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Number of results: 8
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Abstract

Background/Aim: Factors influencing the survival of the nursing home population have not yet been clearly defined. The aim of the study was to investigate the impact of nutritional, mental, functional, disease and pharmacological factors on the survival of nursing home residents with severe disabilities.
Material and Methods: A retrospective cohort study was conducted with a 9-year follow-up period among nursing home residents with a Barthel score ≤40. The initial assessment included the following scales: Mini Nutritional Assessment Short-Form (MNA-SF), Abbreviated Mental Test Score (AMTS), the Barthel Index, and blood pressure (BP) measurements. Comorbidities, medications and all-cause mortality were extracted from medical records. The analyzed cohort was divided into two groups: Deceased — residents who died ≤3 years and Survivors — those who survived >3 years of observation.
Results: Survivors (n = 40) and Deceased (n = 48) did not differ significantly in terms of age, sex, systolic and diastolic BP, the Barthel Index, number of diseases and medications used. Survivors had significantly higher scores in MNA-SF (p <0.001) and AMTS (p <0.003) than Deceased. Moreover, Survivors had hyper-tension significantly more often and took aspirin and ACE inhibitors (p <0.05). The multivariable logistic regression analysis showed that the MNA-SF score significantly affected mortality [OR = 0.62, (95%CI, 0.46– 0.84), p <0.001].
Conclusion: Higher MNA-SF scores were a factor that significantly affected the survival of nursing home residents, while functional status assessed using the Barthel Index had no effect on survival. MNA-SF was found to be a useful tool for assessing the risk of death in a nursing home.
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Authors and Affiliations

Anna Kańtoch
1
Jadwiga Wójkowska-Mach
2
Barbara Wizner
1
Piotr Heczko
2
Tomasz Grodzicki
1
Barbara Gryglewska
1

  1. Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, University Hospital in Kraków, Kraków, Poland
  2. Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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Abstract

Objectives: The aim of the study was to assess the relationship between body composition, nutritional status and physical ability in elderly outpatients.
Method:. In this cross-sectional study, demographic data and medical history were collected from patients aged ≥60 years followed in the Geriatric Outpatient Clinic from October 2010 to February 2014. Body composition was examined using a dual-energy X-ray absorptiometry. Physical performance was assessed by gait speed (GS), Timed Up & Go Test (TUG), Six Minute Walk Test (6MWT). The nutritional status was evaluated using the Mini Nutritional Assessment (MNA) and serum albumin level.
Results: Mean age (± SD) of 76 patients (64.47% men) was 71.93 ± 8.88 yrs. The most common diseases were: hypertension (89.47%), coronary heart disease (81.58%) and chronic heart failure (68.4%). In multiple regression analyses, the factors significantly affecting GS were: age (B = –0.017, p ≤0.0001), good nutritional status (B = 0.038, p <0.01) and percent of lower extremity fat (B = –0.009, p <0.05). Longer TUG time was associated with poorer nutritional status (B = –0.031, p <0.01), older age (B = 0.01, p <0.01) and a higher number of comorbidities (B = 0.034, p <0.05). 6MWT was influenced negatively by age (B = –3.805, p <0.01) and percent of lower extremity fat (B = –2.474, p <0.05).
Conclusions: Age and nutritional status remain a strong determinant of physical fitness deterioration. Different measures of physical performance are influenced by different elements of body composition — no single element of body composition was found determining the deterioration of all assessed parameters of physical fitness.
Identifying the relationship between body composition, nutritional status and physical performance can help elucidate the causes of disability and target preventive measures.
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Authors and Affiliations

Paulina Fatyga-Kotula
1
Barbara Wizner
2
Małgorzata Fedyk-Łukasik
2
Tomasz Grodzicki
2
Anna Skalska
2

  1. Department of Toxicology and Occupational Diseases, Jagiellonian University Medical College, Kraków, Poland
  2. Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
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Abstract

The aim of this cross-sectional study is to examine if neglect is associated with self-rated health (SRH) and if neglect mediates the association between selected factors and self-rated health, among older men and women. The analyses were based on face-to-face computer-assisted personal interviews con-ducted with 1632 randomly selected community-dwelling individuals aged 65 years and more from among the general population of Lesser Poland. The regression models’ analysis revealed that elder neglect was associated with self-rated health, and the mediation analysis demonstrated that neglect mediates the association between frequency of church attendance and SRH, as well as between marital status (being a widower vs being married) and SRH, among men. These observations can be helpful in better under-standing of the broad context of elder neglect in order to develop instruments for an efficient improve-ment of older adults’ health and quality of life. In addition to this, the study underlines the role of social networks and social engagement as factors which might protect against neglect, and thus improve self- rated health of older people.
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Authors and Affiliations

Agata Stodolska
1
Katarzyna Zawisza
1
Barbara Wizner
2
Beata Tobiasz-Adamczyk
1
Tomasz Grodzicki
2

  1. Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
  2. Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
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Abstract

A i m: The main purpose of this article is to present the main assumptions of the FRAILTOOLS project and the characteristics of the recruitment process in the Polish part of the study.

M a t e r i a l a n d M e t h o d s: The FRAILTOOLS project is a prospective observational study conducted in 5 European countries. The study included people aged 75 and older. Each participating center was required to recruit 388 patients, which corresponded to 97 subjects in each clinical setting by center. Recruitment took place in clinical settings (hospital geriatric acute care, geriatric outpatient clinic, primary health care) and in social conditions (nursing homes). The frailty syndrome was assessed among study participants using 7 different scales. The follow-up period was 18 months.

R e s u l t s: In Poland, 268 elderly subjects took part in the study, which constituted 69.1% of planned recruitment. The majority of participants were acute care patients (108 participants). A high percentage of people successfully recruited for the study was seen in nursing homes (83.5% of predicted number). The lowest recruitment came from primary healthcare (53 participants) and geriatric outpatient clinic (26). About a quarter of recruited participants were lost during follow-up period. The poorest results of control visits were observed among patients from geriatric wards and geriatric outpatient clinic.

C o n c l u s i o n s: The recruitment process for older people in Poland was satisfactory, mainly in hospitalized and institutionalized patients. The worst enrollment result was observed among outpatients. A detailed analysis of enrollment problems among the older Polish population is necessary to determine the optimal recruitment strategy and retain eligible study participants.

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Authors and Affiliations

Anna Kańtoch
Barbara Gryglewska
Barbara Wizner
Agnieszka Parnicka
Tomasz Grodzicki
Frailtools Consortium
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Abstract

Common variable immunodeficiency (CVID) is a primary immunodeficiency disorder related to recurrent infections, as well as a range of non-infectious manifestations including autoimmune and inflammatory disorders. We hypothesized that patients with CVID and different clinical phenotypes would demonstrate alterations in lymphocyte T subsets, including T lymphocytes expressing programmed cell death protein 1 (PD-1), and regulatory T lymphocytes. We performed flow cytometry in two CVID groups: group 1 with infections only, and group 2 with infections and concomitant noninfectious manifestations. Patients were 18–59 years old (mean 35.8 years of age). Increased proportions of CD8+PD-1+ T cells and reduced regulatory T cells were associated with lymphadenopathy. Amount of regulatory T cells correlated with CD8+PD-1+ T lymphocytes (r = 0.54; p = 0.013), and with CRP (r = –0.64; p = 0.004). Forty percent of patients expressed manifestations in addition to infections (group 2), and they had reduction in number of regulatory T cells [8 (3–12) vs. 24 (11–26)/μl; p = 0.034), naive CD4+ T lymphocytes [36 (27–106) vs. 149 (81–283)/μl; p = 0.034], and elevated C-reactive protein (CRP) [5.33 (3.15–8.82) vs. 1 (1–2.16) mg/l; p = 0.003] in comparison to group 1. In conclusion, the amount of CD8+ T cells expressing PD-1 is associated with lymphadenopathy and number of regulatory T cells in patients with CVID. Patients with CVID and non-infectious complications have increased level of inflammation and alterations in regulatory T cells.
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Authors and Affiliations

Ewelina Nowak
1
Joanna Sulicka-Grodzicka
2
Magdalena Strach
1
Karolina Bukowska-Strakova
3
Maciej Siedlar
3
Mariusz Korkosz
2
ORCID: ORCID
Tomasz Grodzicki
1

  1. Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
  2. Department of Rheumatology, Jagiellonian University Medical College, Kraków, Poland
  3. Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
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Abstract

The complex course of the COVID-19 and the distant complications of the SARS-CoV-2 infection still remain an unfaded challenge for modern medicine. The care of patients with the sympto-matic course of COVID-19 exceeds the competence of a single specialty, often requiring a multispecialist approach. The CRACoV-HHS (CRAcow in CoVid pandemic — Home, Hospital and Staff) project has been developed by a team of scientists and clinicians with the aim of optimizing medical care at hospital and ambulatory settings and treatment of patients with SARS-CoV-2 infection. The CRACoV project integrates 26 basic and clinical research from multiple medical disciplines, involving different populations infected with SARS-CoV-2 virus and exposed to infection.
Between January 2021 and April 2022 we plan to recruit subjects among patients diagnosed and treated in the University Hospital in Cracow, the largest public hospital in Poland, i.e. 1) patients admitted to the hospital due to COVID-19 [main module: ‘Hospital’]; 2) patients with signs of infection who have been confirmed as having SARS-CoV-2 infection and have been referred to home isolation due to their mild course (module: ‘Home isolation’); 3) patients with symptoms of infection and high exposure to SARS- CoV-2 who have a negative RT-PCR test result. In addition, survey in various professional groups of hospital employees, both medical and non-medical, and final-fifth year medical students (module: ‘Staff’) is planned.
The project carries both scientific and practical dimension and is expected to develop a multidisciplinary model of care of COVID-19 patients as well as recommendations for the management of particular groups of patients including: asymptomatic patient or with mild symptoms of COVID-19; symptomatic patients requiring hospitalization due to more severe clinical course of disease and organ complications; patient requiring surgery; patient with diabetes; patient requiring psychological support; patient with undesirable consequences of pharmacological treatment.
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Bibliography

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2. Sydor W.: COVID-19 a zaburzenia krzepnięcia. Medical Research Reviews. ISBN 978–83–65515–97–1.
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Authors and Affiliations

Wojciech Sydor
1 2
Barbara Wizner
3
Magdalena Strach
2
Monika Bociąga-Jasik
4 5
Krzysztof Mydel
6
Agnieszka Olszanecka
7
Marek Sanak
8 5
Maciej Małecki
9 5
Jadwiga Wójkowska-Mach
10
Robert Chrzan
11
Aleksander Garlicki
4 5
Tomasz Gosiewski
12 5
Marcin Krzanowski
13 5
Jarosław Surowiec
14 5
Stefan Bednarz
15 5
Marcin Jędrychowski
16 5
Tomasz Grodzicki
3 5
The CraCoV-HHS Investigators

  1. Center for Innovative Therapies, Clinical Research Coordination Center, University Hospital in Cracow, Poland
  2. Department of Rheumatology and Immunology, Jagiellonian University Medical College, Cracow, Poland
  3. Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
  4. Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Cracow, Poland
  5. Steering Committee of the CRACoV-HHS
  6. Deputy Director for Coordination and Development, University Hospital in Cracow, Poland
  7. Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Cracow, Poland
  8. 2nd Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
  9. Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Cracow, Poland
  10. Chair of Microbiology, Medical Faculty, Jagiellonian University Medical College, Cracow, Poland
  11. Department of Radiology, Jagiellonian University Medical College, Cracow, Poland
  12. Department of Molecular Medical Microbiology, Chair of Microbiology, Medical Faculty, Jagiellonian University Medical College, Cracow, Poland
  13. Department of Nephrology and Dialysis Unit, Jagiellonian University Medical College; Deputy Medical Director, University Hospital in Cracow, Poland
  14. Head of Quality, Hygiene and Infection Control Section at University Hospital in Cracow, Poland
  15. Head of Primary Care Unit at University Hospital in Cracow, Poland
  16. Director of University Hospital in Cracow, Poland

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