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The objective of the present study was to investigate the association between angiotensin-converting enzyme (ACE) inhibitor use and cancer incidence (overall, and breast, prostate, and colorectal cancers specifically) in a large representative sample of US adults. Cross-sectional data on cancer diagnosis, timing of cancer diagnosis, ACE inhibitor use, and other characteristics were extracted from 49 512 adults aged ≥ 20years participating in the National Health and Nutrition Examination Survey (1999–2016). Multivariable-logistic and propensity score matching (PSM) regressions examined the relationship between pre-diagnosis use of ACE inhibitors and diagnosis of all cancers, and breast, prostate, and colorectal cancers specifically. Overall, we observed an increased likelihood of cancer diagnosis [odds ratio (OR) 1.269, 95% confidence interval (CI) 1.088–1.480] among those who used ACE inhibitors compared to non-ACE inhibitor use, and for prostate cancer diagnosis (OR 1.438, 95% CI 1.090–1.897), after adjusting for age, sex, body mass index, race/ethnicity, educational attainment, physical activity, alcohol drinking status, smoking status, and high blood pressure. PSM regression retrieved more conservative estimates such that the increased likelihood of cancer diagnosis was only observed when comparing ACE inhibitor users with non-drug users (OR 1.022, 95% CI 1.016–1.027). Compared with non-ACE inhibitor use, ACE inhibitor use was associated with an increased risk of prostate cancer. In conclusion, in this large representative sample of US adults, it was found that ACE inhibitor use may have a marginal influence on some cancers. © 2020, Springer Nature Switzerland AG.

Background: Literature regarding cardiovascular disease (CVD) and incident physical performance limitations and disability in older people is equivocal. Aims: This study aimed to investigate whether CVD is longitudinally associated with incident physical performance limitations and disability in alarge population-based sample. Methods: This was an 8‑year prospective study using data collected as part of the Osteoarthritis Initiative. Participants were community-dwelling adults with knee osteoarthritis or at high risk for this condition. Diagnosed CVD was self-reported. Physical performance was assessed with measures of chair stand time and gait speed, whereas disability was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Longitudinal associations between CVD and changes in physical performance tests (chair stand time and gait speed) and disability score were analyzed using generalized linear models with repeated measurements. Results: The analyzed sample comprised 4796 adults (mean age 61.2 years, 58.5% female), of whom 313 people (6.5%) reported CVD at baseline. During 8years of follow-up, after adjustment for 11 potential confounders measured at baseline, those with CVD experienced aworse profile in chair stand time over the 8‑year follow-up period than those without CVD (p = 0.006). Conclusion: In acohort of middle-aged and older adults with knee osteoarthritis or at high risk for this condition those with CVD experienced aworse profile in chair stand time over the 8‑year follow-up period than those without CVD; however, CVD was not significantly associated with an increased incidence of poor gait speed and disability over 8years of follow-up. Importantly, no associations were observed when utilizing propensity score matching. © 2019, Springer-Verlag GmbH Austria, part of Springer Nature.

The objective of this study was to investigate cross-sectional and longitudinal associations between declines in sexual activity and function and health outcomes in a large population-based sample of older adults. Data were from 2577 men and 3195 women aged ≥ 50 years participating in the English Longitudinal Study of Ageing. Past-year changes in sexual desire, frequency of sexual activity, and ability to have an erection (men)/become sexually aroused (women) were assessed at baseline by self-completion questionnaire. Health outcomes (self-rated health, limiting long-standing illness, doctor-diagnosed diseases of the vascular system, and cancer) were self-reported at baseline (2012/2013) and 4-year follow-up (2016/2017). Data were analyzed using logistic regression, adjusted for sociodemographics, health behaviors, and depressive symptoms. Prospectively, men who reported a decline in sexual desire had higher odds of incident limiting long-standing illness (OR 1.41, 95% CI 1.04–1.91) and incident cancer (OR 1.63, 95% CI 1.06–2.50) than those who maintained their sexual desire. Men who reported a decline in the frequency of sexual activities had higher odds of deterioration in self-rated health (OR 1.47, 95% CI 1.04–2.08) and incident limiting long-standing illness (OR 1.69, 95% CI 1.20–2.37). In women, a decline in frequency of sexual activities was associated with deterioration of self-rated health (OR 1.64, 95% CI 1.07–2.51). Erectile dysfunction was longitudinally associated with poorer health outcomes including incident cancer (OR 1.73, 95% CI 1.11–2.70), coronary heart disease (OR 2.29, 95% CI 1.29–4.07), and fair/poor self-rated health (OR 1.66, 95% CI 1.19–2.32). Practitioners should be mindful that a decline in sexual activity, desire, or function in older age may be an important indicator of future adverse health outcomes. Electronic supplementary material The online version of this article (10.1007/s10508-019-1443-4) contains supplementary material, which is available to authorized users.

Introduction: Angiotensin-converting enzyme inhibitors (ACEI) may have several pleiotropic effects, but the literature regarding a possible relationship between ACEI use and frailty is limited. We investigated whether ACEI use is associated with lower risk of frailty in a cohort of North American individuals. Methods: Data from the Osteoarthritis Initiative, a cohort study with 8years of follow-up including community-dwelling adults with knee osteoarthritis or at high risk for this condition, were analyzed. ACEI use was defined through self-reported information and confirmed by a trained interviewer. Frailty was defined using the Study of Osteoporotic Fracture (SOF) index as the presence of at least two of the following criteria: (1) weight loss ≥ 5% between baseline and any subsequent follow-up visit; (2) inability to do five chair stands; and (3) low energy level according to the SOF definition. A multivariable Poisson regression analysis was used to assess the association between ACEI use at baseline and incident frailty. The data were reported as relative risks (RRs) with their 95% confidence intervals (CIs). Results: The final sample consisted of 4295 adults (mean age 61.2years, females 58.1%). At baseline, 551 participants (12.8%) used ACEI. After adjusting for 15 potential confounders, the use of ACEI was associated with a lower risk of frailty (RR 0.72; 95% CI 0.53–0.99). The adjustment for the propensity score substantially confirmed these findings (RR 0.75; 95% CI 0.54–0.996). Conclusion: ACEI use may be associated with a reduced risk of frailty in individuals with/at risk of knee osteoarthritis, suggesting a potential role for ACI in the prevention of frailty. © 2019, Springer Nature Switzerland AG.

Background: Age-related declines in sexuality and increase in mental health complications have been well documented. However, whether these two phenomena are related has not been explored. The present study therefore aimed to investigate associations between a decline in sexuality and markers of mental health and wellbeing. Method: Data were collected in 2012/13 from 2614 men and 3217 women participating in the English Longitudinal Study of Ageing, a population-representative panel study of older adults (≥ 50 years). Past-year declines in sexual desire, frequency of sexual activities, and sexual function were self-reported. Three markers of wellbeing (depressive symptoms, quality of life and life satisfaction) were assessed using validated scales. Associations between declines in sexuality and wellbeing were analysed using one-way independent analyses of variance, adjusted for a range of socio-demographic and health-related covariates. Results: Men and women who reported a past-year decline in sexual desire or frequency of sexual activities had a higher number of depressive symptoms (desire p = 0.001, frequency p < 0.001) and lower quality of life (all p < 0.001). Decline in sexual desire was also associated with lower life satisfaction in men (p = 0.012) and decline in frequency of sexual activities was associated with lower life satisfaction in women (p < 0.001). Declines in erectile function in men and ability to become sexually aroused in women were also significantly associated with more depressive symptoms (p < 0.001), lower quality of life (p < 0.001) and lower life satisfaction (p < 0.001 in men, p = 0.024 in women). Conclusion: Older adults who experience a decline in sexuality report poorer wellbeing than those who do not. © 2018 Elsevier B.V.

Background This paper aims to examine associations between pet ownership and symptoms of depression in a large, population-based sample of older adults. Specifically, we tested whether: (i) people who report more depressive symptoms are more likely to own a pet; (ii) pet ownership protects against an increase in depressive symptoms over time; (iii) associations differ by symptom type. Methods Data were drawn from the English Longitudinal Study of Ageing, a longitudinal panel study of men and women aged 50 and older (n = 7,617, 52.5% female). Pet ownership (dog/cat/other/none) was self-reported in 2010/11. Depressive symptoms were assessed in 2010/11 and 2016/17 using the 8-item centre for Epidemiologic Studies Depression (CES-D) scale. We analysed total CES-D score and derived symptom subscales (depressed mood, anhedonia, somatic symptoms) in relation to pet ownership, adjusting for sociodemographic and health-related covariates. Results A one-symptom increase in total CES-D score was associated with 7% increased odds of dog ownership (OR=1.07, 95% CI 1.03–1.11). Significant associations were observed between each subset of depressive symptoms and dog ownership, with models run on z-scores showing a slightly stronger association for symptoms of depressed mood (OR=1.13, 95% CI 1.06–1.21) compared with anhedonia (OR=1.10, 95% CI 1.04–1.17) or somatic symptoms (OR=1.10, 95% CI 1.03–1.18). Prospectively, no significant associations were found. Limitations Self-reported data; small sample size for some pet categories. Conclusion Amongst older adults in England, those with more depressive symptoms are more likely to own a dog, but pet ownership is not significantly associated with change in depressive symptoms over time.

Purpose: The aim of the present study was to assess the association between levels of physical activity (PA) and the presence of cataracts in people aged 15–69years residing in Spain. Methods: Cross-sectional data from the Spanish National Health Survey 2017 were analysed (n=17,777≥15years; 52% females; self-weighting sample). The International Physical Activity Questionnaire (IPAQ) short form was used to measure PA. Total PA MET-minutes/week were calculated, and participants were divided into two categories: 1) Less than 600MET-minutes/week. 2) At least 600MET-minutes/week, equivalent to meeting current PA recommendations. Cataracts were self-reported in response to the question “Have you ever been diagnosed with cataracts?”. Multivariable logistic regression was used to assess associations overall and by age groups (15–49, 50–64, and 65–69years; 15–49 and 50–69years). Covariates included in the analysis were sex, education, BMI (Body Mass Index), multimorbidity, smoking, and alcohol consumption. Results: The overall prevalence of cataract was 3.7%, and the overall prevalence of participating in less than 600MET-minutes/week of PA was 30.2%. In the adjusted overall analysis, less than 600MET-minutes/week of PA was associated with significantly higher odds for cataract: OR=1.324 (95% CI=1.116–1.571). Age-stratified analyses showed that the association between PA and cataract was significant only in the age groups of 65–69years and 50–69years. Conclusions: A significant association between PA and cataract was observed in people aged 15–69years residing in Spain. Considering the impact on health and quality of life due to reduced PA in people with cataract, at least 600MET-minutes/week activity should be promoted. © 2020, © 2020 Taylor & Francis Group, LLC.

International audience; Purpose: The purpose of this research is to investigate the association between consumption of chocolate and measures of adiposity in a large, representative sample of US adults. Methods: Cross-sectional data from 13,626 nondiabetic adults (≥20 years) participating in the National Health and Nutrition Examination Survey study were aggregated using 5 study cycles from 2005-2006 through 2013-2014. Chocolate consumption was determined based on 2 24-hour dietary recalls. Body mass index (BMI) and waist circumference were objectively measured. We used multivariable linear regression to test associations of 1) any chocolate consumption (yes/no), and 2) the total amount of chocolate consumption (grams/day, in quartiles) with BMI and waist circumference. Models controlled for sociodemographic, lifestyle, health-related, and dietary covariates. Results: Overall, 11.1% of the population self-reported any chocolate consumption in either of their 2 24-hour dietary recalls. Adjusted linear regression models showed that individuals who reported any chocolate consumption had 0.92 kg/m2 (95% confidence interval, 0.53-1.32) lower BMI, and 2.07 cm (95% confidence intervals, 1.22-2.92) lower waist circumference than those who reported no chocolate consumption. In models examining the association of amount of chocolate consumption and weight status, compared with those who did not consume chocolate, lower BMI (P for trend = .003) and waist circumference (P for trend = .001) were observed in the first, second, and third quartiles of total chocolate consumption. Conclusions: In this representative sample of US adults, chocolate consumption was associated with lower markers of adiposity. Further research using a longitudinal or experimental design is needed to establish the direction of causation.

Multiple studies have suggested that ω-3 fatty acid intake may have a protective effect on cancer risk; however, its true association with cancer risk remains controversial. We performed an umbrella review of meta-analyses to summarize and evaluate the evidence for the association between ω-3 fatty acid intake and cancer outcomes. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to December 1, 2018. We included meta-analyses of observational studies that examined associations between intake of fish or ω-3 fatty acid and cancer risk (gastrointestinal, liver, breast, gynecologic, prostate, brain, lung, and skin) and determined the level of evidence of associations. In addition, we appraised the quality of the evidence of significant meta-analyses by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We initially screened 598 articles, and 15 articles, including 57 meta-analyses, were eligible. Among 57 meta-analyses, 15 reported statistically significant results. We found that 12 meta-analyses showed weak evidence of an association between ω-3 fatty acid intake and risk of the following types of cancer: liver cancer (n = 4 of 6), breast cancer (n = 3 of 14), prostate cancer (n = 3 of 11), and brain tumor (n = 2 of 2). In the other 3 meta-analyses, studies of endometrial cancer and skin cancer, there were no assessable data for determining the evidence levels. No meta-analysis showed convincing, highly suggestive, or suggestive evidence of an association. In the sensitivity analysis of meta-analyses by study design, we found weak associations between ω-3 fatty acid intake and breast cancer risk in cohort studies, but no statistically significant association in case-control studies. However, the opposite results were found in case of brain tumor risk. Although ω-3 fatty acids have been studied in several meta-analyses with regard to a wide range of cancer outcomes, only weak associations were identified in some cancer types, with several limitations. Considering the nonsignificant or weak evidence level, clinicians and researchers should cautiously interpret reported associations between ω-3 fatty acid consumption and cancer risks. Copyright © 2020 The Author(s) on behalf of the American Society for Nutrition.

Background: To explore the association between sexual activity and change in cognitive function over 4years in a representative sample of older adults in England. Methods: Data were from 1963 men and 2513 women participating in Wave 6 (2012/2013) and Wave 8 (2016/2017) of the English Longitudinal Study of Ageing. Participants reported whether or not they had engaged in any sexual activity in the last year. Cognitive function was assessed with tests of immediate and delayed recall. Adjusted general linear models were used to test associations between sexual activity and changes in cognitive function. Results: Men who were sexually active at baseline had better preservation in immediate (0.18 points, 95% CI 0.07–0.29, p = 0.002) and delayed recall (0.19 points, 95% CI 0.08–0.29, p = 0.001) over 4-year follow-up. No significant associations were observed for women. Discussion: Strengths of this study include large, representative sample, longitudinal design and adjustment for a wide range of potential confounders. The observational nature of our study means we cannot deduce the exact direction of effect of our findings. In addition, cognitive ability test scores in older people may reflect not only a possible decline, but also their peak prior cognitive ability; but we did not have any information regarding the trajectories of their cognitive function during the lifespan. Conclusion: Health practitioners should be encouraged to screen older men relating to their sexual activity to identify those who may be at risk of cognitive decline. Older men will be heartened to know that sexual activity may aid in the prevention of age-related decline in cognition. © 2019, Springer Nature Switzerland AG.

There is increasing academic and clinical interest in how "lifestyle factors" traditionally associated with physical health may also relate to mental health and psychological well-being. In response, international and national health bodies are producing guidelines to address health behaviors in the prevention and treatment of mental illness. However, the current evidence for the causal role of lifestyle factors in the onset and prognosis of mental disorders is unclear. We performed a systematic meta-review of the top-tier evidence examining how physical activity, sleep, dietary patterns and tobacco smoking impact on the risk and treatment outcomes across a range of mental disorders. Results from 29 meta-analyses of prospective/cohort studies, 12 Mendelian randomization studies, two meta-reviews, and two meta-analyses of randomized controlled trials were synthesized to generate overviews of the evidence for targeting each of the specific lifestyle factors in the prevention and treatment of depression, anxiety and stress-related disorders, schizophrenia, bipolar disorder, and attention-deficit/hyperactivity disorder. Standout findings include: a) convergent evidence indicating the use of physical activity in primary prevention and clinical treatment across a spectrum of mental disorders; b) emerging evidence implicating tobacco smoking as a causal factor in onset of both common and severe mental illness; c) the need to clearly establish causal relations between dietary patterns and risk of mental illness, and how diet should be best addressed within mental health care; and d) poor sleep as a risk factor for mental illness, although with further research required to understand the complex, bidirectional relations and the benefits of non-pharmacological sleep-focused interventions. The potentially shared neurobiological pathways between multiple lifestyle factors and mental health are discussed, along with directions for future research, and recommendations for the implementation of these findings at public health and clinical service levels. ispartof: WORLD PSYCHIATRY vol:19 issue:3 pages:360-380 ispartof: location:Italy status: published

To investigate potential relationships between orthostatic hypotension (OH) and negative health outcomes and mortality, through an umbrella review with integrated meta-analyses. Orthostatic hypotension is significantly associated with several negative outcomes in older people, but a suggestive evidence is available only for higher risk of coronary heart disease congestive heart failure, stroke, falls dementia, and all-cause mortality. Orthostatic hypotension seems to be significantly associated with several negative health outcomes in older people, even if only associations with coronary heart disease, congestive heart failure, stroke, falls, dementia, and all-cause mortality are supported by suggestive evidence. Orthostatic hypotension (OH) is associated with older age and many negative clinical outcomes in geriatric practice. We aimed to capture the breadth of outcomes that have been associated with the presence of OH and systematically assess the quality, strength and credibility of these associations using an umbrella review with integrated meta-analyses. We systematically searched several major databases from their commencements through to 16th May 2019 for meta-analyses of observational studies of OH and any health-related outcome. We used these metrics to categorize the strength of evidence of significant outcomes (p

Objective: To examine associations between chocolate consumption and depressive symptoms in a large, representative sample of US adults. Methods: The data were from 13,626 adults (≥20 years) participating in the National Health and Nutrition Examination Survey between 2007–08 and 2013–14. Daily chocolate consumption was derived from two 24-hr dietary recalls. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9), with scores ≥10 indicating the presence of clinically relevant symptoms. We used multivariable logistic regression to test associations of chocolate consumption (no chocolate, non-dark chocolate, dark chocolate) and amount of chocolate consumption (grams/day, in quartiles) with clinically relevant depressive symptoms. Adults with diabetes were excluded and models controlled for relevant sociodemographic, lifestyle, health-related, and dietary covariates. Results: Overall, 11.1% of the population reported any chocolate consumption, with 1.4% reporting dark chocolate consumption. Although non-dark chocolate consumption was not significantly associated with clinically relevant depressive symptoms, significantly lower odds of clinically relevant depressive symptoms (OR = 0.30, 95%CI 0.21–0.72) were observed among those who reported consuming dark chocolate. Analyses stratified by the amount of chocolate consumption showed participants reporting chocolate consumption in the highest quartile (104–454 g/day) had 57% lower odds of depressive symptoms than those who reported no chocolate consumption (OR = 0.43, 95%CI 0.19–0.96) after adjusting for dark chocolate consumption. Conclusions: These results provide some evidence that consumption of chocolate, particularly dark chocolate, may be associated with reduced odds of clinically relevant depressive symptoms. Further research capturing long-term chocolate consumption and using a longitudinal design are required to confirm these findings and clarify the direction of causation. © 2019 Wiley Periodicals, Inc.

Background: Data on the association between overweight/obesity and bullying victimization among adolescents are scarce from low- and middle-income countries. Objectives: We assessed the associations between overweight/obesity and bullying victimization in 41 low- and middle-income countries. Methods: Cross-sectional data from the Global School-based Student Health Survey were analysed. Data on past 30-day bullying victimization (including type) and body mass index based on measured weight and height were collected. The 2007 WHO Child Growth reference was used to define overweight and obesity. Multivariable logistic regression (multinomial and binary) and meta-analyses based on country-wise estimates were conducted. Data on 114240 adolescents aged 12 to 15years were analysed (mean age [SD], 13.8 [1.0]y; 48.8% girls). Results: Among girls, compared with normal weight, overweight (OR=1.08; 95% CI, 1.02-1.16; between-country heterogeneity I2=0.0%) and obesity (OR=1.20; 95% CI, 1.07-1.34; I2=0.0%) were associated with significantly higher odds for any bullying victimization, but no significant association was observed among boys. However, overweight and obesity were both associated with significantly increased odds for bullying by being made fun of because of physical appearance among both sexes—obesity (vs normal weight): girls OR=3.42 (95% CI, 2.49-4.71); boys OR=2.38 (95% CI, 1.67-3.37). Conclusions: Effective strategies to reduce bullying of children with overweight/obesity are needed in low- and middle-income countries. © 2019 World Obesity Federation

Appropriate management of diabetes mellitus (DM) includes following a healthy lifestyle, in which reaching physical activity (PA) recommendations is an important factor. Despite this, it remains unclear whether people with DM meet the recommended PA targets. We therefore aimed to investigate the proportion of older adults with DM (type 1 and 2) engaging in the recommended amount of PA per week in a cross-sectional study. PA levels were objectively measured using the GT1M ActiGraph accelerometer for seven consecutive days, and the cut-off of 150 min of moderate-to-vigorous PA (MVPA) was used. To assess the relationship between not meeting the recommendation for, and the significant factors associated with PA level (MVPA &lt, 150 min/week), a multivariable logistic regression analysis was applied. 197 diabetic participants (mean age = 66.8 years, 46.7% males) spent only 74.5 &plusmn, 94.4 min/weekly in MVPA, and only 39 (=19.8%) reached the cut-off for sufficient PA levels. Significant correlates of not meeting the recommendation for PA levels were female sex, depressive symptoms, and age. In conclusion, only one-fifth of diabetic people reached the recommended amount of PA, suggesting that more intervention is needed to increase PA levels in this population.

Objectives: This study compared (1) levels of engagement in lifestyle risk behaviours and (2) mental and physical health status in individuals who have previously been homeless to those of individuals who have not. Design: Cross-sectional. Participants: Data were from participants (n=6931) of the English Longitudinal Study of Ageing. Measures: Participants reported whether they had ever been homeless. We used regression models to analyse associations between homelessness and (1) cigarette smoking, daily alcohol consumption and physical inactivity, adjusting for sociodemographic covariates (age, sex, ethnicity, highest level of education, marital status and household non-pension wealth) and (2) self-rated health, limiting long-standing illness, depressive symptoms, life satisfaction, quality of life and loneliness, adjusting for sociodemographics and health behaviours. Results: 104 participants (1.5%) reported having been homeless. Individuals who had been homeless were significantly more likely to be physically inactive (OR 1.62, 95% CI 1.44 to 2.52), report fair/bad/very bad self-rated health (OR 1.75, 95% CI 1.07 to 2.86), have a limiting long-standing illness (OR 2.66, 95% CI 1.65 to 4.30) and be depressed (OR 3.06, 95% CI 1.85 to 5.05) and scored lower on measures of life satisfaction (17.34 vs 19.96, p

Severe mental illnesses (SMI), including major depressive disorder, bipolar disorder, and schizophrenia, are associated with increased inflammation. Given diet's role in modulating inflammatory processes, excessive calorie-dense, nutrient-deficient processed food intake may contribute toward the heightened inflammation observed in SMI. This review assesses the evidence from observational and experimental studies to investigate how diet may affect physical and mental health outcomes in SMI through inflammation-related pathways. Cross-sectional studies indicate that individuals with SMI, particularly schizophrenia, consume more pro-inflammatory foods and fewer anti-inflammatory nutrients than the general population. Cohort studies indicate that high levels of dietary inflammation are associated with increased risk of developing depression, but there is currently a lack of evidence for schizophrenia or bipolar disorder. Randomized controlled trials show that dietary interventions improve symptoms of depression, but none have tested the extent to which these benefits are due to changes in inflammation. This review summarizes evidence on dietary inflammation in SMI, explores the directionality of these links, and discusses the potential use of targeted nutritional interventions for improving psychological well-being and physical health outcomes in SMI. Establishing the extent to which diet explains elevated levels of inflammatory markers observed in SMI is a priority for future research. Copyright © 2019 Firth, Veronese, Cotter, Shivappa, Hebert, Ee, Smith, Stubbs, Jackson and Sarris. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

The poor physical health of people with mental illness is a multifaceted, transdiagnostic, and global problem. People with mental illness have an increased risk of physical disease, as well as reduced access to adequate health care. As a result, physical health disparities are observed across the entire spectrum of mental illnesses in low-income, middle-income, and high-income countries. The high rate of physical comorbidity, which often has poor clinical management, drastically reduces life expectancy for people with mental illness, and also increases the personal, social, and economic burden of mental illness across the lifespan. This Commission summarises advances in understanding on the topic of physical health in people with mental illness, and presents clear directions for health promotion, clinical care, and future research. The wide range and multifactorial nature of physical health disparities across the range of mental health diagnoses generate a vast number of potential considerations. Therefore, rather than attempting to discuss all possible combinations of physical and mental comorbidities individually, the aims of this Commission are to: (1) establish highly pertinent aspects of physical health-related morbidity and mortality that have transdiagnostic applications; (2) highlight the common modifiable factors that drive disparities in physical health; (3) present actions and initiatives for health policy and clinical services to address these issues; and (4) identify promising areas for future research that could identify novel solutions. These aims are addressed across the five parts of the Commission: in Parts 1 and 2 we describe the scope, priorities, and key targets for physical health improvement across multiple mental illnesses; in Parts 3, 4, and 5, we highlight emerging strategies and present recommendations for improving physical health outcomes in people with mental illness.

Background Our aim was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies and physical health outcomes associated with human immunodeficiency virus (HIV) but not acquired immunodeficiency syndrome. Methods We performed an umbrella review of observational studies. Evidence was graded as convincing, highly suggestive, suggestive, weak, or nonsignificant. Results From 3413 studies returned, 20 were included, covering 55 health outcomes. Median number of participants was 18 743 (range 403–225 000 000). Overall, 45 (81.8%) of the 55 unique outcomes reported nominally significant summary results (P < .05). Only 5 outcomes (9.0%; higher likelihood of presence of breathlessness, higher chronic obstructive pulmonary disease [COPD] prevalence, maternal sepsis, higher risk of anemia, and higher risk of all fractures among people living with HIV [PLWHIV]) showed suggestive evidence, with P values < 10–3; only 3 (5.5%; higher prevalence of cough in cross-sectional studies, higher incidence of pregnancy-related mortality, and higher incidence of ischemic heart disease among PLWHIV in cohort studies) outcomes showed stronger evidence using a stringent P value (, This umbrella review captures the complexities and variety of physical outcomes associated with human immunodeficiency virus. It reports on 55 unique outcomes: 3 (higher prevalence of cough and higher incidences of pregnancy-related mortality and ischemic heart disease) had strong evidence.

BACKGROUND: The aim was to investigate the relationship between sexual behaviors and suicide attempts by using data from 38 countries from four World Health Organization regions. METHODS: Cross-sectional data from 116,820 adolescents aged 12-15 years participating in the Global School-based Student Health Survey 2009-2016 were analyzed. Data on sexual behaviors were collected: (i) ever having had intercourse; among those who reported having had intercourse, (ii) multiple (≥2) lifetime sexual partners and (iii) condom use in last sexual intercourse and past 12-month suicide attempts were self-reported. Associations were analyzed using multivariable logistic regression. RESULTS: The prevalence of sexual intercourse and suicide attempts were 13.2% and 9.1%, respectively. A positive association between sexual intercourse and suicide attempts was found in 32 of the 38 countries (pooled OR for whole sample 2.12 [95% CI 1.98-2.27]). Having had multiple sexual partners was associated with increased odds of suicide attempts (pooled OR for whole sample 1.58 [1.27-1.96]). Condom non-use was only associated with suicide attempts among boys in the Americas (OR: 1.75 [1.25-2.45]). CONCLUSION: Engaging in sexual intercourse was associated with increased risk of suicide attempt. Moreover, having had multiple sexual partners may also increase the risk of suicide attempts. ispartof: PSYCHIATRY RESEARCH vol:287 ispartof: location:Ireland status: published

Physical activity (PA) is a potential modifiable correlate of the age-related decline in sexual function, but no studies have explicitly tested this. This study aimed to examine associations between PA, television viewing (TV) time and sexual activity, problems, and concerns. Data were from 7,038 men and women aged &ge, 50 years participating in the English Longitudinal Study of Ageing. PA and TV viewing time were self-reported. Sexual behaviour and concerns were assessed by self-completion questionnaire. Covariates included age, partnership status, socio-economic status, limiting long-standing illness, smoking status, alcohol intake and depressive symptoms. The odds of reporting any sexual activity were increased among individuals who participated in moderate (OR = 1.64, 95% CI: 1.24&ndash, 2.15 in men) or vigorous (OR = 2.06, 95% CI: 1.50&ndash, 2.84 in men, OR = 1.42, 95% CI: 1.09&ndash, 1.85 in women) PA at least once a week. Erectile difficulties were less common among men who were active (OR = 0.58, 95% CI: 0.44&ndash, 0.77 for vigorous PA). Women who watched &ge, 6 hours of TV/day had lower odds of thinking about sex frequently (OR = 0.69, 95% CI: 0.50&ndash, 0.96) or, if they did not live with a partner, being sexually active (OR = 0.40, 95% CI: 0.22&ndash, 0.72). Encouraging older adults to be more physically active could help to improve sexual relationships and, as a result, mental health and wellbeing.

Introduction One factor that may plausibly be associated with sexual dysfunction is sleep disturbance. Like sexual problems, complaints of sleep disturbance increase with age and are commonly reported by older adults. Aims To examine associations between sleep quality, duration, and a range of sexual problems in a large, representative sample of older adults. Methods Data were from 2,568 men and 1,376 women (age ≥50 years) participating in Wave 6 of the English Longitudinal Study of Ageing (2012–2013). Sleep quality, duration, and problems with erectile function, sexual arousal, and orgasmic experience were self-reported; associations were examined using logistic regression models. Covariates included age, ethnicity, partner status, wealth, limiting long-standing illness, smoking, alcohol consumption, physical activity, and depressive symptoms. Main Outcome Measure Participants self-reported problems with erectile function, sexual arousal, and orgasmic experience. Results In women, moderate (odds ratio [OR] = 1.53, 95% CI 1.09–2.13, P = .013) and low sleep quality (OR = 1.70, 95% CI 1.24–2.32, P = .001) were associated with increased odds of arousal problems relative to high sleep quality. In men, moderate sleep quality was associated with increased odds of erectile difficulties (OR = 1.47, 95% CI 1.16–1.85, P = .001), the difference between low and high sleep quality did not reach statistical significance (OR = 1.24, 95% CI 0.97–1.58, P = .091). Sleep quality was not associated with difficulty achieving an orgasm in men, but in women low sleep quality was associated with increased odds of orgasmic difficulty (OR = 1.63, 95% CI 1.18–2.25, P = .003). No associations between sleep duration and problems with sexual function were observed in women, but, in men, long sleep was associated with higher odds of difficulty achieving orgasm (OR = 1.75, 95% CI 1.04–2.95, P = 0.036) relative to optimal sleep duration. Clinical Implications Older adults presenting sleep problems should be screened for sexual dysfunction and vice versa. Strength & Limitations Strengths of this study include the large representative sample of older English adults, the assessment of several aspects of sexual dysfunction and sleep, and the inclusion of potentially important confounding variables into statistical models. However, the study was cross-sectional, meaning we were unable to ascertain the direction of the observed associations. Conclusion Sleep problems are associated with sexual dysfunction in older English adults, although some variation is noted between men and women.