Study protocol: a randomised controlled trial on the clinical effects of levothyroxine treatment for subclinical hypothyroidism in people aged 80 years and over

Background: Subclinical hypothyroidism is common in older people and its contribution to health and disease needs to be elucidated further. Observational and clinical trial data on the clinical effects of subclinical hypothyroidism in persons aged 80 years and over is inconclusive, with some studies suggesting harm and some suggesting benefits, translating into equipoise whether levothyroxine therapy provides clinical benefits. This manuscript describes the study protocol for the Institute for Evidence-Based Medicine in Old Age (IEMO) 80-plus thyroid trial to generate the necessary evidence base. Methods: The IEMO 80-plus thyroid trial was explicitly designed as an ancillary experiment to the Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism randomised placebo controlled Trial (TRUST) with a near identical protocol and shared research infrastructure. Outcomes will be presented separately for the IEMO and TRUST 80-plus groups, as well as a pre-planned combined analysis of the 145 participants included in the IEMO trial and the 146 participants from the TRUST thyroid trial aged 80 years and over. The IEMO 80-plus thyroid trial is a multi-centre randomised double-blind placebo-controlled parallel group trial of levothyroxine treatment in community-dwelling participants aged 80 years and over with persistent subclinical hypothyroidism (TSH ≥4.6 and ≤ 19.9 mU/L and fT4 within laboratory reference ranges). Participants are randomised to levothyroxine 25 or 50 micrograms daily or matching placebo with dose titrations according to TSH levels, for a minimum follow-up of one and a maximum of three years. Primary study endpoints: hypothyroid physical symptoms and tiredness on the thyroid-related quality of life patient-reported outcome (ThyPRO) at one year. Secondary endpoints: generic quality of life, executive cognitive function, handgrip strength, functional ability, blood pressure, weight, body mass index, and mortality. Adverse events will be recorded with specific interest on cardiovascular endpoints such as atrial fibrillation and heart failure. Discussion: The combined analysis of participants in the IEMO 80-plus thyroid trial with the participants aged over 80 in the TRUST trial will provide the largest experimental evidence base on multimodal effects of levothyroxine treatment in 80-plus persons to date

Patient-centred ambulatory healthcare for people aged 80 and over

People aged 80 and over are the fastest-growing age group in most industrialised countries. On average, this life phase is characterised by a significantly higher burden of morbidity, limitations in daily activities, medical and dental treatment needs and phenomena such as multimorbidity and frailty. However, individual ageing and health trajectories are highly heterogenous. This challenges current healthcare systems that are still primarily organised around acute care occasions. Ambulatory healthcare is in particular demand as the sector closest to people’s lives and the guarantor to enable ageing in place. By now, ambulatory healthcare providers already face considerable work burdens and are the first to encounter the challenges of this demographic change, especially due to lacking adaptations on the health system level. So far, care models for the improvement of ambulatory healthcare for older people have mainly been developed without their participation. These models primarily focused on structural elements such as coordination to manage the complexity of conditions, with mixed results. A more recent approach to redesigning healthcare is the concept of patient-centred care, which puts the patients with their individual goals, expectations and living realities at the centre of healthcare design. Patient-centred care has gained widespread recognition and can now be considered an overall goal for healthcare. However, few studies have systematically incorporated older people’s views to design patient-centred care. In particular, the group of the oldest old, aged 80 and over, were seldom of interest, despite their rapid growth and special healthcare needs. Moreover, the topic of their oral health and healthcare was rarely included in researching health services. Additionally, the investigation of the perspectives of their healthcare providers is needed to understand the practical reality and to advance the support of an appropriate health workforce for an ageing population. Consequently, this dissertation aimed at investigating what matters in developing patientcentred ambulatory healthcare for people aged 80 and over. Three dissertation projects (DPs) were conducted to examine the views of community-dwelling people aged 80 and over and their healthcare providers regarding ambulatory healthcare comprehensively as well as indepth. In DP1, a systematic review of qualitative studies on the views and experiences of people aged 80 and over regarding ambulatory healthcare was conducted. A meta-synthesis of the 22 included primary studies resulted in the development of three core motives that older people have regarding healthcare: feeling safe, feeling like a meaningful human being, and maintaining control and independence. Parallel to that, a meta-summary of the same set of studies was conducted, resulting in 23 specific desirable features of ambulatory healthcare that were systematically appraised on their confidence in the evidence using the tool GRADE CERQual. In DP2, the findings from DP1 were used to further investigate desirable features of ambulatory healthcare from the perspective of community-dwelling people aged 80 and over in Cologne, Germany. In qualitative interviews using a semi-structured interview guide, 22 participants were asked about their perspectives on general ambulatory healthcare and oral healthcare. The interview transcripts were analysed thematically and resulted in a framework of 16 characteristics of good healthcare for the very old, incorporating oral healthcare equally. The study also revealed that older people particularly value and wish for trustful care relationships, that they are rarely aware of their oral health matters, and that they frequently encounter negative stereotypes of older age in the context of healthcare. In DP3, physicians and dentists providing ambulatory healthcare in the state of North-Rhine Westphalia, Germany, were researched. Using a qualitative survey design in the mode of online data collection, they were asked about their perceptions and views on their routine work and interactions with patients aged 80 and over. The results from 77 cases analysed with the approach of structuring qualitative content analysis showed that the healthcare providers found working with the very old particularly challenging due to their medical complexity and nonmedical demands, such as psychosocial matters. The results from all three DPs were taken together to describe and explain what is relevant in the design of patient-centred ambulatory healthcare for the very old. Apart from features of such healthcare, the dissertation discusses the broader implications in referring to the understanding of health, ageing and the role of healthcare, the further development of patientcentred care and the building of a healthcare workforce for the ageing population

Thrombolysis in Patients Aged over 80 Years Is Equally Effective and Safe

BACKGROUND: Despite stroke's high prevalence in the elderly, intravenous thrombolysis is licensed in Europe only for patients younger than 80 years old. We aimed to compare the functional outcomes and complication rates in patients older versus younger than 80 years old treated with intravenous thrombolysis. METHODS: A retrospective observational study of patients who received intravenous thrombolysis in a stroke unit between January 1, 2009, and June 30, 2012, was conducted. Variables were compared between 2 subgroups (≤80 and >80 years). RESULTS: Overall, 512 patients underwent intravenous thrombolysis, of which 13.1% were over 80 years. The mean age was 65.4 years in the younger subgroup and 82.9 years in the older subgroup. Prior independence rates did not differ between the subgroups. Prevalence of atrial fibrillation and cardioembolic stroke was higher in the older subgroup (P = .004 and .026). Only 3% of the elderly with atrial fibrillation were taking oral anticoagulants. Symptoms-to-needle time was lower in the older subgroup (P = .048). Stroke severity was higher in patients over 80 years (P = .026). There was significant improvement in the National Institutes of Health Stroke Scale score 7 days after intravenous thrombolysis (P < .001) in both subgroups. The proportion of patients with 3 months' favorable outcome and independence, hemorrhagic transformation, and mortality rates were similar in both subgroups. CONCLUSIONS: Elderly patients' benefits and outcomes from intravenous thrombolysis treatment were identical to the younger subgroup without excess hemorrhagic transformation or mortality. These results favor the use of intravenous thrombolysis in patients over 80 years.info:eu-repo/semantics/publishedVersio

Stress corrosion cracking in Al-Zn-Mg-Cu aluminum alloys in saline environments

Copyright 2013 ASM International. This paper was published in Metallurgical and Materials Transactions A, 44A(3), 1230 - 1253, and is made available as an electronic reprint with the permission of ASM International. One print or electronic copy may be made for personal use only. Systematic or multiple reproduction, distribution to multiple locations via electronic or other means, duplications of any material in this paper for a fee or for commercial purposes, or modification of the content of this paper are prohibited.Stress corrosion cracking of Al-Zn-Mg-Cu (AA7xxx) aluminum alloys exposed to saline environments at temperatures ranging from 293 K to 353 K (20 °C to 80 °C) has been reviewed with particular attention to the influences of alloy composition and temper, and bulk and local environmental conditions. Stress corrosion crack (SCC) growth rates at room temperature for peak- and over-aged tempers in saline environments are minimized for Al-Zn-Mg-Cu alloys containing less than ~8 wt pct Zn when Zn/Mg ratios are ranging from 2 to 3, excess magnesium levels are less than 1 wt pct, and copper content is either less than ~0.2 wt pct or ranging from 1.3 to 2 wt pct. A minimum chloride ion concentration of ~0.01 M is required for crack growth rates to exceed those in distilled water, which insures that the local solution pH in crack-tip regions can be maintained at less than 4. Crack growth rates in saline solution without other additions gradually increase with bulk chloride ion concentrations up to around 0.6 M NaCl, whereas in solutions with sufficiently low dichromate (or chromate), inhibitor additions are insensitive to the bulk chloride concentration and are typically at least double those observed without the additions. DCB specimens, fatigue pre-cracked in air before immersion in a saline environment, show an initial period with no detectible crack growth, followed by crack growth at the distilled water rate, and then transition to a higher crack growth rate typical of region 2 crack growth in the saline environment. Time spent in each stage depends on the type of pre-crack (“pop-in” vs fatigue), applied stress intensity factor, alloy chemistry, bulk environment, and, if applied, the external polarization. Apparent activation energies (E a) for SCC growth in Al-Zn-Mg-Cu alloys exposed to 0.6 M NaCl over the temperatures ranging from 293 K to 353 K (20 °C to 80 °C) for under-, peak-, and over-aged low-copper-containing alloys (~0.8 wt pct), they are typically ranging from 20 to 40 kJ/mol for under- and peak-aged alloys, and based on limited data, around 85 kJ/mol for over-aged tempers. This means that crack propagation in saline environments is most likely to occur by a hydrogen-related process for low-copper-containing Al-Zn-Mg-Cu alloys in under-, peak- and over-aged tempers, and for high-copper alloys in under- and peak-aged tempers. For over-aged high-copper-containing alloys, cracking is most probably under anodic dissolution control. Future stress corrosion studies should focus on understanding the factors that control crack initiation, and insuring that the next generation of higher performance Al-Zn-Mg-Cu alloys has similar longer crack initiation times and crack propagation rates to those of the incumbent alloys in an over-aged condition where crack rates are less than 1 mm/month at a high stress intensity factor

PENGARUH WAKTU PENGENALAN PERTAMA SUSU FORMULA TERHADAP KEJADIAN GIZI LEBIH PADA BAYI USIA 11 - 12 BULAN

Pengenalan susu formula kepada bayi merupakan masalah yang saat ini mulai banyak timbul di Indonesia. Memberikan susu formula kepada bayi dianggap lebih bergengsi dan lebih praktis dari pada memberikan ASI kepada bayi. Kandungan zat gizi susu formula dan pola pemberian yang salah mengakibatkan bayi yang mengenal susu formula menderitan gizi lebih. Penelitian ini bertujuan untuk menganalisis pengaruh waktu pengenalan susu formula terhadap gizi lebih saat bayi berusia 12 bulan. Jenis penelitian ini adalah penelitian deskriptif retrospektif, yaitu menggambarkan pengaruh antara variabel yang ditetapkan dan menguji hipotesa yang dirumuskan. Metode penelitian yang digunakan adalah metode survei dengan pendekatan studi belah lintang (cross sectional). Jumlah sampel yang digunakan adalah sebanyak 80 bayi berusia 11 - 12 bulan. Pengujian statistik menggunakan regresi logistik untuk mengetahui kekuatan pengaruh variabel yang diteliti. Hasil penelitian menunjukkan ada pengaruh antara waktu pengenalan pertama susu formula terhadap kejadian gizi lebih saat bayi usia 11 - 12 bulan dengan p < 0,05. Keterbatasan penelitian ini adalah kontrol yang tidak mencukupi sehingga tidak dapat diketahui secara pasti apakah adanya obesitas semata-mata disebabkan karena susu formula atau faktor lain. Oleh sebab itu disarankan bagi peneliti lain supaya menggunakan kontrol untuk penelitian sejenis. Kata Kunci: Waktu pengenalan pertama, Susu formula, Gizi lebih, Bayi usia 11 - 12 bulan THE EFFECT OF INITIATING FORMULATED MILK TO OVER WEIGHT ON 11TH - 12ND-MONTH-AGED INFANT) Problems began to arise in Indonesia at present when people introduce formulated milk to infant. They considered that feeding the infant with that kind of milk was more prestigious and more practical that breast-feeding. Nutrition contents in the formulated milk may cause infant to suffer from over weight earlier. The aim of the study was to analyze the effect of initiating formulated milk to over weight on 11th - 12nd-month-aged infant. The type of the study was retrospected descriptive: illustrating effects among fixed variables and to testing the hypothesis formulated. The method used was a survey on cross sectional design. The amount of samples was 80 of 11th - 12nd-month-aged infants. Checking statistic was log regression to reveal the strength of studied variable effects. The results showed that there were effects in initiating formulated milk to over weight on 11th - 12nd-month-aged infant with p < 0,05. The lack of the study was that there was no control whether the only cause of over weight the formulated milk or other factors altogether. We cannot precisely reveal it. So it i adviseable that the other researchers may add control on the study of the same type anyway. Keyword: Initiating, Formulated Milk, Over veight, 11th - 12nd-month-aged infan

A comparison of measured height and demi-span equivalent height in the assessment of body mass index among people aged 65 years and over in England

Objectives: to examine differences between measured height and demi-span equivalent height (DEH) among people aged >= 65 and investigate the impact on body mass index (BMI) of using DEH.Design and Setting: nationally representative cross-sectional sample of adults living in England.Participants: 3,346 non-institutionalised adults aged >= 65, taking part in the Health Survey for England (HSE) 2001.Measurements: height, weight and demi-span measurements were taken according to standardised HSE protocols. DEH was calculated using Basseys equation.Results: the height measurement was lower than the DEH from age group 70-74 years onwards in men and in each age group in women. No significant differences in mean DEH and measured height were found for men (0.46) or women (2.64). BMI derived from measured height did not differ significantly from BMI derived from DEH. The prevalence of underweight was lower when using measured height than when using DEH in women aged >= 65, particularly in those aged 80 years and over. The prevalence of overweight and obesity was higher using measured height than DEH in women aged >= 65.Conclusion: we confirmed in a large nationally representative sample that demi-span measurement may be a useful estimate of stature in people (particularly women) aged >= 65 for BMI calculations

Factors predicting a successful post-discharge outcome for individuals aged 80 years and over

<p><strong>Introduction and background</strong>: The early post-discharge period is a vulnerable time for older patients with complex care requirements. This paper identifies factors predicting a self-reported successful post-discharge outcome for patients aged 80 and over by exploring factors related to the discharge process, the provision of formal home-care services, informal care and characteristics of the patients.</p><p><strong>Methods:</strong> The study reports results from survey interviews with patients admitted from home to 14 hospitals in Norway and later discharged home. Logistic regression analysis was performed to assess the impact of a number of factors on the likelihood that the patients would report that they managed well after discharge.</p><p><strong>Results:</strong> The odds of managing well after discharge were more than four times higher (OR=4.75, p= .022) for patients reporting that someone was present at homecoming than for those who came home to an empty house. Patients who reported receiving adequate help from the municipality had an odds four times (OR 4.18, p= .006) higher of reporting that everything went well after discharge than those who stated the help was inadequate.</p><p><strong>Conclusions:</strong> Having someone at home upon return from hospital and having adequate formal home-care services are significantly associated with patient-reported success in managing well.</p

Age and Prostate-Specific Antigen Level Prior to Diagnosis Predict Risk of Death from Prostate Cancer.

A single early prostate-specific antigen (PSA) level has been correlated with a higher likelihood of prostate cancer diagnosis and death in younger men. PSA testing in older men has been considered of limited utility. We evaluated prostate cancer death in relation to age and PSA level immediately prior to prostate cancer diagnosis. Using the Veterans Affairs database, we identified 230,081 men aged 50-89 years diagnosed with prostate cancer and at least one prior PSA test between 1999 and 2009. Prostate cancer-specific death over time was calculated for patients stratified by age group (e.g., 50-59 years, through 80-89 years) and PSA range at diagnosis (10 ranges) using Kaplan-Meier methods. Risk of 10-year prostate cancer mortality across age and PSA was compared using log-rank tests with a Bonferroni adjustment for multiple testing. 10.5% of men diagnosed with prostate cancer died of cancer during the 10-year study period (mean follow-up = 3.7 years). Higher PSA values prior to diagnosis predict a higher risk of death in all age groups (p &lt; 0.0001). Within the same PSA range, older age groups are at increased risk for death from prostate cancer (p &lt; 0.0001). For PSA of 7-10 ng/mL, cancer-specific death, 10 years after diagnosis, increased from 7% for age 50-59 years to 51% for age 80-89 years. Men older than 70 years are more likely to die of prostate cancer at any PSA level than younger men, suggesting prostate cancer remains a significant problem among older men (even those aged 80+) and deserves additional study

Indigenous child safety

Indigenous children are over represented in areas where child safety and security are compromised, argues this report. Summary National data show that Aboriginal and Torres Strait Islander children are over-represented in various aspects of child safety compared with their non-Indigenous counterparts. In particular, Indigenous children have higher rates of hospitalisations and deaths due to injury, and more frequently come into contact with child protection and youth justice systems. Indigenous children have higher hospitalisation and mortality rates for injury The rate of injury hospitalisations among Indigenous children aged 0-17 was 1.3 times that for non-Indigenous children between July 2010 and June 2012. The most common cause of these hospitalisations were accidental falls, followed by transport accidents and assault. The hospitalisation rate for assault for Indigenous children was more than 5 times the rate for non-Indigenous children. In 2007-2011, more than one-quarter (26%) of all deaths among Indigenous children aged 0-17 were due to external causes of injury. The death rate due to external causes of injury for Indigenous children was more than twice the rate for non-Indigenous children (80 deaths per 100,000 children compared with 34 per 100,000). They are more likely to be victims of child abuse, neglect and sexual assault During 2011-12, Indigenous children aged 0-17 were nearly 8 times as likely as non-Indigenous children to be the subject of substantiated child abuse or neglect (42 per 1,000 children compared with 5 per 1,000). In 2012, rates of sexual assault reported to police among Indigenous children aged 0-9 in New South Wales, Queensland, South Australia and the Northern Territory were 2 to 4 times higher than rates among non-Indigenous children in these jurisdictions. They are over-represented among specialist homelessness services clients and in the youth justice system In 2012-13, almost 1 in 3 (31%) children aged 0-17 who received assistance from a specialist homelessness agency was Indigenous; by comparison, Indigenous children comprise 5.5% of the total Australian child population. On an average day in 2012-13, 39% of all males and 45% of all females aged 10-17 under youth justice supervision were Indigenous. Over-representation was highest in younger age groups; of all children aged 10-13 under supervision, 61% were Indigenous. Indigenous young people aged 10-17 were 17 times as likely to be under youth justice supervision as non-Indigenous young people. This over-representation was even higher for those in detention-Indigenous young people were 28 times as likely to be detained as non-Indigenous young people. However, their rate of youth justice supervision has fallen over time In 2012-13, Indigenous young people aged 10-17 were supervised at a rate of 225 per 10,000, down from 233 per 10,000 in 2008-09