Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men Project.

BACKGROUND: frailty is a concept used to describe older people at high risk of adverse outcomes, including falls, functional decline, hospital or nursing home admission and death. The associations between frailty and use of specific health and community services have not been investigated. METHODS: the cross-sectional relationship between frailty and use of several health and community services in the last 12 months was investigated in 1,674 community-dwelling men aged 70 or older in the Concord Health and Ageing in Men study, a population-based study conducted in Sydney, Australia. Frailty was assessed using a modified version of the Cardiovascular Health Study criteria. RESULTS: overall, 158 (9.4%) subjects were frail, 679 (40.6%) were intermediate (pre-frail) and 837 (50.0%) were robust. Frailty was associated with use of health and community services in the last 12 months, including consulting a doctor, visiting or being visited by a nurse or a physiotherapist, using help with meals or household duties and spending at least one night in a hospital or nursing home. Frail men without disability in activities of daily living were twice more likely to have seen a doctor in the previous 2 weeks than robust men (adjusted odds ratio 2.04, 95% confidence interval 1.21-3.44), independent of age, comorbidity and socio-economic status. CONCLUSION: frailty is strongly associated with use of health and community services in community-dwelling older men. The high level of use of medical services suggests that doctors and nurses could play a key role in implementation of preventive interventions.

Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study.

OBJECTIVES: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. DESIGN: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. SETTING AND PARTICIPANTS: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. OUTCOME MEASURES: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. RESULTS: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. CONCLUSIONS: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.

Global surveillance of cancer survival 1995-2009 : analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75 000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems. FUNDING: Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).

Fenologia, exigência térmica e produtividade de videiras 'Niagara Branca', 'Niagara Rosada 'e 'Concord' submetidas a duas safras por ciclo vegetativo

Este trabalho objetivou avaliar a fenologia, a demanda térmica e a produtividade das cvs. Niagara Branca, Niagara Rosada e Concord submetidas a uma poda seca no inverno e a uma poda verde no final da primavera, visando à obtenção de duas safras de uva por ciclo vegetativo. O experimento foi conduzido em vinhedo pertencente à Estação Experimental Agronômica de Eldorado do Sul-RS, na safra de 2007/2008. As plantas foram submetidas a duas épocas de poda de inverno (22-07-07 e 20-08-07), em cordão esporonado, e duas épocas de poda verde (15-11-07 e 17-12-07), mediante desponte do sarmento a partir da quarta gema acima do último cacho. Os subperíodos fenológicos considerados da videira foram: vegetativo, compreendendo da poda à brotação e da brotação à floração; e reprodutivo, abrangendo da floração à colheita. Os respectivos intervalos tiveram um acompanhamento com base no acúmulo de graus-dia. A produção por planta, sólidos solúveis totais e acidez total titulável foram avaliados em ambas as safras. As cultivares necessitaram aproximadamente de 1.500 graus-dia para completar seu ciclo, tanto na primeira como na segunda safra. A poda de inverno antecipada aumentou a duração do ciclo fenológico das plantas comparativamente à poda de agosto, devido ao aumento do subperíodo poda/floração nas videiras podadas precocemente. A antecipação da poda de inverno antecipou a colheita da primeira safra, possibilitando obter uvas precoces com maior valorização de mercado. A duração do ciclo fenológico da segunda safra foi menor se comparada à primeira safra, devido às temperaturas mais elevadas decorridas no desenvolvimento das plantas submetidas à poda verde. A produtividade da segunda safra foi maior quando a poda seca foi realizada em agosto, associada à poda verde em novembro. Nas plantas submetidas à poda verde, obteve-se uma segunda colheita em meados de março/abril, oferecendo vantagens econômicas ao viticultor e ampliando a disponibilidade da fruta ao consumidor.

Sensibilidade ao rachamento de bagas das videiras 'Concord', 'Isabel' e 'BRS Rúbea'

Com o objetivo de avaliar a sensibilidade ao rachamento de frutos, foram realizados diferentes testes de laboratório com bagas de uva para processamento das cultivares Concord, Isabel e BRS Rúbea. Para a determinação do índice de rachamento, bagas maduras foram imersas em água destilada e avaliadas a cada hora, durante um período de dez horas. Com o auxílio de um texturômetro, foram realizados testes mecânicos. Em testes de compressão, foram avaliadas, no momento de rompimento das bagas, pressão de compressão, energia de deformação e força máxima de compressão. Com uma sonda de menor calibre, as bagas foram perfuradas, obtendo-se a força máxima de perfuração e deformação de perfuração no rompimento da película. Em testes de relaxação, foram avaliados o grau de solidez e a velocidade inicial de decaimento. Foram avaliadas também as correlações entre o índice de rachamento, e os testes mecânicos. Tanto o índice de rachamento quanto os testes mecânicos apontaram para a cultivar BRS Rúbea como a mais resistente ao rachamento e a cultivar Concord como a mais suscetível. A 'Isabel' apresentou resistência intermediária. O índice de rachamento, apresentou forte correlação com as variáveis avaliadas nos testes mecânicos e possui bom potencial para a avaliação da sensibilidade ao rachamento de materiais distintos de videira.

Ciclo de produção e demanda térmica de clones da videira 'Concord' sobre diferentes porta-enxertos

O objetivo do trabalho foi determinar a duração do ciclo de produção e a necessidade térmica de seis clones de 'Concord' sobre três porta-enxertos no norte do Paraná. Foram avaliados os clones '22', '28', '49', '202', '211' e '225', obtidos pela Embrapa Uva e Vinho, e enxertados sobre os porta-enxertos 'IAC 766', 'IAC 572' e '420-A'. O trabalho foi realizado em área experimental pertencente ao Centro Tecnológico da COROL - Cooperativa Agroindustrial, localizado no município de Rolândia-PR. O experimento foi realizado em esquema fatorial (6 clones x 3 porta-enxertos), em delineamento inteiramente casualizado, com cinco repetições. As plantas foram conduzidas em sistema de latada, no espaçamento de 4,0 m x 2,0 m, e as avaliações foram realizadas nas safras de 2009/2010 e 2010/2011. Verificou-se que dentre os clones de 'Concord' avaliados, o '202' apresenta a menor duração do ciclo entre a poda e a colheita, sendo portanto o mais precoce. Dentre os porta-enxertos, o '420-A' induz a maior taxa de acúmulo diário de sólidos solúveis do mosto, proporcionando redução do ciclo total e da demanda térmica dos clones de 'Concord', enquanto o 'IAC 572' induz a menor taxa, promovendo aumento do ciclo e da demanda térmica dos clones.

Ylirajaista rauhaa rakentamassa. Kansainvälisyys osana rauhanaatetta Concord-lehdessä vuosina 1898–1903

Peace Associationin julkaisemassa Concord-lehdessä rakennettua kansainvälisyyttä osana rauhanaatetta vuosina 1898–1903. Lehden näkemys heijasteli vuosisadan vaihteen rauhanliikkeessä suosittua uskoa sotien poistamiseen kansainvälisellä toiminnalla. Tukea näkemys sai valtioiden keskinäisen yhteistyön tiivistymisestä, mutta myös 1800-luvun alussa syntyneiden rauhanjärjestöjen kansainvälisen toiminnan ammattimaistumisesta vuosisadan lopulla. Toisaalta samanaikaisesti vahvistunut nationalismi ja tieteeseen nojannut aikalaisnäkemys Euroopan ylivoimasta kyseenalaistivat rauhanjärjestöjen tavoitteet. Pro gradu -tutkielmassani tutkitaan, miten nämä kolme eri ulottuvuutta – kansallinen, valtioiden välinen ja rauhanliikkeen ei-valtiollinen toiminta – kohtasivat Concordin tulkinnassa kansainvälisyydestä. Tutkielmassani myötäillään transnationalistista tutkimussuuntausta, jonka avulla kansainvälisyyttä tarkastellaan ylirajaisena, valtioiden rajat ylittävänä prosessina ja aatemaailmana. Kansainvälisyys mielletään täten valtiotasoa laajemmaksi toiminnaksi, johon osallistuivat myös ei-valtiolliset toimijat. Näkökulma ei kiellä kansallisen ja kansainvälisten suhteiden tasojen vaikutusta, vaan paljastaa niiden lomasta uusia painotuksia. Näkemykseen liittyy risteävät historiat -teorian korostama eriaikaisten tasojen monitahoinen vuorovaikutus vastakkainasettelun sijaan. Tärkeänä tutkimuksellisena lähtökohtana työssä on myös käsitehistoriallinen näkökulma, joka korostaa herkistymistä määritteiden monimuotoisuudelle ja avoimuudelle lopullisen määrittelyn sijaan. Rauhanaatteeseen kietoutunut kansainvälisyys miellettiin kirjoituksissa prosessiksi, joka pyrki ihmiskunnan ykseyden toteutumiseen kanssakäymistä lisäämällä. Kansainvälinen rauhan edistäminen laajennettiin totutusta valtioiden välisestä toiminnasta osaksi ei-valtiollisia ja kansallisia painotuksia. Toisaalta tutkielmassa havaittiin, etteivät artikkeleiden kirjoittajat olleet vapaita ajan vallitsevista aatevirtauksista. Aikalaiskeskusteluissa toistetut teemat, kuten kansalaisyhteiskunnan muutokset ongelmineen, kansalliset ennakkoluulot, kansainvälisen oikeuden kehittyminen sekä tieteis- ja edistysusko, ulottuivat myös Concordiin. Näin ennalta vastakkaisilta ja ristiriitaisilta näyttäytyneet kansallisen, valtioiden välisen ja ylirajaisen tematiikat kohtasivat lehdessä toisensa leikaten ja kirjoituksissa rakennettua kansainvälisyyden määritelmää muokaten.

Functional genomics of O-glucosyltransferases from Concord grape (Vitis labrusca)

Grape (Vitis spp.) is a culturally and economically important crop plant that has been cultivated for thousands of years, primarily for the production of wine. Grape berries accumulate a myriad of phenylpropanoid secondary metabolites, many of which are glucosylated in plantae More than 90 O-glucosyltransferases have been cloned and biochemically characterized from plants, only two of which have been isolated from Vitis spp. The world-wide economic importance of grapes as a crop plant, the human health benefits associated with increased consumption of grape-derived metabolites, the biological relevance of glucosylation, and the lack of information about Vitis glucosyltransferases has inspired the identification, cloning and biochemical characterization of five novel "family 1" O-glucosyltransferases from Concord grape (Vitis labrusca cv. Concord). Protein purification and associated protein sequencIng led to the molecular cloning of UDP-glucose: resveratrollhydroxycinnamic acid O-glucosyltransferase (VLRSGT) from Vitis labrusca berry mesocarp tissue. In addition to being the first glucosyltransferase which accepts trans-resveratrol as a substrate to be characterized in vitro, the recombinant VLRSGT preferentially produces the glucose esters of hydroxycinnamic acids at pH 6.0, and the glucosides of trans-resveratrol and flavonols at 'pH 9.0; the first demonstration of pH-dependent bifunctional glucosylation for this class of enzymes. Gene expression and metabolite profiling support a role for this enzyme in the bifuncitonal glucosylation ofstilbenes and hydroxycinnamic acids in plantae A homology-based approach to cloning was used to identify three enzymes from the Vitis vinifera TIGR grape gene index which had high levels of protein sequence iii identity to previously characterized UDP-glucose: anthocyanin 5-0-glucosyltransferases. Molecular cloning and biochemical characterization demonstrated that these enzymes (rVLOGTl, rVLOGT2, rVLOGT3) glucosylate the 7-0-position of flavonols and the xenobiotic 2,4,5-trichlorophenol (TCP), but not anthocyanins. Variable gene expression throughout grape berry development and enzyme assays with native grape berry protein are consistent with a role for these enzymes in the glucosylation of flavonols; while the broad substrate specificity, the ability of these enzymes to glucosylate TCP and expression of these genes in tissues which are subject to pathogen attack (berry, flower, bud) is consistent with a role for these genes in the plant defense response. Additionally, the Vitis labrusca UDP-glucose: flavonoid 3-0-glucosyltransferase (VL3GT) was identified, cloned and characterized. VL3GT has 96 % protein sequence identity to the previously characterized Vitis vinifera flavonoid 3-0-glucosyltransferase (VV3GT); and glucosylates the 3-0-position of anthocyanidins and flavonols in vitro. Despite high levels of protein sequence identity, VL3GT has distinct biochemical characteristics (as compared to VV3GT), including a preference for B-ring methylated flavonoids and the inability to use UDP-galactose as a donor substrate. RT-PCR analysis of VL3GT gene expression and enzyme assays with native grape protein is consistent with an in planta role for this enzyme in the glucosylation of anthocyanidins,but not flavonols. These studies reveal the power of combining several biochemistry- and molecular biology-based tools to identify, clone, biochemically characterize and elucidate the in planta function of several biologically relevant O-glucosyltransferases from Vitis spp.

Concord Grape Juice, cognitive function and driving performance: a 12 week, placebo controlled, randomised, crossover trial in mothers of pre-teen children

Background: Daily consumption of Concord grape juice (CGJ) over three to four months has been shown to improve memory function in adults with mild cognitive impairment, and reduce blood pressure in hypertensive adults. These benefits are likely due to the high concentration of polyphenols in CGJ. Increased stress can impair cognitive function and elevate blood pressure. Thus we examined the potential beneficial effect of CGJ in individuals experiencing somewhat stressful demanding lifestyles. Objective: To examine the effects of twelve weeks’ daily consumption of CGJ on cognitive function, driving performance, and blood pressure in healthy, middle-aged working mothers. Design: Twenty five healthy mothers of pre-teen children, aged 40-50 years, who were employed for > 30 hours/week consumed 12oz (355ml) CGJ (containing 777mg total polyphenols) or an energy, taste and appearance matched placebo daily for twelve weeks according to a randomised, crossover design with a four week washout. Verbal and spatial memory, executive function, attention, blood pressure and mood were assessed at baseline, six weeks and twelve weeks. Immediately following the cognitive battery, a subsample of seventeen females completed a driving performance assessment in the University of Leeds Driving Simulator. The twenty five minute driving task required participants to match the speed and direction of a lead vehicle. Results: Significant improvements in immediate spatial memory and driving performance were observed following CGJ relative to placebo. There was evidence of an enduring effect of CGJ such that participants who received CGJ in arm 1 maintained better performance in the placebo arm. Conclusions: Cognitive benefits associated with chronic consumption of flavonoid-rich grape juice are not exclusive to adults with mild cognitive impairment. Moreover, these cognitive benefits are apparent in complex everyday tasks such as driving. Effects may persist beyond cessation of flavonoid consumption and future studies should carefully consider the length of washout within crossover designs.