How are APOE4, changes in body weight, and longevity related? Insights from a causal mediation analysis.

The ε4 allele of the APOE gene (APOE4) is known for its negative association with human longevity; however, the mechanism is unclear. APOE4 is also linked to changes in body weight, and the latter changes were associated with survival in some studies. Here, we explore the role of aging changes in weight in the connection between APOE4 and longevity using the causal mediation analysis (CMA) approach to uncover the mechanisms of genetic associations. Using the Health and Retirement Study (HRS) data, we tested a hypothesis of whether the association of APOE4 with reduced survival to age 85+ is mediated by key characteristics of age trajectories of weight, such as the age at reaching peak values and the slope of the decline in weight afterward. Mediation effects were evaluated by the total effect (TE), natural indirect effect, and percentage mediated. The controlled direct effect and natural direct effect are also reported. The CMA results suggest that APOE4 carriers have 19%-22% (TE p = 0.020-0.039) lower chances of surviving to age 85 and beyond, in part, because they reach peak values of weight at younger ages, and their weight declines faster afterward compared to non-carriers. This finding is in line with the idea that the detrimental effect of APOE4 on longevity is, in part, related to the accelerated physical aging of ε4 carriers.

Psychosocial evaluation of living liver donors-State of current practices in the United States.

We surveyed living donor liver transplant programs in the United States to describe practices in the psychosocial evaluation of living donors focused on (1) composition of psychosocial team; (2) domains, workflow, and tools of the psychosocial assessment; (3) absolute and relative mental health-related contraindications to donation; and (4) postdonation psychosocial follow-up. We received 52 unique responses, representing 33 of 50 (66%) of active living donor liver transplant programs. Thirty-one (93.9%) provider teams included social workers, 22 (66.7%) psychiatrists, and 14 (42.4%) psychologists. Validated tools were rarely used, but domains assessed were consistent. Respondents rated active alcohol (93.8%), cocaine (96.8%), and opioid (96.8%) use disorder, as absolute contraindications to donation. Active suicidality (97%), self-injurious behavior (90.9%), eating disorders (87.9%), psychosis (84.8%), nonadherence (71.9%), and inability to cooperate with the evaluation team (78.1%) were absolute contraindications to donation. There were no statistically significant differences in absolute psychosocial contraindications to liver donation between geographical areas or between large and small programs. Programs conduct postdonation psychosocial follow-up (57.6%) or screening (39.4%), but routine follow-up of declined donors is rarely conducted (15.8%). Psychosocial evaluation of donor candidates is a multidisciplinary process. The structure of the psychosocial evaluation of donors is not uniform among programs though the domains assessed are consistent. Psychosocial contraindications to living liver donation vary among the transplant programs. Mental health follow-up of donor candidates is not standardized.

Patterns of Aging Changes in Bodyweight May Predict Alzheimer's Disease.

Relationships between patterns of aging-changes in bodyweight and AD are not fully understood. We compared mean age-trajectories of weight between those who did and did not develop late-onset-AD, and evaluated impact of age at maximum weight (AgeMax), and slope of decline in weight, on AD risk. Women with late-onset-AD had lower weight three or more decades before AD onset, and ∼10 years younger AgeMax, compared to AD-free women. APOE4 carriers had younger AgeMax and steeper slope. Older AgeMax and flatter slope predicted lower AD risk. Premature decline in weight could be a sign of accelerated physical aging contributing to AD.

Vaccination Against Pneumonia May Provide Genotype-Specific Protection Against Alzheimer's Disease.

Vaccine repurposing that considers individual genotype may aid personalized prevention of Alzheimer's disease (AD). In this retrospective cohort study, we used Cardiovascular Health Study data to estimate associations of pneumococcal polysaccharide vaccine and flu shots received between ages 65-75 with AD onset at age 75 or older, taking into account rs6859 polymorphism in NECTIN2 gene (AD risk factor). Pneumococcal vaccine, and total count of vaccinations against pneumonia and flu, were associated with lower odds of AD in carriers of rs6859 A allele, but not in non-carriers. We conclude that pneumococcal polysaccharide vaccine is a promising candidate for genotype-tailored AD prevention.

Psychiatric Disorders and Their Treatment: Impact of Outcomes in Patients With Chronic Liver Disease.

Content available: Audio Recording.

A Review on the Management of Hip and Knee Osteoarthritis.

Arthritis is the most common chronic condition affecting patients over the age of 70. The prevalence of osteoarthritis increases with age, and with an aging population, the effect of this disease will represent an ever-increasing burden on health care. The knee is the most common joint affected in osteoarthritis, with up to 41% of limb arthritis being located in the knee, compared to 30% in hands and 19% in hips. We review the current concepts with regard to the disease process and risk factors for developing hip and knee osteoarthritis. We then explore the nonsurgical management of osteoarthritis as well as the operative management of hip and knee arthritis. We discuss the indications for surgical treatment of hip and knee arthritis, looking in particular at the controversies affecting young and obese patients in both hip and knee replacements. Patient and implant related outcomes along with survivorships are addressed as well as the experiences and controversies described in national joint registries.

Red light-green light: from kids' game to discharge tool.

Lean manufacturing methods are being evaluated in the healthcare sector. Improving the flow of patients in acute care should the eliminate delays that contribute to the cost of healthcare. Our patient care unit uses the colours of a traffic light to visually identify the expected date of discharge. This facilitates the distribution of the work relating to discharge over a couple of days, rather than the usual concentration within the last couple of hours of a patient's stay. The Red Light-Green Light system contributes to reduced backlogs in the emergency department and fewer cancellations of elective surgeries due to a lack of in-patient beds.

Brief report: "I can't talk about it:" sexuality and self-silencing as interactive predictors of depressive symptoms in adolescent dating couples.

This longitudinal study examined sexual intercourse within adolescent romantic relationships as a couple-level moderator of the association between adolescent individual characteristics and depressive symptoms. Two hundred nine middle- and older-adolescent dating couples (aged 14-17 and 17-21, respectively) reported on their own self-silencing, depressive symptoms, and sexual behaviors. At Time 1, frequency of sexual intercourse significantly moderated the relationship between self-silencing and depressive symptoms, such that adolescents higher in self-silencing engaging in more frequent sex were at risk for clinically significant levels of depression. Adolescents who were low in self-silencing were not at increased risk for depression, regardless of frequency of sex. Self-silencing also significantly predicted increases in depressive symptoms from Time 1 to Time 2. Implications include the possibility that frequent sex in highly self-silencing adolescents exacerbates psychological depletion believed to link self-silencing to depressive symptoms, and that this depletion compounds over time.

The communication of emotion via touch.

The study of emotional communication has focused predominantly on the facial and vocal channels but has ignored the tactile channel. Participants in the current study were allowed to touch an unacquainted partner on the whole body to communicate distinct emotions. Of interest was how accurately the person being touched decoded the intended emotions without seeing the tactile stimulation. The data indicated that anger, fear, disgust, love, gratitude, and sympathy were decoded at greater than chance levels, as well as happiness and sadness, 2 emotions that have not been shown to be communicated by touch to date. Moreover, fine-grained coding documented specific touch behaviors associated with different emotions. The findings are discussed in terms of their contribution to the study of emotion-related communication.

The communicative functions of touch in humans, nonhuman primates, and rats: a review and synthesis of the empirical research.

Although touch is one of the most neglected modalities of communication, several lines of research bear on the important communicative functions served by the modality. The authors highlighted the importance of touch by reviewing and synthesizing the literatures pertaining to the communicative functions served by touch among humans, nonhuman primates, and rats. In humans, the authors focused on the role that touch plays in emotional communication, attachment, bonding, compliance, power, intimacy, hedonics, and liking. In nonhuman primates, the authors examined the relations among touch and status, stress, reconciliation, sexual relations, and attachment. In rats, the authors focused on the role that touch plays in emotion, learning and memory, novelty seeking, stress, and attachment. The authors also highlighted the potential phylogenetic and ontogenetic continuities and discussed suggestions for future research.