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Objectives: We explored associations between mammographic features and risk of breast cancer death among women with small (<15 mm) and large (≥15 mm) invasive screen-detected breast cancer. Methods: We included data from 17,614 women diagnosed with invasive breast cancer as a result of participation in BreastScreen Norway, 1996–2020. Data on mammographic features (mass, spiculated mass, architectural distortion, asymmetric density, density with calcification and calcification alone), tumour diameter and cause of death was obtained from the Cancer Registry of Norway. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for breast cancer death by mammographic features using spiculated mass as reference, adjusting for age, tumour diameter and lymph node status. All analyses were dichotomised by tumour diameter (small versus large). Results: Mean age at diagnosis was 60.8 (standard deviation, SD=5.8) for 10,160 women with small tumours and 60.0 (SD=5.8) years for 7454 women with large tumours. The number of breast cancer deaths was 299 and 634, respectively. Mean time from diagnosis to death was 8.7 (SD=5.0) years for women with small tumours and 7.2 (4.6) years for women with large tumours. Using spiculated mass as reference, adjusted HR for breast cancer death among women with small tumours was 2.48 (95% CI 1.67–3.68) for calcification alone, while HR for women with large tumours was 1.30 (95% CI 1.02–1.66) for density with calcification. Conclusions: Small screen-detected invasive cancers presenting as calcification and large screen-detected cancers presenting as density with calcification were associated with the highest risk of breast cancer death. Clinical relevance statement: Small tumours (<15 mm) presented as calcification alone and large tumours (≥ 15 mm) presented as density with calcification were associated with the highest risk of breast cancer death among women with screen-detected invasive breast cancer diagnosed 1996–2020. Key Points: • Women diagnosed with invasive screen-detected breast cancer 1996–2020 were analysed. • Small screen-detected cancers presenting as calcification alone resulted in the highest risk of breast cancer death. • Large screen-detected cancers presenting as density with calcification resulted in the highest risk of breast cancer death. [ABSTRACT FROM AUTHOR]

This article explores the lay meaning(s) and understanding of depression among middle-aged and elderly patients in Uganda and its impact on treatment seeking. Through an interpretive phenomenological approach, data was collected using in-depth interviews with purposively selected participants and analyzed using thematic content analysis. The findings revealed that depression with disruptive behaviors is regarded as "clan illness," "witchcraft" or "madness" while depression with non – disruptive symptoms is perceived to be a "disease of thoughts" normative to life circumstances and aging. Conclusively, the cultural understanding of depression may imply that the western medical approach would be less recommended compared to traditional healing. [ABSTRACT FROM AUTHOR]

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

Background: Continued proliferation of accelerometers in physical activity research has opened new avenues for understanding activity behaviours beyond simple aggregate measures of frequency and duration. This study explores the standing and stepping composition, and the temporal distribution, of upright events, and investigates their associations with sociodemographic and health factors. Methods: Participants from the 1970 British Cohort Study wore activPAL3 accelerometers for seven days. Event-based analysis was used to extract a time series of upright, standing, and stepping events. Derived metrics included daily number of upright and stepping events, total upright and stepping time, the burstiness of upright events and burstiness of sedentary events (burstiness refers to the pattern of how physical activity and sedentary behaviour are distributed throughout a given time period), within-event stepping proportion, within-event step count, and stepping cadence. Generalized linear regression models, adjusted for total step count, were employed to explore associations between derived metrics and sociodemographic and health-related factors. Results: A total of 4527 participants, provided 30992 valid days (≥ 10 h of waking wear) and 1.64 million upright events. Upright event composition and temporal distribution varied across a range of sociodemographic and health-related factors. Females had more upright events than males (4.39 [3.41,5.38] n), spent more time upright, and exhibited burstier patterns of upright events (0.05 [0.04,0.05] Bn). Individuals with higher BMI had fewer upright events and a lower daily step count, but their temporal distribution of upright events was less bursty (overweight -0.02 [-0.02,-0.01] Bn; obese -0.03 [-0.04,-0.02] Bn), and upright events had a higher step count. People in active occupations were upright for longer, displayed burstier patterns of upright events (standing 0.04 [0.03,0.05] Bn; physical work 0.05 [0.04,0.05] Bn; heavy manual 0.06 [0.04,0.07] Bn), with more variable durations and shorter, slower paced stepping events compared with sedentary occupations. Conclusions: This study has revealed novel phenotypes of standing and sitting that go beyond simple aggregate measures of total steps, step event duration or time between events. People with the same volume of stepping and frequency of gaps between upright events can accumulate their steps in very different ways. These differences and associations with population sub-groups, which persisted after adjustment for total stepping volume, may have important relations with functional and health outcomes. The findings lay the groundwork for future studies to investigate how different sitting and standing phenotypes can add to our understanding of the relationship between physical activity and health. [ABSTRACT FROM AUTHOR]

Aim: Investigating what is underlying late‐life depression is becoming increasingly important with the rapidly growing elderly population. Yet, the associations between plasma biomarkers of neuroaxonal damage and late‐life depression remain largely unclear. Therefore, we determined cross‐sectional and longitudinal associations of neurofilament light chain (NfL) with depression in middle‐aged and elderly individuals, and total tau, β‐amyloid 40 and 42 for comparison. Methods: We included 3,895 participants (71.78 years [SD = 7.37], 53.4% women) from the population‐based Rotterdam Study. Between 2002 and 2005, NfL, total tau, β‐amyloid 40 and β‐amyloid 42 were determined in blood and depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale (CES‐D). Incident depressive events (clinically relevant depressive symptoms, depressive syndromes, major depressive disorders) were measured prospectively with the Center for Epidemiologic Studies Depression, a clinical interview and follow‐up of medical records over a median follow‐up of 7.0 years (interquartile range 1.80). We used linear and Cox proportional hazard regression models. Results: Each log2 pg./mL increase in NfL was cross‐sectionally associated with more depressive symptoms (adjusted mean difference: 0.32, 95% CI 0.05–0.58), as well as with an increased risk of any incident depressive event over time (hazard ratio: 1.22, 95% CI 1.01–1.47). Further, more amyloid‐β 40 was cross‐sectionally associated with more depressive symptoms (adjusted mean difference: 0.70, 95% CI 0.15–1.25). Conclusion: Higher levels of NfL are cross‐sectionally associated with more depressive symptoms and a higher risk of incident depressive events longitudinally. The association was stronger for NfL compared to other plasma biomarkers, suggesting a potential role of neuroaxonal damage in developing late‐life depression. [ABSTRACT FROM AUTHOR]

Background: Primary healthcare centers (PHCs) serve as the cornerstone of accessible medical services in society, playing a crucial role in screening, detecting, and treating various health issues. This study aimed to investigate the prevalence of psychiatric disorders in middle-aged individuals who refer to PHCs and the potential of PHCs in diagnosing mental disorders. Methods: This cross-sectional study was implemented at PHCs under the supervision of Mashhad University of Medical Sciences (MUMS) in northeast Iran in 2018. The enrolled subjects were middle-aged adults who had electronic medical records in SINA, an integrated health management system, and the electronic medical records of MUMS. The prevalence of psychiatric disorders by type and their relationship with demographic information was evaluated by a Chi-square test using SPSS 22. Results: This study involved 218,341 middle-aged participants. Prevalence of psychiatric disorders was 8.59%, and depression (53.72%) and anxiety (42.02%) were the most common psychiatric disorders in both males and females. The prevalence of mental disorders was significantly higher in females than in males (88.18% vs. 18.81%; P < 0.0001). Indeed, a significant higher prevalence of depression, anxiety, somatoform, childhood psychiatric disorder, and bipolar disorders was observed in females compared to males (P < 0.05). In addition, individuals between the age of 45–60 years, and those from rural areas showed more prevalence of mental disorders than others, but these differences were not significant. Conclusions: Considering the previous studies in Iran, the prevalence of mental disorders among patients presenting to PHCs was noticeably lower than expected rates. It seems probable that this huge difference is due to poor screening and detection of mental illness in PHCs of MUMS. It is recommended that health policymakers pursue specific measures to make PHCs more helpful for people with mental health problems in the community. [ABSTRACT FROM AUTHOR]

Background: The prevalence of short sleep duration is rising and is linked to chronic comorbidities, such as metabolic syndrome (MetS). Sleep extension interventions in adults with MetS comorbidities and short sleep duration are limited and vary widely in terms of approach and duration. Objectives: This pilot study aimed to test the feasibility and acceptability of a personalized 12-week systematic sleep time extension intervention on post-intervention sleep outcomes in middle-aged adults at risk forMetSwith actigraphy-estimated short sleep duration. Methods: A single-arm, 12-week, 12-session systematic sleep time extension intervention was delivered weekly via videoconferencing. Feasibility and acceptability were assessed using retention rates and mean sleep diary completions. Sleep was estimated for 14 consecutive days prior to and immediately following the 12-week intervention using wrist actigraphy. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Paired sample t-tests modeled changes in study outcomes. Results: Study participants (N = 41) had a mean age of 52 years and were mostly female and White; 86% attended >80% of sessions, and mean sleep diary completion was 6.7 diaries/week. Significant improvements in sleep from pre- to post-intervention included increased total sleep time, earlier sleep onsets, more regular sleep onsets, a higher sleep regularity index, and reduced daytime sleepiness. Extending sleep, as well as improving sleep timing and regularity in middle-aged adults with actigraphy-estimated short sleep duration and at risk for MetS, is feasible and acceptable. Discussion: Behavioral sleep characteristics may be modifiable and present a novel behavioral paradigm for mitigating MetS risk. This pilot study provides a proof of concept for the feasibility, acceptability, and preliminary effectiveness of a systematic sleep time extension for middle-aged adults at risk for MetS with actigraphy-estimated short sleep duration. [ABSTRACT FROM AUTHOR]

Purpose: It is important for middle-aged patients who have undergone acute treatment for coronary artery disease to voluntarily improve their lifestyle and risk factors based on their recognition as patients with chronic diseases. This study conducted individual education to improve risk factors and tried to verify its effectiveness. Methods: The hypothesis was verified by applying a randomized controlled pre- and post-test design through random assignment of two groups. Middle-aged (40–64 years) patients who underwent percutaneous coronary intervention for the first time were recruited from a university hospital in Seoul, Korea. For the experimental group, based on the Self-Determination Theory, risk factor- tailored counseling and education were provided individually for one hour based on the education booklet, and telephone counseling was conducted twice for 12 weeks. Differences in autonomous motivation, resilience, self-care compliance and biochemical indicators measured after 12 weeks in the experimental group and the control group were compared. Data were analyzed using SPSS/WIN ver. 22.0. Results: The autonomous motivation, resilience, and self-care compliance of the experimental group were significantly higher than those of the control group (p <.05). Body mass index (p =.005) and current smoking rate (p <.001) were also significantly decreased in the experimental group but there was no significant difference in other biochemical parameters. Conclusion: For middle-aged patients with first coronary intervention, risk factor-tailored education emphasizing autonomy by nurses should be provided early after discharge. Trial registration: This study was retrospectively registered in the Clinical Research Information Service and the identification number is KCT0008698(11/08/2023). [ABSTRACT FROM AUTHOR]

This longitudinal study investigated the pathways from childhood socioemotional characteristics and cognitive skills to health behaviours in midlife. Methods: Participants in the Jyväskylä Longitudinal Study of Personality and Social Development (JYLS) were followed from age 8 (n = 369) to age 50 (n = 271). Outcomes included physical activity, smoking, alcohol consumption and body mass index (BMI) assessed at ages 36, 42 and 50. Predictors were socioemotional characteristics (behavioural activity, negative emotionality, and well-controlled behaviour) and parents' occupational status collected at age 8, cognitive skills (school success at age 14 and the highest education at age 27) and adulthood personality traits (extraversion, neuroticism and conscientiousness). Longitudinal path modelling was used for analyses. Results: Well-controlled behaviour and extraversion predicted physical activity in women. Behavioural activity predicted alcohol consumption in women and smoking in men. Negative emotionality was not directly connected to health behaviours. Adulthood neuroticism was associated with smoking in men and with alcohol-related problems in both men and women. There were some indirect paths from childhood socioemotional characteristics to midlife health behaviours through cognitive skills. None of the study variables predicted midlife BMI. Conclusions: Childhood socioemotional characteristics have some predictive value on midlife health behaviours, both directly and through cognitive skills. Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2022.2041639. [ABSTRACT FROM AUTHOR]

Several studies focus on the use of emerging technologies to support and monitor health but are centred around the elderly group of people. Meanwhile, the average elderly popularly known as the middle-aged have not been put into consideration regarding the subject matter. This article focuses on the use behaviour and acceptance of emerging technologies that can assist in providing a middle-aged population with a healthy lifestyle. This study collected the primary data through an online questionnaire survey to empirically evaluate final 169 respondents. The analysis for this study was done utilising SmartPLS software via partial least squares structural equation modelling. The results indicate that 9 out of 11 were tested as supported hypotheses. All supported hypotheses showed the strong relationship between acceptance and user behaviour with emerging technology. The experience of acceptance and behaviour of using emerging technology in a healthy lifestyle was found as an important determinant of outcome in preparing the middle-aged for their elderly age by adapting emerging technology as early as possible. [ABSTRACT FROM AUTHOR]

This study aimed to examine changes over a 10-year period in experiencing climacteric symptoms and their associations with sociodemographic and health-related background factors in a birth cohort of Finnish women who have never used menopausal hormone therapy (MHT). This nationwide population-based follow-up study consists of 1491 women who during the follow-up period moved from the age group 42–46 years to the age group 52–56 years. The experience of climacteric symptoms was assessed by 12 symptoms commonly associated with the climacterium. The data were analyzed using statistical techniques. Both the intensity, expressed as a symptom score of four symptoms associated with a decrease in estrogen production (sweating, hot flushes, vaginal dryness, sleeping problems), and the prevalence of the five most common symptoms (sweating, hot flushes, sleeping problems, lack of sexual desire, depressive symptoms) increased clearly during the follow-up period. The examined sociodemographic and health-related variables did not explain the changes in experiencing the symptoms. The results of this study can be considered in primary and occupational health care and in gynecological settings when working with symptomatic women or women with hidden climacteric problems and carrying out health promotion and counseling for them. [ABSTRACT FROM AUTHOR]

Background: Climacteric changes in women are associated with an increased probability of psychological symptoms. Identifying the relationship between adjustment to this period and mental health helps to plan for middle-aged women's health improvement. Therefore, the present study aimed to investigate the relationship between climacteric adjustment (CA) and mental health in middle aged women. Method: This cross-sectional study was conducted on 190 women aged 40 to 53 years. Mental health symptoms (including hypochondriasis, anxiety, depression, and social impairment) and CA were assessed using 28-item general health questionnaire and the CA questionnaire, respectively, as a self-report. Data were analyzed using linear and stepwise regression methods, and the fitting of the resulting conceptual model was assessed using AMOS software. Results: The results showed that hypochondriasis score and social impairment, anxiety level and CA in the perfection dimension, and social impairment score and CA in perfection, decline in beauty, and sexual silence dimensions had an inverse relationship. Moreover, the relationship between anxiety score and CA in the reaction to end of menstruation and the relationship between social impairment and decline of femininity were positive and significant. Factor analysis of the conceptual model obtained from the study results demonstrated a good model fit (CMIN /DF = 0.807, P =.671). Conclusion: The results showed a relationship between CA and psychological symptoms in middle-aged women. In other words, the level of hypochondriasis, anxiety, and social impairment symptoms decreased with increasing CA in sexual silence, perfection, and decline in beauty. Plain English summary: Climacteric changes in women are associated with increased psychological symptoms. Identifying the relationship between adjustment to this period and mental health helps to plan for middle-aged women's health improvement. Therefore, the present study aimed to investigate the relationship between climacteric adjustment (CA) and mental health in middle aged women. This cross-sectional study was conducted on 190 women aged 40 to 53 years. Mental health symptoms (including hypochondriasis, anxiety, depression, and social impairment) and CA were assessed using 28-item general health questionnaire and the CA questionnaire, respectively, as a self-report. The results showed that hypochondriasis score and social impairment, anxiety level and CA in the perfection dimension, and social impairment score and CA in perfection, decline in beauty, and sexual silence dimensions had an inverse relationship. Moreover, the relationship between anxiety score and CA in the reaction to end of menstruation and the relationship between social impairment and decline of femininity were positive and significant. The results showed a relationship between CA and psychological symptoms in middle-aged. In other words, the level of hypochondriasis, anxiety, and social impairment symptoms decreased with increasing CA in sexual silence, perfection, and decline in beauty. [ABSTRACT FROM AUTHOR]

Background: Cognitive and brain reserve refer to individual differences that allow some people to better withstand brain pathology than others. Although early life stress has been recognized as a risk factor for low reserve in late life, no research yet has studied this across midlife. Objective: To examine the associations of life stress with brain and cognitive reserve in midlife. Methods: We included 1,232 middle-aged women who participated in the ORACLE Study between 2002-2006). Life stress was calculated as the shared variance of four cumulative stress domains, created from items measured between pregnancy and 10 years after childbirth. Brain reserve was defined as healthy-appearing brain volume measured with MRI; cognitive reserve as better cognitive functioning than expected based on age, education, and brain MRI measures, using structural equation modelling. Results: More life stress was associated with lower brain (standardized adjusted difference: -0.18 [95% CI 0.25,-0.12]) and cognitive reserve (-0.19 [-0.28,-0.10]). Although, effect sizes were typically smaller, cumulative stress domains were also associated with brain reserve (life events: -0.10 [-0.16,-0.04]; contextual stress: -0.13 [-0.19,-0.07]; parenting-related stress: -0.13[-0.19,-0.07]; interpersonal stress: -0.10 [-0.16,-0.04]) and cognitive reserve (life events: -0.18 [-0.25,-0.11]; contextual stress: -0.15 [-0.10,-0.02]; parenting-related stress: -0.10 [-0.18,-0.03]; interpersonal stress not significant). Conclusion: Women who experience more life stress in midlife were found to have lower reserve. Effects were primarily driven by shared variance across cumulative stress domains, suggesting that focusing on single domains may underestimate effects. The effect of life stress on lower reserve may make women with stress more prone to neurodegenerative disease later in life than women without stress. [ABSTRACT FROM AUTHOR]

Compared to the general older population, older adults living with mental illness are at greater risk of falling and these risks can be present from middle age. This study aimed to explore the understanding of falls and the experiences community-dwelling adults aged 50 years and over living with mental illness who have had a fall, and to identify any falls prevention strategies valued by them. A qualitative descriptive approach was adopted. Ten adults with past experience of falls were recruited at a community mental health service in Sydney, Australia. Semi-structured interviews were conducted between July and September 2018. Interviews were transcribed verbatim and data were thematically analysed. Three major themes emerged: (1) making sense of falls, (2) being self-reliant and enduring the consequences of falls, and (3) preventing future falls – perceptions and strategies. Most participants in this study were uncertain about the cause of their falls and seemed to have limited understanding of falls risk factors. They were also less likely to seek help after a fall, despite an injury. Consequences of falls included physical injuries and negative emotional impacts experienced following a fall. Most participants expressed a certain degree of concern regarding future falls, however, their strategy to prevent falls was to simply "be careful." Adults aged over 50 years and living with mental illness in the community need support to identify and manage their falls risk. Fall prevention interventions tailored to the needs of this population are needed. [ABSTRACT FROM AUTHOR]

Background: Previous epidemiological studies have indicated that high‐density lipoprotein cholesterol (HDL‐C) is inversely associated with the risk of cardiovascular disease. However, this issue has aroused controversy in recent years. Besides, the relationship between HDL‐C and the risk of total stroke in sex and race is less clear. Thus, we aimed to examine the association between different ranges of HDL‐C and the risk of total stroke in adults over 40 years old. Methods: This cross‐sectional study was conducted on a sample of 8643 participants (4222 men and 4421 women) aged ≥40 years old from the National Health and Nutrition Examination Survey 2007–2016. HDL‐C was an independent variable and stroke was a dependent variable in this study, with the other variables as potential effect modifiers. To examine the associations between them, we used multivariate logistical regression models and smooth curve fittings, as well as subgroup analyses. Results: HDL‐C was inversely associated with stroke when HDL‐C was less than 1.55 mmol/L (odds ratio [OR] = 0.36, 95% confidence interval [CI] :0.21–0.62, p <.05). However, above 1.55 mmol/L, the incidence of stroke was not significant (OR = 1.29, 95% CI: 0.79–2.09, p>.05). Stratified by race/ethnicity and sex, the subgroup analyses demonstrated that HDL‐C was inversely associated with stroke in men and Whites, but no significant differences among women, Mexicans, blacks, and other races. Conclusion: We found a nonlinear relationship between HDL‐C and total stroke. Our study reveals a range of inverse associations between HDL‐C and stroke (HDL‐C<1.55 mmol/L), especially among men and Whites. This finding suggested that maintaining an appropriate HDL‐C range may be beneficial in reducing the incidence of stroke. [ABSTRACT FROM AUTHOR]

Retirement is a psycho social process. It refers to the phase of life when a person leaves his job and withdraws from active working life. Proper optimization of retirement is only possible when a person has pre planned his life with proper finances and saving or the government is providing him with a lot of social security benefits. However, such conditions rarely occur as a person is preoccupied in his pre retirement phases. But proper optimization of retirement can also take place when a person has high social intelligence which affects physical and mental health. Hence, this paper is an endeavor to look into the relevance of social intelligence which helps the people in their retirement process in the people. Thus, a survey was done to find the level of Social Intelligence in the people who are ageing and are going to be retired soon. Around 252 people between 55 to 70 years were studied from Delhi and NCR. The result indicated that middle aged and just retired people had high social intelligence as compared to older adults and the former were also able to optimize their retirement effectively for successful ageing. The older adults were not able to cope up with the various issues of retirement due to low social intelligence. Hence, further studies can be carried out to design proper training for enhancement of social intelligence in aged people for their effective optimization of retirement. [ABSTRACT FROM AUTHOR]

Objective: Low back pain (LBP) is a global health problem that affects the productivity of the patients. Several factors such as individual, occupational, and psychosocial factors increase the risk of LBP. However, only a few studies investigated those factors, especially in middle adulthood in Indonesia. Indonesia is a country with a young population that has been rapidly developing in recent years. This study was conducted to find out the factors associated with LBP in middle adulthood. Methods: This study is a cross-sectional observational analytic study using a convenience sampling method with a total sample of 3005 respondents. Data were collected using a questionnaire which was then analyzed using the chi-square test, Kolmogorovsmirnov, Spearman's Rank, and logistic regression test. Results: From the result of this study, it was found that the 12-month prevalence of LBP in middle-aged adults was 44,29%. Female (odds ratio [OR], 1.3; 95% confidence interval [Cl], 1.098-1.545; p=0.002), lack of physical exercises (OR, 0.87; 95% Cl, 0.794-0.959; p=0.005), high body mass index (OR, 1.09; 95% Cl, 1.009-1.187; p=0.002), stress level (OR, 1.26; 95% Cl, 1.088-1.458; p=0.002), and years of work experience (OR, 1.1; 95% Cl, 1.001-1.225; p=0.047) were determined as risk factors that significantly associated with LBP. Conclusion: LBP is quite common among middle-aged adults in Indonesia. Female gender, higher body mass index, lack of physical activity, stress level, and years of work experience were all potential risk factors for LBP in middle-aged adults. Middle-aged adults in Indonesia should be aware of LBP and avoid disabilities by identifying risk factors that may worsen LBP in the future. [ABSTRACT FROM AUTHOR]

Aim: To systematically review current literature to determine the association between symptomatic osteoarthritis and dietary patterns, diet quality and food groups in adults aged ≥45 years. Methods: The review was registered on PROSPERO (CRD42021270891). Cochrane Central Library, Cumulative Index of Nursing and Allied Health Literature, Embase, Medline and Web of Science databases were searched. A total of 3816 records were identified. Eligible articles involved populations aged ≥45 years with symptomatic osteoarthritis, assessing dietary patterns, diet quality or food groups, with pain in joints as outcomes. The Joanna Briggs Institute Critical Appraisal Checklists were used for quality assessment. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the certainty of evidence. Results: Six cohort studies were included. The Prudent dietary pattern and the Mediterranean dietary pattern reduced the progression of osteoarthritis symptoms. The Western dietary pattern increased symptomatic osteoarthritis progression. Increased total fibre consumption reduced symptomatic osteoarthritis progression and pain worsening, but the effects of fibre from each food group were inconclusive. Diet with high inflammatory potential increased risk of new onset symptomatic osteoarthritis, but the effects of overall diet quality were inconclusive. Conclusions: The Prudent dietary pattern showed the highest protection on symptomatic osteoarthritis in adults aged 45 years and over. The body of evidence is limited, suggesting that further research is needed to corroborate the estimated effect at a high certainty of evidence, and to incorporate previously unstudied dietary patterns and food groups. Identifying the most beneficial dietary pattern may inform future guidelines for reducing symptomatic osteoarthritis in middle aged and older adults. [ABSTRACT FROM AUTHOR]

Background: Timely diagnosis and adequate care is important for persons with young-onset dementia (YOD) and their caregivers, due to the high impact of the disease. Initiating care can be difficult for the general practitioner (GP) and other healthcare professionals. Objective: Provide insight in the care use of persons with YOD and identify factors influencing care use. Methods: A primary care register was used for this study. Information on the care use of persons with YOD was extracted from the GPs written notes. Information entailed time until start of care use, reasons and factors influencing the GP's decision, and reasons and factors influencing actual care use were included. Analyses included quantitative explorative descriptive analyses, and qualitative manifest content analyses. Results: 75 persons with YOD were included in this study. The main reason for GPs to refer for diagnosis was concerns of caregivers. After diagnosis, 72% of the persons were assigned a case manager, 42.7% received day care, and 44% were admitted to a long-term care facility. A higher percentage of persons without a case manager was admitted to a long-term care facility (64%) compared to the persons with a case manager (36%). Reasons for not initiating care were reluctancy of the persons with YOD or their caregivers, the person deceased, or because the GP did not refer for care. Conclusion: Care use differed between persons due to different needs and reasons. Although most persons with YOD receive care in the years after diagnosis, there are still factors that could be improved. [ABSTRACT FROM AUTHOR]

Background: Timely diagnosis and adequate care is important for persons with young-onset dementia (YOD) and their caregivers, due to the high impact of the disease. Initiating care can be difficult for the general practitioner (GP) and other healthcare professionals. Objective: Provide insight in the care use of persons with YOD and identify factors influencing care use. Methods: A primary care register was used for this study. Information on the care use of persons with YOD was extracted from the GPs written notes. Information entailed time until start of care use, reasons and factors influencing the GP's decision, and reasons and factors influencing actual care use were included. Analyses included quantitative explorative descriptive analyses, and qualitative manifest content analyses. Results: 75 persons with YOD were included in this study. The main reason for GPs to refer for diagnosis was concerns of caregivers. After diagnosis, 72% of the persons were assigned a case manager, 42.7% received day care, and 44% were admitted to a long-term care facility. A higher percentage of persons without a case manager was admitted to a long-term care facility (64%) compared to the persons with a case manager (36%). Reasons for not initiating care were reluctancy of the persons with YOD or their caregivers, the person deceased, or because the GP did not refer for care. Conclusion: Care use differed between persons due to different needs and reasons. Although most persons with YOD receive care in the years after diagnosis, there are still factors that could be improved. [ABSTRACT FROM AUTHOR]

Whether older adults can more likely commit suicide than those in other age groups, after adjusting for other possible causes, remains unknown. We aimed to examine why elderly individuals are more likely to develop first-onset suicidal ideation than individuals in other age groups. We identified 2018 young, 3329 middle-aged, and 2714 elderly individuals without a history of suicidal ideation, from the Korean Welfare Panel Study 2011–2021. To determine key stressors that can induce suicidal ideation, selected groups of variables were adjusted progressively in a generalized estimating equation (GEE) model. Incidence rates of the elderly, middle-aged, and young individuals were 15.9, 22.0, and 11.3 per 1000 person-years, respectively. In GEE analysis, a positive association was not noted between age group and suicidal ideation after adjusting for stressor variables. Furthermore, the overly adjusted model (Full model) showed a strong negative association with aging; young [odds ratio (OR): 1.68, 95% confidence interval (CI): 1.35–2.11] and middle-aged (OR: 1.94, 95% CI: 1.38–2.73) individuals were more likely to develop first-onset suicidal ideation than the elderly. We found that full models, particularly assessing wealth rather than income, can explain why the elderly have higher suicide rates than those in other age groups. [ABSTRACT FROM AUTHOR]

Background and Objective: Middle age is associated with various biopsychosocial changes. Sexual health is one of the most important aspects of health, which is less addressed in middle age. The study aimed to determine the relationship between sexual self-concept and sexual health in middle-aged women in Gorgan, Iran. Methods: This descriptive-analytical study was carried out on 428 eligible married women (mean age: 46.38±5.46 years) who had electronic records in one of the comprehensive health centers of Gorgan, Iran. Data collection was done in 2019 using a demographic checklist, the Persian version of Snell’s multidimensional sexual self-concept questionnaire, and the sexual health of middle-aged women scale. Results: The mean score of sexual self-concept was 115.10±26.88 in the positive domain, 18.09±11.22 in the negative domain, and 39.92±11.88 in the situational domain. The mean score of sexual health was 129.18±18.71. There was a significant positive correlation between sexual health and the positive (r=0.67, P<0.001) and situational sexual self-concept (r=0.63, P<0.001). There was also a significant inverse correlation between sexual health and negative sexual self-concept (r=-0.48, P<0.001). Conclusion: This study showed that the sexual health of married middle-aged women has a direct relationship with the positive sexual self-concept and an inverse relationship with the negative sexual self-concept. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease (COVID-19) pandemic continues its deadly reign all over the world. Devising effective strategies for detecting and controlling the infection has become ever more critical. Effective prevention and control of the pandemic is entirely dependent on human behavior in terms of practicing preventive and curative measures. During the second wave of COVID-19, people's perceptions of preventive and curative measures changed. Objective: To study healthcare-seeking behavior of hospitalized COVID-19 patients. Methods: Hospitalized patients due to COVID-19 in the month of March, April and May of 2021 were included in the study. Their attendants/close relatives were contacted telephonically to know about the admitted patients' healthcare-seeking behavior. Verbal consent was taken from attendants before the commencement of the interview, followed by informing them about the purpose of the interview. Results: Amongst the subjects, there were more males than females (67.5 vs 32.4%), age ranged between 18 to 88 with a mean value of 56.61 ± 14.7 years. Self-medication was significantly associated with study subjects' mortality (p=0.03). Conclusion: Elderly people were having higher mortality rate than their younger counterparts. People were hesitant to visit primary care physicians after having symptoms of COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Hypertension (HTN) is a modifiable risk factor for coronary artery disease, heart failure, cerebrovascular disease and chronic renal failure. HTN affects about 1 billion people globally; by 2025, up to 1.58 billion adults worldwide are likely to suffer from complications of HTN. This study was done to know the diet and physical activity patterns and HTN among the population of three districts of Western Rajasthan. Objectives: To study the dietary and physical activity patterns among the population of Western Rajasthan. and to compare key findings among three districts Pali, Jodhpur and Barmer so that lifestyle changes can be recommended. Methods: A case-control study was done among attendees of NCD clinics of tertiary-level centers in Pali, Barmer and Jodhpur. Hospital controls were matched to age (± 5 years) and gender considering the prevalence of HTN to be 20%*, the proportion of exposure in the general population as 0.2, odds ratio to be 2.2, power =80%, alpha=5% sample size is estimated to be 102 cases & 102 controls (from each district). Results: Overall 'being married' (OR= 3.3), having diabetes/Cardiac disease(OR= 2.6), excessive salt consumption (OR= 2.7), moderate physical exercise less than 30 minutes (OR=1.9), using oil other than vegetable oil(OR=1.8), Age > 60 years (OR = 1.4) were the key risk factors. It was found that high BMI (BMI>27), consumption of non-vegetable oils (12.7%) was highest in Jodhpur, lack of moderate exercise for at least 30 minutes (81%), lack of sports activity (92%) was highest in Pali, least number of days/week of fruits and vegetables consumption (~1.64 days) was seen in Barmer. Conclusions: Change in quantity of salt consumption and incorporation of moderate physical exercise for >30 minutes was most followed in control of HTN among the attendees of NCD Clinics from the multiple advise given. [ABSTRACT FROM AUTHOR]

Background: Rabies is one of zoonotic viral disease, estimated to cause 59000 human deaths annually in over 150 countries, of which 20,000 are from India alone; about 40% of which are in children under the age of 15. Rabies though 100% fatal is preventable with post-exposure prophylaxis which includes wound washing, anti-rabies vaccination and rabies immunoglobulin. Objective: To describe the clinico-social profile of animal bite patients attending the anti-rabies clinic of BRD Medical College, Gorakhpur. Methodology: A cross-sectional study was conducted in the anti-rabies clinic of Nehru hospital, BRD Medical College, Gorakhpur from January 2022 to May 2022. Study participants were interviewed by using a pre-phrased, pre-designed and pre-tested questionnaire. Data regarding socio-demographic and clinical profile of the study participants following animal bite exposure was collected. Results: The total number of animal bite victims were 250, in which majority of them were males (76.77%) and highest percentage was of adult population (20-59 years). Maximum number of victims were from rural area (78.70%). 19.35% were working and 39.35% were students. 77.43% were category III bites and in 50.96% cases lower limb was the site of bite and dogs were responsible for 89.67% of the bites. 60.64% victims did not wash the wound properly before reaching the anti-rabies clinic. Conclusion: This study concludes that as majority of the animal bite victims were students and majority of victims were unaware about the importance of wound care, therefore a step can be taken to create awareness in various schools. [ABSTRACT FROM AUTHOR]

Verify which test, Glitttre-ADL test (TGlittre) or six-minute walk test (6MWT), better predicts balance, fear, and risk of falling in middle-aged and older adults. Twenty-eight individuals (15 women) completed the study protocol, which included: anthropometric assessment, spirometry, Falls Efficacy Scale-International-Brazil (FES-I-Brazil), Activities-specific Balance Confidence Scale (ABC), Timed Up and Go Test (TUG), Berg Balance Scale (BBS), TGlittre, and 6MWT. The Shapiro Wilk test investigated the distribution of the data. To verify if there was a correlation between the performance in TGlittre and 6MWT and the balance, fear, and risk of falling variables, the Pearson or Spearman correlation coefficient were used. Simple linear regression and stepwise multiple linear regression were conducted to identify which functional capacity test better predicts balance, fear, and risk of falling. Both TGlittre and 6MWT correlated (r = 0.44, p =.02 and r = −0.59, p =.003, respectively) and were able to predict the TUG (R2 = 0.17 and R2 = 0.26, p <.005, respectively). However, when analyzed in a multiple regression model, the 6MWT was better predictor of TUG (26%). Only TGlittre correlated (r = 0.39 and r = −0.38, p =.04) and was able to predict the FES-I-Brazil and BBS scores (17%), suggesting that TGlittre better reflects the worry about falls and balance in multiple ADL contexts. The 6MWT and the TGlittre are able to predict balance assessed by the TUG. However, the 6MWT has proved to be more effective in predicting TUG results. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop and psychometrically validate the Sexual Health Scale for Middle-Aged sexually active women (SHIMA).Methods: This study was a sequential exploratory study consisting of two phases. In phase one, we interviewed 19 middle-aged women and reviewed the existing instruments to generate an item pool. Then, a panel of experts (n = 16) examined the items. In the second phase, the psychometric properties of the scale were assessed. For content and face validity, a panel of experts (n = 8) and a group of middle-aged women (n = 10) reviewed the items. For construct validity, a cross-sectional study was carried out on a sample of 427 married women. Finally, SHIMA's reliability was assessed.Results: In the first phase, the sexual health concept was explored, and a provisional scale including 60 items was generated. Next, 21 items were removed based on content and face validity. Accordingly, the results obtained from the exploratory factor analysis (EFA) indicated acceptable loading for 34 items tapping into six factors that jointly explained 48.67% of the total variance observed. The internal consistency evaluation revealed that Cronbach's alpha and McDonald's omega were greater than 0.7, and the average inter-item correlation was greater than 0.4, except for one factor that showed borderline results. Test-retest reliability over a 2-weeks interval was 0.90, indicating its high stability.Conclusion: The SHIMA is a reliable and valid scale for measuring sexual health in middle-aged married women. It can be used as a sexual health screening scale by healthcare professionals and for research purposes. [ABSTRACT FROM AUTHOR]

The objective of this study was to verify the effect of 12 weeks of multicomponent exercises on functional capacity (FC), hemodynamic indicators (HI), anthropometric (AI) and body composition (BC) in middle-aged and elderly women. Eleven middle-aged women (51.09 ± 5.00) and 8 elderly women (66.75 ± 2.31) participated in the study. FC, HI, AI and BC were evaluated before and after the intervention. The data were presented descriptively and compared between the moments. There was an improvement in upper limb strength (Pre: 17; Post: 19; p = 0.017), aerobic endurance (Pre: 469; Post: 492; p = 0.019), heart rate (Pre: 82; Post: 77; p = 0.004), double product (Pre: 9483; Powders: 8831; p = 0.036), fat (Pre: 28.22; Powders: 27.12; p = 0.025) and body water (Pre: 52.55; Powders: 53, 35; p = 0.024) in the middle age group and lower limb strength (Pre: 17; Post 22; p = 0.003) and systolic blood pressure (Pre: 135; Post: 120; p = 0.014) in the elderly. Thus, 12 weeks of multicomponent exercises improved the FC, HI, AI and BC of middle-aged and elderly women. [ABSTRACT FROM AUTHOR]

Objective: Nocturnal leg cramps are painful, sleep related involuntary muscle contractions of the lower limb. The objective was to determine the frequency of nocturnal leg cramp symptoms and to compare stress, sleep disturbances, and physical activity between males and females in middle-aged adults having nocturnal leg cramps. Materials and Methods: An analytical cross-sectional survey was conducted on 220 participants in twin cities of Pakistan. Patients between the ages of 35-55 years who experienced nocturnal leg cramps in the previous three months were included, those with any comorbidities were excluded from the study. A diagnostic criterion from a previous systematic review was used to determine and find the frequency of nocturnal leg crampsymptoms. The perceived stress scale, Pittsburgh sleep quality index, and global physical activity questionnaire were used to analyze stress, sleep, and physical activity, respectively. Results: The mean age of all participants was 44.01±6.74 years. The most reported symptom by participants was pain duration lasting from seconds to 10 minutes 219 (99.55%), whereas pain/cramps in thigh/hamstrings 162 (73.64%) was least reported symptom. The mean age of participants in the male and female groups was 44.27±7.65 years, 44.72±6.56 years. Group comparison of gender showed a significant difference with stress (p<0.05) whereas sleep and physical activity showed no significant difference (p>0.05). Conclusion: The study concludes that majority of the participants experienced all symptoms of the nocturnal leg cramps, whereas leg cramps were the most frequent symptom. Furthermore, females suffering from nocturnal leg cramp reported higher levels of stress compared with males. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated the impact of spousal psychological distress on an individual's distress over time based on detailed measurements of mental status. Hence, we investigate the spillover effect of spousal psychological distress.Methods: This cohort study included 11,819 individuals (men, 51.4 %), aged 50-59 (mean 54.7) years, selected from the Japanese nationally representative longitudinal study from 2005 to 2016. Participants were categorized according to their spousal score on the Kessler Psychological Distress Scale (K6) as follows: 0, 1-4, 5-8, 9-12, and 13-24. The incidence of at least moderate distress (K6 ≥ 5) or serious distress (K6 ≥ 13) was determined during follow-up. A complementary log-log discrete time hazard model was constructed.Results: A total of 5912 and 857 cases of at least moderate and serious distress were identified, with follow-up durations of 72,669 and 105,515 person-years, respectively. Compared with the spousal K6 of 0 group, the multivariable hazard ratios (95 % confidence intervals) of at least moderate distress and serious distress were 1.13 (1.07-1.20) and 1.00 (0.85-1.18) for spousal K6 of 1-4, 1.29 (1.19-1.39) and 1.14 (0.93-1.40) for 5-8, 1.42 (1.26-1.60) and 1.28 (0.95-1.72) for 9-12, and 1.46 (1.22-1.73) and 2.14 (1.49-3.07) for 13-24, respectively. No significant sex differences were observed.Limitations: Psychological distress was based on self-reported data without diagnosis by psychiatrists.Conclusions: High spousal K6 score contributed to a subsequent higher incidence of one's own at least moderate and serious distress. [ABSTRACT FROM AUTHOR]

Background: Guillain-Barré syndrome (GBS) is an autoimmune condition that presents as weakness, numbness, paresthesia, and areflexia. GBS may occur following infection or vaccination. The pathogenesis of GBS is characterized by inflammatory infiltrates and segmental demyelination. The mechanism of GBS following COVID-19 vaccination is hypothesized to arise from an autoimmune-mediated mechanism leading to an increase in inflammatory cytokines. While there were no reported cases of GBS during the mRNA COVID-19 vaccination clinical trials, there have been a few case reports of GBS following COVID-19 vaccination. Case Report: We report a case of symmetric weakness and paresthesia that began 3 days after the patient received his first dose of the Moderna COVID-19 vaccine. Cerebrospinal fluid (CSF) studies demonstrated albuminocytologic dissociation. The combination of the patient's CSF findings and clinical symptoms was concerning for Guillain-Barré syndrome. Given the clinical findings 3 days following COVID-19 vaccination, there was a high concern for COVID-19 vaccine-induced GBS. The patient was treated with IVIG followed by plasmapheresis but failed to show significant improvement from either treatment. Conclusions: Our case report demonstrates occurrence of GBS soon after the patient received the COVID-19 Moderna vaccine. Although rare, there is some evidence to support an association between COVID-19 vaccination and GBS, but this is generally limited to case reports and case series. Clinicians, however, should remain vigilant to mitigate potential risks, such as autonomic dysfunction, respiratory failure, permanent disability, and death in patients who develop GBS after vaccination. [ABSTRACT FROM AUTHOR]

Background: Middle-aged adults may be the ideal target group for dementia-related stigma reduction interventions to encourage the utilization of services among those who may become family caregivers. Neighborhood social cohesion may diminish dementia-related stigma, particularly in terms of perceived public attitudes. The COVID-19 pandemic can further negatively impact perceived public stigma.Objective: To investigate the association between neighborhood social cohesion and dementia-related stigma during the pre- and current COVID-19 period.Methods: We employed a cross-sectional design using data from a large population-based cohort, the Tokyo Teen Cohort, in Japan. Overall, 2,469 mothers of 16-year-old adolescents self-completed a questionnaire comprising nine dementia-related stigma questions evaluating perceived public and personal attitudes. Neighborhood social cohesion was assessed using a five-item instrument. The participants were divided into two groups according to the time of assessment: prior to the pandemic's onset (February 2019-March 2020) and during the pandemic (April 2020-July 2021). A multiple regression analysis of stigma was performed using neighborhood social cohesion as an independent variable, and caring experience, age, educational level, and working status as covariates.Results: Personal and perceived public stigma were significantly lower in participants who perceived greater neighborhood social cohesion. However, level of personal and perceived public stigma did not differ between pre- and during the pandemic period.Conclusion: Neighborhood social cohesion may be a modifiable factor for dementia-related stigma. A localized intervention to enhance social cohesion in the neighborhood community would promote the utilization of services among those who may become family caregivers. [ABSTRACT FROM AUTHOR]

Background: Young-onset dementia (YOD) has many underlying etiologies, leading to a large heterogeneity in first symptoms. This makes it difficult for general practitioners (GPs) to recognize YOD.Objective: Identify early symptoms that are more common in the pre-diagnostic phase of YOD.Methods: We performed a case-control study nested in a primary-care registry on 89 cases and 162 matched controls, where we compared symptoms of people with YOD up to 5 years before diagnosis to their matched control group without YOD. The variables included in this study were International Classification of Primary Care codes and symptoms extracted from written GP notes and categorized in groups. We used Generalized Equation Estimation to analyze symptom's time-trajectories and logistic regression and ROC-curves to analyze differences in number of symptom categories reported.Results: Cognitive symptoms were more common in people with YOD 5 years before diagnosis, affective symptoms 4 years before diagnosis, social symptoms 3 years, behavioral symptoms 2 years, and daily functioning disturbances 1 year before diagnosis. The ROC-curve suggested that reporting two or more symptom categories at the GP gave the best trade-off between sensitivity (85%) and specificity (77%), for the highest percentage of correctly diagnosed persons.Conclusion: This study showed people with YOD present differently than people without YOD. However, it may still be difficult for GPs to use these symptom categories to distinguish people with YOD, since the symptoms also occur in people with other diseases. A combination of reported symptom categories increases the probability of an underlying cause of YOD. [ABSTRACT FROM AUTHOR]

Background: Disease-modifying treatments for Alzheimer's disease (AD) may be more successful if interventions occur early, prior to significant neurodegeneration and subsequent to the onset of clinical symptoms, potentially during middle age. Polymorphisms within BDNF, COMT, and KIBRA have been implicated in AD and relate to episodic memory and executive functioning, two domains that decline early in AD.Objective: The purpose of the current study was to use an endophenotype approach to examine in healthy, non-demented middle-aged adults the association between polymorphisms in BDNF, COMT, and KIBRA and functional connectivity within networks related to episodic memory and executive function (i.e., default mode network (DMN), executive control network (ECN), and frontoparietal network (FPN)).Methods: Resting state networks were identified using independent component analysis and spatial maps with associated time courses were extracted using a dual regression approach.Results: Functional connectivity within the DMN was associated with polymorphisms in BDNF (rs11030096, rs1491850) and KIBRA (rs1030182, rs6555791, rs6555802) (ps < 0.05), ECN connectivity was associated with polymorphisms in KIBRA (rs10475878, rs6555791) (ps < 0.05), and FPN connectivity was associated with KIBRA rs6555791 (p < 0.05). There were no COMT-related differences in functional connectivity of any of the three networks investigated (ps > 0.05).Conclusion: Our study demonstrates that in middle age, polymorphisms in BDNF and KIBRA are associated with altered functional connectivity in networks that are affected early in AD. Future preclinical work should consider these polymorphisms to further elucidate their role in pathological aging and to aid in the identification of biomarkers. [ABSTRACT FROM AUTHOR]

Background: Potentially inappropriate prescribing (PIP) is common in older adults and is associated with increased medication costs and costs of associated adverse drug events. PIP also affects almost 1/5 of middle‐aged adults (45–64 y), as defined by the PRescribing Optimally in Middle‐aged People's Treatments (PROMPT) criteria. However, there has been little research on PIP medication costs within this age group. Aims: Calculate the medication costs of PIP for middle‐aged adults according to the 22 PROMPT criteria and compare with the cost of consensus‐validated, evidence‐based (adequate) alternative prescribing scenarios. Methods: Adequate alternatives to the 22 PROMPT criteria were created via literature review. A Delphi consensus panel of experts was recruited (n = 16), supported by a patient and public involvement group, to achieve consensus on the alternatives. A retrospective repeated cross‐sectional study from 2014 to 2019 was then conducted utilising pseudonymised primary care data from Lambeth DataNet in South London (41 general practices, n = 1 185 335, using Lambeth DataNet May 2020 extract) to calculate the cost of PIP. Results: The cross‐sectional study included 55 880 patients. The total PIP cost was £2.79 million, with adequate alternative prescribing costing £2.74 million (cost savings of £51 278). Duplicate drug classes was the most costly criterion for both PIP and alternative prescribing. Conclusion: This study calculated the medication costs of PIP and created alternative prescribing scenarios for the 22 PROMPT criteria. There is no substantial cost difference between adequate prescribing vs. PIP. Future studies should investigate the wider health economic costs of alternative prescribing, such as reducing hospital admissions. [ABSTRACT FROM AUTHOR]

Polypharmacy, commonly defined as taking ≥5 medications, is an undesirable state associated with lower quality of life. Strategies to prevent polypharmacy may be an important priority for patients. We sought to examine the association of healthy lifestyle, a modifiable risk factor, with incident polypharmacy. We performed a secondary analysis of the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study, including 15,478 adults aged ≥45 years without polypharmacy at baseline. The primary exposure was healthy lifestyle at baseline as measured by the Healthy Behavior Score (HBS), a cumulative assessment of diet, exercise frequency, tobacco smoking, and sedentary time. HBS ranges from 0-8, whereby 0-2 indicates low HBS, 3-5 indicates moderate HBS, and 6-8 indicates high HBS. We used multinomial logistic regression to examine the association between HBS and incident polypharmacy, survival without polypharmacy, and death. Higher HBS (i.e., healthier lifestyle) was inversely associated with incident polypharmacy after adjusting for sociodemographic and baseline health variables. Compared with participants with low HBS, those with moderate HBS had lower odds of incident polypharmacy (odds ratio [OR] 0.85; 95% confidence interval [CI], 0.73-0.98) and lower odds of dying (OR 0.74; 95% CI, 0.65-0.83). Participants with high HBS had even lower odds of both incident polypharmacy (OR 0.75; 95% CI, 0.64-0.88) and death (OR 0.62; 95% CI, 0.54-0.70). There was an interaction for age, where the association between HBS and incident polypharmacy was most pronounced for participants aged ≤65 years. Healthier lifestyle was associated with lower risk for incident polypharmacy. [ABSTRACT FROM AUTHOR]

Falling experiences and the fear of falling in relation to subjective cognitive decline (SCD) was examined in middle-aged Koreans. A nationwide cross-sectional study was conducted using data from the 2019 Korea Community Health Survey. The final analysis included 92,323 individuals aged 40–64 years who had available data on SCD and falls. A multivariate regression model was applied to examine the independent effect of SCD on falls. Approximately 10.7% of participants had experienced a fall in the previous 12 months. Stepwise multivariate regression analysis showed that SCD was independently associated with a falling experience (adjusted odds ratio [95% confidence interval], 1.16 [1.53–1.70]); individuals with SCD were more likely to experience falling (13.9% vs. 9.14%, p < 0.001) and had more fear of falling (2.33% vs. 1.74%, p < 0.001). In conclusion, SCD is independently associated with falls in the middle-aged, which highlight the clinical need to investigate cognitive deficits among this population. [ABSTRACT FROM AUTHOR]

Background: Palliative care is underutilized due in part to fear and misunderstanding, and depression might explain variation in fear of palliative care. Objective: Informed by the socioemotional selectivity theory, we hypothesized that older adults with cancer would be less depressed than younger adults, and subsequently less fearful of utilizing palliative care. Setting/Subjects: Patients predominately located in the United States with heterogeneous cancer diagnoses (n = 1095) completed the Patient-Reported Outcomes Information System (PROMIS) Depression scale and rated their fear of palliative care using the Palliative Care Attitudes Scale (PCAS). We examined the hypothesized intercorrelations, followed by a bootstrapped analysis of indirect effects in the PROCESS macro for SPSS. Results: Participants ranged from 26 to 93 years old (mean [M] = 60.40, standard deviation = 11.45). The most common diagnoses were prostate (34.1%), breast (23.3%), colorectal (17.5%), skin (15.3%), and lung (13.5%) cancer. As hypothesized, older participants had lower depression severity (r = −0.20, p < 0.001) and were less fearful of palliative care (r = −0.11, p < 0.001). Participants who were more depressed were more fearful of palliative care (r = 0.21, p < 0.001). An indirect effect (β = −0.04, standard error = .01, 95% confidence interval: −0.06 to −0.02) suggested that depression severity may account for up to 40% of age-associated differences in fear of palliative care. Conclusions: Findings indicate that older adults with cancer are more likely to favor palliative care, with depression symptom severity accounting for age-related differences. Targeted interventions among younger patients with depressive symptoms may be helpful to reduce fear and misunderstanding and increase utilization of palliative care. [ABSTRACT FROM AUTHOR]

Objectives: Physical activity and nutrition can affect some serum markers associated with metabolic syndrome (MetS). We aimed to ascertain the prevalence and predictors of MetS among middle-aged women in this study. Materials and Methods: This cross-sectional descriptive-analytical study was performed on 164 eligible middle-aged women. Sampling was performed by two-stage cluster random sampling among all the health care centers in Kamyaran, Iran. Data were collected through anthropometrics, Food Records, and International Physical Activity Questionnaires. Serum lipid profile and glycemic control indexes, calcium, and 25-hydroxy vitamin D3 were assayed. Blood pressure was measured. The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria were used to detection of MetS. Results: Forty-one women (25.0%; 95% CI: 18.4% to 31.6%) had MetS. Fasting blood sugar (FBS) (adjusted odds ratio (aOR): 0.020; 95% CI: 1.001 to 1.039), triglyceride (aOR: 1.024; 95% CI: 1.015-1.033), low physical activity: walking (aOR: 0.999; 95% CI: 0.998 0.999), dietary iron (aOR: 1.059; 95% CI: 0.989-1.134) and waist circumference (aOR: 1.062: 95% CI; 1.020 1.105) have been detected as the MetS predictors in this study. Conclusions: Higher serum levels of FBS and triglyceride, higher iron intake and waist circumference, and low physical activity enhanced the chance of getting MetS. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to test the effect of an information and support intervention on physical activity (PA) in women aged 50+ years.Design: Randomized wait-list controlled trial.Setting: Sydney, Australia.Sample: 126 female university and health service employees, aged 50+.Intervention: Information session, activity tracker, regular motivational emails.Measures: Proportion achieving ≥ 10,000 steps/day (primary outcome), daily step count, proportion meeting 150 mins/week of moderate to vigorous PA (MVPA), self-reported PA.Analysis: Odds-ratios and general linear regression models.Results: At 3 months, the intervention group reported significantly more vigorous PA (1.04 hours, 95% CI 0.24 to 1.85, P = .01, measured by IPAQ), were more likely to achieve 300 mins/week of MVPA (OR = 1.98, 95% CI 0.89 to 4.36, P = .09, measured by Actigraph) than the control wait-list group, and reported adopting PA promotion strategies (technology = 31/58% or goal-setting = 39/74%). No significant between-group differences in the primary outcome were detected (1.39, 95% CI 0.61 to 3.18, P = .44).Conclusions: This low-dose intervention significantly increased self-reported vigorous PA time and non-significantly increased the proportion of people achieving 300 mins/week of MVPA but did not significantly increase the proportion of participants achieving 10,000 steps/day. Relatively small effects may be important at a population level given the minimal resources needed to deliver this intervention. [ABSTRACT FROM AUTHOR]

Objectives: We examined the effects of aging and of gadolinium-based contrast agent (GBCA) exposure on MRI measurements in brain nuclei of healthy women. Methods: This prospective, IRB-approved single-center case-control study enrolled 100 healthy participants of our high-risk screening center for hereditary breast cancer, who had received at least six doses of macrocyclic GBCA (exposed group) or were newly entering the program (GBCA-naïve group). The cutoff "at least six doses" was chosen to be able to include a sufficient number of highly exposed participants. All participants underwent unenhanced 3.0-T brain MRI including quantitative T1, T2, and R2* mapping and T1- and T2-weighted imaging. The relaxation times/signal intensities were derived from region of interest measurements in the brain nuclei performed by a radiologist and a neuroradiologist, both board certified. Statistical analysis was based on descriptive evaluations and uni-/multivariable analyses. Results: The participants (exposed group: 49, control group: 51) were aged 42 ± 9 years. In a multivariable model, age had a clear impact on R2* (p < 0.001–0.012), T2 (p = 0.003–0.048), and T1 relaxation times/signal intensities (p < 0.004–0.046) for the majority of deep brain nuclei, mostly affecting the substantia nigra, globus pallidus (GP), nucleus ruber, thalamus, and dentate nucleus (DN). The effect of prior GBCA administration on T1 relaxation times was statistically significant for the DN, GP, and pons (p = 0.019–0.037). Conclusions: In a homogeneous group of young to middle-aged healthy females aging had an effect on T2 and R2* relaxation times and former GBCA applications influenced the measured T1 relaxation times. Key Points: The quantitative T1, T2, and R2* relaxation times measured in women at high risk of developing breast cancer showed characteristic bandwidth for all brain nuclei examined at 3.0-T MRI. The effect of participant age had a comparatively strong impact on R2*, T2, and T1 relaxation times for the majority of brain nuclei examined. The effect of prior GBCA administrations on T1 relaxation times rates was comparatively less pronounced, yielding statistically significant results for the dentate nucleus, globus pallidus, and pons. Summary statement: Healthy women with and without previous GBCA-enhanced breast MRI exhibited age-related T2* and T2 relaxation alterations at 3.0 T-brain MRI. T1 relaxation alterations due to prior GBCA administration were comparatively less pronounced. [ABSTRACT FROM AUTHOR]

Background: The population-based Cancer Registry of Cali Colombia operates continuously since 1962, disseminating incidence information in the XI volumes of Cancer Incidence in Five Continents. Aim: To describe the incidence and mortality rates for the period 2011-2020 and the changes in the trend of incidence rates (1962-2017) and mortality rates from cancer (1986-2020). Methods: The Joinpoint model and the annual percentage change (APC) were used as summary measures of the changes in the trends of incidence rates (ASR-I) and mortality (ASR-M) standardized by age with the direct method. Results: Trough 1988-2017 the ASR-I for all locations increased 0.4% annually (95% CI: 0.2, 0.6) in men and decreased annually 0.2% (95% CI: -0.3; -0.1) in women. The ASR-Is of cancers related to opportunity screening activities (prostate and breast) increased until the early 21st century and then decreased. The ASR-I of cancers related to infectious agents continue to decrease (cervix, vulva, and stomach). There is evidence of control of cancer related to tobacco consumption (lung, oral cavity, bladder). In both sexes, the ASR-I of thyroid, colorectal and lymphoma cancers increased and those of ovarian cancer decreased. Between 1984-2020 the ASR-M for all locations decreased annually 0.7% (95% CI: -0.9, -0.5) in men and 1.1% (95% CI: -1.3, -0.9) in women. For both sexes, ASR-M decreased for cancers of the esophagus, stomach, lung, bladder, lymphomas, and leukemias; and increased in colorectal cancer. The ASR-M for cervical and prostate cancer decreased annually by 3.5% (95% CI: -3.9, -3.2) and 0.1% (95% CI: -0.5, -0.3), respectively. Comment: This information allows the construction of some indicators to monitor the City Cancer Challenge initiative and the current 10-year plan for cancer control in Colombia, 2011-2021. [ABSTRACT FROM AUTHOR]

Objective: To compare the mortality risk due to covid-19 with death due to overdose in British Columbia, Canada. The opioid epidemic was declared a public health emergency in 2016.Methods: Mortality risk was calculated in micromorts with covid-19 data for January-October 2020, derived from the BC center for Disease Control, and illicit drug toxicity deaths for January 2010-September 2020, derived from the BC Coroners Service. Age-stratified covid-19 incidence and deaths per 100,000 population and age-stratified illicit drug toxicity death rates per 100,000 population were calculated. A micromort is a unit of risk equivalent to a one-in-a-million chance of death.Results: During the covid-19 pandemic, illicit drug toxicity deaths reached 1.0 micromorts per day, representing an increase of 0.5 micromorts per day relative to 2019 rates. In comparison, covid-19 mortality risk was 0.05 micromorts per day among individuals from the general population living in British Columbia and 21.1 micromorts per day among those infected with covid-19. Covid-related mortality risk was significantly lower among individuals aged <60 years, relative to older adults, whereas drug toxicity-related mortality was highest for individuals aged 30-59 years.Conclusions: The mortality associated with covid-19 is apparent and distributed unevenly across subpopulations. The mortality due to overdose has increased during covid-19 and exceeds mortality due to covid-19. Our results instantiate the triple threat caused by covid-19 (i.e., public health crisis, economic crisis and mental health crisis) and quantitatively highlight the externality of increased mortality due to deaths of despair in response to public health efforts to reduce covid-related mortality. [ABSTRACT FROM AUTHOR]

Since the human papillomavirus (HPV) vaccine guidelines were developed by the Korean Society of Gynecologic Oncology (KSGO) in 2011, 2016, and 2019, several recent studies on the efficacy and safety of HPV vaccines in middle-aged women and men have been reported. Furthermore, there has been an ongoing debate regarding the efficacy of the HPV vaccine in women with prior HPV infection or who have undergone conization for cervical intraepithelial neoplasia (CIN). We searched and reviewed studies on the efficacy and safety of the HPV vaccine in middle-aged women and men and the efficacy of the HPV vaccine in patients infected with HPV and those who underwent conization for CIN. The KSGO updated their guidelines based on the results of the studies included in this review. [ABSTRACT FROM AUTHOR]

Background: Despite the intention to perform physical activity (PA), a number of individuals cannot manage to have PA program on a regular basis. In this study we explored the barriers of regular PA behavior among healthy adults in Tabriz, Iran. Methods: This qualitative study with a conventional content analysis approach, was carried out from June to September 2020. Nineteen 30-59 years old individuals, were purposefully (purposive sampling) selected to participate in the study. The participants were formerly registered as "physically inactive" in the health records of Tabriz Health System. Individual semi-structured interviews were conducted until data saturation. Data were managed using MAXQDA-10 software. Results: The barriers of regular PA that emerged from our data were being listless and lethargic, non-supportive environment, disintegration in PA education chain, and restrictive social norms. Conclusion: Our findings uncover several PA barriers that are less discussed in the literature. Poor level of regular PA among adults in Iran, as a developing context, is rooted in perceptions with social and economic origins, which should be taken into account by public health policy makers while planning PA promotion programs in such communities. To promote regular PA among healthy adults in developing countries, regular PA programs should be tailored to bridge the gap between their recognition of PA barriers and subsequent behavior change through creating group dynamics highlighting the measures to diminish the behavior. [ABSTRACT FROM AUTHOR]

Study from an umbrella project with a multi-center action, from Interdisciplinary Nucleus of Studies and Research on Family Health Care Conviability with Chronic Diseases (Niefam). This research had resilience and reproductive aging as theoretical frameworks. The objectives of this study were to make an educative-caring intervention on the empowerment of women in the climacteric/menopause phase and in the chronic disease confrontation process, Systemic Arterial Hypertension, HAS, and Type 2 Diabetes Mellitus, DM2, and to evaluate intervention in the HAS, DM2 markers, and the feeling of living the old age phase effects, with a mixed and interventionist method, performed in Bahia, during August/2019 and July/2020, with 17 women, participants of Niefam. In order to collect the data, one-toone and group semi-structured interviews were performed; educational workshops and conversation circles. The quantitative data was subjected to descriptive statistical analysis, and a qualitative one to content analysis. The results showed they are women with high self-esteem, conscious of the health-disease process, namely, the nontransmittable chronic diseases that affect them, such as HAS in 100% of the participants as well as grade II and III obesity, and DM2. In conclusion, middle-age women can (re)elaborate their experience with their bodies and their health when empowered to their resilient potential. [ABSTRACT FROM AUTHOR]

Background: Reducing disparities in men with prostate cancer (PCa) that may be caused by racial and socioeconomic differences is a major public health priority. Few reports have studied whether these disparities have changed over time. Methods: Men diagnosed with PCa from January 1, 2000 to December 31, 2015 were identified from the Massachusetts and Pennsylvania cancer registries. All‐cause mortality and PCa and cardiovascular cause‐specific mortality were assessed. To estimate neighborhood socioeconomic position (nSEP), a summary score was generated using census tract‐level measures of income, wealth, educational attainment, and racial and income segregation. Participants were grouped by diagnosis year (2000‐2003, 2004‐2007, 2008‐2011, or 2012‐2015), and changing trends in the mortality rate ratio by race and nSEP were estimated using covariate‐adjusted Cox models with follow‐up for up to 10 years, until death, or until censoring on January 1, 2018. Results: There were 193,883 patients with PCa and 43,661 deaths over 1,404,131 person‐years of follow‐up. The Black‐White adjusted hazard ratio (aHR) from 2000 to 2003 through 2012 to 2015 was stable for all‐cause mortality (aHR, 1.14 to 0.97; P for heterogeneity =.42), decreased for PCa‐specific mortality (aHR, 1.38 to 0.93; P for heterogeneity =.005), and increased for cardiovascular mortality (aHR, 1.09 to 1.28; P for heterogeneity =.034). The aHR comparing those in the lowest versus the highest nSEP quintile increased significantly for all‐cause mortality (aHR, 1.54 to 1.79; P for heterogeneity =.008), but not for PCa‐specific mortality (aHR, 1.60 to 1.72; P for heterogeneity =.40) or cardiovascular mortality (aHR, 1.72 to 1.89; P for heterogeneity =.085). conclusions: Although Black‐White disparities in prostate mortality declined in Massachusetts and Pennsylvania over the study period, nSEP mortality disparity trends were stagnant or increased, warranting further attention. Lay Summary: Few reports have examined whether racial and socioeconomic disparities in prostate cancer mortality have widened or narrowed in recent years.Using data from 2 state registries (Massachusetts and Pennsylvania) with differing intensities of government‐mandated health insurance, trends in racial and neighborhood socioeconomic disparities were studied among Black and White men diagnosed from 2000 to 2015.Overall, trends in racial disparities were stagnant for all‐cause mortality, shrank for prostate mortality, and widened for cardiovascular mortality.Disparities associated with neighborhood socioeconomic status either were stagnant or widened across all mortality end points.In general, disparities were more pronounced in Pennsylvania than in Massachusetts. Trends in racial disparities among Black men and White men in Pennsylvania and Massachusetts diagnosed with prostate cancer from 2000 to 2015 are stagnant for all‐cause mortality, shrink for prostate mortality, and widen for cardiovascular mortality. Disparities associated with neighborhood socioeconomic status either are stagnant or widen across all mortality endpoints. [ABSTRACT FROM AUTHOR]

Objective: To compare the performance of the Six-Minute Walk Test on 20-meter (6MWT20) and 30-meter (6MWT30) tracks and to test the validity and reliability of the 6MWT20 in middle-aged and older adults. Method: The subjects underwent lung function assessment and performed the 6MWT30 and 6MWT20. Student´s t-tests or Wilcoxon tests were used to compare the variables. The Pearson or Spearman correlation coefficients were used to evaluate the validity of the 6MWT20 and the reliability of the 6MWT20. The 6MWT30 was tested by the two-way mixed model of the Intraclass Correlation Coefficient (ICC 3,1). Results: Twenty-five subjects (age: 60 ± 10 years) walked, on average, 11.0 ± 21.9 m more in the 6MWT30 than in the 6MWT20 (p <.05). The walking distance, the number of steps, the energy expenditure and the movement intensity between the 6MWT20 and 6MWT30 was correlated (r = 0.95; r = 0.81; r = 0.91; r = 0.67; respectively, p <.001). The walking distances showed high reliability and were similar between test and re-test in the 6MWT30 (544 ± 72.1 vs. 551 ± 70.5; p <.05; ICC = 0.97) and in the 6MWT20 (533 ± 73.1 vs. 532 ± 59.1; p <.05; ICC = 0.87). Conclusion: The 6MWT20 performance is lower than the 6MWT30 However, this difference is not clinically relevant. Additionally, the 6MWT20 is a valid and reproducible test to assess the functional capacity of middle-aged and older adults. [ABSTRACT FROM AUTHOR]

Background: Relative to the abundance of publications on dementia and clock drawing, there is limited literature operationalizing 'normal' clock production.Objective: To operationalize subtle behavioral patterns seen in normal digital clock drawing to command and copy conditions.Methods: From two research cohorts of cognitively-well participants age 55 plus who completed digital clock drawing to command and copy conditions (n = 430), we examined variables operationalizing clock face construction, digit placement, clock hand construction, and a variety of time-based, latency measures. Data are stratified by age, education, handedness, and number anchoring.Results: Normative data are provided in supplementary tables. Typical errors reported in clock research with dementia were largely absent. Adults age 55 plus produce symmetric clock faces with one stroke, with minimal overshoot and digit misplacement, and hands with expected hour hand to minute hand ratio. Data suggest digitally acquired graphomotor and latency differences based on handedness, age, education, and anchoring.Conclusion: Data provide useful benchmarks from which to assess digital clock drawing performance in Alzheimer's disease and related dementias. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study was to investigate the relationship between health literacy dimensions and the perceived risk of cardiovascular disease in middle-aged Iranian women. Materials and Methods: This is a descriptive-correlational study in which 280 women aged 40-60 years were investigated by random cluster sampling out of seven health centers in Yazd city in 2018. Data collection tools included predesigned demographic information from a standard Health Literacy for Iranian Adults (HELIA), and a standard perceived susceptibility and perceived risk components of the preventive behaviors of cardiovascular disease questionnaire. The data were analyzed using one-way ANOVA, independent t-test, Kruskal-Wallis, and Mann Whitney tests. Results: A significant relationship was identified between demographic information and health literacy (p < 0.001). The mean (SD) scores of the perceived risk of cardiovascular disease and health literacy appeared to be 30.71 (5.10) and 35.62 (15.32), respectively. The perceived risk of cardiovascular disease in the participants turned out to be significantly correlated with the accessibility dimension of health literacy (r = 0.31, p < 0.001), but it failed to have any significant relationship with demographic information, especially obesity. Conclusions: As there is a significant relationship between health literacy and perceived risk of cardiovascular disease, hence increasing the health literacy of middle-aged women, especially in persons with high body mass index through the media and health centers, considered as an important source of health information, can be an appropriate task to augment the perceived risk of cardiovascular diseases. [ABSTRACT FROM AUTHOR]