Extra Years Research Articles

Effect of aerobic training versus brain gym exercises to improve global cognition and quality of life in elderly - a randomised clinical trial protocol

Literature implies that the length of life spent in good health continues to be fairly stable, indicating that additional years usually deteriorate health The aftermath for older people and society will be more profound if these extra years are primarily marked by declines in physical and mental competence. The cultures and settings individuals live in, paired with their personality traits have a lasting impact on how they age. Health can be shaped by physical and social environments that influence wellness practices. It is therefore essential to consider environmental and personal strategies as well as those that could aid in recovery, adaptation, and psychosocial development while constructing a public health response to aging. According to research, over the next three decades, there will be a more than doubling of the global elderly population. There will be 1.25 billion more people over the age of 60 in 2050, and 115.4 million of those people are expected to have dementia. 48 million people worldwide are affected by Alzheimer's disease, which accounts for 60–70% of dementia cases and causes serious societal, financial, and clinical issues. This alarms for a solution for the plethora of problems that arise with advancing age. Giving up a sedentary lifestyle and incorporating physical activity into daily activities has shown some amazing results in not only lowering the risk of developing serious illnesses but also 10 improving quality of life. Numerous studies have been conducted in recent years to determine how aerobic exercise and brain gymnastics can each improve health and life expectancy in the elderly, but relatively fewer researches have been done on how these two activities can work together. Consequently, here we intend to probe how aerobic exercise and brain training can enhance general cognition and overall quality of life.

Trends in cancer-free working life expectancy based on health insurance data from Germany-Is the increase as strong as in working life expectancy?

Against the backdrop of population ageing, governments are facing the need to raise the statutory retirement age. In this context, the question arises whether these extra years added to working life would be spent in good health. As cancer represents a main contributor to premature retirement this study focuses on time trends and educational inequalities in cancer-free working life expectancy (WLE). The analyses are based on the data of a large German health insurer covering annually about 2 million individuals. Cancer-free WLE is calculated based on multistate life tables and reported for three periods: 2006-2008, 2011-2013, and 2016-2018. Educational inequalities in 2011-2013 were assessed by two educational levels (8 to 11 years and 12 to 13 years of schooling). While labour force participation increased, cancer incidence rates decreased over time. Cancer-free WLE at age 18 increased by 2.5 years in men and 6.3 years in women (age 50: 1.3 years in men, 2.4 years in women) between the first and third period while increases in WLE after a cancer diagnosis remained limited. Furthermore, educational inequalities are substantial, with lower groups having lower cancer-free WLE. The proportion of cancer-free WLE in total WLE remained constant in women and younger men, while it decreased in men at higher working age. The increase in WLE is accompanied by an increase in cancer-free WLE. However, the subgroups considered have not benefitted equally from this positive development. Among men at higher working age, WLE increased at a faster pace than cancer-free WLE. Particular attention should be paid to individuals with lower education and older men, as the general level and time trends in cancer-free WLE are less favourable.

Investigating the Association of Pain Intensity and Health Status among Older US Adults with Pain Who Used Opioids in 2020 Using the Medical Expenditure Panel Survey.

The number of older United States (US) adults is increasing, yet extra life years are not always spent in good health. This study explored the relationship between pain intensity and health status among US adults aged ≥50 with pain who used an opioid in the 2020 Medical Expenditure Panel Survey using multivariable logistic regression adjusting for demographic, economic, and health variables. Most (60.2%) older US adult opioid users with pain reported having good health (versus 39.8% poor health). In the fully adjusted analysis, those with extreme pain (odds ratio (OR) = 0.19, 95% confidence interval (CI) = 0.10, 0.35) and quite a bit of pain (OR = 0.34, 95% CI = 0.19, 0.60) had lower odds of reporting good health compared to those with little pain. There was no statistical relationship between health status for moderate versus little pain. In addition, males (versus females; OR = 0.61, 95% CI = 0.40, 0.91), white race (versus not white; OR = 0.43, 95% CI = 0.22, 0.84), education ≤high school (versus >high school; OR = 0.61, 95% CI = 0.41, 0.92), and current smoker (versus non-smoker; OR = 0.55, 95% CI = 0.32, 0.93) were associated with lower odds of reporting good health. Being employed (versus unemployed; OR = 1.88, 95% CI = 1.06, 3.33), having <2 chronic conditions (versus ≥2; OR = 4.38, 95% CI = 1.91, 10.02), and doing regular physical activity (versus not; OR = 2.69, 95% CI = 1.73, 4.19) were associated with higher odds of reporting good health. These variables should be considered when assessing the health needs and developing treatment plans for older US adult opioid users with pain.

GOD AND GOD’S WORLD IN A. I. SOLZHENITSYN’S SHORT NOVEL (POVEST’) “CANCER WARD”

The research is devoted to revealing the features of understanding of God and God’s world in A. I. Solzhenitsyn’s “Cancer Ward.” The heroes of the short novel travel a difficult path on which they have to think about God. At the beginning of the short novel there is a parable illustrating a legalistic understanding of God as Allah who punishes man, and at the end of the work the image of the Lamb, that is, Christ going to his death, appears, which means that the protagonist rises to the realization of Grace. A. I. Solzhenitsyn demonstrates how, having consciously separated himself from God, a person turns into an animal. The zoo visited at the end of the story by Kostoglotov is a model of the animal world that shows how people can turn into animals. An important place in the short novel is occupied by the parable about God endowing a person with extra years of life, taking them from a horse, a dog and a monkey. Images-symbols of these three animals are of great importance for understanding the characters of the key heroes of the story: Kostoglotov and Rusanov (dog), Vadim, Efrem, Roan, Doctor Dontsova and Asya (horse), Zoey (monkey). Turning away from God, man renounces his immortal soul and becomes similar to an animal immersed in incessant movement and leading a biological existence. He becomes a hostage to the cyclical model of time, which is steadily moving towards death. The symbol of this movement is a squirrel in a wheel, which Kostoglotov sees in the zoo. However, the short novel also sets a different trajectory of time: from the meat-eater through Maslenitsa and Lent to Easter, that is, to the Resurrection that awaits the immortal human soul. Aunt Stepha, cancer ward patient who believes in God, talks about this model of time. Images of plants also play an important role, serving as a reminder to a person about the happiness and harmony of God’s world. The short novel of A. I. Solzhenitsyn calls for understanding God as a merciful, Grace-giving Creator and calls for acceptance of God’s world.

Cost-effectiveness analysis measuring the total costs against the health benefits of three different rotavirus vaccines for Mexico

ABSTRACT Rotavirus (RV) infection causes acute rotavirus gastroenteritis (RVGE) in infants. Safe and effective RV vaccines are available, of which Mexico has included one in its national immunization program (NIP) since 2007. Health outcome gains, expressed in quality-adjusted life years (QALYs), and cost improvements are important additional factors for the selection of a NIP vaccine. These two factors were analyzed here for Mexico over one year implementing three RV vaccines: 2-dose Rotarix (HRV), versus 3-dose RotaTeq (HBRV), and 3-dose Rotasiil (BRV-PV), presented in a 1-dose or 2-dose vial). HRV would annually result in discounted QALY gains of 263 extra years compared with the other vaccines by averting an extra 24,022 homecare cases, 10,779 medical visits, 392 hospitalizations, and 12 deaths. From a payer’s perspective and compared with HRV, BRV-PV 2-dose vial and BRV-PV 1-dose vial would annually result in $13,548,179 and $4,633,957 net savings, respectively, while HBRV would result in $3,403,309 extra costs. The societal perspective may also show savings compared with HRV for BRV-PV 2-dose vial of $4,875,860, while BRV-PV 1-dose vial and HBRV may show extra costs of $4,038,363 and $12,075,629 respectively. HRV and HBRV were both approved in Mexico, with HRV requiring less investment than HBRV with higher QALY gains and cost savings. The HRV vaccine produced those higher health gains due to its earlier protection and greater coverage achieved after its schedule completion with two doses only, providing full protection at four months of age instead of longer periods for the other vaccines.

41. Defining Predictors of Academic Productivity in Plastic Surgery Residency: A Bibliometric Analysis of Research Experiences Throughout Training

Background: It is likely that the importance of research experience in plastic and reconstructive surgery residency candidates will increase as the Step 1 exam and medical school rotations transition to pass/fail scoring. Institutional characteristics in undergraduate and graduate medical education that may influence academic productivity have not been collectively explored prior to this study. This study aims to assess predictors of academic productivity in residency, including medical school academic productivity, graduate institutional characteristics, and career intentions. Methods: This study utilizes a retrospective correlational study design to examine associations between academic history and research productivity during residency for chief residents of 2019 and 2020 of integrated programs. Background characteristics such as the following were collected for each resident: dedicated research time during medical school and residency, gap year after medical school, completion of other degrees, completion of fellowship, and academia versus private practice. Variables such as the following were collected to measure productivity: number of publications during medical school, number of publications during residency, and h-index. Descriptive statistics and linear regressions were generated to assess associations between medical school-related variables and residency-related variables with measures of academic productivity. Results: Overall, there were 221 graduates included, 95 (43.0%) of which were class of 2019 and 126 (57.0%) of which were class of 2020. The number of publications while in medical school and h-index calculated at the end of residency was positively associated with dedicated research time in medical school (coefficient=0.74, p=0.000; coefficient=2.96, p=0.002). For h-index calculated at the end of residency, having dedicated medical school research time was positively related and statistically significant (coefficient=2.96, p=0.002). Conclusion: The findings demonstrate that dedicated research time during medical school was an independent predictor of the number of publications and h-index by the end of residency, markers of quality and quantity of academic productivity. The study demonstrates that dedicated research time included in mandatory curricula shows impact, while optional research time, such as during gap years, does not. The findings have important implications for stakeholders in graduate medical education, including those considering taking extra research years and those looking to recruit candidates with academic potential.

Morphological and Functional Effects of Ultrasound on Blood–Brain Barrier Transitory Opening: An In Vitro Study on Rat Brain Endothelial Cells

With the recent advances in medicine, human life expectancy is increasing; however, the extra years of life are not necessarily spent in good health or free from disability, resulting in a significantly higher incidence of age-associated pathologies. Among these disorders, neurodegenerative diseases have a significant impact. To this end, the presence of the protective blood-brain barrier (BBB) represents a formidable obstacle to the delivery of therapeutics. Thus, this makes it imperative to define strategies to bypass the BBB in order to successfully target the brain with the appropriate drugs. It has been demonstrated that targeting the BBB by ultrasound (US) can transiently make this anatomical barrier permeable and in so doing, allow the delivery of therapeutics. Thus, our aim was to carry out an in depth in vitro molecular and morphological study on the effects of US treatment on the BBB. The rat brain endothelial (RBE4) cell line was challenged with exposure to 12 MHz diagnostic US treatment for 10, 20, and 30 min. Cell viability assays, Western blotting analysis on the endoplasmic reticulum (ER), and oxidative stress marker evaluation were then performed, along with cytological and immunofluorescence staining, in order to evaluate the effects of US on the intercellular spaces and tight junction distribution of the brain endothelial cells. We observed that the US treatment exerted no toxic effects on either RBE4 cell viability or the upregulation/dislocation of the ER and oxidative stress marker (GRP78 and cytochrome C, respectively). Further, we observed that the application of US induced an increase in the intercellular spaces, as shown by Papanicolaou staining, mainly due to the altered distribution of the tight junction protein zonula occludens-1 (ZO-1). This latter US-dependent effect was transient and disappeared 20 min after the removal of the stimulus. In conclusion, our results show that US induces a transient alteration of the BBB, without altering the intracellular signaling pathways such as the ER and oxidative stress that could potentially be toxic for endothelial cells. These results suggested that US treatment could represent a potential strategy for improving drug delivery to the brain.

Validity of Utme and Post-Utme in Predicting Students’ Academic Achievement in Undergraduate Mathematics

Some Mathematics undergraduate students who reckoned high grades in SSCE Mathematics, high scores in UTME and Post-UTME Mathematics end up spending extra years in the university, some graduating with low class of degrees and some others dropping out of school. Hence, the need for this study which was specifically aimed at determining students’ UTME scores in Mathematics, and Post-UTME scores in Mathematics as correlates of the first year mean achievement scores of the students in undergraduate Mathematics. The design of the study was correlational survey research design. The study was guided by three research questions, and three hypotheses. The study was carried out in Ebonyi State. The study used a sample of 120 students out of the total population of 146 students drawn from the 2018/2019, 2019/2020, and 2020/2021 academic sessions in both the Pure and Applied Mathematics and Mathematics Education courses using both purposive sampling and proportionate random sampling techniques. The data were collected using a researchers-made instrument which was face validated by three experts, one in Measurement and Evaluation; and two experts in Mathematics Education all in Department of Science Education. The data were analyzed using Pearson Product Moment correlation, Regression Analysis and Analysis of Variance. The research questions were answered using the Pearson Product Moment correlation coefficients, while all the hypotheses were tested at 0.05 level of significance, using exact probability approach. The findings of the study showed that students’ UTME and Post-UTME scores in Mathematics significantly positively correlated with the first year mean achievement scores of the students in undergraduate Mathematics. Hence, the researchers concluded that both UTME and Post-UTME scores in Mathematics are reliable predictors of the students’ academic achievement in undergraduate Mathematics.

THE IMPACT OF THE OLD AGE PENSION EXPANSION ON BLOOD PRESSURE AMONG OLDER MEN IN RURAL SOUTH AFRICA

Abstract The impact of improved socioeconomic welfare after retirement on cardiovascular health among older men in low-income settings is unknown. Using natural experiment, we investigated the impact of eligibility for additional Old Age Pension (OAP) income on systolic blood pressure (SBP) among older men in rural South Africa using data from 1,208 men aged ≥60 in the population-representative “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in Rural South Africa” (HAALSI) cohort. The South African Old Age Pension (OAP) incrementally expanded age eligibility for men from age 65 prior to 2008 to age 60 in 2010. This expansion provided exogenous variation in pension income among men, based on their year of birth. We estimated predicted SBP among the birth cohorts of men who were eligible for one through five extra years of OAP income, using a multivariable linear regression model estimated in those without access to extra pension income (over age 65 when the expansion rolled out) based on covariates. We then estimated mean SBP difference scores among men in each of these five birth cohorts, based on their observed SBP minus predicted SBP. Men in OAP expansion birth cohorts had lower SBP than those who were not exposed to extra pension, although the differences were not statistically significant (5-years estimate = -2.735 (p=0.353) vs. 1-year estimate = 1.633 (p=0.531)). This trend suggests a possible long-term benefit of blood pressure control with greater cumulative pension income among men living in rural, low-income settings.

Estimated Lifetime Benefit of Combined RAAS and SGLT2 Inhibitor Therapy in Patients with Albuminuric CKD without Diabetes.

Despite high rates of complications in patients with CKD without diabetes, the implementation of proven therapies in this group remains low. Expressing the clinical benefit of a therapy in terms of extra years free from the disease or death may facilitate implementation. We estimated lifetime survival free of kidney failure for patients with albuminuric CKD without diabetes treated with the combination therapy of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and sodium-glucose cotransporter-2 (SGLT2) inhibitors relative to patients not treated. We used trial-level estimates of the effect of treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ramipril/benazepril; n=690) and SGLT2 inhibitors (dapagliflozin; n=1398) compared with placebo to derive the effect of combination therapy versus no treatment. Using this effect, we estimated treatment effect of combination therapy to the active treatment group of patients with albuminuric CKD without diabetes participating in the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial (n=697) and projected eventfree and overall survival for those treated and not treated with combination therapy. We also performed our calculations anticipating lower adherence and less pronounced benefits than were observed in the clinical trials. The primary outcome was a composite of doubling of serum creatinine, kidney failure, or death. The aggregate estimated hazard ratio comparing combination therapy with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and SGLT2 inhibitor versus no treatment for the primary end point was 0.35 (95% confidence interval, 0.30 to 0.41). For a 50-year-old patient until the age of 75 years, the estimated survival free from the primary composite end point was 17.0 (95% confidence interval, 12.4 to 19.6) years with the combination therapy and 9.6 years (95% confidence interval, 8.4 to 10.7) with no treatment with any of these agents, corresponding to a gain in eventfree survival of 7.4 (95% confidence interval, 6.4 to 8.7) years. When assuming lower adherence and less pronounced efficacy of combination therapy, the gain in eventfree survival ranged from 5.3 years (95% confidence interval, 4.4 to 6.1) to 5.8 years (95% confidence interval, 4.8 to 6.8). Treatment with the combination of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and SGLT2 inhibitor in patients with albuminuric CKD without diabetes is expected to substantially increase kidney failure-free survival. Benazepril for Advanced Chronic Renal Insufficiency, NCT00270426, and a Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (Dapa-CKD), NCT03036150.

Life-Course Persistent Antisocial Behavior and Accelerated Biological Aging in a Longitudinal Birth Cohort.

Prior research shows that individuals who have exhibited antisocial behavior are in poorer health than their same-aged peers. A major driver of poor health is aging itself, yet research has not investigated relationships between offending trajectories and biological aging. We tested the hypothesis that individuals following a life-course persistent (LCP) antisocial trajectory show accelerated aging in midlife. Trajectories of antisocial behavior from age 7 to 26 years were studied in the Dunedin Multidisciplinary Health and Development Study, a population-representative birth cohort (N = 1037). Signs of aging were assessed at age 45 years using previously validated measures including biomarkers, clinical tests, and self-reports. First, we tested whether the association between antisocial behavior trajectories and midlife signs of faster aging represented a decline from initial childhood health. We then tested whether decline was attributable to tobacco smoking, antipsychotic medication use, debilitating illnesses in adulthood, adverse exposures in childhood (maltreatment, socioeconomic disadvantage) and adulthood (incarceration), and to childhood self-control difficulties. Study members with a history of antisocial behavior had a significantly faster pace of biological aging by midlife, and this was most evident among individuals following the LCP trajectory (β, 0.22, 95%CI, 0.14, 0.28, p ≤ 0.001). This amounted to 4.3 extra years of biological aging between ages 25-45 years for Study members following the LCP trajectory compared to low-antisocial trajectory individuals. LCP offenders also experienced more midlife difficulties with hearing (β, -0.14, 95%CI, -0.21, -0.08, p ≤ 0.001), balance (β, -0.13, 95%CI, -0.18, -0.06, p ≤ 0.001), gait speed (β, -0.18, 95%CI, -0.24, -0.10, p ≤ 0.001), and cognitive functioning (β, -0.25, 95%CI, -0.31, -0.18, p ≤ 0.001). Associations represented a decline from childhood health. Associations persisted after controlling individually for tobacco smoking, antipsychotic medication use, midlife illnesses, maltreatment, socioeconomic status, incarceration, and childhood self-control difficulties. However, the cumulative effect of these lifestyle characteristics together explained why LCP offenders have a faster Pace of Aging than their peers. While older adults typically age-out of crime, LCP offenders will likely age-into the healthcare system earlier than their chronologically same-aged peers. Preventing young people from offending is likely to have substantial benefits for health, and people engaging in a LCP trajectory of antisocial behaviors might be the most in need of health promotion programs. We offer prevention and intervention strategies to reduce the financial burden of offenders on healthcare systems and improve their wellbeing.

The preventable productivity burden of sleep apnea in Australia: a lifetime modelling study.

Obstructive sleep apnea (OSA) is a common disorder. OSA is associated with cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM) and depression, among other comorbidities. We aim to determine the productivity burden of OSA in Australia using productivity-adjusted life-years (PALYs). Using life table modelling, we built a multistate Markov model to estimate the impact of moderate to severe OSA on the whole working-age Australian population in 2021 (aged 20-65 years) with OSA until retirement (aged 66 years). The model also captured the impact of OSA on CVD, T2DM, depression, and vehicle-related accidents. Data for OSA and comorbidities and Australian specific labour data, were extracted from published sources. A second cohort was then modelled to test the effect of a hypothetical intervention, assuming a 10% reduction in OSA prevalence and a 10% reduction in comorbidities in patients with OSA. The primary outcome of interest were PALYs accrued. All outcomes were discounted 5% annually. Over a lifetime, the Australian population with OSA accrued 193,713,441 years of life lived and 182,737,644 PALYs. A reduction of 10% in OSA prevalence and comorbidities would result in 45,401 extra years of life lived and 150,950 extra PALYs. This resulted in more than AU$25 billion of gained gross domestic product over the lifetime of the working population. Our study highlights the substantial burden of OSA on the Australian population and the need to tailor interventions at the population level to reduce the health and economic impacts.

Association Between the Community Prevalence of COVID-19 and Daily Unscheduled Absences of Anesthesiologists, Nurse Anesthetists, and Residents in an Academic Anesthesia Department.

Introduction An "unscheduled absence" refers to an occurrence when an employee does not appear for work and the absence was not approved in advance by an authorized supervisor. Daily unscheduled absences need to be forecasted when doing staff scheduling to maintain an acceptable risk of beingunable torun all anesthetizing locations and operating rooms planned. The number of extra personnel to be scheduled needs to be atleast twice aslarge as the mean number absent. In an earlier historical cohort study, we found that our department's modeled risks of being unavailable unexpectedly differed among types of anesthesia practitioners (e.g., anesthesiologists and nurse anesthetists) and among weekdays (i.e., Mondays, Fridays, and workdays adjacent toholidays versus other weekdays). In the current study, with two extra years of data, we examined the effect of the coronavirus COVID-19 pandemic onthe frequency of unscheduled absences. Methods There were 50 four-week periods studied atalarge teaching hospital inthe United States, from August 30, 2018to June29, 2022. The sample size of 120,687 person-assignment days (i.e., a person assigned to work on a given day) included 322 anesthesia practitioners (86 anesthesiologists, 88 certified registered nurse anesthetists, 99 resident and fellow physicians, and 49 student nurse anesthetists). The community prevalence ofCOVID‑19 was estimated using the percentage positive among asymptomatic patients tested before surgery and other interventional procedures at the hospital. Results Each 1% increase in the prevalence of COVID-19 among asymptomatic patients was associated with a 1.131 increase in the odds ofunscheduled absence (P < 0.0001, 99% confidence interval 1.086 to1.178). Using an alternativemodel with prevalence categories, unscheduled absences were substantively more common when the COVID-19 prevalence exceeded 2.50%, P [Formula: see text]0.0002. For example, there was a 1% unscheduled absence rate among anesthesiologists working Mondays and Fridays early in the pandemic when the prevalence of COVID-19 among asymptomatic patients was 1.3%. At a 1% unscheduled absence rate, 67 would be the minimum scheduled tomaintain a <5.0% risk for being unable to run all 65 anesthetizing locations. Incontrast, there was a 3% unscheduled absence rate among nurse anesthetists working Mondays and Fridays during the Omicron variant surge when the prevalence was 4.5%. At a 3% unscheduled absence rate, 70would be the minimum scheduled tomaintain the same risk of not being able to run 65 rooms. Conclusions Increases in the prevalence of COVID-19 asymptomatic tests were associated with more unscheduled absences, with no detected threshold. This quantitative understanding ofthe impact ofcommunicable diseases on the workforce potentially has broad generalizability toother fields and infectious diseases.

Optimal Cost-Effective Screening Strategy for Unruptured Intracranial Aneurysms in Female Smokers.

The prevalence of intracranial aneurysms among female cigarette smokers was shown to be high in previous studies, yet the cost-effectiveness of screening them has never been explored. To explore the most cost-effective screening strategy for female smokers. A decision analytical study was performed with a Markov model to compare different screening strategies with no screening and to explore the most optimal screening strategy for female smokers. Input data for the model were extracted from literature. A single screening at different ages and multiple screening every 15 years, 10 years, 5 years, and 2 years were performed for female smokers in different age ranges. Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the model. Finally, value of information analysis was performed to investigate the value of collecting additional data. Screening female smokers for unruptured intracranial aneurysm is cost-effective. All screening strategies yield extra quality-adjusted life years. Screening at younger age brings more health benefit at lower cost. Frequent screening strategies decrease rupture rate of aneurysms more with higher costs per quality-adjusted life year. Screening after age 70 years and frequent screening (every 2 years) after age 60 years is not optimal. Among all the parameters in the model, collecting additional data on utility of the unscreened population would be most valuable. Screening female smokers for intracranial aneurysms once at younger age is most optimal. However, in clinical practice, the duration and intensity of exposure to cigarettes should be taken into consideration.

The UN Decade of healthy ageing: strengthening measurement for monitoring health and wellbeing of older people.

Over the past 100 years, life expectancy has increased dramatically in nearly all nations. Yet, these extra years of life gained have not all been healthy, particularly for older people aged 60 years and over. In 2020, the World Health Organisation (WHO) and United Nations (UN) member states embraced a sweeping 10-year global plan of action to ensure all older people can live long and healthy lives, formally known as the UN Decade of Healthy Ageing (2021–2030). With the adoption of the UN Decade of Healthy Ageing resolution, countries are committed to implementing collaborative actions to improve the lives of older people, their families and the communities in which they reside. The Decade addresses four interconnected areas of action. Adopting the UN's resolution on the Decade of Healthy Ageing has caused excitement, but a question that has weighed on everyone's mind is how governments will be held accountable? Besides, there have been no goals or targets set for the UN Decade of Healthy Ageing from a programmatic perspective for the action areas, and guidance on measures, data collection, analysis and reporting are urgently needed to support global, regional and national monitoring of the national strategies, programmes and policies. To this end, WHO in collaboration with UN agencies and international agencies established a Technical Advisory Group for Measurement of Healthy Ageing (TAG4MHA) to provide advice on the measurement, monitoring and evaluation of the UN Decade of Healthy Ageing at the global, regional and national levels.

Reanalysis of a Randomized Controlled Trial on Promoting Influenza Vaccination in General Practice Waiting Rooms: A Zelen Design.

In 2014–2015, we conducted a randomized controlled trial (RCT) assessing the effect of an advertising campaign for influenza vaccination using posters and pamphlets in general practitioner (GP) waiting rooms. No effect of the intervention could be demonstrated, but the immunization uptake increased in both arms of the study. In 2019, we deepened the investigations explaining the increased uptake conducting a registry-based 4/2/1 cluster RCT designed by Zelen with two extra years of follow-up of the study cohort. The study population included 23,024 patients eligible to be vaccinated who were registered with 175 GPs. The main outcome remained the number of vaccination units delivered per study group. Data were extracted from the SNIIRAM warehouse claim database for the Lille-Douai district (northern France). No difference in vaccination uptake was found in the Zelen versus the control group of the initial RCT. Overall, the proportion of vaccinated patients increased in the cohort from 51.4% to 70.4% over the three years. Being vaccinated the previous year was a strong predictor of being vaccinated in a subsequent year. The increase in vaccination uptake, especially among people older than 65, can be explained by a cohort effect. Health promotion and the promotion of primary health care may play an important role in this increase.

Progress Toward Long-Term Care Protection in Latin America: A National Long-Term Care System in Costa Rica.

The aging of the world's population is a reality. People are living longer, not just in high-income countries, but it remains unclear whether their extra years will be lived in better health. In fact, an increasing number of older adults will probably require help to perform activities of daily living. Within the framework of its Global Strategy and Action Plan on Ageing and Health, the World Health Organization has called on all countries to create suitable and equitable long-term care systems that meet the needs of older people. The challenge is particularly acute in Latin America. The region is aging faster than other areas in the world, and its less-prepared social protection systems suffer from limited economic resources. Costa Rica is one the first middle-income countries to create a national long-term care system. This article describes the main characteristics of this system and discusses it from an international perspective. The results show that it has been designed to prioritize severity of dependency and cost containment, and to reinforce the formalization of care. The outcome of its implementation will affect the decisions of neighboring countries and those with similar economic conditions concerning the development of their own long-term care systems.

Socijalno-ekonomske determinante rodnih razlika u samoproceni zdravlja kod starije populacije

Introduction: Self-reported health status is considered one of the highly significant indicators of general health and overall quality of life. Aim: to examine whether there are gender differences in self-reported health status among the older population depending on the socioeconomic determinants. Methods: The analysis was carried out based on the data collected from the fourth National Health Survey of the population of Serbia, which was designed as a cross-sectional study. The research was conducted in accordance with the methodological guidelines and research instruments of the European Health Interview Survey. Results: A statistically significant correlation was observed between gender and the self-reported health status of the respondents. Women were significantly more likely to report poor self-rated health (27.8%), whereas men reported better self-rated health (21.3%). The results of the multivariate logistic regression analysis showed that poor self-rated health status among women was more likely to be affected by age, educational level, and region, whereas age and economic status were significant factors associated with poor self-rated health status among men. Conclusion: Taking into consideration the fact that the advantages of increased life expectancy will achieved only if these extra years of life gained through increased longevity are spent in good health, the importance of conducting additional research on gender differences is more than evident, particularly in terms of providing meaningful insight into the development of action plans devised to deal with gender differences in health status, simultaneously promoting healthy and active aging for both men and women.

Won't you stay just a little bit longer? A discrete choice experiment of UK doctors’ preferences for delaying retirement

Introduction and aimsHealth systems around the world face difficulties retaining their workforce, which is exacerbated by the early retirement of experienced clinicians. This study aims to determine how to incentivise doctors to delay their retirement. MethodsWe used a discrete choice experiment to estimate the relative importance of job characteristics in doctors’ willingness to delay retirement, and the number of extra years they were willing to delay retirement when job characteristics improved. 2885 British Medical Association members aged between 50 and 70 years, registered with the General Medical Council, practising in Scotland (in December 2019), and who had not started to draw a pension were invited. We compared the preferences of hospital doctors (HDs) and general practitioners (GPs). ResultsThe response rate was 27.4% (n = 788). The number of extra years expected to work was the most important job characteristic for both respondents, followed by work intensity for GPs, whereas working hours and on-call were more important for HDs. Personalised working conditions and pension taxation were the least important characteristics for both groups. Setting all characteristics to their BEST levels, GPs would be willing to delay retirement by 4 years and HDs by 7 years. ConclusionsCharacteristics related to the job rather than pension could have the greatest impact on delaying retirement among clinicians.

THE WANDERING INTRA UTERINE DEVICE: A RARE CASE REPORT

Intra Uterine Device (IUD) is one of the widely used reversible methods of female contraception. There are many complications reported with IUD insertion, among which device migration and delayed perforation of viscera like small bowel is one of the rare and serious complication. Here we report a case of 29 year old female who presented with sudden onset of abdominal pain associated with vomiting. Her Computed Tomography (CT) scan of abdomen revealed IUD lying within peritoneal cavity causing terminal ileal perforation. She was treated surgically and she recovered well. Extra uterine visceral organ injury many months or years following IUD insertion is rare and should be considered as a differential in any female with IUD presenting with abdominal symptoms.