Demographic Changes Research Articles

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.

We 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. The 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). The 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. The 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.

Long-run perspectives on [formula omitted] in OECD countries: An empirical analysis

The difference between the implicit nominal interest rate and the growth rate of nominal GDP is a key determinant of the dynamics and the sustainability of public debt. This paper studies the determinants of r-g in a panel of 17 OECD countries since the early 1980s. Whereas the focus of existing empirical studies is mainly on fiscal, monetary and financial factors behind the interest–growth difference, our approach and contribution are to highlight in particular the role of real long-run determinants, such as technical progress, employment growth, demographic change, and income inequality. This allows us to derive empirically based projections for r-g beyond the next five or ten years. Our baseline expectation is that r-g will stay below zero for the next two decades in most European countries that we study. An important policy implication is that the debt-carrying capacity of governments is substantially higher now than in the 1980s or 1990s. For the United States, however, our baseline projection of r-g is positive.

The Role of the Anaesthesiologist in Liver Transplantation - Preoperative Evaluation

Preoperative evaluation prior to listing for orthotopic liver transplantation (LT) requires a careful multidisciplinary approach with specialized teams including surgeons, hepatologists and anesthesiologists in order to improve short- and long-term clinical outcomes. Due to inadequate supply of donor organs and changing demographics, patients listed for LT have become older, sicker and share more comorbidities. As cardiovascular events are the leading cause for early mortality precise evaluation of risk factors is mandatory. This review focuses on the detection and management of coronary artery disease, cirrhotic cardiomyopathy, portopulmonary hypertension and hepatopulmonary syndrome in patients awaiting LT. Further insights are being given into scoring systems, patients with Acute-on-chronic-liver-failure (ACLF), frailty, NASH cirrhosis and into psychologic evaluation of patients with substance abuse.

The Effect of the COVID Pandemic on the Rate of Same-Day Discharge in Primary Hip and Knee Arthroplasty

IntroductionSame-day discharge (SDD) following primary total hip (THA) and total knee (TKA) arthroplasty started increasing prior to 2020. The purpose of this study was to evaluate the change in the rate of SDD after the pandemic and determine whether those changes became permanent. MethodsThe annual rate of SDD for 15,208 primary THA and TKA cases performed between January 1, 2015, and September 9, 2022, at a single institution was determined. We also examined changes in SDD patient demographics as well as differences in the 90-day complication rates of SDD and overnight patients. ResultsIn 2015, the rate of SDD for primary arthroplasty was 24%, which grew annually to 29% in 2019. Post-pandemic, the rate of SDD jumped above 50% and continued up to 64% by 2022. The biggest increase was in TKA, which went from under 10% SDD pre-pandemic to 50% by 2022. The average age and BMI of SDD cases pre-pandemic increased significantly to 62 ± 9 years and 29.4 ± 5.3 (P < 0.01). Overnight patients had higher rates of 90-day postoperative complications (8.4 versus 4.2%, P < 0.00001). DiscussionThe pandemic caused major changes in the rate of SDD for primary THA and TKA, increasing in subsequent years. The SDD patients became older and heavier due to the expanded criteria for SDD cases. The 90-day postoperative complication rate was lower for SDD patients since higher risk patients were kept overnight. At the pre-pandemic rate, 29% of patients currently being sent home would have stayed overnight.

Analysis, Modelling, and Financial Perspectives of Reverse Mortgage Implementation in Colombia

PurposeIncreased life expectancy in recent years, together with the downward trend in fertility rates, will accelerate the aging of the Latin American population [1]. This demographic change represents a problem for pension systems as the economic capacity to finance the retirement of the population could be insufficient in the future. This creates a favorable scenario for new financial products, including reverse mortgages. This study determines, from the supply approach, the potential of reverse mortgages in the main cities of Colombia as a complement to the financing of old age according to the guidelines of Benavides et al [2]. Methodology: The following variables were used: housing prices, interest rates, mortality rates, and the consumer price index. The econometric testing simulates the possible paths of these variables, estimates the probability of occurrence of the paths, and calculates the expected losses of bidding banks. FindingsThe results show that reverse mortgages are a good complement to Colombia’s pension system and confirm the feasibility of implementation at city level. It is recommended that the State stimulate the growth of this market and improve the corresponding regulatory framework. OriginalityThis study confirms the hypothesis that the reverse mortgages are a good complement to the pension system with city-level data. Specifically, it uses housing prices and mortality records from the main cities of the country (Bogotá, Cali, and Medellín) to capture their idiosyncrasies.

생존을 위한 아사드 정권의 ‘쓸모 있는 시리아’ 전략

One of the Assad regime’s strategies to survive is control over strategically important ‘useful Syria (suriya al-mufidah)’. For this purpose, the Assad regime forced displacement of local residents, especially Sunnis. Meanwhile, anti-government forces claim that the Assad regime and its allies are turning Sunnis into a minority group in Syria through deliberate demographic change. This study analyzes the goal of the Assad regime’s refugee strategies in ‘Useful Syria’ and examines the suspicions about the Shiaization of Syria. The debate on demographic changes in ‘Useful Syria’ suggests that the perspective distinguishes between ‘us’ and ‘the enemy’ based on sectarian identity continues to be an important factor in the Syrian civil war.

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.

Is there a beneficial effect of a high-protein diet on body composition and strength capacity in physical active middle-aged individuals?-An eight-week randomized controlled trial.

Demographic changes are resulting in a continual increase in the proportion of individuals over 65 years old. Simultaneously, muscle mass (MM) tends to decrease with age, with a decline noticeable from the middle of the fourth decade of life. While physical activity is considered a modulator for maintaining MM, the interaction with nutrient uptake, especially protein intake, is getting more into focus. Due to a lack of data on the effect of a high-protein diet on middle-aged individuals (40-65 years), this study aimed to investigate the influence of a high-protein diet in middle-aged physically active persons on body composition and performance. Using stratified randomization, participants were allocated to either a high-protein group (>2.3 g/kg FFM/day) (n = 12, age = 57.83 ± 7.74 years, height = 170.42 cm ± 11.04 cm, BMI = 30.26 ± 4.46, MM = 31.71 ± 6.89 kg) or a control group (<2.3 g/kg/FFM/day) (n = 14, age = 58.21 ± 6.44 years, height = 170.57 cm ± 8.28 cm, BMI = 26.31 ± 5.59, MM = 29.67 ± 8.08 kg). Body composition [fat-free mass (FFM), fat mass (FM), MM] and strength were assessed at baseline (T0), after four weeks (T1) and after eight weeks (T2). Exercise habits were not changed over the entire period and dietary habits were recorded using FDDB Explorer. Statistical analysis was performed using the current version of R and linear mixed models. No significant differences in energy intake were found between the groups (p = .974). In macronutrient distribution, a significantly higher consumption of protein was found in the high-protein group (p < .0001, d = 2.22) [140 ± 70 g/day (HPG) vs. 79 ± 40 g/day (CG)]. A trivial reduction in FM over time in both groups (p = .046, d = 0.04, ) was observed. No significant differences were detected in FFM (p = .887) and MM (p = .711). Trivial interaction effects (time*group) were observed for upper (p = .007, d = 0.12, ΔHPG = 4.38 ± 3.25 kg) and lower body strength (p = .0507, d = 0.07, ΔHPG = 3.33 ± 2.36 kg). Our results indicate no to only trivial effects of adding a high-protein diet to otherwise physically active middle-aged individuals. Trivial effects could be seen for an increase in muscle strength after this eight-week intervention. However, MM and FFM were not significantly affected. Based on the small effect sizes we observed in our results we do not see a benefit of a high-protein diet on body composition and strength capacity without altering the exercise habits.

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.

Impact Of Walking And The OTAGO Exercise Program On Improving Balance Parameters In The Elderly

There will likely be a rise in fall rates as the population ages. This will impact our society and put more strain on healthcare systems by increasing the number of unintentional injuries and injury-related deaths. According to Zijlstra et al. (2007), falls have a significant psychological impact on individuals, frequently leading to diminished confidence, decreased functional activity, deconditioning, and an elevated risk of falls. Estimated costs of fall-related damage to older adults owing to demographic changes in Australia (2003) predict that by 2051, fall-related injuries, which currently account for 5% of the country's overall health budget, would triple and cost the Australian health system about $1,375 million annually. Exercise and other modifications in lifestyle can potentially reduce the risk of many physical falls (Gregg et al., 2000; Sherrington et al., 2011). The current recommendations for physical exercise among older persons, which include elements of aerobic, resistance, and balance training, are not met by many of them. According to Chodzko-Zajko et al. (2009), the American College of Sports Medicine (ASCM) advises older persons to engage in aerobic, muscle-strengthening, and flexibility exercises. People who have mobility issues or are at risk of falling should also engage in certain activities designed to enhance their balance. We determined that the study's subjects would be third-age individuals (over 65) who reside in assisted living facilities located in Tirana's district and city due to the issues that this demographic faces. Keywords: falls prevention, ageing, nursing home support services, quality of life, older people, walking, OTAGO exercise program, balance, preventive care.

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.