RESUMO
Background: In the latest American Heart Association guidelines, influenza vaccination is recommended for patients with peripheral arterial disease (PAD). The vaccination coverage in this specific population is currently unknown. This study aims to determine the adherence to influenza vaccination in a PAD population and identify associated determinants. Patients and methods. Hospitalized patients and outpatients with PAD from two university departments of vascular medicine were prospectively included. A questionnaire was administered to collect sociodemographic data, cardiovascular risk factors, influenza vaccination status, history of cardiovascular disease, and perception and knowledge about vaccination. Logistic regression was conducted to assess vaccination determinants. Results: Over a six-month period, 494 patients were included (median age 69.5, IQR [63-77], 78% male). Overall, 60.1% were either vaccinated or intended to be (Group 1). Vaccination was associated with age (odds-ratio [OR]=1.055, 95% confidence intervals [95%CI]: 1.035-1.075, p<0.0001), abdominal aorta aneurysm (OR=0.390, 95%CI: 0.229-0.664, p=0.001), chronic obstructive pulmonary disease (OR=0.545, 95%CI: 0.367-0.810, p=0.003), chronic renal disease (OR=0.630, 95%CI: 0.400-0.993, p=0.046), and valvulopathy (OR=2.444, 95%CI: 1.122-5.326, p=0.025). Only 25.3% received vaccination information mainly from their general practitioners. Among patients against vaccination, 59.9% considered themselves not concerned about potential influenza consequences on their PAD, and 37.6% did not intend to change their decision. Conclusions: This study highlights the low adherence to influenza vaccination in the PAD population of 2 university hospital centers. Vaccination is often related to age, and there is a need for adapted information regarding influenza consequences on cardiovascular disease overall, particularly on PAD. Addressing common information and advice about vaccination will be a challenge.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Vacinas contra Influenza , Influenza Humana , Doença Arterial Periférica , Cobertura Vacinal , Humanos , Doença Arterial Periférica/epidemiologia , Masculino , Feminino , Idoso , Vacinas contra Influenza/administração & dosagem , Pessoa de Meia-Idade , Influenza Humana/prevenção & controle , Estudos Prospectivos , Cobertura Vacinal/estatística & dados numéricos , Fatores de Risco , Fatores Etários , VacinaçãoRESUMO
BACKGROUND AND AIMS: The epidemiology of lower extremity artery disease (LEAD) is evolving. This meta-analysis of aggregate data aimed to (1) determine the global prevalence of LEAD and by regions in the 21st century and (2) update the associated risk factors in this period. METHODS: A systematic literature review was performed through PubMed, Cochrane, Scopus, Science Direct and Google Scholar databases, restricted to general population studies between 01/2000 and 09/2021, with LEAD defined by a low (≤0.90) ankle brachial index. The Newcastle-Ottawa Scale was used to evaluate the quality of the articles before data extraction. Due to high heterogeneity, the random effect model was applied to this meta-analysis. RESULTS: Among 1418 references, 38 studies (127,961 participants) were retained. The global prevalence in adults, mostly ≥40 years, was estimated at 9.7% (95%CI: 7.1-12.4), higher in women (10.2%) than in men (8.8%), increasing sharply with age. The highest prevalence was found in South-Center Asia (14.5%) and the lowest in North America (5.6%). Significant associations were found between LEAD and current- (odds-ratio (OR) = 1.9, 95%CI: 1.4-2.5) and past-smoking (OR = 1.6, 95%CI: 1.3-1.9), and between LEAD and diabetes (OR = 2.3, 95%CI: 2.0-2.8). Hypertension was significantly associated with LEAD (OR = 2.3, 95%CI: 1.9-2.8) and in particular in South America (OR = 4.0). Obesity (OR = 1.5, 95%CI: 1.2-1.8) and hypercholesterolemia ≥200â mg/dL (OR = 1.9, 95%CI:1.3-2.8) were also significantly associated with LEAD. Conclusion: This meta-analysis highlights a currently high prevalence of LEAD worldwide, with substantial differences in global regions and between sexes. The strongest associations were found with metabolic risk factors.
The global epidemiology of lower extremity artery disease has evolved since the 21st century as has its association with cardiovascular risk factors. High overall prevalence (9.7%) in men and women, increasing with age. It is associated with traditional risk factors (tobacco, dyslipidaemia) but also diabetes, hypertension and obesity in all regions of the world.
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BACKGROUND: Repetitive behaviors (RBs) are a well-known symptom of Alzheimer's disease (AD); however, they have been little studied and have not been the subject of any specific literature review. OBJECTIVE: To conduct a systematic review of all studies to document RBs in AD. METHODS: An extensive literature search combining five databases and a meta-analysis were conducted to investigate the frequency, nature, and cognitive correlates of RBs in AD. RESULTS: Ten studies were included in the review. Seven studies out of ten investigated the frequency of RBs in patients with AD, which ranged from 52.3% to 87%. A meta-analysis showed an overall frequency of 66.3% (95% CI: 55.5; 77.1) of patients exhibiting RBs in AD, but important heterogeneity was observed between studies. Three studies investigated the predominant nature of RBs in AD. Verbal RBs, complex behavioral stereotypies, and simple motor stereotypies have been identified to different degrees depending on the level of dementia. Most verbal RBs are underpinned by episodic memory impairment, while simple motor stereotypies and complex behavioral stereotypies are mostly underpinned by executive dysfunction. CONCLUSIONS: The current review seems to suggest that there are two types of mechanisms underpinning RBs involved in AD. The first is observed especially in the mild stages of the disease and is mediated by episodic memory impairment. The second occurs later and is mediated by executive impairment. Additional studies should be conducted to improve the knowledge about RBs in AD and thus improve their management.Systematic review registration number: PROSPERO 2022: CRD42022310027.