Predicting depression in old age: Combining life course data with machine learning.

With ageing populations, understanding life course factors that raise the risk of depression in old age may help anticipate needs and reduce healthcare costs in the long run. We estimate the risk of depression in old age by combining adult life course trajectories and childhood conditions in supervised machine learning algorithms. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we implement and compare the performance of six alternative machine learning algorithms. We analyse the performance of the algorithms using different life-course data configurations. While we obtain similar predictive abilities between algorithms, we achieve the highest predictive performance when employing semi-structured representations of life courses using sequence data. We use the Shapley Additive Explanations method to extract the most decisive predictive patterns. Age, health, childhood conditions, and low education predict most depression risk later in life, but we identify new predictive patterns in indicators of life course instability and low utilization of dental care services.

Role of serum-free light chain assay for defining response and progression in immunoglobulin secretory multiple myeloma.

The International Myeloma Working Group (IMWG) guidelines recommend using electrophoresis and immunofixation to define response and progressive disease (PD) in immunoglobulin (Ig) secretory multiple myeloma (Ig-MM), whereas the role of serum-free light chain (sFLC) is controversial. We retrospectively analyzed the value of adding sFLC assays in the definition of response and PD according to IMWG criteria in 339 Ig-MM patients treated with a first-line novel agent-based therapy (median follow-up 54 months). sFLC PD was defined according to conventional criteria plus increased sFLC levels, or sFLC escape (sFLCe); progression/sFLCe-free survival (ePFS) was the time from the start of treatment to the date of first PD or sFLCe, or death; overall survival after PD/sFLCe (OS after Pe) was the time from first PD or sFLCe to the date of death. 148 (44%) patients achieved a complete response and 198 (60%) a normal sFLC ratio (sFLCR). sFLCR normalization was an independent prognostic factor for extended PFS (HR = 0.46, p = 0.001) and OS (HR = 0.47, p = 0.006) by multivariable analysis. 175 (52%) patients experienced PD according to the IMWG criteria, whereas 180 (53%) experienced PD or sFLCe. Overall, a sFLCe was observed in 31 (9%) patients. Median PFS and ePFS were both equal to 36 (95% CI = 32-42, and 32-40, respectively) months. sFLC PD adversely affected the OS after Pe compared to PD with increasing monoclonal Ig only (HR = 0.52, p = 0.012). Our results support the inclusion of the sFLC assay for defining response and PD in Ig-MM.

Subcutaneous bortezomib-containing regimens as up-front treatment of newly diagnosed transplant-eligible multiple myeloma patients: a retrospective, non-interventional observational study.

Subcutaneous (SC) bortezomib-based regimens represent the standard induction therapy prior to autologous stem cell transplantation (ASCT) in newly diagnosed multiple myeloma patients. Published data are based principally on intravenous (IV) administration: this retrospective observational study aimed to define patients' outcomes upon SC bortezomib administration, before and after ASCT. Of 131 enrolled patients, 86% received bortezomib-dexamethasone plus thalidomide (VTD), 5% plus cyclophosphamide (VCD), and 9% alone (VD), for a median of 4 cycles induction therapy, followed by single (52%) or double (48%) ASCT. 48 patients received consolidation with the same induction regimen. 35% had at least one adverse event, mainly gastrointestinal disorders and peripheral neuropathy (PN). ORR was 93.1%, 97.7% and 100%, after induction, ASCT(s) and consolidation, respectively. Median PFS and PFS2 were 55.8 months and 72 months, respectively, (median follow-up 45.3 months), while median OS was unreached. Concluding, SC bortezomib has similar efficacy with reduced PN than IV administration.

Application of the EU-SILC 2011 data module "intergenerational transmission of disadvantage" to robust analysis of inequality of opportunity.

This data article describes the original data, the sample selection process and the variables used in Andreoli and Fusco (Andreoli and Fusco, 2019) to estimate gap curves for a sample of European countries. Raw data are from 2011 roaster of EU-SILC, cross-sectional sample of module "intergenerational transmission of disadvantage". This article reports descriptive statistics of the using sample. It also discusses the algorithm adopted to estimate the main effects and details the content of additional Stata files stored on the online repository. These additional files contain raw estimates from bootstrapped samples, which form the basis for estimating gap curves and their variance-covariance matrices. The data article also reports representations of gap curves for all 16 selected countries.

Understanding how older age drives decision-making and outcome in Immune Thrombocytopenia. A single centre study on 465 adult patients.

We analysed the impact of older age on the management of immune thrombocytopenia (ITP) in 465 adult patients diagnosed between 1995 and 2017 and followed at our institution for a minimum of 12 months. Over a follow-up of 4248 patient-years, front-line corticosteroids therapy was required in 334 patients (71·8%), mainly (85·3%) within 1 year from diagnosis. Need for first-, second- and third-line therapy was comparable in younger and older (age ≥65 years, n = 154) patients. Older patients presented more frequently with severe haemorrhages, started therapy with a higher platelet count and received lower dose front-line corticosteroids; thereafter, they were preferentially treated with mild immunosuppressive therapies/thrombopoietin-receptor agonists. Conversely, younger patients were more frequently treated with rituximab and splenectomy, achieving higher rates of complete responses. Incidence rates of ≥grade 2 complications were: 2·87 (haemorrhages), 1·55 (infections) and 0·66 (thromboses) per 100 patient-years. Older age (P = 0·01) and active haemorrhages at diagnosis (P = 0·01) significantly predicted grade ≥2 haemorrhages during follow-up. Older age (P = 0·01), male gender (P = 0·01), and thrombopoietin receptor agonist use (P = 0·02) were significantly associated with a higher probability of thrombosis over time. Older age is a significant driver of diagnostic/therapeutic strategy in ITP resulting in different responses and complications rates.

On social polarization and ordinal variables: the case of self-assessed health.

Social polarization refers to the measurement of the distance between different social groups, defined on the basis of variables such as race, religion, or ethnicity. We propose two approaches to measuring social polarization in the case where the distance between groups is based on an ordinal variable, such as self-assessed health status. The first one, the 'stratification approach', amounts to assessing the degree of non-overlapping of the distributions of the ordinal variable between the different population subgroups that are distinguished. The second one, the 'antipodal approach', considers that the social polarization of an ordinal variable will be maximal if the individuals belonging to a given population subgroup are in the same health category, this category corresponding either to the lowest or to the highest health status. An empirical illustration is provided using the 2009 cross-sectional data of the European Union Statistics on Income and Living Conditions (EU-SILC). We find that Estonia, Latvia, and Ireland have the highest degree of social polarization when the ordinal variable under scrutiny refers to self-assessed health status and the (unordered) population subgroups to the citizenship of the respondent whereas Luxembourg is the country with the lowest degree of social polarization in health.