Elderly Individuals Research Articles

Health-Related Quality of Life for the Insured and Non-Insured Elderly in Rural Tanzania: A Cross-Sectional Study

Introduction The growing number of elderlies in low—and middle-income countries is straining healthcare systems. Affordable health services are essential to prevent poor health outcomes and low quality of life. Health insurance can improve access to care and enhance the quality of life for elderly individuals. This study compares the quality of life of elderly individuals with and without health insurance. Methods A household survey was conducted in the Nzega and Igunga districts in the Tabora region of Tanzania from 2017 to 2022. The survey used a multistage sampling method to select wards, villages in each district, and households with elderly residents. The European Quality of Life 5-dimension 3-level (EQ-5D-3L) instrument was used to assess health-related quality of life (HRQoL), including the EQ-5D descriptive system and the EQ visual analog scale (EQ VAS). Value sets from Zimbabwe were used to calculate HRQoL. The survey used crude and adjusted linear regression analyses to assess the relationship between HRQoL and HI by accounting for confounding factors. Results A total of 1,899 elderly individuals aged 60 years and above participated in the study, with the majority (58%) falling in the 60-69 age group. Among the participants, 45% were married, and only 44% had insurance coverage. The overall mean EQ-5D and EQ-VAS scores were slightly higher for the uninsured elderly (0.75 and 61.20) compared to the insured elderly (0.73 and 60.31). According to the linear crude model, there is a decrease in HRQoL among the uninsured compared to the insured. This trend was also observed in the adjusted model, although it was not statistically significant (p=0.052). Conclusion Access to health insurance can significantly improve the HRQoL for elderly populations in Tanzania. These findings are crucial for policymakers. Extending health insurance coverage to vulnerable sub-populations like the elderly should be a priority, with targeted financial subsidies for HI premiums. This initiative would be a significant step towards achieving universal health coverage in Tanzania, ensuring a higher quality of life for all citizens.

Developing the age-friendly community parks survey for older adults: Assessing aging environment

Many scholars have developed tools to assess the public green environment and examine the impact of parks on people's health and recreational activities. However, environmental reviews often overlook the vulnerability of older adults, and an age-friendly community parks survey (AF-CPS) is lacking. This study developed a comprehensive assessment system, the AF-CPS. The research process was divided into three phases covering eight dimensions: a. humanistic environment (e.g., participation in the green space environment and in cultural exchange); b. infrastructure (e.g., edutainment, medical, and sports facilities); c. recreation comfort (e.g., atmospheric conditions, noise environment, trail comfortableness); d. site planning (e.g., spatial layout, activity space diversity); e. environmental quality (e.g., plant richness, latitude of vision); f. barrier-free environment (e.g., barrier-free site identification，barrier-free service facilities and barrier-free functional facilities); g. environmental maintenance (e.g., participation in building policy decisions, landscape maintenance management); and h. security management. The establishment of the evaluation system was based on a literature review. During the verification and modification of the model, an on-site investigation and questionnaire survey were conducted with elderly individuals (60+) in a community park to identify an evaluation system that can be used as a research tool to promote the construction and renewal of an aging-friendly environment in community parks.

The use of exercise-assisted psychotherapy in China to treat depression among elderly solitary individuals

The use of exercise-assisted psychotherapy in China to treat depression among elderly solitary individuals

The burden of injury among elderly individuals in China from 1990 to 2019: An analysis of data from the global burden of disease study 2019

BackgroundWith the rapid ageing of the population, injuries are increasingly threatening the health of elderly individuals. A comprehensive evaluation of the injury burden is important for selecting and formulating strategies for injury prevention. ObjectiveTo evaluate the temporal trends of injury burden among elderly Chinese individuals aged 60 years and older. MethodsBased on the results of the Global Burden of Disease Study 2019, the injury mortality, morbidity, and disability-adjusted life years (DALYs) of elderly individuals from 1990 to 2019 were estimated by age and sex. The autoregressive integrated moving average model was used to predict the injury burden in the next decade. ResultsIn 2019, there were an estimated 304 373 deaths due to injuries in China, accounting for 3.55 % of all deaths. The main cause of injury-related death was unintentional injuries (67.28 deaths per 100 000), followed by transport injuries (30.44 deaths per 100 000). The standardized DALYs rate due to injuries among elderly individuals was 3488.54 DALYs per 100 000. In the past 30 years, the morbidity of injuries among elderly individuals in China has increased by 52.18 %. In 2030, we estimated that there will be 398 200 deaths of elderly individuals due to injury. ConclusionsOver 21% of injury-related deaths among elderly individuals occurred in China. The injury burden among elderly individuals is high, and efforts are needed to inform injury prevention policies and adopt injury prevention strategies to reduce the injury burden and promote the health and well-being of elderly individuals.

The association of adherence to 24-hour movement guidelines with frailty and mortality: cross-sectional and longitudinal analyses of NHANES data

BackgroundAdherence to the Canadian 24-Hour Movement Guidelines (24 H-MG) has been associated with a reduced risk of developing various chronic conditions. However, its association with frailty and all-cause mortality has not been investigated. Therefore, our primary and secondary objective was to investigate the association between adherence to the 24 H-MG and frailty and mortality, respectively.MethodsThis study included 2739 individuals (age = 50.6 ± 18.1 years; male = 1370 (50.0%)) from the 2005–2006 cycle of the National Health and Nutrition Examination Survey (NHANES). Frailty was quantified with a 46-item frailty index and analyzed cross-sectionally using linear regression. All-cause mortality data were obtained from the National Death Index and was analyzed prospectively over 10 years using Cox regression. The primary exposure variable was six individual and combined 24 H-MG components including the moderated-to-vigorous physical activity, light physical activity, sedentary time, recreational screen time, sleep, and strength training guidelines. All analyses were stratified into two age groups (younger: 20–64 and older adults 65 + years).ResultsOur cross-sectional analyses demonstrated an inverse dose-response relationship between the number of individual 24 H-MG components met and frailty level in adults aged 20–64 (β = -0.439 (95% C.I. = -0.551:-0.328)) and 65+ (β = -0.322 (95% C.I. = -0.490:-0.154)). Of the individual guideline components, following the moderate-to-vigorous physical activity (MVPA) guideline in individuals aged 20–64 and the recreational screen time guideline in adults aged 65 + was associated with lower frailty (p < 0.001). There was no clear prospective relationship between adherence to the combined 24 H-MG and mortality. Of the individual guideline components, only meeting the MVPA guideline component in the 65 + group was prospectively associated with reduced mortality risk (HR = 0.48 (95% C.I. = 0.25–0.93)).ConclusionAdherence to the Canadian 24 H-MG may be protective against frailty. Increasing MVPA and decreasing recreational screen time may be important behaviors to consider for frailty prevention and should be investigated further.

A retrospective analysis of the clinical profile and factors associated with mortality and poor hospital outcomes in adult Guillain–Barre syndrome patients

Guillain–Barré syndrome (GBS) is an acute autoimmune polyneuropathy with substantial geographic variations in demography, antecedent events, clinical manifestations, electrophysiological sub-types, diagnostic findings, treatment modalities, and prognostic indicators. However, there is limited contemporary data on GBS patient profiles and prognostic factors from low-resource settings like Ethiopia. The objective of this study is to investigate the clinical profile, factors associated with mortality, and hospital outcomes among GBS patients admitted to Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. A retrospective cross-sectional study was conducted among 60 GBS patients admitted to TASH from January 2018 to December 2022. Data on demographics, clinical features, treatments, complications, and outcomes were extracted from medical records. Bivariate and multivariate logistic regression analyses identified factors associated with mortality and poor hospital outcomes. The cohort had a mean age of 28.5 years, with 76.7% aged 14–34 years. Males comprised 61.7% of cases. Ascending paralysis (76.7%) was the predominant presentation. Absent or reduced reflexes were seen in 91.7% of patients. The most common antecedent event was gastroenteritis (26.7%), followed by upper respiratory tract infection (URTI) (15%) and vaccination (11.7%). The mean interval from symptom onset to hospital presentation was 8.77 days, and the peak symptom severity was 4.47 days. The axonal variant (75.5%) was the most common subtype, followed by the demyelinating variant (24.5%). Intravenous immunoglobulin was administered to 41.7% of patients. Respiratory failure requiring invasive mechanical ventilator (MV) support occurred in 26.7% of cases. The mortality rate was 10%, with mechanical ventilation being the only factor significantly associated with mortality (95% CI 2.067–184.858; P < 0.010). At discharge, 55% had a good outcome, and 45% had a poor outcome, according to the Hughes Functional Disability Scale (HFDS). Mechanical ventilation (AOR 0.024, 95% CI 0.001–0.607) and a GBS disability score > 3 (AOR 0.106, 95% CI 0.024–0.467) were factors significantly associated with poor hospital outcomes. GBS in this cohort primarily affected individuals of young age, commonly preceded by gastroenteritis and characterized by a high frequency of the axonal variant. Mechanical ventilation was found to be significantly linked to mortality. Alongside mechanical ventilation requirements, severe disability upon presentation emerged as a crucial determinant of poor outcomes upon discharge, underscoring the importance of early identification of high-risk patients and prompt interventions.

Plasma neurofilament light protein is differentially associated with age in individuals with treatment-resistant schizophrenia and bipolar affective disorder compared to controls

Accelerated brain ageing has been observed in multiple psychiatric disorders. This study examined whether relationships between age and plasma neurofilament light (NfL) protein differed in individuals with psychiatric disorders (major depressive disorder (n = 42), bipolar affective disorder (n = 121), treatment-resistant schizophrenia (TRS, n = 82)) compared to two healthy control (HC) groups (n = 1,926 and n = 59). Compared to two independent HC samples, individuals with TRS demonstrated a stronger positive relationship between age and NfL levels. Individuals with BPAD had a stronger negative relationship between age and NfL levels compared to the large normative HC cohort, but not locally-acquired HCs. These findings show that plasma NfL levels are differentially associated with age in individuals with TRS and BPAD compared to healthy individuals.

Association of M2 macrophages with EMT in glioma identified through combination of multi-omics and machine learning

BackgroundThe incidence of glioma, a prevalent brain malignancy, is increasing, particularly among the elderly population. This study aimed to elucidate the clinical importance of epithelial–mesenchymal transition (EMT) in gliomas and its association with malignancy and prognosis. BackgroundThe incidence of glioma, particularly among elderly individuals, is on the rise. The malignancy of glioma is determined not only by the oncogenic properties of tumor cells but also by the composition of the tumor microenvironment, which includes immune system macrophages. The prevalence of M2-type macrophages typically fosters tumor progression, yet the underlying mechanism remains elusive. Our study explored the clinical importance of epithelial–mesenchymal transition (EMT) in gliomas and its association with malignancy and prognosis. MethodsOur study used the gene set variation analysis (GSVA) algorithm to classify different levels of EMT activation based on the transcriptomic and multi-omics data. Machine learning (ML) and single-cell analysis were integrated into our model for comprehensive analysis. A predictive model was constructed and in vitro experiments were performed to validate our findings. ResultsOur study classified 1,641 samples into two clusters based on EMT activation: the EMT-hot group and the EMT-cold group. The EMT-hot group had elevated copy number loss, tumor mutational burden (TMB), and a poorer survival rate. Conversely, the EMT-cold group showed a better survival rate, likely attributed to lower stromal and immune cell scores, as well as decreased expression of human leukocyte antigen-related genes. Driving genes were identified through weighted gene coexpression network analysis (WGCNA) and dimensionality reduction techniques. These genes were then utilized in the construction of a prognostic model using ML and protein-protein interaction (PPI) network analysis. Furthermore, the impact of the core genes identified through single-cell analysis on glioma prognosis was examined. ConclusionOur research underscores the efficacy of our model in predicting glioma prognosis and elucidates the connection between the M2 macrophages and EMT. Additionally, core genes such as LY96, C1QB, LGALS1, CSPG5, S100A8, and CHGB were identified as pivotal for mediating the occurrence of EMT induced by M2 macrophages.

Impact of urban and rural residents medical insurance on self-rated health of residents in China: a panel study from the China family panel studies national baseline survey.

This study aimed to investigate the health performance of the Urban and Rural Residents Medical Insurance (URRMI) scheme in China and to make practical recommendations and scientific references for its full implementation in China. This is a panel study that uses data from the China Family Panel Studies from 2018 to 2020, which is separated into treated and control groups each year, utilizing the key approach of propensity score matching and difference-in-difference (PSM-DID). Using 1-to-1 k-nearest neighbor matching, we proportionate the baseline data. Using difference-in-difference model, we examine the mean treatment impact of the outcome variables. Using a 500-time random sample regression model, we validate the robustness of the model estimation. The result was credible after matching, minimizing discrepancies. Good overall performance of self-rated health with an average Hukou status of, respectively, 0.8 and 0.4 in the treated and control group, primarily in rural and urban regions separately. The participation of URRMI significantly impacted self-rated health of residents, with a 0.456-unit improvement probabilities observed (p < 0.1). Additionally, the individuals are categorized into urban and rural, and those with urban hukou had a 0.311 expansion in the probability of having better health status compared to rural hukou (p < 0.05). Other factors, such as age, highest education, annual income, medical expenditure, hospital scale, clinic satisfaction, and napping, also impacted self-rated health. Moreover, elder individuals, higher education levels, and higher medical expenditure having a higher probability of improvement. The study utilized a placebo test to verify the robustness of the URRMI regression. The estimated coefficients showed that basic medical insurance did not significantly improve the health of insured residents under the URRMI scheme. The study demonstrates the crucial role of PSM-DID in determining the influence of URRMI on self-rated health status. It indicates that purchasing in URRMI has a favorable influence on the health of residents, advancing enhanced self-rated health effectiveness. It does, however, reveal geographical disparities in health, with urban dwellers faring far better than those who live in the suburb. Study suggests expanding URRMI coverage, narrowing urban-rural divide, increasing insurance subsidies, reforming laws, and developing effective advertising strategies.

Ageing and wellbeing co-creation: systematic literature review and future avenues for Transformative Service Researchers

ABSTRACT Ageing is a natural process that is accompanied by several physical, psychological, cognitive, and social changes, which can have significant impact on health and wellbeing. This bibliometric analysis combined with a systematic thematic examination of the literature delves into the interplay of ageing, wellbeing, and service provision with a focus on reviewing publications in the eight top-tier service journals. This review seeks to answer how transformative service providers address the changing needs and unique requirements of the ageing populations, co-create services with them, and assess the challenges and potential advantages they encounter in co-creating wellbeing with the ageing population. This research examines the service ecosystem ‘wellbeing of the ageing population’ across all levels, including the ageing individuals (micro level), service providers (meso level), and government (macro level). Thematic analysis revealed eight salient key themes, illuminating how transformative services impact wellbeing co-creation when ageing. A comprehensive future research agenda for Transformative Service Research (TSR) is proposed to guide the development of services for wellbeing co-creation with the ageing population. This review calls attention to the pivotal role of transformative services in maintaining and enhancing wellbeing among ageing individuals and offers valuable insights to inform policy and practice.

Heterosis of the interspecific sea urchin hybrids between Strongylocentrotus intermedius and Heliocidaris crassispina

In order to study the heterosis of the interspecific hybrids between sea urchin Strongylocentrotus intermedius and Heliocidaris crassispina, comparative culturing experiments were conducted on individuals of the same age from four groups: S. intermedius (SI), H. crassispina (HC), S. intermedius ♀ × H. crassispina ♂ (SH), and H. crassispina ♀ × S. intermedius ♂ (HS). Growth rate at different stages of development, gonadal production and quality, high-temperature tolerance, and resistance to black-mouth disease were compared among these four species. The results were as follows: in the juvenile sea urchin stage, SH sea urchins exhibited 79.11% and 55.28% body weight heterosis at 16 and 20 °C, respectively, with particularly high single-parent heterosis observed at 16 °C compared to the male parent HC (247.79%). In the young sea urchin stage, SH sea urchins displayed mid-parent heterosis in body weight at all temperatures except 28 °C, reaching a maximum of 94.62% at 12 °C. HS Sea urchins showed mid-parent heterosis only at 12, 24, and 28 °C, with the highest observed at 28 °C (36.51%). The body weight specific growth rate of SH sea urchins was significantly higher than those of the other three species (P < 0.05), and they achieved the largest body weight (48.43 g) by the end of the experiment. The gonad wet weight of SH sea urchins was significantly higher than those of the other three species (P < 0.05). While there was no difference in gonad index between SH and SI sea urchins, it was significantly higher than those of HC and HS sea urchins. In terms of high-temperature tolerance, the upper thermal tolerances (UTT) of HC and HS sea urchins were significantly higher than those of SI and SH sea urchins (P < 0.05). Regarding resistance to black-mouth disease, there was no statistically significant difference in survival rates between SH sea urchins and SI sea urchins after infection with Vibrio echinoideorum at a concentration of 1 cfu/mL. However, the survival rate of HS sea urchins was significantly higher than that of SI. The study demonstrated that the SH hybrid sea urchins exhibit notable advantages in growth and gonad yield compared to its parental species, suggesting its potential as a valuable candidate for the cultivation of new sea urchin varieties in aquaculture. These findings hold significant promise for enhancing the efficiency and sustainability of sea urchin farming practices.

Spatiotemporal alterations in the brain oscillations of Arctic explorers

BackgroundThe limited understanding of the physiology and psychology of polar expedition explorers has prompted concern over the potential cognitive impairments caused by exposure to extreme environmental conditions. Prior research has demonstrated that such stressors can negatively impact cognitive function, sleep quality, and behavioral outcomes. Nevertheless, the impact of the polar environment on neuronal activity remains largely unknown. MethodsIn this study, we aimed to investigate spatiotemporal alterations in brain oscillations of 13 individuals (age range: 22–48 years) who participated in an Arctic expedition. We utilized electroencephalography (EEG) to record cortical activity before and during the Arctic journey, and employed standardized low resolution brain electromagnetic tomography to localize changes in alpha, beta, theta, and gamma activity. ResultsOur results reveal a significant increase in the power of theta oscillations in specific regions of the Arctic, which differed significantly from pre-expedition measurements. Furthermore, microstate analysis demonstrated a significant reduction in the duration of microstates (MS) D and alterations in the local synchrony of the frontoparietal network. ConclusionOverall, these findings provide novel insights into the neural mechanisms underlying adaptation to extreme environments. These findings have implications for understanding the cognitive consequences of polar exploration and may inform strategies to mitigate potential neurological risks associated with such endeavors. Further research is warranted to elucidate the long-term effects of Arctic exposure on brain function.

Analysis of events from sudden isolated dysarthria to diagnosis of myasthenic crisis: myasthenia gravis mimicking acute lacunar stroke—a case report

BackgroundMyasthenic crisis (MC) is a life-threatening complication of myasthenia gravis (MG), necessitating ventilation. Achieving a safe and timely diagnosis of myasthenic crisis with atypical, isolated presentation is a considerable challenge particularly in elderly patients, where myasthenia gravis can present with isolated dysarthria in rare instances, giving a clinical impression of lacunar stroke.Case presentationWe present a compelling case of a 73-year-old Caucasian female presenting with abrupt onset of isolated dysarthria. Despite initial treatment for a presumed lacunar stroke, subsequent evaluations led to her diagnosis of a myasthenic crisis. Within 72 h of admission, the patient developed dysphagia and shortness of breath, requiring supplemental oxygen. The case highlights the sequential progression of events from the atypical presentation of isolated dysarthria and its course to the management of a myasthenic crisis.ConclusionOur reported case focuses on the discussion of myasthenia that mimicked a lacunar stroke and was finally diagnosed at a critical time of medical crisis. This case highlights the imperative notion that isolated dysarthria in elderly individuals warrants vigilant monitoring for possible myasthenia gravis, given the low incidence of lacunar stroke presenting with only dysarthria.

Cardiac autonomic modulation and exercise capacity in older adults with intellectual disability: A 6-month randomised control trial.

Despite reported physical and functional improvements with aerobic and sprint interval training (SIT) protocols in individuals with intellectual disability (ID), it is not known if these interventions' effectivity would promote improvements in cardiac autonomic modulation. This study aimed to investigate if a 6-month SIT or a continuous aerobic programme could enhance physical performance and cardiac autonomic modulation at rest, during physical activity (PA) and after it in older adults with an ID. This is a randomised control trial. Participants with ID (age: 50.58±7.25) were allocated to one of three groups [multicomponent aerobic training group (MATG), multicomponent interval sprint training group (MISTG) and control group (CG)]. The programmes lasted 24weeks, with three sessions/week, 75-90min per session. The HRV was analysed at rest and recovery, the delta of heart rate (HR) was analysed during 6MWT, and the HR t-off kinetics was analysed in recovery after 6MWT. There were not found differences between groups, moments, or interaction for cardiac autonomic modulation at rest and recovery. During exercise, only MSITG showed a significant increase of HR between rest and the first 30s of exercise (P<0.05). Physical performance increased only in MSITG (P<0.05), while CG showed a significant reduction (P<0.01). The MSITG improved the physical performance and the vagal withdrawal at the beginning of the submaximal exercise. These findings suggest that high-intensity exercise may positively impact baroreflex function, mitigating the decline in autonomic reflex response capacity associated with aging in individuals with ID.

A collaborative pharmacist-led intervention to prevent hospital readmissions among elderly patients discharged from the emergency department: a retrospective cohort study

Unplanned hospital readmission is a safety and quality healthcare measure, conferring significant costs to the healthcare system. Elderly individuals, particularly, are at high risk of readmissions, often due to issues related to medication management. Pharmacists play a pivotal role in addressing medication-related concerns, which can potentially reduce readmissions. This retrospective single-centre cohort study, conducted from November 2022 to February 2023 in an emergency department, aimed to determine if integrating emergency medicine pharmacists into Emergency Department care models reduces unplanned hospital readmissions within 28 days and to identify the interventions they employ. The inclusion criteria included patients aged ≥ 65, taking ≥ 3 medications, and presenting with falls, cognition changes, or reduced mobility and were planned for discharge to home from the emergency department. Collaborating with the Emergency Department Aged Care Service Emergency Team, a pharmacist provided comprehensive medication management consultations, discharge liaison services, and other pharmacy related interventions to eligible participants whenever the pharmacist was available. Patients who met the eligibility criteria but did not receive pharmacist interventions due to the pharmacist's unavailability served as the control group. This method was chosen to ensure that the control group consisted of comparable patients who only differed in terms of receiving the pharmacist intervention. The study included 210 participants, with 120 receiving pharmacist interventions and 90 acting as controls. The results revealed a significant reduction in unplanned hospital readmissions among participants who received pharmacist interventions (10.0%, n = 12) compared to controls (22.2%, n = 20), with a notable difference of 12.2% (95% confidence interval 2.4–23.4%, p = 0.01). A total of 107 interventions were documented, emphasising medication selection recommendations (28.0%) and identification of adverse drug reactions/drug-drug interactions (21.5%) as primary areas of focus. These findings suggest that integrating skilled pharmacists into Emergency Department Aged Care Service Emergency Team (ASET) lowered the rate of unplanned hospital readmission within 28 days resulting in improved hospital performance metric outcomes. This highlights the potential role of pharmacists in addressing medication-related issues and enhancing the quality and safety of healthcare delivery, particularly for elderly patients transitioning from the ED to home care settings.

273 Outcomes Reported in Elective Colorectal Cancer Surgery Research for Older Patients: A Scoping Review

Abstract Aim This scoping review aimed to identify outcome measures for assessing the impact of elective colorectal cancer surgery on older patients, given their higher surgical risk and mortality rates. Conventional surgery-specific outcomes, like 5-year mortality rates, may not be appropriate, necessitating a focus on postoperative quality of life. The challenge lies in determining optimal outcomes to assess the effects of colorectal cancer resections in the older population. Method A comprehensive literature search of major electronic databases from inception to March 2023 was conducted. Studies exploring frail or elderly individuals with colorectal cancer undergoing elective surgery and reporting postoperative outcomes were included. Outcomes were classified as surgery-specific versus person-centred and summarised using a narrative synthesis. The type and rate of surgery-specific outcomes were tabulated. Results Of 1366 identified citations, 16 studies focused on person-centred outcomes and 66 exclusively on surgery-specific outcomes. Nine of the 16 ‘person-centred outcome’ studies reported discharge destination, with home discharge being predominant. Postoperative delirium ranged from 8.2% to 18.1% in six studies. Four studies explored geriatric syndromes and three analysed activities of daily living. Three studies reported a significant improvement in quality of life. The 66 ‘surgery-specific outcome’ studies assessed mortality (N=61); length of stay (N=40); postoperative complications (N=47); readmission (N=18); reoperation (N=16); and survival (N=42). Conclusions Person-centred outcomes are underreported, despite their importance in guiding patient management. Older patients require adequate information about their recovery after surgery to manage their lives better. Future research must address this gap to improve care for older patients undergoing elective colorectal cancer surgery.

Involvement of Restored Treg Cells in the Immune Pathogenesis of Parkinson’s Disease (PD) Running Title: Immune Pathogenesis of Parkinson’s Disease

Neural regression with neuroinflammation and immune dysfunction through neuro-degradative disorder is known as Parkinson’s disease (PD). Parkinson’s disease is a progressive degradative neuronal disorder. In this disease, the continuous depletion of dopaminergic neurons and the existence of protein Lewy bodies are the key points of PD development. In PD patients, regulatory T cells (Tregs) are decreased in number and have an impaired proliferative capacity that affects the suppression of T-cell characteristics. The thymus involution decline in the functionality of T-cell development and consequently naïve T cells makes the immune system more vulnerable to losing its immune surveillance, increasing morbidity and mortality in aged individuals. The persistent process of thymic involution with age vigorously contributes to a progressive reduction in thymic output. Genomic damage, cellular senescence, and epigenetic alterations are the hallmarks of cellular or molecular damage in aging. Therapeutic potential for regeneration of the thymus would improve immunity. Some strategies and approaches have focused on cell-based approaches, technology based on organoid and scaffold modulating of endogenous and exogenous compounds to help in the thymus regeneration, and fabrication technologies that could be used as regenerative approaches. Last but not least the pluripotent stem cell therapies.

Transgender healthcare: metabolic outcomes and cardiovascular risk.

Transgender identity is often associated with gender dysphoria and minority stress. Gender-affirming hormone treatment (GAHT) includes masculinising or feminising treatment and is expected to be lifelong in most cases. Sex and sex hormones have a differential effect on metabolism and CVD in cisgender people, and sex hormone replacement in hypogonadism is associated with higher vascular risk, especially in ageing individuals. Using narrative review methods, we present evidence regarding metabolic and cardiovascular outcomes during GAHT and propose recommendations for follow-up and monitoring of metabolic and cardiovascular risk markers during GAHT. Available data show no increased risk for type 2 diabetes in transgender cohorts, but masculinising GAHT increases lean body mass and feminising GAHT is associated with higher fat mass and insulin resistance. The risk of CVD is increased in transgender cohorts, especially during feminising GAHT. Masculinising GAHT is associated with a more adverse lipid profile, higher haematocrit and increased BP, while feminising GAHT is associated with pro-coagulant changes and lower HDL-cholesterol. Assigned male sex at birth, higher age at initiation of GAHT and use of cyproterone acetate are separate risk factors for adverse CVD markers. Metabolic and CVD outcomes may improve during gender-affirming care due to a reduction in minority stress, improved lifestyle and closer surveillance leading to optimised preventive medication (e.g. statins). GAHT should be individualised according to individual risk factors (i.e. drug, dose and form of administration); furthermore, doctors need to discuss lifestyle and preventive medications in order to modify metabolic and CVD risk during GAHT. Follow-up programmes must address the usual cardiovascular risk markers but should consider that biological age and sex may influence individual risk profiling including mental health, lifestyle and novel cardiovascular risk markers during GAHT.

P-357 Exposure to bleomycin in vitro reduces biomarkers of human male gamete competence

Abstract Study question Does male human sperm exposure to bleomycin in vitro affect their aptitude to breed? Summary answer Bleomycin, an antitumor antibiotic, adversely impacts human male gamete morphology and functionality, thus potentially compromising male fertility. What is known already Bleomycin is a chemotherapeutic agent used to treat a number of tumors that affect males of reproductive age. Hitherto, its effect on human male reproductive capacity alone has not been previously shown. The little information available on this subject relates to in vivo animal studies and supports the feasibility of this study. Study design, size, duration Between November 2022 and June 2023, individuals of reproductive age were enrolled in this study and had their clinical semen analyzed. The remaining ejaculate was supplied by 45 participants with sperm concentration above the World Health Organization (WHO) threshold for scientific purposes. Sperm were isolated from seminal plasma in the ejaculate of each individual, diluted to a concentration of 16 X 106 sz/mL (raw). Participants/materials, setting, methods In vitro incubation was performed in sperm preparation medium (SPM; control) or bleomycin (100 µg/mL; exposed) augmented for two hours at 37oC and 5% CO2. The results of exposed group were compared to raw and control. To evaluate the competence of human sperm, markers such as acrosome and DNA integrity, mitochondrial membrane potential, sperm motility, vitality, and oxidative stress were evaluated. Ultrastructural data from transmission electron microscopy was also obtained and correlated with functional experiments. Main results and the role of chance The participants were all of reproductive age (median age of 36 years old). The raw sperm parameters fulfilled the normozoospermia threshold set by the WHO, 2021. Prior to the current trial, none of the participants had been diagnosed with cancer or had received chemotherapy, radiation therapy, or both. Bleomycin exposure for two hours in vitro significantly (P &amp;lt; 0.001) reduced sperm motility, vitality, and chromatin condensation as compared to raw and control sperm. Moreover, bleomycin significantly (P &amp;lt; 0.001) increased the percentage of sperm with DNA fragmentation (sDNAfrag) and low mitochondrial membrane potential (MMP). Broad strands were significantly (P &amp;lt; 0.001) attained by bleomycin-induced breaks in the sperm DNA (Head staining pattern), which were succeeded by histone-rich areas (PAR-post-acrossomic region staining pattern). Additionally, bleomycin significantly (P &amp;lt; 0.05) delayed the acrossomic response, but had no significantly influence on the generation of extracellular and intracellular reactive oxygen species or in its reconstitution. Modifications in ultrastructural morphology caused by bleomycin corroborate the results obtained by functional tests. Limitations, reasons for caution Bleomycin impact on male fertility competence in vivo remains crucial. Increased sample sizes, including prepubertal subjects, are needed to pinpoint the precise bleomycin’s mechanism to cause oxidative stress, apoptosis, and sDNAfrag. Long-term implications on fertility and reproductive health, besides methods to lessen or offset bleomycin’s effects, should also be pursued. Wider implications of the findings Bleomycin adversely affects male gamete competence in humans. Along with its accompanying lung toxicity, healthcare practitioners should actively monitor and further investigate bleomycin’s gonadotoxicity in males. It is advised that all cancer patients undergoing chemotherapy treatments that contain bleomycin be provided with a fertility preservation plan in the meantime. Trial registration number not applicable

O-106 The FERTILITAS study: exploring parenthood intentions among reproductive-aged individuals without children in Belgium

Abstract Study question What are parenthood intentions of reproductive-aged individuals without children in Belgium? Summary answer Our findings show that 63% of study participants were either actively trying to conceive or expressed an intention to have a child(ren) in the future. What is known already Over the past decades, there has been a noticeable trend marked by declining fertility rates and a delay in the onset of parenthood. Narratives promoting childbirth co-exist in parallel with an ongoing social debate questioning the ethical justification of bringing new life into the world, given concerns about overpopulation and climate change. Younger generations seem to be increasingly choosing to remain childfree. To date, most studies have used a dichotomy approach (yes/no) to assess parenthood intentions, which inadequately captures the complexities of individuals' real-life experiences. Study design, size, duration We conducted a cross-sectional survey study using convenience sampling. Non-pregnant individuals of reproductive age without children were invited to answer a self-administered questionnaire. A pilot study (n = 10) was conducted to assess the readability, clearness and the length of the questionnaire. Based on our sample size calculation we aimed to recruit 1067 participants (95% confidence level, 3% margin of error). Data collection was carried out between November 2023 and January 2024. Participants/materials, setting, methods The study population consisted of reproductive-aged (18-45 years) individuals without children residing in Belgium. Participants were recruited through a multi-modal recruitment strategy (flyers, social media, etc.). The questionnaire was available in Dutch, French and English and contained questions on socio-demographic characteristics, parenthood intentions (based on the taxonomy of reproductive intentions developed by Bola et. al. (2022)) and sources of fertility information. In addition, it also included the Cardiff Fertility Knowledge Scale (Boivin et. al. (2013)). Main results and the role of chance In our current study sample (n = 1826), 71% participants self-identified as female and 28% as male. The mean age of our study sample was 25 years (SD 5). Most participants were born in Belgium (95%), were in a relationship (64%) and had some form of higher education (74%). A limited number of participants (2%) had previous experience with fertility treatment. Most participants were classified as ‘desirers’ (63%; n = 1146/1826), of which 5% (n = 83/1826) were actively trying to conceive and 58% (n = 1063/1826) were planning to have child(ren) in the future. In addition, 9% (n = 158/1826) of our study participants were ‘avoiders’ who expressed their preference to not have any children in the future. The remaining participants were classified as ‘flexers’ (28%; n = 508/1826). This group encompassed participants that were unsure about their desire to have children in the future (18%; n = 337/1826), those who indicated to not want any children now (8%; n = 150/1826) and those that indicated to be undecided (1%; n = 21/1826). On average, participants expressed a desire to have 2 children (SD 0,8), indicated a preference to have their first child at the age of 28 (SD 5) and to have their last child at the age of 32 (SD 6). Limitations, reasons for caution Our study employed convenience sampling to recruit participants, therefore our reported results should be interpreted with caution. The use of social media for recruitment could have introduced a bias towards participants with higher levels of education. Wider implications of the findings While most participants expressed an intention to have a child(ren) in the future, a significant number also expressed the wish to remain childfree or indicated to be unsure about their desire to have children. More in-depth research would be of value to better understand the reasons behind parenthood intentions. Trial registration number Not applicable