Search

Background: Body weight may be a risk factor for anxiety; however, there is a scarcity of studies on this association in older adults especially from low and middle income countries (LMICs). Therefore, we investigated the association between body mass index (BMI) and anxiety symptoms among adults aged ≥ 50 years from 6 LMICs., Methods: Cross-sectional, community-based, nationally representative data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analyzed. The BMI was based on measured weight and height and was categorized as: < 18.5 kg/m 2 (underweight), 18.5-24.9 kg/m 2 (normal weight), 25.0-29.9 kg/m 2 (overweight), 30.0-34.9 kg/m 2 (obesity class I), 35.0-39.9 kg/m 2 (obesity class II), and ≥ 40 kg/m 2 (obesity class III). Anxiety symptoms referred to severe/extreme problems with worry or anxiety in the past 30 days. Multivariable logistic regression analysis was conducted., Results: Data on 34,129 individuals aged ≥ 50 years (mean age 62.4 years, SD 16.0 years; 52.1% female) were analyzed. Overall, compared to normal weight, only underweight was significantly associated with anxiety symptoms (odds ratio, OR = 1.56; 95% confidence interval, CI = 1.26-1.95). Obesity class III (vs. normal weight) was associated with significantly increased odds for anxiety symptoms (OR = 4.15; 95%CI = 1.49-11.59) only among males., Conclusion: In this large representative sample of older adults from LMICs, underweight was associated with anxiety symptoms in males and females. Class III obesity was associated with anxiety symptoms only in males. Future studies to shed light on the reason why severe obesity was associated with anxiety symptoms only among males in LMICs are needed., (© 2021. Springer-Verlag GmbH Austria, part of Springer Nature.)

Background and Aim: We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses., Methods: We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV)., Results and Discussion: From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p < 0.05), with 22 associations surviving the application of a more stringent p-value (p < 10 -6 ). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551-2.124), and anxiety (OR = 1.498; 95% CI: 1.273-1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053-2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV)., Conclusions: UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Internet usage among adolescents has increased substantially over the last years, concurrently with emerging concerns that an abusive use is associated with detrimental health outcomes. Our objective was to examine the association between age of first exposure and heavy Internet usage in different domains. Data from the 2018 wave of the Programme for International Student Assessment (PISA) were retrieved. This included a total of 317,443 participants (49.2% boys) aged 15 and 16 years from 52 countries. Data from both Internet use and age of first exposure were retrieved and used to conduct metanalyses with random effects. Adolescents reporting an age of first exposure of Internet usage at ≥ 13 years old had the lowest odds for heavy Internet use (> 2 h/day) (reference group: ≤ 9 years) during weekends (odds ratio, 0.41 [95% CI, 0.35-0.48]), weekdays (odds ratio, 0.45 [95% CI, 0.37-0.56]), and during school time (odds ratio (odds ratio, 0.86 [95% CI, 0.77-0.96]) even when adjusted for sex, socioeconomic status, and country. A stronger association was observed in adolescents from South and Central America and Eastern Mediterranean regions in the domain of weekends and weekdays. The results indicate that early internet exposure is associated with heavy Internet use, particularly during weekends and weekdays, regardless the geographical region, in a linear fashion. Further research should aim to examine if better education and parental control in specific areas may avoid excessive Internet use that possibly have a negative influence on both mental and physical health., (© 2021. The Author(s).)

Activities of daily living (ADL) may be limited by the presence of chronic diseases, and limitations in ADL contribute to an increased risk of falling. In people with asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO), ADL may be affected owing to poor asthma control and COPD ventilatory limitations. The aim of this study was to establish the differing prevalence of limitations in ADL among older Spanish adults with chronic respiratory diseases (COPD, asthma, and ACO). Data from the Spanish National Health Survey were analyzed. The sample was composed of 944 older adults aged ≥65 years and with a positive diagnosis of COPD ( n = 502), asthma ( n = 241), or ACO ( n = 201). Five basic activities of daily living (BADL) and seven instrumental activities of daily living (IADL) were studied. Frequency and percentages were used to describe sample characteristics and limitations of ADL. Significant differences were analyzed using chi-square tests. Results revealed a significant higher number of older adults with COPD (34.8%) and asthma (32.5%) without limitations in doing hard housework in comparison to ACO (17.8%). Regarding meal preparation, a higher percentage of asthmatics without difficulties (77.7%) and a lower percentage with many difficulties (2.6%) were observed in comparison to ACO (64.8%-10.2%). No differences were found in BADL, with approximately 80-90% without limitations. It seems that limitations in IADL vary according to the type of chronic pulmonary diseases, but further research is needed to clarify why differences were found only for preparing meals and hard housework. These findings should be considered in the design of interventions to promote ADL in older adults with respiratory disease.

Purpose: Food insecurity and multimoribidity (i.e., ≥ 2 chronic conditions) may be linked bidirectionally, but there are no studies on this topic from LMICs. Therefore, the aim of the present study was to examine the association between food insecurity and physical multimorbidity in a large representative sample of older adults from six LMICs., Methods: Cross-sectional, community-based data on adults aged ≥ 50 years from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia, and South Africa were analyzed. A total of 11 chronic physical conditions were assessed. Past 12 month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted to assess the associations., Results: Data on 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 47.9% males] were analyzed. After adjustment for potential confounders, in the overall sample, compared to being food secure, moderate and severe food insecurity were associated with 1.29 (95% CI 1.06-1.56) and 1.56 (95% CI 1.13-2.16) times higher odds for multimorbidity, respectively CONCLUSION: Food insecurity was associated with greater odds for multimorbidity in older adults from LMICs. Addressing food insecurity in the general population may reduce risk for multimorbidity, while screening for food insecurity and addressing it among those with multimorbidity may lead to better clinical outcomes, pending future longitudinal research., (© 2022. The Author(s).)

Objective: To assess the effectiveness of 448 kHz monopolar capacitive resistive radiofrequency (MCRR) in the treatment of females with stress urinary incontinence (SUI)., Materials and Methods: Forty females with SUI complaints were separated randomly into two equal groups. Group A with 20 females received the MCRR therapy for 20 min and performed pelvic floor exercises for 20 min. Group B with 20 females received placebo treatment by applying the same application as in Group A without emitting any waves for 20 min, three times a week, for 4 weeks. The patients in both groups were instructed to pause the treatment during their menstruation; the patients were instructed to maintain home pelvic floor exercises. Both groups were assessed by a perineometer that was used to assess the strength of the pelvic floor muscles (PFM), the visual analogue scale (VAS), and the Incontinence Symptom Severity Index to assess the frequency of urinary incontinence symptoms as described by each patient before treatment and after 4 weeks of treatment., Results: There was a significant reduction ( p  < 0.05) in VAS and the Incontinence Symptom Severity Index and a significant increase in the strength of the PFM in both groups post-treatment compared with the pre-treatment. Regarding between-subject effects, there was a significant difference in VAS, the Incontinence Symptom Severity Index, and the perineometer between both groups ( p  < 0.05), and this significant improvement favored Group A., Conclusion: MCRR and pelvic floor exercises are more effective methods for the treatment of SUI than just pelvic floor exercises of females with SUI., Clinical Trial Registration: ClinicalTrials.gov. Identifier: NCT04612205., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Elhosary, Ahmed Hamada, Ali AlMubali, López Sánchez and Ahmed.)

Introduction: Physical multimorbidity is plausibly linked to sarcopenia. However, to date, only a few studies exist on this topic, and none have examined this association in low- and middle-income countries (LMICs). Thus, we aimed to investigate the association between multimorbidity and sarcopenia in a sample of older adults from six LMICs (China, Ghana, India, Mexico, Russia, South Africa)., Methods: Cross-sectional, community-based data from the WHO Study on Global Ageing and Adult Health (SAGE) were analysed. Sarcopenia was defined as having low skeletal muscle mass (SMM) and weak handgrip strength, while severe sarcopenia was defined as having low SMM, weak handgrip strength, and slow gait speed. A total of 11 physical chronic conditions were assessed and multimorbidity referred to ≥2 chronic conditions. Multivariable logistic regression analysis was conducted., Results: Data on 14,585 adults aged ≥65 years were analysed (mean age 72.6 years, SD 11.5 years; 53.7% females). Adjusted estimates showed that compared to no chronic physical conditions, ≥2 conditions are significantly associated with 1.49 (95% CI = 1.02-2.19) and 2.52 (95% CI = 1.53-4.15) times higher odds for sarcopenia and severe sarcopenia, respectively., Conclusions: In this large sample of older adults from LMICs, physical multimorbidity was significantly associated with sarcopenia and severe sarcopenia. Our study results tentatively suggest that targeting those with multimorbidity may aid in the prevention of sarcopenia, pending future longitudinal research., (© 2022 S. Karger AG, Basel.)

Objectives: To assess alcohol use and perceived change in alcohol consumption (before and during the pandemic) in Brazilians during the COVID-19 pandemic, their correlates, and their associations with depressive, anxiety and co-occurring depressive and anxiety symptoms (D&A)., Methods: This is a cross-sectional study comprising 992 individuals in self-isolation. A self-report questionnaire was used to assess whether participants were drinking during self-isolation and whether they changed their drinking behavior (drinking less, more, or no change) from before to during the pandemic. D&A symptoms were assessed using the Beck Depression and Anxiety Inventories (BDI and BAI)., Results: A total of 68.5% of participants reported alcohol consumption during the pandemic, and 22.7% of these reported increased alcohol use. Smoking was positively associated with alcohol consumption during the pandemic. Alcohol consumption was associated with anxiety (OR = 1.40, 95%CI 1.06-1.85, p < 0.01) and D&A (OR = 1.38, 95%CI 1.02-1.87, p = 0.033) symptoms., Conclusions: Drinking during self-isolation was prevalent and was associated with risk factors for alcohol use disorders. The long-term effects of high drinking rates and increased consumption should be proactively monitored and assessed., Competing Interests: No conflicts of interest declared concerning the publication of this article.

Objectives: The association between physical multimorbidity and suicidal ideation or suicide attempts among older adults from low- and middle-income countries (LMICs) is largely unknown. We aimed to assess this association as well as its mediators using nationally representative data from six LMICs., Methods: Cross-sectional, community-based data from the Study on Global Aging and Adult Health were analyzed. A total of 11 chronic physical conditions were assessed. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analyses were conducted., Results: The final sample consisted of 34,129 adults aged ≥50 years (mean [SD] age 62.4 (16.0) years; maximum age 114 years; 52.1% females). In the overall sample, physical multimorbidity was associated with increased odds for suicidal ideation (OR = 2.99; 95% CI = 2.06-4.34) and suicide attempts (OR = 2.79; 95% CI = 1.58-4.95), with the association being stronger in males than females. The association between multimorbidity and suicidal ideation or suicide attempts was largely mediated by pain/discomfort (mediated% 33.3%-44.2%), sleep/energy (28.2%-33.8%), and mobility limitations (26.6%-34.8%)., Conclusions: Physical multimorbidity among older adults in LMICs was associated with a substantially increased risk for suicidal ideation and suicide attempts. Addressing the identified mediators in people with physical multimorbidity may aid in the prevention of suicidal ideation and suicide attempts., (© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

(1) Objective: We performed a systematic review to explore the prevalence of intravenous (IV) rehydration therapy in hospital settings, and we assessed it by patient groups and populations. (2) Methods: A systematic review of major databases and grey literature was undertaken from inception to 28 March 2022. Studies reporting prevalence of IV rehydration therapy in a hospital setting were identified. The data were synthesised in a narrative approach. (3) Results: Overall, 29 papers met the inclusion criteria. The prevalence of IV rehydration therapy in paediatric patients ranged from 4.5% (hospitalised with diarrhoea and dehydration) to 100% (admitted to the emergency department with mild to moderate dehydration caused by viral gastroenteritis), and in adults this ranged from 1.5% (had single substance ingestion of modafinil) to 100% (hospitalised with hypercalcemia). The most common indication for IV rehydration therapy in paediatric patients was dehydration due to fluid loss from the gastrointestinal tract. Other causes included malnutrition, neuromuscular disease, bronchiolitis, and influenza. In adults, indications for IV rehydration therapy were much more diverse: fever, diarrhoea, drug intoxication, hypercalcemia, cancer, and postural tachycardia syndrome; (4) Conclusions: This systematic review showed that IV rehydration therapy in paediatric patients is often used to treat dehydration and diarrhoea, while in adults it has a broader spectrum of use. While IV rehydration therapy is important in correcting fluid problems and electrolyte status, the maintenance fluid prescribing practices vary considerably, and guidelines are scarce.

Social participation may theoretically decrease risk for mild cognitive impairment (MCI). However, to date, no study has specifically investigated the association between social participation and MCI in LMICs, while the mediating role of loneliness is unknown. Thus, we investigated this association in a sample of adults aged ≥50 years from six low- and middle-income countries (LMICs; China, Ghana, India, Mexico, Russia, South Africa) using nationally representative datasets. We analyzed cross-sectional, community-based data from the Study on Global Ageing and Adult Health. A social participation score (range 0-10 with higher scores corresponding to greater levels of social participation) was created based on nine questions about involvement in community activities in the last 12 months. The National Institute on Ageing-Alzheimer's Association criteria were used to define MCI. Multivariable logistic regression and mediation analysis was performed. The analytical sample consisted of 32,715 individuals aged ≥50 years with preserved functional abilities [mean (SD) age 62.1 (15.6) years; 51.7% females]. In the overall sample, after adjustment for potential confounders, a one-unit increase in the social participation score was associated with a 13% decrease in odds for MCI (OR = 0.87; 95%CI = 0.82-0.93). Loneliness only explained 3.0% of the association. Greater levels of social participation were associated with a reduced odds for MCI, and this was not largely explained by loneliness. It may be prudent to implement interventions in LMICs to increase levels of social participation to aid in the prevention of MCI and ultimately dementia., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

The objective was to analyse the association between physical activity and the risk of suffering from 32 chronic conditions using a large representative sample of Spanish adults. We utilised the dataset of the last edition of the Spanish National Health Survey, which was conducted in the year 2017. This dataset included a total of 23,089 adults between the ages of 15 and 103 years. The average age was 53.4 years (standard deviation 18.9 years). Regarding sex distribution, 54.1% of the participants were females. The instrument used to measure physical activity was the short form of the international physical activity questionnaire. The question used to evaluate if the participants suffered from chronic conditions was "Have you ever been diagnosed with chronic condition?". This question was asked for 32 different chronic conditions. The association between low levels of physical activity (exposure) and chronic conditions (outcome) was assessed with multivariable logistic regression analyses. The highest prevalence of chronic conditions was found in the group doing less than 600 MET (metabolic equivalent of task)-min/week of physical activity (in 28 of the 32 conditions analyzed). The lowest prevalence was in the group doing at least 1200 MET-min/week (in 30 of the 32). Adjusted multivariable logistic regression analyses showed that less than 600 MET-min/week of physical activity was significantly associated with a higher risk of 19 chronic conditions. All these significant associations, except for hypertension, were also maintained in those doing less than 1200 MET-min/week. In conclusion, higher physical activity is a protective factor against the risk of suffering from chronic conditions, with the lowest prevalence of chronic conditions in people doing more than 1200 MET-min/week. International physical activity guidelines should recommend at least 1200 MET-min/week to prevent the risk of chronic conditions.

People with depression and subjective cognitive complaints (SCC) may be at particularly high risk for developing dementia. However, to date, studies on depression and SCC are limited mainly to single high-income countries. Thus, the aim of the present study was to investigate the association between depression and SCC in adults from low- and middle-income countries (LMICs). Cross-sectional, community-based data were analyzed from the World Health Survey. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). ICD-10 Diagnostic Criteria for Research was used for the diagnosis of subsyndromal depression, brief depressive episode, and depressive episode. Multivariable linear regression was conducted to explore the associations. Data on 237,952 individuals aged ≥18 years [mean (SD) age 38.4 (16.0) years; females 50.8%] were analyzed. After adjustment for potential confounders (age, sex, education, anxiety), compared to no depressive disorder, subsyndromal depression (b-coefficient 7.91; 95%CI = 5.63-10.18), brief depressive episode (b-coefficient 10.37; 95%CI = 8.95-11.78), and depressive episode (b-coefficient 13.57; 95%CI = 12.33-14.81) were significantly associated with higher mean SCC scores. The association was similar in all age groups (i.e., 18-44, 45-64, and ≥65 years), and both males and females. All depression types assessed were associated with worse SCC among adults in 47 LMICs. Future longitudinal studies are needed to investigate whether older people with depression and SCC are at higher risk for dementia onset in LMICs., Competing Interests: Declaration of competing interest None., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Physical multimorbidity (i.e., ≥2 chronic conditions) may induce feelings of wish to die (WTD), but there is limited literature on this topic, while the mediators in this association are largely unknown. Thus, the aim of the present study was to investigate this association and its mediators among older Irish adults., Methods: Cross-sectional, nationally representative data from Wave 1 of the Irish Longitudinal Study on Ageing 2009-2011 were analyzed. Information on self-reported lifetime diagnosis of 14 chronic physical conditions were obtained. WTD was defined as answering affirmatively to the question "In the last month, have you felt that you would rather be dead?" Multivariable logistic regression and mediation analyses were conducted., Results: Data on 2941 adults aged ≥65 years [mean (SD) age 73.2 (5.2) years; 45.0 % males] were analyzed. Physical multimorbidity was associated with 3.39 (95%CI 1.58, 7.28) times higher odds for WTD. This association was largely explained by pain (% mediated 28.1 %), followed by depression (19.4 %), sleep problems (18.4 %), perceived stress (13.0 %), loneliness (10.4 %), anxiety (8.1 %), and disability (7.2 %)., Conclusions: Multimorbidity was associated with increased odds for WTD among Irish older adults. Addressing the identified mediators may contribute to reducing feelings of WTD among older adults with multimorbidity., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

There is a small body of evidence suggesting that unclean cooking fuel use may be associated with cognitive decline. However, to date, no study has investigated the association between unclean cooking fuel and mild cognitive impairment (MCI). Thus, we investigated the association between cooking fuel type or ventilation type and MCI among adults aged ≥ 65 years using nationally representative datasets from six low- and middle-income countries. Cross-sectional, community-based data from the World Health Organization (WHO) Study on global Ageing and adult health (SAGE) were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Unclean cooking fuel referred to kerosene/paraffin, coal/charcoal, wood, agriculture/crop, animal dung, and shrubs/grass. Multivariable logistic regression analysis was conducted to assess associations. Data on 13,623 individuals were analyzed [mean (SD) age 72.8 (11.0) years; 45.5% males]. Unclean cooking fuel (vs. clean cooking fuel) was associated with a significant 1.48 (95% CI = 1.08-2.03) times higher odds for MCI. Having no chimney or hood for cooking ventilation was also associated with significantly higher odds for MCI (OR = 1.88; 95% CI = 1.25-2.84). Unclean cooking fuel use and lack of chimney or hood for cooking ventilation were associated with higher odds for MCI. Findings support the implementation of the United Nations Sustainable Goal 7, which advocates affordable, reliable, sustainable, and modern energy for all, as this may also help reduce MCI and ultimately dementia., (© 2022. The Author(s).)

Background: We aimed to investigate associations of unclean cooking fuels with depression and anxiety symptoms in a large sample of adults aged ≥65 years from six low- and middle-income countries (LMICs)., Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Unclean cooking fuel referred to kerosene/paraffin, coal/charcoal, wood, agriculture/crop, animal dung, and shrubs/grass. Depression referred to DSM-IV depression based on past 12-month symptoms or receiving depression treatment in the last 12 months. Anxiety symptoms referred to severe/extreme problems with worry or anxiety in the past 30 days. Multivariable logistic regression analysis and meta-analysis were conducted., Results: Data on 14,585 people aged ≥65 years were analyzed [mean (SD) age 72.6 (11.5) years; maximum age 114 years; 55.0% females]. After adjustment for potential confounders, unclean cooking fuel was associated with a significant 2.52 (95%CI = 1.66-3.82) times higher odds for depression with a low level of between-country heterogeneity (I 2  = 0.0%). For anxiety symptoms, unclean fuel use was not significantly associated with anxiety symptoms (OR = 1.13; 95%CI = 0.77-1.68; I 2  = 0.0%)., Limitations: 1. Cross-sectional design. 2. Self-reported measures. 3. No information about outdoor pollution exposure, personal exposure, and smoke composition of different cooking fuels., Conclusions: Unclean cooking fuel was significantly associated with higher odds for depression, but not anxiety, with little observed variability between settings. Findings from the present study provide further support and call for action in appropriate implementation of the United Nations Sustainable Goal 7, which advocates affordable, reliable, sustainable, and modern energy for all., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

This study including older adults from Ireland aimed to analyze the prospective association between multimorbidity and falls and to identify the mediators in this relationship. The present study used data from two consecutive waves of the Irish Longitudinal Study on Ageing (TILDA) survey. Multimorbidity was assessed at Wave 1 (2009-2011) and was defined as the presence of at least two chronic conditions. Falls occurring at Wave 2 (2012-2013) were self-reported. Mediating variables considered were polypharmacy, cognitive impairment, sleep problems, pain, low handgrip strength, difficulty in activities of daily living (ADL), obesity, and underweight. Multivariable binary logistic regression and mediation analysis using the Karlson Holm Breen method were conducted. This study included 6900 adults aged ≥50 years (51.6% women; mean [SD] age 63.1 [8.9] years). Compared to no chronic conditions at baseline, there was a positive and significant association between multimorbidity and falls at follow-up, with ORs ranging from 1.32 (95% CI = 1.06-1.64) for 2 conditions to 1.92 (95% CI = 1.54-2.38) for ≥4 conditions. Pain (23.5%), polypharmacy (13.3%), and difficulty in ADL (10.7%) explained the largest proportion of the multimorbidity-fall relationship. Multimorbidity increased risk for incident falls in older adults from Ireland. Interventions should be implemented to reduce fall risk in people with multimorbidity, especially targeting the identified mediators.

Background: Sleep duration may influence risk for sarcopenia but studies on this topic are scarce, especially from low and- middle-income countries (LMICs). Thus, the aim of the present study was to investigate the association between sleep duration and sarcopenia among adults aged ≥ 65 years from five LMICs (China, Ghana, India, Russia, South Africa)., Methods: Cross-sectional, community-based data from the WHO study on global ageing and adult health (SAGE) were analysed. Sarcopenia was defined as having low skeletal muscle mass (SMM) and weak handgrip strength, while severe sarcopenia was defined as having low SMM, weak handgrip strength, and slow gait speed. Self-reported sleep duration in the past two nights were averaged and classified as ≤ 6, > 6 to ≤ 9, and ≥ 9 h/day. Multivariable logistic regression analysis was conducted., Results: Data on 13,210 adults aged ≥ 65 years [mean (SD) age 72.6 (11.3) years; 55.0% females] were analyzed. In the overall sample, compared to > 6 to ≤ 9 h/day of sleep duration, > 9 h/day was associated with 1.70 (95% CI 1.15-2.51) and 1.75 (95% CI 1.08-2.84) times higher odds for sarcopenia and severe sarcopenia, respectively. No significant associations were observed among males, but associations were particularly pronounced among females [i.e., OR = 2.19 (95% CI 1.26-3.81) for sarcopenia, and OR = 2.26 (95% CI 1.20-4.23) for severe sarcopenia]., Conclusions: Long sleep duration was associated with an increased odds of sarcopenia and severe sarcopenia in LMICs, particularly in females. Future studies should investigate whether addressing long sleep duration among females can lead to lower risk for sarcopenia onset in LMICs., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: The prevalence of diabetes mellitus in Mexico is very high. This study aimed to compare the risk factors of diabetes mellitus in Mexican adults in 2003 and in 2014., Methods: This study had a repeated cross-sectional design. Data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) from Mexico (Wave 0, 2003, and Wave 2, 2014) were compared. Self-reported diabetes mellitus (outcome) was evaluated with the yes/no question: "Have you ever been diagnosed with diabetes mellitus (high blood sugar)?" Bivariate analyses and multivariable logistic regression analyses adjusted for potential risk factors were conducted., Results: In 11 years (2003-2014), the prevalence of self-reported diabetes mellitus in Mexican adults increased by 2.6 times in those younger than 50 years (2003: 2.1%; 2014: 5.5%) and by 1.9 times in those ≥50 years (2003: 12.7%; 2014: 24.2%). In 2003, the risk factors associated with diabetes mellitus were female sex (OR 1.344, 95% CI 1.176-1.536), age ≥50 years (OR 6.734, 95% CI 5.843-7.760), being overweight (OR 1.359, 95% CI 1.175-1.571), obesity (OR 1.871, 95% CI 1.583-2.211), and lower physical activity of <600 MET-minutes/week (OR 1.349, 95% CI 1.117-1.630). In 2014, the exposure characteristics significantly associated with diabetes mellitus were female sex (OR 1.244, 95% CI 1.025-1.511), older age ≥50 years (OR 4.608, 95% CI 3.260-6.515), being overweight (OR 1.649, 95% CI 1.305-2.083), obesity (OR 1.778, 95% CI 1.398-2.261), and in those who had not attended/completed primary school (OR 1.360, 95% CI 1.042-1.773)., Conclusion: The prevalence of diabetes mellitus in Mexico significantly increased from 2003 to 2014. Female sex, age older than 50 years, and being overweight or obese were significant risk factors in both 2003 and 2014. Not having completed primary school was a new significant risk factor in 2014. Public health policies and strategies should prioritize decreasing the high levels of overweight and obesity, and improve health literacy in Mexico., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 López Sánchez, López-Bueno, Villaseñor-Mora and Pardhan.)

Background: Currently, a small body of evidence suggests that sleep problems are positively associated with subjective cognitive complaints (SCC). However, no studies on this topic exist from low- and middle-income countries (LMICs). Thus, we investigated the association between sleep problems and SCC in a large sample of middle-age and older adults from 45 LMICs., Methods: Cross-sectional, predominantly nationally representative, community-based data were analyzed from the World Health Survey. Sleep problems (such as difficulties falling asleep, waking up frequently during the night or waking up too early in the morning) in the last 30 days were self-reported. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). Multivariable linear regression was conducted to explore the association between sleep problems (exposure) and SCC (outcome)., Results: Data on 60,228 adults aged ≥ 50 years were analyzed [mean (SD) age 61.4 (9.9) years; 53.9% females]. After adjustment for potential confounders, compared to those without sleep problems, the mean SCC score for the multivariable model was 13.32 (95% CI 12.01, 14.63), 19.46 (95% CI 17.95, 20.98), 24.17 (95% CI 22.02, 26.33), and 31.39 (95% CI 28.13, 34.65) points higher for mild, moderate, severe, and extreme sleep problems, respectively. Similar results were found for analyses stratified by age and country-income level., Conclusion: Sleep problems were positively associated in a dose-response manner with SCC among middle-aged and older adults in multiple LMICs. Addressing sleep problems may aid in the prevention of SCC and ultimately dementia, pending future longitudinal research., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objectives: To assess the association between far vision impairment (objective and subjective) and perceived stress among older adults from six low- and middle-income countries (LMICs, i.e., China, Ghana, India, Mexico, Russia, and South Africa)., Methods: Data from the WHO Study on global AGEing and adult health were analyzed. Objective visual acuity was measured using the tumbling E LogMAR chart and was used as a four-category variable (no, mild, moderate, and severe visual impairment). Subjective visual impairment referred to difficulty in seeing and recognizing an object or a person across the road. Using two questions from the Perceived Stress Scale, a perceived stress variable was computed, and ranged from 0 (lowest stress) to 100 (highest stress). Multivariable linear regression with perceived stress as the outcome was conducted., Results: Data on 14,585 adults aged ≥65 years [mean (SD) age 72.6 (11.5) years; 55.0% females] were analyzed. Only severe objective visual impairment (versus no visual impairment) was significantly associated with higher levels of stress (b = 6.91; 95% CI = 0.94-12.89). In terms of subjective visual impairment, compared with no visual impairment, mild (b = 2.67; 95% CI = 0.56-4.78), moderate (b = 8.18; 95% CI = 5.84-10.52), and severe (b = 11.86; 95% CI = 9.11-14.61) visual impairment were associated with significantly higher levels of perceived stress., Conclusions: This large study showed that far vision impairment was associated with increased perceived stress levels among older adults in LMICs. Increased availability of eye care services may reduce stress among those with visual impairment in LMICs, while more research is needed to better characterize the directionality of the far vision impairment-perceived stress relationship., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Background: Little is known about the association between multimorbidity (i.e., two or more chronic conditions) and sleep problems in the general adult populations of low- and middle-income countries (LMICs). Thus, we aimed to assess this association among adults from 46 LMICs, and to quantify the extent to which anxiety, depression, stress, and pain explain this association., Methods: Cross-sectional, predominantly nationally representative, community-based data from the World Health Survey were analyzed. Nine chronic physical conditions (angina, arthritis, asthma, chronic back pain, diabetes, edentulism, hearing problems, tuberculosis, visual impairment) were assessed. To be included in the analysis, sleep problems had to have been experienced in the past 30 days and to have been severe or extreme; they included difficulties falling asleep, waking up frequently during the night or waking up too early in the morning. Multivariable logistic regression and mediation analyses were conducted to explore the associations., Results: Data on 237,023 individuals aged ≥18 years [mean (SD) age 38.4 (16.0) years; 49.2% men] were analyzed. Compared with no chronic conditions, having 1, 2, 3, and ≥4 conditions was associated with 2.39 (95%CI=2.14, 2.66), 4.13 (95%CI=3.62, 4.71), 5.70 (95%CI=4.86, 6.69), and 9.99 (95%CI=8.18, 12.19) times higher odds for sleep problems. Pain (24.0%) explained the largest proportion of the association between multimorbidity and sleep problems, followed by anxiety (21.0%), depression (11.2%), and stress (10.4%)., Conclusions: Multimorbidity was associated with a substantially increased odds for sleep problems in adults from 46 LMICs. Future studies should assess whether addressing factors such as pain, anxiety, depression, and stress in people with multimorbidity can lead to improvement in sleep in this population., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2022. Published by Elsevier B.V.)

Background: There is a scarcity of literature on the association between physical multimorbidity (i.e., ≥2 chronic physical conditions) and depression among older adults, especially from low- and middle-income countries (LMICs). In addition, the mediators in this association are largely unknown. Therefore, we aimed to examine this association among adults aged ≥50 years from six LMICs (China, Ghana, India, Mexico, Russia, and South Africa), and to identify potential mediators., Methods: Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health were analyzed. Depression was defined as past-12 months DSM-IV depression or receiving depression treatment in the last 12 months. Information on 11 chronic physical conditions were obtained. Multivariable logistic regression and mediation analyses were conducted., Results: Data on 34,129 individuals aged ≥50 years were analyzed [mean (SD) age 62.4 (16.0) years; maximum 114 years; 52.1% females]. Compared to no chronic conditions, 2, 3, 4, and ≥5 chronic conditions were associated with 2.55 (95% CI = 1.90-3.42), 3.12 (95% CI = 2.25-4.34), 5.68 (95% CI = 4.02-8.03), and 8.39 (95% CI = 5.87-12.00) times higher odds for depression. Pain/discomfort (% mediated 39.0%), sleep/energy (33.2%), mobility (27.5%), cognition (13.8%), perceived stress (7.3%), disability (6.7%), loneliness (5.5%), and food insecurity (1.5%) were found to be significant mediators in the association between physical multimorbidity and depression., Conclusions: Older adults with physical multimorbidity are at increased odds of depression in LMICs. Future studies should assess whether addressing the identified potential mediators in people with physical multimorbidity can lead to reduction in depression in this population., (© 2022 Wiley Periodicals LLC.)

Objectives: To identify levels of physical activity (PA) among the Spanish population with asthma and chronic obstructive pulmonary disease overlap (ACO). A further aim was to analyze differences in PA levels by sex, age, education, marital status, cohabiting, smoking habits, alcohol consumption and body mass index (BMI)., Methods: In this cross sectional study, data from the Spanish National Health Survey 2017 were analyzed. A total of 198 people with ACO aged 15-69 years were included in the analyses. The short version of the international physical activity questionnaire (IPAQ) was used to measure total PA (MET·min/week). PA was further classified as low, moderate and high, and analyzed according to sample characteristics. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis H test and chi squared test. Statistical significance was set at p  < 0.05., Results: People with ACO engaged in a mean volume of 2038.1 MET·min/week. Those aged 30-60 years and those with normal weight were significantly more active than those aged ≥60 and those with obesity. When classifying PA level in low, moderate and high, results showed no significant differences between sample characteristics. Overall, moderate and high levels of PA were the most and least frequent levels (48.0% and 16.2%, respectively)., Conclusions: More than three out of ten Spanish adults with ACO do not achieve PA recommendations. Therefore, it is recommended to implement programs that promote the importance and benefits of PA among the Spanish population with ACO, and such programs should focus on older adults and those who are obese.

The authors investigated the association between vision impairment and physical activity among older adults from low- and middle-income countries. Visual acuity was measured using the tumbling ElogMAR chart, and vision impairment was defined as visual acuity worse than 6/18 (0.48 logMAR) in the better seeing eye. Physical activity was assessed by the Global Physical Activity Questionnaire. Multivariable logistic regression and meta-analysis were conducted to assess associations. The sample included 34,129 individuals aged 50-114 years (mean [SD] age 62.4 [16.0] years; 47.9% male). After adjustment for confounders, near vision impairment was not significantly associated with low physical activity, but far vision impairment showed a significant association (odds ratio = 1.32; 95% confidence interval [1.17, 1.49], I2 = 0.0%). Far vision impairment was dose-dependently associated with low physical activity (e.g., severe [<6/10] vs. no [≥6/12] far vision impairment; odds ratio = 1.80; 95% confidence interval [1.03, 3.15]). Interventions to address low levels of physical activity in the visually impaired in low- and middle-income countries should target those with far vision impairment.

Purpose: There is a paucity of literature identifying factors that influence the back and neck pain (BNP)-workplace absenteeism relationship. Therefore, this study aimed to investigate the association between BNP and workplace absenteeism and potential mediating variables in a large sample of the US population., Methods: Nationally representative data collected in 2019 from the RAND American Life Panel (ALP) were used for this retrospective study. Workplace absenteeism was defined as the number of days of absence in the past 12 months for health-related reasons (count variable), while BNP corresponded to the presence of back pain due to spinal stenosis, back pain due to other causes, or neck pain (dichotomous variable). Control variables included sex, age, ethnicity, marital status, education, occupation, annual family income, health insurance, obesity, and diabetes. There were eight influential variables (depression, anxiety, sleep disorder, alcohol dependence, opioid dependence, walking difficulty, standing difficulty, and sitting difficulty). The association between BNP and workplace absenteeism was analyzed using a negative binomial regression model., Results: There were 1,471 adults aged 22-83 years included in this study (52.9% of men; mean [standard deviation] age 44.5 [13.0] years). After adjusting for control variables, BNP was positively and significantly associated with workplace absenteeism (incidence rate ratio = 1.40, 95% confidence interval: 1.07-1.83). Walking, standing, and sitting difficulties individually explained between 24 and 43% of this association., Conclusions: Workplace interventions focusing on the management of BNP and overcoming difficulties in walking, standing, and sitting, potentially utilizing exercise, therapy, and ergonomic interventions, may prevent absenteeism., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study aimed to examine associations between physical inactivity and mental health in Spanish adults with vision or hearing difficulties and explored differences between men and women. Data from the Spanish National Health Survey in 2017 were analyzed (n = 23,089 adults, 15−103 years, mean age 53.4 ± 18.9 years, 45.9% men). Physical inactivity (exposure) was evaluated with the International Physical Activity Questionnaire Short Form. Participants self-reported whether they had previously suffered from depression, chronic anxiety and other mental-health complications (outcomes). Associations between physical inactivity and mental-health complications were assessed with multivariable logistic regression in people with difficulty seeing and hearing, after grouping by gender and adjusting for age, body-mass index, education level, living as a couple, smoking and alcohol consumption. The overall multivariable logistic-regression analyses showed that women with vision impairment showed significant associations between physical inactivity and depression (OR 1.403, 95% CI 1.015−1.940) and other mental-health complications (OR 2.959, 95% CI 1.434−6.104). In the overall analyses, there were no significant associations in men and in people with hearing impairment. The age-stratified analyses showed that inactive people with visual impairment who were <65 years old had a higher risk of mental-health conditions. In conclusion, physical activity has been shown to be important in the prevention of mental-health complications. Healthcare practitioners and policy makers should look at appropriate strategies to increase levels of physical activity in people with vision loss, especially in women and in those <65 years old.

Background: Data on the association between visual difficulty and physical activity (PA) from low- and middle-income countries (LMICs) are scarce. Thus, the aim of the study was to investigate the association between visual difficulty and PA among adults from 36 LMICs, and to assess the mediators in this association., Methods: Cross-sectional, community-based, predominantly nationally representative data from the World Health Survey were analysed. The final sample included 199,110 individuals aged ≥18 years [mean (SD) age 38.6 (16.1) years; 49.4% males]. Visual difficulty referred to having severe/extreme difficulties in seeing and recognizing a person that the participant knows across the road. Low PA was defined as not complying with PA recommendations of 150 min of moderate-vigorous PA per week. Multivariable logistic regression, meta-analysis, and mediation analysis were conducted to assess associations., Results: Meta-analysis based on country-wise multivariable logistic regression analysis showed that overall, visual difficulty is associated with a 1.53 (95% CI = 1.38-1.71) times higher odds for low PA. Particularly strong associations were observed in males (OR = 1.72; 95% CI = 1.45-2.05) and adults aged ≥65 years (OR = 1.95; 95% CI = 1.67-2.29). Interpersonal activities, cognition, and sleep/energy explained >10% of the association between visual difficulty and low PA., Conclusions: In conclusion, we found evidence that especially in the case of males and older adults with visual difficulties in LMICs, there were low levels of engagement with PA. Addressing issues such as interpersonal activities, cognition, and sleep/energy in people with visual difficulties may increase levels of PA., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Background: There are no multi-country studies on the association between informal caregiving and anxiety from low- and middle-income countries (LMICs). Therefore, we investigated this relationship in a large predominantly nationally representative sample from 47 LMICs., Methods: Cross sectional data from the World Health Survey were analyzed. Anxiety symptoms referred to severe or extreme problems with worries or anxiety in the past 30 days. Information on caregiving in the past 12 months was obtained. Multivariable logistic regression analysis adjusting for age, sex, marital status, education, household size, employment, disability, and country was conducted. Data on 237,952 individuals aged ≥18 years [mean (SD) age 38.4 (16.0) years; 50.8% female] were analyzed., Results: After adjustment for potential confounders, caregiving was positively associated with anxiety symptoms (OR = 1.52; 95%CI = 1.40, 1.65). Greater number of caregiving activities was associated with higher odds for anxiety symptoms dose-dependently, with the OR (95%CI) for engagement in 5 activities (vs. no caregiving) being 2.19 (1.86-2.58)., Conclusion: Caregiving is associated with higher odds for anxiety symptoms among adults in LMICs. Given the increasing importance of informal caregivers in long-term care provision and the fact that good health of caregivers is vital to sustain this system, interventions to address mental health of caregivers in LMICs are urgently needed., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The main purpose of this research was to demonstrate the changes in 25(OH)D concentration, bone resorption markers, and physical fitness along the one-year training season in young soccer players. A total of 24 young soccer players (age: 17.2 ± 1.16 years, mass: 70.2 ± 5.84, height: 179.1 ± 4.26 cm) were tested at four different time points across one year (T1-September 2019; T2-December 2019; T3-May 2020; T4-August 2020). After T2 (during COVID-19 lockdown), players were divided into a supplemented (GS) group and a placebo group (GP). Variables such as 25(OH)D, calcium (Ca), phosphorus (P), parathyroid hormone (PTH), aerobic capacity, speed, and explosive power were measured. Analyses performed for all participants indicated significant changes in all selected blood markers and running speed. The highest values in 25(OH)D were noted during summertime in T1 and T4. After individuals were split into two groups, a two-factorial ANOVA demonstrated a significant time interaction for 25(OH)D, Ca, P, PTH, 30 m sprint, and counter-movement jump. Significant time x group effect was calculated for aerobic capacity. This study confirmed that 25(OH)D concentration varies between four seasons, with the greatest decreases in the low sunlight periods. Vitamin D supplementation did not cause a preventive and long-lasting effect of increasing the 25(OH)D concentration in the young soccer players.

We aimed to analyze personality-related determinants of physical activity among Polish and Spanish physical education (PE) students. The study was conducted among 219 Polish and 280 Spanish PE students, using the International Physical Activity Questionnaire (IPAQ) and the NEO-FFI Personality Inventory. Compared with Spanish PE students, their Polish counterparts are characterized by a higher level of extraversion and conscientiousness and a lower level of neuroticism. The level of total physical activity for all students was 8,697.21 METs, and this value was higher among Polish students. Among Polish and Spanish PE students, the level of total, vigorous, and moderate physical activity increased along with the increase in extraversion, while a decrease occurred along with the increase in neuroticism. The level of each domain of physical activity also increased in line with the intensification of student conscientiousness. In moderation analyses, it was shown that the home country of students may be considered a moderator of the relationship between conscientiousness and total exercise in such a way that the physical activity increased along with the increase in conscientiousness only among the Polish students. In addition, the country is a moderator of the correlation between moderate physical activity and neuroticism ( p = 0.031), openness ( p = 0.049), and conscientiousness ( p = 0.019), with moderate activity only decreasing among Polish students and increasing along with the increase in openness and conscientiousness. Positive correlations among physical activity, extraversion, and conscientiousness, as well as negative ones with neuroticism, were demonstrated among Polish and Spanish students, and also the moderating impact of the country on the correlation between personality-related dimensions and physical activity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gacek, Kosiba, Wojtowicz, López Sánchez and Szalewski.)

Background: There is a scarcity of studies on the relationship between visual impairment (VI) and time spent in sedentary behavior (SB), especially from low- and middle-income countries (LMICs). Thus, we investigated the association of objectively and subjectively measured VI with SB in adults aged ≥18 years across 6 LMICs., Methods: Cross-sectional data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Objective and subjective visual acuity were measured. Information on self-reported SB was also collected. Multivariable multinomial logistic regression analysis was conducted to assess associations with time spent in SB as the outcome., Results: The sample consisted of 42,489 individuals (mean age = 43.8 [14.4] y; 50.1% females). Only severe objective VI (vs no VI) was significantly associated with ≥11 hours per day of SB (vs <4 h/d) (odds ratio = 4.50; 95% confidence interval, 1.57-12.92). Increasing severity of subjective VI was associated with greater odds for ≥8 hours per day of SB (vs <4 h/d) dose dependently., Conclusions: The present study identified an association of both objectively and subjectively measured VI with time spent in SB in adults residing in LMICs, with subjectively measured VI being a stronger predictor of time spent in SB. Targeted interventions to decrease SB especially in those who perceive themselves to have VI are needed in LMICs.

Background: The COVID-19 pandemic imposed major changes on daily-life routine worldwide. To the best of our knowledge, no study quantified the changes on moderate to vigorous physical activity (MVPA) and sedentary behaviors (SB) and its correlates in Brazilians. This study aimed to (i) evaluate the changes (pre versus during pandemic) in time spent in MVPA and SB in self-isolating Brazilians during the COVID-19 pandemic, and (ii) to explore correlates., Methods: A cross-sectional, retrospective, self-report online web survey, evaluating the time spent in MVPA and SB pre and during the COVID-19 pandemic in self-isolating people in Brazil. Sociodemographic, behavioral, and clinical measures, and time in self-isolation were also obtained. Changes in MVPA and SB and their correlates were explored using generalized estimating equations (GEE). Models were adjusted for covariates., Results: A total of 877 participants (72.7% women, 53.7% young adults [18-34 years]) were included. Overall, participants reported a 59.7% reduction (95% CI 35.6-82.2) in time spent on MVPA during the pandemic, equivalent to 64.28 (95% CI 36.06-83.33) minutes per day. Time spent in SB increased 42.0% (95% CI 31.7-52.5), corresponding to an increase of 152.3 (95% CI 111.9-192.7) minutes per day. Greater reductions in MVPA and increases in SB were seen in younger adults, those not married, those employed, and those with a self-reported previous diagnosis of a mental disorder., Conclusions: People in self-isolation significantly reduced MVPA levels and increased SB. Public health strategies are needed to mitigate the impact of self-isolation on MVPA and SB., Supplementary Information: The online version contains supplementary material available at 10.1007/s11332-021-00788-x., Competing Interests: Conflict of interestThe authors have no conflict of interest to declare., (© The Author(s), under exclusive licence to Springer-Verlag Italia S.r.l., part of Springer Nature 2021.)

Objectives: The relationship between consuming ≥2 servings of fruits and ≥3 servings of vegetables a day, which has been identified as optimal for health (i.e., adequate fruit/vegetable consumption), and non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is largely unknown. Therefore, using data from six LMICs, we investigated the independent association between inadequate fruit/vegetable consumption and 12 NCDs, and estimated the prevalence of inadequate fruit/vegetable consumption among people with NCDs., Design and Setting: Cross-sectional, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed., Participants: Data on 34129 individuals aged ≥50 years were analyzed [mean (SD) age 62.4 (16.0); maximum age 114 years; 52.1% females]., Measurements: Information on the number of servings of fruits and vegetables consumed on a typical day was self-reported. Twelve NCDs were assessed. Multivariable logistic regression analysis was conducted., Results: Overall, 67.2% had inadequate fruit/vegetable consumption. Inadequate fruit/vegetable consumption was independently associated with significantly higher odds for chronic lung disease (OR=1.25), diabetes (OR=1.45), hearing problems (OR=1.75), and visual impairment (OR=2.50). The prevalence of inadequate fruit/vegetable consumption was particularly high among people with visual impairment (92.5%), depression (90.5%), asthma (79.8%), and hearing problems (78.4%)., Conclusion: Promotion of fruit and vegetable consumption (≥2 servings of fruits and ≥3 servings of vegetables a day) in LMICs may lead to prevention of some NCDs (e.g., diabetes, chronic lung disease). Furthermore, people with certain NCDs (e.g., visual impairment, depression) had particularly high prevalence of inadequate fruit/vegetable consumption, and it is thus important to target this population to increase fruit/vegetable consumption., Competing Interests: None.

Introduction: Evidence on sexual behaviour and COVID-19 shows a change in sexual habits; however, there is no research on the association between mental health and sexual activity., Aim: To examine the relationship between mental health and sexual activity during the quarantine in Spanish adults., Methods: A sample of 305 adults filled out an online questionnaire. Sexual activity was assessed with one question. Anxiety and depression symptoms were assessed using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI), respectively. To check associations between levels of both anxiety and depressive symptoms (exposure) and weekly prevalence of sexual activity (outcome), we conducted multiple logistic regression adjusted for control variables (marital status, employment, average household annual income, place of living, pre-COVID-19 sexual activity, current smoking, current alcohol consumption, chronic physical conditions, chronic psychiatric conditions, physical symptoms, and days of confinement)., Results: Higher depression level was associated with lower weekly sexual activity in a dose-response fashion in the three implemented models. Participants with higher levels of depression were associated with significantly lower sexual activity in the fully adjusted model (OR: 0.09, 95% CI 0.01-0.61). Mild anxiety-level participants consistently presented significantly lower ORs for lower sexual activity than their minimal-anxiety category counterparts. Particularly, the fully adjusted model showed the lower values (OR: 0.40, 95% CI 0.19-0.84)., Conclusion: The results of this study support existing evidence stressing the association between mental health and sexual activity in quarantined adults.

Suicide is the fourth leading cause of death worldwide in young people aged 15-19 years. However, little is known about the correlates of multiple suicide attempts in adolescents, especially from a global perspective. Therefore, the aim of the present study was to investigate the association of putative physical, behavioral, and social correlates with multiple suicide attempts among adolescents aged 12-15 years from 61 countries. Data from the Global school-based Student Health Survey (2009-2017) were analyzed. Multiple suicide attempts was classified as having attempted suicide at least twice in the past 12 months. Multivariable logistic regression analyses were conducted to assess the potential correlates. Data on 162,994 adolescents [mean (SD) age 13.8 (0.9) years; 50.8% boys] were analyzed. The overall prevalence of multiple suicide attempts was 4.4% [range 1.2% (Laos) to 13.8% (Ghana)]. Among those who had attempted suicide at least once in the past 12 months, in the overall sample, food insecurity, smoking, alcohol consumption, cannabis use, amphetamine use, sedentary behavior, sexual intercourse, sleep problems, loneliness, no close friends, and bullying victimization were all independently associated with higher odds for multiple suicide attempts although some regional differences were observed. Our study results indicate potential target factors that could be addressed amongst those who had attempted suicide in the past to reduce future suicide attempts and possibly completed suicides. Furthermore, it is possible that region-specific interventions are necessary., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Currently, there is limited research reporting the symptoms of long COVID among athletes, and the recommendations for athletes returning to competition/training who have experienced long COVID symptoms. Therefore, the aim of this systematic review is to synthesise the recommendations for returning athletes who have experienced long COVID symptoms. The protocol was registered in PROSPERO under CRD42021265939. Two authors searched the electronic databases PubMed, Embase, Scopus, the Cochrane Library, Web of Science, CINAHL, PsycINFO, and SPORTDiscus from August 2019-July 2021. Search terms included words related to "long COVID", "athlete" and "return". Data extraction was completed for each study by two independent investigators for: (1) first author name; (2) year of publication; (3) journal; (4) Definition of athlete (i.e. elite or non-elite) (5) Recommendations reported. A total of 220 records were found. Following title and abstract screening, 61 studies were eligible for full text screening. Overall, no studies, commentaries, editorials or reviews provided specific recommendations for "long COVID" defined as COVID-19 signs and symptoms lasting for over 4 weeks as a result of COVID-19 infection. In addition, we found no studies which reported symptoms of athletes suffering from long COVID. Despite the lack of evidence, we did find eight separate professional recommendations for managing "long-term effects" and "ongoing" or "prolonged" symptoms and COVID-19 complications among athletes. Practitioners should be aware of both mental and physical symptoms of long COVID, and additional considerations may be required for athletes who have undergone intensive care. The present review provides a list of recommendations based on existing literature that may be followed and implemented for returning athletes.Key MessagesFurther research, including longitudinal research of athletes who have tested positive for COVID-19, is required to develop evidenced-based guidelines for athletes with ongoing COVID-19 symptoms.Prior to returning to play after COVID-19 infection, a thorough medical history, physical and psychological examination should be conducted by a medical professional.Athletes should continue to monitor and record their own physical and psychological markers of health.

High-heeled shoes adversely affect spinal curvature, increase the risk of low back pain, and disturb the normal gait pattern. The purpose of this study was to examine, from a biopsychosocial point of view, the combined effect of wearing two different heel heights and of hormonal oscillation throughout different phases of the menstrual cycle on spinopelvic alignment. Notably, 70 females with an average age of 20.42 ± 1.51 years participated in this study, wearing each female two different heel heights as follows: low (2.5 cm) and high (7 cm). Spinopelvic alignment was evaluated by rasterstereography formetric 3D analysis during early follicular, ovulatory, and mid-luteal phases of the menstrual cycle. Statistical analysis showed that there was no significant difference ( p > 0.05) on spinopelvic alignment [kyphotic angle (KA), trunk inclination (TI), and pelvic inclination] between wearing low- or high-heeled shoes during early follicular, ovulatory, and mid-luteal phases of the menstrual cycle. Considering that high-heeled shoes are traditionally associated with femininity, body image, beauty, and charm, this research has important biopsychosocial implications that should be explored in detail in future studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 El-Shafei, Yousef, Hamada, Mohamed, Al-Shenqiti, Koura and López Sánchez.)

Background: There are currently no studies on visual impairment and sarcopenia. We investigated the cross-sectional association between objectively measured far vision impairment and sarcopenia in a nationally representative sample of older adults aged 65 years and over from six low- and middle-income countries (LMICs)., Methods: Cross-sectional, community-based data from the study on global ageing and adult health (SAGE) were analyzed. Far vision acuity was measured using the tumbling E LogMAR chart and classified as: no vision impairment (6/12 or better); mild vision impairment (6/18 or better but worse than 6/12); moderate vision impairment (6/60 or better but worse than 6/18); severe vision impairment (worse than 6/60). Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Associations were assessed with multivariable logistic regression., Results: Fourteen thousand five hundred and eighty five individuals aged ≥ 65 years were included in the analysis [mean (SD) age 72.6 (11.5) years; 54.1% females]. After adjustment for multiple potential confounders, compared to those with no vision impairment, the OR (95% CI) for sarcopenia in those with mild, moderate, and severe vision impairment were 1.10 (0.87-1.40), 1.69 (1.25-2.27), and 3.38 (1.69-6.77), respectively. The estimates for females and males were similar., Conclusions: The odds for sarcopenia increased with increasing severity of far vision impairment among older people in LMICs. The mere co-occurrence of these conditions is concerning, and it may be prudent to implement interventions to address/prevent sarcopenia in those with far vision impairment through the promotion of physical activity and appropriate nutrition., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: To assess the association between sexual orientation and functional limitations in a large representative sample of the English population., Design: Cross-sectional., Setting: Data were from the 2007 Adult Psychiatric Morbidity Survey., Participants: A total of 7403 adults aged 16-95 years (51.4% female; mean age, 46.3±18.6y) were included in the present study., Interventions: Not applicable., Main Outcome Measures: Sexual orientation was assessed using 2 items adapted from the Kinsey scale and was dichotomized into heterosexual and sexual minority orientation. Functional limitations were assessed using 7 activities of daily living (ADL) and instrumental activities of daily living (IADL). Functional limitations were defined as at least 1 difficulty in 1 of 7 ADL and IADL. Adjusted logistic regression analyses were conducted to investigate the association between sexual orientation (independent variable) and functional limitations (dependent variable)., Results: The level of sexual minority orientation and prevalence of functional limitations in the sample was 7.1% and 32.9%, respectively. After adjusting for several potential confounders, sexual minority orientation was positively and significantly associated with functional limitations (odds ratio, 1.51; 95% confidence interval, 1.18-1.95; reference group: heterosexual orientation)., Conclusions: Based on the findings of this study, interventions aiming to prevent against and/or manage/reduce functional limitations in sexual minorities are needed. More research is also warranted to better understand mediators (eg, obesity, cognitive complaints, psychiatric disorders) involved in the sexual orientation-functional limitation relationship., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background/aim: People with diabetes are at a greater risk of serious complications from Coronavirus disease (COVID-19). Self-management of diabetes is therefore of paramount importance. The purpose of this study is to compare self-management of diabetes pre-COVID-19 and during the COVID-19 pandemic., Methods: 679 participants with diabetes completed an online structured questionnaire survey. Various exposure variables (demographics, duration, treatment and complications of diabetes, self-isolation, etc.) were analysed to examine associations with the following outcome variables: (i) fluctuation of blood glucose levels, (ii) access to diabetes medicine, (iii) access to healthy diet, (iv) physical activity. Adjusted multiple regression analysis ascertained significant associations for each outcome variable against exposure variables., Results: Multiple regression analysis showed that self-isolation was significantly associated with greater fluctuation in blood glucose levels (OR = 1.8, 95% CI = 1.2-2.6, p = 0.005), reduced access to diabetes medicine (OR = 1.9, 95% CI = 1.1-3.1, p = 0.02) and reduced access to healthy diet (OR = 3.0, 95% CI = 2.0-4.6, p < 0.001). Fluctuation in blood glucose level was also significantly associated with having at least one complication of diabetes (OR = 2.2, 95% CI = 1.2-3.9, p = 0.008) and reduced access to diabetes medicine was significantly higher in people who were on insulin (OR = 2.1, 95% CI = 1.3-3.3, p = 0.001)., Conclusions: Self-isolation was shown to impact almost all factors that influence self-management of diabetes. A targeted approach to improved access to diabetes medicine, healthy diet for people who needed to self-isolate is vital in order to ensure that they are able to self-manage their diabetes effectively., (© 2021. The Author(s).)

Background: The goal of this study was to investigate the association between several oral health outcomes and cancer in adults living in Spain., Methods: Data from the Spanish National Health Survey 2017 were analysed. Seven oral health outcomes (dental caries, dental extraction, dental filling, gingival bleeding, tooth movement, dental material and missing tooth) were assessed with questions with 'yes' and 'no' options. Cancer was assessed and defined with the following yes-no question: 'Have you ever been diagnosed with malignant tumours?'. The relationship of each oral health outcome and the number of poor oral health outcomes with cancer was studied in regression models adjusted for sex, age, marital status, education, smoking and alcohol consumption., Results: This study included 23 089 participants aged 15-103 years [45.9% of males; mean (standard deviation) age 53.4 (18.9) years]. The prevalence of cancer was 5.0% in the overall population. After adjusting for several potential confounding factors, all oral health outcomes except missing tooth were significantly and positively associated with cancer [odds ratios (ORs) ranging from 1.15 for dental filling to 1.48 for dental extraction]. In addition, there was a positive and significant association between the number of poor oral health outcomes and cancer (OR = 1.16, 95% confidence interval = 1.11-1.22)., Conclusions: On a nationally representative sample of 23 089 participants in Spain, poorer oral health outcomes were found in participants with history of cancer, with positive associations between several oral health outcomes as well as the number of poor oral health outcomes and cancer., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

This study aimed to analyse the temporal change of diabetes and any associated risk and protective factors for diabetes in Chinese adults between Wave 0 (2003) and Wave 1 (2009) of the World Health Organization (WHO) Study on global AGEing and adult health (SAGE). Data from China of the SAGE were analysed. Diabetes (outcome variable) was assessed by the yes/no question: "Have you ever been diagnosed with diabetes (high blood sugar)?". Exposure variables examined in bivariate and multivariate multiple regression included sex, age, marital status, education, smoking, alcohol, fruit and vegetables consumption, physical activity and body mass index (BMI). Significant exposure variables in bivariate analyses were included in multivariate analyses (2003: age and tobacco; 2009: age, BMI, education and alcohol). In Wave 0 (2003), there were 3993 Chinese adults, of which 67 (1.7%) self-reported to have diabetes. In Wave 1 (2009), there were a total of 9524 Chinese adults, of which 770 (8.1%) had diabetes. The overall prevalence of diabetes in Chinese adults increased by 4.76 times between the two timeframes (1.7%, age range 27-84 years, average age 58.51 ± 12.70 years, 59.70% females in 2003 to 8.1%, age range 20-95 years, average age 65.31 ± 10.19 years, 53.64% females in 2009). Multivariate regression retained older age ≥ 60 years (OR 4.34, 95% CI 2.67-7.07) as the main risk factor in 2003 data, while in 2009 the odds ratio for older age ≥ 60 years decreased (OR 2.45, 95% CI 2.06-2.92), but included a significant association of obesity (OR 2.11, 95% CI 1.60-2.78) and excess weight (OR 1.42, 95% CI 1.19-1.69). The significant association with excess weight and obesity associated with the increased prevalence of diabetes in 2009 is a cause of concern and should be addressed by public health strategies in China., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Background: The limited available literature suggests that sleep problems are linked to an increased risk of mild cognitive impairment (MCI). However, this association has been little studied to date in low-income settings., Objective: To investigate the association between sleep problems and MCI in a large sample of adults from six low-and middle-income countries (LMICs)., Design: Cross-sectional., Setting: Study on Global Ageing and Adult Health (SAGE)., Subjects: 32,715 individuals aged ≥50 years with preservation in functional abilities [age range 50-114 years; 51.7% females]., Methods: MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Sleep problems were assessed by the question "Overall in the last 30 days, how much of a problem did you have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning?" and categorized as "None", "Mild", "Moderate", "Severe/Extreme". Multivariable logistic regression analysis and meta-analysis were conducted., Results: Compared to no sleep problems, mild, moderate, and severe/extreme sleep problems were associated with significant 1.40, 1.83, and 2.69 times higher odds for MCI with similar associations being observed between age groups and sex. Severe/extreme sleep problems were positively associated with MCI (i.e., OR > 1) in the six countries studied with the overall estimate being OR = 1.80 (95% CI = 1.50-2.16), and a low level of between-country heterogeneity was observed (I 2  = 28.2%)., Conclusions: Sleep problems were associated with higher odds for MCI. Interventions to improve sleep quality among middle-aged and older adults in LMICs may be an effective strategy in reducing risk of MCI and dementia., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aim: The association between visual impairment and mild cognitive impairment (MCI) has not been investigated to date. Thus, we assessed this association among older adults from six low- and middle-income countries (LMICs) (China, India, Ghana, Mexico, Russia, and South Africa) using nationally representative datasets., Methods: Cross-sectional, community-based data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Visual acuity was measured using the tumbling ElogMAR chart, and vision impairment (at distance and near) was defined as visual acuity worse than 6/18 (0.48 logMAR) in the better-seeing eye. The definition of MCI was based on the National Institute on Aging-Alzheimer's Association criteria. Multivariable logistic regression was conducted., Results: Data on 32,715 individuals aged ≥ 50 years [mean (SD) age 62.1 (15.6) years; 51.2% females] were analyzed. Compared to those without far or near vision impairment, those with near vision impairment but not far vision impairment (OR = 1.33; 95% CI = 1.16-1.52), and those with both far and near vision impairment (OR = 1.70; 95% CI = 1.27-2.29) had significantly higher odds for MCI. Only having far vision impairment was not significantly associated with MCI., Conclusions: Visual impairment is associated with increased odds for MCI among older adults in LMICs with the exception of far vision impairment only. Future longitudinal and intervention studies should examine causality and whether improvements in visual acuity, or early intervention, can reduce risk for MCI and ultimately, dementia., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature.)

Introduction: Previous studies on the diabetes-edentulism relationship have yielded conflicting results. Therefore, the goal of this study was to investigate the association between diabetes and edentulism, and their joint effects on health status in adults from 40 low and middle-income countries (LMICs)., Research Design and Methods: Data from the World Health Survey were used for this cross-sectional study (2002-2004). Forty countries (18 low-income and 22 middle-income countries) were included. Edentulism and diabetes were assessed using yes-no questions based on self-report. Health status was assessed in seven different domains (self-care, pain/discomfort, cognition, interpersonal activities, sleep/energy, affect, and perceived stress). The association between diabetes (exposure) and edentulism (outcome) was analyzed using multivariable logistic regression models, while their joint effects on health status were assessed using multivariable linear regression models., Results: There were 175 814 adults aged ≥18 years included in this study (mean (SD) age 38.4 (16.0) years; 49.3% men). Overall, the prevalence of edentulism was 6.0% and diabetes was 2.9%. There was a positive and significant association between diabetes and edentulism in the overall sample (OR=1.40, 95% CI 1.18 to 1.66), in low-income countries (OR=1.78, 95% CI 1.21 to 2.62) and in middle-income countries (OR=1.24, 95% CI 1.04 to 1.47). In addition, people with comorbid diabetes and edentulism had worse health status in the domains of cognition, sleep/energy, and perceived stress, compared with those with diabetes only., Conclusions: Diabetes was positively associated with edentulism in this sample of more than 175 000 individuals living in LMICs. Providing oral care to individuals with diabetes may potentially lead to a reduction in their risk of edentulism., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: We investigated the association between food insecurity and fall-related injury among older adults from six low- and middle-income countries (LMICs), and the extent to which this association is mediated by mental health., Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Fall-related injury referred to those that occurred in the past 12 months. Multivariable logistic regression analysis and mediation analysis were conducted to assess associations., Results: Data on 14,585 adults aged ≥65 years [mean (SD) age 72.5 (11.5) years; 54.9% females] were analyzed. After adjustment for potential confounders, severe food insecurity (versus no food insecurity) was associated with 1.95 (95%CI = 1.11-3.41) times higher odds for fall-related injury. Moderate food insecurity was not significantly associated with fall-related injury (OR = 1.34; 95%CI = 0.81-2.25). The mediation analysis showed that 37.3%, 21.8%, 17.7%, and 14.0% of the association between severe food insecurity and fall-related injury was explained by anxiety, sleep problems, depression, and cognition, respectively., Conclusion: Severe food insecurity was associated with higher odds for injurious falls among older adults in LMICs, and a large proportion of this association may be explained by mental health complications. Interventions to improve mental health among those who are food insecure and a strong focus on societal and government efforts to reduce food insecurity may contribute to a decrease in injurious falls., (Copyright © 2021 Elsevier B.V. All rights reserved.)