A multistate model of health transitions in older people: a secondary analysis of ASPREE clinical trial data

Background: Understanding the nature of transitions from a healthy state to chronic diseases and death is important for planning health-care system requirements and interventions. We aimed to quantify the trajectories of disease and disability in a population of healthy older people. Methods: We conducted a secondary analysis of data from the ASPREE trial, which was done in 50 sites in Australia and the USA and recruited community-dwelling, healthy individuals who were aged 70 years or older (≥65 years for Black and Hispanic people in the USA) between March 10, 2010, and Dec 24, 2014. Participants were followed up with annual face-to-face visits, biennial assessments of cognitive function, and biannual visits for physical function until death or June 12, 2017, whichever occurred first. We used multistate models to examine transitions from a healthy state to first intermediate disease events (ie, cancer events, stroke events, cardiac events, and physical disability or dementia) and, ultimately, to death. We also examined the effects of age and sex on transition rates using Cox proportional hazards regression models. Findings: 19 114 participants with a median age of 74·0 years (IQR 71·6–77·7) were included in our analyses. During a median follow-up of 4·7 years (IQR 3·6–5·7), 1933 (10·1%) of 19 114 participants had an incident cancer event, 487 (2·5%) had an incident cardiac event, 398 (2·1%) had an incident stroke event, 924 (4·8%) developed persistent physical disability or dementia, and 1052 (5·5%) died. 15 398 (80·6%) individuals did not have any of these events during follow-up. The highest proportion of deaths followed incident cancer (501 [47·6%] of 1052) and 129 (12·3%) participants transitioned from disability or dementia to death. Among 12 postulated transitions, transitions from the intermediate states to death had much higher rates than transitions from a healthy state to death. The progression rates to death were 158 events per 1000 person-years (95% CI 144–172) from cancer, 112 events per 1000 person-years (86–145) from stroke, 88 events per 1000 person-years (68–111) from cardiac disease, 69 events per 1000 person-years (58–82) from disability or dementia, and four events per 1000 person-years (4–5) from a healthy state. Age was significantly associated with an accelerated rate for most transitions. Male sex (vs female sex) was significantly associated with an accelerate rate for five of 12 transitions. Interpretation: We describe a multistate model in a healthy older population in whom the most common transition was from a healthy state to cancer. Our findings provide unique insights into the frequency of events, their transition rates, and the impact of age and sex. These results have implications for preventive health interventions and planning for appropriate levels of residential care in healthy ageing populations. Funding: The National Institutes of Health

Perspectives of Portuguese People with Physical Disabilities Regarding Their Sexual Health: A Focus Group Study

The World Health Organization has considered sexual health as a major dimension of global health and a sexual right. However, the sexual health of people with physical disabilities is still poorly addressed by health and social care professionals, and it is very stigmatized by society. This study aimed to assess the perspectives of Portuguese people living with physical disabilities regarding issues affecting their sexual health. Nine women and 17 men with different physical disabilities participated in the study. Participants were recruited from a professional rehabilitation facility located in the North of Portugal and were assigned to four groups in one-hour sessions. Three main categories emerged from the content analysis: (1) meanings and beliefs regarding sexuality; (2) experiences of sexuality; (3) necessary changes. Despite the positive social changes towards sexuality, participants expressed that their sexual rights are still unfulfilled, as they live in a context that perpetuates their dependency. They pointed out low self-esteem, prejudice and social isolation, poor architectural accessibility and scarcity of financial support as some of the barriers to their lives and their sexual health. Finally, participants identified the main needs regarding their sexual health, such as: access to specialized information; training for health professionals. This study gives voice to people with physical disabilities and sheds light into both individual and contextual factors affecting their sexual health. Of utmost importance, this study draws attention to the need for reinforcing sexuality of people with disabilities in the social agenda and brings implications for future research and practice.This study was supported by a Grant attributed to the first author by the Portuguese Foundation for Science and Technology (SFRH/BD/112168/2015)info:eu-repo/semantics/publishedVersio

An Experimental and Mechanical Study of a Two-Layer, Bioinspired Seismic Isolator for Multistory Buildings

This work illustrates a novel two-layer version of the sliding–stretching isolator recently proposed in the literature to protect buildings and infrastructure from seismic waves. Such a device has a biomimetic character and is formed by rigid members mimicking the role played by human arms and legs when walking or running, and deformable membranes referred to as tendons. It tunes the elongation and contraction of the tendons to recenter the system and to safely avoid resonance of the system with earthquake frequencies. The paper illustrates how is possible to generalize the mechanical model of the one-layer isolator (SSI1) formulated in previous studies to account for the presence of the second layer (SSI2 system). The two-layer device doubles the lateral displacement capacity of the system, while keeping the footprint of the device fixed. Shake-table tests on reduced-scaled SSI2 prototypes are employed to derive the constitutive parameters of the proposed mechanical model and to experimentally validate it. The given results demonstrate that SSI2 systems pave the way to real-life applications of sliding–stretching isolators in multistory buildings

Physicochemical characterization of eighteen peach cultivars grown in the Mid-Adriatic area

Peach is the species with the highest number of new cultivars licensed on the market. The genetic improvement of peach is focusing on multiple productive and quality aspects, even if the very high availability of cultivars with very different characteristics tends to confuse the producer when choosing a cultivar for a new orchard. The purpose of this study is to evaluate the varietal collection present in a farm located in the Mid-Adriatic area, in the Marche region (Italy), in order to explore at least in part, the variability of the peach market in this area and to investigate which cultivar presents fruits with the most interesting characteristics. The trial was carried out in 2020 year, and a total of 18 cultivars were involved (comprising both peaches and nectarines). To evaluate the fruit quality, the main physicochemical parameters (overcolor, caliber, firmness, soluble solids and titratable acidity content) were considered. The obtained results indicated that there is a great variability within the collection for the tested parameters, but some traits seems to be in some way related, as early ripening cultivars are usually associated with higher overcolor percentage, while some other cultivars stand out for the high fruit weight and sugar/acid ratio (‘Lady Erica’ and ‘Gea’) or for low sugar/acid ratio (‘Extreme Late’ and ‘Orion’). In conclusion, it is clear that both the consumers and the growers have a great possibility of choice among the available cultivars

Design and modeling of an in-house-built shake table setup for testing prototypes of innovative seismic isolators

This work formulates procedures and methods for the design, assembling, mechanical modeling, and experimental validation of a shake-table setup that has been in-house–built at the Laboratory of Structural Engineering of the University of Salerno. The analyzed shake table permits the experimental characterization of small- and medium-scale prototypes of seismic protection devices as well as the execution of experimental studies on mock-ups of earthquake-proof structures. The main features of this setup are the possibility of applying large lateral displacements histories of various shapes; the application of considerably high vertical loads; and the achievement of high peak velocities of the horizontal motion. Based on such targets, the design strategy presented in this work follows a different path compared with other desktop shake tables available on the market. The latter is most often scaled and built on requirements typical of conventional shake table modes (high accelerations, very low vertical loads, control in acceleration/velocity/displacements, etc.). The paper diffusely presents the approach followed by the development team at the University of Salerno - which may be of interest to research laboratories worldwide wishing to build similar setups - and explores the engineering potential of novel seismic protection devices. An experimental characterization test of a bioinspired seismic isolator that recently appeared in the literature is presented