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To a larger extend than in case of a man the transition of a woman from one socio-age status to another in traditional culture was connected with her physiological changes. Stages of growing-up and ageing which were similar in many societies were regulated by the means of local tradition. It included complex of rights and obligations, restrictions and opportunities, which were determined by a combination of climatic, socioeconomic, cultural, religious, ethnic and other factors. The focus of the paper is to identify the universal and the ethnically specific traits in the scenarios of women aging in Karelian culture. Research purposes included consideration of issues about the old age limits, the field of female socio- age stratification terminology, the matter of sociocultural status, limitations and opportunities for Karelian women within and outside the family. The study observes the period of the late XIX - early XX century. The territorial framework is outlined by the boundaries of the Karelian population dwelling in the Olonets and Arkhangelsk provinces (the part of the Republic of Karelia in present). The authors conclude that late maturity was an important milestone in the life of Karelian woman. Normative role was growing, hierarchical relations in the family were redefined. However, the life of an elderly woman was not limited to family affairs. Participation in life cycle ceremonies, religious and missionary activities was a symbolic resource of the Karelian women in rural society and could be converted into revenue.

Background Despite the aging HIV epidemic, increasing age can be associated with hesitancy to test. Addressing this gap is a critical policy concern and highlights the urgent need to identify the underlying factors, to improve knowledge of HIV-related risks as well as uptake of HIV testing and prevention services, in midlife-older adults. Methods We conducted five focus group discussions and 12 in-depth interviews between April 2013 and November 2016 among rural and urban Malawian midlife-older (≥30 years) men and women. Using a life-course theoretical framework we explored how age is enacted socially and its implications on HIV testing and sexual risk behaviours. We also explore the potential for HIV self-testing (HIVST) to be part of a broader strategy for engaging midlife-older adults in HIV testing, prevention and care. Thematic analysis was used to identify recurrent themes and variations. Results Midlife-older adults (30–74 years of age) associated their age with respectability and identified HIV as “a disease of youth” that would not affect them, with age protecting them against infidelity and sexual risk-taking. HIV testing was felt to be stigmatizing, challenging age norms, threatening social status, and implying “lack of wisdom”. These norms drove self-testing preferences at home or other locations deemed age and gender appropriate. Awareness of the potential for long-standing undiagnosed HIV to be carried forward from past relationships was minimal, as was understanding of treatment-as-prevention. These norms led to HIV testing being perceived as a threat to status by older adults, contributing to low levels of recent HIV testing compared to younger adults. Conclusions Characteristics associated with age-gender norms and social position encourage self-testing but drive poor HIV-risk perception and unacceptability of conventional HIV testing in midlife-older adults. There is an urgent need to provide targeted messages and services more appropriate to midlife-older adults in sub-Saharan Africa. HIVST which has often been highlighted as a tool for reaching young people, may be a valuable tool for engaging midlife-older age groups who may not otherwise test.

Background: Cardiac disorders are the leading causes of morbidity and mortality globally. Aim: The current study aimed to compare the effectiveness of echocardiographic and scintigraphy investigation in cardiovascular disorders detection and evaluation, including ischemic heart disease (IHD) diagnosis at King Abdulaziz University in Saudi Arabia. Methods: 157 patients (male/ female: 68%/32%; mean age 64 ± 0.83 years) were included in the report in the current study. All subjects underwent gated myocardial perfusion scintigraphy and standard Echocardiography. Results: About 84% of cases were diagnosed with any types of cardiac disorders by Echocardiography, whereas through scintigraphy, 61% of patients were detected cardiac disorders. The age stratification did not impact the prevalence of cardiac disorders detected by them. Scintigraphy showed a higher detection rate (59%), while only 29% of cases were detected with IHD by eco-cardiograph. Conclusions: In conclusion, both techniques, namely standard Echocardiography, and myocardial scintigraphy, are useful in the evaluation and detection of cardiac disorders in patients having any type of cardiac problems. Both investigations showed a differential pattern in cardiac disorders diagnosis with a particular focus on IHD. Gender differences and age stratification also contributed to this differential pattern of diagnosis. Trial Registration: The research doesn’t include experiments in humans or animals. It is a retrospective study for data record review as an observational study, so no trial registration is required.

Background The aim of this study was to analyze clinicopathological characteristics and prognostic value of age stratification for in patients with major salivary gland mucoepidermoid carcinoma (MSG-MEC). Methods MSG-MEC patients were extracted from the Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2014. We examined the clinicopathological variables using Chi-squared tests. Univariate and multivariate analyses were performed to determine the effects of each variable on survival. Results A total of 729 patients were analyzed. Younger patients tended to be female and present with low grade disease and less-advanced N classification (P1,000), 0.187 (95% CI: 0.041–0.854), 0.172 (95% CI: 0.039–0.771), 0.006 (95% CI: 0.010–0.361), 0.310 (95% CI: 0.140–0.685), 0.541 (95% CI: 0.261–1.121) and 0.440 (95% CI: 0.230–0.840), respectively. Subgroups analysis shows that the effect of advancing age was significantly associated with a higher risk of poor survival in Caucasian who harbored N0 classification (P

To further clarify the associations between sleep and body mass index (BMI) using the most recent dataset from the National Health and Nutrition Examination Survey (NHANES). Our study is notable for the inclusion of analyses with age subpopulations and subjective sleep symptoms. Cross-sectional study was performed using the NHANES 2017-18 dataset. Weighted multivariate regressions were utilized. NHANES is a standardized survey conducted biennially in the United States, for a sample population which is weighted to represent national demographics. 6161 participants met inclusion criteria. Measurements were collected via NHANES protocol, with objective measurements collected by trained technicians and self-reported measurements collected via questionnaire. Our results corroborate a roughly U-shaped relationship of sleep duration with BMI, varying with age. Greatest magnitudes were observed in a bimodal age ranges of 18-30 and 61-75, with decreases in BMI of 0.248 and 0.385 associated with each marginal hour of sleep. Our secondary analysis with daytime sleepiness and snoring have a significant association with BMI. Snoring symptoms showed a decreasing magnitude of association with BMI as age increases; for ages 18-30, snoring at least once a week correlated with an increase in BMI of 3.571, while for ages 61-75, this correlated with an increase of 1.619. Our study adds to existing literature on the relationship of sleep and BMI. Age stratification methods were used to further clarify associations. Subjective sleep symptoms were used in a secondary analysis to identify clinical screening questions for adverse effects of sleep on BMI.

Backgrounds Stroke is a sudden disorder of cerebral blood circulation. Many studies have illustrated that dyslipidemia, hypertension, diabetes, smoking and excessive drinking are the traditional risk factors for stroke. This study aimed to observe the relationship between CYP1A1 and CYP1A2 variants and stroke risk in the Chinese population. Methods Agena MassARRAY Assay was used to genotype four single nucleotide polymorphisms (SNPs) in 477 cases and 480 controls. The chi-square test and logistic-regression analysis were used to explore the relationship between CYP1A1 and CYP1A2 variants and stroke risk. Results Individuals with CYP1A2 rs762551 C was associated with a lower risk of stroke than that of allele A. Age stratification analysis showed that rs762551 was only observed to be associated with a lower risk of stroke in ≤64ys age group. After gender stratification analysis, a significant association between rs762551 and stroke risk was found in males, but not in females. The four SNPs were found to be correlated with stroke risk in patients with hypertension, coronary heart disease, cerebral infarction and lacunar infarction. Conclusion In this study, the results first showed that CYP1A1 and CYP1A2 variants were associated with stroke risk. Larger and well-designed studies are needed to confirm the results.

Objective To assess the association between triglycerides (TG), total cholesterol (TC) and hyperuricemia (HUA) in the general Chinese population. Methods A population-based cross-sectional survey included 9680 participants aged 35-74 years in 2006 and 2009 in Qingdao, China. TG, TC and uric acid (UA) were measured. The logistic regression model was performed to estimate the association between TG, TC, and HUA with an odds ratio (OR) and 95% confidence intervals (CI). Meanwhile, age stratification analysis (

Chinese society is facing a serious aging problem which causes a continuous decline on the economic, social and cultural status of the elderly due to natural and social factors. Basing on the age stratification theory, social alienation theory, activity theory and subculture theory, this paper conducts sociological analysis on the declining social status of the elderly, discusses the necessity of aging education, and offers suggestions to improve their social status from the perspective of aging education.

Summary Background Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic. Age is an independent factor in death from the disease, and predictive models to stratify patients according to their mortality risk are needed. Aim To compare the laboratory parameters of the younger (≤70) and the elderly (>70) groups, and develop death prediction models for the two groups according to age stratification. Design A retrospective, single-center observational study. Methods This study included 437 hospitalized patients with laboratory-confirmed COVID-19 from Tongji Hospital in Wuhan, China, 2020. Epidemiological information, laboratory data and outcomes were extracted from electronic medical records and compared between elderly patients and younger patients. First, recursive feature elimination (RFE) was used to select the optimal subset. Then, two random forest (RF) algorithms models were built to predict the prognoses of COVID-19 patients and identify the optimal diagnostic predictors for patients’ clinical prognoses. Results Comparisons of the laboratory data of the two age groups revealed many different laboratory indicators. RFE was used to select the optimal subset for analysis, from which 11 variables were screened out for the two groups. The RF algorithm were built to predict the prognoses of COVID-19 patients based on the best subset, and the area under ROC curve (AUC) of the two groups is 0.874 (95% CI: 0.833–0.915) and 0.842 (95% CI: 0.765–0.920). Conclusion Two prediction models for COVID-19 were developed in the patients with COVID-19 based on random forest algorithm, which provides a simple tool for the early prediction of COVID-19 mortality.

Background With the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in early 2020, Mongolia implemented rapid emergency measures and did not report local transmission until November 2020. We conducted a national seroprevalence survey to monitor the burden of SARS-CoV-2 in Mongolia in the months surrounding the first local transmission. Methods During October-December 2020, participants were randomly selected using age stratification and invited for interviews and blood samples at local primary health centres. We screened for total SARS-CoV-2 antibodies, followed by two-step quantitative SARS-CoV-2 IgG serology tests for positive samples. Weighted and test-adjusted seroprevalences were estimated. We used chi-square, Fisher's exact and other tests to identify variables associated with seropositivity. Findings A total of 5000 subjects were enrolled. We detected SARS-CoV-2 IgG antibodies in 72 samples. Crude seroprevalence of SARS-CoV-2 antibodies was 1·44% (95%CI,1·21-1·67). Population weighted and test-adjusted seroprevalences were 1·36% (95%CI,1·11-1·63) and 1·45% (95%CI,1·11-1·63), respectively. Age, sex, geographical, and occupational factors were not associated with seropositivity (p>0·05). Symptoms and signs within past 3 months and seropositivity were not associated at the time of the survey (p>0·05). Interpretation SARS-CoV-2 seroprevalence in Mongolia was low in the first year of the pandemic potentially due to strong public health measures, including border restrictions, educational facilities closure, earlier adoption of mask-wearing and others. Our findings suggest large-scale community transmission could not have occurred up to November 2020 in Mongolia. Additional serosurveys are needed to monitor the local pandemic dynamic and estimate how far from herd immunity Mongolia will be following-up with vaccination programme in 2021 and 2022. Funding World Health Organisation, WHO UNITY Studies initiative, with funding by the COVID-19 Solidarity Response Fund and the German Federal Ministry of Health (BMG) COVID-19 Research and development. Translation Cyrillic and Traditional Mongolian translation of abstract is available on appendix section.

The outbreak of COVID-19 (coronavirus disease 2019) has become the focus of attention in the field of urban geography. Built environment, such as the layout of public spaces like transportation hubs and urban open spaces, is an important factor affecting the spread of the epidemic. However, due to the different behavior patterns of different age groups, the intensity and frequency of their use of various built environment spaces may vary. Based on this, we selected patients that were infected, with a non-manipulated time period, and the classification of human behavior patterns, we then conducted a regression analysis study on the spatial distribution and building environment of these COVID-19 patients. The results showed that the spatial distribution of young and middle-aged patients (18–59 years old) was more homogeneous, while the spatial distribution of elderly patients (60 years old and above) had a strong clustering characteristic. Moreover, the significant built environment factors exhibited in the two populations were extremely different. More diverse urban facilities and public spaces exhibited influential properties for older patients, while middle-aged and young adults were more influenced by commuting facilities. It can be said that the built environment shows different influences and mechanisms on the transmission of respiratory infectious diseases in different populations. Therefore, the results of this paper can inform decision makers who expect to reduce the occurrence of urban respiratory infectious diseases by improving the urban built environment.

Life expectancy has increased substantially; yet universities remain age-segregated and fail to educate people across the longer life course. Demographic shifts call for universities to change their orientation toward age and life course. Arguments as to why universities should serve students of all ages and operate as age-diverse communities include: ensuring the capacity of individual workers and the labor force; educating people to succeed in age-diverse settings; producing innovation in an aging society; supporting meaningful engagement, social connection, and cognitive health into later life; and ensuring the supply of students. Conceptual foundations for these arguments derive from ideas about age stratification, where chronological age is used as a criterion for inclusion or exclusion from social expectations, roles, and privileges and where age integration is viewed as a positive alternative. In response to population aging and the constraints associated with age segregation in higher education, the Age-Friendly University Global Network was formed to increase the inclusion of older learners in all aspects of university life. The challenge is to create conditions where nontraditionally aged students expect to engage fully in educational activities, where students of all ages are valued and supported, and where age diversity is a common feature of campus life. The transformation of our universities must be done for the sake of society, for younger and older people, and for the self-interest of institutions themselves.

BACKGROUND: Results of previous studies examining associations between cigarette smoking and sleep-disordered breathing (SDB) are inconsistent. We therefore investigated this association in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). METHODS: A total of 13,863 US Hispanic/Latino subjects, 18 to 76 years old, provided smoking histories and underwent home SDB testing. Logistic regression analyses were conducted to assess the independent association of smoking and SDB with covariate adjustment. Sex- and age-stratified analyses were performed. RESULTS: The weighted prevalence of moderate to severe SDB was 9.7% (95% CI, 9.0-10.5). No independent and statistically significant association was observed between ever smoking (defined as minimum lifetime cigarette use of 100) and moderate to severe SDB (defined as an apnea-hypopnea index ≥ 15 events per hour) (OR, 1.02; 95% CI, 0.85-1.22; P = .85). Sex and age were effect modifiers of the aforementioned association. Stratification according to age and sex revealed that younger (aged 35-54 years) female smokers had 83% higher odds of SDB compared with younger female never smokers (OR, 1.83; 95% CI, 1.19-2.81; P = .01). A significant dose-response relation was noted between smoking intensity and SDB in younger female smokers (P < .01). Lastly, use of ≥ 10 cigarettes per day was associated with a nearly threefold increase in SDB odds in younger female ever smokers. These associations were not observed in younger male subjects. CONCLUSIONS: In the HCHS/SOL, no independent and statistically significant association was found between smoking and SDB. Sex and age stratification revealed a novel statistically significant association between smoking and SDB in younger (35-54 years old) female smokers. Our findings highlight the importance of investigating sex- and age-specific associations of SDB risk factors.

BACKGROUND High-risk human papillomavirus (HPV)-Papanicolaou (Pap) cotesting is recommended for cervical cancer screening in women aged ≥30 years. The current study analyzed the effectiveness of cotesting on risk management in different age groups. METHODS A retrospective review of a 5-year cytology database identified 9434 women with HPV-Pap cotesting and follow-up cervical biopsy. The 3-year cumulative risk of developing high-grade cervical lesions (≥high-grade squamous intraepithelial lesion [HSIL]) was analyzed using age stratification. RESULTS The 3-year cumulative risk of developing ≥HSIL was found to be significantly different in women with baseline cotesting HPV-positive and Pap-positive results (HPV+/Pap+; defined as ≥atypical squamous cells of undetermined significance), HPV+ and Pap-negative results, and HPV-negative and Pap+ results at 19.2%, 7.9%, and 3.1%, respectively (P

Introduction As asthma medications are frequently prescribed for children, knowledge of the safety of these drugs in the paediatric population is important. Although spontaneous reports cannot be used to prove causality of adverse events, they are important in the detection of safety signals. Objective Our objective was to provide an overview of adverse drug events associated with asthma medications in children from a spontaneous reports database and to identify new signals. Methods Spontaneous reports concerning asthma drugs were obtained from EudraVigilance, the European Medicine Agency’s database for suspected adverse drug reactions. For each drug–event combination, we calculated the proportional reporting ratio (PRR) in the study period 2011–2017. Signals in children (aged 0–17 years) were compared with signals in the whole population. Analyses were repeated for different age categories, by sex and by therapeutic area. Results In total, 372,345 reports in children resulted in 385 different signals concerning asthma therapy. The largest group consisted of psychiatric events (65 signals). Only 30 signals were new, with seven, including herpes viral infections, associated with omalizumab. Stratification by age, sex and therapeutic area provided additional new signals, such as hypertrichoses with budesonide and encephalopathies with theophylline. Of all signals in children, 60 (16%) did not appear in the whole population. Conclusions The majority of signals regarding asthma therapy in children were already known, but we also identified new signals. We showed that signals can be masked if age stratification is not conducted. Further exploration is needed to investigate the risk and causality of the newly found signals. Electronic supplementary material The online version of this article (10.1007/s40264-019-00870-x) contains supplementary material, which is available to authorized users.

Background Prostate cancer (PCa) is the second most common cancer among men worldwide. Recent research has identified [-2]proPSA (p2PSA), %p2PSA and prostate health index (phi) as new biomarkers for the early diagnosis and grading of PCa. However, few studies have used these parameters in a healthy population. In this study, we aimed to establish reference intervals (RIs) for p2PSA, %p2PSA and phi in healthy men based on age stratification. Methods Between April 2016 and March 2018, healthy subjects were recruited. Healthy men were then stratified into four age groups

Background The purpose of this study is to assess the epidemiology, population-specific treatment trends, and complications of distal radius fractures in the United States. Methods The PearlDiver database (Humana [2007–2014], Medicare [2005–2014]) was used to access US inpatient and outpatient data for all patients who had undergone operative and nonoperative treatment for a distal radius fracture in the United States. Epidemiologic analysis was performed followed by age-based stratification, to assess prevalence, treatment trends, and rates of complications. Results A total of 1,124,060 distal radius treatment claims were captured. The incidence of distal radius fractures follows a bimodal distribution with distinct peaks in the pediatric and elderly population. Fractures in the pediatric population occurred predominately in males, whereas fractures in the elderly population occurred more frequently in females. The most commonly used modality of treatment was nonoperative; however, the use of internal fixation increased significantly during the study period, from 8.75 to 20.02%, with a corresponding decrease in percutaneous fixation. The overall complication rate was 8.3%, with mechanical symptoms most frequently reported. Conclusions The last decade has seen a significant increase in the use of internal fixation as treatment modality for distal radius fractures. The impetus for this change is likely multifactorial and partly related to recent innovations including volar locking plates and an increasingly active elderly population. The implicated financial cost must be weighed against the productivity cost of maintaining independent living to determine the true burden to the healthcare system.

We investigated the infection status and genotype distribution of human papillomavirus (HPV) in women of different ages and various ethnic groups in the Yili region, Xinjiang, China. We checked the HPV genotypes of 3,445 samples of exfoliated cervical cells using the PCR–reverse dot blot method. The total infection rate of HPV was 25.60% (882/3,445). The ethnic stratification showed that the infection rates were 22.87% (196/857) in Uygur, 21.55% (122/566) in Kazak, and 27.89% (564/2,022) in Han individuals. The most prevalent high-risk genotypes were HPV16, HPV52, and HPV53 in Uygur and Kazak and HPV16, HPV52, and HPV58 in Han ethnic groups. The age stratification showed that the infection rates in Han, Uygur, and Kazak women were up to 40.9% (61/149) in those aged 26–30 years, 41.5% (22/53) in those over 61 years old, and 30.2% (29/96) in those 46–50 years old, respectively. Therefore, HPV infection and HPV genotype distribution varied among the different age groups of the three ethnic groups.

BACKGROUND: This study compared the efficacy and tolerability of available direct-acting antiviral (DAA) regimens between individuals aged 60 years and older and younger patients in a real-life setting. Specifically, we aimed to provide evidence of the efficacy and safety of DAAs in the treatment of older adults in Tianjin, China. METHODS: In this retrospective observational cohort study, patients with chronic hepatitis C virus (HCV) were enrolled between April 2018 and December 2019 at 2 tertiary hospitals in Tianjin, China. We assessed the sustained virologic response (SVR) 12 weeks (SVR12) after DAA treatment, and adverse events in two groups using age stratification by comparing older adults (≥60 years) and younger adults (

Introduction Predictors of deaths of despair, including substance use disorder, psychological distress, and suicidality, are known to be elevated among young adults and recent military veterans. Limited information is available to distinguish age effects from service-era effects. We assessed these effects on indicators of potential for deaths of despair in a large national sample of U.S. adults aged ≥19 years. Materials and Methods The study was a retrospective, cross-sectional analysis of publicly available data for 2015-2019 from 201,846 respondents to the National Survey on Drug Use and Health (NSDUH), which measures psychological symptoms and substance use behaviors using standardized scales and diagnostic definitions. Indicators of potential for a death of despair included liver cirrhosis, past-year serious suicidal ideation, serious psychological distress per the Kessler-6 scale, and active substance use disorder (e.g., binge drinking on ≥5 occasions in the past month, nonmedical use of prescribed controlled substances, and illicit drug use). Bivariate, age-stratified bivariate, and multivariate logistic regression analyses were performed using statistical software and tests appropriate for the NSDUH complex sampling design. Covariates included demographic characteristics, chronic conditions, and religious service attendance. Results Indicators were strongly and consistently age-associated, with ≥1 indicator experienced by 45.5% of respondents aged 19-25 years and 10.7% of those aged ≥65 years (P < .01). After age stratification, service-era effects were modest and occurred only among adults aged ≥35 years. The largest service-associated increase was among adults aged 35-49 years; service beginning or after 1975 was associated (P Conclusions After accounting for age, military service-era effects on potential for a death of despair were modest but discernible. Because underlying causes of deaths of despair may vary by service era (e.g., hostility to Vietnam service experienced by older adults versus environmental exposures in the Persian Gulf and Afghanistan), providers treating veterans of different ages should be sensitive to era-related effects. Findings suggest the importance of querying for symptoms of mental distress and actively engaging affected individuals, veteran or nonveteran, in appropriate treatment to prevent deaths of despair.

Selenium, residing in a series of selenoproteins, plays an important role in both female and male reproductive function. Of particular significance for reproduction is the antioxidant glutathione peroxidase (GPx), a main selenoenzyme, whose level is regulated by the availability of Se in the body. We hypothesized that changes in Se status, closely related to GPx activity, would result in an increased risk of reproductive dysfunction in individuals. We retrospectively investigated the serum selenium (SeS) concentrations of 1264 apparently healthy people, aged 16–89 years, from Western Romania. The general analysis revealed a non-normal SeS distribution with a median SeS of 100.26 ± 18.32 μg/L and a significant difference in SeS levels between age groups. The analysis of the young group (16–35 years) revealed that up to 50% of individuals did not reach the SeS threshold corresponding to maximum GPx activity (80 μg/L), and a significant imbalance between the genders was apparent when looking at SeS values outside the range. Our results correlated with the general diminished reproductive ability registered in Romania during the last few years. Serum selenium content proves to offer a proper reflection of the fertility competence of the young population, and its monitoring is important for guiding dietary adjustments and attaining normal reproductive function.

Background Whether a sex difference exists in long-term cardiovascular (CV) outcomes after acute myocardial infarction (AMI) is worth exploration. This study is sought to investigate the relationships among sex, age and the long-term prognosis after AMI. Methods This population-based retrospective cohort study used Taiwan's National Health Insurance Research Database (NHIRD) to investigate the sex differences in in-hospital and long-term CV outcomes in patients with AMI. We enrolled patients who were first diagnosed with AMI from January 1, 2000 to December 31, 2013. The outcomes of interest included all-cause mortality, CV death, nonfatal stroke, nonfatal heart failure, and AMI recurrence during hospitalization and 5-year follow up. The CV outcomes were also analyzed by age stratification. Results Overall, 201,921 patients with AMI were analyzed; 68.72% were men and 31.28% were women, with mean ages of 65.34 ± 14.12 and 73.05 ± 12.22 years, respectively. Major adverse cardiac events (MACE) during hospitalization and up to 5 years were consistently greater in women than in men. Multivariable regression analysis revealed no sex difference existed in long-term all-cause and CV mortality. Men of all age groups consistently showed higher risk of both short- and long-term recurrence of AMI. Nonetheless, the female sex still independently predicted increased risk of nonfatal stroke and heart failure from hospitalization until 3-year follow up. Conclusion Women with AMI had poorer short-term and long-term outcomes. The sex differences in long-term all-cause and CV death disappear after multivariate analysis. Nonetheless, female AMI patients independently predicted higher risk of stroke and heart failure from hospitalization until a 3-year follow-up. To better understand the pathophysiology of female patients with AMI and develop more effective management, more studies in this field are necessary in the future.

ObjectivesSeveral studies have linked diabetes mellitus to adverse childhood experiences (ACEs). While a number of studies have examined the association between ACEs and diabetes in Western populations, few have done it in Asian populations. The current study aimed to examine (1) the association between ACEs and diabetes, including the association after age stratification, and (2) the association of comorbid depression, resource use and health-related quality of life (HRQoL) among those with diabetes and ACEs in Singapore.SettingsParticipants were surveyed in their homes or any other preferred venue of their choice.Participants6126 individuals aged 18 years and above were randomly selected among Singapore residents.DesignCross-sectional nationwide epidemiological study.ResultsExposure to any ACE was not associated with increased odds of diabetes; however, those who had experienced parental separation, death or divorce of a parent had higher odds of diabetes. In addition, we observed significant interaction between age and ACEs in relation to odds of diabetes. ACEs were significantly associated with higher odds of diabetes mainly in the younger age group. The prevalence of major depressive disorder was significantly higher among those with diabetes and ACEs than those with diabetes alone (3.7% and 0.3% respectively).ConclusionsEfforts to promote regular exercise and healthy lifestyles both in the population and among those with diabetes must continue for the prevention and management of diabetes. The findings emphasise the need to create more awareness of both the prevalence and impact of ACEs among those treating chronic diseases.

BACKGROUND The objective of this study is to assess the clinical manifestations and prognostic value of age on overall survival (OS) and cancer-specific survival (CSS) for hypopharynx squamous cell carcinoma (SCC) using the Surveillance, Epidemiology and End Results (SEER) database. METHODS Patients with hypopharynx SCC were extracted from the SEER database between 2004 and 2014. We examined the clinicopathological variables using Chi-squared tests and we evaluated the association between survival and different variables, including age, race, grade, tumour location, T category, N category and surgery therapies to the primary tumour, using the methods of Kaplan-Meier. Univariate and multivariate analyses were performed to determine the effects of each variable on survival. RESULTS A total of 3702 patients were analysed. The patients aged 25-49 tended to be black and present withN3 and stage IV (P

Melanoma mortality particularly affects older patients, and age is a powerful independent predictor of death. The pathogenic mutations and transcriptomic changes associated with poor survival in aged patients are not known.We analyzed 5 cohorts of metastatic (N=324, N=18, N=66) and primary melanomas (N=103, N=30) to establish the effect of age on prognosis, identify age-specific driver genes and transcriptomic changes linked to survival and immunotherapy response.We identify the pathogenic mutations and transcriptomic changes associated with poor survival by age, and show mutations in BRAF, NRAS, CDKN2A or IDH1 identify metastatic and primary melanoma aged patients with worse outcome. In contrast, activation of immune-regulatory pathways is a hallmark of long-term survival. We tested if mutations in genes linked to poor outcome are associated to immunotherapy responders, exploring combinations of agespecific mutations in metastatic immune checkpoint inhibitor aged responders. Strikingly, aged patients with BRAF, NRAS, CDKN2A or IDH1 mutations and high tumor mutation burden treated with immunotherapy have an improved median survival of 12 months. These data highlight the molecular landscape of melanoma varies by age, and age stratification can refine prognosis and therapy rationales. A set of mutations identifies patients at highest risk of death who are likely immunotherapy responders.

Shang-Rong Zhong,1 Han-Hsuan Yang,1– 3 Cheng-Hsi Liao,4– 7 Deng-Ho Yang,5,6,8,9 Shih-Kai Tu,1,5 Chia-Lien Hung,6 Chun-Cheng Liao1,5,6 1Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan; 2Department of Occupational Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 3School of Professional Education and Continuing Studies, National Taiwan University, Taipei, Taiwan; 4Division of Urology, Department of Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan; 5School of Medicine, National Defense Medical Center, Taipei, Taiwan; 6Department of Medical Education and Research, Taichung Armed Forces General Hospital, Taichung, Taiwan; 7Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan; 8Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan; 9Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, TaiwanCorrespondence: Chun-Cheng Liao Email milkbottle97@yahoo.com.twPurpose: To assess the association between serum testosterone (T) and metabolic syndrome (MS) in different age groups in Taiwanese men.Materials and Methods: Male participants, regardless of age or any underlying disease, were identified from MJ Health Screening Center in Taiwan from 2007 to 2016 for this cross-sectional study. They were divided into three groups according to age, and further classified according to MS diagnosis. Basic patient characteristics with relevant parameters were obtained. One-way ANOVA of mean T values between different numbers of measures that exceeds the cut-off values of MS components was performed to assess the relationship of T and MS. Logistic regression analysis was also used to estimate the risk for MS with each increment in T, age, and BMI.Results: A total of 4,931 men were included. The MS group had significantly lower serum T levels compared to the non-MS group in each age group. The one-way ANOVA found the mean value of T was significantly higher in patients without MS component (6.19± 2.12 ng/mL) than those with 1– 5 MS components (with one MS component: 5.48± 2.13 ng/mL, two MS components: 4.93± 2.03 ng/mL, three MS components: 4.37± 1.60 ng/mL, four MS components: 4.13± 2.89 ng/mL, five MS components: 3.74± 1.27 ng/mL, and P< 0.001). There was no significant difference between the patients with three components and the patients with four or five components. Logistic regression models with age stratification showed T with lower odds ratio (OR) for MS after adjusting for BMI in those ≥ 65 years old (OR=0.693; 95% CI=0.559– 0.858; P< 0.001); 50– 64 years old (OR=0.868; 95% CI=0.802– 0.940; P< 0.001) and < 50 years old (OR=0.810; 95% CI=0.758– 0.865; P< 0.001).Conclusion: Lower serum T was strongly associated with MS, with the predictive value increasing with age in Taiwanese men.Keywords: testosterone, metabolic syndrome, hypogonadism, insulin resistance

Background The association between breakfast skipping and abnormal metabolic outcomes remains controversial. A comprehensive study with various stratified data is required. Objective The aim of this study was to investigate the relationship between abnormal metabolic outcomes and breakfast skipping by sex, age, and work status stratification. Methods We used data from the Korea National Health and Nutrition Examination Surveys from 2013 to 2018. A total of 21,193 (9022 men and 12,171 women) participants were included in the final analysis. The risk of metabolic outcomes linked to breakfast skipping was estimated using the negative binomial regression analysis by sex, work status, and age stratification. Results A total of 11,952 (56.4%) participants consumed breakfast regularly. The prevalence of abnormal metabolic outcomes was higher among those with irregular breakfast consumption habits. Among young male workers, negative binomial regression analysis showed that irregular breakfast eaters had a higher risk of abnormal metabolic outcomes, after adjusting for covariates (odds ratio, 1.15; 95% confidence interval, 1.03–1.27). Conclusions The risk of abnormal metabolic outcomes was significant in young men in the working population. Further studies are required to understand the association of specific working conditions (working hours or shift work) with breakfast intake status and the risk of metabolic diseases.

MACC1 gene is a newly discovered gene and plays an important role in the metastasis of colorectal cancer (CRC). The objective of this study was to investigate whether MACC1 is an independent factor associated with lymphatic metastasis in CRC patients. We analyzed the association between MACC1 expression and lymphatic metastasis in a nested case-control study including 99 cases and 198 matched controls in CRC patients, assessed from August 2001 to March 2015. Cases were defined as lymphatic metastasis and non-lymphatic metastasis according to AJCC TNM stages; for each case, two age-matched control without lymphatic and distant metastasis was randomly selected from the study participants. Demographic, variables about metastasis and MACC1 expression were collected. In multivariate analysis, the OR (95% CI) of MACC1 expression was 1.5 (1.1 to 2.0) in patients with lymphatic metastasis versus non-lymphatic metastasis after adjusting all variables. After adjustment for all variables and age stratification, MACC1 expression was found to be an independent risk factor for lymph node metastasis in the middle-aged group (OR 2.1, 95%CI 1.1–4.0). A nonlinear relationship between MACC1 expression and 64–75 age group was observed. The probability of metastasis slightly increased with the MACC1 level lower than turning point 1.4. At the same time, the probability of lymphatic metastasis was obviously increased even after adjusting all variables when MACC1 level higher than 1.4 (OR 11.2, 95% CI 1.5–81.5; p = 0.017) in the middle age group. The expression of MACC1 was not associated with lymphatic metastasis in populations younger than 64 or older than 75. The results demonstrates that increased MACC1 level in 64–75 age group might be associated with lymphatic metastasis in CRC patients.

Objectives-This report describes the prevalence of multiple (two or more) chronic conditions (MCC) among veterans and nonveterans and examines whether differences by veteran status may be explained by differences in sociodemographic composition, smoking behavior, and weight status based on body mass index. Methods-Data from the 2015-2018 National Health Interview Survey were used to estimate the prevalence of MCC among adults aged 25 and over by veteran status and sex. Estimates (age-stratified and age-adjusted) were also presented by race and Hispanic origin, educational attainment, poverty status, smoking status, and weight status. Multivariate logistic regression models examined the odds of MCC by veteran status after age stratification (65 and over or under 65) and further adjustment for age and other covariates. Results-Among adults aged 25 and over, age-adjusted prevalence of MCC was higher among veterans compared with nonveterans for both men and women (22.2% compared with 17.0% for men aged 25-64, 66.9% compared with 61.9% for men aged 65 and over, 25.4% compared with 19.6% among women aged 25-64, and 74.1% compared with 61.8% among women aged 65 and over). Following stratification by age and adjustment for selected sociodemographic characteristics, the prevalence of MCC remained higher among veterans compared with nonveterans for both men and women. After further adjustment for smoking status and weight status, differences in the prevalence of MCC by veteran status were reduced but remained statistically significant, with the exception of men aged 65 and over.

Background: Using residual values calculated from models regressing appendicular lean mass on fat mass and height is one of several suggested strategies for adjusting appendicular lean mass for body size when measuring sarcopenia. However, special consideration is required when using this technique in different subgroups in order to capture the correct individuals as sarcopenic. Objectives: To provide guidance about how to conduct stratified analyses for the regression adjustment technique using age groups as an example. Design: Cross-sectional study. Setting: Data collected at baseline (2012-2015) for the Canadian Longitudinal Study on Aging. Participants: Community dwelling participants of European descent aged 45 to 85 years (n=25,399). Measurements: Appendicular lean mass, height, and weight were measured. Sex-specific residuals were calculated in participants before and after stratifying participants by age group (45-54, 55-64, 65-74, 75-85 years). Cut offs corresponding to the sex-specific 20th percentile residual values in participants ≥65 years were determined first in the residuals calculated in all participants and residuals calculated in only those aged ≥65 years. For each set of cut offs, the percentage of age and sex-stratified participants with low appendicular lean mass were compared for the residuals calculated in all participants and the residuals calculated after stratifying by age. Results: In 12,622 males and 12,737 females, regardless of the cut off used, the percentage of participants with low appendicular lean mass decreased with age when residuals were calculated after age stratification. When the residuals were calculated in all participants, the percentage of participants with sarcopenia increased from the youngest to the oldest age groups. Conclusions: Sex-specific residuals in all participants should be calculated prior to stratifying the sample by age group, or other stratification variables, for the purposes of developing appendicular lean mass cut offs or subgroup analyses.