Effectiveness of Tocilizumab in COVID-19 patients with pneumonia: A systematic review

Background and Objective@#COVID-19 contributes significantly to global morbidity and mortality. Age-related comorbidities elevate the risk of severe cases. Studies have recently demonstrated that widely available medications, including tocilizumab (TCZ), can manage severe symptoms. However, its effectiveness is unclear, particularly among the older population. Therefore, this review aimed to evaluate TCZ’s efficacy in managing severe pneumonia in individuals aged 50 and older.@*Methods@#We systematically search several databases and gray literature including Web of Science, CINAHL, Academic Search Complete, PsycINFO, PsycArticles, SocINDEX, CENTRAL/Cochrane Library, PubMed/MEDLINE for original research articles in English across several study designs published in the year 2020-2022. A narrative synthesis was conducted to summarize the evidence. We employed the NIH quality assessment tool for observational cohort studies to evaluate risk of bias. Additionally, we utilized GRADE to appraise the certainty of evidence.@*Results@#Among 539 screened articles, only five studies met the selection criteria. Tocilizumab's impact on severe COVID-19 pneumonia revealed a diverse effect on mortality rate, with 29% in the TCZ group, and 40% in the controls died within 30 days of intubation (OR 0.61; 95% CI, 0.27-1.36). It is also reported that TCZ was not associated with mortality, despite faster decline in pulmonary function and prolonged fever. Hospital mortality in the TCZ group was significantly lower than in the controls, and age over 60 was the only significant risk factor. Moreover, administering TCZ reduced mechanical ventilation needs, with 82% extubated compared to 53% in controls. However, 45% in TCZ group was associated with a higher ventilator-associated pneumonia rate than in the untreated group which was 20% (P < 0.001). Despite this, TCZ-treated patients had shorter hospital stays.@*Conclusions@#The effects of tocilizumab on reducing mortality risk and improving the survival rate of COVID-19 patients with pneumonia remained inconclusive. Yet, the majority of results suggested that giving tocilizumab leads to shorter hospital stays, lowers the requirement for mechanical ventilation, and decreases the likelihood of ICU transfer. Tocilizumab is linked to the incidence of secondary infections; hence, this medication should be closely monitored for side effects.

Regional Disparity of Physical Function Limitation Among Older Adults in Thailand.

Thailand was among the first to introduce a universal healthcare coverage among low- and middle-income countries but, regional disparities remain in the health status of people. Using the 2016 Population Change and Well-being in the Context of Ageing Societies, a nationally-representative survey, the prevalence of having limitations in physical function activities, instrumental activities of daily living, or activities of daily living were identified to estimate how each was associated with region of residence, sociodemographic and health behaviour and conditions. It was observed that living in Bangkok was associated with having limitations in any form than the other four regions of the country where generally the socioeconomic status of its older population is lower. Although higher prevalence of functional status was consistently observed in Bangkok, older people in the rural areas have a disadvantage in healthcare because of lower socioeconomic capacity and less access to healthcare facilities.

Correlação entre incontinência urinária, disfunção sexual e avaliação subjetiva da contração muscular perineal em idosas fisicamente ativas / Correlación entre incontinencia urinaria, disfunción sexual y evaluación subjetiva de la contracción del músculo perineal en mujeres ancianas físicamente activas / Urinary incontinence and female sexual dysfunction in physically active older women

RESUMO Incontinência urinária (IU) e disfunção sexual feminina (DSF) são disfunções que afetam a qualidade de vida. Com a mudança na pirâmide etária brasileira, a prevalência de tais disfunções tende a aumentar. O objetivo deste estudo foi estabelecer a relação entre a IU, a DSF e a contração muscular perineal em idosas ativas fisicamente. Trata-se de estudo transversal, do qual participaram 35 idosas ≥60 anos. Inicialmente foram aplicados a ficha diagnóstica e os questionários International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF) e Female Sexual Function Index (FSFI). Em seguida foram avaliados os músculos do assoalho pélvico (MAP) por meio do toque vaginal, de acordo com o que propõe o esquema perfect. Entre as idosas, 20% apresentaram ambas as disfunções dos MAP. No total, 17 (48,6%) apresentavam IU e 16 (45,7%) DSF. Observou-se diferença significativa no número de partos vaginais (p=0,028) e no item rapidez do esquema perfect (p=0,033) entre as idosas com e sem DSF. Não houve diferença estatística entre os grupos com e sem IU. A análise apontou uma correlação inversamente proporcional entre a gravidade da IU e a função sexual nas idosas incontinentes (p=0,008; r=−0,622), de forma que, para cada aumento na gravidade da IU pelo ICIQ-SF, diminuiu-se 0,507 de função sexual avaliada pelo FSFI (p=0,034; r=0,516). Há uma associação entre IU e DSF em idosas fisicamente ativas. Algumas idosas apresentam ambas as disfunções dos MAP, apesar de serem ativas fisicamente. Dessa forma, é necessário reforçar a importância de avaliações minuciosas, da atividade física orientada e da atuação multiprofissional em saúde.

RESUMEN La incontinencia urinaria (IU) y la disfunción sexual femenina (DSF) son trastornos que afectan la calidad de vida de las personas. Con el cambio en la pirámide de edad brasileña se aumentará la prevalencia de tales disfunciones. El objetivo de este estudio fue establecer la relación entre la IU, la DSF y la contracción del músculo perineal en mujeres mayores físicamente activas. Este es un estudio transversal, en el que participaron 35 mujeres ≥60 años. Inicialmente se aplicó el formulario de diagnóstico y los cuestionarios International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF) e Índice de Función Sexual Femenina (FSFI). Luego, se evaluó la musculatura del piso pélvico (MAP) mediante toque vaginal siguiendo lo que propone el esquema perfect. Entre las ancianas, el 20% tenía ambas disfunciones de MAP. En total, 17 (48,6%) tenía IU, y 16 (45,7%) DSF. Hubo una diferencia significativa en el número de partos vaginales (p=0,028) y en el ítem rapidez del esquema perfect (p=0,033) entre mujeres ancianas con y sin DSF. No hubo diferencia estadística entre los grupos con y sin IU. El análisis mostró una correlación inversamente proporcional entre la gravedad de la IU y la función sexual en mujeres ancianas con incontinencia (p=0,008; r=−0,622), de modo que por cada aumento en la gravedad de la IU por el ICIQ-SF se disminuyó 0,507 de función sexual evaluada por el FSFI (p=0,034; r=0,516). Existe una asociación entre la IU y la DSF en mujeres ancianas físicamente activas. Algunas ancianas tuvieron ambas disfunciones del MAP a pesar de ser físicamente activas. Por lo tanto, es necesario reforzar la importancia de las evaluaciones detalladas, la actividad física orientada y la acción multiprofesional en salud.

ABSTRACT Urinary incontinence (UI) and female sexual dysfunction (FSD) are disorders that affect quality of life. With the change in the Brazilian age pyramid, the prevalence of such disorders tends to increase. The aim of the present study was to correlate the relationship between UI, FSD and the functionality of the pelvic floor muscles (PFM) in physically active older women. This is a cross-sectional study, in which 35 older women ≥60 years old participated. Initially, the diagnostic form, the International Consultation on Incontinence Questionnaire - Short form (ICIQ-UI-SF) and Female Sexual Function Index (FSFI) were applied. Then, the PFM were evaluated by vaginal touch, following what is proposed in the perfect scheme. Among older women, 20% had both PFM dysfunctions. In total, 17 (48.6%) had UI and 16 (45.7%) FSD. There was a significant difference in the number of vaginal deliveries (p=0.028) and in the perfect schedule (p=0.033) between older women with and without FSD. There was no statistical difference between the groups with and without UI. The analysis showed an inversely proportional correlation between UI severity and sexual function in incontinent older women. (p=0.008; r=−0.622). Since, for each increase in UI severity by the ICIQ-SF, 0.577 of sexual function assessed by the FSFI is decreased (p=0.034; r=0.516). There is an association between UI and FSD in physically active older women. Some older women have both PFM dysfunctions despite being physically active. Thus, it is important to reinforce the importance of thorough evaluations, oriented physical activity and multiprofessional action in health.

Abordagem fisioterapêutica da incontinência urinária em idosos na atenção primária em saúde / Enfoque fisioterapéutico de incontinencia urinaria en ancianos en la atención primaria de salud / Physiotherapeutic approach for urinary incontinence in older adults in primary health care

RESUMO O objetivo deste estudo foi avaliar os benefícios da abordagem fisioterapêutica da IU em idosos em uma unidade básica de saúde (UBS) de Belém (PA). Trata-se de uma proposta para treinamento dos músculos do assoalho pélvico (MAP) em 10 encontros semanais com atividades progressivas. Foram incluídos idosos de ambos os sexos, e excluídos os indivíduos com prejuízo cognitivo, instabilidade hemodinâmica e mobilidade impossibilitada, além dos idosos com participação inferior a 50% dos encontros. Foi realizada avaliação por meio de dados sociodemográficos e clínicos, e da QV, por meio do King's Health Questionaire (KHQ), que foi reaplicado ao final dos encontros. A amostra inicial contou com 10 idosos, com idade de 70,3±5,01 anos, sendo 80% do sexo feminino, 80% dos idosos relataram cirurgias pélvicas prévias, prolapsos em 3 idosos, destes, 2 eram de bexiga. Os domínios do KHQ com escores mais altos, e consequente pior QV, foram impacto da IU (54,1±24,8), percepção de saúde (43,7±11,5) e medidas de gravidade (31,2±23,8). Houve significância estatística em vários domínios da QV dos idosos submetidos a abordagem fisioterapêutica, demonstrando que, mesmo em um nível mais baixo de atenção à saúde é possível ter efeitos relevantes sobre a IU e a QV desse público.

RESUMEN El objetivo de este estudio fue evaluar los beneficios del enfoque fisioterapéutico de la incontinencia urinaria (IU) en ancianos de una Unidad Básica de Salud (UBS) en Belém (PA, Brasil). Este enfoque consiste en una propuesta de entrenamiento de los músculos del suelo pélvico (MSP) durante 10 sesiones semanales con actividades progresivas. Se incluyeron a ancianos de ambos sexos, y se excluyeron a personas con deterioro cognitivo, inestabilidad hemodinámica y movilidad reducida, además de los ancianos con menos del 50% en asistencia a las reuniones. La evaluación se llevó a cabo con datos sociodemográficos y clínicos y de calidad de vida (CV) utilizando King's Health Questionnaire (KHQ), que lo volvieron a aplicar al final de las reuniones. La muestra inicial estuvo formada por 10 ancianos de 70,3±5,01 años; el 80% de ellos eran del sexo femenino y el 80% informaron haber realizado cirugías pélvicas previas, con prolapsos en 3 ancianos; de estos, 2 eran de vejiga. Los dominios KHQ con las puntuaciones más altas y, en consecuencia, la peor calidad de vida fueron el impacto de la IU (54,1±24,8), de la percepción de la salud (43,7±11,5) y de medidas de gravedad (31,2±23,8). Hubo una significación estadística en varios dominios de CV de los ancianos que se sometieron al enfoque fisioterapéutico, lo que demuestra que incluso en un nivel más bajo de asistencia sanitaria es posible generar efectos relevantes sobre la IU y la CV de esta población.

ABSTRACT The aim of this study was to evaluate the benefits of the physiotherapeutic approach to urinary incontinence (UI) in the older population in a health center of Belém (PA). This is a proposal for strengthening pelvic floor muscles (PFM) in ten weekly meetings with progressive activities. Patients of both genders were included, and individuals with cognitive impairment, hemodynamic instability and immobility were excluded, as well as those with less than 50% participation in the meetings. Sociodemographic and clinical data were evaluated and quality of life (QoL) was analyzed through the King's Health Questionnaire (KHQ), which was reapplied at the end of the meetings. The initial sample consisted of ten older adults, aged 70.3±5.01 years, 80% female; 80% of the sample reported previous pelvic surgeries, three reported prolapses, of which two were in the bladder. The KHQ domains with higher scores and consequent worse QoL were the impact of UI (54.1±24.8), health perception (43.7±11.5), and severity measures (31.2±23.8). There was statistical significance in several domains of QoL of the patients undergoing the physiotherapeutic approach, demonstrating that even in a lower level of health care it is possible to have relevant effects on the UI and QoL of this public.

"Geografias" do acesso dos idosos aos cuidados de saúde primários na Área Metropolitana de Lisboa, Portugal - um território de diferenças / "Geographies" of primary healthcare access for older adults in the Lisbon Metropolitan Area, Portugal - a territory of differences

Resumo Vários autores têm refletido sobre a questão do acesso aos serviços de saúde, considerando a existência de várias dimensões, nas quais se inclui a disponibilidade e a acessibilidade. No contexto de envelhecimento que caracteriza as sociedades, a população idosa precisa de mais cuidados de saúde, e a acessibilidade a essas unidades assume importância acrescida. O objetivo do estudo é caracterizar o acesso da população idosa aos serviços de saúde, confrontando as possibilidades decorrentes da oferta de serviços com os padrões de procura. Do confronto entre oferta e procura resulta a possibilidade de identificar as dinâmicas intrarregionais e associá-las às diferentes condições socioeconômicas dos idosos, ao seu enquadramento familiar, modo de transporte e tipo de serviço. Esta abordagem considera duas fases metodológicas: o cálculo do potencial de cobertura populacional das unidades de cuidados primários, considerando a acessibilidade física recorrendo aos modos pedonal e rodoviário; e o confronto desses valores com a procura dos serviços, determinada a partir de inquéritos realizados aos residentes. Concluiu-se que, apesar dos equipamentos de saúde prestadores de cuidados primários terem sido programados como serviço de proximidade, a forma de prestação do serviço, as características socioeconômicas da população idosa e o modelo de urbanização apontam para diferenças relevantes no contexto da Área Metropolitana de Lisboa.

Abstract Several authors have reflected upon access to health services considering several dimensions, such as availability and accessibility. Due to the aging of societies, the older population's demands for healthcare increase, and accessibility to these units acquires special importance. Our study aims to characterize the access of older people to healthcare services, facing the possibilities arising from service supply and demand patters. From the supply and demand confrontation, comes the possibility of identifying intraregional dynamics and associating them with the various socioeconomic conditions of older people, family background, modes of transportation, and type of service. This approach considers two methodological phases: calculating the potential for primary healthcare coverage, considering physical accessibility for pedestrian and highway modes; and confronting these values with services demand, determined from surveys conducted with residents. We concluded that, although healthcare centers were designed as a proximity service, service provision, socioeconomic aspects, and the urbanization model entail meaningful inequalities of access in the context of the Lisbon Metropolitan Area.

Adverse outcomes of frailty in the older population of Costa Rica / Eventos adversos de la Fragilidad en la población adulta mayor de Costa Rica

Resumen Objetivo: Entre los años del 2000 y 2050 el número de habitantes mayores de 60 años de edad en Costa Rica se duplicarán. Un número considerable de ellos llegarán a ser frágiles. Estudios han demostrado la relación entre la condición de fragilidad y pobres desenlaces. El objetivo del presente trabajo fue identificar los eventos adversos asociados a la fragilidad en la población adulta mayor de Costa Rica. Métodos: Para realizar el análisis, se emplea la totalidad de los casos disponibles en la base de datos del estudio de CRELES en el 2005, que pertenecen a la cohorte que da seguimiento en el periodo 2005-2009. En el año de partida de esta cohorte, se cuenta con un total de 2827 pacientes. El fenotipo de la fragilidad fue construido basado en el modelo fenotípico. Se realizó un análisis longitudinal, y se examinó los años iniciales y finales de esta cohorte. Los desenlaces analizados fueron la mortalidad, los ingresos hospitalarios, el deterioro funcional, las caídas y la autopercepción de la salud en el año 2009. Se utilizó una técnica de regresión logística multinomial, utilizando variables de desenlaces como variables dependientes. La condición de fragilidad se utilizó como variable independiente. Como resultado, se obtuvo una odds ratio para la incidencia de cada categoría de desenlaces con un 95% de confianza. Resultados: La condición de fragilidad se asoció con mayor deterioro funcional, aumento en los ingresos hospitalarios y empeoramiento en la autopercepción de la salud. Conclusión: La fragilidad se relacionó con pobres desenlaces en la población costarricense. La identificación de esta condición proporciona una oportunidad para una intervención temprana.

Abstract Objective: Between 2000 and 2050 the number of inhabitants aged 60 years or older in the World and in Costa Rica will double. A considerable number of them will become frail. Studies have shown the relationship between the frailty condition and poor outcomes. The aim of this study was to identify the adverse outcomes of frailty in the older Costa Rican population. Methods: To carry out the analysis, all the available cases of the CRELES study database in 2005 which belong to the cohort that follows in the period 2005-2009 were used. In the year of the initial cohort there was a total of 2827 patients. A frailty phenotype was constructed based on the phenotypic model. A longitudinal analysis was conducted, and it examined the initial and final years of this cohort. The outcome variables analysed were mortality, hospital admittances, functional deterioration, falls, and self-perception of worsening health in the year 2009. A multinomial logistic regression technique was used, using outcome variables as dependent variables. The frailty condition was used as an independent variable. As a result, there was an odds ratio obtained for the incidence of each outcome category with 95% confidence. Results: Frailty was associated with functional declines, hospital admittances, and worsening of the self-perception. Conclusion: Frailty was related to adverse outcomes in Costa Rica. Identifying this provides an opportunity for an early intervention.

Urinary tract infection: a cohort of older people with urinary incontinence / Infección del tracto urinario: cohorte de ancianos con incontinencia urinaria / Infecção do trato urinário: uma coorte de idosos com incontinência urinária

ABSTRACT Objective: To evaluate epidemiological aspects of urinary tract infection in older patients with urinary incontinence living in long-term care institutions in Belo Horizonte. Method: Concurrent cohort held from April 1st to October 1st, 2015. The study was conducted in two long-term care institutions in the city of Belo Horizonte, Minas Gerais, with 84 incontinent older people. Results: Cumulative incidence of urinary tract infection was 19% (95% CI: 7.83-23.19) and the incidence density was 3.6 cases/100 people-month of follow-up period. The variables Bacteriuria and Institution presented statistical association with the occurrence of urinary tract infection. Conclusion: It is observed that the incidence of urinary tract infection in the study was smaller than in other similar international and national studies, however this is an important world health problem for the older population, with impact on mortality of these individuals.

RESUMEN Objetivo: Analizar los aspectos epidemiológicos de infección del tracto urinario en ancianos con incontinencia urinaria, en residencias para ancianos de Belo Horizonte, Brasil. Método: Se realizó una cohorte del 1º de abril al 1º de octubre de 2015. Se realizó el estudio en dos residencias para ancianos de la ciudad de Belo Horizonte, del cual participaron 84 ancianos con incontinencia urinaria. Resultados: La incidencia acumulada de infección en el tracto urinario fue del 19% (IC 95%: 7,83-23,19) y la densidad de la incidencia fue de 3,6 casos/100 personas-mes por seguimiento. Las variables Bacteriuria y la residencia presentaron asociación estadística en la aparición de este tipo de infección. Conclusión: A pesar de que la incidencia de infección del tracto urinario en este estudio fue menor que en otros estudios nacionales e internacionales de mismo tema, es un grave problema de salud para los ancianos por todo el mundo, puesto que implica la mortalidad de ellos.

RESUMO Objetivo: Avaliar aspectos epidemiológicos da infecção do trato urinário em pacientes idosos com incontinência urinária, residentes em instituições de longa permanência, de Belo Horizonte. Método: Coorte concorrente realizada no período de 01 de abril a 01 de outubro de 2015. O estudo foi realizado em duas instituições de longa permanência, na cidade de Belo Horizonte, MG, com 84 idosos incontinentes. Resultados: A incidência acumulada de infecção do trato urinário foi de 19% (IC 95%: 7,83-23,19) e a densidade de incidência foi de 3,6 casos/100 pessoas-mês de seguimento. As variáveis Bacteriúria e Instituição apresentaram associação estatística com a ocorrência de infecção do trato urinário. Conclusão: Observa-se que a incidência de infecção do trato urinário no estudo foi menor que em outros estudos nacionais e internacionais semelhantes, no entanto trata-se de um importante problema de saúde mundial para os idosos, com impacto na mortalidade desses indivíduos.

Analysis on the major chronic non-communicable diseases and associated common risk factors among Chinese middle-aged and older population / 上海预防医学

Objective To estimate the prevalence of eight chronic non-communicable diseases ( NCDs) and associated common risk factors among Chinese middle-aged and older population . Methods The prevalence of eight NCDs and five common risk factors for NCDs among adults aged 50 years and older were estimated based on the survey data from SAGE-China wave Ⅰ.Ordinal logistic regression models were performed to examine the associated risk factors and social determinates for multiple chronic conditions . Results Adjusting for design weights and post-stratification , the proportions of insufficient vegetables and fruits intake ,low level of physical activity , current daily smoking use , obesity and frequent heavy drinker were 35.6%, 28.1%, 26.7%, 12.8% and 6.3%, respectively.And the prevalence of hypertension , arthritis, angina, chronic lung disease , diabetes, stroke, asthma and depression were 61.3%, 22.0%, 7.9%, 7.9%, 6.6%, 3.1%, 1.9%and 0.3%, separately.The proportion of multiple chronic condi-tions was 28.4%.The older elderly, women, living in the urban, more risk factors would increase the risk of multiple chronic conditions . Conclusion The prevalence of NCDs is very high and multiple chronic conditions are common among middle-aged and older population .Hence, more attentions should be paid and multiple effective control measures should be taken .

Life Course Approach on Health Disparities in Older Adults

When taking into account for social, economic, health disparities over the life courses among older adults, we should observe how such disparities arise and how they are maintained over the generations. The first part of this paper addressed the framework and approaches for understanding lifetime influences on late life disadvantages of health. The second part presented specific examples of late life disparities and their potential sources including chronic diseases, cognitive functions and disabilities. Context was considered to be broad and included early life experiences, descendants of generations and family influences. The third part addressed the roles of specific contextual influences. The final section of this review summarized the limitation of life course approaches and implementations for intervention. For geriatric medicine, it should be expanded into the focus of medical interventions and research of earlier age, with a wider range from individual to community and society, together with various other factors.