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Purpose: In this study, we tested the "golden youth" hypothesis, which suggests that in Eastern Europe, affluent adolescents are at an increased risk of alcohol use. Also, we hypothesized that the relationship between high socioeconomic position (SEP) and more alcohol use is stronger in countries with wider income inequality., Methods: In total, 50,421 adolescents aged 13-15 years were included from 16 Eastern European countries participating in the 2013-2014 Health Behaviour in School-aged Children survey. Multilevel logistic regression analyses were performed., Results: Affluent adolescents had greater odds of weekly alcohol use (OR = 1.32, 95% CI = 1.23-1.41) and binge drinking (OR = 1.24, 95% CI = 1.16-1.32) than their peers from low-SEP families. However, no significant difference was observed between middle- and low-SEP adolescents. In countries with wider income inequality, the relationship between high family-SEP and weekly alcohol use (p interaction = .006), as well as high family-SEP and binge drinking (p interaction = .007), was stronger compared to countries with lower income inequality., Discussion: Possibly, influenced by the lifestyle choices of their parents, and using alcohol as a status symbol to establish and maintain friendly relationships with peers, Eastern European adolescents from affluent families, particularly in the most unequal settings, are at increased risk of alcohol use, confirming the golden youth hypothesis. Insecure self-image and perceived threat to their high status might be explanatory factors. More research is needed to identify the precise individual and family characteristics responsible for increased alcohol use among wealthy adolescents, especially in Eastern European countries with high income inequality., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The relationship between low socioeconomic status (SES) and depressive symptoms is well described, also in older persons. Although studies have found associations between low SES and unhealthy lifestyle factors, and between unhealthy lifestyle factors and depressive symptoms, not much is known about unhealthy lifestyles as a potential explanation of socioeconomic differences in depressive symptoms in older persons., Methods: To study the independent pathways between SES (education, income, perceived income, and financial assets), lifestyle factors (smoking, alcohol use, body mass index, and physical activity), and incident depressive symptoms (Center for Epidemiologic Studies-Depression [CES-D 10] and reported use of antidepressant medication), we used 9 years of follow-up data (1997-2007) from 2,694 American black and white participants aged 70-79 years from the Health, Aging, and Body Composition (Health ABC) study. At baseline, 12.1% of the study population showed prevalent depressive symptoms, use of antidepressant medication, or treatment of depression in the 5 years prior to baseline. These persons were excluded from the analyses., Results: Over a period of 9 years time, 860 participants (31.9%) developed depressive symptoms. Adjusted hazard ratios for incident depressive symptoms were higher in participants from lower SES groups compared with the highest SES group. The strongest relationships were found for black men. Although unhealthy lifestyle factors were consistently associated with low SES, they were weakly related to incident depressive symptoms. Lifestyle factors did not significantly reduce hazard ratios for depressive symptoms by SES., Conclusion: In generally healthy persons aged 70-79 years, lifestyle factors do not explain the relationship between SES and depressive symptoms., (Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) as a screening instrument for depression in elderly patients with diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) without known depression., Study Design and Setting: DM and COPD patients aged >59 years were selected from general practices. A test-retest was conducted in 105 patients. Criterion validity, using the Mini International Neuropsychiatric Interview psychiatric interview to diagnose major depressive disorder (MDD) and any depressive disorder (ADD) as diagnostic standard, was evaluated for both summed and algorithm-based PHQ-9 score in 713 patients. Correlations with quality of life and severity of illness were calculated to assess construct validity., Results: Cohen's kappa for the algorithm-based score was 0.71 for MDD and 0.69 for ADD. Correlation for test-retest assessment of the summed score was 0.91. The algorithm-based score had low sensitivity and high specificity, but both sensitivity and specificity were high for the optimal cut-off point of 6 on the summed score for ADD (Se 95.6%, Sp 81.0%). Correlations between summed score and quality of life and severity of illness were acceptable., Conclusion: The summed PHQ-9 score seems a valid and reliable screening instrument for depression in elderly primary care patients with DM and COPD.

Objective: This article describes the process evaluation of the Depression in Elderly with Long-Term Afflictions (DELTA) intervention, a nurse-led minimal psychological intervention to reduce depression in chronically ill elderly persons. The aim was to assess whether the DELTA intervention was implemented and received as planned, which barriers were encountered and whether nurses and patients were satisfied with the intervention., Methods: Quantitative and qualitative data were gathered from all 183 patients who participated in the intervention and from four nurses who administered the intervention. Data were assessed by means of self-administered questionnaires, checklists, and a group interview with the nurses., Results: Although several barriers were encountered, the intervention was well performed by nurses and well received by patients. However, a small proportion of the patients found the intervention not useful and thought they would not benefit., Conclusion: The implementation of the minimal psychological intervention aimed at reducing depression in chronically ill elderly persons was successful and therefore feasible., Practice Implications: By making the intervention part of regular care for patients with a chronic condition, patients can be monitored and, if necessary, support can be provided to implement the intervention in their daily life.

Objective: The objective of this study was to investigate the effects of a structured 6-week neuropsychological course on the executive functioning of older adults with cognitive complaints., Methods: A randomised controlled design was used involving 69 community dwelling individuals aged 55 years and older. Both objective and subjective measures were included to assess executive functioning. General linear model with repeated measures analysis of variance was used to examine the intervention effects., Results: After the intervention, the participants in the intervention group were significantly less annoyed by their cognitive failures, were better able to manage their executive failures and reported less anxiety symptoms than those in the waiting list control group., Conclusion: These findings indicate that a combination of psycho-education and training has the potential to change the attitude of older individuals towards their cognitive functioning., Practice Implications: Because this training focussed on cognitive functions that are among the first to decline in older adults and the subjective evaluation of the people after training was quite favourable, the proposed intervention may be considered a valuable contribution to cognitive interventions for older adults.

In this paper we describe self-reported health problems and haemoglobin status among 1200 Sudanese adolescents (53.2% females, 46.8% males). Many adolescents report their general health as excellent and good (84%). A large number, however, report separate physical and psychological complaints. Report of psychological complaints is equal for both gender, and more psychological problems are reported with increasing age. Females and age groups 13-15 more often report chronic diseases. Malaria consistently has a relatively high prevalence. The overall prevalence of anaemia in our study is 32% (46.9% males, 19.2% females). The findings in our study do not sustain the traditional assumption that adolescence is a healthy period in human life. Implications for Sudanese health policies are discussed.

Purpose: This study examines the association between socioeconomic status and cognitive decline in a community-based cohort of well-functioning older adults and seeks to determine whether this link could be explained by biomedical factors., Methods: Data are from 2574 men and women aged 70 to 79 years from Pittsburgh, PA, and Memphis, TN, participating in the Health, Aging and Body Composition study (Health ABC). Three indicators of socioeconomic status were used: education, income, and ownership of financial assets. Cognitive decline over 4 years was defined as a decrease of five points or more in the Modified Mini-Mental State Examination (3MS) score. Biomedical factors measured at baseline, included heart disease, cerebrovascular disease, diabetes, hypertension, poor pulmonary function, and high serum levels of inflammatory markers., Results: Adjusted odds ratios were significantly higher in those with low education, low income, and few assets. Odds ratios ranged from 1.51 to 2.16 in the lowest socioeconomic groups. Additional adjustment for biomedical factors reduced the odds ratios of cognitive decline by an average of 2% for education, 5% for income, and 8% for the number of assets., Conclusions: Low socioeconomic status predicts a decline in cognitive function in older adults and this relationship is not mediated by biomedical factors.

The objective of the study was to examine the effectiveness of two types of memory training (collective and individual), compared to control (waiting list), on memory performance. Participants were 139 community-dwelling older individuals recruited through media advertisements asking for people with subjective memory complaints to participate in a study. Data were collected at baseline, and at 1 week and 4 months after the intervention. Training efficacy was assessed using measures of subjective and objective memory performance. After the intervention, participants in the collective training group reported more stability in memory functioning and had fewer feelings of anxiety and stress about memory functioning. In addition, positive effects were found on objective memory functioning. Compared with the other two groups, the collective training group participants had an improved recall of a previously learned word list. Compared to controls, participants in the individual training group reported fewer feelings of anxiety and stress in relation to memory functioning.

Alzheimer's disease (AD) probably involves several pathobiochemical mechanisms and this may be reflected by changes in different serum components. The present study investigated whether the combined analysis of serum molecules related to different mechanisms improves the discrimination of AD patients from healthy controls. Serum of patients with AD was analyzed for a broad spectrum of marker molecules, including 11 inflammatory proteins, 12 sterol intermediates and phytosterols, 2 brain-specific proteins and 4 constituents involved in homocysteine homeostasis. The serum molecule concentrations were combined in a logistic regression model, using a forward stepwise inclusion mode. The results showed that the combination of interleukin-6 (IL-6) receptor, protein alpha1 fraction, cysteine and cholesterol concentrations improved the discrimination between AD patients and healthy controls compared to the single markers. In conclusion, the results of this study have shown that the complex pathology in AD is reflected in a pattern of altered serum concentrations of several marker molecules related to several pathobiochemical mechanisms.

The efficiency of higher cortical functions, such as memory and speed of complex information processing, tends to decrease with advancing age in normal healthy individuals. Recently, a high habitual intake of caffeine was found associated with better verbal memory performance and psychomotor speed in several cross-sectional population studies. We tested the hypothesis that habitual caffeine intake can reduce or postpone age-related cognitive decline in healthy adults. For this purpose, the cognitive performance of all participants in the Maastricht Aging Study (MAAS), aged between 24 and 81 years, was reassessed after 6 years. Information on the intake of caffeine-containing beverages was available from the baseline questionnaire. After 6 years, 1376 (75.6%) individuals were available for reassessment. After correction for demographic characteristics, baseline performance and health status, there were small albeit significant associations between the overall estimated caffeine intake at baseline and the 6-year change in complex motor speed (motor choice reaction time). The earlier found association between caffeine intake and verbal memory performance was not apparent in this longitudinal study. These results imply that the longitudinal effect of habitual caffeine intake is limited and will not promote a substantial reduction in age-related cognitive decline at a population level.

The present study investigated if a causal relation exists between serum concentrations of precursors and metabolites of cholesterol and cognitive performance in a healthy aging population. Cognitive function addressing four domains of 144 individuals (30-80 years) was tested at baseline and after 6 years of follow-up. Serum concentrations of different sterols related to cholesterol were measured. Serum levels of lathosterol and lanosterol correlated negatively with cognitive performance on the Word Learning tests for verbal learning and memory. This was observed at baseline and follow-up and was independent of age, sex and educational level. Furthermore, the levels of lathosterol and lanosterol at baseline correlated with performance on the Stroop test and Word Learning tests over the 6-year follow-up period. Serum levels of 27-hydroxycholesterol and 24S-hydroxycholesterol showed inconsistent correlations, while cholesterol, desmosterol, sitosterol and campesterol were not related to cognitive performance.Thus, relative high serum ratios of the cholesterol precursors lanosterol and lathosterol, indicative for a high rate of endogenous cholesterol synthesis, are associated with relatively low memory performance in this aging population.

Purpose: To quantify the contribution of material and behavioral factors to educational differences in the incidence of acute myocardial infarction (AMI), taking into account their interrelationship., Methods: Self-reported information about educational level, behavioral factors (alcohol, smoking, physical inactivity, and obesity), and material factors (housing conditions, crowding, employment status, financial problems, and an income proxy) was obtained from 45 to 74 year old responders to the baseline measurement of the Dutch prospective GLOBE-study in 1991 (n = 9872). Incidence of AMI in study participants was determined by hospital admissions due to AMI between 1991 and 1998., Results: The increased hazard ratio of AMI in the lowest compared to the highest educational group [hazard ratio (HR) = 1.85, 95% confidence interval (CI): 1.19; 2.88] decreased by 60% after adjustment for all four behavioral factors. Similarly, adjustment for housing conditions, employment status and the income proxy reduced the hazard ratio by 76%. Thirty-six percent of the contribution of behavioral factors to educational differences in AMI in the lowest compared to the highest educational group was the result of more often living in worse material circumstances in the first group., Conclusions: Material factors contribute more to educational differences in incidence of AMI than behavioral factors. Improving material circumstances in lower educational groups may form an important strategy in the reduction of inequalities in AMI, partly because of its influence on unhealthy behavior.

A large sample of older participants of the Maastricht Aging Study (MAAS) were compared to drop-outs at the 3-year follow-up with respect to socio-demographic, health, and cognitive characteristics. In addition, the impact of selective drop-out on measures of cognitive change was examined. To this end, hypothetical scores were estimated for drop-outs by using single and multiple imputation methods. Of the initial sample of 539 subjects, aged 49 years and older at baseline, 116 (22 %) did not return for the follow-up (n = 32 had died, n = 84 refused participation). Drop-outs who refused to participate in the follow-up were more often women, had lower educational levels, and had lower baseline scores on neurocognitive tests. Follow-up drop-outs who had died were more often men, older, and had a poorer performance on cognitive tests than the follow-up participants. Although follow-up participants and drop-outs differed in terms of socio-demographic and cognitive characteristics, attrition appeared to have little effect on the estimates of cognitive change.

Adolescents' views of communication with their parents are examined in relation to measures of family satisfaction, adolescent decision-making and disagreement with parents (Study I), and to measures of self-esteem, well-being and coping (Study II). The results provide some support for the psychometric qualities of the Parent-Adolescent Communication Scale (PACS) and suggest that good family communication is associated with satisfaction with the family and with lack of disagreement between adolescents and parents. They also indicate a positive association between family communication and adolescent self-esteem, certain aspects of adolescent well-being and type of coping strategy employed., (Copyright 1998 The Association for Professionals in Services for Adolescents.)

Background: The first Whitehall Study showed an inverse social gradient in mortality from coronary heart disease (CHD) among British civil servants--namely, that there were higher rates in men of lower employment grade. About a quarter of this gradient could be attributed to coronary risk factors. We analysed 5-year CHD incidence rates from the Whitehall II study to assess the contribution to the social gradient of psychosocial work environment, social support, coronary risk factors, and physical height., Methods: Data were collected in the first three phases of examination of men and women in the Whitehall II study. 7372 people were contacted on all three occasions. Mean length of follow-up was 5.3 years. Characteristics from the baseline, phase 1, questionnaire, and examination were related to newly reported CHD in people without CHD at baseline. Three self-reported CHD outcomes were examined: angina and chest pain from the Rose questionnaire, and doctor-diagnosed ischaemia. The contribution of different factors to the socioeconomic differences in incident CHD was assessed by adjustment of odds ratios., Findings: Compared with men in the highest grade (administrators), men in the lowest grade (clerical and office-support staff) had an age-adjusted odds ratio of developing any new CHD of 1.50. The largest difference was for doctor-diagnosed ischaemia (odds ratio for the lowest compared with the highest grade 2.27). For women, the odds ratio in the lowest grade was 1.47 for any CHD. Of factors examined, the largest contribution to the socioeconomic gradient in CHD frequency was from low control at work. Height and standard coronary risk factors made smaller contributions. Adjustment for all these factors reduced the odds ratios for newly reported CHD in the lowest grade from 1.5 to 0.95 in men, and from 1.47 to 1.07 in women., Interpretation: Much of the inverse social gradient in CHD incidence can be attributed to differences in psychosocial work environment. Additional contributions were made by coronary risk factors--mainly smoking--and from factors that act early in life, as represented by physical height.

Regional changes of cerebral blood flow and biochemical substrates were assessed in the gerbil brain following different grades of cerebral ischemia. Ischemia was produced by occlusion of the right common carotid and left external carotid arteries. Gerbils were classified according to the severity of neurological symptoms as animals without, with mild and with severe neurological deficits. Brains were frozen in situ, sliced in 20-microns sections and processed for pictorial presentation of glucose and ATP, using bioluminescence techniques. Cerebral blood flow was determined in adjacent brain sections, using [14C]iodoantipyrine autoradiography. NADH fluorescence was recorded by illuminating the surface of the tissue block with ultraviolet light. Most animals without visible neurological symptoms exhibited reduced blood flow in circumscribed regions of cortex and basal ganglia of the right hemisphere without concomitant changes of biochemical substrates. In animals with mild neurological symptoms, blood flow in the right hemisphere was reduced, glucose and ATP decreased, and NADH fluorescence unhomogeneously enhanced. In animals with severe neurological symptoms blood flow was almost arrested in the right hemisphere and was distinctly reduced in the medial parts of the left hemisphere. The ischemic tissue was depleted from glucose and ATP, and exhibited bright NADH fluorescence. The severity of neurological symptoms, in consequence, correlated closely with both the degree and the size of biochemical lesions observed in the ischemic territory.

In Mongolian gerbils (Meriones unguiculatus) cerebral ischemia was produced by occlusion of the right common and the left external carotid arteries. Gerbils were classified according to their neurological appearance as "symptom-negative" (8 animals), "mild symptoms" (unilateral hemiparesis, 10 animals) and "severe symptoms" (hemiparesis and rolling seizures, 8 animals). Two hours after vascular occlusion various substrates and enzymes related to the energy-producing metabolism, were assessed in tissue samples from both hemispheres. In symptom-negative animals, the only change was a slight decrease of glycolytic intermediates in the right hemisphere. In animals with mild symptoms, the right hemisphere additionally exhibited an impairment of the redox and energy state and an enhancement of the activity of most enzymes of the glycolytic pathway, except hexokinase. In animals with severe symptoms, these changes were even more pronounced and affected--to a lesser degree--also the left hemisphere. The results obtained demonstrate that the neurological appearance of the animals after vascular occlusion correlates with the biochemical alterations and, therefore, can be used for estimating the density of graded ischemia.