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Histories of politics in the late medieval European town present a struggle between town oligarchs and town citizens. While the conclusions that historians draw differ, the stakes of politics are the same: exclusion, participation and representation in town government. Politics is the 'public' domain of officeholding, elections and voting, its actors exclusively male, its locations the council chamber, the craft guild, the workshop. Starting and ending with the evidence of a 1532 'insurrection of women' in the English city of Norwich, this article seeks to reconceptualise town politics in the late Middle Ages. Its premise is that urban citizenship was a social and performative practice as much as a formal legal and political status. It argues that the relationship between home, household and family was fundamental to the lived experience of citizenship. The urban household was a complex source of political agency, where the official separation between citizen and non-citizen was difficult to sustain. The 1532 insurrection of women allows us to connect the politics of the household to the politics of the town hall and to write a social history of town politics, in which women were political actors. [ABSTRACT FROM AUTHOR]

Background: While the variety of biologics (b) and targeted synthetic (ts) disease-modifying anti-rheumatic drugs (DMARDs) available for patients with psoriatic arthritis (PsA) has proved to be efficacious in randomized clinical trials, there is a growing importance to understand the benefits and potential drawbacks of these different therapies in real-world settings, which includes bio-experienced and older patients as well. Objective: To evaluate the real-world adherence, drug survival, and discontinuation risk of bDMARDs and tsDMARDs among patients with PsA, comprising both younger and older patients. Methods: A retrospective study using a computerized database. Treatment-naïve and treatment-experiencedpatients with PsA, younger and older than 60 years, who initiated treatment with bDMARDs [TNF-α inhibitors (TNF-αis), IL-17 inhibitors (IL-17is), IL-12/23 inhibitors (IL-12/23i)] or tsDMARDs (the PDE-4 inhibitor apremilast) during 2015–2018 were included. Adherence was assessed using the proportion of days covered (PDC) method. Time to discontinuation was analyzed using Kaplan–Meier estimates. Risk of discontinuation was estimated by Cox proportional hazard model. Results: We identified 427 eligible patients (22.2 % were older than 60 years), utilizing 673 treatment lines. The proportion of adherent patients (PDC ≥ 0.8) was similar (62.1–66.5%) across all lines of therapy and across different biologics (70.0–72.0%), while apremilast showed the lowest, in both treatment-naïve and experienced settings (43.6% and 25.5%, respectively). The Kaplan–Meier analysis showed that in the treatment-naïve TNF-αis had higher drug survival compared with apremilast (P = 0.032). Apremilast also had the lowest drug survival in the treatment-experienced group (P < 0.0001). Kaplan–Meier analysis by age groups showed similar drug survival rates in older (≥ 60 years) and younger (age < 60 years) patients, regardless of treatment-experience status. The multivariable model showed that apremilast had increased risk for discontinuation compared with TNF-αis. Conclusion: Adherence, drug survival and risk for discontinuation were similar for all included bDMARDs, regardless of treatment experience status, while apremilast showed lower rates and increased risk. Adherence and discontinuation rate were similar in older and younger patients. With the variety of drug modes of action available for patients with PsA, these findings may assist caregivers in selecting the appropriate treatment. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: Loneliness is common among young and middle‐aged stroke survivors. It not only hinders the recovery of their neurological and physical functions but also increases the risk of stroke recurrence, disability, and even death.Improving the mental health of young and middle‐aged stroke survivors is of utmost importance. However, previous research has not yet investigated the impact of interpersonal sensitivity and resilience on the relationship between stigma and feelings of loneliness. What the paper adds to existing knowledge?: This study confirms that stigma has a positive impact on loneliness among young and middle‐aged stroke survivors.Interpersonal sensitivity partially mediates the relationship between stigma and loneliness, and resilience plays a moderating role in the mediating mechanism. What are the implications for practice?: Mental health nurses can formulate nursing interventions to reduce loneliness of young and middle‐aged stroke survivors with the goals of improving stigma, reducing interpersonal sensitivity and cultivating resilience. Introduction: Previous studies have not explored the impact of interpersonal sensitivity and resilience on the relationship between stigma and loneliness. However, improving the resilience of young and middle‐aged stroke survivors and increasing their social participation is of great significance for reducing patients' loneliness of patients and promoting their physical and mental rehabilitation. Aims: To investigate the influence of stigma, interpersonal sensitivity and resilience on loneliness among young and middle‐aged stroke survivors. Methods: A cross‐sectional design was used to collect data. A total of 330 participants completed measures of stigma, resilience, interpersonal sensitivity and loneliness. The descriptive statistical approach, Pearson's correlation analysis and Hayes' PROCESS Macro Model 4 and 7 in regression analysis were used to analyse the available data. Results: The results revealed that young and middle‐aged stroke survivors' stigma, resilience, interpersonal sensitivity and loneliness were significantly correlated between every two variables, with coefficients ranging between −0.157 and 0.682. Interpersonal sensitivity played a partial mediating role in stigma and loneliness, accounting for 63.27% of the total effect; This process was moderated by resilience. Discussion: Stigma positively predicts participants' loneliness. As a mediating mechanism with moderating, interpersonal sensitivity and resilience further explain how stigma affects loneliness. Implications for Practice: Understanding this mechanism is of guiding significance to reduce loneliness of young and middle‐aged stroke patients and promote their physical and mental rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the relationship between sarcopenia and fracture risk in older adults and to investigate the effects of increased fracture risk in individuals with sarcopenia on the fear of falling, fall risk, kinesiophobia, and quality of life (QOL). Materials and Methods: The study involved 132 participants. Sarcopenia risk was assessed using the SARC-F questionnaire, fracture risk with the Fracture Risk Assessment Tool, QOL with the "World Health Organization Quality of Life Scale" short form, presence of kinesiophobia with the TAMPA Kinesiophobia scale, and fall risk with the "Berg Balance scale" and "International Fall Effectiveness scale". Results: The study included 102 women (77.3%) and 30 men (23.7%). The average age of the individuals was 70.83±6.98. There was a risk of sarcopenia in 55.5% of patients, and those at risk of sarcopenia had a 33.3% risk of hip fracture and 22.2% risk of both hip and major fracture. With regard to the risk of sarcopenia, it was observed that the fall and fracture risks increased, and the QOL decreased (p-value <0.05). Fracture risk and sarcopenia risk were higher in women, increased with age, and negatively correlated with body mass index and education level (p-value <0.05). It has been observed that both fracture risk and sarcopenia risk with fracture risk increased the risk of falls, kinesiophobia, and decreased QOL (p-value <0.05). Conclusion: Appropriate treatment and early intervention of these conditions in sarcopenic individuals with isarcopenia and increased fracture risk may provide clinical benefits to reduce the risk of falls and fractures and improve QOL. [ABSTRACT FROM AUTHOR]

Objectives We examine cross-national variation in (a) loneliness trajectories and (b) the association between common social risk factors and chronic loneliness in middle and older adulthood. Methods Using longitudinal data, we assess the country-level prevalence of loneliness trajectories (chronic, transitory, and no loneliness) and the extent of common social risk factors for loneliness (living alone, widowhood, divorce, no grandchildren, having chronic conditions, and never working) among adults 50 and older in 20 countries covering 47% of the global population in this age bracket. Additionally, we compare how the associations between social risk factors and chronic loneliness vary across countries. Results We find considerable variation in the prevalence of chronic loneliness cross-nationally, ranging between 4% (Denmark) and 15% (Greece) of adults 50 and older. Living arrangements have the most consistent association with the likelihood of chronic loneliness across countries, with those ever living alone having an 8% higher likelihood of chronic loneliness on average across countries, with a range of 2%–25%. Additionally, those who never report working and those with chronic conditions have a higher likelihood of chronic loneliness across more than a third of the countries. Discussion These results suggest that policies and interventions targeted to middle age and older adults living alone and with limited work histories or with chronic conditions are critical in reducing the public health challenges of chronic loneliness. [ABSTRACT FROM AUTHOR]

Background: Generalized joint hypermobility as a characteristic feature of Ehlers–Danlos syndromes (EDS) is among the factors contributing to temporomandibular disorders (TMD). Objective: To evaluate the prevalence of TMD symptoms and their risk factors among women born in Sweden or Finland who were 27‐ to 78‐year‐olds with diagnosed hypermobile EDS (hEDS). Methods: A cohort of women with confirmed hEDS (n = 185) was constructed from the members of the National EDS Associations in both countries. Based on questionnaire data, frequency of independent variables in terms of socio‐demographic, general health and oral health‐related factors, comorbid symptoms and psychological distress for self‐reported TMD symptoms as the dependent variables, were calculated first. Prevalence ratios (PR) and their 95% confidence interval (95% CI) were estimated for the association between independent and dependent variables. Results: Nearly all participants reported TMD symptoms (98%) with TMD pain (95%), TMJ clicking (90%) and jaw fatigue (80%) as the most common symptoms and TMJ crepitation (63%) and luxation (44%) as the least common symptoms. Risk factors for TMD among 27‐ to 50‐year‐olds participants were Finland as a country of birth, living alone and self‐reported worst pain in the body (not the joints). The respective risk factors among the 51‐ to 78‐year‐olds were Finland as a country of birth, family history of EDS, tinnitus and regularly taking contraceptives. Conclusions: Among adult women with confirmed hEDS, socio‐demographic and health‐related factors and comorbid symptoms were significantly associated with TMD but with differences regarding age group. Therefore, management of TMD requires a multidisciplinary approach among the affected. [ABSTRACT FROM AUTHOR]

Unintentional and undetermined intent drug overdose fatality records from the State Unintentional Drug Overdose Reporting System (SUDORS) for Hawai'i from July 1, 2020, to December 31, 2021 revealed that 58.2% of decedents were aged 50 - 75. The main substance associated with cause of death for those aged 50 - 75 years was methamphetamine, followed by a combination of mixed drugs. Of those aged 50 and older, 25.5% died from cardiovascular or neurological complications which were likely to be associated with chronic, long-term methamphetamine use. Based on death investigator narrative reports, 76.5% of the older decedents had a history of substance abuse, suggesting possible long-term substance use starting at a young age. The trajectory of substance use over the life course is often influenced by life events and transitions, which can be stressors. Hawai'i kūpuna (older adults) should be screened for substance use and dependence to ensure that there is treatment if needed, for the entirety of this use trajectory. Also, barriers to kūpuna seeking treatment, such as stigma towards drug use should be addressed. [ABSTRACT FROM AUTHOR]

Purpose: This study explores the relationship between sensorineural hearing loss (SNHL) in mid-life adults and cognitive function, focusing on executive functions. Given the projected rise in dementia cases, identifying modifiable risk factors for cognitive decline is imperative. SNHL has emerged as a potential risk factor, with hearing loss accounting for a substantial portion of dementia cases. However, the cognitive implications of SNHL in mid-life adults are not well understood. Method: The study examined 50 participants, 25 with bilateral unaided mild SNHL (AHL) and 25 with normal hearing (ANH). A battery of audiological assessments and cognitive tests, including the Trail Making Test (TMT), was administered. TMT measures included direct scores (completion time and errors) and derived scores (difference, ratio, proportion, sum, and multiplication scores). Results: The AHL group displayed significantly poorer peripheral hearing compared to the ANH group, as reflected in pure-tone audiometry, speech reception thresholds, and speech identification scores. Significant differences were observed in all direct and derived TMT measures except for the ratio and proportion scores. This suggests that while overall cognitive disturbances were evident in the AHL group, they were not exclusive to executive function deficits. Notably, we did not identify any statistically significant effects of hypertension, diabetes, smoking, alcohol consumption, or physical activity on TMT scores. Conclusion: This study highlights the potential impact of SNHL on cognitive function in mid-life adults. Mid-life SNHL is associated with cognitive differences, emphasizing its role as a modifiable risk factor for future cognitive decline. This research underlines the need for further investigation into the cognitive effects of aided hearing and a multidisciplinary approach to understanding these alterations in cognitive function. [ABSTRACT FROM AUTHOR]

Introduction: Low-energy fragility fractures of the pelvis (FFP) are an underestimated entity, yet increasing in incidence. The bleeding risk for pelvic fractures in high-energy trauma is well known, resulting in adequate treatment guidelines and clear protocols. This is not the case for FFPs but this risk is presumably low. This study aims to investigate the clinically relevant bleeding risk, in patients older than 50 years with a fragility fracture of the pelvis admitted to the emergency department (ED). Method: A retrospective cohort study was conducted of consecutive patients aged over 50 years with a FFP due to low-energy trauma (LET) presented to the ED of a single trauma center (North-West Clinics in Alkmaar, The Netherlands) between January 2018 and August 2022. The primary outcome was the percentage of patients requiring blood transfusion, or invasive procedures such as coiling by the interventional radiologists or damage control surgery, due to bleeding. Secondary outcomes were the mean decrease of hemoglobin and mortality. Results: In total, 322 consecutive patients with a mean age of 80 years of which 84% female were included. In total 66% was admitted to the hospital and seven patients underwent surgical intervention. Three cases (0.9%) of potentially clinically relevant bleeding were observed. These three cases needed a blood transfusion, without other interventions, and were all admitted with a low hemoglobin level without signs of hemodynamic instability. No invasive interventions were noted. Conclusion: The risk of bleeding in FFP's is very low with very few patients requiring blood transfusions (< 1%) and with no invasive interventions due to bleeding. Since the risk of clinically relevant bleeding is low, the significance of repeated Hb checks and CECT may be questionable. The effect of these diagnostics in case of absence of hemodynamic instability and above borderline normal Hb levels needs to be investigated in further studies. [ABSTRACT FROM AUTHOR]

Exposure to infectious diseases in early life has been linked to increased mortality risk in later life in high-disease settings, such as eighteenth- and nineteenth-century Europe. Less is known about the long-term effects of early-life disease exposure in milder disease environments. This study estimates heterogeneous effects from disease exposure in infancy on later-life mortality in twentieth-century Sweden, by socioeconomic status at birth and sex. Using historical population data for southern Sweden, we study 11,515 individuals who were born in 1905–1929 from age 1 until age 85. We measure exposure to disease using the local post–early neonatal mortality rate in the first 12 months after birth and apply flexible parametric survival models. For females, we find a negative effect on life expectancy (scarring) at ages 1–85 following high disease exposure in infancy, particularly for those born to unskilled workers. For males, we find no negative effect on later-life survival, likely because stronger mortality selection in infancy outweighs scarring. Thus, even as the incidence of infectious diseases declined at the start of the twentieth century, early-life disease exposure generated long-lasting negative but heterogeneous population health effects. [ABSTRACT FROM AUTHOR]

BACKGROUND: Healthcare workers (HCWs) have been significantly impacted by the pandemic. Elderly health care workers carry out a variety of duties at work and have years of clinical expertise. Anxiety and insomnia are among the more commonly encountered problems in senior physicians and other geriatric medical professional populations. OBJECTIVE: The study aims to determine the effect of vagal nerve stimulation on anxiety and sleep disturbances among geriatric medical professionals. METHODS: 42 participants were enrolled in this study based on the inclusion and exclusion criteria. The participants were divided into two groups using the closed envelope approach, and they took part in therapy sessions lasting 30 minutes, three times per week for a period of four weeks. The Experimental group A received non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) and Control group A received Jacobson's progressive muscle relaxation technique. RESULTS: With a p value of 0.001, taVNS stimulation significantly improved sleep quality and reduced anxiety after 4 weeks. The post-intervention assessment revealed a highly significant improvement in Group A, with a T value of 251 (p < 0.001). CONCLUSION: The findings suggest that taVNS may be an effective intervention for addressing anxiety and sleep issues in geriatric medical professionals. These results contribute to the exploration of non-invasive strategies to enhance the well-being of healthcare professionals working in demanding environments. [ABSTRACT FROM AUTHOR]

Objectives: Parkinson disease (PD) is the third leading cause of mortality among middle‐aged and older individuals in China. This study aimed to explore the trends and distribution features of PD mortality in China from 2013 to 2021 and make predictions for the next few decades. Methods: Relevant data were obtained from the Chinese Center for Disease Control and Prevention Disease Surveillance Point system. The joinpoint regression model was used to evaluate trends. The R software was used to predict future trends. Results: Age‐standardized mortality rate (ASMR) of PD increased from 0.59 per 100,000 individuals to 1.22 per 100,000 individuals from 2013 to 2021, with an average annual percent change (AAPC) of 9.50 (95% CI: 8.24–10.78). The all‐age ASMR of PD were higher in male individuals than in female individuals, and ASMR increased with age. The number of deaths and ASMR increased gradually from west to east and from rural to urban areas. Furthermore, ASMR is expected to increase to 2.66 per 100,000 individuals by 2040. Conclusions: The heightened focus on the ASMR of PD among male individuals, urban areas, eastern China, and individuals aged ≥85 years has become a key determinant in further decreasing mortality, thereby exhibiting novel challenges to effective strategies for disease prevention and control. [ABSTRACT FROM AUTHOR]

Prior studies have identified variable effects of aging on neurovascular coupling (NVC). Carbon dioxide (CO2) affects both cerebral blood velocity (CBv) and NVC, but the effects of age on NVC under different CO2 conditions are unknown. Therefore, we investigated the effects of aging on NVC in different CO2 states during cognitive paradigms. Seventy-eight participants (18–78 yr), with well-controlled comorbidities, underwent continuous recordings of CBv by bilateral insonation of middle (MCA) and posterior (PCA) cerebral arteries (transcranial Doppler), blood pressure, end-tidal CO2, and heart rate during poikilocapnia, hypercapnia (5% CO2 inhalation), and hypocapnia (paced hyperventilation). Neuroactivation via visuospatial (VS) and attention tasks (AT) was used to stimulate NVC. Peak percentage and absolute change in MCAv/PCAv, were compared between CO2 conditions and age groups (≤30, 31–60, and >60 yr). For the VS task, in poikilocapnia, younger adults had a lower NVC response compared with older adults [mean difference (MD): −7.92% (standard deviation (SD): 2.37), P = 0.004], but comparable between younger and middle-aged groups. In hypercapnia, both younger [MD: −4.75% (SD: 1.56), P = 0.009] and middle [MD: −4.58% (SD: 1.69), P = 0.023] age groups had lower NVC responses compared with older adults. Finally, in hypocapnia, both older [MD: 5.92% (SD: 2.21), P = 0.025] and middle [MD: 5.44% (SD: 2.27), P = 0.049] age groups had greater NVC responses, compared with younger adults. In conclusion, the magnitude of NVC response suppression from baseline during hyper- and hypocapnia, did not differ significantly between age groups. However, the middle age group demonstrated a different NVC response while under hypercapnic conditions, compared with hypocapnia. NEW & NOTEWORTHY: This study describes the effects of age on neurovascular coupling under altered CO2 conditions. We demonstrated that both hypercapnia and hypocapnia suppress neurovascular coupling (NVC) responses. Furthermore, that middle age exhibits an NVC response comparable with younger adults under hypercapnia, and older adults under hypocapnia. [ABSTRACT FROM AUTHOR]

Longitudinal studies on chronic loneliness and before and during the COVID-19 pandemic are lacking in Africa. The study aimed to estimate the prevalence and associated factors of loneliness and chronic loneliness using cross-sectional and longitudinal data from middle-aged and older adults from rural South Africa. The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (analytic sample: n = 3,418, aged 40 years and older). Loneliness was assessed with a single and 3-item measure. The proportion of loneliness was 19.5% in the 2021/2022 survey, the incidence of chronic loneliness (having loneliness in wave 2 and 3, and free of loneliness in wave 1) was 18.9%, and the 7-year incidence of loneliness was 41.0%. Comparing the 2019 (pre-COVID-19) to 2021/2022 (during COVID-19 pandemic) surveys participants experienced a significant reduction of loneliness. In cross-sectional and/or longitudinal analyses, we found that younger age, living alone, food insecurity, lack of social engagement, depressed mood, poor life satisfaction, poor sleep quality, impaired cognition, poor self-rated health, functional disability, underweight, obesity, and not living with HIV were associated with a higher prevalence, incidence and/or increases in loneliness. One in five aging adults had acute or chronic loneliness. Several social, mental, and physical health factors were identified as associated with loneliness. [ABSTRACT FROM AUTHOR]

This paper aims to capture the interrelationship between two life transitions linking the generation of elderly parents and their adult children: early retirement and the transition to (grand)parenthood. A (grand)parents' early retirement might be driven by the need to care for a grandchild. Conversely, the transition of their adult children into parenthood might be shaped by the availability of flexible, reliable, and affordable childcare provided by retired (grand)parents. Employing an event history approach, we examine the reciprocal influence that the birth of the first grandchild and early retirement have in midlife. Our study focuses on gender and socio-economic differences drawing on the SHARE multi-country dataset. Results show that becoming a grandparent increases the chances of early retirement for both men and women, slightly more among grandmothers than grandfathers. Among new grandfathers, those with higher education are more likely to go into early retirement compared to their less-educated counterparts. Early retirement, on the contrary, does not predict grandparenthood in a significant way, though there is a relatively higher chance of becoming a grandfather if the person who retired is highly educated. [ABSTRACT FROM AUTHOR]

Background: Tooth wear is a non-pathological loss of hard tissues on the incisal and occlusal tooth surface. In archaeology, the loss of dental tissue through attrition is associated with living opportunities and habits, availability, characteristics and methods of food preparation. In forensics, tooth wear is used to estimate the dental age on cadavers. Material and methods: For this study, we used an archaeological sample from two sample collections. In this study, tooth wear was compared in archaeological samples of well-preserved maxilla and mandible specimens (n=392) from Croatian coastal and continental populations from Late Antiquity (LA) and the Early Middle Ages (EMA). The computer system VistaMetrix 1.38 was used to analyse the abrasion and attrition of hard dental tissues. The Shapiro-Wilk and chi-square tests were performed for categorical data to test the difference between two historical periods and two geographical locations, while the KruskalWallis test was performed for continuous data. Results: There was a statistically significant difference in the proportion of tooth wear in total teeth area (P < 0.001) when comparing continental and coastal Croatia in LA and coastal Croatia between LA and EMA (P = 0.006 and P < 0.001, respectively). Samples from coastal Croatia from the LA period had the lowest percentage of tooth wear with a median of 8.35%, while samples from coastal Croatia from the EMA had the highest percentage of tooth wear with a median of 18.26%. Our results generally show greater tooth wear in the EMA period in male subjects.Conclusion: The results of the tooth wear research obtained with the Vista Metrix software can contribute to the study of life circumstances and changes that the analysed population has experienced in its historical development. [ABSTRACT FROM AUTHOR]

The population of people in federal custody in Canada is aging. Those in custody report experiencing poorer health and high rates of chronic health conditions. Two health concerns that are disproportionately higher among those in custody are mood disorders and pain. This cross-sectional study examined health indicators associated with pain and depressive symptoms among older people (50 years and above) from multiple facilities and security levels in federal custody in Canada. Participants were assessed using the interRAI Emergency Department Contact Assessment, which captures key health indicators. Chi square and logistic regression analyses were conducted to describe the population and identify health indicators associated with mood- and pain-related outcomes, respectively. Of the 1,422 participants in this study, the majority (55%) experienced pain and at least 1 out of 5 experienced depressive symptoms. Health indicators associated with depressive symptoms and/or pain were functional measures, including mobility, managing medication(s), and dyspnea. Depressive symptoms and pain are highly prevalent among older adults in federal custody. The relationship between functional health, depressive symptoms, and pain highlights the importance of interprofessional health care and biopsychosocial intervention(s). [ABSTRACT FROM AUTHOR]

Systemic inflammation generally coexists with functional limitations that seriously affect quality of life. This study aimed to investigate the association between systemic inflammation in midlife and the risk of functional limitations in late-life. A total of 10,044 participants with an average age of 53.9 ± 5.7 years at baseline were included in a cohort study. At the last follow-up, the prevalence of impaired activities of daily living (ADLs), instrumental activities of daily living (IADLs), and lower extremity function (LEF) was 14.7%, 21.6%, and 50.3%, respectively. The values of four inflammatory biomarkers were used to calculate the inflammation composite score. Compared with the participants in the lowest quartile of the inflammation composite score (Q1), those in the highest quartile (Q4) exhibited an odds ratio (OR) of 1.589 and a 95% confidence interval (CI) of 1.335–1.892 for impaired ADLs, an OR of 1.426 and a 95% CI of 1.228–1.657 for impaired IADLs, and an OR of 1.728 and a 95% CI of 1.526–1.957 for impaired LEF. The association between systemic inflammation and functional limitations was partly mediated by cardiac and brain function. The present study provides evidence that systemic inflammation in midlife is associated with a higher risk of late-life functional limitations. Protecting vital organ functions in midlife may have a positive impact on reducing the risk of future functional limitations. Trial registration: www.clinicaltrials.gov; Unique identifier: NCT00005131. [ABSTRACT FROM AUTHOR]

Menopausal women may experience symptoms of depression, sometimes even progressing clinical depression requiring treatment to improve quality of life. While varying levels of estrogen in perimenopause may contribute to an increased biological vulnerability to mood disturbances, the effectiveness of estrogen replacement therapy (ERT) in the relief of depressive symptoms remains controversial. Menopausal depression has a complex, multifactorial etiology, that has limited the identification of optimal treatment strategies for the management of this psychiatric complaint. Nevertheless, clinical evidence increasingly supports the notion that estrogen exerts neuroprotective effects on brain structures related to mood regulation. Indeed, research using preclinical animal models continues to improve our understanding of menopause and the effectiveness of ERT and other substances at treating depression-like behaviors. However, questions regarding the efficacy of ERT in perimenopause have been raised. These questions may be answered by further investigation using specific animal models of reduced ovarian function. This review compares and discusses the advantages and pitfalls of different models emulating the menopausal stages and their relationship with the onset of depressive-like signs, as well as the efficacy and mechanisms of conventional and novel ERTs in treating depressivelike behavior. Ovariectomized young rats, middle-to-old aged intact rats, and females treated with reprotoxics have all been used as models of menopause, with stages ranging from surgical menopause to perimenopause. Additionally, this manuscript discusses the impact of organistic and therapeutic variables that may improve or reduce the antidepressant response of females to ERT. Findings from these models have revealed the complexity of the dynamic changes occurring in brain function during menopausal transition, reinforcing the idea that the best approach is timely intervention considering the opportunity window, in addition to the careful selection of treatment according to the presence or absence of reproductive tissue. Additionally, data from animal models has yielded evidence to support new promising estrogens that could be considered as ERTs with antidepressant properties and actions in endocrine situations in which traditional ERTs are not effective. [ABSTRACT FROM AUTHOR]

AbstractThe island of Syros in the Cyclades almost spontaneously emerged in 1830 as a prominent transit and trade hub for Greece and the Ottoman Empire. The present work is an attempt to conduct a deductive reading on the impressive number of documents produced by the Ottoman Consulate General of Syros (şehbenderlik) records to answer two interrelated questions: (I) how the Ottoman Empire engaged with its former territory and (II) what kind of diplomatic tools the Sublime Porte used to deal with the security challenges it perceived emerging in the Eastern Mediterranean after the establishment of the Hellenic Kingdom in 1830. Delimiting a definition of illegality during the Age of Mobility in the Middle East, the states depended on one another to control and define the movements of illegality but paradoxically refused to cooperate. Frustrated, the Ottoman Empire, appropriated from European international legal thought, acted in typical nineteenth-century imperial coerciveness and considered using force to occupy Syros to compel the Greek state. The current article asserts that the Ottomans not only appropriated the French model of diplomacy but also European justifications of imperialism as it pertained to diplomatic coercion. [ABSTRACT FROM AUTHOR]

Background: Women carrying the APOE4 allele are at greater risk of developing Alzheimer's disease (AD) from ages 65-75 years compared to men. To better understand the elevated risk conferred by APOE4 carrier status among midlife women, we investigated the separate and interactive associations of endogenous estrogens, plasma AD biomarkers, and APOE4 carrier status on regional brain volumes in a sample of late midlife postmenopausal women. Methods: Participants were enrolled in MsBrain, a cohort study of postmenopausal women (n = 171, mean age = 59.4 years, mean MoCA score = 26.9; race = 83.2% white, APOE4 carriers = 40). Serum estrone (E1) and estradiol (E2) levels were assessed using liquid chromatography-tandem mass spectrometry. APOE genotype was determined using TaqMan SNP genotyping assays. Plasma AD biomarkers were measured using single molecule array technology. Cortical volume was measured and segmented by FreeSurfer software using individual T1w MPRAGE images. Multiple linear regression models were conducted to determine whether separate and interactive associations between endogenous estrogen levels, plasma AD biomarkers (Aβ42/Aβ40, Aβ42/p-tau181), and APOE4 carrier status predict regional brain volume (21 regions per hemisphere, selected a priori); and, whether significant interactive associations between estrogens and AD biomarkers on brain volume differed by APOE4 carrier status. Results: There was no main effect of APOE4 carrier status on regional brain volumes, endogenous estrogen levels, or plasma AD biomarkers. Estrogens did not associate with regional brain volumes, except for positive associations with left caudal middle frontal gyrus and fusiform volumes. The interactive association of estrogens and APOE4 carrier status on brain volume was not significant for any region. The interactive association of estrogens and plasma AD biomarkers predicted brain volume of several regions. Higher E1 and E2 were more strongly associated with greater regional brain volumes among women with a poorer AD biomarker profile (lower Aβ42/40, lower Aβ42/p-tau181 ratios). In APOE4- stratified analyses, these interactions were driven by non-APOE4 carriers. Conclusion: We demonstrate that the brain volumes of postmenopausal women with poorer AD biomarker profiles benefit most from higher endogenous estrogen levels. These findings are driven by non-APOE4 carriers, suggesting that APOE4 carriers may be insensitive to the favorable effects of estrogens on brain volume in the postmenopause. [ABSTRACT FROM AUTHOR]

Background: Short- and midterm evaluations of arthroscopic meniscal surgery have shown little or no effect in favor of surgery, although long-term effects, including radiographic changes, are unknown. Purpose: To compare the 10-year outcomes in middle-aged patients with meniscal symptoms between a group that received an exercise program alone and a group that received knee arthroscopy in addition to the exercise program with respect to the prevalence of radiographic and symptomatic osteoarthritis (OA), patient-reported outcomes, and clinical status. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to undergo either 3 months of exercise therapy (nonsurgery group) or knee arthroscopy in addition to the exercise therapy (surgery group). Surgery usually consisted of partial meniscectomy (n = 56) or diagnostic arthroscopy (n = 8). Radiographs were assessed according to the Kellgren-Lawrence score at the baseline and 5- and 10-year follow-ups. Patient-reported outcome measures were reported at the baseline and 1-, 3-, 5-, and 10-year follow-ups. Clinical status was assessed at a 10-year follow-up. The primary outcomes were radiographic OA and changes in the Knee injury and Osteoarthritis Outcome Score Pain subscale (KOOSPAIN) from the baseline to the 10-year follow-up. The primary analysis was performed using the intention-to-treat approach. Results: At the time of the 10-year follow-up, eight patients had died, leaving 142 eligible patients. Radiographic OA was assessed for 95 patients (67%), questionnaires were answered by 110 (77%), and the clinical status was evaluated for 95 (67%). Radiographic OA was present in 67% of the patients in each group (P ≥.999); symptomatic OA was present in 47% of the nonsurgery group and 57% of the surgery group (P =.301). There were no differences between groups regarding changes from baseline to 10 years in any of the KOOS subscales. Conclusion: Knee arthroscopic surgery, in most cases consisting of partial meniscectomy or diagnostic arthroscopy, in addition to exercise therapy in middle-aged patients with meniscal symptoms, did not increase the rates of radiographic or symptomatic OA and resulted in similar patient-reported outcomes at the 10-year follow-up compared with exercise therapy alone. Considering the short-term benefit and no long-term harm from knee arthroscopic surgery, the treatment may be recommended when first-line treatment—including exercise therapy for ≥3 months—does not relieve patient's symptoms. Registration: Clinical Trials NCT01288768 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Aging is an imperative issue in Korean society, and a healthy life is important for a better quality of life for older adults. Therefore, the purpose of this research was to investigate the determinants of subjective health and depression in middle-aged and elderly Korean individuals. This study used three attributes as the determinants of subjective health and depression, including the curve linear effect of medical expenses and eating-out expenses and the linear impact of regular exercise. We utilized the Korean Longitudinal Study of Aging (KLOSA) to determine the associations between five attributes: subjective health, depression, medical expenses, eating-out expenses, and regular exercise. Research panel data were employed as the data source. The study period was between 2018 and 2020. This research implemented various multiple linear panel regression econometric analysis instruments: ordinary least squares, random effects, and fixed effects. The mean age of survey participants was 72.10 years, and 35 percent of participants were female. The number of observations for data analysis was 7197. The results revealed that medical and eating-out expenses had a curved linear effect on subjective health and depression. Moreover, regular exercise positively affected subjective health and resulted in less depression. These findings may inform policy decisions that promote regular exercise and manage medical and eating-out expenses, thereby enhancing subjective health and mitigating depression. [ABSTRACT FROM AUTHOR]

AbstractWhen men root manhood in sexual performance, their inability to get and maintain an erection (i.e. erectile dysfunction) may pose a threat to ageing men’s ability to enact masculinity. Using data from the 2015–2016 National Social Life, Health and Aging Project (NSHAP) – a nationally representative survey of the USA – this study finds that age and erectile dysfunction interact: men who report ‘trouble getting or maintaining an erection’ have a higher odds of reporting anxiety before sex. However, this effect gradually declines as the sample of men with erectile dysfunction ages (from ages 49 to 95). Additionally, men who do not report erectile dysfunction have the same odds of sex-anxiety throughout the sample, regardless of their age. The change in sexual performance may cause distress for men, as they feel unable to maintain their dominant masculinity in old age. While previous studies have shown that age and gender interact to affect men’s sexual health in mid-life and later-life, this study adds to the feminist gerontology literature by providing indirect evidence that changes in sexual response may become gradually less anxiety-inducing, and thereby, less threatening for men as they age. [ABSTRACT FROM AUTHOR]

Background: High completed fertility among married and cohabiting women has profound consequences, including straining resources, increasing healthcare challenges, and contributing to educational and gender inequalities. This study examined the factors associated with high completed fertility among married and cohabiting women aged 40–49 years in Ghana. Methods: Data for the study was sourced from the 2022 Ghana Demographic and Health Survey (GDHS). A spatial map was used to present the women's geographic variations in high completed fertility. A mixed-effect multilevel binary logistic regression analysis was performed to identify the factors associated with high completed fertility. The findings were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI). Results: The national proportion of high completed fertility among married and cohabiting women aged 40–49 years in Ghana was 52.0% [48.8, 55.2]. Women who were Ga/Dangme/Ewe by tribe [aOR = 2.32, 95% CI = 1.06, 5.08] had higher odds of high completed fertility than Akans. Women who indicated 6 + as their ideal number of children had a higher [aOR = 5.60, 95% CI = 2.90, 10.82] likelihood of high completed fertility compared to those whose ideal number of children was 0–3. Those who were using contraceptives at the time of the survey had a higher [aOR = 2.31, 95% CI = 1.17, 4.55] likelihood of high completed fertility compared to those who were not using contraceptives. Women with secondary/higher education [aOR = 0.32, 95% CI = 0.17, 0.58] had lower odds of high completed fertility than those without no formal education. Women with females as household heads [aOR = 0.56, 95% CI = 0.33, 0.95] had lower odds of high completed fertility than males. Women in Volta, Western North, Ahafo, and Bono regions had lower odds of high completed fertility compared to those living in the Northeast region, with the lowest odds among those living in the Volta region [aOR = 0.08, 95% CI = 0.02, 0.40]. Conclusion: High completed fertility is prevalent in Ghana, with more than half of married and cohabiting women having at least five or more children. The government and policymakers in Ghana should promote education for women, increase culturally sensitive family planning programs, increase access to family planning resources, address ideal family size preferences, and improve understanding of contraceptive use. [ABSTRACT FROM AUTHOR]

Background: Limited lung function represents a serious health impairment. However, studies investigating social inequalities in limited lung function are rare. Thus, the current study investigates which socioeconomic groups are the most affected by overall limited lung function and severely limited lung function. Methods: Data from the population-based German Aging Survey were used (N = 4472), with participants being 40 + years old. Lung function was assessed by the peak flow test. Education, income, and occupational prestige were used as socioeconomic indicators. Results: We found that overall limited lung function was highly prevalent across the whole sample, with about 33% (Women: 35%; Men: 30%) having overall limited lung function and 8% (Women: 7%; Men: 8%) having severely limited lung function. Socioeconomic differences in limited lung function emerged for all three indicators, education, income, and occupational prestige, in both men and women in single effect analyses. These differences persisted for occupational prestige and income when controlling for all indicators simultaneously. Conclusions: Thus, overall and severely limited lung function are highly prevalent health conditions. Men and women with a low occupational position and those with low income are the most affected. Socioeconomic indicators cannot be used interchangeably when studying health inequalities in lung functioning. Occupational hazards and physical working conditions are likely to constitute major risks of health inequalities in limited lung functioning and should be investigated as such by future studies. [ABSTRACT FROM AUTHOR]

Backgrounds: Cognitive problems are common symptoms among individuals with stress-related exhaustion. It is still unknown whether these individuals are at a higher risk of developing dementia later. This study aims to examine the relationship between midlife stress-related exhaustion and dementia incidence. Methods: A population sample of 777 women (aged 38, 46, 50 and 54 years) without dementia at baseline was followed over 50 years, from 1968 to 2019. Stress-related exhaustion was based on information from the psychiatric examination in 1968/69. Information on dementia incidence between 1968 and 2019 was obtained from neuropsychiatric examinations, key-informant interviews, and hospital registry. Dementia was diagnosed according to the DSM-III-R criteria. A subgroup of non-demented women (n = 284) was examined for cognitive functions by the Gottfries-Bråne-Steen scale 24 years after baseline. Results: Stress-related exhaustion in midlife was associated with higher risk for development of dementia before age 75 (Hazard ratio and 95% confidence interval: 2.95 and 1.35–6.44). The association remained after adjustment for age, major depression, and anxiety disorder. Mean age of dementia onset was younger for women with stress-related exhaustion than women without stress (mean ± SD, 76 ± 9 vs. 82 ± 8. p = 0.009). Women with stress-related exhaustion in midlife still showed more cognitive impairments 24 years later compared with women without stress (Odds ratio and 95% confidence interval: 2.64 and 1.15–6.06). Conclusions: We found that women with stress-related exhaustion in midlife were at a higher risk to develop dementia at relatively younger age. These women showed persistently lower cognitive functions over years even without dementia. Present study results need to be interpreted with caution due to small sample size and should be confirmed in future studies with larger sample size. Our study findings may imply the importance of long-term follow-up regarding cognitive function among individuals with stress-related exhaustion. [ABSTRACT FROM AUTHOR]

Emotional intimacy is considered a fundamental factor contributing to the quality of marital relationships. However, marital strain can often limit intimacy. Thus, our first objective was to explore the intricate interplay between spouses' sense of intimacy and the levels of marital strain experienced by both themselves and their partners. In addition, the way partners respond to the challenges posed by marital strain can be pivotal in shaping the overall dynamics. Therefore, our second objective was to investigate whether and how the empathy exhibited by partners can protect the couple from the potential adverse effects of marital strain on emotional intimacy within the relationship. 96 midlife and older heterosexual couples reported on their sense of marital strain, emotional intimacy, and their level of empathy. We used Actor‐Partner Interdependence Model (APIM) to analyze the results. Negative associations were found between marital strain and emotional intimacy for both men and women. Men's empathy moderated the relationship between women's strain and intimacy, but women's empathy did not moderate the association between men's strain and intimacy. Assessing both spouses' strain is essential for understanding marital intimacy. Men's empathy can have a meaningful role in mitigating the experienced strain on marital outcomes. [ABSTRACT FROM AUTHOR]

Our study aimed to investigate the relationship between sleep–wake changes and depressive symptoms events among midlife women. We enrolled 1579 women aged 44–56 years who had no clinically relevant depressive symptoms at baseline. Depressive symptoms were assessed at each visit using the Center for Epidemiologic Studies Depression scale. At the third and fourth follow-up visits, women reported their sleep habits. The sleep midpoint was defined as the time to fall asleep plus one-half of the sleep duration. Sleep–wake changes were determined by the difference in the midpoint of sleep between the third and fourth visits, which were 1 year apart. The median follow-up time was 7 years (range 1–7 years). Cox proportional hazard models were fitted to calculate hazard ratios and 95% confidence intervals for the incidence of depressive symptoms associated with sleep–wake changes. After adjusting for potential confounding factors, the hazard ratio (95% confidence interval) of depressive symptoms for severe sleep midpoint changes was 1.51 (1.12, 2.05) compared with mild sleep midpoint changes. This relationship remained statistically significant and changed little when additionally controlling for sleep duration, sleep quality, insomnia symptoms, use of sleep medications, use of nervous medications, glucose, insulin, lipids, dietary energy intake, and C-reactive protein. Our findings indicate that exposure to long-term severe sleep–wake changes increases the risk of depressive symptoms in midlife women. [ABSTRACT FROM AUTHOR]

Despite theoretical accounts asserting the importance of children for the wellbeing of individuals as they age, research evidence suggests that children may be inconsequential when it comes to loneliness. Yet, there is reason to expect some subgroups may be more vulnerable to the impact of childlessness than others and this may also differ depending on the type of loneliness being assessed. This paper addresses the relationship between childlessness and social and emotional loneliness in middle and later life, including differential vulnerability associated with age, gender and marital/partner status. The study drew on data from three waves (2007, 2012 and 2018) of the Canadian General Social Survey for a nationally representative sample of adults aged 45 and older (N = 49,892). In general, childlessness assumed greater importance with regard to social than emotional loneliness. Women reported lower levels of social loneliness in conjunction with childlessness than men. Further, childlessness was associated with higher levels of overall and social loneliness among older than middle-aged adults. Fewer interactions were evident between marital/partner status and childlessness. Among women specifically, those who were co-habiting, separated/divorced or never married reported lower levels of social loneliness than their married counterparts. In contrast, childlessness was linked to greater emotional loneliness only among separated/divorced men and widowed women. Overall, our results suggest that having children available does matter for feelings of loneliness in middle and later life but that the relationship varies and is contingent on the social contexts (age, gender, marital/partner status) and the type of loneliness (social, emotional) involved. [ABSTRACT FROM AUTHOR]

Introduction: Smoking significantly burdens human health, contributing to an increasing incidence of mortality and morbidity. This study aims to explore the prevalence of smoking, cessation, and the association between various risk factors and smoking intensity measured in pack-years among Chinese adults. Methods: During 2020-2021, the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP) invited participants aged ≥ 40 from 31 provinces in mainland China. This cross-sectional study presented the standardized prevalence of smoking and cessation across various demographics, including age, sex, residence, income, education, BMI, and geographical region. Multivariable logistic regression was employed to examine the associations between smoking pack-years and related factors. Results: Among 524,741 participants (mean age: 61.9±10.9; 41.1% male; 58.9% female), standardized smoking prevalence was 19.3% (95% CI=19.2-19.4%), with men (37.2%; 95% CI=37.0-37.4%) displaying significantly higher rates than women (1.3%; 95% CI=1.2-1.3%). Smoking cessation rate stood at 11.2% (95% CI: 11.0-11.4%), with figures of 11.3% (95% CI: 11.1-11.5%) for men and 8.4% (95% CI: 7.5-9.2%) for women. Urban residents and those with advanced education had lower smoking rates and higher cessation rates. Additionally, the dose-response relationship indicated a more pronounced association between higher smoking pack-years and elevated health risks, including hypertension (aOR=1.30, 95% CI: 1.24-1.36), diabetes (aOR=1.26, 95% CI: 1.20-1.33), hyperlipidemia (aOR=1.22, 95% CI: 1.16-1.28), heart disease (aOR=1.40, 95% CI: 1.26-1.54), and stroke (aOR=1.23, 95% CI: 1.10-1.36). Conclusions: This comprehensive study emphasizes the profound impact of smoking on health in Chinese adults, indicating the critical need for tailored cessation programs, particularly for middle-aged individuals, men, rural residents, and those with lower educational backgrounds. [ABSTRACT FROM AUTHOR]

Case: A 53-year-old man presented with a 13-mm leg length discrepancy following left hip resurfacing arthroplasty (HRA), resulting in pain and imbalance. Advanced osteoarthritis of the contralateral hip was also noted. The patient strongly preferred HRA over total hip arthroplasty. Adequate remaining bone stock and the ability to resurface the contralateral hip allowed for resolution with 2 HRAs. Conclusion: This is the first known revision of a HRA with a subsequent HRA. Assuming sufficient bone stock and precise implant positioning, resurfacing presents a feasible methodology to overcome complex anatomical deformities and improve mobility. [ABSTRACT FROM AUTHOR]

Case: An overall healthy 48-year-old man suffered a left foot mangled crush injury resulting in a post-transmetatarsal amputation and subsequently developing a painful neuroma on the plantar surface of the foot. To avoid the zone of injury, targeted muscle reinnervation was used to treat the neuroma by coapting the tibial nerve to the motor point of the flexor hallucis longus (FHL) muscle. At 1-year follow-up, the patient reported no pain at rest, returned to work, and could ambulate with an orthosis for 30 minutes. Conclusion: Rare tibial nerve coaptations to the FHL could serve as a treatment option for patients with neuromas in traumatic postmetatarsal amputation. [ABSTRACT FROM AUTHOR]

Case: A 51-year-old woman, who had previously undergone C5-C7 anterior cervical discectomy and fusion, presented with symptomatic hardware failure and subsequently underwent instrumentation removal. Her postoperative course was complicated by an esophageal perforation. Despite initial repair using a rotational flap, the leak persisted, prompting esophageal reconstruction with a radial forearm free flap (RFFF). Conclusion: Persistent esophageal perforation is exceedingly rare and difficult to treat. This report discusses the surgical technique for RFFF, an excellent option for revising failed sternocleidomastoid rotational flaps. The decision between rotational repair and free flap reconstruction depends on factors such as defect size, vascularization, wound condition, and donor site morbidity. [ABSTRACT FROM AUTHOR]

Case: We report a unique case of dynamic scapular winging due to compression of the long thoracic nerve by a ventral scapular osteochondroma, representing a combination of mechanical and neural causes. Arthroscopic resection of the lesion was performed, which led to complete resolution of the symptoms. Conclusion: By reporting this case, we aimed to increase awareness of the importance of a correct etiological diagnosis of dynamic scapular winging, so that targeted treatment can be addressed. Arthroscopic resection seems ideal for this indication because it reduces the risk of complications and patient recovery time. [ABSTRACT FROM AUTHOR]

Case: We present the case of a 59-year-old man who had MIS L4-5 decompression. He presented the next day with intractable back and leg pain. Magnetic resonance imaging revealed ventral displacement of the cauda equina and a subdural collection on the right L3/L4 nerve roots. Revision decompression revealed occult durotomy caudal and contralateral to the index decompression. Conclusion: Minimally invasive spine (MIS) surgery leverages shorter operative time and reduced postoperative pain. Yet, decreased exposure can make identification and management complications challenging. This report highlights occult durotomy and spinal subdural extra-arachnoid hygroma in patients with postoperative nerve compression after seemingly uncomplicated MISS. [ABSTRACT FROM AUTHOR]

Introduction: The first signs of deteriorated balance impairment begin during middle age. Early intervention could delay the fall risk in older populations; hence, addressing balance deficits during this age is crucial. The authors aimed to determine the effects of transcranial direct current stimulation (tDCS) combined with balance training (BT) on the improvement of static and dynamic balance in a middle-aged population, along with the participants' safety and satisfaction. Methods: Participants (n = 28) were randomized into two groups: active tDCS (active tDCS + BT) and sham tDCS (sham tDCS + BT). Both groups received the intervention thrice a week for 6 weeks. Dynamic and static balance were assessed by sway rate changes with eyes open and closed, and the functional reach test and a postintervention survey were conducted to assess participants' safety and satisfaction. Results: The active tDCS group showed significantly greater static and dynamic balance improvements in sway scores. The surveys demonstrated the safety of the program and satisfaction of 80% of the participants with the combined intervention. Conclusion: tDCS could be used in a middle-aged population as part of regular BT to improve balance and minimize the risk of balance deficits in older populations while ensuring patient safety and satisfaction. This study is a subanalysis of a larger clinical trial that included young adults as well (Clinical trial number: KCT0007414). [ABSTRACT FROM AUTHOR]

To assess the bidirectional association between chronic pain and depressive symptoms among middle-aged and older adults from two prospective cohort studies. We used prospective data (12y of follow-up) from the English Longitudinal Study of Ageing (n = 9149, 5018 women, 65.0 ± 10.2y) and the Health and Retirement Study (n = 16,883, 9810 women, 66.9 ± 10.3y), including data from seven waves of each cohort between 2006 and 2018/2019. Depressive symptoms were assessed using the Centre of Epidemiological Studies Depression scale, while chronic pain was estimated using questions about the frequency of being troubled with pain. We used random-intercept cross-lagged panel models to assess the bidirectional association between pain and depressive symptoms, adjusting for potential confounders. There was a cross-lagged effect of chronic pain on depressive symptoms (ELSA: β: 0.038; 95%CI: 0.011–0.066. Standardized coefficient (B): 0.021. SHARE: β: 0.044; 95%CI: 0.023–0.065. B: 0.023–0.024) as well as depressive symptoms on pain (ELSA: β: 0.010; 95%CI: 0.002–0.018. B: 0.017–0.019. SHARE: 0.011; 95%CI: 0.005–0.017. B: 0.020–0.021). Moreover, there were auto-regressive effects of both chronic pain (ELSA: β: 0.149; 95%CI: 0.128–0.171. SHARE: β: 0.129; 95%CI: 0.112–0.145) and depressive symptoms (ELSA: β: 0.149; 95%CI: 0.130–0.168. SHARE: β: 0.169; 95%CI: 0.154–0.184). We identified a modest bidirectional association between depressive symptoms and chronic pain, using two large prospective ageing cohorts. • The stable trait variances of both chronic pain and depressive symptoms were correlated in both cohorts. • There is a relatively low bidirectional relationship between chronic pain and depressive symptoms. • Strategies to address both conditions are needed in middle-aged and older adults. [ABSTRACT FROM AUTHOR]

Aims: The association of sleep traits (insomnia, sleep duration, chronotype, daytime sleepiness, and snoring) with benign prostatic hyperplasia (BPH) is unclear. This research aimed to examine the effects of sleep traits on BPH risk. Methods: A total of 170 241 men aged 38 to 73 years from UK Biobank were included. An overall healthy sleep score was created based on five sleep traits. A Cox regression model was utilized to compute adjusted hazard ratios (HRs) and population attributable fractions (PAFs) with 95% confidence intervals (CIs) for BPH risk in relation to sleep traits. Results: During a median of 12.0 years follow‐up, 13 026 incident BPH cases occurred. We observed that sleep duration (7–8 h/d; HR 0.95; 95% CI 0.92–0.99), no frequent insomnia (HR 0.71; 95% CI 0.69–0.74), and no frequent daytime sleepiness (HR 0.86; 95% CI 0.79–0.93) were significantly related to reduced BPH risk. Each one‐point increment of the healthy sleep score was related to a decreased BPH risk, with an adjusted HR of 0.90 (95% CI 0.89–0.92). The multivariable‐adjusted HR in men adopting five versus zero to one low‐risk sleep traits was 0.68 (95% CI 0.61–0.75) for BPH risk. Estimates of the PAF indicated that 9.1% (95% CI 5.8–12.5%) of BPH cases would be prevented if all individuals had adopted all five low‐risk sleep traits, assuming causality. Conclusions: Our study indicates an association between a healthy sleep pattern and a lower risk of BPH, emphasizing the importance of adhering to such patterns for potentially reducing BPH risk. Geriatr Gerontol Int 2024; 24: 675–682. [ABSTRACT FROM AUTHOR]

• The dietary intake of patients with type 2 diabetes mellitus (T2DM) is imbalanced. • The insufficient fruit intake was associated with a higher risk of T2DM. • Indicators of Dietary Balance Index-16 may predict the risk of T2DM. The association between dietary quality and type 2 diabetes mellitus (T2DM) based on the Chinese Dietary Balance Index (DBI-16) is seldom reported. We hypothesized that poor dietary quality might increase the risk of T2DM in the middle-aged and older populations. A total of 1816 individuals (≥50 years) were included in the study. Demographic characteristics and dietary intake data were collected. Logistic regression and restricted cubic spline (RCS) analyses were conducted to explore the association between DBI-16 indexes and the risk of T2DM. The insufficient intake of vegetables and dairy might decrease the risk of T2DM (OR Vegetable = 0.77, 95% CI = 0.60-0.97; OR Dairy = 0.58, 95% CI = 0.35-0.96), but the individuals with insufficient intake of fruit were more likely to have a higher risk of T2DM (OR fruit = 2.26, 95% CI = 1.69-3.06). Compared with the subjects with the lowest quartile of Low Bound Score (LBS) or Diet Quality Distance (DQD), the individuals with Q2 and Q3 level of LBS (OR Q2 = 1.40, 95% CI = 1.03-1.90, P =.033; OR Q3 = 1.52, 95% CI = 1.11-2.08, P <.01) or DQD (OR Q2 = 1.45, 95% CI = 1.06-1.99, P =.021; OR Q3 = 1.64, 95% CI = 1.20-2.24, P <.01) showed increased risk of T2DM with a nonlinear association observed by RCS analysis. We concluded that imbalanced dietary intake, especially insufficient daily fruit intake, might predict an increased risk of T2DM in the middle-aged and elderly Chinese. Dietary quality was assessed by DBI-16, based on the Chinese Food Guide Pagoda and Chinese dietary guidelines. Individuals with higher DQD, especially higher LBS, are at an increased risk of developing diabetes. Among this, fruit, vegetables, and dairy significantly contribute to the overall dietary insufficiency associated with the risk of T2DM, especially insufficient fruit intake. Abbreviations: Chinese Diet Balance Index 2016, DBI-16; Diet Quality Distance, DQD; Low Bound Score, LBS. [Display omitted] [ABSTRACT FROM AUTHOR]

Using a sample of middle-aged and older adults, this research explores associations between generativity and two key risk factors for suicide: thwarted belonging (T.B.) and perceived burdensomeness (P.B.). These variables are typically studied as predictors of suicide; the current study is unique in examining their psychosocial correlates. Erikson described, generativity as a psychosocial construct that characterizes adult well-being in mid-life, conceptualized as the sense one has successfully guided and contributed to the younger generation through mentoring. Using the Midlife in the United States Survey (MIDUS), the current analyses indicate that generativity is associated with lower levels of P.B. and T.B., even after accounting for measures of hopelessness, depressive symptoms, financial stability, perceived neighborhood quality, chronic health conditions, and respondent's demographic characteristics including gender and age. Results are discussed in terms of applications for suicide-risk prevention, and with regard to the promotion of positive psychosocial development across the lifespan. [ABSTRACT FROM AUTHOR]

Nicotinamide adenine dinucleotide (NAD+) is a universal coenzyme regulating cellular energy metabolism in many cell types. Recent studies have demonstrated the close relationships between defective NAD+ metabolism and aging and age-associated metabolic diseases. The major purpose of the present study was to test the hypothesis that NAD+ biosynthesis, mediated by a rate-limiting NAD+ biosynthetic enzyme, nicotinamide phosphoribosyltransferase (NAMPT), is essential for maintaining normal adipose tissue function and whole body metabolic health during the aging process. To this end, we provided in-depth and comprehensive metabolic assessments for female adipocyte-specific Nampt knockout (ANKO) mice during aging. We first evaluated body fat mass in young (<4-mo-old), middle aged (10-14-mo-old), and old (≥18-mo-old) mice. Intriguingly, adipocyte-specific Nampt deletion protected against age-induced obesity without changing energy balance. However, data obtained from the hyperinsulinemic-euglycemic clamp procedure (HECP) demonstrated that, despite the lean phenotype, old ANKO mice had severe insulin resistance in skeletal muscle, heart, and white adipose tissue (WAT). Old ANKO mice also exhibited hyperinsulinemia and hypoadiponectinemia. Mechanistically, loss of Nampt caused marked decreases in WAT gene expression of lipogenic targets of peroxisome proliferator-activated receptor gamma (PPAR-γ) in an age-dependent manner. In addition, administration of a PPAR-γ agonist rosiglitazone restored fat mass and improved metabolic abnormalities in old ANKO mice. In conclusion, these findings highlight the importance of the NAMPT-NAD+-PPAR-γ axis in maintaining functional integrity and quantity of adipose tissue, and whole body metabolic function in female mice during aging. NEW & NOTEWORTHY Defective NAD+ metabolism is associated with aging and age-associated metabolic diseases. In the present study, we provided in-depth metabolic assessments in female mice with adipocyte-specific inactivation of a key NAD+ biosynthetic enzyme NAMPT and revealed an unexpected role of adipose tissue NAMPT-NAD+-PPAR-γ axis in maintaining functional integrity and quantity of adipose tissue and whole body metabolic health during the aging process. [ABSTRACT FROM AUTHOR]

Objective: To examine associations between body mass index (BMI) in early pregnancy and gestational weight gain (GWG) with cardiovascular health in middle age using the 'Life's Essential 8' (LE8) concept of the American Heart Association (AHA). Design: Population‐based cohort study. Setting: Swedish CardioPulmonary bioImage Study (SCAPIS). Population: A total of 8871 women from SCAPIS were included. Methods: Information on cardiovascular health in middle age was collected from SCAPIS and linked to pregnancy weight data obtained from the Swedish Medical Birth Register, with an average follow‐up time of 24.5 years. An LE8 score between 0 and 100 was determined, where a score under 60 points was defined as poor cardiovascular health. Binary logistic regression and restricted cubic splines were used. Main outcome measures: Cardiovascular health according to LE8 in middle age. Results: The odds of having poor cardiovascular health in middle age were significantly higher in women who had overweight (adjusted odds ratio, aOR 3.30, 95% CI 2.82–3.88) or obesity (aOR 7.63, 95% CI 5.86–9.94), compared with women classified as being of normal weight in pregnancy. Higher odds were also found for excessive GWG (aOR 1.31, 95% CI 1.09–1.57), compared with women who gained weight within the recommendations. Conclusions: A high BMI in early pregnancy and excessive GWG were associated with greater odds of poor cardiovascular health in middle age. Although further studies are needed, our results highlight pregnancy as an important period to support long‐term cardiovascular health. [ABSTRACT FROM AUTHOR]

Adults who are beginning or returning to finish a degree program at midlife face different challenges than do their younger counterparts whose college experience begins at 18 years of age. We suspect that internalized ageism, defined as self-directed ageist attitudes and behaviors, may hinder nontraditional age students along with the experience of individual and institutional ageism. To evaluate this notion, we assessed the prevalence of self-reported positive and negative ageist behaviors in 205 students (M = 21.95, SD = 7.28, age range: 16-52 years) and 29 faculty (M = 49.55, SD = 11.07, age range: 33-71 years) in a community college in southeast Louisiana in the spring of 2019. All completed the Relating to Older People Evaluation (ROPE; Cherry & Palmore, 2008) and an open-ended question on how they viewed middle-aged students. Quantitative analyses indicated that students' ROPE scores exceeded those of the faculty and more positive than negative ageist behaviors were reported. Qualitative analyses revealed mostly positive expectations of middle-aged students among narrative responses to the open-ended question. As a follow-up, 10 nontraditional age students were individually interviewed in person to obtain an in-depth assessment of their community college experience. Strong evidence of internalized, individual, and institutional ageism were evident in their responses. Their narratives also revealed atypical life experiences and rich details of faculty-level and institutional-level policies that supported or hindered their academic progress. Implications of these data for addressing ageism on multiple levels in higher education are considered. [ABSTRACT FROM AUTHOR]

Background: To describe Clinical & demographic profile of the patient admitted with poisoning, drug overdose, drug adverse effects and anaphylaxis. Materials and Methods: This is a retrospective hospital record-based study conducted in a tertiary care hospital in Kolhapur, Maharashtra. Medical records of 408 admitted patients were included from May 2018 – Dec 2023 after permission from the Institutional Ethics Committee. Medical records having incomplete details were excluded from the study. Data was collected in predefined proforma. Results: Maximum Patients admitted were of 21 to 30 years of age group with duration of stay up to 4 days. Male (224, 54.90%) were predominant over female (184, 45.09%).Most common diagnosis at admission was poisoning (209, 51.22%), followed by drug adverse effects (115, 28.18%), overdose (57, 19.97%) and drug induced anaphylaxis (27, 6.61%). At early age (up to 40 years) poisoning and drug overdose were common, at middle age (41 to 60 yrs) anaphylaxis was common while at elderly age (51 yrs and more) drug adverse effects were most common. Organophosphorus poisoning is most common with male predominance while household poisoning is commoner in females. Drug induced hypoglycemia is most common drug adverse effect with male predominance followed by drug induced hyponatremia with female predominance. Most common outcome at the time of discharge was complete recovery (283, 69.36%) followed by leave against medical advice (81, 19.85%), and death (31, 7.59 %). Paraquat poisoning is the most common cause of death followed by Organophosphorus. Conclusion: Maximum admissions were from 21 – 30 years of age.Overall males are predominating over female but up to 20 years of age females are more than males.Poisoning and overdose is most common in young generation while in middle age anaphylaxis is common and in old age group drug adverse effects are commonest. Among causes of hospital admissions poisoning is most common in which Organophosphorus poisoning is commonest followed by paraquat poisoning. [ABSTRACT FROM AUTHOR]

Summary: A knowledge gap exists in associating later life's osteoporotic fracture and middle adulthood's BMI trajectories. We observed an association showing those transitioning from overweight to normal weight face a higher fracture risk in late adulthood, emphasizing the potential benefits of maintaining a stable BMI to reduce late-life fractures. Purpose: Numerous studies on the relationship between obesity and fractures have relied on body mass index (BMI) at a single time point, yielding inconclusive results. This study investigated the association of BMI trajectories over middle adulthood with fracture risk in late adulthood. Methods: This prospective cohort study analyzed 1772 qualified participants from the Framingham Original Cohort Study, with 292 (16.5%) incident fractures during an average of 17.1-year follow-up. We constructed BMI trajectories of age 35–64 years based on latent class mixed modeling and explored their association with the risk of fracture after 65 years using the Cox regression. Results: The result showed that compared to the BMI trajectory Group 4 (normal to slightly overweight; see "Methods" for detailed description), Group 1 (overweight declined to normal weight) had a higher all-fracture risk after age 65 (hazard ratio [HR], 2.22, 95% CI, 1.13–4.39). The secondary analysis focusing on lower extremity fractures (pelvis, hip, leg, and foot) showed a similar association pattern. Conclusions: This study suggested that people whose BMI slightly increased from normal weight to low-level overweight during 30 years of middle adulthood confer a significantly lower risk of fracture in later life than those whose BMI declined from overweight to normal weight. This result implies the potentially beneficial effects of avoiding weight loss to normal weight during middle adulthood for overweight persons, with reduced fracture risk in late life. [ABSTRACT FROM AUTHOR]

To determine and appraise the certainty of fracture liaison service (FLS) in reducing the risk of secondary fragility fractures in older adults aged ≥ 50 years and to examine the nature of the FLS and the roles of various disciplines involved in the delivery of the FLS. Medline, EMBASE, PubMed, CINAHL, SCOPUS, and The Cochrane Library were searched from January 1st, 2010, to May 31st, 2022. Two reviewers independently extracted data. The risk of bias was evaluated using the Newcastle–Ottawa Scale for cohort studies and the PEDro scale for randomized trials, while the GRADE approach established the certainty of the evidence. Thirty-seven studies were identified of which 34 (91.9%) were rated as having a low risk of bias and 22 (59.5%) were meta-analyzed. Clinically important low certainty evidence at 1 year (RR 0.26, CI 0.13 to 0.52, 6 pooled studies) and moderate certainty evidence at ≥ 2 years (RR 0.68, CI 0.55 to 0.83, 13 pooled studies) indicate that the risk of secondary fragility fracture was lower in the FLS intervention compared to the non-FLS intervention. Sensitivity analyses with no observed heterogeneity confirmed these findings. This review found clinically important moderate certainty evidence showing that the risk of secondary fragility fracture was lower in the FLS intervention at ≥ 2 years. More high-quality studies in this field could improve the certainty of the evidence. Review registration: PROSPERO―CRD42021266408. [ABSTRACT FROM AUTHOR]

Objective: To investigate the bidirectional association between oral diseases and cognitive function comprehensively. Subjects and Methods: This cross sectional study utilized data from the National Health and Nutrition Examination Survey. Oral diseases include periodontitis, dental caries, and tooth loss (end point of oral disease resulting in tooth extraction). Cognitive function included three domains: memory, processing speed, and executive function. A global cognitive score was then derived from sum of the three cognitive domains. Oral cognition associations were examined using various statistical models: (1) Regress oral disease on cognitive function; (2) Regress cognitive function on oral disease; and (3) Structural equation modelling treating cognition and oral disease as latent variables. Results: There were 2508 participants aged 60+ who had both oral and cognitive information. Associations between various oral disease and global cognitive score were observed (Odds ratio ORcog‐>periodontitis 0.95, 95% Confidence Interval [0.92, 0.99]; βcog‐>caries −0.13, [−0.23, −0.04]; βcog‐>tooth loss −0.03 [−0.04, −0.01]; βtooth loss‐>cog −0.04 [−0.06, −0.02]; βcaries‐>cog −0.03 [−0.06, −0.01]; βperiodontitis‐>cog −0.39 [−0.69, −0.10]). Significant correlation was also found between these oral disease and cognitive function using structural equation model (r −0.22, [−0.34, −0.10]). Conclusions: This study found robust bidirectional associations between oral disease and cognitive function using various modelling approaches among the aging population. [ABSTRACT FROM AUTHOR]

Brisk walking is a simple exercise for older adults. We aimed to assess the cardiovascular response to a short bout of brisk walking on walking loops in an innovative senior playground in Thailand. Twenty older adults were randomly assigned to brisk walking on artificial turf (AT group, n = 10) or an uneven surface (US group, n = 10). We assessed cardiovascular parameters, average walking speed, and rate of perceived exertion. Blood pressure, heart rate, rate-pressure product, and rate perceived exertion were significantly increased, while the mean RR interval of heart rate variability was significantly decreased in both AT and US groups after exercise compared with pre-exercise (p < 0.05). A greater change in systolic blood pressure was observed in the US group than in the AT group (p < 0.05). These data indicated that brisk walking on AT and US increases cardiovascular response. Our findings provide information on planning exercise programs for older adults. [ABSTRACT FROM AUTHOR]

Importance: The prevalence of multiple sclerosis (MS) and aging MS patients is increasing worldwide. There is a need to better understand this MS sub-population, which historically is underrepresented in the literature. This narrative review examines the evolving demographics, disease course, and treatments for older adults with MS (OAMS) to address current knowledge gaps and highlight areas critical for future research. Observations: OAMS populations require special consideration by clinicians. Older individuals have different care needs than individuals with adult onset MS who are mid-life or younger. Comorbidities, an aging immune system, increasing neurodegeneration, decreasing neurologic reserve, changing benefit/risk relationship for disease modifying therapies (DMTs), and wellness require special attention to provide holistic comprehensive care. Active areas of research include potential cessation of DMTs and novel disease targets. Conclusions and relevance: This review highlights both the current knowledge and information gaps in the literature that are critical to understanding and properly managing OAMS. The aims are to inform MS clinicians in their current practice, as well as inspire future studies which are critical to providing quality and evidence-based care for OAMS. [ABSTRACT FROM AUTHOR]