The impact of the Mediterranean diet on immune function in older adults.

Diet is one of the lifestyle factors that is most amenable to intervention, and has a substantial effect on the potential for successful aging and mitigation of the risk of disease. Good nutrition is a pillar of healthy aging, and a large body of evidence attests to the benefits of the Mediterranean diet on the quality of the aging process. The Mediterranean diet comprises a wide range of nutrients which, both individually and collectively, exert positive effects on immunity, in large part mediated by the gut microbiota. In this article, we review the effect of the Mediterranean diet on immunity, and how its beneficial effects are mediated by the gut microbiota. We review the effects of certain key components of the Mediterranean dietary pattern, including vitamins, zinc, selenium, and polyphenols. Overall, the existing body of evidence convincingly demonstrates that the Mediterreanean diet affects immune health by maintaining a healthy body weight and reducing the risk of metabolic and cardiovascular diseases; by reducing inflammation and by promoting a healthy gut microbiota profile.

The need to distinguish intervention thresholds and diagnostic thresholds in the management of osteoporosis.

This position paper of the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) addresses the rationale for separate diagnostic and intervention thresholds in osteoporosis. We conclude that the current BMD-based diagnostic criteria for osteoporosis be retained whilst clarity is brought to bear on the distinction between diagnostic and intervention thresholds.

Biochemical Markers of Musculoskeletal Health and Aging to be Assessed in Clinical Trials of Drugs Aiming at the Treatment of Sarcopenia: Consensus Paper from an Expert Group Meeting Organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the Centre Académique de Recherche et d'Expérimentation en Santé (CARES SPRL), Under the Auspices of the World Health Organization Collaborating Center for the Epidemiology of Musculoskeletal Conditions and Aging.

In clinical trials, biochemical markers provide useful information on the drug's mode of action, therapeutic response and side effect monitoring and can act as surrogate endpoints. In pharmacological intervention development for sarcopenia management, there is an urgent need to identify biomarkers to measure in clinical trials and that could be used in the future in clinical practice. The objective of the current consensus paper is to provide a clear list of biochemical markers of musculoskeletal health and aging that can be recommended to be measured in Phase II and Phase III clinical trials evaluating new chemical entities for sarcopenia treatment. A working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) proposed classifying biochemical markers into 2 series: biochemical markers evaluating musculoskeletal status and biochemical markers evaluating causal factors. For series 1, the group agreed on 4 biochemical markers that should be assessed in Phase II or Phase III trials (i.e., Myostatin-Follistatin, Brain Derived Neurotrophic Factor, N-terminal Type III Procollagen and Serum Creatinine to Serum Cystatin C Ratio - or the Sarcopenia Index). For series 2, the group agreed on 6 biochemical markers that should be assessed in Phase II trials (i.e., the hormones insulin-like growth factor-1 (IGF-I), dehydroepiandrosterone sulphate, and cortisol, and the inflammatory markers C-reactive protein (CRP), interleukin-6 and tumor necrosis factor-α), and 2 in Phase III trials (i.e., IGF-I and CRP). The group also proposed optional biochemical markers that may provide insights into the mode of action of pharmacological therapies. Further research and development of new methods for biochemical marker assays may lead to the evolution of these recommendations.

Long-term beneficial impact of the randomised trial 'Train the Brain', a motor/cognitive intervention in mild cognitive impairment people: effects at the 14-month follow-up.

No treatment options are currently available to counteract cognitive deficits and/or delay progression towards dementia in older people with mild cognitive impairment (MCI). The 'Train the Brain' programme is a combined motor and cognitive intervention previously shown to markedly improve cognitive functions in MCI individuals compared to non-trained MCI controls, as assessed at the end of the 7-month intervention. Here, we extended the previous analyses to include the long-term effects of the intervention and performed a data disaggregation by gender, education and age of the enrolled participants. We report that the beneficial impact on cognitive functions was preserved at the 14-month follow-up, with greater effects in low-educated compared to high-educated individuals, and in women than in men.

Multimorbidity increases the risk of dementia: a 15 year follow-up of the SHARE study.

AIMS: the literature regarding the association between multimorbidity and dementia is still unclear. Therefore, we aimed to explore the potential association between multimorbidity at the baseline and the risk of future dementia in the SHARE (Survey of Health, Ageing and Retirement in Europe) study, a large European research survey, with a follow-up of 15 years. METHODS: in this longitudinal study, multimorbidity was defined as the presence of two or more chronic medical conditions, among 14 self-reported at the baseline evaluation. Incident dementia was ascertained using self-reported information. Cox regression analysis, adjusted for potential confounders, was run and hazard ratios (HRs), with their 95% confidence intervals (CIs), that were estimated in the whole sample and by 5 year groups. RESULTS: among 30,419 participants initially considered in wave 1, the 23,196 included participants had a mean age of 64.3 years. The prevalence of multimorbidity at baseline was 36.1%. Multimorbidity at baseline significantly increased the risk of dementia in the overall sample (HR = 1.14; 95% CI: 1.03-1.27) and in participants younger than 55 years (HR = 2.06; 95% CI: 1.12-3.79), in those between 60 and 65 years (HR = 1.66; 95% CI: 1.16-2.37) and in those between 65 and 70 years (HR = 1.54; 95% CI: 1.19-2.00). In the overall sample, high cholesterol levels, stroke, diabetes and osteoporosis increased the risk of dementia, particularly if present among participants between 60 and 70 years of age. CONCLUSIONS: multimorbidity significantly increases the risk of dementia, particularly in younger people, indicating the need for early detection of multimorbidity for preventing cognitive worsening.

Frailty Prevalence, Incidence, and Association with Incident Disability in the Italian Longitudinal Study on Aging.

INTRODUCTION: Data on frailty frequency are heterogeneous and mostly based on cross-sectional studies. Little is known about frailty development and progression over time. Our aim was to conduct a systematic analysis of frailty prevalence and incidence in a large cohort of older adults and to evaluate the association with incident disability, in order to tackle the current paucity and fragmentation of longitudinal data on frailty. METHODS: As secondary analysis of the Italian Longitudinal Study on Aging (ILSA) population-based cohort (n = 5,632, 65-84), frailty status was operationalized according to Fried criteria (n = 2,457). Weighted prevalence and incidence rates were calculated at each ILSA wave (T0 1992-1993, T1 1995-1996, T2 2000-2001). The association with incident disability in Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL) was investigated through Cox proportional hazard models, controlling for possible confounders. RESULTS: Prevalence of frailty and pre-frailty at baseline (mean age 71.6 years; women 58.9%) were 4.0% (95% confidence interval [CI]: 3.4-4.6) and 44.6% (95% CI: 43.1-46.1), respectively. Incidence rates per 1,000 person-years for the T0-T1 interval were 7.3 (95% CI: 5.2-9.3) for frailty and 83.7 (95% CI: 73.6-93.8) for pre-frailty. Prevalence and incidence of frailty, and to a lesser degree of pre-frailty, were overall higher for women and increased with age, yet no increasing trend with advancing age was detected for pre-frailty incidence. Frailty incidence rates were significantly higher among pre-frail than non-frail individuals at follow-up entry. After full adjustment, being frail markedly increased the risk of incident disability in ADL (hazard ratio [HR] 3.58, 95% CI: 1.97-6.52) and IADL (HR 2.56, 95% CI: 1.58-4.16) over a 4-year period. DISCUSSION/CONCLUSION: According to our findings, frailty is common among older people and is a strong and independent predictor of disability. Further research on factors and characteristics related to frailty progression, and especially remission, over time is crucial to calibrate effective public health preventive measures.

Hospital length of stay and 30-day readmissions in older people: their association in a 20-year cohort study in Italy.

BACKGROUND: There are conflicting data on whether hospital length of stay (LOS) reduction affects readmission rates in older adults. We explored 20-year trends of hospital LOS and 30-day rehospitalizations in a cohort of Italian older people, and investigated their association. METHODS: Participants in the Pro.V.A. project (n = 3099) were followed-up from 1996 to 2018. LOS and 30-day rehospitalizations, i.e. new hospitalizations within 30 days from a previous discharge, were obtained from personal interviews and regional registers. Rehospitalizations in the 6 months before death were also assessed. Linear regressions evaluated the associations between LOS and the frequency of 30-day rehospitalizations, adjusting for the mean age of the cohort within each year. RESULTS: Over 20 years, 2320 (74.9%) participants were hospitalized. Mean LOS gradually decreased from 17.3 days in 1996 to 11.3 days in 2018, while 30-day rehospitalization rates increased from 6.6% in 1996 to 13.6% in 2018. LOS was inversely associated with 30-day rehospitalizations frequency over time (ß = -2.33, p = 0.01), similarly in men and women. A total of 1506 individuals was hospitalized within 6 months before death. The frequency of 30-day readmissions at the end of life increased from 1.4% in 1997 to 8.3% in 2017 and was associated with mean LOS (ß = -1.17, p = 0.03). CONCLUSIONS: The gradual LOS reduction observed in the latter decades is associated with higher 30-day readmission rates in older patients in Italy. This suggests that a careful pre-discharge assessment is warranted in older people, and that community healthcare services should be improved to reduce the risk of readmission.

Knee osteoarthritis and adverse health outcomes: an umbrella review of meta-analyses of observational studies.

BACKGROUND: Knee osteoarthritis (OA) is a common condition, associated with a high rate of disability and poor quality of life. Despite the importance of such evidence in public health, no umbrella review (i.e., a review of other systematic reviews and meta-analyses) has systematically assessed evidence on association between knee OA and adverse health outcomes. AIMS: To map and grade all health outcomes associated with knee OA using an umbrella review approach. METHODS: The search was made across several databases up to 22 April 2022. We used an umbrella review of systematic reviews with meta-analyses of observational studies assessing the effect sizes, based on random effect summary, 95% prediction intervals, heterogeneity, small study effects, and excess significance bias. The evidence was then graded from convincing (class I) to weak (class IV). RESULTS: Among 3,847 studies initially considered, five meta-analyses were included for a total of five different outcomes. Three adverse outcomes were significantly associated with knee OA (i.e., cardiovascular mortality, falls, and subclinical atherosclerosis). The presence of knee OA was associated with a significantly higher risk of cardiovascular mortality (odds ratio, OR = 1.17; 95%CI, confidence intervals: 1.02-1.34), falls (RR = 1.34; 95%CI: 1.10-1.64), and conditions associated with subclinical atherosclerosis (OR = 1.43; 95%CI: 1.003-2.05). The certainty of each of this evidence was weak. CONCLUSIONS: Our umbrella review suggests that knee OA can be considered as putative risk factor for some medical conditions, including cardiovascular diseases and falls, however, it is important to note that the evidence is affected by potential biases.

Dementia, infections and vaccines: 30 years of controversy.

This paper reports the proceedings of a virtual meeting convened by the European Interdisciplinary Council on Ageing (EICA), to discuss the involvement of infectious disorders in the pathogenesis of dementia and neurological disorders leading to dementia. We recap how our view of the infectious etiology of dementia has changed over the last 30 years in light of emerging evidence, and we present evidence in support of the implication of infection in dementia, notably Alzheimer's disease (AD). The bacteria and viruses thought to be responsible for neuroinflammation and neurological damage are reviewed. We then review the genetic basis for neuroinflammation and dementia, highlighting the genes that are currently the focus of investigation as potential targets for therapy. Next, we describe the antimicrobial hypothesis of dementia, notably the intriguing possibility that amyloid beta may itself possess antimicrobial properties. We further describe the clinical relevance of the gut-brain axis in dementia, the mechanisms by which infection can move from the intestine to the brain, and recent findings regarding dysbiosis patterns in patients with AD. We review the involvement of specific pathogens in neurological disorders, i.e. SARS-CoV-2, human immunodeficiency virus (HIV), herpes simplex virus type 1 (HSV1), and influenza. Finally, we look at the role of vaccination to prevent dementia. In conclusion, there is a large body of evidence supporting the involvement of various infectious pathogens in the pathogenesis of dementia, but large-scale studies with long-term follow-up are needed to elucidate the role that infection may play, especially before subclinical or clinical disease is present.

Essential steps in primary care management of older people with Type 2 diabetes: an executive summary on behalf of the European geriatric medicine society (EuGMS) and the European diabetes working party for older people (EDWPOP) collaboration.

We present an executive summary of a guideline for management of type 2 diabetes mellitus in primary care written by the European Geriatric Medicine Society, the European Diabetes Working Party for Older People with contributions from primary care practitioners and participation of a patient's advocate. This consensus document relies where possible on evidence-based recommendations and expert opinions in the fields where evidences are lacking. The full text includes 4 parts: a general strategy based on comprehensive assessment to enhance quality and individualised care plan, treatments decision guidance, management of complications, and care in case of special conditions. Screening for frailty and cognitive impairment is recommended as well as a comprehensive assessment all health conditions are concerned, including end of life situations. The full text is available online at the following address: essential_steps_inprimary_care_in_older_people_with_diabetes_-_EuGMS-EDWPOP___3_.pdf.

Measuring health-related quality of life in sarcopenia: summary of the SarQoL psychometric properties.

Patient perspectives are now widely recognized as a key element in the evaluation of health interventions. Therefore, the provision of specific and validated Patient Reported Outcome Measures that emphasize the lived experience of patients suffering from specific diseases is very important. In the field of sarcopenia, the only validated specific health-related quality of life (HRQoL) instrument available is the Sarcopenia Quality of Life questionnaire (SarQoL). This self-administrated HRQoL questionnaire, developed in 2015, consists of 55 items arranged into 22 questions and has currently been translated into 35 languages. Nineteen validation studies performed on SarQoL have consensually confirmed the capacity of SarQoL to detect difference in HRQoL between older people with and without sarcopenia, its reliability and its validity. Two further observational studies have also indicated its responsiveness to change. A short form SarQoL, including only 14 items has further been developed and validated to reduce the potential burden of administration. Research on the psychometric properties of SarQoL questionnaire is still encouraged as the responsiveness to change of SarQoL has not yet been measured in the context of interventional studies, as limited prospective data currently exist and as there is still not cut-off score to define a low HRQoL. In addition, SarQoL has mainly been used in community-dwelling older individuals with sarcopenia and would benefit to be studied in other types of populations. This review aims to provide to researchers, clinicians, regulators, pharmaceutical industries and other stakeholders a clear summary of comprehensive evidence on the SarQoL questionnaire published up to January 2023Query.

Risk of progression to diabetes and mortality in older people with prediabetes: The English longitudinal study on ageing.

AIMS: Prediabetes is used to identify people at increased risk for diabetes. However, the importance of prediabetes in older populations is still poorly explored. Therefore, we aimed to investigate the prevalence of prediabetes, based on either glycated haemoglobin (HbA1c) levels or fasting glucose (FG) levels, or both and the progression of prediabetes to diabetes or to mortality in older participants of the English Longitudinal Study on Ageing. MATERIALS AND METHODS: Prediabetes was categorized based on HbA1c levels (5.7%-6.4%) and/or FG levels (5.6-7.0 mmol/L). Information regarding mortality and incident diabetes were recorded during follow-up period of 10 years. RESULTS: In 2027 participants (mean age: 70.6 years, 55.2% females), the prevalence of prediabetes ranged between 5.9% and 31.1%. Over 8 years of follow-up, 189 participants (5.4% of the initial population) developed diabetes and 606 (17.4%) died. Among 1,403 people with HbA1c at the baseline <5.7%, 33 developed diabetes and 138 died; in contrast, among 479 participants with a diagnosis of prediabetes using a value of HbA1c between 5.7% and 6.4%, 62 developed diabetes and 56 died. Similarly, among 1,657 people with normal values of FG at baseline 60 had a diagnosis of diabetes during follow-up and 163 died, compared to 225 with FG between 5.6 mmol/L and 7.0 mmol/L in which 35 developed diabetes and 31 died. CONCLUSION: The prevalence of prediabetes in older adults is high, but the progression from prediabetes to diabetes is uncommon, whereas the regression to normoglycemia or the progression to death was more frequent.

Comprehensive geriatric assessment in older people: an umbrella review of health outcomes.

BACKGROUND: Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. METHODS: Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. RESULTS: Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P < 0.05). There was high certainty of evidence that CGA reduces nursing home admission (risk ratio [RR] = 0.86; 95% confidence interval [CI]: 0.75-0.89), risk of falls (RR = 0.51; 95%CI: 0.29-0.89), and pressure sores (RR = 0.46; 95%CI: 0.24-0.89) in hospital medical setting; decreases the risk of delirium (OR = 0.71; 95%CI: 0.54-0.92) in hip fracture; decreases the risk of physical frailty in community-dwelling older adults (RR = 0.77; 95%CI: 0.64-0.93). Systematic reviews without meta-analysis indicate that CGA improves clinical outcomes in oncology, haematology, and in emergency department. CONCLUSIONS: CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.

Multidimensional frailty and quality of life: data from the English Longitudinal Study of Ageing.

PURPOSE: Frailty has been found to be associated with poor quality of life (QoL) in older people, but data available are limited to cross-sectional studies. We therefore aimed to assess the association between multidimensional frailty, determined by Multidimensional Prognostic Index (MPI), with mortality and good QoL expectancy (GQoLE) in a large representative sample of older adults, over 10 years of follow-up. METHODS: In the English Longitudinal Study of Ageing, using the data from 2004-2005 and 2014-2015, MPI was calculated using a weighted score of domains of comprehensive geriatric assessment, i.e., number of difficulties in activities of daily living (ADL) and instrumental ADL, depressive symptoms, number of medical conditions, body mass index, physical activity level, and social aspects. Mortality was assessed using administrative data, GQoLE indicators were used for longitudinal changes in QoL. RESULTS: 6244 Participants (mean age 71.8 years, 44.5% males) were followed up for 10 years. After adjusting for potential confounders, compared to people in the MPI low-risk group, people in the moderate (hazard ratio, HR = 4.27; 95% confidence interval, CI 3.55-5.14) and severe-risk group (HR = 10.3; 95% CI 7.88-13.5) experienced a significantly higher mortality rate. During the follow-up period, people in the moderate and severe-risk groups reported lower GQoLE values than their counterparts, independently from age and gender. CONCLUSIONS: Multidimensional frailty was associated with a higher risk of mortality and significantly lower GQoLE, suggesting that the multifactorial nature of frailty is associated not only with mortality, but also poor QoL.

Predictors of resilience in older adults with lower limb osteoarthritis and persistent severe pain.

BACKGROUND: Resilience refers to the process in which people function well despite adversity. Persistent severe pain may be considered an adversity in people with lower limb osteoarthritis (LLOA). The objectives of this study are: (1) to identify what proportion of older adults with LLOA and persistent severe pain show good functioning; and (2) to explore predictors of resilience. METHODS: Data from the European Project on OSteoArthritis (EPOSA) were used involving standardized data from six European population-based cohort studies. LLOA is defined as clinical knee and/or hip osteoarthritis. Persistent severe pain is defined as the highest tertile of the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index both at baseline and follow-up. Resilience is defined as good physical, mental or social functioning at follow-up despite having LLOA with persistent severe pain. RESULTS: In total, 95 (14.9%) out of 638 individuals with LLOA had persistent severe pain. Among these, 10 (11.0%), 54 (57.4%) and 49 (53.8%) had good physical, mental and social functioning, respectively. Only 4 individuals (4.5%) were resilient in all three domains of functioning. Younger age, male sex, higher education, higher mastery, smoking and alcohol use, higher physical activity levels, absence of chronic diseases, and more contacts with friends predicted resilience in one or more domains of functioning. CONCLUSIONS: Few people with LLOA and persistent severe pain showed good physical functioning and about half showed good mental or social functioning. Predictors of resilience differed between domains, and might provide new insights for treatment.

Clinical trial on the effects of oral magnesium supplementation in stable-phase COPD patients.

BACKGROUND AND AIMS: COPD is a common chronic condition in older age that impacts on daily activities and quality of life. Previous studies suggest that magnesium deficit in COPD patients affects bronco-obstruction, inflammation, and physical performance. We investigated whether oral magnesium supplementation in stable-phase COPD patients improves lung function, physical performance, and quality of life. METHODS: We conducted a double-blind randomized-controlled clinical study with 49 participants divided into two groups: one given 300 mg/day of magnesium citrate (n = 25) and the other one sachet/day of a placebo (n = 24). The following parameters were assessed at baseline and after 3 and 6 months: lung function (spirometry), physical performance (handgrip strength, lower limb strength, six-minute walk test), inflammation (e.g., C-reactive protein, CRP), disease-related symptoms, and quality of life (St George's Respiratory Questionnaire, EuroQoL-5D, the Modified British Medical Research Council Questionnaire). RESULTS: Linear mixed models revealed significantly lower CRP values in the intervention group than in the placebo group at the 6 month follow-up (ß = - 3.2, 95% CI - 6.0, - 0.4, p = 0.03). Moreover, the maximum work for flexion tended to increase in both groups between the 3 and the 6 month assessments, especially in the placebo group. No significant differences within and between groups over the study period were observed for the other parameters tested. CONCLUSIONS: Although the established minimum sample size was not reached, our results suggests that oral magnesium supplementation may have a potential anti-inflammatory role. On the other hand, it does not seem to substantially influence lung function, physical performance, and quality of life in COPD patients. TRIAL REGISTRATION: The study is registered in clinicaltrial.gov (Trial Registration: NCT02680769, 13 June 2016, retrospectively registered).

The prevalence of frailty and its associated factors in an Italian institutionalized older population: findings from the cross-sectional Alvise Cornaro Center Study.

BACKGROUND: While it is well established that frail older people have a higher risk of negative health outcomes, the prevalence of frailty and its associated factors in Italian older institutionalized population has never been investigated. AIMS: The aims of this study were to assess the prevalence of frailty and to identify its associated factors in an Italian residential care home population. METHODS: An observational cross-sectional study was designed to evaluate older people aged 70 or over of an Italian residential care home. A multidimensional assessment examining functional, geriatric, ophthalmic, and audiological domains was carried out to identify factors associated with frailty. Physical frailty was evaluated using Fried's criteria. RESULTS: Data analysis uncovered a 51.1% prevalence of pre-frailty and a 40.4% prevalence of frailty in the 94 eligible participants (64 females) whose data were complete. The multivariable analysis showed that a low education level (OR = 5.12, 95% CI 1.22-21.49), a low physical quality of life score (OR = 13.25, 95% CI 3.51-50.08), a low mental quality of life score (OR = 9.22, 95% CI 2.38-35.69), visual impairment (OR = 7.65, 95% CI 1.77-33.14), and hearing impairment (OR = 4.62, 95% CI 1.03-20.66) were independently associated with frailty. CONCLUSIONS: Frailty was found to be highly prevalent in the residential care home studied. Since frailty is a reversible condition, identifying the modifiable factors associated to it should be viewed as an important step in planning and implementing targeted, early prevention strategies.

Chronic cough in adults: recommendations from an Italian intersociety consensus.

BACKGROUND: Chronic cough (CC) is a burdensome health problem in adult and older people, with a major impact on quality of life. Its management is often troublesome, and many guidelines have been released. Notwithstanding, a proportion of cases still do not reach a definite diagnosis and resolutive treatment. A coordinated approach between different specialists would be highly recommended, but its implementation in clinical practice suffers from the lack of shared protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIMS: To develop evidence-based recommendations for the management of adults with CC. METHODS: A 12-member expert task force of general practitioners, geriatricians, pneumologists, allergologists, otorhynolaringologists and gastroenterologists was established to develop evidence-based recommendations for the diagnostic and therapeutic approach to subjects with CC. A modified Delphi approach was used to achieve consensus, and the US Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS: A total of 56 recommendations were proposed, covering 28 topics and concerning definitions and epidemiology, pathogenesis and etiology, diagnostic and therapeutic approach along with the consideration of specific care settings. CONCLUSION: These recommendations should ease the management of subjects with CC by coordinating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.

Improving vaccination rates in older adults and at-risk groups: focus on pertussis.

Despite the implementation of effective paediatric vaccination programmes, pertussis remains a global health problem. Disease epidemiology has changed over time, shifting towards the adolescent and adult populations. In adults, the true burden of pertussis is greatly underestimated and pertussis vaccine coverage rates are suboptimal, including individuals with chronic conditions. Here, we report the outcomes of a virtual international scientific workshop to assess the evidence on the burden of pertussis in older adults and identify potential solutions to improve uptake of pertussis vaccines. In adults, pertussis is underdiagnosed in part due to atypical or milder clinical presentation and the lack of testing and case confirmation. However, contemporary epidemiological data denoted an increase in the burden of pertussis among adolescents and adults. This might be related to a variety of reasons including the waning of immunity over time, the lack of booster vaccination, and the improved diagnostic methods that led to increased recognition of the disease in adults. Pertussis sequelae can be severe in older adults, particularly those with existing chronic medical conditions, and the vulnerability of these groups is further enhanced by low pertussis vaccine coverage. Possible measures to increase vaccine uptake include strengthening and harmonisation of immunisation guidelines, healthcare professionals taking a more active role in recommending pertussis vaccination, involvement of vaccination centres and pharmacies in the vaccination process, and improving knowledge of pertussis burden and vaccine efficacy among the general population.

Dietary acrylamide and incident osteoporotic fractures: an 8-year prospective cohort study.

BACKGROUND: Acrylamide, a component of fried foods, has been associated with several negative health outcomes. However, the relationship between dietary acrylamide and osteoporotic fractures has been explored by a few cross-sectional studies. AIMS: To investigate if dietary acrylamide is associated with the onset of fractures in North American participants at high risk/having knee osteoarthritis (OA), over 8 years of follow-up. METHODS: A Cox's regression analysis, adjusted for baseline confounders was run and the data were reported as hazard ratios (HRs) and 95% confidence intervals (CIs). Dietary acrylamide intake was assessed at the baseline using a food frequency questionnaire and categorized in tertiles (T), whilst fractures' history was recorded using self-reported information. RESULTS: Altogether, 4,436 participants were included. Compared to participants with lower acrylamide intake (T1; < 3,313 µg), those with a higher acrylamide intake (T3; > 10,180 µg) reported a significantly higher risk of any fracture (HR = 1.37; 95% CI 1.12-1.68; p for trend = 0.009), forearm (HR = 1.73; 95% CI 1.09-2.77; p for trend = 0.04), spine (HR = 2.21; 95% CI 1.14-4.31; p for trend = 0.04), and hip fracture (HR = 4.09; 95% CI 1.29-12.96; p for trend = 0.046). CONCLUSIONS: Our study is the first to report that high dietary acrylamide may be associated with an increased risk of osteoporotic fractures.