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Background: The minor G-allele of FOXO3 rs2802292 is associated with human longevity. The aim of this study was to test the protective effect of the variant against the association with type 2 Diabetes and NAFLD. Methods: rs2802292 was genotyped in a large population of middle-aged subjects (n = 650) from a small city in Southern Italy. All participants were interviewed to collect information about lifestyle and dietary habits; clinical characteristics were recorded, and blood samples were collected from all subjects. The association between rs2802292 and NAFLD or diabetes was tested using a logistic model and mediation analysis adjusted for covariates. Results: Overall, the results indicated a statistical association between diabetes and rs2802292, especially for the TT genotype (OR = 2.14, 1.01 to 4.53 95% C.I., p = 0.05) or in any case for those who possess the G-allele (OR = 0.45, 0.25 to 0.81 95% C.I., p = 0.008). Furthermore, we found a mediation effect of rs2802292 on diabetes (as mediator) and NAFLD. There is no direct relationship between rs2802292 and NAFLD, but the effect is direct (β = 0.10, −0.003 to 0.12 95% C.I., p = 0.04) on diabetes, but only in TT genotypes. Conclusions: The data on our cohort indicate that the longevity-associated FOXO3 variant may have protective effects against diabetes and NAFLD. [ABSTRACT FROM AUTHOR]

Walking is crucial for independence and quality of life. This study leverages wrist-worn sensor data from UK Biobank participants to establish normative daily-life walking data, stratified by age and sex, to provide benchmarks for research and clinical practice. The Watch Walk digital biomarkers were developed, validated, and applied to 92,022 participants aged 45–79 who wore a wrist sensor for at least three days. Normative data were collected for daily-life walking speed, step-time variability, step count, and 17 other gait and sleep biomarkers. Test–retest reliability was calculated, and associations with sex, age, self-reported walking pace, and mobility problems were examined. Population mean maximal and usual walking speeds were 1.49 and 1.15 m/s, respectively. The daily step count was 7749 steps, and step regularity was 65%. Women walked more regularly but slower than men. Walking speed, step count, longest walk duration, and step regularity decreased with age. Walking speed is associated with sex, age, self-reported pace, and mobility problems. Test–retest reliability was good to excellent (ICC ≥ 0.80). This study provides large-scale normative data and benchmarks for wrist-sensor-derived digital gait and sleep biomarkers from real-world data for future research and clinical applications. [ABSTRACT FROM AUTHOR]

Background: While numerous studies have been conducted on sudden sensorineural hearing loss (SSNHL), research on how treatment outcomes and prognosis vary by age remains insufficient. This study aims to investigate the differences in recovery rates among SSNHL patients divided by age groups. Methods: A retrospective study was conducted on 177 patients diagnosed with SSNHL from 2020 to 2023. The patients were categorized into four age groups: under 20, 30–40, 50–60, and over 70. Recovery rates and associated symptoms were compared across these groups. Results: Significant recovery rates were observed in all age groups except for those over 70 (p = 0.006, p = 0.003, p = 0.009). No significant differences were found in recovery rates based on gender (p > 0.75) or symptoms such as tinnitus, ear fullness, and dizziness (p > 0.05). Conclusions: The study revealed that younger and middle-aged adults showed statistically significant improvements in recovery rates, while the elderly exhibited relatively lower recovery rates. [ABSTRACT FROM AUTHOR]

Background/Objectives: Depression and anxiety are prevalent disorders, particularly during emerging adulthood. Uncertainty about the future, exacerbated by unstable times, can lead to heightened future anxiety in this group. This study aimed to examine the complex associations of depression symptoms, future anxiety, and self-efficacy in adults from Poland. Additionally, we investigated age and gender differences in depression symptoms, future anxiety, and self-efficacy. Methods: A cross-sectional online survey study was performed in 2023 in Poland using snowball sampling. A convenience sample of 284 adults participated in this study, ranging in age between 18 and 65 years old (M = 32.18, SD = 11.87), including 95 men (33.45%) and 189 (66.55%) women, and also 157 (55.63%) emerging adults (18–28 years old) and 126 (44.37%) middle-aged adults (29–65 years old). The Patient Health Questionnaire (PHQ-9), Dark Future Scale (DFS-5), and Generalized Self-Efficacy Scale (GSES) were used to measure depression, future anxiety, and self-efficacy, respectively. Results: A 2-way ANOVA showed that both emerging adults and women scored significantly higher in depression symptoms and future anxiety than middle-aged adults and men, respectively. Furthermore, women scored lower in self-efficacy than men. Analyses revealed that there was a positive correlation between depression and future anxiety. Self-efficacy was negatively correlated with depression and future anxiety. Self-efficacy and future anxiety accounted for 48% of depression variance, controlling for age and gender. Future anxiety was found to be a partial mediator of the relationship between self-efficacy and depression. Conclusions: This study significantly advances the understanding of mental health in adults, grounded in social cognitive theories, revealing that low self-efficacy heightens future anxiety, thereby exacerbating depression symptoms in the Polish adult population, independent of age and gender. Emerging adults and women need psychological support to reduce depression and future anxiety. Women, in particular, should be the main focus of interventions to boost self-efficacy. Implementing targeted preventive measures and support systems can mitigate the challenges faced by emerging adults and women. [ABSTRACT FROM AUTHOR]

Depression is a mental disorder that causes great discomfort, is associated with unhealthy lifestyle habits, and affects the quality of life. People with pain show high depressive symptoms and a prevalence of physical inactivity. This study aimed to analyse the associations between depression (self-reported depression, depression status, depressive symptoms, and depression types) and physical activity frequency (PAF) in leisure time in middle-aged and older people with different pain levels (low, medium, and severe) living in Spain. A cross-sectional study based on the European Health Survey data from Spain (2014–2020) was carried out, with a final sample of 13,686 people with pain. Associations between depression-related variables and PAF were studied at the three levels of pain, comparing the prevalence of depression as a function of PAF. Regression models were performed to assess adjusted risk factors for depression (self-reported depression and depression status). It was found that PAF was related to depression at all three pain levels. Inactive people at each pain level had higher depression prevalence (self-reported depression, depression status, depression symptoms, and depressive types). Physical inactivity emerged as a risk factor for depression, both for self-reported depression and for depression status. Thus, increased PAF could help prevent or reduce depression and depressive symptoms in people with pain. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine the effect of applying synchronized music and appropriate music selection on motivation for exercise and achieving better results in individuals of different fitness levels. Methods: The study included a total of 20 female participants, who for certain analyses were divided into two groups with slightly different levels of aerobic fitness: students from the Faculty of Sport and Physical Education (n = 10, age 23.0 ± 2.8), and middle-aged adult women exercising recreationally (n = 10, age 38.3 ± 11.6). Cardiopulmonary exercise testing (CPET) was conducted using a treadmill and gas analysis equipment, and motivational music qualities were assessed using the BMRI-2 questionnaire. The procedure included an initial maximal CPET test, echocardiography, and spirometric tests, followed by an interview to select preferred music tracks. A second CPET test was then performed with the chosen motivational music. The Borg Rating of Perceived Exertion (RPE) scale was used in both tests. Results: The internal consistency of the questionnaire was confirmed with a Cronbach's Alpha of 0.982. The synchronized motivational music significantly improved cardiopulmonary parameters such as peak oxygen consumption (peak VO2), oxygen consumption (VO2) at the second ventilatory threshold (VT2), peak heart rate (peak HR), test duration, and reduced perceived exertion (RPE) at the beginning of the test and at the intensity level corresponding to the VT2. Negligible differences were noted between students and recreational athletes, so it can be assumed that music had an equal impact on these two groups of subjects. Conclusions: The study concluded that synchronous motivational music significantly enhances cardiopulmonary performance and reduces perceived fatigue during physical exertion by serving as a key motivational element and facilitating more economical movement. [ABSTRACT FROM AUTHOR]

Health, environmental, and animal advocacy organisations emphasise reducing or eliminating high meat consumption due to its adverse effects on health, sustainability, climate change, and animal welfare. Increasingly, people are deciding to reduce their meat consumption frequency. Our study aimed to examine predictors of meat reduction among Slovenian consumers, focusing on gender, age, partner and children status, size of residential settlement, socioeconomic status, and political orientation. We conducted a survey using non-probability sampling. We examined demographic, socioeconomic, and political predictors of individuals' self-assessed intent to reduce meat consumption in the month following the survey. Additionally, we analysed respondents' meat reduction during the three years prior. A correlation analysis revealed that higher age and education levels were significantly positively correlated with meat reduction patterns. An ordinal logistic regression analysis indicated that age was the only significant predictor of meat reduction intentions and past behaviour. Our findings suggest that middle-aged and elderly individuals are more likely than younger adults to report meat reduction behaviours. Future public health interventions should tailor approaches to different age groups, and, in particular, target younger individuals. Educational campaigns should highlight the health and environmental benefits of reducing meat and animal product consumption, particularly in primary and secondary schools. [ABSTRACT FROM AUTHOR]

Limited research suggests mushroom consumption may improve indexes of brain health. Mushrooms contain bioactive compounds and antioxidants capable of crossing the blood–brain barrier and impacting vital neurological processes. We conducted a randomized controlled feeding trial assessing the effects of adopting a healthy U.S. Mediterranean-style dietary pattern (MED) with or without mushrooms on indexes of brain health and well-being. Sixty adults (aged 46 ± 12 y; BMI 28.3 ± 2.84 kg/m2; mean ± SD) without severe depression consumed a fully controlled MED diet with 84 g/d of mushrooms (4 d/week white button and 3 d/week oyster) or without (control with breadcrumbs) for 8 weeks. At baseline and post-intervention, surveys were used to evaluate anxiety, depression, mood, and well-being, and behavioral tests were used to evaluate cognition. Consumption of the MED diet, with or without mushrooms, increased (improved) self-reported vigor/activity (Time p = 0.026) and both behavioral measures of immediate memory (Time p < 0.05). Mixed effects were observed for other domains of neuropsychological function, and there were no changes in other measured indexes of brain health with the consumption of either MED diet. Adopting a healthy MED-style dietary pattern, with or without consuming white button and oyster mushrooms, may improve vigor/activity and immediate memory among middle-aged and older adults. [ABSTRACT FROM AUTHOR]

Physical activity promotes metabolic health and prevents lifestyle-related diseases. Adiponectin is specifically produced by adipose tissue and comes in three forms, differing in terms of weight: trimers (LMW), hexamers (MMW), and high-molecular-weight (HMW) oligomers. The oligomers are associated with the beneficial effects of adiponectin. In this study, we aimed to investigate the impact of a single bout of exhaustive exercise on adiponectin expression in 25 male amateur athletes, divided into two groups, one comprising young adults (YAs) (n = 15), and the other comprising middle-aged adults (MAs) (n = 10). Body fat was estimated through skinfold thickness. Adiponectin levels were assessed at baseline and at 15 min and 24 h post-exercise, while HMW oligomer levels were evaluated at baseline and at 24 h post-exercise. We observed a significant increase in total adiponectin at both 15 min and 24 h after exercise, with there being a more evident effect among the YA subjects. HMW oligomers also increased significantly after exercise both in the total sample and among the YA subjects, but this was not the case in the MA subjects. The increase in adiponectin levels was significantly associated with Powerpeak. Furthermore, a significant inverse correlation was found between basal adiponectin and VO2peak and Powerpeak. In conclusion, a single bout of exhaustive exercise can rapidly and significantly enhance the basal circulating adiponectin concentration, which seems to be negatively associated with maximal aerobic capacity. [ABSTRACT FROM AUTHOR]

This observational study examined the relationships between age, vaccine conspiracy beliefs, and COVID-19 vaccine uptake in emerging adults (ages 20–30) and middle-aged adults (ages 50–60) residing in the United States. It also examined sociodemographic predictors of vaccine conspiracy beliefs and COVID-19 vaccine uptake—political conservativism, household income, and educational attainment. We recruited 198 emerging adults and 198 middle-aged adults to complete an online survey assessing vaccine conspiracy beliefs and COVID-19 vaccination status. First, we found that emerging adults reported stronger vaccine conspiracy beliefs than middle-aged adults (estimated mean difference = 0.43, 95CI = 0.08, 0.79, p = 0.017), but that emerging adults and middle-aged adults did not differ in their likelihood of being vaccinated with estimated rates of COVID-19 vaccination uptake of 63% in emerging adults and 64% in middle-aged adults. Political conservativism was associated with stronger vaccine conspiracy beliefs and lower COVID-19 vaccine uptake. Lower household income and lower educational attainment were associated with lower COVID-19 vaccine uptake but not associated with vaccine conspiracy beliefs. Second, we found that age moderated the relationship between vaccine conspiracy beliefs and COVID-19 vaccine uptake; stronger vaccine conspiracy beliefs predicted lower COVID-19 vaccine uptake among middle-aged adults (B = −0.63, 95CI = −0.90, −0.36, p < 0.001) but were not associated with COVID-19 vaccine uptake among emerging adults (B = −0.21, 95CI = −0.47, 0.05, p = 0.12). These results provide insight into the sociodemographic and psychological factors that influence COVID-19 vaccine uptake. Our findings can help to inform the design of targeted public health interventions to increase vaccine uptake in the ongoing fight against COVID-19. Given the crucial role of vaccination in controlling the spread of COVID-19, it is also imperative for future studies to continue investigating how age and vaccine conspiratorial beliefs intersect to impact vaccine uptake. [ABSTRACT FROM AUTHOR]

Thus far, few cross-sectional studies have investigated the association between pet ownership and psychosocial factors. As longitudinal studies on this topic are mostly lacking, this study aimed to analyze the association between pet ownership and psychosocial factors (in terms of depressive symptoms, loneliness, social isolation, and life satisfaction) using a longitudinal approach. The data used were taken from the German Ageing Survey (DEAS), a nationally representative sample of community-dwelling middle-aged and older adults (n = 12,438 observations). Two waves were used (year 2014 and year 2017). Validated multi-item scales were used to measure psychosocial factors. Linear fixed effects (FE) regressions were performed. In summary, only a few significant longitudinal associations were detected in regression analyses. No associations between general pet ownership and psychosocial factors were found. However, cat ownership was significantly longitudinally associated with increases in loneliness levels among the total sample and men. Cat ownership was also significantly longitudinally associated with increases in social isolation levels among men. Among women, dog ownership was significantly longitudinally associated with decreases in life satisfaction. This study reveals some associations between pet ownership and unfavorable psychosocial factors longitudinally. These associations were only significant for subgroups (cat vs. dog ownership and females vs. males). [ABSTRACT FROM AUTHOR]

Exercise is a front-line intervention to increase functional capacity and reduce pain and disability in people with low strength levels or disorders. However, there is a lack of validated field-based tests to check the initial status and, more importantly, to control the process and make tailored adjustments in load, intensity, and recovery. We aimed to determine the test–retest reliability of a submaximal, resistance-band test to evaluate the strength of the trunk stability muscles using a portable force sensor in middle-aged adults (48 ± 13 years) with medically diagnosed chronic low back pain and healthy peers (n = 35). Participants completed two submaximal progressive tests of two resistance-band exercises (unilateral row and Pallof press), consisting of 5 s maintained contraction, progressively increasing the load. The test stopped when deviation from the initial position by compensation movements occurred. Trunk muscle strength (CORE muscles) was monitored in real time using a portable force sensor (strain gauge). Results revealed that both tests were highly reliable (intra-class correlation [ICC] > 0.901) and presented low errors and coefficients of variation (CV) in both groups. In particular, people with low back pain had errors of 14–19 N (CV = 9–12%) in the unilateral row test and 13–19 N (CV = 8–12%) in the Pallof press. No discomfort or pain was reported during or after the tests. These two easy-to-use and technology-based tests result in a reliable and objective screening tool to evaluate the strength and trunk stability in middle-aged adults with chronic low back pain, considering an error of measurement < 20 N. This contribution may have an impact on improving the individualization and control of rehabilitation or physical training in people with lumbar injuries or disorders. [ABSTRACT FROM AUTHOR]

Backgrounds: Sleep disturbances are prevalent among elderly individuals. While polysomnography (PSG) serves as the gold standard for sleep monitoring, its extensive setup and data analysis procedures impose significant costs and time constraints, thereby restricting the long-term application within the general public. Our laboratory introduced an innovative biomarker, utilizing artificial intelligence algorithms applied to PSG data to estimate brain age (BA), a metric validated in cohorts with cognitive impairments. Nevertheless, the potential of exercise, which has been a recognized means of enhancing sleep quality in middle-aged and older adults to reduce BA, remains undetermined. Methods: We conducted an exploratory study to evaluate whether 12 weeks of moderate-intensity exercise can improve cognitive function, sleep quality, and the brain age index (BAI), a biomarker computed from overnight sleep electroencephalogram (EEG), in physically inactive middle-aged and older adults. Home wearable devices were used to monitor heart rate and overnight sleep EEG over this period. The NIH Toolbox Cognition Battery, in-lab overnight polysomnography, cardiopulmonary exercise testing, and a multiplex cytokines assay were employed to compare pre- and post-exercise brain health, exercise capacity, and plasma proteins. Results: In total, 26 participants completed the initial assessment and exercise program, and 24 completed all procedures. Data are presented as mean [lower 95% CI of mean, upper 95% CI of mean]. Participants significantly increased maximal oxygen consumption (Pre: 21.11 [18.98, 23.23], Post 22.39 [20.09, 24.68], mL/kg/min; effect size: −0.33) and decreased resting heart rate (Pre: 66.66 [63.62, 67.38], Post: 65.13 [64.25, 66.93], bpm; effect size: −0.02) and sleeping heart rate (Pre: 64.55 [61.87, 667.23], Post: 62.93 [60.78, 65.09], bpm; effect size: −0.15). Total cognitive performance (Pre: 111.1 [107.6, 114.6], Post: 115.2 [111.9, 118.5]; effect size: 0.49) was significantly improved. No significant differences were seen in BAI or measures of sleep macro- and micro-architecture. Plasma IL-4 (Pre: 0.24 [0.18, 0.3], Post: 0.33 [0.24, 0.42], pg/mL; effect size: 0.49) was elevated, while IL-8 (Pre: 5.5 [4.45, 6.55], Post: 4.3 [3.66, 5], pg/mL; effect size: −0.57) was reduced. Conclusions: Cognitive function was improved by a 12-week moderate-intensity exercise program in physically inactive middle-aged and older adults, as were aerobic fitness (VO2max) and plasma cytokine profiles. However, we found no measurable effects on sleep architecture or BAI. It remains to be seen whether a study with a larger sample size and more intensive or more prolonged exercise exposure can demonstrate a beneficial effect on sleep quality and brain age. [ABSTRACT FROM AUTHOR]

The impact of short-term exposure to air pollutants on the morbidity of schizophrenia, particularly in low- and middle-income countries, remains inadequately explored. The objective of this research was to investigate the relationship between short-term exposure to ambient air pollutants and the risk of schizophrenia hospitalization in Jingmen, China. We performed a time-stratified case-crossover study using daily records of hospital admissions due to schizophrenia in Jingmen Mental Health Center from 2015 to 2017. Environmental exposures to air pollutants and meteorological conditions on case and control days were estimated on the basis of measurements from ground monitoring stations. To investigate the relationship between short-term exposure to ambient air pollutants and the risk of hospitalization for schizophrenia, a conditional logistic regression model was employed. We performed subgroup analyses stratified according to sex, age groups, and season. In total, 4079 schizophrenia hospitalizations were recorded during the designated period. Increased risk of schizophrenia was merely associated with short-term exposure to SO2 and NO2. The estimated odds per interquartile range (IQR) increase in exposure was 1.112 (95% confidence interval (CI): 1.033, 1.196) for SO2 (IQR = 12 µg/m3) and 1.112 (95% CI: 1.033, 1.197) for NO2 (IQR = 18 µg/m3) on lag-0 day. Greater air pollution-schizophrenia associations were observed among middle-aged and older adults (over 45 years of age) and during the cold season. This study added case-crossover evidence indicating that short-term exposure to ambient air pollution, specifically SO2 and NO2, is linked to a higher risk of hospital admissions for schizophrenia. These findings contribute to a better understanding of the detrimental effects of air pollution on neuropsychiatric health conditions. [ABSTRACT FROM AUTHOR]

Background: Endocrine-disrupting chemicals (EDCs) are pervasive in everyday environments. The impacts of these chemicals, along with EDC-related lifestyle and dietary habits on neurocognitive function, are not well understood. Methods: The Chang Gung Community Medicine Research Center conducted a cross-sectional study involving 887 participants. From this initial cohort, 120 individuals were selected based on their EDC exposure scores for detailed analysis. Among these, 67 participants aged 55 years or older were further chosen to undergo cognitive impairment assessments using the Ascertain Dementia-8 (AD-8) questionnaire. Results: These 67 older participants did not significantly differ in age, albuminuria, or estimated glomerular filtration rate compared to those with lower impairment scores. This study revealed that mono-(2-ethylhexyl) phthalate (MEHP) levels (8.511 vs. 6.432 µg/g creatinine, p = 0.038) were associated with greater risk of cognitive impairment (AD-8 ≥ 2). Statistical models adjusting for age, gender, and diabetes indicated that MEHP levels positively correlated with AD-8 scores, achieving statistical significance in more comprehensive models (β ± SE: 0.160 ± 0.076, p = 0.042). Logistic regression analysis underscored a significant positive association between high MEHP levels and higher AD-8 scores (odds ratio: 1.217, p = 0.006). Receiver operating characteristic curves highlighted the association of high MEHP levels and EDC exposure scores for significant cognitive impairment, with areas under the curve of 66.3% and 66.6%, respectively. Conclusion: Exposure to EDCs, specifically di-(2-ethylhexyl) phthalate, the precursor to MEHP, may be associated with neurocognitive impairment in middle-aged and older adults. [ABSTRACT FROM AUTHOR]

This cross-sectional analysis aimed to assess the quality of life (QoL) among hospitalized patients with alcohol use disorder (AUD) in Romania, utilizing the WHOQOL survey. Conducted from January to December 2023 in the Psychiatry Clinic of the "Pius Brinzeu" Emergency Clinical Hospital in Timisoara, this study engaged 70 participants, adhering to ethical standards outlined in the Declaration of Helsinki. Employing the WHOQOL-BREF instrument, the research hypothesized that AUD patients would show significantly lower QoL scores across its domains compared to general population norms. The study focused on identifying the QoL domains most impacted by AUD, exploring correlations between QoL scores and AUD background characteristics, and pinpointing intervention areas for patient care improvement. Participants were predominantly males (88.57%) with a middle-aged average of 55.51 years. Educational backgrounds varied, with a notable percentage having attended college (44.29%) or university (17.14%). Regarding marital status, 41.43% were married. Comorbidities were present in 52.86% of the sample, with hypertension being the most common (34.29%). Results showed mean QoL scores in the physical (61.84 ± 16.05), psychological (64.11 ± 17.16), social (60.48 ± 24.85), and environmental (68.44 ± 17.34) domains, revealing a significant diversity in satisfaction levels across these areas. Statistical analyses highlighted marital status as significantly associated with a better QoL in the physical domain, with married, co-habiting, and divorced participants reporting higher scores compared to single ones. In conclusion, while AUD significantly affects the QoL of hospitalized patients in Romania, marital status emerges as a critical factor in mitigating these effects, particularly in the physical domain of QoL. These findings underscore the complexity of AUD's impact on QoL and the importance of considering sociodemographic factors in patient care practices and interventions. The study contributes valuable insights into the nuanced relationship between AUD and QoL, proposing a foundation for enhancing care outcomes for AUD patients in Romania. [ABSTRACT FROM AUTHOR]

Midlife risk factors such as type 2 diabetes mellitus (T2DM) confer a significantly increased risk of cognitive impairment in later life with executive function, memory, and attention domains often affected first. Spatiotemporal gait characteristics are emerging as important integrative biomarkers of neurocognitive function and of later dementia risk. We examined 24 spatiotemporal gait parameters across five domains of gait previously linked to cognitive function on usual-pace, maximal-pace, and cognitive dual-task gait conditions in 102 middle-aged adults with (57.5 ± 8.0 years; 40% female) and without (57.0 ± 8.3 years; 62.1% female) T2DM. Neurocognitive function was measured using a neuropsychological assessment battery. T2DM was associated with significant changes in gait phases and rhythm domains at usual pace, and greater gait variability observed during maximal pace and dual tasks. In the overall cohort, both the gait pace and rhythm domains were associated with memory and executive function during usual pace. At maximal pace, gait pace parameters were associated with reaction time and delayed memory. During the cognitive dual task, associations between gait variability and both delayed memory/executive function were observed. Associations persisted following covariate adjustment and did not differ by T2DM status. Principal components analysis identified a consistent association of slower gait pace (step/stride length) and increased gait variability during maximal-pace walking with poorer memory and executive function performance. These data support the use of spatiotemporal gait as an integrative biomarker of neurocognitive function in otherwise healthy middle-aged individuals and reveal discrete associations between both differing gait tasks and gait domains with domain-specific neuropsychological performance. Employing both maximal-pace and dual-task paradigms may be important in cognitively unimpaired populations with risk factors for later cognitive decline—with the aim of identifying individuals who may benefit from potential preventative interventions. [ABSTRACT FROM AUTHOR]

Background: Poor cardiorespiratory fitness poses the highest risk of mortality. Long-COVID-19 survivors exhibit a reduced cardiorespiratory fitness (CRF). While exercise rehabilitation, such as cardiopulmonary exercise, is used for long-COVID-19 survivors, the effects of exercise on CRF in this population remain inconclusive. In this study, we aim to systematically summarise and synthesise whether exercise rehabilitation improves CRF among long-COVID-19 survivors. Methods: A comprehensive search was performed through PubMed, CINAHL, Embase, Scopus, and the Cochrane Library (since their inception to November 2023) and study reference lists. Studies presenting the effects of exercise rehabilitation on CRF (peak oxygen consumption (VO2peak) and six-minute walk distance (6MWD)) in long-COVID-19 survivors were identified. The standardised mean difference (SMD), mean difference (MD), and 95% confidence interval (CI) were used for analyses. The certainty of evidence was measured using a Grading of Recommendation Assessment, Development and Evaluation approach. Results: Twelve eligible studies (five RCTs and seven non-RCTs) with 682 participants were analysed. The meta-analysis showed significantly improved 6MWDs (MD 76.47, 95% CI 59.19–93.71, low certainty) and significantly greater 6MWDs (SMD 0.85, 95% CI 0.11–1.59, very low certainty) in the exercise rehabilitation group compared to the control group. A significantly improved 6MWD was found in subgroups of young to middle-aged adults and subgroups of patients who undertook aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. Conclusions: Exercise rehabilitation is effective for improving CRF, as measured by the 6MWD in long-COVID-19 survivors. Improvements are likely to be more pronounced in specific subgroups of young to middle-aged adults and patients undertaking aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. However, recommendations for clinical practice are limited due to the very low evidence certainty. [ABSTRACT FROM AUTHOR]

Simple Summary: A significant portion of adults with clinically normal hearing sensitivity have difficulty understanding speech in background noise. Current clinical assessments fail to explain this phenomenon, prompting the exploration of auditory mechanisms beyond those covered by routine clinical testing. One mechanism important for separating sound sources—a key task for understanding speech-in-noise—is temporal processing, or the extraction and organization of acoustic timing characteristics. Here, we investigate the hypothesis that deficits in temporal processing contribute to difficulties in understanding speech-in-noise. We explore this in middle-aged adults—an under-investigated group, despite their high prevalence of speech-in-noise difficulties. In this study, we found that differences in speech-in-noise abilities were associated with deficits in two aspects of temporal processing: the neural encoding of periodic speech features, such as pitch, and perceptual sensitivity to rapid acoustic timing differences between ears. Interestingly, the use of these mechanisms was task-dependent, suggesting various aspects of temporal processing differentially contribute to speech-in-noise perception based on the characteristics of the listening environment. These findings contribute to our overall understanding of which auditory mechanisms play a role in speech-in-noise difficulties in normal hearing listeners, and can inform future clinical practice to serve this population. Auditory temporal processing is a vital component of auditory stream segregation, or the process in which complex sounds are separated and organized into perceptually meaningful objects. Temporal processing can degrade prior to hearing loss, and is suggested to be a contributing factor to difficulties with speech-in-noise perception in normal-hearing listeners. The current study tested this hypothesis in middle-aged adults—an under-investigated cohort, despite being the age group where speech-in-noise difficulties are first reported. In 76 participants, three mechanisms of temporal processing were measured: peripheral auditory nerve function using electrocochleography, subcortical encoding of periodic speech cues (i.e., fundamental frequency; F0) using the frequency following response, and binaural sensitivity to temporal fine structure (TFS) using a dichotic frequency modulation detection task. Two measures of speech-in-noise perception were administered to explore how contributions of temporal processing may be mediated by different sensory demands present in the speech perception task. This study supported the hypothesis that temporal coding deficits contribute to speech-in-noise difficulties in middle-aged listeners. Poorer speech-in-noise perception was associated with weaker subcortical F0 encoding and binaural TFS sensitivity, but in different contexts, highlighting that diverse aspects of temporal processing are differentially utilized based on speech-in-noise task characteristics. [ABSTRACT FROM AUTHOR]

With the rapid evolution of the rural digital economy, analyzing the impact of digital literacy level on farm households' formal borrowing is crucial for easing credit constraints and fostering rural economic growth. Leveraging the data from the 2020 China Family Panel Studies (CFPSs) and applying binary probit models and the Karlson–Holm–Breen (KHB) method, this study delineates the positive correlation between the digital literacy level and increased formal borrowing among farm households. The findings, which were robust against endogeneity and robustness tests, underscore the role of digital literacy level in augmenting farmers' earnings and social networks, with a notably stronger mediation by earnings. The effects are particularly significant for middle-aged and older, less educated males in the central and western regions, in contrast with younger, highly educated females in the east. This research advocates for enhancing rural digital infrastructure and education, alongside financial system reforms, to advance rural financial development and support sustainable rural revitalization. [ABSTRACT FROM AUTHOR]

Background/Objectives: Both hypertension and carotid atherosclerosis are independent risk factors for cardiovascular disease. We aim to investigate the synergistic effects of hypertension and carotid plaques on cardiovascular events and all-cause mortality. Methods: A follow-up study was conducted at the Preventive Cardiology Department of Vilnius University Hospital Santaros Klinikos between 2012 and 2021. The study recruited participants aged 40–65 who did not have overt cardiovascular disease (CVD) and were part of the Lithuanian High Cardiovascular Risk primary preventive program. The study collected demographic and clinical data, including an ultrasound assessment of carotid plaque. Results: The participants were monitored for 4–10 years for CVD events and all-cause mortality. Among 6138 participants, 954 (16%) experienced CVD events. The presence of carotid plaque on both sides was significantly associated with CVD events, myocardial infarction, and all-cause mortality. However, the combination of hypertension and carotid plaque did not significantly increase the risk for CVD events or all-cause mortality. Conclusions: The risk of CVD events or all-cause mortality was not significantly increased by the combination of hypertension and carotid plaque. Cardiovascular events depend on the extent of atherosclerosis in the carotid arteries. [ABSTRACT FROM AUTHOR]

Background: An evaluation of the persistence of symptoms following COVID-19 in economically active young and middle-aged adults is crucial due to its significant socioeconomic impact resulting from compromised work performance. Methods: A prospective, multicenter study at 12 South Korean hospitals from January to December 2022 involved telephone interviews along with validated questionnaires. Results: Among 696 participants with a median age of 32 and no prior diagnoses, 30% of participants experienced persistent fatigue, while 21.4% suffered from sleep disturbance at 6 months following infection. Additionally, approximately 25% of the participants exhibited depression that endured for up to 6 months. Symptomatic individuals at 3 months exhibited a significantly higher prevalence of persistent fatigue, sleep disturbances, and depression at 6 months compared to those who remained asymptomatic. Notably, sleep disturbance and persistent fatigue at 3 months emerged as significant independent predictors of the presence of depression at 6 months. Conclusions: Even among young and middle-aged healthy adults, prolonged fatigue, sleep disturbance, and depression exhibit a significant prevalence and persisted for up to 6 months. Therefore, implementing a workplace management protocol for these symptoms is essential to mitigate the socioeconomic burden caused by the impairment of work efficiency. [ABSTRACT FROM AUTHOR]

Simple Summary: Do nonhuman primates, such as Tibetan macaques, exhibit personalities that influence their collective movements? In this study, we not only confirmed the presence of three personality types in Tibetan macaques but also found that individuals with higher sociability scores, higher rank, or lower anxiousness scores were more likely to initiate successful collective movement. We found that macaques with lower anxiousness scores or higher rank attracted more followers, and that higher-rank individuals tended to join movements earlier. Moreover, individuals with higher sociability and boldness scores exhibited shorter joining latency in group movements. These findings provide valuable insights into how personality influences collective movement in nonhuman primates. Collective movement has emerged as a key area of interest in animal behavior. While individual differences are often viewed as a potential threat to group cohesion, growing evidence suggests that these differences can actually influence an animal's behavior as an initiator or follower during collective movements, thereby driving the group's movement and decision-making processes. To resolve the divergence, we asked how personality can affect the dynamics of collective movements in one group of free-ranging Tibetan macaques (Macaca thibetana) in Huangshan, China. We assessed individual personality using principal component analysis and applied the generalized linear mixed model and linear mixed model to examine the influence of personality on decision making during collective movements. Our findings reveled three distinct personality types among Tibetan macaques: sociability, boldness, and anxiousness. Individuals with higher sociability scores and rank, or those with lower anxiousness scores, were more likely to initiate successful collective movements. Older individuals were less successful in initiating movements compared to young adults. Leaders with lower anxiousness scores or higher rank attracted more followers, with females attracting larger groups than males. As for followers, individuals with higher rank tended to join the collective movement earlier. Additionally, individuals with higher sociability or boldness scores had shorter joining latency in collective movement. Finally, there was a longer joining latency for middle-aged adults compared to young adults. These results suggest that individual differences are a potential driver of collective movements. We provide some insights into the relationships between personality and decision making in Tibetan macaques. [ABSTRACT FROM AUTHOR]

Background: The assessment of future risk of cardiovascular diseases (CVD) is strongly recommended for all asymptomatic adults without CVD history. Carotid atherosclerosis (CA) is a preclinical phenotype of CVDs. However, data on estimated future CVD risks with respect to preclinical atherosclerosis are limited. This community-based study aimed to assess the relationships between predicted CVD risks and CA. Methods: We enrolled 3908 subjects aged 40–74 years without CVD history and calculated their 10-year CVD risks using the Framingham Risk Score (FRS) and the Pooled Cohort Equations (PCE). Carotid plaque (CP) at the extracranial carotid arteries was determined by high-resolution B-mode ultrasonography and further classified into mild or advanced CA. Results: The means of FRS for CP-negative and mild and advanced CA were 9.0%, 14.4%, and 22.1%, respectively (p-value < 0.0001). The corresponding values for PCE score were 4.8%, 8.8%, and 15.0%, respectively (p-value < 0.0001). The odds ratios (ORs) of having CP per 5.0% increase in FRS and PCE score were 1.23 (95% CI, 1.19–1.28) and 1.36 (95% CI, 1.28–1.44), respectively. The corresponding values of having advanced CA were 1.24 (95% CI, 1.19–1.29) and 1.38 (95% CI, 1.30–1.48), respectively. Among the models of FRS or PCE plus other conventional CVD risk factors, the FRS + age model had the highest discrimination for the presence of CP (AUROC, 0.7533; 95% CI, 0.7375–0.7691) as well as for the presence of advanced CA (AUROC, 0.8034; 95% CI, 0.7835–0.8232). The calibration of the FRS + age models for the presences of CP and advanced CA was excellent (χ2 = 8.45 [p = 0.49] and 10.49 [p = 0.31], respectively). Conclusions: Estimated future CVD risks were significantly correlated with risks of having CA. Both FRS and PCE had good discrimination for the presences of CP and advanced CA. [ABSTRACT FROM AUTHOR]

This study investigated the impact of subjective expectations of the future (e.g., income, life expectancy, and national policies) on the onset of dementia and mild cognitive impairment by sex and age in middle-aged and older adults. The Korean Longitudinal Study of Aging (KLoSA) data from 2008 to 2020, comprising 4116 people above 45 years, were used. A time-series analysis and multiple panel logistic regression were conducted to highlight subjective expectation trends and their effect on dementia and mild cognitive impairment, respectively. Low subjective expectations of the future negatively affected cognitive impairment (total: odds ratio [OR] = 1.02, 95% confidence interval [CI] = 1.01–1.03) and dementia (total: OR = 1.05, 95% CI = 1.03–1.06), and those of national policies were the biggest risk factors for cognitive impairment (total: OR = 1.17, 95% CI = 1.12–1.22) and dementia (total: OR = 1.10, 95% CI = 1.07–1.13). Individuals about to retire and with low expectations of workability were more likely to develop cognitive impairment (total: OR = 1.03, 95% CI = 1.02–1.06). Subjective expectations of economic downturn also caused cognitive impairment, especially in women (OR = 1.04, 95% CI = 1.01–1.07) and early stage older adults (OR = 1.06, 95% CI = 1.02–1.10). Policymakers must consider the impact of changes in national policies and living environments on cognitive impairment and dementia in older adults. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVDs) persist as a significant contributor to global morbidity and mortality despite advances in medical technology. Air pollution has emerged as a significant contemporary challenge due to increased energy consumption and rapid economic development. The study utilized multivariable Poisson regression and Distributed Lag Models (DLM) to assess the link between brief exposure to outdoor air pollutants (PM10—particulate matter with a diameter ≤ 10 μm, NO2—nitrogen dioxide, and O3—ozone) and the risk of acute myocardial infarction with ST-segment elevation (STEMI) hospitalization, stratified by season. The research was conducted from January 2019 to December 2021 at the University Hospital in Timisoara, Romania, and daily records were collected for STEMI admissions, atmospheric pollutant levels, and meteorological parameters. The most pronounced impacts were observed with each 10 μg/m3 increase at lag 07 for PM10 during summer, leading to a 2% increase in STEMI admissions, and for NO2 during spring at lag 07, resulting in a 0.9% rise in CVD incidence. Men, middle-aged adults, and older adults exhibited greater susceptibility to elevated NO2 and PM10 concentrations than women and younger individuals. Brief exposure to diverse air pollutants heightens the likelihood of hospitalization due to STEMI, particularly among men and adults over 45. Effective measures must be implemented to mitigate these impacts, especially for vulnerable populations. [ABSTRACT FROM AUTHOR]

This study examined associations between COVID-19-related anxiety and sleep in middle-aged and older adults and tested whether these varied by age or sex. In June/July 2020, middle-aged/older adults aged 50+ (n = 277, 45% women, Mage = 64.68 ± 7.83) in the United States completed measures of sleep and COVID-19-related anxiety. Multiple regressions examined whether anxiety was independently associated with or interacted with age or sex in its associations with sleep health, controlling for age, education, medical conditions, sleep/pain medication use, and COVID-19 status. Greater COVID-19 anxiety was associated with worse sleep quality and daytime dysfunction. COVID-19-related anxiety interacted with age (not sex) in associations with total sleep time and sleep efficiency. Greater anxiety was associated with shorter total sleep time and lower sleep efficiency in oldest-older adults (~73 years old) and youngest-older adults (~65 years old) but not middle-aged adults (~57 years old). In mid to late life, older adults may be most vulnerable to the impact of COVID-19-related anxiety on sleep health. Social and behavioral (e.g., knowledge on age-related vulnerability to COVID-19 risk/morbidity/mortality, uncertainty, and changes to daily routines) and physiological factors (sleep disruption and age-related autonomic dysfunction) may underlie these associations. Interventions that mitigate negative pandemic-related psychological and sleep outcomes may be particularly relevant for older adults. [ABSTRACT FROM AUTHOR]

Simple Summary: Hepatic encephalopathy (HE) is a major neurological condition that occurs following acute or chronic liver failure. There are two types of HE: acute (Type A) and chronic (Type C). The acute form leads to rapid coma and death due to increased intracranial pressure, while neurobehavioral abnormalities potentially characterize the chronic form. There is currently no available treatment to regress or cure HE. This may be due to various factors, of which age and sex are the most important to consider when treating patients with HE. Accordingly, we examined whether sex and age play a role in the development of HE. We found that drug-induced (thioacetamide, TAA) brain edema was more severe in aged males than in young males or young/aged female rats. Furthermore, adding alcohol to the young male or young/aged female rats aggravated the brain edema. Regarding the behavioral changes, TAA-induced deficits were less pronounced in young and aged females than in aged males, whereas in the chronic type, young and aged males showed no behavioral changes when alcohol was infused along with TAA despite the severe brain edema and death that occurred. These findings suggest that aged males and young/aged females are more prone to developing brain edema in the presence of one or more liver toxins. Hepatic encephalopathy (HE) is a neurological condition linked to liver failure. Acute HE (Type A) occurs with acute liver failure, while chronic HE (Type C) is tied to cirrhosis and portal hypertension. HE treatments lag due to gaps in understanding its development by gender and age. We studied how sex and age impact HE and its severity with combined liver toxins. Our findings indicate that drug-induced (thioacetamide, TAA) brain edema was more severe in aged males than in young males or young/aged female rats. However, adding alcohol (ethanol, EtOH) worsens TAA's brain edema in both young and aged females, with females experiencing a more severe effect than males. These patterns also apply to Type A HE induced by azoxymethane (AZO) in mice. Similarly, TAA-induced behavioral deficits in Type C HE were milder in young and aged females than in males. Conversely, EtOH and TAA in young/aged males led to severe brain edema and fatality without noticeable behavioral changes. TAA metabolism was slower in aged males than in young or middle-aged rats. When TAA-treated aged male rats received EtOH, there was a slow and sustained plasma level of thioacetamide sulfoxide (TASO). This suggests that with EtOH, TAA-induced HE is more severe in aged males. TAA metabolism was similar in young, middle-aged, and aged female rats. However, with EtOH, young and aged females experience more severe drug-induced HE as compared to middle-aged adult rats. These findings strongly suggest that gender and age play a role in the severity of HE development and that the presence of one or more liver toxins may aggravate the severity of the disease progression. [ABSTRACT FROM AUTHOR]

This systematic review with meta-analysis aimed to explore the association between formal social participation and cognitive function in middle-aged and older adults using data from longitudinal studies. A comprehensive search was conducted in Scopus, PubMed, and Web of Science for longitudinal studies that assessed the association between formal social participation and cognitive function in middle-aged and older adults published between January 2010 to 19 August 2022. Risk of bias was judged using the RoBANS tool. Meta-analysis using a random-effects model was computed with odds ratio (OR) and 95% confidence interval (CI) for cognitive decline probability. Sensitivity analyses were made to explore any changes to the pooled statistical heterogeneity and pooled effect size. Certainty of evidence was judged using the GRADE framework. We included 15 studies comprising 136,397 participants from 5 countries. Meta-analyses showed that formal social participation was associated with reduced cognitive decline (OR = 0.78, 95% CI 0.75–0.82, p < 0.001), with very low certainty of evidence. Formal social participation appears to enhance cognition in middle-aged and older adults, but further high-quality research is needed given the very low certainty of evidence. [ABSTRACT FROM AUTHOR]

Background: Restless legs syndrome/Willis–Ekbom disease (RLS/WED) has occasionally but not consistently been associated with cognitive and most notably language and executive impairment. The present study was conducted to investigate the cognitive trajectories of older individuals with RLS/WED. Methods: Participants were drawn from the randomly selected, older (>64 years), population-based HELIAD cohort. Individuals without dementia and with available neuropsychological evaluations at baseline and follow-up were considered for potential eligibility. A comprehensive assessment examining five principal components of cognition (memory, visuo-spatial ability, attention, executive function, and language) was administered to the participants. Generalized estimating equation analyses were used to examine the unadjusted and adjusted (for critical factors and covariates) effects of RLS/WED on cognition over time. Results: A total of 1003 predominantly female (59.5%), older (72.9 ± 4.9 years) participants with follow-up evaluations after a mean of 3.09 ± 0.85 years and without dementia at baseline and follow-up were included in the present study. Among them, 81 were diagnosed with RLS/WED at baseline. Global cognition, memory, attention, and executive and visuo-perceptual skills did not differ between those with and without RLS/WED. However, the RLS/WED group performed worse on language at baseline by a standard deviation of 0.249, while demonstrating a mitigated language decline over time, by a standard deviation of 0.063. The unadjusted models yielded similar results. Conclusions: Our findings were indicative of a baseline language disadvantage among older individuals with RLS/WED, but the initial discrepancy tends to dissolve over time. [ABSTRACT FROM AUTHOR]

(1) Background: Bifidobacterium plays a pivotal role within the gut microbiota, significantly affecting host health through its abundance and composition in the intestine. Factors such as age, gender, and living environment exert considerable influence on the gut microbiota, yet scant attention has been directed towards understanding the specific effects of these factors on the Bifidobacterium population. Therefore, this study focused on 98 adult fecal samples to conduct absolute and relative quantitative analyses of bifidobacteria. (2) Methods: Using droplet digital PCR and the PacBio Sequel II sequencing platform, this study sought to determine the influence of various factors, including living environment, age, and BMI, on the absolute content and biodiversity of intestinal bifidobacteria. (3) Results: Quantitative results indicated that the bifidobacteria content in the intestinal tract ranged from 106 to 109 CFU/g. Notably, the number of bifidobacteria in the intestinal tract of the school population surpassed that of the off-campus population significantly (p = 0.003). Additionally, the group of young people exhibited a significantly higher count of bifidobacteria than the middle-aged and elderly groups (p = 0.041). The normal-weight group displayed a significantly higher bifidobacteria count than the obese group (p = 0.027). Further analysis of the relative abundance of bifidobacteria under different influencing factors revealed that the living environment emerged as the primary factor affecting the intestinal bifidobacteria structure (p = 0.046, R2 = 2.411). Moreover, the diversity of bifidobacteria in the intestinal tract of college students surpassed that in the out-of-school population (p = 0.034). This was characterized by a notable increase in 11 strains, including B. longum, B. bifidum, and B. pseudolongum, in the intestinal tract of college students, forming a more intricate intestinal bifidobacteria interaction network. (4) Conclusions: In summary, this study elucidated the principal factors affecting intestinal bifidobacteria and delineated their characteristics of intestinal bifidobacteria in diverse populations. By enriching the theory surrounding gut microbiota and health, this study provides essential data support for further investigations into the intricate dynamics of the gut microbiota. [ABSTRACT FROM AUTHOR]

A seroepidemiological study was conducted in 2018 to assess diphtheria and tetanus antibodies in Guangzhou, China. Diphtheria and tetanus antibody concentrations were measured with an enzyme-linked immunosorbent assay. A total of 715 subjects were enrolled in the study. The overall diphtheria and tetanus toxoid IgG-specific antibody levels were 0.126 IU/mL (95% CI: 0.115, 0.137) and 0.210 IU/mL (95% CI: 0.185, 0.240), respectively; the overall positivity rate was 61.82% (95% CI: 58.14, 65.39) and 71.61% (95% CI: 68.3, 74.92), respectively. The diphtheria and tetanus antibody concentration was decreased by age and increased by doses. The geometric mean concentrations and positivity rate of diphtheria and tetanus antibodies were lowest and below the essential protection level in people over 14 years of age. Compared to children and adolescents, middle-aged people and the aged are at much higher risk of infection with Corynebacterium diphtheriae and Clostridium tetani. The current diphtheria and tetanus immunization schedule does not provide persistent protection after childhood. There is an urgent need to adjust the current immunization schedule. [ABSTRACT FROM AUTHOR]

(1) Background: The relationship between nonalcoholic fatty liver disease (NAFLD) and incident chronic kidney disease (CKD) is unclear, and long-term follow-up data are limited. Therefore, this study aimed to evaluate whether NAFLD, as assessed by the fatty liver index (FLI), could predict the development of CKD in a community-based Korean cohort over 16 years. (2) Methods: Among the 10,030 total participants, 7778 patients without CKD were selected from the Korean Genome and Epidemiology Study (KoGES). The FLI grade ranged from 0 to 100 and was divided into three groups: low (FLI, <30), intermediate (FLI, 30–59), and high (FLI, ≥60). An estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 or the development of proteinuria was considered to indicate incident CKD. (3) Results: During the 16-year follow-up period, 919 individuals (11.8%) developed CKD. The HRs of incident CKD in the intermediate FLI group (30–59) and high FLI group (≥60) increased compared with the reference low FLI group (<30) after adjusting for potentially confounding variables. NAFLD, as assessed by the FLI, was an independent risk factor for CKD. (4) Conclusions: Our findings suggest that the FLI, a simple surrogate biomarker of fatty liver disease, may be used to identify people at high risk of incident CKD in clinical practice. [ABSTRACT FROM AUTHOR]

Recently, the fifth edition of the WHO classification recognized the thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) as a separate entity from conventional non-small cell lung cancer with SMARCA4 deficiency because of the different clinicopathological characteristics of these two diseases. SMARCA4-UT mainly occurs in young to middle-aged adults and involves a large mass compressing the tissues surrounding the mediastinum and lung parenchyma. Unfortunately, SMARCA4-UT shows a high probability of recurrence after upfront surgery as well as radiotherapy resistance; moreover, chemotherapy has low efficacy. Moreover, given the recent classification of SMARCA4-UT, no data concerning specific clinical trials are currently available. However, several case reports show immunotherapy efficacy in patients with this disease not only in a metastatic setting but also in a neoadjuvant manner, supporting the development of clinical trials. In addition, preclinical data and initial clinical experiences suggest that inhibiting pathways such as CDK4/6, AURKA, ATR, and EZH2 may be a promising therapeutic approach to SMARCA4-UT. [ABSTRACT FROM AUTHOR]

Background: Currently, it is essential to adopt physical therapy strategies, such as resistance training, to enhance muscle strength and gait in middle-aged individuals (ages 45–65) suffering from Multiple Sclerosis. This is crucial in combating the typical symptoms of neurodegenerative diseases associated with functional loss. The objective of this study is to determine the effects of resistance training interventions on walking and muscle strength in middle-aged people with Multiple Sclerosis. Methods: A systematic review with meta-analysis was conducted by searching specific keywords in the PubMed, Scopus, Cochrane, and Web of Science databases. For inclusion, studies had to incorporate resistance training as a primary or significant component of the overall intervention for middle-aged patients with MS. Out of the 3675 articles identified, 12 randomized clinical trials met the criteria for inclusion in the review, with resistance training being a consistent feature in all of them. Results: Muscle strength and gait were evaluated as the main variables, with fatigue and the quality of life as secondary variables. This review reveals that resistance training significantly improves muscle strength. Resistance training achieves modest and non-significant improvements in gait. Notably, studies combining resistance training with motor control exercises achieve results of greater clinical significance in terms of gait. However, resistance training yields variable positive effects on perceived fatigue and the quality of life. Conclusion: Resistance training is useful for improving muscle strength; however, walking needs to be combined with motor control training. [ABSTRACT FROM AUTHOR]

Echo intensity determined by muscle ultrasound has been proposed as an efficient method for the assessment of muscle quality. The influence of changing ultrasound parameter settings on echo intensity values was assessed using a standardized approach. In this repeated measures cross-sectional study, sixteen repeated scans of rectus femoris, gracilis, and rectus abdominis were taken in 21 middle-aged persons with a portable Mindray M7 premium ultrasound machine equipped with a linear 5.0–10.0 MHz transducer. The settings of three parameters were fixed: gain, depth, and frequency. The settings of the following adjustable parameters were changed over their entire range: dynamic range, gray map, line density, persistence, and IClear. Repeated measures analyses were performed to evaluate the effect of changing the settings on echo intensity values. In all three muscles, dynamic range, gray map, and IClear correlated significantly (rrm-values ranging between −0.86 and 0.45) with echo intensity. In all three muscles, the echo intensity values differed significantly across the dynamic range (p < 0.013), gray map (p < 0.003), and IClear (p < 0.003). In middle-aged subjects, echo intensity values of lower limb and trunk muscles are significantly related to ultrasound parameters and significantly differ across their respective setting range. For the assessment of muscle quality through ultrasound, it is suggested to fix parameter settings within their midrange in order to minimize the effect of setting-dependent factors on EI values. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to investigate the associations between sociodemographic and health-related factors and sedentary time in middle-aged and older Taiwanese adults. Materials and Methods: A total of 1031 participants (460 men, 571 women; mean age 65.0 years ± 7.8 years; range 55 to 93 years) were randomly recruited from the National Computer Assessment Telephone Interview, Taiwan, in 2013. Sedentary time, TV viewing, physical activity, and sociodemographic factors were assessed through questionnaires. Body mass index was self-reported and calculated to evaluate obesity. In 2023, the associations between sedentary time and sociodemographic and health-related factors were analyzed using Pearson's correlation, cross tabulation, and logistic regression and were stratified by gender. Results: Over 47% of participants reported spending more than 2 h watching TV, and more than 33% reported engaging in over 6 h of total sedentary activities. Men and women with insufficient physical activity had a higher probability of prolonged sedentary time than their physically active counterparts (p = 0.032 for men, p = 0.024 for women). Both men and women who spent more than 2 h watching TV daily were more likely to have high sedentary time compared to those with shorter TV viewing durations (both p < 0.001). Highly educated and unmarried women exhibited a higher likelihood of prolonged sedentary time than their less educated and married counterparts (p = 0.021 and p = 0.01, respectively). Conclusions: Sedentary time showed significant and positive associations with both insufficient physical activity and prolonged TV viewing in both genders. Additionally, significant associations were observed between sedentary time and high education and unmarried status in women. These findings emphasize the importance of implementing gender-specific approaches in future interventions and policy initiatives aimed at reducing sedentary behavior among middle-aged and older adults. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated that the center of gravity (COG) is more unstable in the elderly than in young people. However, it is unclear whether aging itself destabilizes the COG. This study aimed to investigate changes in COG sway and gait kinematics over time by a longitudinal study of middle-aged and elderly adults. Methods: This study included 198 healthy middle-aged and elderly people who underwent stabilometry at ten-year intervals. The participants' mean age at baseline was 62.9 ± 6.5 years, and 77 (39%) of them were male. The results of stabilometry (mean velocity, sway area, postural sway center in the medial–lateral direction [X center], and postural sway center in the anterior–posterior direction [Y center]), and results of exercise tests (the height-adjusted maximum stride length [HMSL] and the 10 m walk test [10MWT]) were analyzed. The destabilized group with 11 participants, whose mean velocity exceeded 3 cm/s after 10 years, was compared with the stable group with 187 participants, whose mean velocity did not exceed 3 cm/s. Results: Mean velocity increased significantly over ten years (open-eye, from 1.53 ± 0.42 cm to 1.86 ± 0.67 cm, p < 0.001); however, the sway area did not change significantly. X center showed no significant change, whereas Y center showed a significant negative shift (open-eye, from −1.03 ± 1.28 cm to −1.60 ± 1.56 cm, p < 0.001). Although the results of 10MWT and initial HMSL did not differ significantly, the HMSL in the destabilized group at ten years was 0.64, which was significantly smaller than the 0.72 of others (p = 0.019). Conclusions: The ten-year changes in COG sway in middle-aged and elderly adults were characterized by a significant increase in mean velocity but no significant difference in sway area. Because the destabilized group had significantly smaller HMSL at ten years, instability at the onset of movement is likely to be affected by COG instability. [ABSTRACT FROM AUTHOR]

This study emerges at the intersection of adult development and systems theory frameworks and their contributions to understanding migration experiences and associated cultural transitions. The adult development approach enables a deep understanding of the complexities that adults experience when they move from exploring themselves and their environment in emerging adulthood to establishing their identities and roles during middle adulthood. The systems theory framework, on the other hand, provides insights into the role of social and cultural dimensions in the lives of emerging and middle-adult immigrants who have navigated diverse cultures, roles, and identities. The study highlights the patterns and dynamic interactions of diverse systems of influences and their roles in shaping the self and relational identities of thirty emerging and middle-aged adults who have experienced migration. [ABSTRACT FROM AUTHOR]

Migraines are a common neurological disorder that generally affects young to middle-aged adults and females more than males. Various treatment options are available; however, these can cause undesirable side effects. Therefore, alternative treatments with minimal side effects are still being investigated. Palmitoylethanolamide (PEA) is a signalling lipid known to have anti-inflammatory and analgesic properties. Previous prophylactic research has reported PEA supplementation to decrease pain associated with migraines. Upon commencement of migraine symptoms, participants were supplemented with either 600 mg of PEA (Levagen+) or a placebo (maltodextrin). Once a dose was taken, participants recorded a visual analogue scale (VAS) for pain every 30 min for 4 h or until the migraine resolved. If the migraine had not resolved 2 h post-dose, participants were instructed to take a second dose. Levagen+ supplementation resolved more headaches after 2- and 8 h, had a lower VAS for pain score at 1.5 and 4 h, and reduced rescue medication use significantly more than a placebo. No adverse events were reported in either group. Overall, PEA was safe and effective in reducing migraine pain, duration, and medication use in an otherwise healthy adult population. [ABSTRACT FROM AUTHOR]

The Ross procedure is gaining recognition as a significant option for aortic valve replacement (AVR), and is particularly beneficial in specific patient groups. Although categorized as a class IIb recommendation in the 2020 American College of Cardiology (ACC)/American Heart Association (AHA), and the European Society of Cardiology (ESC) management guidelines on valvular heart disease, recent studies bolster its credibility. Research, including a propensity-matched study, underlines the Ross procedure's association with enhanced long-term survival and reduced adverse valve-related events compared to other AVR types. This positions the Ross procedure as a primary option for AVR in young and middle-aged adults within specialized centers, and potentially the only choice for children and infants requiring AVR. This review meticulously examines the Ross procedure, covering historical perspectives, surgical techniques, imaging, and outcomes, including hemodynamic performance and quality of life, especially focusing on pediatric and young adult patients. It explores contemporary techniques and innovations like minimally invasive approaches and tissue engineering, underscoring ongoing research and future directions. A summarization of comparative studies and meta-analyses reiterates the Ross procedure's superior long-term outcomes, valve durability, and preservation of the left ventricular function, accentuating the crucial role of patient selection and risk stratification, and pinpointing areas for future research. [ABSTRACT FROM AUTHOR]

Myxoinflammatory fibroblastic sarcoma (MIFS) is an infiltrative, locally aggressive fibroblastic neoplasm of intermediate malignancy that typically arises in the distal extremities of middle-aged adults. It can histologically be confused with a number of benign and malignant conditions. Recently, high-grade examples of MIFS have been described. Immunohistochemistry plays a very limited role in the diagnosis of MIFS. Several genetic alterations have been identified in MIFS, including a t(1;10)(p22;q24) translocation with TGFBR3 and/or OGA rearrangements, BRAF rearrangement, and VGLL3 amplification. Although it appears that VGLL3 amplification is the most consistent alteration, the molecular pathogenesis of MIFS remains poorly understood. A wide resection is considered the standard treatment for MIFS. Radiotherapy may be a viable option in cases with inadequate surgical margins or cases where surgery is likely to cause significant functional impairment. The systemic treatment options for advanced or metastatic disease are very limited. This review provides an updated overview of the clinicoradiological features, pathogenesis, histopathology, and treatment of MIFS. [ABSTRACT FROM AUTHOR]

In this narrative review, we delve into the evolving concept of brain health, as recognized by the WHO, focusing on its intersection with cognitive decline. We emphasize the imperative need for preventive strategies, particularly in older adults. We describe the target population that might benefit the most from risk-based approaches—namely, people with subjective cognitive decline. Additionally, we consider universal prevention in cognitively unimpaired middle-aged and older adults. Delving into multidomain personalized preventive strategies, we report on empirical evidence surrounding modifiable risk factors and interventions crucial in mitigating cognitive decline. Next, we highlight the emergence of brain health services (BHS). We explain their proposed role in risk assessment, risk communication, and tailored interventions to reduce the risk of dementia. Commenting on ongoing BHS pilot experiences, we present the inception and framework of our own BHS in Monza, Italy, outlining its operational structure and care pathways. We emphasize the need for global collaboration and intensified research efforts to address the intricate determinants of brain health and their potential impact on healthcare systems worldwide. [ABSTRACT FROM AUTHOR]

Long COVID is a multisystem condition that has multiple consequences for the physical, mental, and social health of COVID-19 survivors. The impact of the long COVID condition remains unclear, particularly among middle-aged and older adults, who are at greater risk than younger people of persisting symptoms associated with COVID-19. Therefore, we aimed to understand the experiences of middle-aged and older people who had been hospitalized for COVID-19 and the repercussions of long-term COVID symptoms in their daily lives. A qualitative study was carried out, adopting the framework of the constructivist grounded theory (CGT) proposed by Kathy Charmaz. Fifty-six middle-aged and older adult participants from the southern region of Brazil were recruited. Data were gathered from semi-structured telephone interviews. Concomitantly a comparative analysis was performed to identify categories and codes using the MaxQDA® software (version 2022). Three subcategories were identified: (1) experiencing COVID-19 in the acute phase; (2) oscillating between 'good days' and 'bad days' in long COVID; and (3) (re)constructing identity. These concepts interact with each other and converge upon the central category of this study: recasting oneself to the uniqueness of the illness experience of long COVID. Our findings provided insights related to the disruption in the lives of long COVID-19 sufferers who still live with persistent symptoms of the disease, including physical, social, family, emotional and spiritual repercussions. Likewise, this study may aid in developing friendly and welcoming social environments, lowering stigma and prejudice towards patients with long COVID, and fostering prompt and suitable policy support and mental health care for these individuals. [ABSTRACT FROM AUTHOR]

Background: Middle-aged adults have the highest obesity rates, leading to significant health complications in later years. Obesity triggers the release of altered molecules, including extracellular vesicles (EVs) from excess adipose tissue (AT), contributing to various health complications. In this study, we assessed the effects of age and a high-fat diet on AT-derived EV miRNA profiles to understand their potential roles in aging and obesity. Method: C57BL/6 male mice were subjected to a normal chow diet (NCD) or a high-fat diet (HFD) for either 10–12 weeks (young mice, n = 10) or 50–61 weeks (middle-aged mice, n = 12). After evaluating metabolic characteristics, peri-gonadal white AT was isolated and cultured to obtain EVs. AT-derived EV miRNAs were profiled using a NanoString miRNA panel (n = 599). Results: Middle-aged mice exhibited obesity regardless of diet. Young mice fed an HFD showed similar metabolic traits to middle-aged mice. In the NCD group, 131 differentially expressed miRNAs (DE-miRNAs) emerged in middle-aged mice compared to young mice, including miR-21, miR-148a, and miR-29a, associated with cancer, neuro/psychological disorders, and reproductive diseases. In the HFD group, 55 DE-miRNAs were revealed in middle-aged mice compared to young mice. These miRNAs were associated with significantly suppressed IGF1R activity. Conclusion: This study demonstrates the potential significant impact of miRNAs of AT EVs on aging- and obesity-related diseases. [ABSTRACT FROM AUTHOR]

Diabetes mellitus and depression rank among the leading causes of disease burden and are present in the top ten causes of disability-adjusted life years worldwide. Numerous studies have shown that both depression and diabetes have a detrimental effect on the quality of life, and when they coexist, the effect is considerably worse. This study aimed to analyse how grip strength moderates the relationship between diabetes and depressive symptoms among middle-aged and older adults. In total, 41,701 participants (18,003 men) in wave 8 of the cross-sectional population-based Survey of Health, Ageing, and Retirement in Europe (2019/2020) data were studied. A dynamometer was used to test grip strength twice on each hand. Depressive symptoms were measured using the 12-item EURO-D scale. The relationship between diabetes and depressive symptoms is negatively moderated by grip strength (male: B = −0.03, 95% CI = −0.04, −0.03; female: B = −0.06, 95% CI = −0.07, −0.06). Furthermore, the significant zone grip strength moderation values for males and females were less than 48.7 kg and 38.9 kg, respectively. Muscular strength was a moderator of depressive symptoms, attenuating its association with diabetes. This supports the premise that physical activity, namely muscle-strengthening exercises, should be included in diabetes treatment programs. [ABSTRACT FROM AUTHOR]

Background and Objectives: The older members of a population might experience unmet medical needs, despite desiring medical care due to activity limitations driven by their perception of aging. This study conducted a cross-sectional analysis of the association between perceived activity restriction (PAR) due to people's own perception of aging and unmet medical needs (UMN) in late middle-aged and older Koreans based on the Korean National Health and Nutrition Examination Survey (KNHANES). Materials and Methods: The 2016–2020 KNHANES was used to analyze a total of 2008 participants among groups aged 45 years or older by applying individual weights imposed from the raw data. The independent variable of PAR was assessed using self-reported questionnaires based on the global activity limitation indicator. Also, the dependent variable of UMN, referring to the state in which a patient's medical care or service was insufficient, inadequate, or lacking, was assessed using a single question. After excluding missing values, the data on 2008 individuals were analyzed using a chi-square test, weighted logistic regression, and a stratified analysis of gender, age, and the presence of chronic illnesses. Results: The group that experienced PAR had an OR 2.13 higher (odds ratio [OR]: 2.13; 95% confidence interval [CI]: 1.27–3.56) to present UMN than the group that did not experience PAR. Furthermore, the results of the stratified analysis indicated that, in the group of female participants with chronic illness and in the group of elderly people, experiencing PAR was associated with a higher experience of UMN. Conclusions: There was a close association between PAR and UMN. In particular, when PAR occurred in the group of female participants with chronic illness and in the group of elderly people, the incidence rate of UMN was also found to be high. This finding highlights the need for policies and institutional measures to reduce UMN within vulnerable groups with an increased risk of medical inaccessibility due to activity restriction. [ABSTRACT FROM AUTHOR]

Background: To prevent diabetes complications, the American Diabetes Association (ADA) has recommended the treatment of blood glucose, blood pressure, and LDL-cholesterol (LDL-c) to target levels. Our aim is to characterize the risk of death according to the achievement of these goals in subjects with diabetes participating in the ELSA-Brasil study. Methods: ELSA-Brasil is an occupational cohort study of middle-aged and elderly adults followed from a 2008–2010 baseline to 2019 by two additional clinic visits and annual telephone interviews. We ascertained known diabetes by self-reported diagnosis or anti-diabetic medication use. We used treatment targets based on the 2022 ADA guidelines. We ascertained deaths from any cause based on the annual surveillance confirmed by death certificates. Results: After 11 (1.8) years of follow-up, 261 subjects had died among 2423 with known diabetes. Within-target HbA1c was associated with the greatest protection (HR = 0.66; 95%CI 0.50–0.88) against all-cause mortality. Achieving both glycemic and blood pressure targets conferred substantial protection (HR = 0.54; 95%CI 0.37–0.78). Within-target LDL-c, however, was associated with increased mortality (HR = 1.44; 95%CI 1.11–1.88). Conclusions: Glucose and blood pressure control, especially when concomitant, reduced mortality. The increased mortality associated with achieving the LDL-c target merits further investigation. [ABSTRACT FROM AUTHOR]

The intra-assessment resting metabolic rate variability is related to cardiometabolic health, as suggested by previous literature. We studied whether that variability (expressed as coefficient of variation [CV; %]) for oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER), and resting energy expenditure (REE) is similar between men and women, and if is similarly associated with cardiometabolic risk factors. Gas exchange in 72 middle-aged adults was measured by indirect calorimetry. Anthropometrics and body composition, cardiorespiratory fitness, circulating cardiometabolic risk factors, and heart rhythm parameters were also determined. Men and women presented similar intra-assessment resting metabolic rate variability (all p > 0.05). Notably, in men, CV for RER was positively associated with BMI and adiposity (both standardized β = 0.35, Ps ≤ 0.048), while CVs for VO2, VCO2, and REE were negatively associated (standardized β ranged from −0.37 to −0.46, all p ≤ 0.036) with cardiometabolic risk factors. In women, CVs for VCO2 and REE were negatively associated with adiposity (both standardized β = −0.36, Ps ≤ 0.041) and cardiometabolic risk Z-score (standardized β = −0.40 and −0.38, respectively, Ps ≤ 0.05). In conclusion, intra-assessment resting metabolic rate variability could be considered an indicator of cardiometabolic health in middle-aged adults. [ABSTRACT FROM AUTHOR]

Background: The main objective of this study was to investigate the risk of falls among middle-aged and older adults with dynapenic abdominal obesity. Methods: A systematic literature search was conducted to review and analyze relevant studies. Dynapenia was measured by handgrip strength, and abdominal obesity was measured by waist circumference. The search keywords included "older people" OR "elderly" OR "middle age" AND "dynapenia" AND "abdominal obesity" AND "fall." The search was not limited by time and included articles published up until April 2023. The literature search process followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, involving extraction and examination of the retrieved relevant articles. Systematic literature searches were performed in databases such as Embase, PubMed, MEDLINE, CINAHL, and Cochrane Library. Results: This study collected a total of eight articles with a combined sample size of 15,506 participants. The findings revealed that the average follow-up period for falls was 6.6 years (SD = 3.67). The overall results of the study showed that individuals with dynapenic abdominal obesity had a higher risk of falls compared to those without dynapenic abdominal obesity (RR = 6.91, 95% CI: 5.42–8.80). Subgroup analysis demonstrated that both prospective studies (HR = 6.61; 95% CI = 4.29–10.20) and retrospective studies (OR = 7.37; 95% CI = 5.13–10.59) consistently found a higher risk of falls among individuals with dynapenic abdominal obesity. However, there was no significant difference in fall risk between community-dwelling individuals with dynapenic abdominal obesity and hospitalized individuals with dynapenic abdominal obesity (Qbetweenx2 = 0.29, p = 0.58). Additionally, there was no difference in fall risk between individuals with dynapenic abdominal obesity residing in Europe and Latin America compared to those residing in Asia (Qbetweenx2 = 0.05, p = 0.81). It was worth noting that male individuals with dynapenic abdominal obesity had a higher risk of falls compared to females (Qbetweenx2 = 4.73, p = 0.03). Conclusions: Empirical studies have demonstrated that individuals with dynapenic abdominal obesity have a higher risk of falls. Therefore, healthcare professionals should conduct early fall risk assessments and develop effective preventive strategies specifically targeted at individuals with dynapenic abdominal obesity. [ABSTRACT FROM AUTHOR]