Increase In Life Expectancy Research Articles

Evidence-based recommendations for the rehabilitation and management of the ageing population with spinal cord injury: a systematic review of clinical practice guidelines.

The intersection of ageing and spinal cord injury (SCI) is of global concern. Two scenarios have been described: 1) "SCI with ageing," an increase in the average age of SCI onset, and 2) "ageing with SCI," an increase in post-injury life expectancy. These scenarios entail complex health care and rehabilitation needs due to the accumulation of comorbidities, ageing-related and SCI-induced physiological changes, and post-SCI secondary health conditions. We systematically reviewed Clinical Practice Guidelines (CPGs) with the objective of identifying the extent to which SCI CPGs include recommendations for the rehabilitation and management of people who are "ageing with SCI" or who have acquired an "SCI with ageing". We termed these as "ageing-related recommendations". We also aimed to describe them and identify gaps. We searched PubMed (NCBI), CINAHL Complete (EBSCOhost) and Embase (Elsevier) for relevant CPGs between 28 December 2022 and 5 January 2023. Included CPGs were evidence-based and had at least one ageing-related recommendation for SCI rehabilitation and management. We used the two core sets of the International Classification of Functioning, Disability and Health (ICF) to identify gaps. Only 16 (30%) of the 52 identified CPGs included ageing-related recommendations. Most were recent US or European publications and lacked specific chapters on ageing. These CPGs included 40 ageing-related recommendations, mostly "strong" but based on "low" to "very low" quality of evidence. The overall quality of the development process was low and did not consider the values and preferences of stakeholders and patients. Common topics included cardiovascular, bone, metabolic, bowel, bladder, and skin health. The recommendations could be linked to 30 ICF categories which represented only 18% of the ICF categories included in the comprehensive versions of two ICF Core Sets. Key gaps were found in mobility, interpersonal interactions, and relationships, neuromusculoskeletal and movement-related, mental, sensory and pain functions. There is a notable lack of high-quality ageing-related recommendations for SCI management and rehabilitation. Future research should prioritize the generation of high-quality evidence to develop age-sensitive CPGs. Future SCI CPGs need to address the complex challenges at the interface of ageing and SCI, considering patient and stakeholder preferences.

Exploring strategies for building a sustainable healthcare system in Africa: lessons from Japan and Switzerland.

Strengthening healthcare infrastructure is an important strategy for building a sustainable healthcare system in Africa. This involves investing in facilities, equipment, and supplies, as well as training and retaining skilled healthcare workers. Additionally, improving healthcare infrastructure and investing in healthcare education and training can lead to significant improvements in health outcomes, such as reducing maternal and child mortality. This is critical for building a sustainable healthcare system. Through a literature review, we assessed the approaches to building a sustainable healthcare system in Africa from the perspectives of Japan's and Switzerland's healthcare systems. It was discovered that Japan currently has the highest life expectancy, which can be attributed to insurance policies, healthcare policies, and the integration of emerging technologies and clinical research into their healthcare system. Lessons that Africa must emulate from the Japanese healthcare system include ensuring universal healthcare coverage, improving the workforce, improving primary healthcare, prioritizing the aging population, and investing in technology, infrastructure, and research. Japans healthcare system is also sustainable thanks to its stable workforce and primary healthcare. Switzerland also has an exceptional healthcare system globally, with technical and socioeconomic advancements leading to increased life expectancy and population aging through a worldwide health policy approach, programs tackling professional responsibilities and interprofessional cooperation, and initiatives to support family medicine. By learning from Japan's and Switzerland's approaches, Africa will gradually achieve the Sustainable Development Goals and build a sustainable healthcare system.

Maximizing longevity: erythropoietin's impact on sickle cell anaemia survival rates.

Sickle cell anaemia (SCA) stands as a hereditary blood disorder characterized by mutated haemoglobin, causing red blood cells to adopt a sickle shape, leading to complications like vaso-occlusive crises, anaemia, and organ damage. Despite advancements in treatment, managing SCA remains challenging, with limited options to increase life expectancy and improve quality of life for affected individuals. This paper reviews the potential impact of erythropoietin (EPO) therapy in enhancing life expectancy and ameliorating complications in individuals with SCA. EPO, primarily recognized for its role in stimulating red blood cell production, holds promise in mitigating anaemia, reducing transfusion dependence, and possibly diminishing the frequency and severity of vaso-occlusive crises in SCA patients. Moreover, by stimulating red blood cell production, EPO therapy might alleviate the vaso-occlusive process, thus reducing the frequency of painful crises and associated complications. Additionally, considering the potential side effects and the need for continuous monitoring, the use of EPO in SCA treatment requires cautious consideration. The potential of EPO therapy in SCA offers a glimpse into novel strategies aimed at improving the quality of life and extending the life expectancy of affected individuals. In conclusion, while the application of EPO in SCA treatment holds promise, additional research is indispensable to comprehend its precise role, optimize dosing strategies, and ensure safety, thereby paving the way for enhanced life expectancy and improved outcomes for individuals living with SCA.

The top 100 most cited articles on intramedullary nail fixation from 2018-2022: a bibliometric and visualized analysis.

Intramedullary nails are commonly used for the purposes of internal fixation in the repair of tubular bone fractures, allowing for optimal fixation while minimizing intraoperative bleeding, surgical incision size, and associated stress. These nails are thus often utilized to repair hip and peripheral fractures, femur fractures, tibial fractures, humerus fractures, and clavicle fractures. Recent life expectancy increases, rising economic standards, and technological innovations have led to the application of a wider range of materials and techniques in the context of orthopedic device production, further expanding the clinical indications for intramedullary nailing. Despite the growing importance of this technique, there is currently a lack of any bibliometric or visual analyses that provide a robust overview of recent progress in the intramedullary nailing research space. Accordingly, this study was developed to succinctly and comprehensively summarize the current research status and major hotspots in this field through a bibliometric review of major relevant scientific articles focused on intramedullary nailing published in recent years. For this analysis, the top 100 most-cited articles focused on intramedullary nails published between 2018 and 2022 were identified through a search of the Web of Science Core Collection database. Countries, institutions, journals, and other specific parameters associated with these articles were then analyzed using tools including CiteSpace, VOS-viewer, Origin, and SCImago Graphica in an effort to more clearly define the latest trends in the intramedullary nail-related research space. The top 3 most-cited articles related to intramedullary nailing over the past five years were "Antibacterial and immunogenic behavior of silver coatings on additively manufactured porous titanium", "Diaphyseal long bone nonunions - types, etiology, economics, and treatment recommendations", and "Epidemiology, treatment, and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register", all of which were published in 2018, respectively exhibiting 93, 83, and 81 citations. Of the 100 most-cited intramedullary nailing-related articles, 38, 20, and 12 were respectively published by researchers from the USA, China, and the UK, while research groups from Italy and Spain each published 7 articles. Four of this field's most highly cited articles were published by individuals affiliated with the US-based University of California System and the University System of Ohio. Of the 15 journals that published the largest number of these top 100 articles, the "Injury International Journal of The Care of The Injured" and the "Journal of Orthopaedic Trauma" published 9 manuscripts each, which was more than any other journal, while the "Journal of Orthopaedic Surgery" and the "Journal of Pediatric Orthopaedics" published 7 each. In total, 73 highly cited articles focused on utilizing intramedullary nailing in orthopedic applications. Rozbruch SR from the USA published 3 high-quality articles in this research space, while the Chinese researchers Chang Shi Min, Du Shou Chao, Hou Zhi Yong, and Hu Sun Jun exhibited a total linkage strength of 21 in global interaction analyses. The most common keywords associated with intramedullary nail-related research identified in these analyses included "Hip fracture", "Nonunion", "Limb lengthening", "Proximal humeral fractures", "Additive manufacturing", "Induced membrane", and "Endoprosthetic replacement". Promising areas of potential future research focus may include "Limb reconstruction", "Pediatric deformity", and "Congenital femoral deficiency". This analysis revealed that the highest volume of high-impact research output focused on intramedullary nailing over the past 5 years has been produced by the USA, followed by China and the UK. The most influential journals in this research space were Injury International Journal of The Care of The Injured and the Journal of Orthopaedic Trauma, while the institutions associated with the most highly cited articles were the University of California System and the University System of Ohio. Intramedullary nailing is commonly utilized to treat intertrochanteric fractures and other tubular bone fractures. In the future, the application of augmented and virtual reality technologies may help shorten the learning curve for orthopedic surgeons and trauma surgeons who are learning intramedullary nailing-related techniques, and the combination of intramedullary nailing with antibacterial drugs, metal alloys, 3D navigation, and sensor devices may help improve patient outcomes.

Progression analysis versus traditional methods to quantify slowing of disease progression in Alzheimer’s disease

BackgroundThe clinical meaningfulness of the effects of recently approved disease-modifying treatments (DMT) in Alzheimer’s disease is under debate. Available evidence is limited to short-term effects on clinical rating scales which may be difficult to interpret and have limited intrinsic meaning to patients. The main value of DMTs accrues over the long term as they are expected to cause a delay or slowing of disease progression. While awaiting such evidence, the translation of short-term effects to time delays or slowing of progression could offer a powerful and readily interpretable representation of clinical outcomes.MethodsWe simulated disease progression trajectories representing two arms, active and placebo, of a hypothetical clinical trial of a DMT. The placebo arm was simulated based on estimated mean trajectories of clinical dementia rating scale–sum of boxes (CDR-SB) recordings from amyloid-positive subjects with mild cognitive impairment (MCI) from Alzheimer’s Disease Neuroimaging Initiative (ADNI). The active arm was simulated to show an average slowing of disease progression versus placebo of 20% at each visit. The treatment effects in the simulated trials were estimated with a progression model for repeated measures (PMRM) and a mixed model for repeated measures (MMRM) for comparison. For PMRM, the treatment effect is expressed in units of time (e.g., days) and for MMRM in units of the outcome (e.g., CDR-SB points). PMRM results were implemented in a health economics Markov model extrapolating disease progression and death over 15 years.ResultsThe PMRM model estimated a 19% delay in disease progression at 18 months and 20% (~ 7 months delay) at 36 months, while the MMRM model estimated a 25% reduction in CDR-SB (~ 0.5 points) at 36 months. The PMRM model had slightly greater power compared to MMRM. The health economic model based on the estimated time delay suggested an increase in life expectancy (10 months) without extending time in severe stages of disease.ConclusionPMRM methods can be used to estimate treatment effects in terms of slowing of progression which translates to time metrics that can be readily interpreted and appreciated as meaningful outcomes for patients, care partners, and health care practitioners.

Cemented vs. Cementless Fixation in Primary Knee Replacement: A Narrative Review.

Knee osteoarthritis (OA) is one of the leading causes of disability around the globe. Osteoarthritis is mainly considered a disease affecting the elderly. However, more and more studies show that sports overuse, obesity, or congenital disorders can initiate a pathologic cascade that leads to OA changes in the younger population. Nevertheless, OA mostly affects the elderly, and with increasing life expectancy, the disease will develop in more and more individuals. To date, the golden standard in the treatment of the end-stage of the disease is total joint replacement (TJR), which restores painless knee motion and function. One of the weakest elements in TJR is its bonding with the bone, which can be achieved by bonding material, such as poly methyl-methacrylate (PMMA), or by cementless fixation supported by bone ingrowth onto the endoprosthesis surface. Each technique has its advantages; however, the most important factor is the revision rate and survivor time. In the past, numerous articles were published regarding TJR revision rate, but no consensus has been established yet. In this review, we focused on a comparison of cemented and cementless total knee replacement surgeries. We introduced PICO rules, including population, intervention, comparison and outcomes of TJR in a PubMed search. We identified 783 articles published between 2010 and 2023, out of which we included 14 in our review. Our review reveals that there is no universally prescribed approach to fixate knee prostheses. The determination of the most suitable method necessitates an individualized decision-making process involving the active participation and informed consent of each patient.

Patterns and Changes in Life Expectancy in Korea, 1990-2020

Objectives: The purpose of this study is to measure the contribution of life expectancy to changes in mortality due to age, sign in Korea.Methods: This study used the life table data (1990-2020) and analyzed the data of the death statistics of the National Statistical Office in 1990 and 2020 (Categorization data by ICD-10). The contribution of differen ages, and causes of death to the change in life expectancy at birth during the 1900-2020 was estimated with a decomposition technique developed by Arriaga.Results: The contribution to the average life span of 1990-2007 was 7.50 years, and 2.91 years between 2007-2015. From 1990 to 2007, the positive contributing causes of death were cerebrovascular disease (0.781 years), hypertensive disease (0.599 years), and heart disease (0.475 years), and the negative contributing causes were intentional self-harm (-0.304 years), pneumonia (-0.209 years), and colon cancer (-0.092 years). From 2007 to 2015, the positive contributing causes were malignant neoplasms (0.548 years), cerebrovascular disease (0.529 years), and diabetes (0.162 years), and the negative contributing causes were pneumonia (-0.198 years), Alzheimer’s (-0.060 years), sepsis (-0.038 years), etc. From 2015 to 2020, the positive contributing causes of death were malignant neoplasms (0.474 years), cerebrovascular disease (0.301 years), and heart disease (0.475 years), and the negative contributing causes were intentional self-harm (-0.304 years), pneumonia (-0.209 years), and colon cancer (-0.092 years). In general, pneumonia was shown to be the cause of death with the largest negative contribution due to increased mortality, and the pattern by age group showed that the positive contribution was relatively large in the age group after 65 years of age. In common, the positive contribution of most causes decreased as time passed.Conclusions: The age group that contributed the most to the increase in life expectancy after 1990 was found to be 70-74 years old (0.74 years) from 1990-2007. In addition, it was found to have contributed significantly to those aged 70-74 (0.42 years) from 2007-2015 and those aged 75-79 (0.27 years) from 2015-2020. In the overall period, the contribution to average life expectancy appears to be large in the age group of 65 years or older, and in recent years, the contribution to average life expectancy from age 0 gradually decreases, while the contribution to average life expectancy in the middle-aged and older age group increases. This study evaluated the increase in life expectancy by age and cause of death by applying join point regression analysis, which can partially complement the limitations of existing models, to evaluate and analyze the amount of life expectancy according to changes in mortality level.

Prevalence of sexual complaints in subjects aged 20 to 40 consulting at the central hospital of Yaoundé

Background: Male sexual dysfunction is a problem that is becoming more common with the increase in life expectancy. Few data are available in sub-Saharan Africa, and in Cameroon, no study has been documented. The objective was to determine the prevalence of sexual complaints among subjects aged 20 to 40 consulting the Urology Service at the Central Hospital of Yaoundé. Methods: We conducted a descriptive cross-sectional study at the Central Hospital of Yaoundé over a 4-month period from January 1 to April 30, 2019. Men aged 20 to 40, sexually active, and freely consenting to participate were included in our study (66 had sexual complaints and 39 had other complaints). Results :105 patients were included in the study, with 66 reporting sexual complaints and 39 presenting other complaints. The average age of our study population was 31.7 years. Alcohol was found in 60.6% of cases, followed by tobacco at 30.3% for toxicological history. 78.7% of patients were overweight. Digital rectal examination was mostly normal; however, hemorrhoids were the most common finding at 14.2%. Decreased libido was very common in our study population, with a proportion of 41%, followed by erectile dysfunction at 37.1%. 66.3% of patients had a normal ejaculation time of 1 to 20 minutes. 21.2% of patients had premature ejaculation. 80.3% of patients had a Perceived Stress Scale (PSS) score higher than 27. 9.2% of patients had severe erectile dysfunction according to the IIEF5 score. 3.8% of patients had low testosterone levels. 62.2% of patients had never talked to anyone in their circle about sexual problems. 68.1% of patients resorted to self-medication, while 18.1% turned to traditional medicine. Conclusion: Despite the increasing frequency of sexual disorders worldwide, the subject remains taboo in our context, leading to underdiagnosis and undertreatment.

Nutritional supplementation of an apple callus extract to target epidermal aging

The global increase in life expectancy has led to a growing elderly population, which places a significant burden on healthcare systems. As a result, there is a growing interest to improve healthspan and promote healthy aging with accessible means, such as nutrition and lifestyle interventions. The skin, the body's largest organ and first line of defense against environmental stressors, is particularly vulnerable to aging due to both intrinsic and extrinsic factors. Various molecular and biochemical changes can drive skin aging, including the depletion of stem cells, which can lead to impaired skin properties. Nutrition plays a crucial role in skin aging, and dietary supplements could be a viable intervention to support a healthy skin. In this study, a plant callus extract from a specific apple variety (Malus Domestica Borkh), the Uttwiler Spätlauber, was evaluated as a dietary supplement to combat epidermal aging. The extract was found to maintain the function of keratinocyte progenitor cells during aging in vitro. Furthermore, an open-label pilot clinical study involving 31 female volunteers showed that the intake of apple callus extract led to improvements in skin elasticity, density, and firmness after 56 days of supplementation. This study highlights the potential of plant callus extracts as natural dietary supplements to support healthy skin aging. The use of plant callus cultures provides a sustainable and reproducible source of bioactive molecules, which is gaining acceptance in the nutraceutical market. These findings suggest that dietary interventions can play a role in promoting healthy skin aging and contribute to a holistic approach to improving healthspan during the aging process.

Prevention of dementia

With increasing life expectancy, the prevalence of dementia is increasing worldwide. Dementia is among the greatest challenges for healthcare and social systems of the future. Approximately 40% of newly diagnosed cases of dementia are associated with risk factors that can potentially be influenced by preventive measures. Based on the evidence from longitudinal studies, systematic reviews and meta-analyses, the Lancet commission on dementia prevention, intervention and care has defined 12risk factors that are associated with an increased risk for dementia: low level of education, hearing impairment, traumatic brain injury, arterial hypertension, diabetes mellitus, smoking, excessive alcohol consumption, depression, obesity, social isolation, and air pollution.

A systematic review and meta-analysis of serum lipid concentrations in people with Down syndrome.

Down syndrome (DS) is the most prevalent chromosomal disorder, being the leading cause of intellectual disability. The increased life expectancy of individuals with DS has led to a shift in the incidence of non-communicable chronic diseases, resulting in new concerns, particularly cardiovascular disease (CVD) and Alzheimer's disease. This study aimed to analyse the blood lipid profile of a large DS cohort to establish a baseline for evaluating health risk parameters. A comprehensive literature search was conducted on PubMed and Virtual Health Library databases to identify original articles published before July 2022. Selected studies were included in the meta-analysis. Fifteen studies reporting serum lipid levels in individuals with DS were incorporated into the analysis. The meta-analysis used the means and standard deviations extracted from the selected studies. The analysis encompassed 671 participants in the DS group and 898 euploid controls. The results indicated significant differences in total cholesterol [C] (mean difference [MD]: -3.34; CI: 95%: -4.94 to -1.73; P<0.0001), HDL-C (MD: -3.39; CI: 95%: -6.72 to -0.06; P=0.05) and triglycerides (MD: 21.48; CI: 95%: 9.32 to 33.65; P=0.0005) levels between individuals with DS and their control counterparts. Individuals with DS have less favourable blood lipid concentrations than their controls, particularly HDL-C, triglycerides, and total-C, even when grouped by age. These findings underscore the importance of closer monitoring of lipid profiles in people with DS and the necessity for specific cut-offs for this population, considering the risk for ischemic heart and Alzheimer's diseases.

Role of mitochondrial potassium channels in ageing

Ageing is described as an inevitable decline in body functions over time and an increase in susceptibility to age-related diseases. Therefore, the increase of life expectancy is also viewed as a condition in which many elderly will develop age-related diseases and disabilities, such as cardiovascular, metabolic, neurological and oncological ones. Currently, several recognized cellular hallmarks of senescence are taken in consideration to evaluate the level of biological ageing and are the topic to plan preventive/curative anti-ageing interventions, including genomic instability, epigenetic alterations, and mitochondrial dysfunction. In this scenario, alterations in the function/expression of mitochondrial ion channels have been found in ageing and associated to an impairment of calcium cycling and a reduced mitochondrial membrane potential. Although several ion channels have been described at mitochondrial level, undoubtedly the mitochondrial potassium (mitoK) channels are the most investigated. Therefore, this review summarized the evidence that sheds to light a correlation between age-related diseases and alteration of mitoK channels, focusing the attention of the main age-related diseases, i.e. cardiovascular, neurological and oncological ones.

Age-Inclusive Healthcare Sustainability: Romania’s Regulatory and Initiatives Landscape in the European Union Context

Sustainable healthcare is “healthcare that is economical and has a positive impact on society”. Considering the definition of sustainable healthcare and the increase in life expectancy, the healthcare system is expected to face an increase in presentations addressed to healthcare facilities of older persons with multiple chronic diseases. Age-friendly environments support active living of older persons and healthcare support in their home. Our goal was to assess how the regulatory landscape undertaken in Romania and the ongoing research project initiatives with Romanian partners reflect the concept of age-friendly environments. Romania had a poor overall active aging index (rank 26/28) and a decrease in life expectancy by 1.4 years in 2020, with a high gender gap of 8 years in favor of women. Key findings highlight the integration of EU principles into Romania’s policies, which emphasize inclusivity, non-discrimination, and active aging. Romania’s involvement in European collaborative initiatives is primarily through private associations, lacking representation from governmental structures. National focus in Romania has been on social services for the elderly. The partners in ongoing research projects range from enterprises to universities and research institutes. The majority of ongoing research focuses on assistive technology solutions. The findings underscore the importance of national, regional, and local attention to the environmental and societal aspects of age-friendly initiatives, alongside promoting technology acceptance and adoption.

Reducing Barriers and Strategies to Improve Appropriate Screening Mammogram Attendance in Women 75 Years and Older.

Although breast cancer death rates have persistently declined over the last 3 decades, older women have not experienced the same degree in mortality reduction as younger women despite having more favorable breast cancer phenotypes. This occurrence can be partially attributed to less robust mammographic screening in older women, the propensity to undertreat with advancing age, and the presence of underlying comorbidities. With recent revisions to breast cancer screening guidelines, there has been a constructive shift toward more agreement in the need for routine mammographic screening to commence at age 40. Unfortunately, this shift in agreement has not occurred for cutoff guidelines, wherein the recommendations are blurred and open to interpretation. With increasing life expectancy and an aging population who is healthier now than any other time in history, it is important to revisit mammographic screening with advanced age and understand why older women who should undergo screening are not being screened as well as offer suggestions on how to improve screening mammogram attendance in this population.

Morphological differences in the isthmus and funnel of the fallopian tubes of women in young and old age

BACKGROUND: Scientific interest in age-related changes of the female organism is invariably increasing, which is caused, first of all, by the increase in life expectancy of modern man.&#x0D; AIM: Identification of patterns of age-related morphological changes in the isthmus and funnel of fallopian tubes of women giving birth in old age versus young age using sectional material.&#x0D; MATERIALS AND METHODS: The study was performed on the sectional material of 70 women who had given birth and were divided into two groups: group 1 included 34 women of young age (22–35 years) and group 2 consisted of 36 elderly women (75–88 years). The external diameter of the isthmus and funnel of the fallopian tubes was determined. For histological examination, fallopian tubes fragments taken at autopsy were stained with Van Gieson picrofuchsin and hematoxylin and eosin.&#x0D; RESULTS: There was a decrease in the external diameter of the isthmus and funnel of both fallopian tubes in women from young age to old age (p 0.01). At old age, there was a predominance of external diameter parameters of the isthmus and funnel of the right fallopian tube in comparison with those of the left fallopian tube (p 0.01), while at young age there was only a tendency for the diameter of the isthmus and funnel of the right fallopian tube to predominate (p 0.05). The histological study showed the presence of thickened folds of the mucous membrane and flattened epithelium in the studied areas in older women, thinning of the muscular membrane layers and overgrowth of connective tissue in comparison with the samples taken for the study in younger women.&#x0D; CONCLUSIONS: Morphologic restructuring of the isthmus and funnel of the fallopian tubes from young to old age consists in thickening of the mucous membrane folds, flattening of the epithelium, overgrowth of connective tissue in the wall and reduction of their outer diameter with predominant parameters in the right fallopian tube.

Methodological Approaches to Assessing the Quality of Life of Older People in Russia

The paper presents the core findings of a study on improving methodological approaches to adequate assessment of dynamics of the quality of life of older people in Russia. The author has identified challenges in implementing some international recommendations on the topic thereon. These challenges resulted from differences in the socio-economic development of the Russian Federation and its ethnocultural traditions. The article defines domestic information and statistical base for studying the quality of life of the population, in particular, the older population.The author describes a system of basic indicators that includes key measures of health status of older people, their financial security and economic activity. Based on the proposed approach and official statistics, the situation with the older generation in Russia in 2010–2020 is analyzed. An assessment is made of the significance of both positive trends in improving the quality of life in the older generation (increased life expectancy, improved health, increased economic activity of the population aged 60 years and older), as well as unresolved problems, primarily, relatively low level of pensions compared to the subsistence level and high degree of interregional differentiation of pensions.The paper concludes with proposals concerning directions and sequence of organizational and financial measures aimed at improving the quality of life of pensioners, proposed by the author, based on specific results of statistical analysis. Among the top priorities are: indexation of pensions for non-working pensioners ahead of the inflation rate, indexation of pensions for working pensioners at 1/2 of the inflation rate, registration and, if necessary, organization of medical and social services for older citizens living alone.

Utilization and reimbursement of diagnostic cerebral angiograms: A Medicare trends analysis from 2013 to 2020.

Increasing life expectancy has caused growing concern about maintaining viable neurointerventional practices due to altered Medicare payment structures. This study analyzes the financial trends of three common diagnostic tests for cerebrovascular disease: cerebral digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). Medicare Part B National Summary Data files from 2013 to 2020 were queried by Current Procedural Terminology (CPT) codes for DSA (36221-36228), CTA (70496, 70498), and MRA (70544-70547, 70549). Inflation-adjusted charges and reimbursement were calculated using the U.S. City Average Consumer Price Index for Medical Services. Regression analysis was performed on charges, reimbursement, and volume. A total of 1,519,245 diagnostic procedures were conducted between 2013 and 2020 (782,370 angiograms, 246,603 CTAs, and 490,272 MRAs). A total of $41.005 million was reimbursed by Medicare in 2020 for these diagnostic procedures. The annual percent change in volume for all procedures was -2.90%. From 2013 to 2020, inflation-adjusted: Medicare total physician reimbursement decreased for cerebral angiograms (-4.12%, p = 0.007), CTAs (-2.77%, p = 0.458), and MRAs (-9.06%, p < 0.001). Procedural volume billed to Medicare decreased for cerebral angiograms (-4.63%, p = 0.007) and MRAs (-2.94%, p = 0.0.81) and increased for CTAs (+3.15%, p = 0.004). The greatest increase in Medicare reimbursement (+66.75%) came from CPT code 36224, "place catheter carotid artery", and the greatest decrease in Medicare reimbursement (-8.66%) came from CPT code 36226, "place catheter vertebral artery." This study provides an analysis of Medicare reimbursement trends for routine cerebrovascular angiogram techniques. The findings highlight a decline in Medicare reimbursements for neurointerventionalists.

Aging people with intellectual disabilities in need of care: challenges, strategies, and consequences for special housing in Germany

Objective While the increasing life expectancy of people with intellectual disabilities is a positive development, it also means that special housing for people with intellectual disabilities has to adapt to meet age-related needs. Method This qualitative study analyzes the decision-making processes of staff in special housing facilities for people with intellectual disabilities in Germany regarding care and housing options as these people age and their care needs increase. Results Drawing on 18 interviews with staff, the study describes the challenges that arise as age-related decline increases and behavioral changes manifest, leading to what we call ‘care boundary’. Using a Grounded Theory approach, the study constructs a theoretical framework of the dynamics between challenges, care boundaries, action strategies, and consequences, especially with regard to the decision of people remaining in special housing or having to move to a nursing home. The study underscores the critical role of staff in navigating these challenges and outlines two primary action strategies: ‘compensating’ adaptations within the existing care context and ‘cooperating’ entailing strategic collaboration with external care providers. Conclusion These insights have implications for the future design of care and support systems for aging individuals with intellectual disabilities in special housing settings and beyond.

Classification of brain tumors based on magnetic resonance imaging (MRI) using deep learning models

Nowadays, With the advancements in medical care and the improvement in global living standards, there has been a continuous increase in the average life expectancy of people around the world, and the aging problem is constantly aggravated, brain tumors have become a growing global health problem. The project aims to use deep learning models to classify magnetic resonance imaging (MRI) images of brain tumors. By constructing convolutional neural network model, image feature extraction and classification are carried out. Data preprocessing, data enhancement, Adaptive Moment Estimation (Adam) are used to improve the model performance, plot the accuracy curve and generate the confusion matrix, and visualize the classification performance of the model. Possible future tasks may include optimizing the model architecture and expanding the exploration of data augmentation techniques to bolster the model's performance, while also further investigating the model's interpretability to understand the internal mechanisms of the model when making predictions. In addition, the project has great application potential, and the model can be applied to the actual clinical assisted diagnosis system, which has good scalability and application prospect. By using deep learning model and related technologies, the accuracy of brain tumor classification can be improved in clinical diagnosis, and better diagnosis and treatment services can be provided for the majority of brain tumor patients.

ASSOCIATION BETWEEN MEDICATION USE AND BULLOUS PEMPHIGOID: A TEN-YEAR SYSTEMATIC REVIEW

Background: Bullous pemphigoid is an autoimmune subepithelial disease. It was associated with autoantibodies targeting hemidesmosome protein BPAG1 and BPAG2. The incidence of bullous pemphigoid has increased 1.9-4.3 times in the past two decades, possibly due to increased life expectancy, medication use, and improved diagnostic methods. Trigger factors of BP included drugs, physical factors, radiotherapy, trauma, and thermal exposure. The aim: This study aims to determine association between medication use and bullous pemphigoid. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed and ScienceDirect, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Results: In the PubMed database, the results of our search brought up 1,662 articles, whereas the results of our search on ScienceDirect brought up 1,143 articles. The results of the search conducted by title screening yielded a total of 13 articles for PubMed and 32 articles for ScienceDirect. We compiled a total of 26 papers, 8 of which came from PubMed and 18 of which came from ScienceDirect. We excluded 2 review articles, 1 duplicate article, 3 non-full text articles, and 3 articles having insufficient outcomes. In the end, we included seventeen research that met the criteria. Conclusion: Our study suggests that dipeptidyl peptidase-4 inhibitors and aldosterone antagonists are associated with BP. Other medications, such as immunomodulatory agents, anticonvulsants, tyrosine kinase inhibitors, antibiotics, anticoagulants, diuretics, and mRNA COVID-19 vaccine, may be associated with BP. Regarding these results, clinicians should pay close attention to prescribing the medicine to their patients.