Adult Mortality Research Articles

Global variations in elderly cancer mortality pattern in 2020 & prediction to 2040: A population-based study

Background & objectives Cancer contributes to decreasing life expectancy, especially in low- and middle- income countries (LMIC) and countries in transition where resources for diagnosis and care are limited. As the world population is ageing, and by 2050, two-thirds of the population in LMIC will be elderly, the greater impact of cancer on the expectation of life in years at a given age of an adult will be seen in these countries. Methods Estimated cancer mortality for older adults (60 yr or above) was estimated using statistics available on Globocan 2020 platform (gco.iarc.fr). This platform provided the number of deaths and age‐standardized truncated mortality rates (per 100,000) by sex and continent. We calculated the projected cancer deaths in 2040 by applying the projection model, considering a stable rate. Results Globally, with an estimated 7.5 million deaths, cancer deaths in older population represented a total of 71.2 per cent of all cancer-related deaths. The truncated age-adjusted mortality rate among the older population (both sexes) was estimated as 615.1 deaths per 100,000 and the mortality rate was 62.6 per cent higher in elderly (60 yr or above) males as compared to elderly females. The overall future cancer death among the elderly was estimated to increase from 7.05 to 12.7 million deaths, representing a total 80.2 per cent increase in deaths by 2040. Interpretation & conclusions The projected mortality increase will challenge existing healthcare systems, especially in lower or lower medium-income countries where resources are limited. Elderly patients are at an elevated risk of adverse outcomes due to the high prevalence of co-morbid conditions. Geriatric oncology will play an important role in the coming years to ensure the overall health and well-being of elderly patients, which needs to be supported by good stratified data on elderly cancer.

The role of platelets and megakaryocytes in sepsis and ARDS.

Since the global COVID-19 pandemic, there has been a renewed focus on lung injury during infection. Systemic inflammatory responses such as acute respiratory distress syndrome (ARDS) and sepsis are a leading cause of morbidity and mortality for both adults and children. Improvements in clinical care have improved outcomes but mortality remains ∼40% and significant morbidity persists for those patients with severe disease. Mechanistic studies of the underlying biological processes remain essential to identifying therapeutic targets. Furthermore, methods for identifying the underlying drivers of organ failure are key to treating and preventing tissue injury. In this review, we discuss the contribution of megakaryocytes (MKs) and platelets to the pathogenesis of systemic inflammatory syndromes. We explore the role of MKs and the new identification of extramedullary MKs during sepsis. We describe the alterations in the platelet transcriptome during sepsis. Lastly, we explore platelet function as defined by aggregation, activation and the formation of heterotypic aggregates. Much more work is necessary to explore the contribution of platelets to these heterogenous syndromes, but the foundation of platelets as key contributors to inflammation has been laid.

Handgrip strength as a predictor of 1‑year mortality after hip fracture surgery in the Colombian Andes Mountains.

The aim of this study was to determine the association between low HGS and 1-year mortality in a cohort of older patients over 60years old with fragility hip fractures who underwent surgery in the Colombian Andes Mountains. A total of 126 patients (median age 81years, women 77%) with a fragility hip fracture during 2019-2020 were admitted to a tertiary care hospital. HGS was measured using dynamometry upon admission, and data about sociodemographic, clinical and functional, laboratory, and surgical intervention variables were collected. They were followed up until discharge. Those who survived were contacted by telephone at one, three, and 12months. Bivariate, multivariate, and Kaplan-Meier analyses with survival curves were performed. The prevalence of low HGS in the cohort was 71.4%, and these patients were older, had poorer functional and cognitive status, higher comorbidity, higher surgical risk, time from admission to surgery > 72h, lower hemoglobin and albumin values, and greater intra-hospital mortality at one and three months (all p < 0.01). Mortality at one year in in patients with low HGS was 42.2% and 8.3% in those with normal HGS, with a statistically significant difference (p = 0.000). In the multivariate analysis, low HGS and dependent gait measured by Functional Ambulation Classification (FAC) were the factors affecting postoperative 1-year mortality in older adults with hip fractures. In this study of older people with fragility hip fractures, low HGS and dependent gait were independent predictive markers of 1-year mortality.

Social inequalities in adult mortality across Europe (18th-21st centuries): A critical analysis of theories and evidence

This study examines the historical evolution of socioeconomic disparities in adult mortality, with a focus on European societies. Despite the widespread improvements in population health, social inequalities in mortality are a pervasive phenomenon nowadays. This paper employs a critical analysis of both theoretical and empirical literature to investigate major international studies and their findings on longevity differences associated with socioeconomic status from the nineteenth century to the early twenty-first century. Findings reveal that adult mortality trajectories have differed notably across social classes and regions, with some areas exhibiting disparities before the demographic transition and others showing inequalities emerging later. Understanding these long-term health inequality trends sheds light on the changing influence of medical advances and their interplay with economic growth, educational disparities, environmental factors, state roles, and production distribution, which have shaped mortality disparities through different development stages. These factors elucidate the international heterogeneity of results until the mid-twentieth century and offer explanatory insights into observed north-south patterns in Europe. Our findings contribute to a deeper understanding of how advancements in public health, economic development, and social policies have shaped health outcomes over centuries. The implications of this research inform ongoing debates and health policy, emphasizing a nuanced interpretation of historical data to craft effective strategies that address health inequalities today.

Effect of oral health on functional disability and mortality in older adults in Japan: a cohort study.

Oral health has previously shown associations with functional disability and mortality. We aimed to explore the associations of various aspects of oral health status with functional disability and mortality using survival analysis, as well as the relative magnitudes of the impact of these aspects on outcomes. We obtained data for individuals aged 75years and older in Shimane, Japan, who had at least one oral health check-up between April 1, 2016, and March 31, 2022under Japan's long-life medical care system insurance system. Those with missing data or with functional disability at baseline were excluded. 13aspects of oral health status were assessed by dentists or dental hygienists as part of the check-up (using protocols provided by the JapanDental Association and the Japanese Ministry of Health, Labour and Welfare): number of remaining teeth, subjective masticatory performance, objective masticatory performance, periodontal tissue status, functional dysphagia, tongue mobility, articulation, oral hygiene, number of decayed teeth, inadaptation of dentures of the upper jaw and lower jaw (considered separately), oral mucosal disease, and dry mouth. Multivariate Cox proportional hazards models were used to analyse the associations between each aspect of oral health and functional disability and mortality, with fully adjusted models adjusting for sex, age, BMI, medical history, or a propensity score derived from these covariates. Population-attributable fractions (PAFs) were calculated to assess the differential impacts of these oral health status aspects on outcome occurrence. Of the 24 619individuals who had an oral health check-up during the study period, 21 881individuals wereincluded in the analysis of functional disability (9175 [41·93%] men, 12 706 [58·07%] women, mean age 78·31years [SD 2·88], mean follow-up 41·43months [20·80]), and 22 747individuals in the analysis of mortality (9722 [42·74%] men, 13 025 [57·26%] women, mean age 78·34years [2·89], mean follow-up 42·63months [20·58]). All 13aspects of oral health status showed significant associations with the occurrence of mortality, while functional disabilitywas associated with 11aspects (excluding oral mucosal disease and dry mouth) in the fully adjusted model. Based on PAFs, of all oral health aspects assessed, objective masticatory performance hadthegreatestimpact on both functional disability (PAF 23·10% [95% CI 20·42-25·69] for the lowest and 10·62% [8·18-12·99] for the second-lowest quartile of performance) and mortality (16·47% [13·44-19·40] and 8·90% [5·87-11·82]). Various aspects of oral health are associated with mortality and functional disability. Maintaining good oral health in older adults might help to reduce these outcomes. None.

Health, economic and social impacts of the Brazilian cash transfer program on the lives of its beneficiaries: a scoping review

BackgroundThe Bolsa Família cash transfer Program (BFP) aims to break the poverty cycle by providing a minimum income to poor families conditioned on their investment in human capital (such as, education and health) and currently is the largest Program in the world in terms of the number of beneficiaries. Because there is a scarcity of reviews grouping studies on the impacts of the BFP, the objective of this scoping review was to identify and describe studies which evaluate the impact of the BFP on poverty, health, education, and other related outcomes.MethodsWe searched for quantitative, qualitative, and mixed-method articles that assessed the impact of the BFP on any aspect of the beneficiaries' lives between 2003 and March 2021. We included quantitative articles that used experimental, quasi-experimental or pre and post comparison designs. We excluded articles that analyzed impacts on political outcomes. There was no age restriction for the participants. The search was done in seven electronic databases.ResultsOne thousand five hundred forty-six papers were identified and 94 fulfilled the inclusion criteria. Poverty and health outcomes were the most common outcomes studied. We found consistent evidence of the positive impact of the BFP on poverty reduction, as well as employment outcomes. We also found positive impacts in relation to mortality rates for children and adults, school dropout and school attendance among children and adolescents, and violence related outcomes such as homicide, suicide, crime, and hospitalization. However, we also found some evidence that BFP increased intimate partner violence and gender stereotypes among women and no evidence of impact on teenage pregnancy.ConclusionsOverall, the studies included found that BFP showed positive impacts on most poverty, health and education outcomes. More studies are needed to confirm some results, especially about violence and stereotype against women as there were few evaluations on these outcomes.

Molecular Insight into Obesity-Associated Nephropathy: Clinical Implications and Possible Strategies for its Management.

Obesity is a significant health concern due to its rapid increase worldwide. It has been linked to the pathogenic factors of renal diseases, cancer, cardiovascular diseases, hypertension, dyslipidemia, and type 2 diabetes. Notably, obesity raises the likelihood of developing chronic kidney disease (CKD), leading to higher adult mortality and morbidity rates. This study explores the molecular mechanisms that underlie obesity-associated nephropathy and its clinical implications. Obesity-Associated Nephropathy (OAN) develops and worsens due to insulin resistance and hyperinsulinemia, which promote renal sodium reabsorption, glomerular hyperfiltration, and hypertension, leading to progressive kidney damage. Renal damage is further aggravated by persistent inflammation and redox damage, mediated by adipokines and proinflammatory cytokines, such as TNF-α and IL-6. Furthermore, stimulation of the sympathetic nervous system and the renin-angiotensin- aldosterone system (RAAS) intensifies glomerular hypertension and fibrosis. These elements cause glomerular hyperfiltration, renal hypertrophy, and progressive kidney damage. Clinical manifestations of obesity-associated nephropathy include proteinuria, reduced glomerular filtration rate (GFR), and ultimately, CKD. Management strategies currently focus on lifestyle modifications, such as weight loss through diet and exercise, which have been effective in reducing proteinuria and improving GFR. Pharmacological treatments targeting metabolic pathways, including GLP-1 receptor agonists and SGLT2 inhibitors, have shown renoprotective properties. Additionally, traditional RAAS inhibitors offer therapeutic benefits. Early detection and comprehensive management of OAN are essential to prevent its progression and lessen the burden of CKD.

Impact of mental disorders on the all-cause mortality and cardiovascular disease outcomes in adults with new-onset type 1 diabetes: A nationwide cohort study

AimsThis population-based study aimed to investigate the impact of mental disorders on the risk of mortality and cardiovascular disease (CVD) outcomes in adults with new-onset type 1 diabetes. Materials and methodsWe included 17,429 patients with new-onset type 1 diabetes without CVD from the Korean National Health Insurance Service database. Mental disorders include depression, bipolar, persistent affective and other affective disorders, anxiety, eating disorders, personality and behavioral disorders, and substance abuse. Individuals with or without mental disorders were matched 1:1 by age, sex, and year of the index date. The primary outcomes were all-cause mortality and composite CVD events. Hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using multivariate Cox proportional hazards regression models. ResultsDuring a median follow-up of 7.99 years, all-cause mortality (composite CVD outcomes) occurred in 1,562 patients (1,993 patients with CVD outcomes) with mental disorders and 1,211 patients (1,611 patients with CVD outcomes) without mental disorders. The adjusted HR for all-cause mortality and composite CVD outcomes in patients with mental disorders was 1.35 and 1.32, respectively, compared to those without mental disorders. The aHR for the all-cause mortality and composite CVD events was 1.27 and 1.28 in the subgroup with one mental disorder and 1.57 and 1.43 in the subgroup with multiple mental disorders, compared to those without mental disorders. ConclusionsMental disorders are associated with an elevated risk of all-cause mortality and CVD in adults with newly diagnosed type 1 diabetes. Early detection and greater attention to premature death and CVD development are required in patients with new-onset type 1 diabetes and mental disorders.

Demographic-based disparities in outcomes for adults with central line-associated bloodstream infections in the United States: a National Inpatient Sample database study (2016-2020).

Central line-associated bloodstream infections (CLABSI) are prevalent and preventable hospital-acquired infections associated with high morbidity and costs. Disparities based on race, ethnicity, and hospital factors remain underexplored. This study compares cost, length of stay, and mortality for adults with CLABSI by race-ethnicity, hospital location-teaching status, and geographic region in the United States using data from the National Inpatient Sample (NIS) database from 2016 to 2020. The hospitalization cohort included adults diagnosed with CLABSI, excluding those with primary CLABSI diagnoses, cancer, immunosuppressed states, or neonatal conditions. Primary outcomes were in-hospital mortality, length of stay, and hospital costs, adjusted to mid-year 2020 US dollars. Independent variables included race-ethnicity, hospital location-teaching status, and geographic region. All analyses accounted for NIS sampling design. From 2016 to 2020, there were approximately 19,835 CLABSI hospitalizations. The overall in-hospital mortality rate was 9.1%, with a median hospital stay of 16.9 days and median cost of $44,810. Hispanic patients experienced significantly higher mortality, longer length of stay, and higher costs compared to non-Hispanic Black and White patients. Urban teaching hospitals had longer stays and higher costs than rural and urban non-teaching hospitals. Regionally, the Northeast and West had higher costs and longer stays than the Midwest and South, but mortality rates did not differ significantly. This study highlights significant disparities in CLABSI outcomes based on demographic factors. Addressing these disparities is crucial for improving CLABSI management and healthcare equity. Further research should explore the underlying causes of these differences to inform targeted interventions.

Deciphering Osteosarcopenia through the hallmarks of aging

Osteosarcopenia is a major driver of functional loss and a risk factor for falls, fractures, disability and mortality in older adults, urgently requiring the development of effective interventions to address it. The hallmarks of aging provide a theoretical and practical framework that allows for the structured organization of current knowledge and the planning of new development lines. This article comprehensively reviews the currently available literature on the role of the hallmarks of aging in the development of osteosarcopenia, thereby offering a panoramic view of the state of the art and knowledge gaps in this field.

Acceptability of a remotely delivered sedentary behaviour intervention to improve sarcopenia and maintain independent living in older adults with frailty: a mixed-methods study

BackgroundSarcopenia is a leading cause of functional decline, loss of independence, premature mortality, and frailty in older adults. Reducing and breaking up sedentary behaviour is associated with positive sarcopenia and frailty outcomes. This study aimed to explore the acceptability, engagement and experiences of a remotely delivered sedentary behaviour intervention to improve sarcopenia and independent living in older adults with frailty.MethodsThis was a mixed-methods study. In-depth qualitative semi-structed interviews were conducted with a subset (N = 15) of participants with frailty (aged 74 ± 6 years) who had participated in the Frail-LESS (LEss Sitting and Sarcopenia in Frail older adults) intervention aimed at reducing sedentary behaviour. The interviews explored acceptability of the intervention overall and its individual components (a psychoeducation workbook, wrist-worn activity tracker, health coaching, online peer support and tailored feedback on sitting, standing and stepping). Process evaluation questionnaires with closed and scaled questions explored intervention engagement, fidelity and experiences.ResultsOverall acceptability of the intervention was good with most participants perceiving the intervention to have supported them in reducing and/or breaking up their sedentary behaviour. The wrist-worn activity tracker and health coaching appeared to be the most acceptable and useful components, with high levels of engagement. There was attendance at 104 of 150 health coaching sessions offered and 92% of participants reported using the wrist-worn activity tracker. There was a mixed response regarding acceptability of, and engagement with, the psychoeducation workbook, tailored feedback, and online peer support.ConclusionsThe Frail-LESS intervention had good levels of acceptability and engagement for some components. The findings of the study can inform modifications to the intervention to optimise acceptability and engagement in a future definitive randomised controlled trial.Trial registrationThe trial was registered with ISRCTN (number ISRCTN17158017).

Frailty or sarcopenia: which is a better indicator of mortality risk in older adults?

BackgroundDespite the different conditions, frailty and sarcopenia overlap regarding their common link: the assessment of walking speed and muscle strength. This study aimed to compare the frailty phenotype to the...

Effects of wind farms on raptors: A systematic review of the current knowledge and the potential solutions to mitigate negative impacts

AbstractWind farms are a clean and efficient source of renewable energy. However, they cause negative impacts on raptors. Here, we present a review of the existing scientific literature on the effects of wind farms on raptors' ecology with a particular interest in the potential solutions. After collecting 216 studies, we found a consensus in the literature that raptors exhibit avoidance behaviors, and that the abundance of raptors decreases after wind farm installation, although it might recover over time. The position of wind farms on mountaintop ridges poses a particular danger to large soaring raptors, as they rely on orographic uplift to gain altitude. Adult mortality significantly affects population dynamics, particularly in endangered species, but young inexperienced individuals show a higher collision risk. The combination of different methods including field monitoring, GPS telemetry and systematic search for carcasses is an adequate approach to further investigate the problem and solutions. Shutdowns on demand, the installation of deterrents, turbine micro‐sitting and the repowering of wind farms have been suggested as potential solutions, although results are contradictory and case‐specific. Furthermore, it is essential to report the potential occurrence of conflicts of interest in scientific papers, as they can influence the interpretation of the results. Finally, from a future perspective, it is crucial to assess the effectiveness of solutions to mitigate the negative effects of wind farms to promote raptor conservation. This becomes increasingly relevant in the context of renewable energy development and increasing energy demand worldwide.

Investigation of the Effect of the COVID-19 Pandemic Period on Respiratory Tract Viruses at Istanbul Medical Faculty Hospital, Turkey.

Aim: Respiratory viruses significantly impact public health, contributing to high morbidity and mortality rates in both children and adults. This study evaluates the distribution and incidence of respiratory tract viruses in our hospital from 2019 to 2022, focusing on changes post-COVID-19 pandemic. Material and Methods: Utilizing molecular methods, we analyzed nasopharyngeal swabs with the FTD Respiratory Pathogens 21 kit and the QIAStat Dx Respiratory Panel kit at Istanbul Faculty of Medicine. A total of 1186 viruses were detected in 2488 samples (47.6% of the total) examined with the FTD Respiratory Pathogens 21 kit between 2019 and 2022. Results: It was determined that the detection rates were 52.8% in 2019, 44.3% in 2020, 50.0% in 2021, and 40.0% in 2022. Notable changes in prevalence were observed for pandemic influenza A (IAV-H1N1pdm2009), parainfluenza virus (PIV)-3, rhinovirus (RV), and respiratory syncytial virus (RSV)-A/B (p < 0.05). RV consistently showed the highest detection rates across all years (17.6% to 7.9%). Additionally, 1276 viruses were detected in 1496 samples using the QIAStat DX kit, with 91.3% positivity in 2021 and 78.6% in 2022, highlighting the kit's effectiveness in rapid diagnosis. Conclusions: This study enhances understanding of respiratory virus epidemiology during and after the pandemic, emphasizing the need for ongoing surveillance and strategic public health measures to address the evolving landscape of respiratory infections.

Cluster-Based White Matter Signatures and the Risk of Dementia, Stroke, and Mortality in Community-Dwelling Adults.

Markers of white matter (WM) injury on brain MRI are important indicators of brain health. Different patterns of WM atrophy, WM hyperintensities (WMHs), and microstructural integrity could reflect distinct pathologies and disease risks, but large-scale imaging studies investigating WM signatures are lacking. This study aims to identify distinct WM signatures using brain MRI in community-dwelling adults, determine underlying risk factor profiles, and assess risks of dementia, stroke, and mortality associated with each signature. Between 2005 and 2016, we measured WMH volume, WM volume, fractional anisotropy (FA), and mean diffusivity (MD) using automated pipelines on structural and diffusion MRI in community-dwelling adults aged older than 45 years of the Rotterdam study. Continuous surveillance was conducted for dementia, stroke, and mortality. We applied hierarchical clustering to identify separate WM injury clusters and Cox proportional hazard models to determine their risk of dementia, stroke, and mortality. We included 5,279 participants (mean age 65.0 years, 56.0% women) and identified 4 distinct data-driven WM signatures: (1) above-average microstructural integrity and little WM atrophy and WMH; (2) above-average microstructural integrity and little WMH, but substantial WM atrophy; (3) poor microstructural integrity and substantial WMH, but little WM atrophy; and (4) poor microstructural integrity with substantial WMH and WM atrophy. Prevalence of cardiovascular risk factors, lacunes, and cerebral microbleeds was higher in clusters 3 and 4 than in clusters 1 and 2. During a median 10.7 years of follow-up, 291 participants developed dementia, 220 had a stroke, and 910 died. Compared with cluster 1, dementia risk was increased for all clusters, notably cluster 3 (hazard ratio [HR] 3.06, 95% CI 2.12-4.42), followed by cluster 4 (HR 2.31, 95% CI 1.58-3.37) and cluster 2 (HR 1.67, 95% CI 1.17-2.38). Compared with cluster 1, risk of stroke was higher only for clusters 3 (HR 1.55, 95% CI 1.02-2.37) and 4 (HR 1.94, 95% CI 1.30-2.89), whereas mortality risk was increased in all clusters (cluster 2: HR 1.27, 95% CI 1.06-1.53, cluster 3: HR 1.65, 95% CI 1.35-2.03, cluster 4: HR 1.76, 95% CI 1.44-2.15), compared with cluster 1. Models including clusters instead of an individual imaging marker showed a superior goodness of fit for dementia and mortality, but not for stroke. Clustering can derive WM signatures that are differentially associated with dementia, stroke, and mortality risk. Future research should incorporate spatial information of imaging markers.

Evaluation of three inert materials in controlling Cowpea weevil (&lt;em&gt;Callasobruchus maculatus&lt;/em&gt; F.) on stored cowpea (&lt;em&gt;Vigna unguiculate&lt;/em&gt; L.)

Eco-friendly inert materials can be achieved minimizing insect damages, this study was conducted to explore the efficacy of the three inert materials at 20% (w/w) paddy husk ash (PHA), fine dry sea salt and tiny bricks against the cowpea weevil C. maculatus on stored cowpea (V. unguiculata) on the basis of adulticidal effects and asses the influence against germination losses of the seeds. The result exhibited a significant difference (p≤ 0.0001) in their level of weevil attack during the storage. Maximum 100% adult mortality was recorded in the cowpea seeds incorporated with PHA after 96 hours of the treatment followed by dry salt it was observed 94% at the 5th day whereas, tiny bricks killed only 20% weevils as untreated control until 5th day after the treatment. Further, PHA treated seeds much reduced the capable of the egg laying capacity of weevil (9.8± 0.58eggs/ female) as well as minimized the production of new progenies (13.6 ± 0.37) and also there were recorded 0.03% weight loss and zero percent germination losses proving it to be best protectant on stored cowpea. However, significantly (p≤ 0.0001) any adverse effects that, egg laying capacity and new progeny production did not visible in dry salt up to 90 days after the treatments except minimize the germination loss. Among the inert materials used, tiny bricks were found ineffective to cause adult mortality, fecundity and adult emergency in F1 generation (119.8± 1.78), it was further increased production of new weevils obtained following the next F2 generation (1301 ± 0.65) and play down the losses of weight and germination of the seeds. Considering it was noticed tiny bricks treated seeds significantly equivalence with the level of damage by the weevil C. maculatus in untreated control on stored cowpea.

7465 Impact Of Geography And Insurance On Healthcare Utilization Preferences Of Individuals With Congenital Adrenal Hyperplasia In The United States

Abstract Disclosure: P.N. Surampudi: Research Investigator; Self; Spruce Biosciences. A.H. Hamrahian: Consulting Fee; Self; Spruce Biosciences. Research Investigator; Self; Spruce Biosciences. R. Charlton: Employee; Self; Spruce Biosciences. P. Ramtin: Employee; Self; Spruce Biosciences. M.E. Geffner: Consulting Fee; Self; Spruce Biosciences, Ferring Pharmaceuticals, Adrenas, Neurocrine Biosciences, Novo Nordisk, Eton, Pfizer, Inc., Nutritional Growth Solutions, Nutritional Growth Solutions. Research Investigator; Self; Novo Nordisk. Background: Relative to the general population, patients with classic congenital adrenal hyperplasia (CAH) have increased risks for morbidity and mortality which require specialized management across life stages[1]. Endocrine care, particularly as part of multi-disciplinary teams, can help mitigate risks of developing adrenal crises as well as the impact of glucocorticoid under- or overexposure, including adrenal insufficiency; cardiometabolic risk associated with insulin resistance and excess weight gain; fertility issues associated with irregular menses and gonadal adrenal rest tumors; diminished quality of life; increased mental health issues, including anxiety, depression, and sleep disturbance; and increased fracture risk associated with decreased bone mineral density. Study Objectives and Design: We hypothesized that the utilization of endocrine and multi-disciplinary care by patients with CAH in the United States (U.S.) could be adversely affected by non-therapeutic factors related to geographic location and access to health care. In this cross-sectional study, we utilized the Definitive Healthcare database (Nov. 2020-Nov. 2022) to gain insight into these factors in adults with CAH. Study Findings: Analysis of healthcare provider utilization revealed that only ∼30% of U.S. adults with CAH received care from endocrinologists. The rest utilized primary-care providers (PCPs: IM, FP, NP, PA, and Ob-Gyn) to obtain care. A review of insurance coverage of U.S. adults with CAH suggests that ∼70% had access to commercial insurance and over 50% resided in states with the largest populations (California, Texas, New York, Florida, Ohio, Michigan, and Illinois), both factors which should ordinarily increase accessibility of subspecialty endocrine and multi-disciplinary care. Conclusions: In our study, only 30% of U.S. CAH adults received care from an endocrinologist. Limited utilization of specialty care does not appear to be due to either diverse geographical distribution or access to healthcare. The gap in expert care may adversely affect the management of CAH and contribute to associated comorbidities. Increased partnership between PCPs and endocrinologists, and increased awareness and education regarding specialty care among patients with CAH are needed to improve health outcomes and thereby reduce the risk of morbidity and mortality in adults with CAH.

Assessment of larvicidal, growth-suppressing, and developmentaltering bioefficacy of Ageratum houstonianum against Aedes aegypti (L.).

Aedes aegypti is a major vector responsible for spreading dengue, chikungunya, yellow fever, and Zika viruses worldwide. These illnesses have increased globally due to climate and environmental changes. Vector control and management are the principal tactics for combating mosquitoes-borne diseases in the absence of an effective vaccine. The study aimed to ascertain bioactivities of Ageratum houstonianum leaf acetone extract (AhLAE) against Aedes aegypti. Bioefficacy of AhLAE was tested against fourth instar larvae (L4) of Ae. aegypti using standard WHO protocol. The mortality, growth, and development of larvae, pupae and adults were recorded after exposure to the extract. The AhLAE showed larvicidal activity against L4 with LC50 and LC90 values of 401.88 and 691.24 mg/L, respectively. The mortality of the larvae further increased on subsequent days. The AhLAE caused a significant reduction in pupae formation and adult emergence. It also increased the larval duration of L4 and development duration of the pupa formed from the treated L4, indicating its growth-suppressing effects. The impact of the AhLAE was dose-dependent; high concentrations caused reduction in survival and growth of L4. Consequently, the L4-pupal and L4-adult growth indexes decreased. Additionally, the AhLAE induced developmental anomalies in the form of larva-pupa (L-P) intermediates. The study found that the AhLAE exhibited larvicidal, growth-suppressing, and development-altering activities against Ae. aegypti. The findings suggest the potential of AhALE as a natural insecticidal agent for controlling mosquitoes.

Insecticidal effect of two Turkish entomopathogenic nematode isolates against Tribolium castaneum (Herbst) larvae and adults at different conditions

Red flour beetle, Tribolium castaneum (Herbst.), is the most common pest of stored grains and products. Aerial and contact pesticides are used to control this pest. However, the red flour beetle has also developed significant resistance to phosphine, the main fumigant currently in use worldwide. The adverse effects of pesticides on non-target organisms, groundwater contamination, residues on food crops, and the emergence of insect resistance to chemicals have compelled the industry to prioritize the development of alternative control measures. Entomopathogenic nematodes find application in various agricultural systems. The insecticidal effect of two isolates of Steinernema feltiae Filipjev (Nematoda: Steinernematidae) and Heterorhabditis bacteriophora Poinar (Nematoda: Heterorhabditidae) against the different stages of T. castaneum. The entomopathogenic nematode isolates were examined at four concentrations (0, 250, 500, and 1000 IJs/ml) with a distilled water at 15 and 25 ± 1 °C temperatures. Results revealed that both S. feltiae (A-16) caused with 92.33% mortality rate while H. bacteriophora (O-7) caused with 76.77% mortality in the last instar larvae of the red flour beetle while these two species caused 75.38% and 66.85% mortality in adults, at 25 °C. The effect of nematodes decreased as the temperature decreased. According to results, the mortality rate of T. castaneum larvae treated with S. feltiae (A-16) with (54.62%) was significantly higher than that of H. bacteriophora (O-7) with (32.13%) 96 h after inoculation at 15 °C. The data indicated that 1000 IJs/ml was the most effective concentration of tested EPN isolates for all larval and adult stages.In this study, our findings indicate that S. feltiae (A-16) and H. bacteriophora (O-7) can be used as effective biological control agents against both the larval and adult stages of the red flour beetle. The results demonstrate that EPNs are promising candidates for biocontrol of T. castaneum. This information is useful in designing future biological control programs.

The Relationship Between 10-year Changes in Cognitive Ability and Subsequent Mortality: Findings from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Trial.

Cognitive ability and cognitive decline are related to mortality in older adults. Cognitive interventions have been found to improve cognitive performance and slow cognitive decline in later life. However, the longitudinal effects of cognitive interventions on mortality in older adults remain unclear. Using twenty-year follow-up data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, we examined the association between cognitive trajectory (i.e., intercept, slope, and retest effect) and mortality, using shared growth-survival models. We evaluated the effect of ACTIVE cognitive training (memory, reasoning, and speed of processing) on mortality risk. Among the 2,802 participants, 2,021 died on or before the year 2019 (72.1%). Higher baseline, slower decline, and greater retest effects in general cognitive performance were associated with lower mortality risk after adjusting for covariates. Associations with mortality were similar contrasting general and domain-specific cognitive abilities. We did not observe any significant effects of ACTIVE cognitive training in memory, reasoning, or speed of processing on all-cause mortality. Our findings suggest cognitive training interventions do not have a significant effect on cognitive trajectory and mortality among older adults; rather, older adults with higher education tend to incur greater survival benefits from memory training.