Credibility of self-reported health parameters in elderly population

Population reference equations for handheld peak expiratory flow in older U.S. adults

BACKGROUND

Peak expiratory flow (PEF) is a simple, inexpensive measure of respiratory effort and is a valuable predictor of health outcomes in older adults. Yet, there is a lack of epidemiological data validating PEF prediction equations among older adult populations, especially those ≥80 years. The National Health and Aging Trends Study (NHATS) is a large, nationally representative sample of U.S. adults ages ≥65 years that offers a unique opportunity to develop PEF population reference equations.

METHODS

Using a healthy subsample from the NHATS 2011 cohort (N = 1740; 68.9 % female; mean [SD] age = 77.0 [7.9] years), sex-specific reference equations were generated for PEF, measured via a handheld flow meter, using height and age as predictors. Reference equations for both sexes were validated against the NHATS 2015 cohort by testing measured vs. predicted PEF values. Additionally, new reference equations were compared to spirometry PEF reference equations from the National Health and Nutrition Examination Survey (NHANES).

RESULTS

After applying NHATS 2011 reference equations to the NHATS 2015 cohort, measured vs. predicted PEF values were not significantly different (Ps > 0.05). The NHANES equations tended to slightly overestimate handheld PEF measurements in the NHATS 2015 cohort by an average of 29.3 L/min and 10.1 L/min in males and females, respectively.

CONCLUSIONS

Results demonstrate the comparability of PEF reference equations from a handheld meter to spirometry reference equations in older adults. New reference equations can be applied to a traditionally undersampled population with an easily obtained and low-cost measure.

Improving the accuracy of self-reported height and weight in surveys: an experimental study

Background

Many studies rely on self-reported height and weight. While a substantial body of literature exists on misreporting of height and weight, little exists on improving accuracy. The aim of this study was to determine, using an experimental design and a comparative approach, whether the accuracy of self-reported height and weight data can be increased by improving how these questions are asked in surveys, drawing on the relevant evidence from the psychology and survey research literatures.

Methods

Two surveys from two separate studies were used to test our hypotheses (Science Survey, n = 1,200; Eating Behaviours Survey, n = 200). Participants were randomly assigned to one of six conditions, four of which were designed to improve the accuracy of the self-reported height and weight data (“preamble”), and two of which served as the control conditions ( “no preamble”). Four hypotheses were tested: (H1) survey participants read a preamble prior to being asked their height and weight will report lower heights and higher weights than those not read a preamble; (H2) the impact of question-wording (i.e., preamble vs. no preamble) on self-reported weight will be greater for participants with higher BMIs; (H3) the impact of question-wording on height will be greater for older participants; (H4) either version of the weight question – standard or “weight-specific”—may result in participants reporting more accurate self-reported weight. One-way MANOVA was conducted to test Hypothesis 1; two-way analysis of variance were conducted to test Hypothesis 2; moderation analysis was used to test Hypothesis 3; independent samples t-test was conducted to test Hypothesis 4.

Results

None of the hypotheses was supported.

Conclusions

This paper provides an important starting point from which to inform further work exploring how question wording can improve self-reported measurement of height and weight. Future research should explore how question preambles may or may not operationalise hypothesised underlying mechanisms, the sensitivity or intrusiveness of height and weight questions, individual beliefs about one’s height and weight, and survey context.

COVID-19 pandemic and the great impulse to telemedicine: the basis of the WONCA Europe Statement on Telemedicine at the WHO Europe 70th Regional Meeting September 2020

Telemedicine is the use of telecommunication and information technologies to support the delivery of healthcare at a distance, guaranteeing patients healthcare by facilitating access where barriers exist; the COVID-19 pandemic has attracted worldwide interest in this field.

The purpose of this paper is to highlight the main pros and cons of telemedicine, which serve as the basis of the WONCA Europe Statement at the WHO Europe 70th Regional Meeting on 14 September 2020.

Pros of telemedicine include virtual healthcare at home, where patients receive support in certain conditions without leaving their houses. During a pandemic, it can be adopted to limit physical human interaction. Unfortunately, it can negatively affect the quality of the doctor–patient relationship, the quality of the physical examination, and the quality of care. Telemedicine requires effective infrastructure and robust investments to be feasible and effective.

Applicability of the GLIM criteria for the diagnosis of malnutrition in older adults in the emergency ward: A pilot validation study

BACKGROUND & AIMS

Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW).

METHODS

We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic [nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion [reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses.

RESULTS

GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9).

CONCLUSION

GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice.

"Mass gathering events and COVID-19 transmission in Borriana (Spain): A retrospective cohort study"

OBJECTIVE

Mass gathering events (MGEs) are associated with the transmission of COVID-19. Between 6 and 10 March 2020, several MGEs related to the Falles festival took place in Borriana, a municipality in the province of Castellon (Spain). The aim of this study was to estimate the incidence of COVID-19 and its association with these MGEs, and to quantify the potential risk factors of its occurrence.

METHODS

During May and June 2020, a population-based retrospective cohort study was carried out by the Public Health Center of Castelló and the Hospital de la Plana in Vila-real. Participants were obtained from a representative sample of 1663 people with potential exposure at six MGEs. A questionnaire survey was carried out to obtain information about attendance at MGEs and COVID-19 disease. In addition, a serologic survey of antibodies against SARS-Cov-2 was implemented. Inverse probability weighted regression was used in the statistical analysis.

RESULTS

A total of 1338 subjects participated in the questionnaire survey (80.5%), 997 of whom undertook the serologic survey. Five hundred and seventy cases were observed with an attack rate (AR) of 42.6%; average age was 36 years, 62.3% were female, 536 cases were confirmed by laboratory tests, and 514 cases were found with SARS-CoV-2 total antibodies. Considering MGE exposure, AR was 39.2% (496/1264). A dose-response relationship was found between MGE attendance and the disease, (adjusted relative risk [aRR] = 4.11 95% confidence interval [CI]3.25-5.19). Two MGEs with a dinner and dance in the same building had higher risks. Associated risk factors with the incidence were older age, obesity, and upper and middle class versus lower class; current smoking was protective.

CONCLUSIONS

The study suggests the significance of MGEs in the COVID-19 transmission that could explain the subsequent outbreak in Borriana.

Anthropometric assessment in ambulatory nutrition amid the COVID-19 pandemic: Possibilities for the remote and in-person care

Background and aims

The COVID-19 pandemic has caused many changes in the nutritional care process as a result of the social distancing measures imposed, especially in the assessment of nutritional status, in which obtaining anthropometric measures is necessary.

Methods

Critical review of the international anthropometry literature, in the light of the recent scientific evidence of COVID-19.

Results

This paper presents recommendations for anthropometric assessment of the nutritional status of people in ambulatory settings for both remote and in-person assessment. The most appropriate measures to the current pandemic scenario are also discussed, in order to contribute to the monitoring of nutritional status and to minimize health impacts.results

Conclusion

When sanitary conditions cannot be guaranteed during in-person encounters or when the person cannot attend the office of the professional, the remote anthropometric assessment can be a useful strategy to nutritional surveillance.conclusions