Extreme Age Research Articles

738Health Status and Quality of Life of Indigenous Elderly Population of Bangladesh

Abstract Background Indigenous people, although constitute 1.8% of the country’s population, are one of the most deprived communities of Bangladesh in all sectors. This study was conducted to explore the health status and quality of life of indigenous elderly of Bangladesh as there is scarcity of knowledge regarding this. Methods A mixed-method approach was deployed on October,2019 in Sylhet-division of Bangladesh. A cross-sectional survey was conducted among 400 indigenous elderlies from 8 tea-gardens and ten in-depth-interviews were conducted with health-service providers of tea-garden health-facilities. Results Of the indigenous elderly-respondents, majority (79.5%) were suffering from any kind of chronic diseases. Visual difficulty was found predominant (74%) among the chronic conditions, followed by locomotion difficulty (49%) and gastrointestinal problem (41%). Extreme age, being male, living alone and low family income were significantly associated with suffering from chronic conditions. Furthermore, having chronic condition and extreme-age was found to be significantly associated with low quality of life. Health-service providers identified lack of logistical support in health-facilities, economic crisis and lack of awareness as the causes of poor health-status and health-seeking behavior of the indigenous elderly. Conclusions Indigenous older men in extreme old age are more vulnerable to adverse health conditions and poor quality of life. Health literacy and health seeking behaviour is poor among indigenous older adults generally and there is a huge gap in the health services and social supports available to them. Key messages Indigenous, Older population, Bangladesh.

Human mortality at extreme age.

We use a combination of extreme value statistics, survival analysis and computer-intensive methods to analyse the mortality of Italian and French semi-supercentenarians. After accounting for the effects of the sampling frame, extreme-value modelling leads to the conclusion that constant force of mortality beyond 108 years describes the data well and there is no evidence of differences between countries and cohorts. These findings are consistent with use of a Gompertz model and with previous analysis of the International Database on Longevity and suggest that any physical upper bound for the human lifespan is so large that it is unlikely to be approached. Power calculations make it implausible that there is an upper bound below 130 years. There is no evidence of differences in survival between women and men after age 108 in the Italian data and the International Database on Longevity, but survival is lower for men in the French data.

ST-elevation Myocardial Infarction in Over 100 Years Old Patient: What is The Better Option

Background: Optimal therapy in ST-elevation myocardial infarction (STEMI) patients with extreme age is still a challenge. The presence of comorbidities and multiorgan dysfunction simultaneously increases the risk of ischemia and bleeding. Unfortunately, there are no adequate data for the benefit and reliability of the treatment in elderly patients. Case Summary: We report a case of a 103-year-old patient with substernal chest pain 6 hours before admission. His medical history was unremarkable. The physical examination revealed irregularly irregular pulse. An electrocardiogram showed atrial fibrillation with a moderate ventricular response with ST-elevation and Q waves in inferior lead. The patient was treated conservatively with dual antiplatelet aspirin and clopidogrel, and anticoagulated with fondaparinux. Although medical management was carried out because of family concerns, the best choice of therapy for STEMI patients of extreme ages was still a question. Discussion: Current practice guidelines recommend primary percutaneous coronary intervention as therapy of choice in STEMI patients with no upper age limit, and to start dual antiplatelet therapy using aspirin and a P2Y12 receptor blocker in all patients including the elderly. In a patient with atrial fibrillation, a shorter duration of dual antiplatelet therapy is recommended. Data regarding reperfusion therapy with the best level of efficacy and safety in this group is limited. Trials comparing various treatment strategies with oral anticoagulants are designed to investigate the safety, rather than efficacy. Another option to use single antiplatelet therapy to minimize bleeding risk still has limited data.

Association of socio-demographic characteristics with knowledge and perception about disease among newly diagnosed pulmonary tuberculosis patients in western Utter Pradesh: a cross-sectional study

Background: TB is one of the top 10 causes of death worldwide. The risk of TB is high among populations living in poverty, low socioeconomic groups, low income, immune-suppressed (including AIDS), and extreme age (old age and children) groups, etc. Methods: The study was conducted in TB and chest department of Sarojini Naidu medical college Agra city. The total number of patients registered during the period of July to September 2017 was 518; out of these 288 were new pulmonary and extrapulmonary patients. Out of 288 subjects, 123 were pulmonary patients. All the 123 new pulmonary tuberculosis patients (both smear +ve and smear -ve) were included in the study. 18 patients were loss to follow up after registration thus final effective sample size was 105 for further follow-up study. Results: Overwhelming (84.76%) patients belonged to a lower socioeconomic class. The maximum number (85.33%) of the study subjects among upper lower socioeconomic status had no knowledge regarding causative microbes of the disease (p=0.001). Conclusions: The majority of patients belong to illiterate, lower socioeconomic group, married and other than general cast, living in a joint, overcrowded family with more than four family members. About half of the subjects not knowing the method of prevention & consequence of treatment interruption. Most of them felt that quality of life affected after disease and about 1/4th of them felt hurtful behaviour of family members.

Prevalence and determinants of unintended pregnancy in Ethiopia: narrative synthesis and meta-analysis

BackgroundUnintended pregnancy has enormous health, social and psychological impacts. Thus, comprehensive local evidence is required to guide interventions to prevent the occurrence and consequences of unintended pregnancy. This systematic review was conducted to examine the prevalence and determinants of unintended pregnancy in Ethiopia. MethodsThe review was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis Without Meta-analysis (SWiM) guideline. Electronic databases including Medline/PubMed, Cochrane Library, CINAHL, Google scholar, and African journal online were searched to retrieve studies published from January 1/1990 to October 30/2020. Grey literatures were accessed from the online libraries of academic institutions in Ethiopia using the Google search engine. The qualities of the studies were assessed using Joanna Briggs Institute critical appraisal checklists. The retrieved studies were analyzed using STATA software version 13. The prevalence of unintended pregnancy was pooled using the random-effects model. The evidences on the determinants of unintended pregnancy were summarized in a narrative format. The statistical heterogeneity between studies was quantified by using the I-square values. Sub-group analysis and meta-regressions were done to identify the sources of heterogeneity among studies. ResultsA total of 250 studies were retrieved of which 25 studies with 23,030 women were included for meta-analysis. Only 24 studies scrutinized the determinants of unintended pregnancy. The overall prevalence of unintended pregnancy was 30 % (95% CI; 27–33 %) with high heterogeneity among studies (I2 = 95.06 %). The pooled prevalence of unwanted and mistimed pregnancy was 12 &17% respectively. The study region was the source of heterogeneity whereas study setting, study year, sample size, and study quality score were not the sources of heterogeneity (p > 0.1). Unintended pregnancy was positively associated with a low level of education, poverty, multiparity, rural residence, extreme ages, being unmarried, lack of decision-making power, inaccessibility of health facilities, poor knowledge, and non-use of contraceptives. ConclusionsThe pooled prevalence of unintended pregnancy in Ethiopia was high. Empowering women and ensuring the accessibility of quality family planning services can reduce the prevailing high prevalence of unintended pregnancy. Interventions that target rural, poor, unmarried, multiparous, less-educated, and adolescent women are also important to avert untended pregnancy in Ethiopia.

COVID-19 Infection in Octagenarian Patients: Imaging Aspects and Clinical Correlations

Introduction: Computed tomography (CT) of the chest, although not a screening test or diagnosis of infection with the new coronavirus, has a fundamental role in assessing the extent of lung involvement and complications such as pleural effusion. Considering the higher morbidity and mortality of elderly patients due to this infection, the objective of this study was to evaluate the imaging aspects and clinical correlations of an extreme age (≥80 years) with a confirmed diagnosis for COVID-19. Methods: This was a retrospective and single-center cohort study. CT scans were categorized qualitatively and quantitatively. In the first case, 3 descriptors were used to describe CT findings: “compatible” (findings of greater specificity for COVID-19: opacities with attenuation in ground glass with peripheral and bilateral distribution, with rounded morphology, with or without consolidations, crazy-pavement aspect, inverted halo sign, or organizing pneumonia findings), “doubtful” (findings not specific or unusual for COVID-19: opacities with attenuation in ground glass with nonrounded morphology, central, diffuse, or unilateral distribution, with or without consolidation, lobar or segmental consolidation without ground-glass opacity, small centrilobular nodules with the appearance of “tree-in-bud,” excavations, pleural effusion, and thickening of interlobular septa), and “negative” (absence of pneumonia signs). For the quantitative assessment, which referred to the extent of pulmonary involvement, a tomographic severity classification was used: grade 1 (lung involvement ≤25%), grade 2 (pulmonary involvement between 26 and 50%), and grade 3 (pulmonary involvement >50%). Results: A total of 138 patients were evaluated, with an average age of 86.2 years (84 women and 34 men). The mean time interval between onset of symptoms and tomography was 5.63 days. The most prevalent comorbidity was systemic arterial hypertension (81.2%). Compatible, doubtful, and negative tests were 117 (84.7%), 20 (14.4%), and 1 (0.7%), respectively. As for compatible exams, the most common findings were opacities in peripheral ground glass and rounded morphology, followed by crazy paving. The prevalence of pleural effusion was 28.2% and consolidation was 63.7%, and none of these findings were influenced by the duration of symptoms (p = 0.08 and p = 0.2, respectively). The exams classified as grade 1, grade 2, and grade 3 were 57 (41.6%), 46 (33.6%), and 34 (24.8%), respectively. There were statistically significant associations between the classification of tomographic severity and outcomes such as invasive ventilation (p = 0.004), admission to the intensive care unit (p < 0.001), and death (p < 0.001). Discussion/Conclusion: Our results show that patients ≥80 years old present tomographic manifestations similar to those described for the general population (ground-glass opacities and “crazy paving”) and that the extent of lung involvement is associated with the need for intensive care, invasive ventilation, and death. Although the literature describes an association between the stage of the disease and the appearance of consolidations and pleural effusion, this correlation was not observed in our study, which may suggest that this age-group is more predisposed to the appearance of such findings, typically described in the more advanced stages of infection.

Clinical Features of Acute Chikungunya Virus Infection in Children and Adults during an Outbreak in the Maldives.

ABSTRACT.The chikungunya virus is an arthritogenic arbovirus that has re-emerged in many tropical and subtropical regions, causing explosive outbreaks. This re-emergence is due to a genomic polymorphism that has increased the vector susceptibility of the virus. The majority of those infected with chikungunya virus exhibit symptoms of fever, rash, and debilitating polyarthralgia or arthritis. Symptoms can persist for weeks, and patients can relapse months later. Fatalities are rare, but individuals of extreme age can develop severe infection. Here, we describe the 2019 outbreak, the second-largest since the virus re-emerged in the Maldives after the 2004 Indian Ocean epidemic, in which a total of 1,470 cases were reported to the Health Ministry. Sixty-seven patients presenting at the main referral tertiary care hospital in the Maldives capital with acute undifferentiated illness were recruited following a negative dengue serology. A novel point-of-care antigen kit was used to screen suspected cases, 50 of which were subsequently confirmed using real-time reverse transcription–polymerase chain reaction. We describe the genotype and polymorphism of Maldives chikungunya virus using phylogenetic analysis. All isolates were consistent with the East Central South African genotype of the Indian Ocean lineage, with a specific E1-K211E mutation. In addition, we explored the clinical and laboratory manifestations of acute chikungunya in children and adults, of which severe infection was found in some children, whereas arthritis primarily occurred in adults. Arthritides in adults occurred irrespective of underlying comorbidities and were associated with the degree of viremia.

A 10-Year Single-Center Experience of Adverse Drug Reaction Monitoring

Background/Aims: Despite proper use of pharmaceuticals, adverse drug reactions (ADRs) can lead to problems related to patient safety. We analyzed the characteristics of ADRs, particularly serious adverse events (SAEs), in a single tertiary medical institution. Methods: Spontaneous ADR report data collected from 2010 to 2019 in Seoul National University Hospital were assessed. Causality was evaluated according to the World Health Organization-Uppsala Monitoring Centre criteria. Age, sex, onset, severity, seriousness, and system organ class (SOC) of ADRs and SAEs were analyzed. Results: During the study period, a total of 49,955 individual case safety reports were assessed as possible, probable, or certain. Although the number of gastrointestinal ADR reports was high (25.9%), severe cases were uncommon (2.6%). By contrast, the number of hematologic disorders was low (6.6%) but 39.2% of them were severe. Among ADRs, 10.2% were assessed as SAEs, the proportion of which was high at extreme ages and in males. Body as a whole-general disorders were the most frequently reported SOC for SAEs, followed by skin and appendage disorders. Antineoplastic agents and antibiotics were the most common causative agents of SAEs and ADRs. Anaphylactic reaction was the most frequent SAE (6.5%). Conclusions: The proportion of SAE differs according to SOC and drug. Attention should be paid to SAEs in children and older adults because the rate of SAEs is significantly higher at extreme ages.

Comparative Outcomes of Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Among Medicare Beneficiaries With Multivessel Coronary Artery Disease: An National Cardiovascular Data Registry Research to Practice Project.

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Contribution of the smartphone in medical practice

Purpose to determine the place of the smartphone by evaluating the possession and the use of medical applications in the practice of the professionals at the Mohamed VI University Hospital of Marrakech and hospital “Moulay Youssef Rabat” This is a prospective descriptive and mono-centric analytical study on health professionals working or performing their training at hospital structures during the 6 months of the study using a smartphone. Our study took place over a period of 6 months, from August 1, 2018 to January 31, 2019, is carried out on two sites. Within the Moulay Youssef Hospital Rabat CHR, Hospital mother and child Mohamed VI Hospital Marrakech hospital. A clear predominance of female 131 (65%) , with a sex ratio F / H of 0.51.with an average age of 34.4 years, with extreme ages between 60 and 18 years. We found that 149 (74.5%) were hospital professionals, 86 (43%) were medical students, 191 (95.57%) used French as their main language. - 142 (71%) use a smartphone and 125 (62.5%) use it in the medical prescription. Of the 200 professionals, 81% were convinced of the benefit of using Smartphones. The overflow of professional boundaries was highlighted as a disadvantage by 47% of the professionals.130 (65%) want more APPS communications and more than 50% were willing to pay between 50 and 200 MAD for medical APPS. In our study There is a statistically significant linear correlation between the age and the number of smartphone users during these 6 months (p = 0.023).There is a statistically significant linear correlation between professional status and number of smartphone uses during these 6months (p &lt;0.001). Our study joins the data of the literature with an average of the number of use during these 6 months which is not statistically different according to the sex (p = 0.27). There is a statistically significant linear correlation between the average number of smartphone uses for medical purposes and the number of Smartphone usage during these 6 months (p &lt;0.001). In our study, the average number of uses during these 6months is statistically different depending on the professionals we judge that it is beneficial (p = &lt;0.01). The smartphone is a real tool in the practice of health professionals for optimal care of the patient. It would be interesting to develop formal assessment strategies and training in these medical applications for use with confidence in our context.

The intrinsic chaperone network of Arabidopsis stem cells confers protection against proteotoxic stress.

The biological purpose of plant stem cells is to maintain themselves while providing new pools of differentiated cells that form organs and rejuvenate or replace damaged tissues. Protein homeostasis or proteostasis is required for cell function and viability. However, the link between proteostasis and plant stem cell identity remains unknown. In contrast to their differentiated counterparts, we find that root stem cells can prevent the accumulation of aggregated proteins even under proteotoxic stress conditions such as heat stress or proteasome inhibition. Notably, root stem cells exhibit enhanced expression of distinct chaperones that maintain proteome integrity. Particularly, intrinsic high levels of the T‐complex protein‐1 ring complex/chaperonin containing TCP1 (TRiC/CCT) complex determine stem cell maintenance and their remarkable ability to suppress protein aggregation. Overexpression of CCT8, a key activator of TRiC/CCT assembly, is sufficient to ameliorate protein aggregation in differentiated cells and confer resistance to proteotoxic stress in plants. Taken together, our results indicate that enhanced proteostasis mechanisms in stem cells could be an important requirement for plants to persist under extreme environmental conditions and reach extreme long ages. Thus, proteostasis of stem cells can provide insights to design and breed plants tolerant to environmental challenges caused by the climate change.

Clinical features and outcomes of critically ill patients with Elizabethkingia meningoseptica: an emerging pathogen.

BackgroundElizabethkingia meningoseptica, formerly known as Chryseobacterium meningosepticum, is a non-motile, non-fastidious, catalase and oxidase-positive, aerobic, glucose-non-fermentative, Gram-negative bacillus that was first defined by Elizabeth O. King in 1959. It has emerged as an opportunistic pathogen that has infected patients in extreme age groups and immunocompromised individuals, especially in intensive care settings. There has been an increased interest in this pathogen due to its increasing occurrence around the world, ubiquitous nature, and inherent capacity for antimicrobial resistance.Methods We describe an observational study at a tertiary care center in Karachi, Pakistan, based on patients admitted between January 2013 and December 2018, with E. meningoseptica infections. All patients were confirmed to have a positive clinical culture specimen for E. meningoseptica along with symptoms and signs consistent with infection. Data were collected on a structured proforma from the Hospital Information Management Systems.Results Sixteen patients with E. meningoseptica that met the criteria for infection were identified, 13 of whom required admission. Eight patients had bacteremia in addition to confirmed E. meningoseptica infection. Two of the isolates were multi-drug resistant and only sensitive to minocycline. Nine out of 13 patients that were admitted required intubation and mechanical ventilation. The median length of hospital stay was 13 days, and five out of the 13 patients died during the hospital stay.ConclusionsThis is the largest case series to date reporting E. meningoseptica infections and highlights the importance of this organism as an emerging nosocomial pathogen.

Development of a Robot for In-service Radiography Inspection of Subsea Flexible Risers

The extreme operational environmental conditions and aging conditions of subsea structures pose a risk to their structural integrity and is critical to their safety. Nondestructive testing is essential to identify defects developing within the structure, allowing repair in a timely manner to mitigate against failures that cause damage to the environment and pose a hazard to human operators. However, to be cost effective, inspections must be carried out without taking the risers out of service. This poses significant safety risks if undertaken manually. This paper presents the development of an automated inspection system for flexible risers that are used to connect wellheads on the seafloor to the offshore production and storage facility. Due to the complex structure of risers, radiography is considered as the best technique to inspect multiple layers of the risers. However, radiography inspection, in turn, requires a robotic system for in-situ inspection with higher payload capacity, precise movement of source and detector which is able to withstand an extreme operational environment. The deployment of a radiography inspection system has been achieved by developing a customized subsea robotic system called RiserSure that can provide precise scanning motion of a gamma ray source and digital detector moving in alignment. The prototype has been tested on a flexible riser during shallow water sea trials with the system placed around a riser by a remotely operated vehicle. The results from the trials show that the internal inner and outer tensile armor layer and defects in the riser can be successfully imaged in real operational conditions.

Contributors

Contributors

Probabilistic forecasting of maximum human lifespan by 2100 using Bayesian population projections.

We consider the problem of quantifying the human lifespan using a statistical approach that probabilistically forecasts the maximum reported age at death (MRAD) through 2100. We seek to quantify the probability that any person attains various extreme ages, such as those above 120, by the year 2100. We use the exponential survival model for supercentenarians (people over age 110) of Rootzén and Zholud (2017) but extend the forecasting window, quantify population uncertainty using Bayesian population projections, and incorporate the most recent data from the International Database on Longevity (IDL) to obtain unconditional estimates of the distribution of MRAD this century in a fully Bayesian analysis. We find that the exponential survival model for supercentenarians is consistent with the most recent IDL data and that projections of the population aged 110-114 through 2080 are sensible. We integrate over the posterior distributions of the exponential model parameter and uncertainty in the supercentenarian population projections to estimate an unconditional distribution of MRAD by 2100. Based on the Bayesian analysis, there is a greater than 99% probability that the current MRAD of 122 will be broken by 2100. We estimate the probabilities that a person lives to at least age 126,128, or 130 this century, as 89%, 44%, and 13%, respectively. We have updated the supercentenarian survival model of Rootzén and Zholud using the most recent IDL data, incorporated Bayesian population projections, and extended the forecasting window to create the first fully Bayesian and unconditional probabilistic projection of MRAD by 2100.

Centenarians and extremely old people living with frailty can elicit durable SARS-CoV-2 spike specific IgG antibodies with virus neutralization functions following virus infection as determined by serological study.

BackgroundThe SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus 2) has led to more than 165 million COVID-19 cases and >3.4 million deaths worldwide. Epidemiological analysis has revealed that the risk of developing severe COVID-19 increases with age. Despite a disproportionate number of older individuals and long-term care facilities being affected by SARS-CoV-2 and COVID-19, very little is understood about the immune responses and development of humoral immunity in the extremely old person after SARS-CoV-2 infection. Here we conducted a serological study to investigate the development of humoral immunity in centenarians following a SARS-CoV-2 outbreak in a long-term care facility.MethodsExtreme aged individuals and centenarians who were residents in a long-term care facility and infected with or exposed to SARS-CoV-2 were investigated between April and June 2020 for the development of antibodies to SARS-CoV-2. Blood samples were collected from positive and bystander individuals 30 and 60 days after original diagnosis of SARS-CoV-2 infection. Plasma was used to quantify IgG, IgA, and IgM isotypes and subsequent subclasses of antibodies specific for SARS-CoV-2 spike protein. The function of anti-spike was then assessed by virus neutralization assays against the native SARS-CoV-2 virus.FindingsFifteen long-term care residents were investigated for SARS-CoV-2 infection. All individuals had a Clinical Frailty scale score ≥5 and were of extreme older age or were centenarians. Six women with a median age of 98.8 years tested positive for SARS-CoV-2. Anti-spike IgG antibody titers were the highest titers observed in our cohort with all IgG positive individuals having virus neutralization ability. Additionally, 5 out of the 6 positive participants had a robust IgA anti-SARS-CoV-2 response. In all 5, antibodies were detected after 60 days from initial diagnosis.

HUBUNGAN USIA DAN PARITAS TERHADAP KEJADIAN PRE EKLAMPSIA DI RSD BALUNG JEMBER

&#x0D; &#x0D; &#x0D; One of the contributors to maternal and infant mortality is the incidence of preeclampsia that occurs during pregnancy. The cause of preeclampsia is still unknown, but it is suspected that age and parity are one of the triggers for this occurrence. Women of childbearing age who are nulliparous with extreme age under the age of less than 20 years and women with the age of more than 35 years are most commonly found to have preeclampsia. The design in this study is analytic with a cross sectional approach. The population of all mothers giving birth in the delivery room of RSD Balung Jember was 3594 in 2019. The number of samples taken using non-random sampling by purposive sampling was finally obtained by 97 respondents. In this study, the independent variables were maternal age and parity, while the dependent variable was the incidence of preeclampsia. The instrument used is medical records. The data is processed by editing, coding, processing and cleaning processes. Data were analyzed using multiple logistic regression. The results of the chi-square test for the age variable obtained that the Pearson chi-square value was 0.019 and the p value = 0.000 &lt;0.05 from these results Ho was rejected, and the parity variable the Pearson chi- square value was 0.019 and the p value = 0.000 &lt;0.05 from these results Ho is rejected. In conclusion, there is a relationship between age and preeclampsia, and there is a relationship between parity and preeclampsia.&#x0D; &#x0D; &#x0D;

Circulating miR-19a-3p and miR-19b-3p characterize the human aging process and their isomiRs associate with healthy status at extreme ages.

Blood circulating microRNAs (c‐miRs) are potential biomarkers to trace aging and longevity trajectories to identify molecular targets for anti‐aging therapies. Based on a cross‐sectional study, a discovery phase was performed on 12 donors divided into four groups: young, old, healthy, and unhealthy centenarians. The identification of healthy and unhealthy phenotype was based on cognitive performance and capabilities to perform daily activities. Small RNA sequencing identified 79 differentially expressed c‐miRs when comparing young, old, healthy centenarians, and unhealthy centenarians. Two miRs, that is, miR‐19a‐3p and miR‐19b‐3p, were found increased at old age but decreased at extreme age, as confirmed by RT‐qPCR in 49 donors of validation phase. The significant decrease of those miR levels in healthy compared to unhealthy centenarians appears to be due to the presence of isomiRs, not detectable with RT‐qPCR, but only with a high‐resolution technique such as deep sequencing. Bioinformatically, three main common targets of miR‐19a/b‐3p were identified, that is, SMAD4, PTEN, and BCL2L11, converging into the FoxO signaling pathway, known to have a significant role in aging mechanisms. For the first time, this study shows the age‐related increase of plasma miR‐19a/b‐3p in old subjects but a decrease in centenarians. This decrease is more pronounced in healthy centenarians and was confirmed by the modified pattern of isomiRs comparing healthy and unhealthy centenarians. Thus, our study paves the way for functional studies using c‐miRs and isomiRs as additional parameter to track the onset of aging and age‐related diseases using new potential biomarkers.

Characteristics of people with severe hypertension in France and determinants of medication persistence after 6 years.

Low medication persistence is reported in patients with severe hypertension but few data are available according to drug classes. Adults without cardiovascular disease who started treatment, in a semester between 2010 and 2012, with two concurrent dispensings of at least three classes were identified in the French national health data system. High persistence after 12 semesters of follow-up was defined by a 6-monthly mean of number of drug classes equal to or greater than 80%. Five hundred and seventy-six thousand and forty-eight adults alive at 6 years were included (three classes: 79%, four classes: 18%, five or more classes: 4%) with a mean age of 65.3 years, constituting 42% of men. High persistence was observed for 72% of people and multivariate analysis of baseline factors found a negative association for: female sex, extreme ages, living in an overseas department, at least one comorbidity, absence or frequent general practitioner consultations and a cardiologist consultation. The adjusted odds ratio was low for dispensing of ACEIs (0.87; 95% CI: 0.8-0.95), other RAS antagonists (0.91; 95% CI: 0.83-0.99) and a high number of classes (4: 0.17; 95% CI: 0.15-0.19, five and more: 0.06; 95% CI: 0.05-0.08). An inverse association was observed for diuretics (1.45; 95% CI: 1.33-1.59), calcium channel blockers (1.63; 95% CI: 1.50-1.79), beta-blockers (1.92; 95% CI: 1.76-2.1) and other antihypertensive classes (1.6; 95% CI: 1.5-1.8). No significant association was observed for ARBs (1.0; 95% CI: 0.9-1.1). These results based on a large primary prevention population should encourage the implementation of new pharmacological and nonpharmacological management strategies for people with severe hypertension in France.

Menarche characteristics in association with total and cause-specific mortality: a prospective cohort study of Mexican teachers

We evaluated the relation between age at menarche and time to menstrual regularity with all-cause and cause specific mortality in a cohort of Mexican women. We followed 113,540 women from the Mexican Teachers' Cohort. After a mean follow-up time of 9.2 years, 1,355 deaths were identified. We estimated hazard ratios from Cox regression models for total mortality and a competitive risk models for cause-specific mortality adjusting for year of birth and childhood factors. Women with extreme age of menarche were at increased risk of all-cause mortality (HR [95% CI]: <11years 1.50 [1.20, 1.87]; 14years 1.19 [0.97, 1.43]) relative to those with menarche at 13 years. Extreme ages at menarchehad higher risk of mortality for diabetes (HR: <11years 1.66 [0.90, 3.05]; 14years 1.47 [0.90, 2.40]), breast cancer (HR: <11years 1.34 [0.56, 3.20]), and other cancer (HR:<11years 1.65 [1.10, 2.48]) compared to menarche at 13 years. Women who took three or more years to achieve menstrual regularity had a higher risk of all-cause mortality compared to those who took less (HR: 1.27 [1.01, 1.58]). Extreme ages at menarche and longer time to reach menstrual regularity were associated with an increased rate of all-cause and cause-specific mortality.