Cumulative Deficit Research Articles

Functional Dentition, Chronic Periodontal Disease and Frailty in Older Adults—A Narrative Review

The likelihood of experiencing the impact of chronic disease rises with age, and cumulative functional deficits over time increase the risk of frailty in older adults. The exact causes of frailty are not clear, and research is needed to identify appropriate intervention measures to reduce risk of developing frailty in old age. To review the evidence on the relationship between frailty, dental status and chronic periodontitis and to determine if improvements in oral health of older adults can contribute to reversal of frailty. The oral cavity is the entry point to the gastro-intestinal tract, and natural teeth facilitate efficient mastication of food prior to swallowing and subsequent digestion. The loss of natural teeth, which is gradual and cumulative over the life course, is associated with diminished nutritional intake, especially in older adults. Furthermore, chronic periodontitis has been postulated as a risk factor for frailty. The evidence supporting a strong relationship between oral health status and frailty is not clearcut. Cross sectional studies suggest an association with missing teeth and chronic periodontal inflammation. However, there are very few longitudinal studies and accordingly, it is not currently possible to claim a causal relationship. As yet, there is no evidence to suggest that improvements in oral health contribute to reversal of frailty. Longitudinal studies with robust designs are required to better inform the relationship across functional dentition, chronic periodontitis and frailty in older adults.

Frailty and risk of subsequent fracture among older adults presenting to hospital with a minimal trauma fracture.

Minimal trauma fractures are common among older adults, and frailty increases risk of an initial minimal trauma fracture. This study was undertaken to estimate the risk of subsequent fracture based on frailty status at the time of an initial fracture. The study population was older adults presenting to hospital, aged 60years or more, with a minimal trauma fracture. Frailty was estimated using a cumulative deficit approach. The risk of subsequent fracture based on increasing cumulative frailty deficit item group, adjusted for sex, age, and site of initial fracture, was estimated using Cox's proportional hazard model. Between January 2014 and December 2020, 12,115 older adults presented to hospital (8371 women [69%]), with an initial minimal trauma fracture. The average age was 80years (SD 9.5). Subsequent fractures identified during the follow-up period occurred in 1137 (9.4%) of study participants. The incidence of subsequent fracture ranged from 25.0 per 1000 older adults (95% confidence interval (CI) 22.4 to 27.8) among the lowest frailty deficit group (1 deficit item) to 31.8 per 1000 (95% CI 28.0 to 35.8) among the highest frailty deficit group (4 to 12 deficit items). After adjusting for age, sex, and site of initial fracture, an increasing number of frailty deficit items was associated with increased risk subsequent fracture (p-value for trend = 0.008). Our results indicate that following an initial minimal trauma fracture, frailty independently increases the risk of a subsequent fracture. Therefore, it is important at the time of an initial fracture that older women and men are screened for the presence of frailty, and models of care are implemented to reduce the risk of subsequent fracture among this vulnerable group of older adults.

EPH114 Impact of the COVID-19 Pandemic on HPV Vaccinations in Switzerland and Greece: Road to Recovery

The COVID-19 pandemic led to significant interruptions of human papilloma virus (HPV) vaccinations in Europe resulting in a substantial number of adolescents missing an opportunity to get protected against HPV. Although a slow recovery in vaccination rates was observed, the dose deficit remains uncleared. This study aims to estimate the cumulative number of vaccine doses missed due to pandemic and capacity required to clear the deficit in Switzerland and Greece. A published COVID-19 recovery tool (Saxena 2022) was used to project the dose deficit accumulated due to the pandemic and to estimate the expected time and vaccination catch-up rates required to clear the deficit in Switzerland and Greece. Country-specific monthly number of HPV vaccine doses disseminated before (2019) and during the COVID-19 pandemic (2020-2021) was used to estimate the cumulative deficit at the start of the catch-up period commencing in March/2022 and September/2022 in Switzerland and Greece, respectively. Compared to 2019, the decrease in the number of HPV vaccines disseminated during the first pandemic year (2020) was -14.8% in Switzerland and -4.8% in Greece; during the second year (2021), a decrease of -12.3% was observed in Greece and 7.9% in Switzerland. The dose deficit accumulated until the commencement of a catch-up period was -24.4% in Switzerland and -20.4% in Greece. To clear the dose deficit by December 2025, monthly vaccination rates need to be increased by 6.2% (910 additional doses/month) and 6.0% (715 additional doses/month) compared to 2019 rates in Switzerland and Greece, respectively. The projected cumulative deficit of missed doses during the COVID-19 pandemic was substantial in both Greece and Switzerland. A sustained increase in vaccination rates over the upcoming years will be required to reverse the deficit and prevent long-term public health and economic consequences.

Clarifying the Role of ENSO on Easter Island Precipitation Changes: Potential Environmental Implications for the Last Millennium

AbstractEl Niño Southern Oscillation (ENSO) events yield precipitation deficits and ensuing droughts, often damaging regional forests, in many parts of the world. The relative roles of ENSO, other natural climate changes, and anthropogenic factors on the forest clearing of Easter Island over the last millennium are still debated. Here, we analyze Easter Island precipitation changes using in situ, satellite‐derived and reanalysis products spanning the last 4–7 decades, and 46 monthly 156‐year‐long (1850–2014) simulations derived from 25 CMIP5 and 21 CMIP6 (Coupled Model Intercomparison Project phases 5 and 6) General Circulation Models. Our analysis shows that La Niña events, the cold phases of ENSO, cause precipitation deficits of −0.2 to −0.3 standard deviation (relative to long‐term mean) in all analyzed data types. ENSO‐like events are further examined over the last millennium (850–1981). A new multiproxy reconstruction of the NINO3.4 index based on proxy records from the Past Global Changes 2k database and Random Forest method is produced. Our reconstruction reveals unusual high recurrences of La Niña‐like situations during the fifteenth to seventeenth centuries, which likely induced significant precipitation deficits on the island. These situations are compared to published vegetation reconstructions based on pollen analyses derived from sedimentary cores collected in three island sites. We conclude the environmental consequences of cumulative precipitation deficits over long‐lasting La Niña‐like situations reconstructed here over the fifteenth to seventeenth centuries were likely favoring drought and forest flammability. La Niña events should be better accounted for among the causes of forest clearing on Easter Island.

Development and validation of retrospective electronic frailty index using operational data of aged care homes

BackgroundAlthough elderly population is generally frail, it is important to closely monitor their health deterioration to improve the care and support in residential aged care homes (RACs). Currently, the best identification approach is through time-consuming regular geriatric assessments. This study aimed to develop and validate a retrospective electronic frailty index (reFI) to track the health status of people staying at RACs using the daily routine operational data records.MethodsWe have access to patient records from the Royal Freemasons Benevolent Institution RACs (Australia) over the age of 65, spanning 2010 to 2021. The reFI was developed using the cumulative deficit frailty model whose value was calculated as the ratio of number of present frailty deficits to the total possible frailty indicators (32). Frailty categories were defined using population quartiles. 1, 3 and 5-year mortality were used for validation. Survival analysis was performed using Kaplan-Meier estimate. Hazard ratios (HRs) were estimated using Cox regression analyses and the association was assessed using receiver operating characteristic (ROC) curves.ResultsTwo thousand five hundred eighty-eight residents were assessed, with an average length of stay of 1.2 ± 2.2 years. The RAC cohort was generally frail with an average reFI of 0.21 ± 0.11. According to the Kaplan-Meier estimate, survival varied significantly across different frailty categories (p < 0.01). The estimated hazard ratios (HRs) were 1.12 (95% CI 1.09–1.15), 1.11 (95% CI 1.07–1.14), and 1.1 (95% CI 1.04–1.17) at 1, 3 and 5 years. The ROC analysis of the reFI for mortality outcome showed an area under the curve (AUC) of ≥0.60 for 1, 3 and 5-year mortality.ConclusionA novel reFI was developed using the routine data recorded at RACs. reFI can identify changes in the frailty index over time for elderly people, that could potentially help in creating personalised care plans for addressing their health deterioration.

Understanding the transgression of global and regional freshwater planetary boundaries

Freshwater ecosystems have been degraded due to intensive freshwater abstraction. Therefore, environmental flow requirements (EFRs) methods have been proposed to maintain healthy rivers and/or restore river flows. In this study, we used the Variable Monthly Flow (VMF) method to calculate the transgression of freshwater planetary boundaries: (1) natural deficits in which flow does not meet EFRs due to climate variability, and (2) anthropogenic deficits caused by water abstractions. The novelty is that we calculated spatially and cumulative monthly water deficits by river types including the frequency, magnitude and causes of environmental flow (EF) deficits (climatic and/or anthropogenic). Water deficit was found to be a regional rather than a global concern (less than 5% of total discharge). The results show that, from 1960 to 2000, perennial rivers with low flow alteration, such as the Amazon, had an EF deficit of 2–12% of the total discharge, and that the climate deficit was responsible for up to 75% of the total deficit. In rivers with high seasonality and high water abstractions such as the Indus, the total deficit represents up to 130% of its total discharge, 85% of which is due to withdrawals. We highlight the need to allocate water to humans and ecosystems sustainably. This article is part of the Royal Society Science+ meeting issue ‘Drought risk in the Anthropocene’.

Surgical Tolerability and Frailty in Elderly Patients Undergoing Robot-Assisted Radical Prostatectomy: A Narrative Review.

Simple SummaryLife expectancy in Western countries and East Asian countries has incremented over the past decades, resulting in a rapidly aging world, while in general, radical prostatectomy (RP) is not recommended in elderly men aged ≥75 years. Together with the evolving technique of robotic surgeries, surgical indications for RP should be reconsidered in ‘elderly’ and ‘frail’ men, since this procedure has now become one of the safest and most effective cancer treatments for prostate cancer. One important element to determine surgical indications is surgical tolerability. However, evidence is scarce regarding the surgical tolerability in elderly men undergoing robot-assisted radical prostatectomy (RARP). In this review, we focused on the surgical tolerability in ‘elderly’ and/or ‘frail’ men undergoing RARP, with the intent to provide up-to-date information on this matter and to support the decision making of therapeutic options in this spectrum of patients.Robot-assisted radical prostatectomy (RARP) has now become the gold standard treatment for localized prostate cancer. There are multiple elements in decision making for the treatment of prostate cancer. One of the important elements is life expectancy, which the current guidelines recommend as an indicator for choosing treatment options. However, determination of life expectancy can be complicated and difficult in some cases. In addition, surgical tolerability is also an important issue. Since frailty may be a major concern, it may be logical to use geriatric assessment tools to discriminate ‘surgically fit’ patients from unfit patients. Landmark studies show two valid models such as the phenotype model and the cumulative deficit model that allow for the diagnosis of frailty. Many studies have also developed geriatric screening tools such as VES-13 and G8. These tools may have the potential to directly sort out unfit patients for surgery preoperatively.

Electronic Frailty Index: A risk stratification tool for survival and health care outcomes in veterans with colorectal cancer.

375 Background: Frailty reflects decreased physiologic reserve and subsequent increased vulnerability to stress. Frailty has been associated with poor health outcomes in patients with cancer, however traditional frailty indices are time consuming and not widely implemented in clinical oncology practice. An electronic frailty index (EFI) derived from electronic medical records (EMR) is an objective and standardized approach to frailty that can be automated. Little is known about the association between EFI and survival and healthcare utilization outcomes in patients with colorectal cancer (CRC). Methods: We used VA administrative files from 2016 – 2020 and the VA Central Cancer Registry to identify a cohort of patients diagnosed with CRC. EFI was calculated based on the Veterans Affairs-FI (VA-FI), a validated 31-item cumulative deficit FI, to define three groups: robust (≤0.1), prefrail (0.1-0.2), and frail (&gt; 0.2). We conducted Cox proportional hazard analyses to evaluate survival. We performed logistic regression to examine prolonged length of stay (LOS) ≥ median (11 days) during all-cause hospitalization and emergency department (ED) visits within one year after diagnosis. All models were adjusted for age, gender, race, Charlson comorbidity index, and stage. Confidence intervals (CI) were calculated as 95%. Results: Of 6,043 CRC patients (age: 69.7 ± 10.6 years), 45.6% were robust, 34.5% were prefrail, and 19.9% were frail. The cohort included 22.9% rectal cancer and 77.1% colon cancer cases, distributed across stages I (29.2%), II (25.0%), III (25.2%), and IV (20.6%). Increased risk of death was found in prefrail (adjusted hazard ratio [aHR] 1.21; CI 1.10-1.32) and frail (aHR 1.90; CI 1.71-2.11) patients when compared to robust patients. Increased odds of one-year ED visits were identified in prefrail (adjusted odds ratio [aOR] 1.18; CI 1.06 – 1.35) and frail (aOR, 1.66, CI 1.43-1.94) patients. Frailty status was associated with increased odds of one-year hospitalization of prolonged LOS among prefrail (aOR 1.38; CI 1.11-1.70) and frail patients (aOR 1.79; 95% CI 1.39-2.30). Conclusions: EFI was significantly associated with survival and healthcare utilization among patients with CRC, independent of stage. Frail patients had nearly 80% increased likelihood of prolonged hospitalization. EFI has the potential to be an automated and objective decision support tool at the point of care for risk assessment prior to CRC treatment-related stressors, such as surgery or chemotherapy. Future work is needed to develop a cancer specific EFI with dynamic variables that can be followed prospectively, as well as evaluating barriers to implementation within the EMR to guide treatment decisions and improve the quality of cancer care.

Missing Care: the Initial Impact of the COVID-19 Pandemic on CKD Care Delivery

BackgroundChronic kidney disease (CKD) is a common condition with adverse health outcomes addressable by early disease management. The impact of the COVID-19 pandemic on care utilization for the CKD population is unknown.ObjectiveTo examine pandemic CKD care and identify factors associated with a high care deficit.DesignRetrospective observational studyParticipants248,898 insured individuals (95% Medicare Advantage, 5% commercial) with stage G3–G4 CKD in 2018Main MeasuresPredicted (based on the pre-pandemic period of January 1, 2019–February 28, 2020) to observed per-member monthly face-to-face and telehealth encounters, laboratory testing, and proportion of days covered (PDC) for medications, evaluated during the early (March 1, 2020–June 30, 2020), pre-vaccine (July 1, 2020–December 31, 2020), and late (January 2021–August 2021) periods and overall.Key ResultsIn-person encounters fell by 24.1% during the pandemic overall; this was mitigated by a 14.2% increase in telehealth encounters, resulting in a cumulative observed utilization deficit of 10% relative to predicted. These reductions were greatest in the early pandemic period, with a 19.8% cumulative deficit. PDC progressively decreased during the pandemic (range 9–20% overall reduction), with the greatest reductions in hypertension and diabetes medicines. CKD laboratory monitoring was also reduced (range 11.8–43.3%). Individuals of younger age (OR 1.63, 95% CI 1.16, 2.28), with commercial insurance (1.43, 95% CI 1.25, 1.63), residing in the Southern US (OR 1.17, 95% CI 1.14, 1.21), and with stage G4 CKD (OR 1.21, 95% CI 1.17, 1.26) had greater odds of a higher care deficit overall.ConclusionsThe early COVID-19 pandemic resulted in a marked decline of healthcare services for individuals with CKD, with an incomplete recovery during the later pandemic. Increased telehealth use partially compensated for this deficit. The downstream impact of CKD care reduction on health outcomes requires further study, as does evaluation of effective care delivery models for this population.

An Assessment of Potential Severe Droughts in the Colorado River Basin

ABSTRACTMuch has been learned about Colorado River hydrology since the severe sustained drought study in 1995. We summarize our updated understanding of plausible future drought conditions by considering historical flows, tree‐ring reconstructions, and climate change. We focus on natural streamflow at Lees Ferry, the primary metric used to quantify the runoff in the Colorado River Basin. We identify drought periods using historical records and tree‐ring reconstructed streamflow at Lees Ferry, which we then use to characterize potential future droughts. Resampling from past drought periods generates plausible future conditions to consider during planning. We produced three drought scenarios, each comprising 100 streamflow sequences to be used as input to systems operation and management models. We used analysis of the duration‐severity and cumulative deficit relative to the mean natural flow to evaluate droughts and drought simulations and show that the current millennium drought that started in 2000 has an average flow far less than the historical record. However, the flows reconstructed from tree rings or future flows projected from climate models indicate that even more severe droughts are possible. When used as input to the Colorado River Simulation System the drought scenarios developed indicate considerable periods when Lake Powell falls below its hydropower penstocks, indicating a need to rethink management and operation of these reservoirs during these critical conditions.

Sacubitril/Valsartan and Frailty in Patients With Heart Failure and Preserved Ejection Fraction

BackgroundFrailty is an increasingly common problem, and frail patients are less likely to receive new pharmacologic therapies because the risk–benefit profile is perceived to be less favorable than in nonfrail patients. ObjectivesThis study investigated the efficacy of sacubitril/valsartan according to frailty status in 4,796 patients with heart failure with preserved ejection fraction randomized in the PARAGON-HF (Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial. MethodsFrailty was measured by using the Rockwood cumulative deficit approach. The primary endpoint was total heart failure hospitalizations or cardiovascular death. ResultsA frailty index (FI) was calculable in 4,795 patients. In total, 45.2% had class 1 frailty (FI ≤0.210, not frail), 43.5% had class 2 frailty (FI 0.211-0.310, more frail), and 11.4% had class 3 frailty (FI ≥0.311, most frail). There was a graded relationship between FI class and the primary endpoint, with a significantly higher risk associated with greater frailty (class 1: reference; class 2 rate ratio: 2.19 [95% CI: 1.85-2.60]; class 3 rate ratio: 3.29 [95% CI: 2.65-4.09]). The effect of sacubitril/valsartan vs valsartan on the primary endpoint from lowest to highest FI class (as a rate ratio) was: 0.98 [95% CI: 0.76-1.27], 0.92 [95% CI: 0.76-1.12], and 0.69 [95% CI: 0.51-0.95]), respectively (Pinteraction = 0.23). When FI was examined as a continuous variable, the interaction with treatment was significant for the primary outcome (Pinteraction = 0.002) and total heart failure hospitalizations (Pinteraction < 0.001), with those most frail deriving greater benefit. ConclusionsFrailty was common in heart failure with preserved ejection fraction and associated with worse outcomes. Compared with valsartan, sacubitril/valsartan seemed to show a greater reduction in the primary endpoint with increasing frailty, although this was not significant when FI was examined as a categorical variable. (Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711).

Efficacy and Safety of Dapagliflozin According to Frailty in Patients With Heart Failure: A Prespecified Analysis of the DELIVER Trial.

Frailty is increasing in prevalence. Because patients with frailty are often perceived to have a less favorable risk/benefit profile, they may be less likely to receive new pharmacologic treatments. We investigated the efficacy and tolerability of dapagliflozin according to frailty status in patients with heart failure with mildly reduced or preserved ejection fraction randomized in DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure). Frailty was measured using the Rockwood cumulative deficit approach. The primary end point was time to a first worsening heart failure event or cardiovascular death. Of the 6263 patients randomized, a frailty index (FI) was calculable in 6258. In total, 2354 (37.6%) patients had class 1 frailty (FI ≤0.210; ie, not frail), 2413 (38.6%) had class 2 frailty (FI 0.211-0.310; ie, more frail), and 1491 (23.8%) had class 3 frailty (FI ≥0.311; ie, most frail). Greater frailty was associated with a higher rate of the primary end point (per 100 person-years): FI class 1, 6.3 (95% CI 5.7-7.1); class 2, 8.3 (7.5-9.1); and class 3, 13.4 (12.1-14.7; P<0.001). The effect of dapagliflozin (as a hazard ratio) on the primary end point from FI class 1 to 3 was 0.85 (95% CI, 0.68-1.06), 0.89 (0.74-1.08), and 0.74 (0.61-0.91), respectively (Pinteraction=0.40). Although patients with a greater degree of frailty had worse Kansas City Cardiomyopathy Questionnaire scores at baseline, their improvement with dapagliflozin was greater than it was in patients with less frailty: placebo-corrected improvement in Kansas City Cardiomyopathy Questionnaire Overall Summary Score at 4 months in FI class 1 was 0.3 (95% CI, -0.9 to 1.4); in class 2, 1.5 (0.3-2.7); and in class 3, 3.4 (1.7-5.1; Pinteraction=0.021). Adverse reactions and treatment discontinuation, although more frequent in patients with a greater degree of frailty, were not more common with dapagliflozin than with placebo irrespective of frailty class. In DELIVER, frailty was common and associated with worse outcomes. The benefit of dapagliflozin was consistent across the range of frailty studied. The improvement in health-related quality of life with dapagliflozin occurred early and was greater in patients with a higher level of frailty. URL: https://www. gov; Unique identifier: NCT03619213.

Recent extreme drought events in the Amazon rainforest: assessment of different precipitation and evapotranspiration datasets and drought indicators

Abstract. Over the last decades, the Amazon rainforest has been hit by multiple severe drought events. Here, we assess the severity and spatial extent of the extreme drought years 2005, 2010 and 2015/16 in the Amazon region and their impacts on the regional carbon cycle. As an indicator of drought stress in the Amazon rainforest, we use the widely applied maximum cumulative water deficit (MCWD). Evaluating nine state-of-the-art precipitation datasets for the Amazon region, we find that the spatial extent of the drought in 2005 ranges from 2.2 to 3.0 (mean =2.7) ×106 km2 (37 %–51 % of the Amazon basin, mean =45 %), where MCWD indicates at least moderate drought conditions (relative MCWD anomaly &lt;-0.5). In 2010, the affected area was about 16 % larger, ranging from 3.0 up to 4.4 (mean =3.6) ×106 km2 (51 %–74 %, mean =61 %). In 2016, the mean area affected by drought stress was between 2005 and 2010 (mean =3.2×106 km2; 55 % of the Amazon basin), but the general disagreement between datasets was larger, ranging from 2.4 up to 4.1×106 km2 (40 %–69 %). In addition, we compare differences and similarities among datasets using the self-calibrating Palmer Drought Severity Index (scPDSI) and a dry-season rainfall anomaly index (RAI). We find that scPDSI shows a stronger and RAI a much weaker drought impact in terms of extent and severity for the year 2016 compared to MCWD. We further investigate the impact of varying evapotranspiration on the drought indicators using two state-of-the-art evapotranspiration datasets. Generally, the variability in drought stress is most dependent on the drought indicator (60 %), followed by the choice of the precipitation dataset (20 %) and the evapotranspiration dataset (20 %). Using a fixed, constant evapotranspiration rate instead of variable evapotranspiration can lead to an overestimation of drought stress in the parts of Amazon basin that have a more pronounced dry season (for example in 2010). We highlight that even for well-known drought events the spatial extent and intensity can strongly depend upon the drought indicator and the data sources it is calculated with. Using only one data source and drought indicator has the potential danger of under- or overestimating drought stress in regions with high measurement uncertainty, such as the Amazon basin.

Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people.

SummaryBackgroundPrevalence of both multimorbidity and frailty increases with age, but more evidence is needed to elucidate their relationship and their association with other health-related outcomes. We analysed the dynamics of both conditions as people age and calculate the associated risk of death, nursing home admission, and need for home care.MethodsData were drawn from the primary care electronic health records of a longitudinal cohort of people aged 65 or older in Catalonia in 2010–2019. Frailty and multimorbidity were measured using validated instruments (eFRAGICAP, a cumulative deficit model; and SNAC-K, respectively), and their longitudinal evolution was described. Cox regression models accounted for the competing risk of death and adjusted by sex, socioeconomical status, and time-varying age, alcohol and smoking.FindingsWe included 1 456 052 patients. Prevalence of multimorbidity was consistently high regardless of age, while frailty almost quadrupled from 65 to 99 years. Frailty worsened and also changed with age: up to 84 years, it was more related to concurrent diseases, and afterwards, to frailty-related deficits. While concurrent diseases contributed more to mortality, frailty-related deficits increased the risk of institutionalisation and the need for home care.InterpretationThe nature of people’s multimorbidity and frailty vary with age, as does their impact on health status. People become frailer as they age, and their frailty is more characterised by disability and other symptoms than by diseases. Mortality is most associated with the number of comorbidities, whereas frailty-related deficits are associated with needing specialised care.FundingInstituto de Salud Carlos III through PI19/00535, and the PFIS Grant FI20/00040 (Co-funded by European Regional Development Fund/European Social Fund).

Frequency of Abnormally Low Neuropsychological Scores in Post-COVID-19 Syndrome: the Geneva COVID-COG Cohort.

ObjectiveSeveral studies have reported poor long-term neuropsychological performances in patients following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but none has yet considered the effect of administering multiple intercorrelated neuropsychological tests and assessed the frequency of cognitive deficits in a normative population. Our aim was therefore to assess the presence of cumulative neuropsychological deficits in an actual post-coronavirus disease of 2019 (COVID-19) comparison group versus one simulated using Monte-Carlo methods.MethodValidated neuropsychological Monte-Carlo simulation methods were applied to scores from a battery of neuropsychological tests (memory, executive, attentional, perceptual, logical reasoning, language, and ideomotor praxis) administered to 121 patients who had had mild, moderate, or severe COVID-19 (mean age: 56.70 years; 32% women), 222 ± 43 days post-infection. The cumulative percentages of the three severity subgroups were compared with the results of a false discovery rate-corrected probability analysis based on normative data.ResultsThe cumulative percentages of deficits in memory and executive functions among the severe and moderate patients were significantly higher than those estimated for the normative population. Moderate patients also had significantly more deficits in perception and logical reasoning. In contrast, the mild group did not have significantly more cumulative deficits.ConclusionsModerate and severe forms of COVID-19 cause greater long-term neuropsychological deficits than those that would be found in a normative population, reinforcing the hypothesis of long-term effects of SARS-CoV-2 on cognitive function, independent of the severity of the initial infection.

Amazon fires in the 21st century: The year of 2020 in evidence

AbstractAimThe aim was to evaluate fire activity for the entire Amazon and Amazon regions within each country/department from 2003 to 2020, assessing the potential contributions of drought and deforestation and contrasting 2020 with the previous years.LocationAmazoniasensu lato.Time periodAnnually from 2003 to 2020.Major taxa studiedTerrestrial plants.MethodsWe collected time series of MODIS active fire detections and burned area and assessed the yearly burned area of several land‐use/land‐cover types. We also divided the Amazon territory into 10 km × 10 km grid cells to identify annual anomalies in active fire occurrence, rainfall, maximum cumulative water deficit (MCWD) and deforestation. Rainfall and MCWD anomalies for a given cell each year consisted of annual values at least one standard deviation below average for that cell from 2003 to 2020, whereas fire and deforestation anomalies had annual values at least one standard deviation above the average for that cell.ResultsBrazil and Bolivia have contributed, on average, &gt;70% and about 15%, respectively, of annual active fire detections in the Amazon, in addition to more than half and about one‐third of annual burned areas in the region. On average, 32% of annual burned areas in the Amazon have consisted of agricultural lands, 29% of natural grasslands and 16% of old‐growth forests. The annual extent of areas with fire anomalies was significantly associated with the annual extent of areas with deforestation anomalies, but not significantly associated with the annual extent of areas experiencing water deficit anomalies. In 2020, the total burned area in the Amazon was the greatest since 2010, and the ratio of burned area per active fire was the second greatest of the time series, despite a much lower extent of areas with anomalously high water deficit in comparison to the 2015–2016 megadrought.Main conclusionsOur findings suggest that the majority of anomalously high fire occurrences in the Amazon since 2003 did not occur in anomalous drought conditions. The intensification of agricultural fires and deforestation aggravated the burning of Amazonian ecosystems in 2020.

Development and validation of a frailty index compatible with three interRAI assessment instruments.

a Frailty Index (FI) calculated by the accumulation of deficits is often used to quantify the extent of frailty in individuals in specific settings. This study aimed to derive a FI that can be applied across three standardised international Residential Assessment Instrument assessments (interRAI), used at different stages of ageing and the corresponding increase in support needs. deficit items common to the interRAI Contact Assessment (CA), Home Care (HC) or Long-Term Care Facilities assessment (LTCF) were identified and recoded to form a cumulative deficit FI. The index was validated using a large dataset of needs assessments of older people in New Zealand against mortality prediction using Kaplan Meier curves and logistic regression models. The index was further validated by comparing its performance with a previously validated index in the HC cohort. the index comprised 15 questions across seven domains. The assessment cohort and their mean frailty (SD) were: 89,506 CA with 0.26 (0.15), 151,270 HC with 0.36 (0.15) and 83,473 LTCF with 0.41 (0.17). The index predicted 1-year mortality for each of the CA, HC and LTCF, cohorts with area under the receiver operating characteristic curves (AUCs) of 0.741 (95% confidence interval, CI: 0.718-0.762), 0.687 (95%CI: 0.684-0.690) and 0.674 (95%CI: 0.670-0.678), respectively. the results for this multi-instrument FI are congruent with the differences in frailty expected for people in the target settings for these instruments and appropriately associated with mortality at each stage of the journey of progressive ageing.

Climatic legacy effects on the drought response of the Amazon rainforest.

Extreme precipitation and drought events are predicted to become more intense and more frequent over the Amazon rainforest. Because changes in forest dynamics could prompt strong feedback loops to the global climate, it is of crucial importance to gain insight into the response of tropical forests to these recurring extreme climatic events. Here, we evaluated the Amazon forest stability (resistance and resilience) to drought in the context of past dry and wet climatic events using MODIS EVI satellite imagery and cumulative water deficit anomalies. We observed large spatial differences in the occurrence of extreme climatic events from 1980 to 2019, with an increase in drought frequency in the central and northern Amazon and drought intensity in the southern Amazon basin. An increasing trend in the occurrence of wet events was found in the western, southern, and eastern Amazon. Furthermore, we found significant legacy effects of previous climatic events on the forest drought response. An extreme drought closely preceding another drought decreased forest resilience, whereas the occurrence of a recent drier-than-usual event also decreased the forest resistance to later droughts. Both wetter-than-usual and extreme wet events preceding an extreme drought increased the resistance of the forest, and with similar effects sizes as dry events, indicating that wet and dry events have similarly sized legacy effects on the drought response of tropical forests. Our results indicate that the predicted increase in drought frequency and intensity can have negative consequences for the functioning of the Amazon forest. However, more frequent wet periods in combination with these droughts could counteract their negative impact. Finally, we also found that more stable forests according to the alternative stable states theory are also more resistant and resilient to individual droughts, showing a positive relationship between the equilibrium and non-equilibrium stability dynamics.

Does social participation decrease the risk of frailty? Impacts of diversity in frequency and types of social participation on frailty in middle-aged and older populations

BackgroundSocial participation (SP) may be an effective measure for decreasing frailty risks. This study investigated whether frequency and type of SP is associated with decreased frailty risk among Chinese middle-aged and older populations.MethodsData were derived from the China Health and Retirement Longitudinal Study (CHARLS). Frailty was assessed using the Rockwood’s Cumulative Deficit Frailty Index. SP was measured according to frequency (none, occasional, weekly and daily) and type (interacting with friends [IWF]; playing mah-jong, chess, and cards or visiting community clubs [MCCC], going to community-organized dancing, fitness, qigong and so on [DFQ]; participating in community-related organizations [CRO]; voluntary or charitable work [VOC]; using the Internet [INT]). Smooth curves were used to describe the trend for frailty scores across survey waves. The fixed-effect model (N = 9,422) was applied to explore the association between the frequency/type of SP and frailty level. For baseline non-frail respondents (N = 6,073), the time-varying Cox regression model was used to calculate relative risk of frailty in different SP groups.ResultsWeekly (β = − 0.006; 95%CI: [− 0.009, − 0.003]) and daily (β = − 0.009; 95% CI: [− 0.012, − 0.007]) SP is associated with lower frailty scores using the fixed-effect models. Time-varying Cox regressions present lower risks of frailty in daily SP group (HR = 0.76; 95% CI: [0.69, 0.84]). SP types that can significantly decrease frailty risk include IWF, MCCC and DFQ. Daily IWF and daily DFQ decreases frailty risk in those aged < 65 years, female and urban respondents, but not in those aged ≥ 65 years, male and rural respondents. The impact of daily MCCC is significant in all subgroups, whereas that of lower-frequent MCCC is not significant in those aged ≥ 65 years, male and rural respondents.ConclusionThis study demonstrated that enhancing participation in social activities could decrease frailty risk among middle-aged and older populations, especially communicative activities, intellectually demanding/engaging activities and community-organized physical activities. The results suggested very accurate, operable, and valuable intervening measures for promoting healthy ageing.

Comment on: Validation of the cumulative deficit theory in bariatric surgery: new bariatric frailty score is associated with non-home discharge, prolonged hospital stay and mortality in the era of fast-track bariatric surgery

Who benefits from metabolic bariatric surgery (MBS)? Who does not? While these questions seem simple, the answers are more complex than can be fulfilled by the commonly used and outdated guidelines. The 1991 National Institutes of Health Consensus Conference on Gastrointestinal Surgery for Severe Obesity, now more than 30 years old, provided the last major reiteration by a government agency that is now no longer involved in such initiatives [1]. These recommendations are becoming increasingly disconnected from the realities of a growing obesity epidemic, evolving clinical practice patterns, and the many advances that have occurred in the surgical management of obesity as well as the medical alternatives.