Use of angiotensin converting enzyme inhibitors is associated with reduced risk of late bladder toxicity following radiotherapy for prostate cancer.

BACKGROUND AND PURPOSE: Genome-wide association studies (GWAS) of late hematuria following prostate cancer radiotherapy identified single nucleotide polymorphisms (SNPs) near AGT, encoding angiotensinogen. We tested the hypothesis that patients taking angiotensin converting enzyme inhibitors (ACEi) have a reduced risk of late hematuria. We additionally tested genetically-defined hypertension. MATERIALS AND METHODS: Prostate cancer patients undergoing potentially-curative radiotherapy were enrolled onto two multi-center observational studies, URWCI (N = 256) and REQUITE (N = 1,437). Patients were assessed pre-radiotherapy and followed prospectively for development of toxicity for up to four years. The cumulative probability of hematuria was estimated by the Kaplan-Meier method. Multivariable grouped relative risk models assessed the effect of ACEi on time to hematuria adjusting for clinical factors and stratified by enrollment site. A polygenic risk score (PRS) for blood pressure was tested for association with hematuria in REQUITE and our Radiogenomics Consortium GWAS. RESULTS: Patients taking ACEi during radiotherapy had a reduced risk of hematuria (HR 0.51, 95%CI 0.28 to 0.94, p = 0.030) after adjusting for prior transurethral prostate and/or bladder resection, heart disease, pelvic node radiotherapy, and bladder volume receiving 70 Gy, which are associated with hematuria. A blood pressure PRS was associated with hypertension (odds ratio per standard deviation 1.38, 95%CI 1.31 to 1.46, n = 5,288, p < 0.001) but not hematuria (HR per standard deviation 0.96, 95%CI 0.87 to 1.06, n = 5,126, p = 0.41). CONCLUSIONS: Our study is the first to show a radioprotective effect of ACEi on bladder in an international, multi-site study of patients receiving pelvic radiotherapy. Mechanistic studies are needed to understand how targeting the angiotensin pathway protects the bladder.

Is There a Cohort Explanation for Declines in Elderly Migration?

Previous research documented a dramatic decline in the residential mobility of elderly Canadians (65 years and older) since 1961. We examine more recent data from the 2011 and 2016 censuses to update findings and extend previous research. We first found that elderly residential mobility has continued to decline. There were substantial declines of 20 per cent and more for all types of residential mobility. Second, descriptive analysis of changes over time in the proportion of the population that lives in a different province than their province of birth for 1871 to the present suggests that the 1906-1925 birth cohorts experienced migration rates that were slightly higher than comparable later cohorts. Third, multivariate analysis of 1971-2016 interprovincial migration data shows that the 1906-1925 birth cohort who entered early adult years during World War II had higher migration rates than earlier or later birth cohorts. The cohort explanation accounted for 10 per cent of the decrease in elderly migration between 1981 and 2016. A cohort explanation can therefore contribute to understanding decreased elderly migration, but many questions remain for future study.

Implementation of photographic triage in a paediatric dental, orthodontic, and maxillofacial department during COVID-19.

BACKGROUND: During the COVID-19 pandemic, limitations were placed on face-to-face encounters in dentistry and oral and maxillofacial surgery (OMFS) in order to promote physical distancing and reduce viral propagation. To facilitate continued assessment of dental, orthodontic, and maxillofacial emergencies, a photographic triage system was initiated at Alder Hey Children's Hospital (AHCH). We will discuss the benefits this system offers at a patient, clinician, departmental, and NHS service level. AIM: To share our experience of photographic triage during the first 3 months of COVID-19 lockdown, lessons learned, and recommendations. DESIGN: Prospective data collection over 3 months. RESULTS: 220 photographic referrals were received, and swelling (30%) and dental trauma (27%) were the most common presenting complaints. 57% of referrals were not seen, 23% were seen semi-urgently, and 20% booked for outpatient review. Of those seen, 7 children were seen elsewhere and 44 were seen face-to-face at AHCH, with 8 being admitted. CONCLUSION: Photographic triage reduced physical encounters and proved useful in training junior staff, assessment of new patient referrals, and first on-call from home. Implementation should be considered throughout dental, orthodontic, and OMFS departments nationwide. In the event of a COVID-19 resurgence or emergence of a new pandemic, photographic triage could facilitate physical distancing and service provision.

Living Alone Among Older Adults in Canada and the U.S.

Increasing proportions of people, including older adults, live alone. Studying living arrangements of the elderly is important because these affect and reflect general well-being of the elderly and inform communities' response to elderly housing needs. We analyze data from the 2006 Canadian Census and the 2006 American Community Survey to examine living alone among non-married older adults aged 55 and older in Canada and the U.S. The paper has two parts. First, we compare native- and foreign-born elderly to see if immigrants are less likely to live alone. Second, we examine factors associated with living alone among older immigrants. While older immigrants in both countries are less likely to live alone, the large differences are substantially reduced once various explanatory variables are considered. Comparisons of four gender/country groups of older immigrants show the positive role of economic and acculturation factors on living alone among older immigrants. With few exceptions, predictors of living alone are similar for older immigrants in Canada and the U.S.: living alone is mainly explained by a combination of economic and acculturation factors, taking demographic variables into account. Findings underline the need for age-friendly housing with innovative design and technology that can accommodate older people who live alone, including older immigrants who may have different needs and cultural preferences.

Group size and secular endogamy among the religiously unaffiliated in Canada.

High religious intermarriage among the religiously unaffiliated is usually interpreted as evidence of religion's minor importance for this group. Between 1981 and 2011, religious intermarriage among the unaffiliated in Canada declined from 38 percent to 21 percent, while the unaffiliated population tripled from 7 percent to 23 percent. This paper examines the role of demographic factors such as increased group size in decreased religious intermarriage among the unaffiliated. Using census and survey data, we estimate probit models of religious intermarriage for unaffiliated men and women. The models include individual and group-level characteristics. Results show that for both sexes, relative group size was the single largest contributor to decreased intermarriage. Increased group size allowed the expression of endogamous or within-group marital preferences among the unaffiliated. This secular endogamy, or preference for within-group marriage among the unaffiliated, represents an increasingly important form of religion-related marriage as the unaffiliated population grows.

Residential mobility of elderly Canadians: trends and determinants.

An understanding of trends and determinants for the residential mobility of elderly Canadians is essential for public policy and planning. Study of the patterns, changes over time, and determinants of the mobility of older Canadians has become increasingly important as the population ages. Elderly residential mobility has decreased substantially since 1971, and almost one-half of this decrease is due to changes in population composition. Because the multivariate analysis described here does not account for most of the downward trends in residential mobility, however, further work is needed on speculative explanations discussed in this article.

Residential independence of elderly immigrants in Canada.

This article addresses three questions: Are elderly immigrants less likely than Canadian-born elderly people to reside independently? What are the effects of economic, cultural, and life course factors on residential independence among elderly immigrants? What are the effects of immigrant-specific characteristics such as duration of residence and cultural background? Descriptive results show that elderly immigrants are less likely to reside independently, but the large gap of over 15 per cent is reduced to 5 per cent once economic, cultural, life course, and other factors are considered in the multivariate analysis. Effects of economic, cultural, and life course factors are mostly as expected, as are those of immigrant-specific characteristics such as duration of residence. Although aging immigrants have more-varied living arrangements than their Canadian-born peers, these are likely to increasingly include residential independence.