A comparison between effects of Square-Stepping Exercise and Tai Chi Chuan on functional fitness and fear of falling in older women.

BACKGROUND: It is challenging to find exercise programs that are safe, effective, attractive, and feasible to reduce the risk of falls and fall-related injuries in older adults. AIMS: We compared the effects of SSE (Square-Stepping Exercise) versus TCC (Tai Chi Chuan) on functional fitness and fear of falling in older women aged 60 years and above. METHODS: It was a single blind randomized control trial. We purposefully selected 36 older women (aged 65.2 ± 3.82 years). They were then paired based on the criterion of functional reach test and randomly assigned to two groups (18 people) of TTC and SSE. The exercise program included 8 weeks of three 1-h-session training. We measured functional fitness and fear of falling. Functional fitness was assessed using the following tests: Single Leg-Stance-Eyes Open/Closed, Timed Up and Go, Functional Reach Test, Chair Stand, Arm Curl, and Back Scratch. Fear of falling was assessed using the Falls Efficacy Scale-International. RESULTS: We analyzed the data using repeated measure ANOVA. Within-group comparisons revealed significant improvements for both groups in all nine measures of functional tests as well as fear of falling [Formula: see text]. Interaction comparisons revealed that improvements in measures of functional fitness were greater in the TTC group [Formula: see text]. Nevertheless, the groups were not significantly different in fear of falling [Formula: see text]. CONCLUSION: Our findings showed that both TCC and SSE interventions improved functional fitness and fear of falling. The TCC is more effective than SSE, though the latter is easier to learn and perform.

Recommendations for the conduct of clinical trials for drugs to treat or prevent sarcopenia.

PURPOSE: Sarcopenia is an age-related muscle condition which is frequently a precursor of frailty, mobility disability and premature death. It has a high prevalence in older populations and presents a considerable social and economic burden. Potential treatments are under development but, as yet, no guidelines support regulatory studies for new drugs to manage sarcopenia. The objective of this position paper is therefore to suggest a set of potential endpoints and target population definitions to stimulate debate and progress within the medico-scientific and regulatory communities. METHODS: A multidisciplinary expert working group was hosted by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, which reviewed and discussed the recent literature from a perspective of clinical experience and guideline development. Relevant parallels were drawn from the development of definition of osteoporosis as a disease and clinical assessment of pharmaceutical treatments for that indication. RESULTS: A case-finding decision tree is briefly reviewed with a discussion of recent prevalence estimations of different relevant threshold values. The selection criteria for patients in regulatory studies are discussed according to the aims of the investigation (sarcopenia prevention or treatment) and the stage of project development. The possible endpoints of such studies are reviewed and a plea is made for the establishment of a core outcome set to be used in all clinical trials of sarcopenia. CONCLUSIONS: The current lack of guidelines for the assessment of new therapeutic treatments for sarcopenia could potentially hinder the delivery of effective medicines to patients at risk.

Community-based Men's Sheds: promoting male health, wellbeing and social inclusion in an international context.

Males experience greater mortality and morbidity than females in most Western countries. The Australian and Irish National Male Health Policies aim to develop a framework to address this gendered health disparity. Men's Sheds have a distinct community development philosophy and are thus identified in both policies as an ideal location to address social isolation and positively impact the health and wellbeing of males who attend. The aim of this international cross-sectional survey was to gather information about Men's Sheds, the people who attend Men's Sheds, the activities at Men's Sheds, and the social and health dimensions of Men's Sheds. Results demonstrate that Men's Sheds are contributing a dual health and social role for a range of male subgroups. In particular, Men's Sheds have an outward social focus, supporting the social and mental health needs of men; health promotion and health literacy are key features of Men's Sheds. Men's Sheds have an important role to play in addressing the gendered health disparity that males face. They serve as an exemplar to health promotion professionals of a community development context where the aims of male health policy can be actualized as one part of a wider suite of global initiatives to reduce the gendered health disparity.

Screening for Pelvic Floor Disorders and Sexual Dysfunction in Postpartum Women: A Retrospective Cohort Study.

Objectives This study assesses the screen rate and prevalence of postpartum pelvic floor disorders and sexual dysfunction (PFDs/SD) within the first year of delivery. Methods This is a retrospective review of postpartum women seen in a university clinic who delivered at the associated hospital and had postpartum visits from June 1, 2020, to April 15, 2022. Charts were reviewed from delivery to one year postpartum. Demographic and clinical characteristics were compared between women with and without postpartum screening. Results Three hundred thirty-four women met inclusion criteria. Two hundred twenty (65.9%) were screened for PFDs/SD. Compared to women who were not screened, women who were screened were older (32.6 vs 31.3 years, p=0.02). Women with a cesarean delivery (73% vs. 58% vaginal, p=0.004), delivered by an attending or resident (70% vs 60% midwife, p=0.06), first postpartum visit at less than six weeks after delivery (76% vs. 43% 6-12 weeks, p<0.001), and three or more postpartum visits (80% vs. 65% two visits, 50% one visit, p<0.001) were more likely to be screened. In an adjusted model, only timing of the first postpartum visit remained significant. Urinary incontinence and fecal incontinence were the most common PFDs diagnosed. Of the 41 women who had PFDs and/or SD, 31 (75.6%) were referred to pelvic floor physical therapy (PFPT) and/or urogynecology. Discussion In this retrospective cohort study, we found a low rate of postpartum screening for PFDs/SDs. This deficiency highlights critical gaps in care for postpartum women.

Psychometric development of the COVID-19 vaccine misinformation scale and effects on vaccine hesitancy.

To help inform post-COVID-19 pandemic practical health policies, the researchers created the COVID-19 vaccine misinformation scale (CVMS). During the COVID-19 pandemic, falsehoods spread online which casted doubt and concerns about the vaccine. Example misconceptions included vaccination leads to greater vulnerability to other illness and would alter someone's DNA. The researchers performed two large surveys with U.S. participants. The researchers reviewed debunked COVID-19 vaccine falsehoods online. Construction of the CVMS followed standard psychometric scale development steps. Statistical analysis provided support for the 10-item CVMS with satisfactory reliability, discriminant validity, and convergent validity. Predictive validity regression analysis demonstrated the CVMS associated with higher vaccine hesitancy. The prevalence of vaccine misbeliefs broadened pandemic healthcare challenges. On top of existing duties, healthcare workers had to explain vaccine efficacy and safety to dispel fallacies. The researchers discuss implications for the CVMS within the context of motivated reasoning theory.

The Effect and Cost-Effectiveness of Offering a Combined Lifestyle Intervention for the Prevention of Cardiovascular Disease in Primary Care: Results of the Healthy Heart Stepped-Wedge Trial.

OBJECTIVE: To evaluate the effectiveness and cost-effectiveness of offering the combined lifestyle programme "Healthy Heart", addressing overweight, diet, physical activity, smoking and alcohol, to improve lifestyle behaviour and reduce cardiovascular risk. DESIGN: A practice-based non-randomised stepped-wedge cluster trial with two-year follow-up. Outcomes were obtained via questionnaires and routine care data. A cost-utility analysis was performed. During the intervention period, "Healthy Heart" was offered during regular cardiovascular risk management consultations in primary care in The Hague, The Netherlands. The period prior to the intervention period served as the control period. RESULTS: In total, 511 participants (control) and 276 (intervention) with a high cardiovascular risk were included (overall mean ± SD age 65.0 ± 9.6; women: 56%). During the intervention period, 40 persons (15%) participated in the Healthy Heart programme. Adjusted outcomes did not differ between the control and intervention period after 3-6 months and 12-24 months. Intervention versus control (95% CI) 3-6 months: weight: ß -0.5 (-1.08-0.05); SBP ß 0.15 (-2.70-2.99); LDL-cholesterol ß 0.07 (-0.22-0.35); HDL-cholesterol ß -0.03 (-0.10-0.05); physical activity ß 38 (-97-171); diet ß 0.95 (-0.93-2.83); alcohol OR 0.81 (0.44-1.49); quit smoking OR 2.54 (0.45-14.24). Results were similar for 12-24 months. Mean QALYs and mean costs of cardiovascular care were comparable over the full study period (mean difference (95% CI) QALYs: -0.10 (-0.20; 0.002); costs: EUR 106 (-80; 293)). CONCLUSIONS: For both the shorter (3-6 months) and longer term (12-24 months), offering the Healthy Heart programme to high-cardiovascular-risk patients did not improve their lifestyle behaviour nor cardiovascular risk and was not cost-effective on a population level.

Effectiveness of the Wearable Sensor-based Ambient Intelligent Geriatric Management (AmbIGeM) System in Preventing Falls in Older People in Hospitals.

BACKGROUND: The Ambient Intelligent Geriatric Management (AmbIGeM) system augments best practice and involves a novel wearable sensor (accelerometer and gyroscope) worn by patients where the data captured by the sensor are interpreted by algorithms to trigger alerts on clinician handheld mobile devices when risk movements are detected. METHODS: A 3-cluster stepped-wedge pragmatic trial investigating the effect on the primary outcome of falls rate and secondary outcome of injurious fall and proportion of fallers. Three wards across 2 states were included. Patients aged ≥65 years were eligible. Patients requiring palliative care were excluded. The trial was registered with the Australia and New Zealand Clinical Trials registry, number 12617000981325. RESULTS: A total of 4924 older patients were admitted to the study wards with 1076 excluded and 3240 (1995 control, 1245 intervention) enrolled. The median proportion of study duration with valid readings per patient was 49% ((interquartile range [IQR] 25%-67%)). There was no significant difference between intervention and control relating to the falls rate (adjusted rate ratio = 1.41, 95% confidence interval [0.85, 2.34]; p = .192), proportion of fallers (odds ratio = 1.54, 95% confidence interval [0.91, 2.61]; p = .105), and injurious falls rate (adjusted rate ratio = 0.90, 95% confidence interval [0.38, 2.14]; p = .807). In a post hoc analysis, falls and injurious falls rate were reduced in the Geriatric Evaluation and Management Unit wards when the intervention period was compared to the control period. CONCLUSIONS: The AmbIGeM system did not reduce the rate of falls, rate of injurious falls, or proportion of fallers. There remains a case for further exploration and refinement of this technology given the post hoc analysis findings with the Geriatric Evaluation and Management Unit wards. Clinical Trials Registration Number: 12617000981325.

A Biomarker-based Biological Age in UK Biobank: Composition and Prediction of Mortality and Hospital Admissions.

BACKGROUND: Chronological age is the strongest risk factor for most chronic diseases. Developing a biomarker-based age and understanding its most important contributing biomarkers may shed light on the effects of age on later-life health and inform opportunities for disease prevention. METHODS: A subpopulation of 141 254 individuals healthy at baseline were studied, from among 480 019 UK Biobank participants aged 40-70 recruited in 2006-2010, and followed up for 6-12 years via linked death and secondary care records. Principal components of 72 biomarkers measured at baseline were characterized and used to construct sex-specific composite biomarker ages using the Klemera Doubal method, which derived a weighted sum of biomarker principal components based on their linear associations with chronological age. Biomarker importance in the biomarker ages was assessed by the proportion of the variation in the biomarker ages that each explained. The proportions of the overall biomarker and chronological age effects on mortality and age-related hospital admissions explained by the biomarker ages were compared using likelihoods in Cox proportional hazard models. RESULTS: Reduced lung function, kidney function, reaction time, insulin-like growth factor 1, hand grip strength, and higher blood pressure were key contributors to the derived biomarker age in both men and women. The biomarker ages accounted for >65% and >84% of the apparent effect of age on mortality and hospital admissions for the healthy and whole populations, respectively, and significantly improved prediction of mortality (p < .001) and hospital admissions (p < 1 × 10-10) over chronological age alone. CONCLUSIONS: This study suggests that a broader, multisystem approach to research and prevention of diseases of aging warrants consideration.

Examining sleep deficiency and disturbance and their risk for incident dementia and all-cause mortality in older adults across 5 years in the United States.

BACKGROUND: Sleep disturbance and deficiency are common among older adults and have been linked with dementia and all-cause mortality. Using nationally representative data, we examine the relationship between sleep disturbance and deficiency and their risk for incident dementia and all-cause mortality among older adults. METHODS: The National Health and Aging Trends Study (NHATS) is a nationally-representative longitudinal study of Medicare beneficiaries in the US age 65 and older. Surveys that assessed sleep disturbance and duration were administered at baseline. We examined the relationship between sleep disturbance and deficiency and incident dementia and all-cause mortality over the following 5 years using Cox proportional hazards modeling, controlling for confounders. RESULTS: Among the sample (n = 2,812), very short sleep duration (≤5 hours: HR = 2.04, 95% CI: 1.26 - 3.33) and sleep latency (>30 minutes: HR = 1.45, 95% CI: 1.03 - 2.03) were associated with incident dementia in adjusted Cox models. Difficulty maintaining alertness ("Some Days": HR = 1.49, 95% CI: 1.13 - 1.94 and "Most/Every Day": HR = 1.65, 95% CI: 1.17 - 2.32), napping ("Some days": HR = 1.38, 95% CI: 1.03 - 1.85; "Most/Every Day": HR = 1.73, 95% CI: 1.29 - 2.32), sleep quality ("Poor/Very Poor": HR = 1.75, 95% CI: 1.17 - 2.61), and very short sleep duration (≤5 hours: HR = 2.38, 95% CI: 1.44 - 3.92) were associated with all-cause mortality in adjusted Cox models. CONCLUSIONS: Addressing sleep disturbance and deficiency may have a positive impact on risk for incident dementia and all-cause mortality among older adults.

Application of Machine Vision in Classifying Gait Frailty Among Older Adults.

Background: Frail older adults have an increased risk of adverse health outcomes and premature death. They also exhibit altered gait characteristics in comparison with healthy individuals. Methods: In this study, we created a Fried's frailty phenotype (FFP) labelled casual walking video set of older adults based on the West China Health and Aging Trend study. A series of hyperparameters in machine vision models were evaluated for body key point extraction (AlphaPose), silhouette segmentation (Pose2Seg, DPose2Seg, and Mask R-CNN), gait feature extraction (Gaitset, LGaitset, and DGaitset), and feature classification (AlexNet and VGG16), and were highly optimised during analysis of gait sequences of the current dataset. Results: The area under the curve (AUC) of the receiver operating characteristic (ROC) at the physical frailty state identification task for AlexNet was 0.851 (0.827-0.8747) and 0.901 (0.878-0.920) in macro and micro, respectively, and was 0.855 (0.834-0.877) and 0.905 (0.886-0.925) for VGG16 in macro and micro, respectively. Furthermore, this study presents the machine vision method equipped with better predictive performance globally than age and grip strength, as well as than 4-m-walking-time in healthy and pre-frailty classifying. Conclusion: The gait analysis method in this article is unreported and provides promising original tool for frailty and pre-frailty screening with the characteristics of convenience, objectivity, rapidity, and non-contact. These methods can be extended to any gait-related disease identification processes, as well as in-home health monitoring.

Effects of Active Learning Education on Arterial Stiffness of Older Adults with Low Health Literacy: A Randomized Controlled Trial.

AIM: We examined the effects of active learning education on arterial stiffness and physical activity of community-dwelling older adults with low health literacy. METHODS: This study is a secondary analysis of randomized controlled trial of 60 participants aged 65 and older with low health literacy. The intervention group (n=30) participated in a weekly 90-minute active learning program session for 24 weeks, which addressed health promotion in older age. The control group (n=30) attended a 90-minute health education class in a didactic manner. The outcomes were measured at baseline and in week 24. The degree of arterial stiffness was assessed based on the cardio-ankle vascular index (CAVI) using the VS-1500 device (Fukuda Denshi Co., Ltd., Tokyo, Japan). The shortened version of the self-reported International Physical Activity Questionnaire was used to assess the amount of total physical activity determined by the metabolic equivalent hours per week. We used analysis by intention-to-treat, with multiple imputation for missing data. RESULTS: Seven participants (11.7%) dropped out prior to the post-intervention assessment. The multiple imputation analysis revealed that the intervention group showed significant improvement in CAVI [between-groups difference (95% confidence interval)=-0.78 (-1.25 to -0.31), Cohen's d=0.82] and physical activity [32.5 (0.3 to 64.7), Cohen's d=0.57] as compared with the control group. The sensitivity analysis for the complete cases showed similar results. CONCLUSION: Active learning health education may be effective in improving arterial stiffness and physical activity in older adults with low health literacy.

The Effects of Preventive Home Visits on Older People's Use of Health Care and Social Services and Related Costs.

BACKGROUND: We use data from a randomized controlled trial on preventive home visits exploring effectiveness on health-related quality of life. In this article, we examine the intervention's cost-effectiveness and effects on quality-adjusted life years in older home-dwelling adults. METHODS: There were 422 independently home-dwelling participants in the randomized, controlled trial, all aged more than 75 years, with equal numbers in the control and intervention groups. The intervention took place in a municipality in Finland and consisted of multiprofessional preventive home visits. We gathered the data on health care and social services use from central registers and medical records during 1 year before the intervention and 2 years after the intervention. We analyzed the total health care and social services use and costs per person-years and the difference in change in health-related quality of life as measured using the 15D measure. We calculated quality-adjusted life years and incremental cost-effectiveness ratios. RESULTS: There was no significant difference in baseline use of services or in the total use and costs of health care and social services during the 2-year follow-up between the two groups. In the intervention group, health-related quality of life declined significantly more slowly compared with the control group (-0.015), but there was no significant difference in quality-adjusted life years gained between the groups. The cost-effectiveness plane showed 60% of incremental cost-effectiveness ratios lying in the dominant quadrant, representing additional effects with lower costs. CONCLUSIONS: This multiprofessional preventive home visit intervention appears to have positive effects on health-related quality of life without accruing additional costs. THE CLINICAL TRIAL REGISTRATION NUMBER: ACTRN12616001411437.

Beyond Implementation: Sustaining Group Prenatal Care and Group Well-Child Care.

INTRODUCTION: Group prenatal care and group well-child care (collectively called group care) provide health care in groups. Group care is being introduced in many settings, and the model's benefits are increasingly recognized. Yet, little attention has been paid to understanding model sustainability. This study examined barriers to sustainability and offers suggestions for sustaining group care programs. METHODS: This qualitative research was guided by interpretive description. Semistructured interviews with 17 professionals were conducted in 4 sites in one community to explore barriers to sustaining group care and key ingredients for sustainability. Sites were 2 clinics that had provided group prenatal care, a clinic currently providing group prenatal care, and a clinic currently providing group well-child care. Two clinics have continued providing group care and 2 have discontinued it. Participants included midwives, physicians, nurses, and nurse practitioners. Interviews were audio recorded, transcribed, and entered in ATLAS.ti. A priori and inductive coding schemes were developed; code content was compared across individuals, participant types, and settings. RESULTS: Five themes were identified: administrative buy-in, robust recruitment, clinician and staff buy-in, owning it, and sustainability mindset. Group care needs to be sold to many different constituencies: administrators, staff and clinicians, and patients. Furthermore, sustainability requires having a conscious awareness of the importance of sustainability from the outset, taking ownership by adapting group care to needs of settings, creating venues for expressing divergent viewpoints and problem-solving, and recognizing that these processes are ongoing with change occurring incrementally. It also includes addressing the need for long-term financing. DISCUSSION: Those implementing group care must be prepared to go beyond managing the logistics of introducing a complex new program; they must also be prepared to develop sustainability mindsets, sell the model to everyone on all levels within their institutions, and advocate for enhanced reimbursement for group care and value-driven payment systems.

High Flavonoid Cocoa Supplement Ameliorates Plasma Oxidative Stress and Inflammation Levels While Improving Mobility and Quality of Life in Older Subjects: A Double-Blind Randomized Clinical Trial.

BACKGROUND: The age-related decline in mass, strength, and performance of skeletal muscle is associated with loss of independence, falls risk, disability, institutionalization, and death. METHODS: To determine whether a cocoa supplement enriched in flavonoids can improve plasma markers of oxidative stress and inflammation, physical performance and frailty in middle-aged and older subjects, we conducted a two-phase, randomized, double-blind, clinical trial. The initial study included 60 subjects (55- to 70-year-old) allocated into placebo (P), highly alkalinized (no-flavonoid; NF), or flavonoid-rich natural cocoa (F) beverage groups. The follow-up study included 74 older subjects (65- to 90-year-old) randomly distributed into NF or F groups. Subjects were instructed to consume the beverages once/day for up to 12-weeks. A comprehensive (aging relevant) set of end points were assessed, which included mean change in blood plasma metabolic and oxidative stress indicators, in physical performance tests and quality of life (QoL). RESULTS: In the initial study, the F group showed improved glycemia, triglyceridemia, High-density lipoprotein cholesterol, Low-density lipoprotein cholesterol, triglyceridemia/HDL index, and oxidative markers. Performance on the Up and Go test, skeletal muscle index, and quality of life also improved. In the follow-up study, F treatment was associated with significant improvements in metabolic, oxidative stress, and inflammatory endpoints and positive effects on physical performance, frailty indicators, and quality of life (F vs. NF group). CONCLUSIONS: Regular flavonoids consumption positively affects blood oxidative stress and inflammation end points, cardiometabolic risk markers, physical performance, and quality of life. The sum of such effects may help to mitigate the extent of frailty development in the elderly people. TRIAL REGISTRATION: NCT03585868.

Use of an Evidence-Based Guideline for Management of Side Effects from Long-Acting Reversible Contraceptives: A Quality Improvement Report.

INTRODUCTION: Many health care providers believe that women who initiate long-acting reversible contraceptives (LARC) discontinue the method because of side effects too soon for the method to be economical. The purpose of this quality improvement project was to implement and evaluate an evidence-based telephone triage nursing guideline for management of side effects of LARC with an ultimate goal of reducing the number of early discontinuations. PROCESS: A telephone triage guideline was adapted from the Contraceptive Choice Project's Clinician Call Back System, supplemented with evidence-based resources, and approved by clinicians at 2 community women's health and midwifery offices. Baseline retrospective data were collected on all women over the age of 18 who had LARC inserted at the 2 sites in the year prior to guideline implementation and in the 3 months after implementation. Rates of LARC removal at or before 3 months postinsertion, before and after guideline implementation, were evaluated. OUTCOMES: Approximately 1 in 5 women called for help managing LARC side effects. Of the callers, 3 of 32 (9.4%) women receiving standard care discontinued their LARC prior to 3 months, whereas 0 of 24 women who were triaged using the guideline discontinued their LARC prior to 3 months (P = .12). Cramping, bleeding, and malposition or expulsion were the most common concerns and reasons for discontinuation. DISCUSSION: Fewer women than anticipated called to report side effects, and even fewer chose to discontinue their LARC early. There were fewer discontinuations with guideline use, but this was not a statistically significant difference. Most women did not discontinue their LARC early for any reason, including side effects.

Implementation and evaluation of community-based drop-in centres for breastfeeding support in Victoria, Australia.

BACKGROUND: While Australia has high breastfeeding initiation, there is a sharp decline in the first weeks postpartum and this continues throughout the first year. Supporting breastfeeding In Local Communities (SILC) was a three-arm cluster randomised controlled trial to determine whether early home-based breastfeeding support by a maternal and child health nurse (SILC-MCHN), with or without access to a community-based breastfeeding drop-in centre, increased the proportion of infants receiving any breast milk at three, four and six months. The trial was conducted in ten Local Government Areas (LGAs) in Victoria, Australia.The primary aim of this paper is to describe the three drop-in centres established during the trial; and the profile of women who accessed them. The secondary aim is to explore the views and experiences of the drop-in centre staff, and the challenges faced in establishing and maintaining a breastfeeding drop-in centre in the community. METHODS: Evaluation of the three LGAs with drop-in centres was multifaceted and included observational visits and field notes; data collected from attendance log books from each drop-in centre; a written survey and focus groups with maternal and child health (MCH) nurses who ran the drop-in centres; and semi-structured interviews with MCH coordinators of the participating LGAs. RESULTS: The three LGAs developed and ran different models of breastfeeding drop-in centres. They reported challenges in finding convenient, accessible locations. Overall, attendance was lower than expected, with an average of only one attendee per session. Two global themes were identified regarding staff views: implementation challenges, encompassing finding accessible, available space, recruiting volunteers to provide peer support, and frustration when women did not attend; and the work of SILC-MCHNs, including themes of satisfying and rewarding work, juggling roles, and benefits to women, babies and the community. CONCLUSION: Providing community-based breastfeeding support was satisfying for the drop-in centre staff but proved difficult to implement, reflected by the lower than anticipated attendances at all of the drop-in centres. Interventions to increase breastfeeding in complex community settings require sufficient time to build partnerships with the existing services and the target population; to understand when and how to offer interventions for optimum benefit. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12611000898954.

Preeclampsia and the Risk of Future Vascular Disease and Mortality: A Review.

INTRODUCTION: Preeclampsia increases a woman's long-term risk of vascular disease and/or death including chronic hypertension, myocardial infarction, heart failure, stroke, and venous thromboembolism. The literature suggests that maternity care providers may be unaware of this association. METHODS: A database search was conducted examining the long-term effects of hypertensive disorders of pregnancy using MEDLINE, Scopus, CINAHL, ISI Web of Knowledge, and the Cochrane Database of Systematic Reviews. Inclusion criteria were: 1) English language, 2) peer-reviewed journals, 3) January 2000 to July 2015, 4) systematic reviews with or without meta-analyses, and 5) studies that addressed the relationship between hypertensive disorders of pregnancy and vascular disease such as hypertension, cardiovascular disease (CVD), and cerebrovascular diseases. RESULTS: Three systematic reviews with meta-analysis qualified for this review. They represented 48 unique studies from 20 countries and included a total of 3,598,601 women. Preeclampsia was associated with a 3-fold increased risk for developing chronic hypertension. Compared with normotensive women, those with preeclampsia experienced double the risk, or more, for CVD or CVD-related mortality. Preeclampsia was also associated with approximately double the risk for fatal or nonfatal stroke. DISCUSSION: Preeclampsia is associated with an increased risk for future chronic hypertension, CVD, cerebrovascular disease, and death. While evidence shows that women with cardiac risk factors may have a higher chance of developing preeclampsia, many women with preeclampsia have no CVD risk factors. Measures to prevent preeclampsia such as calcium supplementation for women with low calcium intake and low-dose aspirin for women with a history of more than one incident of preeclampsia or a preterm birth associated with preeclampsia are supported by evidence. Reduction of modifiable risks associated with CVD before, during, and after pregnancy is recommended. All care providers and women should be educated regarding these risks and the importance of pregnancy history to future health.

Leisure-time physical activity in midlife is related to old age frailty.

BACKGROUND: There are scarce studies of the long-term associations between leisure-time physical activity (LTPA) in midlife and phenotypic frailty in old age. METHODS: We studied healthy Caucasian men of high socioeconomic status (N = 514), who had participated in health checkups during the 1960s (the Helsinki Businessmen Study, Finland). In 1974, they were examined with questionnaires and clinical examinations, and LTPA was collapsed into three categories: low (n = 87), moderate (n = 256), and high (n = 171). In 2000, at mean age of 74, survivors were assessed for physical activity and frailty phenotype using the modified Fried criteria validated in our cohort. Four criteria were used: (a) weight loss > 5% from midlife or current body mass index < 21kg/m(2), (b) physical inactivity, (c) low vitality, and (d) physical weakness. Responders with 3-4, 1-2, and zero criteria were classified as frail, prefrail, and nonfrail, respectively. RESULTS: The prevalence of frailty was 16.1%, 10.2%, and 4.7% in the low, moderate, and high LTPA groups, respectively. Higher midlife LTPA was significantly related to lower prevalence of both frailty and prefrailty in old age. After adjusting for baseline age, smoking, body mass index, blood pressure, and alcohol, the risk of frailty was 80% lower in the high LTPA group compared with the low LTPA group (odds ratio = 0.20; 95% confidence interval 0.07-0.55). This finding was supported by the relationships between the change of physical activity and frailty in old age. CONCLUSIONS: In this socioeconomically homogenous male cohort, higher physical activity since midlife was strongly associated with less frailty in old age.