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Bhardwaj K, Sharma A, Kumar R, Tyagi V, Kumar R. Improving Oral Bioavailability of Herbal Drugs: A Focused Review of Self-Emulsifying Drug Delivery System for Colon Cancer. Curr Drug Deliv 2024; 21:389-402. [PMID: 37151062 DOI: 10.2174/1567201820666230505113108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/19/2023] [Accepted: 03/24/2023] [Indexed: 05/09/2023]
Abstract
One of the most frequent malignancies in the world is colon cancer. Both men and women are affected in the same way. The colon, which makes up the last part of the digestive system and is where water and minerals from food waste are absorbed, is vulnerable to cancer. The most suitable technique of drug administration is oral administration. Aqueous solubility is low in more than 40% of novel chemical entities, resulting in poor oral drug administration. In the formulation of oral medications, low inconsistent bioavailability is a major challenge. Increasing medication bioavailability is one of the most difficult aspects of pharmacological development. Self-nano-emulsifying drug delivery systems (SNEDDS) have been a potential platform for biopharmaceutical classification system class II and IV drugs for oral delivery. Enhanced bioavailability and solubility, control of toxicity, pharmacological effects, improved stability, improved tissue macrophage dispersion, prolonged delivery, and resistance to physical and chemical degradation are just a few benefits of SNEDDS for herbal drugs. To increase activity and address problems associated with herbal drugs, nanosized modern drug delivery technologies are expected to have a promising future. Improved patient compliance, fewer problems with liquid SNEDDS filled in capsules, and enhanced stability SNEDDS are all benefits of converting liquid SNEDDS to solid oral dosage forms or solid SNEDDS. SNEDDS differs from previous solubility augmentation methods due to its biodegradable components, simplicity of large-scale production, and range of drug-targeting possibilities.
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Affiliation(s)
- Khushboo Bhardwaj
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144402, India
| | - Arun Sharma
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144402, India
| | - Rajan Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144402, India
| | - Varnit Tyagi
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144402, India
| | - Rajesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144402, India
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Stout RL, Rigatti SJ. Prevalence of Antibodies to COVID-19 Due to Infection or Vaccination in US Adults. J Insur Med 2023; 50:49-53. [PMID: 37725500 DOI: 10.17849/insm-50-1-49-53.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/06/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE -Determine the seroprevalence of SARS-CoV-2 infection and vaccination in a population applying for life insurance. SETTING -This is a cross-sectional study of 2584 US life insurance applicants, to determine the seroprevalence of antibodies to COVID-19. This convenience sample was selected on two consecutive days April 25-26, 2022. RESULTS -For COVID-19, 97.3% are seropositive, and 63.9% have antibodies to nucleocapsid protein, a marker of prior infection. An additional, 33.7% have been vaccinated with no serologic evidence of infection. METHODOLOGY -Serum and urine samples from a nationwide group of insurance applicants for routine risk assessment were collected. The examination of applicants typically occurs, in their homes, their place of employment, or a clinic. The paramedic exam occurs 7-14 days after the insurance application. Before the exam, an office assistant calls the applicant and inquires if they have been in contact with a person with SARS-CoV-2, been ill within the last 2 weeks, felt sick, or recently had a fever. If the applicant answers yes, the exam is rescheduled. Before sample collection, the applicant reads and signs a consent form to release medical information and testing. Next, the examiner records the applicant's blood pressure, height, and weight. Then, a blood and a urine sample are collected and sent with the consent form to our laboratory via Federal Express. On April 25-26, 2022, we tested 2584 convenience samples from adult insurance applicants for the presence of antibodies to nucleocapsid and spike proteins from SARS-CoV-2. As a standard practice, we reported the client-specified test profile results to our life insurance carriers. In contrast, the COVID-19 test results were only available to the authors. Patient and Public Involvement.-There was no patient involvement in study design, reporting of results, or journal publication selection. There was patient consent to publish de-identified study results. No public involvement occurred in the creation or completion of the study. The authors thank the participants in this study for approving the use of their blood samples to further society's understanding of the SARS-CoV-19 pandemic. Ethics Review.-Western Institutional Review Board reviewed the study design and determined it to be exempt under the Common Rule and applicable guidance. Therefore, it is exempt under 45 CFR § 46.104(d)(4) from using de-identified study samples for epidemiologic investigation, WIRB Work Order #1-1324846-1. In addition, all test subjects had signed a consent allowing research of their blood and urine samples with the removal of personally identifiable information. RESULTS -The combined seroprevalence for antibodies to nucleocapsid, a marker of prior infection, and antibodies to spike protein, an indicator of either previous infection or vaccination, was 97.3%. Higher infection rates occur in younger vs older age groups, with a non-statistical difference for vaccinated and acquired natural immunity. For the age group 16-84, the total estimated seroprevalence of COVID-19 in the US is 249 million cases. CONCLUSIONS -The US population has widespread immune resistance to current variants of COVID-19 due to prior infection or vaccination. The infectivity of new variants and silent disease, independent of previous infection or vaccination, are the driving force behind the sporadic increase in clinical SARS-CoV-2 cases.
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Affiliation(s)
- Robert L Stout
- Stout - Chief Science Officer, Clinical Reference Laboratory, Inc
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Chkhaberidze N, Axobadze K, Kereselidz M, Pitskhelauri N, Jorbenadze M, Chikhladze N. Study of Epidemiological Characteristics of Fatal Injuries Using Death Registry Data in Georgia. Bull Emerg Trauma 2023; 11:75-82. [PMID: 37193013 PMCID: PMC10182725 DOI: 10.30476/beat.2023.97931.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 03/12/2023] [Indexed: 05/18/2023] Open
Abstract
Objective This study aimed to evaluate epidemiological aspects of fatal injuries in Georgia. Methods This was a retrospective, descriptive study that included all traumatic injury deaths in Georgia from January 1 to December 31, 2018. The National Center for Disease Control and Public Health of Georgia's Electronic Death Register database was utilized in this research. Results Of the study fatal injuries, 74% (n=1489) were males. 74% (n=1480) of all fatal injuries were caused by unintentional injuries. Road traffic accidents (25%, n=511) and falls (16%, n=322) were the primary causes of mortality. During the research year, the number of Years of life lost (YLL) was associated with injuries and was increased to 58172 for both sexes (rate per 1000 population: 15.6). Most of the years were lost in the age group of 25-29 years (7515.37). Road traffic deaths accounted for 30% (17613.50) of YLL. Conclusion Injuries are still a major public health problem in Georgia. In 2018, 2012 individuals died from injuries across the country. However, mortality and YLL rates of injury varied by age and cause of injury. To prevent injury-related mortality, it is crucial to conduct ongoing research on high-risk populations.
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Affiliation(s)
- Nino Chkhaberidze
- Department of Public Health, Medical Faculty, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
- Corresponding author: Nino Chkhaberidze Address: National Center for Disease Control and Public Health, Kakheti Highway 99, Tbilisi 0198, Georgia. Tel: +995 591 933344 e-mail:
| | - Ketevan Axobadze
- Department of Public Health, Medical Faculty, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Maia Kereselidz
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Nato Pitskhelauri
- Department of Public Health, Medical Faculty, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Maka Jorbenadze
- Department of Public Health, Medical Faculty, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Nino Chikhladze
- Department of Public Health, Medical Faculty, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
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Bittencourt AA, Oyafuso LKM, Cavalin RF, Palhares RB, Benard G, Gimenes VMF, Del Negro GMB, Siqueira LPM, de Freitas Xavier RS, Lopes-Bezerra LM, Buccheri R, Lindoso JAL. A neglected disease. Human sporotrichosis in a densely populated urban area in São Paulo, Brazil: clinical-epidemiological and therapeutic aspects. Braz J Microbiol 2022; 53:739-48. [PMID: 35301695 DOI: 10.1007/s42770-022-00713-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/13/2022] [Indexed: 02/07/2023] Open
Abstract
Human sporotrichosis is caused by different Sporothrix species; however, Sporothrix brasiliensis is the main species, usually related to cat transmission in urban areas. A retrospective descriptive study was conducted at the Institute of Infectology Emílio Ribas from 2010 to 2018. Demography, clinical, diagnostic, and therapeutic data were obtained from medical records. Polymerase chain reaction of the calmodulin gene was performed to identify Sporothrix species. In addition, to evaluate the spread of the disease across São Paulo metropolitan region, TerraView version 4.2.2 software was used for geocoding cases according to residence addresses. Kernell's maps using QGIS software version 2.16.3 were constructed to determine the concentration of cases. Results: 260 cases of sporotrichosis were diagnosed between 2010 and 2018. We observed a 700% increment in the number of human cases in the 2016-2018 triennium compared with the 2013-2015 triennium. Female adults with a median age of 46 years old were the predominant infected group associated with cats' exposition at home care, although the age range of all patients was 01 to 86 years old. The main epidemiological risk of acquiring sporotrichosis was contact with cats, reported by 96.5% of the patients. Molecular identification showed that most of the tested isolates were Sporothrix brasiliensis. Lymphocutaneous form was observed in 59.2% and fixed cutaneous form in 37.5% of the patients. Regarding treatment, itraconazole was the main drug used (94.2%) with a cure rate of 98.8%. We observed an important spread of human sporotrichosis involving cat transmission caused by Sporothrix brasiliensis in a densely populated area of São Paulo state. These results are important to alert clinicians and dermatologists about the occurrence and progression of a neglected tropical disease in an urban area and the urgent necessity to include sporotrichosis as a differential diagnosis in the clinical investigation routine.
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Supervía A, Salgado E, Córdoba F, García Gibert L, Martínez Sánchez L, Moreno A, Fuentes E, Galicia Paredes M, Martínez Millán D, Clemente C, Nogué S. Poisoning cases in Catalonia: characteristics according to age groups in the Intox.28 study. Emergencias 2021; 33:115-120. [PMID: 33750052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The Toxicology Working Group of the Catalan Society of Emergency Medicine (SoCMUETox) began the Intox-28 study in 2013. The aim was to identify differences in poisoning cases between 3 age groups. MATERIAL AND METHODS Descriptive observational study of poisoning cases managed in 8 hospital emergency departments on the 28th day of each month from 2013 to 2019. We gathered information on patient particulars, type of poison, clinical data, and discharge destination. The patient sample was distributed into 3 groups for comparison: minors under the age of 17 years, adults aged 17 to 65 years, and adults over the age of 65 years. RESULTS The hospitals registered 1088 cases: 132, 859, and 97 in each age group. In comparisons between the minors and the adults aged 65 years or younger, the minors had more females (58.3% vs 46.1%), fewer recreational poisonings (22% vs 46.1%) more poisonings inside the home (67.4% vs 51.1%), more medication poisonings (49.2% vs 31.1%), and less often received treatment (43.2% vs 73%) (P .001, all comparisons). The proportion of older adults receiving treatment (73.2%) was similar to that of the younger adults. CONCLUSION The characteristics of poisonings vary according to age. Differences lie in gender, intentionality, and type of poison.
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Affiliation(s)
- August Supervía
- Servicio de Urgencias, Hospital Universitario del Mar, Barcelona, España. Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox)
| | - Emilio Salgado
- Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox). Servicio de Urgencias, Hospital Clínic de Barcelona, España
| | - Francisca Córdoba
- Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox). Hospital Moises Broggi Sant Joan Despí, Barcelona, España
| | - Lidia García Gibert
- Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox). Servicio de Urgencias, Consorci Sanitari Parc Taulí Sabadell, Barcelona, España
| | - Lidia Martínez Sánchez
- Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox). Área de Urgencias, Hospital Sant Joan de Déu, Barcelona, España
| | - Albert Moreno
- Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox). Servicio de Urgencias, Hospital Joan XXIII, Tarragona, España
| | - Elena Fuentes
- Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox). Servicio de Urgencias, Hospital Universitario de Bellvitge, Barcelona, España
| | - Miguel Galicia Paredes
- Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox). Servicio de Urgencias, Hospital Clínic de Barcelona, España
| | - Daniel Martínez Millán
- Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox). Servei d'Emergències Mediques, Barcelona, España
| | - Carlos Clemente
- Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox). Centre Forum, Parc de Salut Mar, Barcelona, España
| | - Santiago Nogué
- Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox). Servicio de Urgencias, Hospital Clínic de Barcelona, España
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Dasgupta A, Sengupta S. Scalable Estimation of Epidemic Thresholds via Node Sampling. Sankhya Ser A 2021; 84:321-344. [PMID: 34248309 PMCID: PMC8260572 DOI: 10.1007/s13171-021-00249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/11/2021] [Indexed: 02/06/2023]
Abstract
Infectious or contagious diseases can be transmitted from one person to another through social contact networks. In today's interconnected global society, such contagion processes can cause global public health hazards, as exemplified by the ongoing Covid-19 pandemic. It is therefore of great practical relevance to investigate the network transmission of contagious diseases from the perspective of statistical inference. An important and widely studied boundary condition for contagion processes over networks is the so-called epidemic threshold. The epidemic threshold plays a key role in determining whether a pathogen introduced into a social contact network will cause an epidemic or die out. In this paper, we investigate epidemic thresholds from the perspective of statistical network inference. We identify two major challenges that are caused by high computational and sampling complexity of the epidemic threshold. We develop two statistically accurate and computationally efficient approximation techniques to address these issues under the Chung-Lu modeling framework. The second approximation, which is based on random walk sampling, further enjoys the advantage of requiring data on a vanishingly small fraction of nodes. We establish theoretical guarantees for both methods and demonstrate their empirical superiority.
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Affiliation(s)
- Anirban Dasgupta
- Computer Science and Engineering, Indian Institute of Technology, Gandhinagar, Gandhinagar, India
| | - Srijan Sengupta
- Statistics, North Carolina State University, Raleigh, NC USA
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Chazal T, Lhote R, Rey G, Haroche J, Eb M, Amoura Z, Cohen Aubart F. Giant-cell arteritis-related mortality in France: A multiple-cause-of-death analysis. Autoimmun Rev 2018; 17:1219-24. [PMID: 30316993 DOI: 10.1016/j.autrev.2018.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/24/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Giant-cell arteritis (GCA) is a large vessel vasculitis. Data regarding mortality are controversial. We describe the mortality data of the French death certificates for the period of 2005 to 2014. METHODS Using multiple-cause-of-death (MCOD) analysis, we calculated age-adjusted mortality rates for GCA, examined differences in mortality rates according to age and gender and analyzed the underlying causes of death (UCD). RESULTS We analyzed 4628 death certificates listing a diagnosis of GCA as UCD or non-underlying cause of death (NUCD). The mean age of death was 86 (±6.8) years. The overall age-standardized mortality rate among GCA patients was 7.2 per million population. Throughout the study period, the mean age of death was significantly increased (r = 0.17, p < .0001) in both genders. There was no significant difference with age repartition of death in the general population (p = .26). When GCA was listed as the UCD, most frequent associated diseases were cardiovascular (79%) and infectious diseases (35%). When GCA was reported as the NUCD, the listed UCD was a cardiovascular event in 40% of cases, neoplasm in 13%, neurodegenerative disorder in 11% and infectious disease in 10%. When GCA was the UCD or NUCD, an age-adjusted observed/expected ratio > 1 in GCA-associated mortality compared with the general population mortality was observed for tuberculosis, pneumonia and cardiovascular diseases. CONCLUSION In this analysis of French death certificates mentioning GCA, we observed a stable standardized mortality rate between 2005 and 2014. The most frequent associated diseases were cardiovascular diseases and infections.
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Gojanur S, Yeluri R, Munshi AK. Prevalence and Etiology of Traumatic Injuries to the Anterior Teeth among 5 to 8 Years Old School Children in Mathura City, India: An Epidemiological Study. Int J Clin Pediatr Dent 2015; 8:172-5. [PMID: 26628850 PMCID: PMC4647035 DOI: 10.5005/jp-journals-10005-1308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/21/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives: To assess the prevalence of traumatic injuries to the anterior teeth among the 5 to 8 years old children attending the schools in Mathura city. Study design: A total of 1657 children of the age groups: 5, 6, 7 and 8 years from 20 schools situated in various parts of Mathura city were included in this study, utilizing stratified cluster random sampling method. Results: The prevalence of traumatic injuries to the anterior teeth in 5 to 8 years old age group was found to be 2.7%. Males accounted for 3.1% whereas females accounted for 2.3%. Overall, males experienced more traumatic injuries than the females with male to female ratio of 1.8:1. The etiology of traumatic injuries was mostly due to falls, followed by bicycle accidents, collisions, violence and bike accidents in that order. How to cite this article: Gojanur S, Yeluri R, Munshi AK. Prevalence and Etiology of Traumatic Injuries to the Anterior Teeth among 5 to 8 Years Old School Children in Mathura City, India: An Epidemiological Study. Int J Clin Pediatr Dent 2015;8(3):172-175.
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Affiliation(s)
- Sushma Gojanur
- Senior Lecturer, Department of Pedodontics and Preventive Dentistry, KD Dental College and Hospital, Mathura, Uttar Pradesh, India
| | - Ramakrishna Yeluri
- Professor, Department of Pedodontics and Preventive Dentistry, KD Dental College and Hospital, Mathura, Uttar Pradesh, India
| | - Autar Krishen Munshi
- Former Professor and Head, Department of Pedodontics, KD Dental College and Hospital Mathura, Uttar Pradesh, India
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Abstract
Objective: To analyze the epidemiological aspects of proximal humerus fractures and describe the profile of patients with proximal humerus fractures hospitalized and treated at Hospital São Paulo, between 2008 and 2013. Methods: Hospital records were retrospectively analyzed for surgically treated patients diagnosed with proximal humerus fracture. Age, gender, injury mechanism, length of hospital stay, performed treatment and associated diseases were considered. Results: From all patients studied, 52 were female at their sixth decade of life. As for the injury mechanism, fall from height was the main cause for women (88.46%) and for man it was motorcycle accidents (31.42%). Fixation with locked plate was the most frequently used treatment. Conclusion: Most patients were female in their fifth decade of life, injured mainly by fall from height. Fixation with locked plate was the most frequently used treatment and the patients were admitted for 7 days, on average. Level of Evidence II, Retrospective Study.
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del Canto M, García-Martínez L, Fernández-Villa T, Molina AJ, Campanario F, García-Sanz M, López-Abente G, Honrado E, Martín-Sánchez V. Municipal distribution and trends in bladder cancer incidence in health area of León, Spain (1996-2010). Actas Urol Esp 2015; 39:349-53. [PMID: 25682356 DOI: 10.1016/j.acuro.2014.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/09/2014] [Accepted: 09/22/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Spain is a country where bladder cancer incidence and mortality rates are some of the highest in the world. The aim of this study is to know the incidence, trends and geographical distribution of bladder cancer in the health area of León. MATERIAL AND METHODS the new cases of bladder cancer (CIE-188) in patients residing in the health area of León and registered in the Hospital Tumor Registry of the Centro Asistencial Universitario in León (Spain) between 1996-2010 were included in this study. Triennial crude incidence and adjusted incidence rates to the worldwide and European population were calculated. Population data of the municipalities of Leon (Spain) were obtained from National Institute of Statistic of Spain (INE, Instituto Nacional de Estadística). Data were disaggregated by sex-groups and five-year age groups. Spatial distribution of smoothed municipal relative risks (RR) of bladder cancer was carried out using a Besag, York and Mollié model. Bayesian model were used to calculate the posterior probability (PP) of RR greater than one. RESULTS 1.573 cases were included. Incidence rates standardized to European population increased among men from 20,8/100.000 (1996-98) to 33,1/100.000 (2006-2008) and among women these rates increased from 1,9/100.000 to 5,9/100.000 for the same period of time. No relevant differences were found in the municipal distribution of the incidences. CONCLUSIONS bladder cancer incidence rates are high in the European context. Rising trends in incidence in both sexs, particularly in women are observed.
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Affiliation(s)
- M del Canto
- Servicio de Urología, Complejo Asistencial Universitario de León, León, España
| | - L García-Martínez
- Grupo de Investigación en Interacción Gen-Ambiente-Salud, Universidad de León, León, España.
| | - T Fernández-Villa
- Grupo de Investigación en Interacción Gen-Ambiente-Salud, Universidad de León, León, España
| | - A J Molina
- Grupo de Investigación en Interacción Gen-Ambiente-Salud, Universidad de León, León, España
| | - F Campanario
- Servicio de Urología, Complejo Asistencial Universitario de León, León, España
| | - M García-Sanz
- Servicio de Urología, Complejo Asistencial Universitario de León, León, España
| | - G López-Abente
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - E Honrado
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de León, León, España
| | - V Martín-Sánchez
- Grupo de Investigación en Interacción Gen-Ambiente-Salud, Universidad de León, León, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Ferrat E, Paillaud E, Laurent M, Le Thuaut A, Caillet P, Tournigand C, Lagrange JL, Canouï-Poitrine F, Bastuji-Garin S. Predictors of 1-Year Mortality in a Prospective Cohort of Elderly Patients With Cancer. J Gerontol A Biol Sci Med Sci 2015; 70:1148-55. [PMID: 25834194 DOI: 10.1093/gerona/glv025] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 02/20/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Mortality prediction is crucial to select the optimal treatment in elderly cancer patients. Our objective was to identify cancer-related factors and Comprehensive Geriatric Assessment (CGA) findings associated with 1-year mortality in elderly inpatients and outpatients with cancer. METHODS We prospectively included patients aged ≥70 years who had solid or hematologic malignancies and in whom the CGA was performed by geriatricians in two French teaching hospitals. We identified independent predictors of 1-year mortality after study inclusion, using multivariate Cox models stratified on inpatient/outpatient status. We built three multivariate Cox models, since strong correlations linked activities of daily living (ADL), Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and timed get-up-and-go test (GUG) results; and since physicians' preferences for these three assessments vary. A sensitivity analysis was performed using multiple imputation. RESULTS Of the 993 patients (mean age, 80.2 years; 51.2% men), 58.2% were outpatients and 46% had metastatic disease. Colorectal cancer was the most common malignancy (21.4%). Mortality rates after 6 and 12 months were 30.1% and 41.2%, respectively. In all models, tumor site and metastatic status (p < .001), age >80 years (p < .05), higher number of severe comorbidities (p < .05), and malnutrition (p < .001) were associated with death independently from impaired ECOG-PS (p < .001), ADL (p < .001), and GUG (p < .001). The adverse effect of metastatic status differed significantly across tumor sites, being greatest for breast and prostate cancer (p < .001). Multiple imputation produced similar results. CONCLUSION The predictors of 1-year mortality identified in our study may help physicians select the optimal cancer-treatment strategy in elderly patients.
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Affiliation(s)
- Emilie Ferrat
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Primary Care Department, School of Medicine, Paris East Créteil University (UPEC), France.
| | - Elena Paillaud
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Geriatric Oncology Coordination Unit (UCOG)
| | - Marie Laurent
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Geriatric Oncology Coordination Unit (UCOG)
| | - Aurélie Le Thuaut
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Public Health Department, Clinical Research Unit (URC Mondor)
| | - Philippe Caillet
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Geriatric Oncology Coordination Unit (UCOG)
| | | | - Jean-Léon Lagrange
- Radiotherapy Department, Henri-Mondor Teaching Hospital, APHP, Créteil, France
| | - Florence Canouï-Poitrine
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Public Health Department
| | - Sylvie Bastuji-Garin
- Université Paris Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA 4393, UPEC, F-94010, Créteil, France. Public Health Department, Clinical Research Unit (URC Mondor)
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12
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Abstract
Geographical and ethnic diversity in Nepal has led to interesting epidemiology of viral hepatitis and liver diseases. Before the epidemic of Biratnagar that occurred in April to June 2014, Kathmandu was the only known endemic region for hepatitis E virus infection (HEV), where at least four previous epidemics have been documented since 1973. Due to rapid urbanization with still low socioeconomic condition, other major cities are appreciated to be at increasing risk of outbreaks. Characteristics of HEV epidemics and genetic changes of HEV during last decade have been studied. While hepatitis A virus infection was only common during childhood till recent years, it is re-emerging as an important etiology of acute hepatitis in young adults. Nepal is classified as low endemic region for hepatitis B virus infection (HBV) with overall seroprevalence of 1.1%. But, some ethnic groups and geographical areas have high prevalence rates. Despite low endemicity, HBV accounts for majority of cases of hepatocellular carcinoma and liver cirrhosis in the country. Similarly, though hepatitis C virus (HCV) is present in only 0.4% of general population, high seroprevalence was found among intravenous drug abusers many of them with HIV coinfection. Apart from hepatitis viruses, alcohol use also contributes significantly to liver cirrhosis and chronic liver failure. A unique form of hepatic venous outflow obstruction called ‘hepatic vena cava syndrome’ has been identified as an important etiology of liver cirrhosis and hepatocellular carcinoma.
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Affiliation(s)
- Ananta Shrestha
- Department of Hepatology, The Liver Clinic, Liver Foundation Nepal, Tripureshwor, Kathmandu, Nepal
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Chen DS, Betz J, Yaffe K, Ayonayon HN, Kritchevsky S, Martin KR, Harris TB, Purchase-Helzner E, Satterfield S, Xue QL, Pratt S, Simonsick EM, Lin FR. Association of hearing impairment with declines in physical functioning and the risk of disability in older adults. J Gerontol A Biol Sci Med Sci 2014; 70:654-61. [PMID: 25477427 DOI: 10.1093/gerona/glu207] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/08/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying factors associated with functional declines in older adults is important given the aging of the population. We investigated if hearing impairment is independently associated with objectively measured declines in physical functioning in a community-based sample of older adults. METHODS Prospective observational study of 2,190 individuals from the Health, Aging, and Body Composition study. Participants were followed annually for up to 11 visits. Hearing was measured with pure-tone audiometry. Physical functioning and gait speed were measured with the Short Physical Performance Battery (SPPB). Incident disability and requirement for nursing care were assessed semiannually through self-report. RESULTS In a mixed-effects model, greater hearing impairment was associated with poorer physical functioning. At both Visit 1 and Visit 11, SPPB scores were lower in individuals with mild (10.14 [95% CI 10.04-10.25], p < .01; 7.35 [95% CI 7.12-7.58], p < .05) and moderate or greater hearing impairment (10.04 [95% CI 9.90-10.19], p < .01; 7.00 [95% CI 6.69-7.32], p < .01) than scores in normal hearing individuals (10.36 [95% CI 10.26-10.46]; 7.71 [95% CI 7.49-7.92]). We observed that women with moderate or greater hearing impairment had a 31% increased risk of incident disability (Hazard ratio [HR] =1.31 [95% CI 1.08-1.60], p < .01) and a 31% increased risk of incident nursing care requirement (HR = 1.31 [95% CI 1.05-1.62], p = .02) compared to women with normal hearing. CONCLUSIONS Hearing impairment is independently associated with poorer objective physical functioning in older adults, and a 31% increased risk for incident disability and need for nursing care in women.
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Affiliation(s)
- David S Chen
- Johns Hopkins University School of Medicine, Baltimore, Maryland. Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Joshua Betz
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Stephen Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn R Martin
- Laboratory of Epidemiology and Population Sciences and Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland. Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences and Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland
| | - Elizabeth Purchase-Helzner
- Department of Epidemiology and Biostatistics, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Qian-Li Xue
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheila Pratt
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Frank R Lin
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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14
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Rosso AL, Sanders JL, Arnold AM, Boudreau RM, Hirsch CH, Carlson MC, Rosano C, Kritchevsky SB, Newman AB. Multisystem physiologic impairments and changes in gait speed of older adults. J Gerontol A Biol Sci Med Sci 2014; 70:319-24. [PMID: 25380599 DOI: 10.1093/gerona/glu176] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Slowed gait is an important health indicator in older adults but a single identifiable cause is often lacking. We assessed whether a summary index measuring impairments across multiple physiologic systems was associated with slowed gait in older individuals. METHODS Data from the Cardiovascular Health Study (n = 3,010) were used to assess associations between baseline physiologic index (measuring vasculature, brain, kidneys, lungs, and glucose metabolism; range 0-10 with 0-2 points/system and lower score indicating higher function) and annual gait speed (m/s) over 6 years. Participants with complete data on the physiologic index and at least two gait speed measures were included. Mean gait speed and 95% confidence intervals (CI) by category of index were calculated using mixed effects models. RESULTS Those with scores of three or higher on the index had significantly slower gait speed at baseline compared to those with scores of 0-2 (7-10: mean speed = 0.83 m/s, 95% CI: 0.80, 0.84; 0-2: mean speed = 1.01 m/s, 95% CI: 0.99, 1.03). Those with higher indices also had faster decline in gait speed compared to those with lower scores after adjustment for demographic and health characteristics (7-10: change in speed = -0.020 m/s/year, 95% CI: -0.024, -0.016; 0-2: change in speed= -0.010 m/s/year, 95% CI: -0.014, -0.006). CONCLUSIONS Greater impairment across five organ systems was associated with slower gait speed and greater declines in gait speed over 6 years. Impairments accumulated over multiple physiologic systems may make older adults more vulnerable to slow gait speed.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pennsylvania.
| | - Jason L Sanders
- Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital & Brigham and Women's Hospital, Massachusetts
| | - Alice M Arnold
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Robert M Boudreau
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pennsylvania
| | - Calvin H Hirsch
- Division of General Medicine, University of California, Davis Medical Center, Sacramento
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Caterina Rosano
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pennsylvania
| | - Stephen B Kritchevsky
- The Sticht Center on Aging and Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pennsylvania
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15
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Kaup AR, Simonsick EM, Harris TB, Satterfield S, Metti AL, Ayonayon HN, Rubin SM, Yaffe K. Older adults with limited literacy are at increased risk for likely dementia. J Gerontol A Biol Sci Med Sci 2014; 69:900-6. [PMID: 24158765 PMCID: PMC4067115 DOI: 10.1093/gerona/glt176] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/06/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low literacy is common among the elderly and possibly more reflective of educational attainment than years of school completed. We examined the association between literacy and risk of likely dementia in older adults. METHODS Participants were 2,458 black and white elders (aged 71-82) from the Health, Aging and Body Composition study, who completed the Rapid Estimate of Adult Literacy in Medicine and were followed for 8 years. Participants were free of dementia at baseline; incidence of likely dementia was defined by hospital records, prescription for dementia medication, or decline in Modified Mini-Mental State Examination score. We conducted Cox proportional hazard models to evaluate the association between literacy and incidence of likely dementia. Demographics, education, income, comorbidities, lifestyle variables, and apolipoprotein E (APOE) ε4 status were included in adjusted analyses. RESULTS Twenty-three percent of participants had limited literacy (<9th-grade level). Limited literacy, as opposed to adequate literacy (≥9th-grade level), was associated with greater incidence of likely dementia (25.5% vs17.0%; unadjusted hazard ratio [HR] = 1.75, 95% confidence interval 1.44-2.13); this association remained significant after adjustment. There was a trend for an interaction between literacy and APOE ε4 status (p = .07); the association between limited literacy and greater incidence of likely dementia was strong among ε4 noncarriers (unadjusted HR = 1.85) but nonsignificant among ε4 carriers (unadjusted HR = 1.25). CONCLUSIONS Limited literacy is an important risk factor for likely dementia, especially among APOE ε4-negative older adults, and may prove fruitful to target in interventions aimed at reducing dementia risk.
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Affiliation(s)
- Allison R Kaup
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco VA Medical Center, California. Department of Psychiatry, University of California San Francisco.
| | - Eleanor M Simonsick
- National Institute on Aging, Translational Gerontology Branch, Harbor Hospital, Baltimore, Maryland
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | | | | | - Kristine Yaffe
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco VA Medical Center, California. Department of Psychiatry, University of California San Francisco. Department of Epidemiology and Biostatistics and Department of Neurology, University of California San Francisco
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16
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Capistrant BD, Mejia NI, Liu SY, Wang Q, Glymour MM. The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort. J Gerontol A Biol Sci Med Sci 2014; 69:860-70. [PMID: 24444610 PMCID: PMC4067116 DOI: 10.1093/gerona/glt191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 10/29/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace. METHODS Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace. RESULTS Compared with similar cohort members who remained stroke free, participants who developed stroke had faster declines in IADL independence and lower probability of IADL independence prior to stroke. After stroke, independence declined at an annual rate similar to those who did not have stroke. The black-white disparity in IADL independence narrowed poststroke. CONCLUSION Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities.
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Affiliation(s)
- Benjamin D Capistrant
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
| | - Nicte I Mejia
- Department of Neurology, Massachusetts General Hospital, Boston. Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Sze Y Liu
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts. Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
| | - Qianyi Wang
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - M Maria Glymour
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts. Department of Epidemiology & Biostatistics, University of California - San Francisco
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Cheung KL, Montez-Rath ME, Chertow GM, Winkelmayer WC, Periyakoil VS, Kurella Tamura M. Prognostic stratification in older adults commencing dialysis. J Gerontol A Biol Sci Med Sci 2014; 69:1033-9. [PMID: 24482541 DOI: 10.1093/gerona/glt289] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Accurate prognostic models could inform treatment decisions for older adults with end-stage renal disease who are considering dialysis and might identify patients more appropriate for conservative care or hospice. METHODS In a cohort of patients aged ≥ 67 years commencing dialysis in the United States between January 1, 2008 and June 30, 2009, we compared the discrimination of three existing instruments (the Liu index; the French Renal Epidemiology and Information Network score; and hospice eligibility criteria) for the prediction of 6-month mortality. We estimated the odds of death associated with each prognostic index using logistic regression with and without adjustment for age. Predictive indices were compared using the concordance ("c")-statistic. RESULTS Of 44,109 eligible patients, 10,289 (23.3%) died within 6 months of dialysis initiation. The c-statistic for the Liu, Renal Epidemiology and Information Network, hospice eligibility criteria, and combined Liu/hospice eligibility criteria scores without and with age were 0.62/0.65, 0.63/0.66, 0.65/0.68, and 0.68/0.70, respectively. Discrimination was poorer at older ages, especially for the Liu and Renal Epidemiology and Information Network scores. Although sensitivity was poor, a Renal Epidemiology and Information Network score ≥ 9 or an hospice eligibility criteria ≥ 3 had relatively high specificity. CONCLUSIONS Existing prognostic indices based on administrative data perform poorly with respect to prediction of 6-month mortality in older patients with end-stage renal disease commencing dialysis.
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Affiliation(s)
- Katharine L Cheung
- Division of Nephrology, University of Vermont College of Medicine, Burlington.
| | - Maria E Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | | | - Vyjeyanthi S Periyakoil
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, California. Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, California
| | - Manjula Kurella Tamura
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California. Geriatric Research and Education Clinical Center, Veterans Affairs Palo Alto Health Care System, California
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18
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Tian Q, Erickson KI, Simonsick EM, Aizenstein HJ, Glynn NW, Boudreau RM, Newman AB, Kritchevsky SB, Yaffe K, Harris TB, Rosano C. Physical activity predicts microstructural integrity in memory-related networks in very old adults. J Gerontol A Biol Sci Med Sci 2014; 69:1284-90. [PMID: 24474004 DOI: 10.1093/gerona/glt287] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although the beneficial effects of physical activity (PA) on memory and executive function are well established in older adults, little is known about the relationship between PA and brain microstructure and the contributions of physical functional limitations and chronic diseases. This study examined whether higher PA would be longitudinally associated with greater microstructural integrity in memory- and executive function-related networks and whether these associations would be independent of physical function and chronic diseases. METHODS Diffusion tensor imaging was obtained in 2006-2008 in 276 participants (mean age = 83.0 years, 58.7% female, 41.3% black) with PA (sedentary, lifestyle active, and exercise active) measured in 1997-1998. Gait speed, cognition, depressive symptoms, cardiovascular and pulmonary diseases, hypertension, stroke, and diabetes were measured at both time points. Mean diffusivity and fractional anisotropy were computed from normal-appearing gray and white matter in frontoparietal and subcortical networks. Moderating effects of physical function and chronic diseases were tested using hierarchical regression models. RESULTS Compared with the sedentary, the exercise active group had lower mean diffusivity in the medial temporal lobe and the cingulate cortex (β, p values: -.405, .023 and -.497, .006, respectively), independent of age, sex, and race. Associations remained independent of other variables, although they were attenuated after adjustment for diabetes. Associations between PA and other neuroimaging markers were not significant. CONCLUSIONS Being exercise active predicts greater memory-related microstructural integrity in older adults. Future studies in older adults with diabetes are warranted to examine the neuroprotective effect of PA in these networks.
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Affiliation(s)
- Qu Tian
- Department of Epidemiology, Graduate School of Public Health and
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pennsylvania
| | - Eleanor M Simonsick
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | | | - Nancy W Glynn
- Sticht Center on Aging, Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Robert M Boudreau
- Department of Psychiatry, Neurology and Epidemiology, University of California, San Francisco
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health and
| | - Stephen B Kritchevsky
- Sticht Center on Aging, Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Kristine Yaffe
- Department of Psychiatry, Neurology and Epidemiology, University of California, San Francisco
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health and
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Wolinsky FD, Ayyagari P, Malmstrom TK, Miller JP, Andresen EM, Schootman M, Miller DK. Lower extremity function trajectories in the African American Health Cohort. J Gerontol A Biol Sci Med Sci 2013; 69:1004-10. [PMID: 24336800 DOI: 10.1093/gerona/glt197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We addressed two understudied issues in estimating lower extremity functional trajectories in older adults-incorporating the effect of mortality and evaluating heterogeneity among African Americans. METHODS Data were taken from the 998 participants in the African American Health cohort. A highly reliable and valid 8-item lower extremity function scale was used at baseline and at the 1-, 2-, 3-, 4-, 7-, and 9-year follow-up interviews. Semiparametric (ie, discrete) group-based mixture modeling identified the trajectories, and multinomial logistic regression identified risk factors for differential trajectory groups. RESULTS When treating mortality as informative censoring, six discrete trajectories were observed with 45% of the participants belonging to three stable trajectories (good, fair, or poor function), and the remainder belonging to three declining trajectories (very high function with minimal improvement then minimal decline, very good function with a slow and modest decline, and very good function with a large and quick decline). CONCLUSION Substantial heterogeneity in lower extremity function trajectories exists in the African American Health cohort, after appropriately treating mortality as informative censoring.
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Affiliation(s)
- Fredric D Wolinsky
- Department of Health Management and Policy, College of Public Health, The University of Iowa.
| | - Padmaja Ayyagari
- Department of Health Management and Policy, College of Public Health, The University of Iowa
| | - Theodore K Malmstrom
- Department of Neurology & Psychiatry, School of Medicine, Saint Louis University, Missouri
| | - J Phillip Miller
- Department of Biostatistics, Washington University in St. Louis, Missouri
| | - Elena M Andresen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
| | - Mario Schootman
- Department of Epidemiology, School of Public Health, Saint Louis University, Missouri
| | - Douglas K Miller
- Center for Aging Research, Indiana University & the Regenstrief Institute, Indianapolis
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Shikany JM, Barrett-Connor E, Ensrud KE, Cawthon PM, Lewis CE, Dam TTL, Shannon J, Redden DT. Macronutrients, diet quality, and frailty in older men. J Gerontol A Biol Sci Med Sci 2013; 69:695-701. [PMID: 24304504 DOI: 10.1093/gerona/glt196] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Frailty, a phenotype of multisystem impairment and expanding vulnerability, is associated with higher risk of adverse health outcomes not entirely explained by advancing age. We investigated associations of macronutrients, dietary fiber, and overall diet quality with frailty status in older community-dwelling men. METHODS Participants were 5,925 men aged ≥ 65 years enrolled in the Osteoporotic Fractures in Men (MrOS) study at six U.S. centers. Diet was assessed at baseline with a food frequency questionnaire. We assessed frailty status (robust, intermediate, or frail) at baseline and at a second clinic visit (a mean of 4.6 years later) using a slightly modified Cardiovascular Health Study frailty index. We used multinomial logistic regression to assess associations between macronutrient intake, dietary fiber, and the Diet Quality Index Revised with frailty status at baseline and at the second clinic visit. RESULTS At baseline, 2,748 (46.4%) participants were robust, 2,681 (45.2%) were intermediate, and 496 (8.4%) were frail. Carbohydrate, fat, protein, and dietary fiber showed no consistent associations with frailty status. Overall diet quality exhibited fairly consistent associations with frailty status. The Diet Quality Index Revised was inversely associated with frail status relative to robust status at the baseline visit (odds ratio for Q5 vs Q1 = 0.44, 95% confidence interval: 0.30, 0.63; p for trend < .0001) and at the second clinic visit (odds ratio for Q5 vs Q1 = 0.18, 95% confidence interval: 0.03, 0.97; p for trend = .0180). CONCLUSIONS Overall diet quality was inversely associated with prevalent and future frailty status in this cohort of older men.
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Affiliation(s)
- James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham.
| | - Elizabeth Barrett-Connor
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego School of Medicine
| | - Kristine E Ensrud
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco
| | - Cora E Lewis
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham
| | | | - Jackilen Shannon
- Division of Epidemiology, Public Health & Preventive Medicine, Oregon Health & Science University, Portland
| | - David T Redden
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
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Arai Y, Inagaki H, Takayama M, Abe Y, Saito Y, Takebayashi T, Gondo Y, Hirose N. Physical independence and mortality at the extreme limit of life span: supercentenarians study in Japan. J Gerontol A Biol Sci Med Sci 2013; 69:486-94. [PMID: 24225329 DOI: 10.1093/gerona/glt146] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prevention of disability is a major challenge in aging populations; however, the extent to which physical independence can be maintained toward the limit of human life span remains to be determined. METHODS We examined the health and functional status of 642 centenarians: 207 younger centenarians (age: 100-104 years), 351 semi-supercentenarians (age: 105-109 years), and 84 supercentenarians (age: >110 years). All-cause mortality was followed by means of an annual telephone or mailed survey. RESULTS Age-specific disability patterns revealed that the older the age group, the higher the proportion of those manifesting independence in activities of daily living at any given age of entry. Multiple logistic regression analysis identified male gender and better cognitive function as consistent determinants of physical independence across all age categories. In a longitudinal analysis, better physical function was significantly associated with survival advantage until the age of 110. However, mortality beyond that age was predicted neither by functional status nor biomedical measurements, indicating alternative trajectories of mortality at the highest ages. CONCLUSIONS These findings suggest that maintaining physical independence is a key feature of survival into extreme old age. Future studies illuminating genetic and environmental underpinnings of supercentenarians' phenotypes will provide invaluable opportunities not only to improve preventive strategies but also to test the central hypotheses of human aging.
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Affiliation(s)
- Yasumichi Arai
- Division of Geriatric Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Dumurgier J, Singh-Manoux A, Tavernier B, Tzourio C, Elbaz A. Lipid-lowering drugs associated with slower motor decline in the elderly adults. J Gerontol A Biol Sci Med Sci 2013; 69:199-206. [PMID: 24097424 DOI: 10.1093/gerona/glt140] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Vascular risk factors contribute to motor decline in the elderly persons. We investigated the relationship between lipid-lowering drugs (LLDs) use and decline in walking speed (WS) in older adults. METHODS Data on 4,009 community-dwelling men and women, aged ≥65 years at baseline, are drawn from the Dijon (France) center of the Three-City study. "Fast" WS was assessed over 6 m at baseline and at 4, 6, 8, and 10 years of follow-up. Mixed linear models were used to determine the relationship between LLDs and change in WS over the follow-up. RESULTS At baseline, 1,295 (32%) participants used LLDs (statins, n = 643; fibrates, n = 652); mean fast WS was 152.9cm/s and not significantly different between LLDs users and nonusers. In models adjusted for age, sex, cholesterol level, and other covariates, WS decline was 25% slower in LLDs users (difference with nonusers: 0.58cm/s/y, 95% CI: 0.30, 0.86; p < .001). Both fibrates and statins were associated with slower decline, but only the effect of statins was robust in analyses that took missing values into account. The beneficial effect was more pronounced in those on LLDs continuously over the follow-up. CONCLUSION Fast WS declined less in those on LLDs, suggesting that the effect of LLDs, statins in particular, extend beyond that on cardiovascular disease in the elderly persons. However, these effects were modest and their clinical relevance is unclear.
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Affiliation(s)
- Julien Dumurgier
- Memory Center of Lariboisiere Hospital, 200 rue du Faubourg Saint-Denis, 75010 Paris, France.
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23
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Murphy RA, Ip EH, Zhang Q, Boudreau RM, Cawthon PM, Newman AB, Tylavsky FA, Visser M, Goodpaster BH, Harris TB. Transition to sarcopenia and determinants of transitions in older adults: a population-based study. J Gerontol A Biol Sci Med Sci 2013; 69:751-8. [PMID: 24013673 DOI: 10.1093/gerona/glt131] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Diagnostic criteria for sarcopenia from appendicular lean mass (ALM), strength, and performance have been proposed, but little is known regarding the progression of sarcopenia. We examined the time course of sarcopenia and determinants of transitioning toward and away from sarcopenia. METHODS ALM, gait speed, and grip strength were assessed seven times over 9 years in 2,928 initially well-functioning adults aged 70-79. Low ALM was defined as less than 7.95 kg/m(2) (men) or less than 6.24 kg/m(2) (women), low performance as gait speed less than 1.0 m/s, low strength as grip strength less than 30 kg (men) or less than 20 kg (women). Presarcopenia was defined as low ALM and sarcopenia as low ALM with low performance or low strength. Hidden Markov modeling was used to characterize states of ALM, strength, and performance and model transitions leading to sarcopenia and death. Determinants of transitioning toward and away from sarcopenia were examined with logistic regression. RESULTS Initially, 54% of participants had normal ALM, strength, and performance; 21% had presarcopenia; 5% had sarcopenia; and 20% had intermediate characteristics. Of participants with normal ALM, strength, and performance, 1% transitioned to presarcopenia and none transitioned to sarcopenia. The greatest transition to sarcopenia (7%) was in presarcopenic individuals. Low-functioning and sarcopenia states were more likely to lead to death (12% and 13%). Higher body mass index (p < .001) and pain (p = .05) predicted transition toward sarcopenia, whereas moderate activity predicted transition from presarcopenia to more normal states (p = .02). CONCLUSIONS Pain, physical activity, and body mass index, potentially modifiable factors, are determinants of transitions. Promotion of health approaching old age is important as few individuals transition away from their initial state.
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Affiliation(s)
- Rachel A Murphy
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
| | - Edward H Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Qiang Zhang
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Robert M Boudreau
- Department of Epidemiology, Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco
| | - Anne B Newman
- Department of Epidemiology, Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
| | - Frances A Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Marjolein Visser
- Department of Health Sciences, VU University and the EMGO Institute, Amsterdam, The Netherlands. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
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24
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Carriere I, Pérès K, Ancelin ML, Gourlet V, Berr C, Barberger-Gateau P, Bouillon K, Kivimaki M, Ritchie K, Akbaraly T. Metabolic syndrome and disability: findings from the prospective three-city study. J Gerontol A Biol Sci Med Sci 2013; 69:79-86. [PMID: 23833203 DOI: 10.1093/gerona/glt101] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a potentially reversible cause of disability in the elderly people. The published literature suggests that the MetS-disability association is likely to be complex, depending on co-existing risk factors and with possible variation for each of the specific MetS components. Further evidence is needed to understand the specific consequences of the MetS as a whole and as a function of its components. METHODS Prospective analyses included data from 6,141 participants (60.9% women) aged 65 and older from the Three-City cohort. Mixed logistic models were used to determine associations between MetS (National Cholesterol Education Program Adult Treatment Panel III criteria) and 7-year incident disability measured as social restriction, mobility limitations (Rosow and Breslau scale), and limitations in instrumental and basic activities of daily living. RESULTS MetS was associated with incident social restriction (odds ratio = 1.55, 95% CI: 1.14-2.09), limited mobility (odds ratio = 1.52, 95% CI: 1.21-1.90), and instrumental activities of daily living limitations (odds ratio = 1.62, 95% CI: 1.24-2.10) after adjustment for a range of potential sociodemographic, health behavior, and health status confounders at baseline. These associations were independent of chronic conditions, including cardiovascular disease and dementia. There was evidence of associations between MetS components: central obesity, high triglycerides, and elevated fasting glucose and incidence of limitations in mobility and instrumental activities of daily living. CONCLUSIONS Our results suggest that the increased risk of mobility and instrumental activities of daily living limitations in the elderly people associated with MetS is over and above that associated with its components.
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Affiliation(s)
- Isabelle Carriere
- INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Hôpital La Colombière, 39 Avenue Charles Flahault, BP 34493, 34093 Montpellier Cedex 05, France.
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25
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Tseng LA, Delmonico MJ, Visser M, Boudreau RM, Goodpaster BH, Schwartz AV, Simonsick EM, Satterfield S, Harris T, Newman AB. Body composition explains sex differential in physical performance among older adults. J Gerontol A Biol Sci Med Sci 2013; 69:93-100. [PMID: 23682159 DOI: 10.1093/gerona/glt027] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Older women have higher percent body fat, poorer physical function, lower strength, and higher rates of nonfatal chronic conditions than men. We sought to determine whether these differences explained physical performance differences between men and women. METHODS Physical performance was assessed in the Health, Aging and Body Composition study in 2,863 men and women aged 70-79 with a composite 0-4 point score consisting of chair stands, standing balance including one-leg stand, and 6-m usual and narrow walk tests. Total body composition was measured by dual x-ray absorptiometry, thigh composition by computed tomography, and knee extensor strength by isokinetic dynamometer. Analysis of covariance estimated least square mean performance scores for men and women. RESULTS Men had higher performance scores than women (least square means: 2.33±0.02 vs 2.03±0.02, p < .0001), adjusted for race, study site, age, and height. Body composition measures (total body fat and thigh muscle area, muscle density, subcutaneous fat, and intermuscular fat) accounted for differences between men and women (least square means: 2.15±0.02 vs 2.17±0.02, p = .53). Higher strength in men partly explained the sex difference (least square means: 2.28±0.02 vs 2.12±0.02, p < .0001). Strength attenuated the association of thigh muscle mass with performance. Chronic health conditions did not explain the sex difference. CONCLUSIONS In a well-functioning cohort, poorer physical function in women compared with men can be explained predominantly by their higher fat mass, but also by other body composition differences. The higher proportion of body fat in women may put them at significant biomechanical disadvantage for greater disability in old age.
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Affiliation(s)
- Lisa A Tseng
- MS, 130 North Bellefield Avenue, Suite 500, Pittsburgh, PA 15213.
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