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Knowledge on multiple interdependences between quality of life (QoL) and behavioural problems in relation to asthma severity and control is undetermined. The aims of the study were: (i) to assess the relationship of QoL and behavioural problems with asthma severity and control (ii) to predict children's "abnormal/borderline" status with variation in QoL. For these purposes a multicenter case-control study on 47 Severe Asthma (SA) and 94 Moderate Asthma (MA) children was performed. The MIMIC approach was applied to investigate the effect of SA and non-controlled asthma (NC) on QoL and behavioural disorders. Logistic regression was used to estimate probabilities of having an "abnormal/borderline" status with variation in QoL. The MIMIC model showed that the magnitude of the effect of SA and NC was larger on QoL (β = −0.37 and β = −0.30, respectively) than on behavioural problems (β = 0.27). With regards to the probability of having a borderline status, in MA a QoL of 1 returned a probability of 0.81, whereas in SA a QoL of 1 returned a probability of 0.89. In conclusion, SA children are highly affected by impaired QoL and behavioural problems. The MIMIC model allowed us to obtain a comprehensive assessment of QoL and behavioural problems with asthma severity and control. [ABSTRACT FROM AUTHOR]

Objective: Older women have frequently low serum 25-hydroxivitamin D (25[OH]D) concentrations, high parathormone (PTH) levels and low bone mineral density (BMD) values. Endogenous synthesis, dietary habits, sunlight exposure and fat-mass-mediated storage may influence 25(OH)D levels and bone metabolism, but the relevance of these factors in the elderly has yet to be fully elucidated. We aimed to investigate the influence of dietary vitamin D intake and fat mass on serum 25(OH)D levels and bone metabolism in older women. Design: Cross-sectional. Setting: Community. Participants: 218 fit older women attending a biweekly mild fitness program. Measurements: Dietary habits was investigated through a 3-day record questionnaire. Serum 25(OH)D and intact parathormone (PTH) concentrations were measured by radioimmunoassay and by a 2-step immunoradiometric assay, respectively. BMD and body composition were estimated using dualenergy X-ray absorptiometry with fan-beam technology. Results: Only fat mass showed a significant negative association with 25(OH)D (β=-3.76, p<0.001), and positive associations with whole body, lumbar, femoral neck and total hip BMD. Binary logistic analysis revealed a protective effect of adiposity on secondary hyperparathyroidism (OR=0.42, 95%CI:0.19-0.92, p=0.03). Dietary vitamin D intake was not associated to any of these outcomes. Conclusion: Fat mass has a greater influence on serum 25(OH)D than dietary vitamin D intake. [ABSTRACT FROM AUTHOR]

Purpose: As studies examining the association between bone mineral density (BMD) and airflow limitation (AL) have produced conflicting results, the current one set out to analyze if and to what degree there are any correlations between these variables in a population of fit elderly women. Methods: One hundred and twenty-one non-smoking, fit and healthy women (age ≥ 65 years) underwent anthropometric assessment, laboratory testing (serum 25-hydroxy vitamin D, parathormone, and cytokine levels), pulmonary function testing (PFT), and dual-energy X-ray absorptiometry to evaluate BMD values of the lumbar and femoral regions. Results: A significant positive association was found between FEV/FVC ratio (Tiffeneau index), a sensitive index of AL, and lumbar and femoral BMD; a 10 % increase in the FEV/FVC ratio resulted in a significant increase of 0.025 g/cm in the total hip ( p = 0.05), 0.027 g/cm in the femoral neck ( p = 0.02), 0.028 g/cm in the femoral trochanter ( p = 0.01), and 0.047 g/cm in the lumbar ( p = 0.03) BMDs. Binary logistic analyses demonstrated more than a threefold higher risk of low BMD values for the lowest FEV/FVC quartile in the lumbar (OR 4.62, 95 % CI 1.48-14.40, p = 0.008), total hip (OR 4.09, 95 % CI 1.28-13.05, p = 0.02 for the second quartile), and femoral trochanter regions (OR 3.90, 95 % CI 1.25-12.20, p = 0.02 for the third quartile). Conclusions: AL was associated with a higher risk of reduced BMD in healthy, fit elderly women. [ABSTRACT FROM AUTHOR]

Introduction Acute decompensated heart failure (ADHF) is a common condition in older people, but little research has been conducted on the appropriate decision pathways for this population. The aim of this review was to explore ADHF management in older people, paying particular attention to the comprehensive geriatric assessment (CGA). Material and methods A search was run in the PubMed literature database, combining the term “acute heart failure” with “management”, “geriatric” “multidisciplinary”, “co-management”, “co-care”, “approach”, and “comprehensive geriatric assessment”, from the database's inception to 1st January 2015. A manual check was also conducted on the reference lists in the articles and reviews identified as relevant to check for any additional sources of information. Results The management of older patients with ADHF depends on the setting. After being assessed at the emergency department, unstable patients could be addressed to intensive care or coronary care units, while the in-hospital solutions for stable patients could be an observation unit or a cardiology or internal medicine ward. For end-stage patients, the hospital at home with telemonitoring and the hospice are worthwhile options. In all these settings, a CGA could improve the management of patients with ADHF. Conclusions The most appropriate pathway for elderly ADHF patient management depends on several factors, including hemodynamic stability, social and family networks. CGA seems to be relevant because it enables a global assessment of this complex patient. Future trials are needed, however, to test whether a multidimensional approach to these patients could reduce their mortality rate and other negative outcomes. [ABSTRACT FROM AUTHOR]

Background/objectives: The objective of this study was to ascertain the effect of weight loss over the course of 1 year on 5-year mortality in old nursing home (NH) residents in different classes of body mass index (BMI).Subjects/methods: A longitudinal study was conducted on 161 NH residents aged ⩾ 70 years at the Istituto di Riposo per Anziani, Padova, Italy. Data were collected using a comprehensive geriatric assessment at baseline and at a 1-year follow-up visit. Mortality was recorded over a 5-year follow-up. We divided our sample into four groups using as cutoffs a BMI of 25 and a weight gain or loss of 5% at 1 year (BMI ⩾ 25 and weight stable/gain, BMI ⩾ 25 and weight loss, BMI<25 and weight stable/gain and BMI <25 and weight loss).Results: People with a BMI ⩾ 25 and weight loss suffered the worst decline in activities of daily living, whereas those with a BMI <25 and weight loss had the most significant decline in nutritional status, which coincided with the worst decline in the Multidimensional Prognostic Index among the groups whose weight changed. Compared with those with a BMI ⩾ 25 and weight stable/gain (reference group), those with a BMI <25 were at the highest risk of dying (in association with weight loss: hazard ratio HR=3.60, P=0.005; in association with weight stable/gain: HR=2.45, P=0.01), and the mortality risk was also increased in people with a BMI ⩾ 25 and weight loss (HR=1.74, P=0.03).Conclusions: In conclusion, weight loss increases the mortality risk in frail, disabled NH residents, even if they are overweight or obese. [ABSTRACT FROM AUTHOR]

Prospective studies have suggested that hypovitaminosis D can predict the onset of obesity, but they relied mainly on body mass index, which could be scarcely reliable in older people. We investigated whether baseline hypovitaminosis D could predict higher fat mass (FM) levels using dual-energy X-ray absorptiometry in a sample of 116 fit and healthy older subjects. Although no significant differences in FM estimates emerged between subjects with and without hypovitaminosis D at the baseline, abdominal FM was found significantly higher in the former group (with hypovitaminosis D at the baseline) than in the latter after 3 years of follow-up. Adjusted logistic regression analysis confirmed these findings: hypovitaminosis D coincided with an approximately sixfold higher risk of subjects having higher abdominal FM levels at the follow-up. In conclusion, hypovitaminosis D predicts higher abdominal FM levels in the elderly. [ABSTRACT FROM AUTHOR]