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Cyprus College
cycollege.ac.cy
The college was founded in 1961 with the purpose to provide a well rounded education of high calibre where students can acquire the necessary academic knowledge.
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Wroclaw University
international.uni.wroc.pl
Founded in 1702 by Leopold I Habsburg. Since the beginning of 20th century the university has produced 9 Nobel Prize winners.
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Volyn University
vdu.edu.ua
The history dates back to 1940. At present, the university includes 4 institutes, 14 faculties and 73 departments.
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Berkeley College
berkeleycollege.edu
Through the power of internet, Berkeley college online brings the classroom to you anywhere in the world with the same high level of support as On-Campus classes.
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AIS
ais.ac.nz
New Zealand's largest international degree provider. The programmes are focused on the global marketplace.
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<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Immunity and inflammation may be essential to the pathogenesis of dementia. However, the association of immune-mediated diseases with the risk of incident dementia has not been well characterised.<div class="boxTitle">Objectives</div>We aimed to investigate the prospective association of 27 immune-mediated diseases and incident dementia risk and to explore the underlying mechanisms driven by brain structures.<div class="boxTitle">Methods</div>We included 487 459 UK Biobank participants aged 37–73 years without dementia at enrolment. Immune-mediated diseases and dementia cases were ascertained according to the International Classification of Diseases codes. Time-varying Cox proportional hazards regression and general linear regression models were used to examine the association of immune-mediated disease with incident dementia risk and brain morphometric measures, respectively.<div class="boxTitle">Results</div>Over a median follow-up of 12.3 years, 1654 cases of incident dementia were documented in 86 243 patients with immune-mediated diseases. Overall, immune-mediated diseases were associated with a higher all-cause dementia risk (hazard ratio [HR], 1.24; 95% confidence interval, 1.17–1.32). Five out of 27 immune-mediated diseases were associated with an increased risk of dementia individually. Comorbidity of multiple immune-mediated diseases further increased the risk. Moreover, the immune-mediated disease was associated with smaller total surface areas of both left (β, −286.51; SE, 102.58; <span style="font-style:italic;">P</span> = .014) and right hemispheres (β, −298.56; SE, 103.96; <span style="font-style:italic;">P</span> = .016), greater white matter hyperintensities volume (β, 1.02; SE, 0.13; <span style="font-style:italic;">P</span> < .001) and less healthy white matter microstructures.<div class="boxTitle">Conclusions</div>Immune-mediated diseases were associated with an increased risk of incident dementia, and the association of those diseases with brain structural abnormalities might provide clues to the underlying mechanisms.</span>
<span class="paragraphSection">This is a correction to: Anne Hendry, Realising the right to rehabilitation—commentary on ‘reablement, rehabilitation, recovery: everyone’s business’, Age and Ageing, Volume 53, Issue 10, October 2024, afae228, <a href="https://doi.org/10.1093/ageing/afae228">https://doi.org/10.1093/ageing/afae228</a></span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Hearing loss (HL) and visual loss (VL) are recently identified as promising dementia risk factors, but long-term studies with adequate control of other modifiable dementia risk factors are lacking. This 25-year follow-up study investigated the association between objectively measured HL and VL with cognitive decline and incident dementia.<div class="boxTitle">Methods</div>1823 participants (age 24–82 years) of the Maastricht Aging Study were assessed at baseline, 6, 12 and 25 years. Baseline HL was defined as pure-tone hearing loss ≥20 dB at frequencies of 1, 2 and 4 kHz and VL as binocular, corrected visual acuity <0.5. Associations with cognitive decline (verbal memory, information processing speed, executive function) and incident dementia were tested using linear mixed models and Cox proportional hazard models, respectively. Analyses were adjusted for demographics and 11 modifiable dementia risk factors (LIfestyle for BRAin health index).<div class="boxTitle">Results</div>Participants with HL (<span style="font-style:italic;">n</span> = 520, 28.7%) showed faster decline in all cognitive domains than participants without HL. No consistent association was found for VL (<span style="font-style:italic;">n</span> = 58, 3.2%), but below-average visual acuity (<1) showed significant associations with information processing speed and executive function. No significant associations with dementia risk were found. Findings were independent of demographics and modifiable dementia risk factors.<div class="boxTitle">Conclusions</div>HL predicts faster cognitive decline but not dementia risk in adults aged 24–82 years. VL shows no consistent associations, though below-average visual acuity is linked to faster cognitive decline. This study supports HL as an independent risk factor for cognitive decline. Future studies should further evaluate the roles of HL and VL in dementia risk reduction.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Adverse early-life events influence the health with ageing throughout the life course. However, the effects of combined early-life risks on ageing acceleration in adults and the roles of social environment risks remain unknown.<div class="boxTitle">Objective</div>To investigate associations of maternal smoking, breastfeeding and birth weight with accelerated biological age (BA), and to explore genetic-predicted effect and mediating effect of social environment risks.<div class="boxTitle">Design</div>Population-based prospective cohort.<div class="boxTitle">Setting</div>UK Biobank.<div class="boxTitle">Subjects</div>151 773 participants.<div class="boxTitle">Methods</div>We used Klemera–Doubal BA (KDM-BA), PhenoAge and leukocyte telomere length (LTL) as BA biomarkers. Associations of early-life risk factors and score with BA acceleration were estimated using linear regression models. Genetic risk score (GRS) was calculated based on genetic variations for maternal smoking and birth weight. Polysocial risk scores (PsRS) for each BA were calculated by summing the number of dichotomised social environment factors significantly associated with each of the three BA biomarkers.<div class="boxTitle">Results</div>Maternal smoking, non-breastfeeding and low birth weight were individually associated with BA acceleration. The early-life risk score was significantly associated with accelerated KDM-BA and PhenoAge and shorter LTL. The effects of GRS on accelerated BA were in the same direction. The BA-specific PsRS mediated the accelerated KDM-BA and PhenoAge and shorter LTL by 8.37%, 22.34% and 7.90%, respectively.<div class="boxTitle">Conclusions</div>Our findings demonstrated a dose-dependent association of combined early-life risks with accelerated BA in middle-aged and older adults, partially mediated by social environment risks. The findings highlight the importance of early identification and surveillance of high-risk individuals for ageing acceleration during adulthood.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>Systematically review and critically appraise the evidence for the association between delirium and falls in community-dwelling adults aged ≥60 years.<div class="boxTitle">Methods</div>We searched EMBASE, MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and Evidence-Based Medicine Reviews databases in April 2023. Standard methods were used to screen, extract data, assess risk of bias (using Newcastle–Ottawa scale), provide a narrative synthesis and, where appropriate, conduct meta-analysis.<div class="boxTitle">Results</div>We included 8 studies, with at least 3505 unique participants. Five found limited evidence for an association between delirium and subsequent falls: one adjusted study showed an increase in falls (risk ratio 6.66; 95% confidence interval (CI) 2.16–20.53), but the evidence was low certainty. Four non-adjusted studies found no clear effect. Three studies (one with two subgroups treated separately) found some evidence for an association between falls and subsequent delirium: meta-analysis of three adjusted studies showed an increase in delirium (pooled odds ratio 2.01; 95% CI 1.52–2.66); one subgroup of non-adjusted data found no clear effect. Number of falls and fallers were reported in the studies. Four studies and one subgroup were at high risk of bias and one study had some concerns.<div class="boxTitle">Conclusions</div>We found limited evidence for the association between delirium and falls. More methodologically rigorous research is needed to understand the complex relationship and establish how and why this operates bidirectionally. Studies must consider confounding factors such as dementia, frailty and comorbidity in their design, to identify potential modifying factors involved. Clinicians should be aware of the potential relationship between these common presentations.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The impact of cardiometabolic multimorbidity (CMM) on functional dependency (FD) is well established, but the temporal effect of FD on CMM and its mechanisms remain underexplored.<div class="boxTitle">Design</div>A multicohort study pooled data from three international cohorts.<div class="boxTitle">Setting</div>Data were sourced from the Health and Retirement Study (USA), the China Health and Retirement Longitudinal Study (China) and the Survey of Health, Ageing and Retirement in 18 European countries.<div class="boxTitle">Methods</div>FD was defined as the inability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs) independently. CMM was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease and stroke. Generalised estimating equation models assessed associations between FD and CMM, with mediation analysis using the Karlson, Holm and Breen method to explore the effects of hypertension and depressive symptoms. Sensitivity analyses ensured robustness.<div class="boxTitle">Results</div>The final cohort included 157 512 and 190 249 individuals for ADL and IADL analyses, respectively. CMM prevalence was 18.97% and 16.65% in these groups. FD was consistently associated with higher CMM risk, with odds ratios ranging from 1.47 (95% confidence interval: 1.33–1.63) to 1.56 (1.42–1.73). Hypertension and depressive symptoms increased CMM risk, particularly at higher FD levels. Mediation analysis showed hypertension and depressive symptoms accounted for 8.01%–16.43% and 12.04%–18.36% of the adverse effect of FD on CMM, respectively, with more pronounced effects among smokers and heavy drinkers.<div class="boxTitle">Conclusions</div>Targeted interventions focusing on hypertension, mental wellness, lifestyle factors, and integrated treatments for FD are crucial to prevent CMM in older adults.</span>
<span class="paragraphSection">This is a correction to: Pippa Collins, Sarah Hopkins, Helen Milbourn, Simon N Etkind, Uncertainty and advance care planning in older adults living with frailty. A collection and commentary on the theme of advance care planning, <span style="font-style:italic;">Age and Ageing</span>, Volume 53, Issue 9, September 2024, afae146, <a href="https://doi.org/10.1093/ageing/afae146">https://doi.org/10.1093/ageing/afae146</a></span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The association between ultra-processed food (UPF) intake and markers of biological ageing has been scarcely investigated, despite the evident adverse health effects associated with UPF. This study aimed to test the association between UPF intake and biological ageing, and evaluate how much of this association is accounted for by overall diet quality.<div class="boxTitle">Methods</div>This cross-sectional study assessed 16 055 participants aged 20–79 years (51% women, 46 ± 0.3 years) from the National Health and Nutrition Examination Survey (NHANES) 2003–2010. Dietary UPF intake was assessed using the Nova system. Values were expressed as % of total energy intake and were denominated as a continuous variable and in quintiles. Diet quality was assessed with the American Heart Association 2020 and the Healthy Eating Index 2015. Biological ageing was assessed <strong>using the PhenoAge algorithm</strong>.<div class="boxTitle">Results</div>For each 10% of energy intake accounted for by UPF, participants were 0.21 (95%CI 0.16–0.26) years biologically older in terms of PhenoAge. As compared to participants in the lowest UPF quintile (≤39%), those in the highest UPF quintile (68–100%) were 0.86 (95% CI 0.55, 1.16) years older (P-for-trend across quintiles ≤0.001). Adherence to a healthy diet moderately attenuated the relationship between UPF and PhenoAge (adjusted <span style="font-style:italic;">β</span> = 0.14 per 10% increment of UPF).<div class="boxTitle">Conclusions</div>Adults with higher UPF tended to be biologically older. This association is partly independent of diet quality, suggesting that food processing may contribute to biological ageing acceleration. Our findings point to a compelling reason to target UPF consumption to promote healthier ageing.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle"> </div>Decline in the ability to perform activities of daily living (ADL) or ‘<span style="font-style:italic;">functional decline’</span> is a major health concern among aging populations. With intervention, ADL decline may be delayed, prevented or reversed. The capacity to anticipate the trajectory of future functional change can enhance care planning and improve outcome for residents.<div class="boxTitle">Methods</div>This is a 36 months’ retrospective longitudinal analysis of LTC residents in five Canadian provinces. Group-based trajectory modelling (GBTM) was performed to identify distinct trajectories and resident attributes associated with membership of the trajectory groups.<div class="boxTitle">Results</div>A total of 204 036 LTC residents were included in this study. Their admission mean age was 83.7 years (SD = 8.6), and 63.3% were females. Our model identified four distinct trajectories namely: ‘<strong>Catastrophic decline</strong>’ (<span style="font-style:italic;">n</span> = 48 441, 22.7%), ‘<strong>Rapid decline with some recovery</strong>’ (<span style="font-style:italic;">n</span> = 27 620, 18.7%), ‘<strong>Progressive decline</strong>’ trajectory (n = 30 287, 14.4%), and the ‘<strong>No/Minimal decline</strong>’ (<span style="font-style:italic;">n</span> = 97 688, 47.9%) Residents’ admission ADL Hierarchy score was the single, strongest predictor of functional decline trajectory that residents followed. Residents with ADLH 5–6 OR 0.03 (0.03–0.04) were least likely to follow a catastrophic decline trajectory, while those with ADLH 5–6 OR 39.05 (36/60–41.88) were most likely to follow a minimal or no decline trajectory.<div class="boxTitle">Conclusion</div>Results of this study further highlight the heterogeneity of health trajectory among residents in LTC setting, re-affirming the need for personalized care. The study shows who among residents would be most at risk for different levels of functional decline.The study findings provide useful information that would assist both immediate and advanced care planning as well as to forecast care personnel requirements into the future based on total acuity levels of residents.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Frailty—the loss of physiological reserve to withstand a stressor event—is associated with poorer outcomes following acute stroke reperfusion therapies. However, the mechanisms underlying this relationship are poorly understood. This study investigated the association between frailty and penumbral volumes in hyperacute ischemic stroke.<div class="boxTitle">Methods</div>Total ischemic lesion volumes (comprising infarct core and penumbral volumes) were measured using computed tomography (CT) perfusion imaging to give the penumbral fraction within the ischemic lesion. Pre-stroke frailty was measured using a validated frailty index. The relationship between frailty and penumbral fraction was adjusted for age, onset-to-CT interval, collateral scores, small vessel disease burden and vascular comorbidities. Stroke severity was measured using the National Institutes of Health Stroke Scale at baseline and after 24 h.<div class="boxTitle">Results</div>In 55 individuals receiving thrombolysis for ischemic stroke, increasing frailty was associated with a reduction in penumbral fraction (<span style="font-style:italic;">rs</span> = −0.36, <span style="font-style:italic;">P</span> < 0.01). This remained significant after adjustment for age, onset-to-imaging time and collateral score (beta = −1.16, <span style="font-style:italic;">P</span> < 0.001). Correspondingly, frailty was independently negatively associated with proportional improvement in stroke severity following treatment (beta = −2.00, <span style="font-style:italic;">P</span> < 0.01). C-reactive protein (CRP) on presentation was associated with frailty index (<span style="font-style:italic;">rs</span> = 0.38, <span style="font-style:italic;">P</span> < 0.01) and penumbral fraction (<span style="font-style:italic;">rs</span> = −0.30, <span style="font-style:italic;">P</span> = 0.02).<div class="boxTitle">Discussion</div>A reduction in salvageable penumbra in frailty may explain the treatment-attenuating effects of frailty on reperfusion therapies. The association with CRP motivates further research into a possible inflammatory component of this relationship.<div class="boxTitle">Conclusion</div>Frailty is independently associated with reduced penumbra and poorer neurological recovery in acute stroke. These findings may explain the attenuated response to stroke reperfusion therapies seen in frailer individuals.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Frailty, malnutrition and low socioeconomic status may mutually perpetuate each other in a self-reinforcing and interdependent manner. The intertwined nature of these factors may be overlooked when investigating impacts on perioperative outcomes. This study aimed to investigate the impact of frailty, malnutrition and socioeconomic status on perioperative outcomes.<div class="boxTitle">Methods</div>A multicentre cohort study involving six Australian tertiary hospitals was undertaken. All consecutive surgical patients who underwent an operation were included. Frailty was defined by the Hospital Frailty Risk Score, malnutrition by the Malnutrition Universal Screening Tool (MUST) and low socioeconomic status by the Index of Relative Socioeconomic Disadvantage. Linear mixed-effects and binary logistic generalised estimated equation models were performed for the outcomes: inpatient mortality, length of stay, 30-day readmission and re-operation.<div class="boxTitle">Results</div>A total of 21 976 patients were included. After controlling for confounders, malnutrition and socioeconomic status, patients at high risk of frailty have a mean hospital length of stay 3.46 times longer (mean ratio = 3.46; 95% confidence interval (CI): 3.20, 3.73; <span style="font-style:italic;">P</span> value < .001), odds of 30-day readmission 2.4 times higher (odds ratio = 2.40; 95% CI: 2.19, 2.63; <span style="font-style:italic;">P</span> value < .001) and odds of in-hospital mortality 12.89 times greater than patients with low risk of frailty (odds ratio = 12.89; 95% CI: 4.51, 36.69; <span style="font-style:italic;">P</span> value < .001). Elevated MUST scores were also significantly associated with worse outcomes, but to a lesser extent. Socioeconomic status had no association with outcomes.<div class="boxTitle">Conclusion</div>Perioperative risk evaluation should consider both frailty and malnutrition as separate, significant risk factors. Despite strong causal links with frailty and malnutrition, socioeconomic disadvantage is not associated with worse postoperative outcomes. Additional studies regarding the prospective identification of these patients with implementation of strategies to mitigate frailty and malnutrition and assessment of perioperative risk are required.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The clinical relevance of blood pressure variability (BPV) is still unknown, despite increasing evidence associating BPV to negative health outcomes (NHOs). There is currently no gold standard to define high BPV and normal reference values for BPV are lacking.<div class="boxTitle">Aim</div>The primary aim was to examine whether high BPV can predict NHO in adults aged ≥65. The predictive value of BPV was compared to mean BP (mBP) when both parameters were available.<div class="boxTitle">Methods</div>PubMed and Web of Science were systematically screened; 49 articles (12 retrospective, 18 prospective and 19 cross-sectional studies) were included and evaluated for methodological quality. Meta-analyses were conducted to examine the association of BPV (and mBP when available) with NHO.<div class="boxTitle">Results</div>Systolic BPV and systolic mBP seem to indicate at least comparable odds for cardiovascular disease (BPV: odds ratio (OR) = 1.33 (95% CI: 1.19–1.48, <span style="font-style:italic;">P</span> < .00001) vs mBP: OR = 1.06 (95% CI: 1.03–1.09, <span style="font-style:italic;">P</span> = .0002)) and cerebral deterioration (BPV: OR = 1.28 (95% CI: 1.17–1.41, <span style="font-style:italic;">P</span> < .00001) vs mBP: OR = 1.06 (95% CI: 1.04–1.09, <span style="font-style:italic;">P</span> < .00001)). Increased diastolic BPV was associated with higher odds of cerebral deterioration (OR = 1.18 (95% CI: 1.04–1.35), <span style="font-style:italic;">P</span> = .01).<div class="boxTitle">Conclusion</div>High systolic BPV and high systolic mBP are associated with 33% and 6% higher odds of cardiovascular disease in adults aged ≥65, respectively. High BPV is also related to an 18%–28% and 11% increased odds of cerebral deterioration and poor stroke recovery. An overview of cut-off values is provided for the most often reported BPV parameters in literature, which can be used as a guideline to identify elevated BPV in clinical practice.</span>
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