Two-year Study Research Articles

Two-Year Retrospective Study of Cataract Surgery and Schlemm Canal Hydrus Microstent in Black and Afro-Latino Patients.

The Hydrus Microstent has been shown to be efficacious in the treatment of Open-angle Glaucoma. We previously reported 1-year results of the Hydrus Microstent in Black and Afro-Latino patients. Here we report two-year results of the Hydrus Microstent in Black and Afro-Latino patients with mild to moderate open-angle glaucoma. This was a retrospective, nonrandomized study that was carried out at two private practices in Harlem, NY and Queens, NY. This study consisted of Black and Afro Latino patients who had a Hydrus Microstent implanted for the treatment of glaucoma. The evaluated parameters were intraocular pressure (IOP), reductions in the number of medications, mean deviation on visual field test and visual acuity. We excluded persons with advanced glaucoma and incomplete data. We included those with mild to moderate glaucoma and had complete two-year follow-up data. The study consisted of 86 patients and 86 eyes. The mean age was 69.The mean pre-op IOP was 14.1 on 2.17 medications. At two years the mean IOP was 14 (p = 0.651) on 0.42 medications (p = 0.000003); 88% of patients were medication free (p = 0.651), The MD on the visual field changed little from -5.73 preoperatively to -5.21 at two years. There were 3 intraocular pressure spikes and 1 case of hyphema that were treated and had complete resolution. No patients required secondary surgery. Our results show that at two years the Hydrus Microstent can maintain low intraocular pressures, reduce medication burden and, in aggregate, experienced little change in visual field Mean Deviation in Black and Afro Latino patients with mild to moderate glaucoma.

Long-Term Outcomes of Traditional Chinese Medicine in the Treatment of Granulomatous Lobular Mastitis: A Two-Year Follow-Up Study on Recurrence and New Occurrence Rates with Analysis of Risk Factors.

Patients with clinically cured granulomatous lobular mastitis (GLM) still face a high probability of recurrence and new occurrence. To evaluate the long-term efficacy of traditional Chinese medicine (TCM) in treating GLM and to hypothesize potential risk factors for recurrence or new occurrence. A retrospective analysis was conducted on GLM patients treated with TCM at Longhua Hospital affiliated with Shanghai University of Traditional Chinese Medicine from January 2016 to July 2021. We analyzed general data, two-year recurrence and new occurrence rates, and 12 risk factors associated with recurrence or new occurrence. This cross-sectional study included 261 GLM patients with an average age at onset of 31.95 years (primarily aged 31-40). The two-year recurrence rate for GLM was 1.53%, and the new occurrence rate was 4.21%. Univariate and multivariate conditional logistic regression analyses revealed that a history of inverted nipples was associated with the risk of both recurrence and new occurrence of GLM (HR = 8.672, 5.375, P < 0.05), and menstrual irregularity was related to a higher risk of recurrence (HR = 13.172, P < 0.001). A history of inverted nipples is identified as a potential risk factor associated with the long-term recurrence and new occurrence of GLM, while menstrual irregularity is associated with recurrence. Despite this, patients with GLM undergoing TCM demonstrate low rates of long-term recurrence and new occurrence after achieving clinical cure, underscoring the effectiveness of TCM. This study lays the groundwork for a long-term effectiveness strategy to guide future GLM treatments.

Influence of composted manures and co-composted biochar on growth performance of saffron and soil nutrients under varying electrical conductivity soil conditions: A two-year field study

The stigmas of saffron (Crocus sativus L.) are known as “red gold” for being the most expensive spice of the world. This medicinal crop grows well in the regions with cold winter Mediterranean climate. However, salinity can be one of the limiting factors for its cultivation in these regions. Composted manures and their co-compost with wood-derived biochar as fertilizers in saline soil can reduce the salinity stress on saffron. In this study, the composted manures from dairy farms (FYM), sheep and goats (SG) and poultry (PM) and their co-compost with wood-derived biochar (FYM-B, SG-B and PM-B) were amended in non-saline (EC1:2 0.25 dS m−1, SOM; 9.9 g kg−1) and soil with natural slight salinity (EC1:2; 1.95 dS m−1, SOM; 30.9 g kg−1) soil for two consecutive years with the total amendment rate of 65 t ha−1 for each fertilizer. The saline soil was transported from an agricultural farm (30 km away from research field); whereas, the non-saline soil was not transported and was not cultivated before. The amendment of fertilizers and sowing of corms were conducted at the same time in the mid of August. The stigma yield in saline control soil was significantly lower than non-saline control in both cropping years. In non-saline soil, all fertilizers reduced stigma yield of first-year crop by 14–60 % (P < 0.05). No differences between treatments for the stigma yield of second year crop in non-saline and of first year crop in saline soil were observed. In saline soil, FYM and PM fertilizers increased stigma yield of second year crop by 44 % and 41 %, respectively (P < 0.05). The two-year cumulative agronomic efficiencies for nitrogen and phosphorus and the nitrogen use efficiency for leaf biomass were lower under fertilizer treatments than control in non-saline and saline soil. In non-saline soil the PM-B; whereas, in saline soil all fertilizers (except SG) increased the phosphorus use efficiency of leaves (P < 0.05). The two-year amendment of composted manures and FYM-B in non-saline soil resulted in high uptake of sodium in leaves (P < 0.05); whereas, such effect was not observed for saline soil. Almost all fertilizers increased ∼2–5 fold the concentration of bioavailable phosphorus and ∼2–3 fold the concentration of potassium in non-saline and saline soil (P < 0.05). The positive influence of fertilizers on stigma yield and PUE of leaves of second year crop was observed only for saline soil. Furthermore, contrary to the results for non-saline soil, these fertilizers did not cause an increased uptake of Na in leaves in saline soil. We attribute this effect to the high concentration of SOM and gradual decline in EC (0.94–1.71 dS m−1) over time in saline soil. The gradual improvement in yield (from negative to neutral in non-saline and from neutral to positive in saline soil) was observed over time. Amendment of fertilizers and sowing of corms at same time may be the reason for their negative influence on stigma yield in low SOM-containing non-saline soil.

Effect of Dupilumab on Radiological Remission in Patients with Chronic Rhinosinusitis with Nasal Polyp: A One Step Forward Toward Clinical Remission.

While achieving complete radiological improvement in patients with nasal polyps is often observed following surgical resection, the impact of biologic therapy, specifically dupilumab, on polyp size is an area of great interest. The objective of this study was to assess the effect of dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) by assessing nasal polyps using the computed tomography (CT) staging system, Lund-Mackay score (LMS). A two-year prospective cohort study was conducted on 29 patients diagnosed with CRSwNP and asthma and eligible for dupilumab as an add-on therapy. The study involved comprehensive assessments of patients before biologic initiation and after the study. These assessments included clinical, laboratory, and radiological evaluations. Dupilumab treatment reduces LMS across sinuses (p<0.001) and improves nasal obstruction (p=0.001). Blood eosinophil count (BEC) predicts persistent sinus obstruction, doubling the likelihood per unit increase (odds ratio: 1.67, p=0.02). BEC levels identify persistent nasal obstruction (AUC: 76%, p=0.04), with a cutoff point above 255.5 cells per microliter, revealing a sensitivity of 100% and a specificity of 42%. The probability of persistent nasal obstruction at the 20th month is 55%, regardless of prior nasal polyp surgery (p=0.41). Dupilumab led to significant radiological improvements in patients with CRSwNP, demonstrating a potential role of radiological remission, irrespective of prior nasal polyp surgery. Additionally, BEC levels may guide the likelihood of persistent nasal obstruction.

Effect of Ocular Perfusion Pressure on Incidence of Diabetic Retinopathy in Type 2 Diabetes: A Two-Year Prospective Study.

To investigate the association between mean ocular perfusion pressure (MOPP), estimated cerebrospinal fluid pressure (CSFP), and changes in diabetic retinopathy (DR) in a Southern Chinese population with type 2 diabetes (T2DM). A total of 1224 subjects from the Guangzhou Diabetic Eye Study were enrolled. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and intraocular pressure (IOP) were measured. MOPP was calculated with the formula: MOPP = 2/3 [DBP + 1/3 (SBP - DBP)] - IOP. CSFP was calculated using the formula: CSFP = 0.44 × body mass index (kg/m2) + 0.16 × DBP - 0.18 × age (years) - 1.91. Incidence, progression, and regression of DR were graded based on seven-field 45° conventional fundus photographs at baseline and during two-year follow-up examinations according to the United Kingdom National Diabetic Eye Screening Program guidelines. Higher MOPP was associated with DR incidence in the multivariate model (per 1 mm Hg increase: relative risk, 1.05; 95% confidence interval, 1.01-1.09; P = 0.02) and was not associated with DR development and DR regression in two-year follow-up of T2DM patients. However, CSFP was not associated with DR changes (incidence, progression, or regression). The higher MOPP is an independent risk factor for DR incidence among T2DM patients in a Southern Chinese cohort. Monitoring MOPP and managing blood pressure can be part of a comprehensive approach to prevent or delay the onset of DR in T2DM patients. MOPP might be an indicator for the detection of DR incidence.

Navigating dementia feeding decisions in Asia: a mixed methods study of caregivers.

Tube feeding is discouraged among older adults with advanced dementia; nevertheless, caregivers often find feeding decisions challenging to navigate. This study aims to gain a comprehensive understanding of tube feeding among community-dwelling older adults with advanced dementia in Singapore and its relationship to older adult quality of life (QoL) and caregiver psychological distress. We use a convergent mixed-methods design, synthesising analysis of qualitative caregiver interviews (n= 25) and two-year prospective, longitudinal cohort survey data (n= 215, 1018 observations). Findings from the qualitative interviews revealed caregivers' expectations of reduced QoL for older adults with feeding tubes and their own distress related to making feeding decisions and fears prompting plans to tube-feed. Sixteen percent of community-dwelling older adults with advanced dementia relied on feeding tubes during the two-year study period. Adjusting for potential confounding and using instrumental variables estimation, tube feeding was associated with reduced older adult QoL (P< .05) and increased caregiver anxiety and depression (P< .10). Consistent with expert guidelines, we found that tube feeding was associated with significantly reduced QOL among older adults living with dementia and increased distress among caregivers relative to those of older adults without feeding tubes. Despite caregivers' recognition of reduced QOL associated with older adult use of feeding tubes, many expressed angst related to feeding choices. Our findings suggest the need for decision tools to support caregivers in making informed decisions concordant with their values.

Revealing spatial and temporal patterns of residential cooling in Southern California through combined estimates of AC ownership and use

Air conditioning (AC) is an important tool for combatting the adverse health effects of heat, but its use can also drive surges of high demand for electricity. To better understand these effects, there is a need for non-intrusive methods of estimating AC access and operation. In this study, we use a novel methodology to identify residential AC ownership rates using smart meter data from 200,000 customers in Southern California, and find that 79 % of all customers in the region have AC. In contrast to previous methods, we classify AC ownership using hourly, rather than daily, electricity consumption records and directly account for the potential presence of electric heating. We then adapt and apply an algorithm to determine in which hours these households operate their AC. We estimate that the average customer runs their AC during 8.3 % of all hours in the two-year study period, but census-tract level averages range from 1 to 23 % of all hours. Lastly, we combine our estimates of AC ownership and use to analyze cooling behavior spatially and temporally, and are able to identify pockets of high cooling demand, areas lacking in access or the ability to use their AC, and potential targets for cooling-related DR programs.

Prevalence, antimicrobial resistance, and genomic characterization of Salmonella strains isolated in Hangzhou, China: a two-year study.

This study explored the molecular epidemiology and resistance mechanisms of 271 non-duplicate Salmonella enterica (S. enterica) strains, isolated mainly from adults (209/271) in a tertiary hospital in Hangzhou between 2020 and 2021. Through whole-genome sequencing and bioinformatics, the bacterial strains were classified into 46 serotypes and 54 sequence types (ST), with S. Enteritidis, S. 1,4,[5],12:i:-, and S. Typhimurium being the most prevalent serotypes and ST11, ST34, and ST19 the most common STs. The strains isolated from adults were primarily S. Enteritidis (59/209), while from children were mainly S. 1,4,[5],12:i:- (20/62). Worryingly, 12.55% strains were multi-drug resistant (MDR), with resistance rates to cefepime (FEP), ceftazidime (CAZ), ceftriaxone (CRO) and cefotaxime (CTX) of 7.38%, 9.23%, 15.87% and 16.24%, respectively, and resistance rates to levofloxacin (LEV) and ciprofloxacin (CIP) of 8.49% and 19.19%, respectively. It is worth noting that the resistance rates of CRO and CTX in children reached 30.65%. A total of 34 strains carried extended-spectrum β-lactamase (ESBL) genes, dominated by blaCTX-M-65 (13/34) and blaCTX-M-55 (12/34); it is notable that one strain of S. Saintpaul carried both blaCTX-M-27 and blaCTX-M-55. The resistance mechanism to cephalosporins was mainly due to ESBL genes (20/43), and other genes included AmpC and β-lactamase genes. The strains resistant to quinolones mainly carried qnrS1 (27/53), and others included qnrB6, aac(6')-Ib-cr, and mutations in gyrA and parC. One strain did not carry common quinolone resistance genes but had a parC (p.T57S) mutation to cause CIP resistance. This research provides vital insights into the molecular epidemiology and resistance mechanisms of clinical S. enterica, implicating possible infection control strategies.

Urinary Stone Formation and Testosterone Supplementation: Insights from a Cross-sectional Study in Athletes

Introduction: The use of exogenous testosterone has become increasingly prevalent in sports fields, raising concerns about its potential risks and benefits. Methods &amp; Materials: This study aimed to investigate the effects of testosterone supplementation on stone formation in the urinary tract and urine composition. A total of 1080 athletes participated in a two-year cross-sectional study, with 495 individuals receiving testosterone supplementation and 585 individuals serving as non-users. Blood and urine samples were collected, and CT scans were performed to assess stone presence. Results: The results revealed a significant increase in crystalluria among testosterone users compared to non-users (38.2% vs. 2.7%, p=0.004). Imaging findings also showed a higher incidence of abnormal results in testosterone users (25.2% vs. 4.3%, p=0.0017), with kidney calcification, pelvic and calyceal stones, ureteral stones, and bladder stones observed. Conclusion: However, further metabolic studies are required to establish a definitive cause-and-effect relationship between testosterone use and stone formation. This study sheds light on the potential risks associated with exogenous testosterone use and highlights the need for evidence-based recommendations in sports and athletic performance.

Infauna evolution of the invertebrate community after a severe eutrophic crisis in the coastal lagoon of the Mar Menor (W Mediterranean)

The coastal lagoon of the Mar Menor (SE Spain) has undergone a critical transformation in the last decade due to a dramatic eutrophication crisis, primarily as a direct consequence of very-intensive agriculture along the adjacent coast. This has compromised the ecosystem balance, resulting in irreversible impacts such as the proliferation of macro and microalgae, biodiversity loss, and the formation of dead zones. The Mar Menor's resilience has been tested, showing serious environmental degradation evidenced by a significant shift in ecological state around 2016. During a two-year study period (2017–2018), 25 taxa belonging to 5 phyla were identified, with the phylum Annelida (class Polychaeta) being the best represented, followed by the phylum Mollusca. Initially, the benthic fauna was dominated by species tolerant to hypoxia, such as polychaetes. Over time, other species that can withstand slightly less eutrophication have also emerged and integrated with the polychaetes, indicating a complex dynamic in response to environmental changes.

Blooming Phenograms, Pollen Production, and Pollen Quality during Storage of Pistachio Cultivars in New Mediterranean Growing Areas.

Pistachio (Pistacia vera L.) is a dioecious, anemophilous, and drought-resistant fruit tree species. It is cultivated in new Mediterranean areas, including the regions of southern Italy (Apulia and Basilicata). It has been estimated that over 40,000 ha are suitable for pistachio cultivation in areas infected by Xylella fastidiosa subsp. pauca. As a newly introduced species, knowledge of its biological reproductive behaviors in its new areas of spreading is essential for appropriate agronomic planning and management. This two-year study (2022 and 2023), carried out in the countryside of Stigliano (MT, Italy), had the objective of evaluating the flowering phenograms, pollen production, and assessing protocols for the conservation and extension of pollen viability, of the most widespread cultivars. A slight delay was observed in the blooming phenograms, compared to other cultivation Mediterranean areas, such as Spain or Sicily. Furthermore, the overlap between female and male phenograms was partial. No significant differences were observed in the polliniferous aptitude of the two male cultivars. Among the different protocols tested, the pollen storage at 33% relative humidity and a temperature of -80 °C maintained the pollen germinability above 50% for up to three weeks. These findings highlight the importance of controlled environmental conditions in preserving pollen viability over extended periods, providing valuable insights for agricultural and botanical research that relies on maintaining pollen viability for breeding and genetic studies.

Pain catastrophizing negatively impacts drug retention rate in patients with Psoriatic Arthritis and axial Spondyloarthritis: results from a 2-years perspective multicenter GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica) study

BackgroundChronic pain and inflammation are common features of rheumatic conditions such as Psoriatic Arthritis (PsA) and Axial Spondyloarthritis (axSpA), often needing prolonged medication treatment for effective management. Maintaining drug retention is essential for both achieving disease control and improving patients' quality of life. This study investigates the influence of pain catastrophizing, a psychological response to pain, on the drug retention rates of PsA and axSpA patients.MethodsA two-year prospective multicenter observational study involved 135 PsA and 71 axSpA patients. Pain Catastrophizing Scale (PCS) was employed to assess pain catastrophizing. Univariable and multivariable regression analyses were utilized to identify factors associated with drug retention.ResultsIn the PsA group, patients early discontinuing therapy showed higher baseline disease activity as well as higher incidence of comorbid fibromyalgia. Notably, pain catastrophizing, specifically the domains of Helplessness, Magnification, and Rumination, were significantly elevated in PsA patients who interrupted the treatment. Multivariable analysis confirmed pain catastrophizing as an independent predictor of drug suspension within two years.In axSpA, drug discontinuation was associated with female gender, shorter disease duration, higher baseline disease activity as well as elevated levels of pain catastrophizing. Univariable analysis supported the role of pain catastrophizing, including its domains, as predictors of treatment interruption. However, limited events in axSpA patients precluded a multivariate analysis.ConclusionThis prospective study emphasizes the impact of pain catastrophizing on drug retention in patients with PsA and axSpA.

Genotype × Environment Interaction for Grain Yield and Its Component Traits in Wheat (Triticum aestivum L.) for Varietal Recommendations in Meghalaya State of India

The study aims to evaluate the stability of fifteen wheat (Triticum aestivum L.) genotypes under varying sowing dates to identify genotypes with superior grain yield and stability in the North Eastern Region of India. The study also seeks to assess G×E using the Eberhart and Russell model and the AMMI model, to recommend suitable genotypes for cultivation in this region. This is a two-year field study conducted during the rabi seasons of 2017-18 and 2018-19. Fifteen genotypes were sown on six different dates including E1 (27th Oct. 2017-18), E2 (6th Nov. 2017-18), E3 (16th Nov. 2017-18), E4 (27th Oct. 2018-19), E5 (6th Nov. 2018-19), and E6 (16th Nov. 2018-19) to evaluate the stability of these genotypes. This experiment was performed in Randomized Block Design (RBD) with three replications. All genotypes exhibited significant differences across the studied environments. The genotype-environment interaction was significant for most traits except days to 50% crop emergence, test weight, and harvest index. RAJ-3765 and HD-2985 were identified as high-yielding and stable genotypes across all environments, while HD-3118 and HD-2733 performed well in favorable conditions. The AMMI analysis revealed that HD-2985 and RAJ-3765 were the most stable, and WR-544 was the poorest performer. Genotypes RAJ-3765 and HD-2985 showed superior stability and yield across diverse environments, making them suitable for broader cultivation in Meghalaya. HD-2733 and HD-3118 were better suited for favorable environments, while WR-544 was the least adapted. These findings suggest the potential for expanding wheat cultivation in the region using these stable genotypes.

Venezuelan migration to Brazil: teachers and students co-constructing multicultural education inside classrooms

PurposeThis study aims to show the complexities of engagement between students - Venezuelan and Brazilian - and their teachers. This qualitative ethnographic study documents the everyday pedagogies and practices that take place in elementary schools with high levels of refugee and immigrant children. While Brazilian law ensures the basic right to public education, forbidding discrimination based on nationality or immigration status (Lei de Diretrizes e Bases da Educação, 1996), the barriers remain. Through the frameworks of multicultural (USA) and intercultural (Brazil) education, this paper shows how Brazilian teachers and students of Venezuelan and Brazilian backgrounds engage, learn from one another and build welcoming spaces, but also how stereotypes are reinforced inside classrooms and schools.Design/methodology/approachThis qualitative study uses ethnography to understand how recent Venezuelan migratory flow influences Brazilian and Venezuelan children’s educational experiences in elementary education. Participants were Venezuelan (N = 57) and Brazilian (N = 76) children in two elementary schools in the city of Boa Vista. Data sources for the study are school observations in four elementary classrooms (1st and 2nd grade) and semi-structured interviews with caregivers, teachers, administrators and other educators. This paper also collected children’s drawings and writings and documents like curricula, strategic planning, guidelines, policies, grades, reports and any other textual or photographic material made available at the city level.FindingsIn the field of education, there is a critical need for understanding children’s education experiences. This paper focuses on the experiences of teachers and students in two elementary schools in Brazil. This paper focus on two findings: first that teachers promote the learning of Portuguese to show care toward their Venezuelan students. Second, children in the classroom show solidarity with one another and resist some of the more rigid Portuguese-only practices enacted by teachers. This work uses the frameworks of intercultural (more commonly used in Brazil) and multicultural education to inform the analysis.Research limitations/implicationsIn this study, this paper puts these frameworks of interculturalism, multiculturalism, language use and solidarity into conversation to understand the dynamics of two elementary classrooms in the city of Boa Vista, Brazil. While this paper shows the shortcomings of a seemingly multicultural and multilanguage classroom, it also shows how children actively resist the rigidity of teaching and learning in elementary schooling.Originality/valueThis study is a response both to the increasing South–South migration trend in Latin America and its consequences on public education systems. Through multicultural and intercultural lenses, this research highlighted the complexity of interactions within multicultural classrooms by delving into a two-year ethnographic study conducted in Boa Vista, Brazil, focusing on Venezuelan and Brazilian children in two local elementary schools. This paper focused on two main observations this paper refers to as “Teaching Portuguese as a Way of Caring” and “Children's Solidarity Work.” Teachers primarily centered their instruction on teaching Portuguese to migrant children, believing it to lead to quicker integration in the classroom and beyond – thus as a way of caring for their migrant students.

Greenhouse Gas Fluxes from Cranberry and Highbush Blueberry Plantations on Former Peat Extraction Fields Compared to Active Peat Extraction Fields and Pristine Peatlands in Latvia

Emissions of carbon dioxide (CO2), nitrous oxide (N2O), and methane (CH4), particularly those from organic soils, need to be reduced in the context of climate change mitigation (CCM). Here, we estimated the greenhouse gas (GHG) fluxes from nutrient-poor organic soils in cranberry (Vaccinium macrocarpon) and highbush blueberry (Vaccinium corymbosum) plantations established on former peat extraction fields compared to active peat extraction fields and pristine raised bogs in Latvia. A two-year study (2016–2018) was conducted using the manual closed chamber method. In berry plantations and active peat extraction fields, annual net CO2 fluxes contributed the most to total GHG emissions, accounting for over 67%, and temperature had the most significant impact on CO2 fluxes. Conversely, annual CH4 fluxes were the primary contributor to total net GHG emissions in the pristine raised bog, which simultaneously acted as a slight CO2 sink. N2O fluxes were relatively low among all studied land use types. This study provided quantitative insights into the variation in GHG fluxes and the environmental variables influencing them, and the obtained data are valuable to estimate the impact of the establishment of berry plantations on former peat extraction fields on CCM in the hemiboreal region of Europe.

Principals’ Use of Leadership Metaphors in Three Urban Junior High Schools in Taiwan

Principals utilize leadership metaphors to guide teachers in implementing educational, curriculum, and institutional/structural change. This study explores how principals employ metaphors to drive school change and presents a two-year qualitative case study of three urban junior high schools in Taiwan. During the first year, the researcher observed and participated in school meetings, collecting documents and data from the perspectives of principals, teachers, and parents. In the subsequent year, in-depth interviews were conducted with three principals. The findings demonstrate that principals who incorporate metaphors into their collective sense-making processes in leadership can facilitate social change and foster innovation in education.

Association between polypharmacy and 2-year outcomes among Chinese older inpatients: a multi-center cohort study

BackgroundThe escalating global prevalence of polypharmacy presents a growing challenge to public health. In light of this issue, the primary objective of our study was to investigate the status of polypharmacy and its association with clinical outcomes in a large sample of hospitalized older patients aged 65 years and over.MethodsA two-year prospective cohort study was carried out at six tertiary-level hospitals in China. Polypharmacy was defined as the prescription of 5 or more different medications daily, including over-the-counter and non-prescription medications. Baseline polypharmacy, multimorbidity, and other variables were collected when at admission, and 2-year outcomes were recorded by telephone follow-up. We used multivariate logistic regression analysis to examine the associations between polypharmacy and 2-year outcomes.ResultsThe overall response rate was 87.2% and 8713 participants were included in the final analysis. The mean age was 72.40 years (SD = 5.72), and women accounted for 42.2%. The prevalence of polypharmacy among older Chinese inpatients is 23.6%. After adjusting for age, sex, education, marriage status, body mass index, baseline frailty, handgrip strength, cognitive impairment, and the Charlson comorbidity index, polypharmacy is significantly associated with frailty aggravation (OR 1.432, 95% CI 1.258–1.631) and mortality (OR 1.365, 95% CI 1.174–1.592), while inversely associated with readmission (OR 0.870, 95% CI 0.764–0.989). Polypharmacy was associated with a 35.6% increase in the risk of falls (1.356, 95%CI 1.064–1.716). This association weakened after adjustment for multimorbidity to 27.3% (OR 1.273, 95%CI 0.992–1.622).ConclusionsPolypharmacy was prevalent among older inpatients and was a risk factor for 2-year frailty aggravation and mortality. These results highlight the importance of optimizing medication use in older adults to minimize the risks associated with polypharmacy. Further research and implementing strategies are warranted to enhance the quality of care and safety for older individuals exposed to polypharmacy.Trial registrationChinese Clinical Trial Registry, ChiCTR1800017682, registered 09/08/2018.

Association of open skill exercise and long-chain polyunsaturated fatty acid intake with brain volume changes among older community-dwelling Japanese individuals

Considering that a multifactorial lifestyle approach may prove more effective than a single factor approach to improve or maintain brain health, we evaluated the association of exercise (open skill exercise [OSE] or closed skill exercise [CSE]) combined with long-chain polyunsaturated fatty acid (LCPUFAs) (docosahexaenoic acid [C22:6n-3, DHA], eicosapentaenoic acid [C20:5n-3, EPA], and arachidonic acid [C20:4n-6, ARA]) intake with brain atrophy among older Japanese individuals (n = 795, aged 60–88 years) without a self-reported history of dementia based on the datasets of a two-year longitudinal study. Brain volumes were measured using three-dimensional T1-weighted brain magnetic resonance imaging for follow-up periods of two years. The associations between multivariate-adjusted changes in brain volumes and OSE or CSE frequency (≥ once/month and < once/month) along with LCPUFA intake (≥ median and < median) at the baseline were assessed using a general linear model. Subgroup analysis was performed by restricting DHA and EPA intakes (n = 263; median, 323 mg/d), which represented levels similar to those in countries with low fish consumption. Higher OSE frequencies, ARA intakes, and their combination were inversely associated with decreases in total gray matter and frontal cortex volumes. In subgroup analysis, a combination of higher OSE frequencies and DHA intakes was also associated with a smaller decrease in total gray matter volume. Overall, our findings suggest that regular OSE engagement and appropriate LCPUFA intake may contribute to preventing brain volume decreases in older individuals.

Court-ordered forensic psychiatry treatment in prison: determinants of outcome and risk mitigation.

Court-ordered forensic psychiatry treatments (COT) are specifically designed to reduce the risk of violence in mentally disordered offenders. Given their high costs and ethical issues, mental health professionals need admission criteria to be able to select those candidates with optimal benefit. This study analyses offender-related and treatment-related determinants of COT outcome and risk mitigation. This two-year longitudinal study assessed the evolution of 117 adult offenders admitted to a specialized medium-security forensic psychiatry clinic. Treatment outcome included court-ordered discharge locations and the Historical Clinical Risk Management (HCR) score evolution. Treatment progress was assessed every six months across five time-points including measures of protective factors, work rehabilitation and security. Outcome determinants included psychiatric diagnosis and type of offence. Discharge locations are predicted by pre-treatment risk level. Lower HCR scores are associated with discharge into low-security psychiatry wards independently of the psychiatric diagnosis. Risk reduction follows diagnosis-specific and offense-related patterns and reveals that mentally disordered offenders with Cluster B personality disorders or those sentenced for drug crimes are significantly less prone to benefit from COT. Our findings indicate that criminological characteristics at baseline as well as diagnosis of personality disorders are the main determinants of treatment outcome in our care setting. Inmates with concomitant higher violence risk at baseline and presence of Cluster B personality disorders might benefit the least from court-ordered forensic inpatient psychiatric care in prison.

Effect of Chinese Milk Vetch on Zinc Content and Zinc Absorption of Rice in Purple Tidal Mud Soil

Rice is a staple food crop that feeds billions globally. Addressing Zn deficiency in rice is crucial for improving nutrition and food security. Zn deficiency in rice is a widespread issue, especially in purple tidal mud substrates, which often exhibit low Zn availability. The objective of this two-year pot study was to explore the relationship between Zn content, yield components, and Zn absorption in rice grown in purple tidal mud substrate with varying amounts of Chinese milk vetch (Astragalus sinicus L.) incorporation. The experimental design consisted of seven treatments: an unfertilized control, a Chinese milk vetch control, a chemical fertilizer control, and four treatment variations incorporating Chinese milk vetch alongside chemical fertilizer applications. The results indicated that planting and applying Chinese milk vetch improved the grain yield of rice in purple tidal mud substrate, and the yield increased with higher levels of Chinese milk vetch applied. The increased grain yield resulted in higher Zn absorption in rice grains. The application of Chinese milk vetch, both solely and in combination with chemical fertilizers, had varying effects on zinc uptake and grain zinc formation efficiency in early and late rice, with the control and low-level Chinese milk vetch treatments generally exhibiting the highest performance across the two-year period. By introducing Chinese milkvetch following the use of chemical fertilizers, the Zn content in rice grains increased starting from the second year. The treatment with Chinese milkvetch applied at a rate of 2.25 t/hm2 showed the best results in increasing the Zn content in rice grains. The increase in Zn content and Zn uptake by the rice plants gave rise to a lowering of the DTPA-extractable Zn content in the purple tidal mud substrate. Sole Chinese milk vetch application and using Chinese milk vetch following chemical fertilizer application both increased Zn content extracted by DTPA in purple tidal mud substrate.