Not all worries were created equal: the case of COVID-19 anxiety.

OBJECTIVES: The objective of this study was to investigate possible differences in COVID-19-related anxiety based on previous theories in social psychology. STUDY DESIGN: Cross-sectional online questionnaire delivered via the crowdworking platform. METHODS: Four-hundred and seven (120 men and 287 women) adults (aged >18 years) from the United Kingdom answered the State-Trait Anxiety Inventory 'in light of the COVID-19 situation', followed by three health and three financial anxiety items. RESULTS: Our findings imply that women are more anxious than men, people are more anxious about others than about themselves, their anxiety about relatives is higher than about strangers, and anxiety about health is higher than about financial issues. CONCLUSIONS: We suggest that these preliminary findings should be further investigated to help policymakers improve both their treatment of pandemic-related anxiety and their messages.

Frailty, cognitive impairment and mortality among the oldest old.

INTRODUCTION: Both frailty and cognitive impairment are increasingly prevalent with advancing age. Nonetheless among the oldest old their relationship is poorly described. This study examines the association between frailty status and cognitive impairment at age 85 and their impact on 5-year mortality. METHODS: A representative sample of 840 community dwelling people from the Jerusalem Longitudinal Cohort Study was comprehensively assessed at age 85. Frailty was defined according to the "phenotype of frailty", as including at least three of the following: weight loss, slowness, weakness, exhaustion and low physical activity levels. Pre frailty was defined as 1-2/5 criteria. Cognitive impairment was assessed according to the Mini Mental State Examination (MMSE). Mortality data was collected from age 85-90. RESULTS: A total of 164 (19.5%) were frail, 470 (56%) were pre frail and 206 (24.5%) were not frail, with prevalence of MMSE≤24 being 53.3%, 15%, and 7.4% respectively. A uniform pattern of increased adverse health, affective, disease and functional measures were associated with frailty status. Frailty status was significantly associated with cognitive impairment, with an Odds Ratios of 3.77 (95%CI 1.42-9.99) for MMSE≤24 after adjustment for socio demographic, medical mood and functional covariates. Among frail, pre frail and non frail subjects, 5-year mortality was 44.5%, 20.4%, 13.6% respectively. Mortality among frail subjects with or without cognitive impairment was 54.2% vs. 54.9%, p=0.9). Adjusting together for frailty, MMSE, education and gender, the Hazards ratio for 5-year mortality for frailty was 3.861 (95%CI 2.4-6.2), and for MMSE≤24 was 1.25 (95%CI 0.87-1.78). CONCLUSIONS: Among the oldest old, frailty status was significantly associated with cognitive impairment; after adjustment, frailty alone was predictive of subsequent mortality.

Glomerular filtration rate estimation and mortality in an elderly population.

BACKGROUND: Few studies have addressed the link between minor renal dysfunction and mortality in the elderly. AIM: To compare three equations for estimated GFR (eGFR) in assessing renal dysfunction and predicting mortality in an elderly population. DESIGN: Longitudinal observational study. METHODS: We studied 441 people from the Jerusalem Seventy Year Olds Longitudinal Study who had measurements of serum creatinine, all of whom were aged 70 years at study initiation and were living in the community. GFR was estimated based on serum creatinine and using the Cockcroft-Gault (CG), the abbreviated Modification of Diet in Renal Disease (MDRD) and the Mayo Clinic equations. Twelve-year mortality was the main outcome measure. RESULTS: The prevalence of reduced eGFR was 51% using the CG, 34% using MDRD and 16% using the Mayo Clinic equation. eGFR dichotomized by the definition of CKD significantly predicted mortality only with the Mayo Clinic equation (hazard ratio 1.56, 95%CI 1.01-2.39). When eGFR was divided into quartiles and the lowest compared to the highest, all equations predicted mortality. Hazard ratios (95%CI) were 5.48 (1.27-23.65), 7.47 (2.74-20.3), and 7.375 (3.13-17.36), for CG, MDRD, and Mayo Clinic, respectively. DISCUSSION: Reduced eGFR was prevalent in this study group, and associated with mortality. This association was strongest using the Mayo Clinic equation.

Moderate renal insufficiency at 70 years predicts mortality.

BACKGROUND: Glomerular filtration rate (GFR) diminishes with age. Kidney function in the elderly is often assessed by serum creatinine alone, although it is insensitive in this age group. Formulae for predicting GFR are not widely used. AIM: To study the effect of low predicted GFR on mortality. DESIGN: Longitudinal cohort study. SETTING: The community-based Jerusalem Seventy Year Olds Longitudinal Study. METHODS: We studied 445 subjects, all aged 70 years, using questionnaires, a medical examination with history-taking, and standard laboratory tests. Moderate renal insufficiency was defined as a predicted GFR of <60 ml/min, based on the Cockcroft-Gault (CG) and the Modification of Diet in Renal Disease (MDRD) equations. RESULTS: Predicted GFR was normally distributed, with a mean +/- SD of 62.4 +/- 15.27 ml/min. Predicted GFR was <60 ml/min in 221 (46%), most of whom had normal serum creatinine. Twelve-year mortality was 38.7% in these 221 vs. 27% in the other 204. The survival advantage was already evident after 3 years. Under Cox proportional hazard analysis using numerous common risk factors as independent variables, lower predicted GFR had a significant mortality risk (hazard ratio 2.108, 95%CI 1.43-3.12, p = 0.0002). DISCUSSION: In community-dwelling elderly people, moderate renal insufficiency as assessed using the CG equation is a strong and independent predictor of mortality. Most of these at-risk patients have 'normal' serum creatinine.

Recommended micronutrient supplementation for institutionalized elderly.

A committee nominated by the Israel Ministry of Health examined the relevant literature and the local recommendations as well as the recommendations from other countries and suggested a daily micronutrient supplementation for institutionalized elderly living in institutions supervised by the Ministry of Health. The micronutrient preparatory, tailored for this population, is designed to contain about half the RDA for most of the vitamins and some microelements. Biotin and vitamins C, D and B12 as well as zinc, copper, chromium and molybdenum are suggested at a level higher than half the RDA, whereas fluorine, at a lower level. Major elements (calcium, magnesium and phosphorus) are excluded and should be supplied separately. Vitamin K and iron are also excluded. Fat-soluble vitamins should be microencapsulated. Micronutrient supplementation for institutionalized elderly is part of the Ministry of Health s balanced nutrition policy. The committee s recommendations are also applicable to the free-living elderly population.

[Micronutrient (vitamins and minerals) supplementation for the elderly, suggested by a special committee nominated by Ministry of Health].

The elderly tend to be at a higher risk for nutritional deficiencies and in particular for micronutrient deficiencies. A committee nominated by Ministry of Health examined the relevant literature and the local recommendations as well as the recommendations from other countries and suggested a daily special micronutrient supplementation for institutionalized elderly. The preparatory will contain about half the RDA for most of the micronutrients, except for fluorine that is recommended at a lower level and biotin, vitamins D, C, B12 as well as zinc, copper and molybdenum at a level higher than half the RDA. Major elements such as calcium, are not included in the preparatory and would be supplied separately when needed. Vitamin K and iron are excluded as well. The suggested preparatory composition, mg: vitamin A, 0.450; vitamin D, 0.015; vitamin E, 10; thiamin, 0.6 Pound riboflavin, 0.7; biotin, 0.030; pantothenic acid, 3; niacin, 8; vitamin C, 60; vitamin B6, 0.8; folic acid, 0.120; vitamin B12, 0.0024; choline up to 275; zinc, 8; copper, 0.9; fluorine, 0.5; manganese, 1.2; chromium 0.020; molybdenum, 0.045; selenium, 0.030; and iodine, 0.075. Fat-soluble vitamins should be microencapsulated. Micronutrient supplementation is part of Ministry of Health balanced nutrition policy. The committees recommendations are also applicable for the free-living elderly.

Nutrition and quality of life in the aged: the Jerusalem 70-year olds longitudinal study.

Inadequate nutrition is a major problem of elderly people today. Yet, despite the prevalence and significance of the problem, there is little information on the nutritional status of elderly persons in the community, and its impact on their quality of life. During 1990-1991, as part of a first cross-section in a longitudinal medical and social study of 70-year olds in Jerusalem, we surveyed the nutritional status of this population. During the first phase, 605 people were examined in their homes; data were collected regarding socioeconomic status, education, self-perceived health state, use of medications and health services, and ADL. During the second stage, a sub-group of 463 people was examined in a geriatric outpatient clinic; all subjects underwent medical history, physical examination, cognitive assessment, psychiatric questionnaire, blood and urine tests, electrocardiogram, and pulmonary function tests. In addition, general hospital admissions and morbidity and mortality in the two years following the study were studied. The nutritional status of the participants was determined according to nutritional assessment (NA) scale, based on the Mini Nutritional Assessment (MNA). The majority of the study population lived at home, was without cognitive disturbance (86%), and was independent in ADL (83%). Based on NA > 24, 91% of the study population were in good nutritional state, 8.3% were at risk of undernutrition, and 0.7% were malnourished. There was a significant positive relationship between NA score and ADL as well as cognitive state. In addition, a strong negative relation was found between NA score and visits to the family physician in the previous fortnight, visits to the emergency room in the previous year, and hospital admissions in the following two years. An inverse relation, although not significant, was found between NA score and two-year post-study mortality. These results suggest that the nutritional status of the studied population is inadequate, and that the nutritional state is one of the major determinants of the quality of life in the elderly and therefore, should be part of any geriatric assessment. Elder population surveys are needed to identify and treat at risk elders.

The effects of physical activity on mortality in the Jerusalem 70-Year-Olds Longitudinal Study.

OBJECTIVE: To study the association between physical activity and mortality in older men and women. DESIGN: A community-based cohort study: the Jerusalem 70-Year-Olds Longitudinal Study. PARTICIPANTS: A systematically selected and representative sample of all residents of the western part of Jerusalem born in 1920-1921: 456 subjects, 25% of the total population. MEASUREMENTS: An extensive social and medical profile was developed by extensive interview and physical and ancillary examination. Medical diagnoses were established and subjects reported their level of regular physical activity. RESULTS: Unadjusted mortality at 6-year follow-up was significantly greater for subjects reporting no regular exercise than for those walking as little as 4 hours weekly (23.4% vs 9.9%, odds ratio (OR) = 2.77; 95% confidence interval (CI), 1.64-4.69). The significance of these benefits was demonstrated for males as well as for females (30.28% vs 12.14%, P < .001, 16.19% vs 6.86%, P = .036, respectively). Logistic regression analysis demonstrated the survival advantage to be independent of gender, smoking, subjective economic hardship, or preexisting medical conditions (hypertension; diabetes; coronary artery, cerebrovascular, renal, and respiratory diseases; anemia; and malignancy). Increased regularity of activity correlated with declining mortality. The odds ratios for mortality compared to the sedentary group were 0.73 (CI, 0.33-1.62) for those doing sports activity at least twice weekly, 0.41 (CI, 0.19-0.91) for those walking at least 4 hours weekly, 0.14 (CI, 0.04-0.50) for those exercising daily, and 0.40 (CI, 0.22-0.72) for all levels of physical activity combined. CONCLUSIONS: These results suggest that regular physical activity confers increased survival in the aged. It is proposed that older people be encouraged to engage in regular, moderate physical activity.

Mortality in the Jerusalem 70-year-olds longitudinal study: does nifedipine have a role?

BACKGROUND: Short-acting nifedipine was found to be associated with increased mortality in elderly patients in some studies. METHODS: We examined effects of long-acting nifedipine in a longitudinal study of Jerusalem 70 year olds (448 participants). RESULTS: After follow-up of 6.5 years (1990-1996) 70 subjects died. We examined the effects of baseline variables on total mortality. Hypertensives had higher mortality than normotensives, 21.2% versus 13.8%, p = 0.01. Diuretic-treated patients (n = 72), mostly hypertensive (n = 71), had significantly higher mortality than non-diuretic-treated patients (n = 375), 45.5% versus 14.1%; p < 0.001. Although nifedipine-treated patients had a higher prevalence of coronary heart disease diagnosis than diuretic-treated patients (52% versus 35%), their relative risk of mortality was 0.8 (CI 0.4-1.4) of that of diuretic-treated patients. A multiple logistic regression model, including gender, systolic blood pressure, creatinine, cholesterol, diagnosis of congestive heart failure, cardiovascular arrest, diabetes, previous myocardial infarction, physical activity, nifedipine, other calcium channel and beta blockers and diuretics, found only serum creatinine and diuretic therapy associated with total mortality, p = 0.004 and p < 0.02, respectively. When interaction terms were added to account for drug combinations, diuretic therapy lost significance, but the combination of diuretics and beta blockers (probably representing a more severe form of hypertension) became significant, p = 0.03. CONCLUSION: Long acting nifedipine is not associated with increased mortality in elderly hypertensives.

Inhibition of concanavalin A-induced acute T cell dependent hepatic damage in mice by hypothyroidism.

AIMS/BACKGROUND: Concanavalin A (Con A) activates T lymphocytes and causes acute T-cell-mediated hepatic injury in mice. Decreased thyroid hormonal production is associated with a variety of immunological manifestations, including inactivation of macrophages with reduced TNF production and reduced soluble IL-2 receptors in the serum. We have recently shown that hypothyroidism prevents the development of cirrhosis and also minimizes hepatic damage in rats with fulminant hepatic failure. In the present study we examined the effects of hypothyroidism on a mouse model of Con A induced T cell-mediated acute hepatitis. METHODS: Hypothyroidism was induced both medically (MMI, PTU) and surgically. Eight groups of 10 mice each were studied: euthyroid controls (2 groups: water, Con A) and hypothyroid (6 groups: MMI, PTU, Surgical, MMI-Con A, PTU-Con A, Surgical-Con A). RESULTS: Hepatic inflammation was significantly decreased in each of the Con A treated hypothyroid groups of mice. The serum transaminases, TNF-alpha and IL-6 levels were significantly elevated in the Con A treated group while near normal levels were found in the hypothyroid Con A treated groups (mean+/-SE AST: 1499+/-18 vs 78+/-10 IU/l, p<0.001; TNF: 2500+/-250 vs 135+/-15 pg/ml, p<0.001, IL-6: 12,200+/-300 vs 1260+/-140 pg/ml, p<0.001, respectively). CONCLUSIONS: Hypothyroidism, independent of the mode of induction, can effectively inhibit the development of acute T cell-mediated liver damage in mice. These results suggest that some decrease in thyroid function might have a role in the prevention of immune mediated liver diseases.

Methimazole slows hepatocyte streaming in rats.

Hepatocytes are hypothesized to continually stream from the portal tract to the terminal hepatic vein. By this model, when a cell divides, one of its progeny replaces the dividing ancestor and the other is displaced into a more remote location. The present experiment aims to demonstrate that hypothyroidism affects liver cell turnover. Thirty male adult rats were divided into two groups. One received methimazole for two weeks and the other served as control. Each rat was injected intraperitoneally with 18.5 KBq [3H]thymidine/g body weight. Rats were killed after 1 hr and two and four weeks. Autoradiography was done. The distance of the labeled cells from the portal tract was measured. The mean TSH levels of the methimazole-treated group and controls were 1.45 and 0.25 mM/liter, respectively (P < 0.01). Hepatocyte streaming was lower in hypothyroid (1.8 microns/day) than in untreated rats (2.5 microns/day) (P < 0.01). The respective labeling indices 1 hr after labeling were 0.9% and 1.24% (P < 0.05). We conclude that hypothyroidism diminishes hepatocyte and littoral cell turnover and slows down their streaming.

Anti-thyroid drugs decrease mucosal damage in a rat model of experimental colitis.

BACKGROUND: Methimazole, an anti-thyroid drug, was recently found to be useful in the treatment of systemic lupus erythematosus and other autoimmune diseases. Moreover, decreased thyroid hormone production is associated with a variety of immunological manifestations, such as reduced activation of CD4+ cells, increased CD8+ cell activity and reduced soluble IL-2 receptors. In the present study we examined the effects of methimazole and propylthiouracil on a rat model of experimental colitis. METHODS: Colitis was induced by intracolonic administration of 30 mg trinitrobenzene sulphonic acid (TNB). Two weeks prior to induction of colitis, rats were treated by either methimaziole (0.04%) or propylthiouracil (0.01%) in drinking water after a week of free access to water. Rats were sacrificed 48 h or 7 days after induction of colitis. The colon was isolated, rinsed with ice-cold water and weighed. Damage was assessed both macroscopically and microscopically and myeloperoxidase (MPO) activity determined. RESULTS: All treated rats were hypothyroid as manifested by a significant elevation of thyroid stimulating hormone (TSH), by comparison with the control groups (mean -1.82 +/- 0.40 versus 0.11 +/- 0.02 mmol/L, respectively). The inflammatory response elicited by TNB resulted in severe mucosal damage 48 h after damage induction, which persisted for 7 days. Pre-treatment with either methimazole 0.04% or propylthiouracil 0.01% significantly decreased mucosal damage macroscopically (lesion area, lesion score and segmental weight) microscopically and also significantly decreased MPO level at both time points (P < 0.01). CONCLUSIONS: Methimazole and propylthiouracil significantly reduce mucosal damage and colonic weight in a rat model of colitis. The mode by which they do so remains to be studied.

Laboratory reference values for the 70 year olds.

Reference values for common laboratory tests were determined as part of a cross-sectional survey of 70 year olds in Jerusalem in 1991. Subjects were systematically chosen from electoral lists. They were extensively interviewed regarding demographic, socioeconomic and health characteristics. Subsequently, 456 underwent a thorough medical examination including hematologic, biochemical and endocrinologic testing. Analysis of disease-specific mortality and hospital morbidity at 3 year follow-up proved these subjects to be representative of the overall Jerusalem Jewish population of 70 year olds. Test-specific reference subgroups were determined to exclude effects of known diseases and drug consumption. Reference values in these subgroups differ significantly from reference values currently used for adults without regard to age. The determination of disease for subjects provided the opportunity to identify changes that might reflect normal aging and those that might be affected by subclinical pathology. Interpretation of laboratory testing of older adults must consider the age-related differences in reference values.

The nutritional status of 70 year olds in Jerusalem.

Inadequate nutrition is a major problem of elderly people today, a rapidly growing segment of western societies. Yet information on the nutritional state of the elderly in the community is much needed. We surveyed the nutritional status of a cohort of 70 year olds living in western Jerusalem. A total of 605 persons were interviewed in their home regarding socioeconomic variables, education, self-assessed global health status, use of medicines, and activities of daily living (ADL). In the second stage, a subsample of 463 of the above attended an outpatient geriatric clinic where a medical history was taken and a physical examination, a cognitive test, a psychological profile, blood and urine tests, electrocardiogram, pulmonary function tests, and grip strength measurement performed. Most of the sample population lived at home. Twelve percent reported having severe financial problems. Approximately 14% exhibited some cognitive problems, 83% were totally independent in ADL, and only 15% were housebound with 2.5% being bedbound. Body mass index (BMI) of < 19 kg/m2 was found in 1.1% of the population, while obesity, defined as a BMI > 30 kg/m2, was found in 13.5% of males and 28.6% of females. Polypharmacy was prevalent. A quarter of the study population were taking three or more prescription drugs. Serum triglycerides were below the normal limit in 7.3% of males and 4.7% of females, while total serum cholesterol concentrations were low in 13.9% and 4.7% of males and females respectively. Serum albumin was found below the lower limit of normal (35 g/l) in 16.9% of females and 11.4% of males. The significance of these results, their relation to other nutritional surveys, and their implications for the future are discussed.

Hemodynamic effects of hypothyroidism induced by methimazole in normal and portal hypertensive rats.

Portal hypertension is accompanied by a hyperdynamic circulatory state that shares some similarities with thyrotoxicosis. This study was conducted in order to investigate the hemodynamic effects of hypothyroidism in a rat model with portal hypertension induced by partial portal vein ligation (PVL). Four groups of 10 rats each were studied: normal control and hypothyroid rats, and PVL control and hypothyroid rats. Hypothyroidism was induced by methimazole 0.04% in drinking water. Hemodynamic measurements were performed using the radioactive microsphere technique. Induction of hypothyroidism was confirmed by elevated TSH levels. In the PVL groups, hypothyroidism ameliorated the hyperdynamic circulation. Portal venous inflow and portal pressure dropped significantly: 7.1 +/- 0.2 vs 4.8 +/- 0.3 ml/min/100 g body wt (P < 0.01) and 13.4 +/- 0.9 vs 10.9 +/- 0.8 mm Hg; (P < 0.01), respectively. In normal rats, hypothyroidism was manifested by a hypodynamic circulatory state. These results demonstrate that hypothyroidism induced by methimazole is followed by amelioration of the hyperdynamic circulation, normalization of portal venous inflow, and reduction of portal pressure.

Somatostatin-receptor imaging of medullary thyroid carcinoma.

In-111 pentetreotide scintigraphy of 10 patients with residual or metastatic medullary thyroid carcinoma is described. Six patients had sporadic tumor and 4 had MEN IIB. Foci of increased tracer uptake were observed in 9 patients: in the thyroid bed (4 patients), the mediastinum (3 patients.), the shoulder area and left lower abdomen (1 patient), and the left upper abdomen (1 patient). The 10th patient had no abnormal uptake. CT confirmed 2 mediastinal lesions and 2 out of 3 thyroid masses, but did not detect the thyroid remnants or the lesions in the shoulder area and abdomen. Lung lesions < or = 1 cm in diameter and ill-defined liver foci (2 patients) were seen on CT, but not on scintigraphy. Small liver metastases not demonstrated on CT or on scintigraphy were identified at surgery in a MEN IIB patient. Elevated urinary epinephrine was found in 2 out of 4 MEN IIB patients. In one, tracer uptake in the left adrenal corresponded to a mass on CT, to pathological uptake of MIBG and DMSA, and to a tumor removed at surgery. The second patient had peritoneal spread of malignant pheochromocytoma (at surgery), but negative CT and only a single focus in the left lower abdomen on scintigraphy. Somatostatin-receptor imaging is useful for the detection of residual and recurrent medullary thyroid carcinoma, and may identify pheochromocytoma in MEN IIB patients.

A unique presentation of lymphoma of the colon.

Non-Hodgkin's lymphoma often involves the gastrointestinal tract, but primary lymphoma of the colon is rare. Primary lymphoma of the colon masquerading as inflammatory bowel disease is even rarer. We report a patient with an initial diagnosis of Crohn's colitis, who later appeared to have had non-Hodgkin's lymphoma of the colon. We review the diagnosis and treatment of this rare disease.