Middle-aged Ones Research Articles

The influence of social support on sleep and fatigue level among patients receiving hemodialysis in Saudi Arabia: a cross-sectional correlational design.

Patients on hemodialysis (HD) are more likely to experience sleep problems and fatigue that may affect their health outcomes. Management of these patients with social support may improve their sleep quality and fatigue as well as their health. This study aimed to assess the influence of social support on sleep quality and fatigue levels among HD patients. A cross-correlational study was conducted among 260 conveniently sampled HD patients from four dialysis centers in Hail and Al-Qassim cities of Saudi Arabia from Jun 2022 to January 2023. Besides sociodemographic data, the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Assessment of Fatigue (MAF) and the Oslo Social Support Scale (OSSS-3) were used to assess sleep quality, fatigue levels and social support, respectively. Chi-square test was used to determine the association between categorical variables, while Pearson's correlation coefficient was used to test the correlation between sleep quality, fatigue, and social support. Poor sleep and high fatigue were significantly higher in older patients compared to younger patients (p <0.001), while strong social support was significantly lower in older patients than younger and middle-aged ones (p = 0.001). On the other hand, poor sleep and high fatigue were significantly higher in males than females (p = 0.022 and p <0.001, respectively), while strong social support was significantly higher in females than males (p <0.001). Married patients showed significantly poorer sleep than single ones (p = 0.019), but single patients received significantly stronger social support. Retired patients showed significantly poorer sleep, higher fatigue and weaker social support than other groups (p <0.001). There was a significant negative correlation between fatigue and sleep quality among HD patients, where patients with more fatigue had poorer sleep (r = -0.510, p <0.001). A significant positive correlation was found between social support and sleep quality, where patients with stronger social support had more normal sleep (r = 0.415, p <0.001). However, a significant negative correlation was found between social support and fatigue, where patients with stronger social support had lower levels of fatigue (r = -0.479, p <0.001). Saudi patients on HD who have stronger social support have better sleep quality and reduced fatigue levels than those with less social support. There is a need to design and implement intervention studies with structured social support programs, and to evaluate their effectiveness on improving sleep and reducing fatigue among HD patients.

New insight into the management of psychoemotional risk factors in patients with cardiovascular diseases in middle and young age

Affective spectrum disorders, such as depression and anxiety disorders, are important psychoemotional risk factors for the development and complicated course of many common chronic non-communicable diseases, including cardiovascular ones: arterial hypertension, coronary heart disease, chronic heart failure, atrial fibrillation, acute coronary syndrome, etc. A feature of this comorbidity is the significant impact of psychoemotional factors on the motivation and adherence of patients to a healthy lifestyle, as well as various drug treatment options, which involves an increased risk of complications and, as a consequence, increased healthcare costs. The topicality of the issues of screening and management of psychoemotional disorders in the internist practice arises from a variety of reasons. On the one hand, it is a high incidence of these disorders in patients with cardiovascular diseases, including young and middle-aged ones, which is associated with a deterioration in the quality of life and an increased risk of complications and adverse outcomes in the future. On the other hand, it is caused by insufficient level of awareness among doctors about new possibilities for the management of the psychoemotional state of such patients. This review presents data on the effectiveness and safety of therapy of psychoemotional disorders in patients with various CVDs with a drug containing D,L-hopanthenic acid (rat-hopanthenic acid) as an active substance of the nootranquilizer class, which has a wide range of clinical effects, including a beneficial effect not only on psychoemotional sphere, but also on cognitive functions. The prospects for prescribing a D,L-hopantenic acid drug to young and middle-aged patients with CVD, which reduces the drug burden on the patient and provides high quality of life for patients both in hospital and at subsequent stages of treatment, are discussed. The key point is availability of an option for prolonged use of D,L-hopanthenic acid drug without any risk of addiction, withdrawal syndrome or hyperstimulation, which is an important clinical aspect of drug therapy for patients with CVD, especially in young and middle age.

Age-specific effects of density and weather on body condition and birth rates in a large herbivore, the Przewalski’s horse

Reproduction in young females can show a particularly sensitive response to environmental challenges, although empirical support from individual-based long-term studies is scarce. Based on a 20-year data set from a free-roaming Przewalski’s horse population (Equus ferus przewalskii), we studied effects of large-herbivore density (horses + cattle) and weather conditions experienced during different life stages on females’ annual birth rates. Foaling probability was very low in 2-year-olds, reaching maximum values in 5 to 10-year-olds, followed by a decrease in older females indicating reproductive senescence. Mother’s previous reproductive investment affected her current reproduction; young and old mothers (as opposed to middle-aged ones), which had nursed a foal for at least 60 days during the previous year, reproduced with a lower probability. Foaling probability and body condition of young females were lower when large-herbivore density was high. Reproduction was also influenced by interactive weather effects during different life stages. Low late-summer precipitation during the females’ year of birth was associated with a pronounced decrease in foaling probability in response to harsh late-winter temperatures prior to the mating season. In turn, increased amounts of late-summer rain during this early age together with more late-summer rain during the females’ current pregnancy led to an increased reproductive probability in 2–3-year-olds. These results were corroborated by the ameliorating effects of late-summer rain on body condition in such females. In conclusion, our findings highlight the interactive importance of weather conditions experienced during early life, and of density and weather during current pregnancy on foaling probability, particularly in young females.

The CSIESA: A Novel Score for the Assessment of Intrinsic and Extrinsic Skin Aging Based on Reflectance Confocal Microscopy Imaging.

Skin aging is an intricate physiological process governed by intrinsic and extrinsic factors. Increasing life expectancy has turned skin aging into a growing concern for the general population. Clinical examination of the skin does not fully describe the skin aging process. This study aims to evaluate the healthy skin of five different age groups in order to develop an easy-to-use confocal score for quantifying signs of skin aging and test the correlation between this new score and the already described clinical score, SCINEXA (score of intrinsic and extrinsic skin aging). Thirty-five subjects split into five age groups: &lt;35; 36-45; 46-55; 56-65, and &gt;65 years old were enrolled. Clinical signs were quantified using the SCINEXA score, and known confocal variables of skin aging were evaluated. Three different semi-quantitative scores were calculated: epidermal disarrangement score (EDS), epidermal hyperplasia score (EHS), and dermal score (DS). The EDS showed a stable trend up to the age of 65 and a dramatic increase in older subjects. EHS was characterized by an ascending trend from younger subjects to middle-aged ones. The DS was progressive with age, with a different proportion of distinct collagen types. The confocal CSIESA (confocal score for the assessment of intrinsic and extrinsic skin aging) score correlated well with the SCINEXA score. Reflectance confocal microscopy is a powerful, non-invasive technique for microscopically quantifying aging signs.

The Comparison of Physical Activity, Cognitive Function, and Depression between Older and Middle-Aged Adults

Background: Aging increased the risks of cognitive impairment and depression. Then, these conditions can lead to poor quality of life by reducing one’s ability to perform activities of daily living. Recently, it is established that physical activity can decrease the cognitive decline and the risk of depression in older adults. Moreover, regular physical activity can improve physical and mental functions in populations of all ages. However, level and speed of cognitive decline occurs varies greatly among individual especially the difference between middle-aged and older adults. Objective: This study aimed to focus on the comparison of physical activity, cognitive function and depression between older and middle-aged adults, which has never been done before. Moreover, the associations of physical activity with cognitive impairment and depression were also investigated in older and middle-aged adults. The information in this study will provide an understanding regarding the design of physical activity program for different age groups. Methods: All participants were divided into two groups of 50 middle-aged adults and 50 older adults. The assessments of physical activity, cognitive function, and level of depression were conducted for all participants. Results: The total level of physical activity and cognitive function in older adults was decreased when compared with middle-aged ones. Moreover, each work and transportation domain of physical activity in older adults also was decreased when compared with that in middle-aged ones. However, the leisure domain of physical activity in older adults was increased via a decreasing depression level. In addition, the level of physical activity associated with both cognitive function and depression and depression alone in middle-aged and older adults, respectively. Conclusion: We suggested that total level of physical activity in older adults can increase via stimulating work and transportation activities in physical activity program. Moreover, the level of physical activity associated with both cognitive function and depression and depression alone in middle-aged and older adults, respectively.

Vulnerability and Resilience Among Older Adults During the COVID Pandemic

The COVID-19 pandemic is particularly challenging for many older adults. They are strongly encouraged to practice social distancing and sheltering in place to decrease morbidity and mortality risks. However, social isolation and loneliness increase the risk of mental and physical health problems. Nonetheless, there are indications that older adults may be more resilient than originally thought. Park et al. present longitudinal findings that younger adults fared worse than middle-aged or older ones, reporting greater distress and less social support, mindfulness, and emotion regulation skills. For older participants, acceptance of negative emotions and social support predicted lower distress. Choun et al. also present longitudinal data, showing that depressive symptoms decreased among older adults during the lockdown phase of the pandemic, but reflected changes in loneliness and physical health symptoms. Stellman et al. found that moderate levels of combat experience were helpful for some older Vietnam veterans coping with the pandemic, although a few found that it made coping more difficult. Turner et al. found that positive, non-familial intergenerational contacts were associated with a higher number of positive pandemic-related changes, such as finding new hobbies and meaning in work. Finally, Aldwin et al. present a social ecological approach to vulnerability and resilience. Using qualitative data, they found that stressors and resources were reported at personal, interpersonal and societal levels. Further, older adults both took comfort from and contributed to community resources during this pandemic. In summary, this symposium identified factors that contribute to older adults’ resilience during this pandemic.

ПРОБЛЕМЫ ПСИХИЧЕСКОГО ЗДОРОВЬЯ И ОБРАЩЕНИЕ ЗА ПОМОЩЬЮ СРЕДИ ПОДРОСТКОВ

The mental health problems among adolescents have long-lasting effects throughout life. However, research evidence indicates that only 10–30% of adolescents who needed mental health care had received specialized help. The present study reports the prevalence of mental health problems and help-seeking among adolescents, taking into account gender and age differences. The sample included 1752 adolescents (47 % boys,) aged 12-17 years. Data were collected on in two Siberian cities (Novosibirsk and Krasnoyarsk) using an international self-report questionnaire developed for the school-based Eurasian Child Mental Health Study. Participants were recruited from 18 schools, students completed questionnaires anonymously during school lessons. Statistical analysis included analysis of variance (ANOVA), multiple regression analysis, and crosstabs using a chi-squared test. The level of emotional and behavioral problems in Siberian adolescents was slightly higher than that found in European and Asian countries. Twenty three percent of adolescents reported frequent headaches (at least once a week), 11 % reported frequent abdominal pain and 14% suffered from frequent sleep disturbances (3–5 times a week or more). Girls reported a significantly higher level of problems than boys, with the largest gender differences for emotional problems, recurrent pains and sleep disturbances. Weekly consumption of alcohol and daily use of nicotine among boys was more common than among girls (3 % and 6 %, respectively), whereas less frequent use of alcohol and nicotine was commoner in girls (16 %) than in boys (10 %); 7 % of boys and girls had tried drugs at least once. Suicidal thoughts were reported by 22 % of adolescents, 6 % reported suicide attempts and 6 % reported repeated self-harm. One third of adolescents considered seeking outside help and 9 % had actually done so. Girls reported more help-seeking than boys; older girls sought help more often than younger and middle-aged ones. Around one third of adolescents sought help from their relatives; 26 % from friends, the Internet or other non-professional sources; 5 % reported seeking help from a doctor or nurse, and 3 % from a psychologist. The most important independent predictors of seeking help were emotional symptoms, suicidal ideation and hyperactivity/inattention. The results suggest a need for future investigation of the factors associated with help-seeking behavior among adolescents. It is also necessary to develop mental health promotion programs for adolescents, interventions to improve mental health literacy and access to mental health care.

Gender and age differences in anatomical parameters of proximal femur in middle-aged and elderly patients with femoral intertrochanteric fracture

Objective To determine the gender and age differences in anatomical parameters of proximal femur in middle-aged and elderly patients with femoral intertrochanteric fracture so as to provide theoretical evidence for development of internal fixation devices. Methods The clinical and CT data of 375 patients with intertrochanteric fracture were analyzed retrospectively who had been treated at Department of Orthopedics, The First Medical Center, General Hospital of Chinese PLA from September 2009 to March 2017. The patients were divided into 4 age groups. The middle-aged group (from 45 to 59 years old) had 22 cases, 16 males and 6 females; the early elderly group (from 60 to 74 years old) had 87 cases, 37 males and 50 females; the elderly group (from 75 to 89 years old) had 238 cases, 76 males and 162 females; the late elderly group (≥90 years old) had 28 cases, 6 males and 22 females. The anteversion angle of femoral neck, femoral neck-shaft angle, femoral head diameter, femoral neck length, femoral neck offset and femoral neck width were measured on their images. The anatomical parameters of proximal femur were compared between genders in the same age group and between groups of the same gender. Results There were no significant differences between male and female patients with femoral intertrochanteric fracture in body mass index or AO classification, showing comparability(P>0.05). The anteversion angle of femoral neck (8.33°±5.00°) of the male middle-aged and elderly patients with intertrochanteric fracture was significantly smaller than that of the female ones (11.28°±6.15°), but their femoral head diameter, femoral neck length, femoral neck offset and femoral neck width (49.10 mm±2.48 mm, 99.70 mm±5.22 mm, 7.18 mm±2.20 mm and 39.10 mm±4.92 mm) were significantly larger than those of the female ones (43.46 mm±2.79 mm, 90.00 mm ± 4.75 mm, 6.29 mm±2.07 mm and 33.49 mm±4.87 mm) (all P 0.05). Conclusions Compared with the middle-aged and elderly male patients with femoral intertrochanteric fracture, the middle-aged and elderly female ones have a larger anteversion angle of femoral neck, smaller offset, width and length of femoral neck, and a smaller femoral head diameter. There are no significant age differences in anatomical parameters of the proximal femur in middle-aged and elderly patients with femoral intertrochanteric fracture. Key words: Hip fractures; Femur; Clinical anatomy; Gender; Imaging, three-dimensional

ВОЗОБНОВЛЕНИЕ ГЛАВНЫХ ЛЕСООБРАЗУЮЩИХ ПОРОД И СВЕТОВОЙ РЕЖИМ В ЛЕСНЫХ ПОЛОСАХ КАМЕННОЙ СТЕПИ

With an increase in the anthropogenic load on agricultural landscapes and global climate change, the role of not only the forests of Russia, but also artificially created, man-made forest stands, especially systems of protective stands, is growing. The system of forest belts of the Stone Steppe consists of forest strips of different ages, species composition and width. The oldest stands are 126 years old, the youngest are 28 years old. After the drought of 2010, the death of birch, poplar and partially ash began in many forest belts of the southeast of the Central Chernozem region. Forest strips of the Stone-Steppe system were not an exception. The death of birch and poplar occurred not only in old plantings, but also in middle-aged ones. It is necessary to know their renewable potential to restore the protective functions of forest strips. Old-age forest belts have suffered more from drought. Therefore the article is devoted to the study of the main reserve of renewable potential - the presence of reliable undergrowth and the conditions of its existence under the canopy of the parent forest stand of forest belts aged 62 to 120 years. The article touches upon the concept of a new direction in agroforestry: the mechanism of spatial expansion of protective forest belts on arable land due to the appearance of forest edges consisting of maple and the role of forest edges in the forest-forming process of man-made strip stands have been shown

Analysis of the Influence of Age, BMI, and WHtR on Body Mass Acceptance, Attitudes, and Motivation towards Body Mass Reduction in Overweight and Obese Caucasian Women.

The emotional consequences of excessive body mass, associated with body image and acceptance, have become a global public health challenge as they may decrease the general well-being and hinder weight loss in overweight and obese individuals. Therefore, this study aimed to analyze the influence of age, body mass index (BMI), and waist-to-height ratio (WHtR) on body mass acceptance, attitudes, and motivation toward body mass reduction in overweight and obese Caucasian women with excessive abdominal fat. The previously validated BodyMass–DRama (Body Mass–Dietary Restrictions: Acceptance, Motivation, Attitudes) questionnaire was applied in this study. The declared acceptance, attitudes and motivation towards body mass reduction were compared between subgroups based on age (20–40, 40–50, and 50–60 years), BMI (25.0–30.0, 30.0–35.0, and ≥35.0 kg/m2), and quartiles of WHtR. The age, BMI and WHtR were stated to be associated with declared acceptance, attitudes, and motivation towards body mass reduction. The different age groups indicated the following as the reasons for excessive body mass: young respondents—low physical activity and consumption of sweets; middle-aged ones—large/irregular meals; aging ones—large/irregular meals and low physical activity (p = 0.0161). While describing motivation toward body mass reduction, young respondents indicated the role of a physician or dietitian (p = 0.0012) or someone who can control them (p = 0.0044), as well as their expectation to be more successful at work after body mass reduction (p = 0.0045), while the aging ones indicated appreciation and plaudits from others (p = 0.0264) as a motivating factor. Respondents with the highest BMI declared having spending free time actively constricted (p = 0.0007); they declared more often than others of feeling exhausted (p = 0.0395) or tired all the time (p = 0.0445), but less often of feeling full of joy (p = 0.0457) or full of energy (p <0.0001). Respondents with moderate WHtR declared less often than others that they expect to enjoy socializing (p = 0.0376), but more often to be able to have a better vacation after body mass reduction (p = 0.0128), while those with the lowest WHtR expected to be more physically active (p = 0.0487). Women with the highest WHtR most commonly indicated external pressure from relatives or co-workers as a motivating factor for body mass reduction (p = 0.0435). Due to these differences between Caucasian women with excessive body mass, the approach of physicians and dietitians, as well as methods applied to motivate patients, need to be customized.

중 · 장년층과 노인층 거주자의 장기공공임대아파트 공용공간의 인지건강증진을 위한 디자인 개선에 대한 평가

As the residents of long-term rental apartment houses have lived long and got older, they are tend to have dementia or cognitive health problems. Therefore, the renovation for them should be done on the base of consideration of old residents. On these backgrounds, Seoul design policy division carried out Design Renovation Project for Improving Cognitive Health to long-term public rental apartment complex. This study was intended to evaluate the design renovation for common areas in long-term rental apartment complex through the middle-aged and the elderly residents. The renovation was carried out to support the cognitive health of their old residents, including the middle-aged ones. The subjects were the indoor and outdoor common areas in S long-term public rental apartment complex and 85 residents. The renovation items were consisted of 49 elements in 6 indoor and outdoor common areas. The one to one interview method and the self-administrative method were selectively used. This renovation project had positive effect on their residents’ living. The residents were generally using the renovated common areas more often and conveniently. Also they were satisfied with the renovated common areas.

Incidence and risk factors of deep venous thrombosis in lower extremity in patients with tibial plateau fracture

Objective To investigate the incidence and risk factors of deep venous thrombosis (DVT) in lower extremity in patients with tibial plateau fracture. Methods The data from 148 patients with tibial plateau fracture were retrospectively analyzed who had been admitted to the Department of Orthopaedic Trauma, Honghui Hospital between September 2014 and December 2017. They were 90 males and 58 females, aged from 19 to 83 years (average, 47.2±13.1 years). According to the Schatzker classification of tibial plateau fractures, 24 cases belonged to type Ⅰ, 17 to type Ⅱ, 25 to type Ⅲ, 29 to type Ⅳ, 34 to type Ⅴ, and 19 to type Ⅵ. The incidence of DVT was detected by venous ultrasound of bilateral lower extremities before and after surgery. The factors related to the occurrence of DVT were statistically analyzed. Univariate analysis was used to determine risk factors, and multivariate logistic regression analysis was used to identify the primary independent risk factors. Results The preoperative DVT incidence was 43.92% (65/148) and the postoperative DVT incidence 52.70% (78/148). Distal thrombus predominated both preoperatively and postoperatively. Age (OR=1.043, 95%CI 1.015~1.072, P=0.002) and D-dimer level upon admission(OR=1.219, 95%CI 1.009~1.473, P=0.040) were independent risk factors for preoperative DVT formation; age (OR=1.075, 95%CI 1.042~1.110, P=0.000), operative time (OR=0.994, 95%CI 0.989~0.999, P=0.016), D-dimer level at 1 day postoperatively (OR=1.135, 95%CI 1.025~1.258, P=0.015) and at 3 days postoperatively (OR=1.366, 95%CI 1.008~1.853, P=0.044) were independent risk factors for postoperative DVT. Conclusions The incidence of DVT in the lower ex-tremity may be high in patients with tibial plateau fracture. Distal thrombus is the main manifestation. In fracture patients, especially the middle-aged and elderly ones, dynamic monitoring of D-dimer level should be combined with lower extremity venous ultrasound for early diagnosis of DVT. In patients with lower extremity DVT, surgical progress should be accelerated on the basis of good surgical quality to reduce the incidence of postoperative lower extremity DVT. Key words: Venous thrombosis; Risk factors; Age factors; D-dimer; Tibial plateau fracture

The soil microbial community of turf: linear and nonlinear changes of taxa and N-cycling gene abundances over a century-long turf development.

Turf, consisting of closely spaced grasses and the subtending soil, is a unique ecosystem subject to intense management. Yet soil organic matter accumulates quickly and reaches equilibrium after 20 to 50 years. Resource availability is an important driver of species richness and theoretically their relationship is expected to be unimodal. In this work, we examined the effects of turf development (i.e. a 1, 15, 20 and 109 year-old chronosequence) on microbial taxon richness, community composition, and abundances of genes putatively involved in N cycling through 16S rRNA gene and ITS region amplicon sequencing. Microbial alpha-diversity remained relatively stable although soil organic C and N increased by up to 3-fold over a century-long turf development. However, both bacterial and fungal community compositions changed substantially from those in the previous land use, pine stands and along turf development. Youngest turf was closer to the oldest turf than to middle-aged ones, specifically for bacterial community. Microbial changes to resource availability were also taxonomically specific. The relative abundance of Proteobacteria was independent of resource availability; Nitrospirae increased monotonically, and Bacteroidetes, Actinobacteria and Glomeromycota varied curvilinearly. However, abundances of most taxa from the phylum to operational taxonomic unit level and N-cycling genes varied nonlinearly with turf development.

Study of Age-Related Changes in Compensatory Processes in the Model of Neurodegeneration of the Nigrostriatal System in Rats

It is generally accepted that old age is the main risk factor for the development and progression of Parkinson’s disease (PD). However, there is currently no data available that experimentally confirm the age dependence of the neurodegeneration progression rate and the activity of compensatory processes in the nigrostriatal system in the development of PD. The present study applies a model of nigrostriatal system neurodegeneration in rats of different ages, which was developed using the microinjections with proteasome inhibitor lactacystin (LC) into the substantia nigra pars compacta (SNpc). The model reproduces the main pathomorphological signs of PD with great reliability. It has been demonstrated that the administration of LC to old rats, compared to young and middle-aged ones, causes more pronounced neurodegenerative changes in the nigrostriatal system which are associated with impairments in fine motor function, a decrease in the growth of the stress-inducible heat shock protein Hsp70 in surviving neurons of SNpc, and a decrease in contents of tyrosine hydroxylase and the vesicular monoamine transporter 2. The data obtained suggest that the aging-related decrease in Hsp70 expression together with a decrease in the efficiency of compensatory processes is a significant factor which determines the progression of pathology in the nigrostriatal system in PD model in old rats. The age-related loss of compensatory mechanisms observed may be one of the causes of the rapid PD progression in the elderly.

Pattern of tyrosine hydroxylase expression during aging of mesolimbic pathway of the rat

Senescence is a physiological and progressive event that leads to the impairment of normal functions of the organism. The nervous system is one of the most affected systems during aging, presenting both structural and functional alterations associated with a decline in normal brain functions. In the present study we aimed to evaluate the impact of senescence on the mesolimbic pathway (nucleus accumbens – NAc and ventral tegmental area – VTA) of the rat, through immunohistochemistry for tyrosine hydroxylase (TH) enzyme, in young (3 months old), middle-aged (10 months old) and aged animals (18 months old). There was a significant decrease in the TH-immunoreactivity across NAc in aged animals as compared to the young and middle-aged ones, as revealed by optical densitometry. Medium and caudal regions of the VTA in the young animals possessed a higher number of TH-immunoreactive neurons as compared to the more aged groups. Comparisons among VTA regions in young animals revealed a difference in the number of cell bodies when the medium region was compared to the rostral and caudal regions whilst in both the middle-aged and aged groups comparisons between rostral vs caudal and medium vs caudal regions were significant. Our results show that aging impacts the mesolimbic pathway across its rostrocaudal axis, with a decrease of TH-reactivity in NAc and loss of neurons in VTA. These events may be involved with behavioral alterations observed throughout aging.

A relationship between the integrated assessment of magnetic resonance imaging markers for cerebral small vessel disease and the clinical and functional status in the acute period of ischemic stroke

Cerebral small vessel disease (CSVD) is the most common neurological pathological process and contributes to the process of aging and to the development of dementia and stroke. At the same time, the role of CSVD as a factor influencing the course of acute ischemic stroke (IS) has been little studied. There is no generally accepted magnetic resonance imaging (MRI) scale for the integrated assessment of CSVD markers. Objective : to carry out an integrated assessment of the MRI manifestations of CSVD in acute ischemic stroke and to analyze a correlation of both individual markers and the final indicator with the clinical and functional status of patients. Patients and methods. 100 patients with acute IS were examined. All patients underwent standard clinical, laboratory and instrumental examinations, as well as brain MRI estimating the number of lacunae, visible perivascular spaces (PVSs) and leukoaraiosis. The number of cerebral microbleeds (CMBs) was additionally calculated in 57 patients. Integral scale scores were calculated by gradation and summation of four MRI markers of CSVD. Results . The patients with acute IS showed the high representativeness of individual markers for CSVD. The values of MRI markers for CSVD correlated with age, education level, and cardiovascular parameters in patients. An integrated CSVD severity assessment scale was developed. The overall manifestations of CSVD, which were assessed using this scale, were associated with the severity of a stenotic process in the brachycephalic arteries, with BP levels at admission, ejection fraction, hyperglycemia, and atherogenic index of blood lipids. The high CSVD score was also correlated with low mobility and more severe disability in patients being discharged from hospital. The high severity of CSVD was associated with lower neurological deficit regression during inpatient treatment. Subgroup analysis showed the greatest negative impact of CSVD on the severity of stroke in female patients, young and middle-aged ones, diabetics, as well as in patients with noncardioembolic stroke, a smallsized focus, and intima-media thickening. Conclusion . The overall manifestations of CSVD calculated using the original scale based on the analysis of the degree of lacunae, PVSs, leukoaraiosis, and CMBs are associated with premorbid cardiovascular parameters in a patient and are important indicators for the neurological, cognitive, and functional outcomes of acute IS.

Factors Related to Presenteeism in Young and Middle-aged Nurses

Presenteeism is considered to be not only a work-related stressor but also a factor involved in the development of workaholism and error proneness, which is often described as careless. Additionally, increasing health issues arising from aging suggest the possibility that presenteeism in middle-aged nurses is different than that in young ones. Therefore, the present study aimed to identify and tease apart factors involved in presenteeism among young and middle-aged nurses. An anonymous self-administered questionnaire survey was conducted among 2,006 nurses working at 10 hospitals. In total, 761 nurses aged <40 years and 536 nurses aged ≥40 years were enrolled in this study. Work Impairment Scores (WIS) on the Japanese version of the Stanford Presenteeism Scale were measured for presenteeism. Job stressors, workaholism, and error proneness were measured for related factors. Multiple regression analysis was conducted after determining the WIS as the dependent variable and related factors as independent variables. Overall, 70.8% of the young nurses reported health problems compared to 82.5% of the middle-aged nurses. However, WIS in young nurses was significantly higher than that in middle-aged ones (p < 0.001). WIS in young nurses showed a significant relationship with the degree of stressors, "difficulty of work" (β = 0.28, p < 0.001) and tendency to "work excessively" (β = 0.18, p < 0.001), which is a subscale of workaholism, error proneness of "action slips" (β = 0.14, p < 0.01) and "cognitive narrowing" (β = 0.11, p < 0.05). Conversely, WIS in middle-aged nurses showed a significant relationship with "cognitive narrowing" (β = 0.29, p < 0.001) and to "work excessively" (β = 0.17, p < 0.001), the degree of stressors on "difficulty of work" (β = 0.12, p < 0.05) and "lack of communication" (β = 0.13, p < 0.01). It was clarified that the increased health problems of middle-aged nurses does not necessarily lower their working capacity. Also, compared to young nurses, the degree of failing tendency, rather than the degree of job stressors, was more related to presenteeism for middle-aged nurses. It can be considered that middle-aged nurses simply realize that their working ability is hindered because of incidents resulting from attention narrowing. As fatigue and state of tension tend to cause narrowing of attention, it may be necessary to reduce such risks and adjust work environments so mistakes can be avoided.

High levels of lipoprotein (a) and premature acute coronary syndrome

Background and aimsHigh levels of lipoprotein(a) [Lp(a)] are associated with increased risk of acute coronary syndrome (ACS). We explored whether Lp(a) exhibits a stronger association with premature ACS. MethodsA case-control study was conducted; 1457 patients with a history of ACS (54.8 ± 13 years, 86% males) and 2090 age-sex matched adults free of cardiovascular disease were enrolled. Bio-clinical characteristics [risk factors, low-density lipoprotein-cholesterol, Lp(a)] were derived through standard procedures. ResultsA 10 mg/dL increase in Lp(a) was associated with 4% (95% CI, 1.01 to 1.02) higher likelihood of having ACS in younger (<45 years) and 2% (95% CI, 1.01 to 1.02) higher likelihood in middle-aged (45-60 years) individuals. Adjusting for common risk factors, elevated Lp(a), i.e. >50 mg/dL, was still associated with increased likelihood of ACS in younger adults (<45 years) (OR = 2.88, 95% CI, 1.7 to 4.6) and in middle aged ones (45 and 60 years) (OR = 2.06, 95% CI, 1.4 to 3.2), but not in older participants (>60 years) (OR = 1.31, 95% CI, 0.8 to 2.4). ConclusionsLp(a) seems to be an independent risk factor for ACS in individuals <45 years, and high Lp(a) levels increase by ∼3folds the risk for ACS. The association is preserved but is less in middle-aged individuals (45-60 years) and is abolished >60 years.

Sex- and age-associated differences in episodic-like memory and transcriptional regulation of hippocampal steroidogenic enzymes in rats.

The aim of this study was to evaluate the episodic-like memory (ELM) and the transcriptional regulation of the enzymes involved in hippocampal allopregnanolone synthesis in young adult and middle-aged male and female rats. Young adult males, but not middle-aged ones, showed a good performance in the ELM task. In contrast, neither young nor middle-aged females were able to discriminate the spatial order in which the objects were presented. In females, aging decreased the transcription of steroidogenic-related genes. In addition, the mRNA levels of 5α-reductase-1 were higher and the methylation of its promoter was lower in young adult females than in males, suggesting an epigenetic control. Further studies are needed to establish correlations between ELM and the transcriptional regulation of hippocampal steroidogenic enzymes. Our results contribute to the knowledge of sex differences in gene expression, methylation and memory during aging.

Does age matter? A mixed methods study examining determinants of good recovery and resilience in young and middle-aged adults following moderate-to-severe traumatic brain injury.

To examine whether age contributes to functional recovery and resilience after moderate-to-severe traumatic brain injury. The ability to recover may change across the lifespan, but the influence of age on brain injury outcome is understudied. Mixed methods study. All adults of working age (18-64years) discharged from a level I trauma centre between 2010-2013 after sustaining a moderate-to-severe traumatic brain injury were considered. Functional recovery was assessed during a telephone interview with the Glasgow Outcome Scale-Extended 12-36months postinjury. A subgroup completed the Connor-Davidson Resilience Scale and a face-to-face interview about resilience. Ninety-seven young (mean age: 27years; 75% male) and 47 middle-aged brain trauma survivors (mean age: 53years; 75% male) completed the telephone interview. Eight young and five middle-aged adults were also assessed for resilience. Overall, young participants experienced more severe head injuries. Yet, they achieved slightly higher levels of functional recovery compared with middle-aged ones as per the Glasgow Outcome Scale-Extended. Controlling for CT scan findings and posttraumatic amnesia duration, age was not found to be associated to functional recovery in adults of working age. Although both groups showed similar levels of resilience, young participants discussed the challenges related to "having more time on their hands" and "being a changed person", two elements perceived positively by middle-aged ones. While age does not appear to interfere with functional recovery in adults of working age, younger brain trauma survivors could benefit from nursing interventions to strengthen their resilience process related to re-employment orientation and identity.