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Purpose of the study Quality of life represents the principal outcome of health interventions for the oldest old. However, little is known about the determinants of quality of life in this population stratum. We evaluated the association between health-related quality of life (HRQoL) and handgrip strength in a cohort of 331 participants aged 90+ with a living in the Mugello area (Tuscany, Italy). Design and methods HRQoL was assessed using the Medical Outcomes Study Short Form 12 (SF12), considering the Physical Composite Score (PCS) and the Mental Composite Score (MCS) of the SF-12. Muscle strength was tested by hand grip dynamometry. Results The median MCS was 46.9, while the median PCS was 43.0. According to logistic regression, muscle strength was associated with increased probability of better PCS (OR = 1.05; 95 % CI = 1.01–1.10, P = .042), and better MCS (OR = 1.05; 95 % CI = 1.01–1.10, P = .036), after adjusting. Implication Muscle strength is associated with both physical and mental HRQoL among nonagenarians. Further studies are needed to explore the subsystems involved in this association, and whether improving muscle performance might improve global mental and physical quality of life in the most advanced age.

To investigate eating habits and adherence to Mediterranean Diet (MD) in relation to the risk of depression in a cohort of nonagenarians enrolled within the Mugello Study, an epidemiological study aimed at investigating both clinically relevant geriatric items and various health issues, including those related to nutritional status. Cross-sectional study. Homes and nursing homes in the Mugello area, Florence, Italy. Subjects aged 90-99 years [N=388 (271F; 117M) mean age: 92.7±3.1]. All subjects were evaluated through questionnaires and instrumental examinations. Adherence to MD was assessed through the Mediterranean Diet Score. A shorter version of the Geriatric Depression Scale (GDS) was used to detect the possible presence of depressive symptoms. In addition, cognitive and functional status was assessed using the Mini-Mental State Examination, the Clock Drawing Test, as well as the Basic and Instrumental Activities of Daily Living test. Depressed subjects (DS) (GDS score≥5, 43.8%) were older, females and widows, than non-depressed subjects (NDS). DS reported a slightly but not statistically significant lower MD score than NDS (33.9±3.9 vs. 34.6±3.3, p=0.149). Subjects who reported to consume a greater amount of olive oil and fruit were associated with a lower risk of depression (OR=0.35, 95%CI=0.20–0.59, p

Background Sarcopenia is the progressive loss of muscle mass and strength that occurs with advancing age and plays a pivotal role in the causal pathway leading to frailty, disability and, eventually, to death among older persons. As oxidative damage of muscle proteins has been shown to be a relevant contributory factor, in this study we hypothesized that uric acid (UA), a powerful endogenous antioxidant, might exert a protective effect on muscle function in the oldest old and we tested our hypothesis in a group of nonagenarians who participated in the Mugello Study. Methods 239 subjects, 73 men and 166 women, mean age 92.8 years ± SD 3.1, underwent the assessment of UA serum level and isometric handgrip strength, a widely used clinical measure of sarcopenia. Results Mean UA serum level was 5.69 mg/dL ± SD 1.70 and mean handgrip strength was 15.0 kg ± SD 6.9. After adjusting for relevant confounders, higher UA serum levels remained independent positive predictors of isometric handgrip strength (β 1.24 ± SE(β) 0.43, p = 0.005). Conclusion Our results show that higher UA serum levels are associated with better muscle function in the oldest old and, accordingly, might slow down the progression of sarcopenia.

Objectives The association of body fat with health status and depression in the oldest old is still debated. The aim of this cross-sectional study is to investigate the association of body fat with health-related quality of life and depression in a sample of nonagenarians. Design Data are from the Mugello study, a community-based project conducted in Italian older adults aged 90 years. Setting and participants Total body fat was assessed by body impedance assessment. Participants were divided into 3 groups according to gender-specific tertiles of body fat percentage (BF%). Self-perceived mental and physical health status were assessed by the Mental Component Summary (MCS) and the Physical Component Summary (PCS) subscales derived from the 12-item Short Form Health Survey. Lower scores of MCS and PCS indicated poorer mental health and physical health status, respectively. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale, and a score ≥5 was used to identify participants with depression. Results The mean age of 251 study participants was 92.5 years, and 173 (68.9%) were women. Participants were included in the low (n = 83), medium (n = 83), and high (n = 85) BF% groups. In the whole sample, mean scores at PCS progressively declined with the increasing BF% group (P = .004). This association was stronger in women, although no significant interaction was observed between the gender and BF% group (P = .63). No significant association between BF% and MCS was documented. Medium and high BF% were associated with a significantly higher probability of depression as compared with low BF% [odds ratio (OR) 2.15, 95% confidence interval (CI) 1.04-4.44, and OR 2.15, 95% CI 1.06-4.34, respectively]. This association was stronger in women, although no significant interaction was observed between gender and BF% group (P = .70). Conclusions and implications High BF% is significantly positively associated with poor health-related quality of life and depression, underpinning the clinical relevance to test BF% in older adults. These associations appear to be stronger in women than in men, highlighting the need to investigate deep inside this gender discrepancy.

Background and aim Adherence to the Mediterranean Diet (MD) has been associated with a longer and better life. The aim of this study was to examine the effects of adherence to the MD, and of nutritional habits on endothelial progenitor (EPCs) and circulating progenitor (CPCs) cells in a cohort of nonagenarians enrolled within the Mugello Study, an epidemiological study aimed at investigating both clinically relevant geriatric items and various health issues, including those related to nutritional status. Methods and Results Four hundred twenty-one nonagenarians (306 F, 115 M, mean age: 93.1 ± 3.2 years) were evaluated. Adherence to MD was assessed through the Mediterranean Diet Score. Elderly subjects who were in the fourth quartile of the Mediterranean diet score showed significantly higher EPCs than subjects grouped into the other three quartiles. After adjustment for confounders, elderly subjects who were in the highest quartile of adherence to the MD score reported to have EPCs' levels significantly higher than those who reported lower values of adherence to the MD. Furthermore, by analyzing different food categories, it was reported that daily consumption of olive oil and a higher consumption of fruit and vegetables showed higher CPCs CD34 + and EPCs CD34 + /KDR + than subjects with not daily or lower consumption. Conclusion Our results support the hypothesis that the adherence to MD, as well as a daily consumption of olive oil and fruit and vegetables, characteristics of MD, may protect against the development of endothelial dysfunction through increasing EPCs and CPCs in older age.

Previous studies have shown that increased levels of C-reactive protein (CRP) predict cardiovascular events, including stroke, myocardial infarction and death from cardiovascular causes. Previous studies have also shown that increased levels of CRP are strong predictors of the progression of pre-existing carotid artery plaques. However, whether CRP is involved in the development of new plaques, that may or may not be associated with clinical events, in subjects with clean carotid arteries has been scarcely investigated.486 "InCHIANTI" Study participants (200 men and 286 women, 72% aged 65 years and over) free from carotid artery plaques at baseline, also underwent carotid artery scan three years later. We tested the association of baseline characteristics, cardiovascular risk factors and inflammatory markers with the development of new carotid artery plaques. Older participants were significantly more likely to develop new plaques. Independent of age, the relative risks of developing new plaques associated with heavy smoking and family history of atherosclerosis were 1.7 (95%CI 1.5-1.9) and 1.9 (95%CI 1.2-3.1), respectively. Participants with high (3 μg/mL) and moderate (≥1 and ≤3 μg/mL) CRP levels had a relative risk of 2.2 (95%CI 1.9-2.6) and 1.9 (95%CI 1.6-2.3) respectively, when compared with subjects with low (1 μg/mL) CRP levels. Surprisingly, risk factors such as hypertension, diabetes, dyslipidemia and overweight/obesity were not significant predictors of the development of new carotid artery plaques.High CRP levels independently predict the development of new plaques in older persons with carotid arteries free from atherosclerotic lesions.

Summary Objective To describe prevalence, characteristics and correlates of hip pain (HP) and knee pain (KP) in an Italian community based cohort aged 65 and older (65+). Method Baseline survey (1998–2000), population-based study in the Chianti area (Tuscany, Italy); 1299 persons aged 65+ were selected from the city registry of Greve in Chianti and Bagno a Ripoli (multistage sampling method); 1006 participants (564 women and 442 men, age 75.2±7.1) provided information for this analysis. Persons reporting HP/KP in the past 4 weeks were recorded and their Western Ontario and McMaster University Osteoarthritis Index pain score (WPS-range 0–20) calculated. Potential correlates of HP/KP, including clinical, lifestyle and psycho-social features and physical measures, were tested in age- and gender-adjusted regression analyses and then entered a multivariate regression model. Results HP was reported by 11.9% participants, while 22.4% reported KP and 7.2% both conditions. Climbing/descending stairs and walking were the activities eliciting more severe pain in either condition. Average WPSs were 5.6±3.5 for HP and 5.4±10.4 for KP. Both HP and KP were related to back pain, reduced hip abduction, reduced muscle power and increased trunk flexibility. HP was also related to KP and poor self-rated health (SRH), while KP to HP, foot pain, high body mass index, reduced knee passive flexion and knee extension torque, low education. Conclusion In a community sample of an Italian persons aged 65+, the prevalence of KP almost doubled that of HP. While both conditions were related to pain in other joints and specific joint impairment, only HP was related to poor SRH, and only KP to mechanical overload.

Background and aims Whether uric acid (UA) serves as risk factor for cardiovascular diseases or as antioxidant defense has not yet been completely clarified. In this study we investigated the effects of UA on functional recovery in patients receiving cardiac rehabilitation. Methods and results 306 patients, 209 men and 97 women, age range 25–87 years (mean 68 ± 11), performed the 6-min walk test (6mWT) before and after the rehabilitation, and the increase in walking distance was considered as the outcome measure of the study. Baseline UA serum levels ranged from 1.0 to 10.9 mg/dL (mean 5.2 ± 1.7). As there was a significant ( p = 0.005) age*UA levels interaction, patients were divided into two subgroups, less then 65 years (n. 103, 68 men and 35 women, mean age 56 ± 9) and 65 years or more (n. 203, 141 men and 62 women, mean age 74 ± 5). After adjusting for relevant confounders, higher UA levels remained independent positive predictors of the increase in walking distance in older ( p p = 0.807). Conclusions Our findings show an independent association of higher UA levels with better functional recovery after cardiac rehabilitation selectively in elderly patients, suggesting that higher UA levels might reflect the decline in antioxidant defenses that occurs with advancing age. Future studies aimed at understanding the several contradictions concerning UA should, probably, address the issue within this perspective.

Objective: To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain. Design: Randomized trial, 12-month follow-up. Setting: Outpatient rehabilitation department. Participants: 210 patients with chronic, non-specific low back pain, 140/210 women, age 59 ± 14 years. Interventions: Back school and individual physiotherapy scheduled 15 1-hour-sessions for 3 weeks. Back school included: group exercise, education/ ergonomics; individual physiotherapy: exercise, passive mobilization and soft-tissue treatment. Spinal manipulation, given according to Manual Medicine, scheduled 4 to 6 20’-sessions once-a-week. Outcome: Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6) were assessed at baseline, discharge 3, 6, and 12 months. Results: 205 patients completed the study. At discharge, disability score decreased by 3.7 ± 4.1 for back school, 4.4 ± 3.7 for individual physiotherapy, 6.7 ± 3.9 for manipulation; pain score reduction was 0.9 ± 1.1, 1.1 ± 1.0, 1.0 ± 1.1, respectively. At 12 months, disability score reduction was 4.2 ± 4.8 for back school, 4.0 ± 5.1 for individual physiotherapy, 5.9 ± 4.6 for manipulation; pain score reduction was 0.7 ± 1.2, 0.4 ± 1.3, and 1.5 ± 1.1, respectively. Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups (P Conclusions: Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.

Background. Hip pain (HP) and knee pain (KP) may specifi cally affect function and performance; few studies investigate the functional impact of HP or KP in the same population. Methods. Population-based sample of older individuals living in the Chianti area (Tuscany, Italy) (1998 – 2000); 1006 persons (564 women and 442 men) were included in this analysis; 11.9% reported HP and 22.4% reported KP in the past 4 weeks. Self -reported disability and lower extremity performance, measured by 400-m walk test and by the short physical performance battery (SPPB, including standing balance, chair raising, and 4-m walk test), were compared in participants reporting HP or KP versus those free of these conditions; the relationship of HP or KP with performance and self-reported disability was studied, adjusting for age, sex, hip or knee fl exibility, muscle strength, multiple joint pain, major medical conditions, and depression. Results. Participants reporting HP were more likely to report disability in shopping, cutting toenails, carrying a shopping bag, and using public transportation; those with KP reported more disability in cutting toenails and carrying a shopping bag. Participants reporting HP or KP had signifi cantly lower SPPB scores. Adjusting by SPPB, pain no longer predicted self-reported disability, except for “ HP — carrying a shopping bag. ” Conclusions. In our cohort of older persons, those with HP reported disability in a wider range of activities than those with KP. Physical performance measured by SPPB was impaired in both conditions. Reduced lower extremity performance captures the excess disability associated with either HP or KP.

Nutritional therapy is a cornerstone of the treatment of type 2 diabetes. The aim of this study was to assess differences in dietary habits between subjects with and without known type 2 diabetes.In a sample of 1242 predominantly elderly subjects enrolled in the InCHIANTI study, total energy and macronutrient intake was assessed cross-sectionally using the EPIC self-reported questionnaire. Results were compared in subjects with (N=109) and without known diabetes, and differences were adjusted for age, sex, and reported comorbidities. Subjects with known diabetes reported a significantly lower (p0.001) total energy and soluble carbohydrate intake in comparison with the rest of the sample (1793+/-481 vs 2040+/-624 kCal/day, and 66.9+/-22.3 vs. 93.5+/-34.9 g/day, respectively). Conversely, consumption of total and saturated fats, dietary fibres and proteins was not significantly different.Known diabetes is associated with a reduction of soluble carbohydrate consumption and total energy intake without any further modification of dietary habits. These data suggest that the diagnosis of diabetes could induce some changes in nutritional style. However, corrections in dietary habits do not appear to be consistent with current guidelines and recommendations.

Summary Study design. Prospective case series with six and twelve months follow up. Objective. To observe clinical and morphological results of the intradiscal ozone chemionucleolysis in patients aected by non- contained lumbar disc herniations. Methods. 30 patients were included in the study on the base of precise inclusion and exclusion criteria. The patients were followed on 6 and 12 months period by Visual Analogic Scale (VAS), Roland Morris Disability Questionnaire (RMDQ) and Overall Patient Rat- ing Scale (OPRS). Disc herniation volume morphology was eval- uated at 5 months by control MRI scanning. Results. Twenty-seven patients (90%) showed a statistically sig- nificant improvement in pain (P < 0.001, Wilcoxon test) and func- tion (P < 0.001, Wilcoxon test), on VAS and RMDQ evaluation, respectively. The mean satisfaction with the treatment on OPSR was 79.3%, with 24 patients referring satisfaction equal or greater than 80%. There were no major complications related to the procedure. Conclusions. The results of this study indicate the ozone chemo- nucleolysis as a possibly eective modality of treatment in patients aected by signs and symptoms of non-contained lumbar disc her- niations that have overpassed conservative measures and have not yet fulfilled the indications for open surgical treatment.

Simple Doppler examination of saphenofemoral junction (SFJ) may often lead to wrong conclusions due to the presence of pelvic shunts (PS).

To compare three-years results following classical “CHIVA” Care to those, from Reading, following Stripping Operation, with the same follow-up.

To investigate perforator veins behavior in the upstanding patient at muscle compression-relaxation test. Perforator veins are divided into 2 groups: “terminal”, i.e. below which the saphenous vein is competent, and “non terminal”, i.e. below which the saphenous vein is still incompetent.