Dissecting the midlife crisis: disentangling social, personality and demographic determinants in social brain anatomy.

In any stage of life, humans crave connection with other people. In midlife, transitions in social networks can relate to new leadership roles at work or becoming a caregiver for aging parents. Previous neuroimaging studies have pinpointed the medial prefrontal cortex (mPFC) to undergo structural remodelling during midlife. Social behavior, personality predisposition, and demographic profile all have intimate links to the mPFC according in largely disconnected literatures. Here, we explicitly estimated their unique associations with brain structure using a fully Bayesian framework. We weighed against each other a rich collection of 40 UK Biobank traits with their interindividual variation in social brain morphology in ~10,000 middle-aged participants. Household size and daily routines showed several of the largest effects in explaining variation in social brain regions. We also revealed male-biased effects in the dorsal mPFC and amygdala for job income, and a female-biased effect in the ventral mPFC for health satisfaction.

Invasive Coronary Physiological Assessment in Symptomatic Middle-Aged Endurance Athletes

Despite the health benefits of routine exercise, coronary artery disease (CAD) is common among older competitive athletes and is an important cause of sudden cardiac death. Athletes with suspected or confirmed CAD routinely undergo conventional coronary angiography involving the performance of invasive coronary physiological assessment using the fractional flow reserve (FFR) or the instantaneous-wave free ratio (iFR). Data defining the role of invasive coronary physiological assessment, while robust in general clinical populations, are untested among older competitive athletes with CAD. The paper discusses the challenges and uncertainties surrounding the use of the FFR and iFR in this unique population with an emphasis on the need for future work to better define this approach

Systemic Inflammation and Cardio-Renal Organ Damage Biomarkers in Middle Age Are Associated With Physical Capability Up to 9 Years Later.

BACKGROUND: Physical capability, a key component of healthy aging, is associated with cardiovascular and other risk factors across life. We investigated whether midlife biomarkers of heart and kidney damage capturing the cumulative impact of long-term adverse exposures were associated with the level and decline in physical capability over 9 years of follow-up, taking account of systemic inflammatory biomarkers and conventional cardiovascular risk factors. METHODS: We used data on 1736 men and women from the oldest British birth cohort study with walking speed, chair rise speed, balance time, and grip strength assessed at ages 60 to 64 and 69 years. We tested associations between logged and standardized measures of cystatin C, NT-proBNP (N-terminal pro-B-type natriuretic peptide), interleukin (IL)-6, and E-selectin at age 60 to 64 years with performance at age 69 years, adjusting for sex, height, and body mass index; then for performance at age 60 to 64 years. These biomarkers were mutually adjusted, and additionally adjusted for cardiovascular risk factors (pulse pressure, total/high density lipoprotein cholesterol, glycosylated hemoglobin), diabetes mellitus, cardiovascular and kidney disease, smoking status, and lifetime socioeconomic position. RESULTS: Cystatin C, NT-proBNP, and IL-6 (but not E-selectin) were inversely associated with all outcomes, adjusted for sex, height, and body mass index. For example, a 1-SD increase in logged NT-proBNP was associated with weaker grip (-0.63 kg, 95% CI, -0.99 to -0.28); the equivalent association for cystatin C was -0.60 kg (95% CI, -0.94 to -0.25) and for IL-6 was -0.76 kg (95% CI, -1.11 to -0.41). Most associations remained, albeit attenuated, after adjustment for previous performance and mutual adjustment of the biomarkers. NT-proBNP and IL-6 (but not cystatin C) were more strongly associated with the outcomes than many of the conventional risk factors after mutual adjustment. CONCLUSIONS: Higher levels of NT-proBNP may identify those in midlife at risk of accelerated physical decline. Before considering the use of NT-proBNP for risk stratification, further research should untangle whether these associations exist because the biomarker is an integrated measure of cumulative exposures to relevant stressors across life, or whether it is marking additional risk pathways. Randomized trials to reduce the rate of decline in physical capability or delay incident disability could benefit from including middle-aged adults and adding NT-proBNP and IL-6 as intermediate outcomes.

The serum homocysteine level in patients with acute ischemic stroke (AIS) after thrombolysis and its relationship with clinical outcomes

SUMMARY OBJECTIVE The present study aims to investigate whether hyperhomocysteinemia (HHcy) affects the outcomes of the thrombolytic treatment for patients with AIS. METHODS A sample of 120 AIS patients were recruited and grouped according to their serum homocysteine (Hcy) levels. The National Institute of Health Stroke Scale (NIHSS) was obtained before treatment and 7 days after it to evaluate neurological outcomes; modified Rankin Scale (mRS) was obtained 12 weeks later to assess functional outcomes. Receiver operating characteristic curve (ROC) was used to demonstrate the relationship between serum Hcy level and the outcomes after tPA treatment. RESULTS The serum Hcy level of 120 patients was of 27.57±20.17μmol/L. The NIHSS scores of the patients in the low Hcy level group were remarkably lower compared to those in the high-level group (p<0.05), after 7 days of treatment. In addition, the mRS scores of the patients in the low Hcy level group, after 12 weeks, were remarkably lower compared to those in the high-level group (p<0.01). ROC demonstrated that the serum Hcy level is related to the clinical outcomes of thrombolytic treatment with moderate specificity (80.3%) and sensitivity (58.2%). CONCLUSION In conclusion, higher serum Hcy levels can indicate poorer clinical outcomes of thrombolytic treatment in patients with AIS.

RESUMO OBJETIVO O presente estudo tem por objetivo investigar se a hiperhomocisteinemia (HHcy) afeta os resultados do tratamento trombolítico em pacientes com AVCI agudo. METODOLOGIA Uma amostra de 120 pacientes AVCI agudo foi recrutada e agrupada de acordo com os níveis séricos de homocisteína (Hcy). Uma avaliação nos padrões do National Institute of Health Stroke Scale (NIHSS) foi obtida antes do tratamento e 7 dias após ele para avaliar desfechos neurológicos e a escala de Rankin modificada foi utilizada 12 semanas depois para avaliar os desfechos funcionais. A curva ROC (Receiver Operating Caracteristic) foi utilizada para demonstrar a relação entre os níveis séricos de Hcy e os desfechos após tratamento com t-PA. RESULTADOS Os níveis séricos de Hcy de 120 pacientes foi de 27,57±20,17μmol/L. Os escores NIHSS dos pacientes no grupo de baixo nível de Hcy foram notavelmente mais baixos em comparação àqueles do grupo de nível mais alto (p<0,05), após 7 dias de tratamento. Além disso, os escores mRS dos pacientes no grupo de baixo nível de Hcy, após 12 semanas, foram consideravelmente mais baixos em comparação com os do grupo de alto nível (p<0,01). A curva ROC demonstrou que o nível sérico de Hcy tem relação com os desfechos clínicos do tratamento trombolítico com especificidade moderada (80,3%) e sensibilidade (58,2%). CONCLUSÃO Podemos concluir então que níveis séricos mais altos de Hcy podem prever desfechos clínicos piores para o tratamento trombolítico em pacientes com AVCI agudo.

Phonemic verbal fluency task in adults with high-level literacy.

OBJECTIVE:: To establish normative parameters for the F-A-S form of the phonemic verbal fluency test, in a population of Brazilian Portuguese speaking adults with high-level literacy. METHODS:: The sample comprised 40 male and female volunteers aged 19 to 59 years, and at least 8 years of formal education. Volunteers were first submitted to the Mini-Mental State Examination and the Clock Drawing cognitive screening tests, then to the F-A-S Verbal Phonemic Fluency Test; in this test, examinees were given 60 seconds to generate as many words as possible beginning with each of the three test letters. RESULTS:: The means for number of words beginning the letters F, A and S and for total number of words beginning with either letter generated per minute corresponded to 15.3, 14.4, 13.9 and 43.5, respectively. CONCLUSION:: Reference values obtained from young adults with high levels of literacy submitted to the F-A-S Verbal Phonemic Fluency Test in this study were similar to those reported in the international literature. These reference values can be used for clinical assessment of language disorder and neuropsychological evaluation. OBJETIVO:: Obter parâmetros de normalidade na tarefa de fluência verbal fonêmica, versão F-A-S, em uma população de alto letramento de adultos falantes do português brasileiro. MÉTODOS:: A amostra foi constituída por 40 voluntários, de ambos os sexos, com idade entre 19 e 59 anos, e com mais de 8 anos de estudo. Todos os voluntários foram inicialmente submetidos ao Miniexame do Estado Mental e ao Teste do Desenho do Relógio, para fins de rastreio cognitivo, e, então, ao Teste de Fluência Verbal Fonêmica F-A-S. Neste último, os indivíduos foram orientados a produzirem o maior número de palavras que conseguissem, iniciadas com cada uma das três letras ditas pelo examinador, em um intervalo de 60 segundos cada. RESULTADOS:: As médias das palavras produzidas com as letras F-A-S foram as seguintes: "F" = 15,3 palavras por minuto; "A" = 14,4 palavras por minuto; e "S" = 13,9 palavras por minuto. A média do total de palavras emitidas iniciada com todas as letras do teste foi de 43,5 palavras. CONCLUSÃO:: Foram obtidos valores de referência para o Teste de Fluência Verbal Fonêmica F-A-S para indivíduos adultos jovens de alto grau de letramento semelhantes aos de estudos internacionais. Tais valores podem ser utilizados na avaliação clínica de transtornos da linguagem e na avaliação neuropsicológica.

Phonemic verbal fluency task in adults with high-level literacy / Fluência verbal fonêmica em adultos de alto letramento

ABSTRACT Objective: To establish normative parameters for the F-A-S form of the phonemic verbal fluency test, in a population of Brazilian Portuguese speaking adults with high-level literacy. Methods: The sample comprised 40 male and female volunteers aged 19 to 59 years, and at least 8 years of formal education. Volunteers were first submitted to the Mini-Mental State Examination and the Clock Drawing cognitive screening tests, then to the F-A-S Verbal Phonemic Fluency Test; in this test, examinees were given 60 seconds to generate as many words as possible beginning with each of the three test letters. Results: The means for number of words beginning the letters F, A and S and for total number of words beginning with either letter generated per minute corresponded to 15.3, 14.4, 13.9 and 43.5, respectively. Conclusion: Reference values obtained from young adults with high levels of literacy submitted to the F-A-S Verbal Phonemic Fluency Test in this study were similar to those reported in the international literature. These reference values can be used for clinical assessment of language disorder and neuropsychological evaluation.

RESUMO Objetivo: Obter parâmetros de normalidade na tarefa de fluência verbal fonêmica, versão F-A-S, em uma população de alto letramento de adultos falantes do português brasileiro. Métodos: A amostra foi constituída por 40 voluntários, de ambos os sexos, com idade entre 19 e 59 anos, e com mais de 8 anos de estudo. Todos os voluntários foram inicialmente submetidos ao Miniexame do Estado Mental e ao Teste do Desenho do Relógio, para fins de rastreio cognitivo, e, então, ao Teste de Fluência Verbal Fonêmica F-A-S. Neste último, os indivíduos foram orientados a produzirem o maior número de palavras que conseguissem, iniciadas com cada uma das três letras ditas pelo examinador, em um intervalo de 60 segundos cada. Resultados: As médias das palavras produzidas com as letras F-A-S foram as seguintes: “F” = 15,3 palavras por minuto; “A” = 14,4 palavras por minuto; e “S” = 13,9 palavras por minuto. A média do total de palavras emitidas iniciada com todas as letras do teste foi de 43,5 palavras. Conclusão: Foram obtidos valores de referência para o Teste de Fluência Verbal Fonêmica F-A-S para indivíduos adultos jovens de alto grau de letramento semelhantes aos de estudos internacionais. Tais valores podem ser utilizados na avaliação clínica de transtornos da linguagem e na avaliação neuropsicológica.

Failure to consider the menstrual cycle phase may cause misinterpretation of clinical and research findings of cardiometabolic biomarkers in premenopausal women.

Biomarker assessment plays a critical role in the study and prevention of disease. However, variation in biomarkers attributable to the menstrual cycle in premenopausal women may impair understanding the role of certain biomarkers in disease development and progression. Thus, in light of the recently increasing evidence of menstrual cycle variability in multiple cardiometabolic biomarkers, a reexamination of approaches for appropriately studying and diagnosing cardiovascular disease in premenopausal women is warranted. We reviewed studies (from 1934 through 2012) evaluating changes in cardiometabolic biomarkers across phases of the menstrual cycle, including markers of oxidative stress, lipids, insulin sensitivity, and systemic inflammation. Each was observed to vary significantly during the menstrual cycle. For example, nearly twice as many women had elevated cholesterol levels warranting therapy (≥200 mg/dL) during the follicular phase compared with the luteal phase (14.3% vs. 7.9%), with only 3% having consistently high levels during all phases of the cycle. Similarly, nearly twice as many women were classified as being at an elevated risk of cardiovascular disease (high sensitivity C-reactive protein >3 mg/L) during menses compared with other phases (12.3% vs. 7.4%). Menstrual cycle-associated variability in cardiometabolic biomarkers is an important source of variability that should be accounted for in both research and clinical settings.

Area deprivation across the life course and physical capability in midlife: findings from the 1946 British Birth cohort.

Physical capability in later life is influenced by factors occurring across the life course, yet exposures to area conditions have only been examined cross-sectionally. Data from the National Survey of Health and Development, a longitudinal study of a 1946 British birth cohort, were used to estimate associations of area deprivation (defined as percentage of employed people working in partly skilled or unskilled occupations) at ages 4, 26, and 53 years (residential addresses linked to census data in 1950, 1972, and 1999) with 3 measures of physical capability at age 53 years: grip strength, standing balance, and chair-rise time. Cross-classified multilevel models with individuals nested within areas at the 3 ages showed that models assessing a single time point underestimate total area contributions to physical capability. For balance and chair-rise performance, associations with area deprivation in midlife were robust to adjustment for individual socioeconomic position and prior area deprivation (mean change for a 1-standard-deviation increase: balance, -7.4% (95% confidence interval (CI): -12.8, -2.8); chair rise, 2.1% (95% CI: -0.1, 4.3)). In addition, area deprivation in childhood was related to balance after adjustment for childhood socioeconomic position (-5.1%, 95% CI: -8.7, -1.6). Interventions aimed at reducing midlife disparities in physical capability should target the socioeconomic environment of individuals-for standing balance, as early as childhood.

The association between midlife cardiorespiratory fitness levels and later-life dementia: a cohort study.

BACKGROUND: Primary prevention of Alzheimer disease and other types of dementia (all-cause dementia) is an important public health goal. Evidence to date is insufficient to recommend any lifestyle change to prevent or delay the onset of dementia. OBJECTIVE: To assess the association between objectively measured midlife cardiorespiratory fitness ("fitness") levels and development of all-cause dementia in advanced age. DESIGN: Prospective, observational cohort study. SETTING: Preventive medicine clinic. PATIENTS: 19 458 community-dwelling, nonelderly adults who had a baseline fitness examination. MEASUREMENTS: Fitness levels, assessed using the modified Balke treadmill protocol between 1971 and 2009, and incident all-cause dementia using Medicare Parts A and B claims data from 1999 to 2009. RESULTS: 1659 cases of incident all-cause dementia occurred during 125 700 person-years of Medicare follow-up (median follow-up, 25 years [interquartile range, 19 to 30 years]). After multivariable adjustment, participants in the highest quintile of fitness level had lower hazard of all-cause dementia than those in the lowest quintile (hazard ratio, 0.64 [95% CI, 0.54 to 0.77]). Higher fitness levels were associated with lower hazard of all-cause dementia with previous stroke (hazard ratio, 0.74 [CI, 0.53 to 1.04]) or without previous stroke (hazard ratio, 0.74 [CI, 0.61 to 0.90]). LIMITATIONS: Dementia diagnoses were based on Medicare claims, and participants generally were non-Hispanic white, healthy, and well-educated and had access to preventive health care. This study evaluated fitness levels, so a specific exercise prescription cannot be generated from results and the findings may not be causal. CONCLUSION: Higher midlife fitness levels seem to be associated with lower hazards of developing all-cause dementia later in life. The magnitude and direction of the association were similar with or without previous stroke, suggesting that higher fitness levels earlier in life may lower risk for dementia later in life, independent of cerebrovascular disease. PRIMARY FUNDING SOURCE: The Cooper Institute; University of Texas Southwestern Medical Center; National Heart, Lung, and Blood Institute; and American Heart Association.

Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa.

BACKGROUND: South Africa is experiencing a demographic and epidemiological transition with an increase in population aged 50 years and older and rising prevalence of non-communicable diseases. This, coupled with high HIV and tuberculosis prevalence, puts an already weak health service under greater strain. OBJECTIVE: To measure self-reported chronic health conditions and chronic disease risk factors, including smoking and alcohol use, and to establish their association with health care use in a rural South African population aged 50 years or older. METHODS: The Study on Global Ageing and Adult Health (SAGE), in collaboration with the INDEPTH Network and the World Health Organization, was implemented in the Agincourt sub-district in rural northeast South Africa where there is a long-standing health and socio-demographic surveillance system. Household-based interviews were conducted in a random sample of people aged 50 years and older. The interview included questions on self-reported health and health care use, and some physical measurements, including blood pressure and anthropometry. RESULTS: Four hundred and twenty-five individuals aged 50 years or older participated in the study. Musculoskeletal pain was the most prevalent self-reported condition (41.7%; 95% Confidence Interval [CI] 37.0-46.6) followed by hypertension (31.2%; 95% CI 26.8-35.9) and diabetes (6.1%; 95% CI 4.1-8.9). All self-reported conditions were significantly associated with low self-reported functionality and quality of life, 57% of participants had hypertension, including 44% of those who reported normal blood pressure. A large waist circumference and current alcohol consumption were associated with high risk of hypertension in men, whereas in women, old age, high waist-hip ratio, and less than 6 years of formal education were associated with high risk of hypertension. Only 45% of all participants reported accessing health care in the last 12 months. Those who reported higher use of the health facilities also reported lower levels of functioning and quality of life. CONCLUSIONS: Self-reported chronic health conditions, especially hypertension, had a high prevalence in this population and were strongly associated with higher levels of health care use. The primary health care system in South Africa will need to provide care for people with non-communicable diseases.

An fMRI study of episodic encoding across the lifespan: changes in subsequent memory effects are evident by middle-age.

Although it is well-documented that there are age differences between young and older adults in neural activity associated with successful memory formation (positive subsequent memory effects), little is known about how this activation differs across the lifespan, as few studies have included middle-aged adults. The present study investigated the effect of age on neural activity during episodic encoding using a cross-sectional lifespan sample (20-79 years old, N=192) from the Dallas Lifespan Brain Study. We report four major findings. First, in a contrast of remembered vs. forgotten items, a decrease in neural activity occurred with age in bilateral occipito-temporo-parietal regions. Second, when we contrasted forgotten with remembered items (negative subsequent memory), the primary difference was found between middle and older ages. Third, there was evidence for age equivalence in hippocampal regions, congruent with previous studies. Finally, low-memory-performers showed negative subsequent memory differences by middle age, whereas high memory performers did not demonstrate these differences until older age. Taken together, these findings delineate the importance of a lifespan approach to understanding neurocognitive aging and, in particular, the importance of a middle-age sample in revealing different trajectories.

Prostaglandin and myokine involvement in the cyclooxygenase-inhibiting drug enhancement of skeletal muscle adaptations to resistance exercise in older adults.

Twelve weeks of resistance training (3 days/wk) combined with daily consumption of the cyclooxygenase-inhibiting drugs acetaminophen (4.0 g/day; n = 11, 64 ± 1 yr) or ibuprofen (1.2 g/day; n = 13, 64 ± 1 yr) unexpectedly promoted muscle mass and strength gains 25-50% above placebo (n = 12, 67 ± 2 yr). To investigate the mechanism of this adaptation, muscle biopsies obtained before and ∼72 h after the last training bout were analyzed for mRNA levels of prostaglandin (PG)/cyclooxygenase pathway enzymes and receptors [arachidonic acid synthesis: cytosolic phospholipase A(2) (cPLA(2)) and secreted phospholipase A(2) (sPLA(2)); PGF(2α) synthesis: PGF(2α) synthase and PGE(2) to PGF(2α) reductase; PGE(2) synthesis: PGE(2) synthase-1, -2, and -3; PGF(2α) receptor and PGE(2) receptor-4], cytokines and myokines involved in skeletal muscle adaptation (TNF-α, IL-1ß, IL-6, IL-8, IL-10), and regulators of muscle growth [myogenin, myogenic regulatory factor-4 (MRF4), myostatin] and atrophy [Forkhead box O3A (FOXO3A), atrogin-1, muscle RING finger protein 1 (MuRF-1), inhibitory κB kinase ß (IKKß)]. Training increased (P < 0.05) cPLA(2), PGF(2α) synthase, PGE(2) to PGF(2α) reductase, PGE(2) receptor-4, TNF-α, IL-1ß, IL-8, and IKKß. However, the PGF(2α) receptor was upregulated (P < 0.05) only in the drug groups, and the placebo group upregulation (P < 0.05) of IL-6, IL-10, and MuRF-1 was eliminated in both drug groups. These results highlight prostaglandin and myokine involvement in the adaptive response to exercise in older individuals and suggest two mechanisms underlying the enhanced muscle mass gains in the drug groups: 1) The drug-induced PGF(2α) receptor upregulation helped offset the drug suppression of PGF(2α)-stimulated protein synthesis after each exercise bout and enhanced skeletal muscle sensitivity to this stimulation. 2) The drug-induced suppression of intramuscular PGE(2) production increased net muscle protein balance after each exercise bout through a reduction in PGE(2)-induced IL-6 and MuRF-1, both promoters of muscle loss.

[Physical activity of elderly people living in district Koprzywnica (Poland)]. / Aktywnosc fizyczna starszych osób mieszkajacych w gminie koprzywnica.

BACKGROUND: Physical activity has good influence on health. The physical activity of elderly people may decrease, because of the health problems or think that with aging sport activity should be reduced. OBJECTIVE: The aim of the study was to assess a physical activity and energy expenditure of people in age 60 and more in the Koprzywnica district (Poland). MATERIAL AND METHODS: 95 persons in age 60 and more (51 women and 44 men) participated in the study. All participants live alone or with family. The following data: total energy expenditure, active energy expenditure, physical activity duration (MET > 3,0), vigorous physical activity duration (MET > 6,0), number of steps, lying down duration were collected using SenseWear Pro3 Armband, Body Media Pittsburgh, USA. The measurement was conducted for 24 hours. Physical activity was also classified on the basis of the number of steps. RESULTS: The median of the age of participants was 71 years. The median of BMI was 27,1 kg/m2. Age was correlated with BMI (R = -0,28, p = 0,005). Participants made on average 6335 steps daily, 42% of them made less than 5000 steps and 31,5% more than 10000 steps a day. The median of the total energy expenditure was 33,1 kcal/kg of body mass a day (2522 kcal a day), while the median of the active energy expenditure was 5,7 kcal/kg of body mass a day (482 kcal a day). The median of the physical activity duration was 1 hour and 22 minutes, and in most cases it was the moderate physical activity. In case of 17 women (33%) and 20 men (45,5%) the vigorous physical activity was detected, and duration of this physical activity was 1-22 minutes. The median of the lying down duration was 8 hours and 44 minutes. Older persons had shorter physical activity duration, made less steps and at the same time had lower active energy expenditure and total energy expenditure than younger ones. There were no differences between younger and older participants in the sedentary energy expenditure and lying down duration. Simultaneously participants with higher BMI compared with participants with lower BMI had shorter physical activity duration as well as lower active energy expenditure and total energy expenditure but there were no differences in number of steps, lying down duration and sedentary energy expenditure between them. CONCLUSIONS: In case of older persons the duration of physical activity was shorter and the active energy expenditure was lower than in case of younger persons. Both groups had the sedentary energy expenditure and the lying duration at the same level. Elderly people with higher BMI had lower total energy expenditure and lower intensity and shorter physical activity duration than elderly people with lower BMI.

Depression and midlife: are we overpathologising the menopause?

OBJECTIVE: Cross sectional and longitudinal studies have suggested that the menopausal transition is a period of vulnerability for the development of depressive symptoms in women. It has been proposed that depression at the time of transition to menopause is part of a distinct diagnostic group of 'reproductive-related depressive disorders'. Furthermore it is proposed that these disorders are so prevalent that that middle aged women should be routinely screened to improve detection. The aims of this paper were to explore key studies undertaken over the past three decades to examine what evidence exists to support the proposals that depression in midlife women occurs as a biological response to hormonal change and that it is so common that all middle aged women should be routinely screened for depression. METHOD: A systematic search was carried out of electronic databases for original research using population-based studies examining the relationship between menopause and depression. RESULTS: Longitudinal change in menopausal status over time is associated with an increased risk of elevated depressive symptoms, independent of relevant demographic, psychosocial, behavioural and health factors. However, depressive symptoms have non-specific diagnostic significance, and even when severe do not always reflect a depressive syndrome. There is no clear evidence that depressive disorders occur more commonly in association with the menopause. Rather, it appears that the true rate of disorder is similar to that at other times in a woman's reproductive life. CONCLUSIONS: The studies identified here do not provide evidence for the delineation of depression at the menopausal transition as part of a distinctive diagnostic group of 'reproductive-related depressive disorders' which occur as a biological response to hormonal change. The most plausible explanation is a bio-psycho-socio-cultural model of the processes which might lead to a depressive disorder in midlife. Although depressive symptoms are common at this time, data do not support the call for screening of all women for depression at the time of the MT. Rather, given the frequency of depression in the general population, clinicians should be alert to the possibility of depression in every clinical encounter.

Cáncer de mama en mujeres de edad media evaluación de los factores de riesgo / Breast cancer in medical age woman risk factors evaluation

Evaluar factores de riesgo para cáncer de mama en pacientes de edad media en comparación con riesgo de mujeres jóvenes y tercera edad, estudiar si la mayor frecuencia de cáncer de mama en edades medias está en relación con la distribución de la población venezolana. En 515 pacientes 36 (7 por ciento) menores de 40 años, 379 (74 por ciento) entre 40 y 64 años, y 100 (19 por ciento) mayores de 64 años. Se analizaron antecedentes familiares de cáncer de mama, ovario, factores de riesgo hormonales (endógenos y exógenos) antecedentes de patología mamaria benigna. Se calcularon tasas por 100.000 habitantes. El grupo de edad media se asemeja al de la tercera edad con referencia a antecedentes familiares de cáncer de mama y ovario; y al grupo de pacientes jóvenes con referencia al promedio del número de abortos, nuliparidad e ingestión de anticonceptivos orales. Los tres grupos son diferentes con respecto al promedio del número de embarazos a término y son similares en cuanto a la menarquía, el promedio de edad del primer embarazo a término, la lactancia y antecedentes de patología mamaria benigna. Hubo tasas similares en el grupo de edad media y de la tercera edad. El cáncer de mama en mujeres de edad media tiene factores de riesgo similares al de mujeres jóvenes y tercera edad, observamos que la mayor frecuencia de cáncer en edad media puede atribuirse a distribución general de la población venezolana

The objective of this study is to known risk factors for breast cancer in the middle age patients in comparison with the younger and the older patients. In addition, we must study whether the high frequency of middle age patients is attributable to venezuelan population distribution. Only five hundred fifteen patients with breast cancer were included in our study; 36 (7 percent) younger than 40 years old, 379 (74 percent) between 40 and 64 years old, and 100 (19 percent) older than 64 years old. We analyzed the family history of the breast and the ovarian cancer, and the hormonal risk factors (The endogenous and the exogenous), and previous benign breast disease. In addition, we measured teases for 100 000 habitants. The middle age group was similar to the older group according to the family history of breast and the ovarian cancer; and similar to the younger group according to number of abortions, null parity, and oral contraceptives ingestion. The three groups were different according to number of terminal pregnancies and similar according to menarche, mean age of first terminal pregnancy, lactation, and previous benign breast disease. There were similar teases in the middle age and older patient groups. The middle age group has similar risk factors for breast cancer shared between older and younger groups; besides, the high frequency of breast cancer in the middle age group can be attributable to the venezuelan population distribution

Predicting older adults' driving difficulties using the Roadwise Review.

The Roadwise Review has been reported to provide an effective means of self-assessing and predicting driving difficulties in older adults. We administered it to 73 community-dwelling older drivers (M = 73 years) and also gathered data on self-reported driving difficulties, 2-year retrospective collisions, and moving violations. The acuity tests and Useful Field of View exhibited substantial ceiling effects that limit predictive utility, and there was a high failure rate on the head and neck flexibility test. Additionally, the Roadwise Review did not predict self-reported driving problems or collision risk. Thus, in current form, it does not appear to be a useful tool for assessing older drivers. Future research efforts should assess predictive validity in a more heterogeneous sample of older adults and with a broader range of outcomes, including on-road driving performance.

Middle age is not associated with altered fibrinogen concentration and production in males.

Whether ageing is associated with increased fibrinogen concentration and production remains unclear. We measured fibrinogen fractional (FSR) and absolute synthesis (ASR) rates in male volunteers, of either young (mean age: 28 years, range: 22-34) or middle age (mean age: 57 years, range: 38-72), using a leucine-tracer isotope dilution technique. In the middle-age group, neither fibrinogen FSR (20.8 +/- 1.6%/day) nor ASR (1.8 +/- 0.1 g/day), or concentration (274 +/- 15 mg/dl), were different from those of the younger group (FSR: 20.2 +/- 1.4; ASR: 1.7 +/- 0.2; concentration: 265 +/- 8, respectively). Leucine Ra, an index of endogenous proteolysis, was approximately 20% lower in the older than in the younger group (P < 0.02). Thus, middle age in males is not associated with increased fibrinogen concentration and turnover, whereas endogenous protein breakdown in decreased. Factor(s) different from age per se are likely to be involved in the dysfibrinogenemia possibly occurring with ageing. Protein turnover is already reduced in middle-age males.