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Nimmons D, Bazo-Alvarez JC, Avgerinou C, Hayes J, Osborn D, Cooper C, Petersen I, Walters K. Exploring the co-occurrence of depression, anxiety and insomnia symptoms, diagnoses and treatments in primary care: observational study using UK primary care data. BJPsych Open 2024; 10:e76. [PMID: 38634320 DOI: 10.1192/bjo.2024.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Depression, anxiety and insomnia often co-occur. However, there is a lack of research regarding how they cluster and how this is related to medication used to treat them. AIMS To describe the frequencies and associations between depression, anxiety and insomnia, and treatment for these conditions in primary care. METHOD A retrospective cohort study using UK electronic primary care records. We included individuals aged between 18 and 99 years old with one or more records suggesting they had a diagnosis, symptom or drug treatment for anxiety, depression or insomnia between 2015 and 2017. We report the conditional probabilities of having different combinations of diagnoses, symptoms and treatments recorded. RESULTS There were 1 325 960 records indicative of depression, anxiety or insomnia, for 739 834 individuals. Depression was the most common condition (n = 106 117 records), and SSRIs were the most commonly prescribed medication (n = 347 751 records). Overall, individuals with a record of anxiety were most likely to have co-occurring symptoms and diagnoses of other mental health conditions. For example, of the individuals with a record of generalised anxiety disorder (GAD), 24% also had a diagnosis of depression. In contrast, only 0.6% of those who had a diagnosis of depression had a diagnosis or symptom of GAD. Prescribing of more than one psychotropic medication within the same year was common. For example, of those who were prescribed an SNRI (serotonin-norepinephrine reuptake inhibitor), 40% were also prescribed an SSRI (selective serotonin reuptake inhibitor). CONCLUSIONS The conditional probabilities of co-occurring anxiety, depression and insomnia symptoms, diagnoses and treatments are high.
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Affiliation(s)
- Danielle Nimmons
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - Christina Avgerinou
- Research Department of Primary Care and Population Health, University College London, UK
| | - Joseph Hayes
- Division of Psychiatry, University College London, UK
| | - David Osborn
- Division of Psychiatry, University College London, UK
| | - Claudia Cooper
- Centre of Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, UK
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2
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Hanbali S, Avgerinou C. Association between adherence to the Nordic diet and frailty in older adults: A systematic review of observational studies. Maturitas 2024; 182:107923. [PMID: 38325135 DOI: 10.1016/j.maturitas.2024.107923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/13/2024] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The Nordic or Baltic Sea diet is a healthy plant-based dietary pattern composed of foods originating from Nordic countries, closely related to the Mediterranean diet. Adherence to the Mediterranean diet has been found to be associated with a reduced risk of frailty. Although adherence to the Nordic diet has been associated with health benefits, little is known about its association with frailty. OBJECTIVES To investigate the evidence from observational studies regarding the association between the Nordic/Baltic Sea diet and frailty among older adults. DESIGN Systematic review. METHODS Three databases (Medline/Ovid, Embase/Ovid, and Scopus) were systematically searched in February 2023 for observational studies examining the association between adherence to the Nordic diet and frailty among adults ≥60 years. The two authors independently assessed the full text of the papers for eligibility of studies and risk of bias. RESULTS Three studies (the results of which were reported across 6 papers) met the inclusion criteria, among which one study (2 papers) included only women. Greater adherence to the Nordic diet was associated with a reduced risk of frailty measured by modified Fried criteria in women (one study). Moreover, greater adherence to the Nordic diet was associated with improved muscle (handgrip/leg) strength (one study) and physical performance (two studies), but these differences were seen only in women, with no significant results in men in two studies. Greater adherence to the Nordic diet was also associated with a lower risk of mobility limitations and improved ability to carry out self-care tasks (one study) and a borderline non-significant difference in Activities of Daily Living (one study). A meta-analysis was not performed due to heterogenous outcomes. Although all studies were of good quality, the results should be carefully interpreted due to methodological limitations. CONCLUSIONS Adherence to the Nordic diet could be promising in reducing frailty risk, but more robust studies with equal gender representation and frailty-specific outcomes are needed.
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Affiliation(s)
- Sarah Hanbali
- Division of Medicine, University College London, London, United Kingdom
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, United Kingdom.
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3
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Barrado-Martín Y, Frost R, Catchpole J, Rookes T, Gibson S, Avgerinou C, Gardner B, Gould R, Chadwick P, Jowett C, Hopkins J, Kumar R, Elaswarapu R, Marston L, Kharicha K, Drennan VM, Walters K. Goal setting as part of a holistic intervention to promote independence in older people with mild frailty: a process evaluation alongside a randomised controlled trial. Lancet 2023; 402 Suppl 1:S1. [PMID: 37997048 DOI: 10.1016/s0140-6736(23)02069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/16/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Frailty is a condition resulting from a decline in physiological reserves caused by an accumulation of several deficits, which progressively impairs the ability to recover from health adverse events. Following a promising feasibility study, the HomeHealth trial assessed a holistic tailored intervention for older adults with mild frailty to promote independence in their own homes, compared with usual care. We aimed to understand how goal setting worked among older people with mild frailty. METHODS This study was a process evaluation alongside the HomeHealth randomised trial in older adults with mild frailty. The intervention was delivered at participants' homes, either in person or by telephone or videoconferencing. We carried out semi-structured interviews with older participants who had received the intervention (between three and six appointments), on average 233 days (range 68-465) after their last appointment, purposively sampled according to age, gender, number of sessions attended, adverse events, ethnicity, Index of Multiple Deprivation, Montreal Cognitive Assessment (MoCA) and Barthel scores, research site, and HomeHealth worker. We also conducted interviews with HomeHealth workers who delivered the intervention (n=7). Interviews explored the experience and process of goal setting, benefits and challenges, perceived progress, and behaviour change maintenance after the service had finished. Ethics approval was obtained, and all participants gave informed consent. Interviews were thematically analysed. HomeHealth workers kept formal records of goals set and assessed progress towards goals (0-2 rating scale) during six monthly-sessions, which were descriptively summarised. FINDINGS 56 interviews were completed between July 15, 2022, and May 18, 2023. Study participants (n=49) had a mean age of 80 years (range 66-94), including 32 (65%) women and 17 (35%) men. Participants self-identified as White (n=42), Asian (n=3), Black (n=2), Mixed (n=1), and other ethnic (n=1) backgrounds. Findings suggested goal setting could be both a challenge and a motivator for older participants with mild frailty. Goal setting worked well when the older person could identify a clear need and set realistic goals linked to functioning, which led to a positive sense of achievement. Challenges occurred when older people were already accessing multiple resources and health services, or where the terminology of "goals" was off-putting due to work or school connotations. Average progress towards goals was 1·15/2. Most participants set goals around improving mobility (or a combination of mobility and another goal type such as socialising), and there was evidence of participants sustaining these behaviour changes after the intervention. INTERPRETATION Older people with mild frailty can engage well with goal setting to promote independence. The lapse between receiving the intervention and being interviewed limited recall for some participants. However, the acceptability and adherence to the intervention for older people with mild frailty, and their moderate progress towards goals, should encourage further tailored and person-centred practices to promote their independence. FUNDING National Institute for Health Research (NIHR) Health Technology Assessment.
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Affiliation(s)
- Yolanda Barrado-Martín
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK.
| | - Rachael Frost
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jessica Catchpole
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Tasmin Rookes
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sarah Gibson
- Academic Unit for Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christina Avgerinou
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Rebecca Gould
- Division of Psychiatry, University College London, London, UK
| | - Paul Chadwick
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Claire Jowett
- Patient and Public Involvement Contributor, London, UK
| | - Jane Hopkins
- Patient and Public Involvement Contributor, London, UK
| | - Rashmi Kumar
- Patient and Public Involvement Contributor, London, UK
| | | | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kalpa Kharicha
- NIHR Health & Social Care Workforce Research Unit, The Policy Institute, King's College London, London, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University, London, UK
| | - Kate Walters
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
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Frost R, Avgerinou C, Kalwarowsky S, Mahmood F, Goodman C, Clegg A, Hopkins J, Gould R, Gardner B, Marston L, Hunter R, Kharicha K, Cooper C, Skelton DA, Drennan V, Logan P, Walters K. Enabling health and maintaining independence for older people at home (HomeHealth trial): a multicentre randomised controlled trial. Lancet 2023; 402 Suppl 1:S42. [PMID: 37997084 DOI: 10.1016/s0140-6736(23)02071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/29/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND NHS frailty services commonly target more severely frail older people, despite evidence suggesting frailty can be prevented or reversed when addressed at an earlier stage. HomeHealth is a new home-based, manualised voluntary sector service supporting older people with mild frailty to maintain their independence through behaviour change. Over six appointments, a trained HomeHealth worker discusses what matters to the older person and supports them to set and achieve goals around mobility, nutrition, socialising and/or psychological wellbeing. The service showed promising effects in a feasibility trial. We aimed to test the clinical and cost-effectiveness of HomeHealth for maintaining independence in older people with mild frailty compared with treatment as usual. METHODS In this single-blind multicentre randomised controlled trial, we recruited community-dwelling older people aged 65 years or older with mild frailty from 27 general practices, community groups and sheltered housing in London, Yorkshire, and Hertfordshire. Participants were randomly assigned (1:1) to receive either HomeHealth monthly for 6 months or treatment as usual (usual GP and outpatient care, no specific frailty services). Our primary outcome was independence in activities of daily living, measured by blinded outcome assessors using the modified Barthel Index, and analysed using linear mixed models, including 6-month and 12-month data and controlling for baseline Barthel score and site. The study was approved by the Social Care Research Ethics Committee, and all participants provided written or orally recorded informed consent. This study is registered with the ISRCTN registry, ISRCTN54268283. FINDINGS This trial took place between Jan 18, 2021, and July 4, 2023. We recruited 388 participants (mean age 81·4 years; 64% female [n=250], 94% White British/European [n=364], 2·5% Asian [n=10], 1·5% Black [n=6], 2·0% other [n=8]). We achieved high retention for 6-month follow-up (89%, 345/388), 12-month follow-up (86%, 334/388), and medical notes data (89%, 347/388). 182 (93%) of 195 participants in the intervention group completed the intervention, attending a mean of 5·6 appointments. HomeHealth had no effect on Barthel Index scores at 12 months (mean difference 0·250, 95% CI -0·932 to 1·432). At 6 months, there was a small reduction in psychological distress (-1·237, -2·127 to -0·348) and frailty (-0·124, -0·232 to -0·017), and at 12 months, we found small positive effects on wellbeing (1·449, 0·124 to 2·775) in those receiving HomeHealth. Other outcomes in analysis to date showed no significant difference. Health economic outcomes (including quality of life, capability, health services use and care needs or burden) are pending. INTERPRETATION This high-quality trial showed that HomeHealth did not maintain independence in older people with mild frailty, and had limited effects upon secondary outcomes. Future studies need to explore different ways to promote health in this population. FUNDING National Institute for Health and Care Research Health Technology Assessment (NIHR HTA).
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Affiliation(s)
- Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Christina Avgerinou
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sarah Kalwarowsky
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Farah Mahmood
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford, UK
| | | | - Rebecca Gould
- Division of Psychiatry, University College London, London, UK
| | | | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK.
| | - Kalpa Kharicha
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
| | - Claudia Cooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Dawn A Skelton
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, UK
| | - Vari Drennan
- Centre for Health and Social Care Research, St George's University, London, UK
| | - Pip Logan
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
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Chen H, Avgerinou C. Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review. Nutrients 2023; 15:4255. [PMID: 37836538 PMCID: PMC10574803 DOI: 10.3390/nu15194255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE Although the Mediterranean diet has been associated with a lower risk of hip fracture, the effect of other dietary patterns on bone density and risk of fracture is unknown. This scoping review aims to investigate the association between adherence to alternative dietary patterns (other than the traditional Mediterranean diet) and osteoporosis or osteoporotic fracture risk in older people. METHODS A systematic search was carried out on three electronic databases (Medline, EMBASE, and Scopus) to identify original papers studying the association between alternative dietary patterns (e.g., Baltic Sea Diet (BSD), modified/alternative Mediterranean diet in non-Mediterranean populations, Dietary Approaches to Stop Hypertension (DASH)) assessed using 'prior' methods (validated scores) and the risk of osteoporotic fracture or Bone Mineral Density (BMD) in people aged ≥50 (or reported average age of participants ≥ 60). Results from the included studies were presented in a narrative way. RESULTS Six observational (four prospective cohort and two cross-sectional) studies were included. There was no significant association between BMD and BSD or DASH scores. Higher adherence to DASH was associated with a lower risk of lumbar spine osteoporosis in women in one study, although it was not associated with the risk of hip fracture in another study with men and women. Higher adherence to aMED (alternative Mediterranean diet) was associated with a lower risk of hip fracture in one study, whereas higher adherence to mMED (modified Mediterranean diet) was associated with a lower risk of hip fracture in one study and had no significant result in another study. However, diet scores were heterogeneous across cohort studies. CONCLUSIONS There is some evidence that a modified and alternative Mediterranean diet may reduce the risk of hip fracture, and DASH may improve lumbar spine BMD. Larger cohort studies are needed to validate these findings.
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Affiliation(s)
- Huiyu Chen
- Division of Medicine, University College London, London WC1E 6BT, UK;
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
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6
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Avgerinou C, Petersen I, Clegg A, West RM, Osborn D, Walters K. Trends in incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fractures in people aged 50 years and above: retrospective cohort study using UK primary care data. Osteoporos Int 2023:10.1007/s00198-023-06739-1. [PMID: 37162537 PMCID: PMC10382342 DOI: 10.1007/s00198-023-06739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/29/2023] [Indexed: 05/11/2023]
Abstract
This study used primary care data to estimate the incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in the UK during 2000-2018 accounting for age, sex, calendar year and social deprivation. More than 3 million people aged 50-99 years were included. We found that men living in the most deprived areas had a 45% higher risk of being diagnosed with osteoporosis and 50% higher risk of fragility fracture compared to men living in the least deprived areas. PURPOSE a) To estimate the incidence trends of a recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in the UK over time; b) to describe differences according to age, sex, and social deprivation. METHODS This is a longitudinal population-based cohort study using routinely collected primary care data obtained via IQVIA Medical Research Database (IMRD). All patients aged 50-99 years registered with a practice participating in THIN (The Health Improvement Network) between 2000-2018 were included. The first recorded diagnosis of osteoporosis, osteopenia, or fragility fracture was used to estimate incidence rates (IR) per 10,000 person-years at risk. Poisson regression was used to provide Incidence Rate Ratios (IRR) adjusted by age, sex, social deprivation, calendar year, and practice effect. RESULTS The year-specific adjusted IRR of recorded osteoporosis was highest in 2009 in women [IRR 1.44(95%CI 1.38-1.50)], whereas in men it was highest in 2013-2014 [IRR 1.94(95%CI 1.72-2.18)] compared to 2000. The year-specific adjusted IRR of fragility fracture was highest in 2012 in women [IRR 1.77(95%CI 1.69-1.85)], whereas in men it was highest in 2013 [IRR 1.64(95%CI 1.51-1.78)] compared to 2000. Men in the most deprived areas had a higher risk of being diagnosed with osteoporosis [IRR 1.45(95%CI 1.38-1.53)], osteopenia [IRR 1.17(95%CI 1.09-1.26)], and fragility fracture [IRR 1.50(95%CI 1.44-1.56)] compared to those living in the least deprived areas, but smaller differences were seen in women. CONCLUSION Use of fracture risk assessment tools may enhance the detection of osteoporosis cases in primary care. Further research is needed on the effect of social deprivation on diagnosis of osteoporosis and fractures.
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Affiliation(s)
- Christina Avgerinou
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, University of Leeds, Leeds, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Osborn
- Division of Psychiatry, University College London, Leeds, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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7
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Visser M, Mendonça N, Avgerinou C, Cavdar S, Cederholm T, Cruz-Jentoft AJ, Kiesswetter E, Siebentritt HM, Sieber C, Torbahn G, Volkert D. A Core Outcome Set for nutritional intervention studies in older adults with malnutrition and those at risk: a study protocol. BMC Geriatr 2023; 23:221. [PMID: 37024825 PMCID: PMC10080774 DOI: 10.1186/s12877-023-03832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/16/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Malnutrition (i.e., protein-energy malnutrition) in older adults has severe negative clinical consequences, emphasizing the need for effective treatments. Many, often small, randomized controlled trials (RCTs) testing the effectiveness of nutritional interventions for the treatment of malnutrition showed mixed results and a need for meta-analyses and data pooling has been expressed. However, evidence synthesis is hampered by the wide variety of outcomes and their method of assessment in previous RCTs. This paper describes the protocol for developing a Core Outcome Set (COS) for nutritional intervention studies in older adults with malnutrition and those at risk. METHODS The project consists of five phases. The first phase consists of a scoping review to identify frequently used outcomes in published RCTs and select additional patient-reported outcomes. The second phase includes a modified Delphi Survey involving experienced researchers and health care professionals working in the field of malnutrition in older adults, followed by the third phase consisting of a consensus meeting to discuss and agree what critical outcomes need to be included in the COS. The fourth phase will determine how each COS outcome should be measured based on a systematic literature review and a second consensus meeting. This will be followed by a dissemination and implementation phase. Patient and Public Involvement (PPI) representatives will contribute to study design, oversight, consensus, and dissemination. CONCLUSIONS The result of this project is a COS that should be included in any RCT evaluating the effect of nutritional interventions in older adults with malnutrition and those at risk. This COS will facilitate comparison of RCT results, will increase efficient use of research resources and will reduce bias due to measurement of the outcome and publication bias. Ultimately, the COS will support clinical decision making by identifying the most effective approaches for treating and preventing malnutrition in older adults.
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Affiliation(s)
- Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands.
| | - Nuno Mendonça
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Rua do Instituto Bacteriológico n°5, Lisbon, 1150-082, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Christina Avgerinou
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sibel Cavdar
- Division of Geriatrics, Department of Internal Medicine, Ege University Hospital, Izmir, Turkey
- Ege University Hospital, Kazımdirik, University Street. No:9, Bornova/İzmir, 35100, Turkey
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Alfonso J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Ctra. Colmenar km 9.1, Madrid, 28034, Spain
| | - Eva Kiesswetter
- Institute for Evidence in Medicine, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 86, Freiburg, 79110, Germany
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
| | - Hanna M Siebentritt
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
| | - Cornel Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
- Department of Medicine, Kantonsspital Winterthur, Brauerstrasse 15, Postfach 834, Winterthur, Zurich, 8401, Switzerland
| | - Gabriel Torbahn
- Department of Pediatrics, Paracelsus Medical University, Nuremberg, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
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Avgerinou C, Mendonça N, Cavdar S, Cederholm T, Cruz-Jentoft AJ, Kiesswetter E, Siebentritt HM, Sieber C, Torbahn G, Volkert D, Visser M. 1322 DEVELOPMENT OF A CORE OUTCOME SET FOR NUTRITIONAL INTERVENTION STUDIES IN OLDER ADULTS WITH MALNUTRITION AND THOSE AT RISK. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Background
Malnutrition (i.e., protein-energy malnutrition) in older adults is associated with significant complications and increased mortality, highlighting the need for effective treatments. Many randomised controlled trials (RCTs) testing the effectiveness of nutritional interventions for the treatment of malnutrition showed mixed results and there is a need for meta-analyses. However, evidence synthesis is hampered by the wide variety of outcomes and assessment methods in RCTs. This project, led by EuGMS Special Interest Group Nutrition, aims to develop a Core Outcome Set (COS) for nutritional intervention studies in older adults with malnutrition and those at risk.
Methods
The project consists of five phases: 1) a scoping review (completed) to identify frequently used outcomes in published RCTs and select additional patient-reported outcome measures (PROMs). Patient and Public Involvement (PPI) representatives have been involved to provide feedback on the proposed list of outcomes resulting from the review and PROMs; 2) a modified Delphi Survey whereby experienced researchers and health care professionals working in the field of malnutrition in older adults will be invited to rate the importance of the proposed outcomes; 3) a consensus meeting to discuss and agree what critical outcomes need to be included in the COS; 4) a systematic review to determine how each COS outcome should be measured and a second consensus meeting; 5) a dissemination and implementation phase.
Conclusions
The result of this project will be a COS that should be included in any RCT testing the effectiveness of interventions to tackle malnutrition in older people as a minimum. This COS will facilitate comparison of RCT results, will promote efficient use of research resources and might reduce bias in measurement of the outcome and publication bias. Ultimately, the COS will support clinical decision making by identifying the most effective approaches for treating and preventing malnutrition in older adults.
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Affiliation(s)
| | | | - S Cavdar
- Ege University Hospital , Izmir, Turkey
| | | | | | - E Kiesswetter
- University of Freiburg , Germany
- Institute for Biomedicine of Aging , Nuremberg, German
| | | | - C Sieber
- Institute for Biomedicine of Aging , Nuremberg, German
- Kantonsspital Winterthur , Zurich, Switzerland
| | - G Torbahn
- Institute for Biomedicine of Aging , Nuremberg, German
- Paracelsus Medical University , Nuremberg, Germany
| | - D Volkert
- Paracelsus Medical University , Nuremberg, Germany
| | - M Visser
- Vrije Universiteit Amsterdam , Netherlands
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9
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Avgerinou C, Petersen I, Clegg A, West RM, Osborn D, Walters K. 1071 INCIDENCE OF RECORDED OSTEOPOROSIS, OSTEOPENIA AND FRAGILITY FRACTURE IN OLDER PEOPLE: ANALYSIS OF UK PRIMARY CARE DATA. Age Ageing 2022. [DOI: 10.1093/ageing/afac124.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Osteoporosis is common in later life, leading to fragility fractures associated with increased mortality, disability, and costs. There is a surprising lack of data regarding the incidence of osteoporosis. We aimed to estimate the incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in older people, explore time trends in diagnosis, and differences by age, sex, and social deprivation.
Method
We used de-identified patient data provided as part of routine primary care (IQVIA Medical Research Database (IMRD). All patients aged 50-99y registered with THIN (The Health Improvement Network) participating practices between 1/1/2000–31/12/2018 were included. Crude incidence rates (IR) were estimated per 10,000 person-years (PY). We used Poisson regression to calculate adjusted Incidence Rate Ratios (IRR) accounting for sex, age, calendar year and deprivation.
Results
The IR of osteoporosis was significantly higher in women, 84.32 (95%CI 83.81–84.83) vs. 16.66 (95%CI 16.43–16.90) in men per 10,000PY. In women, recorded IR of osteoporosis reached a peak in 2009. In the adjusted model, older men in most deprived areas had a higher IRR of osteoporosis [1.67 (95% 1.59–1.74)] compared to those in least deprived areas. Women were more likely to be diagnosed with osteopenia compared to men, at any age. Incidence of osteopenia diagnosis increased over time. In the adjusted model, men in most deprived areas had a higher IRR of osteopenia [1.44 (95%CI 1.35–1.53)] compared to least deprived areas. The IR of fragility fracture was higher in women, 84.97 (95%CI 84.45–85.48) vs. 31.15 (95%CI 30.83–31.48) in men per 10,000PY. In the adjusted model, men in most deprived areas had an increased IRR of fragility fracture [1.53 (95%CI 1.48–1.59)] compared to least deprived areas.
Conclusion
Community bone health interventions might be targeted at populations at higher risk of fragility fractures, including older men living in socially deprived areas.
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Affiliation(s)
- C Avgerinou
- Department of Primary Care and Population Health, University College London , UK
| | - I Petersen
- Department of Primary Care and Population Health, University College London , UK
| | - A Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds , UK
| | - R M West
- Leeds Institute of Health Sciences, University of Leeds , UK
| | - D Osborn
- Division of Psychiatry, University College London , UK
| | - K Walters
- Department of Primary Care and Population Health, University College London , UK
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10
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Frost R, Avgerinou C, Goodman C, Clegg A, Hopkins J, Gould RL, Gardner B, Marston L, Hunter R, Manthorpe J, Cooper C, Skelton DA, Drennan VM, Logan P, Walters K. Clinical and cost-effectiveness of a personalised health promotion intervention enabling independence in older people with mild frailty (‘HomeHealth’) compared to treatment as usual: study protocol for a randomised controlled trial. BMC Geriatr 2022; 22:485. [PMID: 35659196 PMCID: PMC9166243 DOI: 10.1186/s12877-022-03160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Frailty is clinically associated with multiple adverse outcomes, including reduced quality of life and functioning, falls, hospitalisations, moves to long-term care and mortality. Health services commonly focus on the frailest, with highest levels of need. However, evidence suggests that frailty is likely to be more reversible in people who are less frail. Evidence is emerging on what interventions may help prevent or reduce frailty, such as resistance exercises and multi-component interventions, but few interventions are based on behaviour change theory. There is little evidence of cost-effectiveness.
Previously, we co-designed a new behaviour change health promotion intervention (“HomeHealth”) to support people with mild frailty. HomeHealth is delivered by trained voluntary sector support workers over six months who support older people to work on self-identified goals to maintain their independence, such as strength and balance exercises, nutrition, mood and enhancing social engagement. The service was well received in our feasibility randomised controlled trial and showed promising effects upon outcomes.
Aim
To test the clinical and cost-effectiveness of the HomeHealth intervention on maintaining independence in older people with mild frailty in comparison to treatment as usual (TAU).
Methods
Single-blind individually randomised controlled trial comparing the HomeHealth intervention to TAU. We will recruit 386 participants from general practices and the community across three English regions. Participants are included if they are community-dwelling, aged 65 + , with mild frailty according to the Clinical Frailty Scale. Participants will be randomised 1:1 to receive HomeHealth or TAU for 6 months. The primary outcome is independence in activities of daily living (modified Barthel Index) at 12 months. Secondary outcomes include instrumental activities of daily living, quality of life, frailty, wellbeing, psychological distress, loneliness, cognition, capability, falls, carer burden, service use, costs and mortality. Outcomes will be analysed using linear mixed models, controlling for baseline Barthel score and site. A health economic analysis and embedded mixed-methods process evaluation will be conducted.
Discussion
This trial will provide definitive evidence on the effectiveness and cost-effectiveness of a home-based, individualised intervention to maintain independence in older people with mild frailty in comparison to TAU, that could be implemented at scale if effective.
Trial registration
ISRCTN, ISRCTN54268283. Registered 06/04/2020.
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11
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Hallam B, Petersen I, Cooper C, Avgerinou C, Walters K. Time Trends in Incidence of Reported Memory Concerns and Cognitive Decline: A Cohort Study in UK Primary Care. Clin Epidemiol 2022; 14:395-408. [PMID: 35359800 PMCID: PMC8961006 DOI: 10.2147/clep.s350396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/11/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Brendan Hallam
- UCL Research Department of Primary Care & Population Health, University College London, London, UK
- Correspondence: Brendan Hallam, UCL Research Department of Primary Care & Population Health, University College London, London, UK, Email
| | - Irene Petersen
- UCL Research Department of Primary Care & Population Health, University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
| | - Christina Avgerinou
- UCL Research Department of Primary Care & Population Health, University College London, London, UK
| | - Kate Walters
- UCL Research Department of Primary Care & Population Health, University College London, London, UK
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12
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White N, Oostendorp LJ, Vickerstaff V, Gerlach C, Engels Y, Maessen M, Tomlinson C, Wens J, Leysen B, Biasco G, Zambrano S, Eychmüller S, Avgerinou C, Chattat R, Ottoboni G, Veldhoven C, Stone P. An online international comparison of palliative care identification in primary care using the Surprise Question. Palliat Med 2022; 36:142-151. [PMID: 34596445 PMCID: PMC8796152 DOI: 10.1177/02692163211048340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Surprise Question ('Would I be surprised if this patient died within 12 months?') identifies patients in the last year of life. It is unclear if 'surprised' means the same for each clinician, and whether their responses are internally consistent. AIM To determine the consistency with which the Surprise Question is used. DESIGN A cross-sectional online study of participants located in Belgium, Germany, Italy, The Netherlands, Switzerland and UK. Participants completed 20 hypothetical patient summaries ('vignettes'). Primary outcome measure: continuous estimate of probability of death within 12 months (0% [certain survival]-100% [certain death]). A threshold (probability estimate above which Surprise Question responses were consistently 'no') and an inconsistency range (range of probability estimates where respondents vacillated between responses) were calculated. Univariable and multivariable linear regression explored differences in consistency. Trial registration: NCT03697213. SETTING/PARTICIPANTS Registered General Practitioners (GPs). Of the 307 GPs who started the study, 250 completed 15 or more vignettes. RESULTS Participants had a consistency threshold of 49.8% (SD 22.7) and inconsistency range of 17% (SD 22.4). Italy had a significantly higher threshold than other countries (p = 0.002). There was also a difference in threshold levels depending on age of clinician, for every yearly increase, participants had a higher threshold. There was no difference in inconsistency between countries (p = 0.53). CONCLUSIONS There is variation between clinicians regarding the use of the Surprise Question. Over half of GPs were not internally consistent in their responses to the Surprise Question. Future research with standardised terms and real patients is warranted.
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Affiliation(s)
- Nicola White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Linda Jm Oostendorp
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Christina Gerlach
- Palliative Care Unit, Department of Oncology, Hematology and BMT, and Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Interdisciplinary Palliative Care Unit, Department of Hematology, Oncology, and Pneumology, University Medical Center, Mainz, Germany
| | - Yvonne Engels
- Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maud Maessen
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christopher Tomlinson
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Johan Wens
- Department Family Medicine and Population Health (FamPop), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Bert Leysen
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Guido Biasco
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna & Academy of the Sciences of Palliative Medicine, Bologna, Italy
| | - Sofia Zambrano
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Eychmüller
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Christina Avgerinou
- Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Carel Veldhoven
- Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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13
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Hallam B, Rees J, Petersen I, Cooper C, Avgerinou C, Walters K. How are people with mild cognitive impairment or subjective memory complaints managed in primary care? A systematic review. Fam Pract 2021; 38:669-683. [PMID: 33907811 PMCID: PMC8604277 DOI: 10.1093/fampra/cmab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary care is typically the first point of contact in the health care system for people raising concerns about their memory. However, there is still a lack of high-quality evidence and understanding about how primary care professionals (PCPs) currently manage people at higher risk of developing dementia. OBJECTIVES To systematically review management strategies provided by PCPs to reduce cognitive decline in people with mild cognitive impairment and subjective memory complaints. METHOD A systematic search for studies was conducted in December 2019 across five databases (EMBASE, Medline, PsycInfo, CINAHL and Web of Science). Methodological quality of included studies was independently assessed by two authors using the Mixed Methods Appraisal Tool. RESULTS An initial 11 719 were found, 7250 were screened and 9 studies were included in the review. Most studies were self-reported behaviour surveys. For non-pharmacological strategies, the most frequent advice PCPs provided was to increase physical activity, cognitive stimulation, diet and social stimulation. For pharmacological strategies, PCPs would most frequently not prescribe any treatment. If PCPs did prescribe, the most frequent prescriptions targeted vascular risk factors to reduce the risk of further cognitive decline. CONCLUSION PCPs reported that they are much more likely to provide non-pharmacological strategies than pharmacological strategies in line with guidelines on preventing the onset of dementia. However, the quality of evidence within the included studies is low and relies on subjective self-reported behaviours. Observational research is needed to provide an accurate reflection of how people with memory problems are managed in primary care.
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Affiliation(s)
- Brendan Hallam
- UCL Research Department of Primary Care and Population Health, London, UK
| | - Jessica Rees
- Division of Psychiatry, University College London, London, UK
| | - Irene Petersen
- UCL Research Department of Primary Care and Population Health, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
| | | | - Kate Walters
- UCL Research Department of Primary Care and Population Health, London, UK
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14
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Smyrnakis E, Symintiridou D, Andreou M, Dandoulakis M, Theodoropoulos E, Kokkali S, Manolaki C, Papageorgiou DI, Birtsou C, Paganas A, Stachteas P, Vlachopoulos N, Pagkozidis I, Zeimbekis A, Roka V, Giakoumis A, Kotsani M, Avakian I, Makridou E, Gavana M, Haidich AB, Avgerinou C. Primary care professionals' experiences during the first wave of the COVID-19 pandemic in Greece: a qualitative study. BMC Fam Pract 2021; 22:174. [PMID: 34474684 PMCID: PMC8412972 DOI: 10.1186/s12875-021-01522-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022]
Abstract
Background The coronavirus outbreak (COVID-19) tested health care systems worldwide. This qualitative study aimed to explore and understand the experiences, beliefs and concerns of Primary Care Professionals (PCPs) regarding the preparedness and response of primary care to the first wave of the pandemic in Greece, a country where a public structured primary care system has been developing. Methods We conducted semi-structured telephone interviews with 33 PCPs (General Practitioners, community General Internal Medicine Specialists, community Paediatricians and nurses) recruited from all regions of Greece after the first wave of the pandemic (June 2020). Interviews were transcribed verbatim, data were anonymised and analysed. Thematic analysis was applied developing a conceptual framework. Results Four main themes were identified: a) Primary care unit adaptation and issues faced during the pandemic; b) Management of suspected COVID-19 cases; c) Management of non-suspected cases; d) Consequences of the pandemic. In the first phase of the pandemic, remote management of suspected cases and their referral to the hospital were preferred as a result of a shortage of personal protective equipment and inaccessibility to coronavirus testing in primary care. Due to the discontinuation of regular medical services and the limited in-person contact between doctors and patients, chronic disease management and prevention programmes were left behind. Social and emotional consequences of the pandemic, such as workplace stigma, isolation and social seclusion, deriving from fear of viral transmission, as well as burnout symptoms and exhaustion were commonly experienced among PCPs. Positive consequences of the pandemic were considered to be the recognition of the importance of an empowered public healthcare system by citizens and the valuable insight, knowledge and experience professionals gained in times of crisis. Conclusions Primary care has a key role to play during and after the pandemic by using its information infrastructure to identify at-risk groups, detect new cases of COVID-19, provide care according to needs, and carry out vaccination programmes. Central coordination and empowerment of primary care will increase its effectiveness, via public awareness, holistic patient management, and unburdening of hospitals.
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Affiliation(s)
- Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | | | | | | | - Charis Birtsou
- Regional Practice of Lagadikia, Zagliveri Health Center, Prefecture of Thessaloniki, Greece
| | | | - Panagiotis Stachteas
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ilias Pagkozidis
- Aristotle University of Thessaloniki Primary Health Care Research Network, Thessaloniki, Greece
| | | | - Violeta Roka
- Farkadona Health Center, Prefecture of Trikala, Greece
| | | | - Marina Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle "Maladies du Vieillissement, Gérontologie et Soins Palliatifs", F-54000, Nancy, France
| | - Ioanna Avakian
- Regional Practice of Zappeio, Farsala Health Center, Prefecture of Larissa, Greece
| | - Efthymia Makridou
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magda Gavana
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Laboratory of Hygiene, Social and Preventive Medicine, and Medical Statistics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
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15
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Habaybeh D, de Moraes MB, Slee A, Avgerinou C. Nutritional interventions for heart failure patients who are malnourished or at risk of malnutrition or cachexia: a systematic review and meta-analysis. Heart Fail Rev 2021; 26:1103-1118. [PMID: 32124164 PMCID: PMC8310486 DOI: 10.1007/s10741-020-09937-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Malnutrition is common in heart failure (HF), and it is associated with higher hospital readmission and mortality rates. This review aims to answer the question whether nutritional interventions aiming to increase protein and energy intake are effective at improving outcomes for patients with HF who are malnourished or at risk of malnutrition or cachexia. Systematic searches of four databases (Medline, Embase, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL)) were conducted on 21 June 2019. Randomized controlled trials (RCTs) or other interventional studies using protein or energy supplementation for adult HF patients who are malnourished or at risk of malnutrition or cachexia were included. Two independent reviewers assessed study eligibility and risk of bias. Five studies (four RCTs and one pilot RCT) met the inclusion criteria. The majority of studies were small and of limited quality. The pooled weighted mean difference (WMD) for body weight showed a benefit from the nutritional intervention by 3.83 kg (95% confidence interval (CI) 0.17 to 7.50, P = 0.04) from three trials with no significant benefit for triceps skinfold thickness (WMD = - 2.14 mm, 95% CI - 9.07 to 4.79, P = 0.55) from two trials. The combination of personalized nutrition intervention with conventional treatment led to a decrease in all-cause mortality and hospital readmission in one study. Findings of this review suggest that nutritional interventions could potentially improve outcomes in HF patients who are malnourished or at risk of malnutrition. However, the strength of the evidence is poor, and more robust studies with a larger number of participants are needed.
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Affiliation(s)
- Dina Habaybeh
- Division of Medicine, University College London, London, UK
| | | | - Adrian Slee
- Division of Medicine, University College London, London, UK
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, UK.
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16
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Kotsani M, Kravvariti E, Avgerinou C, Panagiotakis S, Bograkou Tzanetakou K, Antoniadou E, Karamanof G, Karampeazis A, Koutsouri A, Panagiotopoulou K, Soulis G, Stolakis K, Georgiopoulos I, Benetos A. The Relevance and Added Value of Geriatric Medicine (GM): Introducing GM to Non-Geriatricians. J Clin Med 2021; 10:3018. [PMID: 34300184 PMCID: PMC8304813 DOI: 10.3390/jcm10143018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Geriatric Medicine (GM) holds a crucial role in promoting health and managing the complex medical, cognitive, social, and psychological issues of older people. However, basic principles of GM, essential for optimizing the care of older people, are commonly unknown or undermined, especially in countries where GM is still under development. This narrative review aims at providing insights into the role of GM to non-geriatrician readers and summarizing the main aspects of the added value of a geriatric approach across the spectrum of healthcare. Health practitioners of all specialties are frequently encountered with clinical conditions, common in older patients (such as cancer, hypertension, delirium, major neurocognitive and mental health disorders, malnutrition, and peri-operative complications), which could be more appropriately managed under the light of the approach of GM. The role of allied health professionals with specialized knowledge and skills in dealing with older people's issues is essential, and a multidisciplinary team is required for the delivery of optimal care in response to the needs and aspirations of older people. Thus, countries should assure the educational background of all health care providers and the specialized health and social care services required to meet the demands of a rapidly aging society.
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Affiliation(s)
- Marina Kotsani
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
| | - Evrydiki Kravvariti
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- 1st Department of Propaedeutic Internal Medicine, Laiko General Hospital, 11527 Athens, Greece
- Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christina Avgerinou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Symeon Panagiotakis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Internal Medicine, Heraklion University Hospital, 71003 Heraklion, Greece
| | - Katerina Bograkou Tzanetakou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Medical Psychology Unit, School of Medicine, European University Cyprus, 1516 Nicosia, Cyprus
| | - Eleftheria Antoniadou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Rehabilitation Unit, Patras University Hospital, 26504 Rio, Greece
| | - Georgios Karamanof
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Geriatric Clinic, Vrinnevi Hospital, 60379 Norrköping, Sweden
| | - Athanasios Karampeazis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Medical Oncology Unit, NIMTS Veterans Hospital, 11521 Athens, Greece
| | - Anastasia Koutsouri
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Henry Dunant Hospital Center, Outpatient Geriatric Assessment Unit, 11526 Athens, Greece
| | - Kyriaki Panagiotopoulou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Geriatric Ward, Hôpital “Sainte Thérèse”, VIVALIA-IFAC, 6600 Bastogne, Belgium
| | - George Soulis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Henry Dunant Hospital Center, Outpatient Geriatric Assessment Unit, 11526 Athens, Greece
- School of Social Sciences, Hellenic Open University, 26335 Patras, Greece
| | - Konstantinos Stolakis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- School of Medicine, Patras University, 26504 Rio, Greece
| | - Ioannis Georgiopoulos
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
| | - Athanase Benetos
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
- INSERM DCAC, 54505 Vandœuvre-lès-Nancy, France
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Avgerinou C, Kotsani M, Gavana M, Andreou M, Papageorgiou DI, Roka V, Symintiridou D, Manolaki C, Soulis G, Smyrnakis E. Perceptions, attitudes and training needs of primary healthcare professionals in identifying and managing frailty: a qualitative study. Eur Geriatr Med 2021; 12:321-332. [PMID: 33125682 PMCID: PMC7990835 DOI: 10.1007/s41999-020-00420-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/14/2020] [Indexed: 10/28/2022]
Abstract
PURPOSE Although frailty can be delayed or prevented by appropriate interventions, these are often not available in countries lacking formal education and infrastructure in geriatrics. The aim of this study was to: (a) explore ideas, perceptions and attitudes of primary health care (PHC) professionals towards frailty in a country where geriatrics is not recognised as a specialty; (b) explore PHC professionals' training needs in frailty; and (c) define components of a frailty educational programme in PHC. METHODS Qualitative design, using two focus groups with PHC professionals conducted in Thessaloniki, Greece. Focus groups were audio recorded and transcribed. Data were analysed with thematic analysis. RESULTS In total 31 PHC professionals (mean age: 46 years; gender distribution: 27 females, 4 males) participated in the study (physicians n = 17; nurses n = 12; health visitors n = 2). Four main themes were identified: (1) Perceptions and understanding of frailty; (2) Facilitators and barriers to frailty identification and management; (3) Motivation to participate in a frailty training programme; (4) Education and training. The main barriers for the identification and management of frailty were associated with the healthcare system, including duration of appointments, a focus on prescribing, and problems with staffing of allied health professionals, but also a lack of education. Training opportunities were scarce and entirely based on personal incentive. Professionals were receptive to training either face-to-face or online. A focus on learning practical skills was key. CONCLUSION Education and training of professionals and interdisciplinary collaboration are essential and much needed for the delivery of person-centred care for people with frailty living in the community.
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Affiliation(s)
- Christina Avgerinou
- Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, UK.
| | - Marina Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle "Maladies du Vieillissement, Gérontologie et Soins Palliatifs", 54000, Nancy, France
| | - Magda Gavana
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitra-Iosifina Papageorgiou
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Violeta Roka
- Farkadona Health Center, Farkadona, Trikala, Greece
| | | | | | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
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18
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Kotsani M, Avgerinou C, Haidich AB, Smyrnakis E, Soulis G, Papageorgiou DI, Andreou M, Zeimbekis D, Kokkali S, Gavana M. Feasibility and impact of a short training course on frailty destined for primary health care professionals. Eur Geriatr Med 2021; 12:333-346. [PMID: 33646537 DOI: 10.1007/s41999-021-00467-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/04/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is an unmet need for training primary health care professionals on frailty, especially in countries where geriatrics is still emerging. PURPOSE We aimed to evaluate the feasibility and efficacy of a training course for primary health care professionals on the detection, assessment, and management of frailty. METHODS A single-day training course, developed and facilitated by three physicians trained in geriatrics abroad, was organized by the Aristotle University of Thessaloniki Primary Hearth Care Research Network. Primary health care professionals' attitudes, knowledge, and everyday practices regarding frailty were assessed by self-administered anonymous questionnaires (using Likert-type scales) at three time-points (before, upon completion of the training course, and 3 months afterward). RESULTS Out of 31 participants (17 physicians, 12 nurses, 2 health visitors; 87.1% women; mean age 46.4 years), 31(100%) filled in the first, 30(97%) the second, and 25(81%) the third questionnaire. Improvements were reported in familiarization with the frailty syndrome (p = 0.041) and in self-perception of knowledge and skills to detect (p < 0.001) and manage (p < 0.001) frailty, that were also sustained 3 months afterward (p = 0.001 and p = 0.003 respectively). Improvement was also observed in the attitude that frailty is an inevitable consequence of aging (p = 0.007) and in the frequency of application of screening (but not management) strategies, 3 months following the workshop compared to baseline (p = 0.014). Participants reported less disagreement with the statement that systematic screening for frailty was unfeasible in their daily practice at 3 months compared to baseline (p = 0.006), mainly due to time restrictions. CONCLUSION A short skill-oriented training course can significantly and sustainably improve primary health care professionals' attitudes and practices regarding frailty.
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Affiliation(s)
- Marina Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle «Maladies du Vieillissement, Gérontologie et Soins Palliatifs», 54000, Nancy, France.
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Dimitra Iosifina Papageorgiou
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Stamatia Kokkali
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Magda Gavana
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Moraes MBD, Avgerinou C, Fukushima FB, Vidal EIO. Nutritional interventions for the management of frailty in older adults: systematic review and meta-analysis of randomized clinical trials. Nutr Rev 2020; 79:889-913. [PMID: 33330911 DOI: 10.1093/nutrit/nuaa101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
CONTEXT Although nutrition is considered an important intervention for the management of frailty, the actual effectiveness of interventions addressing nutrition in frail older people remains unclear. OBJECTIVE The aim for this systematic review was to appraise the evidence regarding the effectiveness of nutritional interventions for the management of frailty in older adults. DATA EXTRACTION We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Web of Science, and Latin American and Caribbean Health Sciences Literature databases were searched from January 2001 to November 2019. Two independent reviewers extracted relevant data. From 2370 initial records, 19 publications presenting data from 17 studies (1564 individuals; follow-up: 7-96 weeks) were included. DATA ANALYSIS None of the Bayesian random-effects meta-analyses comparing nutritional supplements with placebo regarding mortality, body mass index, weight, frailty status, muscle strength, gait speed, body composition, and cognitive function showed statistically significant differences. The same applies to a single meta-analysis comparing nutritional education with general health advice regarding muscle strength. CONCLUSION Our results suggest, mostly with low to very low degrees of certainty, that nutritional supplements or nutritional education delivered in isolation may not be effective for the management of frailty in older people. REVIEW REGISTRATION NUMBER CRD42018111510 (PROSPERO).
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Affiliation(s)
- Mariana B de Moraes
- Public Health Department, São Paulo State University, Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Fernanda B Fukushima
- Anesthesiology Department, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Edison I O Vidal
- Internal Medicine Department, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
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White N, Oostendorp L, Vickerstaff V, Gerlach C, Engels Y, Maessen M, Tomlinson C, Wens J, Leysen B, Biasco G, Zambrano S, Eychmüller S, Avgerinou C, Chattat R, Ottoboni G, Veldhoven C, Stone P. Correction to: An online international comparison of thresholds for triggering a negative response to the “Surprise Question”: a study protocol. Palliat Care 2020; 19:15. [PMID: 31987055 PMCID: PMC6986139 DOI: 10.1186/s12904-020-0518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Avgerinou C, Bhanu C, Walters K, Croker H, Tuijt R, Rea J, Hopkins J, Kirby-Barr M, Kharicha K. Supporting nutrition in frail older people: a qualitative study exploring views of primary care and community health professionals. Br J Gen Pract 2020; 70:e138-e145. [PMID: 31932297 PMCID: PMC6960002 DOI: 10.3399/bjgp20x707861] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/08/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Malnutrition is associated with increased morbidity and mortality, and is very common in frail older people. However, little is known about how weight loss in frail older people can be managed in primary care. AIMS To explore the views and practices of primary care and community professionals on the management of malnutrition in frail older people; identify components of potential primary care-based interventions for this group; and identify training and support required to deliver such interventions. DESIGN AND SETTING Qualitative study in primary care and community settings. METHOD Seven focus groups and an additional interview were conducted with general practice teams, frailty multidisciplinary teams (MDTs), and community dietitians in London and Hertfordshire, UK (n = 60 participants). Data were analysed using thematic analysis. RESULTS Primary care and community health professionals perceived malnutrition as a multifaceted problem. There was an agreement that there is a gap in care provided for malnutrition in the community. However, there were conflicting views regarding professional accountability. Challenges commonly reported by primary care professionals included overwhelming workload and lack of training in nutrition. Community MDT professionals and dietitians thought that an intervention to tackle malnutrition would be best placed in primary care and suggested opportunistic screening interventions. Education was an essential part of any intervention, complemented by social, emotional, and/or practical support for frailer or socially isolated older people. CONCLUSIONS Future interventions should include a multifaceted approach. Education tailored to the needs of older people, carers, and healthcare professionals is a necessary component of any intervention.
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Affiliation(s)
- Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London
| | - Cini Bhanu
- Department of Primary Care and Population Health, University College London, London
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London
| | - Helen Croker
- Health Behaviour Research Centre, University College London, London
| | - Remco Tuijt
- Department of Primary Care and Population Health, University College London, London
| | - Jennifer Rea
- Department of Primary Care and Population Health, University College London, London
| | - Jane Hopkins
- Patient and Public Involvement representative, London
| | | | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London
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22
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Bhanu C, Avgerinou C, Kharicha K, Bauernfreund Y, Croker H, Liljas A, Rea J, Kirby-Barr M, Hopkins J, Walters K. 'I've never drunk very much water and I still don't, and I see no reason to do so': a qualitative study of the views of community-dwelling older people and carers on hydration in later life. Age Ageing 2019; 49:111-118. [PMID: 31819953 PMCID: PMC6911653 DOI: 10.1093/ageing/afz141] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Indexed: 12/11/2022] Open
Abstract
Background dehydration is associated with significant adverse outcomes in older people despite being largely preventable and treatable. Little research has focused on the views of community-dwelling older people on hydration, healthy drinking and the perceived importance of drinking well in later life. Objectives to understand community-dwelling older people and informal carers’ views on hydration in later life and how older people can be supported to drink well. Methods qualitative study using interviews and a focus group exploring hydration and nutrition in later life (24 older people at risk of malnutrition and dehydration, 9 informal carers) and thematic analysis. Results this article presents the findings on hydration alone. Four themes are presented: perceptions of healthy drinking, barriers to and facilitators of drinking in later life and supporting older people to drink well. The perceived importance of adequate hydration in later life was polarised. Concerns about urinary incontinence and knowledge gaps were significant barriers. Consideration of individual taste preference and functional capacity acted as facilitators. Distinct habitual drinking patterns with medications and meals exist within individuals. Many relied on thirst at other times or when fluid demands are greater (such as hot weather), a known unreliable prompt in later life. Conclusions older people could be supported to drink well by building upon existing habitual drinking patterns. Primary care and public health should consider individual barriers, facilitators and tailored education. A multidisciplinary approach to promote hydration should be incorporated into care for older people with more complex needs.
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Affiliation(s)
- Cini Bhanu
- Department of Primary Care and Population Health, University College London, UK
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, UK
| | | | - Helen Croker
- Health Behaviour Research Centre, University College London, UK
| | - Ann Liljas
- Department of Primary Care and Population Health, University College London, UK
| | - Jennifer Rea
- Department of Primary Care and Population Health, University College London, UK
| | - Maggie Kirby-Barr
- Patient and Public Involvement Representative, Department of Primary Care and Population Health, University College London, UK
| | - Jane Hopkins
- Patient and Public Involvement Representative, Department of Primary Care and Population Health, University College London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, UK
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Avgerinou C, Gardner B, Kharicha K, Frost R, Liljas A, Elaswarapu R, Manthorpe J, Drennan VM, Goodman C, Iliffe S, Walters K. Health promotion for mild frailty based on behaviour change: Perceptions of older people and service providers. Health Soc Care Community 2019; 27:1333-1343. [PMID: 31148312 PMCID: PMC6771617 DOI: 10.1111/hsc.12781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/22/2019] [Accepted: 04/26/2019] [Indexed: 06/02/2023]
Abstract
Mild frailty is common among older people, but it is potentially reversible with health promotion interventions. Behaviour change may be a key to preventing progression of frailty; however, we know little about what interventions work best and how a behaviour change approach would be perceived by this group. The aim of this study was to explore how mildly frail older people perceive health promotion based on behaviour change and what factors affect engagement with this approach. We conducted semi-structured interviews with 16 older people with mild frailty who received a pilot home-based behaviour change health promotion service, including a dyad of older person/family carer, and two service providers delivering the service in two diverse areas of South England. Interviews were audio-recorded, transcribed and thematically analysed. The concept of goal setting was acceptable to most participants, though the process of goal setting needed time and consideration. Goals on maintaining independence, monitoring of progress and receiving feedback were reported to increase motivation. Physical/mental capability and knowledge/perception of own needs were main determinants of the type of goals chosen by participants as well as the approach used by the project workers. Older people with complex needs benefited from care coordination, with a combination of goal setting and elements of social, practical and emotional support in varying proportions. Mildly frail older people responded well to a behaviour change approach to promote health and well-being. Further consideration is needed of the most effective strategies based on complexity of needs, and how to overcome barriers among people with cognitive impairment.
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Affiliation(s)
- Christina Avgerinou
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | | | - Kalpa Kharicha
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Rachael Frost
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Ann Liljas
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Rekha Elaswarapu
- Age UK Ealing (Patient and Public Involvement and Engagement representative)LondonUK
| | - Jill Manthorpe
- Social Care Workforce Research UnitKing’s College LondonLondonUK
| | - Vari M. Drennan
- Centre for Health and Social Care ResearchKingston University and St George’s, University of LondonLondonUK
| | - Claire Goodman
- Centre for Research in Primary and Community CareUniversity of HertfordshireHatfieldUK
| | - Steve Iliffe
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Kate Walters
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
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Avgerinou C, Bhanu C, Walters K, Croker H, Liljas A, Rea J, Bauernfreund Y, Kirby-Barr M, Hopkins J, Appleton A, Kharicha K. Exploring the Views and Dietary Practices of Older People at Risk of Malnutrition and Their Carers: A Qualitative Study. Nutrients 2019; 11:E1281. [PMID: 31195731 PMCID: PMC6627873 DOI: 10.3390/nu11061281] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/10/2019] [Accepted: 06/03/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND While malnutrition is an important cause of morbidity and mortality in older people, it is commonly under-recognised. We know little on the views of community-dwelling older people and their carers regarding the management of malnutrition. The aim of the study was: (a) to explore views and dietary practices of older people at risk of malnutrition and their carers; (b) to identify gaps in knowledge, barriers and facilitators to healthy eating in later life; (c) to explore potential interventions for malnutrition in primary care. METHODS A qualitative study was performed using semi-structured interviews with participants recruited from four general practices and a carers' focus group in London. Community-dwelling people aged ≥75, identified as malnourished or at risk of malnutrition (n = 24), and informal carers of older people (n = 9) were interviewed. Data were analysed using thematic analysis. RESULTS Older people at risk of malnutrition rarely recognise appetite or weight loss as a problem. Commonly held perceptions include that being thin is healthy and 'snacking' is unhealthy. Changes in household composition, physical or mental health conditions and cognitive impairment can lead to inadequate food intake. Most carers demonstrate an awareness of malnutrition, but also a lack of knowledge of what constitutes a nutritious diet. Although older people rarely seek any help, most would value advice from their GP/practice nurse, a dietitian or another trained professional. CONCLUSION Older people at risk of malnutrition and their carers lack knowledge on nutritional requirements in later life but are receptive to intervention. Training for health professionals in delivering tailored dietary advice should be considered.
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Affiliation(s)
- Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
| | - Cini Bhanu
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
| | - Helen Croker
- Health Behaviour Research Centre, University College London, London WC1E 6BT, UK.
| | - Ann Liljas
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
| | - Jennifer Rea
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
| | - Yehudit Bauernfreund
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
| | | | - Jane Hopkins
- Patient and Public Involvement Representative, London, UK.
| | - Amber Appleton
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
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White N, Oostendorp L, Vickerstaff V, Gerlach C, Engels Y, Maessen M, Tomlinson C, Wens J, Leysen B, Biasco G, Zambrano S, Eychmüller S, Avgerinou C, Chattat R, Ottoboni G, Veldhoven C, Stone P. An online international comparison of thresholds for triggering a negative response to the "Surprise Question": a study protocol. BMC Palliat Care 2019; 18:36. [PMID: 30979361 PMCID: PMC6461816 DOI: 10.1186/s12904-019-0413-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/06/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Surprise Question (SQ) "would I be surprised if this patient were to die in the next 12 months?" has been suggested to help clinicians, and especially General Practitioners (GPs), identify people who might benefit from palliative care. The prognostic accuracy of this approach is unclear and little is known about how GPs use this tool in practice. Are GPs consistent, individually and as a group? Are there international differences in the use of the tool? Does including the alternative Surprise Question ("Would I be surprised if the patient were still alive after 12 months?") alter the response? What is the impact on the treatment plan in response to the SQ? This study aims to address these questions. METHODS An online study will be completed by 600 (100 per country) registered GPs. They will be asked to review 20 hypothetical patient vignettes. For each vignette they will be asked to provide a response to the following four questions: (1) the SQ [Yes/No]; (2) the alternative SQ [Yes/No]; (3) the percentage probability of dying [0% no chance - 100% certain death]; and (4) the proposed treatment plan [multiple choice]. A "surprise threshold" for each participant will be calculated by comparing the responses to the SQ with the probability estimates of death. We will use linear regression to explore any differences in thresholds between countries and other clinician-related factors, such as years of experience. We will describe the actions taken by the clinicians and explore the differences between groups. We will also investigate the relationship between the alternative SQ and the other responses. Participants will receive a certificate of completion and the option to receive feedback on their performance. DISCUSSION This study explores the extent to which the SQ is consistently used at an individual, group, and national level. The findings of this study will help to understand the clinical value of using the SQ in routine practice. TRIAL REGISTRATION Clinicaltrials.gov NCT03697213 (05/10/2018). Prospectively registered.
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Affiliation(s)
| | | | | | | | - Yvonne Engels
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | | | | | - Guido Biasco
- University of Bologna & Academy of the Sciences of Palliative Medicine, Bologna, Italy
| | | | | | | | | | | | - Carel Veldhoven
- Radboud University Medical Centre, Nijmegen, The Netherlands
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Abstract
BACKGROUND Frailty has been defined as a clinical syndrome of multicausal origin characterized by a reduction of physiologic reserves that increase the vulnerability of an individual to adverse outcomes such as the development of functional dependence and death. Considered one of the most important geriatric syndromes, frailty's prevention and management represent important goals for gerontology and geriatrics. Although nutrition plays an important role within the multifactorial susceptibility for this syndrome, up to the present no systematic review specifically addressed the effectiveness of nutritional interventions for the treatment of frailty. Therefore, we propose the present systematic review with the aim to assess the effectiveness of nutritional interventions for the treatment of frailty in older adults living in the community or in long-term care facilities. METHODS We will search Medline (via Pubmed), Embase, Cinahl, Central, Lilacs, Web of Science, and sources of gray literature. We will accept trials whereby the unit of randomization consisted of individuals or clusters of individuals. Our primary outcome is all-cause mortality. Secondary outcomes are quality of life, functional status, cognitive function, frailty status, body composition, and physical activity. Risk of bias will be assessed using the Cochrane Collaboration tool. We will analyze the overall strength of the evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Two independent researchers will conduct all evaluations and any disagreements will be resolved through the participation of a 3rd author. If possible, we will perform random-effects meta-analyses and subgroup analyses concerning specific details of nutritional interventions (e.g., components and duration), research scenario, risk of bias, and criteria used to diagnose frailty. CONCLUSION In this systematic review protocol we outline the details of the aims and methods of a systematic review on the effectiveness of nutritional interventions for the management of frailty in older adults living in the community or in long-term care facilities". We believe this wording to be more objective and balanced than the previous one. We understand that it is not ideal to propose changes to the text after manuscripts have been accepted. However, we feel that the new wording of the conclusion section of the abstract is more consistent with the overall content of the main text of the review than its previous version. Hence, we hope you may accept our request.
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Affiliation(s)
| | | | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
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Kojima G, Avgerinou C, Iliffe S, Jivraj S, Sekiguchi K, Walters K. Erratum to: Fruit and Vegetable Consumption and Frailty: A Systematic Review. J Nutr Health Aging 2018. [DOI: 10.1007/s12603-018-1074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Koutsodontis G, Papaxoinis G, Kotsantis I, Economopoulou P, Strati A, Avgerinou C, Spathas N, Kirodimos E, Tsavaris O, Maratou E, Hoxhallari L, Anastasiou M, Prevezanou M, Lianidou E, Psyrri A. Surrogates of immunologic cell death (ICD) and chemoradiotherapy outcomes in head and neck squamous cell carcinoma (HNSCC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy287.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Rea J, Avgerinou C, Walters K. 162Can Dietary Education and Support Alone Improve Outcomes for Older People at Risk of Malnutrition in the Community? Age Ageing 2018. [DOI: 10.1093/ageing/afy140.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jennifer Rea
- University College London, London, United Kingdom
- King’s College London, London, United Kingdom
| | | | - Kate Walters
- University College London, London, United Kingdom
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Kojima G, Avgerinou C, Iliffe S, Jivraj S, Sekiguchi K, Walters K. 15FRUIT AND VEGETABLE CONSUMPTION AND FRAILTY: A SYSTEMATIC REVIEW. Age Ageing 2018. [DOI: 10.1093/ageing/afy134.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Kojima
- Department of Primary Care and Population Health, University College London
| | - C Avgerinou
- Department of Primary Care and Population Health, University College London
| | - S Iliffe
- Department of Primary Care and Population Health, University College London
| | - S Jivraj
- Department of Epidemiology and Public Health, University College London
| | - K Sekiguchi
- Department of General Medicine, Shinshu University School of Medicine
| | - K Walters
- Department of Primary Care and Population Health, University College London
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Walters K, Frost R, Kharicha K, Avgerinou C, Gardner B, Ricciardi F, Hunter R, Liljas A, Manthorpe J, Drennan V, Wood J, Goodman C, Jovicic A, Iliffe S. Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT. Health Technol Assess 2018; 21:1-128. [PMID: 29214975 DOI: 10.3310/hta21730] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. OBJECTIVES (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). DESIGN Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. INTERVENTION DEVELOPMENT Two systematic reviews (including systematic searches of 14 databases and registries, 1990-2016 and 1980-2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65-94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the 'HomeHealth' intervention in collaboration with older people and multidisciplinary stakeholders. 'HomeHealth' comprised 3-6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. FEASIBILITY RCT Single-blind RCT, individually randomised to 'HomeHealth' or treatment as usual (TAU). SETTING Community settings in London and Hertfordshire, UK. PARTICIPANTS A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. MAIN OUTCOME MEASURES Feasibility - recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. RESULTS We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire -3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. CONCLUSIONS Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. FUTURE WORK A large, definitive RCT of the HomeHealth service is warranted. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London, UK
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Federico Ricciardi
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ann Liljas
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Vari Drennan
- Centre for Health and Social Care Research, Kingston University and St George's, University of London, London, UK
| | - John Wood
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Ana Jovicic
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
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Drennan V, Walters K, Avgerinou C, Gardner B, Goodman C, Frost R, Kharicha K, Iliffe S, Manthorpe J. Moving upstream in health promoting policies for older people with early frailty in England? A policy analysis. J Health Serv Res Policy 2018; 23:168-175. [PMID: 29325443 PMCID: PMC6050943 DOI: 10.1177/1355819617752971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives Globally, populations are rapidly ageing and countries have developed health promotion and wellbeing strategies to address increasing demand for health care and old-age support. The older population is not homogeneous however, and includes a large group in transition between being active and healthy to being frail, i.e. with early frailty. This review explores the extent to which policy in England has addressed this group with a view to supporting independence and preventing further progression towards frailty. Methods A narrative review was conducted of 157 health and social care policy documents current in 2014-2017 at three levels of the health and social care system in England. Findings We report the policy problem analysis, the shifts over time in language from health promotion to illness prevention, the shift in target populations to mid-life and those most at risk of adverse outcomes through frailty, and changes to delivery mechanisms to incentivize attention to the frailest rather than those with early frailty. We found that older people in general were not identified as a specific population in many of these policies. While this may reflect a welcome lack of age discrimination, it could equally represent omission through ageism. Only at local level did we identify some limited attention to preventative actions with people with early frailty. Conclusion The lack of policy attention to older people with early frailty is a missed opportunity to address some of the demands on health and social care services. Addressing the individual and societal consequences of adverse experiences of those with the greatest frailty should not distract from a more distinct public health perspective which argues for a refocusing upstream to health promotion and illness prevention for those with early frailty.
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Affiliation(s)
- Vari Drennan
- Professor of Health Care & Policy Research, Centre for
Health & Social Care Research, Kingston University & St. George’s
University of London, UK
| | - Kate Walters
- Director of the Centre for Ageing & Population Studies,
University College London, UK
| | - Christina Avgerinou
- Senior Clinical Research Associate, Department of Primary Care
and Population Health, University College London, UK
| | - Benjamin Gardner
- Senior Lecturer, Department of Psychology, King’s College
London, UK
| | - Claire Goodman
- Professor of Health Care, University of Hertfordshire, UK
| | - Rachael Frost
- Research Associate, Department of Primary Care and Population
Health, University College London, UK
| | - Kalpa Kharicha
- Senior Research Fellow, Department of Primary Care and
Population Health, University College London, UK
| | - Steve Iliffe
- Emeritus Professor of Primary Care for Older People, Department
of Primary Care and Population Health, University College London, UK
| | - Jill Manthorpe
- Professor of Social Work, Social Care Workforce Research Unit,
King’s College London, UK
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Frost R, Kharicha K, Jovicic A, Liljas AEM, Iliffe S, Manthorpe J, Gardner B, Avgerinou C, Goodman C, Drennan VM, Walters K. Identifying acceptable components for home-based health promotion services for older people with mild frailty: A qualitative study. Health Soc Care Community 2018; 26:393-403. [PMID: 29210136 DOI: 10.1111/hsc.12526] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 06/07/2023]
Abstract
Mild frailty is common in later life, increasing the risk of hospitalisation, loss of independence and premature death. Targeted health promotion services may reduce adverse outcomes and increase quality of life; however, effective, well-developed theory-based interventions are lacking. We aimed to explore perceptions of health promotion behaviours undertaken by older people with mild frailty, barriers and facilitators to engagement, and identify potential components for new home-based health promotion services. We carried out 17 semi-structured qualitative interviews and six focus groups with 53 stakeholders, including 14 mildly frail older people, 12 family carers, 19 community health and social care professionals, and 8 homecare workers, in one urban and one semi-rural area of England. Transcripts were thematically analysed. Older people with mild frailty reported engaging in a variety of lifestyle behaviours to promote health and well-being. Key barriers or facilitators to engaging in these included transport, knowledge of local services, social support and acceptance of personal limitations. Older people, carers and professionals agreed that any new service should address social networks and mobility and tailor other content to each individual. Services should aim to increase motivation through focussing on independence and facilitate older people to continue carrying out behaviours that improve their well-being, as well as provide information, motivation, psychological support and practical support. Stakeholders agreed services should be delivered over a sustained period by trained non-specialist workers. New services including these components are likely to be acceptable to older people with mild frailty.
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Affiliation(s)
- Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ana Jovicic
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ann E M Liljas
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University & St Georges, University of London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
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Avgerinou C, Fostira F, Economopoulou P, Psyrri A. Cancer gene-panel testing identifies two loss-of-function alleles in PALB2 and PTEN. Clin Genet 2018; 93:1250-1251. [PMID: 29430632 DOI: 10.1111/cge.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 12/01/2022]
Abstract
Synchronous loss-of-function mutations in the cancer predisposing genes, PTEN and PALB2 identified by multigene panel.
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Affiliation(s)
- C Avgerinou
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - F Fostira
- Molecular Diagnostics Laboratory, INRaSTES, National Center for Scientific Research Demokritos, Athens, Greece
| | - P Economopoulou
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Psyrri
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kojima G, Avgerinou C, Iliffe S, Walters K. Adherence to Mediterranean Diet Reduces Incident Frailty Risk: Systematic Review and Meta-Analysis. J Am Geriatr Soc 2018; 66:783-788. [PMID: 29322507 DOI: 10.1111/jgs.15251] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To conduct a systematic review of the literature on prospective cohort studies examining associations between adherence to a Mediterranean diet and incident frailty and to perform a meta-analysis to synthesize the pooled risk estimates. DESIGN Systematic review and meta-analysis. SETTING Embase, MEDLINE, CINAHL, PsycINFO, and Cochrane Library were systematically searched on September 14, 2017. We reviewed references of included studies and relevant review papers and performed forward citation tracking for additional studies. Corresponding authors were contacted for additional data necessary for a meta-analysis. PARTICIPANTS Community-dwelling older adults (mean age ≥60). MEASUREMENTS Incident frailty risk according to adherence to a Mediterranean diet. RESULTS Two reviewers independently screened the title, abstract, and full text to ascertain the eligibility of 125 studies that the systematic search of the literature identified, and four studies were included (5,789 older people with mean follow-up of 3.9 years). Two reviewers extracted data from the studies independently. All four studies provided adjusted odds ratios (ORs) of incident frailty risk according to three Mediterranean diet score (MDS) groups (0-3, 4-5, and 6-9). Greater adherence to a Mediterranean diet was associated with significantly lower incident frailty risk (pooled OR = 0.62, 95% CI = 0.47-0.82, P = .001 for MDS 4-5; pooled OR = 0.44, 95% CI = 0.31-0.64, P < .001 for MDS 6-9) than poorer adherence (MDS 0-3). Neither significant heterogeneity (I2 = 0-16%, P = .30) nor evidence of publication bias was observed. CONCLUSION Greater adherence to a Mediterranean diet is associated with significantly lower risk of incident frailty in community-dwelling older people. Future studies should confirm these findings and evaluate whether adherence to a Mediterranean diet can reduce the risk of frailty, including in non-Mediterranean populations.
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Affiliation(s)
- Gotaro Kojima
- Department of Primary Care and Population Health, University College London, London, UK
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
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Kojima G, Avgerinou C, Iliffe S, Jivraj S, Sekiguchi K, Walters K. Fruit and Vegetable Consumption and Frailty: A Systematic Review. J Nutr Health Aging 2018; 22:1010-1017. [PMID: 30272107 PMCID: PMC6182506 DOI: 10.1007/s12603-018-1069-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify currently available evidence on fruit and vegetable consumption in association with frailty by conducting a systematic review of the literature and to summarise and critically evaluate it. DESIGN Systematic review. SETTING Four electronic databases (Embase, MEDLINE, CINAHL and PsycINFO) were systematically searched in August 2017 for observational cohort studies providing cross-sectional or prospective associations between fruit and vegetable consumption and frailty risks. Additional studies were searched by manually reviewing the reference lists of the included studies and related review papers and conducting forward citation tracking of the included studies. The methodological quality of prospective studies was assessed using the Newcastle-Ottawa scale. PARTICIPANTS Community-dwelling general populations. RESULTS A total of 6251 studies were identified, of which five prospective studies with follow-up periods of 2-10.5 years and two cross-sectional studies were included. Among the five prospective studies, three had adequate methodological quality. Because of different measurements and statistical methodologies, a meta-analysis was not possible. The two studies of good quality showed that fruit and vegetable consumption was mostly associated with lower risk of incident frailty. The other study as a sub-analysis retrospectively examined baseline fruit and vegetable consumption of those who developed frailty and those who did not at follow-up and showed no significant associations. CONCLUSIONS Although good quality studies on this topic are scarce, there is some suggestion that higher fruit and vegetable consumption may be associated with lower frailty risk. More high quality research is needed.
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Affiliation(s)
- G Kojima
- Gotaro Kojima, MD, Department of Primary Care and Population Health, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK, Phone: +44 (0)20 7794 0500, Fax: +44 (0)20 7472 6871,
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Avgerinou C, Giannezi I, Theodoropoulou S, Lazaris V, Kolliopoulou G, Zikos P, Alamanos Y, Leotsinidis M, Symeonidis A. Occupational, dietary, and other risk factors for myelodysplastic syndromes in Western Greece. ACTA ACUST UNITED AC 2017; 22:419-429. [PMID: 28102107 DOI: 10.1080/10245332.2016.1277006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE We have observed an increasing incidence of myelodysplastic syndromes (MDS) in the geographic area of Western Greece during the past two decades. The objective of this study was to investigate potential risk factors for the manifestation of MDS in this area of Greece. METHODS A hospital-based case-control study was conducted in the public hospitals of the region. Participants were interviewed based on a questionnaire regarding demographics, occupational exposures, smoking, alcohol consumption, dietary, and domestic factors. RESULTS A total of 228 individuals (126 cases, 102 controls) were recruited in this study. Univariate analysis showed that risk of MDS was associated with a family history of hematologic malignancy or solid tumor, exposure to pesticides, insecticides, herbicides, increased weekly intake of meat and eggs, and increased alcohol intake, whereas fruit intake had a protective effect. Analysis by pesticide ingredient showed a weak association of exposure to paraquat and glyphosate with the occurrence of MDS. Multivariate analysis showed that independent risk factors for the manifestation of MDS were family history of solid tumor (OR 2.47, 95% CI 1.32-4.65), meat intake for ≥5 days/week (OR 2.67, 95% CI 1.05-6.80) and exposure to pesticides (OR 3.25, 95% CI 1.73-6.11). CONCLUSIONS Exposure to pesticides is a major risk factor of MDS in Western Greece. Family history of solid tumor and increased meat intake also appear to play a role in the pathogenesis of MDS. Public health authorities should implement policies to advise and protect farmers from the harmful effects of agrochemicals. Emphasis should also be given to health promotion advice including healthy eating.
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Affiliation(s)
- Christina Avgerinou
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece.,b Laboratory of Public Health , Medical School, University of Patras , Greece
| | - Ioanna Giannezi
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Stela Theodoropoulou
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Vasileios Lazaris
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Georgia Kolliopoulou
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Panagiotis Zikos
- c Department of Hematology , 'St Andrew' General Hospital , Patras , Greece
| | - Yannis Alamanos
- b Laboratory of Public Health , Medical School, University of Patras , Greece
| | | | - Argiris Symeonidis
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
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Avgerinou C, Kouraklis A, Theodoropoulou S, Giannezi I, Lazaris V, Lampropoulou P, Labropoulou V, Tzouvara E, Zikos P, Alamanos Y, Karakantza M, Symeonidis A. P-260 Exposure to pesticides is a major risk factor for myelodysplastic syndromes (MDS) in Southwestern Greece. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Avgerinou C, Alamanos Y, Zikos P, Lampropoulou P, Melachrinou M, Labropoulou V, Tavernarakis I, Aktypi A, Kaiafas P, Raptis C, Kouraklis A, Karakantza M, Symeonidis A. The incidence of myelodysplastic syndromes in Western Greece is increasing. Ann Hematol 2013; 92:877-87. [PMID: 23572136 PMCID: PMC3674340 DOI: 10.1007/s00277-013-1712-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 02/15/2013] [Indexed: 11/26/2022]
Abstract
Descriptive epidemiology of the myelodysplastic syndromes (MDS) is always interesting and may reveal time-dependent and geographical variations, as well as occupational exposure. Epidemiological data in Greece are not available by now. We have collected and analyzed medical records of all patients with a documented diagnosis of MDS, performed by an expert hematologist and/or hematopathologist, in the geographical area of Western Greece, during the 20-year period, defined between 1990 and 2009. We have then calculated and described demographic and clinical features of the diagnosed MDS patient population, and assessed the incidence and prevalence rates of MDS in Western Greece, during the above-mentioned period. A total of 855 patients with newly diagnosed MDS have been identified. Refractory anemia was the most common subtype in both FAB and WHO classification systems and in both genders. Del-5q and RARS were more commonly encountered among females, and the dysplastic subtype of chronic myelomonocytic leukemia among males. Trisomy 8 was the most common single cytogenetic abnormality. The crude mean annual incidence rate of MDS was 6.0 per 100,000 inhabitants aged ≥15 years old (all subtypes according to FAB), and it was 4.8 per 100,000 when CMML and RAEB-T were excluded. Crude incidence rate was higher in rural than in urban areas, but this finding was not confirmed after age standardization. Age-standardized mean annual incidence rate in men was 7.9/100,000 and in women 3.4/100,000. A continuously increasing incidence rate of MDS has been observed throughout the study period.
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Affiliation(s)
- Christina Avgerinou
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, 26504 Rion, Patras, Greece
- Department of Public Health, University of Patras Medical School, 26504 Rion, Patras, Greece
| | - Yannis Alamanos
- Department of Public Health, University of Patras Medical School, 26504 Rion, Patras, Greece
| | - Panagiotis Zikos
- Department of Hematology, “St Andrew” General Hospital of Patras, Tsertidou Str. No 1, Patras, 263.35 Greece
| | - Polyxeni Lampropoulou
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, 26504 Rion, Patras, Greece
| | - Maria Melachrinou
- University of Patras Medical School, Laboratory of Pathology, 26504 Rion, Patras, Greece
| | - Vassiliki Labropoulou
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, 26504 Rion, Patras, Greece
| | - Ioannis Tavernarakis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, 26504 Rion, Patras, Greece
| | - Anthi Aktypi
- Department of Hematology, “Olympion” Hospital, Patras, Volou and Meilihou Str. Kato Sihaina, Patras, 264.41 Greece
| | | | - Christos Raptis
- Department of Internal Medicine, General Hospital of Messolonghi, Greece, Messolonghi, 302.00 Patras, Greece
| | - Alexandra Kouraklis
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, 26504 Rion, Patras, Greece
| | - Marina Karakantza
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, 26504 Rion, Patras, Greece
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, 26504 Rion, Patras, Greece
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Avgerinou C, Alamanos Y, Zikos P, Tavernarakis I, Aktypi A, Kaiafas P, Raptis C, Kouraklis A, Karakantza M, Symeonidis A. 140 Incidence of myelodysplastic syndromes in a well-defined population of Southwestern Greece. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Avgerinou C, Lazaris V, Alamanos Y, Kouraklis A, Karakantza M, Symeonidis A. 141 A case-control study to investigate risk factors for myelodysplastic syndromes in Southwestern Greece. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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