. SETTING AND PARTICIPANTS: Longitudinal studies involving individuals age 60 years and older living in a NH and with at least 2 functional capacity assessments were eligible. METHODS: The search was carried out up to June 2021 and was conducted in Embase, PubMed, Web of Science, Cochrane Library, CINAHL, Scopus, SciELO, and Google Scholar databases. RESULTS: A total of 27 studies met the eligibility criteria, most of which were prospective, recruiting participants in more than 1 NH, and conducted in a single country. Studies reported a high rate of functional dependency at baseline and FD at follow-up; in 1 year, 38.9% to 50.6% of residents experienced FD. Predictive factors of FD that were significant in at least 2 of the included studies were cognitive impairment, functional status at baseline, urinary incontinence, length of institutionalization, age, depression, being married, being male, and stroke disease. Protective factors were licensed nursing hours and presence of a geriatrician within the NH staff. CONCLUSIONS AND IMPLICATIONS: This review highlights the high incidence of FD in NH residents and identifies risk and protective factors of FD that may support the design of preventative strategies for this vulnerable and frail population.

Pancreatic cáncer incidence and mortality trends: a population-based study / incidencia de cáncer pancreático y tendencias de mortalidad: un estudio basado en la población

ABSTRACT Objectives To analyze trends in pancreatic cancer incidence and mortality in Latin American countries. Methods An ecological study with incidence data from the International Agency for Research on Cancer and mortality data from the World Health Organization. The trend of incidence by Joinpoint regression, the variation of the annual average and the 95% confidence interval were analyzed. Results There were increasing trends in incidence in Brazil, in males, aged 40-59 years, and reduction in Costa Rica. In females, there was stability in all age groups. The mortality rates increased in the elderly in Brazil (AAPC: 1.09%; 95% CI: 0.76; 1.42), Peru (AAPC: 1.76%; 95% CI: 0.36; 3.17) and El Salvador (AAPC: 2.88%; 95% CI: 0.38; 5.43), while in Mexico, there was a reduction. In females, this rate increased in Brazil (AAPC: 1.38%; 95% CI: 1.07; 1.69), Peru (AAPC: 2.25%; 95% CI: 0.68; 3.85), Chile (AAPC: 3.62%; 95% CI: 1.96; 5.31), Nicaragua (AAPC: 2.51%; 95% CI: 0.36; 4.71) and Paraguay (AAPC: 1.17%; 95% CI: 0.37; 1.98) and a downward trend was observed in Colombia and Ecuador. Conclusions Pancreatic cancer had a higher incidence in the elderly population of both sexes and an increase of the mortality trend in females was noted.

RESUMEN Objetivo Analizar las tendencias en la incidencia y mortalidad por cáncer de páncreas en los países latinoamericanos. Método Se realizó un estudio ecológico con datos de incidencia de la Agencia Internacional de Investigación sobre Cáncer y datos de mortalidad de la Organización Mundial de la Salud. Se analizó la tendencia de incidencia por regresión de Joinpoint, la variación del promedio anual y el intervalo de confianza del 95%. Resultados Hubo tendencias crecientes en la incidencia en Brasil en varones entre 40 y 59 años, y una reducción en Costa Rica. En las mujeres, hubo estabilidad en todos los grupos de edad. Las tasas de mortalidad aumentaron en los ancianos en Brasil (AAPC: 1,09%; IC 95%: 0,76; 1.42), Perú (AAPC: 1,76%; IC 95%: 0,36; 3,17) y El Salvador (AAPC: 2,88%; 95% IC 0,38; 5,43), mientras que en México hubo una reducción. En las mujeres, esta tasa aumentó en Brasil (AAPC: 1,38%; IC 95%: 1,07; 1.69), Perú (AAPC: 2,25%; IC 95%: 0,68; 3.85), Chile (AAPC: 3,62%; IC 95%: 1,96; 5,31), Nicaragua (AAPC: 2,51%; IC 95%: 0,36; 4,71) y Paraguay (AAPC: 1,17%; IC 95%: 0,37; 1,98) y se observó una tendencia a la baja en Colombia y Ecuador. Conclusiones El cáncer de páncreas tuvo una mayor incidencia en la población anciana de ambos sexos; cabe también señalar que debido a este aumentó su mortalidad en las mujeres.

Can the sustainable development goals for cancer be met in Brazil? A population-based study.

Background: A one-third reduction in premature mortality (30-69 years) from chronic noncommunicable diseases is goal 3.4 of the United Nations Sustainable Development Goals (UN SDG). The burden of NCDs is expected to continue to increase in low- and middle-income countries, including Brazil. Objectives: The aim of this study was to assess geographical and temporal patterns in premature cancer mortality in Brazil between 2001 and 2015 and to predict this to 2030 in order to benchmark against the 3.4 SDG target. Methods: We used data on deaths from cancer in those aged 30-69, by age group, sex and cancer site, between 2001 and 2015 from the National Mortality Information System of Brazil (SIM). After correcting for ill-defined causes, crude and world age-standardised mortality rates per 100,000 inhabitants were calculated nationally and for the 5 regions. Predictions were calculated using NordPred, up to 2030. Results: The difference in observed (2011-2015) and predicted (2026-2030) mortality was compared against the SDG 3.4 target. Between 2011-2015 and 2026-2030 a 12.0% reduction in premature cancer age-standardised mortality rate among males and 4.6% reduction among females is predicted nationally. Across regions this varied from 2.8% among females in North region to 14.7% among males in South region. Lung cancer mortality rates are predicted to decrease among males but not among females nationally (men 28%, females 1.1% increase) and in all regions. Cervical cancer mortality rates are projected to remain very high in the North. Colorectal cancer mortality rates will increase for both sexes in all regions except the Southeast. Conclusions and recommendation: Cancer premature mortality is expected to decrease in Brazil, but the extent of the decrease will be far from the SDG 3.4 target. Nationally, only male lung cancer will be close to reaching the SDG 3.4 target, reflecting the government's long-term efforts to reduce tobacco consumption. Projected colorectal cancer mortality increases likely reflect the epidemiological transition. This and, cervical cancer control will continue to be major challenges. These results will help inform strategic planning for cancer primary prevention, early detection and treatment programs; such initiatives should take cognizance of the regional differences highlighted here.

Urinary incontinence and sedentary behaviour in nursing home residents in Osona, Catalonia: protocol for the OsoNaH project, a multicentre observational study.

INTRODUCTION: Several studies have shown that physical activity (PA) levels and sedentary behaviour (SB) are independent risk factors for many health-related issues. However, there is scarce evidence supporting the relationship between SB and urinary incontinence (UI) in community-dwelling older adults, and no information on any possible association in institutionalised older adults. Stage I of this project has the main objective of determining the prevalence of UI and its associated factors in nursing home (NH) residents, as well as analysing the association between UI (and its types) and SB. Stage II aims to investigate the incidence and predictive factors of functional and continence decline, falls, hospitalisations, mortality and the impact of the COVID-19 pandemic among NH residents. METHODS AND ANALYSIS: Stage I is an observational, multicentre, cross-sectional study with mixed methodology that aims to explore the current status of several health-related outcomes in NH residents of Osona (Barcelona, Spain). The prevalence ratio will be used as an association measure and multivariate analysis will be undertaken using Poisson regression with robust variance. Stage II is a 2-year longitudinal study that aims to analyse functional and continence decline, incidence of falls, hospitalisations, mortality and the impact of the COVID-19 pandemic on these outcomes. A survival analysis using the actuarial method for functional decline and continence, evaluated every 6 months, and the Kaplan-Meier method for falls, hospitalisations and deaths, and Cox regression for multivariate analysis will be undertaken. ETHICS AND DISSEMINATION: The study received the following approvals: University of Vic - Central University of Catalonia Ethics and Research Committee (92/2019 and 109/2020), Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (FORES) (code 2020118/PR249). Study results will be disseminated at conferences, meetings and through peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04297904.

Multimorbidity and its associated factors among adults aged 50 and over: A cross-sectional study in 17 European countries.

AIMS: To estimate the prevalence of multimorbidity among European community-dwelling adults, as well as to analyse the association with gender, age, education, self-rated health, loneliness, quality of life, size of social network, Body Mass Index (BMI) and disability. METHODS: A cross-sectional study based on wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted, and community-dwelling participants aged 50+ (n = 63,844) from 17 European countries were selected. Multimorbidity was defined as presenting two or more health conditions. The independent variables were gender, age group, educational level, self-rated health, loneliness, size of network, quality of life, BMI and disability (1+ limitations of basic activities of daily living). Poisson regression models with robust variance were fit for bivariate and multivariate analysis. RESULTS: The prevalence of multimorbidity was 28.2% (confidence interval-CI 95%: 27.5.8-29.0) among men and 34.5% (CI95%: 34.1-35.4) among women. The most common health conditions were cardiometabolic and osteoarticular diseases in both genders, and emotional disorders in younger women. A large variability in the prevalence of multimorbidity in European countries was verified, even between countries of the same region. CONCLUSIONS: Multimorbidity was associated with sociodemographic and physical characteristics, self-rated health, quality of life and loneliness.

Social support in the healthcare of women submitted to breast cancer treatment.

This study aimed to verify the prevalence of low social support (LSS) and associated factors in women submitted to breast cancer (BC) treatment. A cross-sectional study was carried out with 101 female residents of the municipality of Natal (Northeast Brazil), diagnosed with BC and submitted to oncological treatment. Data collection took place between July/2015 and May/2016 from medical records and individuals' interviews, and from the Medical Outcome Study-Social Support Survey. Descriptive, bivariate and multivariate statistics were carried out through Poisson's regression with robust variance and significance level 0.05. Prevalence of LSS in women with BC was 22.8% with confidence interval 14.6-39.94. Type of access to public services (p < .03), prevalence ratio (PR) 1.84 and negative self-rated health (p < .001), PR 4.47 were associated with LSS. These results were obtained after adjustments by the variables age and presence of chronic diseases. The associations established herein could have been mostly related to fragilities of the Brazilian health system, and can contribute to the planning of actions directed to the studied population.

Regional and gender differences in laryngeal cancer mortality: trends and predictions until 2030 in Brazil.

OBJECTIVE: Analysis of laryngeal cancer mortality trends in Brazil and its geographic regions for the period 1996-2010 and calculation of mortality predictions for the period 2011-2030. STUDY DESIGN: An epidemiologic, ecologic, demographic-based study, which utilized information from the Mortality Information System on all cancer-related deaths in Brazil, is presented here. Mortality trends were analyzed by Joinpoint regression, and Nordpred was utilized for the calculation of predictions. RESULTS: When comparing the last observed period and the last predicted period for men, an increase of 10,588 deaths is expected, representing an increase of 69%. For women, the expected increase in the number of deaths will be 2217, representing an increase of 104%. Laryngeal cancer mortality rates will increase in the North and Northeast regions for men and in the Northeast and Southeast regions for women. CONCLUSIONS: Despite the current high mortality for laryngeal cancer, rates will continue to increase until 2030 in Brazil.

Effectiveness of intervention programs in primary care for the robust elderly.

OBJECTIVE: This study aimed to search the literature for intervention programs in primary care with a multiprofes-sional character, specifically directed at the robust elderly, and with viable and cost-effective interventions. MATERIALS AND METHODS: The search strategies were applied in Cochrane, Lilacs, Pubmed, Scopus, WHOLIS, Embase, Medcarib, SciELO, Web of Science, and PAHO databases. RESULTS: 3 665 articles were found and 32 remained for analysis, grouped into four categories: care management; multidisciplinary intervention; interventions on the basis of risk; and educational interventions with health professionals. CONCLUSION: Strategies such as domestic interventions can promote health and functionality of elderlies, as well as reduce mortality, use of the health system and costs. Besides that, the use of hard and light-hard technologies are important for risk prevention and care management for the elderly.There is a need to create programs for risk prevention and effective management of elderly care at the primary level.

Laryngeal cancer survival in Zaragoza (Spain): a population-based study.

OBJECTIVE: This article aims to study larynx cancer survival from the Population-Based Cancer Registry of Zaragoza, Spain, for the period 1978-2002. METHODS: The survival rates were calculated using the Kaplan-Meier method. The automated calculation of the Catalan Institute of Oncology was utilised to obtain the relative survival. RESULTS: The observed survival rate was 84.6% in the first year and 60.9% in the fifth year. The one-year relative survival in both genders was 86.8% (CI 95%: 85.3-88.4) and 70.1% (CI 95%: 67.8-72.4) after five years. Glottic cancer presented a better survival rate than supraglottic and subglottic cancers, and a better survival rate was also observed in younger ages. There were no statistical differences when comparing survival rates by gender and between the periods 1978-1986, 1987-1994 and 1995-2002. CONCLUSIONS: The data suggest there were no significant changes in laryngeal cancer survival in the province of Zaragoza in the period 1978-2002 and that the tumours located in the glottis presented a better prognosis.

[Esophageal cancer incidence and survival in the province of Zaragoza (Spain): a population-based study]. / Incidencia y supervivencia del cáncer de esófago en la provincia de Zaragoza: un estudio de base poblacional.

BACKGROUND AND OBJECTIVE: The objective of the present paper is to study the incidence and survival of esophageal cancer from data of the Population-Based Cancer Registries of Zaragoza. PATIENTS AND METHODS: Crude and adjusted incidence rates were calculated according to sex and the Joinpoint log-linear regression was utilized to calculate trends in adjusted incidence rates for the period 1978-2002. The observed survival was calculated by utilizing the Kaplan-Meier method. For relative survival, the automate calculation of the Oncology Institute of Catalonia was utilized. RESULTS: Joinpoint analysis revealed stability in the incidence rates with Annual Percentage Change of 0.16 (CI 95%: -0.8; 1.1) for men and 0.04 for women (CI 95%: -2.8; 2.8). Observed survival in the period 1978-2002 was 33.2% in the first year and 15.3% in the last year. Relative 1-year survival for males and females was 36.3% (CI 95%: 32.7-40.4) and 23.8% (CI 95%: 20.0-28.4) after 5 years. CONCLUSIONS: Data suggest that there were no significant changes in the incidence rates of esophageal cancer in the province of Zaragoza and that survival was low.