Falls,injuries from falls,health related quality of life and mortality in older adults with vision and hearing impairment-Is there a gender difference?

Background

Vision and hearing decline with age. Loss of these senses is associated with increased risk of falls, injuries from falls, mortality and decreased health-related quality of life (HRQOL). Our objective was to determine if there are gender differences in the associations between visual and hearing impairment and these outcomes.

Methods

2340 men and 3014 women aged 76–81 years from the Health in Men Study and the Australian Longitudinal Study on Women's Health were followed for an average of 6.36 years. Dependent variables were self-reported vision and hearing impairment. Outcome variables were falls, injuries from falls, physical and mental components of HRQOL (SF-36 PCS and MCS) and all-cause mortality.

Results

Vision impairment was more common in women and hearing impairment was more common in men. Vision impairment was associated with increased falls risk (odds ratio (OR) = 1.77, 95% CI = 1.35–2.32 in men; OR = 1.82, 95% CI = 1.44–2.30 in women), injuries from falls (OR = 1.69, 95% CI = 1.23–2.34 in men, OR = 1.79, 95% CI = 1.38–2.33 in women), and mortality (hazard ratio (HR) = 1.44; 95% CI = 1.17–1.77 in men; HR = 1.50, 95% CI = 1.24–1.82 in women) and declines in SF-36 PCS and MCS. Hearing impairment was associated with increased falls risk (OR = 1.38, 95% CI = 1.08–1.78 in men; OR = 1.45, 95% CI = 1.08–1.93 in women) and declines in SF-36 PCS and MCS. Overall there were no gender differences in the association between vision and hearing impairment and the outcomes.

Conclusion

In men and women aged 76–81 years, there were no gender differences in the association between self-reported vision and hearing impairment and the outcomes of falls, mortality and HRQOL.     

Is there a gender difference in associates of adolescents’ lifetime illicit drug use in Tehran,Iran?

Introduction

Information regarding gender differences in drug use of adolescents is essential for designing gender-specific drug prevention policies. This study was conducted in high school students in Tehran, Iran, in 2007. Here, we report the gender differences in lifetime prevalence as well as psychosocial associates of drug use.

Material and methods

This was a gender analysis of the data collected in a drug use survey conducted in a random sample of high school adolescents (573 boys and 551 girls) in Tehran, Iran, 2007. Demographic characteristics, parental and peers’ substance use, school performance, religious beliefs, attachment, self-esteem and emotional intelligence (EI) were entered in logistic regression analyses to predict the lifetime illicit drug use in boy and girls, separately.

Results

Boys were more likely to report lifetime illicit drug use than girls (10.1% vs. 6.4%, p = 0.023). Differences in the risk profile associated with lifetime illicit drug use by gender included history of substance use in the family, higher score of attachment, and having an employed mother as predictors of substance use in boys, but not girls.

Conclusions

Understanding this gender difference in predictors of lifetime use of illicit drugs in high school adolescents facilitates the design of gender-sensitive drug use preventive programmes. It seems that family variables may have more value in prevention of illicit drug use in male adolescents.     

Is inefficient multisensory processing associated with falls in older people?

Although falling is a significant problem for older persons, little is understood about its underlying causes. Spatial cognition and balance maintenance rely on the efficient integration of information across the main senses. We investigated general multisensory efficiency in older persons with a history of falls compared to age- and sensory acuity-matched controls and younger adults using a sound-induced flash illusion. Older fallers were as susceptible to the illusion as age-matched, non-fallers or younger adults at a short delay of 70 ms between the auditory and visual stimuli. Both older adult groups were more susceptible to the illusion at longer SOAs than younger adults. However, with increasing delays between the visual and auditory stimuli, older fallers did not show a decline in the frequency at which the illusion was experienced even with delays of up to 270 ms. We argue that this relatively higher susceptibility to the illusion reflects inefficient audio–visual processing in the central nervous system and has important implications for the diagnosis and rehabilitation of falling in older persons.     

Is gender a factor in psychiatrists' evaluation and treatment of patients with major depression?

BACKGROUND: Gender differences in clinical assessment and treatment have been reported in several areas of medicine. We examine whether differences exist in the routine outpatient psychiatric management of men and women with major depression. METHODS: Psychiatrists practicing in the community completed case forms on a systematic sample of their adult outpatients with major depression. Comparisons are presented between male (n=261) and female (n=472) patients focusing on their background characteristics, clinical presentation, assessment, and treatment. Significant gender disparities in assessment and treatment are also examined with respect to the gender of the treating psychiatrist. RESULTS: Although male and female patients had generally similar clinical profiles, a significantly greater proportion of males than females had psychomotor retardation and substance use disorders. No significant gender differences were observed in the assessment of depressive symptoms, psychiatric comorbidities, and treatment with antidepressant medications or psychotherapy. However, a significantly smaller percentage of depressed women than men received assessments of sexual function and medication-related sexual side effects. Female patients were also less likely to have discussed their treatment preferences with their psychiatrists. LIMITATIONS: Only a minority (33.2%) of psychiatrists invited to participate contributed patients to this study. The results are based on structured assessments completed by practicing psychiatrists rather than patient self-assessments or independent research assessments. CONCLUSIONS: Although we find overall little evidence of gender bias in the clinical management of major depression, both male and female psychiatrists need to further explore sexual function and treatment preferences in female patients.     

Is there a relationship between anti-HPA-1a concentration and severity of neonatal alloimmune thrombocytopenia?

There is uncertainty about the relationship between anti-HPA-1a levels and severity of neonatal alloimmune thrombocytopenia (NAIT). To investigate this relationship further,the concentration of anti-HPA-1a in HPA-1b homozygous women was determined, using a newly developed quantitative ELISA that uses purified anti-HPA-1a to obtain a standard curve. Seventy-eight samples collected from 22 HPA-1b homozygous pregnant women at various stages of pregnancy were tested. These included five women who had delivered babies with severe NAIT. A national HPA-1a antibody standard (NIBSC 93/710), designated as 1 arbitrary unit/mL (AU/mL),was used in each ELISA to calibrate the purified anti-HPA- 1a, enabling the presentation of results as AU/mL. Moreover, selected samples were also assayed by PAK 12 and their reactivity compared with quantity of antibody. The use of the purified HPA- 1a antibody yielded consistent sigmoid curves, enabling the measurement of HPA-1a antibody concentration in the test samples. The antibody concentration was significantly correlated with the antibody titer in the 78 samples studied (R = 0.54, p < 0.001). Furthermore, there was a significant correlation between PAK 12 and the quantitative ELISA in a selected number of cases, with or without NAIT (R = 0.71, n = 10; p < 0.02). On the other hand, there was no correlation of antibody concentration with NAIT incidence (R = -0.046). This study indicates that there is no relationship between anti-HPA-1a concentration and severity of NAIT when ELISA is used, although the correlation between ELISA and other methods, such as monoclonal antibody immobilization of platelet antigens (MAIPA) assay, remains to be determined.     

Whole,Turret and step methods of rapid rescreening: Is there any difference in performance?

We compared the performance of the Whole, Turret and Step techniques of 100% rapid rescreening (RR) in detection of false-negatives in cervical cytology. We tested RR performance with cytologists trained and among those without training. We revised 1,000 consecutive slides from women participating in an ongoing international screening trial. Two teams of experienced cytologists performed the RR techniques: one trained in RR procedures and the other not trained. The sensitivities in the trained group were Whole 46.6%, Turret 47.4% and Step 50.9%; and in the non-trained group were 38.6, 31.6 and 47.4%, respectively. The kappa coefficient showed a weak agreement between the two groups of cytologists and between the three RR techniques. The RR techniques are more valuable if used by trained cytologists. In the trained group, we did not observe significant differences between the RR techniques used, whereas in the non-trained group, the Step technique had the best sensitivity.     

Risks and benefits of UV radiation in older people: More of a friend than a foe?

Incident ultraviolet radiation from sunlight varies in intensity and spectrum with season and latitude and has both deleterious and beneficial effects on health in older people. Sunlight is the major preventable risk factor for skin cancer. Non-melanoma skin cancer is the commonest malignancy in a pale skinned older population, but the mortality is extremely low. Intermittent sun exposure is a risk factor for the more dangerous melanoma but chronic sun exposure and outdoor occupation may be protective. Public health advice has tended to concentrate on the dangers of sun exposure despite the absence of any data that increased sun exposure correlates with raised all-cause mortality.Inadequate sun exposure carries its own risks, and the older population are particularly sun deprived as recorded by low serum Vitamin D levels and lack of outdoor activity. Sunlight has health benefits dependently and independently of vitamin D synthesis. Low serum vitamin D levels correlate with increased morbidity and mortality but the direction of association is not always clear. Vitamin D has a causal role in calcium and phosphate metabolism, in skeletal health and probably reduction of colorectal cancer. Evidence is weak for a role in cardiovascular health, but mobilisation of nitric oxide by UVA radiation from nitrate stores in skin, with consequent reduction in BP, may account for the observed reduction in cardiovascular disease and all-cause mortality with increased sun exposure. Advice on healthy sun exposure needs to be reconsidered, with reduction in all-cause mortality and morbidity as the primary end point.     

Sexuality in the later years — the impact of health and body-image in a sample of older women

Research on sexuality in the elderly is still rather scarce. Quite often, there is an underlying assumption that health problems function as main constraints against sexuality in the later years. This article tries to challenge this view and proposes that health aspects tend to be — at least among women — quite overestimated. The data presented here are from a study on sexuality and ageing. Sixty West German women, born between 1907 and 1936 had been interviewed on their psychosexual development in the context of their life-histories. The results show that health variables are of rather little significance in explaining the development and/or maintenance of sexual interest and activity in old age. More general aspects of the so-called body-image seem to be more valid in shedding some more light on the determinants of psychological well-being and of keeping sexuality alive in old age.     

Is urinary continence considered in the assessment of older people after a fall in England and Wales? Cross-sectional clinical audit results

Objectives

To investigate adherence to the urinary function assessments of the national falls guidelines for England and Wales.

Study design

Secondary data analysis of the 2006 National Clinical Audit of Falls and Bone Health.

Setting

Acute hospitals in the UK.

Participants

Patients aged 65 years and older with a fragility fracture as a result of a fall.

Main outcome measures

Data were analysed to determine whether patients with fragility fractures received an assessment of urinary function including continence status; whether impairment was detected and if action was taken to prevent continence related falls.

Results

63% (2009) of 3184 patients were assessed for urinary continence following a hip fracture and 41% (817) of these identified a problem. 21% (1187) of 5642 patients with nonhip fragility fractures were assessed and a problem was found in 27% (316). Hip fracture patients were more likely (p < 0.0001) to receive a continence assessment and have problems detected. Only about half of those with problems had any intervention or a referral to a continence service. Admission to hospital for nonhip fracture patients was a strong predictor of being assessed (p < 0.0001).

Conclusion

Rates of assessment and action for those with who fall and have continence problems are low despite current national guidelines.     

What do community-dwelling older adults with chronic pain value in a program of combined pain neuroscience education plus exercise?

ObjectiveTo explore the experience of older adults after a pain neuroscience education (PNE) and exercise intervention.MethodsFocus group interviews were conducted with 14 older adults after receiving 8-weekly sessions of PNE and exercise and encompassed older adults’ perceptions of the intervention and its impact. Interviews were transcribed verbatim and analyzed by 3 researchers using thematic analysis in a five-step approach (compiling, disassembling, reassembling, interpreting, and concluding).ResultsThree themes emerged: pain reconceptualization, motivational factors, and perceived improvements. Pain reconceptualization was illustrated by participants’ ability to use language that related to PNE concepts (n = 12), increased self-efficacy (n = 5), and adjusted emotions (n = 2) and behaviors (n = 6). Motivational factors were the group-administered intervention (n = 6) and the physical therapists’ communication skills (n = 10). The intervention was perceived as having a positive impact on sleep (n = 3), well-being (n = 6), and activity/ability to perform activities (n = 8).ConclusionOlder adults understand PNE concepts and reconceptualize pain. PNE and exercise were perceived as having a positive impact on day-to-day life.Practice ImplicationsMode of administration, communication skills, and rapport are aspects of the intervention that are valued by older adults. Also, PNE might be used as a strategy to increase older adults’ adherence to physical activity.     

Is there a role of taurine bromamine in inflammation? Interactive effects with nitrite and hydrogen peroxide

Objective and Design: The myeloperoxidase system of neutrophils generates chlorinating and brominating oxidants in vivo. The major haloamines of the system are taurine chloramine (TauCl) and taurine bromamine (TauBr). It has been demonstrated in vitro that TauCl exerts both antiinflammatory and anti-bacterial properties. Much less is known about TauBr. The present study was conducted to compare bactericidal and immunoregulatory capacity of TauBr with that of the major chlorinating oxidants: HOCl and TauCl. Moreover, the effect of nitrites and H₂O₂ on TauBr activity was investigated.Materials: TauBr was prepared by reaction of HOBr with taurine. The reaction was monitored by UV absorption spectra.Methods: Bactericidal activity of TauBr, TauCl and HOCl was tested by incubation of E. coli with the compounds and determined by the pour-plate method. To test the anti-inflammatory activity the compounds were incubated with LPS and IFN- stimulated murine peritoneal macrophages. The production of following mediators was measured: nitrites by Griess reaction; TNF-, IL-6, IL-10, IL-12p40 using capture ELISA. In some experiments the compounds were incubated with either nitrites or H₂O₂.Results: In our experimental set-up TauBr and HOCl exerted strong bactericidal effects on E. coli (MBC = 110 M and 8 M, respectively), while TauCl (< 1000 M) did not kill test bacteria. However, both, TauBr and TauCl, at noncytotoxic concentrations (< 300 M) inhibited the cytokine and nitric oxide production by macrophages. H₂O₂ completely abolished the biological activities of TauBr but not those of TauCl. Nitrites did not affect any activity of TauBr or TauCl while they diminished the HOCl^– mediated bacterial killing.Conclusion: TauBr, despite very low concentration of Br^– in body fluids, may support TauCl and HOCl in the regulation of inflammatory response and in killing of bacteria by neutrophils. However, TauBr activity in vivo will depend on the presence of H₂O₂ and possible other mediators of inflammation which can compete with target molecules for TauBr.Received 16 August 2004; returned for revision 16 September 2004; accepted by A. Falus 13 October 2004     

Is the female preponderance in major depression secondary to a gender difference in specific anxiety disorders?

BACKGROUND: While a female preponderance in unipolar depression is a consistent finding in community-based studies, determinants remain speculative. This study aimed to examine whether a female preponderance in certain anxiety disorders drives a gender difference in depression. METHOD: The relevant data from the National Comorbidity Study (NCS) are analysed. RESULTS: We observed a biphasic pattern in the emergence of a female preponderance in the depressive and anxiety disorders, with an initial pre-pubertal or early adolescent onset, and after attenuation in early to middle adulthood, re-emergence in mid- to late-adulthood. Analyses focused on determinants of the initial female preponderance. Female gender, presence of an anxiety disorder and variable ages of onset in the anxiety disorder all contributed to the increased chance of an initial depressive episode. Some specificity in linking the onset of depressive temporally in early adolescence with two anxiety disorders was demonstrated, specifically generalized anxiety disorder and panic disorder. CONCLUSIONS: The separate anxiety disorders and their age of onset had variable links with depression, but female gender remained a significant predictor of depression after accounting for the effects of prior anxiety.     

Is physical activity a part of who I am? A review and meta-analysis of identity,schema and physical activity

Two parallel literatures on the physical activity (PA) identity and schema constructs have the potential to supplement traditional social cognitive approaches used for PA promotion. The purpose of this paper was to review schema/identity research and appraise its relationship with PA via meta-analysis followed by thematic analyses of its correlates, as well as its proposed mechanisms on PA. Eligible studies were from English, peer-reviewed published articles that examined identity and/or schema in the context of PA. Searches were completed in June 2015 in five databases. Sixty-two independent data-sets (32 available for meta-analysis), primarily of modest quality, were identified. Results of the random effects meta-analysis showed that the point-estimate between identity/schema and behaviour was r?=?.44 (CI?=?.39?.48), and invariant to selected study characteristics. Thematic review showed that identity/schema was associated with commitment, ability, affective judgments, identified/integrated regulation and social comparison and predicted intention, self-regulatory efficacy, and self-regulation strategy use. It had reliable evidence as a moderator of the intention–behavior relationship, was associated with increases in the speed of processing of relevant information and created negative affect under hypothetical identity–behavior discrepant situations. While this initial research is promising, more rigorous research designs, including interventions to increase identity/schema, are warranted.     

Do gender, disability, and morbidity affect aging rate in the LLFS? Application of indices of cumulative deficits

We used an approach of cumulative deficits to evaluate the rate of aging in 4954 participants of the Long-Life Family Study (LLFS) recruited in the U.S. (Boston, New York, and Pittsburg) and Denmark. We used an array of 85 health-related deficits covering major health dimensions including depression, cognition, morbidity, physical performance, and disability to construct several deficit indices (DIs) with overlapping and complementary sets of deficits to test robustness of the estimates. Our study shows that the DIs robustly characterize accelerated rates of aging irrespective of specific of deficits. When a wider spectrum of health dimensions is considered these rates are better approximated by quadratic law. Exponential rates are more characteristic for more severe health dimensions. The aging rates are the same for males and females. Individuals who contracted major diseases and those who were free of them exhibited the same aging rates as characterized by the DI constructed using mild deficits. Unlike health, disability can qualitatively alter the aging patterns of the LLFS participants. We report on systemic differences in health among the LLFS centenarians residing in New York and Boston. This study highlights importance of aggregated approaches to better understand systemic mechanisms of health deterioration in long-living individuals.     

Is there a difference between chronic airway inflammation in chronic severe asthma and chronic obstructive pulmonary disease?

PURPOSE OF REVIEW: The lack of a universally accepted definition of chronic severe asthma and the continuous changes in the classification of the severity of stable chronic obstructive pulmonary disease in the last 10 years make it difficult to compare the many studies available. The aim of the review is to compare studies on chronic severe asthma that have a control group of patients with mild to moderate persistent asthma and studies on stable chronic obstructive pulmonary disease that have an age-matched control group of smokers with normal lung function (with or without chronic bronchitis). RECENT FINDINGS: Our review of the recent literature in this field seems to indicate that chronic airway inflammation in chronic severe asthma is characterized in most cases, both in central and peripheral airways, by the same pathological features of mild-moderate persistent asthma with an increased number of activated T lymphocytes, particularly CD4 Th2 cells, and sometimes eosinophils and mast cells. The most notable difference of chronic severe asthma compared with mild to moderate disease is the increased number of neutrophils. Chronic airway inflammation in stable chronic obstructive pulmonary disease is characterized, both in central and peripheral airways, by an increased number of T lymphocytes, particularly CD8+, macrophages and neutrophils. Macrophage and neutrophil counts increase with the progression of the severity of the disease. SUMMARY: These differences in chronic airway inflammation support the consensus that asthma and chronic obstructive pulmonary disease are different diseases along all their stages of severity.