Middle-aged Person Research Articles

Cardiovascular risk factor assessment in late-onset seizures: A study protocol to assess the value of structured intervention.

A growing body of evidence suggests patients with late-onset seizures are at an increased risk of stroke, but the potential for reducing cardiovascular morbidity through risk factor screening and management is unknown. We aim to determine whether individuals with new-onset unprovoked seizures after middle age should undergo vascular risk assessment. The long follow-up needed to assess stroke risk and the known benefit of vascular risk factor modification make a standard RCT logistically and ethically challenging. Instead, we propose and have developed a protocol for a cluster project assessing the effect of vascular risk factor screening in an intervention trial as well as a cohort study. Participating neurology clinics will implement standard cardiovascular risk factor assessment into the routine evaluation for individuals aged ≥50 years attending their first specialized consultation after an unprovoked seizure, excluding those with progressive brain disease. The project has two interlinked components: a prospective single group trial, in which risk factor assessment is performed and subsequent management is followed for one year; and a register-based cohort study examining the long-term effects of the intervention on a system level by comparing patients attending initial consultations in the 2 years after start of the study, with patients seen in the four preceding years at the same clinics. The primary outcome of the intervention trial is the proportion of patients receiving subsequent pharmacological treatment. The primary outcome of the cohort study is the incidence of acute stroke in the Swedish Stroke Register. Swedish Ethical Review Authority approval (which is valid for 2 years only) will be sought when funding is obtained. The results will be disseminated through peer-reviewed scientific publications. The study will be registered at clinicaltrials.gov. A first seizure in a middle-aged or older person indicates a higher risk of stroke. It is not known whether investigating and treating blood pressure, blood cholesterol, or similar risk factors after a first seizure is an effective way to prevent stroke. A traditional clinical study would need too many patients and it would be unethical not to treat the control group. We have designed a study in which participating neurology departments change their practice to test and treat vascular risk factors. Patients are then compared to historic controls using registered data.

A case of postoperative Sphingomonas paucimobilis endophthalmitis after parsplana vitrectomy

We report a case of acute onset of postoperative endophthalmitis following pars plana vitrectomy, in a healthy middle-aged male person, caused by Sphingomonas paucimobilis, a gram-negative bacillus widely distributed in the environment and reported to cause opportunistic infection in immunocompromised. The case showed complete resolution on vitrectomy and intravitreal antibiotics. The bacillus was multi-drug resistant, showing resistance to all known commonly used antibiotics except intermediate sensitivity to meropenem. There have been two reported cases of postoperative endophthalmitis caused by Sphingomonas paucimobilis following cataract surgery, but this is the first reported case following pars plana vitrectomy.

저소득 장년층 1인 가구의 생활경험에 관한 사례연구

The purpose of this study is to understand the life experiences of low-income middle-aged single person households who are prone to the crisis of the welfare blind spot. In-depth interviews were conducted with 8 participants who had agreed to the research purpose and analyzed using a qualitative case study method. As a result of the analysis, the life experience of low-income middle-aged single person households has 4 categories such as ‘Not intending to live alone’ ,‘Difficulties as a single person households’, ‘Different daily life for each single households’, ‘Suggestions for the middle-aged single person households’ and 16 sub-categories. Based on these results, policy and practical suggestions were made to prevent social isolation and improve the quality of life of low-income middle-aged single person households, which are emerging as new social risks.

An Ecological Context That Scars: Reflections on Three Nature Documentaries of 2020

An Ecological Context That Scars: Reflections on Three Nature Documentaries of 2020

FUNCTIONAL OUTCOME OF FLEXOR HALLUCIS LONGUS TRANSFER AUGMENTED WITH GASTROCNEMIOUS TURNDOWN FLAP IN THE RECONSTRUCTION OF CHRONIC ACHILLES TENDON RUPTURE

Introduction Chronic spontaneus rupture of Achilles tendon commonly occurs in middle aged and elderly person, which often goes undiagnosed or untreated for long duration, resulting in large gap in between two ruptured ends. Disrupted Tendo Achilles causes weakness in plantar exion of foot and abnormal gait. Surgical repair of the chronic rupture have poor result due to large gap in between ends. Different surgical procedures are described in the literature for Reconstruction of chronic Tendo Achilles injuries without any clear superior technique. Purpose of this study is assessment of functional outcome of Flexor Hallucis Longus transfer augmented by turn down Gastrocnemius ap in chronic Tendo achilles rupture. Methods This study Assessed functional outcome of Chronic achilles tendon rupture, reconstructed by Flexor Hallucis Longus transfer augmented by turndown gastrocnemius ap done at orthopaedics department, Bankura Sammilani medical college between november 2020 to october 2021. Patients were followed up for 12 months and then assessed clinically for range of movement , return to normal mobility , persistance of pain and complications . Functional outcome were assesed by American Orthopaedic Foot and Ankle Society(AOFAS) ankle and hindfoot score and Visual analogue Score (VAS). Observations Out of 8 patients, 6 had Excellent AOFAS score of 90 to 100, while 2 patient had a good score of 80 to 89. None had fair or poor score.None of the patients had wound breakdown, ankle stiffness, persistant nerve palsy or rerupture of the reconstructed tendon. Mean VAS score for pain at 12 month follow for 8 patients was 0, as none had any pain complain. None of the patient had any loss of ankle joint movement or stability, All patient resumed there normal day to day activity but none could restart recreational or sporting activity. Conclusions. Flexor Hallucis Longus transfer with turndown ap augmentation gives good to excellent outcome with minimal complication, if meticulous soft tissue handling and proper wound closure are done.

Remission in Type 2 DM with Personalized Medical Interventions Including Life Style Modification and Appropriate Pharmacotherapy - A Case Report

Introduction: Increase in prevalence of type-2 diabetes in background of increased prevalence of obesity has increased overall health risk and complicates its management. Health benefits of weight loss and strategies for the same have been found to be effective. Caring for people living with diabetes and obesity requires a person-centred approach using the most appropriate evidence based individualized care. This case study discusses diabetes and weight management in a patient with sub-optimally controlled diabetes and a high BMI with potential for reversal of Diabetes. Clinical Problem: Extremely obese (BMI-43.23kg/m2) middle-aged person with hypertension and diabetes as comorbidity with sedentary lifestyle having sub-optimal glycaemic control (HbA1c 11.2%) with fatty liver disease presented for management of his sub-optimal glycaemic control. Management plan and its rationales with outcomes: Proper education about self-management of diabetes and counselling for importance of weight management and its long-term benefits were explained to patient. Low calorie diet with a calorie deficit of 600 calories per day, one-hour moderate intensity exercise day, SGLT-2i (dapagliflozin 10mg daily), Metformin 2000mg daily, GLP1RA (Liraglutide in incremental dose followed by switch over to oral similitude), Saroglitazar (dual PPAR agonist) along with antihypertensive medication and statin was started in this patient.At 4 months of intervention patient has tolerated the treatment very well and lost 26kg of body weight. His glycated HbA1c came down to 4.2% from 11.2%. Reversal of urine albumin to creatinine ratio to normal range was another significant change. Conclusion: Personalized medical interventions including lifestyle changes and appropriate antidiabetic medication was associated with>25% weight loss, which can potentially induce complete remission of type-2 diabetes.

Public perceptions of urgency of severe cases of COVID-19 and inflammatory gastrointestinal disease.

BackgroundThere is evidence that perceived urgency of medical complaints is associated with emergency care utilization. Patients’ perception of urgency can differ from physicians’ assessment. This study explored public perceptions of urgency of severe cases of COVID-19 and inflammatory gastrointestinal disease and analyzed variations in perceptions of urgency by characteristics of the afflicted person in the vignettes and sociodemographic characteristics of respondents.MethodsVignettes with severe symptoms of either inflammatory gastrointestinal disease or COVID-19 with comparable urgency of treatment were used in a telephone survey in Germany (N = 1,207). Besides disease, the vignettes varied in terms of sex, age (child, middle-aged person, old person) and daytime (Tuesday morning, Tuesday evening). Respondents were asked to rate the urgency of the reported symptoms with four items. A sum scale was computed. Variations in perceptions of urgency according to vignette characteristics and sociodemographic characteristics of the respondents (sex, age, educational level, migration background, children (yes/no) and personal affliction) were analyzed using a linear regression model.ResultsIn terms of vignette characteristics, multivariate analysis showed a lower estimated urgency for males, as well as for the middle-aged and aged persons, compared to the child vignettes, and for COVID-19, compared to inflammatory gastrointestinal disease. Regarding the characteristics of the respondents, estimated urgency increased with age and was lower among respondents, who were previously affected by the symptoms themselves.ConclusionAlthough urgency in the vignettes was comparable, variations in estimated urgency by age and sex of the afflicted person and the described disease as well as age and personal affliction of the respondents were identified. This could result in an inadequate health care service utilization. Therefore, variations in public perceptions of urgency should be considered in the planning of public campaigns on adequate health care services utilization.

중년의 스포츠 참여활동에 따른 사회적지지, 재미요인, 운동지속의 관계연구

This paper selected sample group middle aged persons, male and female, residing in Gwangju. This paper selected the sample by Random Sampling Method, and made objects respond to questionnaire investigation by Five-phase Likert Scale Self-administred Method. At last, this paper secured analysis materials from 262 objects.BR First, as for the relationship between social support of a middle-aged person participating in sports and pleasure of interest factor, evaluative support and emotional support of social support had an affirmative influence. As for the relationship between

Intergenerational Transfer of Ethnic Medicine Knowledge by Tribal Communities of Malappuram District in Kerala, India

The present study aimed to study the intergenerational transfer of the ethnic medicines related knowledge among the tribes people of Kerala. The study was conducted among three tribal communities in the Malappuram district of Kerala, a district that has a high number of tribal communities. Paniyans, Aranadans, and Kattunaikkans are the predominant tribal communities in Malappuram. These communities are living on the fringes of Nilambur forests and depend on the forest for their livelihood. The study showed that 36.7% of elderly tribespeople have ethnic medicine knowledge compared to middle-aged (27.54%) and young people (26. 15%). Further, the young tribespeople shared about 97 citations (single or combinations of medicinal plants to treat a particular ailment/ for a single health condition), making an average of 5.7 citations per young person. Middle-aged tribespeople shared a total of 87 citations, which created an average of 4.58 citations per middle-aged person. And among the elderly category, they shared about 144 citations, which made the largest average citation of 8.47 among all the three age categories. The respondents with ethnic medicine knowledge were further asked whether they were ready to pass this knowledge to the next generation or not. The majority (51%) of respondents responded that they would pass the knowledge to the next generation only if they showed interest in it. 41.5% of the respondents expressed that they are ready to pass their knowledge to the next generation, and 8 percent of the respondents would never pass their knowledge to the next generation. A chi-square test was done to know the significance of the relationship between age and readiness.
 The test revealed that there is a significant relationship between the variable's age and their readiness to share their ethnic medicine knowledge. That is, the elderly tribal people are less ready to share their ethnic medicine knowledge with others. The study also documented the ethnic medicine knowledge of the tribal respondents in three age groups. It was found that the old age tribes people know the usage of 75 plant species to cure various diseases and also for different health conditions, whereas the middle-aged group of tribespeople expressed about 44 plants and young people shared only 30 plants. The study indicated that the ethnic medicine knowledge of tribespeople is decreasing from the old generation to the young generation. Serious efforts should be taken to conserve this valuable knowledge.

Watching children play: toward the earth in bliss

Watching children at play is favorite pastime for many elderlies. However, the growing safety concerns have prompted parents to become increasingly resistant to the idea of having strangers watch their children in parks and playgrounds. This creates an intergenerational gap in communication with potentially detrimental consequences for all social groups. Oral interviews were conducted and written surveys distributed that validated the hesitance of seniors, especially in the United States, to spend time at children’s playgrounds despite their finding the vicinity of children stimulating. Behavioral observations were conducted at playgrounds to quantify the positive and negative effects of supervisors’ ages on children’s play and thus indirectly assess whether there can be mutual benefits of making the presence of older people at playgrounds, which is customary in many countries, more culturally acceptable. Observations focused on the behavior of a pair of siblings showed that there is an increased probability of both conflicts and joyful expressions when the children were in the presence of a middle-aged person than when they were watched over by the elderlies. This has suggested that freer expressions stimulated in the presence of parent-like figures simultaneously induce the undesired and the desired behavioral patterns in the form of propensities for conflict and propensities for expressions of joy, respectively. This has confirmed that the observational stance has a critical effect on the observational outcome and that the age of the watchers has an effect on the behavior of children at play, with the age correlating directly with the calmness of the play, but also with a lower degree of exhilaration.

Intended healthcare utilisation in cases of severe COVID-19 and inflammatory gastrointestinal disease: results of a population survey with vignettes

ObjectivesTo examine variations in intended healthcare utilisation in severe cases of COVID-19 and inflammatory gastrointestinal disease (IGD).DesignRepresentative cross-sectional telephone survey.Setting and participants1207 randomly drawn adults of the city of Hamburg,...

Factors associated with progression of different prediabetic status to Diabetes: A Community-based cohort study

AimsTo examine the predictive factors associated with the progression of different prediabetic status to diabetes. MethodsA two-year retrospective cohort study was conducted on 5741 participants aged 40 years or older. Finally, 1685 participants with prediabetes defined by IFG (impaired fasting glucose), IGT (impaired glucose tolerance) and CGI (combined IFG and IGT) were included. Logistic regression model was used to evaluate the risk of prediabetes progression to diabetes. ResultsOf the 1685 subjects with prediabetes at baseline, 212 (12.6%) subjects progressed to diabetes and 1473 (87.4%) subjects did not. Logistic regression analysis demonstrated that people with CGI were associated with an increased risk of progressing to diabetes compared to those with IFG (OR, 95% CI: 3.127, 2.047–4.776). Moreover, males, obese people, people with increased BMI and WHR (Waist/ Hip ratio), and hypertension were positively associated with the progression to diabetes, while HOMA-β was negatively associated with the progression to diabetes. ConclusionsSubjects with CGI are prone to progressed to diabetes compared to those with IFG or IGT in middle-aged and older person in China. More attention should be paid to male and obese prediabetic subjects, and measures should be taken to control the increase in their BMI and WHR.

Effects of step monitoring using ICT on physical activity and function of middle-aged and elderly person

Effects of step monitoring using ICT on physical activity and function of middle-aged and elderly person

Inequalities in catastrophic health expenditures in conflict-affected areas and the Colombian peace agreement: an oaxaca-blinder change decomposition analysis

BackgroundThe present study analyzes inequalities in catastrophic health expenditures in conflict-affected regions of Meta, Colombia and socioeconomic factors contributing to the existence and changes in catastrophic expenditures before and after the sign of Colombian Peace Agreement with FARC-EP guerilla group in 2016.MethodsThe study uses the results of the survey Conflicto, Paz y Salud (CONPAS) conducted in 1309 households of Meta, Colombia, a territory historically impacted by armed conflict, for the years 2014 and 2018. We define catastrophic expenditures as health expenditures above 20% of the capacity to pay of a household. We disaggregate the changes in inequalities in catastrophic expenditures through the Oaxaca-Blinder change decomposition method.ResultsThe incidence of catastrophic expenditures slightly increased between 2014 to 2018, from 29.3 to 30.7%. Inequalities in catastrophic expenditures, measured through concentration indexes (CI), also increased from 2014 (CI: -0.152) to 2018 (CI: -0.232). Results show that differences in catastrophic expenditures between socioeconomic groups are mostly attributed to an increased influence of specific sociodemographic variables such as living in rural zones, being a middle-aged person, living in conflict-affected territories, or presenting any type of mental and physical disability.ConclusionsConflict-deescalation and the peace agreement may have facilitated lower-income groups to have access to health services, especially in territories highly impacted by conflict. This, consequently, may have led to higher levels of out-of-pocket expenditures and, therefore, to higher chances of experiencing catastrophic expenditures for lower-income groups in comparison to higher-income groups. Therefore, results indicate the importance of designing policies that guarantee access to health services for people in conflict -affected regions but also, that minimize health care inequalities in out-of-pocket payments that may arouse between people at different socioeconomic groups.

Fluoroscopic “calcium sign” or reverse “c” sign of the aortic knuckle in a case of chronic total occlusion of left anterior descending coronary artery

We describe an interesting fluoroscopic calcification of the aortic knuckle assuming a reverse “C” shape in an atherosclerotic aorta in a 42-year-old male presenting with anterior wall ST-elevation myocardial infarction with dyslipidemia. Although calcification of the aortic knuckle and dilatation of the aorta is a common phenomenon in the elderly population, otherwise known as the “unfolding of aorta,” we observed this interesting pattern of calcification in a middle-aged person in an atherosclerotic aorta with calcification. The patient had double-vessel coronary artery disease with chronic total occlusion in the left anterior descending coronary artery and significant stenosis in the mid-segment of the right coronary artery, which we revascularized with drug-eluting stents and achieved TIMI III flow. Although calcium sign or C sign is described in aortic dissection and it is not specific to it, we observed this interesting pattern of calcification in a middle-aged person in the atherosclerotic aorta with dyslipidemia.

Primary gastroduodenal tuberculosis complicated with acute pancreatitis: a rare case report and literature review

BackgroundTuberculosis (TB) is a major health problem worldwide. Even in highly prevalent countries, primary gastroduodenal tuberculosis is a rare manifestation of extrapulmonary tuberculosis. In recent years, as the incidence of tuberculosis has increased year by year, the occur of gastroduodenal tuberculosis has also increased. Endoscopy is an important tool for diagnosing gastroduodenal tuberculosis. The performance of gastroduodenal tuberculosis under endoscopy is often non-specific, which may imitate other benign or malignant gastroduodenal diseases. Diagnosis of gastroduodenal tuberculosis relies on a combination of endoscopy and guided biopsy.Case presentationHere, we report a rare and interesting case of gastroduodenal tuberculosis with acute pancreatitis. The case initially mimicked gastroduodenal ulcers in morphology and appeared in a middle-aged person with normal immunity but with prolonged fever and abdominal pain. The disease was diagnosed through endoscopy and guided biopsy, and it responded well to antituberculosis drugs.ConclusionsClinicians must remember that even in the absence of immunodeficiency, as in this case, tuberculosis can affect any part of the gastrointestinal tract.

Non-clostridial gas gangrene of a diabetic foot with COVID-19 infection

Gas gangrene is a manifestation of soft tissue infection by clostridial group of bacteria. Non-clostridial gas gangrene is uncommon and seen rarely in diabetics. In the era of COVID-19 pandemic where COVID-19 itself induces hyperglycemia non clostridial gas gangrene may arise due to altered immunity. We present a case of non clostridial gas gangrene of lower limb in a middle aged person who was not a known diabetic. A brief case report with review of literature is presented.

Consumer Behavior towards Regional Eco-Labels in Slovakia

Slovakia, as part of the European Union, participates in all forms of regional development and sustainability. A transparent form of regional development and sustainability is regional labeling, which has a 10-year tradition. Our regions represent excellent potential for the development of domestic products. Acceptance of essential requirements for regional products (domestic raw materials, manual work share, respect for the environment) opens up opportunities for the labor market, promotes tourism, and increases citizens’ purchase ability, none of which are clearly demonstrable in Slovak regions. Residents of individual regions have specific approaches in relation to regional brands depending on the region studied. For the purpose of the survey, four regions of southern Slovakia (with common environmental morphology and different industrial development) were selected. Indicators of age, gender, education, monthly income, and location relative to regional product preferences were studied. The results obtained were processed by cluster analysis (as a way of segmenting consumers). An average conscious purchaser of regional products is a local productive middle-aged person with a secondary or tertiary education, either male or female, and from a more economically advanced region. The results show regional branding as a mobilizing function for connecting inhabitants and the subsequent joint presentation of regional activities.

Short- and long-term systolic blood pressure changes have different impacts on major adverse cardiovascular events: Results from a 12.5 years follow-up study

BackgroundSystolic blood pressure increased in middle-aged person contributes significantly to the risk of major adverse cardiovascular events (MACE). Meanwhile, different patterns (short- or long-term change) of SBP increase may result in differential risk and lead to differences in predictive ability. MethodsA total of 19,544 and 22,610 participants in the Fuxin Cardiovascular Cohort Study underwent measurement of SBP at 2 examinations for short- and long-term change study population. Cox proportional hazards models were used to relate future clinical outcomes with change in SBP. ResultsDuring a median follow-up period of 12.5 years, 1064 (772 stroke, 247 myocardial infarction, 528 CVD deaths) and 1316 (958 stroke, 301 myocardial infarction, 660 CVD deaths) MACE were identified during short- and long-terms SBP change, respectively. For SBP increased participants, short-term change in SBP was associated with future MACE (hazard ratio [HR]: 1.241 per 1-SD increase; 95% confidence interval [CI]: 1.146–1.344; P < 0.001), long-term change in SBP (HR: 1.218; 95% CI: 1.123–1.322; P < 0.001). For prehypertension participants, long-term changes conferred a strong impact than short-term. For hypertensive participants, short-term changes conferred a strong impact than long-term. ConclusionsHaving a SBP rise in short- or long-term both confer an increased risk of MACE and its subgroups. Furthermore, short- and long-term SBP increase patterns adds different additional information beyond one single baseline examination. Change in SBP may be a prognostic surrogate marker and future studies are needed to clarify the possible mechanism for predicting MACE.

Dissimilarities Between Illusion And Reality In Herzog By Saul Bellow

Mosses Herzog is a disappointed middle-aged person. He always led his life in illusion. He is expecting more from his life and wants to lead a happy life with family. But the things come to pass in his life are entirety fluctuate from his expectations. He spends the majority of his life time in illusion only. He has two wives and he predictable more affection and love from them, he disillusioned when he not get his expectations from them. At one stage he planned to murder his former wife. The protagonist, Professor Mosses Herzog has a tendency to write letters that will never be sent to the famous, the dead, his friends, and his family. A prolific Nobel Laureate Saul Bellow inspected the Moses mind with his unpublished letter. The writer exhibits the dissimilarity linking the expectations and reality of the protagonist life with his notable work Herzog.