Online health communities,contributions to caregivers and resilience of older adults

The aim of this paper is twofold. Firstly, to investigate the potential benefits of online health communities (OHCs) for informal caregivers by conducting a systematic literature review. Secondly, to identify the relationship between the potential benefits of OHCs and resilience factors of older adults. Performing a thematic analysis, we identified the potential benefits of OHCs for informal caregivers of older adults, including two salient themes: (a) caregivers sharing and receiving social support and (b) self and moral empowerment of caregivers. Then, we uncovered how these potential benefits can support resilience of older adults. Our findings show that sharing and receiving of social support by informal caregivers, and self and moral empowerment of informal caregivers in OHCs, can support four resilience factors among older adults, including self-care, independence, altruism and external connections. This review enables a better understanding of OHCs and Gerontology, and our outcomes also challenge the way healthcare and aged-care service providers view caregivers and older adults. Furthermore, the identified gap and opportunities would provide avenues for further research in OHCs.     

照料失能配偶对老年女性抑郁程度的影响--基于CHARLS数据的实证分析

目的:研究照料失能配偶对老年女性抑郁程度的影响。方法:利用“中国健康与养老追踪调查”2015年全国数据,通过工具变量回归进行分析。结果:相比于没有照料配偶的女性,参与配偶照料的女性抑郁得分更高(P<0.01)。结论:提供长期照料会增加老年女性的抑郁程度。制定老年长期照料政策时应关注女性照料者的心理健康。     

Multiple drug use by older people: exploring the health development and political economy perspectives

The use of multiple medications by a large number of older people provides grounds for concern in terms of quality of life as well as cost. We argue that problems faced by older people are being over-medicalized in a manner that palliates and obscures social causes such as loss of income, the falling away of social support and a discounted role in society. Primary health care is a policy model for the development of health services which offers a credible strategy for addressing clinical problems associated with growing old in ways that also contribute to recognizing and addressing social and structural problems that may be expressed in people's private troubles.     

Enteroenterale Invagination des Dünndarms beim Erwachsenen

Zusammenfassung Es wird über eine 43jährige Patientin berichtet, die mehrere Wochen lang über inkonstant auftretende, krampfartige Mittelbauchschmerzen klagte. Die Diagnose einer ileoilealen Invagination konnte bei der Patientin erst beim dritten stationären Aufenthalt gestellt werden. Folgende Fehldiagnosen waren während des 4wöchigen Verlaufs bei der Patientin gestellt worden: Nierenbeckenentzundung, acute Appendizitis, chronische Appendizitis und zuletzt psychosomatische Bauchschmerzen. Die Patientin wurde zunächst antibiotisch, zuletzt mit Psychopharmaka medikamentös behandelt. Schließlich wurde die Diagnose einer Invagination des Dünndarms mittels Sonographie vermutet und in der konventionellen fortlaufenden Magen-Darm-Passage röntgenologisch gesichert. Bei der Patientin wurde daraufhin eine Dünndarmsegmentresektion durchgeführt. Die enteroenterale Invagination ist im Erwachsenenalter ein sehr seltenes Ereignis, bei der meistens eine Ursache (oft Tumore) als Auslöser der Invagination ermittelt werden kann. Durch Peristaltik und Ingesta wird der nach aboral bewegte Tumor zum Motor der Invagination. Prädilektionsorte sind die Übergänge eines beweglichen zu einem retroperitoneal fixierten Darmabschnitts (z. B. Ileozökalregion). Die Sonographie des Abdomens ist die Methode der ersten Wahl bei der Diagnose einer enteroenteralen Invagination. Beim Erwachsenen ist die operative Beseitigung der Invagination und deren Ursache (meist Tumore) angezeigt.

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Entero-enteric invagination of the small intestine in adultsA rare cause of abdominal distress

The present paper reports on a 43-year-old female patient who complained over a number of weeks of paroxysms of crampy pain in the mesogastrium. The diagnosis of ileoileal invagination was only made after she had been admitted to hospital for the third time. The following false diagnoses had been made during the 4-week course of the condition: pyelonephritis, acute appendicitis, chronic appendicitis and, most recently psychosomatic abdominal distress. The patient was initially treated with antibiotics and finally with psychotropic drugs. Eventually ultrasound suggested the diagnosis of invagination of the small intestine, which was then verified by conventional barium follow-through radiography. The patient subsequently underwent resection of a segment of the small intestine. Entero-enteric invagination is a very rare event in adults, in which a single (often malignant) cause is identified as triggering the invagination. Peristalsis and ingested food push the tumor distad, thus acting as a motor for invagination. The preferred localizations are the junctions between freely moving segments to retroperitoneally fixed segments (e.g., ileocecal region). Ultrasound of the abdomen is the examination of choice for diagnosis of enteroenteric invagination. Surgical resection of the invagination and its cause (generally tumors) is indicated in adults.

     

Immunological evidence of an early seroconversion to oncogenic Merkel cell polyomavirus in healthy children and young adults

Oncogenic Merkel cell polyomavirus (MCPyV) provokes a widespread and asymptomatic infection in humans. Herein, sera from healthy children and young adults (HC, n = 344) aged 0–20 years old were evaluated for anti-MCPyV immunoglobulin G (IgG) and IgM antibodies employing a recently developed immunoassay. Serum MCPyV IgG data from healthy subjects (HS, n = 510) and elderlies (ES, n = 226), aged 21–65/66–100 years old, from our previous studies, were included. The anti-MCPyV IgG and IgM rates in HC sera were 40.7% and 29.7%, respectively. A lower prevalence of anti-MCPyV IgGs was found in HC aged 0–5 years old (13%) compared to 6–10 (52.3%), 11–15 (60.5%) and 16–20 years old (61.6%) cohorts. Age-stratified HCs exhibited similar anti-MCPyV IgM rates (27.9%–32.9%). Serological profiles indicated that anti-MCPyV IgGs and IgMs had low optical densities (ODs) during the first years of life, while IgM ODs appeared to decrease throughout young adulthood. A lower anti-MCPyV IgGs rate was found in HC (40.7%) than HS (61.8%) and ES (63.7%). Upon the 5-years range age-stratification, a lower anti-MCPyV IgGs rate was found in the younger HC cohort aged 0–5 years old compared to the remaining older HC/HS/ES cohorts (52.3%–72%). The younger HC cohort exhibited the lowest anti-MCPyV IgG ODs than the older cohorts. Low anti-MCPyV IgMs rates and ODs were found in the 21–25 (17.5%) and 26–30 (7.7%) years old cohorts. Our data indicate that, upon an early-in-life seroconversion, the seropositivity for oncogenic MCPyV peaks in late childhood/young adulthood and remains at high prevalence and relatively stable throughout life.     

Prevalence and factors associated with late diagnosis among older adults living with HIV in liuzhou,China: 2010−2020

This paper aimed to quantify and characterize the prevalence and associated factors for late diagnosis in older adults living with human immunodeficiency virus (HIV) in Liuzhou, China, from 2010 to 2020. The characteristics of older adults living with HIV were described separately in time, space and population. Multivariate logistic regression analysis evaluates the factors influencing late diagnosis in HIV-positive adults ≥ 50 years of age. The majority of older adults living with HIV were over 60 years old, male, and with CD4 counts < 200 cells/μl at diagnosis, with most late diagnoses being more likely to report heterosexual transmission. These two factors may potentially provide a positive influence on late diagnosis: older and CD4 counts < 500 cells/μl. In contrast, females and those with homosexual or other transmission provide a negative. These results suggest that late diagnosis of HIV-positive adults ≥ 50 years of age remains a severe and growing epidemiological issue.     

Being in charge: Older women and their younger female kin

Our cross-cultural study of the relationship between older women and their younger female kin examines women's hierarchies based on age and focuses on the exercise of authority by women, when such authority is traditional and accepted. Data were collected for two world-wide samples each consisting of 30 societies, varying in complexity, subsistence base, geographic location, and in customs related to women's lives. Three hypotheses were tested. The findings, which are statistically significant, suggest that the relationships between older women and their younger female kin are patterned and predictable, determined by the role of women in subsistence activities, by rules for post-marital residence, and by descent.When domination can only be exercised... directly, between one person and another, it can not take place overtly and must be disguised under the veil of enchanted relationships, the official model of which is presented by the relations between kinsmen.The gentle, invisible form of violence, which is never recognized as such... can not fail to be seen as the most economical mode of domination...The system is such that the dominant agents have a vested interest in virtue. (Bourdieu 1991191, 192, 194)     

Natural helping functions of lay health advisors in breast cancer education

Summary The Save Our Sisters Project builds on the roles of 95 natural helpers to increase mammography screening among older African American women in a NC county. Natural helpers are lay people to whom others naturally turn for advice, emotional support, and tangible aid. Findings from 14 focus group interviews showed that older women seek out these individuals when they have a female-specific concern, rather than or before seeking help from professionals. The characteristics of natural helpers, revealed in the findings, were used to identify and recruit them to become trained lay health advisors in breast cancer education. Through the SOS Project, natural helpers provide a community-based system of care and social support that complements the more specialized role of health professionals; linking them to women through places and ways that no health professional could begin to acquire. The three roles of lay health advisors are: (1) to assist individuals in their social networks with needs that are difficult for professionals to address; (2) to negotiate with professionals for support from the health system; and (3) to mobilize the resources of associations in their community to sustain support from the health system.     

Informal caregiving for frail older people at home and in long-term care institutions: who are the key supporters?

This paper describes the extent of the informal caregiving unit for older people who are physically or mentally frail living in private households or resident in long-term care institutions using cross-sectional analysis of survey data. A total of 1444 people aged 65 years or more registered with a general practitioner (GP) in four areas in England and, consenting to the study, were screened for mental or physical frailty. Of 1127 older subjects living at home 7% reported receiving no informal support, 15% had a paid supporter only and 78% nominated a key informal supporter who helped with defined activities of daily living of whom 650 (74%) were interviewed. Only 13% nominated more than one informal supporter. Key supporters were spouses (38%), daughters (30%), sons (9%), daughters-in-law (4%), other relatives (11%) and friends and neighbours (8%). Of 317 frail older people resident in long-term care institutions 175 (55%) received a main visitor at least once a week of whom 132 (75%) were interviewed. Main visitors were spouses (11%), daughters (36%), sons (23%), daughters-in-law (2%), other relatives (24%) and friends (4%). Qureshi & Walker's (1989) hierarchical, decision-making model for selecting informal caregivers was applied to the data and correctly identified 85% of key informal supporters and 79% of main visitors interviewed. This large-scale comprehensive survey of informal care for frail older people supports earlier small-scale localized studies highlighting the key role of spouses and daughters in the provision of informal support. Families of frail older people provide the support to maintain people at home.     

GAD-Ab、ICA和IAA联合检测对成人隐匿性自身免疫性糖尿病的诊断价值（附138例分析）

目的 评价血清谷氨酸脱羧酶抗体(GAD—Ab)、胰岛细胞抗体(ICA)和胰岛素自身抗体(IAA)联合测定对成人隐匿性自身免疫性糖尿病(LADA)的诊断价值。方法 利用ELISA法测定138例临床诊断为2型糖尿病患者及46例健康者的血清GAD—Ab、ICA和IAA，并比较抗体阳性和阴性患者的临床特征。结果 临床诊断为2型糖尿病患者GAD-Ab和ICA的阳性率分别为20．3％和11．6％，与对照组比较差异有显著性(X^2=8．528，P=0．003；X^2=5．841，P=0．016)；IAA的阳性率8．0％。与对照组比较无显著性差异(X^2=1．902，P=0．168)。抗体阳性患者血清C肽水平较低。结论 胰岛自身抗体联合检测可提高LADA患者的检出率；LADA患者胰岛储备功能较差。