Tuberculosis-related mortality in people living with HIV in Europe and Latin America: an international cohort study

BACKGROUND Management of tuberculosis in patients with HIV in eastern Europe is complicated by the high prevalence of multidrug-resistant tuberculosis, low rates of drug susceptibility testing, and poor access to antiretroviral therapy (ART). We report 1 year mortality estimates from a multiregional (eastern Europe, western Europe, and Latin America) prospective cohort study: the TB:HIV study. METHODS Consecutive HIV-positive patients aged 16 years or older with a diagnosis of tuberculosis between Jan 1, 2011, and Dec 31, 2013, were enrolled from 62 HIV and tuberculosis clinics in 19 countries in eastern Europe, western Europe, and Latin America. The primary endpoint was death within 12 months after starting tuberculosis treatment; all deaths were classified according to whether or not they were tuberculosis related. Follow-up was either until death, the final visit, or 12 months after baseline, whichever occurred first. Risk factors for all-cause and tuberculosis-related deaths were assessed using Kaplan-Meier estimates and Cox models. FINDINGS Of 1406 patients (834 in eastern Europe, 317 in western Europe, and 255 in Latin America), 264 (19%) died within 12 months. 188 (71%) of these deaths were tuberculosis related. The probability of all-cause death was 29% (95% CI 26-32) in eastern Europe, 4% (3-7) in western Europe, and 11% (8-16) in Latin America (p<0·0001) and the corresponding probabilities of tuberculosis-related death were 23% (20-26), 1% (0-3), and 4% (2-8), respectively (p<0·0001). Patients receiving care outside eastern Europe had a 77% decreased risk of death: adjusted hazard ratio (aHR) 0·23 (95% CI 0·16-0·31). In eastern Europe, compared with patients who started a regimen with at least three active antituberculosis drugs, those who started fewer than three active antituberculosis drugs were at a higher risk of tuberculosis-related death (aHR 3·17; 95% CI 1·83-5·49) as were those who did not have baseline drug-susceptibility tests (2·24; 1·31-3·83). Other prognostic factors for increased tuberculosis-related mortality were disseminated tuberculosis and a low CD4 cell count. 18% of patients were receiving ART at tuberculosis diagnosis in eastern Europe compared with 44% in western Europe and 39% in Latin America (p<0·0001); 12 months later the proportions were 67% in eastern Europe, 92% in western Europe, and 85% in Latin America (p<0·0001). INTERPRETATION Patients with HIV and tuberculosis in eastern Europe have a risk of death nearly four-times higher than that in patients from western Europe and Latin America. This increased mortality rate is associated with modifiable risk factors such as lack of drug susceptibility testing and suboptimal initial antituberculosis treatment in settings with a high prevalence of drug resistance. Urgent action is needed to improve tuberculosis care for patients living with HIV in eastern Europe. FUNDING EU Seventh Framework Programme.

Use of pneumococcal vaccine in people with chronic disease in United States

Objective. The risk of complications and deaths related to pneumococcal infections is high among high risk population (i.e. those with chronic diseases such as diabetes or asthma), despite current immunization recommendations. The aim of this study is to evaluate the use of pneumonia vaccine in adults with and without diabetes or asthma by year of age and whether immunization practices conform to policy recommendations. ^ Methods. Data were drawn from 2005 Behavioral Risk Factor Surveillance Study. Age specific estimated counts and proportions of pneumonia vaccination status were computed. The association of socio-demographic factors with vaccination status was estimated from multiple logistic regression and results were presented for adults (18-64yrs) and elderly (65 or older). ^ Results. Overall 12.3% of the adults and 61.5% of elderly reported ever received pneumonia vaccine. 66.8% of diabetics and 72.6% of asthmatics received the vaccine among elderly. 33.4% of diabetics and 21.6% of asthmatics received the vaccine among adults. These numbers are far away from Healthy people 2010 objective coverage rates of 90% for elderly and 60% for high risk adults. Though diabetes was one of the recommendations for the pneumonia vaccine still the status was less than 70% even at older ages. Although asthma was not an indication for pneumonia vaccine, asthmatics still achieved 50% level by an early age of 60 and reached up to 80% at as early as 75 years. In those having both asthma and diabetes, although the curve reaches to 50% level at a very early age of 40yrs, it is not stable until the age of 55 and percentages reached to as high as 90% in older ages. Odds of receiving pneumonia vaccine were high in individuals with diabetes or asthma in both the age groups. But the odds were stronger for diabetics in adults compared to those in the elderly [2.24 CI (2.08-2.42) and 1.32 CI (1.18-1.47)]. The odds were slightly higher in adults than in elderly for asthmatics [1.92 CI (1.80-2.04) and 1.73 CI (1.50-2.00)].The likelihood of vaccination also differed by gender, ethnicity, marital status, income category, having a health insurance, current employment, physician visit in last year, reporting of good to excellent health and flu vaccine status. ^ Conclusion. There is a very high proportion of high risk adults and elderly that remain unvaccinated. Given the proven efficacy and safety of vaccine there is a need for interventions targeting the barriers for under-vaccination with more emphasis on physician knowledge and practice as well as the recipient attitudes.^

Project development for older adults : Orientation's contribution

This paper systematizes the work developed during the first year of the initiation scholarship for the research project entitled 'Orientation within the new Active Aging Model: educational, work-related, personal and social choices (1)'. This project articulates the Active Aging Model and the Theoretical Operative Model in Orientation, in order to learn how new projects are developed by older adults who used to be part of the formal system of labor and by those who were out of it, and to design programmatic proposals for educational, work-related, personal and social Orientation choices for such population. The sample is made up by seventy people between 64 and 74 years of age, residing in La Plata. The first conclusions evidence the importance that older adults place on project development at this stage of their life cycle, giving special importance to educational, personal and social projects; as well as on the identification of economic factors, health state, family needs for care and social support, among other things, as conditioning the fulfillment of such projects. The differences found in terms of the labor system they used to belong to can be especially observed in the type of project developed.

Project development for older adults : Orientation's contribution

This paper systematizes the work developed during the first year of the initiation scholarship for the research project entitled 'Orientation within the new Active Aging Model: educational, work-related, personal and social choices (1)'. This project articulates the Active Aging Model and the Theoretical Operative Model in Orientation, in order to learn how new projects are developed by older adults who used to be part of the formal system of labor and by those who were out of it, and to design programmatic proposals for educational, work-related, personal and social Orientation choices for such population. The sample is made up by seventy people between 64 and 74 years of age, residing in La Plata. The first conclusions evidence the importance that older adults place on project development at this stage of their life cycle, giving special importance to educational, personal and social projects; as well as on the identification of economic factors, health state, family needs for care and social support, among other things, as conditioning the fulfillment of such projects. The differences found in terms of the labor system they used to belong to can be especially observed in the type of project developed.

Project development for older adults : Orientation's contribution

This paper systematizes the work developed during the first year of the initiation scholarship for the research project entitled 'Orientation within the new Active Aging Model: educational, work-related, personal and social choices (1)'. This project articulates the Active Aging Model and the Theoretical Operative Model in Orientation, in order to learn how new projects are developed by older adults who used to be part of the formal system of labor and by those who were out of it, and to design programmatic proposals for educational, work-related, personal and social Orientation choices for such population. The sample is made up by seventy people between 64 and 74 years of age, residing in La Plata. The first conclusions evidence the importance that older adults place on project development at this stage of their life cycle, giving special importance to educational, personal and social projects; as well as on the identification of economic factors, health state, family needs for care and social support, among other things, as conditioning the fulfillment of such projects. The differences found in terms of the labor system they used to belong to can be especially observed in the type of project developed.

Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study) : a multicentre, randomised, double-blind trial

Acknowledgments We thank the members of the Trial Steering and Data Monitoring Committee and all the people who helped in the conduct of the study (including the OPPTIMUM collaborative group and other clinicians listed in the appendix). We are grateful to Paul Piette (Besins Healthcare Corporate, Brussels, Belgium) and Besins Healthcare for their kind donation of active and placebo drug for use in the study, and to staff of the pharmacy and research and development departments of the participating hospitals. We are also grateful to the many people who helped in this study but who we have been unable to name, and in particular all the women (and their babies) who participated in OPPTIMUM. OPPTIMUM was funded by the Efficacy and Mechanism Evaluation (EME) Programme, a Medical Research Council (MRC) and National Institute of Health Research (NIHR) partnership, award number G0700452, revised to 09/800/27. The EME Programme is funded by the MRC and NIHR, with contributions from the Chief Scientist Office in Scotland and National Institute for Social Care and Research in Wales. The views expressed in this publication are those of the author(s) and not necessarily those of the MRC, National Health Service, NIHR, or the Department of Health. The funder had no involvement in data collection, analysis or interpretation, and no role in the writing of this manuscript or the decision to submit for publication.

Sighted volunteers’ motivations to assist people with visual impairments in freetime sport activities

Since the changing of the political and economic system in 1989-1990 in Hungary, volunteer movements have appeared all over the country. Volunteers of different ages and socioeconomic backgrounds are engaged in a wide range of activities, wishing to add values to the lives of others in need, hoping to improve their micro or/and macro environment. Volunteering has also appeared in the field of sport, and the work of a large number of nongovernmental sport organisations is strongly dependent on volunteers’ participation. In the socialist era disability sports were neglected by the state. The new democratic state has been paying increasing attention to disability sports and volunteers have been a great asset in improving the accessibility of spare time sport activities. The present empirical research investigates which factors motivate sighted volunteers to join Hungarian Sports and Leisure Association for the Visually Impaired (Látássérültek Szabadidős Sportegyesülete, LÁSS). Results confirm that joining LÁSS was in few cases (N=3) attributed to having parental or other family relations with blind or partially sighted people. Respondents unanimously admit to have a wish to share the joy of physical activity with their visually impaired peers.

Validation of a mobility item bank for older patients in primary care

Background: To develop and validate an item bank to measure mobility in older people in primary care and to analyse differential item functioning (DIF) and differential bundle functioning (DBF) by sex. Methods: A pool of 48 mobility items was administered by interview to 593 older people attending primary health care practices. The pool contained four domains based on the International Classification of Functioning: changing and maintaining body position, carrying, lifting and pushing, walking and going up and down stairs. Results: The Late Life Mobility item bank consisted of 35 items, and measured with a reliability of 0.90 or more across the full spectrum of mobility, except at the higher end of better functioning. No evidence was found of non-uniform DIF but uniform DIF was observed, mainly for items in the changing and maintaining body position and carrying, lifting and pushing domains. The walking domain did not display DBF, but the other three domains did, principally the carrying, lifting and pushing items. Conclusions: During the design and validation of an item bank to measure mobility in older people, we found that strength (carrying, lifting and pushing) items formed a secondary dimension that produced DBF. More research is needed to determine how best to include strength items in a mobility measure, or whether it would be more appropriate to design separate measures for each construct.

A relaxation technique enhances psychological well-being and immune parameters in elderly people from a nursing home: A randomized controlled study

Background: The aging process involves a decline in immune functioning that renders elderly people more vulnerable to disease. In residential programs for the aged, it is vital to diminish their risk of disease, promote their independence, and augment their psychological well-being and quality of life. Methods: We performed a randomized controlled study, evaluating the ability of a relaxation technique based on Benson’s relaxation response to enhance psychological well-being and modulate the immune parameters of elderly people living in a geriatric residence when compared to a waitlist control group. The study included a 2-week intervention period and a 3-month follow-up period. The main outcome variables were psychological well-being and quality of life, biomedical variables, immune changes from the pre-treatment to post-treatment and follow-up periods. Results: Our findings reveal significant differences between the experimental and control groups in CD19, CD71, CD97, CD134, and CD137 lymphocyte subpopulations at the end of treatment. Furthermore, there was a decrease in negative affect, psychological discomfort, and symptom perception in the treatment group, which increased participants’ quality of life scores at the three-month follow-up. Conclusions: This study represents a first approach to the application of a passive relaxation technique in residential programs for the elderly. The method appears to be effective in enhancing psychological well-being and modulating immune activity in a group of elderly people. This relaxation technique could be considered an option for achieving health benefits with a low cost for residential programs, but further studies using this technique in larger samples of older people are needed to confirm the trends observed in the present study. Trial registration: International Standard Randomised Controlled Trial Number Register ISRCTN85410212.

Health of an aging America : 1989 bibliography : a guide to reports about older Americans.

Mode of access: Internet.

The people's own book of recipes and information for the million : containing directions for the preservation of health, for the treatment of the sick and the conduct of the sick-room : with a full discussion of the more porminent diseases that afflict the human family, with full directions for their rational treatment : also, 1000 practical and useful recipes, embracing every department of domestic economy and human industry : with copious notes and emendations, explanatory and suggestive /

Recipes for domestic wines, cider, etc., on p. 306-315.

The President's fiscal year 1989 budget proposal : how it would affect programs for older Americans : an information paper /

"Serial no. 100-G."

The aging of the U.S. population [microform] : planning for the retirement and employment needs of older Americans : hearing before the Subcommittee on Retirement Income and Employment of the Select Committee on Aging, House of Representatives, One Hundredth Congress, second session, July 15, 1988, South Burlington, VT.

"Comm. pub. no. 100-686."

Older pedestrian characteristics for use in highway design /

"February 1995."

An Introduction to the National Library Service for the Blind and Physically Handicapped.

Includes bibliographies.