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Introduction: Auricular acupuncture (AA) is a method for diagnosing and treating physical and psychosomatic dysfunctions by stimulating a specific point in the ear. Some studies prove that the acupoints on the pinna have a corresponding relationship to areas of the body. According to several studies, acupoints on the body may influence the temperature of the corresponding region. In our study, we surveyed the change in temperature of the skin surface at the mandibular area when using AA at the Jaw point on each side of the ear in healthy people. Methods: A cross-over study with 35 healthy volunteers was conducted in the Acupuncture Experimental Research Lab, Faculty of Traditional Medicine, University of Medicine and Pharmacy at Ho Chi Minh City from November 2021 to May 2022. Temperatures of the mandibular area before and after using auricular acupuncture were recorded. Results: After using AA at the Jaw point on the left, the temperature of the left mandibular area was increased statistically from that before (from 34.34 ± 0.69 to 34.76 ± 0.72). After using AA at the Jaw point on the right, the temperature of the right mandibular area was increased statistically from that before (from 34.50 ± 0.86 to 34.31 ± 0.68). No side effects were observed during the study. Conclusions: When using AA at the Jaw point on the ear, the temperature of the mandibular area on the side of using auricular acupuncture increased statistically, showing the relationship of the Jaw point on the ear with the mandibular area.

The SPOT-MAS assay “Screening for the Presence Of Tumor by Methylation And Size” detects the five most common cancers in Vietnam by evaluating circulating tumor DNA in the blood. Here, we validated its performance in a prospective multi-center clinical trial, K-DETEK. Our analysis of 2795 participants from 14 sites across Vietnam demonstrates its ability to detect cancers in asymptomatic individuals with a positive predictive value of 60%, with 83.3% accuracy in detecting tumor location. We present a case report to support further using SPOT-MAS as a complementary method to achieve early cancer detection and provide the opportunity for early treatment.

Severe Acute Respiratory Syndrome Coronavirus Type 2 (SARS-CoV-2) induces a global serious pandemic and is responsible for over 4 million human deaths. Currently, although various vaccines have been developed, humans can still get SARS-CoV-2 infection after being vaccinated. Therefore, the blocking of SARS-CoV-2 infection may be potential therapeutic strategies. Ganoderma microsporum immunomodulatory protein (GMI), a small fungal protein, is cloned from Ganoderma microsporum. It exhibits anti-cancer and immunomodulatory functions. Currently, it is still unclear whether GMI involves in interfering with viral infection.This study aimed to examine the potential functions and mechanisms of GMI on inhibiting SARS-CoV-2 pseudovirus infection.The effects of GMI were examined in vitro on ACE2 overexpressing HEK293T (HEK293T/ACE2) cells exposed to SARS-CoV-2 Spike lentiviral pseudovirus encoding a green fluorescent protein (GFP) gene. The infection efficacy was determined using fluorescence microscopy and flow cytometry. The protein level of ACE2 was verified by Western blot. The effects of GMI on cell viability of HEK293T/ACE2 and lung epithelial WI38-2RA cells were determined by MTT assay. Mice received GMI via nebulizer.GMI did not affect the cell viability of HEK293T/ACE2, WI38-2RA and macrophages. Functional studies showed that GMI inhibited GFP expressing SARS-CoV-2 pseudovirus from infecting HEK293T/ACE2 cells. GMI slightly interfered the interaction between ACE2 and Spike protein. GMI interacted with S2 domain of Spike protein. Specifically, GMI dramatically reduced ACE2 expression in HEK293T/ACE2 and WI38-2RA cells. Mechanistically, GMI induced ACE2 degradation via activating protein degradation system, including proteasome and lysosome. Abolishing proteasome and lysosome by MG132 and bafilomycin A1, respectively, rescued GMI-reduced ACE2 levels. In addition, GMI triggered dynamin and lipid raft-mediated ACE2 endocytosis. ACE2 levels were downregulated in the lung tissue after the mice inhaling GMI.GMI prevents SARS-CoV-2 pseudovirus infection via induction of ACE2 degradation in host cells. Our findings suggest that GMI will be a potential prevention agent to alleviate SARS-CoV-2 infection.

The bidirectional communication between the brain and peripheral organs have been widely documented, but the impact of visceral adipose tissue (VAT) dysfunction and its relation to structural and functional brain changes have yet to be fully elucidated. This review initially examines the clinical evidence supporting associations between the brain and VAT before visiting the roles of the autonomic nervous system, fat and glucose metabolism, neuroinflammation, and metabolites. Finally, the possible effects and potential mechanisms of the brain-VAT axis on the pathogenesis of Alzheimer's disease are discussed, providing new insights regarding future prevention and therapeutic strategies.

Liver cancer is the most frequent cancer, making it the leading cause of cancer death globally. Traditional medicinal plants with anticancer properties can be used as drugs or dietary adjuvants to existing therapies. This chapter presents a protocol for the preparation of β-sitosterol and β-sitosterol-glucoside from Indigofera zollingeriana Miq (I. zollingeriana) and the evaluation of these for anticancer activity in hepatocellular cells.

Liver cancer is the most frequent cancer, making it the leading cause of cancer death globally. Traditional medicinal plants with anticancer properties can be used as drugs or dietary adjuvants to existing therapies. This chapter presents a protocol for the preparation of β-sitosterol and β-sitosterol-glucoside from Indigofera zollingeriana Miq (I. zollingeriana) and the evaluation of these for anticancer activity in hepatocellular cells.

Drug delivery to central nervous system (CNS) diseases is very challenging since the presence of the innate blood–brain barrier (BBB) and the blood-cerebrospinal fluid barrier that impede drug delivery. Among new strategies to overcome these limitations and successfully deliver drugs to the CNS, nanotechnology-based drug delivery platform, offers potential therapeutic approach for the treatment of some common neurological disorders like Alzheimer’s disease, frontotemporal dementia, amyotrophic lateral sclerosis, Parkinson’s disease, Huntington’s disease. This review aimed to highlight advances in research on the development of nano-based therapeutics for their implications in therapy of CNS disorders. The challenges during clinical translation of nanomedicine from bench to bed side is also discussed.

Alzheimer's disease (AD) is a neurodegenerative disorder in which the death of brain cells causes memory loss and cognitive decline. Existing drugs only suppress symptoms or delay further deterioration but do not address the cause of the disease. In spite of screening numerous drug candidates against various molecular targets of AD, only a few candidates, such as acetylcholinesterase inhibitors, are currently utilized as an effective clinical therapy. Currently, nano-based therapies can make a difference, providing new therapeutic options by helping drugs to cross the blood-brain barrier and enter the brain more effectively. The main aim of this review was to highlight advances in research on the development of nano-based therapeutics for improved treatment of AD.

Alzheimer's disease (AD) is a neurodegenerative disorder in which the death of brain cells causes memory loss and cognitive decline. Existing drugs only suppress symptoms or delay further deterioration but do not address the cause of the disease. In spite of screening numerous drug candidates against various molecular targets of AD, only a few candidates, such as acetylcholinesterase inhibitors, are currently utilized as an effective clinical therapy. Currently, nano-based therapies can make a difference, providing new therapeutic options by helping drugs to cross the blood-brain barrier and enter the brain more effectively. The main aim of this review was to highlight advances in research on the development of nano-based therapeutics for improved treatment of AD.

Indigofera zollingeriana Miq (I. zollingeriana) is a widely grown tree in Vietnam. It is used to cure various illnesses. The purpose of this study was to investigate the chemical constituents of an I. zollingeriana extract and test its anticancer activity on hepatocellular cells (Huh7 and HepG2). The experimental results of the analysis of the bioactive compounds revealed that &beta, sitosterol (&beta, S) and &beta, sitosterol-glucoside (&beta, SG) were the main ingredients of the I. zollingeriana extract. Regarding anticancer activity, the &beta, S and &beta, SG of I. zollingeriana were found to exhibit cytotoxic effects against HepG2 and Huh7 cells, but not against normal human primary fibroblasts. The &beta, S was able to inhibit the proliferation of HepG2 and Huh7 cells in a dose-dependent manner with half-maximal inhibitory concentration (IC50) values of 6.85 &plusmn, 0.61 &micro, g/mL and 8.71 &plusmn, 0.21 &micro, g/mL, respectively (p &lt, 0.01), whereas the &beta, SG IC50 values were 4.64 &plusmn, 0.48 &micro, g/mL for HepG2 and 5.25 &plusmn, 0.14 &micro, g/mL for Huh7 cells (p &lt, 0.01). Remarkably, our study also indicated that &beta, SG exhibited cytotoxic activities via inducing apoptosis and activating caspase-3 and -9 in these cells. These findings demonstrated that &beta, SG from I. zollingeriana could potentially be developed into promising therapeutic agents to treat liver cancer.

Objective: To provide a direct estimate of the risk of admission to permanent residential aged care among older women while accounting for death, according to housing type and other variables. Methods: A competing risk analysis from 8,867 Australian women born 1921–26, using linked data from the Australian Longitudinal Study on Women's Health (ALSWH), Residential Aged Care (RAC), and the Australian National Death Index. Results: After accounting for deaths, around 35% of women will be admitted to RAC between ages 73 and 90. The conditional cumulative incidence of admission to RAC was 26.9% if living in a house, compared to 36.0% from an apartment, 43.6% within a retirement village, and 37.1% if living in a mobile home. Each one‐year increase in age was associated with a relative 17% increased risk of RAC. Conclusions: Around one‐third of women will enter RAC between age 73 and 90. Living in a house had the lowest risk of entering residential aged care over time. Implications for public health: These findings have important implications for planning for aged care services, including the role of housing in delaying admission to residential aged care, and the need for residential care by a high proportion of women towards the end of life.

Alzheimer's disease (AD) is a progressive deterioration of brain function, initially characterized by cognitive deficits, with loss of recent memory and language ability, impairment of orientation, problem solving, and abstract thinking. While existing drug treatments help reduce the symptoms of AD and improve people’s quality of life, they neither slow its progression nor cure it. Currently, targeted drug delivery to the central nervous system (CNS), for therapy of AD, is confined by the challenges posed by blood-brain interfaces surrounding the CNS, limiting the bioavailability of therapeutics. Among new strategies to overcome these limitations and successfully deliver drugs to the CNS, nanoparticles (NPs) are able to overcome these limitations, offering new therapeutic designations in term of driving drugs to cross the BBB and enter the brain more effectively. The current article aimed to summary and highlight advances in recent research on the development of nanotechnology-based therapeutics for their implications in therapy of AD.

Foodborne pathogens present serious concerns to human health and can even lead to fatalities. The gold standard for pathogen identification – bacterial culture – is costly and time consuming. A cheaper and quicker alternative will benefit in controlling food safety. In this study, we developed a multiplex-PCR protocol for simultaneous detection of five Foodborne pathogens including Escherichia coli O157:H7, Staphylococcus aureus, Salmonella spp., Listeria monocytogenes, and Vibrio cholerae, based on five genes stx1, femA, invA, iap, va ctxA, respectively. Specific primers for multiplex PCR amplification of the stx (Shiga-like toxin), nuc (thermo nuclease), inv A (invasion protein A), iap (invasive associative protein), and ctx A (cholera toxin A) genes that were established to amplify simultaneous detection of the target pathogens. The assay was also validated for its specificity, sensitivity, and applied to test some spiked food samples. The results showed the products expected multiplex PCR fragments of approximately 112, 244, 301, 453, 518 and 720bp for S. aureus, Salmonella spp. V. cholera, L. monocytogenes, E. coli O157:H7 and 16S rRNA, respectively. The assay was specific to the targeted pathogens and was sufficiently sensitive and robust to effectively analyze market samples. The whole process took less than 24 h to complete indicating that the assay is suitable for reliable and rapid identification of these five foodborne pathogens, which could be suitable in microbial epidemiology investigation. You can submit your Manuscripts at: https://symbiosisonlinepublishing.com/submitManuscript.php

Identifying unique patients across multiple care facilities or services is a major challenge in providing continuous care and undertaking health research. Identifying and linking patients without compromising privacy and security is an emerging issue in the big data era. The large quantity and complexity of the patient data emphasize the need for effective linkage methods that are both scalable and accurate. In this study, we aim to develop and evaluate an ensemble classification method using the three most typically used supervised learning methods, namely support vector machines, logistic regression and standard feed-forward neural networks, to link records that belong to the same patient across multiple service locations. Our ensemble method is the combination of bagging and stacking. Each base learner's critical hyperparameters were selected through grid search technique. Two synthetic datasets were used in this study namely FEBRL and ePBRN. ePBRN linkage dataset was based on linkage errors noticed in the Australian primary care setting. The overall linkage performance was determined by assessing the blocking performance and classification performance. Our ensemble method outperformed the base learners in all evaluation metrics on one dataset. More specifically, the precision, which is average of individual precision scores in case of base learners increased from 90.70% to 94.85% in FEBRL, and from 62.17% to 99.28% in ePBRN. Similarly, the F-score increased from 94.92% to 98.18% in FEBRL, and from 72.99% to 91.72% in ePBRN. Our experiments suggest that we can significantly improve the linkage performance of individual algorithms by employing ensemble strategies.

Background Screening reduces cervical cancer incidence and mortality. Objective To describe cervical cancer epidemiology and screening guidelines in six low- and middle-income countries (LMICs) participating in the Study on global AGEing and adult health (SAGE). Search strategy Incidence, mortality, and screening-rate data were obtained for six LMICs and three higher-income comparator countries (Australia, USA, and UK). SCOPUS and PubMed were used to identify literature published after 2000 in English, using several screening-linked terms. Selection Criteria Literature describing the use of cervical cancer screening guidelines in China, Ghana, India, Mexico, Russia, and South Africa were included. Data collection and analysis Incidence, mortality trends, and screening rates were graphed and screening recommendations were summarized. Main Results Higher rates of cervical cancer incidence, mortality, and 5-year prevalence were found in LMICs compared with the comparator countries. LMICs with absent or newly implemented screening guidelines had the lowest rates of crude and effective cervical cancer screening, with high cancer incidence and mortality. Countries with established guidelines had higher screening rates and lower disease burden. Cost, inadequate knowledge, geographical location, and cultural views were common barriers to effective screening coverage. Conclusion Work must continue to improve the implementation of affordable, relevant, and achievable methods to improve screening coverage in LMICs.

Scant research exists on the patterns of changes in older women’s housing, and whether and when women transition into residential aged care (RAC). This study aimed to identify groups of women with different housing patterns (latent classes) over time, with a secondary aim to describe socio-demographic and health characteristics of women in each class. We analysed linked data for 9575 women born 1921–1926 from the Australian Longitudinal Study of Women’s Health (ALSWH), Australian National Death Index, and Residential Aged Care (RAC) administrative records for the years 1999 through to 2011. Seven distinct housing patterns (classes) were identified over time. Four classes showed a stable pattern: living in a house for most surveys (47.0%), living in a house but with earlier death (13.7%), living in an apartment (12.8%), living in a retirement village (5.8%). One class showed a pattern of downsizing: moving from a house to retirement village (6.6%). Two patterns showed transition: from an apartment or retirement village, to RAC and death (7.8%), and from house to RAC (6.4%). This study provides new evidence about socio-demographic and health influences on housing patterns and entry into residential care in later life. These findings can inform policy and aged care planning for women in later life, by identifying patterns of transition into residential aged care, or alternatively, remaining in the community.

Introduction Population aging is associated with a rising burden of non-communicable disease, profoundly impacting health policy and practice. Adopting and adhering to healthy lifestyles in middle or older age can protect against morbidity and mortality. Retirement brings opportunities to reconfigure habitual lifestyles and establish new routines. This study examines the longitudinal association between retirement and a range of lifestyle risk behaviors among a large population-based sample of Australian adults. Methods Study sample included working adults aged ≥45 years at baseline (2006–2009, N=23,478–26,895). Lifestyle behaviors, including smoking, alcohol use, physical activity, diet, sedentary behavior, and sleep, were measured at both baseline and follow-up (2010). Logistic regression models estimated the odds of having each risk factor at follow-up and multiple linear regression models calculated the change in the total number of risk factors, adjusted for baseline risk and other covariates. Sociodemographic characteristics and reasons for retirement were tested as potential effect modifiers. Results During the 3.3-year follow-up, about 11% of respondents retired. Retirement was associated significantly with reduced odds of smoking (AOR=0.74); physical inactivity (AOR=0.73); excessive sitting (AOR=0.34); and at-risk sleep patterns (AOR=0.82). There was no significant association between retirement and alcohol use or fruit and vegetable consumption. Change in the total number of lifestyle risk factors differed significantly by reason for retirement. Conclusions In a large population-based Australian cohort, retirement was associated with positive lifestyle changes. Health professionals and policymakers should consider developing special programs for retirees to capitalize on the healthy transitions through retirement.

We examined retirement transitions by gender, and different associations between retirement, physical function and mental health.Data for 21,608 participants aged 55-69 from the 45 and Up Study were used. Generalised estimating equations were used to investigate longitudinal associations between retirement with psychological distress (Kessler score, K10) and physical dysfunction across two time points, by gender separately.Retirement in men was associated with a 25% relative increase in mean physical dysfunction score (p0.001) and a 2% relative increase in mean K10 score (p=0.004), although men with high physical dysfunction score had a 6% increase in mean K10 score (p=0.005) if retired. For women, retirement was associated with a 17% increase in mean physical dysfunction score (p0.001), with no association observed with the K10 score. Results were adjusted for demographic and health covariates.Retirement is associated with physical dysfunction over time. Retirement is not associated with psychological distress among women, but retirement is associated with psychological distress among men who have a high level of physical dysfunction. The findings point to the importance of attending to the physical and mental health needs, around the retirement period, particularly for men with poor physical health.

Aim To describe and compare the mental health and physical functioning of community-dwelling men aged 70 years and over who live alone, and those who live with their partner/spouse. Method Data were obtained from the baseline survey of the New South Wales 45 and Up Study. Mental health was measured using the Kessler Psychological Distress Scale and physical health was measured using the Medical Outcome Short Form 36 physical functioning scale. Results 37 690 community-dwelling men aged 70 years or over were included in the analyses. Men living alone were more likely to have high psychological distress scores and lower physical functioning scores compared to men living with a spouse/partner within each age group, except those 85 and over. Conclusions Specific health and welfare programs targeted to the increasing number of older men living alone may be needed to address their higher levels of psychological distress and lower levels of physical functioning.

To compare quality of life (QOL) of caregivers of dialysis patients with the cared for patients and population norms.The ACTIVE Dialysis study randomized participants to extended (median 24 h/week) or standard (median 12 h/week) haemodialysis hours for 12 months. A subgroup of participants and their nominated caregivers completed QOL questionnaires including the EuroQOL-5 Dimension-3 Level (EQ5D-3 L), short form-36 (SF-36, also allowing estimation of the SF-6D), as well as a bespoke questionnaire and the personal wellbeing index (PWI). Caregiver QOL was compared with dialysis patient QOL and predictors of caregiver QOL were determined using multivariable regression.There were 54 patients and caregiver pairs, predominantly from China. Caregivers mean (SD) age was 53.4 (11.3) years, 60% were female, 71% cared for their spouse/partner, and 36% were educated to university level. Caregivers had better physical but similar mental QOL compared with dialysis patients (mean SF-36 physical component summary: 46.9 ± 8.7 vs 40.4 ± 10.2, P 0.001; mental component summary: 47.8 ± 9.7 vs 49.6 ± 12.0, P = 0.84). Health utility measured with EQ5D-3 L was not significantly different between caregivers and dialysis patients (mean 0.869 ± 0.185 vs 0.798 ± 0.227, P = 0.083). Caregiver PWI was 43.7 ± 15.5, significantly lower than the Chinese population norm (68.2 ± 14.2, P 0.001). Higher physical and mental QOL among caregivers was predicted by university education but not age, gender or daily hours caring.Caregivers have higher physical and equivalent mental QOL to dialysis patients but poorer personal well-being than the Chinese population. University education predicts better QOL and may be a surrogate for socioeconomic or other factors. (NCT00649298).

Brain–computer interfaces (BCIs) are desirable for people to express their thoughts, especially those with profound disabilities in communication. The classification of brain patterns for each different subject requires an extensively time-consuming learning stage specific to that person, in order to reach satisfactory accuracy performance. The training session could also be infeasible for disabled patients as they may not fully understand the training instructions. In this paper, we propose a unified classification scheme based on ensemble classifier, dynamic stopping, and adaptive learning. We apply this scheme on the P300-based BCI, with the subject-independent manner, where no learning session is required for new experimental users. According to our theoretical analysis and empirical results, the harmonized integration of these three methods can significantly boost up the average accuracy from 75.00% to 91.26%, while at the same time reduce the average spelling time from 12.62 to 6.78 iterations, approximately to two-fold faster. The experiments were conducted on a large public dataset which had been used in other related studies. Direct comparisons between our work with the others’ are also reported in details.

Poor sleep quality is common in haemodialysis patients and associated with worse outcomes. In this pre-specified analysis, we examined the impact of extended hours haemodialysis on sleep quality. The ACTIVE Dialysis trial randomized 200 participants to extended (≥24 hours/week) or standard (target 12-15 hours) hours haemodialysis over 12 months. Sleep quality was measured in the Kidney Disease Quality of Life Short Form 1.3 (KDQOL-SF) by overall sleep quality score (0-10, 10 = "very good") and the sleep subscale (0-100, 100 = 'best possible sleep') every three months via blinded telephone interviewer. The average intervention effect was calculated by mixed linear regression adjusted by time point and baseline score. Factors predicting sleep quality were assessed by multivariate regression analysis. Overall sleep quality score and sleep subscale at baseline were similar in both groups (5.9 [95%CI 5.4-6.4] vs 6.3 [5.9-6.8]; 65.0 [60.9-69.1] vs 63.2 [59.1-67.3]; extended and standard hours respectively). Extended hours haemodialysis led to a non-significant improvement in overall sleep quality score (average intervention effect 0.44 (-0.01-0.89), p=0.053) and sleep subscale (average intervention effect 3.58 (-0.02-7.18), p= 0.051). Poor sleep quality was associated with being female and with current smoking. Sleep quality was positively associated with EuroQol-5D (EQ5D) and the SF-36 Physical Component and Mental Component Summary Scores but not with hospitalisations. Sleep quality was not significantly improved by extended hours dialysis in this study. Sleep quality is positively correlated with quality of life in haemodialysis patients and is poorer in women and current smokers.

© 2017 IEEE. In most Brain-Computer Interface systems, especially the P300-Speller, there must be a harmonized balance between the accuracy and the spelling time. One major drawback of the classical 36-choice P300-Speller is the slow rate of character elicitation. This paper aims to propose a real-time signal processing method to decrease the spelling time by exploiting the score margins of the ensemble Support Vector Machine classifiers during real-time P300-Speller flashes, rather than just getting the classifiers' highest scores. Our experiments were conducted on the dataset of the BCI Competition III and resulted in a successful character rate of over 96% with just approximately 15 to 20 seconds for each character spelling session. As compared with the fixed 31.5 seconds of the best original approach of the competition, our proposed method significantly reduces the required spelling time by over 30% while maintaining the desired classification accuracy.

© 2017 IEEE. Brain-computer interfaces (BCIs) are used to assist people, especially those with verbal or physical disabilities, communicate with the computer to indicate their selections, control a device or answer questions only by their mere thoughts. Due to the noisy nature of brain signals, the required time for each experimental session must be lengthened to reach satisfactory accuracy. This is the trade-off between the speed and the precision of a BCI system. In this paper, we propose a unified method which is the integration of ensemble classifier, dynamic stopping, and adaptive learning. We are able to both increase the accuracy, as well as to reduce the spelling time of the P300-Speller. Another merit of our study is that it does not require the training phase for any new subject, hence eliminates the extensively time-consuming process for learning purposes. Experimental results show that we achieve the averaged bit rate boost up of 182% on 15 subjects. Our best achieved accuracy is 95.95% by using 7.49 flashing iterations and our best achieved bit rate is 40.87 bits/min with 83.99% accuracy and 3.64 iterations. To the best of our knowledge, these results outperformed most of the related P300-based BCI studies.

Objective This study describes hours in paid work for Australian men and women aged over 65, focusing on associations between work and education. Methods Data were analysed separately for men and women, from baseline and first follow-up surveys of the 45 and Up Study. Generalised estimating equation models were used to identify associations between work, education and other factors over time. Results The odds of doing paid work increased with higher education level and decreased with time, age, poorer physical function and having health conditions (high blood pressure, diabetes, stroke and breast cancer). Un-partnered women were more likely to work in later life than partnered women. Conclusion This study quantifies the importance of education and health factors in determining continued participation of Australian men and women in paid work in later life. These factors need to be considered for policies aiming to increase workforce participation beyond 65 years of age.

To examine the relationships of retirement and reasons for retirement with psychological distress in men and women at the age of 45-79 years.Data from 202,584 Australians participating in the large-scale 45 and Up Study was used. Psychological distress was measured by the Kessler psychological distress scale. Associations between different work status and reasons for retirement with psychological distress were assessed for men and women at different ages using logistic regression.Being fully retired or unemployed was associated with the high levels of psychological distress compared to being in paid work for men and women aged 45-64 (p0.0001), and for men aged 65-74 years (p ≤ 0.0014). At the age of 75-79 years, there was no difference in psychological distress between different work statuses. Among retirees, retirement due to ill health, being made redundant or caring duty was associated with the high level of psychological distress.The association between work and mental health underscores the importance of policies and strategies to encourage and enable people to continue in the workforce after age 55, particularly for men. Important reasons for retirement with worse mental health outcomes include redundancy, ill health and needing to care for family or a friend. These circumstances will affect whether a person can continue working and their risk of poor mental health, and both considerations should be addressed in developing approaches for maintaining older workers or assisting them with their retirement transition.

Objectives To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction. Methods A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses. Results With the exception of polypharmacy, commonly collected negative clinical outcomes were rare events. Compared with care homes with

BACKGROUND: Globally, most patients with hypertension are treated with monotherapy, and control rates are poor because monotherapy only reduces blood pressure by around 9/5 mm Hg on average. There is a pressing need for blood pressure-control strategies with improved efficacy and tolerability. We aimed to assess whether ultra-low-dose combination therapy could meet these needs. METHODS: We did a randomised, placebo-controlled, double-blind, crossover trial of a quadpill-a single capsule containing four blood pressure-lowering drugs each at quarter-dose (irbesartan 37·5 mg, amlodipine 1·25 mg, hydrochlorothiazide 6·25 mg, and atenolol 12·5 mg). Participants with untreated hypertension were enrolled from four centres in the community of western Sydney, NSW, Australia, mainly by general practitioners. Participants were randomly allocated by computer to either the quadpill or matching placebo for 4 weeks; this treatment was followed by a 2-week washout, then the other study treatment was administered for 4 weeks. Study staff and participants were unaware of treatment allocations, and masking was achieved by use of identical opaque capsules. The primary outcome was placebo-corrected 24-h systolic ambulatory blood pressure reduction after 4 weeks and analysis was by intention to treat. We also did a systematic review of trials evaluating the efficacy and safety of quarter-standard-dose blood pressure-lowering therapy against placebo. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614001057673. The trial ended after 1 year and this report presents the final analysis. FINDINGS: Between November, 2014, and December, 2015, 55 patients were screened for our randomised trial, of whom 21 underwent randomisation. Mean age of participants was 58 years (SD 11) and mean baseline office and 24-h systolic and diastolic blood pressure levels were 154 (14)/90 (11) mm Hg and 140 (9)/87 (8) mm Hg, respectively. One individual declined participation after randomisation and two patients dropped out for administrative reasons. The placebo-corrected reduction in systolic 24-h blood pressure with the quadpill was 19 mm Hg (95% CI 14-23), and office blood pressure was reduced by 22/13 mm Hg (p