Associations between neighbourhood safety, social cohesion, sleep quality and sleep duration among older adults in India: Findings from the Study on Global Aging and Adult Health (WHO-SAGE), 2015.

BACKGROUND: Most studies on later-life health in India focus on families, with far less attention given to the health repercussions of neighbourhood conditions among older Indians. We address this limitation in existing research by examining the associations between perceptions of neighbourhood safety and social cohesion and sleep duration and sleep quality among older adults in India. METHODS: Data come from the Study on Global Aging and Adult Health (WHO-SAGE), India 2015 wave 2, with a sample of 7118 adults aged 50 years and above. Sleep quality and duration were assessed using subjective responses. Multivariable logistic and linear regression analyses were employed to test the research hypotheses. RESULTS: Prevalence of poor sleep quality was higher among older adults living in unsafe neighbourhoods (4.46%) than peers residing in safe neighbourhoods (3.52%), and it was also higher among those living in neighbourhoods with poor social cohesion (5.31%) than counterparts who lived in socially cohesive communities (3.10%). Older adults in neighbourhoods with poor social cohesion had higher odds of reporting compromised sleep quality (adjusted odds ratio 1.75, CI: 1.22-2.51) than those living in socially cohesive neighbourhoods. Moreover, compared to those who perceived they were living in safe neighbourhoods, their peers who perceived their neighbourhoods as unsafe reported shorter sleep duration, with a negative beta coefficient of -0.27 (CI: -0.45 to -0.085). CONCLUSION: That perceived unsafety and poor social cohesion within one's neighbourhood are associated with compromised sleep reflects the significance of making neighbourhoods safer and more integrated for later-life sleep health. In addition to micro-level strategies (e.g., balanced nutrition and physical activity), efforts to improve sleep health should optimise macro-level opportunities, such as rehabilitating and revitalising neighbourhoods, which may alleviate sleep disturbances and improve sleep outcomes among older adults.

Optical microscopy versus scanning electron microscopy in urolithiasis.

Stone analysis is incompletely done in many clinical centers. Identification of the stone component is essential for deciding future prophylaxis. X-ray diffraction, Fourier transform infrared spectroscopy, and scanning electron microscopy (SEM) still remains a distant dream for routine hospital work. It is in this context that optical microscopy is suggested as an alternate procedure. The objective of this article was to assess the utility of an optical microscope which gives magnification of up to 40x and gives clear picture of the surface of the stones. In order to authenticate the morphological analysis of urinary stones, SEM and elemental distribution analysis were performed. A total of 250 urinary stones of different compositions were collected from stone clinic, photographed, observed under an optical microscope, and optical photographs were taken at different angles. Twenty-five representative samples among these were gold sputtered to make them conductive and were fed into the SEM machine. Photographs of the samples were taken at different angles at magnifications up to 4,000. Elemental distribution analysis (EDAX) was done to confirm the composition. The observations of the two studies were compared. The different appearances of the stones under optical illuminated microscopy were mostly standardized appearances, namely bosselations of pure whewellite, spiculations of weddellite, bright yellow colored appearance of uric acid, and dirty white amorphous appearance of phosphates. SEM and EDAX gave clearer pictures and gave added confirmation of the stone composition. From the references thus obtained, it was possible to confirm the composition by studying the optical microscopic pictures. Higher magnification capacity of the SEM and the EDAX patterns are useful to give reference support for performing optical microscopy work. After standardization, routine analysis can be performed with optical microscopy. The advantage of the optical microscope is that, it is easy to use and samples can be analyzed in natural color.

Problem in analyzing cystine stones using FTIR spectroscopy.

Cystine stones are produced by an inherited disorder of the transport of amino acid cystine that results in excess of cystine in the urine (cystinuria). Cystine calculi in urinary tract present a significant problem in patients. We have recorded that cystine calculi are very uncommon in our region. Cystine crystals are unusually identified in the urinary deposits. The problem of recognizing cystine by FTIR as a component in mixture of stones is significant. The problem is compounded by the similarity of wavelengths of cystine with that of whewellite and uric acid. The objective of this paper is to elucidate the problems of identifying cystine in stone analysis and identifying a solution to get over this deficiency. Out of 1,300 urinary stones analysed by ordinary wet chemical methods and infrared spectroscopy, 30 stone samples, which were reported to have cystine peaks in significant numbers, were selected. These samples were powdered, mixed with potassium bromide, pelletized and taken up for FTIR analysis. The wavelength patterns were scrutinized by comparing with the peaks obtained by the reference standards of cystine. Spectra were also obtained from pure cystine. Comparison of spectra with those of whewellite and uric acid was performed. Then the samples were taken for Scanning electron microscopy with elemental distribution analysis X-ray (SEM-EDAX). The samples were made conductive by gold sputtering and were fed into JEOL JSM 35 C SEM machine. Morphology was recorded by taking photographs. Further elemental distribution analysis (EDAX) was carried out to identify the elemental composition. Of the 30 samples taken up for FTIR analysis, all showed spectra identifiable with the reference peaks for cystine. However, when these peaks were compared with those of whewellite and uric acid, all the stone samples showed duplication of peaks for whewellite and uric acid and whewellite. The pure cystine spectra showed identifiable peaks are in the range of 3026, 1618.28, 1485, 846.75 cm(-1), etc. (from the standard spectrum of pure cystine). All the analysis findings were correlated with EDAX findings. On doing EDAX, we could separately find out the components present in a mixture. Three stones contained elemental pattern to fit with those of cystine. Even though it is difficult to find out the presence of cystine molecule in FTIR, it is possible to recognize it through EDAX and will be possible to confirm the presence of cystine in mixed urinary stones.

Elemental distribution analysis of urinary crystals.

Various crystals are seen in human urine. Some of them, particularly calcium oxalate dihydrate, are seen normally. Pathological crystals indicate crystal formation initiating urinary stones. Unfortunately, many of the relevant crystals are not recognized in light microscopic analysis of the urinary deposit performed in most of the clinical laboratories. Many crystals are not clearly identifiable under the ordinary light microscopy. The objective of the present study was to perform scanning electron microscopic (SEM) assessment of various urinary deposits and confirm the identity by elemental distribution analysis (EDAX). 50 samples of urinary deposits were collected from urinary stone clinic. Deposits containing significant crystalluria (more than 10 per HPF) were collected under liquid paraffin in special containers and taken up for SEM studies. The deposited crystals were retrieved with appropriate Pasteur pipettes, and placed on micropore filter paper discs. The fluid was absorbed by thicker layers of filter paper underneath and discs were fixed to brass studs. They were then gold sputtered to 100 A and examined under SEM (Jeol JSM 35C microscope). When crystals were seen, their morphology was recorded by taking photographs at different angles. At appropriate magnification, EDAX probe was pointed to the crystals under study and the wave patterns analyzed. Components of the crystals were recognized by utilizing the data. All the samples analyzed contained significant number of crystals. All samples contained more than one type of crystal. The commonest crystals encountered included calcium oxalate monohydrate (whewellite 22%), calcium oxalate dihydrate (weddellite 32%), uric acid (10%), calcium phosphates, namely, apatite (4%), brushite (6%), struvite (6%) and octocalcium phosphate (2%). The morphological appearances of urinary crystals described were correlated with the wavelengths obtained through elemental distribution analysis. Various urinary crystals that are not reported under light microscopy could be recognized by SEM-EDAX combination. EDAX is a significant tool for recognizing unknown crystals not identified by ordinary light microscopy or SEM alone.

EDAX versus FTIR in mixed stones.

Mixed stones form a significant number of all urinary stones. Accurate analysis of individual areas of stones is fraught with uncertainties. Scanning electron microscopy with elemental distribution analysis (SEM-EDAX) is a very important tool in assessing stone composition. The objective of this paper is to project the role of the combination of Fourier transform infrared (FTIR) spectroscopy and SEM-EDAX combination in achieving a total understanding of mixed stone morphology. Ten mixed urinary stones were washed and dried and the composition recognized by analysis of FTIR spectra by comparing with the spectra of pure components. Spectra for different layers were obtained. Then the stone samples were further studied by SEM-EDAX analysis. The findings of FTIR were correlated with SEM-EDAX and detailed data generated. Using SEM-EDAX, the spatial distribution of major and trace elements were studied to understand their initiation and formation. As much as 80% of the stones studied were mixtures of calcium oxalate monohydrate (whewellite) and calcium phosphate (hydroxyapatite) in various proportions. Quantitative evaluation of components was achieved through FTIR and SEM-EDAX analysis. It was possible to get an idea about the spatial distribution of molecules using SEM analysis. The composition of different areas was identified using EDAX. Analyzing with EDAX, it was possible to obtain the percentage of different elements present in a single sample. The study concludes that the most common mixed stone encountered in the study is a mixture of calcium oxalate monohydrate and calcium phosphate in a definite proportion. The combination identified not only the molecular species present in the calculus, but also the crystalline forms within chemical constituents. Using EDAX, the amount of calcium, phosphorus, oxygen and carbon present in the stone sample could be well understood.