Demographic Changes Research Articles

Disease modification in axial spondyloarthritis - still a controversy?

This review evaluates recent advancements in disease-modifying therapies for axial spondyloarthritis (axSpA). A recent study could not demonstrate an additional effect of NSAID therapy on golimumab [Tumor Necrosis Factor-α inhibitor (TNFi)] on structural progression; however, this might be due to the fact that the study was underpowered. While DMARDs have shown promise in suppressing inflammation, their impact on structural progression remains uncertain. A well powered trial showed no difference in spinal progression between secukinumab [Interleukin17A inhibitor (IL17Ai)] and adalimumab-biosimilar (TNFi). Preliminary data on Janus kinase inhibitors (JAKi) focus on MRI findings but lack evidence on radiographic spinal progression. While some studies suggest promising outcomes, others reveal limitations and inconclusive findings. Recent studies explore the effectiveness of NSAIDs, biological disease-modifying antirheumatic drugs like TNFi and IL-17i, as well as JAK inhibitors in axSpA. Conflicting evidence surrounds these therapies' ability to impede structural progression, with challenges in study design and interpretation. Moreover, changes in demographics and treatment methods underscore the importance of examining trends over time when assessing disease outcomes. Ultimately, ongoing research could benefit from new imaging tools when evaluating therapeutic strategies for modifying disease progression in axSpA.

Impressive Short-Term Improvement in Functional Outcome and Quality of Life after Primary Total Hip Arthroplasty (THA) in the Orthogeriatric Patient in a Prospective Monocentric Trial

Background/Objectives: Osteoarthritis (OA) represents the most frequent chronic joint disease worldwide. Facing an aging population, resulting from the demographic change, the number of primary total hip arthroplasties (THA) will further increase. Although the geriatric patient strongly differs from the younger one, the current literature on elective orthopedic surgery in the geriatric patient is scarce. This work analyses, whether geriatric patients receiving primary THA significantly improve in terms of their (1) mobility and functional outcome and (2) health-related quality of life at four to six weeks as well as three months postoperatively. Methods: In a prospective study design, we analyzed 101 geriatric patients with osteoarthritis of the hip receiving primary THA. The study is part of the ongoing “Special Orthopaedic Geriatrics” (SOG) trial, which is funded by the German Federal Joint Committee (GBA). In addition to a preoperative comprehensive geriatric assessment (CGA), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the EQ5D-5L were imposed preoperatively (t0), at four to six weeks (t1), and at three months (t2) postoperatively. Results: The 101 enrolled patients had a mean age of 78.1 ± 4.9 years. The total WOMAC score and almost all subcategories significantly improved at four to six weeks as well as three months postoperatively in comparison to the preoperative results (p < 0.001). The same was observed for the EQ-5D-5L, showing significant improvement in overall health at both time points (p < 0.001) and all subcategories (p < 0.05). Conclusions: This study implies that a geriatric patient benefits as much from elective primary THA as a younger patient. However, the preoperative comprehensive geriatric assessment with screening for risk factors is of utmost importance. Regarding the aging population, a lot of effort is needed to obtain more knowledge about geriatric patients receiving elective orthopedic surgery.

Promoting Individual Health Responsibility in the Welfare State.

The public health insurance in Germany will face huge economic challenges in the upcoming years. New diagnostic and therapeutic methods as well as the demographic change contribute to constantly rising expenditure. Although incentives for health-promoting behaviour or financial sanctions for an unhealthy lifestyle have been already discussed in the past, there has been a general reluctance to legally establish corresponding mechanisms for fear of eroding solidarity and increasing state control. In the course of the Coronavirus pandemic however, a stronger awareness rose to the fact that personal health-related life choices can have a huge impact on the stability of the healthcare system including public health insurance. Not only in Germany but throughout much of Europe, the pandemic led to a new and more fundamental debate about the relationship between individual responsibility for personal health and the wider responsibility for public health assumed by the community of solidarity.

Predicting the prevalence of type 2 diabetes in Brazil: a modeling study

AimsWe adopted a modeling approach to predict the likely future prevalence of type 2 diabetes, taking into account demographic changes and trends in obesity and smoking in Brazil. We then used the model to estimate the likely future impact of different policy scenarios, such as policies to reduce obesity.MethodsThe IMPACT TYPE 2 DIABETES model uses a Markov approach to integrate population, obesity, and smoking trends to estimate future type 2 diabetes prevalence. We developed a model for the Brazilian population from 2006 to 2036. Data on the Brazilian population in relation to sex and age were collected from the Brazilian Institute of Geography and Statistics, and data on the prevalence of type 2 diabetes, obesity, and smoking were collected from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL).ResultsThe observed prevalence of type 2 diabetes among Brazilians aged over 25 years was 10.8% (5.2–14.3%) in 2006, increasing to 13.7% (6.9–18.4%) in 2020. Between 2006 and 2020, the observed prevalence in men increased from 11.0 to 19.1% and women from 10.6 to 21.3%. The model forecasts a dramatic rise in prevalence by 2036 (27.0% overall, 17.1% in men and 35.9% in women). However, if obesity prevalence declines by 1% per year from 2020 to 2036 (Scenario 1), the prevalence of diabetes decreases from 26.3 to 23.7, which represents approximately a 10.0% drop in 16 years. If obesity declined by 5% per year in 16 years as an optimistic target (Scenario 2), the prevalence of diabetes decreased from 26.3 to 21.2, representing a 19.4% drop in diabetes prevalence.ConclusionThe model predicts an increase in the prevalence of type 2 diabetes in Brazil. Even with ambitious targets to reduce obesity prevalence, type 2 diabetes in Brazil will continue to have a large impact on Brazilian public health.

‘Successful Ageing’ Needs a Future: Older Incarcerated Adults’ Views on Ageing in Prison

Demographic changes have led to an increase in older people in prisons. Whereas the rehabilitative process of younger offenders is geared towards their reintegration into the labour market, successful ageing should be a policy aim for older prisoners. This study explores how older incarcerated persons view their ageing. A qualitative study using a written survey with only the single question What does ageing in prison mean to you? was conducted in Bavaria, Germany. A total of 64 prisoners (61 male, 3 female) supplied answers varying in length from a few words to several pages. The thematic analysis revealed that together with health concerns, social relations and everyday activities, the uncertainty of the future was a central focus point for the older adults in prison. The authors propose that a positive vision of the future needs to be included in any model of successful ageing. If successful ageing is used as an aim for older prisoners, more attention needs to be paid to support interventions during and after the release process.

Pensions under Pressure: Unraveling the Crisis and Debating Reform in USA’s Aging Society

Abstract: This research paper critically examines the challenges facing the pension system in the United States amidst a rapidly aging society. As demographic shifts lead to an increasing proportion of the population entering retirement, the strain on pension funds intensifies. The paper delves into the intricate interplay of factors contributing to the crisis, encompassing demographic changes, economic challenges, and policy issues. Demographically, the rising life expectancy poses a significant strain on pension programs, necessitating a re-evaluation of their sustainability. Economic hurdles, including low interest rates and market volatility, further compound the issue by affecting pension fund investments. The regulatory framework and policy landscape are scrutinized to assess their efficacy in responding to the evolving needs of an aging society. This paper not only identifies the problems but engages in a comprehensive debate on potential reforms. From adjusting retirement ages to exploring innovative financial instruments, various options are considered to address the pressing challenges. The research concludes by emphasizing the urgency of finding sustainable solutions to alleviate the pressure on the pension system, ensuring the financial security of retirees in the face of an aging population. The insights presented contribute to the ongoing discourse on pension reform, seeking a balanced approach that safeguards the interests of both retirees and the stability of the pension system.

IDENTIFIKASI PENGARUH PENINGKATAN LAHAN TERBANGUN TERHADAP SOSIAL KEPENDUDUKAN WILAYAH PERI URBAN KECAMATAN GEDONG TATAAN

The development of Bandar Lampung as an urban area, has resulted in several sub-districts developing as buffer areas for urban activities, one of which is Gedong Tataan District, Pesawaran. This development has led to the growth of peri-urban characteristics in Gedong Tataan District. The real impact is the increase in changes to built-up area. Apart from that, peri-urban development is also related to the change of socio-demographic. Therefore, this research aims to determine whether there is an influence of increasing built-up area on regional social changes in Gedong Tataan. The research was carried out by testing the built-up area against several demographic condition variables, such as population, sex ratio and education level. With the increase in built-up area from 2014-2022 amounting to 7.97%, it turns out that it does not really affect the demographic changes in Gedong Tataan. This may be influenced by the decrease in the population growth rate of Gedong Tataan and the stagnant level of education, which is still dominated by low levels of education.

2023 Pauline Cerasoli Lecture: It Takes a Village to Raise a Profession.

Personal and profession-related factors affect graduate transition to practice. Social supports and a sense of belonging are recognized as critical factors affecting success. The need for a professional to postprofessional continuum of learning has been identified. Development of a process to effectively move learners through this continuum are affected by conflicts such as economic issues, varied educational and practice philosophies, and capacity demands for clinical sites and instructors. The purpose of this article was to discuss professional formation as an individual experience that needs environmental support. If we look to the intrinsic needs of the individual to develop effective systems, both individuals and the profession will thrive. The changing demographics of students and factors affecting health care and education offer compelling reasons to reconsider the pathway for early professional development. Education and practice must collaborate to cocreate the foundation for professional formation. Basic needs such as economic security and social belonging must be met to create optimal conditions for learning and growth. The profession has not adopted an intentional pathway for new graduates to meet foundational practice needs. Some new graduates seek residencies, but residencies are focused on specialization and supply does not meet the demand. Strategies to promote success of early career professionals include a professional to postprofessional curriculum with intentional mentorship, changes in the regulatory environment, and formation of effective partnerships to support education and practice.

Health District at Queenstown: Catalyst for translational research

Ageing societies dominating global demographics is not new. However, the pace of global population ageing is causing disquietude. In 2017, the global population over age 60 years exceeded those below 5 years for the first time in history, and only 3 years later, the population over age 65 surpassed those below 5.1,2 The US took 72 years to double its proportion of population over age 65 from 7% to 14% while Sweden took 85 years, but Asia has been projected to achieve this in about 23 years, with Singapore having taken 20 years.3 This unprecedented ageing acceleration in populations results from longer individual lifespans due to improvements in healthcare and population health, combined with a steady decline in total fertility rate—the latter being the mean number of children per woman in her lifetime. Unfortunately, the number of years in good health has not kept pace with lengthening lifespan; consequently, time spent in poor health is increasing.4 This demographic change, along with a widening healthspan and lifespan gaps will have dramatic impact on economic growth, workforce composition, healthcare, housing and transportation.

Weakening Demographic Dividend in India

Abstract This study examines the influence of demographic changes on India's economic growth from 1999 to 2019, emphasizing the impact of the rising working-age population on state domestic product per capita and sectoral value-added. While the overall influence of the working-age population ratio and core working-age proportions on per capita economic growth is limited, a higher proportion of high-skilled workers and urban residents positively affects per capita output. Furthermore, our analysis highlights sector-specific effects, with particular significance observed in the industry sector, where the influence of the working-age population is most pronounced.

Care-receivers with physical disabilities’ perceptions on having humanoid assistive robots as assistants: a qualitative study

BackgroundPeople with physical disabilities due to disease or injury face barriers to their daily activities and participation in society. Many depend on formal or informal caregivers for assistance to live independently. However, future healthcare challenges due to demographic changes threaten access to home care and assistants. Assistive technologies, such as robots for physical assistance, can support the independence and autonomy of people with physical disabilities. This study explore Norwegian care-receivers’ perceptions of using robot assistance in their homes, including preferences for tasks acceptable or unacceptable for robot assistance and the underlying reasons.MethodPurposive sampling was employed to recruit 18 participants, aged between 18 and 77 years, with differences in physical function including diagnoses such as stroke, spinal cord injury, amputations, and muscular dystrophy. Qualitative data were gathered through four focus group interviews wherein participants watched videos featuring a humanoid assistive robot, EVEr3. The collected data underwent analysis using reflexive thematic analysis.ResultsThree themes with associated sub-themes were constructed: (a) How a robot could assist in daily life, (b) The robot’s appearance and functionality, and (c) Concerns about having a robot as an assistant. The participants welcomed the idea of a future robotic assistant in areas that may contribute to an increased feeling of independence and autonomy.ConclusionA robot assisting in activities of daily living would need to be individually customized to meet the needs of each user in terms of which tasks to assist with, how to assist in these defined tasks, and how it is controlled.

Changes in transfusion-transmissible infection prevalence and demographics among US blood donors during the COVID-19 pandemic.

The COVID-19 pandemic impacted the US blood supply. We compared blood donor demography and infectious disease prevalence before and during the pandemic using a large multicenter database. Data were categorized as "Before COVID-19" (March 2018-February 2020) or "During COVID-19" (March 2020-February 2022). Donor demographics, donation frequency, and infectious marker prevalence of HIV, HBV, and HCV were compared for the two time periods. The odds of a donor testing positive for these infections among the two time periods were calculated using multivariable logistic regression. Our study assessed a total of 26,672,213 donations including 13,430,380 before and 13,241,833 during COVID-19. There were significantly more donations from donors who were female, aged 40 and older, white, and repeat, during COVID-19. Donation frequency comparison quantified the increase in donations from donors who were white, female, older, and repeat during the pandemic. The prevalence of HIV and HCV decreased significantly during COVID-19 compared to before, but not for HBV. For HIV, the adjusted odds of infection during the pandemic did not differ but for HBV, the odds were significantly more likely during the pandemic and were significantly lower for HCV. Demographics and infectious disease marker prevalence changed during the COVID-19 pandemic in the United States. Prevalence of each infection in the donor population will continue to be monitored to determine if changes were specific to the pandemic period.

Evolution of nutritional management in children with cystic fibrosis - a narrative review.

Nutrition has played a central role in the management and outcomes of people with cystic fibrosis (pwCF) since the 1970s. Advances in therapies and practices in recent decades have led to a significant change in the patient landscape with dramatic improvements in life expectancy, as well as quality of life, bringing with it new issues. Historically, cystic fibrosis was a condition associated with childhood and malnutrition; however, changes in patient demographics, nutritional assessment and fundamental nutritional management have evolved, and it has become an increasingly prevalent adult disease with new nutritional challenges, including obesity. This paper aims to describe these changes and the impact and challenges they bring for those working in this field. Nutritional professionals will need to evolve, adapt and remain agile to the wider range of situations and support required for a new generation of pwCF. Specialised nutrition support will continue to be required, and it will be additionally important to improve and optimise quality of life and long-term health.

Parasite-mediated predation determines infection in a complex predator-prey-parasite system.

The interplay of host-parasite and predator-prey interactions is critical in ecological dynamics because both predators and parasites can regulate communities. But what is the prevalence of infected prey and predators when a parasite is transmitted through trophic interactions considering stochastic demographic changes? Here, we modelled and analysed a complex predator-prey-parasite system, where parasites are transmitted from prey to predators. We varied parasite virulence and infection probabilities to investigate how those evolutionary factors determine species' coexistence and populations' composition. Our results show that parasite species go extinct when the infection probabilities of either host are small and that success in infecting the final host is more critical for the survival of the parasite. While our stochastic simulations are consistent with deterministic predictions, stochasticity plays an important role in the border regions between coexistence and extinction. As expected, the proportion of infected individuals increases with the infection probabilities. Interestingly, the relative abundances of infected and uninfected individuals can have opposite orders in the intermediate and final host populations. This counterintuitive observation shows that the interplay of direct and indirect parasite effects is a common driver of the prevalence of infection in a complex system.

Navigating brain drain in the Western Balkans

This article analyses the European Commission’s attitude vis-à-vis labour migration and brain drain in the Western Balkans. It uses Croatia’s post–EU accession experience as a focal point. Grappling with elevated migration rates and a decline in natality, the Western Balkan countries are an interesting region in terms of demographic change. Examining how much attention the Commission pays to brain drain, the article notes an increase since 2019; yet this focus appears disproportionately limited considering the potential repercussions for economic growth and social welfare in the countries experiencing it. The Commission’s predominantly negative view of brain drain emphasises that it is the nations affected that are responsible for avoiding it, thereby confirming that it is caused by a skills mismatch. The article recommends integrating brain-drain prevention measures into the enlargement process, and encourages the Commission to improve its focus on the matter in its annual candidate and potential candidate country progress reports.

Rethinking urban park accessibility in the context of demographic change: A population structure perspective

Rapid demographic change has reshaped the demand for and use of urban parks, profoundly affecting park accessibility inequities. In response to the need for park equity planning under demographic change, we have rethought the gaps in existing park accessibility research. In this study, we revisited and modified the two-step floating catchment area (2SFCA) method, re-naming this method as the floatable supply and demand improved 2SFCA (FSD-2SFCA) method. The FSD-2SFCA method considers gaps in environmental preferences and travel abilities among population subgroups to better meet the needs of urban park planning based on demographic changes. Overall, the FSD-2SFCA method is robust, sensitive, flexible, and scalable. The method measured park accessibility in Higashiosaka City under existing and projected population dynamics (2020–2060). The results showed that spatial differences and inequalities in park accessibility exist in Higashiosaka City and that park accessibility inequities among age groups showed different trends as the population changed. In addition, park accessibility is generally the lowest and most inequitable for older adults. Our study highlights that in addressing demographic change, policymakers must consider present equitable distribution of parks and future park accessibility based on population projections to ensure equity-oriented, sustainable urban park planning.

Self-reported cultural competence among Czech and Slovakian nurses: A comparative correlation study.

This study aimed to compare the level of cultural competence among nurses working in clinical practice in Slovakia and the Czech Republic. Demographic changes have greatly affected the health sector in Slovakia and the Czech Republic. By identifying the level of nurses' cultural competence, many of the complications encountered in caring for patients from different cultures can be avoided. However, few studies have explored the cultural competence of nurses in clinical practice in these countries. This study was cross-sectional, descriptive, and comparative. It followed the STROBE checklist and used the Cultural Competence Assessment Tool questionnaire to collect data. Descriptive and inferential statistical tests were utilized for data analysis, using SASD 1.5.8 and IBM SPSS Statistics version 28.0.0. The sample comprised 424 nurses, with 202 from the Czech Republic and 222 from Slovakia, primarily female. Most nurses in both countries have not received cultural diversity training. Nevertheless, nurses in both countries indicate the necessity of conducting a cultural impact assessment of patients' health. Cultural diversity training significantly increases the level of cultural competence in nurses. Lower cultural competence scores can negatively impact nursing care for patients from different cultures, leading to additional cultural challenges. The findings highlight the need for enhanced cultural competence among nurses. Nurses need to learn and utilize cultural information to help maximize healthcare for patients from different cultures. By providing nurses with cultural knowledge and skills, they will be able to deliver more effective and culturally competent care to patients from varied cultural backgrounds.

Drivers of socio-spatial change in Istanbul: Historical and longitudinal analysis of 5 cases from Bakırköy

This article aims to reveal the social and spatial change in Bakırköy through time and to identify the drivers behind this transformation. Bakırköy has been chosen as it hosted the Roman, Byzantine, and Ottoman Empires, leading to its multicultural and layered structure. It has been influenced by the dominant features of each era, shaping socio-economic changes, spatial transformations, and urban planning practices over the historical process. The interaction of these socio-spatial elements within Bakırköy encompasses broad themes such as social differentiation, economic change, and urban governance, thereby presenting case studies to examine the dynamics of urban areas in Istanbul. The research has been conducted at two levels. First, spatial changes were examined through relevant documents, literature, and historical maps. The periods were determined as the state-led development period (1923-1950), liberalization period (1950-1980), neoliberal transformation period (1980-2000), and globalization period (post-2000), with the pre-1923 period being considered separately. Subsequently, five case studies were selected to represent different functional land use at the local level. The first case study involves an area known as the İskender Çelebi Farm in the 17th century, which was chosen to represent the transformation from a food production area to industrial production in the 18th century and has become a mass housing area in the 20th century, now known as the Ataköy districts. The second and third case studies represent the transformation from industrial production areas in the 19th and early 20th centuries to residential, tourism, and shopping areas. The fourth case study focuses on the coastal strip, which was used as a public space for ‘sea baths’ in the 19th century and today exists as luxury housing projects under private ownership. The fifth case study involves an area that served as an airport in the early 20th century and is currently planned for a hospital and green spaces, although it remains a public service.Through these cases, which demonstrate the shift from the productional use of space to consumption, the study seeks to answer the following questions: First, how do demographic and economic changes play a significant role in the differentiation of urban space, and in a related context, what is the local-scale impact of changing policies on the functional change of the selected cases? The findings reveal that industrial investments, supported by transportation investments, choose their locations in the changing/transforming economic order. The decentralization of industry and the privatization or transformation of public investments into consumption-focused urban areas through public-private partnerships have also been observed. The study aims to prove that this change in space lays the groundwork for social differentiation.

[Changing team structures in intensive care medicine].

Intensive care units are highly complex environments where critically ill patients are treated. Therefore, it is mandatory for various professional groups to work closely together. In the past, mainly nursing and medical teams were involved, but today team structures are changing, and more professional groups are entering the environment. Demographic change with increasing comorbidities as well as increasingly complex treatments and technologies are challenges for the intensive care teams. Another enormous challenge is the increasing shortage of nursing staff, which affects the entire healthcare system. To meet these challenges, new concepts are necessary. In accordance with long-standing international standards, an academization of the nursing profession is proposed. The aim is to integrate academically educated nurses and to introduce new nursing roles. Concepts integrating nursing sciences should also be considered.

The right time: women, medicine and maternal age in 1980s Aotearoa New Zealand.

In the late twentieth century, increasing numbers of women in wealthy nations waited until they were aged in their 30s to give birth and become parents. This article examines responses to the changing demographics of maternity among social researchers, doctors, pregnant women and mothers in Aotearoa New Zealand. The article analyses raw research data from historical social survey projects The Right Time (interviews completed in 1982-1983) and Motherhood After 30 (1987) by the grassroots organisation the Society for Research on Women in New Zealand.Surveys, statistics and increasingly direct evidence from research participants symbolised modern social life in the mid-twentieth century. Yet, in 1966, women in Wellington, New Zealand concluded that they had been largely ignored in this endeavour. A group of volunteers pledged to produce the missing data and therefore improve policy making. This article analyses the Society's publications and interview schedules to uncover how researchers, medics, pregnant women and mothers forged new connections between age, pregnancy and parenting during the 1980s. During this time, pregnant women advocated for a new model of prepared and mature maternity. A few years on, however, many among them identified the persistence of traditional gender roles that disrupted their plans. At the same time, physicians and public health officials in wealthy nations began to teach women to associate conception at older ages with increased risks, especially of genetic anomalies. Social research archives reveal tensions between these new, population-level recommendations and women's proactive approaches to planning their lives and families. New Zealand's distinctive survey records help to explain the impacts of new medical tests, reproductive technologies and public health recommendations in the context of women's fresh approaches to maternity during the 1980s.