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Objectives: The aims of this study were to assess oral health‐related quality of life (OHRQoL) in a cohort of older Australian men and explore the association between their general health conditions, socio‐demographic factors and OHRQoL. Methods: The Concord Health and Ageing in Men Project (CHAMP) is a cohort study of the health of a representative sample of Australian men, initiated in 2005–2006 with an initial sample of 1705 men 70 years or over. Participants completed a self‐administered health and socio‐demographic questionnaire and attended an interview and clinical assessment at baseline and each of three follow‐up assessments. Information on oral health and responses to the Oral Health Impact Profile (OHIP‐14) were collected in the 4th follow‐up in which 778 men completed the OHIP‐14 questionnaire and 614 men had a dental assessment. The prevalence of oral health impact was defined as a response of fairly often or very often to one or more of the OHIP‐14 questions. Mean OHIP‐14 scores were calculated for the 14 questions and used as the dependent variable in the regression analyses. Zero‐inflated Poisson regression was used to estimate prevalence rate ratios (PRR). Results: Only 10% of men presented oral health impacts. In multivariate regression modelling, being born in Italy/Greece (PRR: 2.16, 95% CI: 1.93–2.42) or in other countries (PRR: 2.12, 95% CI: 1.89–2.38), having poor self‐rated general health (PRR: 1.38, 95% CI: 1.24–1.53), having poor mental wellbeing (PRR: 1.14, 95% CI: 1.04–1.24), having ≥6 depressive symptoms (PRR: 1.18, 95% CI: 1.05–1.32), being a current smoker (PRR: 1.34, 95% CI: 1.06–1.70) and having more decayed tooth surfaces (PRR:1.01, 95% CI: 1.00–1.02) were associated with higher impact scores. Conclusions: Overall, older Australian men exhibit good oral health‐related quality of life. The inter‐relationship between perceptions of general health and well‐being, health and oral health variables and social background supports policy objectives of closer integration of general health and oral health services for older Australian men. [ABSTRACT FROM AUTHOR]

Abstract: Pain is a global public health problem given its high prevalence and incidence, long duration, and social and economic impact. There is growing interest in nutrition as potential modifiable risk factor related to pain; however, the associations between healthy dietary patterns and pain have not yet been well established. Thus, we aimed to systematically review and synthesise current cross-sectional and longitudinal evidence on the relationship between a priori healthy dietary patterns and noncancer pain among adults aged ≥18 years. We identified relevant published cross-sectional and longitudinal studies by systematically searching several electronic databases from inception to September 2021. Risk of bias was assessed using the modified Newcastle-Ottawa scale for cohort studies. A total of 14 cross-sectional and 6 longitudinal studies were included in the review. These studies measured different dietary scores/indices, such as different measures of adherence to the Mediterranean diet and the dietary inflammatory index. Pain ascertainment methods and pain measurements used differed across studies. All 20 of the included studies had different study designs and statistical analysis. Of these studies, 10 reported an inverse association between adherence to a healthy dietary pattern and pain, 5 reported mixed results, and 5 reported no associations. Despite notable heterogeneity, 50% of included observational studies reported that adherence to a healthy diet, particularly the Mediterranean diet, is inversely associated with pain. Of note, the cross-sectional design of most studies precludes any causal interpretation. Moreover, limited and inconsistent evidence from longitudinal studies highlights the need for further studies. [ABSTRACT FROM AUTHOR]

Although characteristic changes in amino acid concentrations occur in obesity and sarcopenia, amino acids concentrations have not been reported in sarcopenic obesity. We studied n = 831 men aged 75 years and older from the 5-year follow-up of the Concord Health and Ageing in Men Project. Sarcopenia was defined using the Foundation of the National Institutes of Health criteria and obesity was defined as >30% fat mass. There were 31 men (3.7%) who had sarcopenic obesity. Branched chain amino acids were elevated in the obese (but not sarcopenic) group (n = 348) but reduced in both the sarcopenic (but not obese) (n = 44) and the sarcopenic obese groups. Apart from this, most of the amino acid concentrations were between those for the obese and the sarcopenic groups. Yet despite low concentrations of branched chain amino acids, the sarcopenic obese group had indications of insulin resistance and diabetes mellitus (fasting glucose and insulin concentrations, homeostatic model assessment, and percentage of participants taking diabetes medications) that were similar to the obese group. In summary, sarcopenic obese participants did not have a unique amino acid signature. In obesity, elevated branched chain amino acids are not a prerequisite for insulin resistance and diabetes if obesity is associated with sarcopenia. [ABSTRACT FROM AUTHOR]

Purpose To evaluate whether a protocol for early intervention addressing the psychosocial risk factors for delayed return to work in workers with soft tissue injuries would achieve better long-term outcomes than usual (stepped) care. Methods The study used a controlled, non-randomised prospective design to compare two case management approaches. For the intervention condition, workers screened within 1–3 weeks of injury as being at high risk of delayed returned to work by the Örebro Musculoskeletal Pain Screening Questionnaire—short version (ÖMPSQ-SF) were offered psychological assessment and a comprehensive protocol to address the identified obstacles for return to work. Similarly identified injured workers in the control condition were managed under usual (stepped) care arrangements. Results At 2-year follow-up, the mean lost work days for the Intervention group was less than half that of the usual care group, their claim costs were 30% lower, as was the growth trajectory of their costs after 11 months. Conclusions The findings supported the hypothesis that brief psychological risk factor screening, combined with a protocol for active collaboration between key stakeholders to address identified psychological and workplace factors for delayed return to work, can achieve better return on investment than usual (stepped) care. [ABSTRACT FROM AUTHOR]

Italian migrants are one of the largest groups of older migrants in Australia. Past research has found lower mortality rates in Italian migrants but it is unclear if this persists into older age. Data came from 334 Italian-born and 849 Australian-born men aged 70 years and over participating in a longitudinal study of men's ageing. Male Italian migrants were more likely to smoke, be overweight, and have lower socio-economic status (SES). They also had higher morbidity from diabetes, chronic pain, dementia and depressive symptoms but lower morbidity from heart disease and cancer. There was no age-adjusted mortality difference. However, adjusting for SES, lifestyle and morbidity differences revealed a 25% lower mortality rate (adjusted HR = 0.75; 95% CI 0.57, 0.98) in Italian-born men. Compared to their Australian-born counterparts, older Italian-born men have a lower mortality than expected considering their lower SES, higher smoking and higher morbidity. [ABSTRACT FROM AUTHOR]

Background previous cross-sectional studies have reported bidirectional associations between sexual activity and cognitive function among older people. However, the temporal associations have not been studied. Methods community-dwelling men aged 70+ from the Concord Health and Ageing in Men Project were assessed. This study was based on 986 men at baseline, 829 men at 2 year and 595 men at 5-year follow-up. Sexual function using a standardised questionnaire (erectile function, sexual activity, sexual satisfaction, sexual desire) was analysed by generalised estimating equations to examine associations between changes in sexual function and changes in mini-mental state examination (MMSE) across three time points over 5 years. Age, BMI, comorbidity, self-rated health, smoking, number of medications, country of birth, education, marital status, depression and reproductive hormones were also measured at all time points. Results in unadjusted models, declines in erectile function (β = −0.317) and sexual activity (β = −0.575) over time were statistically significantly associated with a decline in MMSE over time. The associations observed in the unadjusted models remained after adjusting for a range of covariables. Declines in sexual satisfaction and sexual desire over time were not associated with changes in MMSE. Conclusions our findings provide evidence of a longitudinal temporal relationship between sexual activity and cognitive function. Further studies are warranted to examine whether maintaining a healthy sexual life has a positive effect on cognitive function in older men. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present longitudinal study of community‐dwelling older men was to examine the association between cognitive status at baseline, and falls, fractures and bone loss over time. Methods: In the Concord Health and Aging in Men Project, 1705 community‐dwelling men aged 70–97 years had detailed baseline clinical assessment of cognitive status (dementia, mild cognitive impairment [MCI] and normal cognition), as well as depression, physical activity, neuromuscular function, health status, sociodemographics, comorbidities, medication use and serum 25 hydroxyvitamin D, 1,25 dihydroxyvitamin D and parathyroid hormone levels. During a mean follow‐up period of 6 years, participants were contacted 4‐monthly to ascertain incident falls and fractures, the latter being confirmed by radiographic reports. Bone mineral density was measured by dual X‐ray absorptiometry at multiple time‐points. Results: At baseline, 120 men were assessed to have MCI and 93 men to have dementia. Over time, there were 162 first incident fractures, including 43 hip and 32 vertebral fractures. In univariate models, baseline dementia, but not MCI, predicted an increased incidence of hip fracture (HR 6.95, 95% CI 3.47–13.96), but not vertebral (HR 2.26, 95% CI 0.79–6.46) or non‐hip non‐vertebral fracture (HR 0.73, 95% CI 0.27–1.99). The strong risk of hip fractures associated with dementia remained after accounting for potential confounders (HR 4.44, 95% CI 1.97–9.98). In multivariate analyses, dementia (incidence rate ratio 2.26, 95% CI 1.70–2.99), but not MCI, was associated with an increased risk of falls compared with normal cognition. There was no association between baseline dementia and change in bone mineral density. Conclusions: Older men with dementia, but not MCI, have a greater tendency to fall and sustain hip fractures, but not any other types of fractures. Geriatr Gerontol Int 2018; 18: 1479–1484. [ABSTRACT FROM AUTHOR]

Objectives: to determine whether pain increases the risk of developing the frailty phenotype and whether frailty increases the risk of developing chronic or intrusive pain, using longitudinal data. Design/Setting: longitudinal data from the Concord Health and Ageing in Men Project (CHAMP), a prospective population based cohort study. Participants: a total of 1,705 men aged 70 years or older, living in an urban area of New South Wales, Australia. Measurements: data on the presence of chronic pain (daily pain for at least 3 months), intrusive pain (pain causing moderate to severe interference with activities) and the criteria for the Cardiovascular Health Study (CHS) frailty phenotype were collected in three waves, from January 2005 to October 2013. Data on age, living arrangements, education, smoking status, alcohol consumption, body mass index, comorbidities, cognitive function, depressive symptoms and history of vertebral or hip fracture were also collected and included as covariates in the analyses. Results: a total of 1,705 participants were included at baseline, of whom 1,332 provided data at the 2-year follow-up and 940 at the 5-year follow-up. Non-frail (robust and pre-frail) men who reported chronic pain were 1.60 (95% confidence interval (CI): 1.02-2.51, P = 0.039) times more likely to develop frailty at follow-up, compared to those with no pain. Intrusive pain did not significantly increase the risk of future frailty. Likewise, the frailty status was not associated with future chronic or intrusive pain in the adjusted analysis. Conclusions: the presence of chronic pain increases the risk of developing the frailty phenotype in community-dwelling older men. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effects of number of medications and Drug Burden Index ( DBI) on transitions between frailty stages and death in community-dwelling older men. Design Cohort study. Setting Sydney, Australia. Participants Community-dwelling men aged 70 and older (N = 1,705). Measurements Self-reported questionnaires and clinic visits were conducted at baseline and 2 and 5 years. Frailty was assessed at all three waves according to the modified Fried frailty phenotype. The total number of regular prescription medications and DBI (a measure of exposure to sedative and anticholinergic medications) were calculated over the three waves. Data on mortality over 9 years were obtained. Multistate modeling was used to characterize the transitions across three frailty states (robust, prefrail, frail) and death. Results Each additional medication was associated with a 22% greater risk of transitioning from the robust state to death (adjusted 95% confidence interval ( CI) = 1.06-1.41). Every unit increase in DBI was associated with a 73% greater risk of transitioning from the robust state to the prefrail state (adjusted 95% CI = 1.30-2.31) and a 2.75 times greater risk of transitioning from the robust state to death (adjusted 95% CI = 1.60-4.75). There was no evidence of an adjusted association between total number of medications or DBI and the other transitions. Conclusion Although the possibility of confounding by indication cannot be excluded, additional medications were associated with greater risk of mortality in robust community-dwelling older men. Greater DBI was also associated with greater risk of death and transitioning from the robust state to the prefrail state. [ABSTRACT FROM AUTHOR]

Balance training is the most efficacious exercise to prevent falls. This study examined the associations between common sporting activities and the incidence of falls, and whether lower risks can be attributed to the superior balance of sports participants. We studied a population-based cohort of 1,667 older Australian men (mean age = 76.8 years) in the Concord Health and Ageing in Men Project (CHAMP) between 2005 and 2011. Data on incident falls were captured by 12 triannual telephone call cycles per participant and were analyzed using negative binomial regression. The length of follow-up averaged 43.8 months (median, 48 months), during which time 2,662 falls were recorded. In unadjusted models, golfers (n = 160; incidence rate ratio (IRR) = 0.65, 95% confidence interval (CI): 0.47, 0.89) and swimmers (n = 88; IRR = 0.47, 95% CI: 0.30, 0.71) had significantly lower risks of falling. After adjustment for leisure-time physical activity, walking, lifestyle physical activity score (e.g., chores, gardening), and conventional risk factors for falling, swimming was the only activity that was associated with a protective effect (IRR = 0.67, 95% CI: 0.45, 1.00). Swimmers had significantly lower postural sway (β = −5.23 cm2, P < 0.05) and shorter time to complete a narrow walk test than men who took part in only lifestyle physical activities. Balance indicators were strong predictors of the incidence of falls. The IRR for swimmers was 0.71 (95% CI: 0.48, 1.06) after adding balance measures to the adjusted model. [ABSTRACT FROM PUBLISHER]

Background: chronic knee pain is still considered a fairly benign disease by many, an ‘unavoidable’ consequence of ageing. This passive acceptance may be unnecessarily exposing older people to disability and serious co-morbidity. The aim of this study was to determine the disease burden associated with chronic knee pain and the role of knee extensor strength as a modifiable risk factor.Methods: a longitudinal cohort study with 2-year follow-up conducted among 1,587 community-dwelling men aged 70 years and over, 637 (40%) reported chronic knee pain. Of the 950 (60%) men without knee pain at baseline, 768 (81%) returned for the follow-up assessment with 150 (20%) reporting incident chronic knee pain.Results: knee pain was significantly associated with marked mobility disability [odds ratio (OR) 2.38; 95% confidence interval (CI) 1.74–3.29], falls (OR: 1.31; 95% CI: 1.01–1.70) and having four or more co-morbidity (OR: 1.63; 95% CI: 1.16–2.30) as well as reduced knee extensor strength and mass (dual X-ray absorptiometry). Men with incident knee pain at the 2-year follow-up assessment demonstrated greater increases in these measures of disease burden and greater decreases in muscle strength and mass, compared with those without incident chronic knee pain. Obesity, high co-morbidity burden, back pain, higher levels of physical activity or low knee extensor strength were all significant risk factors for incident knee pain.Conclusion: prevention of chronic knee pain may reduce a considerable burden of mobility disability and increased risk of serious co-morbidity among older men. [ABSTRACT FROM AUTHOR]

• Socioeconomic inequalities in healthy ageing as a multidimensional construct is unclear. • There is evidence that higher education is associated with healthy ageing. • There is evidence that higher income/wealth is associated with healthy ageing. • The number of studies including other socioeconomic indicators were limited. • Evidence-based mapping was used to report heterogeneity between studies. The association between socioeconomic position (SEP) and health is well-established. However, the association between SEP and healthy ageing as a multidimensional construct is unclear. We conducted a systematic review of peer-reviewed cross-sectional and longitudinal studies on the associations between SEP and multidimensional healthy ageing measures. Studies were identified from a systematic search across major electronic databases from inception to February 2021. Fourthy-five articles met inclusion criteria (26 cross-sectional and 19 longitudinal studies). There was no consistency in method of operationalizing healthy ageing across studies, domains included in the healthy ageing measures, or in the definition and number of levels of SEP indicators. Overall, regardless of heterogeneity between studies, a positive association between educational level (85.0 % of studies) and income/wealth (81.4 % of studies) and healthy ageing was evident. Regarding occupational position, evidence from 11 studies was inconclusive. The number of studies including home ownership, parenteral SEP, or composite SEP scores was insufficient to be able to draw a conclusion. There is evidence that socioeconomic inequalities, as assessed by educational level and income/wealth, are associated with healthy ageing. These findings, and the broader evidence base on SEP and healthy ageing, highlight the importance of addressing inequality through integrated health and social policies and strategies. [ABSTRACT FROM AUTHOR]

Objective To determine the speed at which the Grim Reaper (or Death) walks. Design Population based prospective study. Setting Older community dwelling men living in Sydney, Australia. Participants 1705 men aged 70 or more participating in CHAMP (Concord Health and Ageing in Men Project). Main outcome measures Walking speed (m/s) and mortality. Receiver operating characteristics curve analysis was used to calculate the area under the curve for walking speed and determine the walking speed of the Grim Reaper. The optimal walking speed was estimated using the Youden index (sensitivity+specificity-1), a common summary measure of the receiver operating characteristics curve, and represents the maximum potential effectiveness of a marker. Results The mean walking speed was 0.88 (range 0.15-1.60) m/s. The highest Youden index (0.293) was observed at a walking speed of 0.82 m/s (2 miles (about 3 km) per hour), corresponding to a sensitivity of 63% and a specificity of 70% for mortality. Survival analysis showed that older men who walked faster than 0.82 m/s were 1.23 times less likely to die (95% confidence interval 1.10 to 1.37) than those who walked slower (P=0.0003). A sensitivity of 1.0 was obtained when a walking speed of 1.36 m/s (3 miles (about 5 km) per hour) or greater was used, indicating that no men with walking speeds of 1.36 m/s or greater had contact with Death. Conclusion The Grim Reaper's preferred walking speed is 0.82 m/s (2 miles (about 3 km) per hour) under working conditions. As none of the men in the study with walking speeds of 1.36 m/s (3 miles (about 5 km) per hour) or greater had contact with Death, this seems to be the Grim Reaper's most likely maximum speed; for those wishing to avoid their allotted fate, this would be the advised walking speed. [ABSTRACT FROM AUTHOR]

This study compares the outcomes, from pretreatment to 1-year follow-up, of an outpatient, CBT-based pain self-management program (PSM) that included exercises, pain education, and pain coping strategies, with a control condition (exercise-attention control, EAC) that included exercises and a control for the attention of the treatment team. We previously reported short-term results (to 1-month follow-up) from the same study. This new paper considers the important issue of maintenance of treatment-related gains. The participants (n = 141) were a heterogeneous sample of ambulant, community-dwelling older adult patients with chronic pain (mean age: 73.90 [6.5] years [range: 65-87 years]). The long-term results indicate the pain self-management program group achieved and maintained significantly better results than the exercise-attention control group on the primary outcome, pain-related disability, as well as on usual pain, pain distress, depression, and fear-avoidance beliefs. The mean effect size for these gains by the pain self-management program group over the exercise-attention control group was 0.37 (range: 0.29-0.45), which is in the small effect size range. While statistically and clinically meaningful, these findings do indicate some weakening in effects over time but not to a significant degree. The study has implications for the provision of pain management interventions for community-dwelling older adults with chronic pain. [ABSTRACT FROM AUTHOR]

Background: We examined clinical outcomes among combat casualties with genitourinary injuries after blast trauma. Methods: Characteristics, clinical care, urologic complications, and infections for subjects enrolled in the Trauma Infectious Disease Outcomes Study (TIDOS) were collected from Department of Defense (DOD) and Department of Veterans Affairs (VA) sources. Logistic regression identified predictors for urinary tract infections (UTIs) after genitourinary trauma. Results: Among 530 TIDOS enrollees who entered VA care, 89 (17%) sustained genitourinary trauma. The majority of subjects (93%) were injured via a blast and 27% had a dismounted complex blast injury (DCBI). Sexual dysfunction was reported with 36% of subjects, whereas 14% had urinary retention/incontinence and 8% had urethral stricture. Urologic complications were comparable between patients with and without DCBIs. Nineteen (21%) subjects had one or more UTI with a total of 40 unique UTI events (25% during initial hospitalization and 75% during subsequent DOD or VA care). The UTI incidence rate was 0.89 per patient-year during initial hospitalization, 0.05 per patient-year during DOD follow-up, and 0.07 per patient-year during VA healthcare. Subjects with UTIs had a higher proportion of bladder injury (53% vs. 13%; p < 0.001), posterior urethral injury (26% vs. 1%; p = 0.001), pelvic fracture (47% vs. 4%; p < 0.001), soft-tissue infection of the pelvis/hip (37% vs. 4%; p = 0.001), urinary catheterization (47% vs. 11%; p < 0.001), urinary retention or incontinence (42% vs. 6%; p < 0.001), and stricture (26% vs. 3%; p = 0.004) compared with patients with genitourinary trauma and no UTI. Independent UTI risk factors were occurrence of a soft-tissue infection at the pelvis/hip, trauma to the urinary tract, and transtibial amputation. Conclusions: Among combat casualties with genitourinary trauma, UTIs are a common complication, particularly with severe blast injury and urologic sequelae. Episodes of UTIs typically occur early after the initial injury while in DOD care, however, recurrent infections may continue into long-term VA care. [ABSTRACT FROM AUTHOR]

Older adults are largely under-represented in low back pain (LBP) research. In light of the ageing population, it is crucial to understand the influence of comorbidities and lifestyle factors on the risk and prognosis of LBP in older adults. The aims of this study were to describe the course of LBP in older men; to investigate whether comorbidities/lifestyle factors can predict the course of LBP in older men; to assess if comorbidities/lifestyle factors increase the risk of developing LBP in older men. The study sample comprised 1685 older men living in suburban Sydney, Australia. Low back pain, sociodemographic measures, lifestyle factors, and comorbidities were assessed. Of the 1012 men with LBP at baseline, 58% still reported having pain at the 24-month follow-up. Of those without pain at baseline (n = 673), 28% reported pain at follow-up. The odds of persistent pain at 24 months increased with each additional alcoholic drink/wk (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.01-1.22; P = 0.03) and each additional unit of body mass index (OR = 1.28, 95% CI: 1.04-1.60; P = 0.02), but reduced for men who speak English at home (OR = 0.58, 95% CI: 0.35-0.96; P = 0.03). In older men, free of LBP at baseline (n = 673), for every additional comorbidity there was an increased risk of developing LBP (OR = 1.17, 95% CI: 1.00-1.37; P = 0.05). These results demonstrate the influence of lifestyle factors and comorbidities on LBP in older men and suggest that the consideration of these issues in management may improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Statistical analysis plans increase the transparency of decisions made in the analysis of clinical trial results. The purpose of this paper is to detail the planned analyses for the PREVENT trial, a randomized, placebo-controlled trial of patient education for acute low back pain. Results: We report the pre-specified principles, methods, and procedures to be adhered to in the main analysis of the PREVENT trial data. The primary outcome analysis will be based on Mixed Models for Repeated Measures (MMRM), which can test treatment effects at specific time points, and the assumptions of this analysis are outlined. We also outline the treatment of secondary outcomes and planned sensitivity analyses. We provide decisions regarding the treatment of missing data, handling of descriptive and process measure data, and blinded review procedures. Conclusions: Making public the pre-specified statistical analysis plan for the PREVENT trial minimizes the potential for bias in the analysis of trial data, and in the interpretation and reporting of trial results. [ABSTRACT FROM AUTHOR]