HIV incidence and risk contributing factors among men who have sex with men in Benin: A prospective cohort study.

Men who have sex with Men (MSM) are a key population in the transmission of Human Immunodeficiency Virus (HIV) infection. In Benin, there is a lack of strategic information to offer appropriate interventions for these populations who live hidden due to their stigmatization and discrimination. The objective is to identify contributing factors that affect HIV incidence in the MSM population. Study of a prospective cohort of 358 HIV-negative MSM, aged 18 years and over, reporting having had at least one oral or anal relationship with another man during the last 12 months, prior to recruitment. The monitoring lasted 30 months with a follow-up visit every six months. Univariate analyses and a Cox proportional hazards multivariate regression were used to examine the association between bio-behavioral, socio-demographic and knowledge-related characteristics with HIV incidence. The retention rate for the follow-up of the 358 participants was 94.5%. On the 813.5 person-years of follow-up, 48 seroconversions with an HIV incidence of 5.91 per 100 person-years were observed (95% CI: 4.46-7.85). Factors associated with the high risk of HIV were age (HR = 0.4; 95% CI: 0.2-0.8), living in couple (HR = 0.5 95% CI: 0.2-0.96) and the lack of condom systematic use with a male partner during high-risk sex (HR = 3.9; 95% CI: 1.4-11.1). HIV incidence is high within MSM population and particularly among young people. Targeted, suitable and cost-effective interventions for the delivery of the combination prevention package in an environment free of stigma and discrimination are necessary and vital for reaching the 90x90x90 target.

Incidence of shoulder pain in 40 years old and over and associated factors: A systematic review.

BACKGROUND: Shoulder pain is one of the most frequent musculoskeletal complaints, and its prevalence and consequences increase with age. However, little is known about the incidence of shoulder pain among aging adults. We conducted this review to estimate the incidence of shoulder pain in ageing adults and its associated factors. DATABASES AND DATA TREATMENT: We conducted a systematic review of cohort studies in which the incidence of shoulder pain and associated factors were explored in adults aged 40 years and over. PubMed, Embase, and Web of Science databases were consulted. RESULTS: We retrieved 3332 studies and included six, of which five were prospective cohort studies and one was retrospective. For adults aged 45-64 years, the annual cumulative incidence was 2.4%. The incidence density was estimated at 17.3 per 1,000 person-years for adults in the 45-64 years age group, at 12.8 per 1000 person-years for those in the 65-74 years group and at 6.7 per 1000 person-years among those aged 75 years and over. Occupational factors, notably physical demands of work, were associated with the incidence of shoulder pain. Non-occupational factors were also linked to the occurrence of shoulder pain. CONCLUSION: Few studies have estimated the incidence of shoulder pain and associated factors among ageing adults. From this systematic review, we conclude that studies on the incidence of shoulder pain are scarce, and that both occupational and non-occupational factors could be associated with the onset of shoulder pain among adults 40 years and over. This very limited evidence calls for more studies on this topic. SIGNIFICANCE: Shoulder pain is one of the most frequent musculoskeletal complaints, and its prevalence and consequences increase with age. However, since the prevalence of a recurring condition is determined by its incidence and the number and duration of episodes, it is important to have valid incidence estimates and to conduct aetiological studies on incidence measures to untangle risk factors of the occurrence of shoulder pain from those affecting the duration and number of episodes . In this systematic review, we sought to estimate the incidence of shoulder pain in ageing adults along with its associated factors. This work could lead to better interventions to prevent shoulder pain in older individuals.

Antipsychotic prescription and mortality in hospitalized older persons.

BACKGROUND: Recent scientific reports have shown that older persons treated with antipsychotics for dementia-related behavioural symptoms have increased mortality. However, the impact of these drugs prescribed during hospitalization has rarely been assessed. We aimed to investigate whether antipsychotics are associated with an increased risk of mortality during hospitalization and at 3-month follow-up in elderly inpatients. METHODS: We analyzed data gathered during two waves (2010 and 2012) by the REPOSI (Registro Politerapie Società Italiana Medicina Interna). All new prescriptions of antipsychotic drugs during hospitalization, whether maintained or discontinued at discharge, were collected, and logistic regression models were used to analyze their association with in-hospital and 3-month mortality. Covariates were age, sex, the Short Blessed Test (SBT) score, and the Cumulative Illness Rating Scale. RESULTS: Among 2703 patients included in the study, 135 (5%) received new prescriptions for antipsychotic drugs. The most frequently prescribed antipsychotic during hospitalization and eventually maintained at discharge was haloperidol (38% and 36% of cases, respectively). Patients newly prescribed with antipsychotics were older and had a higher Cumulative Illness Rating Scale comorbidity index both at admission and at discharge compared to those who did not receive a prescription. Of those prescribed antipsychotics, 71% had an SBT score ≥10 (indicative of dementia), 12% had an SBT score of 5-9 (indicative of questionable dementia); and 17% had an SBT score <5 (indicative of normal cognition). In-hospital mortality was slightly higher in patients prescribed antipsychotic drugs (14.3% vs 9.4%; P = 0.109), but in multivariate analysis only male sex, older age, and higher SBT scores were significantly related to mortality during hospitalization. At 3-month follow-up, only male sex, older age, and higher SBT scores were associated with mortality. CONCLUSION: We found that the prescription of antipsychotic drugs during hospitalization was not associated with in-hospital or follow-up mortality. Short-term antipsychotic prescriptions (for acutely ill patients) may have a different effect than long-term, repeated prescriptions.

A Multicomponent Intervention to Optimize Psychotropic Drug Prescription in Elderly Nursing Home Residents: An Italian Multicenter, Prospective, Pilot Study.

BACKGROUND: Older nursing home residents often have a large number of diseases and frequently require multiple medications; the high consumption of psychotropic drugs is of particular concern. The majority of residents in nursing homes suffer from dementia, and the use of psychotropic drugs in these patients is very high. Prescription for short periods of time only are usually recommended to avoid the risk of adverse drug reactions and potentially severe drug-drug interactions (DDIs). OBJECTIVES: The aim of this multicenter, prospective study was to optimize the prescription of psychotropic drugs, according to the Beers recommendations, in a sample of older patients living in nursing homes in Italy, through a multicomponent intervention, education of general practitioners, and the use of INTERcheck. METHODS: The study was run in ten nursing homes in Northern Italy from September 2013 to May 2014 (9 months), with the voluntary participation of 14 general practitioners. Each physician was asked to enroll at least 20 consecutive unselected patients. Three educational interventions ('ex cathedra' presentations) were organized by the researchers involved in the project, and a fourth training session was also held on the use of INTERCheck, a Computerized Prescription Support System (CPSS) developed to optimize drug prescription for older people with multimorbidity. Drug prescription information and sociodemographic characteristics of each patient were collected at three different time points-before the educational and training sessions (T0), after 5 months (T1), and after 9 months (T2). RESULTS: Among the 272 patients included in the analysis, a significant reduction was observed in the mean number of drugs, and in the percentage receiving psychotropic drugs and potentially inappropriate psychotropic drugs (11.5 and 30.6 %, respectively; p < 0.0001). Patients exposed to at least one potentially severe DDI also decreased from 145 (53.3 %) at the first time point to 87 (32.0 %) at the last time point (p < 0.0001). Results were confirmed in the 181 patients for whom information regarding drug treatment was available at all time points. CONCLUSIONS: The combination of an educational intervention and the CPSS can achieve a significant reduction in potentially inappropriate psychotropic drug use, psychotropic duplicates, and potentially severe DDIs in nursing homes.

Cognitive and psychological profiles in treatment compliance: a study in an elderly population with hemophilia.

Elderly patients with hemophilia have to face new challenges linked to concomitant pathologies and concurrent use of different treatments. In order to promote optimal care in the elderly hemophilia population, this study is aimed to analyze treatment compliance in relation to the presence of comorbidities and the role of potential determinants that can affect compliance (positively or negatively), including health-related quality of life, cognitive decline, and sociodemographic parameters (eg, living situation, partnership, presence of caregivers). This will be an observational study of elderly patients with hemophilia (aged >60 years). Patients will be interviewed during their routine medical visits. The data interview will pertaining to several dimension of treatment management. This study will detect more vulnerable patients with special care needs and will highlight psychological factors that should be considered for future psychosocial interventions.

Gender difference in drug use in hospitalized elderly patients.

PURPOSE: The aims of this study were to evaluate whether or not there are gender differences in drug use at hospital admission and prescription at discharge and to evaluate the effect of hospitalization on medication patterns in the elderly. METHOD: In-patients aged >65years included in the REPOSI registry during a recruitment period of 3years (2008-2010-2012) were analyzed in order to evaluate drug use at hospital admission and prescription at discharge according to gender. RESULTS: A total of 3473 patients, 52% women and 48% men, were considered. Polypharmacy (>5 drugs) is more frequent in men both at hospital admission and discharge. At hospital discharge, the number of prescriptions increased in both sexes at all age groups. Neuropsychiatric drugs were significantly more prescribed in women (p<0.0001). At admission men were more likely to be on antiplatelets (41.7% vs 36.7%; p=0.0029), ACE-inhibitors (28.7% vs 24.7%; p=0.0072) and statins (22.9% vs 18.3%; p=0.0008). At discharge, antiplatelets (43.7% vs 37.3%; p=0.0003) and statins (25,2% vs 19.6%; p<0.0001) continued to be prescribed more often in men, while women were given beta-blockers more often than men (21.8% vs 18.9%; p=0.0340). Proton pump inhibitors were the most prescribed drugs regardless of gender. At discharge, the medication pattern did not change according to gender. CONCLUSION: Our study showed a gender difference in overall medications pattern in the hospitalized elderly. Hospitalization, while increasing the number of prescriptions, did not change drug distribution by sex.

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia.

BACKGROUND: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). METHODS: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. RESULTS: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. CONCLUSIONS: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia.

Gout, allopurinol intake and clinical outcomes in the hospitalized multimorbid elderly.

BACKGROUND: Increased serum uric acid has been considered a cardiovascular risk factor but no study has assessed its relation with hospital mortality or length of stay. On the basis of data obtained from a prospective registry, the prevalence of gout/hyperuricemia and its association with these and other clinical parameters was evaluated in an Italian cohort of elderly patients acutely admitted to internal medicine or geriatric wards. METHODS: While the prevalence of gout was calculated by counting patients with this diagnosis hyperuricemia was inferred in patients taking allopurinol at hospital admission or discharge, on the assumption that this drug was only prescribed owing to the finding of high serum levels of uric acid. A series of clinical and demographic variables were evaluated for their association with gout/hyperuricemia. RESULTS: Of 1380 patients, 139 (10%) had a diagnosis of gout or were prescribed allopurinol. They had more co-morbidities (7.0 vs 5.6; P<0.0001) and consumed more drugs (6.8 vs 5.0; P<0.0001). The CIRS (co-morbidity index) was worse in these patients (OR 1.28 95% CI 1.15-1.41). Multivariable regression analysis showed that only renal and heart failures were independently associated with gout/allopurinol intake. Moreover, this combined event was associated with an increased risk of adverse events during hospitalization (OR 1.66, 95% CI 1.16-2.36), but not with the risk of re-hospitalization, length of hospital stay or death. CONCLUSIONS: Gout/allopurinol intake has a high prevalence in elderly patients acutely admitted to hospital and are associated with renal and cardiovascular diseases, an increased rate of adverse events and a high degree of drug consumption. In contrast, this finding did not affect the length of hospitalization nor hospital mortality.

Drug-drug interactions in a cohort of hospitalized elderly patients.

PURPOSE: The aim of this study is to assess the prevalence of patients exposed to potentially severe drug-drug interactions (DDIs) at hospital admission and discharge and the related risk of in-hospital mortality and adverse clinical events, readmission, and all-cause mortality at 3 months. METHODS: This cross-sectional, prospective study was held in 70 Italian internal medicine and geriatric wards. Potentially severe DDIs at hospital admission and discharge; risk of in-hospital mortality and of adverse clinical events, readmission, and all-cause mortality at 3-month follow-up. RESULTS: Among 2712 patients aged 65 years or older recruited at hospital admission, 1642 (60.5%) were exposed to at least one potential DDI and 512 (18.9%) to at least one potentially severe DDI. Among 2314 patients discharged, 1598 (69.1%) were exposed to at least one potential DDI and 1561 (24.2%) to at least one potentially severe DDI. Multivariate analysis found a significant association with an increased risk of mortality at 3 months in patients exposed to at least two potentially severe DDIs (Odds ratio 2.62; 95% confidence interval, 1.00-6.68; p = 0.05). Adverse clinical events were potentially related to severe DDIs in two patients who died in the hospital, in five readmitted, and one who died at 3 months after discharge. CONCLUSIONS: Hospitalization was associated with an increase in potentially severe DDIs. A significant association was found for mortality at 3 months after discharge in patients with at least two potentially severe DDIs. Careful monitoring for potentially severe DDIs, especially those created at discharge or recently generated, is important to minimize the risk of harm.

Joint use of cardio-embolic and bleeding risk scores in elderly patients with atrial fibrillation.

BACKGROUND: Scores for cardio-embolic and bleeding risk in patients with atrial fibrillation are described in the literature. However, it is not clear how they co-classify elderly patients with multimorbidity, nor whether and how they affect the physician's decision on thromboprophylaxis. METHODS: Four scores for cardio-embolic and bleeding risks were retrospectively calculated for ≥ 65 year old patients with atrial fibrillation enrolled in the REPOSI registry. The co-classification of patients according to risk categories based on different score combinations was described and the relationship between risk categories tested. The association between the antithrombotic therapy received and the scores was investigated by logistic regressions and CART analyses. RESULTS: At admission, among 543 patients the median scores (range) were: CHADS2 2 (0-6), CHA2DS2-VASc 4 (1-9), HEMORR2HAGES 3 (0-7), HAS-BLED 2 (1-6). Most of the patients were at high cardio-embolic/high-intermediate bleeding risk (70.5% combining CHADS2 and HEMORR2HAGES, 98.3% combining CHA2DS2-VASc and HAS-BLED). 50-60% of patients were classified in a cardio-embolic risk category higher than the bleeding risk category. In univariate and multivariable analyses, a higher bleeding score was negatively associated with warfarin prescription, and positively associated with aspirin prescription. The cardio-embolic scores were associated with the therapeutic choice only after adjusting for bleeding score or age. CONCLUSION: REPOSI patients represented a population at high cardio-embolic and bleeding risks, but most of them were classified by the scores as having a higher cardio-embolic than bleeding risk. Yet, prescription and type of antithrombotic therapy appeared to be primarily dictated by the bleeding risk.

Prevention of inappropriate prescribing in hospitalized older patients using a computerized prescription support system (INTERcheck(®)).

BACKGROUND: Polypharmacy is very common among older adults and can lead to inappropriate prescribing, poor adherence to treatment, adverse drug events and the prevalence of potential drug-drug interactions (DDIs). Electronic prescription database software may help to prevent inappropriate prescribing and minimize the occurrence of adverse drug reactions. INTERcheck(®) is a Computerized Prescription Support System (CPSS) developed in order to optimize drug prescription for elderly people with multimorbidity. OBJECTIVES: The objectives of this study were (i) to evaluate the applicability of INTERcheck(®) as a means of reviewing the pharmacological profiles of elderly patients hospitalized in an acute geriatric ward in Northern Italy; and (ii) to evaluate the effectiveness of INTERcheck(®) in reducing potentially inappropriate medications (PIMs), potentially severe DDIs and the anticholinergic burden in daily practice. METHODS: Two samples of elderly patients (aged 65+ years) hospitalized in a geriatric ward in Italy were enrolled throughout 2012. During the first (observation) phase, medications prescribed to 74 patients at admission and discharge were analyzed with INTERCheck(®) without any kind of interference based on information obtained from the software. During the second (intervention) phase, the treatment of 60 patients was reviewed and changed at discharge according to INTERCheck(®) suggestions. RESULTS: In the observational period, the number of patients exposed to at least one PIM remained unchanged on both admission (n = 29; 39.1 %) and discharge (n = 28; 37.8 %). In the intervention phase, 25 patients (41.7 %) were exposed to at least one PIM at admission and 7 (11.6 %) at discharge (p < 0.001). The number of patients exposed to at least one potentially severe DDI decreased from 27 (45.0 %) to 20 (33.3 %), although the difference was not statistically significant (p = 0.703), while the number of new-onset potentially severe DDIs decreased from 37 (59.0 %) to 9 (33.0 %) [p < 0.001]. CONCLUSIONS: The use of INTERCheck(®) was associated with a significant reduction in PIMs and new-onset potentially severe DDIs. CPSSs combining different prescribing quality measures should be considered as an important strategy for optimizing medication prescription for elderly patients.

Risk factors for hospital readmission of elderly patients.

BACKGROUND: The aim of this study was to identify which factors were associated with a risk of hospital readmission within 3 months after discharge of a sample of elderly patients admitted to internal medicine and geriatric wards. METHODS: Of the 1178 patients aged 65 years or more and discharged from one of the 66 wards of the 'Registry Politerapie SIMI (REPOSI)' during 2010, 766 were followed up by phone interview 3 months after discharge and were included in this analysis. Univariate and multivariate logistic regression models were used to evaluate the association of several variables with rehospitalization within 3 months from discharge. RESULTS: Nineteen percent of patients were readmitted at least once within 3 months after discharge. By univariate analysis in-hospital clinical adverse events (AEs), a previous hospital admission, number of diagnoses and drugs, comorbidity and severity index (according to Cumulative Illness Rating Scale-CIRS), vascular and liver diseases with a level of impairment at discharge of 3 or more at CIRS were significantly associated with risk of readmission. Multivariate logistic regression analysis showed that only AEs during hospitalization, previous hospital admission, and vascular and liver diseases were significantly associated with the likelihood of readmission. CONCLUSIONS: The results demonstrate the need for increased medical attention towards elderly patients discharged from hospital with characteristics such as AEs during the hospitalization, previous admission, vascular and liver diseases.

Association of anticholinergic burden with cognitive and functional status in a cohort of hospitalized elderly: comparison of the anticholinergic cognitive burden scale and anticholinergic risk scale: results from the REPOSI study.

BACKGROUND: Drugs with anticholinergic effects are associated with adverse events such as delirium and falls as well as cognitive decline and loss of independence. OBJECTIVE: The aim of the study was to evaluate the association between anticholinergic burden and both cognitive and functional status, according to the hypothesis that the cumulative anticholinergic burden, as measured by the Anticholinergic Cognitive Burden (ACB) Scale and Anticholinergic Risk Scale (ARS), increases the risk of cognitive decline and impairs activities of daily living. METHODS: This cross-sectional, prospective study (3-month telephone follow-up) was conducted in 66 Italian internal medicine and geriatric wards participating in the Registry of Polytherapies SIMI (Società Italiana di Medicina Interna) (REPOSI) study during 2010. The sample included 1,380 inpatients aged 65 years or older. Cognitive status was rated with the Short Blessed Test (SBT) and physical function with the Barthel Index. Each patient's anticholinergic burden was evaluated using the ACB and ARS scores. RESULTS: The mean SBT score for patients treated with anticholinergic drugs was higher than that for patients receiving no anticholinergic medications as also indicated by the ACB scale, even after adjustment for age, sex, education, stroke and transient ischaemic attack [9.2 (95 % CI 8.6-9.9) vs. 8.5 (95 % CI 7.8-9.2); p = 0.05]. There was a dose-response relationship between total ACB score and cognitive impairment. Patients identified by the ARS had more severe cognitive and physical impairment than patients identified by the ACB scale, and the dose-response relationship between this score and ability to perform activities of daily living was clear. No correlation was found with length of hospital stay. CONCLUSIONS: Drugs with anticholinergic properties identified by the ACB scale and ARS are associated with worse cognitive and functional performance in elderly patients. The ACB scale might permit a rapid identification of drugs potentially associated with cognitive impairment in a dose-response pattern, but the ARS is better at rating activities of daily living.