Patterns of aged care use among older Australian women: A prospective cohort study using linked data

BackgroundWomen live longer than men and have an increased need for long-term care. The objective of this study was to identify patterns of aged care use among older Australian women and to examine how these patterns were associated with their demographic and health-related characteristics.MethodsThe sample consisted of 8768 women from the 1921–1926 birth cohort of the Australian Longitudinal Study on Women’s Health (ALSWH), who had survived to age 75-80 years. ALSWH survey and linked administrative aged care and death datasets from 2001 to 2011 were utilized. Patterns of aged care use were identified using a repeated measure latent class analysis.ResultsWe identified four patterns of aged care use over time, differentiated by timing of service onset, types of service use and time of death. Approximately 41% of the sample were non-users or using basic home and community care (HACC), while 24% were at high risk of using moderate to high-level HACC/community aged care package (CACP). Only 11% had a greater risk of using residential aged care (RAC) over time. Being widowed, residing in remote/regional areas, having difficulty in managing income, having a chronic condition, reporting poor/fair self-rated health, and lower SF-36 quality of life scores were associated with an increased odds of being a member of the following classes: 1) moderate to high-level HACC/CACP, 2) increasing RAC, and 3) early mortality, compared with the non-user class.ConclusionsDistinct patterns of aged care use were identified. These results will facilitate future capacity planning for aged care systems in Australia.     

Considerations and priorities for incorporating the patient perspective on remission in rheumatoid arthritis: An OMERACT 2020 special interest group report

ObjectiveTo determine how best to incorporate the patient perspective into rheumatoid arthritis remission criteria.MethodsAt OMERACT 2020, several studies, including a longitudinal multi-centre study testing the validity of adding patient-valued domains to the ACR/EULAR criteria, were presented and discussed by the virtual Special Interest Group.ResultsOverall consensus was that there is insufficient evidence to change the remission criteria at this point. Future work should focus on measurement of the new domain of independence, clarifying the value of the patient global assessment, and optimizing the input of domains that patients value in the criteria.ConclusionIncorporating the patient perspective into remission criteria should be further explored.     

The relationship between cognition and depressive symptoms,and factors modifying this association,in Alzheimer’s disease: A multivariate multilevel model

ObjectivesTo examine whether there was a bidirectional association between cognition and depressive symptoms in Alzheimer’s disease (AD), and to explore the role of socio-demographic factors and daily performance in this association.MethodsWe conducted a longitudinal study of 104 community-dwelling patients with confirmed AD from Taiyuan, China. We assessed cognition and depressive symptoms (dependent variables) with the Montreal Cognitive Assessment (MoCA) and the Geriatric Depression Scale-30 (GDS-30), respectively. Socio-demographic information and daily performance were treated as explanatory variables. A multivariate multilevel model was built to investigate the interrelationship between patients’ cognition and depression, as well as the effect of related factors on both outcomes.ResultsMoCA scores were negatively correlated with GDS-30 both at the subject level (correlation coefficient r₃ = −0.68, χ² = 19.26, P < 0.001) and time point level (r₂ = −0.35, χ² = 35.68, P < 0.001) in patients with AD. Multivariate analysis showed several significant factors for cognitive function, including educational level, personality, hobbies, exercise, reading, aluminum utensil use, dietary restriction and hypertension (regression coefficients: 0.60, 0.52, 0.51, 0.48, 0.45, −0.48, 0.67, and −0.74, respectively). Significant factors for depressive symptoms included family status, employment before retirement, homemaking, reading, aluminum utensil use, dietary restriction, and hypertension (regression coefficients: 3.09, −1.33, −1.62, −1.31, 0.96, −1.15, and 1.14, respectively).ConclusionThese findings indicated that cognition was negatively associated with depression in patients with AD, and both were influenced by reading, aluminum utensil use, dietary restriction, and hypertension. Considering patient factors may help to slow the progression of dementia.     

Pertactin-negative variants of Bordetella pertussis in New York State: A retrospective analysis, 2004–2013

The first report of pertactin-negative variants of Bordetella pertussis in the United States has raised questions about the role of acellular pertussis vaccines in the recent increase of pertussis cases. Our laboratory utilized a sequence-based method to identify mutations in the pertactin gene responsible for these variants and assessed vaccination status from the associated cases.     

What Proportion of Canadian Women Will Accept an Intrauterine Contraceptive at the Time of Second Trimester Abortion? Baseline Data From a Randomized Controlled Trial

ObjectiveThis report details enrolment findings related to a Canadian randomized controlled trial comparing immediate to delayed intrauterine contraception (IUC) placement after a second trimester abortion. We report acceptance of IUC, satisfaction with prior contraception, adherence to the CONSORT criteria, and challenges faced in the recruitment process.MethodsWomen seeking second trimester abortion and selecting either of two methods of IUC as their preferred contraception method were enrolled and randomized to insertion either immediately post-abortion or four weeks later. Enrolled participants completed a Contraception Satisfaction Questionnaire detailing prior contraceptive satisfaction.ResultsAmong 1813 women assessed, 1500 (83%) met eligibility criteria and IUC was chosen for post-abortion contraception by over one half of them (792/1500, 53%). When both types of device were available cost-free, women selected the levonorgestrel-releasing intrauterine system more than 20 times more frequently than a copper IUD. Participants had an average age of 26. 0 (standard deviation [SD] 6. 8) years, and an average gestational age of 16. 1 (SD 3. 1) weeks. Almost one half (48. 4%) had had a prior abortion and 46. 9% had a prior delivery. Two thirds of participants were using a contraception method at the time of conception, but almost one third of these were using methods in the lowest tiers of effectiveness. There was a weak correlation between prior contraceptive compliance and education level.ConclusionMore than one half of eligible women seeking a second-trimester abortion chose IUC for post-abortion contraception. In Canada, health care for unintended pregnancies is universally subsidized but contraception is not. Offering comprehensive information on the range of contraceptive methods and providing cost-free IUC is an effective strategy to increase uptake of intrauterine contraception among Canadian women who wish to prevent further unintended pregnancy.     

Impact of demographic,environmental, and lifestyle factors on vitamin D sufficiency in 9084 Japanese adults

BackgroundLittle is known about correlates of vitamin D status in Asian populations. In this study, we established the prevalence of vitamin D sufficiency in the Murakami region (latitude N38°13′) in Niigata, Japan, and examined demographic, environmental, and lifestyle factors that might be associated with vitamin D sufficiency, with the aim of clarifying the relative contributions of previously described determinants of vitamin D status as well as identifying new determinants in this Japanese population.MethodsThis study involved a cross-sectional analysis of baseline data obtained from a cohort study conducted in 2011–2013. Participants were 9084 individuals aged between 40 and 74 years who provided blood samples for the determination of plasma 25-hydroxyvitamin D [25(OH)D] concentrations. Lifestyle information was obtained from 8498 participants, with some missing values regarding different lifestyle factors. Multiple logistic regression analysis was used to obtain odds ratios for vitamin D sufficiency, which was defined as a plasma 25(OH)D concentration ≥ 75 nmol/L.ResultsThe prevalence of vitamin D sufficiency (i.e., plasma 25(OH)D concentration ≥ 75 nmol/L) was 9.1%, and significant associations were observed with male gender (P < 0.0001; OR = 2.37, 95% CI: 1.84–3.05), older age (P for trend < 0.0001), lower BMI (P for trend < 0.0001), higher METs score (P for trend = 0.0138), higher vitamin D intake (P for trend = 0.0467), summer season (P for trend < 0.0001), longer duration outdoors (P for trend = 0.0026), no sunscreen use (P = 0.0135; OR = 1.40, 95% CI: 1.07–1.82), higher salmon consumption (P for trend < 0.0001), higher alcohol consumption (P for trend < 0.0001), and lower coffee consumption (P for trend = 0.0025). Unlike other populations previously reported, vitamin D sufficiency was associated with older age.ConclusionsThe prevalence of vitamin D sufficiency (i.e., 25[OH]D ≥ 75 nmol/L) was low (9.1%) in this Japanese population. A number of demographic, environmental, and lifestyle factors are associated with vitamin D sufficiency, and thus lifestyle modification may present an opportunity to achieve vitamin D sufficiency.