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Background: Recent evidence has suggested that chronic physical activities including balance exercises have positive effects on cognition, but their acute effects are still unknown. In the present study, the authors tested the hypothesis that an acute bout of balance exercise would enhance cognitive performance compared with aerobic activity. Methods: A total of 20 healthy middleaged adults completed 2 acute 30-minute balance and moderate-intensity aerobic exercise sessions on 2 counterbalanced separate occasions. To assess cognitive functions, performance tasks in executive control, perceptual speed, and simple reaction time were tested before and immediately after each exercise session. Results: Although there were no significant interactions (time × exercise condition, P > .05), the main effects of time were significant in executive control (P < .05), perceptual speed (P < .05), and simple reaction time (P < .001), showing improvements after both exercises. Conclusions: These findings highlight that both types of exercise (aerobic, more metabolic and less cognitively demanding; balance, more cognitively and less metabolically demanding) were able to positively affect simple reaction time performance, perceptual speed, and executive control independently of physiological adjustments occurring during aerobic or balance exercise. [ABSTRACT FROM AUTHOR]

Background: The life expectancy of individuals with trisomy 21 (Down syndrome, DS) has risen to more than 60 years over the past few decades. As a result, diseases arising in mid and later life have become an issue of major concern in the care of individuals with DS. This article discusses and summarizes, from a multidisciplinary perspective, the diseases commonly affecting this population. Methods: This narrative review is based on publications identified by a selective literature search, extrapolation of the available evidence, and the authors' personal experience. Results: Robust epidemiological evidence indicates that many different diseases, which are dealt with by many different medical specialties, are more common in individuals with DS. The genetic background of some of these diseases is now understood down to the molecular level, e.g., primary hypothyroidism or Alzheimer's disease in DS. Recent gains in epidemiological and pathophysiological understanding contrast with a dearth of evidence on treatment for most of these disorders. Conclusion: In view of the complexity of DS-associated morbidity, it would be desirable for DS-specific multidisciplinary care to be made available to patients with DS. [ABSTRACT FROM AUTHOR]

Limited research exists regarding the effects of resistance exercise (RE) combined with whole body vibration (WBV), blood flow restriction (BFR), or both on the neuropsychological performance of working memory (WM) in late-middle-aged and older adults and regarding the physiological mechanisms underlying this effect. This study thus explored the acute molecular and neurophysiological mechanisms underlying WM performance following RE combined with WBV, BFR, or both. Sixty-six participants were randomly assigned into a WBV, BFR, or WBV + BFR group. Before and after the participants engaged in a single bout of isometric RE combined with WBV, BFR, or both, this study gathered data on several neurocognitive measures of WM performance, namely, accuracy rate (AR), reaction time (RT), and brain event-related potential (specifically P3 latency and amplitude), and data on biochemical indices, such as the levels of insulin-like growth factor-1 (IGF-1), norepinephrine (NE), and brain-derived neurotrophic factor (BDNF). Although none of the RE modalities significantly affected RTs and P3 latencies, ARs and P3 amplitudes significantly improved in the WBV and WBV + BFR groups. The WBV + BFR group exhibited greater improvements than the WBV group did. Following acute RE combined with WBV, BFR, or both, IGF-1 and NE levels significantly increased in all groups, whereas BDNF levels did not change. Crucially, only the changes in NE levels were significantly correlated with improvements in ARs in the WBV + BFR and WBV groups. The findings suggest that combining acute RE with WBV, BFR, or both could distinctively mitigate neurocognitive decline in late-middle-aged and older adults. • Resistance exercise, when paired with WBV, BFR, or both, proves effective in mitigating cognitive decline in the elderly. • The RE + WBV + BFR showed greater enhancements in neurocognitive performance compared to RE + WBV alone. • Changes in NE levels postexercise were significantly correlated with improvements in working memory. [ABSTRACT FROM AUTHOR]

Objective: This study examined the association between parenting adult children with serious conditions and mothers' midlife health in the United States. Background: The literature about the link between the parenting status of having an adult child with a serious condition and maternal wellbeing can be advanced by systematic analysis of the cumulative role that this parenting status can play in maternal health over the life course as opposed to at any one point. Methods: Propensity score reweighting models of data from the National Longitudinal Study of Youth 1979 and its linked child and young adult data estimated disparities in midlife health among mothers of adult children with serious conditions (disabilities, developmental disorders, chronic diseases) and mothers of typically developing children, including examining variation by how long mothers had been in this parenting role and moderation by maternal education and marital status. Results: Mothers of young adult children with serious conditions had poorer physical (but not mental) health at midlife than other mothers, especially when more years had elapsed since the child was diagnosed with or developed the condition. These patterns did not differ by maternal education and marital status. Conclusion: The dynamics of epidemiological risk and protection among parents of children with serious conditions were temporally situated in the maternal life course but were consistent across different segments of the maternal population. [ABSTRACT FROM AUTHOR]

Background: Healthy lifestyle is associated with reduced all‐cause mortality, but it is not known whether this association persists for individuals with high medication burden. We examined the association between healthy lifestyle behaviors and all‐cause mortality across different degrees of polypharmacy. Methods: This was a secondary analysis of 20,417 adults aged ≥45 years from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. The primary exposure was healthy lifestyle (adherence to Mediterranean diet, physical activity, smoking abstinence, sedentary behavior avoidance, and composite healthy behavior score [HBS]). The primary outcome was all‐cause mortality. Strata of medication burden were based on the number of medications taken (no polypharmacy: 0–4, polypharmacy: 5–9, hyperpolypharmacy: ≥10). We used Cox proportional hazards regression models to examine the association between healthy lifestyle behaviors and mortality within each medication burden stratum and examined for interactions with age. Results: The healthiest category of each lifestyle behavior, except sedentary behavior avoidance among the hyperpolypharmacy group, was associated with lower all‐cause mortality (hazard ratio [HR]) regardless of medication burden: Mediterranean diet (no polypharmacy: HR 0.77, polypharmacy: HR 0.78, hyperpolypharmacy: HR 0.85), physical activity (no polypharmacy: HR 0.87, polypharmacy: HR 0.82, hyperpolypharmacy: HR 0.79), smoking abstinence (no polypharmacy: HR 0.40, polypharmacy: HR 0.45, hyperpolypharmacy: HR 0.52), and sedentary behavior avoidance (no polypharmacy: HR 0.88, polypharmacy: HR 0.86, hyperpolypharmacy: HR 0.95). Higher HBS was inversely associated with all‐cause mortality within each medication burden stratum (no polypharmacy: HR 0.52, polypharmacy: HR 0.55, hyperpolypharmacy: HR 0.69). Although there was an interaction with age among those with no polypharmacy and those with polypharmacy, point estimates for HBS followed a graded pattern whereby higher HBS was incrementally associated with improved mortality across all age strata. Conclusion: Greater adherence to a healthy lifestyle was associated with lower all‐cause mortality irrespective of medication burden and age. [ABSTRACT FROM AUTHOR]

Background-. Several obesity related factors are reported to exacerbate premature arterial stiffening, including inactivity and metabolic disarray. The aim of the current study was to investigate the relationship between physical activity, arterial stiffness and adiposity using objective methods. To lurther explore the role of adiposity in this complex process, obesity associated anthropometric and humoral biomarkers were measured. Methods-. Seventy-nine healthy, lifelong nonsmoking subjects were recruited. Habitual physical activity was measured using accelerometry. Arterial stiffness [augmentation index (AIx) and pulse wave velocity (PWV)] was measured using tonometry. Body composition was estimated using bioimpedence. Adipose associated biomarkers, leptin and adiponectin, were also measured. Results: Sedentary time was significantly associated with AIx (r = 0.38, P < .001), PWV (r = 0.33, P < .01), body fat composition (r = 0.40, P < .001) and age (r = 0.30, P < .01). Moderate-to-vigorous physical activity (MVPA) was inversely correlated with AIx (r = -0.28, P < .05), body fat composition (r = -0.30, P < .01), postprandial insulin (r = -0.35, P < .01), and leptin/adiponectin ratio (r = -0.28, P < .05). MVPA, body fat composition, and postprandial insulin remained independent predictors of AIx but not PWV. Conclusion: The more time healthy individuals spend being sedentary, the greater their body fat and arterial stiffness. Conversely higher activity levels are associated with reduced body fat and less arterial stiffness. [ABSTRACT FROM AUTHOR]

Physical inactivity is a pandemic that requires intensive, usually costly efforts for risk reduction of related chronic diseases. Nevertheless, it is challenging to determine the effectiveness of physical activity in healthcare cost reduction based on existing literature. Therefore, this study aimed to investigate the impact of physical activity (daily steps) on healthcare costs utilising the data retrieved from a health promotion project (the e-wellness Project, held in three municipalities in Japan). Evaluating the effects of daily steps, measured by pedometers, on healthcare costs by a quasi-experimental approach among participants aged 40–75 years (about 4000 person-years of observation, between 2009 and 2013), we found that a one-step-increase in the annual average daily step reduced outpatient healthcare costs by 16.26 JPY (≒ 0.11 GBD) in the short run. Based on the assumption of a dynamic relationship between the health statuses in multiple years, the long-run effects of daily steps on healthcare costs were estimated at 28.24 JPY (≒ 0.20 GBD). We determined the health benefits of walking in a sample of middle-aged and older Japanese adults by our findings that an increase in step counts reduced healthcare costs. [ABSTRACT FROM AUTHOR]

Systemic immune-inflammation index (SII) emerged as a biomarker of chronic inflammation and an independent prognostic factor for many cancers. We aimed to investigate the associations of SII level with total and cause-specific mortality risks in the general populations, and the potential modification effects of lifestyle-related factors on the above associations. In this study, we included 30,521 subjects from the Dongfeng-Tongji (DFTJ) cohort and 25,761 subjects from the National Health and Nutrition Examination Survey (NHANES) 1999–2014. Cox proportional hazards regression models were used to estimate the associations of SII with mortality from all-cause, cardiovascular diseases (CVD), cancer and other causes. In the DFTJ cohort, compared to subjects in the low SII subgroup, those within the middle and high SII subgroups had increased risks of total mortality [hazard ratio, HR (95% confidence interval, CI) = 1.12 (1.03–1.22) and 1.26 (1.16–1.36), respectively) and CVD mortality [HR (95%CI) = 1.36 (1.19–1.55) and 1.50 (1.32–1.71), respectively]; those within the high SII subgroup had a higher risk of other causes mortality [HR (95%CI) = 1.28 (1.09–1.49)]. In the NHANES 1999–2014, subjects in the high SII subgroup had higher risks of total, CVD, cancer and other causes mortality [HR (95%CI) = 1.38 (1.27–1.49), 1.33 (1.11–1.59), 1.22 (1.04–1.45) and 1.47 (1.32–1.63), respectively]. For subjects with a high level of SII, physical activity could attenuate a separate 30% and 32% risk of total and CVD mortality in the DFTJ cohort, and a separate 41% and 59% risk of total and CVD mortality in the NHANES 1999–2014. Our study suggested high SII level may increase total and CVD mortality in the general populations and physical activity exerted a beneficial effect on the above associations. [ABSTRACT FROM AUTHOR]

Background: Serum potassium levels have been positively associated with cardiovascular mortality, but little is known about the association with cancer mortality and death due to other causes. We examined whether serum levels of potassium were associated with long-term mortality in a healthy cohort.Methods: Oslo Ischemia Study invited 2341 initially healthy men aged 40-59 years with no use of medication to a comprehensive health survey in 1972. Fasting serum level of potassium (mmol/L) was ascertained at baseline for 1989 men. We have complete follow-up for death throughout 2017. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) and adjusted for multiple confounders.Results: After a median follow-up of 30 years (interquartile range 21.2-38.7), 1736 deaths were observed, of which 494 were cancer deaths, 688 cardiovascular deaths, and 536 deaths related to other causes. Restricted cubic spline analysis showed that potassium level was linearly and positively associated with long-term cancer mortality; HR per mmol/L 1.8, 95% CI 1.4-2.4. Compared with low levels of potassium (≤ 4.0 mmol/L), men with high levels (≥4.6 mmol/L) showed a significantly 78% higher risk of cancer death. A positive linear association was found for all-cause mortality (HR per mmol/L 1.6, 95% CI 1.4-1.8), and for cardiovascular (HR per mmol/L 1.4, 95% CI 1.1-1.7) and other cause mortality (HR per mmol/L 1.7, 95% CI 1.3-2.2).Conclusions: These findings suggest that serum potassium level appears to predict long-term mortality in healthy middle-aged men, and it might imply future surveillance strategies for individuals with high serum potassium levels. [ABSTRACT FROM AUTHOR]

Background: The relationship between sleep duration and physical fitness is one aspect of sleep health. Potential factors associated with sleep duration interfere with physical fitness performance, but the impact trends on physical fitness indicators remain unclear.Methods: This study examined associations between sleep duration and physical fitness among young to middle-aged adults in Taiwan. A total of 42,781 Taiwanese adults aged 23-45 participated in the National Physical Fitness Examination Survey 2013 (NPFES-2013) in Taiwan between October 2013 and March 2014. A standardized structural questionnaire was used to record participants' sleep duration, which was stratified as short (< 6 h/day (h/d)), moderate (6-7 h/d; 7-8 h/d; 8-9 h), and long (≥ 9 h/d) sleep duration groups. Physical fitness was assessed based on four components: body composition (body mass index [BMI], waist-to-height ratio [WHtR], and waist-to-hip ratio [WHR]), muscle strength and endurance (1-min bent-leg sit-up test [BS]), flexibility (sit-and-reach test [SR]), and cardiorespiratory endurance index (3-min step test [CEI]).Results: By using analysis of covariance (ANCOVA), after sex grouping and age adjustment, we observed that sleep duration was significantly associated with obesity, functional fitness, and self-perception of health. The sleep duration for low obesity-related values (BMI, WHtR, and WHR) for men was 7-9 h/d, and that for women was 7-8 h/d. Sleeping more than 8 h/d showed poor functional fitness performances (BS and SR). For both sexes, sleep duration of 8-9 h/d was the optimal sleep duration for self-perceptions of health.Conclusions: Our research found that there were wide and different associations of sleep duration with physical fitness and self-perception of health among Taiwanese adults aged 23-45, and there were differences in these associated manifestations between men and women. This study could be of great importance in regional public health management in Taiwan, and provide inspirations for clinical research on physical fitness. [ABSTRACT FROM AUTHOR]

Objective: Sleep plays an important role in the health and well-being of middle aged and elderly people, and social capital may be one of the important factors for sleep disorders. This study aimed to understand the relationship between social capital and sleep disorders in a unique region of China -Tibet that generally has the disadvantaged economic status compared to other parts of China.Methods: The study was based on Tibetan data from The China Multi-Ethnic Cohort (CMEC) and was conducted from May 2018 to September 2019. A total of 3194 Tibetans aged > 50 were selected from the community population by multi-stage stratified cluster sampling. Social capital was measured using two validated health-related social capital scales, family/community and society.. Sleep disorders were measured as the presence of disorders of initiating and maintaining sleep, early morning awakening, or daytime dysfunction. Logistic regression models were applied to examine the association between social capital and sleep disorders.Results: 39.9% (1271/3194) of the participants had sleep disorders. In addition, after controlling for all potential variables, family social capital was significantly negatively associated with sleep disorders (OR = 0.95, P < 0.05), while community and society social capital was not associated with sleep disorders. Then, when we did all the sex-stratified analyses, the significant association between social capital and sleep disorders was found only in women (OR = 0.94, P < 0.05), while no association was found in males; neither males nor females showed any association with community and society social capital.Conclusion: Our study would help to better understand the extent of health inequality in China, and guide future interventions, strategies and policies to promote sleep quality in low-income areas, taking into account both the role of Tibetan specific cultural traditions, lifestyles and religious beliefs in social capital and the gender differences in social capital. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate (1) the association between solid fuel use for cooking and cognitive function; (2) the moderating effects of gender and residential area on cognitive scores among solid fuel users; and (3) the effects of solid fuel use on cognitive decline among different gender and age subgroups in 2011–2018. A total of 5140 Chinese middle-aged and elderly participants were successfully followed for 7 years (2011–2018). Solid fuel use was self-reported as using solid fuel for cooking at home, and cognitive function was assessed by 4 parts: episodic memory, time orientation, numerical ability and picture drawing. After adjusting for covariates, solid fuel users had lower cognitive scores, and the moderation effects of gender and residence on cognitive function were significant among the solid fuel users. In addition, compared with the group of clean fuel users, solid fuel users had a faster decline rate of cognitive function among the subgroups of female and elderly people. [ABSTRACT FROM AUTHOR]

The association of physical activity and fitness with sleep still remains unclear since there is a lack of studies in this field of research using objective measurements of these variables. This study aimed to investigate the association of objectively-measured sedentariness, physical activity levels, and physical fitness with sleep quantity and quality in sedentary middle-aged adults. A total of 74 volunteers (52.7% women; aged 53.7 ± 5.1) were recruited for the present study. Cardiorespiratory fitness was measured through a maximal treadmill test, and muscular strength by extension and flexion peak torque, and by the hand grip test. Physical activity and objective sleep parameters were determined through accelerometry, and subjective sleep by the Pittsburgh Sleep Quality Index (PSQI). Reduced levels of sedentariness, greater VO2max, and greater muscular strength were positively related to improved objective sleep quantity and quality (all P ≤ 0.05). Furthermore, higher levels of overall physical activity, VO2max, and muscular strength were related to better subjective sleep quantity and quality (all P ≤ 0.05). Reduced sedentariness and increased physical activity and fitness may be a potential prevention and/or treatment pathway to reduce sleep disturbances and, in general, to improve patients physical and psychological health for a successful aging process. [ABSTRACT FROM AUTHOR]

Progressive supranuclear palsy [Steele-Richardson-Olszewski] is a neurodegenerative disease of the central nervous system. It develops mainly in men over 40 years of age. The course of PSP is rather characteristic: motor, cognitive and non-cognitive impairments develop at a fairly rapid rate. The aim of the study is to assess interactional, communicative and linguistic competencies and skills, executive abilities (breathing, phonation and articulation) as well as primary functions of a patient diagnosed with PSP. The article confirms the thesis that dementia disorders overlap with motor disorders in the course of PSP. [ABSTRACT FROM AUTHOR]

Background: Many studies have examined the impact of social insurance on health, but the results have generally been mixed, presumably because they have not fully addressed potential biases related to the study's cross-sectional design. In this study, we conducted a longitudinal analysis to investigate how participation in two social insurance programs in China-the New Rural Social Pension Insurance (NRSPI) and the New Rural Cooperative Medical Scheme (NRCMS)-was associated with health outcomes among middle-aged and older adults in rural China.Methods: Using three-wave longitudinal data from the China Health and Retirement Longitudinal Study conducted in 2011, 2013, and 2015, we estimated the dynamic fixed-effects regression models to examine the association between participation in the NRCMS/NRSPI and six types of health outcomes.Results: Participation in the NRSPI was positively associated with some health outcomes, but the associations were relatively modest and were observed only for some specific age and household income groups. Participation in NRCMS was not associated with any health outcomes.Conclusions: The results provide limited evidence of the positive impact of social insurance on health among middle-aged and older adults in rural China. Thus, social insurance programs should be reformed to enhance their positive impact on health. [ABSTRACT FROM AUTHOR]

Background: Pedometers are becoming widely accepted for physical activity measurement. To use step data effectively, an index which categorizes steps/day by < 5000, > 5000, > 7500, > 10,000, and > 12,500 steps/ day has been previously proposed. However, evidence is insufficient to validate this index compared with health outcomes. This study examined the association of steps/day categories with cardiovascular (CVD) risk. Methods: Cross-sectional data from the National Health and Nutrition Survey of Japan 2006, including 1166 men and 1453 women aged 40-64 years, were analyzed to calculate odds ratios (OR) for having CVD risk including overweight/obesity, blood pressure, high density lipoprotein cholesterol, hemoglobin Ale, and clustered risk factors by steps/day categories. Results: Among men, inverse gradient associations between steps/day categories and CVD risk (overweight/obesity, blood pressure, HbAlc, and clustered risk factors) were observed. Among women, those taking > 5000 steps/day had substantially lower risk of overweight/ obesity and high blood pressure compared with those taking < 5000 steps/day. However, additional decreases of OR by taking more steps were modest among women. Conclusions: CVD risk was generally lower with higher steps/day categories. Given the limitations of cross-sectional design, further studies, especially using longitudinal designs, are needed to precisely calibrate the association between steps/day and CVD risk. [ABSTRACT FROM AUTHOR]

Despite midlife adults accounting for a substantial and growing segment of the population, few large-scale studies have investigated factors which distinguish highly satisfying relationships from less satisfying ones in midlife. In a subsample of partnered 40-59-year-old Canadians (705 men, 743 women), relationship characteristics, sexual activity and communication, and health were investigated individually and simultaneously as predictors of high emotional and sexual satisfaction. Though the vast majority of participants reported being at least somewhat satisfied in their current relationship, less than half reported high satisfaction. For men and women, high emotional and sexual satisfactions were strongly linked. Logistic regressions indicated that longer relationships, dating relationships, and greater subjective overall health predicted high emotional satisfaction for men, whereas older age, married or cohabiting relationships, and frequent sexual communication predicted high emotional satisfaction for women. All types of sexual activities (minus penile-anal intercourse) were bivariately related to high emotional and sexual satisfaction. More frequent partnered sexual activity predicted high emotional and sexual satisfaction for men and women in regression analyses. More frequent sexual communication predicted high emotional satisfaction for women and high sexual satisfaction for both men and women. Newer relationships were more sexually satisfying for men. Postmenopausal women were less likely to be highly sexually satisfied. Findings suggest that physical health conditions are not generally related to high levels of satisfaction in midlife couples and that frequently discussing sex and engaging in (any) sexual activity with a partner are key components of highly satisfying relationships. [ABSTRACT FROM AUTHOR]

In young patients with acute pulmonary embolism (PE), the predictive value of currently available prognostic tools has not been evaluated. Our objective was to compare prognostic value of 7 available tools (GPS, PESI, sPESI, Prognostic Algorithm, PREP, shock index and RIETE) in patients aged <50 years. We used the RIETE database, including PE patients from 2001 to 2017. The major outcome was 30-day all-cause mortality. Of 34,651 patients with acute PE, 5,822 (17%) were aged <50 years. Of these, 83 (1.4%) died during the first 30 days. Number of patients deemed low risk with tools was: PREP (95.9%), GPS (89.6%), PESI (87.2%), Shock index (70.9%), sPESI (59.4%), Prognostic algorithm (58%) and RIETE score (48.6%). The tools with a highest sensitivity were: Prognostic Algorithm (91.6%; 95% CI: 85.6–97.5), RIETE score (90.4%; 95%CI: 84.0–96.7) and sPESI (88%; 95% CI: 81–95). The RIETE, Prognostic Algorithm and sPESI scores obtained the highest overall sensitivity estimates for also predicting 7- and 90-day all-cause mortality, 30-day PE-related mortality, 30-day major bleeding and 30-day VTE recurrences. The proportion of low-risk patients who died within the first 30 days was lowest using the Prognostic Algorithm (0.2%), RIETE (0.3%) or sPESI (0.3%) scores. In PE patients less 50 years, 30-day mortality was low. Although sPESI, RIETE and Prognostic Algorithm scores were the most sensitive tools to identify patients at low risk to die, other tools should be evaluated in this population to obtain more efficient results. [ABSTRACT FROM AUTHOR]

Background: Most ischemic heart disease (IHD) prevention programs that promote physical activity (PA) have focused on overweight/obese populations. Persons with normal body mass index (BMI) may mistakenly think that they are not at risk for IHD and remain physically inactive. Studies exploring the risk of IHD and PA level among adults aged 45 years and older with normal weight are limited. Methods: Cross-sectional study to examine the prevalence of IHD and PA level among 94455 respondents aged 45 years and older with normal BMI using the 2007 Behavioral Risk Factor Surveillance System data. Results: Approximately 50% of respondents reported low/inactive PA. The prevalence of IHD among persons with inactive, low, medium, and high PA was 16.6% (95% CI = 15.1-18.1%), 9.6% (8.9-10.3%), 8.9% (8.3-9.6%), and 5.4% (4.9-5.9%). The adjusted odds ratios of IHD among persons with low, medium, and high PA compared with those with inactive PA was 0.68 (95% CI = 0.59-0.79), 0.63 (0.54-0.73), and 0.49 (0.42-0.57). Conclusions: The percentage of respondents with low or inactive PA among populations aged 45 years and older with BMI 18 to <25 was alarmingly high and independently associated with higher IHD prevalence. Persons who are not overweight/obese still need to have adequate PA to reduce the risk of IHD. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to validate the Actical activity monitor in middle-aged and older adults of varying body composition to develop accelerometer thresholds to distinguish between light and moderate intensity physical activity (PA). Methods: Nonobese 45 to 64 yr (N = 29), obese 45 to 64 yr (N = 21), and ≥65 yr (N = 23; varying body composition) participants completed laboratory-based sitting, household, and locomotive activities while wearing an Actical monitor and a portable metabolic measurement system. Non-linear regression analysis was used to identify activity count (AC) cut-points to differentiate between light intensity (<3 METs) and moderate intensity (≥3METs) PA. Results: Using group-specific algorithms, AC cut points for 3 METs were 1634, 1107, and 431 for the obese 45 to 64 yr group, nonobese 45 to 64 yr group, and ≥65 yr group, respectively. However, sensitivity and specificity analysis revealed that an AC cut-point of 1065 yielded similar accuracy for detecting an activity as less than or greater than 3 METs, regardless of age and body composition. Conclusion: For the Actical activity monitor, an AC cut-point of 1065 can be used to determine light and moderate intensity PA in people ≥45 years of age. [ABSTRACT FROM AUTHOR]

Background: The influence of physical activity (PA) changes on risk of abdominal fat gain in midlife women has not been studied using objective measures and controlling for potentially confounding variables. Methods: Changes in PA were assessed within a prospective cohort of 233 middle-age (40 ± 3 years), nonobese, nonsmoking, primarily Caucasian women by using accelerometers, worn continuously for 7 consecutive days at baseline and again at a 20 month follow-up. Weighed food intake diaries were completed on concurrent days. Bod Pod assessed total body fat. Abdominal fat was measured by abdominal circumference at the umbilicus. Results: Women who decreased PA gained abdominal fat across 20 months, while women who increased PA (F = 4.82, P = .009) did not. Change in PA remained an independent predictor of abdominal fat change after adjusting for potential confounders, including changes in total body fat and total energy intake. Compared with women who maintained or decreased PA, women who increased PA had approximately half the risk (RR = 0.52, 95% CI: 0.27, 0.98) of gaining abdominal fat. Conclusions: Increasing daily physical activity may attenuate risk of abdominal fat gain in middle-age women independent of changes in total body fat or energy intake. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to determine if cardiorespiratory fitness at baseline, and changes in fitness, influence risk of weight gain (≥3 kg) over 20 months. Another aim was to ascertain if potential confounding factors, including age, education, strength training, energy intake, and weight, influence risk of weight gain. Methods: In a prospective study of 257 women, fitness (VO2max) was assessed using a graded, maximal treadmill test at baseline and follow-up. Energy intake was measured using 7-day, weighed food records. Subjects were divided into quartiles based on fitness. Risk ratios were used to show the risk of weight gain among those who were fit at baseline compared with their counterparts. Results: Most women gained weight and 23% gained ≥3 kg. Mean VO2max was 35.7 ± 7.2 mL·kg-1·min-1. Women with low-fitness at baseline had 3.18 times (95% CI: 1.46 to 6.93) greater risk, and moderately fit women had 2.24 times (95% CI: 1.04 to 4.82) greater risk of weight gain than women in the high-fitness quartile. Adjusting for potential confounders had little effect on results. Conclusions: High levels of fitness seem to help protect middle-aged women against weight gain, whereas low and moderate fitness increase risk of weight gain over time. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Middle age has been identified as a critical time period for health later in life. Identifying factors associated with worse brain function in middle‐aged adults may help identify ways to preserve brain function with aging. Our objective was to evaluate factors associated with a novel measure of brain aging in middle‐aged and older adults. DESIGN: Longitudinal cohort study. SETTING: Beaver Dam Offspring Study (BOSS) baseline (2005‐2008), 5‐year (2010‐2013), and 10‐year examinations (2015‐2017). PARTICIPANTS: A total of 2285 adults, 22 to 84 years of age, with complete sensorineural and neurocognitive data at the 5‐year examination. MEASUREMENTS: Principal component analysis (PCA) was performed combining 5‐year sensorineural (hearing, vision, olfaction) and cognitive (Trail Making Test A and B, Digit Symbol Substitution Test, Verbal Fluency Test, Auditory Verbal Learning Test) test data. Participants with a standardized PCA score less than −1 were classified as having brain aging. Incident brain aging was defined as a PCA score less than −1 at 10 years among participants who had a PCA score of −1 or higher at 5 years. Logistic regression and Poisson models were used to estimate associations between baseline factors and prevalent or incident brain aging, respectively. RESULTS: Older age, being male, current smoking, larger waist circumference, not consuming alcohol, cardiovascular disease, and interleukin‐6 were associated with greater odds of prevalent brain aging, whereas more education and exercise were associated with decreased odds. In addition to age and sex, less than a college education, higher levels of soluble intercellular adhesion molecule‐1, diabetes, depressive symptoms, and history of head injury were associated with an increased 5‐year risk of incident brain aging. CONCLUSION: In the current study, vascular and inflammatory factors were associated with a new brain aging marker in middle‐aged and older adults. Many of these factors are modifiable, highlighting the importance of addressing health and lifestyle factors in midlife to potentially preserve function for better brain health later in life. J Am Geriatr Soc 67:1610–1616, 2019 [ABSTRACT FROM AUTHOR]

Abstract Background α-Klotho is a recently discovered gene that accelerates ageing when disrupted and extends lifespan when overexpressed. The age-related decline in DHEAS and testosterone secretion and the increase in cortisol are associated with a rise of frailty and mortality. Objective To investigate the association of DHEAS, cortisol and testosterone plasma levels with S-Klotho plasma levels in healthy sedentary middle-aged adults. Methods 73 (39 women) healthy middle-aged sedentary adults (45–65 years old) were recruited for the present study. The blood samples were collected in the morning after fasting for 12 h. Results DHEAS was positively associated with S-Klotho in men (β = 0.521, R2 = 0.248, P = 0.002), whereas no association was observed in women (P ≥ 0.201). Testosterone was positively associated with S-Klotho in both men and women (β = 0.360, R2 = 0.099, P = 0.047; β = 0.431, R2 = 0.161, P = 0.010, respectively). No association was found between cortisol and S-Klotho neither in men nor in women (all P ≥ 0.141). The association between DHEAS and testosterone with S-Klotho in men disappeared after adjusting by age (all P ≥ 0.151). Nevertheless, the association between testosterone (β = 0.397, R2 = 0.423, P = 0.011) and S-Klotho in women remained after adjusting by age. Conclusions DHEAS and testosterone were positively associated with S-Klotho in healthy sedentary middle-aged men while only testosterone was positively associated in women. Graphical abstract Unlabelled Image Highlights • DHEAS and testosterone were positively associated with S-Klotho plasma levels in men. • Testosterone was positively associated with S-Klotho plasma levels in women. • DHEAS and testosterone may up-regulate α-Klotho gene expression via androgen receptor. [ABSTRACT FROM AUTHOR]

Background: While previous studies have investigated the interplay between affect and health (1) over an extended period of time, (2) in a representative population, and (3) while modelling positive and negative affect simultaneously, no single study has done all three at once. Methods: The present study accomplishes this by sampling adults from the Midlife Development in the US study who completed affect (Mroczek & Kolarz, 1998) and health measures (chronic conditions, Charlson, Szatrowski, Peterson, & Gold, 1994; functional limitations, McHorney, Ware, Lu, & Sherbourne, 1994; self‐reported health) measured three times over 20 years. We ran three (one per health metric) random‐intercept cross‐lagged panel models, where positive and negative affect were modelled simultaneously. Results: Results indicated that positive and negative affect significantly predicted future heath (functional limitations/self‐reported health) and that this relationship was reciprocal (i.e. health measures predicted future affect). However, there were no significant cross‐lagged relations between affect and chronic conditions. Conclusion: Our results suggest that both positive and negative affect play an equal role in predicting future health for functional limitations and self‐reported health as well as highlight the bi‐directionality of this relationship. Additionally, the degree to which affect predicts future health may be moderated by the type of health outcome. [ABSTRACT FROM AUTHOR]

Abstract Introduction The ageing process can be influenced by different dietary patterns and dietary factors. Aim To analyse the association of dietary factors, which include the Mediterranean diet adherence, the compliance with the "Sociedad Española de Nutrición Comunitaria" food portion recommendations, and the intake of different food groups, with the secreted form of the α-Klotho gene (S-Klotho as an anti-ageing marker) in middle-aged sedentary adults. Methods A total of 74 (39 women) middle-aged sedentary adults participated in the study. Dietary factors were assessed with a food frequency questionnaire and the PREDIMED questionnaire. The S-Klotho plasma levels were measured using a soluble α-Klotho ELISA assay kit. Results We observed: (i) a negative association between the adherence to the Mediterranean diet and the S-Klotho plasma levels (β = −53.219; R2 = 0.078; P = 0.020), (ii) a higher intake of wine (>7 glasses/week), was associated with lower S-Klotho plasma levels (P = 0.039), and (iii) a positive association between nuts portion intake and the S-Klotho plasma levels (β = 26.087; R2 = 0.070; P = 0.029). All the associations disappeared after controlling for lean mass index (LMI) (all P > 0.05). Conclusion Our study suggests that, although dietary factors could be related to S-Klotho plasma levels in middle-aged sedentary adults, LMI is the main determinant in this regard. Highlights • Plasma S-Klotho, a longevity biomarker, is influenced by dietary factors. • Higher nuts intake is associated to higher plasma S-Klotho levels. • The lean mass index is the main determinant of the associations. [ABSTRACT FROM AUTHOR]

The chronic phase of schizophrenia is characterized by illness progression and patients encountering difficulties to return to premorbid level of functioning. The objective of this study was to describe the characteristics of a sample of patients with chronic schizophrenia, as well to assess differences between patients under and over 45 years of age. In a clinical sample of 77 chronic schizophrenia patients, we assessed basic symptoms, cognitive performance, social functioning and quality of life. All participants obtained very high scores in residual symptoms, and no differences in sociodemographic or clinical characteristics between the age groups were found. Younger patients had better cognitive performance and older patients obtained better scores for social functioning and quality of life. Number of psychotropic drugs, verbal learning delayed of SCIP, errors in WCST, Similarities and Digit Symbol Coding of WAIS were the most important variables to predict global functioning of patients over 45 years old. Increasing our understanding of differences in characteristics of the chronic phase of the illness and the profile of functioning at different ages, may help us design intervention strategies to improve adaptation in young and middle-aged patients with chronic schizophrenia. [ABSTRACT FROM AUTHOR]

BACKGROUND The paper adopts a long-term perspective in analysing the association between health and employment histories, often characterized by substantial mobility over time across multiple statuses and contractual arrangements. The available evidence is largely based on static or short-run dynamic approaches and only compares across few employment statuses. OBJECTIVE We investigate how different longitudinal employment trajectories defined over multiple yearly labour market states are associated with self-reported health in middle life. METHODS We use a unique dataset linking the Italian component of the EU-SILC cross-sectional samples (2004-2012) with individuals' complete working histories from the National Social Security registers. We apply sequence and cluster analysis to reconstruct individual working histories between the ages of 15 and 45 and to identify typical trajectories. We then estimate the association between employment trajectory and self-reported health at age 45. RESULTS Trajectories characterized by intermittent working episodes and long periods of unemployment or inactivity are associated with worse health at age 45. Long-term exposure to blue-collar jobs (potentially physically demanding, more vulnerable to work accidents, and allowing for low levels of individual control) operates similarly to persisting/intermittent joblessness in terms of health outcomes. CONTRIBUTION Unlike 'point-in-time' approaches, our sequence analysis application provides unique insights into the fact that the association between the configuration of complete trajectories as they unfold over time and health in middle life are significant and substantive over and above the time spent in specific labour market arrangements (e.g., unemployment) and type of occupation (e.g., blue collar). [ABSTRACT FROM AUTHOR]

Objectives: In countries with universal health coverage (UHC), national public health insurances cover 70% of health expenditures on average, but health care user fees and out-of-pocket expenditures have been neglected in empirical patient-centered health inequality research. This study is the first to investigate how health care-related factors are associated with health status among middle-aged and elderly people—vulnerable groups for the burden of illness—in countries with UHC. Design: Longitudinal observational cohort study. Setting: Population-based cohort Survey of Health, Ageing and Retirement in Europe (SHARE) in twelve countries with UHC. Participants: Non-institutionalized people aged 50 and older (n = 29,260). Two subsamples were also used: participants without global activity limitation at baseline (n = 16,879) and participants without depression at baseline (n = 21,178). Main outcome measures: Risk of death, risk of global activity limitations, and risk of depression. We used mixed-effects Cox proportional hazards regressions to estimate hazard ratios (HR) for all-cause mortality, physical limitations, and depression. Results: Having a voluntary private insurance to cover health expenses not included in the public health care system (44.1% of the total sample) was a protective factor for all outcomes (HR≤0.91), controlling for a large range of socio-economic variables. On the contrary, having out-of-pocket expenditures (62.4%) was a risk factor (HR≥1.12). Conclusions: UHC systems are not free from health inequalities: there is a potential effect of lack of voluntary private insurance and out-of-pocket expenditures on mortality and health. Health care-related factors should be at focus in future researches designed to understand and address health inequalities. Reducing out-of-pocket expenditures and developing voluntary private insurance may protect against premature illness and death. [ABSTRACT FROM AUTHOR]

Abstract Introduction Poor sleep health is common and has a substantial negative health impact. Physical activity has been shown to improve sleep health. Many sleep interventions do not explicitly target physical activity, potentially limiting changes in activity and also sleep. Few intervention target those with poor sleep health but without a diagnosed disorder. This study aims to examine the efficacy of a combined physical activity and sleep intervention to improve sleep quality in middle-aged adults and its effect on physical activity, depression and quality of life. Methods A three-arm randomised trial with a three-month primary time-point, will be conducted. Adults (N = 275) aged 40–65 years, who report physical inactivity and poor sleep quality, will be randomly allocated to either a combined Physical Activity and Sleep Health, a Sleep Health-Only or a Wait List Control group. The multi-component m-health intervention will be delivered using a smartphone/tablet "app", supplemented with email and SMS. Participants will use the app to access educational material, set goals, self-monitor and receive feedback about behaviours. Assessments will be conducted at baseline, three-month primary time-point and six-month follow-up. Generalized linear models using an ANCOVA (baseline-adjusted) approach, will be used to identify between-group differences in sleep quality, following an intention-to-treat principle. Discussion This study will determine whether the addition of a physical activity intervention enhances the effectiveness of a sleep intervention to improve sleep quality, relative to a sleep-only intervention, in physically inactive middle-aged adults who report poor sleep health, but without a sleep disorder. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is a global epidemic and affects populations in both developing and developed countries, with differing health care and resource levels. Diabetic retinopathy (DR) is a major complication of DM and a leading cause of vision loss in working middle-aged adults. Vision loss from DR can be prevented with broad-level public health strategies, but these need to be tailored to a country’s and population’s resource setting. Designing DR screening programs, with appropriate and timely referral to facilities with trained eye care professionals, and using cost-effective treatment for vision-threatening levels of DR can prevent vision loss. The International Council of Ophthalmology Guidelines for Diabetic Eye Care 2017 summarize and offer a comprehensive guide for DR screening, referral and follow-up schedules for DR, and appropriate management of vision-threatening DR, including diabetic macular edema (DME) and proliferative DR, for countries with high- and low- or intermediate-resource settings. The guidelines include updated evidence on screening and referral criteria, the minimum requirements for a screening vision and retinal examination, follow-up care, and management of DR and DME, including laser photocoagulation and appropriate use of intravitreal anti–vascular endothelial growth factor inhibitors and, in specific situations, intravitreal corticosteroids. Recommendations for management of DR in patients during pregnancy and with concomitant cataract also are included. The guidelines offer suggestions for monitoring outcomes and indicators of success at a population level. [ABSTRACT FROM AUTHOR]

Background: The effects of skeletal muscle mass on depressive symptoms remain poorly understood, especially in the middle-aged population. We examined the relationship between skeletal muscle mass and depressive symptoms according to sex and menopausal status in the middle-aged Korean population.Methods: Herein, 1,151 men and 2,176 women aged 30-64 years completed questionnaires and underwent health examinations in the Cardiovascular and Metabolic Disease Etiology Research Center study. Appendicular skeletal muscle mass (ASM) was measured via bioelectrical impedance analysis and adjusted for height squared (ASM/Ht2). Both continuous values and tertile groups of ASM/Ht2 were used for analysis. Depressive symptoms were assessed using the Beck Depressive Inventory-II (BDI), and the prevalence of depressive symptoms was determined as a BDI score ≥ 20.Results: Multiple logistic regression analysis using a fully adjusted model showed that depressive symptoms were more frequently observed among men in the lower ASM/Ht2 tertile and middle ASM/Ht2 tertile than among those in the higher ASM/Ht2 tertile. Each 1-kg/m2 decrease in ASM/Ht2 was significantly associated with the presence of depressive symptoms in men. Such significant association was not observed among premenopausal and postmenopausal women.Limitations: The cross-sectional nature of the study design, measurement of skeletal muscle mass and depressive symptoms only once, estimation of skeletal muscle mass using bioelectrical impedance analysis, assessing depressive symptoms by self-reported questionnaire, and potential unknown confounding variables constitute the limitations of our study.Conclusions: The independent association between low skeletal muscle mass and depressive symptoms was observed in men but not in women. [ABSTRACT FROM AUTHOR]

The relationships between efficacy cognitions and causal attributions for exercise progress, and their impact on affective responses, were examined in a sample of previously sedentary middle-aged individuals 10 weeks into an exercise program. Employing theoretical propositions put forth by Bandura (1986) and Weiner (1985), it was hypothesized that exercise efficacy would influence causal attributions and affective responses to exercise participation. Path analysis demonstrated that greater exercise frequency resulted in more internal, somewhat stable, and personally controllable attributions for perceived exercise progress. More efficacious subjects also attributed their progress to more personally controllable causes. All three causal dimensions were related to positive affect, and efficacy had significant direct and indirect effects on affect. The results are discussed with respect to the need to more closely examine the role affect might play in exercise over time, as opposed to single bouts of exercise. Furthermore, the necessity for studying complex interplays of cognitive determinants of exercise behavior is discussed. [ABSTRACT FROM AUTHOR]

Emphysematous pyelonephritis (EPN) is a type of critical renal infection having dire consequences at times. It is said to be result of gases produced inside renal parenchymal tissue or pelvicalyceal system. Rarely coexistence of emphysematous pyelonephritis and emphysematous cystitis (EC) may lead to an intimidating condition in case it is not dealt with swiftly. The resent case report narrates the management of a 45-year-old female patient who suffered from EPN with concomitant EC. Right-sided emergency percutaneous nephrostomy was passed. Afterwards, Double J stent was passed under general anaesthesia. Although she had an initial improvement clinically but later on due to recurrent urinary tract infections and non-resolving right kidney abscess and fever right sided nephrectomy was done. This is a very rare presentation and has not previously reported much in literature. [ABSTRACT FROM AUTHOR]

The author is currently living with a chronic autoimmune disease known as Hashimoto’s Thyroiditis, which caused his hypothyroidism. Although this disease is most common in middle-aged women, he was diagnosed at age 23. This disease is unique, because it is not entirely visible to others. In this piece, he presents a personal narrative of his diagnosis process and utilizes poetic inquiry to demonstrate to readers what “they,” meaning individuals without an invisible chronic autoimmune disease, don’t see. [ABSTRACT FROM AUTHOR]

Background and aim: Knowledge of the impact of social determinants driving asthma–chronic obstructive pulmonary disease overlap (ACO) is lacking. Our objective was to identify determinants of incident ACO. Methods: A total of 55,053 adults (50–64 years) enrolled in the Danish Diet, Cancer, and Health cohort (1993–97) was followed in the National Patient Registry for admissions for asthma (DJ45–46) and chronic obstructive pulmonary disease (COPD; DJ40–44) and vital status. Incident ACO was defined as at least one hospital admission for both asthma and COPD (different time points, one after baseline). Detailed case history was obtained at baseline. Cox proportional hazards model was used to examine associations between possible determinants and incident ACO, in terms of hazard ratio (HR) and 95% confidence interval (CI). Results: During follow-up, 561 incident cases of ACO were identified. Age (HR 4.4, 95% CI 3.3–5.9, age group 60–65 years), current smoking (HR 3.6, 95% CI 2.8–4.6), unemployment (HR 1.5, 95% CI 1.2–1.8), and being divorced (HR 1.5, 95% CI 1.2–1.9) determined a higher risk of incident ACO, whereas the opposite was found for leisure-time physical activity (HR 0.7, 95% CI 0.6–0.8) and high educational level (HR 0.7, 95% CI 0.5–0.9). In contrast to ACO, preexisting myocardial infarction (MI; HR 1.5, 95% CI 1.2–1.8) and stroke (HR 1.5, 95% CI 1.2–1.9) were associated with a higher risk of COPD. Conclusion: Incident ACO is to a large extent determined by factors related to lifestyle and socioeconomic status. [ABSTRACT FROM AUTHOR]

Background: Cross-sectional studies suggest that coffee drinking is associated with better renal function. However, to our knowledge, no prospective study has examined its relation with the risk of end-stage renal disease (ESRD).Objective: We examined the relations between coffee, tea, soda, and total caffeine consumption and the risk of ESRD among middle-aged and older Chinese in Singapore.Methods: We used data from the Singapore Chinese Health Study, a prospective cohort of 63,257 men and women aged 45-74 y at recruitment from 1993 to 1998. Baseline information on the consumption of caffeinated coffee and other caffeinated beverages (tea and sodas), habitual diet, medical history, and lifestyle factors was obtained via in-person interviews. The standard serving size of 1 cup was assigned as 237 mL in the questionnaire. Incident ESRD cases were identified via linkage with the nationwide registry. We used multivariable Cox regression models to estimate HRs and 95% CIs of ESRD risk associated with the consumption of caffeinated beverages, with adjustment for potential confounders.Results: After a mean follow-up of 16.8 y, 1143 cohort subjects developed ESRD. Compared with those who drank coffee less than daily, the HR (95% CI) was 0.91 (0.79, 1.05) for those who drank 1 cup of coffee/d and 0.82 (0.71, 0.96) for those who drank ≥2 cups/d (P-trend = 0.012). When stratified by sex, this association was observed in men but not in women. Compared with those who drank less than daily, the HR (95% CI) for drinking ≥2 cups/d was 0.71 (0.57, 0.87) among men and 0.97 (0.78, 1.19) among women (P-interaction = 0.03). Conversely, intakes of tea, soda, or total caffeine were not associated with the risk of ESRD in multivariable models.Conclusion: The consumption of ≥2 cups of coffee/d may reduce the risk of ESRD in the general population, especially among men. This study was registered at http://www.clinicaltrials.gov as NCT03356340. [ABSTRACT FROM AUTHOR]

In Japan, health insurers are obliged to conduct Specific Health Checkup (SHC) for middle-aged and elderly persons. High-risk persons are referred to Specific Health Guidance (SHG) to receive behavioral counseling based on individual action plans including targets for modification of daily energy balance through diet and physical activity. Using individual-level observational data, we examined the effects of diet and physical activity counseling on cardiometabolic biomarkers across the country. Subjects were 363,440 high-risk persons aged 40-64 who participated in intensive support in SHG for ≥3 months between April 2008 and March 2012. We considered participants as receiving counseling on diet alone, physical activity alone, combined, or neither if they had targets for diet only, physical activity only, both, or neither, respectively. Biomarkers included body mass index, waist circumference, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, and hemoglobin A1c. Under the difference-in-differences approach, we used multivariable linear regression on repeated measures of biomarkers at SHCs before and after SHG and estimated the effects of each counseling type as an interaction with time of SHC. Compared with neither counseling, diet and physical activity counseling, alone or combined, were significantly associated with additional improvements in biomarkers after SHG, for example, body mass index (men: 0.03-0.06 kg/m2, women: 0.10-0.15 kg/m2) and waist circumference (men: 0.16-0.29 cm, women: 0.43-0.47 cm) in both sexes and high-density lipoprotein cholesterol in men (0.13-0.29 mg/dL). Modest improvements in biomarkers were associated with diet and physical activity counseling, although effect sizes were small. [ABSTRACT FROM AUTHOR]

Purpose: Both constant and intermittent acute aerobic exercises have been found to decrease arterial stiffness. However, direct comparisons of these two types of exercise are sparse. It is not known which type of exercise has the greatest effect.Methods: We evaluated the haemodynamic responses in 15 males (age 48.5 ± 1.3 years; BMI 27.5 ± 0.8 kg m-2) following acute constant (CE) and intermittent cycling exercise (IE). Duration and heart rate were matched during both exercises (131.8 ± 3.2 bpm for CE and 132.0 ± 3.1 bpm for IE). Central and peripheral arterial stiffness was assessed through pulse wave velocity (PWV). Plasma concentrations of nitric oxide (NO), atrial natriuretic peptide (ANP), blood lactate, noradrenaline, and adrenaline were measured before and after each exercise.Results: Central (+ 1.8 ± 7.4 and - 6.5 ± 6.8% for CE and IE) and upper limb PWV (+ 2.7 ± 6.2 and - 8 ± 4.6% for CE and IE) were not significantly altered although a small decrease (small effect size) was observed after IE. However, lower limb PWV significantly decreased after exercises (- 7.3 ± 5.7 and - 15.9 ± 4% after CE and IE), with a larger effect after IE.Conclusions: Greater decrease in lower limb PWV occurred after IE despite greater heart rate. This may be due to the higher blood levels of lactate during IE, while NO, ANP, noradrenaline, and adrenaline levels remained not statistically different from CE. These results underlined the importance of lactate in triggering the post-exercise vascular response to exercise, as well as its regional characteristic. [ABSTRACT FROM AUTHOR]

Aim: We investigated the association of impaired glucose metabolism with tooth loss in adults in the Northern Finland Birth Cohort Study 1966 (NFBC1966).Methods: We examined 4394 participants from the 46-year follow-up of the NFBC1966. Self-reported number of teeth as well as insulin and glucose values, taken during a standard oral glucose tolerance test (OGTT), served as the primary study variables. A multinomial logistic regression model served to analyse (unadjusted, smoking-adjusted and fully adjusted) the association between number of teeth (0-24, 25-27, 28-32) and glucose metabolism in women and men.Results: Among women, type 2 diabetes - whether previously known or detected during screening - pointed to a higher likelihood of 0-24 teeth (fully adjusted OR = 2.99, 95%CI = 1.54-5.80) and 25-27 teeth (OR = 1.91, 95%CI = 1.18-3.08) than did normal glucose tolerance. Similarly, impaired fasting glucose and impaired glucose tolerance together indicated a higher likelihood of 0-24 teeth (OR = 1.71, 95%CI = 1.09-2.69) than did normal glucose tolerance. A similar, statistically non-significant, pattern emerged among men. Number of teeth associated with OGTT insulin and glucose curves as well as with the Matsuda index in both women and men.Conclusions: Tooth loss strongly associated with impaired glucose metabolism in middle-aged Finnish women. [ABSTRACT FROM AUTHOR]

Objectives: To demonstrate the efficacy of cochlear implantation for management of a severe single-sided deaf tactical unit officer. Showing that hearing improvement provided by cochlear implantation was sufficient for him to return to work as a police tactical officer.Methods: Case report.Results: A 43 years-old man working as a tactical unit officer suffered from a work-related severe single-sided hearing loss. He tried unsuccessfully many types of hearing aids including a contralateral routing of sound (CROS) system and a bone conduction hearing aid with a headband. He was finally treated with cochlear implantation which provided enough localization and hearing abilities for a complete return to work as a tactical unit officer.Discussion: This case report demonstrates that cochlear implantation was very successful for a patient suffering from severe single-sided hearing loss. The current literature demonstrates benefits from cochlear implant over CROS and osseointegrated devices in unilateral hearing loss. Nevertheless, literature does not report any case of patient suffering from single-sided deafness that received a cochlear implant and a complete bilateral hearing rehabilitation that allowed him to return to work as a police tactical officer.Conclusion: Cochlear implantation was the only effective treatment to provide our patient enough localization and hearing abilities for a complete return to work as a police tactical officer. As no consensus has been established about selection criteria for cochlear implantation in single-sided deafness, we suggest that the patient's occupation should be considered when reviewing his candidacy for cochlear implantation. [ABSTRACT FROM AUTHOR]

Introduction The objective of the present study was to investigate the relationship between sources of household air pollution, respiratory symptoms and lung function. Methods 3039 adults aged from 40 to 65 participated in the 2011–2013 ELISABET cross-sectional survey in northern France. Lung function was measured using spirometry. During a structured interview, respiratory symptoms, household fuels, exposure to moulds, and use of ventilation were recorded on a questionnaire. Results The self-reported presence of mould in at least two rooms (not including the bathroom and the kitchen) was associated with a 2.5% lower predicted forced expiratory volume in 1 s (95% confidence interval, −4.7 to −0.29; p-trend <0.05) and a higher risk of wheezing (p-trend < 0.001). Visible condensation was associated with wheezing (p < .05) and chronic cough (p < .05). There were no significant associations with the type of household fuel or inadequate ventilation/aeration. Similar results were found when the analyses were restricted to participants without known respiratory disease. Conclusion Our results suggest that the presence of mould (known to be associated with more severe asthma symptoms) could also have an impact on respiratory symptoms and lung function in the general population and in populations without known respiratory disease. [ABSTRACT FROM AUTHOR]

Introduction: Increasing mortality rates among midlife non-Hispanic whites have been identified but are not well understood.Methods: Vital statistics data were used in 2017 to examine to what extent increases in mortality rates and years of potential life lost among midlife non-Hispanic whites from 1999 to 2015 are correlated with increases in fatal overdoses and specific drug categories.Results: The mortality rate rose by 21.2 per 100,000 people and years of potential life lost by 712,000 years from 1999 to 2015 for non-Hispanic whites aged 22-56 years; 63% of the mortality rate and 76% of the years of potential life lost increase occurred among individuals aged 22-39 years. For males, 92% of the mortality rate and 98% of the years of potential life lost growth was among individuals aged 22-39 years. The increases attributed to drug poisonings were: 26.4 per 100,000 people and 854,000 years, 51% and 64% of which occurred among individuals aged 22-39 years. Illicit opioids without involvement of prescription opioids were involved in mortality rate and years of potential life lost increases of 13.9 (95% CI=13.2, 14.7) per 100,000 people and 489,000 (95% CI=463,000, 515,000) years. For prescription opioids without illicit opioid involvement, the growth was 7.8 (95% CI=7.3, 8.3) per 100,000 people and 230,000 (95% CI=214,000, 246,000) years. Illicit opioids played a key role for individuals aged 22-39 years, especially males. Mortality rate and years of potential life lost declined dramatically for nonwhites or Hispanics aged 22-56 years, with only small increases because of drug deaths.Conclusions: Growth in fatal overdoses was strongly correlated with increased mortality rate and years of potential life lost for midlife non-Hispanic whites from 1999 to 2015, with a particularly large rise for young adults, especially males, and illicit opioids contributing most to this association. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence, control and factors associated with hypertension among middle aged women of rural Kerala. Background: Hypertension is a major public health problem in India. It is a leading cause for mortality and morbidity in India Result: The overall prevalence of hypertension was 32.1% and prehypertension was 8.4%. Among the hypertensive 32.2% (10.2% of the total study population) were newly diagnosed. 55% the known hypertensive were not taking treatment regularly and 57% of the known hypertensive have uncontrolled hypertension. 32.3% of the study population was overweight where as 12.8% was obese. Multi logistic regression revealed that BMI>25kg/m2, perceived stress, family history of hypertension and diabetes were factors associated with hypertension Conclusion: This study has shown that hypertension is highly prevalent among rural women and the disease is uncontrolled among the rural women. The fact that one tenth of the population has hypertension which is undetected is alarming. Primary and secondary levels prevention of hypertension should be considered. [ABSTRACT FROM AUTHOR]

Objectives: Self-treatment is a widespread practice among patients with common symptoms and ailments; it is necessary to explore multiple aspects of it. Notably, there is little research into self-treatment among middle-aged and elderly people, who are more likely to fall ill. Our goals are to provide a comprehensive description of self-treatment and explore associated factors with insurance utilization and expenditures among the middle-aged and elderly populations in China. Methods: A survey was conducted in July 2016 in Shanxi, China. A stratified sampling scheme was applied to achieve representativeness. A total of 972 subjects were surveyed. Descriptive statistics, t- and Chi-squared tests, multivariate logistic regression, and multivariate linear regression were utilized. Results: In our study, 772 (79.4%) of the surveyed subjects self-treated during the previous twelve months. Among them, 253 (32.8%) used health insurance. Subjects’ characteristics were associated with insurance utilization and expenditures for self-treatment. Total cost was positively associated with insurance utilization. The subjects with a junior high education (p-value < 0.001, aOR = 0.049) and senior high education (p-value = 0.020, aOR = 0.146) had a lower probability of using insurance. For both total costs and out-of-pocket costs, subjects who were 51 to 60 years old had lower costs. The subjects who were seriously sick and had a primary school education, as well as enterprise occupations, had higher costs. Self-treatment times were also positively associated with costs. Finally, it was found that subjects who didn’t use insurance had lower total costs. Conclusions: The prevalence of self-treatment was high (79.4%). Some characteristics were associated with insurance utilization and expenditures in self-treatment. Our results may be helpful for policy interventions, which are needed to further improve the effectiveness of health insurance in China. [ABSTRACT FROM AUTHOR]

Metabolic dysfunction related to diet-induced obesity has recently been linked to the pathogenesis of sporadic Alzheimer's disease (AD). However, the underlying mechanisms linking obesity and AD remain unclear. The purpose of this study was to examine early alterations in brain insulin signaling, inflammatory/stress markers, and energetic stress in a model of diet-induced obesity during middle age. Male C57BL/6J mice were randomized to either a control diet (AGE n = 12) or high-fat and sucrose diet (AGE-HFS n = 12) for 13-weeks from 20-weeks of age. Prefrontal cortex and hippocampal samples were collected at 20-weeks of age (BSL n = 11) and at 33-weeks of age (AGE and AGE-HFS). The HFS diet resulted in increased body weight (30%; P = 0.0001), increased %fat mass (28%; P = 0.0001), and decreased %lean mass (33%; P = 0.0001) compared to aged controls. In the prefrontal cortex, AGE-HFS resulted in increased 50 adenosine monophosphate - activated protein kinase (AMPK) phosphorylation (P = 0.045). In the hippocampus, AGEHFS resulted in increased extracellular signal-regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) phosphorylation and protein kinase B (Akt) serine473 and glycogen synthase kinase (GSK) phosphorylation (P < 0.05). Results from this study demonstrate that aging combined with a HFS diet results in increased inflammation (pERK and pJNK) and energetic stress (pAMPK) in the hippocampus and prefrontal cortex, respectively. Together these novel results provide important information for future targets in early AD pathogenesis. [ABSTRACT FROM AUTHOR]

In adults, greater social integration is associated with reduced risk of cardiovascular disease, including hypertension. Social integration earlier in life may be similarly associated with cardiovascular risk. Using a longitudinal sample of 267 Black and White men, we examined whether greater social integration with peers during childhood and adolescence, assessed by parent report, prospectively predicts lower blood pressure and body mass index two decades later in adulthood and whether these effects differ by race, given well-documented racial disparities in hypertension. Boys who were reported by their parents to be more socially integrated with peers evidenced lower blood pressure and body mass index in adulthood, and this effect was not accounted for by body mass index in childhood, childhood socioeconomic status, childhood hostility, childhood physical health, extraversion measured in adolescence, or concurrent adult self-reports of social integration. Results did not differ by race, but analyses were not powered to detect interactions of small effect size. [ABSTRACT FROM AUTHOR]

Background and purpose: Embolic strokes of undetermined source (ESUS) are a recent entity, not yet thoroughly investigated in young stroke patients. The clinical characteristics and long‐term risks of vascular events and all‐cause mortality between young‐onset ESUS and other aetiological subgroups were compared. Methods: Patients with ESUS were identified amongst the 1008 patients aged 15−49 years with first‐ever ischaemic stroke in Helsinki Young Stroke Registry, and primary end‐points were defined as recurrent stroke, composite vascular events and all‐cause mortality. Cumulative 15‐year risks for each end‐point were analysed with life tables and adjusted risks were based on Cox proportional hazard analyses. Results: Of the 971 eligible patients, 203 (20.9%) were classified as ESUS. They were younger (median age 40 years, interquartile range 32–46 vs. 45 years, 39–47), more often female (43.3% vs. 35.7%) and had fewer cardiovascular risk factors than other modified TOAST groups. With a median follow‐up time of 10.1 years, ESUS patients had the second lowest cumulative risk of recurrent stroke and composite vascular events and lowest mortality compared to other TOAST groups. Large‐artery atherosclerosis and small vessel disease carried significantly higher risk for recurrent stroke than did ESUS, whilst no difference appeared between cardioembolism from high‐risk sources and ESUS. Conclusions: In our cohort, ESUS patients were younger and had milder cardiovascular risk factor burden and generally better long‐term outcome compared to other causes of young‐onset stroke. The comparable risk of recurrent stroke between ESUS and high‐risk sources of cardioembolism might suggest similarities in their pathophysiology. [ABSTRACT FROM AUTHOR]