Adult attachment style and cortisol responses across the day in older adults.

The association between cortisol and adult attachment style, an important indicator of social relationships, has been relatively unexplored. Previous research has examined adult attachment and acute cortisol responses to stress in the laboratory, but less is known about cortisol levels in everyday life. The present study examined adult romantic attachment style and cortisol responses across the day. Salivary cortisol was collected at six time points during the course of the day in 1,807 healthy men and women from a subsample of the Whitehall II cohort. Significant associations were found between attachment on cortisol across the day and slope of cortisol decline. The lowest cortisol output was associated with fearful attachment, with preoccupied attachment having the highest levels and a flatter cortisol profile. The results tentatively support the proposition that attachment style may contribute to HPA dysregulation

Prevalence of Undiagnosed Diabetes in 2004 and 2012: Evidence From the English Longitudinal Study of Aging

BACKGROUND: In light of recent publicity campaigns to raise awareness of diabetes, we investigated changes in the prevalence of diabetes and undiagnosed diabetes in adults age 50 and older in England between 2004 and 2012, and explored risk factors for undiagnosed diabetes. METHOD: 7666 and 7729 individuals were from Wave 2 (2004-2005, mean age 66.6) and Wave 6 (2012-2013, mean age 67.6) of the English Longitudinal Study of Ageing. Diagnosed diabetes was defined as either self-reported diabetes or taking diabetic medications. Undiagnosed diabetes was defined as not self-reporting diabetes and not taking diabetic medications, but having a glycated haemoglobin measurement ≥ 48 mmol/mol (6.5%). RESULTS: There were increases in both diagnosed diabetes (7.7% to 11.5%) and undiagnosed diabetes (2.4% to 3.4%) between 2004 and 2012. However, a small decrease in the proportion of people with diabetes who were unaware of this condition (24.5% to 23.1%, p<0.05) was observed. Only men aged 50-74 showed a stable prevalence of undiagnosed diabetes, with better recognition of diabetes. Age, non-white ethnicity, manual social class, higher diastolic blood pressure and cholesterol level were factors associated with higher risks of undiagnosed diabetes, whereas greater depressive symptoms were related to lower risks. CONCLUSION: This study suggests that the greater awareness of diabetes in the population of England has not resulted in a decline in undiagnosed cases between 2004 and 2012. A greater focus on people from lower socioeconomic groups and those with cardiometabolic risk factors may help early diagnosis of diabetes for older adults

Polypharmacy difference between older people with and without diabetes: evidence from the English Longitudinal Study of Ageing

Aim: To study the association between diabetes and the prevalence of and risk factors for polypharmacy among adults aged 50 and older in England. / Methods: A cross-sectional study (2012−2013) of the English Longitudinal Study of Ageing. Polypharmacy was defined as taking 5-9 long-term medications a day and heightened polypharmacy as 10 or more. Diabetes included diagnosed and undiagnosed cases (glycated haemoglobin ≥ 6.5% (48 mmol/mol)). / Results: Of 7729 participants, 1100 people had diabetes and showed higher prevalence rates of polypharmacy (41.1% vs 14.8%) and heightened polypharmacy (5.8% vs 1.7%) than those without diabetes, even when antihyperglycemic medications were excluded. Risk factors for polypharmacy also differed according to diabetes status. Among people with diabetes, risk factors for polypharmacy and heightened polypharmacy were having more long-term conditions (relative risk ratio (RRR) =1.86; 3.51) and being obese (RRR=1.68; 3.68), while females were less likely to show polypharmacy (RRR=0.51) and heightened polypharmacy (RRR=0.51) than males. Older age (RRR=1.04) was only related to polypharmacy among people without diabetes. / Conclusions: Adults with diabetes had higher prevalence rates of polypharmacy and heightened polypharmacy than those without diabetes, regardless of including antihyperglycemic drugs. Early detection of polypharmacy among older people with diabetes needs to focus on co-morbidities and obesity

The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing.

BACKGROUND: Polypharmacy is common among older people and is associated with an increased mortality risk. However, little is known about whether the mortality risk is related to specific medications among older adults with polypharmacy. This study therefore aimed to investigate associations between high-risk medications and all-cause and cause-specific mortality among older adults with polypharmacy. METHODS: This study included 1356 older adults with polypharmacy (5+ long-term medications a day for conditions or symptoms) from Wave 6 (2012/2013) of the English Longitudinal Study of Ageing. First, using the agglomerative hierarchical clustering method, participants were grouped according to the use of 14 high-risk medication categories. Next, the relationship between the high-risk medication patterns and all-cause and cause-specific mortality (followed up to April 2018) was examined. All-cause mortality was assessed by Cox proportional hazards model and competing-risk regression was employed for cause-specific mortality. RESULTS: Five high-risk medication patterns-a renin-angiotensin-aldosterone system (RAAS) inhibitors cluster, a mental health drugs cluster, a central nervous system (CNS) drugs cluster, a RAAS inhibitors and antithrombotics cluster, and an antithrombotics cluster-were identified. The mental health drugs cluster showed increased risks of all-cause (HR = 1.55, 95%CI = 1.05, 2.28) and cardiovascular disease (CVD) (SHR = 2.11, 95%CI = 1.10, 4.05) mortality compared with the CNS drug cluster over 6 years, while others showed no differences in mortality. Among these patterns, the mental health drugs cluster showed the highest prevalence of antidepressants (64.1%), benzodiazepines (10.4%), antipsychotics (2.4%), antimanic agents (0.7%), opioids (33.2%), and muscle relaxants (21.5%). The findings suggested that older adults with polypharmacy who took mental health drugs (primarily antidepressants), opioids, and muscle relaxants were at higher risk of all-cause and CVD mortality, compared with those who did not take these types of medications. CONCLUSIONS: This study supports the inclusion of opioids in the current guidance on structured medication reviews, but it also suggests that older adults with polypharmacy who take psychotropic medications and muscle relaxants are prone to adverse outcomes and therefore may need more attention. The reinforcement of structured medication reviews would contribute to early intervention in medication use which may consequently reduce medication-related problems and bring clinical benefits to older adults with polypharmacy

Dose-response relationships between polypharmacy and all-cause and cause-specific mortality among older people

BACKGROUND: Although medicines are prescribed based on clinical guidelines and expected to benefit patients, both positive and negative health outcomes have been reported associated with polypharmacy. Mortality is the main outcome, and information on cause-specific mortality is scarce. Hence, we investigated the association between different levels of polypharmacy and all-cause and cause-specific mortality among older adults. METHODS: The English Longitudinal Study of Ageing is a nationally representative study of people aged 50+. From 2012/2013, 6295 individuals were followed up to April 2018 for all-cause and cause-specific mortality. Polypharmacy was defined as taking 5-9 long-term medications daily and heightened polypharmacy as 10+ medications. Cox proportional hazards regression and competing-risks regression were used to examine associations between polypharmacy and all-cause and cause-specific mortality, respectively. RESULTS: Over a 6-year follow-up period, both polypharmacy (19.3%) and heightened polypharmacy (2.4%) were related to all-cause mortality, with hazard ratios of 1.51 (95% CI 1.05-2.16) and 2.29 (95% CI 1.40-3.75) respectively, compared with no medications, independently of demographic factors, serious illnesses and long-term conditions, cognitive function and depression. Polypharmacy and heightened polypharmacy also showed 2.45 (95% CI 1.13-5.29) and 3.67 (95% CI 1.43-9.46) times higher risk of cardiovascular disease (CVD) deaths, respectively. Cancer mortality was only related to heightened polypharmacy. CONCLUSION: Structured medication reviews are currently advised for heightened polypharmacy, but our results suggest that greater attention to polypharmacy in general for older people may reduce adverse effects and improve older adults' health

Extreme wind return periods from tropical cyclones in Bangladesh: insights from a high-resolution convection-permitting numerical model

This is the final version. Available from Copernicus Publications via the DOI in this record.Data availability: The data used in this study are available at https://doi.org/10.5281/zenodo.3600201 (Steptoe et al., 2020) and released under CC-BY 4.0Code availability: Python, R and data analysis code, including the fitted GAM model, is available at https://doi.org/10.5281/zenodo.3953772 (Steptoe, 2020)We use high-resolution (4.4 km) numerical simulations of tropical cyclones to produce exceedance probability estimates for extreme wind (gust) speeds over Bangladesh. For the first time, we estimate equivalent return periods up to and including a 1-in-200 year event, in a spatially coherent manner over all of Bangladesh, by using generalised additive models. We show that some northern provinces, up to 200 km inland, may experience conditions equal to or exceeding a very severe cyclonic storm event (maximum wind speeds in ≥64 kn) with a likelihood equal to coastal regions less than 50 km inland. For the most severe super cyclonic storm events (≥120 kn), event exceedance probabilities of 1-in-100 to 1-in-200 events remain limited to the coastlines of southern provinces only. We demonstrate how the Bayesian interpretation of the generalised additive model can facilitate a transparent decision-making framework for tropical cyclone warnings.International Climate Initiative (IKI

Pre-surgical Caregiver Burden and Anxiety Are Associated with Post-Surgery Cortisol over the Day in Caregivers of Coronary Artery Bypass Graft Surgery Patients.

BACKGROUND: The relationship between pre-surgical distress and diurnal cortisol following surgery has not been investigated prospectively in caregivers of coronary artery bypass graft (CABG) patients before. We aimed to examine the relationship between pre-surgical anxiety and caregiver burden and diurnal cortisol measured 2 months after the surgery in the caregivers of CABG patients. METHOD: We used a sample of 103 caregivers of elective CABG patients that were assessed 28.86 days before and 60.94 days after patients' surgery. Anxiety and caregiver burden were assessed using the anxiety subscale of the Hospital Anxiety and Depression Scale and the Oberst Burden Scale respectively. Saliva samples were collected to measure cortisol area under the curve with respect to ground (AUCg) and diurnal cortisol slope. Anxiety and caregiver burden were entered into linear regression models simultaneously. RESULTS: While high levels of pre-surgical anxiety were positively associated with increased follow-up levels of AUCg (β = 0.30, p = 0.001), greater pre-surgery perceived burden score was associated with steeper cortisol slope (β = 0.27, p = 0.017) after controlling for a wide range of covariates. CONCLUSION: These outcomes support the utility of psychological interventions aimed to increase the awareness of caregiving tasks and demands in informal caregivers

CD4+CD25+ regulatory T cells control CD8+ T-cell effector differentiation by modulating IL-2 homeostasis

Humoral immunity develops in the spleen during blood-stage Plasmodium infection. This elicits parasite-specific IgM and IgG, which control parasites and protect against malaria. Studies in mice have elucidated cells and molecules driving humoral immunity to Plasmodium, including CD4(+) T cells, B cells, interleukin (IL)-21 and ICOS. IL-6, a cytokine readily detected in Plasmodium-infected mice and humans, is recognized in other systems as a driver of humoral immunity. Here, we examined the effect of infection-induced IL-6 on humoral immunity to Plasmodium. Using P.\ua0chabaudi chabaudi AS (PcAS) infection of wild-type and IL-6(-/-) mice, we found that IL-6 helped to control parasites during primary infection. IL-6 promoted early production of parasite-specific IgM but not IgG. Notably, splenic CD138(+) plasmablast development was more dependent on IL-6 than germinal centre (GC) B-cell differentiation. IL-6 also promoted ICOS expression by CD4(+) T cells, as well as their localization close to splenic B cells, but was\ua0not required for early Tfh-cell development. Finally, IL-6 promoted parasite control, IgM and IgG production, GC B-cell development and ICOS expression by Tfh cells in a second model, Py17XNL infection. IL-6 promotes CD4(+) T-cell activation and B-cell responses during blood-stage Plasmodium infection, which encourages parasite-specific antibody production

The role of loneliness in the association between chronic physical illness and depressive symptoms among older adults: A prospective cohort study

BACKGROUND: Chronic physical illness increases the risk of subsequent depressive symptoms, but we know little about the mechanisms underlying this association that interventions can target. We investigated whether loneliness might explain associations between chronic illness and subsequent depressive symptoms. METHODS: We used English Longitudinal Study of Ageing data, a prospective cohort of adults over 50. Our exposure was chronic illnesses (wave two) including arthritis, cancer, diabetes, cardiovascular disease, stroke, and chronic obstructive pulmonary disease. Loneliness scores were a mediator on the short University of California, Los Angeles Loneliness Scale at wave three. Depressive symptom scores (outcome) were measured using the Centre for Epidemiologic Studies Depression Scale (wave four). We examined associations of chronic physical illness with loneliness and depressive symptoms in univariable and multivariable regression models. RESULTS: Fully-adjusted models included 2436 participants with the depression outcome and 2052 participants with the loneliness outcome. Chronic physical illness was associated with 21 % (incident rate ratio = 1.21, 95%CI = 1.03–1.42) higher depression scores at follow-up. We found no evidence of an association between chronic physical illness and loneliness and therefore did not proceed to analyses of mediation. LIMITATIONS: More prevalent chronic illnesses could have driven our results, such as cardiovascular disease. CONCLUSIONS: Chronic physical illnesses increase the risk of depressive symptoms in older adults. However, we did not find any that chronic physical illnesses were associated with an increased risk of subsequent loneliness. Therefore, interventions targeting loneliness to reduce depression in older adults with chronic physical illness may be insufficient