Risk of total knee replacement after proximal tibia fracture: a register-based study of 7,841 patients

Background and purpose — Post-traumatic knee osteoarthritis following proximal tibia fracture (PTF) is a common complication that may lead to total knee replacement as secondary treatment (TKRS). We determined the risk of TKRS following PTF, whether treated nonoperatively or operatively, and compared the results with a 38-fold control group without prior PTF. Patients and methods — We identified all patients over 18 years of age in Finland with PTF treated during the period 2009–2018 from the Finnish Hospital Discharge Register (FHDR) and Finnish Arthroplasty Register (FAR). Age, sex, treatment method, follow-up time, and possible TKRS were recorded. Results — 7,701 patients were treated for PTF during the period 2009–2018. Over the 5.1-year (SD 3.1) follow-up, TKRS was performed in 340 (4.3%) patients with a prior PTF after a mean of 2.1 (SD 2.0) years post-fracture. TKRS was needed in 138 (3.7%, HR 1.8) patients in the nonoperatively treated group and in 202 (5.0%, HR 3.2) patients in the operatively treated group. Operative treatment, female sex, and high age were identified as risk factors for TKRS. The incidence of TKRS was highest during the first 2 years after fracture and remained elevated throughout the follow-up. Interpretation — Patients with a prior PTF had a 1.8- to 3.2-fold higher risk of TKRS compared with controls during the first 5 years post-fracture. Risk of TKRS was associated with an operatively treated PTF, female sex, and high age. The patients in the operative group likely sustained more complex fractures, while female sex and age may be explained by more osteoporotic bone quality.

Profile of the Local Residents and Visitors of the Historical Villages of a Portugal Network

This chapter presents the results of the exploratory study regarding the profile of local residents and visitors of the Historical Villages of Portugal Network (nHVP). This network integrates 12 villages located in low density territories in the center of Portugal. It is important to conduct this study in order to conceive strategies and policies that will contribute to reversing the desertification tendency and to retaining resources and surpluses that would otherwise leave the region. The authors concluded that the local residents present a medium/high level of satisfaction in terms of the impact of tourism in their villages and also with the association of their village with the nHVP brand. However, the local residents' participation in the activities and touristic events is low, which is in part due to the high age of most local residents. Regarding the visitors of the nHVP, they are generally satisfied or very satisfied with several points. The lowest level of satisfaction relates to the public transportation, the communication networks, and the medical care available in the territory.

Birth of the Society of Divorees – Changing Patterns of Civil Status in Later Life

Half a century ago Lopata used the concept “society of widows” to describe the gendered reality of late life singlehood, where widowed women were excluded from coupled social life, depended on a community of other widows for social integration, and refrained from initiating new relationships due to “sanctification” of their former husbands. We use Swedish, American and EU census data and a national survey to Swedes 60-90 years old (n=1225; response rate 42%) to illustrate a substantial change in the demographic landscape of late life singlehood. More people enter later life as divorcees or become divorced at a high age. Among Swedes 60+ divorcees outnumber widowed people, and the incidence of late life divorce has more than doubled since the millennium in what has been called the “grey divorce revolution”. Many other Western countries follow the same demographical trend, posing important questions about the transformation of late life singlehood. Based on two Swedish studies we will show that the structure of the late life single community is becoming less gender skewed as a consequence of the emerging society of divorcees, and that in this society relationship careers are increasingly complex, attitudes to repartnering increasingly liberal and partner sanctification seldom an issue. We conclude by proposing the concept “society of divorcees” for this new demographic landscape of late life singlehood, argue that research is needed to capture this new reality, and discuss the implications of this change for access to social support later life.

Risk factors for the development of bronchiectasis in patients with asthma

Though asthma and bronchiectasis are two different diseases, their coexistence has been demonstrated in many patients. The aim of the present study is to compare the characteristics of asthmatic patients with and without bronchiectasis and to assess risk factors for the development of this condition. Two hundred and twenty-four moderate-severe asthmatic patients were included. The severity of bronchiectasis was assessed by Reiff and FACED parameters. Logistic regression was used to identify independent factors associated with bronchiectasis. Bronchiectasis was identified in 78 asthma patients. In severe asthma patients, its prevalence was 56.9%. Bronchiectasis was defined as mild in81% of patients using modified Reiff criteria and in 74% using FACED criteria. Asthmatic patients with bronchiectasis had decreasing FEV1, FVC and FEV1/FVC (p = 0.002, 0.005 and 0.014 respectively), presented more frequent asthma exacerbations (p < 0.001) and worse asthma control (ACT 21 vs 16pts, p < 0.001). Factors independently associated with bronchiectasis were older age (42–65 years: OR, 3.99; 95% CI 1.60 to 9.95, P = 0.003; ≥ 65 years: OR, 2.91; 95% CI 1.06 to 8.04, P = 0.039), severe asthma grade (OR, 8.91; 95% CI 3.69 to 21.49; P < 0.001) and frequency of asthma exacerbations (OR, 4.43; 95% CI 1.78 to 11.05; P < 0.001). In patients with severe asthma, age of asthma onset (OR, 1.02; 95% CI 1.01 to 1.04; P = 0.015) and asthma exacerbations (OR, 4.88; 95% CI 1.98 to 12.03; P = 0.001) were independently associated with the development of bronchiectasis. The prevalence of bronchiectasis in severe asthmatic patients is high. Age of asthma onset and exacerbations were independent factors associated with the occurrence of bronchiectasis.

Differences in Uveal Melanoma Age-Standardized Incidence Rates in Two Eastern States of Australia Are Driven by Differences in Rurality and Ultraviolet Radiation

Uveal melanoma (UM) is the second-most-common melanoma in humans and has a high age-standardized incidence rate (ASR) in Australia. Regional patterns of UM ASRs in Australia are unknown. The aim of this study was to determine and compare UM ASRs in two geographically disparate eastern states, Queensland (QLD) and Victoria (VIC), by using cancer registry data that was obtained from 2001 to 2013. World-standardized UM ASRs and incidence-rate ratios (IRRs) were calculated. Higher UM ASR was also observed in anterior UM compared to posterior UM ASR. UM ASR remained unchanged from 2001 to 2013 in QLD but decreased in VIC. A south-to-north latitude trend in UM ASR along the east of Australia is weakly evident, and rural populations have higher UM ASRs than major city populations in both states. Differences in ultraviolent radiation (UVR) susceptibility, indigenous populations, social behaviours, chemical exposure, and socioeconomic status could all be contributing to differences in UM rates between QLD and VIC and between rural compared to major city areas. It is possible that a minority of cases in QLD and VIC might be prevented by sun-protective behaviours. This is important, because these findings suggest that QLD, which is already known to have one of the highest cutaneous melanoma (CM) ASRs in the world, also has one of the highest UM ASRs.

Classification of Factors Effect on Sleep in Individuals with Down Syndrome

Background: Sleep disordered breathing (SDB) is a frequent disorder with serious adverse health consequences in people with Down syndrome (DS). This study aims to evaluate and classify sleep and physical activity (PA) characteristics in adults with DS. Methods: Forty participants with DS wore an accelerometer for seven consecutive days to measure physical activity and sleep–wake patterns. The corresponding data were also obtained by survey and polysomnography. The apnea-hypopnea index (AHI) is calculated from the number of apneas and hypopneas per hour of sleep according to international guidelines. Results: Polysomnography showed SDB based on AHI in 95% of adults: 50% had severe SDB, 22.5% presented moderate and 22.5% mild SDB, predominantly in males. They had poor sleep quality (80.1%) and low PA levels. Using statistical classification methods, we observed three clusters with two opposite profiles. Clusters 2 and 3 showed low PA indices (daily steps: 5719 and 5310, respectively) and severe SDB (AHI = 33.6 and 55.5 events/h), high age and high gonial angle. Cluster 1 showed high PA (mean count of daily steps: 6908) and mild to moderate SDB (AHI = 16.8 events/h), low age and low gonial angle. Conclusions: Our findings suggest that there are different profiles (age, gender, obesity, gonial angle) that are associated with SDB in adults with DS. These results suggest that this may represent important factors to consider when planning health promotion and prevention.

High regional mortality due to malignant melanoma in Eastern Finland may be explained by the increase in aggressive melanoma types

Background A regional skin cancer prevention program in Eastern Finland revealed a relatively high age-standardized mortality due to malignant melanoma during 2013–2017. An explanation for this is needed. Purpose To analyse the 543 melanoma samples in 524 subjects collected during 2000–2013 at Kuopio University Hospital and reposited in the Biobank of Eastern Finland. A focus was directed to factors related to metastasis. Methods The samples were analysed anonymously by examining the histopathological report, referral text and the list of diagnoses. A possible state of immunosuppression was evaluated. Results The mean age at the diagnosis of malignant melanoma (MM), lentigo maligna (LM) and melanoma in situ was relatively high, i.e., 66.2, 72.1 and 63.3, respectively. Especially the MM type increased markedly during 2000–2013. In further analyses of a representative cohort of 337 samples, the proportion of nodular melanoma and LM/LMM melanoma was relatively high, 35.6 and 22.0%, respectively, but that from superficial spreading melanoma relatively low (33.8%). Metastasis correlated with immunosuppression, male gender, Clark level, Breslow thickness, ulceration, mitosis count, invasion into vessels and/or perineural area, microsatellites, melanoma subtype, body site, recidivism, and the absence of dysplastic nevus cells. Conclusion The marked increase in aggressive melanomas with associated metastasis, and the relatively high age at diagnosis, can partially explain the mortality.

Analysis of Trend and Associated Factors of Neuropsychological Development of Infants and Toddlers Based on Longitudinal Data

Objective: To explore the trend and associated factors of neuropsychological development of infants and toddlers in China. Methods: A longitudinal study was conducted among 619 infants and toddlers (2914 person-times) aged 0 to 36 months from different provinces or cities in China from January 2013 to December 2019. Results: The development age of each area increased with the extension of follow-up time, but this upward trend slowed down with physiological age at first measurement increasing. Among a low age group and each area, most of the development qualification rates in different follow-up periods were higher than that in the baseline (p < 0.05); however, many of them were not higher than that in the baseline among the medium or high age group (p > 0.05). For the areas of gross motor and self-care, the growth of qualification rate with the extension of follow-up was not obvious in the medium and high age group (both p trend > 0.05). Some impact factors of development in all areas were identified. Conclusions: The neuropsychological development delay of various areas of infants and toddlers, especially that of gross motor and self-care, should be paid early (within 1 years old) and constant attention. The impact of gender and maternal age on the development of young children has been further confirmed in the present study.

Estimating the Risk of Chemotherapy Toxicity in Indian Geriatric Patient Population and Utility of Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) Score

Background Aging is a heterogeneous process, and elderly population is diverse in health status and functional reserve. The present study was undertaken to predict severe chemotherapy toxicity using the Chemotherapy Risk Assessment Scale for High-Age Patients’ (CRASH) score. Materials and Methods Elderly patients (age ≥65 years) with malignancy, who were planned to be treated with a new course of cytotoxic chemotherapy, were enrolled. The CRASH score was calculated, and patients were stratified into four categories, that is, low (0–3), intermediate (Int)-low (4–6), Int-high (7–9), and high (<9). Patients developing grade 3/4/5 nonhematologic (NH) or grade 4/5 hematologic (H) toxicity were taken as the development of severe toxicity. Results Of 100 enrolled patients, 64 (64%) were able to complete their prescribed treatment. Forty-four percent of patients (44 patients) of our study cohort experienced grade-4 H or grade 3/4 NH toxicity. The highest score in each category (heme/nonheme/CRASH) predicts nearly 100% toxicity risk. At a critical value of CRASH ≥ 6.5, the sensitivity is calculated as 100%, while specificity is 89.09%. The accuracy of prediction is 93.88%. The median time taken to develop toxicity was 39.5 days. Conclusion CRASH score utilizes clinical assessment and basic laboratory values. Yet, it accurately predicts severe chemotherapy toxicity above a critical value of 6.5. Based on the above study, the first 30 days are crucial as 45% of patients experienced toxicity in this time frame. With the help of these clinical predictive markers, the care of elderly will be optimized.

Epigenetic clock and methylation studies in cats

Human DNA methylation profiles have been used successfully to develop highly accurate biomarkers of aging (“epigenetic clocks”). Although these human epigenetic clocks are not immediately applicable to all species of the animal kingdom, the principles underpinning them appear to be conserved even in animals that are evolutionarily far removed from humans. This is exemplified by recent development of epigenetic clocks for mice and other mammalian species. Here, we describe epigenetic clocks for the domestic cat (Felis catus), based on methylation profiles of CpGs with flanking DNA sequences that are highly conserved between multiple mammalian species. Methylation levels of these CpGs are measured using a custom-designed Infinium array (HorvathMammalMethylChip40). From these, we present 3 epigenetic clocks for cats; of which, one applies only to blood samples from cats, while the remaining two dual-species human-cat clocks apply both to cats and humans. We demonstrate that these domestic cat clocks also lead to high age correlations in cheetahs, tigers, and lions. It is expected that these epigenetic clocks for cats possess the potential to be further developed for monitoring feline health as well as being used for identifying and validating anti-aging interventions.