A systematic review of reviews on the psychometric properties of measures of older persons' ability to build and maintain social relationships.

BACKGROUND: Within the scope of the World Health Organisation's (WHO) world report on ageing and health and how healthy ageing was conceptualised, the WHO has been working with academia towards producing reviews of the psychometric properties of instruments that measure different domains of functional ability. This study aimed to conduct a review of reviews to examine existing and validated instruments measuring the ability of older persons to build and maintain social relationships and to evaluate the psychometric properties of these instruments. METHODS: We searched for studies published in the English, Spanish and Portuguese languages. No restrictions were placed on the year of publication. The following databases were searched: PubMed, Embase, Psyinfo and Cumulated Index to Nursing and Allied Health Literature. Titles and abstracts were screened and selected articles were screened and reviewed independently by two reviewers. RESULTS: A total of 3,879 records were retrieved, of which 39 records were retrieved for full-text analysis. None of the reviews met the inclusion criteria, thus resulting in an empty review. CONCLUSIONS: Considering the current definition of older persons' functional ability to build and maintain social relationships, this review did not identify instruments that can measure both constructs simultaneously. We suggest the development of an instrument that simultaneously assesses the ability of older persons to build and maintain relationships.

Mean Platelet Volume Predicts Restenosis After Carotid Endarterectomy.

BACKGROUND: Carotid restenosis following carotid endarterectomy (CEA) has a cumulative risk at 5-years up to 32%, which may impact the well-being of patients following CEA. Haematological parameters in the standard complete blood cell count (CBC) are emerging as potential biomarkers, but their application in CEA is scarce. The primary aim of this study was to investigate haematological markers for restenosis following CEA. The secondary aim was to characterize clinical risk factors for restenosis. METHODS: From January 2012 to January 2019, 151 patients who underwent CEA under regional anaesthesia due to carotid stenosis were selected from a prospectively maintained cohort database. Patients were included if a preoperative CBC was available in the 2 weeks preceding CEA. Multivariable analysis was performed alongside propensity score matching (PSM) analysis, using the preoperative CEA parameters, to reduce confounding factors between categories. RESULTS: The study group comprised 28 patients who developed carotid restenosis. The remaining 123 patients without restenosis composed the control group. Mean age of the patients did not differ significantly between groups (70.25 ± 8.05 vs. 70.32 ± 9.61 YO, P = 0.973), neither did gender (male gender 89.3% vs. 78.9%, P = 0.206). Regarding haematological parameters, only MPV remained statistically significant within multivariable analysis (1.855, aOR [1.174-2.931], P = 0.008), a result supported by PSM analysis (2.072, aOR [1.036-4.147], P = 0.042). CONCLUSIONS: MPV was able to predict restenosis 2 years after CEA. Thus, MPV can be incorporated into score calculations to identify patients at greater risk of restenosis, who could benefit from specific monitoring during follow-up. While results are promising, more research is necessary to corroborate them.

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.

OBJECTIVE: To establish European League Against Rheumatism (EULAR) points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older. METHODS: Points to consider were developed in accordance with EULAR standard operating procedures for EULAR-endorsed recommendations, led by an international multidisciplinary task force, including patient research partners and different health professionals from 10 European countries. Level of evidence and strength of recommendation were determined for each point to consider, and the mean level of agreement among the task force members was calculated. RESULTS: Two overarching principles and seven points to consider were formulated based on scientific evidence and the expert opinion of the task force. The two overarching principles focus on shared decisions between patients and non-physician health professionals and involvement of different non-physician health professionals in prevention and management of fragility fractures. Four points to consider relate to prevention: identification of patients at risk of fracture, fall risk evaluation, multicomponent interventions to prevent primary fracture and discouragement of smoking and overuse of alcohol. The remaining three focus on management of fragility fractures: exercise and nutritional interventions, the organisation and coordination of multidisciplinary services for post-fracture models of care and adherence to anti-osteoporosis medicines. The mean level of agreement among the task force for the overarching principles and the points to consider ranged between 8.4 and 9.6. CONCLUSION: These first EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older serve to guide healthcare practice and education.

2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis.

Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

Impact of a Mediterranean-Inspired Diet on Cardiovascular Disease Risk Factors: A Randomized Clinical Trial.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. This study focused on evaluating the impact of a Mediterranean-type diet combined with physical exercise on CVD risk factors of high-risk individuals. A randomized clinical trial (RCT) recruited individuals (≥50 years old) with no history of acute myocardial infarction, but with high CVD risk criteria according to the SCORE2/SCORE2 OP. Anthropometric and biochemical parameters were assessed at baseline and after 12 weeks of diet and exercise intervention. Participants were randomly assigned into 3 groups: no intervention group (Group 1a), physical exercise group (Group 1b), and physical exercise (±2 h/week) plus diet group (Group 2). Briefly, the dietary intervention was based on the principles of an isocaloric Mediterranean diet (MD), with seven main meals/week centered on plant-based foods (legumes and pulses). The combined effect of exercise and the diet showed significant decrease in WC (p = 0.002), BST (p < 0.001), visceral fat (p < 0.001), and TG (p = 0.029), compared with control groups. The intervention significantly increased legume intake (p < 0.001), as well as adherence to the MD, which associates with WC decrease (p = 0.024) and visceral fat (p = 0.017). A combined intervention of exercise and diet should be endorsed as an efficient modifier of cardiometabolic parameters.

Determining the Profile of People with Fall Risk in Community-Living Older People in Algarve Region: A Cross-Sectional, Population-Based Study.

One in three people aged 65 years or older falls every year. Injuries associated with this event among the older population are a major cause of pain, disability, loss of functional autonomy and institutionalization. This study aimed to assess mobility and fall risk (FR) in community-living older people and to determine reliable and independent measures (health, social, environmental and risk factors) that can predict the mobility loss and FR. In total, 192 participants were included, with a mean age of 77.93 ± 8.38. FR was assessed by EASY-Care (EC) Standard 2010, the Tinetti Test and the Modified Falls Efficacy Scale (MFES). An exploratory analysis was conducted using the divisive non-hierarchical cluster method, aiming to identify a differentiator and homogeneous group of subjects (optimal group of variables) and to verify if that group shows differences in fall risk. Individually, the health, social, environmental and risk factor categories were not found to be an optimal group; they do not predict FR. The most significant predictor variables were a mix of the different categories, namely, the presence of pain, osteoarthritis (OA), and female gender. The finding of a profile that allows health professionals to be able to quickly identify people at FR will enable a reduction in injuries and fractures resulting from falls and, consequently, the associated costs.

Evaluation of Antimicrobial Resistance of Different Phylogroups of Escherichia coli Isolates from Feces of Breeding and Laying Hens.

Animal and food sources are seen as a potential transmission pathway of multi-drug resistance (MDR) micro-organisms to humans. Escherichia. coli is frequently used as an indicator of fecal contamination in the food industry and known as a reservoir of antimicrobial resistance genes (ARGs). Microbial contamination as a major outcome for the poultry and egg industry and is a serious public health problem. In the present study we performed the quantification of ß-glucoronidase positive E. coli in 60 fecal samples of breeding and laying hens collected in Portugal in 2019. Phylogenetic and pathotypic characterization, antimicrobial susceptibility, and detection of resistant extended-spectrum ß-lactamase (ESBL) genes were assessed. The phylogenetic and pathogenic characterization and detection of ESBL genes were assessed by real-time PCR and antimicrobial susceptibility was evaluated using the disk diffusion method. Overall, E. coli quantification was 6.03 log CFU/g in breeding hens and 6.02 log CFU/g in laying hens. The most frequent phylogroups were B1. None of the isolates was classified as diarrheagenic E. coli (DEC). In total, 57% of the isolates showed MDR and 3.8% were positive for ESBL. Our study highlights that consumers may be exposed to MDR E. coli, presenting a major hazard to food safety and a risk to public health.

Cross-Cultural Validation of Quebec User Satisfaction with Assistive Technology 2.0 for Spanish Population (QUEST-2.0 ES).

BACKGROUND: Assistive technologies (ATs) are resources to promote the independence and participation of people with a disability. The use of standardized tools, based on outcome measures, is essential for guaranteeing high-quality rates. The Quebec User Evaluation of Satisfaction with AT-2.0 (QUEST) is a scale to assess the satisfaction of people using any AT. OBJECTIVES: To translate and culturally validate the QUEST-2.0 for the Spanish population (QUEST 2.0-ES). METHODS: A validation cross-design and descriptive study. The test-retest reliability, validity, and internal consistency of QUEST 2.0-ES were studied. It was divided into two phases: Sample 1 was formed by 26 persons; in sample 2, 30 persons participated. The conditions included neurological conditions, amputations, rare diseases, and deafness. RESULTS: Thirty-five men and 21 women participated in total. The majority of AT used were those for mobility. QUEST 2.0-ES analysis showed internal consistency values between the test (α = 0.87) and retest versions (α = 0.89). The internal consistency was high for AT (test, α = 0.83; retest, α = 0.87) and Service (test, α = 0.80; retest, α = 0.80). The temporal reliability (1-2 weeks) for test-retest was 0.88. CONCLUSION: QUEST 2.0-ES showed good psychometric properties in terms of validity and test-retest reliability, and it is a good tool to assess the user's satisfaction with ATs and services.

Chefs in Future Integrated Healthcare - Current State and Innovation Needs: A First Overview of the NECTAR Project (aN Eu Curriculum for Chef gasTro-Engineering in Primary Food Care).

People in need of care, chronic or acute, often present problematic food intake and special nutritional needs. Integrated, person-centred and pro-active food and nutritional care delivery has been proven effective for people in health care. However, skills mismatches have been reported in different professions involved, which also applies to the role of chefs in healthcare. The EU funded project NECTAR aims at closing this gap by creating a new job profile, called Chef Gastro-Engineering (CGE). The current publication summarizes the status quo in hospitals and gives a perspective on the future role of chefs in integrated healthcare delivery.

Translation, cultural adaptation and validation of the self-efficacy to manage chronic disease 6-item scale for european Portuguese.

OBJECTIVES: Self-efficacy is an important factor in the acquisition of self-management skills in patients with chronic diseases. The present study provides a translation and cultural adaptation for the Portuguese population, as well as psychometric properties, of the Self-Efficacy for Managing Chronic Disease 6-Item Scale. MATERIALS AND METHODS: This is a cross-sectional study. As a first stage, a translation and cultural adaptation were conducted. After preparation, a final version was applied initially to a sample of 30 participants with chronic disease in two phases, with a one-week gap between phases, to assess teste retest reliability. Subsequently, a sample of 217 participants with chronic disease, mean age 42.8 (10.7) years, participated in the study. Participants were supposed to be over the age of 18 and with at least one clinically diagnosed chronic disease. The questionnaire was applied electronically. RESULTS: The results showed a good test retest reliability (ICC of 0.83, 95% CI: 0.65 - 0.92). Internal consistency met the criterion for a reliable measure (global Cronbach's alpha of 0.95). Item-total correlations of all items were above 0.30. A correlation matrix was considered favorable (KMO = 0.90; Bartlett's sphericity test = 1399.090, p < 0.01). The results confirmed the permanence of the 6 items, as in the original scale. CONCLUSIONS: A Self-Efficacy for Managing Chronic Disease 6-Item Scale is a reliable and valid instrument to assess the patients' self-efficacy for managing chronic diseases in Portuguese, enabling its use in clinical practice and in future studies.

Prediction of short-term prognosis in elderly patients with spontaneous intracerebral hemorrhage.

AIM: The incidence of spontaneous intracerebral hemorrhage (SICH) increases with age. Data on SICH mortality in the very old are sparse. We aimed to describe the predictors of 30-day SICH mortality in the very elderly in southern Portugal. METHODS: A total of 256 community representative SICH patients aged ≥ 75 years (2009-2016) were included. Multiple logistic regression was used to identify predictors of 30-day mortality. RESULTS: Mean age was 82.1 years; 57.4% males. The 30-day case fatality was 38.7%. The frequency of patients taking anticoagulants (29.3% vs. 11.5%); comatose (46.9% vs. 2.5%); with hematoma volume ≥ 30 mL (64.6% vs. 13.4%); intraventricular dissection (78.8% vs. 27.4%) was higher in deceased patients (p < 0.05). Survivors were more often admitted to stroke unit (SU) (68.2 vs. 31.3%) and had lower mean admission glycaemia values (p < 0.05). The likelihood of death was increased in patients with higher admission hematoma volume (≥ 30 mL) (OR: 8.817, CI 1.753-44.340, p = 0.008) and with prior to SICH history of ≥ 2 hospitalizations OR = 1.022, CI 1.009-1.069, p = 0.031). Having higher Glasgow coma scale score, OR: 0.522, CI 0.394-0.692, p < 0.001, per unit was associated with reduced risk of death. Age was not an independent risk factor of short-term death. CONCLUSIONS: The short-term mortality is high in very elderly SICH. Prior to SICH history of hospitalization, an indirect and gross marker of coexistent functional reserve, not age per se, increases the risk of short-term death. Other predictors of short-term death are potentially manageable reinforcing the message against any defeatist attitude toward elderly patients with SICH.

A study on the influence of prosthetic interface material in transtibial amputees' gait.

BACKGROUND: Interfaces of transtibial prosthesis have an important role in the transmission of ground reaction forces, damping gait loads and tissue protection. OBJECTIVE: This work aims to study the influence of prosthesis interfaces on amputees' gait and perception on pain, comfort and the overall interface/prosthesis system. METHODS: Commercial samples of three different interface materials were selected: block copolymer (Material I), silicone gel (Material II) and silicone elastomer (Material III). Using standardized prosthesis, four amputee subjects performed gait tests at three imposed cadences in a barometric platform. The subjects also filled in a questionnaire about their perception. RESULTS: Material II presented the highest asymmetries of vertical ground reaction forces and was perceived as the most painful and uncomfortable. Material III led to the most symmetric load distribution between legs and was perceived as the most comfortable. Material I showed better overall biomechanical behavior and better subject's perception. CONCLUSIONS: Material III showed appropriate characteristics for lower levels of activity for which it is recommended. Prescription of Material II should be rethought, as it is only adequate for specific and occasional situations. Material I should be considered adequate for both active and less active amputees. When correlating the subjects' perception with the interface properties, we concluded that the mechanical properties are the most influential.

Prevention and management of osteoporotic fractures by non-physician health professionals: a systematic literature review to inform EULAR points to consider.

OBJECTIVE: To perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. METHODS: Eight clinical questions based on two criteria guided the SLR: (1) adults≥50 years at high risk of osteoporotic fracture and (2) interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Interventions focused on diagnostic procedures to identify risk of falling, therapeutic approaches and implementation strategies. Outcomes included fractures, falls, risk of falling and change in bone mineral density. Systematic reviews and randomised controlled trials were preferentially selected. Data were synthesised using a qualitative descriptive approach. RESULTS: Of 15 917 records, 43 articles were included. Studies were clinically and methodologically diverse. We identified sufficient evidence that structured exercise, incorporating progressive resistance training delivered to people who had undergone hip fracture surgery, and multicomponent exercise, delivered to people at risk of primary fracture, reduced risk of falling. The effectiveness of multidisciplinary fracture liaison services in reducing refracture rate was confirmed. There was insufficient evidence found to support the effectiveness of nutrients and falls prevention programmes in this patient population. CONCLUSION: Despite study heterogeneity, our SLR showed beneficial effects of some interventions delivered by non-physician health professionals and the positive impact of multidisciplinary team working and patient educational approaches to prevent and manage osteoporotic fractures. These results informed a EULAR taskforce that developed points to consider for non-physician health professionals to prevent and manage osteoporotic fractures.

Tackling frailty and functional decline: Background of the action group A3 of the European innovation partnership for active and healthy ageing.

Ageing populations represent a challenge to the sustainability of current healthcare systems. The need to balance these demographic changes with gains in healthy life years and quality of life (QoL) constitutes an additional challenge. Aware of this, the European Commission (EC) launched the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) in 2012. The EIPonAHA is an interdisciplinary and cross-sector initiative involving more than 3000 partners with two specific objectives: to increase the healthy life expectancy of Europeans by two years by 2020, while increasing their QoL. The initiatives of the EIPonAHA have been organized according to six thematic action groups (AGs), with the A3 group targeting areas relating to the prevention of functional decline and frailty. In addition to the good practices of partners, there are several on-going collaborative works. The involvement of the EC includes support through an elaborated research programme in which the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) and the Directorate-General for Communications Networks, Content and Technology (DG CONNECT) are the main funding bodies. Screening approaches and preventive interventions constitute most of the initiatives within the A3 AG. Partners are distributed across five sub-groups according to good practices: i) cognitive decline, ii) food and nutrition, iii) physical activity, iv) caregivers, and v) frailty and functional decline. Regular updates of the progression of both good practices and collaborative works are presented in A3 AG meetings. The 2017 meeting in Valencia, Spain, showcased in this paper, provides an up-to-date overview of the current status of A3 activities.