Impaired Health Research Articles

Cardiovascular diseases, prevention and management of complications in older adults and frail patients treated for elective or post-traumatic hip orthopaedic interventions.

Due to the aging population, focusing on healthy aging has become a global priority. Cardiovascular diseases (CVDs) and frailty, characterized by increased vulnerability to adverse stress and health events, interact synergistically in advanced age. In older adults, hip fractures are a frequent dramatic "life-transition" event. Conditions such as arrhythmias, orthostatic hypotension, heart failure, peripheral artery disease and adverse drug reactions may facilitate falls and thus bone fractures in older adults. Cardiovascular complications or the worsening of previous CVDs may increase the degree of frailty and disability following this surgery. The close relationship between older age, CVDs, frailty and orthopaedic surgery leads to the need to focus on the various phases of interventions in a multidisciplinary approach. This document aims to provide practical support to prevent cardiovascular complications in older and frail patients undergoing hip procedures by suggesting specific assessments and interventions. In particular, in pre-operative care the focus should be on the assessment and management of concomitant CVD and frailty, while immediate peri- and post-operative care should highlight specific concerns for anesthesia, prevention and management of thrombotic complications, specific nursing needs, including the prevention of infections and delirium, and the establishment of an integrated rehabilitation program focusing on CVDs and the risk of new falls, with a positive role for care-givers. Furthermore, by optimizing the "hip surgery pathway" the objective is to help avoid the deterioration of health and loss of independence that often result from this surgery through the correct management of cardiovascular patients in this peculiar context.

Time course of hospitalizations in patients with heart failure and chronic obstructive pulmonary disease around sleep-disordered-breathing diagnosis.

In heart failure (HF) and chronic obstructive pulmonary disease (COPD) populations, sleep-disordered breathing (SDB) is associated with impaired health outcomes. We evaluated whether in patients with HF, concomitant HF and COPD or COPD, the number of hospitalizations would be reduced in the year after testing for SDB with and without treatment initiation compared to the year before. We performed a multicentre retrospective study of 390 consecutive sleep-clinic patients who had a primary diagnosis of chronic HF, HF and COPD or COPD and a secondary diagnosis of SDB. The date of SDB-testing was defined as the index date. Data on healthcare utilization was extracted for the 12-month period prior to and after this date. The initiation of adaptive servoventilation (ASV) and non-invasive ventilation (NIV) treatment resulted in a statistically significant reduction in the number of hospitalisations. While continuous positive airway pressure (CPAP) treatment also demonstrated a reduction in hospitalisations, the observed effect did not reach the level of statistical significance. After accounting for demographics and comorbidities in multivariable regression analyses, only NIV was significantly associated with a reduction in hospitalizations, while CPAP or ASV were not. NIV appears to be underutilized in COPD. Our data indicate, that patients with HF or COPD and concomitant SDB may benefit from the initiation of appropriate PAP-therapy. Whether treating SDB in HF- and COPD-patients influences healthcare utilization merits further investigation.

Perioperative Management of Patients with Preeclampsia: A Comprehensive Review.

Preeclampsia is a common condition of pregnancy characterized by hypertension complicated by cerebral, cardiac, hepatic, renal, hematologic, and placental dysfunction. Patients with preeclampsia frequently undergo cesarean delivery, the most common major surgical procedure in the world. They represent a high-risk perioperative cohort suffering significant preventable morbidity and mortality. This review focuses on the anesthesiologist's role, through a perioperative lens, in reducing maternal complications through management of hypertension and strategies for preserving the function of the brain, heart, liver, kidney, hematologic and coagulation systems, and placenta in patients with preeclampsia undergoing cesarean delivery. Preeclampsia-specific resuscitation, individualized fluid administration, safe neuraxial and general anesthesia, and management of intraoperative bleeding are discussed along with strategies for postoperative analgesia, thromboprophylaxis, and antihypertensive agents in patients who breastfeed. This review discusses recently recognized postoperative deterioration in maternal mental health, the possibility of myocardial injury after cesarean delivery, and the need for long-term cardiometabolic follow-up.

Association of Blood-Based Biomarkers and 6-Month Patient-Reported Outcomes in Patients With Mild TBI: A CENTER-TBI Analysis.

There is seemingly contradictory evidence concerning relationships between day-of-injury biomarkers and outcomes after mild traumatic brain injury (mTBI). To address this issue, we examined the association between a panel of biomarkers and multidimensional TBI outcomes. Participants with mTBI (Glasgow coma scores [GCSs] 13-15) were selected from Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury, a European observational study recruiting patients with TBI with indication for brain CT and presentation within 24 hours. Exclusion criteria for this secondary analysis were age younger than 16 years, incomplete biomarker panel, death, or no recorded outcomes. Participants were separated into 2 groups, CT-negative and CT-positive. Multivariable binary logistic regression was used to assess the relation between the log biomarker level (glial fibrillary acidic protein [GFAP], neurofilament light [NfL], neuron-specific enolase [NSE], S100 calcium-binding protein B [S100B], tau, ubiquitin C-terminal hydrolase L1 [UCH-L1]) and dichotomized 6-month outcomes (functional outcomes [GOSE score <8], health-related quality of life [HRQoL; Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS) score <52, Short-Form 12-Item Survey version 2 Mental Component Summary (SF12v2 MCS) score <40, Short-Form 12-Item Survey version 2 Physical Component Summary (SF12v2 PCS) score <40], persistent postconcussion symptoms [Rivermead Post-Concussion Symptoms Questionnaire score ≥16], anxiety disorder [Generalized Anxiety Disorder-7 (GAD-7) score ≥8], depression [Patient Health Questionnaire-9 (PHQ-9) score ≥10], and post-traumatic stress disorder [PTSD Checklist for DSM-5 (PCL-5) score ≥33]). A total of 1,589 participants (865 CT-negative, 724 CT-positive) were included (77% GCS 15, median age 52 years, 66% male). Higher biomarker levels were associated with a GOSE score <8: CT-negative: S100B (odds ratio [OR] 1.78, 95% CI 1.43-2.23) and UCH-L1 (OR 1.16, 95% CI 1.01-1.33); CT-positive: GFAP (OR 1.22, 95% CI 1.11-1.36), NfL (OR 1.30, 95% CI 1.11-1.52), S100B (OR 1.51, 95% CI 1.23-1.86), tau (OR 1.36, 95% CI 1.17-1.59), and UCH-L1 (OR 1.34, 95% CI 1.17-1.53). In CT-positive participants, positive association was seen between NfL (OR 1.3, 95% CI 1.06-1.60) and UCH-L1 (OR 1.28, 95% CI 1.07-1.54) with QOLIBRI-OS; S100B (OR 1.32, 95% CI 1.02-1.70) with SF12v2 PCS; and NSE (OR 1.52, 95% CI 1.06-2.18) and UCH-L1 (OR 1.21, 95% CI 1.01-1.46) with the GAD-7. However, in CT-negative participants only, negative associations were seen between GFAP and impairment on the QOLIBRI-OS (OR 0.76, 95% CI 0.66-0.88), SF12v2 MCS (OR 0.71, 95% CI 0.61-0.82), SF12v2 PCS (OR 0.79, 95% CI 0.68-0.91), GAD-7 (OR 0.80, 0.68-0.95), PHQ-9 (OR 0.80, 95% CI 0.68-0.93), and PCL-5 (OR 0.80, 95% CI 0.66-0.97). Participants with higher biomarker levels had greater odds of impaired functional recovery. However, in CT-negative participants, higher GFAP concentrations were associated with better HRQoL and less impaired mental health. Further exploration is required of the patient phenotypes that may explain the relationships observed in this analysis.

Psychological and Social Factors Associated With Reporting Post-COVID Symptoms Among German Healthcare Workers: A Cross-Sectional Study.

Health care workers (HCW) with post-COVID condition (PCC) are frequently reported to suffer from mental health impairment. Given HCW above-average risk for mental health, research is necessary and risk factors need to be assessed. To compare mental health and health of German HCW with and without PCC and to identify associated psychological and social factors. Cross-sectional study. Overall, 2816 German HCW participated (332 reported PCC). Measures were post-COVID condition symptom sum score (PCSS), symptoms of depression (Patient Health Questionnaire-2), anxiety (Generalised Anxiety Disorder-2) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale-6), work-family conflict (Work-Family Conflict Scale), social support (ENRICHD Social Support Inventory), sense of coherence (Sense Of Coherence-3 Scale) and working conditions. Group differences of HCW with and without PCC were investigated. Multiple linear regression analysis was performed for HCW with PCC. PCSS was the dependent variable. Independent variables were a.m. measures and age, gender, occupational group and migration background. HCW with PCC exhibited higher values, with medium effect sizes, for symptoms of depression, anxiety and PTSD. Small effect sizes were observed for work-family conflict, social support, sense of coherence and working conditions. Higher PCSS scores were associated with higher depression, anxiety, PTSD and work-family conflict levels, lower social support and sense of coherence and migration background. Being a physician was associated with lower PCSS. Lower mental health, social factors and resources may play a role in reporting severe post-COVID symptoms. Further research is necessary to investigate these interactions using the biopsychosocial theory. This study can help to understand PCC in HCW to design adjusted treatments and protect HCW from PCC and minimise their risk of PCC. This study complies with the Journal article reporting standards for quantitative research in psychology: The APA Publications and Communications Board task force report (Data S1). Caregivers are the sample group.

Short- and long-term health effects of job insecurity. Fixed effects panel analysis of German data.

Previous research has linked job insecurity to health deterioration. The risk accumulation model suggests that health effects of job insecurity may persist even after job security is restored, yet long-term empirical analyses are scarce. Our study evaluates the long-term effects of accumulated exposures to affective job insecurity on mental and physical health among the working-age population in Germany. Using data from the German Socioeconomic Panel (12 624 individuals; 84 219 observations), we applied panel regression models with individual fixed effects to assess short- and long-term health changes associated with affective job insecurity. Job insecurity was measured by respondents' worries about job security. Mental and physical health was recorded with the SF-12 scale. Job insecurity correlated with short-term worsening in mental and physical health. However, after job insecurity ceased, health recovery was incomplete resulting in a long-term health deterioration. The long-term effects were larger among respondents who accumulated more instances of job insecurity, and showed a similar pattern for mental and physical health. An additional analysis documented stronger health effects of job insecurity among lower educated persons. Our study is one of the first to empirically demonstrate the negative long-term health effects of job insecurity. Our findings for a well-protected labor market like Germany's, suggest that the health risks associated with job insecurity may be substantial and potentially underestimated by studies that focus solely on short-term effects.

Dust exposure and its health implications to miners in Mererani artisanal and small-scale mining industry

ABSTRACT This study aimed to identify and quantify the total dust exposure to underground miners in Mererani, Tanzania, and its composition to generate evidence for informed decision- and policy-making. The Analytical Air Monitoring System (AMS) was used for dust collection, and analysis was conducted gravimetrically. The dust composition was analysed using Inductively Coupled Plasma Optical Emission Spectroscopy. The results showed significant variation in dust exposure levels across different mining zones, with miners inhaling up to 1859 mg of dust over an 8-hour period in drilling zones (DZ), 797 mg in loading zones (LZ), and 382 mg in resting zones (RZ). The mean value of dust exposure was significantly different, with a p-value of <0.05. Miners had higher levels of heavy metal and silica than those from unmined sites, with chromium being the most dominant element across all samples. Cumulative exposure to dust over time is linked to long-term respiratory impairment and serious health conditions such as lung cancer. These findings highlight the need for intervention, including education on dust hazards, provision of personal protective equipment (PPE), and enforcement of safety standards to safeguard miners’ health. Addressing these issues is critical to promoting policy reforms and sustainable mining practices in Mererani and similar communities.

Mental health during and after pregnancy in medically assisted reproduction: a danish cohort study.

Infertility is common and an increasing number of women go through medically assisted reproduction (fertility treatment) to achieve pregnancy. This may affect mental health. We examined if fertility treatment and the specific fertility treatment method used (in vivo or in vitro) were associated with impaired mental health during or after pregnancy. Using self-reported data from the Odense Child Cohort, we assessed prenatal stress by the 10-item Cohen Perceived Stress Scale (PSS-10) during pregnancy at median gestational week 27 and postnatal depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS) at median postpartum week 15. We compared fertility-treated women overall and by fertility treatment method to women who conceived spontaneously. We conducted linear regression analyses to evaluate the PSS-10 score dimensionally and logistic regression to evaluate EPDS scores above cut-off (≥ 11). A total of 108 of 820 women (13%) gave birth after fertility treatment. Their prenatal mean stress (PSS-10) score was 11.38 compared to 11.78 for women who conceived spontaneously, leading to an adjusted mean difference of -0.09 points (95% confidence interval (CI): -1.88 to 1.69). In the fertility-treated group, 9.7% had EPDS scores ≥ 11 compared to 10.7% in the spontaneous conception group (adjusted odds ratio of 0.71 (95% CI: 0.26 to 1.91)). The MAR method (in vivo/vitro) did not influence these results. Women who gave birth after fertility treatment did not report higher levels of prenatal stress or postpartum depressive symptoms than women who conceived spontaneously.

Social Determinants of Health and Cross-Sectional Cognitive Intra-Individual Variability in Adults from the Deep South Living with HIV.

Cognitive intra-individual variability (IIV) is a sensitive marker of neuropathology and is increased in people with HIV (PWH). In a sample of PWH from the United States Deep South, we examined the relationship of cognitive IIV with cognitive impairment and social determinants of health (SDoH). This secondary analysis included 131 PWH from a larger cognitive training protocol. Our primary outcome measure was the coefficient of variation (CoV). We also included the individual standard deviation (iSD), with both calculated from demographically adjusted T-scores and unadjusted sample-based scores. Mixed-effects models investigated the relationship between IIV and cognitive impairment severity (i.e., Global Rating Score), SDoH, and clinical variables. Bivariate correlations were used to further explore these relationships. Greater cognitive IIV was associated with greater cognitive impairment in PWH, when accounting for demographic factors. When IIV is calculated from the sample, then IIV is no longer associated with cognitive impairment, but is associated with race (>IIV in Black and African American participants). Demographically adjusted IIV is associated with global cognition, Wide Range Achievement Test-Fourth Edition reading score, and viral load (iSD only). No correlations were significant when using the unadjusted sample-based IIV metrics. In PWH from the Deep South, greater cognitive variability is seen in those with greater cognitive impairment, in Black participants, and in those with lower reading scores. Further research on the psychometric properties of IIV in HIV and other populations is needed, as results varied depending on the normative adjustments.

Rehabilitation at Home Using Mobile Health for Older Adults Hospitalized for Ischemic Heart Disease

Among older adults with ischemic heart disease, participation in traditional ambulatory cardiac rehabilitation (CR) remains low. While mobile health CR (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments to technology use may limit uptake, and efficacy data are currently lacking. To test whether mHealth-CR improves functional capacity in older adults. The RESILIENT phase 2, multicenter, randomized clinical trial recruited patients aged 65 years or older with ischemic heart disease (defined as a hospital visit for myocardial infarction or coronary revascularization) from 5 academic hospitals in New York, Connecticut, and Massachusetts between January 9, 2020, and April 22, 2024. Participants were randomized 3:1 to mHealth-CR or usual care. mHealth-CR consisted of commercially available software delivered on a tablet computer, coupled with remote monitoring and weekly exercise therapist telephone calls, delivered over a 3-month duration. As RESILIENT was a trial conducted in a routine care setting to inform decision-making, participants in both arms were also allowed to receive traditional CR at their cardiologist's discretion. The primary outcome was change from baseline to 3 months in functional capacity, measured by 6-minute walk distance (6MWD). Secondary outcomes were health status (12-Item Short Form Health Survey [SF-12]), residual angina, and impairment in activities of daily living. A total of 400 participants (median age, 71.0 years [range, 65.0-91.0 years]; 291 [72.8%] male) were randomized to mHealth-CR (n = 298) or usual care (n = 102) and included in the intention-to-treat analysis. Of those, 356 participants (89.0%) returned in person for 6MWD assessment at 3 months. For the primary outcome, there was no adjusted difference in 6MWD between participants receiving mHealth-CR vs usual care (15.6 m; 95% CI, -0.3 to 31.5 m; P = .06). Among subgroups, there was an improvement in 6MWD among women (36.6 m; 95% CI, 8.7-64.4 m). There were no differences in any secondary outcomes between groups (eg, adjusted difference in SF-12 physical component scores at 3 months: -1.9 points; 95% CI, -3.9 to 0.2 points). Based on inverse propensity score weighting, there was no effect of mHealth-CR on 6MWD among those who did not attend traditional CR (25.7 m; 95% CI, -8.7 to 60.2 m). In this randomized clinical trial of mHealth-CR vs usual care, mHealth-CR did not significantly increase 6MWD or result in improvements in secondary outcomes. The findings suggest the older adult population may require more age-tailored mHealth strategies to effectively improve outcomes. ClinicalTrials.gov Identifier: NCT03978130.

Resources to mitigate health impairment among police employees investigating child abuse: a qualitative study exploring the availability of organisational support

Resources to mitigate health impairment among police employees investigating child abuse: a qualitative study exploring the availability of organisational support

Mental Health Care Utilization and Prescription Rates Among Children, Adolescents, and Young Adults in France

Amid escalating mental health challenges among young individuals, intensified by the COVID-19 pandemic, analyzing postpandemic trends is critical. To examine mental health care utilization and prescription rates for children, adolescents, and young adults before and after the COVID-19 pandemic. This population-based time trend study used an interrupted time series analysis to examine mental health care and prescription patterns among the French population 25 years and younger. Aggregated data from the French national health insurance database from January 2016 to June 2023. Data were analyzed from September 2023 to February 2024. The number of individuals with at least 1 outpatient psychiatric consultation, those admitted for full-time psychiatric hospitalization, those with a suicide attempt, and those receiving psychotropic medication was computed. Data were stratified by age groups and sex. Quasi-Poisson regression modeled deseasonalized data, estimating the relative risk (RR) and 95% CI for differences in slopes before and after the pandemic. This study included approximately 20 million individuals 25 years and younger (20 829 566 individuals in 2016 and 20 697 169 individuals in 2022). In 2016, the population consisted of 10 208 277 of 20 829 566 female participants (49.0%) and 6 091 959 (29.2%) aged 18 to 25 years. Proportions were similar in 2022. Significant increases in mental health care utilization were observed postpandemic compared with the prepandemic period, especially among females and young people aged 13 years and older. Outpatient psychiatric consultations increased among women (RR, 1.13; 95% CI, 1.07-1.20), individuals aged 13 to 17 years (RR, 1.15; 95% CI, 1.06-1.23), and individuals aged 18 to 25 years (RR, 1.08; 95% CI, 1.03-1.14). Hospitalizations for suicide attempt increased among women (RR, 1.14; 95% CI, 1.02-1.27) and individuals aged 18 to 25 years (RR, 1.07; 95% CI, 1.03-1.12). Regarding psychotropic medications, almost all classes, except hypnotics, increased in prescriptions between 2016 and 2022 for females, with a particularly marked rise in the postpandemic period. For men, only increases in the prescriptions of antidepressants (RR, 1.03; 95% CI, 1.01-1.06), methylphenidate (RR, 1.09; 95% CI, 1.06-1.12), and medications prescribed for alcohol use disorders (RR, 1.08; 95% CI, 1.04-1.13) were observed, and these increases were less pronounced than for women (antidepressant: RR, 1.13, 95% CI, 1.09-1.16; methylphenidate: RR, 1.15; 95% CI, 1.13-1.18; alcohol use dependence: RR, 1.12; 95% CI, 1.08-1.16). Medications reserved for severe mental health situations, such as lithium or clozapine, were prescribed more frequently starting at the age of 6 years. In this study, an interrupted time-series analysis found a marked deterioration in the mental health of young women in France in the after the COVID-19 pandemic, accentuating a trend of deterioration that was already observed in the prepandemic period.

Topical review: sleep regulation as a novel target for treating preschool-aged children with attention-deficit/hyperactivity disorder symptoms.

Elevated attention-deficit/hyperactivity disorder (ADHD) symptoms in preschoolers are a risk factor for poorer psychiatric health, cognitive deficits, and social and academic impairment across the lifespan. The first-line treatment for these preschoolers, behavioral parent training (BPT), reduces children's disruptive behaviors and parenting stress, yet its impact on core ADHD symptoms is inconsistent. Early interventions targeting biological mechanisms linked to core ADHD pathophysiology are critically needed. This topical review explores sleep dysregulation as a potential key target for early intervention for ADHD symptoms among preschoolers. Sleep dysregulation is common in school-aged children with ADHD, and treating sleep improves core ADHD symptoms in older children. Cross-sectional and prospective research with preschoolers offers compelling evidence that sleep dysregulation and ADHD symptoms are closely linked over the course of early development. BPT and behavioral sleep medicine (BSM) interventions share an underlying theoretical framework and could be streamlined to target sleep in addition to daytime behaviors. Novel early interventions targeting underlying biological mechanisms linked to core ADHD pathophysiology are critically needed to improve the trajectories of ADHD symptoms, comorbidity, and functional deficits for preschoolers with elevated ADHD symptoms. Sleep regulation is a promising mechanistic treatment target for this population, and future interventions may draw from the shared behavioral principles of BPT and BSM to target behaviors across the 24-hr period and employ scalable formats to optimize the number of families who can benefit from parent-based interventions targeting ADHD symptoms and sleep in early development.

Alkol Bağımlılığının Bilişsel Davranışçı Terapi İle Tedavisi Üzerine Bir Olgu Sunumu

This study includes a case report of a client with alcohol addiction. The client is a 34-year-old male and an agricultural engineer. With the deterioration of the client's health, it was decided that it would be beneficial for him to see a psychologist upon the advice of his diabetes doctor, and it is known that the client consulted a psychologist after this decision. The client was determined to be alcohol addicted by his psychologist based on the DSM-V diagnostic criteria. With the decision made by the client and his therapist, it was determined that the client was suitable for the cognitive behavioral therapy school. The CBT school was applied during the client's treatment process. By focusing on cognitive processes, it was aimed to purify the client from automatic negative thoughts, to determine and question the client's basic beliefs, and thus, a cognitive restructuring was achieved in the client. In addition to the CBT school, techniques such as the ABC model, the TAT Test, and the Evidence Counter-Evidence Technique were applied. Keywords: Alcohol addiction , Cognitive Behavioral Therapy, Case report

Investigating how eating behavior shapes mental health: A cross-sectional study.

This study aimed to examine the relationship between eating behavior, nutritional status and mental health. It is a cross-sectional study conducted on a sample of 360 healthy individuals aged 19-64 years. The General Health Questionnaire (GHQ-12) was used to evaluate mental health and the Three-Factor Eating Scale (TFEQ-R21) was used to assess eating behavior. The Healthy Eating Index-2015 (HEI-2015) score was calculated from participants' 24 h food recalls as an indicator of diet quality. The mean age of the participants was 26.0 ± 8.40 years, and 50.6 % were female. Multivariate logistic regression model was performed. A statistically significant relationship was found between the participants' GHQ-12 score and both their emotional eating and uncontrolled eating scores (p < 0.001 for each). It was determined that individuals who had high levels of emotional eating and uncontrolled eating behaviors, along with higher dietary protein and lipid intake, and lower intake of long-chain fatty acids, were at a higher risk of mental health deterioration, according to the established model (R2 = 0.214). Dietary energy and nutrient intakes such as niacin, vitamin B12, folic acid, phosphorus, iron, sodium and carotene, as well as diet quality and BMI were not associated with mental health according to the model in this study. Eating behavior is associated with mental well-being, and nutritional status may be one of the underlying factors contributing to this association.

Adolescent Mental Health during and beyond the COVID-19 Pandemic

During the COVID-19 pandemic, deterioration of adolescent mental health was observed worldwide. In Japan, the impact of COVID-19 on adolescent mental health was more severe among boys than girls and in the later phases of the pandemic. An increased number of adolescent suicides was also reported. In this paper, I outline possible reasons for the observed phenomenon and conclude that continuous monitoring and interventions to promote help-seeking among adolescents are required.

Effects of Age and Atomoxetine on Olfactory Perception and Learning and Underlying Plasticity Mechanisms in Rats.

The locus coeruleus (LC) plays a vital role in cognitive function through norepinephrine release. Impaired LC neuronal health and function is linked to cognitive decline during ageing and Alzheimer's disease. This study investigates age-related alterations in olfactory detection and discrimination learning, along with its reversal, in Long-Evans rats, and examines the effects of atomoxetine (ATM), a norepinephrine uptake inhibitor, on these processes. Adult (6-9 months) and aged (22-24 months) Long-Evans rats underwent odour detection threshold experiments with saline and two doses of ATM (0.3 and 1 mg/kg). Reward-based odour discrimination learning included simple, difficult and reversal learning tasks. LC neuron density, dopamine beta-hydroxylase and norepinephrine transporter expression in the piriform cortex (PC) and orbitofrontal cortex were measured. Reversal learning and olfactory threat extinction were used to measure behavioural flexibility. Immunohistochemistry and western blotting were used to analyse phosphorylated cAMP response element binding protein (pCREB) and cFos expression and exvivo electrophysiology assessed long-term depression (LTD) in the PC. Whereas adult and aged cohorts showed similar odour detection and discrimination learning, fewer aged rats acquired reversal learning successfully. ATM improved reward-based odour discrimination in adults but hindered learning reversal. A delayed CREB phosphorylation in the posterior PC associated with atomoxetine administration possibly underlies learning enhancement. ATM resulted in less freezing behaviour in a threat conditioning and extinction paradigm at moderate, but not at higher doses. ATM administration exvivo prevented PC LTD. These findings highlight the intricate effects of atomoxetine, influenced by target structures, and suggest potential interactions with other neurotransmitters. Our results contribute to understanding the impact of ageing and norepinephrine enhancers on cognitive processes.

Review article: Biodegradation of Pharmaceutical Pollutants: Challenges, Mechanisms, and Environmental Implications

The emergence of such widespread pharmaceuticals as a pollutant has become one of the world's critical environmental problems that may lead to both the public's health and biodiversity deterioration. This article provides an exhaustive account of the current understanding of the environmental persistence of pharmaceutical contaminants following in-depth analysis of the additive effects of existing natural biodegradation pathways on the human health impact of these drugs. Paying special attention to biodegradation decomposing agents such as bacteria, fungi, and algae the paper estimates their ability to convert drug ingredients to compound that is eventually less toxic. Although these biologic systems contain an enormous potential for killing the unwanted pollutants, the variability in the complexity and endurance of the pharmaceutical substances overburden the degradation capabilities of these organisms thus necessitating improved biodegradation methods. Addressing the above-mentioned environmental factors, which include temperature, pH, and the occurrence of other contaminants, play a crucial role and have a direct impact that on the process of biodegradation, enhancing pollutants removal rate. To sum up, this paper enables the environmental science, microbiology and bioengineering enables creating progressively more functional and sustainable techniques of neutralizing these long-standing toxins; thus, protecting ecosystems, as well as human health.

DO TRAJECTORIES OF SELF-IDENTIFIED RETIREMENT STATUS PREDICT HEALTH AND COGNITIVE OUTCOMES?

Abstract Few studies examined the ways older workers self-identify their retirement status (named ‘retirement identity’) over time before exiting the workforce. Examining the trajectories of retirement identity transitions – between “not retired”, “partly retired”, and “completely retired” – clarifies the heterogeneous outcomes found in ‘static’ retirement identity. In this study, we distinguish and categorize these trajectories using sequence analysis, investigate the common sociodemographic and economic characteristics for each trajectory using multinomial logistic regression, and examine the associations between these trajectories and the physical and mental health conditions of older workers using latent growth modeling. Drawing on a sample of respondents from the Health and Retirement Study (HRS) from 1992 to 2020, we use the first nine waves of the initial HRS birth cohort (born 1931-1936, recruited in 1992, N=1,487) and the Early Baby Boomers (born 1948-1953, recruited in 2004, N=1,017). We determine and name four distinct categories of trajectories – early, late, traditional, and partial transitions – based on the timing and sequence of transitions. The membership of these trajectories is strongly associated with the birth cohort, educational attainment, labor income from career jobs, and household wealth. The latent growth modeling reveals that workers in late or partial transition trajectories tend to have better initial physical, mental, and cognitive health and experience slower deterioration of these than those in early or traditional transition trajectories. These results suggest a close relationship between health and self-identification of retirement status that may influence the work attachment and timing of workforce exit.

THE INNER DYNAMICS OF THE OLD AND SOCIALLY WITHDRAWN IN JAPAN: INSIGHTS FOR INTERVENTIONS FROM CASE STUDY ANALYSES

Abstract An increasing number of older adults in Japan are refusing social support even when offered. This lack of support elevates their risk of health deterioration, delays evacuation in disaster scenarios, and increases the likelihood of premature and lonely deaths with inadequate closures. This study examines the psychological factors contributing to the lack of motivation among socially isolated older adults in Japan to seek help. We conducted semi-structured one-on-one interviews with nine individuals aged 60 years or older who reside in the community identified as socially isolated by community-based healthcare personnel. Using a narrative case study approach, the study revealed a prevalent concern among these socially isolated individuals about causing inconvenience to others by seeking help. The findings suggest that their reluctance to ask for help may be driven not by a desire to maintain independence but rather by a concern about inconveniencing others. In the context of Japanese culture, maintaining harmony with others is considered important. Asking for help might inconvenience others and potentially disrupt this harmony. To effectively assist those who refuse necessary support, social and community health workers should develop ways of minimizing the perceived burden of the recipients. However, further research is necessary to establish whether these findings are unique to the Japanese cultural context. Examples of innovative strategies to address this challenge will be discussed.