The Frailty of the Invincible

The COVID-19 pandemic has unveiled the frailty of our societies from too many points of view to look away. We need to understand why we were all caught unprepared. On the one hand, we have all short memories. As we forget too quickly, we were unable to recognize key factors influencing response and preparedness to public health threats. For many years, economic evaluation pushed governments all over the world to cut resources for public health systems, with COVID-19 pandemic the question arises: do we spend too much or too little on health care? What is the right amount to spend on health? Moreover, in many countries, the privatisation, or semi-privatisation, of healthcare may give rise to inequitable access to health care for everyone. Although COVID-19 is very “democratic”, its consequences aren’t. According to OECD, income inequality in OECD countries is at its highest level for the past half century. Three main causes have been recognized, technological revolution, globalization, and “financialisation”.

In this scenario, lockdown measures adopted to save lives are showing dramatic economic consequences. To address post COVID-19 reconstruction we need to go beyond GDP. As an economic measure this has many shortcomings in describing the real well-being of a country, and since what we measure affects what we do, new paradigms will have to guide the post COVID-19 reconstruction strategies, as the fate of countries and their citizens is at stake.

From the bench to practice - Field integration of community-based services for older citizens with different levels of functional limitation across European Regions

The meeting of the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) action group A3 together with members of the Reference site collaborative network (RSCN) in December 2019 in Rome focused on integration of evidence-based approaches on health and care delivery for older citizens at different levels of needs with expertise coming from stakeholder across Europe. It was the final aim of the group to co-create culturally sensitive pathways and facilitate co-ownership for further implementation of the pathways in different care systems across Europe.

The study design is a mixed method approach. Based on data analysis from a cohort of community-dwelling over-65 citizens in the framework of a longitudinal observational study in Rome, which included health, social and functional capacity data, three personas profiles were developed: the pre-frail, the frail and the very frail personas. Based on these data, experts were asked to co-create care pathways due to evidence and eminence during a workshop and included into a final report.

All working groups agreed on a common understanding that integration of care means person-centered integration of health and social care, longitudinally provided across primary and secondary health care including citizens’ individual social, economic and human resources.

Elements for consideration during care for pre-frail people are loneliness and social isolation, which, lead to limitation of physical autonomy in the light of reduced access to social support. Frail people need adaption of environmental structures and, again, social resource allocation to maintain at home. Very frail are generally vulnerable patients with complex needs. Most of them remain at home because of a strong individual social support and integrated health care delivery.

The approach described in this publication may represent a first approach to scaling-up care delivery in a person-centered approach.

The Frailty of the Invincible

The COVID-19 pandemic has unveiled the frailty of our societies from too many points of view to look away. We need to understand why we were all caught unprepared. On the one hand, we have all short memories. As we forget too quickly, we were unable to recognize key factors influencing response and preparedness to public health threats. For many years, economic evaluation pushed governments all over the world to cut resources for public health systems, with COVID-19 pandemic the question arises: do we spend too much or too little on health care? What is the right amount to spend on health? Moreover, in many countries, the privatisation, or semi-privatisation, of healthcare may give rise to inequitable access to health care for everyone. Although COVID-19 is very "democratic", its consequences aren't. According to OECD, income inequality in OECD countries is at its highest level for the past half century. Three main causes have been recognized, technological revolution, globalization, and "financialisation". In this scenario, lockdown measures adopted to save lives are showing dramatic economic consequences. To address post COVID-19 reconstruction we need to go beyond GDP. As an economic measure this has many shortcomings in describing the real well-being of a country, and since what we measure affects what we do, new paradigms will have to guide the post COVID-19 reconstruction strategies, as the fate of countries and their citizens is at stake.

Correlation between sarcopenia and atherosclerosis/cardiovascular risk factors in the elderly

Introduction Sarcopenia is the age-related loss of skeletal muscle mass, strength and function. Uncontrolled diabetes, obesity, chronic inflammation and lipid abnormalities, cause decreases in muscle strength, which contributes to disease-related morbidity.

Objectives The main goal of this study was to correlate the prevalence of sarcopenia with atherosclerosis and cardiovascular risk factors, mainly estimated by cholesterol, triglycerides, C-reactive protein (CRP) and HbA1c levels, in the elderly.

Methodology A quantitative observational cross-sectional study was performed in a convenience sample of individuals aged over 60 years old recruited non-randomly. Main study variables were body composition (seca® mBCA515), muscle strength (peak torque, Humac NORM isokinetic dynamometer), risk of falls (TUG test), muscle function (LEFS) and lipids, inflammation and glycaemic profile (cobas b101-Roche®).

Results Total cholesterol levels fully correlated with LDL and non-HDL cholesterol, and partially with triglycerides, but not with HDL-cholesterol levels, HbA1c, or BMI. LDL-cholesterol levels did not correlate with muscle mass (free-fat mass (%)), strength, function, or risk of falls. Similarly, HDL-cholesterol levels did not correlate with muscle function or falls risk. Cholesterol ratio, obtained by dividing total cholesterol by HDL-cholesterol levels, was significantly higher in individuals with CRP levels above 3 mg/L. Interestingly, when compared to normal values, individuals with triglycerides above 150 mg/dL showed a statistically significant decrease in muscle strength.

Conclusion From the biochemical measured parameters, our data showed that only high triglycerides levels positively correlated with sarcopenia risk, demonstrated by reduced muscle strength. While cholesterol ratio positively correlated with increased inflammation, blood cholesterol levels seem to be independent factors regarding sarcopenia prevalence.

The Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Ageing

Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs.

Building Bridges for Innovation in Ageing: Synergies between Action Groups of the EIP on AHA

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).

Rest Rust ! Physical active for active and healthy ageing

The aim of this paper is to give an insight on how physical activity can be defined, parameterized and measured in older adults and on different options to deal with citizen physical activity promotion at European level. Three relevant aspects are highlighted: When talking about physical activity, two different aspects are often unfairly mixed up: "physical activity" and "physical capacity". Physical activity, is referred to as the level of physical activity someone is actually performing in daily life.Physical capacity is referred to as the maximum physical activity a person can perform.Both physical activity and physical capacity can be expressed in different dimensions such as time, frequency, or type of activity with the consequence that there are many tools and techniques available. In order to support people to choose an appropriate instrument in their everyday practice a list of 9 criteria that are considered important is defined.Older adults score differently across the various physical dimensions, so strategies to promote physical activity should consider individual differences, in order to adapt for these variations.

Self-reported quality care for knee osteoarthritis: comparisons across Denmark, Norway, Portugal and the UK

Objectives

To assess and compare patient perceived quality of osteoarthritis (OA) management in primary healthcare in Denmark, Norway, Portugal and the UK.

Methods

Participants consulting with clinical signs and symptoms of knee OA were identified in 30 general practices and invited to complete a cross-sectional survey including quality indicators (QI) for OA care. A QI was considered as eligible if the participant had checked ‘Yes’ or ‘No’, and as achieved if the participant had checked ‘Yes’ to the indicator. The median percentage (with IQR and range) of eligible QIs achieved by country was determined and compared in negative binominal regression analysis. Achievement of individual QIs by country was determined and compared using logistic regression analyses.

Results

A total of 354 participants self-reported QI achievement. The median percentage of eligible QIs achieved (checked ‘Yes’) was 48% (IQR 28%, 64%; range 0–100%) for the total sample with relatively similar medians across three of four countries. Achievement rates on individual QIs showed a large variation ranging from 11% (referral to services for losing weight) to 67% (information about the importance of exercise) with significant differences in achievement rates between the countries.

Conclusions

The results indicated a potential for improvement in OA care in all four countries, but for somewhat different aspects of OA care. By exploring these differences and comparing healthcare services, ideas may be generated on how the quality might be improved across nations. Larger studies are needed to confirm and further explore the findings.

EUS and clinical characteristics of cystic pancreatic neuroendocrine tumors

Pancreatic neuroendocrine tumors (PNETs) may rarely appear as cystic or mixed solid-cystic masses. The endoscopic ultrasound (EUS) morphology and cyst fluid characteristics of these tumors are not well clarified. We retrospectively identified nine adult patients with nine single cystic pancreatic neuroendocrine tumors (CNETs). These nine included 0.67 % of the 1344 patients with pancreatic cystic lesions and 9.5 % of the 95 confirmed PNETs evaluated over the 12-year study period. At presentation, four patients were asymptomatic and five had known acute pancreatitis (n = 2), MEN-1 syndrome with hypoglycemia (n = 1), and abdominal pain (n = 2). Median maximal tumor diameter was 26 mm (range 20 - 64 mm). EUS morphology was mixed solid and cystic (n = 4) or cystic alone (n = 5). Cytology from EUS-fine-needle aspiration (FNA) (median 2 passes; range 1 - 6) demonstrated a PNET, and immunocytochemistry was confirmatory in all patients. Cyst fluid carcinoembryonic antigen (CEA) (n = 4) and amylase (n = 5) ranged from 0.1 to 1.8 ng/ml (normal 0 - 2.5 ng/ml) and 72 to 1838 U/L (normal 25 - 161 U/L), respectively. Six patients underwent surgery, and the preoperative diagnosis was confirmed in all.

Oral melanotic macule--a case report

A melanotic macule is a benign pigmented lesion of oral cavity characterised by increase in melanin pigmentation. Presented here is a case report of 12 year old girl with black pigmented area on right buccal mucosa. An excision biopsy was done which confirmed the diagnosis by as melanotic macule.

Physical mapping, expression patterns and interphase organisation of rDNA loci in Portuguese endemic Silene cintrana and Silene rothmaleri

Double target in situ hybridization to root tip metaphase and interphase cells of Silene cintrana and Silene rothmaleri was used to allocate the position of 18S-5.8S-25S and 5S rRNA genes. In both species, the 18S-5.8S-25S rDNA probe labelled four sites located on the short arms of two submetacentric chromosomes. Only one locus for 5S rDNA was mapped adjacent to 18S-5.8S-25S genes in a subterminal position on the centromere side: in S. rothmaleri the 5S rDNA locus was adjacent to the small 18S-5.8S-25S locus while in S. cintrana it was near the large one. The NOR activity analysed by Ag-staining in metaphase cells revealed proportionality between in situ labelling dimensions and Ag-NORs. In both species all rDNA loci were potentially active, although in S. rothmaleri a tendency for the expression of only one locus was observed. Interphase organisation analysis of rDNA showed some differences between both species that were correlated with NOR activity.

Factors related to family therapists' breaking confidence when clients disclose high-risks-to-HIV/AIDS sexual behaviors

This national survey of 309 marriage and family therapists examined what therapists do when their HIV-positive clients disclose that they are engaging in high-risk sexual behavior. The participants were given vignettes in which a fictitious client told the therapist about engaging in unprotected sex. Although the basic situations were the same, the client variables of age, gender, race, sexual orientation, and HIV status were systematically varied. The participants were more likely to break confidence regarding unsafe sex practices when their clients were male, young, gay, or African American. Moreover, therapists who were more likely to disclose were older, female, had less experience with gay/lesbian populations, were Catholic, were very religious, and were more likely to practice in urban areas. The authors discuss the implications of these and other findings.

Localization of uricase in mycorrhizas of Ophrys lutea Cav

Infected roots of Ophrys lutea present nymerous peroxisome profiles identified by diaminobenzidine (DAB) staining. The presence of uricase in these peroxisomes could also be recognized cytochemically. The activities of catalase and uricase, assayed using a crude fraction of peroxisomes, reached 0·8 μkat min^-1 protein-1 and 1·73 nakat min^-1 mg protein^-1 respectively. The role of uricase in purine metabolism is discussed in terms of host/endophyte interactions in O. lutea mycorrhzas.

Cytochemical localization of lipases during spore germination from Bryum capillare

In the oil containing spores of Bryum capillare, lipid breakdown occurs within three days after sowing. The periods of activity of acid, neutral and alkaline lipases are coincident. They start at the first day after sowing the spores. After 3 days of germination, when storage fats forming large globules are mobilised no lipase activity could be detected any longer in the glyoxysomes. Acid lipase is preferentially located in spherosomal membrane but is also present at the glyoxysomal membrane. Alkaline lipase is specifically located in the glyoxysomes and mitochondria. A cooperation presumably exists between acid and alkaline lipases in the hydrolysis of monoglycerides at the glyoxysomal level. Neutral lipase activity is localized at the spherosomal membrane, in the endoplasmic reticulum and in dictyosomes. It is absent from glyoxysomes.