Qualitative and quantitative dermatoglyphics of chronic kidney disease of unknown origin (CKDu) in Sri Lanka

Heart rate variability over the decades: a scoping review

Heart rate variability (HRV) measures the variation in the time interval between successive heartbeats, reflecting the influence of the autonomic nervous system (ANS) on heart rate (HR) changes. This review provides an extensive overview of HRV measurement techniques, their applications, and their limitations in healthcare, exploring their potential for prognosis and condition assessment. A scoping review was conducted, gathering literature reviews on HRV spanning the past fifty years using PubMed, Scopus, and Web of Science databases. Our findings identified significant research gaps, including contradictions in the literature and the absence of standardized protocols for HRV measurements, which complicate the establishment of consistent baseline values. Additionally, the lack of protocols for pulse rate variability (PRV) in the context of advanced sensor technology hinders progress in HRV research. Despite these challenges, HRV remains significant in assessing cardiac autonomic function and its potential clinical applications. However, barriers such as device unfamiliarity, data accuracy concerns, and a lack of clinical trials limit its adoption. Further research is required to elucidate the relationship between abnormal HRV and health problems and to establish consistent baseline values for advancing HRV applications.

The Impact of Spatial Orientation Changes on Driving Behavior in Healthy Aging

OBJECTIVES

Global cognitive changes in older age affect driving behavior and road safety, but how spatial orientation differences affect driving behaviors is unknown on a population level, despite clear implications for driving policy and evaluation during aging. The present study aimed to establish how spatial navigation changes affect driving behavior and road safety within a large cohort of older adults.

METHODS

Eight hundred and four participants (mean age: 71.05) were recruited for a prospective cohort study. Participants self-reported driving behavior followed by spatial orientation (allocentric and egocentric) testing and a broader online cognitive battery (visuomotor speed, processing speed, executive functioning, spatial working memory, episodic memory, visuospatial functioning).

RESULTS

Spatial orientation performance significantly predicted driving difficulty and frequency. Experiencing more driving difficulty was associated with worse allocentric spatial orientation, processing speed, and source memory performance. Similarly, avoiding challenging driving situations was associated with worse spatial orientation and episodic memory. Allocentric spatial orientation was the only cognitive domain consistently affecting driving behavior in under 70 and over 70 age groups, a common age threshold for driving evaluation in older age.

DISCUSSION

We established for the first time that worse spatial orientation performance predicted increased driving difficulty and avoidance of challenging situations within an older adult cohort. Deficits in spatial orientation emerge as a robust indicator of driving performance in older age, which should be considered in future aging driving assessments, as it has clear relevance for road safety within the aging population.

Multi-pronged research on endemic chronic kidney disease of unknown etiology in Sri Lanka: a systematic review

Increasing prevalence of endemic chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is a major health problem since the 1990s. Despite numerous studies on CKDu, research groups have been unable to develop a comprehensive approach to mitigate the disorder, and thereby to identify research gaps. We conducted a systematic literature review of 119 publications on CKDu in Sri Lanka from Pubmed, Google Scholar, and Scopus, published until end September 2020. A higher CKDu prevalence in the working population of the North Central Province was reported with recent studies indicating patients from non-endemic regions as well. A majority were etiological studies that recorded conflicting and inconclusive evidence on CKDu etiology. Studies on clinico-pathological, diagnostic, biochemical, and molecular biological aspects of CKDu, studies analyzing CKDu symptom burden, anthropological, and behavioral impacts of CKDu, were reviewed as well. A dearth of research exists on nutritional, demographical, immunological, and microbial aspects of CKDu. The overview of the reviewed literature indicated the absence of a comprehensive plan of action to mitigate this situation. Hence, we propose the "One Health" approach with a systems dynamics model as a potential way forward to alleviate the CKDu epidemic in Sri Lanka. This enables the representation of multiple causative agents (and interactions thereof) among environmental, animal, and human systems, in concert with the "exposome" that provides the totality of exposure the individual has undergone since birth.