OBJECTIVES: The aim of the present study was to disentangle the impact of age and that of cancer diagnosis and treatment on functional status (FS) decline in older patients with cancer.MATERIALS AND METHODS: Patients with breast and colorectal cancer aged 50-69years and aged ≥70years who had undergone surgery, and older patients without cancer aged ≥70years were included. FS was assessed at baseline and after 12months follow-up, using the Katz index for activities of daily living (ADL) and the Lawton scale for instrumental activities of daily living (IADL). FS decline was defined as ≥1 point decrease on the ADL or IADL scale from baseline to 12months follow-up.RESULTS: In total, 179 older patients with cancer (≥ 70years), 341 younger patients with cancer (50-69years) and 317 older patients without cancer (≥ 70years) were included. FS decline was found in 43.6%, 24.6% and 28.1% of the groups, respectively. FS decline was significantly worse in older compared to younger patients with cancer receiving no chemotherapy (44.5% versus 17.6%, p<0.001), but not for those who did receive chemotherapy (39.4% versus 30.8%, p=0.33). Among the patients with cancer, FS decline was significantly associated with older age (OR 2.63), female sex (OR 3.72), colorectal cancer (OR 2.81), polypharmacy (OR 2.10) and, inversely, with baseline ADL dependency (OR 0.44).CONCLUSION: Cancer treatment, and older age are important predictors of FS decline. The relation of baseline ADL dependency and chemotherapy with FS decline suggest that the fittest of the older patients with cancer were selected for chemotherapy.
Due to a number of factors outlined in this article, the issue of population growth is excluded from the sustainability discussion. In this article, we explore some of the ethical presumptions that underlie the issues linking population growth and sustainability. Critics argue that action to address population creates social and economic segregation, and portray overpopulation concerns as being “anti-poor,” “anti-developing country,” or even “antihuman.” Yet, de-linking demographic factors from sustainability concerns ignores significant global realities and trends, such as the ecological limits of the Earth, the welfare and long-term livelihood of the most vulnerable groups, future prospects of humanity, as well as the ecosystems that support society. https://doi.org/10.1080/10042857.2016.1149296 LinkedIn: https://www.linkedin.com/in/helenkopnina/
Background: Stroke is not only an acute disease, but for the majority of patients, it also becomes a chronic condition. There is a major concern about the long-term follow-up with respect to activities of daily living (ADL) in stroke survivors.Some patients seem to be at risk for decline after a first-ever stroke. The purpose of this study was to determine the course of ADL from 3 months after the first-ever stroke and onward and identify factors associated with decline in ADL. Methods: A systematic literature search of 3 electronic databases through June 2015 was conducted. Longitudinal studies evaluating changes in ADL from 3 months post stroke onward were included. Cohorts including recurrent strokes and transient ischemic attacks were excluded. Regarding the course of ADL, a meta-analysis was performed using random-effects model. A best evidence synthesis was performed to identify factors associated with decline in ADL. Results: Out of 10,473 publications, 28 unique studies were included. A small but significant improvement in ADL was found from 3 to 12 months post stroke (standardized mean difference (SMD) 0.17 (0.04–0.30)), which mainly seemed to occur between 3 and 6 months post stroke (SMD 0.15 (0.05–0.26)). From 1 to 3 years post stroke, no significant change was found. Five studies found a decline in ADL status over time in 12–40% of patients. Nine factors were associated with ADL decline. There is moderate evidence for being dependent in ADL and impaired motor function of the leg. Limited evidence was found associated with insurance status, living alone, age ≥ 80, inactive state and having impaired cognitive function, depression and fatigue with decline in ADL. Conclusion: Although on an average patients do not seem to decline in ADL for up to 3 years, there is considerable variation within the population. Some modifiable factors associated with decline in ADL were identified. However, more research is needed before patients at risk of deterioration in ADL can be identified.
For the general public harbour and grey seals are the symbol of the Wadden Sea. The Wadden Sea is an ideal environment for seals: sandbanks that fall dry at low tide are important for rest and for suckle pups. However, the total population of harbour seals has first stabilized and later decreased in recent years, while the annual number of pups born has increased, but the mechanisms underlying this mismatch remain unclear. Furthermore, the harbour seal population has declined since 2022, but the cause of this decline is also unknown. The objective of the proposed study is to increase our understanding of the mechanisms underlying the population trends of harbour seals currently observed in the Dutch Wadden Sea. The study will be carried out by a consortium, involving key players involved in seal conservation and research in the Netherlands. Furthermore, to ensure that the research is embedded in the international context, the Common Wadden Sea Secretariat is a partner in the consortium. The consortium partners have concluded that essential monitoring data on harbour seals is missing and therefore we propose to investigate and report on four themes: (1) mapping of governance, stakeholders and data landscape, (2) identifying mechanisms underlying the observed population numbers, by reviewing available evidence and exploring possible mechanisms, (3) evaluation and improvement of harbour seal monitoring and (4) communication and advice for governance. We will share our findings through reports, scientific papers, infographics, conference presentations, workshops, and proposed monitoring protocols. We will synthesize and communicate our findings targeting four specific groups: (1) the general public (2) the scientific community, (3) educational institutions, and finally (4) the ministry of Agriculture, Nature and Food Quality (LNV), providing them with advice on how to advance research, conservation and management of the harbour seal population in the Dutch Wadden Sea.
