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Frailty is an important consequence of ageing, whereby frail patients are more likely to face adverse outcomes, such as disability and death. Risk of frailty increases in people with poor biological health, and has been shown in many ethnicities and countries. In economically developed countries, 10% of older adults are living with frailty. Ethnic minorities in the West face significant health inequalities. However, little is known about frailty prevalence and the nature of frailty in different ethnic groups. This has implications for healthcare planning and delivery, especially screening and the development of interventions. Global frailty prevalence is variable low- to middle-income countries demonstrate higher rates of frailty than high-income countries, but available evidence is low. Little is known about the characteristics of these differences. However, female sex, lower economic status, lower education levels, and multimorbidity are identified risk factors. Ethnic minority migrants in economically developed countries demonstrate higher rates of frailty than white indigenous older people and are more likely to be frail when younger. Similar patterns are also seen in indigenous ethnic minority marginalised groups in economically developed countries such as the US, Australia and New Zealand, who have a higher prevalence of frailty than the majority white population. Frailty trajectories between ethnic minority migrants and white indigenous groups in high-income countries converge in the 'oldest old' age group, with little or no difference in prevalence. Frailty risk can be attenuated in migrants with improvements in integration, citizenship status, and access to healthcare. Ethnicity may play some role in frailty pathways, but, so far, the evidence suggests frailty is a manifestation of lifetime environmental exposure to adversity and risk accumulation.

To explore the attitudes, confidence and social norm of Dutch occupational physicians (OPs) regarding menopause in a work context.

A nationwide cross-sectional exploratory design. An invitation to participate in an online survey was sent to all OPs registered at the Dutch occupational physicians' society (n = 1663). This survey collected data about attitudes, confidence, social norm and current practice of OPs regarding menopause and work. Descriptive statistics and post hoc logistic multivariate analyses were used to evaluate the data.

Attitudes, confidence and social norms in relation to menopause and work.

Data from 267 OPs were analysed. Most OPs do recognize a role for menopause in presenteeism and sickness absence. However, Reparixin CXCR inhibitor stated that women with bothersome menopausal symptoms are 'not sick' and 'just experiencing symptoms of a normal physiological process'. Over 56% of OPs find it difficult to assess the relationship between menopausal symptoms and work ability, and 63% to report menopause as a diagnosis in the context of a sick leave certification. Over 56% of OPs acknowledge that talking about menopause in the workplace is a taboo. A positive attitude towards menopause (OR 1.11, 95% CI 1.02-1.20) and greater confidence (OR 1.22, 95% CI 1.14-1.31) were associated with significantly higher levels of diagnosing menopause in sick leave certification.

Dutch OPs generally have a positive attitude towards menopause, but perceive a lack of knowledge and a taboo culture around menopause in a work context. They indicate a need for education and a guideline on menopause and work.

Dutch OPs generally have a positive attitude towards menopause, but perceive a lack of knowledge and a taboo culture around menopause in a work context. They indicate a need for education and a guideline on menopause and work.

Various combinations of estrogens and progestogens are available for menopausal hormone therapy that differ in their efficacy and safety profile. We evaluated the efficacy and long-term safety of low-dose estradiol (0.5 mg) / dydrogesterone (2.5 mg) in subgroups of postmenopausal women with vasomotor symptoms.

Efficacy analysis was performed on data from 2 previously published studies for subgroups defined by age, duration of menopause, and body mass index at baseline. The primary efficacy variable was the number of moderate to severe hot flushes from baseline to week 13. Long-term safety was evaluated in relation to age and duration of menopause. Safety variables included adverse events to week 52 and change from baseline to endpoint in laboratory and vital sign values.

The treatment difference seen in the overall population in favour of low-dose estradiol/dydrogesterone was also observed in the subgroups of patients aged 45 to < 55 years (p < 0.01) and ≥55 years (p < 0.05), with menopause duration of >12 months to <60 months (p < 0.05) and ≥ 60 months (p < 0.005), and with a BMI at baseline of <25 kg/m

(p < 0.05) and 25 to <30 kg/m

(p < 0.01). Low-dose estradilol/dydrogesterone was well tolerated across the different subgroups. The incidence of breast-related adverse events was very low. No breast malignancy was reported. Only one adverse endometrial outcome of simple hyperplasia was observed.

The results of our analyses confirmed the consistent treatment effect on vasomotor symptoms and the favourable safety profile of 0.5 mg 17β estradiol and 2.5 mg dydrogesterone in different patient subgroups.

The results of our analyses confirmed the consistent treatment effect on vasomotor symptoms and the favourable safety profile of 0.5 mg 17β estradiol and 2.5 mg dydrogesterone in different patient subgroups.Polycystic ovary syndrome (PCOS) is a common endocrine disorder with heterogenous clinical manifestations. The evidence indicates that PCOS is associated with long-term health risks including type 2 diabetes, metabolic syndrome, obstructive sleep apnea, endometrial cancer, and mood disorders. Although cardiometabolic risk factors are more common among women with PCOS, currently there is no strong evidence for increased cardiovascular morbidity and mortality in these patients. The effect of menopausal transition on the long-term health consequences of PCOS is mostly uncertain. The PCOS phenotype improves with aging in affected women. Accordingly, the differences in the cardiometabolic risk profiles of PCOS patients and of the general population seem to disappear after menopause. However, it is not clear whether this phenotype amelioration is associated with changes in other long-term health risks after the menopause. There are also gaps in our knowledge about the impact of long-term use of oral contraceptives on the prevalence of PCOS-related comorbidities. This review summarizes the current knowledge regarding the long-term health consequences of PCOS and their clinical implications in peri- and postmenopause, and highlights areas for future research.

Following the WHO 2015 policy framework, we tested the effects of older people's intrinsic capacity and their perceptions of their neighborhood environments on mental and physical health-related quality of life (QoL) outcomes across two years.

Participants (mean age = 66) were drawn from two waves of a longitudinal study of aging (n = 2910) in 2016 and 2018. Regression analyses tested the main and interaction effects of intrinsic capacity and neighborhood factors on health-related QoL at T2 (controlling for T1).

Intrinsic capacity was assessed with number of chronic conditions. #link# Neighborhood perceptions was assessed with measures of housing suitability, neighborhood satisfaction, and neighborhood social cohesion. Health-related QoL was assessed with SF12 physical and mental health component scores.

Perceptions of greater neighborhood accessibility and more trust among neighbours were associated with better mental health-related QoL two years later, but not to changes in physical health-related QoL. A significant interaction between intrinsic capacity and neighborhood access to facilities on physical health-related QoL over time showed that those reporting lower neighborhood access experienced a stronger impact of intrinsic capacity on physical health-related QoL.

The neighborhood environment is important to the wellbeing of older people and is amenable to policy interventions. We need more work on the aspects of the immediate environment that support QoL in older age. This study points to the need for accessible facilities and cohesive neighborhoods to support health.

The neighborhood environment is important to the wellbeing of older people and is amenable to policy interventions. We need more work on the aspects of the immediate environment that support QoL in older age. This study points to the need for accessible facilities and cohesive neighborhoods to support health.Children with head injuries commonly present to the emergency department with forehead lacerations, and are frequently referred to the oral and maxillofacial team. link2 Assessing the Glasgow coma scale (GCS) and neurological status of these patients is particularly challenging and there remains marked ambiguity regarding the use of computed tomographic (CT) imaging in children who have no obvious signs of traumatic brain injury. We present a case series of three patients who presented to our unit with forehead lacerations following a fall. All had a normal GCS, no obvious neurological signs, and all were listed for wound closure under general anaesthesia. Intraoperatively they were found to have underlying skull fractures that necessitated emergency CT whilst under general anaesthesia. Retrospective analysis was performed. Current guidelines and the literature were reviewed to identify factors that may help to identify occult skull fractures in the context of paediatric head trauma. Despite the subsequent discovery of skull fractures under general anaesthesia, none of our patients would have satisfied the present absolute indications for CT in the current guidelines. A number of helpful factors are not common in the UK guidelines but are present in others, including the presence of an appreciable haematoma and lacerations greater than 5 cm, amongst others. The assessment of paediatric patients with head trauma often remains a challenge when assessing for features such as headache, focal neurology, and amnesia. A high index of suspicion, formal examination under anaesthesia, and communication with the radiology department, are imperative if we are to avoid missing an occult injury that could potentially result in brain injury.A 14-year-old male, with chronic kidney disease stage 4 (glomerular filtration rate 20 mL/min/1.73 m2) secondary to reflux nephropathy required dietary modification with evidence of renal osteodystrophy, presented with elevated serum phosphorus and parathyroid hormone. link3 He was educated using a novel phosphorus point system where 1 point is equivalent to ∼50 mg of phosphorus. Dietary counseling was provided by a pediatric renal dietitian on phosphorus content of foods the patient typically consumed and converted to point system for daily tracking. The family reported limiting daily phosphorus points to less than 20 points daily for 15 months. The family completed a 3-day food record and provided points assigned to each food item. A Spearman's correlation of 0.7 (P less then .001) was found between the family's and the dietitian's assignment of phosphorus points. The patient's recorded phosphorus intake remained below 1000 mg each day and met estimated calorie and protein needs. The patient also continued with age-appropriate weight gain and linear growth.