Probability Distributions.- Linear Models for Regression.- Linear Models for Classification.- Neural Networks.- Kernel Methods.- Sparse Kernel Machines.- Graphical Models.- Mixture Models and EM.- Approximate Inference.- Sampling Methods.- Continuous Latent Variables.- Sequential Data.- Combining Models.

Pattern Recognition and Machine Learning

Multimorbidity and mortality in older adults: A systematic review and meta-analysis.

Objective To systematically review the research conducted on prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries (LMICs) and to estimate the pooled prevalence of frailty and prefrailty in community-dwelling older adults in LMICs. Design Systematic review and meta-analysis. PROSPERO registration number is CRD42016036083. Data sources MEDLINE, EMBASE, AMED, Web of Science, CINAHL and WHO Global Health Library were searched from their inception to 12 September 2017. Setting Low-income and middle-income countries. Participants Community-dwelling older adults aged ≥60 years. Results We screened 7057 citations and 56 studies were included. Forty-seven and 42 studies were included in the frailty and prefrailty meta-analysis, respectively. The majority of studies were from upper middle-income countries. One study was available from low-income countries. The prevalence of frailty varied from 3.9% (China) to 51.4% (Cuba) and prevalence of prefrailty ranged from 13.4% (Tanzania) to 71.6% (Brazil). The pooled prevalence of frailty was 17.4% (95% CI 14.4% to 20.7%, I2=99.2%) and prefrailty was 49.3% (95% CI 46.4% to 52.2%, I2=97.5%). The wide variation in prevalence rates across studies was largely explained by differences in frailty assessment method and the geographic region. These findings are for the studies with a minimum recruitment age 60, 65 and 70 years. Conclusion The prevalence of frailty and prefrailty appears higher in community-dwelling older adults in upper middle-income countries compared with high-income countries, which has important implications for healthcare planning. There is limited evidence on frailty prevalence in lower middle-income and low-income countries. PROSPERO registration number CRD42016036083.

https://bmjopen.bmj.com/content/bmjopen/8/3/e018195.full.pdf

Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis.

Background
Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease.

Objectives
To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under.

Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase Classic and Embase to identify eligible trials on 30 September 2016. We searched CINAHL and PsycINFO in July 2016, Proquest Dissertations and Theses in November 2016 and three clinical trial registers in November 2016 and June 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials.

Selection criteria
We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.

Data collection and analysis
Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures.We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures.

Main results
We included 50 trials with 137 trial arms and 10,267 participants. Thirty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Eleven trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.

Thirteen of the 50 included trials were judged as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias of remaining studies.

Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% CI 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 grams of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).

Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions.Studies reported receiving governmental or charitable funds, except for two studies reporting industry funding.

Authors' conclusions
Despite identifying 50 eligible trials of various intervention approaches, the evidence for how to increase fruit and vegetable consumption of children remains sparse. There was very low-quality evidence child-feeding practice interventions are effective in increasing vegetable consumption of children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption of children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.

This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

Introduction: Frailty is one of the greatest challenges facing our aging population, as it can lead to adverse outcomes such as institutionalization, hospitalization, and mortality. However, the factors that are associated with frailty are poorly understood. We performed a systematic review of longitudinal studies in order to identify the sociodemographic, physical, biological, lifestyle-related, and psychological risk or protective factors that are associated with frailty among community-dwelling older adults. Methods: A systematic literature search was conducted in the following databases in order to identify studies that assessed the factors associated with of frailty among community-dwelling older adults: Embase, Medline Ovid, Web of Science, Cochrane, PsychINFO Ovid, CINAHL EBSCOhost, and Google Scholar. Studies were selected if they included a longitudinal design, focused on community-dwelling older adults aged 60 years and older, and used a tool to assess frailty. The methodological quality of each study was assessed using the Quality of Reporting of Observational Longitudinal Research checklist. Results: Twenty-three studies were included. Significant associations were reported between the following types of factors and frailty: sociodemographic factors (7/7 studies), physical factors (5/6 studies), biological factors (5/7 studies), lifestyle factors (11/13 studies), and psychological factors (7/8 studies). Significant sociodemographic factors included older age, ethnic background, neighborhood, and access to private insurance or Medicare; significant physical factors included obesity and activities of daily living (ADL) functional status; significant biological factors included serum uric acid; significant lifestyle factors included a higher Diet Quality Index International (DQI) score, higher fruit/vegetable consumption and higher tertile of all measures of habitual dietary resveratrol exposure; significant psychological factors included depressive symptoms. Conclusions: A broad range of sociodemographic, physical, biological, lifestyle, and psychological factors show a longitudinal association with frailty. These factors should be considered when developing interventions aimed at preventing and/or reducing the burden associated with frailty among community-dwelling older adults.

/pdf/risk-factors-and-protective-factors-associated-with-incident-38n8g7stxt.pdf

Risk factors and protective factors associated with incident or increase of frailty among community-dwelling older adults: A systematic review of longitudinal studies.

The main focus of this study was the effect of chronic disease (hypertension, diabetes mellitus, heart disease, lung disease, cancer, and arthropathy) on the functional status (activities of daily living - ADL, instrumental activities of daily living - IADL) among the elderly, controlling for age, gender, living arrangements, education, and comorbidity. The analysis was based on information provided by the SABE Project, from the city of Sao Paulo, Brazil, including individuals 60 years of age and over (n = 1,769), from January 2000 to March 2001. A multinomial logistic regression model was used. Compared to the absence of dependency category, heart disease (OR = 1.82), arthropathy (OR = 1.59), lung disease (OR = 1.50), and hypertension (OR = 1.39) were the main diseases that affected the IADL dependency category. Lung disease (OR = 2.58), arthropathy (OR = 2.27), hypertension (OR = 2.13), and heart disease (OR = 2.10) had important impact on the IADL and ADL dependency categories. The results were statistically significant (p < 0.05).

/pdf/the-effect-of-chronic-diseases-on-functional-status-of-the-5234wpn5i6.pdf

The effect of chronic diseases on functional status of the elderly living in the city of São Paulo, Brazil

OBJETIVO: Investigar a influencia de determinantes demograficos e socioeconomicos, das doencas cronicas e da capacidade funcional sobre a autopercepcao de saude entre os idosos do Municipio de Sao Paulo e verificar a existencia de diferencas entre os sexos quanto a autopercepcao de saude. METODOS: O estudo foi desenvolvido com base em dados do Projeto Saude, Bem-Estar e Envelhecimento na America Latina e Caribe (SABE). Foram analisados os dados de 2 135 idosos (sendo 58,6% mulheres; idade media e mediana = 69,4 e 68,0 anos). A variavel dependente foi a autopercepcao de saude (ruim ou boa). As variaveis independentes foram: as demograficas (idade, sexo, estado conjugal e arranjo familiar), as socioeconomicas (educacao e renda), o numero de doencas cronicas (hipertensao, artrite ou reumatismo, doenca cardiovascular, diabetes, asma, bronquite ou enfisema, embolia ou acidente vascular cerebral e câncer) e a capacidade funcional. Para estimar a associacao entre a autopercepcao de saude e as variaveis independentes e estudar as diferencas entre os sexos, foi realizada uma analise de regressao logistica binaria multipla. RESULTADOS: A presenca de doencas cronicas associada ao sexo do idoso foi o determinante mais fortemente relacionado a autopercepcao de saude no Municipio de Sao Paulo. Para os homens, a presenca de quatro ou mais doencas cronicas implicou um risco 10,53 vezes maior de uma autopercepcao ruim de saude. Para as mulheres, esse risco foi 8,31 vezes maior. A capacidade funcional, o nivel de escolaridade e a renda tambem foram altamente associados com a percepcao de saude, e a idade teve uma significativa influencia. Na ausencia de doencas cronicas, ou na presenca de duas ou mais doencas cronicas, as mulheres idosas tiveram maior probabilidade de relatar uma boa autopercepcao de saude em comparacao com os homens. CONCLUSOES: Os resultados indicam a necessidade de acoes integradas que abordem simultaneamente os principais fatores determinantes da autopercepcao de saude como forma de promover o bem-estar e a qualidade de vida dos idosos.

/pdf/determinants-of-self-rated-health-among-elderly-persons-in-4gu3d4ia2q.pdf

[Determinants of self-rated health among elderly persons in São Paulo, Brazil].

/pdf/determinantes-da-autopercepcao-de-saude-entre-idosos-do-3v7ajyb9aj.pdf

Determinantes da autopercepção de saúde entre idosos do Município

Frailty is a syndrome that leads to practical harm in the lives of elders, since it is related to increased risk of dependency, falls, hospitalization, institutionalization, and death. The objective of this systematic review was to identify the socio-demographic, psycho-behavioral, health-related, nutritional, and lifestyle factors associated with frailty in the elderly. A total of 4,183 studies published from 2001 to 2013 were detected in the databases, and 182 complete articles were selected. After a comprehensive reading and application of selection criteria, 35 eligible articles remained for analysis. The main factors associated with frailty were: age, female gender, black race/color, schooling, income, cardiovascular diseases, number of comorbidities/diseases, functional incapacity, poor self-rated health, depressive symptoms, cognitive function, body mass index, smoking, and alcohol use. Knowledge of the complexity of determinants of frailty can assist the formulation of measures for prevention and early intervention, thereby contributing to better quality of life for the elderly.

/pdf/health-related-and-socio-demographic-factors-associated-with-1dtimjselj.pdf

Health-related and socio-demographic factors associated with frailty in the elderly: a systematic literature review

This article aims to review the main concepts and measures of functional disability currently used in studies focusing on this subject. According to this review, functional disability can be defined as a difficulty or the need for help for performing basic or more complex daily activities necessary for keeping an independent life in the community. As refers to measurement criteria, the studies do not follow a clear-cut standard, varying substantially in relation to scales, dimensions and classifications besides depending directly or indirectly on the kind of available information. A correct method for rating functional disability does not exist at yet. For this reason it is essential that the researchers clearly indicate the concept of functional disability used in the studies and detail, which measures or tools were applied.

/pdf/conceituando-e-mensurando-a-incapacidade-funcional-da-25uhm6nyhn.pdf

Luciana Correia Alves

Papers

The effect of chronic diseases on functional status of the elderly living in the city of São Paulo, Brazil

[Determinants of self-rated health among elderly persons in São Paulo, Brazil].

Determinantes da autopercepção de saúde entre idosos do Município

Health-related and socio-demographic factors associated with frailty in the elderly: a systematic literature review

Conceituando e mensurando a incapacidade funcional da população idosa: uma revisão de literatura