We found an overall 21.5% (95% CI 18.2-24.9) mortality rate in 1 year and a statistically significant SMR of 1,080 (95% CI 794-1450) and 512.8 (95% CI 366.4-698.3) for the first two periods, 1-30 days and 31-90 days after hospital admission, respectively. For the last period the SMR displayed a statistically nonsignificant trend of 137 (95% CI 99-183). Even in the first 15 days after the index hospital admission, most deaths (55.1%) occurred after hospital discharge, reinforcing the importance of linking hospital mortality databases with general population mortality information systems. The leading three basic causes of death, as reported in death certificates, were cardiovascular events, falls, and infections. This study represents an example of the application of PRL methodology to produce relevant data on hip fracture, a subject of rising epidemiological importance in developing countries.

If the association estimated in our study is causal, our results provide evidence that some hip fracture-related deaths could be prevented by improved patient access to appropriate and timely hospital care in the context of a developing country.

Aim To compare subjective and objective measures of adherence to prophylaxis in haemophilia. Methods In this cross‐sectional study, we compared participants’ self‐perceived adherence and their estimate of the number of clotting factor concentrates (CFCs) that had been missed over the last period of CFC dispensation with an objective measure of adherence based on counts of CFC vials returned by participants. Results We included 29 out of 31 eligible patients in the study. There was no significant correlation between self‐perceived degree of adherence and the objective classification of adherence (Rho: 0.10, 95% CI: −028 to 0.46, P: 0.61) and between the classification of adherence based on the proportion of missed CFC doses assessed by participants’ self‐report and objectively (Rho: 0.32, 95% CI: −0.01 to 0.59, P: 0.11). Conversely, we found evidence of moderate correlation between the proportion of missed CFC doses as assessed by participants’ self‐report and objectively (Rho: 0.56, 95% CI: 0.24 to 0.77, P: 0.003). Participants’ self‐perceived adherence was 3 times more likely to be rated as very good or good than it was for the objective assessment to be classified as adherent or suboptimally adherent. Conclusion Our results showed significant discrepancies between subjective and objective measures of adherence, which likely reflect the influence of social desirability bias in self‐reported measures and different concepts of adherence between patients/caregivers and haemophilia experts. Additionally, our results allow us to hypothesize that studies on adherence to prophylaxis in haemophilia relying exclusively on information from self‐reports and questionnaires may substantially overestimate adherence levels.

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).

Only a small number of the Cochrane collaboration's systematic reviews support clinical interventions with no need for additional research. A larger number of high-quality randomized clinical trials are necessary to change the 'insufficient evidence' scenario for clinical practice illustrated by the Cochrane database. It is recommended that we should produce higher-quality primary studies in active collaboration and consultation with global scholars and societies so that this can represent a major component of methodological advance in this context.