Adult Age Research Articles

Validated Integration of Tumor Deposits in N Staging for Prognostication in Colon Cancer.

Tumor deposits have prognostic value in colon cancer, but the current American Joint Committee on Cancer (AJCC) staging only considers them if there are no concurrent positive lymph nodes. To devise a staging system for colon cancer by integrating counts of tumor deposits with positive lymph nodes while retaining the current AJCC staging framework. This retrospective cohort study examines data from a large-volume, tertiary care center database (January 2010 through March 2023 with follow-up until December 2023) and the population-based National Cancer Database (January 2010 through December 2020 with follow-up until December 2021). Participants were adults (age 18-75 years) with stage III colon adenocarcinoma who underwent chemotherapy, and had a specified positive lymph node count and tumor deposit count were selected. A real positive lymph nodes count was developed and used to derive Sassun-Mayo N/tumor, lymph node, and metastasis (TNM) stages that were compared with the AJCC N/TNM stages. Receiver operating characteristic (ROC) curves and Kaplan-Meier analyses for 3-year overall survival were performed to assess the efficiency of the 2 staging systems. The concordance index was used for validation using the National Cancer Database. From a total patient number of 11 162 (institutional) and 848 704 (national), the final patient numbers were 788 and 77 790, respectively. The institutional database patients had a mean (SD) age of 58.5 (11.5) years; there were 433 male patients (54.9%) and 355 female (45.1%). The national database patients had a mean (SD) age of 59.3 (10.6) years; there were 40 315 male patients (51.8%) and 37 475 female (48.2%). ROC curve areas were improved using the Sassun-Mayo stages (3-year death for AJCC TMN, 0.63 [95% CI, 0.57-0.69] vs 0.66 [95% CI, for 0.60-0.72] for Sassun-Mayo TNM). Kaplan-Meier curves revealed visible overlaps among AJCC N stages, which were absent in the Sassun-Mayo N stages. The concordance index in the Sassun-Mayo N/TNM stages was 0.611 and 0.616, respectively, while in the AJCC N/TNM stages, it was 0.598 and 0.606, respectively. Patients upstaged from N1 to N2 (n = 10 307; 13.2%) had a 3-year overall survival rate nearly identical to that of AJCC N2a patients. Additionally, 3001 patients (3.9%) were upstaged from N2a to N2b, indicating that 13 308 patients (17.1%) with stage III colon cancer across cohorts were understaged. This study found that Sassun-Mayo N/TNM staging provided superior overall survival stratification compared with the current AJCC staging, suggesting that their implementation could improve prognostication in colon cancer.

Social Media Apps: A Paradigm for Examining Usability of Mobile Apps for Working Age Adults with Mild-Moderate Cognitive Disabilities

An estimated 79% of the US population used some form of social media regularly in 2019, highlighting a powerful platform for fostering connections with others. This aspect is particularly beneficial for people with cognitive disabilities (PwCDs) who may experience extreme social isolation. Studies have linked social media use amongst PwCDs to increased mental well-being and social capital, and PwCDs have reported corresponding increases in self-esteem and social connection. However, research also indicates that usability issues with social media user interfaces (UIs) often create barriers that deter participation of PwCDs. In this study, we investigate the usability of five social media apps for PwCDs, with the goal of identifying key UI features that facilitate/impede user performance and experience. The five apps selected for testing were: Facebook, Instagram, Pinterest, Snapchat, and Tumblr. Six to eight basic tasks were defined for each app, establishing a usability testing framework designed to compare similar tasks across apps. 19 working-age participants diagnosed with mild/moderate cognitive disabilities by their care provider were recruited and tested with each app across five different sessions. Mixed-methods data analysis and source of error analysis were performed for the resultant data. Snapchat and Pinterest were found to have the highest and lowest rates of task failure, respectively, consistent with the participant preference data on satisfaction and perceived usability. The fundamental task types with the highest rate of participant failure across all apps entailed either selecting or creating media, consistent with the identified qualitative theme that PwCDs tend to avoid using more active features in mobile apps due to their higher task complexity. Ten key types of usability issues were identified across all five apps, with the top issues identified as poor icon design and misleading icons, unclear user interface hierarchy, lack of user interface element separation and contrast, and similar task approaches with very different outcomes.

Tailored Approach to Designing a Digital Research Platform for Adults Aged 95 and older: SuperAgers Family Study.

The SuperAgers Family study aims to investigate phenotypic and genetic mechanisms related to healthy aging in nonagenarians, centenarians, and their family members. A remote study design was tested to demonstrate the feasibility of using digital technology to conduct health research within this rare population of advanced age. This paper describes key design elements of the digital research platform developed to deliver consent, enrollment, and study data collection in a cohort of older adults. SuperAgers participants aged 95 years or older, their offspring, and offspring's spouses were invited to join the study via media and community outreach. Participants completed registration, consent, submitted study data, and completed remote biospecimen collection via the web-based study app. Platform design elements and functionality were adapted for use by older aged adults. Qualitative process evaluation assessed usability and participant data entry completion throughout the study workflow. Preliminary data from SuperAgers (n = 160) of average age 98 years (± 3 SD) and offspring/spouses (n = 127) of average age 69 years (± 5 SD) were evaluated. 97% of participants in both groups successfully used the platform to complete eligibility screening, eConsent, and study surveys. SuperAgers and offspring successfully used the digital research platform to complete eConsent and submit study data. This supports the feasibility of conducting digitally enabled research in older-aged populations using tailored platform design elements that increase usability and minimize entry errors. These findings may contribute to the development of best practices for digitally delivered research studies in aging populations.

A cohort study reveals shared and distinct serum metabolic biomarkers for major adverse cardiovascular events in middle-aged and older adults.

We assessed the association of serum metabolites with the occurrence of major adverse cardiovascular events (MACE) in middle-aged and elderly individuals, explored the value of metabolomics in predicting MACE, and compared the distinctions in MACE risk-related metabolic biomarkers between middle-aged and elderly groups. Among the participants of the UK Biobank who underwent baseline assessment through nuclear magnetic resonance (NMR)-based metabolomic profiling of 168 serum metabolites and had complete covariates and clinical lipid parameters, we included those without a previous diagnosis of ischemic heart disease, cerebrovascular disease, heart failure, or cardiac arrest and not on lipid-lowering medications. Relevant covariates included sociodemographic characteristics, lifestyle factors, clinical information, and fasting time. Cox regression gave adjusted hazard ratios for metabolites, including the concentrations of various lipoprotein particles, compositional profiles of different lipoproteins, ketone bodies, amino acids, fatty acids, and additional low-molecular-weight metabolic biomarkers. The least absolute shrinkage and selection operator (LASSO) regression was applied to these metabolites to screen characteristic metabolic variables. Selected feature metabolic biomarkers were added to the established model for predicting MACE risk; risk differentiation (C-statistic) and reclassification (continuous net reclassification improvement [NRI], integrated differentiation index [IDI]) were evaluated. This study included 54,561 UK Biobank participants (34,797 middle-aged adults and 19,764 elderly adults) and was followed for a median of more than 12 years. Of these, there are 1799 middle-aged individuals and 2527 elderly individuals incident of MACE (ischemic heart disease, stroke, and cardiovascular deaths). After adjusting for relevant covariates, Cox regression yielded metabolic biomarkers associated with the occurrence of MACE in the population (false discovery rate controlled P < 0.05). In the elderly, the metabolites associated with increased MACE risk were notably diminished compared to the middle-aged; and the elderly group underscored the protective function of medium and small HDL and their constituents, docosahexaenoic acid, and glycine. The more comprehensive model, which additionally includes the feature metabolic biomarkers, demonstrated enhanced discriminatory power and predictive accuracy for MACE occurrence among middle-aged individuals, evidenced by improved C-statistics (from 0.711 [95% CI 0.699-0.722] to 0.723 [0.711-0.734]), a continuous NRI of 0.247 [0.207-0.315], and an absolute IDI of 0.005 [0.004-0.008]. Its evaluation value is superior to that in the elderly. Our study explored the association of circulating metabolites with MACE risk in middle-aged and elderly adults and made comparisons. Metabolomic insights have revealed biomarkers associated with new-onset MACE in different age populations, highlighting the value of protective metabolites in the elderly. This provides instrumental information to possibly implement precision medicine for preventing MACE.

Self-Perceptions of Aging and Loneliness Interact when Predicting Cognition in Older Adults.

There is growing interest in the link between self-perceptions of aging (SPA) and cognition in older adults. This study evaluates the relationship between SPA dimensions and objective cognition and its interaction with loneliness. A sample of 184 community-dwelling Spanish older adults aged 65 and above was recruited. The short form of the Aging Perceptions Questionnaire (APQ-S) was used along with a neuropsychological battery and sociodemographic and health measures. The findings reveal links between negative consequences and processing speed; chronic time and inhibition; cyclical time and selective and alternating attention; and emotional representations and inhibition, selective attention, and working memory. SPA dimensions were found to moderate the relationship of loneliness on processing speed and selective attention. This study offers evidence of the differential link between SPA dimensions and cognition as well as their interaction with loneliness, which is valuable for designing intervention programs that promote cognitive health and active aging.

Related studies on measuring the normal values of optic nerve sheath diameter in healthy Chinese adults based on CT scans.

To measure the normal reference value of optic nerve sheath diameter (ONSD) and its correlation with eyeball transverse diameter (ETD), age and sex in Chinese adults by CT. The data of healthy adults who underwent head scan in Baotou Central Hospital from March 2022 to May 2023 were retrospectively collected. The ETD of both eyes and the ONSD (ONSD3mm, ONSD10mm) at 3mm and 10mm behind the eyeball were measured, and the relationship between ONSD and age, sex and ETD was analyzed by linear regression. A total of 360 subjects were included, 180 males and 180 females, aged 48.5 (33.00, 63.00) years. The average ONSD3mm, 10mm and ETD of 360 included subjects were 5.28 (95% CI 5.23-5.32) mm, 4.34 (95% CI 4.30-4.37) mm and 22.47 (95% CI 22.38-22.56) mm, respectively. Univariate linear regression analysis showed that gender (P < 0.001) and ETD (P < 0.001) were the influencing factors of the mean ONSD. Further multivariate linear regression analysis also showed that gender (P < 0.001) and ETD (P < 0.01) were associated with ONSD values. The comparison of parameters between different genders showed that the values of all parameters in males were greater than those in females, and the difference between the two groups was statistically significant (P < 0.001). In addition, we further measured the ONSD/ETD values, which averaged 0.24 (0.23-0.24) at 3mm and 0.19 (0.19-0.20) at 10mm. The average ONSD3mm, 10mm and ETD of healthy Chinese adults were 5.28 (95% CI 5.23-5.32) mm, 4.34 (95% CI 4.30-4.37) mm and 22.47 (95% CI 22.38-22.56) mm, respectively. At the same time, it is found that gender and ETD are the influencing factors of ONSD, and the diameter of ONSD is different between men and women.

Association of lung health and cardiovascular health (Life’s Essential 8)

BackgroundCardiorespiratory health issues often intersect. This study explored the relationship between lung health and the recently updated Cardiovascular Health Measure (Life’s Essential 8).MethodsData from the 2007–2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. Three cohorts were included: lung disease in the Main cohort (N = 9,772), lung function in the Spirometry sub-cohort (N = 3,896), and respiratory symptoms in the Respiratory Symptoms sub-cohort (Age &amp;gt; 40) (N = 3,449). LE8 scores were used as both continuous and categorical variables (0–49, 50–79, 80–100). Weighted multivariate regression analyses examined the correlations between LE8 and lung health, and weighted restricted cubic spline (RCS) regression analyzed potential non-linear relationships. Subgroup analysis was conducted to verify stability.ResultsOverall lung health was better in the high LE8 group than in the low LE8 group. In the fully adjusted model, the high LE8 group had significantly lower odds of asthma (OR = 0.42; 95% CI = 0.29, 0.59) and chronic bronchitis (OR = 0.27; 95% CI = 0.15, 0.49) compared to the low LE8 group. Regarding lung function, each 10-point increase in LE8 was associated with an increase of 50 ml in FEV1 (Beta = 50; 95% CI = 32, 67) and 56 ml in FVC (Beta = 56; 95% CI = 32, 79). Among middle-aged and older adults (age &amp;gt; 40), the high LE8 group had significantly lower odds of respiratory symptoms, including cough (OR = 0.23; 95% CI = 0.12, 0.46), phlegm (OR = 0.42; 95% CI = 0.19, 0.90), and wheezing (OR = 0.29; 95% CI = 0.15, 0.54). RCS analyses demonstrated a non-linear negative correlation between LE8 and cough, sputum, and wheeze. Subgroup and sensitivity analysis suggested stability.ConclusionLife’s Essential 8 (LE8) scores are positively associated with lung health in the US population. These findings provide a valuable reference for maintaining overall cardiorespiratory health.

Implementation of a rapid host-protein diagnostic test for distinguishing bacterial and viral infections in adults presenting to urgent care centers: a pragmatic cohort study

BackgroundUrgent care centers (UCCs) are a growing segment of healthcare with high rates of inappropriate antibiotic use. MeMed BV® (MMBV) is a blood test that differentiates bacterial from viral infections. Between April 2022 and March 2023, we introduced MMBV into routine care at ten UCCs. The primary objective was to assess MMBV’s impact on antibiotic use; the secondary objective was to assess whether MMBV aided in patient management.MethodsA pragmatic prospective cohort study. Physicians who ordered MMBV reported electronically (in real-time) whether they intended to prescribe antibiotics before ordering the test and upon UCC discharge whether MMBV aided in patient management. Hospitalizations were recorded for 7 days post-UCC discharge.ResultsDuring implementation, 3920 MMBV tests were ordered for adults (age ≥ 18) by 144 physicians. The study cohort had 59% female patients and the median age was 42 years (IQR 31–58). For the primary objective, 3262 cases were included. MMBV indicated 629/3262 (19.3%) cases of potentially unwarranted antibiotics, of which physicians avoided prescriptions in 397/629 (63.1%). MMBV indicated 405/3262 (12.4%) cases of potentially missed bacterial infections. Physicians prescribed antibiotics to 283/405 (69.9%). MMBV adherence was associated with fewer hospitalizations (7.8% vs. 30.3%, p < 0.001). For the secondary objective, 2901 cases were included. Physicians reported MMBV aided patient management in 2494/2901 (86.0%) cases and contributed to avoiding emergency department referrals in 595/2901 (20.5%).ConclusionsImplementing MMBV aided urgent care center physicians in their clinical decision-making and may have contributed to appropriate antibiotic use, better resource utilization, and patient management.

Comparison of the Beck Anxiety Inventory and the Geriatric Anxiety Scale in an Older Adult Neurology Clinic Sample.

The Beck Anxiety Inventory (BAI) is a commonly used anxiety measure, but it was not specifically designed for use among older adults. Previous research has raised concern that it may inflate anxiety ratings among older adults because of its emphasis on physical symptoms. The Geriatric Anxiety Scale (GAS) is designed for older adults but has not been examined in a neurology clinic setting. This study sought to compare the psychometric properties of the BAI and the GAS in an older adult neurology clinic sample. An exploratory aim was to determine the influence of motor symptoms on anxiety scores. Participants included 68 adults age 60+ referred for a neuropsychological evaluation in an outpatient neurology clinic. Measures included the BAI, GAS, and the Montreal Cognitive Assessment (MoCA). Psychometric properties were determined. A McNemar test compared the proportion of anxiety classifications between the BAI and GAS. Referral source (cognitive disorder versus movement-oriented teams) was used as a proxy for grouping patients who were likely to have prominent motor symptoms versus those who were not. An independent t-test compared scale performance between these groups to examine the influence of motor symptoms on anxiety ratings. Both scales had good internal consistency (GAS α = 0.93; BAI α = 0.88). Convergent validity (GAS and BAI: r = 0.81, p < .001) and discriminant validity (GAS and MoCA, r = 0.18, p = .20) were supported. The BAI detected anxiety among 40% of participants, while the GAS detected anxiety among 56%, which was a statistically significant difference (p = .002). Anxiety ratings did not differ based on referral source (t(66) = -1.59, p = .12). Both scales had good psychometric properties, though the GAS detected a higher rate of anxiety compared to the BAI despite having less focus on motor symptoms that could be attributed to age-related physical changes or movement disorders. The GAS may capture aspects of anxiety not assessed by the BAI among older adults.

Mapping and modeling age-related changes in intrinsic neural timescales

Intrinsic timescales of brain regions exhibit heterogeneity, escalating with hierarchical levels, and are crucial for the temporal integration of external stimuli. Aging, often associated with cognitive decline, involves progressive neuronal and synaptic loss, reshaping brain structure and dynamics. However, the impact of these structural changes on temporal coding in the aging brain remains unclear. We mapped intrinsic timescales and gray matter volume (GMV) using magnetic resonance imaging (MRI) in young and elderly adults. We found shorter intrinsic timescales across multiple large-scale functional networks in the elderly cohort, and a significant positive association between intrinsic timescales and GMV. Additionally, age-related decline in performance on visual discrimination tasks was linked to a reduction in intrinsic timescales in the cuneus. To explain these age-related shifts, we developed an age-dependent spiking neuron network model. In younger subjects, brain regions were near a critical branching regime, while regions in elderly subjects had fewer neurons and synapses, pushing the dynamics toward a subcritical regime. The model accurately reproduced the empirical results, showing longer intrinsic timescales in young adults due to critical slowing down. Our findings reveal how age-related structural brain changes may drive alterations in brain dynamics, offering testable predictions and informing possible interventions targeting cognitive decline.

Individual and additive effects of vitamin D, omega-3 and exercise on DNA methylation clocks of biological aging in older adults from the DO-HEALTH trial.

While observational studies and small pilot trials suggest that vitamin D, omega-3 and exercise may slow biological aging, larger clinical trials testing these treatments individually or in combination are lacking. Here, we report the results of a post hoc analysis among 777 participants of the DO-HEALTH trial on the effect of vitamin D (2,000 IU per day) and/or omega-3 (1 g per day) and/or a home exercise program on four next-generation DNA methylation (DNAm) measures of biological aging (PhenoAge, GrimAge, GrimAge2 and DunedinPACE) over 3 years. Omega-3 alone slowed the DNAm clocks PhenoAge, GrimAge2 and DunedinPACE, and all three treatments had additive benefits on PhenoAge. Overall, from baseline to year 3, standardized effects ranged from 0.16 to 0.32 units (2.9-3.8 months). In summary, our trial indicates a small protective effect of omega-3 treatment on slowing biological aging over 3 years across several clocks, with an additive protective effect of omega-3, vitamin D and exercise based on PhenoAge.

Association of a novel nutritional index with cognitive impairment in middle-aged and elderly Chinese adults: a cross-sectional analysis from the China Health and Retirement Longitudinal Study

PurposeThe triglyceride-cholesterol-body weight index (TCBI), a novel and easily computable nutritional index, incorporates serum triglyceride (TG), total cholesterol (TC), and body weight (BW). This study explored the association between TCBI and cognitive impairment in middle-aged and elderly Chinese populations.Patients and methodsThis cross-sectional study employed data from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey, including 7,145 participants. TCBI was calculated as TG (mg/dL) × TC (mg/dL) × BW (kg)/1,000. Cognitive function was assessed based on mental status and episodic memory, with a total score below 11 indicating cognitive impairment. The relationship between TCBI and cognitive impairment was examined using multiple logistic regression, smooth curve fitting, and subgroup analyses.ResultsAfter full adjustment, each 1-unit increase in log-transformed TCBI (Lg TCBI) was associated with a 29.7% reduction in cognitive impairment risk [odds ratio (OR) = 0.703, 95% confidence interval (CI): 0.529–0.933; p = 0.015]. When Lg TCBI was categorized into quartiles, the Q2, Q3, and Q4 groups exhibited a reduced risk of cognitive impairment by 19.9, 16.3, and 22.9%, respectively (p for trend = 0.043), compared to the Q1 group. Smooth curve fitting revealed a consistent decrease in cognitive impairment risk with higher Lg TCBI levels. Subgroup analysis indicated that the association was stronger among participants aged ≥60 years (OR = 0.655, 95% CI: 0.438–0.979), non-current drinkers (OR = 0.643, 95% CI: 0.451–0.917), and those who engaged in socializing (OR = 0.568, 95% CI: 0.371–0.871).ConclusionTCBI was significantly and negatively associated with cognitive impairment in Chinese middle-aged and elderly individuals, with the effect more pronounced in those aged ≥60 years, non-current drinkers, and socially active participants.

CAREUP: An Integrated Care Platform with Intrinsic Capacity Monitoring and Prediction Capabilities

This paper describes CAREUP, a novel older adult healthy aging support platform based on Intrinsic Capacity (IC) monitoring. Besides standard functionalities like storing health measurement data or providing users with personalized recommendations, the platform includes novel intrinsic capacity assessment and prediction algorithms. Older adults’ performance is continuously monitored in all five IC domains—locomotion, psychology, cognition, vitality, and sensory capacity—based on measurement results and answers to questionnaires gathered using the platform’s mobile applications. The users are also presented with a machine learning-based prediction of how their intrinsic capacity might change over the following years. The platform’s operation was successfully tested with the participation of older adults and their caregivers in three countries: Austria, Italy, and Romania.

Graded Walking Energetics under Cold Strain.

Although research supports selecting steeper routes to minimize metabolic rate (Ṁ) in mountain racers, the "steeper is cheaper" strategy has yet to be confirmed for slower, more typical graded walking speeds under cold stress. Confirm whether "steeper is cheaper" is true for typical graded walking speeds in individuals exposed to incremental cold stress. Fourteen healthy, military-age adults (age, 24 ± 6 years; height, 1.72 ± 0.08 m; body mass, 72 ± 16 kg) completed four 20-min treadmill walks in three ambient temperatures (20, 10, and 0 °C) in light clothing (i.e., shorts, t-shirt, light gloves). Each walk involved five stages at incremental vertical speeds (0.00, 1.93, 3.86, 5.79, 7.79 m·min-1) but variable treadmill speeds (0.54, 0.72, 1.07 m·s-1). To verify the "steeper is cheaper" strategy, we compared Ṁ between treadmill speeds at matched vertical speeds in each temperature. We also tested if the 90% confidence interval around the mean percent paired difference between Load Carriage Decision Aid (LCDA) metabolic model predictions and measured Ṁ was within ±10%. Ṁ was significantly higher for the faster treadmill speed at matched vertical speeds in all but two comparisons at 20 °C, all but two comparisons at 10 °C, and all comparisons at 0 °C (p < 0.05). LCDA metabolic model predictions were statistically equivalent to measured Ṁ during graded walking at 20 °C (90% CI, -3.1, 0.6%) and 10 °C (-7.8, -2.6%) but not 0 °C (-16.2, -9.5%). Route planners should recommend steeper but shorter routes to minimize Ṁ in individuals that walk in temperate-to-cold environments. The LCDA metabolic model provides accurate Ṁ predictions in lightly dressed individuals in temperatures down to 10 °C, but users should expect underestimated Ṁ in 0 °C or colder.

Assessing Population Well-Being in Saudi Arabia: A Comprehensive National Survey Using the WHO-05 Index and Self-Rated Health Metrics

Introduction: The well-being of populations is crucial for understanding nations’ public health and progress. With its ongoing transformation and development objectives, Saudi Arabia emphasizes its residents’ quality of life and well-being. Recent surveys and health indicators have underlined the nation’s focus on enhancing population well-being. Aim: This study aimed to assess the overall level of well-being of the population living in Saudi Arabia using the WHO-5 index and self-rated health (SRH) metrics. Subject and methods: This cross-sectional study was conducted among thirty-nine thousand five hundred and sixty-two people from the general population in Saudi Arabia, citizens and residents, including all adult age groups (&gt;18 years) and both genders. A self-administered questionnaire was sent to the Saudi adult population using an online survey. The questionnaire includes socio-demographic characteristics, the five-item Well-Being Index (WHO-5), and the self-rated health status. Results: Based on SRH, 77.4% were considered a healthy group. Male gender participants who had a better education were more likely to report a favorable SRH. According to WHO-5, poor well-being was seen in 26% of the population, and the rest had good well-being (74%). Independent predictors for good well-being include increasing age and educational level and being unemployed. Interestingly, we found a positive significant correlation between SRH and WHO-5 scores (r = 0.371; p &lt; 0.001). Conclusions: Poor well-being was common among the general population. Independent risk factors for poor well-being include female gender and Saudi nationality, while increasing age, male gender, and higher education were significant predictors of healthy SRH. More longitudinal studies are needed to extract more data on this nation’s growing prevalence of poor self-rated health status.

Coming Up…

The American Association for Geriatric Psychiatry is holding its 2025 Annual Meeting, “Human Rights and Mental Health Advocacy for Aging Adults,” March 14–17, 2025 in Phoenix, Arizona. For more information, visit https://aagponline.org/education‐events/annual‐meeting.

Transition symptom management careers: Historical patterns of mental health symptoms and service use among young adults experiencing a psychiatric crisis.

Young adults access mental health services at lower rates than both older and younger age groups despite high levels of need. Mental health service use is known to be influenced by prior experiences with treatment, with episodes of symptoms and treatment producing patterns of service use over time, or what we call a "symptom management career". This qualitative study examined the symptom management careers of 55 young adults (ages 18-25) who were admitted to an inpatient, short term, crisis stabilization unit. Participants completed research interviews at the hospital following a psychiatrist's assessment. During semi-structured qualitative interviews, participants retrospectively narrated their experiences of mental health symptoms and service use from symptom onset to the current episode. The research team used an inductive qualitative approach to identify distinct patterns of symptom management, while also examining factors that contributed to service use. Six distinct types of symptom management careers were identified based on the timing of symptom onset and service participation. Notably, none of the participants experienced an uninterrupted pattern of service use from adolescence into young adulthood. The team identified a set of themes that influenced these patterns including traumatic experiences, social supports, social service systems, and substance use. Findings highlight the developmental nature of service connection and disconnection and suggest potential points of intervention in non-specialty settings, such as schools, child welfare, and the juvenile legal system. Findings also demonstrate the need for flexible services that respond to the developmental need for autonomy and self-determination as youth transition into young adulthood.

Dietary Variation Among Herculaneum's Victims of Mt. Vesuvius via Dental Microwear Texture Analysis.

The current study addresses three primary hypotheses: (1) Subadult diets changed as children aged, (2) adult diets differed from subadult diets, and (3) male and female diets differed as they age. This study includes dental microwear texture data from 58 adults (age 16+) and 23 subadults (age 0-16) recovered by Sarah Bisel from within and near to storage rooms adjacent to Herculaneum's beach. The adults include 27 females and 31 males. Dental microwear texture analysis (DMTA) employed standard procedures: data collection used a white-light confocal profiler at 100×. The DMTA variables were complexity, anisotropy, textural fill volume, and scale of maximum complexity. Statistical methods used Bayesian versions of analysis of variance and correlation (Bayes factors above 1.5 were considered meaningful and above 3.0 significant) as well as discriminant function analysis and binary logistic regression. No differences emerged among the children. Adult diets were significantly lower than the subadults for anisotropy. Among the adults, age affected the females more, particularly for anisotropy. Subadult diets did not vary by age, but they did vary. The lower adult anisotropy indicates each adult ate a greater variety of foods compared to the subadults. As females aged, however, their diets became more restricted compared to the males. Overall, age and sex affected the Herculaneum diet.

Organizational factors impacting the implementation of a digital mental health tool in Alberta's mental health care of youth and young adults.

With mental health concerns on the rise among youth and young adults (age 12-24), increased mental health options include virtual care, apps and online tools, self-management and tracking tools, and digitally-enabled coordination of care. These tools may function as alternatives or adjuncts to face-to-face models of care. Innovative solutions in the form of digital mental health (dMH) services not only provide support, resources and care, but also decrease wait times and waitlists, increase access, and empower youth. However, organizational factors may impact the extent of dMH interventions are that accepted, used, and sustained in clinical settings. This qualitative study explores organizational barriers and facilitators surrounding the implementation of a digital platform (Innowell), which uses measurement-based care (MBC) to track youth progress and outcomes. Data was collected from 154 mental health care providers participating in 23 focus groups across Alberta, drawing on school and community settings, specialized mental health services, and primary care networks. A thematic analysis revealed the following: barriers included incompatibility with current systems and workflows, lack of inter-organizational collaboration, time commitment, perceived sustainability and lack of digital literacy. Facilitators included positive attitudes towards using dMH to optimize clinical practices by empowering youth and improving continuity of care, transitions in care, and quality of care, as well as workplace culture and leadership. The study highlights a critical need for decision makers and clinical leaders to address organizational factors by integrating training and support, establishing interoperability between digitized and in-person healthcare systems, and leveraging support for MBC and youth-centred care.

Risk of second primary cancer among patients with a first primary appendiceal adenocarcinoma.

819 Background: Incidence rates of rare appendiceal cancers are increasing across the United States. Although this is suggestive of a growing population of appendiceal cancer survivors over time, the risk of second primary cancers specific to patients with a first primary appendiceal adenocarcinoma remains unknown. Methods: We conducted a population-based study of adults (age ≥18 years) diagnosed with a first primary appendiceal adenocarcinoma from 1992 to 2021, using data from the Surveillance, Epidemiology, and End Results (SEER) Program. We estimated cumulative incidence of second primary cancer, defined as any primary cancer diagnosed at least 3 months after appendiceal adenocarcinoma, with Fine and Gray methods to account for the competing risk of death. For comparison to the general population, we also estimated standardized incidence ratios [SIRs], or the observed number of second cancers relative to the expected number based on age-, sex-, and race-specific incidence rates. Results: A total of 5,827 adults diagnosed with a first primary appendiceal adenocarcinoma (mean age 58.0 years; 51.8% female; 68.5% non-Hispanic White) were identified during the study period, of whom 418 developed a second primary cancer. The most common types of second primary cancer were prostate (17.7%), colorectal (14.4%), female breast (10.5%), lung (8.4%), and melanoma (6.0%). At 10 and 20 years after appendiceal adenocarcinoma diagnosis, the cumulative incidence of second primary cancer was 7.5% (95%CI 6.8%-8.4%) and 11.7% (95%CI 10.5%-12.9%), respectively. Cumulative incidence significantly differed by sex (p&lt;0.01) and age at appendiceal adenocarcinoma diagnosis (early-onset [age&lt;50] vs late-onset; p&lt;0.01). For example, at 10 years post-diagnosis, the cumulative incidence of second primary cancer was 6.4% (95%CI 5.4%-7.4%) for females and 8.8% (95%CI 7.6%-10.1%) for males. The overall SIR for any second primary cancer was 1.12 (95%CI, 1.02-1.23)—corresponding to 14.8 excess cancers per 10,000 person-years. SIRs for common types of second primary cancers were: 1.07 (95%CI 0.84-1.35) for prostate, 2.12 (95%CI 1.63-2.70) for colorectal, 0.91 (95%CI 0.68-1.19) for female breast, 0.81 (95%CI 0.58-1.09) for lung, and 1.20 (95%CI 0.79-1.73) for melanoma. Conclusions: Approximately one in every 13 adults diagnosed with a first primary appendiceal adenocarcinoma in the United States will be diagnosed with a second primary cancer within 10 years. After diagnosis of an appendiceal adenocarcinoma, patients have a 12% excess incidence in second primary cancers and double the excess incidence in second primary colorectal cancers compared to the general population. Implementation of cancer prevention and early detection strategies (e.g., colonoscopy screening, genetic testing) for patients with an appendiceal adenocarcinoma is a clinical priority.