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Background: Little investigation of accelerometry assessed movement behaviors and physical inactivity was carried out in middle-aged and older adults in low-middle-income countries. Objective: Describe accelerometry-measured movement behaviors and prevalence of physical inactivity in middle-aged and older adults. Methods: We collected raw accelerometry data during the third visit (2017–2019) of ELSA-Brasil, a large-scale multicenter Brazilian cohort. Participants wore an ActiGraph wGT3X-BT on the waist for 24 hours for 7 days and documented sleep in a diary. Results: Nine thousand two hundred and seventy-nine participants had valid data (73.4% of the eligible cohort). Overall activity was higher for men (11.82mg; 95% confidence interval [CI], 11.7 to 11.93) than women (10.69mg; 95% CI, 10.6 to 10.77) and lower in older groups—women (−0.12mg/y; 95% CI, −0.13 to −0.11), men (−0.16mg/y; 95% CI, −0.17 to −0.14). Participants were more active from noon to midnight. Distribution of movement behaviors varied with sex and age, and sleep duration was longer in older individuals. Overall, 14.4% (95% CI, 13.7 to 15.1) were inactive, with inactivity being more frequent in women (16.4%; 95% CI, 15.4 to 17.4) than men (12.2%; 95% CI, 11 to 13). Higher rates were observed in the oldest. Retirement was associated with a higher prevalence of physical inactivity in both sexes. Conclusion: Women were less active than men. Older individuals showed a high prevalence of physical inactivity, probably related to transition into retirement. These findings strengthen evidence for public policies promoting physical activity by emphasizing the need to target women, older individuals, and those transitioning to retirement to improve and/or maintain physical activity levels throughout the course of their lives. [ABSTRACT FROM AUTHOR]

Background: Surveillance of domain-specific physical activity (PA) helps to target interventions to promote PA. We examined the sociodemographic correlates of domain-specific PA in New Zealand adults. Methods: A nationally representative sample of 13,887 adults completed the International PA Questionnaire–long form in 2019/20. Three measures of total and domain-specific (leisure, travel, home, and work) PA were calculated: (1) weekly participation, (2) mean weekly metabolic energy equivalent minutes (MET-min), and (3) median weekly MET-min among those who undertook PA. Results were weighted to the New Zealand adult population. Results: The average contribution of domain-specific activity to total PA was 37.5% for work activities (participation = 43.6%; median participating MET-min = 2790), 31.9% for home activities (participation = 82.2%; median participating MET-min = 1185), 19.4% for leisure activities (participation = 64.7%; median participating MET-min = 933), and 11.2% for travel activities (participation = 64.0%; median MET-min among participants = 495). Women accumulated more home PA and less work PA than men. Total PA was higher in middle-aged adults, with diverse patterns by age within domains. Māori accumulated less leisure PA than New Zealand Europeans but higher total PA. Asian groups reported lower PA across all domains. Higher area deprivation was negatively associated with leisure PA. Sociodemographic patterns varied by measure. For example, gender was not associated with total PA participation, but men accumulated higher MET-min when taking part in PA than women. Conclusions: Inequalities in PA varied by domain and sociodemographic group. These results should be used to inform interventions to improve PA. [ABSTRACT FROM AUTHOR]

As new mobility technologies become more widely used, they can transform the way that people travel. Among these technologies are autonomous vehicles (AVs) and micromobility such as bike-sharing and scooters. While the penetration and utilization of these mobility technologies have been extensively studied, little is known about their interaction and association between various age groups. Further, studies have focused on whether respondents would want AVs based upon their age rather than whether they would actually use them. The widespread adoption and use of self-driving vehicles is contingent upon user acceptance and utilization. Therefore, this study evaluated the association between different mobility options for various age groups using text network analysis (TNA) and Bayesian networks (BNs). This study used a data set collected from a survey conducted in Gilbert, Arizona, in 2019. The TNA results facilitated the extraction of additional features that could not be retrieved from the traditional data. The BN results revealed that micromobility devices are associated with higher likelihoods of wanting AVs and using AVs across all age groups, except for young adults who want dockless bikes and older adults who will use docked bikes. Furthermore, for all age groups, electric vehicles are associated with higher likelihoods of wanting AVs and using AVs. Regarding gender, young and middle-aged adult males were more likely to want AVs than their female counterparts. In addition, young and older adult males were more likely to use AVs than females. After combining the variables, the maximum probabilities of wanting AVs and using AVs in the city were 87% and 100% for young adults, 95% and 97% for middle-aged adults, and 59% and 93% for older adults, respectively. Emerging mobility society will have a better understanding of how mobility options are perceived by different age groups. [ABSTRACT FROM AUTHOR]

Background: Health literacy has been linked to positive attitudes toward COVID-19 preventive measures among adolescents and young- or middle-aged adult populations. This study examined the relationship between health literacy and attitudes toward COVID-19 preventive measures among non-English speaking Korean American older adults and their caregivers. The study additionally investigated how sociodemographic characteristics were associated with attitudes. Methods: COVID-19 survey data was collected from potential participants for an ongoing randomized controlled trial involving both Korean American older adults and their caregivers in the Baltimore-Washington and the New York Metropolitan areas (ClinicalTrials.gov Identifier: NCT03909347). Korean American older adults with normal cognition and their caregivers were allowed to participate in the survey. We used latent profile analysis to find unique clusters of participants with a similar pattern of responses to attitudes toward COVID-19 preventive measures. Based on the analysis, we employed multinomial logistic regression to investigate how health literacy and sociodemographic characteristics were associated with the clusters. Results: We found three clusters based on participant responses to COVID-19 preventive measures—Positive, Negative, or Mixed. Health literacy was not associated with COVID-19 related attitudes in the study sample. Men were 2.37 times more likely to be categorized as Mixed than having Positive Attitudes compared to women. The odds of a person living in the New York metropolitan area being categorized as having Mixed Attitudes compared to Positive Attitudes were also 2.67 times more than for a person living in the Baltimore-Washington area. Conclusions: Differences in attitudes toward COVID-19 preventive measures were found among sociodemographic variables but not health literacy. Investigating what information channels or methods drive perception of public health information such as COVID-19 may help identify effective dissemination strategies for non-English speaking Korean older adults. [ABSTRACT FROM AUTHOR]

Augmented-reality (AR) applications have shown potential for assisting and modulating gait in health-related fields, like AR cueing of foot-placement locations in people with Parkinson's disease. However, the size of the AR field of view (AR-FOV), which is smaller than one's own FOV, might affect interaction with nearby floor-based holographic objects. The study's primary objective was to evaluate the effect of AR-FOV size on the required head orientations for viewing and interacting with real-world and holographic floor-based objects during standstill and walking conditions. Secondary, we evaluated the effect of AR-FOV size on gait speed when interacting with real-world and holographic objects. Sixteen healthy middle-aged adults participated in two experiments wearing HoloLens 1 and 2 AR headsets that differ in AR-FOV size. To confirm participants' perceived differences in AR-FOV size, we examined the head orientations required for viewing nearby and far objects from a standstill position (Experiment 1). In Experiment 2, we examined the effect of AR-FOV size on head orientations and gait speeds for negotiating 2D and 3D objects during walking. Less downward head orientation was required for looking at nearby holographic objects with HoloLens 2 than with HoloLens 1, as expected given differences in perceived AR-FOV size (Experiment 1). In Experiment 2, a greater downward head orientation was observed for interacting with holographic objects compared to real-world objects, but again less so for HoloLens 2 than HoloLens 1 along the line of progression. Participants walked slightly but significantly slower when interacting with holographic objects compared to real-world objects, without any differences between the HoloLenses. To conclude, the increased size of the AR-FOV did not affect gait speed, but resulted in more real-world-like head orientations for seeing and picking up task-relevant information when interacting with floor-based holographic objects, improving the potential efficacy of AR cueing applications. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have examined the association of loneliness and cognitive functioning in the US. We used two common measures of loneliness and examined their association in a large sample of US Black, Latino, and White adults (ages = 50). Methods: We analyzed Wave 3 of the National Social Life, Health, and Aging Project (N = 2,757). We examined loneliness using one item from the CES-D and the Felt Loneliness Measure (NFLM); cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA) tool, where higher scores indicated better functioning. We used weighted ordinary least squares regressions to examine the effects of loneliness (CES-D loneliness and NFLM in separate models) on MoCA scores. In exploratory analyses, we examined if these relationships varied by race and ethnicity. We adjusted all models for sociodemographic and other salient factors (e.g., chronic disease, depressive symptoms, living alone). Results: Mean age was 63.49 years, 52% were female, and 9% were Black and 6% Latino persons. Approximately 54% endorsed feeling lonely on at least one measure; 31% (CES-D) and 46% (NFLM). The relationship between loneliness measures was positive and significant, X2 (1, N = 2,757) = 435.493 p < 0.001. However, only 40% of lonely individuals were identified as lonely on both assessments. CES-D loneliness was inversely (β& = -0.274, p = 0.032) associated with MoCA scores and this association did not vary by race and ethnicity. Greater NFLM loneliness was positively associated (β^ = 0.445, p < 0.001) with higher MoCA scores for Latino participants only. Discussion: Loneliness appears to be an important predictor of cognitive functioning. However, the association of loneliness and cognitive functioning varied when using the CES-D loneliness item or the NFLM. Future work is needed to understand how loneliness and its clinically relevant dimensions (social, emotional, existential, chronicity) relate to global and individual cognitive domains. Research is needed with racially and ethnically diverse midlife and older adults, particularly to understand our counterintuitive finding for Latino participants. Finally, findings also support the need for research on interventions to prevent cognitive decline targeting loneliness. [ABSTRACT FROM AUTHOR]

Background: The association between weight-adjusted waist index (WWI) and disability is unclear. This study aimed to assess the relationship between WWI and disability in middle-aged and elderly Chinese individuals and provide more predictive indicators for disability prevention. Methods: In this study, 13,015 middle-aged and older adults aged 45 years and above who were surveyed in 2011 by the China Health and Aging Tracking Survey (CHARLS) database were selected, and 8344 respondents with complete data were included for cohort analysis after seven years of follow-up. Information on clinical demographic characteristics, anthropometric indices, assessment of disability, and related covariates were collected, and the presence or absence of disability was assessed by the disability scale. WWI was calculated by dividing the waist circumference (cm) by the square root of the body weight (kg). Cox proportional hazards model was used to analyze the association between WWI and disability after follow-up. Results: Our study found that 2912 of 8344 participants had disability after seven years of follow-up, and disability incidence was approximately 34.9%. Age, sex, place of residence, chronic disease, depression, waist circumference, and WWI were significantly associated with disability in univariate analysis. Among them, there was a positive association between WWI as a continuous variable and incidence of disability (hazard ratio (HR) = 1.26, 95% CI: 1.22–1.31, p < 0.001). WWI was transformed into categorical variables using quartiles as cutoffs for disability regression analysis. After adjusting covariates, HR values in the 2nd, 3rd and 4th quantile showed an increasing trend compared with the 1st quantile, and the risk of disability among WWI subjects in the 4th quantile increased by 43% (95% CI: 1.24–1.64). P values for the trend test in the model were all < 0.001. In subgroup analyses, the positive association between WWI and risk of disability remained robust for sex, age, alcohol consumption, smoking status, education level, marital status, and place of residence after adjusting for all covariates considered in this study. Conclusions: WWI is a new and reliable obesity-related indicator that can be used for disability prevention. WWI can be detected and controlled for reducing the risk of disability. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to develop and validate a machine learningbased model to predict the development of impaired fasting glucose (IFG) in middle-aged and older elderly people over a 5-year period using data from a cohort study. Methods: This study was a retrospective cohort study. The study population was 1855 participants who underwent consecutive physical examinations at the First Affiliated Hospital of Soochow University between 2018 and 2022. The dataset included medical history, physical examination, and biochemical index test results. The cohort was randomly divided into a training dataset and a validation dataset in a ratio of 8:2. The machine learning algorithms used in this study include Extreme Gradient Boosting (XGBoost), Support Vector Machines (SVM), Naive Bayes, Decision Trees (DT), and traditional Logistic Regression (LR). Feature selection, parameter optimization, and model construction were performed in the training set, while the validation set was used to evaluate the predictive performance of the models. The performance of these models is evaluated by an area under the receiver operating characteristic (ROC) curves (AUC), calibration curves and decision curve analysis (DCA). To interpret the best-performing model, the Shapley Additive exPlanation (SHAP) Plots was used in this study. Results: The training/validation dataset consists of 1,855 individuals from the First Affiliated Hospital of Soochow University, yielded significant variables following selection by the Boruta algorithm and logistic multivariate regression analysis. These significant variables included systolic blood pressure (SBP), fatty liver, waist circumference (WC) and serum creatinine (Scr). The XGBoost model outperformed the other models, demonstrating an AUC of 0.7391 in the validation set. Conclusions: The XGBoost model was composed of SBP, fatty liver, WC and Scr may assist doctors with the early identification of IFG in middle-aged and elderly people. [ABSTRACT FROM AUTHOR]

Objectives: To assess the reliability and validity of measuring resting cerebral blood flow (CBF) and hippocampal CBF using a single-post-labeling delay (PLD) and a multi-PLD pseudo-continuous arterial spin labeling (pCASL) protocol for cerebrovascular reactivity (CVR) testing. Methods: 25 healthy, midlife adults (57 ± 4 years old) were imaged in a Siemens Prisma 3T magnetic resonance imaging (MRI) scanner. Resting CBF and hippocampal CBF were assessed using two pCASL protocols, our modified single-PLD protocol (pCASL-MOD) to accommodate the needs for CVR testing and the multi-PLD Human Connectome Project (HCP) Lifespan protocol to serve as the reference control (pCASL-HCP). During pCASL-MOD, CVR was calculated as the change in CBF from rest to hypercapnia (+9 mmHg increase in end-tidal partial pressure of carbon dioxide [PETCO2]) and then normalized for PETCO2. The reliability and validity in resting gray matter (GM) CBF, white matter (WM) CBF, and hippocampal CBF between pCASL-MOD and pCASL-HCP protocols were examined using correlation analyses, paired t-tests, and Bland Altman plots. Results: The pCASL-MOD and pCASL-HCP protocols were significantly correlated for resting GM CBF [r = 0.72; F (1, 23) = 25.24, p < 0.0001], WM CBF [r = 0.57; F (1, 23) = 10.83, p = 0.003], and hippocampal CBF [r = 0.77; F (1, 23) = 32.65, p < 0.0001]. However, pCASL-MOD underestimated resting GM CBF (pCASL-MOD: 53.7 ± 11.1 v. pCASL-HCP: 69.1 ± 13.1 mL/100 g/min; p < 0.0001), WM CBF (pCASL-MOD: 32.4 ± 4.8 v. pCASL-HCP: 35.5 ± 6.9 mL/100 g/min; p = 0.01), and hippocampal CBF (pCASL-MOD: 50.5 ± 9.0 v. pCASL-HCP: 68.1 ± 12.5 mL/100 g/min; p < 0.0001). PETCO2 increased by 8.0 ± 0.7 mmHg to induce CVR (GM CBF: 4.8% ± 2.6%; WM CBF 2.9% ± 2.5%; and hippocampal CBF: 3.4% ± 3.8%). Conclusion: Our single-PLD pCASL-MOD protocol reliably measured CBF and hippocampal CBF at rest given the significant correlation with the multi-PLD pCASL-HCP protocol. Despite the lower magnitude relative to pCASL-HCP, we recommend using our pCASL-MOD protocol for CVR testing in which an exact estimate of CBF is not required such as the assessment of relative change in CBF to hypercapnia. [ABSTRACT FROM AUTHOR]

Audio-based exergames are beneficial in that they allow users to exercise in an eyes-free and hands-free environment. In this study, we explored two audio-based exergame elements, narrative features and thematic music, that can impact exercise amount (step count and duration) and exercise enjoyment. We conducted a two-week long between-subjects study with 43 young adults and 43 middle-aged adults using SPORTIFY, an audio-based exergame. Our experimental results showed that (1) Using narrative features had a significant main effect on exercise amount and exercise enjoyment both for young adults and middle-aged adults. (2) Using thematic music had no significant main impact on exercise amount and exercise enjoyment both for young adults and middle-aged adults. (3) A significant interaction effect for exercise amount was observed in middle-aged adults, whereas a significant interaction effect for exercise enjoyment was observed in young adults. [ABSTRACT FROM AUTHOR]

Background: Previous studies have reported that anemia was associated with depression, but the association between changes in depressive symptoms and the risk of anemia was unclear. This study aimed to explore whether changes in depressive symptoms were associated with anemia among the middle-aged and elderly adults. Methods: A total of 6112 patients aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) were included in this analysis. Elevated Depression Symptoms (EDS) was defined as the Center for Epidemiological Studies Depression Scale-10 score ≥ 10. Depression status was defined as no depressive symptom [no EDS at Wave 1 (2011–2012) and Wave 2 (2013–2014)], decreasing depressive symptoms (EDS at Wave 1, no EDS at Wave 2), increasing depressive symptoms (no EDS at Wave 1, EDS at Wave 2), persistent depressive symptoms (EDS at Wave 1 and Wave 2). Multivariable logistic regression analyses were conducted to estimate the relationships between depressive symptoms and the changes and risk of anemia. Results: During the follow-up of Wave 1 and Wave 3 (2015–2016), 906 participants (14.82%) developed anemia, the multivariable-adjusted odds ratio for the depressive symptom compared with the no depressive symptom was 1.24 (95% CI, 1.12–1.58) for anemia. From Wave 2 to Wave 3, there were 828 participants (14.62%) diagnosed with anemia. Compared to participants with no depressive symptom, those with persistent depressive symptoms during Wave 1 and Wave 2 had the significantly elevated risk of anemia (odds ratio 1.44, 95% CI 1.21–1.84). Conclusions: The present study demonstrated that baseline depressive symptoms and changes in depressive symptoms were associated with increased risks of anemia. [ABSTRACT FROM AUTHOR]

This article discusses two cases of primary intraosseous glomus tumors with NOTCH2/3 fusions, both of which presented in the long bones. The patients were male, one young adult and one middle-aged adult. The tumors were characterized by nests of monomorphic epithelioid neoplasms with granular cytoplasm that were associated with dilated blood vessels. The tumors were classified as glomus tumors of uncertain malignant potential based on their size and the presence of focal spindled morphology and nuclear atypia. Recurrent NOTCH2/3 fusions have been identified in soft tissue glomus tumors, particularly in visceral lesions with malignant features. However, the relevance of these fusions in intraosseous tumors is unclear, and further clinical follow-up may be necessary. [Extracted from the article]

Metabolic syndrome increases the risks of cardiovascular diseases, type 2 diabetes, and certain cancers. The early detection of metabolic syndrome is clinically relevant, as it enables timely and targeted interventions. In the current study, we aimed to investigate the association between metabolic syndrome and heart rate measured using wearable devices in a real-world setting and compare this association with that for clinical resting heart rate. Data from 564 middle-aged adults who wore wearable devices for at least 7 days with a minimum daily wear time of 20 h were analyzed. The results showed significantly elevated all-day, sleeping, minimum, and inactive heart rates in men with pre-metabolic or metabolic syndrome compared with those in normal individuals, whereas sleeping heart rate and heart rate dips were significantly increased and decreased, respectively, in women with metabolic syndrome. After adjusting for confounders, every 10-beats-per-minute increment in all-day, sleeping, minimum, and inactive heart rates in men corresponded to odds ratios of 2.80 (95% confidence interval 1.53–5.44), 3.06 (1.57–6.40), 4.21 (1.87–10.47), and 3.09 (1.64–6.29), respectively, for the presence of pre-metabolic or metabolic syndrome. In women, the association was significant only for heart rate dips (odds ratio = 0.49 [95% confidence interval 0.25–0.96] for every 10% increment). Models incorporating inactive or minimum heart rate in men and heart rate dip in women demonstrated better fits, as indicated by lower Akaike information criterion values (170.3 in men and 364.9 in women), compared with models that included clinical resting heart rate (173.4 in men and 369.1 in women). These findings suggest that the heart rate indices obtained from wearable devices may facilitate early identification of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: The associations of different obesity and metabolic phenotypes during midlife with the risk of incident dementia remain unclear. This study aimed to investigate the associations between metabolic heterogeneity of obesity and long-term risk of dementia. Methods: We conducted prospective analyses from three cohorts, including the UK Biobank (UKB), Atherosclerosis Risk in Communities (ARIC) study, and Framingham Offspring Study (FOS). Eligible participants were those aged 45–65 years with valid assessments of body mass index (BMI) and metabolic status at the study baseline. Obesity was defined as a BMI of ≥ 30.0 kg/m2, while metabolic abnormality was defined as meeting ≥ 2 of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. Metabolic heterogeneity of obesity was evaluated based on obesity and metabolic phenotypes and grouped as metabolically normal non-obesity (MNNO), metabolically abnormal non-obesity (MANO), metabolically normal obesity (MNO), and metabolically abnormal obesity (MAO). Results: Included in this study were 295,823 participants aged 56.3 ± 5.9 years from the UKB, 12,547 participants aged 54.0 ± 5.7 years from the ARIC, and 2,004 participants aged 53.9 ± 5.9 years from the FOS. Over 4,348,208 person-years, a total of 6,190 participants (3,601 in the UKB, 2,405 in the ARIC, and 184 in the FOS) developed incident dementia. In the pooled analysis of three cohorts, metabolic abnormality was associated with a hazard ratio (HR) of 1.41 (95% confidence interval [CI]: 1.10–1.80) for dementia, while obesity was associated with an HR of 1.20 (1.03–1.41). Compared with MNNO, individuals with MANO and MAO had increased risks of dementia (pooled HR: 1.33, 95% CI: 1.04–1.71 for MANO and 1.48, 1.16–1.89 for MAO). However, there was no significant difference in the risk of dementia among MNO (pooled HR: 1.10, 95% CI: 0.98–1.24). In addition, participants who recovered from MANO to MNNO had a lower risk of dementia (pooled HR: 0.79, 95% CI: 0.64–0.97), as compared with stable MANO. Conclusions: Metabolic abnormality has a stronger association with dementia than obesity. Metabolically abnormal non-obesity and obesity, but not metabolically normal obesity, are associated with higher risks of incident dementia as compared with metabolically normal non-obesity. Recovering from an abnormal metabolic status to normal reduces the risk of dementia in populations without obesity. Our findings highlight the important role of metabolic status in the development of dementia and recommend the stratified management of obesity based on metabolic status. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a leading cause of neurological disability among young and middle-aged adults worldwide, and disability is measured using a variety of approaches, including patient reported outcome measures (PROMs) such as the Patient Determined Disease Steps (PDDS) scale. There is limited evidence for the validity of inferences from the middle-range of scores on the PDDS (i.e., 3 "gait disability" – 6 "bilateral support"), but that range of scores seemingly represents moderate disability characterized by varying levels of walking dysfunction. Purpose: The current study examined whether the middle-range of scores from the PDDS reflect varying levels of walking dysfunction among people with MS. Method: Participants (N = 374) completed the Patient Determined Disease Steps (PDDS) scale, Multiple Sclerosis Walking Scale-12 (MSWS-12), timed 25-foot walk (T25FW), six-minute walk (6 MW), Modified Fatigue Impact Scale (MFIS), and Multiple Sclerosis Impact Scale-29 (MSIS-29), and underwent a neurological exam for generating an Expanded Disability Status Scale (EDSS) score as part of screening and baseline data collection for a clinical trial of exercise training in MS. We undertook a series of linear trend analyses that examined differences in the outcomes of EDSS, T25FW, 6 MW, MSWS-12, MFIS subscales, and MSIS-29 subscales across the 4 levels of PDDS scores (i.e., 3–6). Results: There were statistically significant and strong linear trends for EDSS (F1,370 = 306.1, p <.0001, η2 = 0.48), T25FW (F1,370 = 161.0, p <.0001, η2 = 0.32), 6 MW (F1,370 = 178.9, p <.0001, η2 = 0.34), and MSWS-12 (F1,370 = 97.0, p <.0001, η2 = 0.24). There was a strong correlation between PDDS and EDSS scores (rs = 0.695, 95% CI = 0.643, 0.748). Both PDDS and EDSS scores had strong correlations with walking outcomes, yet weaker correlations with measures of fatigue and QOL. Conclusion: The PDDS could serve as a simple, inexpensive, and rapidly administered PROM for remote screening and early detection of walking dysfunction for initial eligibility into clinical trials and practice for managing mobility-specific disability in MS. Registration: The study was registered on ClinicalTrials.gov on March 19, 2018 (NCT03468868). [ABSTRACT FROM AUTHOR]

The study aimed to assess the prospective associations between sleep duration, sleep restfulness, midday napping and hip fracture (HF) and falls in a nationally representative Chinese population. Data were from the China Health and Retirement Longitudinal Study which was conducted from 2013 to 2018. In total, 10,508 individuals without a history of HF in 2013 were included. Nighttime sleep duration, sleep restfulness and midday napping were self-reported. Logistic regression analyses were performed to examine the relationships between sleep problems and HF as well as falls, adjusting for covariates. A total of 313 (3.0%) participants reported HF, and 3899 (37.1%) experienced at least one fall event over the following 5-year period. Participants who had a short sleep duration (≤ 6) were more likely to report HF (OR = 1.27, 95% CI = 1.00-1.62) and falls (OR = 1.18, 95% CI = 1.07–1.30) than those who had a normal sleep duration (6–9 h) in the fully adjusted model. Participants having unrestful sleep were also more likely to report falls (OR = 1.23, 95% CI = 1.11–1.36) than those who had restful sleep. However, there was no significant association between midday napping and HF and falls. In conclusion, short sleep duration and sleep restfulness were independently associated with an increased risk of HF and falls, which may have important clinical and public health implications. Interventions to improve sleep quality may reduce the risk of HF and fall accidents among middle-aged and older people. [ABSTRACT FROM AUTHOR]

Previous studies have yielded inconsistent results regarding the association between chronic kidney disease (CKD) and the risk of cognitive impairment (CI). This study aimed to investigate the longitudinal association of CKD with CI risk in the Chinese middle-aged and older population. A total of 16,515 CI-free participants 45 years of age or older including 15,595 without CKD and 920 with CKD were followed from 2011 until 2018 (median [interquartile range]: 7 [5.5-7]) to detect incident CI. Over the follow-up, 648 participants developed CI. Data were analyzed using multi-adjusted Cox proportional hazard regression and Laplace regression. The incidence rate (IR) of CI was significantly higher in individuals with CKD at 11.46 per 1,000 person-years (95% confidence interval [CI], 8.90 to 14.76) than in those without CKD at 6.38 per 1,000 person-years (95% CI, 5.89 to 6.92). Compared to those without CKD, the hazard ratios of those with CKD was 1.56 (95% CI, 1.19 to 2.04) for CI. Participants with CKD in the middle-aged group (45–54 years) exhibited a heightened risk of CI in age-stratified analyses. CKD accelerated the onset of CI by 1.24 years (10th percentile difference [PD]; 95% CI, -2.03 to -0.43, p < 0.01). The findings from this study revealed a significantly increased risk of CI in individuals with CKD, especially in middle-aged population, where the risk appeared to be more pronounced. This observation underscores the importance of early detection and intervention strategies to alleviate the potential cognitive decline associated with CKD. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) plays a vital role in maintaining the functional ability that enables well-being in older age (healthy aging), potentially also saving costs for the healthcare system and society. The aim of this study was to examine the association between PA and healthcare and societal costs in a sample of very mild to moderately frail older adults. Methods: This cross-sectional study is a secondary analysis using baseline data from the PromeTheus randomized-controlled trial, which included 385 very mild to moderately frail community-dwelling older adults (70 + years) from Germany. Participants self-reported their health-related resource use in the previous 6 months (FIMA questionnaire), which was monetarily valued using standardized unit costs. PA was also self-reported using the German Physical Activity Questionnaire for middle-aged and older adults (German-PAQ-50+) and categorized as 'insufficient'/'sufficient' or 'insufficient'/'moderate'/'high' in accordance with the World Health Organization guidelines for PA. Mean and median healthcare costs (including outpatient, inpatient, rehabilitation, formal care, and medication costs) and societal costs (healthcare costs plus informal care costs) for different PA groups were estimated using generalized linear models and quantile regression, with sociodemographic variables and physical capacity (Short Physical Performance Battery) as covariates. Results: Of the sample, 24% were classified as insufficiently, 23% as moderately, and 54% as highly active. Sufficient PA, especially high PA, was associated with lower costs in the 6 months prior to data collection compared to insufficient PA (-€6,237, 95% CI [-10,656; -1,817] and -€8,333, 95% CI [-12,183; -4,483], respectively). The cost difference between PA intensity groups was largely driven by differences in informal care costs and decreased substantially when physical capacity was accounted for in the analyses; e.g., the mean difference in societal costs between sufficient and insufficient PA decreased from -€7,615 (95% CI [-11,404; -3,825]) to -€4,532 (95% CI [-7,930; -1,133]). Conclusion: Promoting PA throughout the lifespan as a means of promoting healthy aging and reducing dependency in old age could potentially provide economic benefits and help to mitigate the economic consequences of an aging population with increasing health and long-term care needs. Future longitudinal studies should attempt to disentangle the mediating and confounding role of physical capacity and health status in the association between PA and costs. [ABSTRACT FROM AUTHOR]

Background: Stroke is the leading cause of death in middle-aged and elderly people in China. Insulin resistance (IR) and sarcopenia are both closely associated with metabolic diseases. However, the relationship between these two indicators and stroke has not been fully investigated. The aim of this study was to investigate the relationship between IR and sarcopenia and the risk of new-onset stroke. Methods: Using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, Cox proportional hazards models were used to determine the association between IR surrogate indicators and sarcopenia status with stroke incidence. Results: In the present study, during a median 7 years of follow-up, we included 7009 middle-aged and elderly residents, of whom 515 presented with stroke incidence. After adjustment for potential confounders, both baseline IR surrogates and sarcopenia independently predicted stroke risk. In addition, co-morbidities had a higher risk of stroke than other groups. The positive association between TyG-WC and sarcopenia on stroke risk was particularly significant [HR (95% CI): 2.03 (1.52, 2.70)]. In subgroups of different ages and sexes, the combination of IR and sarcopenia is associated with the highest risk of stroke. Conclusions: We found that IR and sarcopenia synergistically increase the incidence of stroke in older adults. This finding provides new perspectives for stroke detection and intervention and highlights the importance of early detection and management of IR and sarcopenia in older adults. [ABSTRACT FROM AUTHOR]

Background: Five decades into the era of mass incarceration, a growing number of older adults have experienced criminal legal involvement (CLI) in their lifetime. Studies have shown that prior incarceration is associated with substantial disease burden, but little is known about the distinct needs and utilization patterns of middle-aged and older adults with lifetime CLI compared to those without. Using a nationally representative data set, we tested the association between lifetime CLI exposure and use of acute care services among middle-aged and older adults. Methods: Our sample included 44,007 US adults (25,074 middle-aged-50-64 years; 18,709 older- ≥65 years) who participated in the National Survey of Drug Use and Health (2015–2019). The data is publicly available. Our independent variable was lifetime CLI. Using separate negative binomial regression models for middle-aged and older adults, we tested the association between lifetime CLI and acute healthcare utilization (ED visits and nights spent inpatient) controlling for relevant sociodemographic covariates. Results: For middle-aged respondents, 19.1% reported lifetime CLI; for older adults, the rate of exposure was 9.6%. In multivariate models, CLI was associated with increased ED visits in middle-aged adults (IRR 1.18, 95% CI 1.06–1.31) but not older adults (IRR 0.99, 95% CI 0.85–1.16). CLI was associated with increased nights hospitalized in both groups (middle-aged: IRR 1.33, 95% CI 1.08–1.62; older adults: IRR 1.26, 95% CI 1.01, 1.57). Conclusion: Middle-aged and older adults with lifetime CLI experience higher rates of acute care utilization than their peers with no lifetime CLI, even after adjustment for confounders. As the cohort of adults from the era of mass incarceration ages, understanding the mechanisms by which lifetime CLI impacts health outcomes is crucial in designing interventions to improve outcomes and reduce unnecessary acute healthcare utilization. [ABSTRACT FROM AUTHOR]

Background: The association between weight-adjusted waist index (WWI) and disability is unclear. This study aimed to assess the relationship between WWI and disability in middle-aged and elderly Chinese individuals and provide more predictive indicators for disability prevention. Methods: In this study, 13,015 middle-aged and older adults aged 45 years and above who were surveyed in 2011 by the China Health and Aging Tracking Survey (CHARLS) database were selected, and 8344 respondents with complete data were included for cohort analysis after seven years of follow-up. Information on clinical demographic characteristics, anthropometric indices, assessment of disability, and related covariates were collected, and the presence or absence of disability was assessed by the disability scale. WWI was calculated by dividing the waist circumference (cm) by the square root of the body weight (kg). Cox proportional hazards model was used to analyze the association between WWI and disability after follow-up. Results: Our study found that 2912 of 8344 participants had disability after seven years of follow-up, and disability incidence was approximately 34.9%. Age, sex, place of residence, chronic disease, depression, waist circumference, and WWI were significantly associated with disability in univariate analysis. Among them, there was a positive association between WWI as a continuous variable and incidence of disability (hazard ratio (HR) = 1.26, 95% CI: 1.22–1.31, p < 0.001). WWI was transformed into categorical variables using quartiles as cutoffs for disability regression analysis. After adjusting covariates, HR values in the 2nd, 3rd and 4th quantile showed an increasing trend compared with the 1st quantile, and the risk of disability among WWI subjects in the 4th quantile increased by 43% (95% CI: 1.24–1.64). P values for the trend test in the model were all < 0.001. In subgroup analyses, the positive association between WWI and risk of disability remained robust for sex, age, alcohol consumption, smoking status, education level, marital status, and place of residence after adjusting for all covariates considered in this study. Conclusions: WWI is a new and reliable obesity-related indicator that can be used for disability prevention. WWI can be detected and controlled for reducing the risk of disability. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) plays a vital role in maintaining the functional ability that enables well-being in older age (healthy aging), potentially also saving costs for the healthcare system and society. The aim of this study was to examine the association between PA and healthcare and societal costs in a sample of very mild to moderately frail older adults. Methods: This cross-sectional study is a secondary analysis using baseline data from the PromeTheus randomized-controlled trial, which included 385 very mild to moderately frail community-dwelling older adults (70 + years) from Germany. Participants self-reported their health-related resource use in the previous 6 months (FIMA questionnaire), which was monetarily valued using standardized unit costs. PA was also self-reported using the German Physical Activity Questionnaire for middle-aged and older adults (German-PAQ-50+) and categorized as 'insufficient'/'sufficient' or 'insufficient'/'moderate'/'high' in accordance with the World Health Organization guidelines for PA. Mean and median healthcare costs (including outpatient, inpatient, rehabilitation, formal care, and medication costs) and societal costs (healthcare costs plus informal care costs) for different PA groups were estimated using generalized linear models and quantile regression, with sociodemographic variables and physical capacity (Short Physical Performance Battery) as covariates. Results: Of the sample, 24% were classified as insufficiently, 23% as moderately, and 54% as highly active. Sufficient PA, especially high PA, was associated with lower costs in the 6 months prior to data collection compared to insufficient PA (-€6,237, 95% CI [-10,656; -1,817] and -€8,333, 95% CI [-12,183; -4,483], respectively). The cost difference between PA intensity groups was largely driven by differences in informal care costs and decreased substantially when physical capacity was accounted for in the analyses; e.g., the mean difference in societal costs between sufficient and insufficient PA decreased from -€7,615 (95% CI [-11,404; -3,825]) to -€4,532 (95% CI [-7,930; -1,133]). Conclusion: Promoting PA throughout the lifespan as a means of promoting healthy aging and reducing dependency in old age could potentially provide economic benefits and help to mitigate the economic consequences of an aging population with increasing health and long-term care needs. Future longitudinal studies should attempt to disentangle the mediating and confounding role of physical capacity and health status in the association between PA and costs. [ABSTRACT FROM AUTHOR]

Background: Edentulism is considered the ultimate sign of oral health disease burden. It is a common and frequent clinical disease, mostly seen in the elderly, which has been reported to be closely associated with many diseases. While physical activity is known to benefit many chronic diseases, the relationship between the volume of physical activity and edentulism remains unclear. Materials and methods: The CHARLS provided the data for this study. A total of 6,480 participants were enrolled in this study, of whom 46.02% were male and 53.98% were female. The edentulism was defined according to self-report and physical activity volume can be represented by metabolic equivalents. Multiple logistic regression, smooth curve fitting, threshold effects analysis, and Cox regression models were used to explore the relationship between physical activity volume and edentulism. Results: In the fully adjusted model, physically active participants had a 24% lower risk of edentulism compared to those who were physically inactive. Then, we subdivided participants with adequate physical activity into four levels: 600 ≤ PAV < 1200; 1200 ≤ PAV < 1800; 1800 ≤ PAV < 3000; and PAV ≥ 3000. We found that the risk of developing edentulism was lowest and statistically significant at the level of 1,800-3,000 MET-minutes/week physical activity volume (OR = 0.41; 95% CI, 0.24–0.69, p < 0.001). A U-shaped relationship between physical activity volume and edentulism with an inflection point of 2514 (MET-minutes/week) was observed. The results of the longitudinal study also confirm the benefits of physical activity volume with edentulism, participants with adequate physical activity volume had a 21% lower risk of developing edentulism than participants with inadequate physical activity volume (HR = 0.79; 95% CI, 0.67–0.94, p = 0.008). Conclusions: This study reveals a U-shaped relationship between physical activity volume and edentulism. Physical activity reduces the risk of developing edentulism in middle-aged and older populations, but it is important to control the appropriate volume of physical activity. [ABSTRACT FROM AUTHOR]

Background: Five decades into the era of mass incarceration, a growing number of older adults have experienced criminal legal involvement (CLI) in their lifetime. Studies have shown that prior incarceration is associated with substantial disease burden, but little is known about the distinct needs and utilization patterns of middle-aged and older adults with lifetime CLI compared to those without. Using a nationally representative data set, we tested the association between lifetime CLI exposure and use of acute care services among middle-aged and older adults. Methods: Our sample included 44,007 US adults (25,074 middle-aged-50-64 years; 18,709 older- ≥65 years) who participated in the National Survey of Drug Use and Health (2015–2019). The data is publicly available. Our independent variable was lifetime CLI. Using separate negative binomial regression models for middle-aged and older adults, we tested the association between lifetime CLI and acute healthcare utilization (ED visits and nights spent inpatient) controlling for relevant sociodemographic covariates. Results: For middle-aged respondents, 19.1% reported lifetime CLI; for older adults, the rate of exposure was 9.6%. In multivariate models, CLI was associated with increased ED visits in middle-aged adults (IRR 1.18, 95% CI 1.06–1.31) but not older adults (IRR 0.99, 95% CI 0.85–1.16). CLI was associated with increased nights hospitalized in both groups (middle-aged: IRR 1.33, 95% CI 1.08–1.62; older adults: IRR 1.26, 95% CI 1.01, 1.57). Conclusion: Middle-aged and older adults with lifetime CLI experience higher rates of acute care utilization than their peers with no lifetime CLI, even after adjustment for confounders. As the cohort of adults from the era of mass incarceration ages, understanding the mechanisms by which lifetime CLI impacts health outcomes is crucial in designing interventions to improve outcomes and reduce unnecessary acute healthcare utilization. [ABSTRACT FROM AUTHOR]

Background: The associations of weight change with all-cause and cause-specific mortality stratified by age remains unclear. We evaluated the age-stratified (< 65 vs ≥ 65 years) associations of weight change with all-cause and cause-specific mortality in a large sample of Chinese adults. Methods: Our cohort study included 746,991 adults aged at least 45 years from the Shenzhen Healthcare Big Data Cohort in China. BMI change were categorized as change within 5% (stable), decrease by 5% to 10%, decrease by > 10%, increase by 5% to 10%, and increase by > 10%. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, non-communicable disease, cardiovascular disease (CVD), and cancer mortality according to BMI change, with adjustment for potential confounders. Results: During a median follow-up of 2.2 years (2,330,180 person-years), there were 10,197 deaths. A notable interaction emerged between weight change and age. For participants ≥ 65 years, compared with stable BMI, more than a 10% decrease in BMI was associated with higher risk of all-cause mortality (HR: 1.69, 95% CI: 1.54–1.86), non-communicable disease mortality (HR: 1.67, 95% CI: 1.52–1.84), CVD mortality (HR: 1.55, 95% CI: 1.34–1.80), and cancer mortality (HR: 1.59, 95% CI: 1.33–1.92). Similar patterns of results for 5% to 10% decrease in BMI were observed. More than a 10% increase in BMI was associated with increased risk of all-cause mortality (HR: 1.13, 95% CI: 1.04–1.24), non-communicable disease mortality (HR: 1.14, 95% CI: 1.04–1.25), and CVD mortality (HR: 1.27, 95% CI: 1.12–1.44). For participants < 65 years, only more than a 10% decrease in BMI was associated with higher risk of all-cause mortality (HR: 1.41, 95% CI: 1.12–1.77), non-communicable disease mortality (HR: 1.43, 95% CI: 1.13–1.81), and cancer mortality (HR: 1.79, 95% CI: 1.29–2.47). Conclusions: Weight loss and excessive weight gain were associated with increased risks of mortality among older adults, while only excessive weight loss was associated with increased risks of mortality among middle-aged adults. [ABSTRACT FROM AUTHOR]

Previous studies have yielded inconsistent results regarding the association between chronic kidney disease (CKD) and the risk of cognitive impairment (CI). This study aimed to investigate the longitudinal association of CKD with CI risk in the Chinese middle-aged and older population. A total of 16,515 CI-free participants 45 years of age or older including 15,595 without CKD and 920 with CKD were followed from 2011 until 2018 (median [interquartile range]: 7 [5.5-7]) to detect incident CI. Over the follow-up, 648 participants developed CI. Data were analyzed using multi-adjusted Cox proportional hazard regression and Laplace regression. The incidence rate (IR) of CI was significantly higher in individuals with CKD at 11.46 per 1,000 person-years (95% confidence interval [CI], 8.90 to 14.76) than in those without CKD at 6.38 per 1,000 person-years (95% CI, 5.89 to 6.92). Compared to those without CKD, the hazard ratios of those with CKD was 1.56 (95% CI, 1.19 to 2.04) for CI. Participants with CKD in the middle-aged group (45–54 years) exhibited a heightened risk of CI in age-stratified analyses. CKD accelerated the onset of CI by 1.24 years (10th percentile difference [PD]; 95% CI, -2.03 to -0.43, p < 0.01). The findings from this study revealed a significantly increased risk of CI in individuals with CKD, especially in middle-aged population, where the risk appeared to be more pronounced. This observation underscores the importance of early detection and intervention strategies to alleviate the potential cognitive decline associated with CKD. [ABSTRACT FROM AUTHOR]

Background: There has been a sharp increase in the prevalence of hypertension in young and middle-aged people at high risk of the disease. Despite the fact that good self-management can be effective in controlling blood pressure, patients do not perform well in this area, resulting in poor blood pressure control. It is therefore particularly important to gain a thorough understanding of patients' attitudes to self-management and the factors that influence them. The aim of this study was to synthesise the qualitative research on attitudes, motivations and challenges of self-management in young and middle-aged hypertensive patients, to analyse the synthesised results using the COM-B model and to propose appropriate improvement actions. Methods: From the time of construction until May 2023, the system searched PubMed, Web of Science, ProQuest, Embase, MEDLINE, CINAHL, PsyCINFO and CNKI databases. The analyses were carried out using a thematic synthesis approach to summarise the key findings. The findings were then mapped and analysed using the COM-B model. Results: A total of 11 studies were included, involving 250 patients between the ages of 18 and 64. Four themes with ten sub-themes were identified: Poor disease recognition (low disease perception, fuzzy disease knowledge); Barriers to doctor-patient interactions (short communication time, unmet knowledge needs, incomplete guidance for disease management); Living in a hostile environment (heavy workload, lack of companionship, ignorance of families); Expectations for a healthy body (responsibility of family roles, witness the cruelty of illness). Analysis of the composite results based on the COM-B model showed that low disease perceptions, barriers to doctor-patient interactions and life circumstances with enemies on all sides were the main challenges faced by young and middle-aged hypertensive patients, whereas the expectation of a healthy body was a motivation to promote self-management of blood pressure in patients. Conclusions: This study shows that family responsibilities are a particular motivator for self-management in young and middle-aged hypertensive patients. In response to the problems they face, we believe that meeting patients' knowledge needs, improving healthcare professionals' communication skills and valuing the role of community hospitals are effective ways to promote patient self-management. In the future, telemedicine, mobile healthcare and intelligent monitoring devices will provide a solution to reduce the burden on medical resources. Systematic review registration: PROSPERO CRD42018100810. [ABSTRACT FROM AUTHOR]

Introduction: The effects of exposure to particulate matter and frailty, as well as its exposure-response relationship, have not been effectively explored. This study aimed to explore the association between long-term exposure to particulate matter and frailty state and each dimension in Chinese middle-aged and older adults, in addition to the exposure-response relationship. Methods: The data were obtained from the National Urban Air Quality Real-Time Dissemination Platform and China Health and Retirement Longitudinal Study (CHARLS). Frailty was measured by a frailty index containing 39 indicators. Annual averages of seven pollutants were calculated from hourly monitoring data. We used multilevel regression modeling to explore the association between long-term exposure to particulate matter and frailty. Meanwhile, we explored the exposure-response relationship based on a multilevel generalized summation model. We performed a sensitivity analysis using a multi-pollution model and a quantile-based g-computation (QGC) model. Results: A total of 15,611 participants were included in the analysis. We find that long-term exposure to PM2.5 was associated with an increased risk of pre-frailty and frailty (all p < 0.05). PMc and PM10 exhibited similar associations. The exposure-response relationship between PM2.5 showed a linear relationship, whereas the exposure-response relationship between PM10, PMc showed a nonlinear relationship. Elevated PM2.5 concentrations showed significant positive associations with the number of chronic disease score, IADL score, and functional limitation status score (all p < 0.05). PM10 and PMc showed similar positive correlations. These results remained robust after sensitivity analyses using a multi-pollution model and QGC model. Conclusion: Chronic exposure to particulate matter was significantly associated with increased risk of frailty. The exposure-response relationship between PM2.5 concentration and frailty showed a linear relationship, and the exposure-response relationship between PM10 and PMc showed a nonlinear relationship. Exposure to a mixture of pollutants carried a higher risk of frailty than exposure to a single pollutant. [ABSTRACT FROM AUTHOR]

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Background: Most individuals spend a significant amount of their time at work, and the dynamics at work can potentially influence their overall life, especially health and mental health. The present study tried to understand the association of the nature of work categorized as physically demanding, psychologically demanding, and environmentally hazardous on life satisfaction, cognitive functioning, and depressive symptoms among working middle-aged and older adults in India. Method: We used data from the Longitudinal Ageing Study in India (LASI), Wave 1, collected between 2017 and 2018. The study sample consists of 28,653 working adults aged between 45 and 70. The study measures were assessed using standard tools. Linear regression analysis was employed. Results: The results indicate that individuals working in less physically demanding (β = 0.06, 99% CI = 0.02–0.09) and not hazardous environments (β = 0.15, 99% CI = 0.09–0.20) had better life satisfaction. Also, not being involved in hazardous work environments increased the likelihood of good cognitive functioning and reduced depressive symptoms (β= -0.17, 99% CI= -0.20- -0.15). However, samples involved in works requiring less psychological demand had an increased likelihood of reduced life satisfaction and increased depressive symptoms. Conclusion: This study's results highlight the importance of creating a conducive working environment for the ageing adults. [ABSTRACT FROM AUTHOR]

This study identified network types based on multiple indicators reflecting the structure, function, and quality of social relationships, and investigated their associations with mental health in two age-groups. Using 620 South Korean middle-aged and older adults, Latent Profile Analysis (LPA) was conducted for both the total sample and for each age-group separately. LPA derived four network types: diverse-supported, family-focused, friend-focused, and restricted. However, for each age group, the prevalence and composition of the network types differed. While controlling for individuals' demographic information and self-rated health, there were significant differences in terms of mental health among four network types, and an individual's network type membership was found to be significantly associated with their mental health. Although the associations of network types with mental health were overall similar in both groups, the effect sizes of network type impact on mental health were much greater in older adults than they were in middle-aged adults. [ABSTRACT FROM AUTHOR]

As heatwave occurs with increased frequency and intensity, the disease burden for urolithiasis, a heat-specific disease, will increase. However, heatwave effect on urolithiasis subtypes morbidity and optimal heatwave definition for urolithiasis remain unclear. Distributed lagged linear models were used to assess the associations between 32 defined heatwave and upper urinary tract stones morbidity. Relative risk (RR) and attributable fraction (AF) of upper urinary tract stone morbidity associated with heatwave of different intensities (low, middle, and high) were pooled by meta-analysis. Optimal heatwave definition was selected based on the combined score of AF, RR, and quasi-Akaike Information Criterion (QAIC) value. Stratified analyses were conducted to investigate the modification effects of gender, age, and disease subtypes. Association between heatwave and upper urinary tract stones morbidity was mainly for ureteral calculus, and AF was highest for low-intensity heatwave. This study's optimal heatwave was defined as average temperature > 93rd percentile for ≥ 2 consecutive days, with AF of 7.40% (95% CI: 2.02%, 11.27%). Heatwave was associated with ureteral calculus morbidity in males and middle-aged adults. While heatwave effect was statistically insignificant in females and other age groups. Managers should develop appropriate definitions to address heatwave based on regional characteristics and focus on heatwave effects on urolithiasis. [ABSTRACT FROM AUTHOR]

Aim: This study examined the association of low handgrip strength (HGS) for falls in middle-aged adults and older adults every half-decade of life. Methods: This cross-sectional study was conducted using the public data from the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). The participants were allocated into seven age groups 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, and ≥ 80 years. Binary logistic regression analysis was performed to identify the odds ratio (OR) of low HGS to the falls regardless of confounding variables such as sex, balance, gait speed, and total number of health conditions. Results: A total of 8,112 participants aged 50–105 years (median = 62.0 years): 3,490 males (median = 60.0 years) and 4,622 females (median = 63.0 years) attended the study. Altogether, 21.5% of participants experienced at least one fall. HGS gradually decreases over each half-decade of life. In addition, low HGS presented a significative OR (p < 0.05) for falls for age groups, until 80 s, even when considering confounding variables. Conclusions: Low HGS is associated with falls in middle-aged adults over their 50 s and remained a strong measure of falls across each subsequent half-decade of life, until 80 s. [ABSTRACT FROM AUTHOR]

Emerging evidence indicates an association between blood pressure and inflammation, yet this relationship remains unclear in older adults, despite the elevated prevalence of hypertension. We investigated the association between blood pressure, high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and white blood cell (WBC) count in a cohort of 3571 older adults aged 65 and above, and 587 middle-aged participants (55–59 years old). In women aged 65 and above, the relationship between inflammatory markers and blood pressure was consistent, with hs-CRP and WBC emerging as predictors of high blood pressure. For hs-CRP, the adjusted odds ratio (OR) was 1.5 (95% CI, 1.07 to 2.10, P = 0.02), and for WBC, the adjusted OR was 1.41 (95% CI, 1.02 to 1.94, P = 0.04), comparing the highest to the lowest quartiles. In men, only the WBC count was significantly associated with an increased OR for high BP (adjusted OR 1.49, 95% CI, 1.09 to 2.02, P = 0.01) across quartiles. Across the entire study population, in a fully adjusted model, all inflammatory markers were modestly associated with blood pressure levels, while the effect of being over 65 years was the most significant predictor of high blood pressure (OR 1.84, 95% CI, 1.50 to 2.25, P < 0.001). The link between key inflammation markers and blood pressure in older adults varies by sex and biomarker type and may differ from the relationship observed in younger individuals. These relationships are likely to be affected by factors linked to age. [ABSTRACT FROM AUTHOR]

This article discusses two cases of primary intraosseous glomus tumors with NOTCH2/3 fusions, both of which presented in the long bones. The patients were male, one young adult and one middle-aged adult. The tumors were characterized by nests of monomorphic epithelioid neoplasms with granular cytoplasm that were associated with dilated blood vessels. The tumors were classified as glomus tumors of uncertain malignant potential based on their size and the presence of focal spindled morphology and nuclear atypia. Recurrent NOTCH2/3 fusions have been identified in soft tissue glomus tumors, particularly in visceral lesions with malignant features. However, the literature suggests that NOTCH2/3 fusions are enriched in visceral tumors and their significance in intraosseous tumors is unclear. [Extracted from the article]

BACKGROUND High blood pressure (BP) in middle-aged and older adults is associated with lower brain volume and cortical thickness assessed with structural magnetic resonance imaging (MRI). However, little evidence is available on young adults. We investigated the associations of high BP with brain volumes and cortical thickness in healthy young adults. METHODS This cross-sectional study included 1,095 young adults (54% women, 22–37 years) from the Human Connectome Project (HCP) who self-reported not having a history of hypertension or taking antihypertensive medications. Brachial systolic (SBP) and diastolic BP (DBP) were measured with a semi-automatic or manual sphygmomanometer during study visits. Structural MRI was used to measure gray matter (GM) and white matter (WM) volume and mean cortical thickness. Associations of BP and hypertension stage with total and regional brain volumes and cortical thickness were analyzed using linear regression and analysis of covariance (ANCOVA) after adjusting for age, sex, education years, body mass index (BMI), smoking, alcohol consumption history, zygosity, and total intracranial volume. RESULTS SBP and DBP were (mean ± SD) 123.6 ± 14.2 and 76.5 ± 10.6 mm Hg, respectively, (n  = 1,095). High DBP was associated with lower total GM (P  = 0.012), cortical GM (P  = 0.004), subcortical GM (P  = 0.012), and total WM volumes (P  = 0.031). High SBP and DBP were associated with lower regional cortical volume and cortical thickness. CONCLUSIONS These findings suggest that high BP may have deleterious effects on brain health at the early stage of adulthood. [ABSTRACT FROM AUTHOR]

Carbohydrate antigen 19–9 (CA19-9) levels are associated with glycemic control, insulin resistance, and chronic complications in patients with type 2 diabetes (T2D). Women generally show higher CA19-9 levels despite a greater T2D prevalence in men. We evaluated the sex-specific longitudinal associations between CA19-9 levels and T2D incidence. Korean adults (n = 329,380) without previous cancer or T2D were categorized into four groups based on their CA19-9 levels. The study end point was the development of incident T2D during follow-up. Cox proportional hazards models were used to estimate hazard ratios (HR) according to CA19-9 levels. During a median follow-up of 6.1 years (3.3–9.3 years), the incidence rates of T2D were 9.9 per 1,000 person-years in men and 3.6 per 1,000 person-years in women. In the time-dependent analysis, adjusted HRs (95% confidence intervals) for incident T2D comparing CA19-9 levels of 10.0–19.9, 20.0–29.9, and ≥ 30 U/mL to the reference (< 10 U/mL) were 1.08 (1.04–1.13), 1.18 (1.07–1.30), and 1.64 (1.35–1.99), respectively, among men. However, this association was not observed in women. The association between CA19-9 category and incident T2D significantly differed by sex (Pinteraction = 0.006). Among young and middle-aged Korean adults, elevated CA19-9 levels were significantly associated with increased risk of type 2 diabetes in men but not in women. Elevated CA19-9 levels in men could be a useful marker for identifying individuals at high risk of developing T2D. Evaluation approaches for individuals with elevated CA19-9 levels should be sex-specific. [ABSTRACT FROM AUTHOR]

Background: The association between dietary cholesterol and metabolic diseases remains controversial. However, the majority of studies focus on egg intake, and there is a limitation in the availability of prospective cohort studies. Our study examined the association between dietary cholesterol and the incidence risk of metabolic syndrome (MetS) in middle aged adults using large prospective cohort study in Republic of Korea. Methods: The Health Examinees cohort from the Korean Genome and Epidemiology Study was used from baseline to follow-up. Dietary cholesterol intake was assessed by the validated semi-quantitative food frequency questionnaire. Participants were classified as quintile groups according to adjusted dietary cholesterol for total energy intake. MetS was defined as more than 3 of the 5 components of MetS. Hazard ratio (HR) and 95% confidence intervals (CI) for MetS were evaluated by multivariable cox regression analyses. Results: Of the total 40,578 participants, metabolic syndrome developed in 4,172 (10.28%) individuals during an average follow-up period of approximately 4.76 years. Dietary cholesterol did not exhibit a significant association with the risk of MetS after adjusting for potential confounding factors, but a trend was observed indicating an increased risk with higher intake (p for trend = 0.044). Among the components of MetS, the incidence risk of high waist circumference (HR: 1.164, 95% CI: 1.049–1.290), high blood pressure (HR: 1.188, 95% CI: 1.075–1.313), high serum triglyceride (HR: 1.132, 95% CI: 1.044–1.227) and high fasting blood glucose (HR: 1.217, 95% CI: 1.132–1.308) in the group that consumed the highest dietary cholesterol intake was increased compared with the group that consumed the lowest dietary cholesterol intake. Dose-response relationship suggested a positive linear association between dietary cholesterol intake and the risk of high waist circumference (p-linearity = 0.004), blood pressure (p-linearity = 0.012), and triglycerides (p-linearity = 0.005). Conclusion: This study suggests a positive association between dietary cholesterol intake and the risk of MetS and its components (abdominal obesity, hypertension, hypertriglyceridemia, and hyperglycemia) in middle-aged Korean adults. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic status (SES) is associated with both depression and activities of daily living (ADL and IADL). However, the role of ADL as a biological mechanism in the relationship between SES and late-life depression, examined through longitudinal data, remains understudied. This study explored the longitudinal mediation effects of basic ADL or IADL on the SES-depression link in older adults. Methods: Data from the China Health and Retirement Longitudinal Study (N = 4104) were utilized. Mediation analysis was performed using parallel process latent growth curve modeling. Results: The average age of participants was 57.76 years, and 55.7% being females. Significant linear growth over time was observed in ADL, IADL, and depression. Adjusting for covariates, SES was positively linked to the initial levels (intercepts) of ADL (βiADL=-0.100[-0.143, -0.057]), IADL (βiIADL=-0.140[-0.185, -0.095]), and depression (βiDEP=-0.103[-0.158, -0.048]). However, SES showed no significant correlation with the rate of change (slopes) in ADL, IADL, or depression (P > 0.05). The intercepts of ADL (βiDEP = 0.566[0.503, 0.629]) and IADL (βiDEP = 0.607[0.544, 0.670]) were positively correlated with the depression intercept but negatively with the depression slope. Conversely, the slopes of ADL and IADL were positively associated with the depression slope. These results suggest a negative indirect relationship between SES and the initial level of depression, but a positive indirect relationship with the rate of increase in depression through ADL (or IADL) intercept. Conclusions: Higher SES is associated with a lower initial risk of depression and ADL difficulties. However, this same higher SES may relate to a faster increase in ADL difficulties and depression among middle-aged and older adults. The findings underscore the need for increased governmental healthcare funding and improved healthcare accessibility. Additionally, maintaining adequate sleep and physical activity can help prevent disability and reduce depression risk later in life, particularly among older adults with lower SES. [ABSTRACT FROM AUTHOR]

Prolonging life is a global trend, and more medical expenditure is being spent on chronic diseases owing to population aging. Diseases commonly seen in middle-aged and elderly people, such as heart disease and diabetes, have slowed mortality improvement in recent years. Diabetes is a common chronic disease and comorbidity of many serious health conditions. The total estimated cost of diabetes in the United States was $327 billion in 2017. However, many people are unaware that diabetes is common, and at least 21.4% of adults do not know that they have diabetes. The number of diabetes-related deaths has been increasing, and diabetes was the 5th cause of death in Taiwan in 2019. In this study, we explore the trend and influence of diabetes in Taiwan and apply mortality models, such as the Lee-Carter and Age-Period-Cohort models, using data from Taiwan's National Insurance to model the incidence and mortality rates of diabetes. We found that the Lee-Carter model provides fairly satisfactory estimates and that people with diabetes regularly taking diabetes medication have lower mortality rates. Moreover, we demonstrate how these results can be used to design diabetes related insurance products and prepare the insured to face the impact of incurring diabetes. In addition, we consider different criteria for judging whether people have diabetes (as there is no consensus on these criteria) and investigate the issue of moral hazard in designing diabetes insurance products. [ABSTRACT FROM AUTHOR]

The primary objective of this study is to explore the mediating role of depression in the relationship between social participation and life satisfaction among middle-aged and elderly individuals, as well as the moderating role of relative income. To this end, we used the China Health and Retirement Longitudinal Study (CHARLS) for regression analysis to investigate whether social participation affects life satisfaction. The CHARLS data cover 150 county-level units, 450 village-level units, and 17,000 people in about 10,000 households. The "Life_satis = α + β*Soc_parti + γ*X + ε" model was used to evaluate the effect of social participation on life satisfaction. The BK method was used to test whether depression mediates between social participation and life satisfaction.Nowell et al.'s (2016) three-step test was used to determine whether relative income moderates the influence path. Our results show that social participation significantly promotes life satisfaction, but the impact of social participation on rural residents was stronger than on urban residents. Depression mediated the positive impact of social participation on the life satisfaction of middle-aged and elderly people. Relative income negatively moderated the positive impact of social participation on depression. Relative income negatively moderated the positive impact of depression on residents' life satisfaction. We suggest that promoting social participation, managing and alleviating symptoms of depression, and increasing levels of relative income are key factors in positive aging. [ABSTRACT FROM AUTHOR]

Background: A number of studies based on young to middle aged adult and child samples have found that exposure to greenspace and bluespace can have a positive impact on mental health and well-being. However, there is limited research among older adults and the extant studies have provided mixed results. The present study was designed to examine how the association between these forms of exposure and depressive symptoms among older adults varies as a function of different spatially and temporally resolved exposure metrics. Methods: The sample consisted of 617 individuals (46.19% female) aged ≥ 60 years of age. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Individuals' greenspace exposure was quantified using spatially and temporally resolved metrics, including monthly and annual averaged satellite-derived normalized difference vegetation index (NDVI) across multiple buffer distances (250 m to 2,000 m) centered at participants' home address. We also quantified exposure to blue-greenspace from a highly detailed land use and land cover dataset. A multivariable logistic regression model assessed the association between greenspace and blue-greenspace exposure and depressive symptoms, adjusting for age, sex, income, education, marital status, current smoking, alcohol status, medical conditions, temperature, crime rate, population density, and per capita park area. Results: We found a significant association between exposures to greenspace and blue-greenspace and depressive symptoms (CES-D cutoff ≥ 4) among older adults. After adjusting for confounding variables, the odds of depressive symptoms were significantly decreased by an IQR increment in residential exposure to greenspace [odds ratio (OR) = 0.67; 95% confidence interval (95% CI), 0.49 ~ 0.91] and blue-greenspace (OR = 0.59; 95% CI, 0.41 ~ 0.84) measured nearby their home address (i.e., as close as 250 m). When stratified by household income level, the association was only significant among low-income individuals. We also found temporal variation in the association between depressive symptoms and monthly NDVI-based greenspace exposure, in which the odds of depressive symptoms were the lowest for greenspace in cold months (i.e., January, February, and March). Conclusions: Our findings suggest that neighborhood greenspace may serve as a protective factor against depression among older adults, but the benefits may depend on the spatial and temporal context. More investigation is needed to replicate our findings on the spatial and temporal variations of greenspace exposure metrics and their effects on depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship of sleep duration and sleep quality with depression in young and middle-aged people in Tibet. Methods From May 2018 to August 2019, people aged 30 and above in Chengguan District of Lhasa City were selected by random cluster sampling method for questionnaire survey, and the independent and combined effects between sleep and depression was analyzed by multifactor logistic regression model. Results A total of 5 510 young and middle-aged people aged 30-59 years old were included in the study. The age was (44.7 ± 8.5) years old, and 1.9% of them were defined with depression. Multivariate logistic regression models showed that shorter sleep duration and poor sleep quality were risk factors for depression in young and middle-aged people after adjusting for confounding factors. Compared with 8 hours of sleep duration daily, the OR (95% CI) of depression for those with sleep duration ≤ 6h and 7h were 3.51 (1.91-6.44) and 1.89 (1.06-3.37), respectively. The OR (95% CI) of depression was 2.24 (1.46-3.46) in the poor sleep quality group compared with those with good sleep quality. Subgroup analysis showed that male with sleep duration ≤6 h and female with sleep duration ≤7h were risk factors for depression. The association of sleep quality with depression was statistically significant in different gender groups. The combined effects of sleep duration and sleep quality were associated with depression, and sleep duration ≤6 h and poor sleep quality had the strongest association with depression (OR = 7.43, 95%CI: 3.50-15.75). Conclusion Shorter sleep duration (≤7h) and poor sleep quality are associated with depression in young and middle-aged people at high altitude, and there is a combined effect. There are gender differences in the association of sleep duration with depression. [ABSTRACT FROM AUTHOR]

Objective To explore the mediating effect of depression between life self-care ability and frailty. Methods Based on data from the China Health and Retirement Longitudinal Study (CHARLS), Pearson correlation analysis, linear regression model and Bootstrap repeated sampling method were used to analyse the relationships and mediating effects between activity of daily living, depression and frailty. Results A total of 1 554 middle-aged and elderly people aged 45 years or older were included. The prevalence of debility was 14.1%, with a self-care score of 5.9 ± 0.4 and a depression score of 9.4 ± 6.0. Activity of daily living was significantly negatively correlated with depression and frailty (r = -0.14, r = -0.23, both P < 0.001), and depression and frailty were positively correlated (r = 0.34, P < 0.001). Activity of daily living (β = -0.164, P < 0.001) and depression (β = 0.013, P < 0.001) were influences on frailty, and depression partially mediated the relationship between activity of daily living and frailty, with a mediating effect of 12.17%. Conclusion Depression reduces the ameliorative effect of self-care ability on debility. [ABSTRACT FROM AUTHOR]

Background: Neuropsychiatric comorbidities in adult patients with new-onset epilepsy in our university hospitals has not been assessed, so the purpose of this study was to identify the neuropsychiatric comorbidities in adult patients with new onset epilepsy in our university hospitals. We recruited one hundred patients, assessed them clinically, radiologically, electrophysiologically, and we performed Wechsler Adult Intelligence Scale Fourth Edition (WAIS-IV), Liverpool Seizure Severity Scale (LSSS), Generalized Anxiety Disorder 7-item (GAD-7) scale, Beck's Depression Inventory II (BDI II) and Quality of Life In Epilepsy-10 Questionnaire (QOLIE-10) to assess cognitive function, seizure severity, anxiety, depression, and quality of life of the patients, respectively. Results: Older adult age group had higher LSSS than other groups. Middle-aged adults' group had higher WAIS-IV full scale Intelligence Quotient (IQ) score and lower GAD-7 scale scores than other age groups. Patients regularly on more than one anti-seizure medication had lower IQ results, more seizure severity, depression, anxiety and worse quality of life than those on monotherapy. Males had slightly higher IQ scores. Patients with moderate and severe BDI-II score had significantly higher rate of uncontrolled seizures, higher seizures' frequency, more abnormal EEG and were regularly on valproate at significantly higher rates as compared to those with minimal BDI-II score. Patients with moderate anxiety were significantly older than those with normal and severe anxiety. Patients with severe anxiety had higher rate of family history of epilepsy, higher rates of uncontrolled seizures and higher seizures' frequency as compared to those with mild and moderate anxiety. Patients with mild, moderate, and severe score on GAD-7 had more abnormal EEG as compared to those with normal GAD-7 score. Patients with severe and very severe seizures had significantly higher levels of anxiety, depression and impaired quality of life than those with mild and moderate seizure severity. Conclusions: Most patients with epilepsy had psychiatric comorbidities such as depression and anxiety which strongly reduce their quality of life and interfere with their compliance to anti-seizure medication. Males had slightly higher Intelligence Quotient (IQ) scores on WAIS-IV. Moreover, patients regularly taking more than one anti-seizure medication had a statistically significantly lower IQ score, more seizure severity, higher Beckʼs depression inventory II score, higher generalized anxiety disorder 7-item scale score, and worse quality of life than those on monotherapy. [ABSTRACT FROM AUTHOR]

Background: While the motivations of individuals without impairments for participating in mass running events are well-documented, there is a lack of current research exploring why people with physical disabilities engage in these events. This study aims to identify the motives for participation among people with physical disabilities, taking into account factors such as sex, age (emerging adults vs. middle-aged adults), time since injury or illness, and mode of movement during the run (wheelchair vs. standing). Methods: In total, 119 participants (51.3% male; mean age of 36 years) completed the Polish version of the Motivations of Marathoners Scale questionnaire. The study was carried out using the diagnostic survey method. Online survey forms were sent to 31 organizations from the Greater Poland region, including sports clubs for individuals with disabilities and runners' clubs open to both individuals with and without disabilities. Results: This study uncovered distinct motivational differences based on age and mode of movement during the run. For participants aged under 35 compared to those over 35, significant differences were noted in the motives of recognition (Z = − 2.834, p = 0.005) and affiliation (Z = − 2.534, p = 0.011). Similarly, when comparing wheelchair users with standing participants, notable disparities were observed in motives related to weight (Z = − 5.109, p = < 0.001) and personal goal achievement (Z = − 2.613, p = 0.009). There was also a significant positive relationship between the time since injury or illness and five out of nine subscales of the Motivations of Marathoners Scale (i.e. affiliation: r = 0.256, p = 0.007; recognition: r = 0.239, p = 0.011). The study found no significant differences in the motivations between men and women with physical disabilities for participating in mass running events. Conclusions: When organizing and promoting running events for people with physical disabilities, it is important to consider factors such as the age of runners, time since injury, and mode of movement during the run. Additionally, it should be noted that no significant differences are found based on gender, indicating that both male and female participants are driven by similar motivations when it comes to participating in these events. [ABSTRACT FROM AUTHOR]

Background: Limited data are available regarding the association between serum transferrin saturation (TSAT) levels and heart failure (HF). Methods: We utilized data from National Health and Nutrition Examination Survey (NHANES) 2017-2020.03 for analysis. Data on TAST, HF and covariates were extracted and analyzed. Weighted logistic regression and subgroup analysis were used to explore the independent association between TSAT and HF. Furthermore, interaction tests were also carried out to evaluate the strata differences. We subsequently assessed whether there was a non-linear relationship between the 2 using Restricted cubic spline (RCS) and threshold effect models. Result: A total of 282 (3.87%) participants were identified to have HF. Among the total population, participants with HF had significantly lower TSAT levels compared to those without HF (24.63 vs. 27.95, P = 0.001). After fully adjusting for potential confounders, weighted multiple logistic regression models revealed a 2.6% reduced in the risk of HF when each unit of TSAT increased. There was also a negative association between elevated TSAT and developed risk of HF in the quartile groups (Q1 OR:1.00; Q2 OR: 0.924 [95%CI:0.593,1.440]; Q3 OR: 0.515 [95%CI:0.298,0.891]; Q4 OR:0.411 [95%CI:0.201,0.839]). The subgroup analysis results remained consistent across strata, with a strong negative correlation between TSAT and HF. Interaction tests showed no dependence on gender, age, Body Mass Index, race, diabetes, hypertension, hyperlipidemia, ratio of family income to poverty and education for this negative association between TSAT and HF (all p for interaction >0.05). The RCS and threshold effect models indicated a linear negative correlation between TSAT and HF, which was more pronounced when TSAT under 40%. Conclusion: Overall, these findings suggest a consistent and negative association between TSAT levels and the presence of HF among middle-aged and older adults in the United States. [ABSTRACT FROM AUTHOR]

Background: The number of chronic diseases has been associated with changes in depressive symptoms over time among middle-aged and older adults. This study aimed to explore the association between the number of chronic diseases and trajectories of depressive symptoms and the role of age in this association. Methods: A total of 12,974 middle-aged and older Chinese adults (≥ 45 years) participated in the China Health and Retirement Longitudinal Study (CHARLS) in waves 2011, 2013, 2015, 2018, and 2020. The number of chronic diseases was determined by self-reported hospital diagnosis of hypertension, dyslipidemia, diabetes, cancer, chronic lung diseases, liver disease, heart diseases, stroke, kidney diseases, digestive diseases, emotional, nervous, or psychiatric problems, memory-related disease, arthritis or rheumatism, asthma, and then obtaining the total number of chronic diseases. Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Group-based trajectory modeling (GBTM) was adopted to capture the trajectories of depressive symptoms over time. Multinomial logistic regressions were conducted to examine the association between the number of chronic diseases and trajectories of depressive symptoms and the role of age in this association. Results: Four distinct trajectories of depressive symptoms were observed in 34.68% individuals in mild, 40.76% in moderate, 19.41% in increasing, and 5.15% in severe group. Compared to participants without chronic diseases, those with one, two, three or more chronic diseases had a 1.81, 3, and 7.49-fold higher risk of developing severe depressive symptom trajectory, respectively. Moreover, the association between the number of chronic diseases and severe depressive symptoms trajectory differed by age (45–59 and ≥ 60 years) (P for interaction < 0.05). Conclusion: Participants with middle age may play a promoting role in the association between the number of chronic disease and severe depressive symptoms. The severe depressive symptoms intervention may be more beneficial for middle-aged adults. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes mellitus (DM) is a significant public health concern, especially among individuals with short sleep duration. Understanding the relationship between physical exercise and DM in this population is crucial for developing effective prevention strategies. However, the presence of a potential threshold effect of exercise on DM risk remains unclear. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2018, this population-based study investigated the association between physical exercise and DM in individuals with short sleep duration (no more than 7 hours per night). Weighted logistic regression analyses were conducted, adjusting for demographic and lifestyle factors. Additionally, a two-piecewise linear regression model was employed to identify any threshold effect of exercise on DM risk. Results: This study included 15,092 participants identified with short sleep duration. Demographic characteristics stratified by DM status indicate higher prevalence among certain groups, such as middle-aged and older adults, males, and non-Hispanic Whites. The analysis revealed an inverse association between exercise levels and DM prevalence among the short sleep population. In the fully adjusted model, individuals engaging in sufficient exercise (> 600 MET-minutes/ week) exhibited significantly reduced odds of developing DM [OR (95% CI): 0.624 (0.527,0.738), p < 0.001]. Furthermore, the segmented regression model identified an inflection point at 2000 MET-minutes/week, below which a significant correlation between exercise and DM was observed. Conclusions: This study provides evidence of a threshold effect of physical exercise on its association with DM in individuals with short sleep duration. Tailored exercise interventions targeting this population may help mitigate DM risk and improve overall health outcomes. Further research is warranted to validate these findings and explore optimal exercise thresholds for DM prevention strategies. [ABSTRACT FROM AUTHOR]