General Elderly Population Research Articles

Causes of Death in People with Dementia from 2002 to 2015: A Nationwide Study.

Background:Dementia is associated with increased mortality. However, it is not clear whether causes of death in people with dementia have changed over time.Objective:To investigate if causes of death changed over time in people with dementia compared to the general elderly population.Methods:We included longitudinal data from nationwide registries on all Danish residents aged≥65 years to 110 years who died between 2002 to 2015. We assessed the annual frequency of dementia-related deaths (defined as a dementia diagnosis registered as a cause of death) and of underlying causes of death in people registered with dementia compared to the general elderly population.Results:From 2002 to 2015, 621,826 people died, of whom 103,785 were diagnosed with dementia. During this period, the percentage of dementia-related deaths increased from 10.1% to 15.2% in women, and from 6.3% to 9.5% in men in the general elderly population. From 2002 to 2015, dementia became the leading, registered underlying cause of death in people diagnosed with dementia. Simultaneously, a marked decline in cardiovascular and cerebrovascular deaths was observed in people with and without dementia.Conclusion:This is the first study to investigate if the causes of death change over time in people diagnosed with dementia compared with the general elderly population. The increase in the registration of dementia as an underlying cause of death could reflect increasing awareness that dementia is fatal.

Incidence and prediction nomogram for metabolic syndrome in a middle-aged Vietnamese population: a 5-year follow-up study.

We aimed to determine the incidence and prediction nomogram for new-onset metabolic syndrome (MetS) in a middle-aged Vietnamese population. A population-based prospective study was conducted in 1150 participants aged 40-64 years without MetS at baseline and followed-up for 5 years. Data on lifestyle factors, socioeconomic status, family diabetes history, and anthropometric measures were collected. MetS incidence was estimated in general population and subgroup of age, gender, and MetS components. A Cox proportional hazards regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CI) for MetS. A prediction nomogram was developed and checked for discrimination and calibration. During median follow-up of 5.14 years, the accumulate MetS incidence rate was 23.4% (95% CI: 22.2-24.7). The annual incidence rate (95% CI) was 52.9 (46.7-60.1) per 1000 person-years in general population and higher in women [56.6 (48.7-65.9)] than men [46.5 (36.9-59.3)]. The HRs (95% CI) for developing MetS were gender [females vs males: 2.04 (1.26-3.29)], advanced age [1.02 (1.01-1.04) per one year], waist circumference [1.08 (1.06-1.10) per one cm] and other obesity-related traits, and systolic blood pressure [1.02 (1.01-1.03) per one mmHg]. The prediction nomogram for MetS had a good discrimination (C-statistics = 0.742) and fit calibration (mean absolute error = 0.009) with a positive net benefit in the predicted probability thresholds between 0.13 and 0.70. The study is the first to indicate an alarmingly high incidence of MetS in a middle-aged population in Vietnam. The nomogram with simply applicable variables would be useful to qualify individual risk of developing MetS.

Physiologic Frailty and Neurocognitive Decline Among Young-Adult Childhood Cancer Survivors: A Prospective Study From the St Jude Lifetime Cohort.

Eight percent of young-adult childhood cancer survivors meet criteria for frailty, an aging phenotype associated with poor health. In the elderly general population, frailty is associated with neurocognitive decline; this association has not been examined in adult survivors of childhood cancer. Childhood cancer survivors 18-45 years old (≥ 10 years from diagnosis) were clinically evaluated for prefrailty or frailty (respectively defined as ≥ 2 or ≥ 3 of: muscle wasting, muscle weakness, low energy expenditure, slow walking speed, and exhaustion [Fried criteria]) and completed neuropsychologic assessments at enrollment (January 2008-June 2013) and 5 years later. Weighted linear regression using inverse of sampling probability estimates as weights compared differences in neurocognitive decline in prefrail and frail survivors versus nonfrail survivors, adjusting for diagnosis age, sex, race, CNS-directed therapy (cranial radiation, intrathecal chemotherapy, and neurosurgery), and baseline neurocognitive performance. Survivors were on average 30 years old and 22 years from diagnosis; 18% were prefrail and 6% frail at enrollment. Frail survivors declined an average of 0.54 standard deviation (95% CI, -0.93 to -0.15) in short-term verbal recall, whereas nonfrail survivors did not decline (β = .22; difference of βs = -.76; 95% CI, -1.19 to -0.33). Frail survivors declined more than nonfrail survivors on visual-motor processing speed (β = -.40; 95% CI, -0.67 to -0.12), cognitive flexibility (β = -.62; 95% CI, -1.02 to -0.22), and verbal fluency (β = -.23; 95% CI, -0.41 to -0.05). Prefrail and frail survivors experienced greater declines in focused attention (prefrail β = -.35; 95% CI, -0.53 to -0.17; frail β = -.48; 95% CI, -0.83 to -0.12) compared with nonfrail survivors. Over approximately 5 years, prefrail and frail young-adult survivors had greater declines in cognitive domains associated with aging and dementia compared with nonfrail survivors. Interventions that have global impact, designed to target the mechanistic underpinnings of frailty, may also mitigate or prevent neurocognitive decline.

Hallucinations in the general population across the adult lifespan: prevalence and psychopathologic significance.

Community studies have found a relatively high prevalence of hallucinations, which are associated with a range of (psychotic and non-psychotic) mental disorders, as well as with suicidal ideation and behaviour. The literature on hallucinations in the general population has largely focused on adolescents and young adults. We aimed to explore the prevalence and psychopathologic significance of hallucinations across the adult lifespan. Using the 1993, 2000, 2007 and 2014 cross-sectional Adult Psychiatric Morbidity Survey series (N = 33 637), we calculated the prevalence of past-year hallucinations in the general population ages 16 to ≥90 years. We used logistic regression to examine the relationship between hallucinations and a range of mental disorders, suicidal ideation and suicide attempts. The prevalence of past-year hallucinations varied across the adult lifespan, from a high of 7% in individuals aged 16-19 years, to a low of 3% in individuals aged ≥70 years. In all age groups, hallucinations were associated with increased risk for mental disorders, suicidal ideation and suicide attempts, but there was also evidence of significant age-related variation. In particular, hallucinations in older adults were less likely to be associated with a cooccurring mental disorder, suicidal ideation or suicide attempt compared with early adulthood and middle age. Our findings highlight important life-course developmental features of hallucinations from early adulthood to old age.

Association between Stress, Depression and Anxiety with Body Fat Percentage among Medical Students of Faculty of Medicine and Health Sciences of Atma Jaya Catholic University

Background and purpose: Medical students have higher rate of stress, depression and anxiety compared to the general population of the same age and are at risk of having high level of body fat percentage. The objective of this study is to determine the association between stress, depression and anxiety with body fat percentage among medical students.Methods: This is a cross sectional study carried out among 90 undergraduate medical students of Faculty of Medicine and Health Sciences of Atma Jaya Catholic University, North Jakarta, from January to March 2019. Sampling was performed by using the stratified proportional random sampling method. Stress, depression and anxiety were measured with Depression Anxiety Stress Scale 42 and body fat percentage was measured with Bioelectrical Impedance Analysis. Data analysis was performed by using Spearman correlation.Results: Based on sociodemographic characteristics, the respondents were mostly 19 years old, female and 1st year students. This study shows that 34.4% of respondents had stress, 22.2% had depression and 48.9% had anxiety. This study shows that 62.1% of the male respondents and 32.8% of the female respondents had high body fat percentage. Spearman analysis showed moderate positive correlation between stress (r=0.505), depression (r=0,403) and anxiety (r=0,485) with body fat percentage among the respondents.Conclusion: There is a significant association between stress, depression and anxiety with body fat percentage among medical students. This study intends to be an input for educational institutions to screen for mental health problems (stress, depression and anxiety) as well as body fat percentage in students that may affect their well-being and learning process so that they can be diagnosed and intervened as early as possible.

IGFBP7 and GDF-15, but not P1NP, are associated with cardiac alterations and 10-year outcome in an elderly community-based study

BackgroundLittle is known about the clinical value of Insulin-like growth factor-binding protein-7 (IGFBP7), a cellular senescence marker, in an elderly general population with multiple co-morbidities and high prevalence of asymptomatic cardiovascular ventricular dysfunction. Inflammation and fibrosis are hallmarks of cardiac aging and remodelling. Therefore, we assessed the clinical performance of IGFBP7 and two other biomarkers reflecting these pathogenic pathways, the growth differentiation factor-15 (GFD-15) and amino-terminal propeptide of type I procollagen (P1NP), for their association with cardiac phenotypes and outcomes in the PREDICTOR study.Methods2001 community-dwelling subjects aged 65–84 years who had undergone centrally-read echocardiography, were selected through administrative registries. Atrial fibrillation (AF) and 4 echocardiographic patterns were assessed: E/e’ (> 8), enlarged left atrial area, left ventricular hypertrophy (LVH) and reduced midwall circumference shortening (MFS). All-cause and cardiovascular mortality and hospitalization were recorded over a median follow-up of 10.6 years.ResultsIGFBP7 and GDF-15, but not P1NP, were independently associated with prevalent AF and echocardiographic variables after adjusting for age and sex. After adjustment for clinical risk factors and cardiac patterns or NT-proBNP and hsTnT, both IGFBP7 and GDF-15 independently predicted all-cause mortality, hazard ratios 2.13[1.08–4.22] and 2.03[1.62–2.56] per unit increase of Ln-transformed markers, respectively.ConclusionsIn a community-based elderly cohort, IGFBP7 and GDF-15 appear associated to cardiac alterations as well as to 10-year risk of all-cause mortality.

Association of remnant cholesterol with chronic kidney disease in middle-aged and elderly Chinese: a population-based study.

Limited data regarding the association between remnant cholesterol (RC) and chronic kidney disease (CKD), largely based on an estimated glomerular filtration rate (eGFR) of < 60mL/min/1.73m2 (low eGFR), have yielded inconsistent results, and no report has demonstrated the relationship of RC with CKD [defined as low eGFR and/or albuminuria (defined as urinary albumin-to-creatinine ratio (ACR) ≥ 30mg/g)] in Chinese general middle-aged and elderly population. Hence, we aimed to investigate the association between RC and CKD in such population. In total, 7356 Chinese participants aged ≥ 40years were recruited from fiveregional communities in Luzhou city between May 2011 and December 2011. Fasting RC was calculated from the lipid profile measured by standard laboratory procedures. Multivariate logistic regression models were used to evaluate the possible association between RC and CKD. Participants in the highest quartile of RC had higher body mass index, systolic and diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C), fasting and 2-h postload blood glucose, glycated hemoglobin A1C, prevalence of prediabetes, type 2 diabetes mellitus (T2DM), hypertension, CKD, albuminuria, low eGFR, and lower high-density lipoprotein cholesterol (HDL-C) and eGFR compared with those in the lowest quartile (all P for trend < 0.01). Multivariate logistic regression analysis demonstrated that the risk of CKD gradually increased across RC quartiles (P for trend < 0.01), and participants in the highest quartile of RC were at a significantly increased risk of prevalent CKD compared to those in the lowest quartile in total subjects (odds rate: 1.344, 95% confidence intervals 1.097-1.648, P < 0.01). In subgroup analysis, significant relation between RC level and increased risk of prevalent CKD was detected in women, subjects with overweight/obesity, non-prediabetes, hypertension, normal HDL-C, appropriate and high LDL-C, and without cardiovascular disease (CVD) events after multiple adjustments. Higher RC is independently associated with increased risk of prevalent CKD, and RC might serve as a new risk biomarker for CKD in a general middle-aged and elderly Chinese population, especially in women, subjects with overweight/obesity, non-prediabetes, hypertension, normal HDL-C, appropriate and high LDL-C, and without CVD events.

PSEUDOEXFOLIATIVE SYNDROME AS A TRIGGER FOR PSEUDOEXFOLIATIVE GLAUCOMA

Glaucoma is one of the leading causes of blindness and disability worldwide. Pseudoexfoliative glaucoma is known to be the most aggressive and difficult-to-treat form of secondary glaucoma. According to the literature, pseudoexfoliative glaucoma occurs in 25-30% of cases among all open-angle glaucoma. The recent studies have established that a quarter of patients with pseudoexfoliative glaucoma are blind in one eye, and 7% are blind in both eyes. Risk factors for glaucoma include systemic and ophthalmic factors, one of which is the development of pseudoexfoliative syndrome. In patients with pseudoexfoliative syndrome, glaucoma occurs 20 times more often than in the general population of the same age. The purpose of this research is to study the informativeness of individual phenomena of pseudoexfoliative syndrome (PES) in order to improve early diagnosis and prevention of pseudoexfoliative glaucoma. The study included 114 patients diagnosed as having PES. Exclusion criteria were as follows: age up to 45 years, surgery on the eyeball, a history of disease (iridocyclitis, uveitis, corneal pathology, and traumatic eye disease), pigment dispersion syndrome. Along with the standard set of diagnostic measures, patients underwent biomicroscopy in the conditions of maximum drug-induced mydriasis, gonioscopic examination; the proportion of patients was examined by optical coherence tomography (SD-OCT Topson 3D oct-2000FA Plus (version 7/21/003/0)). The study revealed signs of pseudoexfoliative syndrome (deposition of pseudoexfoliative material on various structures of the anterior segment of the eye) in 100% of cases. Higher values of intraocular pressure (from 29 to 34 mm Hg) were found in the patients with elements of blocking the angle of the anterior chamber (narrowing or closing the angle, increased pigmentation and the presence of draining exfoliative conglomerates). The optical coherence tomography study revealed a thinning of the retinal nerve fibres (33.60 ± 0.43 μm), a significant thinning of retinal nerve fibre layer in patients with pseudoexfoliative syndrome and even more significant thinning in 29 patients diagnosed with pseudoexfoliative glaucoma. Thus, we can conclude knowing the microsymptoms of the disease, mandatory investigating the conditions of the maximum drug-induced mydriasis can contribute to detect pseudoexfoliative syndrome even in the initial stages and thus to prevent the development of pseudoexfoliative glaucoma.

Progression along data-driven disease timelines is predictive of Alzheimer’s disease in a population-based cohort

Data-driven disease progression models have provided important insight into the timeline of brain changes in AD phenotypes. However, their utility in predicting the progression of pre-symptomatic AD in a population-based setting has not yet been investigated. In this study, we investigated if the disease timelines constructed in a case-controlled setting, with subjects stratified according to APOE status, are generalizable to a population-based cohort, and if progression along these disease timelines is predictive of AD. Seven volumetric biomarkers derived from structural MRI were considered. We estimated APOE-specific disease timelines of changes in these biomarkers using a recently proposed method called co-initialized discriminative event-based modeling (co-init DEBM). This method can also estimate a disease stage for new subjects by calculating their position along the disease timelines. The model was trained and cross-validated on the Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset, and tested on the population-based Rotterdam Study (RS) cohort. We compared the diagnostic and prognostic value of the disease stage in the two cohorts. Furthermore, we investigated if the rate of change of disease stage in RS participants with longitudinal MRI data was predictive of AD. In ADNI, the estimated disease timeslines for ϵ4 non-carriers and carriers were found to be significantly different from one another (p<0.001). The estimate disease stage along the respective timelines distinguished AD subjects from controls with an AUC of 0.83 in both APOEϵ4 non-carriers and carriers. In the RS cohort, we obtained an AUC of 0.83 and 0.85 in ϵ4 non-carriers and carriers, respectively. Progression along the disease timelines as estimated by the rate of change of disease stage showed a significant difference (p<0.005) for subjects with pre-symptomatic AD as compared to the general aging population in RS. It distinguished pre-symptomatic AD subjects with an AUC of 0.81 in APOEϵ4 non-carriers and 0.88 in carriers, which was better than any individual volumetric biomarker, or its rate of change, could achieve. Our results suggest that co-init DEBM trained on case-controlled data is generalizable to a population-based cohort setting and that progression along the disease timelines is predictive of the development of AD in the general population. We expect that this approach can help to identify at-risk individuals from the general population for targeted clinical trials as well as to provide biomarker based objective assessment in such trials.

Evaluation of Serologic Changes of IgG and IgM Antibodies Associated with SARS-COV-2 in Cancer Patients: A Cohort Seroprevalence Study.

Background:While the coronavirus disease 2019 (COVID-19) pandemic spreads, there is increasing evidence to suggest the elevated risk of SARS-CoV-2 infection and following morbidity and mortality in cancer patients. Serology testing using ELISA proposes major advantages as a diagnostic and preventive tool to control the present SARS-CoV-2 outbreak. This cohort study was to determine the SARS-CoV-2 seroconversion in asymptomatic cancer patients. Methods:Patients in all age groups and with any type of cancer who have been in remission or have stable disease and received their latest anticancer therapy over 2 months ago included in the study. All patients were evaluated for COVID-19 symptoms and only asymptomatic patients were enrolled for serologic screening for SARS-CoV-2. Serum samples evaluated serologically for SARS-CoV-2 antibodies by enzyme-linked immunosorbent assay.Results:A total of 168 asymptomatic cancer patients were included in the study. Of the 168 cases with a history of cancer who were asymptomatic for Covid-19, 29 cases (17.26%) had a positive serological test. Conclusion: In conclusion, in the present study asymptomatic cancer patients revealed 17% seropositivity, approximately equal to the general population of the same age, sex, geographic region, and epidemic status. Asymptomatic infections should further be investigated and considered as playing an important role in the COVID-19 transmission chain.

Predicting Silent Atrial Fibrillation in the Elderly: A Report from the NOMED-AF Cross-Sectional Study.

Background: Silent atrial fibrillation (SAF) is common and is associated with poor outcomes. Aims: to study the risk factors for AF and SAF in the elderly (≥65 years) general population and to develop a risk stratification model for predicting SAF. Methods: Continuous ECG monitoring was performed for up to 30 days using a vest-based system in a cohort from NOMED-AF, a cross-sectional study based on a nationwide population sample. The independent risk factors for AF and SAF were determined using multiple logistic regression. ROC analysis was applied to validate the developed risk stratification score. Results: From the total cohort of 3014 subjects, AF was diagnosed in 680 individuals (mean age, 77.5 ± 7.9; 50.1% men) with AF, and, of these, 41% had SAF. Independent associations with an increased risk of AF were age, male gender, coronary heart disease, thyroid diseases, prior ischemic stroke or transient ischemic attack (ICS/TIA), diabetes, heart failure, chronic kidney disease (CKD), obesity, and NT-proBNP >125 ng/mL. The risk factors for SAF were age, male gender, ICS/TIA, diabetes, heart failure, CKD, and NT-proBNP >125 ng/mL. We developed a clinical risk scale (MR-DASH score) that achieved a good level of prediction in the derivation cohort (AUC 0.726) and the validation cohort (AUC 0.730). Conclusions: SAF is associated with various clinical risk factors in a population sample of individuals ≥65 years. Stratifying individuals from the general population according to their risk for SAF may be possible using the MR-DASH score, facilitating targeted screening programs of individuals with a high risk of SAF.

The cardiovascular safety of oral alitretinoin: a population-based cohort study involving 19 513 patients exposed to oral alitretinoin.

Oral alitretinoin is a retinoid used for severe chronic hand eczema. Although caution is recommended for patients with uncontrolled dyslipidaemia or cardiovascular risk factors, the actual atherothrombotic risk has not been investigated thus far. To detect any excess of atherothrombotic events among patients exposed to alitretinoin, during treatment or in the 2years following initiation. Using the French Health Insurance database, we compared the number of patients who had an atherothrombotic event (coronary artery disease, ischaemic stroke or peripheral artery disease requiring revascularization) in the population exposed to oral alitretinoin vs. the general population of the same age, sex and baseline cardiovascular risk, using standardized morbidity ratios (SMRs). Between 2009 and 2017, 19513 patients were exposed to oral alitretinoin in France. Sixty-four (0·3%) patients had an atherothrombotic event while on alitretinoin. Patients receiving alitretinoin experienced no more atherothrombotic events than the general population: patients without cardiovascular risk factors or previous atherothrombotic events had a SMR of 0·65 [95% confidence interval (CI) 0·26-1·34] during alitretinoin treatment, and 1·21 (95% CI 0·90-1·59) in the 2years following initiation; patients with cardiovascular risk factors or previous atherothrombotic events had a SMR of 0·82 (95% CI 0·60-1·08) during alitretinoin treatment and 0·95 (95% CI 0·82-1·09) in the 2years following initiation. Taken separately, SMRs for each outcome did not increase either. These data from an exhaustive nationwide population-based study do not support an increase in the incidence of atherothrombotic events with alitretinoin use, regardless of the baseline cardiovascular risk of the patient.

Associations of pre-existing cardiovascular disease (CVD) with treatment patterns and survival outcomes in patients with metastatic prostate cancer: A real-world, population-based study.

e17056 Background: Prior cardio-oncology research has focused on examining the future risk of CVD as a result of cancer treatments. The impact of pre-existing CVD on cancer treatments is less clear. This study aimed to identify the associations of baseline CVD on treatment patterns and survival outcomes in metastatic prostate cancer where older age and exposure to androgen deprivation therapy can potentiate cardiac risks. Methods: We identified all patients diagnosed with metastatic prostate cancer in a large Canadian province from 2004 to 2017 using the population-based cancer registry. Administrative claims were linked to ascertain any diagnoses of pre-existing CVD, defined as any of arrythmias [AR], cerebrovascular accidents [CVAs], myocardial infarctions [MIs], or congestive heart failure [CHF] that preceded the diagnosis of metastatic prostate cancer. Logistic and Cox regression models were constructed to determine the associations of baseline CVD with receipt of cancer treatments (such as radiation, or systemic therapy) and overall survival (OS). Results: A total of 3,257 patients were included. The median age was 66 years (interquartile range, 46-95 years). At diagnosis of advanced prostate cancer, 993 (30.5%) had pre-existing CVD: 10.0% AR, 4.3% CVAs, 3.0% MIs, 2.8% CHF and 10.4% multiple CVDs. The Charlson comorbidity index (CCI) was 0, 1 and &gt;1 in 53.4%, 27.3% and 19.3%, respectively. Overall, 2078 (63.8%) patients received chemotherapy, while 747 (22.9%) received radiotherapy. After adjusting for age and CCI, pre-existing CVD was associated with a lower likelihood of chemotherapy (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.61-0.75; P=0.001) and radiotherapy (OR, 0.87; 95% CI, 0.85-0.91; P&lt;0.001). Likewise, CVD was associated with worse OS, after adjusting for measured confounding variables (see table). Conclusions: One-third of patients with metastatic prostate cancer had pre-existing CVD, which was associated with a lower likelihood of chemotherapy and worse OS. In the context of an aging general population, early cardio-oncology consultations to optimize CVD management may lead to safer and broader uptake of appropriate prostate cancer treatments.[Table: see text]

Dementia increases mortality beyond effects of comorbid conditions: A national registry-based cohort study.

Background and purposeMortality is known to be markedly increased in people with dementia. However, the association between multiple chronic conditions and mortality in dementia is not well clarified. The aim of this study was to investigate the impact of somatic and psychiatric diseases on mortality in dementia compared with the general elderly population.MethodsUsing a cohort study design, nationwide registry data from 2006 to 2015 on dementia and psychiatric and somatic comorbidities defined by the Charlson Comorbidity Index (CCI) were linked. Impact of chronic conditions was assessed according to mortality rate ratios (MRRs) in all Danish residents aged ≥65 years with and without dementia.ResultsOur population comprised 1,518,917 people, of whom 114,109 people were registered with dementia. The MRRs was 2.70 (95% confidence interval 2.68, 2.72) in people with dementia after adjusting for sex, age, calendar year, and comorbidities. MRRs increased with higher CCI score, and when comparing people with a similar comorbidity load, MRRs were significantly higher for people with dementia.ConclusionsThe comorbidity load was associated with increased mortality in both people with and without dementia. Mortality in dementia remained increased, even after adjusting for psychiatric and chronic somatic comorbidities. Our findings suggest that dementia disorders alone contribute to excess mortality, which may be further increased by comorbidities.

Influence of manganese exposure on cognitive function, plasma APP and Aβ levels in older men

BackgroundElevated manganese (Mn) exposure impairs cognition in adults and children, but the association between Mn and cognitive function in elderly people is unclear. Previous studies have linked Mn neurotoxicity in AD to Aβ-dependent mechanisms. However, the association between Mn and plasma APP and Aβ in the general elderly population remains unknown. This study aimed to investigate the association between Mn exposure and cognitive function, plasma APP and plasma Aβ in older adults. MethodsCognitive abilities in 375 men aged 60 and older in Guangxi, China were assessed using the Mini-Mental State Examination (MMSE) and cognitive impairment were identified using education-stratified cut-off points of MMSE scores. Urinary Mn levels and plasma APP, and Aβ levels were measured using ICP-MS and ELISA, respectively. ResultsA total of 109 (29.07 %) older men were identified as having cognitive impairment. The median urinary Mn level was 0.22 μg/g creatinine. Urinary Mn levels were negatively correlated with MMSE scores (β = −1.35, 95 % CI: −2.65 to −0.06; p = 0.041). In addition, higher concentrations of urinary manganese were associated with a greater risk of cognitive impairment (OR = 2.03, 95 % CI: 1.14–3.59; comparing the highest and lowest manganese; p = 0.025). Moreover, plasma APP levels were inversely associated with urinary Mn levels (r = −0.123, p = 0.020), and positively associated with MMSE scores (r = 0.158, p = 0.002). Surprisingly, no correlations were observed between plasma Aβ42, Aβ40, Aβ40/Aβ42, or Aβ42/Aβ40 and urinary Mn levels and MMSE scores. ConclusionThese results suggested that Mn exposure is negatively associated with older men’s cognition and plasma APP levels, but not plasma Aβ levels.

Association Between Renal Dysfunction and Low HDL Cholesterol Among the Elderly in China.

Objective: Chronic kidney disease (CKD) and cardiovascular disease (CVD) have a high morbidity and mortality among the elderly. Low levels of high-density lipoprotein cholesterol (HDL-C), a traditional risk marker for CVD, are common in CKD patients. Little is known about the association of low HDL-C with renal dysfunction in the community dwelling population.Methods: This was a population-based cross-sectional study included 4,753 participants enrolled in a prospective study, the Shanghai Elderly Cardiovascular Health (SHECH) study. Estimated glomerular filtration rate (eGFR), calculated by the Chinese Modification of Diet in Renal Disease (C-MDRD equation), was used to assess renal dysfunction. Associations between renal dysfunction and low HDL-C were evaluated using multiple logistic regression models and restricted cubic splines.Results: Of 4,649 individuals who met inclusion criteria, 620 (13.34%) had low HDL-C at <40 mg/dl. In the fully adjusted model, lower eGFR of <60 ml/min/1.73 m2 (OR, 2.03; 95% CI, 1.21–3.43) and marginal eGFR of 60 to 90 ml/min/1.73 m2 (OR, 1.26; 95% CI, 1.01–1.58) were significantly associated with low HDL-C, compared with normal eGFR of ≥90 ml/min/1.73 m2. Moreover, consistent findings were obtained in subsidiary analyses using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Fully adjusted cubic spline models indicated a significant dose-response relationship between eGFR and low HDL-C (P for non-linearity, 0.356).Conclusion: In this general elderly population, renal dysfunction was independently and significantly associated with low HDL-C, and the prevalence of low HDL-C increased with decreasing eGFR, such that even slight changes in renal function may be associated with altered lipid levels.

Decompressive laminectomy with instrumented posterolateral fusion for degenerative lumbar disease in elderly, is it safe and beneficial?

BackgroundWith improvement of health care in last decades, the age of general population increased. As the elderly with degenerative lumbar disease needs to remain physically active for more years, lumbar decompression surgery with instrumented fusion is further considered and is gaining wide acceptance as it provides good results with relative minimal risk. This study aim to evaluate the safety and efficacy of lumbar decompression with instrumented fusion in elderlyResultsThis is a prospective non-randomized clinical study conducted from July 2014 to July 2019. The included patients had chronic low back pain, radiculopathy, and/or neurogenic claudication due to degenerative lumbar disease with failed conservative management. They underwent lumbar decompression with instrumented posterolateral fusion. All patients were at least 55 years old at time of surgery and were clinically assessed as regard perioperative risk and morbidity, besides assessment of pre- and postoperative visual analog score (VAS) and Oswestry Disability Index (ODI). Data was collected and analyzed. Thirty-five patients were included in this study with mean age of 63 years. All patients presented with back pain, 77.1% with radiculopathy, and 60% with neurogenic claudication. Preoperative comorbidity was present in 60% of cases, where hypertension, diabetes, and cardiac troubles were 31.4%, 31.4%, and 14.3% respectively. The average operated level was 3.1. The complication rate was 11.4% with 2 cases with dural tear (5.7%), 2 cases with CSF leakage (5.7%), 1 case with wound seroma (2.8%), and 1 case with wound infection. Postoperative new comorbidity occurred in 5 cases (14.3%). Visual analog score (VAS) and Oswestry disability index (ODI) were recorded preoperatively and 18 months postoperatively; as regards pain, VAS improved significantly from 7.8 ± 0.87 to 1.8 ± 1.04 (P value< 0.00001), and ODI improved significantly from 58.1 ± 11 to 17.5 ± 8.3 (P value< 0.00001).ConclusionLumbar decompression surgery with posterolateral instrumented fusion is a safe and effective surgery in elderly, as it provides significant results and gives them a chance for better quality of life. Preoperative comorbidity could be dealt with, and it should not be considered as a contraindication for surgery in this age group.

Can patients suffering an ST elevation myocardial infarction enjoy a similar life expectancy to that of the general population?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction and objectives There has been a continuous process of improvement after (ST-segment elevation myocardial infarction) STEMI. Our aim was to know whether patients &amp;lt; and ≥ 65 years suffering a STEMI can recover a life expectancy similar to that of the general population of the same age, sex and geographical region. Methods We included all patients who suffered a STEMI from January 2014 until January 2020 and compared them to a reference population provided by the National statistics Institute from Spain. For those patients surviving the acute event as well as the first 30 days, we calculated their observed survival, expected survival and the excess of mortality calculated with the Ederer II method. If the expected survival was inside the 95% confidence interval(CI) of the observed survival there was not a significant excess of mortality. We repeated all analyses for survivors stratifying by 65 years. Results We included 1722 patients, 899 patients were &amp;lt;65 years. For patients &amp;lt; 65 years who survived a STEMI, observed survival at 3 and 5 years of follow-up was 97.68%(95%CI, 96.05%-98.64%) and 94.14%(95%CI, 90.89%-96.25%), respectively. Expected survival for 3 and 5 years was 98.12% and 96.61%. For patients ≥ 65 years who survived the STEMI, observed survival at 3 and 5 years was 85.52%(95%CI, 82.23%-88.24%) and 75.43%(95%CI, 70.26%-79.83%), respectively. Expected survival for 3 and 5 years was 86.48% and 76.56%. Conclusions For survivors of the acute event, life expectancy is similar to that of the general population of the same age, sex and geographical region. Table 1Year of Follow UpObserved Survival (95% CI)Expected SurvivalAnual Excess of Mortality (95% CI)&amp;lt;65 yearsFirst Year99.23%(98.29%-99.65%)99.43%0.19%(-0.23%-1.14%)Second Year98.76%(97.61%-99.36%)98.79%-0.16%(-0.48%-0.84%)Third Year97.68%(96.05%-98.64%)98.12%0.36%(-0.25%-1.82%)Fourth Year95.82%(93.55%-97.31%)97.39%1.37%(0.27%-3.65%)Fifth Year94.14%(90.89%-96.25%)96.61%0.73%(-0.31%-3.88%))≥65 yearsFirst Year93.69%(91.59%-95.29%)95.64%2.15%(0.45%-4.39%)Second Year90.22%(87.61%-92.31%)91.09%-1.05%(-2.46%-1.12%)third Year85.52%(82.23%-88.24%)86.48%0.21%(-1.69%-3.06%)Fourth Year81.32%(77.38%-84.65%)81.80%-0.54%(-2.69%-3.06%)Fifth Year75.43%(70.26%-79.83%)76.56%1.20%(-2.17%6.98%)Abstract Figure 1

018 TSST-1+ Staphylococcus aureus in bullous pemphigoid

Bullous pemphigoid (BP) is an autoimmune blistering disease that is treated with high dose immunosuppression due to lack of specific targets. Staphylococcus aureus is a commensal bacterium implicated inflammatory and autoimmune disorders because of its secretion of toxins with superantigen effects. We prospectively evaluated S. aureus colonization and its production of toxic shock syndrome toxin-1 (TSST-1) in 28 new onset BP patients. Inclusion criteria were active blistering and linear basement membrane IgG/C3 or a serum ELISA >14 for BP180 IgG. Bacterial swabs were obtained from the lesion interior, nares and unaffected skin of BP patients and nares and anatomically matched skin of 28 age- and sex-matched controls. Staphylococcal growth was assessed on blood agar, and TSST-1 production by cultured S. aureus isolates and in blister fluid was evaluated by immunoblot. S. aureus colonization of BP lesions was 3-6-fold higher than the nares or unaffected skin from the same patients (p≤0.300) and 6-fold higher than control nares or skin (p≤0.0015). Evaluation of superantigen gene profiles using PCR indicated that 96% of BP patients are colonized with a clonal strain of TSST-1+ S. aureus. Colonization and circulating levels of TSST-1 neutralizing antibodies, measured by ELISA, did not correlate. Interestingly, S. aureus colonization was not observed in patients who had received prior antibiotics. In colonized patients with severe disease, addition of anti-staphylococcal antibiotics resulted in clinical improvement and eliminated lesional colonization. This study shows that BP lesions harbor a clonal strain of TSST-1 producing S. aureus that is not evident in the general elderly population. Thus, immunosuppressive therapies should be balanced with the knowledge that S. aureus is likely present in BP lesions and the knowledge that antibiotics may play an important therapeutic role through bacterial clearance.

Association of US Nurse and Physician Occupation With Risk of Suicide

Nurses are the largest component of the US health care workforce. Recent research suggests that nurses may be at high risk for suicide; however, few studies on this topic exist. To estimate the national incidence of suicide among nurses and examine characteristics of nurse suicides compared with physicians and the general population. This retrospective cohort study used US data from 159 372 suicides reported in the National Violent Death Reporting System from 2007 to 2018. With the use of workforce denominators, sex-specific suicide incidence estimates were generated among nurses, physicians, and the general population (age, ≥30 years). Associations between clinician type and method of suicide and results of toxicology examination at death were calculated, adjusted for sociodemographic characteristics. Statistical analysis was performed from October 16, 2020, to January 10, 2021. Occupation as a nurse or physician. Suicide incidence and characteristics associated with suicides. A total of 2374 suicides among nurses (1912 women [80.5%]; mean [SD] age, 52.8 [11.8] years), 857 suicides among physicians (723 men [84.4%]; mean [SD] age, 59.8 [15.3] years), and 156 141 suicides in the general population (121 483 men [77.8%]; mean [SD] age, 53.1 [14.7] years) were identified. Overall, suicide was more common among nurses compared with the general population (sex-adjusted incidence in 2017-2018, 23.8 per 100 000 vs 20.1 per 100 000; relative risk, 1.18 [95% CI, 1.03-1.36]). Among women in 2017-2018, the suicide incidence among nurses was 17.1 per 100 000 (506 among 2 966 048) vs 8.6 per 100 000 (8879 among 103 731 387) in the general female population (relative risk, 1.99 [95% CI, 1.82-2.18]). In absolute terms, being a female nurse was associated with an additional 8.5 suicides per 100 000 (95% CI, 7.0-10.0 per 100 000) compared with the general population of women. By sex, physician suicide rates were not statistically different from the general population other than among female physicians in 2011-2012 (11.7 per 100 000 [95% CI, 6.6-16.8 per 100 000] female physicians vs 7.5 per 100 000 [95% CI, 7.2-7.7 per 100 000] general population; P = .04). In terms of the characteristics of suicides, clinicians were more likely to use poisoning than the general population; for example, 24.9% (95% CI, 23.5%-26.4%) of nurses used poisoning compared with 16.8% (95% CI, 16.6%-17.0%) of the general suicide population. The presence of antidepressants, benzodiazepines, barbiturates, and opiates was more common among clinician suicides than suicides in the general population. This study suggests that, in the US, the risk of suicide compared with the general population was significantly greater for nurses but not for physicians. Further research is needed to assess whether interventions would be associated with benefit in reducing suicide risk among nurses.