Longitudinal data resource from the Wellbeing of Older People cohort of people aged >50 years in Uganda and South Africa from 2009 to 2019.

BACKGROUND: The population of people aged ≥60 years continues to increase globally, and has been projected by the United Nations Population Division to increase to 21% of the total population by 2050. In addition, the number of older people living with HIV has continued to increase owing to the introduction of antiretroviral therapy as a treatment for HIV-infected people. Most of the older people living with HIV are in sub-Saharan Africa, an area that faces the biggest burden of HIV globally. Despite the high burden, there are limited reliable data on how HIV directly and indirectly affects the health and wellbeing of older people within this region. OBJECTIVE: To showcase the availability of data on how HIV directly and indirectly affects the health and wellbeing of older people in Uganda and South Africa (SA). METHODS: The World Health Organization Study on global AGEing and adult health (SAGE), in collaboration with Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit and the Africa Health Research Institute (AHRI) in SA, started the SAGE Wellbeing of Older People Study (WOPS) in Uganda and SA in 2009. Since initiation, respondents have been surveyed every 2 years, with four waves of surveys conducted in Uganda and three waves in South Africa. RESULTS: The available datasets consist of two cohorts of people, aged >50 years, who were surveyed every 2 years between 2009 and 2018. The prevalence of HIV positivity over this period increased from 39% to 54% in Uganda and 48% to 62% in SA. The datasets provide comparisons of variables at a household level and at an individual level. At the individual level, the following measures can be compared longitudinally for a 10-year period for the following variables: sociodemographic characteristics; work history and benefits; health states and descriptions; anthropometrics performance tests and biomarkers; risk factors and preventive health behaviours; chronic conditions and health services coverage; healthcare utilisation; social cohesion; subjective wellbeing and quality of life; and impact of caregiving. CONCLUSION: This article describes the WOPS in Uganda and SA, the population coverage of this study, and the survey frequency of WOPS, survey measures, data resources available, the data resource access and the strengths and weaknesses of the study. The article invites interested researchers to further analyse the data and answer research questions of interest to enhance the impact of these data.

SIGNIFICANCE OF ADC MEASUREMENTS AS RADIOLOGICAL MRI MARKER IN DETECTION OF METASTATIC LYMPH NODE INVOLVEMENT IN PATIENTS WITH PROSTATE CANCER.

BACKGROUND: In spite of significant advances in diagnosis of prostate cancer (PCa), the detection and differential diagnosis of metastatic lymph node involvement remains an important clinical dilemma in a large number of cases. Contrast-enhanced abdominal computed tomography and magnetic resonance imaging (MRI), in part when using T1-weighed images (T1-WI and T2-WI), allow evaluating indirectly the presence of invasion in regional lymph nodes by assessing their diameter and morphology. Nonetheless, these techniques do not appear to be sufficiently sensitive for direct identification of lymph nodes with metastatic lesions. AIM: To study the significance of the apparent diffusion coefficient (ADC) of diffusion-weighted MRI in detection of metastatic lymph node involvement in PCa patients. MATERIALS AND METHODS: The study involved 35 patients with histologically verified PCa. Based on multiparametric prostatic MRI findings and pathomorphological reports, we have performed ADC measurements for pelvic lymph nodes either with (n = 15, mean size 1.78 ± 0.59 cm) or without metastases (n = 20, mean size: 0.94 ± 0.06 cm) in PCa patients who underwent radical prostatectomy with lymph node dissection. RESULTS: No significant diffe-rences were observed when comparing mean sizes of N+ and N- pelvic lymph nodes. At the same time, when comparing mean ADC values for N+ and N- pelvic lymph nodes, we observed a statistically significant difference: 0.74 ± 0.09 · 10-3 mm2/s in metastatic lymph node vs 1.05 ± 0.23 · 10-3 mm2/s in lymph nodes without metastatic involvement (p < 0.001). CONCLUSION: The use of ADC for diffusion-weighted MRI may provide valuable information for detection of metastatic lymph node involvement in patients with PCa.

Associations between dietary salt, potassium and blood pressure in South African adults: WHO SAGE Wave 2 Salt & Tobacco.

BACKGROUND & AIMS: In June 2016, South Africa implemented legislation mandating maximum sodium levels in a range of processed foods with a goal of reducing population salt intake and disease burden from hypertension. Our aim was to explore the relationship between salt and blood pressure (BP) in a subsample of the World Health Organization Study on global AGEing and adult health (SAGE) Wave 2 before implementation of legislation in South Africa. METHODS & RESULTS: Blood pressure (BP) was measured in triplicate (n = 2722; median age 56 years; 33% male) and 24-h urine collected in a nested subsample (n = 526) for sodium, potassium and creatinine analysis. Hypertension prevalence was 55% in older adults (50-plus years) and 28% in younger adults (18-49 years). Median salt intake (6.8 g/day) was higher in younger than older adults (8.6 g vs 6.1 g/day; p < 0.001), and in urban compared to rural populations (7.0 g vs 6.0 g/day; p = 0.033). Overall, 69% of participants had salt intakes above 5 g/day. Potassium intakes were generally low (median 35 mmol/day) with significantly lower intakes in rural areas and older adults. Overall, 91% of adults failed to meet the daily potassium recommendation of 90 mmol/d. Salt intakes above 5 g/day, and to a greater extent, a dietary sodium-to-potassium (Na:K) ratio above 2 mmol/mmol, were associated with significantly steeper regression slopes of BP with age. CONCLUSION: These preliminary results indicate that high dietary Na:K ratio may lead to a greater increase in BP and hypertension risk with age. Interventions to increase potassium intakes alongside sodium reduction initiatives may be warranted.

Prevalence of arthritis according to age, sex and socioeconomic status in six low and middle income countries: analysis of data from the World Health Organization study on global AGEing and adult health (SAGE) Wave 1.

BACKGROUND: In higher income countries, social disadvantage is associated with higher arthritis prevalence; however, less is known about arthritis prevalence or determinants in low to middle income countries (LMICs). We assessed arthritis prevalence by age and sex, and marital status and occupation, as two key parameters of socioeconomic position (SEP), using data from the World Health Organization Study on global AGEing and adult health (SAGE). METHODS: SAGE Wave 1 (2007-10) includes nationally-representative samples of older adults (≥50 yrs), plus smaller samples of adults aged 18-49 yrs., from China, Ghana, India, Mexico, Russia and South Africa (n = 44,747). Arthritis was defined by self-reported healthcare professional diagnosis, and a symptom-based algorithm. Marital status and education were self-reported. Arthritis prevalence data were extracted for each country by 10-year age strata, sex and SEP. Country-specific survey weightings were applied and weighted prevalences calculated. RESULTS: Self-reported (lifetime) diagnosed arthritis was reported by 5003 women and 2664 men (19.9% and 14.1%, respectively), whilst 1220 women and 594 men had current symptom-based arthritis (4.8% and 3.1%, respectively). For men, standardised arthritis rates were approximately two- to three-fold greater than for women. The highest rates were observed in Russia: 38% (95% CI 36%-39%) for men, and 17% (95% CI 14%-20%) for women. For both sexes and in all LMICs, arthritis was more prevalent among those with least education, and in separated/divorced/widowed women. CONCLUSIONS: High arthritis prevalence in LMICs is concerning and may worsen poverty by impacting the ability to work and fulfil community roles. These findings have implications for national efforts to prioritise arthritis prevention and management, and improve healthcare access in LMICs.

Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa.

BACKGROUND: The severe burden imposed by frailty and disability in old age is a major challenge for healthcare systems in low- and middle-income countries alike. The current study aimed to provide estimates of the prevalence of frailty and disability in older adult populations and to examine their relationship with socioeconomic factors in six countries. METHODS: Focusing on adults aged 50+ years, a frailty index was constructed as the proportion of deficits in 40 variables, and disability was assessed using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), as part of the Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, Russia and South Africa. RESULTS: This study included a total of 34,123 respondents. China had the lowest percentages of older adults with frailty (13.1%) and with disability (69.6%), whereas India had the highest percentages (55.5% and 93.3%, respectively). Both frailty and disability increased with age for all countries, and were more frequent in women, although the sex gap varied across countries. Lower levels of both frailty and disability were observed at higher levels of education and wealth. Both education and income were protective factors for frailty and disability in China, India and Russia, whereas only income was protective in Mexico, and only education in South Africa. CONCLUSIONS: Age-related frailty and disability are increasing concerns for older adult populations in low- and middle-income countries. The results indicate that lower levels of frailty and disability can be achieved for older people, and the study highlights the need for targeted preventive approaches and support programs.

Gender perspectives in care provision and care receipt among older people infected and affected by HIV in Uganda.

The objective of this study was to examine gender roles in the provision and receipt of care among older Ugandans. Survey data on care work were collected in 2009-2010 from 510 older people infected or affected by HIV/AIDS, at one rural and one semi-urban site. The questionnaire was adapted from the WHO Study on global AGEing and adult health survey. The type of care work done by older men and women for children in their households differs, yet, both men and women are taking on various types of care work. Women were more likely to report taking part in health/personal and physical care, whereas men were more likely to report providing financial assistance. Some older people, particularly women, were providing care at the same time as needing care. The finding on reciprocity of care suggests the need for further studies focused on how the reciprocity of care may affect health and well-being in older age.

Predictors of Subjective Well-Being among Older Ghanaians

Background: Later years of life are accompanied by many physical; emotional and environmental changes which may impact on the well-being of the individual. Many factors are known to influence the subjective well-being of older adults; but most; if not all of this information was the result of studies in the Western world. This study aimed at obtaining and documenting the predictors of subjective well-being (SWB) among older Ghanaians. Methods: Data for the study was obtained from the WHO SAGE study. The single item measure of life satisfaction was used to determine subjective wellbeing. Descriptive statistics as well as logistic regression analysis were carried out to determine the predictors of SWB. Results: A total of 4724 individuals aged 50 years and above responded to the questionnaires. Of these 50.4 were males. Following multivariate logistic regression analysis; age; sex; educational level; income and ethnic background were found to significantly affect the SWB of older Ghanaians. Being male was associated with higher level of SWB (OR=1.68; CI: 1.39 - 2.03). For those 50 years and above; being younger (50-59 years) was also associated with a high level of SWB (OR=17.72; CI: 10.13-30.98). Earning a low income and having low educational level were both associated with low levels of SWB (OR=0.304; CI: 0.22-0.42; and OR=0.47; CI: 0.37-0.60 respectively). Ewes (p=0.027); Grumas (p=0.002) and Mole-Dagbons (p=0.04) had significantly higher SWB compared to the other ethnic groups. Conclusion: Among older Ghanaians; factors that positively influence SWB are younger age; male sex; high educational level and high income

Predictors of subjective well-being among older Ghanaians.

BACKGROUND: Later years of life are accompanied by many physical, emotional and environmental changes which may impact on the well-being of the individual. Many factors are known to influence the subjective well-being of older adults, but most, if not all of this information was the result of studies in the Western world. This study aimed at obtaining and documenting the predictors of subjective well-being (SWB) among older Ghanaians. METHODS: Data for the study was obtained from the WHO SAGE study. The single item measure of life satisfaction was used to determine subjective well-being. Descriptive statistics as well as logistic regression analysis were carried out to determine the predictors of SWB. RESULTS: A total of 4724 individuals aged 50 years and above responded to the questionnaires. Of these 50.4% were males. Following multivariate logistic regression analysis, age, sex, educational level, income and ethnic background were found to significantly affect the SWB of older Ghanaians. Being male was associated with higher level of SWB (OR=1.68; CI: 1.39 - 2.03). For those 50 years and above, being younger (50-59 years) was also associated with a high level of SWB (OR=17.72; CI: 10.13-30.98). Earning a low income and having low educational level were both associated with low levels of SWB (OR=0.304; CI: 0.22-0.42; and OR=0.47; CI: 0.37-0.60 respectively). Ewes (p=0.027), Grumas (p=0.002) and Mole-Dagbons (p=0.04) had significantly higher SWB compared to the other ethnic groups. CONCLUSION: Among older Ghanaians, factors that positively influence SWB are younger age, male sex, high educational level and high income.

Evaluation of warfarin initiation regimens in elderly inpatients.

STUDY OBJECTIVE: To compare initial warfarin doses of 5 mg or below and doses above 5 mg in hospitalized elderly. DESIGN: Retrospective review of charts identified from computerized pharmacy records. SETTING: County teaching hospital. PATIENTS: Inpatients aged 65 years or older receiving at least three warfarin doses. INTERVENTION: We measured the time to first international normalized ratio (INR) of 2.0 or greater, bleeding complications, number of warfarin doses held, and vitamin K use. MEASUREMENTS AND MAIN RESULTS: The average initial low dose (33 patients) was 4.8 +/- 0.8 mg and the average initial high dose (40 patients) was 9.0 +/-1.2 mg. The mean time to first INR of 2.0 or greater was similar, 3.4 and 3.0 days, respectively (p=0.38). The low-dose group had fewer bleeds (7 vs 13, p=0.28) and doses held (11 vs 18 patients, p=0.27, 30 vs 50 doses). Four patients in each group received vitamin K (p=0.8). Forty-four percent of patients with an INR of 4 or above and 48% of patients who had a dose held were on a long-term drug or had a new drug added that could cause a major drug interaction with warfarin. CONCLUSION: In this pilot study, hospitalized elderly who received a low versus high initial dose of warfarin achieved therapeutic INRs in a similar time and had lower but not significantly different safety outcomes.

Large-scale enzymatic synthesis of oligosaccharides.

The increasing recognition of the roles of carbohydrates in fundamental biological processes and their potential as new therapeutics has accentuated the requirement for access to large quantities of varying carbohydrate structures. During the past two years, tremendous advances have been made in the large-scale enzymatic synthesis of oligosaccharides using isolated enzymes or engineered whole cells. Glycosidase mutants, namely glycosynthases, have been constructed to increase both the yields and selectivity of the glycoside bond formation. The use of glycosyltransferases in oligosaccharide synthesis has been further improved by fusing a glycosyltransferase with a sugar nucleotide-synthesizing enzyme and by various routes of in situ sugar nucleotide regeneration. Moreover, several sugar nucleotides and oligosaccharides were produced economically by a combination of recombinant microorganisms harboring sugar nucleotide biosynthesis genes and a glycosyltransferase gene.

Arterial hypertension decreases fibrinogen molecules contribution to the inter-red cells connections in stroke patients.

In a group of 36 patients with acute ischemic stroke, the study of influence of arterial hypertension on the red cells and fibrinogen interaction was carried out by the aspect of fibrinogen molecules contribution to this phenomenon, respecting the role of other plasma biochemical factors. Patients were divided into two clinical groups: with and without arterial hypertension. In the blood samples with stable haematocrit ratio the following rheological properties were estimated: plasma viscosity, yield shear stress (YSS), fibrinogen level and parameter R (the difference between twice measurements of fibrinogen concentration). There were also measured the levels of albumin, IgG, IgA, IgM, cholesterol, HDL and LDL. The value of parameter R in patients with arterial hypertension was lower than the group without accompanying disease (statistical significance was indicated for 80% and 60% of plasma dilution). The first group of patients was also characterized by significant increase of IgA level (in comparison with the control group), whereas the red cells and fibrinogen interaction measured as a value of YSS was similar in both analyzed clinical groups. This study indicated a specific character some of hemorehological changes in relation to a certain vascular pathology.

Quantitative study of fibrinogen molecules' contribution to the inter-red cells connections in selected clinical groups of stroke patients.

In a group of 36 patients with acute ischemic stroke, a study of the influence of arterial hypertension on the red cells and fibrinogen interaction was carried out by the aspect of fibrinogen molecules' contribution to this phenomenon, respecting the role of other plasma biochemical factors. Patients were divided into two clinical groups: with and without arterial hypertension. In the blood samples with stable haematocrit ratio the following rheological properties were estimated: plasma viscosity, yield shear stress (YSS), fibrinogen level and parameter R (the difference between two measurements of fibrinogen concentration). Also measured were the level of albumin, IgG, IgA, IgM, cholesterol, HDL and LDL. The value of parameter R in patients with arterial hypertension was lower than in the group without accompanying disease (statistical significance was indicated for 80 and 60% of plasma dilution). The first group of patients was also characterized by a significant increase of IgA level (in comparison with the control group), whereas the red cells and fibrinogen interaction measured as a value of YSS was similar in both analysed clinical groups. This study indicated a specific character of some hemorheological changes in relation to a certain vascular pathology.

[A quantitative study of the role of fibrinogen molecules in inter-red cell connections of patients with stroke taken from selected clinical groups]. / Badania ilosciowego udzialu czasteczek fibrynogenu w tworzeniu polaczen miedzy krwinkami czerwonymi u chorych z niedokrwiennym udarem mózgu w wybranych grupach klinicznych.

In the group of 36 patients with acute ischemic stroke the study of the influence of arterial hypertension on the red cells and fibrinogen interaction was carried out in the aspect of the fibrinogen molecules contribution to this phenomenon, respecting the role of other plasma biochemical factors. Patients were divided into two clinical groups: with and without arterial hypertension. The quantitative fibrinogen molecules contribution to the inter-red cells connections in patients with arterial hypertension was lower than in the group without this accompanying disease (statistical significance was indicated for 80% and 60% of plasma dilution). The first group of patients was also characterized by a significant increase of IgA level (in comparison with the control group), whereas the red cells and fibrinogen interaction measured as a value of YSS was similar in both analyzed clinical groups.

Hemorheology in cerebral ischemia.

In the acute phase of ischemic stroke blood viscosity has been raised due to impaired plasticity of the erythrocytes and high value of plasma viscosity. Leukocyte membrane elasticity disfunction has also affected cerebral microcirculation. Stroke patients with concomitant hypertension indicated lower fibrinogen molecules contribution to the inter-red cells connections than the group without this additional disease. Persistence of abnormal hemorheological parameters has been observed following cerebral ischemia with increased blood and plasma viscosity, reduced plasticity of erythrocytes, higher fibrinogen level and increased erythrocytes aggregation, which suggests their role as possible risk factors. The selective plasmapheresis application beneficially influenced cerebral blood flow in microcirculation by means of hermorheological disturbances correction.

[Continued study of factors influencing the amount of shear wall stress in the acute phase of ischemic stroke]. / Dalsze badania czynników wplywajacych na wielkosc granicznego naprezenia scinajacego w ostrej fazie niedokrwiennego udaru mózgu.

In 36 patients with the acute ischemic stroke a significant decrease of level of apo A1 and HDL was indicated. Patients with transient ischemic attacks had significantly higher level of trigliceryde in blood than those with completed stroke. High significant correlations between level of fibrinogen and thixotropic effects/value of yield shear on 100 of a cortain biochemical factor/ of apo A1 and albumin were also indicated. The lack of these correlations in controls suggested a role of unknown factors in the red cells and fibrinogen interaction connected with ischemic disorders. The close study of these processes should lead to improve an efficiency of the treatment and prophylaxis of ischemic stroke by means of specific drugs.

[Examination of physical properties of blood in ischemic stroke]. / Badania wlasciwosci fizycznych krwi w niedokrwiennym udarze mózgu.

Physical properties of blood and some parameters of blood clotting have been examined in 41 patients with ischemic stroke. Patients have been divided into two groups-with transient ischemic attacks or reversible ischemic neurological deficit (TIA/RIND) and with completed stroke (CS). Blood viscosity has been significantly higher in the examined patients than that in the control group. It has mainly been associated with an increase in blood plasma viscosity and erythrocyte deformation disorders. Rheological disorders has been more prominent in patients with CS and an increase in blood plasma viscosity significantly exceeded the values noted in TIA/RIND group. It has been showed that an increase in erythrocyte rigidity and aggregation leads to a decrease in hematocrit. However, it is not sufficient to maintain normal blood viscosity.

[The influence of certain biochemical plasma factors on the rheological properties of white blood cells in acute cerebral ischemia]. / Ocena wplywu niektórych czynników biochemicznych osocza na wlasciwosci reologiczne krwinek bialych w ostrym niedokrwieniu mózgu.

Basing on the analysis of correlations between the rheological properties of white blood cells and certain biochemical plasma factors, in a group of 12 patients with acute ischaemic stroke, a positive correlation (p < 0.05) between the level of fibrinogen and the value of the relative filtration rate was determined. The result indicates that fibrinogen plays a role as a one of the factors decreasing white blood cell elasticity in the acute cerebral ischaemia.