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1. Self-reported oral health status, edentulism and all-cause mortality risk in 12 809 Australian older adults: a prospective cohort study

Author: Khan, S, Chen, Y, Crocombe, L, Ivey, E, Owen, AJ, Mcneil, JJ, Woods, RL, Wolfe, R, Freak-Poli, R, Britt, C, Gasevic, D, Khan, S, Chen, Y, Crocombe, L, Ivey, E, Owen, AJ, Mcneil, JJ, Woods, RL, Wolfe, R, Freak-Poli, R, Britt, C, and Gasevic, D
Published: 2024

2. The Impact of the COVID-19 Pandemic on the Mental Health of Healthcare Workers in Italy: Analyzing the Role of Individual and Workplace-Level Factors in the Reopening Phase After Lockdown

Author: Moro, M, Calamandrei, G, Poli, R, Di Mattei, V, Perra, A, Kurotschka, P, Restrepo, A, Romano, F, La Torre, G, Preti, E, Mascayano, F, Picardi, A, Chiarotti, F, Rapisarda, V, Urban, A, Alvarado, R, Susser, E, Carta, M, Moro M. F., Calamandrei G., Poli R., Di Mattei V., Perra A., Kurotschka P. K., Restrepo A., Romano F., La Torre G., Preti E., Mascayano F., Picardi A., Chiarotti F., Rapisarda V., Urban A., Alvarado R., Susser E., Carta M. G., Moro, M, Calamandrei, G, Poli, R, Di Mattei, V, Perra, A, Kurotschka, P, Restrepo, A, Romano, F, La Torre, G, Preti, E, Mascayano, F, Picardi, A, Chiarotti, F, Rapisarda, V, Urban, A, Alvarado, R, Susser, E, Carta, M, Moro M. F., Calamandrei G., Poli R., Di Mattei V., Perra A., Kurotschka P. K., Restrepo A., Romano F., La Torre G., Preti E., Mascayano F., Picardi A., Chiarotti F., Rapisarda V., Urban A., Alvarado R., Susser E., and Carta M. G.
Abstract: Introduction: Italy is one of the high-income countries hit hardest by Covid-19. During the first months of the pandemic, Italian healthcare workers were praised by media and the public for their efforts to face the emergency, although with limited knowledge and resources. However, healthcare workers soon had to face new challenges at a time when the national health system was working hard to recover. This study focuses on this difficult period to assess the impact of the COVID-19 pandemic on the mental health of Italian healthcare workers. Materials and Methods: Healthcare workers from all Italian regions [n = 5,502] completed an online questionnaire during the reopening phase after the first wave lockdown. We assessed a set of individual-level factors (e.g., stigma and violence against HCWs) and a set of workplace-level factors (e.g., trust in the workplace capacity to handle COVID-19) that were especially relevant in this context. The primary outcomes assessed were score ≥15 on the Patient Health Questionnaire-9 and score ≥4 on the General Health Questionnaire-12, indicators of clinically significant depressive symptoms and psychological distress, respectively. Logistic regression analyses were performed on depressive symptoms and psychological distress for each individual- and workplace-level factor adjusting for gender, age, and profession. Results: Clinically significant depressive symptoms were observed in 7.5% and psychological distress in 37.9% of HCWs. 30.5% of healthcare workers reported having felt stigmatized or discriminated, while 5.7% reported having experienced violence. Feeling stigmatized or discriminated and experiencing violence due to being a healthcare worker were strongly associated with clinically significant depressive symptoms [OR 2.98, 95%CI 2.36–3.77 and OR 4.72 95%CI 3.41–6.54] and psychological distress [OR 2.30, 95%CI 2.01–2.64 and OR 2.85 95%CI 2.16–3.75]. Numerous workplace-level factors, e.g., trust in the workplace capacity to han
Published: 2022

3. The effect of depressive symptoms on disability-free survival in healthy older adults: A prospective cohort study

Author: Roebuck, G., Lotfaliany, M., Agustini, B., Forbes, M., Mohebbi, M., McNeil, J., Woods, R.L., Reid, Christopher, Nelson, M.R., Shah, R.C., Ryan, J., Newman, A.B., Owen, A., Freak-Poli, R., Stocks, N., Berk, M., Roebuck, G., Lotfaliany, M., Agustini, B., Forbes, M., Mohebbi, M., McNeil, J., Woods, R.L., Reid, Christopher, Nelson, M.R., Shah, R.C., Ryan, J., Newman, A.B., Owen, A., Freak-Poli, R., Stocks, N., and Berk, M.
Abstract: Background: Gerontology and ageing research are increasingly focussing on healthy life span (healthspan), the period of life lived free of serious disease and disability. Late-life depression (LLD) is believed to impact adversely on physical health. However, no studies have examined its effect on healthspan. This study investigated the effect of LLD and subthreshold depression on disability-free survival, a widely accepted measure of healthspan. Methods: This prospective cohort study used data from the ASPirin in Reducing Events in the Elderly study. Participants were aged ≥70 years (or ≥65 years for African-American and Hispanic participants) and free of dementia, physical disability and cardiovascular disease. Depressive symptoms were measured using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10). LLD and subthreshold depression were defined as CES-D-10 scores ≥8 and 3–7, respectively. Disability-free survival was defined as survival free of dementia and persistent physical disability. Results: A total of 19,110 participants were followed up for a maximum of 7.3 years. In female participants, LLD was associated with lower disability-free survival adjusting for sociodemographic and lifestyle factors, medical comorbidities, polypharmacy, physical function and antidepressant use (HR, 1.50; 95% CI, 1.23–1.82). In male participants, LLD was associated with lower disability-free survival adjusting for sociodemographic and lifestyle factors (HR, 1.30; 95% CI, 1.03–1.64). Subthreshold depression was also associated with lower disability-free survival in both sexes. Conclusions: LLD may be a common and important risk factor for shortened healthspan.
Published: 2023

4. Trajectories of physical health-related quality of life and the risk of incident cardiovascular disease events and all-cause mortality in older people.

Author: Phyo, AZZ, Gonzalez-Chica, DA, Stocks, NP, Woods, RL, Tran, T, Reid, CM, Tonkin, AM, Nelson, MR, McNeil, JJ, Murray, AM, Gasevic, D, Freak-Poli, R, Ryan, J, ASPREE Study Group, Phyo, AZZ, Gonzalez-Chica, DA, Stocks, NP, Woods, RL, Tran, T, Reid, CM, Tonkin, AM, Nelson, MR, McNeil, JJ, Murray, AM, Gasevic, D, Freak-Poli, R, Ryan, J, and ASPREE Study Group
Abstract: STUDY OBJECTIVE: The aim of this study was to identify whether physical component score (PCS) of health-related quality of life trajectories over 4.7-years predicted subsequent risk of incident fatal and non-fatal CVD events, and all-cause mortality. METHODS: This study included 16,871 community-dwelling people aged ≥65 years enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) trial. PCS was assessed annually using the SF-12 (version-2) over a median 4.7-years (i.e. from baseline (2010-2014) till June 2017). Incident CVD events and all-cause mortality occurring after June 2017 until the second-year after the end of the trial were considered. Growth mixture and logistic regression modelling were used. RESULTS: Four PCS trajectories were identified: high (66.5%), intermediate (13.3%), decline (13.8%), and low (6.5%), and there was subsequently a total of 406 (2.50%) incident CVD events, 197 (1.17%) fatal CVD, and 751 (4.45%) deaths. The declining PCS trajectory group had the highest risk of incident CVD (adjusted OR, 1.51; 95% CI 1.14, 1.99), while the low PCS trajectory group had the greatest risk of fatal CVD (adjusted OR, 1.74; 95%CI 1.06, 2.85) and all-cause mortality (adjusted OR, 1.83; 95%CI 1.40, 2.40). After further adjustment for the baseline PCS score, only the association between declining PCS trajectory and incident CVD (adjusted OR, 1.51; 95%CI 1.11, 2.07) remained. CONCLUSION: Our study strengthens the importance of PCS as a predictive measure of CVD and all-cause mortality in older people and also highlights that a declining PCS trajectory could be considered an early predictor of future CVD events.
Published: 2022

5. The Association of Weight Loss, Weight Status, and Abdominal Obesity with All-Cause Mortality in Older Adults

Author: Alharbi, TA, Ryan, J, Freak-Poli, R, Gasevic, D, Scali, J, Ritchie, K, Ancelin, M-L, Owen, AJ, Alharbi, TA, Ryan, J, Freak-Poli, R, Gasevic, D, Scali, J, Ritchie, K, Ancelin, M-L, and Owen, AJ
Abstract: OBJECTIVES: The objectives of this study were to examine whether weight loss, weight status (based on body mass index [BMI] categories), and abdominal obesity (based on waist circumference [WC]) were associated with a 17-year mortality risk in community-dwelling older adults. METHODS: Participants were 2,017 community-dwelling adults aged 65 years or above in the longitudinal Enquête de Santé Psychologique-Risques, Incidence et Traitement study. Self-reported weight loss was collected at baseline during face-to-face interviews. Bodyweight (kg), height (m), and WC (cm) were independently measured at the baseline. BMI was categorized as follows: underweight (BMI <18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥30 kg/m2). Abdominal obesity was defined by a WC of ≥102 cm in men and ≥88 cm in women. Adjusted Cox proportional hazards models were used to examine associations of weight loss, weight status, and abdominal obesity with all-cause mortality. RESULTS: Over 17 years of follow-up (median 15.5 years), 812 participants died. Abdominal obesity compared to nonabdominal obesity was associated with a 49% increased mortality risk (95% confidence interval (CI): 1.22-1.83). However, being overweight (but not obese) was associated with a 20% decreased risk (95% CI: 0.66-0.97) compared to a normal BMI. Gender did not affect these associations. In the whole cohort, self-reported weight loss at baseline was not associated with an increased mortality risk after adjusting for health and lifestyle factors. However, in men, a baseline self-reported recent weight loss of >3 kg was associated with a 52% increase in mortality risk (95% CI: 1.05-2.18) in a fully adjusted model. CONCLUSION: In community-dwelling adults aged ≥65 years, abdominal obesity was strongly associated with increased mortality risk. Being overweight appeared, however, to be protective against mortality. Modest self-reported weight loss was not associated with all-cause mortal
Published: 2022

6. Social Isolation, Social Support, and Loneliness Profiles Before and After Spousal Death and the Buffering Role of Financial Resources

Author: Kelley, J, Freak-Poli, R, Kung, CSJ, Ryan, J, Shields, MA, Kelley, J, Freak-Poli, R, Kung, CSJ, Ryan, J, and Shields, MA
Abstract: OBJECTIVES: We provide new evidence on the profiles of social isolation, social support, and loneliness before and after spousal death for older widows. We also examine the moderating effects of gender and financial resources on changes in social health before and after widowhood. METHODS: We use 19 waves of data from the Household, Income and Labour Dynamics in Australia Survey, including 749 widowed individuals and a comparison group of around 8,000 married individuals. We apply coarsened exact matching weights and control for age and time trends. Local polynomial smoothed plots show the profiles of social health from 3 years pre- to 3 years postspousal death. All analyses were stratified by gender. RESULTS: Spousal death was strongly associated with increased loneliness for women and men, but also an increase in interactions with friends and family not living with the bereaved. For men, financial resources (both income and asset wealth) provided some protection against loneliness. Spousal death was not associated with changes in social support or participation in community activities. DISCUSSION: We demonstrate that loneliness is a greater challenge of widowhood than social isolation or a lack of social support. Our findings suggest that interventions focusing only on increasing social interactions are unlikely to alleviate loneliness following spousal death. Moreover, policies that reduce the cost of formal social participation may have limited effectiveness in tackling loneliness, particularly for women. Alternative strategies, such as helping the bereaved form a new sense of identity and screening for loneliness around widowhood by health care workers, could be beneficial.
Published: 2022

7. Objectively Assessed Weight Change and All-Cause Mortality among Community-Dwelling Older People

Author: Alharbi, T, Ryan, J, Freak-Poli, R, Gasevic, D, Scali, J, Ritchie, K, Ancelin, M-L, Owen, AJ, Alharbi, T, Ryan, J, Freak-Poli, R, Gasevic, D, Scali, J, Ritchie, K, Ancelin, M-L, and Owen, AJ
Abstract: Later life changes in body weight may be associated with an increased risk of mortality in older adults. The objective of this study was to examine whether weight change over four years was associated with a 17-year mortality risk in older adults. Participants were 1664 community-dwelling adults aged ≥65 years in the longitudinal Enquete de Sante’ Psychologique-Risques, Incidence et Traitement (ESPRIT) study. Outcomes were all-cause mortality, cardiovascular disease (CVD) and cancer mortality. Weight change was defined as difference between weight at baseline and 4 years, categorised into: weight stable (±<5% weight change), weight loss (≥5%) and weight gain (≥5%). Association between weight change and mortality risk was evaluated using Cox proportional hazards models. Over 17 years of follow-up (median 15 years), 565 participants died. Compared to stable weight participants, those with ≥ 5% weight loss had an increased risk of all-cause mortality (HR: 1.24, 95% CI: 1.00−1.56, p = 0.05) and CVD mortality (HR: 1.53, 95% CI: 1.10−2.14, p = 0.01), but not cancer mortality (HR: 0.83, 95% CI: 0.50−1.39, p = 0.49). Weight gain of ≥5% was not associated with increased mortality (HR: 1.05, 95% CI: 0.76−1.45, p = 0.74). Weight monitoring in older adults could help identify weight loss at its early stages to better target interventions to maintain nutritional reserve and prevent premature mortality.
Published: 2022

8. The role of health-related quality of life in risk prediction for developing cardiovascular disease, dementia and all-cause death among general older adults.

Author: Phyo, AZZ, Ryan, J, Freak-Poli, R, Phyo, AZZ, Ryan, J, and Freak-Poli, R
Published: 2022

9. Social isolation, social support and loneliness as predictors of cardiovascular disease incidence and mortality

Author: Freak-Poli, R, Ryan, J, Neumann, JT, Tonkin, A, Reid, CM, Woods, RL, Nelson, M, Stocks, N, Berk, Michael, McNeil, JJ, Britt, C, Owen, AJ, Freak-Poli, R, Ryan, J, Neumann, JT, Tonkin, A, Reid, CM, Woods, RL, Nelson, M, Stocks, N, Berk, Michael, McNeil, JJ, Britt, C, and Owen, AJ
Abstract: Abstract Background Poor social health is associated with increased risk of cardiovascular disease (CVD). Recent research suggests that different social health domains should be considered separately as the implications for health and possible interventions may differ. Aim To assess social isolation, low social support and loneliness as predictors of CVD. Methods Secondary analysis of 11,486 community-dwelling, Australians, aged 70 years and over, free of CVD, dementia, or significant physical disability, from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Social isolation, social support (Revised Lubben Social Network Scale), and loneliness were assessed as predictors of CVD using Cox proportional-hazard regression. CVD events included fatal CVD, heart failure hospitalization, myocardial infarction and stroke. Analyses were adjusted for established CVD risk factors. Results Individuals with poor social health were 42 % more likely to develop CVD (p = 0.01) and twice as likely to die from CVD (p = 0.02) over a median 4.5 years follow-up. Interaction effects indicated that poorer social health more strongly predicted CVD in smokers (HR 4.83, p = 0.001, p-interaction = 0.01), major city dwellers (HR 1.94, p < 0.001, p-interaction=0.03), and younger older adults (70-75 years; HR 2.12, p < 0.001, p-interaction = 0.01). Social isolation (HR 1.66, p = 0.04) and low social support (HR 2.05, p = 0.002), but not loneliness (HR 1.4, p = 0.1), predicted incident CVD. All measures of poor social health predicted ischemic stroke (HR 1.73 to 3.16). Conclusions Among healthy older adults, social isolation and low social support may be more im
Published: 2021

10. The association of weight change and all-cause mortality in older adults: a systematic review and meta-analysis

Author: Alharbi, TA, Paudel, S, Gasevic, D, Ryan, J, Freak-Poli, R, Owen, AJ, Alharbi, TA, Paudel, S, Gasevic, D, Ryan, J, Freak-Poli, R, and Owen, AJ
Abstract: Abstract Objective there may be age-related differences in the impact of weight change on health. This study systematically reviewed the evidence on the relationship between weight change and all-cause mortality in adults aged 65 years and older. Methods MEDLINE, EMBASE and CINAHL were searched from inception to 11 June 2020, PROSPERO CRD 42019142268. We included observational studies reporting on the association between weight change and all-cause mortality in older community-dwelling adults. A random-effects meta-analysis was performed to calculate pooled hazard ratios and scored based on the Agency for Healthcare Research and Quality guidelines. Results a total of 30 studies, including 1,219,279 participants with 69,255 deaths, demonstrated that weight loss was associated with a 59% increase in mortality risk (hazard ratio (HR): 1.59; 95% confidence interval (CI): 1.45–1.74; P < 0.001). Twenty-seven studies that reported outcomes for weight gain (1,210,116 participants with 65,481 deaths) indicated that weight gain was associated with a 10% increase in all-cause mortality (HR: 1.10; 95%CI: 1.02, 1.17; P = 0.01). Four studies investigated weight fluctuation (2,283 events among 6,901 participants), which was associated with a 63% increased mortality risk (HR: 1.66; 95%CI: 1.28, 2.15). No evidence of publication bias was observed (all P > 0.05). Conclusion for community-dwelling older adults, weight changes (weight loss, gain or weight fluctuation) are associated with an increased risk of all-cause mortality risk relative to stable weight. Further research is needed to determine whether these associations vary depending upon initial weight, and whether or not the weight loss/gain was intention
Published: 2021

11. Social Isolation, Social Support and Loneliness as independent interconnected concepts

Author: Freak-Poli, R, Ryan, J, Thach, T, Owen, A, Power, JM, Berk, Michael, Stocks, N, Gonzalez-Chica, D, Lowthian, JA, Fisher, J, Byles, J, Freak-Poli, R, Ryan, J, Thach, T, Owen, A, Power, JM, Berk, Michael, Stocks, N, Gonzalez-Chica, D, Lowthian, JA, Fisher, J, and Byles, J
Abstract: Abstract Background Social isolation, lack of social support and loneliness have historically been assessed as overlapping or even interchangeable terms. We aimed to assess whether these three social constructs are independently associated with health-related quality of life (HRQoL). Methods This analysis included 10,517 women aged 70-75 years from the Australian Longitudinal Study on Women's Health (ALSWH). Social isolation (Duke Social Support Index: DSSI), social support (DSSI), and loneliness (one-item) were investigated for their association with HRQoL (physical [PCS] and mental [MCS] component scores of the SF-36® questionnaire). Multivariable analyses adjusted for age, demographics, socio-economic position and medical conditions. Results Social isolation, social support and loneliness were not strongly correlated with one another. However, all were independently associated with HRQoL (PCS: isolation -0.97, low support -2.24, loneliness -2.70; MCS: isolation -1.96, low support -4.78, loneliness -10.31; p-value<0.001 for each). Compared to those with low social isolation, high social support and lack of loneliness, women highly isolated, with low social support and lonely reported the lowest HRQoL (MCS: -18 to -17; PCS: -8 to -6). Other combinations of isolation, support and loneliness varied in their associations with HRQoL. Conclusions Social isolation, social support and loneliness are distinct, yet interconnected concepts that may coexist and are each adversely associated with HRQoL. Key messages Ageing populations present the challenge of supporting older people to maintain a longer, healthy, meaningful and community-dwelling
Published: 2021

12. Dispositional Optimism and All-Cause Mortality in Older Adults: A Cohort Study

Author: Craig, HJ, Ryan, J, Freak-Poli, R, Owen, A, McNeil, J, Woods, R, Ward, S, Britt, C, Gasevic, D, Craig, HJ, Ryan, J, Freak-Poli, R, Owen, A, McNeil, J, Woods, R, Ward, S, Britt, C, and Gasevic, D
Abstract: OBJECTIVE: Optimism is modifiable and may be associated with healthy aging. We aim to investigate whether dispositional optimism is associated with all-cause mortality in adults 70 years and older. METHODS: Between 2010 and 2014, older adults free of serious cardiovascular disease and dementia were recruited through primary care physicians and enrolled in the Aspirin Reducing Events in the Elderly (ASPREE) clinical trial. Australian ASPREE participants were invited to participate in the ASPREE Longitudinal Study of Older Persons (ALSOP) that was running in parallel to ASPREE. Optimism was assessed at baseline using the Life Orientation Test-Revised. The association between optimism, divided into quartiles, and all-cause mortality was assessed using Cox proportional hazards models. RESULTS: A total of 11,701 participants (mean [standard deviation] age = 75.1 [4.24] years; 46.6% men) returned the ALSOP Social questionnaire and completed the Life Orientation Test-Revised. During a median follow-up of 4.7 years, 469 deaths occurred. The fully adjusted model was not significant (hazard ratio = 0.78, 95% confidence interval = 0.58-1.06). There was evidence that age was an effect modifier of the association between optimism and longevity. Higher optimism was associated with lower mortality risk in the oldest individuals only (77+ years; hazard ratio = 0.61, 95% confidence interval = 0.39-0.96). CONCLUSIONS: We observed no independent relationship between optimism and all-cause mortality in the total sample, although optimism seemed to be associated with lower risk among the oldest old (adults 77 years and older).
Published: 2021

13. Health-related quality of life and all-cause mortality among older healthy individuals in Australia and the United States: a prospective cohort study

Author: Phyo, AZZ, Ryan, J, Gonzalez-Chica, DA, Woods, RL, Reid, CM, Nelson, MR, Murray, AM, Gasevic, D, Stocks, NP, Freak-Poli, R, Phyo, AZZ, Ryan, J, Gonzalez-Chica, DA, Woods, RL, Reid, CM, Nelson, MR, Murray, AM, Gasevic, D, Stocks, NP, and Freak-Poli, R
Abstract: PURPOSE: Previous research has demonstrated that lower health-related quality of life (HRQoL) is associated with higher morbidity and mortality, especially in-patient groups. The association of HRQoL with all-cause mortality in community samples requires further investigation. This study aimed to examine whether HRQoL predicts all-cause mortality in older healthy community-dwelling people from Australia and the United States (U.S.) enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial. We also explored whether this association varies by gender or country. METHOD: A prospective cohort of 19,106 individuals aged 65-98 years, who were without a dementia diagnosis or a known major life-limiting disease, and completed the 12-item short-form-HRQoL at recruitment (2010-2014). They were followed until June 2017. Cox proportional-hazard models were used to determine the association between the physical (PCS) and mental component scores (MCS) of HRQoL and all-cause mortality, adjusting for sociodemographic factors, health-related behaviours and clinical measures. Hazards ratios were estimated for every 10-unit increase in PCS or MCS. RESULTS: There were 1052 deaths over a median 4.7-years (interquartile range 3.6-5.7) of follow-up, with 11.9 events per 1000 person-years. Higher PCS was associated with lower all-cause mortality (HR 0.83, 95% CI 0.77, 0.89) in the entire sample, while higher MCS was associated with lower mortality among U.S. participants only (HR 0.78, 95% CI 0.63, 0.95). Gender differences in the association of either PCS or MCS with mortality were not observed. CONCLUSION: Our large study provides evidence that HRQoL is inversely associated with all-cause mortality among initially healthy older people.
Published: 2021

14. The Utility of Assessing Health-Related Quality of Life to Predict Cognitive Decline and Dementia

Author: Phyo, AZZ, Gonzalez-Chica, DA, Stocks, NP, Storey, E, Woods, RL, Murray, AM, Orchard, SG, Shah, RC, Gasevic, D, Freak-Poli, R, Ryan, J, Phyo, AZZ, Gonzalez-Chica, DA, Stocks, NP, Storey, E, Woods, RL, Murray, AM, Orchard, SG, Shah, RC, Gasevic, D, Freak-Poli, R, and Ryan, J
Abstract: BACKGROUND: Health-related quality of life (HRQoL) has been shown to predict adverse health outcome in the general population. OBJECTIVE: We examined the cross-sectional association between HRQoL and cognitive performance at baseline. Next, we explored whether baseline HRQoL predicted 5-year incident cognitive decline and dementia and whether there were gender differences. METHODS: 19,106 community-dwelling participants from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, aged 65-98 years, free of major cognitive impairments, and completed the HRQoL 12-item short-form (SF-12) at baseline (2010-2014), were followed until June 2017. The physical (PCS) and mental component scores (MCS) of SF-12 were calculated. The cognitive tests were assessed at baseline, year 1, 3, 5, and 7 or close-out visit. Cognitive decline was defined as > 1.5 SD drop from baseline on any of the cognitive tests. Dementia was adjudicated according to DSM-IV criteria. Linear and Cox proportional-hazards regressions were used to examine the cross-sectional and longitudinal associations respectively. RESULTS: At baseline, higher PCS and MCS were associated with better cognition. Over a median 4.7-year follow-up, higher MCS was associated with a reduced risk of cognitive decline and dementia (12% and 15% respectively, per 10-unit increase) and a 10-unit higher PCS was associated with a 6% decreased risk of cognitive decline. PCS did not predict dementia incidence. Findings were not different by gender. CONCLUSION: Our study found that higher HRQoL, in particular MCS, predicted a reduced risk of cognitive decline and dementia over time in community-dwelling older people.
Published: 2021

15. Using Health-Related Quality of Life to Identify the Incident Cardiovascular Disease Risk

Author: Phyo, AZZ, Ryan, J, Gonzalez-Chica, DA, Stocks, NP, Reid, CM, Tonkin, AM, Woods, R, Freak-Poli, R, Phyo, AZZ, Ryan, J, Gonzalez-Chica, DA, Stocks, NP, Reid, CM, Tonkin, AM, Woods, R, and Freak-Poli, R
Abstract: Previous studies have revealed that poor health-related quality of life (HRQoL) is associated with a higher risk of hospital readmission and mortality in patients with cardiovascular disease (CVD). The association between HRQoL and incident CVD is still limited for general older people. This study explored the associations between baseline HRQoL and incident and fatal CVD in community-dwelling Australian and the United States older people enrolled in ASPREE clinical trial. A cohort of 19,106 individuals aged 65 to 98 years, who were initially free of CVD, dementia, or disability, were followed between March 2010 and June 2017. The SF-12 questionnaire was used to assess HRQoL, and the physical (PCS) and mental component scores (MCS) of SF-12 were derived using norm-based methods. Incident major adverse CVD events included fatal CVD (death due to atherothrombotic CVD), hospitalizations for heart failure, myocardial infarction or stroke. Analyses were performed using Cox proportional-hazard regression. Over a median 4.7 follow-up years, there were 922 incident CVD events, 203 fatal CVD events, 171 hospitalizations for heart failure, 355 fatal or nonfatal myocardial infarction and 403 fatal or nonfatal strokes. A 10-unit higher PCS, but not MCS, was associated with a lower risk of incident CVD (HR=0.86, 95%CI 0.79-0.92), hospitalization for heart failure (HR=0.72, 95%CI 0.60-0.85), and myocardial infarction (HR=0.85, 95%CI 0.75-0.96). Neither PCS nor MCS was associated with fatal CVD events or stroke. Physical HRQoL can be used in combination with clinical data to identify the incident CVD risk among community-dwelling older people.
Published: 2021

16. Social isolation, social support and loneliness as predictors of cardiovascular disease incidence and mortality

Author: Freak-Poli, R, Ryan, J, Neumann, JT, Tonkin, A, Reid, CM, Woods, RL, Nelson, M, Stocks, N, Berk, M, McNeil, JJ, Britt, C, Owen, AJ, Freak-Poli, R, Ryan, J, Neumann, JT, Tonkin, A, Reid, CM, Woods, RL, Nelson, M, Stocks, N, Berk, M, McNeil, JJ, Britt, C, and Owen, AJ
Abstract: BACKGROUND: Poor social health is associated with increased risk of cardiovascular disease (CVD). Recent research suggests that different social health domains should be considered separately as the implications for health and possible interventions may differ. AIM: To assess social isolation, low social support and loneliness as predictors of CVD. METHODS: Secondary analysis of 11,486 community-dwelling, Australians, aged 70 years and over, free of CVD, dementia, or significant physical disability, from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Social isolation, social support (Revised Lubben Social Network Scale), and loneliness were assessed as predictors of CVD using Cox proportional-hazard regression. CVD events included fatal CVD, heart failure hospitalization, myocardial infarction and stroke. Analyses were adjusted for established CVD risk factors. RESULTS: Individuals with poor social health were 42 % more likely to develop CVD (p = 0.01) and twice as likely to die from CVD (p = 0.02) over a median 4.5 years follow-up. Interaction effects indicated that poorer social health more strongly predicted CVD in smokers (HR 4.83, p = 0.001, p-interaction = 0.01), major city dwellers (HR 1.94, p < 0.001, p-interaction=0.03), and younger older adults (70-75 years; HR 2.12, p < 0.001, p-interaction = 0.01). Social isolation (HR 1.66, p = 0.04) and low social support (HR 2.05, p = 0.002), but not loneliness (HR 1.4, p = 0.1), predicted incident CVD. All measures of poor social health predicted ischemic stroke (HR 1.73 to 3.16). CONCLUSIONS: Among healthy older adults, social isolation and low social support may be more important than loneliness as cardiovascular risk factors. Social health domains should be considered in future CVD risk prediction models.
Published: 2021

17. Social isolation, social support and loneliness as predictors of cardiovascular disease incidence and mortality

Author: Freak-Poli, R., Ryan, J., Neumann, J.T., Tonkin, A., Reid, Christopher, Woods, R.L., Nelson, M., Stocks, N., Berk, M., McNeil, J.J., Britt, C., Owen, A.J., Freak-Poli, R., Ryan, J., Neumann, J.T., Tonkin, A., Reid, Christopher, Woods, R.L., Nelson, M., Stocks, N., Berk, M., McNeil, J.J., Britt, C., and Owen, A.J.
Abstract: Background: Poor social health is associated with increased risk of cardiovascular disease (CVD). Recent research suggests that different social health domains should be considered separately as the implications for health and possible interventions may differ. Aim: To assess social isolation, low social support and loneliness as predictors of CVD. Methods: Secondary analysis of 11,486 community-dwelling, Australians, aged 70 years and over, free of CVD, dementia, or significant physical disability, from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Social isolation, social support (Revised Lubben Social Network Scale), and loneliness were assessed as predictors of CVD using Cox proportional-hazard regression. CVD events included fatal CVD, heart failure hospitalization, myocardial infarction and stroke. Analyses were adjusted for established CVD risk factors. Results: Individuals with poor social health were 42 % more likely to develop CVD (p = 0.01) and twice as likely to die from CVD (p = 0.02) over a median 4.5 years follow-up. Interaction effects indicated that poorer social health more strongly predicted CVD in smokers (HR 4.83, p = 0.001, p-interaction = 0.01), major city dwellers (HR 1.94, p < 0.001, p-interaction=0.03), and younger older adults (70-75 years; HR 2.12, p < 0.001, p-interaction = 0.01). Social isolation (HR 1.66, p = 0.04) and low social support (HR 2.05, p = 0.002), but not loneliness (HR 1.4, p = 0.1), predicted incident CVD. All measures of poor social health predicted ischemic stroke (HR 1.73 to 3.16). Conclusions: Among healthy older adults, social isolation and low social support may be more important than loneliness as cardiovascular risk factors. Social health domains should be considered in future CVD risk prediction models.
Published: 2021

18. Health-related quality of life and all-cause mortality among older healthy individuals in Australia and the United States: a prospective cohort study

Author: Phyo, AZZ, Ryan, J, Gonzalez-Chica, DA, Woods, RL, Reid, CM, Nelson, MR, Murray, AM, Gasevic, D, Stocks, NP, Freak-Poli, R, Phyo, AZZ, Ryan, J, Gonzalez-Chica, DA, Woods, RL, Reid, CM, Nelson, MR, Murray, AM, Gasevic, D, Stocks, NP, and Freak-Poli, R
Abstract: Purpose: Previous research has demonstrated that lower health-related quality of life (HRQoL) is associated with higher morbidity and mortality, especially in-patient groups. The association of HRQoL with all-cause mortality in community samples requires further investigation. This study aimed to examine whether HRQoL predicts all-cause mortality in older healthy community-dwelling people from Australia and the United States (U.S.) enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial. We also explored whether this association varies by gender or country. Method: A prospective cohort of 19,106 individuals aged 65–98 years, who were without a dementia diagnosis or a known major life-limiting disease, and completed the 12-item short-form-HRQoL at recruitment (2010–2014). They were followed until June 2017. Cox proportional-hazard models were used to determine the association between the physical (PCS) and mental component scores (MCS) of HRQoL and all-cause mortality, adjusting for sociodemographic factors, health-related behaviours and clinical measures. Hazards ratios were estimated for every 10-unit increase in PCS or MCS. Results: There were 1052 deaths over a median 4.7-years (interquartile range 3.6–5.7) of follow-up, with 11.9 events per 1000 person-years. Higher PCS was associated with lower all-cause mortality (HR 0.83, 95% CI 0.77, 0.89) in the entire sample, while higher MCS was associated with lower mortality among U.S. participants only (HR 0.78, 95% CI 0.63, 0.95). Gender differences in the association of either PCS or MCS with mortality were not observed. Conclusion: Our large study provides evidence that HRQoL is inversely associated with all-cause mortality among initially healthy older people.
Published: 2021

19. Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes 11 Medical and Health Sciences 1103 Clinical Sciences

Author: Mirijello, A, Viazzi, F, Fioretto, P, Giorda, C, Ceriello, A, Russo, G, Guida, P, Pontremoli, R, De Cosmo, S, Cimino, A, Fava, D, Meloncelli, I, Nicolucci, A, Pellegrini, F, Rossi, M, Turco, S, Vespasiani, G, Graziano, G, Lucisano, G, Memmo, R, Pellicciotta, E, Paciotti, V, Pupillo, M, Armentano, G, Giovannini, C, Armentano, V, Laudato, M, Acquati, S, Ciardullo, A, Laffi, G, Felace, G, Taboga, C, Tortul, C, Santantonio, G, Suraci, C, Ghisoni, G, Raffa, M, Genovese, S, Lovagnini-Scher, C, Rampini, P, Rocca, A, Ruggeri, P, Tortato, E, Cotti, L, Cristofaro, M, Tagliaferri, M, Comoglio, M, Fornengo, R, Gentile, F, Gigante, A, Mastinu, F, Di Benedetto, A, Pata, P, Arcangeli, A, Orsini, P, Acler, P, De Blasi, G, Cicioni, G, Pocciati, S, Marangoni, A, Nogara, A, Lanero, M, Bertero, M, Damassino, R, Bergonzini, C, Schumtz, L, Seksich, L, Pipitone, A, Boaretto, M, Manfroi, I, Parmesan, L, Conte, B, Soccol, F, Pagano, A, Papini, E, Rinaldi, R, Petrucci, L, Graziano, F, Chianelli, M, Silvagni, S, Rosco, M, Ansaldi, E, Malvicino, F, Battezzati, M, Maresca, P, Palenzona, C, Boemi, M, Rabini, R, Brandoni, G, Lanari, L, Gatti, C, Testa, I, Cherubini, V, Doveri, G, Pecorelli, L, Ciccarelli, A, Gallardini, M, Courthoud, R, Sara Bredy, S, Ricciardi, G, Vitalone, G, Setti, D, Contrini, P, Corsi, A, Ghigliotti, V, Oddone, G, Ponzani, P, Valbonesi, G, Mazzini, V, Di Berardino, P, Colleluori, P, Montani, V, Trosini, V, Velussi, M, Alfidi, P, Verdecchia, B, Baliva, L, Di Pietro, A, Franchi, G, Luce, R, Pianta, A, Ferrari, M, Balzano, S, Beltranello, G, Dal Fabbro, S, Arico, C, Cervo, L, Zanon, R, Rossa, S, Di Pace, M, Ciavarella, A, Giangiulio, S, Grimaldi, M, Mustacchio, A, Fattor, B, Monauni, T, Cristini, M, Orion, G, Crazzolara, D, Amor, F, Eisath, J, Lintner, S, Garavelli, S, Calari, T, Marini, P, Sandri, O, Scala, M, Stroppa, C, Trentin, A, Carlin, R, Carli, B, Sandona, M, Zortea, C, Bonet, L, Pradel, L, Reato, S, Buschini, M, Bonfiglioli, D, Mones, D, Beldi, F, Morea, A, Bondesan, L, Perbellini, S, Valentini, U, Agosti, B, Corsini, R, Girelli, A, Zarra, E, Rocca, L, Bergmann, M, Pradi, I, Unterkircher, S, Piok, M, Pichler, M, Trinchera, A, Palama, G, Palma, P, Carboni, L, Murtas, M, Mudadu, T, Turco, M, Floris, M, Delogu, A, Farris, L, Songini, M, Piras, G, Seguro, R, Floris, R, Corona, G, Lai, M, Piras, E, Contini, P, Cocco, S, Pilosu, R, Sannia, M, Spanu, F, Busciantella Ricci, N, Cartechini, M, Agostinelli, G, Fiorelli, C, Nuzzi, A, Ballauri, C, Lesina, A, Romeo, F, Giudici, G, Maciejewska, E, Deroma, A, Paduano, M, Rossi, L, Vagnini, C, Dolci, M, Mori, M, Baccetti, F, Gregori, G, Straface, E, Pozzuoli, G, Barone, M, Stasio, G, Tondini, S, Borgoni, F, Grosso, J, Scarsellato, C, Sciulli, A, De Marco, F, Confortin, L, Marin, N, Lamonica, M, Gialdino, S, Borzi, V, Gatta, C, Rapisard, R, Strano, S, Calabro, M, Puccio, L, Zolli, M, Coracina, A, Starnone, V, Del Buono, A, Terracciano, A, Monda, M, Castro, F, Guaglianone, A, Maccari, V, Corsi, L, Versari, G, Falivene, M, Boletto, N, Corsi, S, Marafetti, L, Vitacolonna, E, Capani, F, Caputo, L, Di Nisio, L, Simonetti, F, Boscolo Bariga, A, Ballarin, G, De Boni, S, Di Benedetto, S, Chiambretti, A, Di Vito, L, Pascuzzo, M, Urli, P, Rumi, P, Balzarini, B, Galli, P, Castellan, M, Giannetti, A, Russotti, C, De Blasi, A, Perna, A, Campanelli, C, Ranchelli, A, Biccheri, D, Dadi, G, Massa, L, Baldi, G, Sciacca, F, Costanzo, E, Spada, M, Paolini, G, Ziller, P, Portolan, F, Pasolini, G, Ghilardi, G, Fiorina, P, Grata, M, Capretti, L, Speroni, G, Fugazza, L, Massafra, C, Lovagnini Scher, A, Cimicchi, M, Percudani, C, Risolo, T, Sacco, P, Gidoni Guarnieri, G, Piccolo, D, Bravin, C, De Noni, E, Scarpel, M, Marcon, M, Giacon, F, Panebianco, G, Tadiotto, F, Da Tos, V, D'Ambrosio, M, Pellizzola, D, Zampini, M, Frezzati, E, Mari, E, Raminelli, E, Gaiti, D, Bosi, E, Chierici, G, Pilla, S, Copelli, M, Zanichelli, P, Bertelli, L, Caretta, P, Vezzani, V, Bodecchi, S, Longobucco, A, Di Lembo, S, Spotti, E, 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R, Muraro, R, Loro, R, Bucciol, S, Lavacca, C, Sabbatini, G, Quadri, F, Sambuco, L, Santacroce, C, Paola Caretta, D, Marino, C, Micheletti, A, Petrelli, A, Corda, A, Pisano, L, Guaita, G, Deias, C, Trevisan, G, Coletti, I, Iannarelli, R, De Luca, A, Minnucci, A, Antenucci, D, Di Florio, C, Angelicola, G, Bosco, A, Fresco, R, Di Marco, G, Ugolotti, D, Cadossi, T, Di Caro, P, Mazzocchetti, M, Buzzetti, R, Leto, G, Gnessi, C, Cipolloni, L, Foffi, C, Moretti, C, Venditti, C, Meniconi, R, Bertoli, S, Cosimi, S, Di Cianni, G, Turco, A, Richini, A, Marconi, S, Sannino, C, Lemmi, P, Giuntoli, S, Manfre, N, Giannini, F, Di Carlo, A, Casadidio, I, Melandri, P, Maolo, G, Polenta, B, Piccinini, N, Vincenti, C, Pastore, N, Mega, P, Magurano, E, Cananiello, A, Francescutto, C, Brussa Toi, E, Gaspardo, G, Angeli, L, Ronchese, L, Sciangula, L, Ciucci, A, Contartese, A, Banfi, E, Castelli, E, Tatti, P, Bloise, D, Di Mauro, P, Masselli, L, Lo Presti, A, Scarpitta, A, Gambina, F, Venezia, A, Morea, R, 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Loddo, C, Loddo, I, Seguro, P, Cuomo, A, Orlando, L, Olanda, G, Pucci, A, Massenzo, M, Sardu, C, Perrone, G, Corazziere, F, La Puzza, I, Tripodi, P, Riggio, S, Giampaolo, A, Mannino, D, Aleandri, A, Guidi, M, Battisti, B, Faraglia, M, Lilli, V, Leotta, S, Visalli, N, Gagliardi, A, Fontana, L, Altomare, M, Carletti, S, Abbruzzese, S, Chiaramonte, F, Giordano, R, Rossini, M, Migneco, G, Cappelloni, D, Urbani, A, Piergiovanni, F, Simonetta, A, Massimiani, F, Bulzomi, R, Giuliano, M, Pennafina, M, Di Perna, P, D'Accinni, M, Paolucci, D, D'Ubaldi, A, D'Angelo, M, Masaro, G, Pietrantoni, M, Fratini, M, La Rosa, R, Poggi, M, Piccirilli, F, Pisano, R, Saponara, C, Conforti, I, Penza, A, Scalpone, R, Lo Pinto, S, Iacovella, L, Caccamo, C, Sposito, S, Teodonio, C, Restuccia, M, Mirto, G, Girardello, R, Gennaro, R, De Moliner, L, Bettini, E, Mattuzzi, A, Speese, K, Frisinghelli, F, Locatelli, F, Nicoletti, M, Trojan, N, Centis, R, L Volsi, P, Levis, E, Zanette, G, Comba, G, Ballatore, L, Cattaneo, A, Aglialoro, A, Guido, R, Patrone, M, Zecchini, M, Clementi, L, Galetta, M, Marconi, V, Bordin, P, Perale, L, Vinci, C, Sira Zanon, M, Geretto, L, Toffolo, C, Furlan, M, Mazzanti, G, Vinci, M, Sica, V, Armeni, M, Derai, R, Ennas, O, Mamusa, S, Pisano, M, Carreras, L, Rauseo, A, Cervone, S, Leggieri, A, Pontonio, M, Sturaro, R, Quattrocchi, F, Molinaro, M, Trasatti, M, Ferretti, B, Labarile, G, Baule, G, Gentilini, A, Spanu, M, Fancellu, A, Bianco, P, Lione, L, Massazza, G, Bocchio, G, Bosco, E, Monachesi, M, Carta, G, Boschetti, M, Ceresola, E, Venier, E, Calcaterra, F, Cataldi, F, Miola, M, Manfrini, S, Lai, A, Locci, B, Putzu, D, Tanganelli, I, Leonini, M, Egger, K, Marchiotto, W, Vincis, L, Orlandini, V, Pilloni, C, Farci, R, Pelligra, I, Renier, G, Mameli, M, Pala, A, Devigus, E, Fumagalli, I, Lalli, C, Leandri, M, Agliani, M, De Pascalis, L, Malci, F, De Ciocchis, A, Diodati, M, Macerola, B, Davi, S, Caccavale, A, Brocato, L, Pognant Gros, M, Borla, S, Lattanzi, E, Piersanti, C, Piersanti, A, Spinelli, I, Tuzzoli, L, Tulini, V, Quaranta, G, Iorio, V, Tirabovi, M, De Terlizi, C, Massarelli, M, Venturi, S, Travaglini, A, Draghi, P, Pomante, P, Richiardi, L, Clerico, A, Bruno, A, Cavallo Perin, P, Ghigo, E, Porta, M, Scuntero, P, Arcari, R, Bertaina, S, Bo, S, Broglio, F, Bruno, G, Degiovanni, M, Fornengo, P, Grassi, G, Inglese, V, Maccario, M, Maghenzani, G, Marena, S, Martina, V, Passera, P, Ruiu, G, Tagliabue, M, Zanone, M, Monge, M, Boffano, G, Macri, K, Maio, P, Ozzello, A, Pergolizzi, E, Gaia, D, Gennari, P, Micali, G, Rossetto, E, Dalmazzo, C, Oreglia, M, Stefani, T, Dossena, C, Paglia, P, Bosoni, S, Romanelli, T, Inchiostro, S, Dauriz, M, Bossi, C, Meregalli, G, Balini, A, Berzi, D, Filippini, B, Crotto, G, Paccagnella, A, Orrasch, M, Sambataro, M, Citro, T, Kiwanuka, E, Bagolin, E, Almoto, B, Macchia, A, Branca, M, Filesi, M, Candido, R, Caroli, E, Manca, E, Petrucco, A, Tommasi, E, Jagodnik, G, Baskar, B, Daris, N, Dal Col, P, Pellegrini, M, Tonutti, L, Venturini, G, Andreani, M, Turchi, F, Fedrighelli, F, Martinelli, G, Rongioletti, R, Candidi, M, Pais, M, Moro, E, Cervellino, F, Sinisi, R, Zampino, A, Mingardi, R, Lora, L, Reitano, R, Stocchiero, C, Simoncini, M, Mesturino, C, Zen, F, Di Pietro, S, Scoponi, C, Tilaro, L, Pelliccioni, S, Slongo, R, Vita, E, Garofalo, A, Vitale, F, Campanella, B, Mastrilli, V, Borrelli, T, D'Avino, A, Perbellini, A, Mirijello A., Viazzi F., Fioretto P., Giorda C. B., Ceriello A., Russo G. T., Guida P., Pontremoli R., De Cosmo S., Cimino A., Fava D., Meloncelli I., Nicolucci A., Pellegrini F., Rossi M. C., Turco S., Vespasiani G., Graziano G., Lucisano G., Memmo R., Pellicciotta E., Paciotti V., Pupillo M., Armentano G., Giovannini C., Armentano V., Laudato M., Acquati S., Ciardullo A. V., Laffi G., Felace G., Taboga C., Tortul C., Santantonio G., Suraci C., Ghisoni G., Raffa M., Genovese S., Lovagnini-Scher C. A., Rampini P., Rocca A., Ruggeri P., Tortato E., Cotti L., Cristofaro M. R., Tagliaferri M., Comoglio M., Fornengo R., Gentile F. M., Gigante A., Mastinu F., Di Benedetto A., Pata P., Arcangeli A., Orsini P., Acler P., De Blasi G., Cicioni G., Pocciati S., Marangoni A., Nogara A., Lanero M., Bertero M. G., Damassino R., Bergonzini C., Schumtz L., Seksich L., Pipitone A., Boaretto M., Manfroi I., Parmesan L., Conte B., Soccol F., Pagano A., Papini E., Rinaldi R., Petrucci L., Graziano F., Chianelli M., Silvagni S., Rosco M., Ansaldi E., Malvicino F., Battezzati M., Maresca P., Palenzona C., Boemi M., Rabini R. A., Brandoni G., Lanari L., Gatti C., Testa I., Cherubini V., Doveri G., Pecorelli L., Ciccarelli A., Gallardini M. B., Courthoud R., Sara Bredy S., Ricciardi G. P., Vitalone G., Setti D., Contrini P., Corsi A., Ghigliotti V., Oddone G., Ponzani P., Valbonesi G., Mazzini V., Di Berardino P., Colleluori P., Montani V., Trosini V., Velussi M., Alfidi P., Verdecchia B., Baliva L., Di Pietro A., Franchi G., Luce R. P., Pianta A., Ferrari M., Balzano S., Beltranello G., Dal Fabbro S., Arico C. N., Cervo L., Zanon R., Rossa S., Di Pace M. C., Ciavarella A., Giangiulio S., Grimaldi M., Mustacchio A., Fattor B., Monauni T., Cristini M., Orion G., Crazzolara D., Amor F., Eisath J. E., Lintner S., Garavelli S., Calari T., Marini P., Sandri O., Scala M., Stroppa C., Trentin A., Carlin R., Carli B., Sandona M., Zortea C., Bonet L., Pradel L., Reato S., Buschini M., Bonfiglioli D., Mones D., Beldi F., Morea A., Bondesan L., Perbellini S., Valentini U., Agosti B., Corsini R., Girelli A., Zarra E., Rocca L., Bergmann M., Pradi I., Unterkircher S., Piok M., Pichler M., Trinchera A., Palama G., Palma P., Carboni L., Murtas M. G., Mudadu T., Turco M. P., Floris M., Delogu A., Farris L., Songini M., Piras G., Seguro R., Floris R., Corona G., Lai M., Piras E., Contini P. P., Cocco S., Pilosu R. M., Sannia M. C., Spanu F., Busciantella Ricci N., Cartechini M. G., Agostinelli G., Fiorelli C., Nuzzi A., Ballauri C., Lesina A., Romeo F., Giudici G., Maciejewska E. G., Deroma A., Paduano M., Rossi L., Vagnini C., Dolci M., Mori M., Baccetti F., Gregori G., Straface E., Pozzuoli G., Barone M., Stasio G. B., Tondini S., Borgoni F., Grosso J., Scarsellato C., Sciulli A., De Marco F., Confortin L., Marin N., Lamonica M., Gialdino S., Borzi V., Gatta C., Rapisard R., Strano S., Calabro M., Puccio L., Zolli M., Coracina A., Starnone V., Del Buono A., Terracciano A. M., Monda M. V., Castro F., Guaglianone A., Maccari V., Corsi L., Versari G., Falivene M. R., Boletto N., Corsi S., Marafetti L., Vitacolonna E., Capani F., Caputo L., Di Nisio L., Simonetti F., Boscolo Bariga A., Ballarin G., De Boni S., Di Benedetto S., Chiambretti A. M., Di Vito L., Pascuzzo M. D., Urli P., Rumi P., Balzarini B., Galli P., Castellan M., Giannetti A., Russotti C., De Blasi A., Perna A., Campanelli C., Ranchelli A., Biccheri D., Dadi G., Massa L., Baldi G. P., Sciacca F., Costanzo E., Spada M., Paolini G., Ziller P., Portolan F., Pasolini G., Ghilardi G., Fiorina P., Grata M. L., Capretti L., Speroni G., Fugazza L., Massafra C., Lovagnini Scher A., Cimicchi M. C., Percudani C., Risolo T., Sacco P., Gidoni Guarnieri G. L., Piccolo D., Bravin C., De Noni E., Scarpel M., Marcon M., Giacon F., Panebianco G., Tadiotto F., Da Tos V., D'Ambrosio M., Pellizzola D., Zampini M. A., Frezzati E., Mari E., Raminelli E., Gaiti D., Bosi E. A., Chierici G., Pilla S., Copelli M., Zanichelli P., Bertelli L., Caretta P., Vezzani V., Bodecchi S., Longobucco A., Di Lembo S., Spotti E., Carrai E., Degli Innocenti A., Manini L., Persico R., Rossi C., Magro G., Marelli G., Vilei V., Andrioli M., Bellato L., Fedeli M., Merlini A., Pinelli G., Marin G., Contin M. L., Gallo A., Parlato P., Pecchielan W., Jacovacci J., Placentino G., Richini D., Molinari S., Strazzeri R., Fabbri T., Di Bartolo P., Garrapa G., D'Incau F., Lagomanzini P., Conte P., Todesco F., Foglini P., Pantanetti P., Bedetta C., Maricotti R., Tomasi F., Monesi M., Graziani R., Beretta F., Penna L., Guberti A., Dazzi D., Forte E., Gasbarrone A., Marrocco T., Moschetta R., Tuccinardi F., De Meo F., Coppola A., Pirolozzi P., Placitelli E., Vallefuoco R., Catone B., Ceschia S., Urban M., Fabbri F., Torresani M., Crovetto R., Battistini M., Carosia P., Viviani G. L., Durante A., Pais F., Lilliu V., Quieto C., D'Ugo E., Squadrone M., Amenduni T., Iovannisci M. M., Della Penna L., Potente F., Delle Donne T., Massa C., Ulisse M. A., De Berardinis S., Guarnieri I., Pace S., Splendiani M., Di Giuseppe R., Brunato B., Assaloni R., Muraro R., Loro R., Bucciol S., Lavacca C., Rossi M., Sabbatini G., Quadri F., Sambuco L., Santacroce C., Paola Caretta D., Marino C., Micheletti A., Petrelli A., Corda A., Pisano L., Guaita G., Deias C., Trevisan G., Coletti I., Iannarelli R., De Luca A., Minnucci A., Antenucci D., Di Florio C., Angelicola G., Bosco A., Fresco R., Di Marco G., Ugolotti D., Cadossi T., Di Caro P., Mazzocchetti M., Buzzetti R., Leto G., Gnessi C., Cipolloni L., Foffi C., Moretti C., Venditti C., Meniconi R., Bertoli S., Cosimi S., Di Cianni G., Turco A., Richini A., Marconi S., Sannino C., Lemmi P., Giuntoli S., Manfre N., Giannini F., Di Carlo A., Casadidio I., Melandri P., Maolo G., Polenta B., Piccinini N., Vincenti C., Pastore N., Mega P., Magurano E., Cananiello A., Francescutto C. A., Brussa Toi E., Gaspardo G., Angeli L., Ronchese L., Sciangula L., Ciucci A., Contartese A., Banfi E., Castelli E., Tatti P., Bloise D., Di Mauro P., Masselli L., Lo Presti A., Scarpitta A. M., Gambina F., Venezia A., Morea R., Lagonigro G., Copeta G., Iannucci V., Milano V., Trupo M., Lochmann A., Marchetto P. E., Incelli G., De Paola G., Steiger M. M., Gamper M. A., Breitenberger S., Holzner M., Frischmann J., Lambiase C., Di Vece T., D'Aniello M., Fezza M., Giordano C., Leo F., Saitta G., Cucinotta D., Di Vieste G., Pintaudi B., Mancuso T., Musacchio N., Giancaterini A., Pessina L., Salis G., Schivalocchi F., Testori G., Cerutti N., Morpugo P. S., Cavaletto M. L., Bonino G., Morreale F., Mariani G., Ragonesi P. D., Bollati P., Colapinto P., Falqui L., Bortolato L., Cosma A., Pistolato P., Centenaro B., Ceccato A., Campobasso G., Zaurino F., Mazzotta G., Manti R., Da Ros R., Carlucci S., Narduzzi L., Bortolotto D., D'Acunto L., Stanic L., Volpi A., Cospite A. M., Manicardi V., Michelini M., Finardi L., Borghi F., Manicardi E., Lombardi S., Tommasi C., Iaccarino M., Cozza S., Binotto M., Marini F., Mecenero I., Massignani S., Stecco P., Urbani E., Massariol W., Parolin R., Gatti A., Bonavita M., Creso E., Giannettino R., Gobbo M., Iovine C., Riccardi G., Iazzetta N., Giannattasio C., Egione O., Galdieri S., Velotti A., Azzolina A., Annicelli G., Sorrentino T., Gaeta I., Zenari L., Bertolini L., Sorgato C., Grippaldi F., Stroppiana M., Popolizio R., Carbone N., Grasso S., Abate S., Gaggero G. C., Strazzabosco M., Brun E., Carlesi G. P., Garrone S., Cicalo A. M., Clausi C., Cau R., Manconi A., Carboni A., Angius M. F., Pinna A. A., Caria S., Filigheddu G. D., Tonolo G., Carta I., Calebich S., Burlotti C., Saglietti G., Schellino A., Madau G., Cossu M., Mulas F., Zoccheddu S., Balsanelli M., Fetonti M., Rotolo A., Sambo P., Secchi E., Angotzi M. A., Loddoni S., Brundu I., Careddu F., Becciu A., Gabriella Piras G., Novara F., Cipro F., Torchio G., Palumbo P., Bianchi A., Colucci G., La Motta G., Tiengo A., Avogaro A., Bruttomesso D., Crepaldi C., Fadini G., Guarnieri G., Lavagnini M. T., Maran A., Vedovato M., De Kreutzenberg V., Fedele D., Lapolla A., Sartore G., Bax G., Cardone C., Dalfra M. G., Masin M., Toniato R., Piarulli F., Mattina G., Fulantelli M. A., Gioia D., Conti M., Ridola G., D'Agati F., Grossi G., Zavaroni I., Dei Cas A., Franzini L., Usberti E., Antonimi M., Anelli N., Poli R., Ridolfi V., Michela M., Haddoub S., Prampolini G., Muoio A., Filippi D., Bucci F., Tardio S. M., Calderini M. C., Magotti M. G., Quarantelli C., Vernazza M. A., Carolfi A., Saracca R., Picchio E., Del Sindaco P., Spalluto A., Maggiulli L., Torreggiani V., Rastelletti S., Ugolini C., Pucci N., Magi S., Muratori S., La Penna G., Consoli A., Galeone F., Magiar A. V., Gherardini V., Moretti L., Bientinesi M., Landi L., Bernardi A., Del Prato S., Miccoli R., Bianchi C., Penno G., Venditti F., Anichini R., De Bellis A., Bruschi T., Butelli L., Gioffredi M., Gori R., Picciafuochi R., Malagoli R., Bernini A., Gelisio R., Zanon M., Del Bianco A., Bamiston A., Signorato M., Citro G., Calabrese M., Ianni L., Lorenzetti M., Marsocci A., Guizzotti S., Memoli G., Cabasino F., Farci F., Atzori A., Sanna A., Ghiani M., Siotto I., Sedda M., Manis A., Loddo C., Loddo I., Seguro P., Cuomo A., Orlando L., Olanda G. B., Pucci A., Massenzo M., Sardu C., Perrone G., Corazziere F., La Puzza I., Tripodi P. F., Riggio S., Giampaolo A., Mannino D., Aleandri A. R., Guidi M. V., Battisti B., Faraglia M. R., Lilli V., Leotta S., Visalli N., Gagliardi A., Fontana L., Altomare M., Carletti S., Abbruzzese S., Chiaramonte F., Giordano R., Rossini M., Migneco G., Cappelloni D., Urbani A., Piergiovanni F., Simonetta A., Massimiani F., Bulzomi R., Giuliano M., Pennafina M. G., Di Perna P., D'Accinni M. P., Paolucci D., D'Ubaldi A., D'Angelo M. T., Masaro G., Pietrantoni M., Fratini M., La Rosa R., Poggi M., Piccirilli F., Pisano R., Saponara C., Conforti I., Penza A., Scalpone R., Lo Pinto S., Iacovella L., Caccamo C., Sposito S., Teodonio C., Restuccia M. G., Mirto G., Girardello R., Gennaro R., De Moliner L., Bettini E., Mattuzzi A., Speese K., Frisinghelli F., Locatelli F., Nicoletti M., Trojan N., Centis R., L Volsi P., Levis E., Zanette G., Comba G., Ballatore L., Cattaneo A., Aglialoro A., Guido R., Patrone M., Zecchini M., Clementi L., Galetta M., Marconi V., Bordin P., Perale L., Vinci C., Sira Zanon M., Geretto L., Toffolo C., Furlan M. G., Mazzanti G., Vinci M., Sica V., Armeni M., Derai R., Ennas O., Mamusa S., Pisano M. A., Carreras L., Rauseo A., Cervone S., Leggieri A., Pontonio M., Sturaro R., Quattrocchi F., Molinaro M., Trasatti M., Ferretti B., Labarile G., Baule G. M., Gentilini A., Spanu M. A., Fancellu A., Bianco P., Lione L., Massazza G., Bocchio G., Bosco E., Monachesi M., Carta G., Boschetti M., Ceresola E., Venier E., Calcaterra F., Cataldi F., Miola M., Manfrini S., Lai A., Locci B., Putzu D., Tanganelli I., Leonini M., Egger K., Marchiotto W., Vincis L., Orlandini V., Pilloni C., Farci R., Pelligra I., Renier G., Mameli M., Pala A., Devigus E., Fumagalli I., Lalli C., Leandri M., Agliani M., De Pascalis L., Malci F., De Ciocchis A., Diodati M. B., Macerola B., Davi S., Caccavale A., Brocato L., Pognant Gros M., Borla S., Lattanzi E., Piersanti C., Piersanti A., Spinelli I., Tuzzoli L., Tulini V., Quaranta G., Iorio V., Tirabovi M., De Terlizi C., Massarelli M. G., Venturi S., Travaglini A., Draghi P., Pomante P., Richiardi L., Clerico A., Bruno A., Cavallo Perin P., Ghigo E., Porta M., Scuntero P., Arcari R., Bertaina S., Bo S., Broglio F., Bruno G., Degiovanni M., Fornengo P., Grassi G., Inglese V., Maccario M., Maghenzani G., Marena S., Martina V., Passera P., Ruiu G., Tagliabue M., Zanone M., Monge M., Boffano G. M., Macri K., Maio P., Ozzello A., Pergolizzi E., Gaia D., Gennari P., Micali G., Rossetto E., Dalmazzo C., Oreglia M., Stefani T., Dossena C., Paglia P., Bosoni S., Romanelli T., Inchiostro S., Dauriz M., Bossi C. A., Meregalli G., Balini A., Berzi D., Filippini B., Crotto G., Paccagnella A., Orrasch M., Sambataro M., Citro T., Kiwanuka E., Bagolin E., Almoto B., Macchia A., Branca M. T., Filesi M., Candido R., Caroli E., Manca E., Petrucco A., Tommasi E., Jagodnik G., Baskar B., Daris N., Dal Col P., Pellegrini M. A., Tonutti L., Venturini G., Andreani M., Turchi F., Fedrighelli F., Martinelli G., Rongioletti R., Candidi M., Pais M., Moro E., Cervellino F., Sinisi R., Zampino A., Mingardi R., Lora L., Reitano R., Stocchiero C., Simoncini M., Mesturino C. A., Zen F., Di Pietro S., Scoponi C., Tilaro L., Pelliccioni S., Slongo R., Vita E., Garofalo A., Vitale F., Campanella B., Mastrilli V., Borrelli T., D'Avino A., Perbellini A., Mirijello, A, Viazzi, F, Fioretto, P, Giorda, C, Ceriello, A, Russo, G, Guida, P, Pontremoli, R, De Cosmo, S, Cimino, A, Fava, D, Meloncelli, I, Nicolucci, A, Pellegrini, F, Rossi, M, Turco, S, Vespasiani, G, Graziano, G, Lucisano, G, Memmo, R, Pellicciotta, E, Paciotti, V, Pupillo, M, Armentano, G, Giovannini, C, Armentano, V, Laudato, M, Acquati, S, Ciardullo, A, Laffi, G, Felace, G, Taboga, C, Tortul, C, Santantonio, G, Suraci, C, Ghisoni, G, Raffa, M, Genovese, S, Lovagnini-Scher, C, Rampini, P, Rocca, A, Ruggeri, P, Tortato, E, Cotti, L, Cristofaro, M, Tagliaferri, M, Comoglio, M, Fornengo, R, Gentile, F, Gigante, A, Mastinu, F, Di Benedetto, A, Pata, P, Arcangeli, A, Orsini, P, Acler, P, De Blasi, G, Cicioni, G, Pocciati, S, Marangoni, A, Nogara, A, Lanero, M, Bertero, M, Damassino, R, Bergonzini, C, Schumtz, L, Seksich, L, Pipitone, A, Boaretto, M, Manfroi, I, Parmesan, L, Conte, B, Soccol, F, Pagano, A, Papini, E, Rinaldi, R, Petrucci, L, Graziano, F, Chianelli, M, Silvagni, S, Rosco, M, Ansaldi, E, Malvicino, F, Battezzati, M, Maresca, P, Palenzona, C, Boemi, M, Rabini, R, Brandoni, G, Lanari, L, Gatti, C, Testa, I, Cherubini, V, Doveri, G, Pecorelli, L, Ciccarelli, A, Gallardini, M, Courthoud, R, Sara Bredy, S, Ricciardi, G, Vitalone, G, Setti, D, Contrini, P, Corsi, A, Ghigliotti, V, Oddone, G, Ponzani, P, Valbonesi, G, Mazzini, V, Di Berardino, P, Colleluori, P, Montani, V, Trosini, V, Velussi, M, Alfidi, P, Verdecchia, B, Baliva, L, Di Pietro, A, Franchi, G, Luce, R, Pianta, A, Ferrari, M, Balzano, S, Beltranello, G, Dal Fabbro, S, Arico, C, Cervo, L, Zanon, R, Rossa, S, Di Pace, M, Ciavarella, A, Giangiulio, S, Grimaldi, M, Mustacchio, A, Fattor, B, Monauni, T, Cristini, M, Orion, G, Crazzolara, D, Amor, F, Eisath, J, Lintner, S, Garavelli, S, Calari, T, Marini, P, Sandri, O, Scala, M, Stroppa, C, Trentin, A, Carlin, R, Carli, B, Sandona, M, Zortea, C, Bonet, L, Pradel, L, Reato, S, Buschini, M, Bonfiglioli, D, Mones, D, Beldi, F, Morea, A, Bondesan, L, Perbellini, S, Valentini, U, Agosti, B, Corsini, R, Girelli, A, Zarra, E, Rocca, L, Bergmann, M, Pradi, I, Unterkircher, S, Piok, M, Pichler, M, Trinchera, A, Palama, G, Palma, P, Carboni, L, Murtas, M, Mudadu, T, Turco, M, Floris, M, Delogu, A, Farris, L, Songini, M, Piras, G, Seguro, R, Floris, R, Corona, G, Lai, M, Piras, E, Contini, P, Cocco, S, Pilosu, R, Sannia, M, Spanu, F, Busciantella Ricci, N, Cartechini, M, Agostinelli, G, Fiorelli, C, Nuzzi, A, Ballauri, C, Lesina, A, Romeo, F, Giudici, G, Maciejewska, E, Deroma, A, Paduano, M, Rossi, L, Vagnini, C, Dolci, M, Mori, M, Baccetti, F, Gregori, G, Straface, E, Pozzuoli, G, Barone, M, Stasio, G, Tondini, S, Borgoni, F, Grosso, J, Scarsellato, C, Sciulli, A, De Marco, F, Confortin, L, Marin, N, Lamonica, M, Gialdino, S, Borzi, V, Gatta, C, Rapisard, R, Strano, S, Calabro, M, Puccio, L, Zolli, M, Coracina, A, Starnone, V, Del Buono, A, Terracciano, A, Monda, M, Castro, F, Guaglianone, A, Maccari, V, Corsi, L, Versari, G, Falivene, M, Boletto, N, Corsi, S, Marafetti, L, Vitacolonna, E, Capani, F, Caputo, L, Di Nisio, L, Simonetti, F, Boscolo Bariga, A, Ballarin, G, De Boni, S, Di Benedetto, S, Chiambretti, A, Di Vito, L, Pascuzzo, M, Urli, P, Rumi, P, Balzarini, B, Galli, P, Castellan, M, Giannetti, A, Russotti, C, De Blasi, A, Perna, A, Campanelli, C, Ranchelli, A, Biccheri, D, Dadi, G, Massa, L, Baldi, G, Sciacca, F, Costanzo, E, Spada, M, Paolini, G, Ziller, P, Portolan, F, Pasolini, G, Ghilardi, G, Fiorina, P, Grata, M, Capretti, L, Speroni, G, Fugazza, L, Massafra, C, Lovagnini Scher, A, Cimicchi, M, Percudani, C, Risolo, T, Sacco, P, Gidoni Guarnieri, G, Piccolo, D, Bravin, C, De Noni, E, Scarpel, M, Marcon, M, Giacon, F, Panebianco, G, Tadiotto, F, Da Tos, V, D'Ambrosio, M, Pellizzola, D, Zampini, M, Frezzati, E, Mari, E, 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G., Di Perna P., D'Accinni M. P., Paolucci D., D'Ubaldi A., D'Angelo M. T., Masaro G., Pietrantoni M., Fratini M., La Rosa R., Poggi M., Piccirilli F., Pisano R., Saponara C., Conforti I., Penza A., Scalpone R., Lo Pinto S., Iacovella L., Caccamo C., Sposito S., Teodonio C., Restuccia M. G., Mirto G., Girardello R., Gennaro R., De Moliner L., Bettini E., Mattuzzi A., Speese K., Frisinghelli F., Locatelli F., Nicoletti M., Trojan N., Centis R., L Volsi P., Levis E., Zanette G., Comba G., Ballatore L., Cattaneo A., Aglialoro A., Guido R., Patrone M., Zecchini M., Clementi L., Galetta M., Marconi V., Bordin P., Perale L., Vinci C., Sira Zanon M., Geretto L., Toffolo C., Furlan M. G., Mazzanti G., Vinci M., Sica V., Armeni M., Derai R., Ennas O., Mamusa S., Pisano M. A., Carreras L., Rauseo A., Cervone S., Leggieri A., Pontonio M., Sturaro R., Quattrocchi F., Molinaro M., Trasatti M., Ferretti B., Labarile G., Baule G. M., Gentilini A., Spanu M. A., Fancellu A., Bianco P., Lione L., Massazza G., Bocchio G., Bosco E., Monachesi M., Carta G., Boschetti M., Ceresola E., Venier E., Calcaterra F., Cataldi F., Miola M., Manfrini S., Lai A., Locci B., Putzu D., Tanganelli I., Leonini M., Egger K., Marchiotto W., Vincis L., Orlandini V., Pilloni C., Farci R., Pelligra I., Renier G., Mameli M., Pala A., Devigus E., Fumagalli I., Lalli C., Leandri M., Agliani M., De Pascalis L., Malci F., De Ciocchis A., Diodati M. B., Macerola B., Davi S., Caccavale A., Brocato L., Pognant Gros M., Borla S., Lattanzi E., Piersanti C., Piersanti A., Spinelli I., Tuzzoli L., Tulini V., Quaranta G., Iorio V., Tirabovi M., De Terlizi C., Massarelli M. G., Venturi S., Travaglini A., Draghi P., Pomante P., Richiardi L., Clerico A., Bruno A., Cavallo Perin P., Ghigo E., Porta M., Scuntero P., Arcari R., Bertaina S., Bo S., Broglio F., Bruno G., Degiovanni M., Fornengo P., Grassi G., Inglese V., Maccario M., Maghenzani G., Marena S., Martina V., Passera P., Ruiu G., Tagliabue M., Zanone M., Monge M., Boffano G. M., Macri K., Maio P., Ozzello A., Pergolizzi E., Gaia D., Gennari P., Micali G., Rossetto E., Dalmazzo C., Oreglia M., Stefani T., Dossena C., Paglia P., Bosoni S., Romanelli T., Inchiostro S., Dauriz M., Bossi C. A., Meregalli G., Balini A., Berzi D., Filippini B., Crotto G., Paccagnella A., Orrasch M., Sambataro M., Citro T., Kiwanuka E., Bagolin E., Almoto B., Macchia A., Branca M. T., Filesi M., Candido R., Caroli E., Manca E., Petrucco A., Tommasi E., Jagodnik G., Baskar B., Daris N., Dal Col P., Pellegrini M. A., Tonutti L., Venturini G., Andreani M., Turchi F., Fedrighelli F., Martinelli G., Rongioletti R., Candidi M., Pais M., Moro E., Cervellino F., Sinisi R., Zampino A., Mingardi R., Lora L., Reitano R., Stocchiero C., Simoncini M., Mesturino C. A., Zen F., Di Pietro S., Scoponi C., Tilaro L., Pelliccioni S., Slongo R., Vita E., Garofalo A., Vitale F., Campanella B., Mastrilli V., Borrelli T., D'Avino A., and Perbellini A.
Abstract: Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage ≥3 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage ≥3 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage ≥3 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 ± 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage ≥3 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage ≥3 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening.
Published: 2018

20. Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes 11 Medical and Health Sciences 1103 Clinical Sciences

Author: Mirijello, A, Viazzi, F, Fioretto, P, Giorda, C, Ceriello, A, Russo, G, Guida, P, Pontremoli, R, De Cosmo, S, Cimino, A, Fava, D, Meloncelli, I, Nicolucci, A, Pellegrini, F, Rossi, M, Turco, S, Vespasiani, G, Graziano, G, Lucisano, G, Memmo, R, Pellicciotta, E, Paciotti, V, Pupillo, M, Armentano, G, Giovannini, C, Armentano, V, Laudato, M, Acquati, S, Ciardullo, A, Laffi, G, Felace, G, Taboga, C, Tortul, C, Santantonio, G, Suraci, C, Ghisoni, G, Raffa, M, Genovese, S, Lovagnini-Scher, C, Rampini, P, Rocca, A, Ruggeri, P, Tortato, E, Cotti, L, Cristofaro, M, Tagliaferri, M, Comoglio, M, Fornengo, R, Gentile, F, Gigante, A, Mastinu, F, Di Benedetto, A, Pata, P, Arcangeli, A, Orsini, P, Acler, P, De Blasi, G, Cicioni, G, Pocciati, S, Marangoni, A, Nogara, A, Lanero, M, Bertero, M, Damassino, R, Bergonzini, C, Schumtz, L, Seksich, L, Pipitone, A, Boaretto, M, Manfroi, I, Parmesan, L, Conte, B, Soccol, F, Pagano, A, Papini, E, Rinaldi, R, Petrucci, L, Graziano, F, Chianelli, M, Silvagni, S, Rosco, M, Ansaldi, E, Malvicino, F, Battezzati, M, Maresca, P, Palenzona, C, Boemi, M, Rabini, R, Brandoni, G, Lanari, L, Gatti, C, Testa, I, Cherubini, V, Doveri, G, Pecorelli, L, Ciccarelli, A, Gallardini, M, Courthoud, R, Sara Bredy, S, Ricciardi, G, Vitalone, G, Setti, D, Contrini, P, Corsi, A, Ghigliotti, V, Oddone, G, Ponzani, P, Valbonesi, G, Mazzini, V, Di Berardino, P, Colleluori, P, Montani, V, Trosini, V, Velussi, M, Alfidi, P, Verdecchia, B, Baliva, L, Di Pietro, A, Franchi, G, Luce, R, Pianta, A, Ferrari, M, Balzano, S, Beltranello, G, Dal Fabbro, S, Arico, C, Cervo, L, Zanon, R, Rossa, S, Di Pace, M, Ciavarella, A, Giangiulio, S, Grimaldi, M, Mustacchio, A, Fattor, B, Monauni, T, Cristini, M, Orion, G, Crazzolara, D, Amor, F, Eisath, J, Lintner, S, Garavelli, S, Calari, T, Marini, P, Sandri, O, Scala, M, Stroppa, C, Trentin, A, Carlin, R, Carli, B, Sandona, M, Zortea, C, Bonet, L, Pradel, L, Reato, S, Buschini, M, Bonfiglioli, D, Mones, D, Beldi, F, Morea, A, 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G., Damassino R., Bergonzini C., Schumtz L., Seksich L., Pipitone A., Boaretto M., Manfroi I., Parmesan L., Conte B., Soccol F., Pagano A., Papini E., Rinaldi R., Petrucci L., Graziano F., Chianelli M., Silvagni S., Rosco M., Ansaldi E., Malvicino F., Battezzati M., Maresca P., Palenzona C., Boemi M., Rabini R. A., Brandoni G., Lanari L., Gatti C., Testa I., Cherubini V., Doveri G., Pecorelli L., Ciccarelli A., Gallardini M. B., Courthoud R., Sara Bredy S., Ricciardi G. P., Vitalone G., Setti D., Contrini P., Corsi A., Ghigliotti V., Oddone G., Ponzani P., Valbonesi G., Mazzini V., Di Berardino P., Colleluori P., Montani V., Trosini V., Velussi M., Alfidi P., Verdecchia B., Baliva L., Di Pietro A., Franchi G., Luce R. P., Pianta A., Ferrari M., Balzano S., Beltranello G., Dal Fabbro S., Arico C. N., Cervo L., Zanon R., Rossa S., Di Pace M. C., Ciavarella A., Giangiulio S., Grimaldi M., Mustacchio A., Fattor B., Monauni T., Cristini M., Orion G., Crazzolara D., Amor F., Eisath J. 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L., Gallo A., Parlato P., Pecchielan W., Jacovacci J., Placentino G., Richini D., Molinari S., Strazzeri R., Fabbri T., Di Bartolo P., Garrapa G., D'Incau F., Lagomanzini P., Conte P., Todesco F., Foglini P., Pantanetti P., Bedetta C., Maricotti R., Tomasi F., Monesi M., Graziani R., Beretta F., Penna L., Guberti A., Dazzi D., Forte E., Gasbarrone A., Marrocco T., Moschetta R., Tuccinardi F., De Meo F., Coppola A., Pirolozzi P., Placitelli E., Vallefuoco R., Catone B., Ceschia S., Urban M., Fabbri F., Torresani M., Crovetto R., Battistini M., Carosia P., Viviani G. L., Durante A., Pais F., Lilliu V., Quieto C., D'Ugo E., Squadrone M., Amenduni T., Iovannisci M. M., Della Penna L., Potente F., Delle Donne T., Massa C., Ulisse M. A., De Berardinis S., Guarnieri I., Pace S., Splendiani M., Di Giuseppe R., Brunato B., Assaloni R., Muraro R., Loro R., Bucciol S., Lavacca C., Rossi M., Sabbatini G., Quadri F., Sambuco L., Santacroce C., Paola Caretta D., Marino C., Micheletti A., Petrelli A., Corda A., Pisano L., Guaita G., Deias C., Trevisan G., Coletti I., Iannarelli R., De Luca A., Minnucci A., Antenucci D., Di Florio C., Angelicola G., Bosco A., Fresco R., Di Marco G., Ugolotti D., Cadossi T., Di Caro P., Mazzocchetti M., Buzzetti R., Leto G., Gnessi C., Cipolloni L., Foffi C., Moretti C., Venditti C., Meniconi R., Bertoli S., Cosimi S., Di Cianni G., Turco A., Richini A., Marconi S., Sannino C., Lemmi P., Giuntoli S., Manfre N., Giannini F., Di Carlo A., Casadidio I., Melandri P., Maolo G., Polenta B., Piccinini N., Vincenti C., Pastore N., Mega P., Magurano E., Cananiello A., Francescutto C. 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A., Loddoni S., Brundu I., Careddu F., Becciu A., Gabriella Piras G., Novara F., Cipro F., Torchio G., Palumbo P., Bianchi A., Colucci G., La Motta G., Tiengo A., Avogaro A., Bruttomesso D., Crepaldi C., Fadini G., Guarnieri G., Lavagnini M. T., Maran A., Vedovato M., De Kreutzenberg V., Fedele D., Lapolla A., Sartore G., Bax G., Cardone C., Dalfra M. G., Masin M., Toniato R., Piarulli F., Mattina G., Fulantelli M. A., Gioia D., Conti M., Ridola G., D'Agati F., Grossi G., Zavaroni I., Dei Cas A., Franzini L., Usberti E., Antonimi M., Anelli N., Poli R., Ridolfi V., Michela M., Haddoub S., Prampolini G., Muoio A., Filippi D., Bucci F., Tardio S. M., Calderini M. C., Magotti M. G., Quarantelli C., Vernazza M. A., Carolfi A., Saracca R., Picchio E., Del Sindaco P., Spalluto A., Maggiulli L., Torreggiani V., Rastelletti S., Ugolini C., Pucci N., Magi S., Muratori S., La Penna G., Consoli A., Galeone F., Magiar A. 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A., Fancellu A., Bianco P., Lione L., Massazza G., Bocchio G., Bosco E., Monachesi M., Carta G., Boschetti M., Ceresola E., Venier E., Calcaterra F., Cataldi F., Miola M., Manfrini S., Lai A., Locci B., Putzu D., Tanganelli I., Leonini M., Egger K., Marchiotto W., Vincis L., Orlandini V., Pilloni C., Farci R., Pelligra I., Renier G., Mameli M., Pala A., Devigus E., Fumagalli I., Lalli C., Leandri M., Agliani M., De Pascalis L., Malci F., De Ciocchis A., Diodati M. B., Macerola B., Davi S., Caccavale A., Brocato L., Pognant Gros M., Borla S., Lattanzi E., Piersanti C., Piersanti A., Spinelli I., Tuzzoli L., Tulini V., Quaranta G., Iorio V., Tirabovi M., De Terlizi C., Massarelli M. 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A., Loddoni S., Brundu I., Careddu F., Becciu A., Gabriella Piras G., Novara F., Cipro F., Torchio G., Palumbo P., Bianchi A., Colucci G., La Motta G., Tiengo A., Avogaro A., Bruttomesso D., Crepaldi C., Fadini G., Guarnieri G., Lavagnini M. T., Maran A., Vedovato M., De Kreutzenberg V., Fedele D., Lapolla A., Sartore G., Bax G., Cardone C., Dalfra M. G., Masin M., Toniato R., Piarulli F., Mattina G., Fulantelli M. A., Gioia D., Conti M., Ridola G., D'Agati F., Grossi G., Zavaroni I., Dei Cas A., Franzini L., Usberti E., Antonimi M., Anelli N., Poli R., Ridolfi V., Michela M., Haddoub S., Prampolini G., Muoio A., Filippi D., Bucci F., Tardio S. M., Calderini M. C., Magotti M. G., Quarantelli C., Vernazza M. A., Carolfi A., Saracca R., Picchio E., Del Sindaco P., Spalluto A., Maggiulli L., Torreggiani V., Rastelletti S., Ugolini C., Pucci N., Magi S., Muratori S., La Penna G., Consoli A., Galeone F., Magiar A. V., Gherardini V., Moretti L., Bientinesi M., Landi L., Bernardi A., Del Prato S., Miccoli R., Bianchi C., Penno G., Venditti F., Anichini R., De Bellis A., Bruschi T., Butelli L., Gioffredi M., Gori R., Picciafuochi R., Malagoli R., Bernini A., Gelisio R., Zanon M., Del Bianco A., Bamiston A., Signorato M., Citro G., Calabrese M., Ianni L., Lorenzetti M., Marsocci A., Guizzotti S., Memoli G., Cabasino F., Farci F., Atzori A., Sanna A., Ghiani M., Siotto I., Sedda M., Manis A., Loddo C., Loddo I., Seguro P., Cuomo A., Orlando L., Olanda G. B., Pucci A., Massenzo M., Sardu C., Perrone G., Corazziere F., La Puzza I., Tripodi P. F., Riggio S., Giampaolo A., Mannino D., Aleandri A. R., Guidi M. V., Battisti B., Faraglia M. R., Lilli V., Leotta S., Visalli N., Gagliardi A., Fontana L., Altomare M., Carletti S., Abbruzzese S., Chiaramonte F., Giordano R., Rossini M., Migneco G., Cappelloni D., Urbani A., Piergiovanni F., Simonetta A., Massimiani F., Bulzomi R., Giuliano M., Pennafina M. G., Di Perna P., D'Accinni M. P., Paolucci D., D'Ubaldi A., D'Angelo M. T., Masaro G., Pietrantoni M., Fratini M., La Rosa R., Poggi M., Piccirilli F., Pisano R., Saponara C., Conforti I., Penza A., Scalpone R., Lo Pinto S., Iacovella L., Caccamo C., Sposito S., Teodonio C., Restuccia M. G., Mirto G., Girardello R., Gennaro R., De Moliner L., Bettini E., Mattuzzi A., Speese K., Frisinghelli F., Locatelli F., Nicoletti M., Trojan N., Centis R., L Volsi P., Levis E., Zanette G., Comba G., Ballatore L., Cattaneo A., Aglialoro A., Guido R., Patrone M., Zecchini M., Clementi L., Galetta M., Marconi V., Bordin P., Perale L., Vinci C., Sira Zanon M., Geretto L., Toffolo C., Furlan M. G., Mazzanti G., Vinci M., Sica V., Armeni M., Derai R., Ennas O., Mamusa S., Pisano M. A., Carreras L., Rauseo A., Cervone S., Leggieri A., Pontonio M., Sturaro R., Quattrocchi F., Molinaro M., Trasatti M., Ferretti B., Labarile G., Baule G. M., Gentilini A., Spanu M. A., Fancellu A., Bianco P., Lione L., Massazza G., Bocchio G., Bosco E., Monachesi M., Carta G., Boschetti M., Ceresola E., Venier E., Calcaterra F., Cataldi F., Miola M., Manfrini S., Lai A., Locci B., Putzu D., Tanganelli I., Leonini M., Egger K., Marchiotto W., Vincis L., Orlandini V., Pilloni C., Farci R., Pelligra I., Renier G., Mameli M., Pala A., Devigus E., Fumagalli I., Lalli C., Leandri M., Agliani M., De Pascalis L., Malci F., De Ciocchis A., Diodati M. B., Macerola B., Davi S., Caccavale A., Brocato L., Pognant Gros M., Borla S., Lattanzi E., Piersanti C., Piersanti A., Spinelli I., Tuzzoli L., Tulini V., Quaranta G., Iorio V., Tirabovi M., De Terlizi C., Massarelli M. G., Venturi S., Travaglini A., Draghi P., Pomante P., Richiardi L., Clerico A., Bruno A., Cavallo Perin P., Ghigo E., Porta M., Scuntero P., Arcari R., Bertaina S., Bo S., Broglio F., Bruno G., Degiovanni M., Fornengo P., Grassi G., Inglese V., Maccario M., Maghenzani G., Marena S., Martina V., Passera P., Ruiu G., Tagliabue M., Zanone M., Monge M., Boffano G. M., Macri K., Maio P., Ozzello A., Pergolizzi E., Gaia D., Gennari P., Micali G., Rossetto E., Dalmazzo C., Oreglia M., Stefani T., Dossena C., Paglia P., Bosoni S., Romanelli T., Inchiostro S., Dauriz M., Bossi C. A., Meregalli G., Balini A., Berzi D., Filippini B., Crotto G., Paccagnella A., Orrasch M., Sambataro M., Citro T., Kiwanuka E., Bagolin E., Almoto B., Macchia A., Branca M. T., Filesi M., Candido R., Caroli E., Manca E., Petrucco A., Tommasi E., Jagodnik G., Baskar B., Daris N., Dal Col P., Pellegrini M. A., Tonutti L., Venturini G., Andreani M., Turchi F., Fedrighelli F., Martinelli G., Rongioletti R., Candidi M., Pais M., Moro E., Cervellino F., Sinisi R., Zampino A., Mingardi R., Lora L., Reitano R., Stocchiero C., Simoncini M., Mesturino C. A., Zen F., Di Pietro S., Scoponi C., Tilaro L., Pelliccioni S., Slongo R., Vita E., Garofalo A., Vitale F., Campanella B., Mastrilli V., Borrelli T., D'Avino A., and Perbellini A.
Abstract: Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage ≥3 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage ≥3 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage ≥3 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 ± 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage ≥3 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage ≥3 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening.
Published: 2018

21. Quality of life and mortality in the general population: a systematic review and meta-analysis

Author: Phyo, A.Z.Z., Freak-Poli, R, Craig, H., Gasevic, D., Stocks, N.P., Gonzalez-Chica, D.A., Ryan, J., Phyo, A.Z.Z., Freak-Poli, R, Craig, H., Gasevic, D., Stocks, N.P., Gonzalez-Chica, D.A., and Ryan, J.
Abstract: Background: Quality of life (QoL) is multi-dimensional concept of an individual’ general well-being status in relation to their value, environment, cultural and social context in which they live. This study aimed to quantitatively synthesise available evidence on the association between QoL and mortality in the general population. Methods: An electronic search was conducted using three bibliographic databases, MEDLINE, EMBASE and PsycINFO. Inclusion criteria were studies that assessed QoL using standardized tools and examined mortality risk in a non-patient population. Qualitative data synthesis and meta-analyses using a random-effects model were performed. Results: Of 4184 articles identified, 47 were eligible for inclusion, involving approximately 1,200,000 participants. Studies were highly heterogeneous in terms of QoL measures, population characteristics and data analysis. In total, 43 studies (91.5%) reported that better QoL was associated with lower mortality risk. The results of four metaanalyses indicated that higher health-re
Published: 2020
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22. It's not age that prevents sexual activity later in life

Author: Freak-Poli, R. (Rosanne) and Freak-Poli, R. (Rosanne)
Abstract: Objective: To describe key factors that facilitate sexual behaviour in later life. Methods: Re-analysis of data from a study of 2,374 Dutch older adults. Results: Partner availability, gender and health are likely to be more important factors influencing sexual behaviour engagement than the factor of age in later life. Lack of partner availability, traditional gender roles and poor health are associated with older age. However, current generations of older adults will be more capable, less ashamed of their sexual desires and engage in more sexual behaviour than prior generations. Conclusion: This analysis observed that sexual activity is associated with partner availability and better health, rather than age, countering stereotypes of decline in sexual behaviour and normalising sexual activity and desire in later life.
Published: 2020
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23. Quality of life and mortality in the general population: a systematic review and meta-analysis

Author: Phyo, AZZ, Freak-Poli, R, Craig, H, Gasevic, D, Stocks, NP, Gonzalez-Chica, DA, Ryan, J, Phyo, AZZ, Freak-Poli, R, Craig, H, Gasevic, D, Stocks, NP, Gonzalez-Chica, DA, and Ryan, J
Abstract: BACKGROUND: Quality of life (QoL) is multi-dimensional concept of an individual' general well-being status in relation to their value, environment, cultural and social context in which they live. This study aimed to quantitatively synthesise available evidence on the association between QoL and mortality in the general population. METHODS: An electronic search was conducted using three bibliographic databases, MEDLINE, EMBASE and PsycINFO. Inclusion criteria were studies that assessed QoL using standardized tools and examined mortality risk in a non-patient population. Qualitative data synthesis and meta-analyses using a random-effects model were performed. RESULTS: Of 4184 articles identified, 47 were eligible for inclusion, involving approximately 1,200,000 participants. Studies were highly heterogeneous in terms of QoL measures, population characteristics and data analysis. In total, 43 studies (91.5%) reported that better QoL was associated with lower mortality risk. The results of four meta-analyses indicated that higher health-related QoL (HRQoL) is associated with lower mortality risk, which was consistent for overall HRQoL (HR 0.633, 95% CI: 0.514 to 0.780), physical function (HR 0.987, 95% CI: 0.982 to 0.992), physical component score (OR 0.950, 95% CI: 0.935 to 0.965), and mental component score (OR 0.980, 95% CI: 0.969 to 0.992). CONCLUSION: These findings provide evidence that better QoL/HRQoL was associated with lower mortality risk. The utility of these measures in predicting mortality risk indicates that they should be considered further as potential screening tools in general clinical practice, beyond the traditional objective measures such as body mass index and the results of laboratory tests.
Published: 2020

24. Sex and intimacy in later life: From understanding and acceptance to policy

Author: Freak-Poli, R, Malta, S, Freak-Poli, R, and Malta, S
Published: 2020

25. An overview of sexual behaviour research in later life-Quantitative and qualitative findings

Author: Freak-Poli, R, Malta, S, Freak-Poli, R, and Malta, S
Abstract: AIM: This article provides an overview of current sexual behaviour research in later life by describing associated factors, including the physical and psychological benefits. METHODS: Recent systematic reviews were interrogated for findings on sexual behaviour research in adults aged 60+. RESULTS: Regardless of research methods employed, all studies showed that there were a range of physical and psychological benefits to remaining sexually active in later life. While quantitative studies placed an emphasis on measuring penile-vaginal intercourse, they provided no definitive conclusion about the benefits due to 'inconsistent results' across studies. Qualitative studies described the myriad ways in which older adults redefine what constitutes sexual activity despite the onset of dysfunction and disability. CONCLUSION: While the different research methods show that engaging in sexual behaviour has physical and psychological benefits at all adult ages, there is limited conclusive evidence about what the overall benefits might be in later life.
Published: 2020

26. It's not age that prevents sexual activity later in life

Author: Freak-Poli, R and Freak-Poli, R
Published: 2020

27. Quality of life and mortality in the general population: a systematic review and meta-analysis

Author: Phyo, AZZ, Freak-Poli, R, Craig, H, Gasevic, D, Stocks, NP, Gonzalez-Chica, DA, Ryan, J, Phyo, AZZ, Freak-Poli, R, Craig, H, Gasevic, D, Stocks, NP, Gonzalez-Chica, DA, and Ryan, J
Published: 2020

28. The impact of psychological stress and trauma on later-life cognitive function and dementia

Author: Nilaweera, D. (D.), Freak-Poli, R. (Rosanne), Ryan, J. (Joanne), Nilaweera, D. (D.), Freak-Poli, R. (Rosanne), and Ryan, J. (Joanne)
Abstract: Dementia is an increasing global issue, currently affecting an estimated 50 million people worldwide. This number is predicted to increase to 82 million by the year 2030, due to the ageing global population. Theoretically, preventing late-onset dementia may seem extremely difficult as the greatest risk factor, age, is unmodifiable. However, it is estimated that a third of dementia cases could potentially be prevented or delayed by removing or reducing modifiable risk factors. Increasing evidence suggests that chronic stress, which may aris
Published: 2019

29. The impact of psychological stress and trauma on later-life cognitive function and dementia

Author: Nilaweera, D., Freak-Poli, R, Ryan, J., Nilaweera, D., Freak-Poli, R, and Ryan, J.
Abstract: Dementia is an increasing global issue, currently affecting an estimated 50 million people worldwide. This number is predicted to increase to 82 million by the year 2030, due to the ageing global population. Theoretically, preventing late-onset dementia may seem extremely difficult as the greatest risk factor, age, is unmodifiable. However, it is estimated that a third of dementia cases could potentially be prevented or delayed by removing or reducing modifiable risk factors. Increasing evidence suggests that chronic stress, which may arise from experiencing a traumatic event or daily stress, may be a potential risk factor for dementia. Whilst it may not play a vital role in causing the syndrome, stress may contribute to the progression of cognitive decline, which is the main symptom of dementia. The primary stress hormone, cortisol, may have detrimental effects on cognitive brain regions when its levels are elevated for long durations. Preliminary evidence suggests that stress may have different effects on brain structure and function, depending on the individual’s age when exposed to the stress. Stress during early and later life may lead to more permanent brain changes, which may contribute to cognitive decline in later life. Limited evidence links chronic stress or major trauma at specific stages of the lifespan, with cognitive decline and incidence of dementia. Whether or not an accumulation of stress across the lifespan influences later life cognition and risk of dementia, still remains to be determined. Understanding to what extent stressful events are risk factors for later-life cognitive decline and dementia will be crucial to the implementation of targeted psychosocial interventions efforts.
Published: 2019

30. The impact of psychological stress and trauma on later-life cognitive function and dementia

Author: Nilaweera, D, Freak-Poli, R, Ryan, J, Nilaweera, D, Freak-Poli, R, and Ryan, J
Published: 2019

31. Cognitive Impairment, Sexual Activity and Physical Tenderness in Community-Dwelling Older Adults: A Cross-Sectional Exploration

Author: Freak-Poli, R. (Rosanne), Licher, S. (Silvan), Ryan, J. (Joanne), Ikram, M.A. (Arfan), Tiemeier, H.W. (Henning), Freak-Poli, R. (Rosanne), Licher, S. (Silvan), Ryan, J. (Joanne), Ikram, M.A. (Arfan), and Tiemeier, H.W. (Henning)
Abstract: Background: The ability to engage in sexual activity and better cognitive functioning are both associated with better health. However, the association between cognitive functioning and sexual activity is understudied. Objective: To examine the association between cognitive functioning with sexual activity and physical tenderness among community-dwelling older adults. Methods: From the Rotterdam Study, cognitive impa
Published: 2018
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32. Cognitive Impairment, Sexual Activity and Physical Tenderness in Community-Dwelling Older Adults: A Cross-Sectional Exploration

Author: Freak-Poli, R, Licher, Silvan, Ryan, J, Ikram, Arfan, Tiemeier, Henning, Freak-Poli, R, Licher, Silvan, Ryan, J, Ikram, Arfan, and Tiemeier, Henning
Published: 2018

33. Vision Making in Large Urban Settings: Unleashing Anticipation?

Author: Poli, R., Ache, P.M., Poli, R., and Ache, P.M.
Abstract: Item does not contain fulltext, Our society will increasingly be an urban society, with large metropolitan regions as the centers of development. These metropolitan spaces are supposed to create the economic and technological dynamics to solve the problems of the very same urban society. They are extremely complex structures, overall, difficult to understand in all their dimensions and asking for new ways of management, strategy formation, and general politics: “if we cannot imagine, we cannot manage.” Stakeholders, citizens, and planners alike will be faced with the challenge to develop appropriate ideas guiding the dynamics and complex settings and to keep development horizons open for not yet anticipated trajectories. Vision-making processes become very important in such a context, in the best case creating open political horizons, interested in becoming and the “midwifing of futures.” A survey of 30 vision-making processes in Europe forms the empirical backcloth for a presentation and discussion of urban systems, vision-making documents, time horizons and instant futures, vision formulations, and the “perpetual pursuit of unknowable novelty.”
Published: 2017

34. Levels of ambient air pollution according to mode of transport: a systematic review

Author: Cepeda, M. (Magda), Schoufour, J.D. (Josje), Freak-Poli, R. (Rosanne), Koolhaas, C.M. (Chantal), Dhana, K. (Klodian), Bramer, W.M. (Wichor), Franco, O.H. (Oscar), Cepeda, M. (Magda), Schoufour, J.D. (Josje), Freak-Poli, R. (Rosanne), Koolhaas, C.M. (Chantal), Dhana, K. (Klodian), Bramer, W.M. (Wichor), and Franco, O.H. (Oscar)
Abstract: Background Controversy exists about the differences in air pollution exposure and inhalation dose between mode of transport. We aimed to review air pollution exposure and inhaled dose according to mode of transport and pollutant and their effect in terms of years of life expectancy (YLE). Methods In this systematic review, we searched ten online databases from inception to April 13, 2016, without language or temporal restrictions, for cohort, cross-sectional, and experimental studies that compared exposure to carbon monoxide, black carbon, nitrogen dioxide, and fine and coarse particles in active commuters (pedestrian or cyclist) and commuters using motorised transport (car, motorcycle, bus, or massive motorised transport [MMT—ie, train, subway, or metro]). We excluded studies that measured air pollution exposure exclusively with biomarkers or on the basis of simulated data
Published: 2017
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35. Vision Making in Large Urban Settings: Unleashing Anticipation?

Author: Poli, R., Ache, P.M., Poli, R., and Ache, P.M.
Abstract: Item does not contain fulltext, Our society will increasingly be an urban society, with large metropolitan regions as the centers of development. These metropolitan spaces are supposed to create the economic and technological dynamics to solve the problems of the very same urban society. They are extremely complex structures, overall, difficult to understand in all their dimensions and asking for new ways of management, strategy formation, and general politics: “if we cannot imagine, we cannot manage.” Stakeholders, citizens, and planners alike will be faced with the challenge to develop appropriate ideas guiding the dynamics and complex settings and to keep development horizons open for not yet anticipated trajectories. Vision-making processes become very important in such a context, in the best case creating open political horizons, interested in becoming and the “midwifing of futures.” A survey of 30 vision-making processes in Europe forms the empirical backcloth for a presentation and discussion of urban systems, vision-making documents, time horizons and instant futures, vision formulations, and the “perpetual pursuit of unknowable novelty.”
Published: 2017

36. Animal Anticipation: A Perspective

Author: Poli, R., Bos, R. van den, Poli, R., and Bos, R. van den
Abstract: Item does not contain fulltext
Published: 2017

37. Animal Anticipation: A Perspective

Author: Poli, R., Bos, R. van den, Poli, R., and Bos, R. van den
Abstract: Item does not contain fulltext
Published: 2017

38. Levels of ambient air pollution according to mode of transport: a systematic review

Author: Cepeda, M, Schoufour, Josje, Freak-Poli, R, Koolhaas, Chantal, Dhana, K, Bramer, WM (Wichor), Franco Duran, OH, Cepeda, M, Schoufour, Josje, Freak-Poli, R, Koolhaas, Chantal, Dhana, K, Bramer, WM (Wichor), and Franco Duran, OH
Published: 2017

39. Associations of heart failure with sleep quality: The rotterdam study

Author: Zuurbier, L.A. (Lisette), Luik, A.I. (Annemarie), Leening, M.J.G. (Maarten), Hofman, A. (Albert), Freak-Poli, R. (Rosanne), Franco, O.H. (Oscar), Stricker, B.H.Ch. (Bruno), Tiemeier, H.W. (Henning), Zuurbier, L.A. (Lisette), Luik, A.I. (Annemarie), Leening, M.J.G. (Maarten), Hofman, A. (Albert), Freak-Poli, R. (Rosanne), Franco, O.H. (Oscar), Stricker, B.H.Ch. (Bruno), and Tiemeier, H.W. (Henning)
Abstract: Study Objectives: The prevalence of sleep disturbances and heart failure increases with age. We aimed to evaluate the associations of incident heart failure and cardiac dysfunction with changes in sleep quality. Methods: This prospective population-based study was conducted in the Rotterdam Study. Of the 3,445 eligible persons (mean age 72.0 ± 7.1 years) available for crosssectional analyses, 8.9% (n = 307) had prevalent clinical heart failure. In longitudinal analyses, 1,989 eligible persons (mean age 70.0 ± 5.8 years) were followed for an average of 6.5 ± 0.4 years, of which 4.6% (n = 91) had prevalent or incident clinical heart failure. Heart failure was assessed according to European Society of Cardiology criteria. To estimate cardiac function, we measured left ventricular fractional shortening, left ventricular systolic function, and E/A ratio by echocardiography. Heart failure and cardiac dysfunction were studied with linear regression in rela
Published: 2015
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40. Measuring the accuracy of self-reported height and weight in a community-based sample of young people

Author: Bowring, AL, Peeters, A, Freak-Poli, R, Lim, MSC, Gouillou, M, Hellard, M, Bowring, AL, Peeters, A, Freak-Poli, R, Lim, MSC, Gouillou, M, and Hellard, M
Abstract: BACKGROUND: Self-reported anthropometric data are commonly used to estimate prevalence of obesity in population and community-based studies. We aim to: 1) Determine whether survey participants are able and willing to self-report height and weight; 2) Assess the accuracy of self-reported compared to measured anthropometric data in a community-based sample of young people. METHODS: Participants (16-29 years) of a behaviour survey, recruited at a Melbourne music festival (January 2011), were asked to self-report height and weight; researchers independently weighed and measured a sub-sample. Body Mass Index was calculated and overweight/obesity classified as ≥25 kg/m². Differences between measured and self-reported values were assessed using paired t-test/Wilcoxon signed ranks test. Accurate report of height and weight were defined as <2 cm and <2 kg difference between self-report and measured values, respectively. Agreement between classification of overweight/obesity by self-report and measured values was assessed using McNemar's test. RESULTS: Of 1405 survey participants, 82% of males and 72% of females self-reported their height and weight. Among 67 participants who were also independently measured, self-reported height and weight were significantly less than measured height (p=0.01) and weight (p<0.01) among females, but no differences were detected among males. Overall, 52% accurately self-reported height, 30% under-reported, and 18% over-reported; 34% accurately self-reported weight, 52% under-reported and 13% over-reported. More females (70%) than males (35%) under-reported weight (p=0.01). Prevalence of overweight/obesity was 33% based on self-report data and 39% based on measured data (p=0.16). CONCLUSIONS: Self-reported measurements may underestimate weight but accurately identified overweight/obesity in the majority of this sample of young people.
Published: 2012

41. Increasing body weight and risk of limitations in activities of daily living: a systematic review and meta-analysis

Author: Backholer, Kathryn, Wong, E, Freak-Poli, R, Walls, Helen, Peeters, Anna, Backholer, Kathryn, Wong, E, Freak-Poli, R, Walls, Helen, and Peeters, Anna
Abstract: This study examined the relationship between normal weight, overweight and obesity class I and II+, and the risk of disability, which is defined as impairment in activities of daily living (ADL). Systematic searching of the literature identified eight cross-sectional studies and four longitudinal studies that were comparable for meta-analysis. An additional four cross-sectional studies and one longitudinal study were included for qualitative review. Results from the meta-analysis of cross-sectional studies revealed a graded increase in the risk of ADL limitations from overweight (1.04, 95% confidence interval [CI] 1.00-1.08), class I obesity (1.16, 95% CI 1.11-1.21) and class II+ obesity (1.76, 95% CI 1.28-2.41), relative to normal weight. Meta-analyses of longitudinal studies revealed a similar graded relationship; however, the magnitude of this relationship was slightly greater for all body mass index categories. Qualitative analysis of studies that met the inclusion criteria but were not compatible for meta-analysis supported the pooled results. No studies identified met all of the pre-defined quality criteria, and subgroup analysis was inhibited due to insufficient comparable studies. We conclude that increasing body weight increases the risk of disability in a graded manner, but also emphasize the need for additional studies using contemporary longitudinal cohorts with large numbers of obese class III individuals, a range of ages and with measured height and weight, and incident ADL questions.
Published: 2012

42. Reductions in transport mortality in Australia: Evidence of a public health success

Author: Walls, Helen, Curtis, Andrea J, Stevenson, C, Mannan, Haider R, McNeil, John J, Freak-Poli, R, Gabbe, Belinda, Walls, Helen, Curtis, Andrea J, Stevenson, C, Mannan, Haider R, McNeil, John J, Freak-Poli, R, and Gabbe, Belinda
Abstract: Objective: To describe trends in transport mortality for a range of common transport types in Australia over a 30-year period (1975-1977 to 2005-2007). Methods: Mortality data on all-cause and transport-related causes of death were supplied by the Australian Institute of Health and Welfare (AIHW). Mortality rates, expected number of deaths and probabilities of death were compared for three time periods: 1975-1977, 1990-1992 and 2005-2007. Results: There were significant decreasing trends between 1975-1977 and 2005-2007 in all-cause and most other transport mortality types for both men and women. There were significant reductions in the contribution of transport-related mortality to all-cause mortality; however the difference in mortality between men and women (higher for men) changed little over the evaluated period. Conclusions: Between 1975-1977 and 2005-2007 there were marked reductions in key causes of transport-related mortality amongst Australian adults, and the reductions in transport-related mortality exceeded reductions in all-cause mortality. The reductions could be attributed to better preventive measures and improved medical treatment for people involved in transport crashes. Although there is scope for further improvement, the reductions are evidence of a success in the prevention of crashes and the medical treatment of crash victims.
Published: 2012

43. Participant characteristics associated with greater reductions in waist circumference during a four-month, pedometer-based, workplace health program

Author: Freak-Poli, R, Wolfe, Rory, Walls, Helen, Backholer, Kathryn, Peeters, Anna, Freak-Poli, R, Wolfe, Rory, Walls, Helen, Backholer, Kathryn, and Peeters, Anna
Abstract: Background: Workplace health programs have demonstrated improvements in a number of risk factors for chronic disease. However, there has been little investigation of participant characteristics that may be associated with change in risk factors during such programs. The aim of this paper is to identify participant characteristics associated with improved waist circumference (WC) following participation in a four-month, pedometer-based, physical activity, workplace health program. Methods. 762 adults employed in primarily sedentary occupations and voluntarily enrolled in a four-month workplace program aimed at increasing physical activity were recruited from ten Australian worksites in 2008. Seventy-nine percent returned at the end of the health program. Data included demographic, behavioural, anthropometric and biomedical measurements. WC change (before versus after) was assessed by multivariable linear and logistic regression analyses. Seven groupings of potential associated variables from baseline were sequentially added to build progressively larger regression models. Results: Greater improvement in WC during the program was associated with having completed tertiary education, consuming two or less standard alcoholic beverages in one occasion in the twelve months prior to baseline, undertaking less baseline weekend sitting time and lower baseline total cholesterol. A greater WC at baseline was strongly associated with a greater improvement in WC. A sub-analysis in participants with a 'high-risk' baseline WC revealed that younger age, enrolling for reasons other than appearance, undertaking less weekend sitting time at baseline, eating two or more pieces of fruit per day at baseline, higher baseline physical functioning and lower baseline body mass index were associated with greater odds of moving to 'low risk' WC at the end of the program. Conclusions: While employees with 'high-risk' WC at baseline experienced the greatest improvements in WC, the other variables
Published: 2011

44. Participant characteristics associated with greater reductions in waist circumference during a four-month, pedometer-based, workplace health program.

Author: Freak-Poli, R, Wolfe, Rory, Walls, Helen, Backholer, Kathryn, Peeters , Anna, Freak-Poli, R, Wolfe, Rory, Walls, Helen, Backholer, Kathryn, and Peeters , Anna
Abstract: Background: Workplace health programs have demonstrated improvements in a number of risk factors for chronic disease. However, there has been little investigation of participant characteristics that may be associated with change in risk factors during such programs. The aim of this paper is to identify participant characteristics associated with improved waist circumference (WC) following participation in a four-month, pedometer-based, physical activity, workplace health program. Methods. 762 adults employed in primarily sedentary occupations and voluntarily enrolled in a four-month workplace program aimed at increasing physical activity were recruited from ten Australian worksites in 2008. Seventy-nine percent returned at the end of the health program. Data included demographic, behavioural, anthropometric and biomedical measurements. WC change (before versus after) was assessed by multivariable linear and logistic regression analyses. Seven groupings of potential associated variables from baseline were sequentially added to build progressively larger regression models. Results: Greater improvement in WC during the program was associated with having completed tertiary education, consuming two or less standard alcoholic beverages in one occasion in the twelve months prior to baseline, undertaking less baseline weekend sitting time and lower baseline total cholesterol. A greater WC at baseline was strongly associated with a greater improvement in WC. A sub-analysis in participants with a 'high-risk' baseline WC revealed that younger age, enrolling for reasons other than appearance, undertaking less weekend sitting time at baseline, eating two or more pieces of fruit per day at baseline, higher baseline physical functioning and lower baseline body mass index were associated with greater odds of moving to 'low risk' WC at the end of the program. Conclusions: While employees with 'high-risk' WC at baseline experienced the greatest improvements in WC, the other variables
Published: 2011

45. Theoretical results in genetic programming: The next ten years?

Author: Poli, R, Vanneschi, L, Langdon, W, Mcphee, N, VANNESCHI, LEONARDO, Langdon, WB, McPhee, NF, Poli, R, Vanneschi, L, Langdon, W, Mcphee, N, VANNESCHI, LEONARDO, Langdon, WB, and McPhee, NF
Abstract: We consider the theoretical results in GP so far and prospective areas for the future. We begin by reviewing the state of the art in genetic programming (GP) theory including: schema theories, Markov chain models, the distribution of functionality in program search spaces, the problem of bloat, the applicability of the no-free-lunch theory to GP, and how we can estimate the difficulty of problems before actually running the system. We then look at how each of these areas might develop in the next decade, considering also new possible avenues for theory, the challenges ahead and the open issues. © Springer Science+Business Media, LLC 2010.
Published: 2010

46. The heart of the matter: Health status of aged care clients receiving home- and community-based care

Author: Yarmo-Roberts, D., Freak-Poli, R., Cooper, B., Noonan, T., Stolewinder, J., Reid, Christopher, Yarmo-Roberts, D., Freak-Poli, R., Cooper, B., Noonan, T., Stolewinder, J., and Reid, Christopher
Abstract: Objective. To determine the current health status of home based elderly clients receiving government funded aged care packages. Design. Prospective Observational study. Setting. Community based, home care program in Australia. Participants. Community-dwelling older adults receiving aged care packages. Measurements. A comprehensive test battery of physical, mental and social scales were completed including a Caregiver Strain Index where appropriate. Results. 37% of the 334 subjects were male and the mean age was 81±8 years. Physical functioning was low compared to the Australian population. Depression was highly prevalent with 15.9% severely depressed and 38.7% mildly depressed. 26% of clients screened positive for dementia. Relatively good levels of social support were reported, however social networking activity levels were low. Sixty one percent of clients had caregivers, of whom 63.3% had high levels of strain. Strain was higher in caregivers of clients on higher levels of care (78.5% versus 50.6% highly strained). Conclusion. The data suggests that as a group there is a high degree of comorbidity, and depression, dementia and caregiver strain are highly prevalent. The findings may aid administrators and health policy planners in directing resources to key areas impacting on health outcomes in this group. Copyright © 2010 Deborah Yarmo-Roberts et al.
Published: 2010

47. Limitations of the fitness-proportional negative slope coefficient as a difficulty measure

Author: Poli, R, Valsecchi, A, Vanneschi, L, VALSECCHI, ANDREA, VANNESCHI, LEONARDO, Poli, R, Valsecchi, A, Vanneschi, L, VALSECCHI, ANDREA, and VANNESCHI, LEONARDO
Abstract: Fitness-Proportional Negative Slope Coefficient is a fitness landscapes measure that has recently been introduced as a potential indicator of problem hardness for optimisation. It is inspired to an older measure, the Negative Slope Coefficient, and it has been theoretically modelled. Preliminary experiments have suggested that it may be a good predictor of problem hardness. However, this measure has not undergone any convincing and comprehensive empirical testing. Our objective is to fill this gap. So, we perform empirical tests using a large set of invertible functions of unitation. We find that while this measure may correctly predict the degree of evolvability of a landscape, this does not necessarily correlate with the difficulty of problems. Some landscapes may show, for example, limited evolvability and yet be easy to solve because either solutions are already present in the initial population or the computational resources provided exceed evolvability obstacles. Or it may be impossible to solve them irrespective of their evolvability simply because they are far too vast for the computational resources provided. These situations are hardly captured by the Fitness-Proportional Negative Slope Coefficient.
Published: 2009

48. The impact of population size on code growth in GP: Analysis and empirical validation

Author: Poli, R, Mcphee, F, Vanneschi, L, VANNESCHI, LEONARDO, Poli, R, Mcphee, F, Vanneschi, L, and VANNESCHI, LEONARDO
Abstract: The crossover bias theory for bloat [18] is a recent result which predicts that bloat is caused by the sampling of short, unfit programs. This theory is clear and simple, but it has some weaknesses: (1) it implicitly assumes that the population is large enough to allow sampling of all relevant program sizes (although it does explain what to expect in the many practical cases where this is not true, e.g., because the population is small); (2) it does not explain what is meant by its assumption that short programs are unfit. In this paper we discuss these weaknesses and propose a refined version of the crossover bias theory that clarifies the relationship between bloat and finite populations, and explains what features of the fitness landscape cause bloat to occur. The theory, in particular, predicts that smaller populations will bloat more slowly than larger ones. Additionally, the theory predicts that bloat will only be observed in problems where short programs are less fit than longer ones when looking at samples created by fitness-based importance sampling, i.e. samplings of the search space in which fitter programs have a higher probability of being sampled (e.g., the Metropolis-Hastings method). Experiments with two classical GP benchmarks fully corroborate the theory. Copyright 2008 ACM.
Published: 2008

49. Elitism reduces bloat in genetic programming

Author: Poli, R, Mcphee, F, Vanneschi, L, VANNESCHI, LEONARDO, Poli, R, Mcphee, F, Vanneschi, L, and VANNESCHI, LEONARDO
Abstract: Elitism is commonly used in generational GP to ensure that the best individuals discovered in a generation are not lost, and are made available for possible further improvements to new generations. Using two GP systems and four problems, we show how elitism reduces the growth of mean program size.
Published: 2008

50. Analysis of the effects of elitism on bloat in linear and tree-based genetic programming

Author: Riolo, R, Soule, T, Worzel, Bil, Vanneschi, L, Poli, R, Mcphee, F, Riolo, R, Soule, T, Worzel, Bil, Vanneschi, L, Poli, R, and Mcphee, F
Abstract: Elitism, a technique which consists of copying, unchanged, one or more of the most fit individuals from one generation to the next, is widely used in generational evolutionary algorithms, including Genetic Programming (GP). Elitism ensures that the best individuals discovered in a generation (and hence in the whole run) are not lost, and, perhaps even more importantly, are made available to new generations for possible further improvements. In a recent study on the evolution of robustness in GP the average size of best of run individuals was reported to grow more slowly in the presence of elitism. This is an important finding, but no explanation was provided for why this happened nor whether this was a general effect. In this paper we model elitism mathematically and explain how, in general, elitism modulates the dynamics of the mean program size of the population, including both its positive and negative effects oil bloat. Experimental results with two GP systems and four different problems corroborate the theory
Published: 2008

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