The association between cardiovascular risk factors and major cardiovascular diseases decreases with increasing frailty levels in geriatric outpatients.

BACKGROUND: Frailty marks a process of increasing dysregulation of physiological systems which increases the risk of adverse health outcomes. This study examines the hypothesis that the association between multiple cardiovascular risk factors (CVRF) and cardiovascular diseases (CVD) becomes stronger with increasing frailty severity. METHODS: Cross-sectional analysis of 339 older adults (55.2% women; aged 75.2 ±â€¯9.1 years) from an outpatient geriatric clinic from a middle-income country. The frailty index (FI) was calculated as the proportion of 30 possible health deficits. We assessed hypertension, diabetes, obesity, dyslipidemia, sedentarism and smoking as CVRF (determinants) and myocardial infarction, stroke, heart failure as CVD. Poisson regression models adjusted for age, sex, and education was applied to estimate the association between frailty as well as CVRF (independent variables) with CVD (dependent variable). RESULTS: Of the 339 patients, 18,3% were frail (FI ≥ 0.25) and 32.7% had at least one CVD. Both frailty and CVRF were significantly associated with CVD (PR = 1.03, 95% CI 1.01 to 1.05; p = 0.001, and PR = 1.46, 95% 1.24 to 1.71; p < 0.001, respectively) adjusted for covariates. The strength of the association between CVRF and CVD decreased with increasing frailty levels, as indicated by a significant interaction term of frailty and CVRF (p < 0.001). CONCLUSION: Frailty and CVRF are both associated with CVD, but the impact of CVRF decreases in the presence of frailty. When confirmed in longitudinal studies, randomized controlled trials or causal inference methods like Mendelian randomization should be applied to assess whether a shift from traditional CVRF to frailty would improve cardiovascular outcome in the oldest old.

The effect of a multicomponent exercise protocol (VIVIFRAIL©) on inflammatory profile and physical performance of older adults with different frailty status: study protocol for a randomized controlled trial.

BACKGROUND: To investigate whether an exercise intervention using the VIVIFRAIL© protocol has benefits for inflammatory and functional parameters in different frailty status. METHODS/DESIGN: This is a randomized clinical trial in an outpatient geriatrics clinic including older adults ≥60 years. For each frailty state (frail, pre-frail and robust), forty-four volunteers will be randomly allocated to the control group (n = 22) and the intervention group (n = 22) for 12 weeks. In the control group, participants will have meetings of health education while those in the intervention group will be part of a multicomponent exercise program (VIVIFRAIL©) performed five times a week (two times supervised and 3 times of home-based exercises). The primary outcome is a change in the inflammatory profile (a reduction in inflammatory interleukins [IL-6, TNF- α, IL1beta, IL-17, IL-22, CXCL-8, and IL-27] or an increase in anti-inflammatory mediators [IL-10, IL1RA, IL-4]). Secondary outcomes are change in physical performance using the Short Physical Performance Battery, handgrip strength, fatigue, gait speed, dual-task gait speed, depressive symptoms, FRAIL-BR and SARC-F scores, and quality of life at the 12-week period of intervention and after 3 months of follow-up. DISCUSSION: We expect a reduction in inflammatory interleukins or an increase in anti-inflammatory mediators in those who performed the VIVIFRAIL© protocol. The results of the study will imply in a better knowledge about the effect of a low-cost intervention that could be easily replicated in outpatient care for the prevention and treatment of frailty, especially regarding the inflammatory and anti-inflammatory pathways involved in its pathophysiology. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (RBR-9n5jbw; 01/24/2020). Registred January 2020. http://www.ensaiosclinicos.gov.br/rg/RBR-9n5jbw/ .

Could Frailty be an Explanatory Factor of the Association between Depression and Other Geriatric Syndromes in Later Life?

OBJECTIVES: This study aimed to investigate whether frailty could be an explanatory factor of the association between depression and the number of geriatric syndromes. METHODS: Cross-sectional baseline data from a cohort study (MiMiCS-FRAIL) were analyzed in a sample of 315 older adults. Depression was measured according to DSM-5 criteria and a self-report questionnaire (PHQ-9). Frailty was assessed according to the FRAIL questionnaire and a 30-item Frailty Index (FI). We considered six geriatric syndromes. Multiple linear regression analyses were performed and adjusted for potential confounders. RESULTS: Multiple linear regression analyses yielded significant associations between depression and geriatric syndromes. These associations decreased substantially in strength when frailty was added to the models. Findings were consistent for different definitions of depression and frailty. CONCLUSIONS: Among depressed patients, frailty may be hypothesized as a causal pathway toward adverse health outcomes associated with depression. Longitudinal studies should explore the causality of this association. CLINICAL IMPLICATIONS: Frailty should be treated or prevented in order to minimize the impact of other geriatric syndromes among depressed older adults. Screening for frailty would be of utmost importance in mental health care, as frailty is neglected especially in this field. Integrated care models are crucial for clinical practice in mental illness care.

Design and protocol of the multimorbidity and mental health cohort study in frailty and aging (MiMiCS-FRAIL): unraveling the clinical and molecular associations between frailty, somatic disease burden and late life depression.

BACKGROUND: To explore the mutual relationship between multimorbidity, mental illness and frailty, we have set-up the Multimorbidity and Mental health Cohort Study in FRAILty and Aging (MiMiCS-FRAIL) cohort. At the population level, multimorbidity, frailty and late-life depression are associated with similar adverse outcomes (i.e. falls, disability, hospitalization, death), share the same risk factors, and partly overlap in their clinical presentation. Moreover, these three variables may share a common underlying pathophysiological mechanism like immune-metabolic dysregulation. The overall objectives of MiMiCS-FRAIL are 1) to explore (determinants of) the cross-sectional and longitudinal relationship between multimorbidity, depression, and frailty among non-demented geriatric outpatients; 2) to evaluate molecular levels of senoinflammation as a broad pathophysiological process underlying these conditions; and 3) to examine adverse outcomes of multimorbidity, frailty and depression and their interconnectedness. METHODS: MiMiCS-FRAIL is an ongoing observational cohort study of geriatric outpatients in Brazil, with an extensive baseline assessment and yearly follow-up assessments. Each assessment includes a comprehensive geriatric assessment to identify multimorbidity and geriatric syndromes, a structured psychiatric diagnostic interview and administration of the PHQ-9 to measure depression, and several frailty measures (FRAIL, Physical Phenotype criteria, 36-item Frailty Index). Fasten blood samples are collected at baseline to assess circulating inflammatory and anti-inflammatory cytokines, leukocytes' subpopulations, and to perform immune-metabolic-paired miRome analyses. The primary outcome is death and secondary outcomes are the number of falls, hospital admissions, functional ability, well-being, and dementia. Assuming a 5-year mortality rate between 25 and 40% and a hazard rate varying between 1.6 and 2.3 for the primary determinants require a sample size between 136 and 711 patients to detect a statistically significant effect with a power of 80% (beta = 0.2), an alpha of 5% (0.05), and an R2 between the predictor (death) and all covariates of 0.20. Local ethical board approved this study. DISCUSSION: Frailty might be hypothesized as a final common pathway by which many clinical conditions like depression and chronic diseases (multimorbidity) culminate in many adverse effects. The MiMiCS-FRAIL cohort will help us to understand the interrelationship between these variables, from a clinical perspective as well as their underlying molecular signature.

Trichoderma spp. on treatment of Handroanthus serratifolius seeds: effect on seedling germination and development.

Fungi of the genus Trichoderma are important microorganisms used in biocontrol processes and the promotion of plant development. However, they remain poorly studied in the context of forestry programs, especially those related to native Amazonian species. Thus, it is the aim of this study to evaluate the effects of different Trichoderma isolates on the germination and development of Handroanthus serratifolius seedlings. During in vitro germination tests, seeds were immersed for 24 h in respective fungal suspensions each prepared using one of five Trichoderma isolates. The suspensions were held in plastic trays and kept at a temperature of 24 ± 2 °C. Metrics related to germination and development assessed under laboratory conditions include: germination speed index (GSI), germination percentage, length of the roots, and hypocotyls, as well as fungal perseverance. In the nursery, Trichoderma were used in two different applications: pre-planting treatment and as a monthly, post-planting treatment. Pre-planting treatments consisted of 10 g of colonized rice grains bearing each isolate being placed into experimental bags five days before seeding. The post-planting treatment involved the application of 10 mL of fungal suspension per experimental bag. Each month, the height, stem diameter, and leaf number were measured for each seedling. At the end of the experiment, the length and mass of roots as well as the total dry mass were recorded. In laboratory conditions, seeds treated with Trichoderma asperellum -TAM03 obtained the greatest fractional germination (76.5%) and GSI. In the nursery experiments, isolates TAM01 and TAM03, when applied as a post-planting treatment, increased the height, stem diameter, and number of leaves of treated plants with respect to the control group by 180 days post-treatment. After 365 days, plants which received TAM01 pre-planting treatments were observed to have increased root and aerial part length, as well as root mass and overall dry mass. These results suggest that T. asperellum -TAM01 positively affects H. serratifolius development.

Visitas domiciliares a crianças com doenças crônicas: influência na formação do estudante de medicina / Las visitas domiciliarias a niños con enfermedades crónicas: influencia en la formación del estudiante de medicina / Home visits to children with chronic diseases: their influence in medical students’ education

O objetivo deste trabalho foi descrever um projeto para ensinar valores fundamentais da Medicina de Família, num contexto de visitas domiciliares a crianças com doenças crônicas. Estudantes de medicina acompanharam médico de família da SOBRAMFA (Sociedade Brasileira de Medicina de Família), em visitas domiciliares a crianças com doenças crônicas e relataram seus pontos de vista através de uma narrativa descritiva. Os relatórios dos estudantes foram avaliados através de uma abordagem qualitativa. O estudo revelou que os estudantes de medicina envolvidos neste projeto obtiveram uma ampla perspectiva sobre a complexidade do cuidar de crianças com doenças crônicas. Aspectos emocionais, a dinâmica familiar, o ambiente doméstico, a dor e a angústia que as famílias sofrem para desativar as barreiras a fim de obter medicamentos específicos, juntamente com problemas financeiros, são retratados todos juntos em cada visita domiciliar. Os alunos percebem que precisam lidar com todas essas questões para obter uma assistência mais eficaz e compassiva. Entendem, ainda, que as visitas domiciliares têm alta eficácia clínica, uma vez que os pacientes permanecem em seus domicílios e são menos hospitalizados. Uma proposta projetada para ensinar estudantes de medicina ao ver crianças com doenças crônicas em visitas domiciliares com médicos de família é um cenário de ensino útil, porque revela os aspectos insuspeitados e essenciais ao próprio doutorando e o introduz aos valores centrais da Medicina de Família.

This work aims to describe a project for teaching basic values of Family Medicine, in a context of home visits to children with chronic diseases. Medical students accompanied a family doctor of SOBRAMFA (Brazilian Society of Family Medicine) in home visits to children with chronic diseases and reported their points of view through a descriptive narrative. The reports were evaluated using a qualitative approach. The study showed that medical students participating in this project managed to build a broader perspective on the complexity of caring for children with chronic diseases. Emotional aspects, family dynamics, the home environment, the pain and the anguish that families suffer to surmount obstacles in orderto obtain specific medicines, together with financial problems, are shown to be correlated in each home visit. Students realize that they need to deal with all these questions to offer a more efficient and compassionate presence as doctors. They also understand that home visits have a high clinical efficiency because patients remain in their homes and are less hospitalized. A proposal for teaching medical students in visits to children with chronic diseases together with family doctors is a useful teaching setting because it reveals unsuspected and essential aspects to medical student sand introduces them to the central values of Family Medicine.

El objetivo de este trabajo ha sido describir un proyecto para enseñar valores fundamentales de la Medicina de Familia, en un contexto de visitas domiciliarias a niños con enfermedades crónicas. Algunos alumnos de medicina han acompañado a un médico de família de la SOBRAMFA (Sociedad Brasileña de Medicina de Familia) en visitas domiciliarias a niños con enfermedades crónicas y relataron sus puntos de vista por medio de una narrativa descritiva. Los informes de los estudiantes han sido evaluados por medio de un abordaje cualitativo. El estudio ha revelado que los alumnos de medicina envolucrados en ese proyecto han logrado una amplia perspectiva acerca de la complejidad del cuidar de niños con enfermedades crónicas. Aspectos emocionales, la dinámica familiar, el ambiente doméstico, el dolor y la angustia que las familias sufren para desactivar lasbarreras a fin de obtener medicamentos específicos, al lado de los problemas financieros, son retractados en conjunto en cada visita domiciliaria. Los alumnos perciben que necesitan manejarse con todas esas cuestiones para obtener una asistencia más eficaz y compasiva. Ellos perciben también que las visitas domiciliarias tienen una alta eficacia clínica, porque los pacientes permanecen en sus domicilios y son menos hospitalizados. Una propuesta proyectada para enseñar alumnos de medicina cuando ven niños con enfermedades crónicas en visitas domiciliarias con médicos de familia es un escenario de enseñanza útil, dado que revela los aspectos insospechados y esenciales al propio doctorando y lo introduce en los valores centrales de la medicina de familia.