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BACKGROUND: Sedentary behavior is linked to excess fat mass; however, this association may be inconclusive due to potential measurement errors in self-reported sedentary behavior. OBJECTIVE: To assess the association between changes in sedentary behavior and fat mass in a Cohort of Health Workers (HWCS) from 2004 to 2010. METHODS: A total of 1,285 adults participating in the Cohort of Health Workers were evaluated in 2004 and 2010. Fat mass (kg) was measured by dual X-ray absorptiometry. A self-administered questionnaire was used to estimate the sedentary behavior. Sedentary behavior was also estimated using accelerometry in a sample of 142 health workers. Accelerometry data were used to correct self-reported sedentary behavior using a generalized linear model, which included values for sleeping time, age, sex, sedentary behavior, glucose, and triglycerides. Concordance between both methods was assessed using a kappa and Bland-Altman analysis. Once sedentary behavior was corrected, the values were used to evaluate the association between changes in sedentary behavior and body fat mass using a fixed effect model in the cohort, adjusting for confounders. RESULTS: Self-reported sedentary behavior was 2.8 ± 1.8 and 2.3 ± 1.6 h/day, and body fat mass was 24.9 ± 8.1 and 26.8 ± 8.5 kg in 2004 and 2010, respectively. After applying the correction model, the self-reported sedentary behavior was 7.6 ± 1.2 and 7.5 ± 1.2 h/day in 2004 and 2010, respectively. For every hour increase in corrected sedentary behavior, there was an observed increase of 0.847 (p > 0.001) kg in body fat mass during the 6.8 years in the Cohort of Health Workers from 2004 to 2010. Conversely, non-corrected self-reported sedentary behavior was associated with a non-significant reduction of 0.097 kg (p = 0.228) for every hour of sedentary behavior. CONCLUSIONS: Increased sedentary behavior was associated with increased body fat mass when corrected self-reported sedentary behavior was used. Implementing public health strategies to reduce sedentary behavior is imperative.

Background: The relationship between serum vitamin D levels and metabolic syndrome (MetS) has been controversial. This study focused on the relationship between the prevalence of MetS and serum vitamin D levels in middle-aged and elderly people. Methods: This study included middle-aged and older adults who participated in the 2023 Zhejiang Provincial Nutrition and Health Survey, which was conducted in 90 districts and counties in Zhejiang Province, China. Results: A total of 11,305 participants were included in this study. MetS was prevalent in 31.7% of participants. Vitamin D and vitamin D3 concentrations were inversely associated with MetS prevalence (Ptrend<0.05), but not with vitamin D2, regardless of whether logistic regression models were adjusted for confounding factors. After adjusting for age, sex, physical activity level, smoking status, education level, annual per capita household income, and body mass index residuals, the highest tertile (Q3) of vitamin D (odds ratio [OR], 0.779; 95% confidence interval [CI], 0.702–0.865) and vitamin D3 (OR, 0.787; 95% CI, 0.709–0.875) concentrations had a lower risk of MetS than the lowest tertile (Q1). We found that vitamin D and D3 levels were correlated with age (Pinteraction<0.05). When age-stratified analyses were performed, vitamin D and vitamin D3 levels were significantly negatively associated with MetS in older adults but not in middle-aged adults. Conclusions: Low total serum vitamin D and vitamin D3 levels were associated with a higher risk of MetS in adults aged 60 years and older. [ABSTRACT FROM AUTHOR]

Background/Objectives: Low or moderate alcohol drinking may reduce the risk of depression, but depression may induce alcohol drinking. However, the bidirectional associations between alcohol drinking and depression were inconsistent, and many prior analyses were not properly conducted. This study explored the within-individual bidirectional associations between alcohol drinking and depressive symptoms under a causal analytic framework. Methods: Using data for the baby boomer cohorts (born between 1948 and 1965) from the Health and Retirement Study (HRS), we employed the unit fixed-effect models with lagged measures to examine the within-individual bidirectional associations between the number of alcohol drinks per week and the changes in the eight-item Center for Epidemiological Studies-Depression (CES-D) scores. Results: Among 11,057 participants at baseline, about 48% were drinkers and 19% had a CES-D ≥4, i.e., at a high risk of depression. Among male low/moderate drinkers, increasing alcohol drinking between consecutive visits was significantly associated with a decrease in depression scores after adjusting for prior alcohol drinking (−0.15 points per 7 drinks/week increase, p = 0.009). Conversely, among male drinkers and female heavy drinkers, increasing depression scores between visits increased alcohol drinking after adjusting for prior depression scores (ranging from 0.22 to 0.79 drinks/week per 1 point increase of depression score, all p values < 0.01). Conclusions: The bidirectional associations between alcohol drinking and depressive symptoms were evident only among male drinkers, and alcohol drinking should not be recommended as a solution for preventing or relieving depressive symptoms. Limitations: Measures of alcohol drinking and depression were coarse, and the study cohorts were limited to the US baby boomer generation. Generalizing findings to other populations should be cautious. [ABSTRACT FROM AUTHOR]

Loneliness, a distressing emotion resulting from unmet social needs, is a growing public health issue. This study analyzes data from the 2017–2018 LASI Wave-1 to examine the impact of socio-demographic and lifestyle factors on loneliness among Indians aged 45 and older. Key variables include age, sex, marital status, residence, living arrangement, physical activity, tobacco and alcohol use, and self-reported health. The findings reveal that living alone significantly increases the likelihood of loneliness, with individuals 4.35 times more at risk compared to those living with spouses and children. Those living with others are 2.33 times more prone to loneliness. Poor health is linked to a 1.53 times higher risk, while physical inactivity increases loneliness risk (OR = 1.19). Interestingly, alcohol consumption appears to slightly reduce loneliness (OR = 0.94). The study highlights the critical role of family support and perceived health in mitigating loneliness in community-based settings. [ABSTRACT FROM AUTHOR]

This study investigates verbal fluency as an indicator of executive function in middle-aged adults with mild sensorineural hearing loss, comparing them to age-matched controls with normal hearing. In this study, 50 middle-aged participants were recruited, comprising 25 with bilateral unaided mild hearing loss and 25 age-matched controls with normal hearing. Demographic information, including age, gender, and health-related factors, was collected. Audiological evaluations confirmed the participants' hearing status, and verbal fluency tests were conducted, encompassing semantic, phonemic, and alternate fluency tasks. Significant differences in audiological measures were observed between both groups. Verbal fluency tests revealed lower mean ranks between the groups on almost all tasks suggesting distinct accuracy and error patterns. This study establishes a link between mild sensorineural hearing loss and executive function in middle-aged adults, evidenced by deficits in verbal fluency tasks. The findings underscore the need for targeted interventions to address cognitive impairments, emphasizing the importance of comprehensive care strategies for individuals in this population. [ABSTRACT FROM AUTHOR]

Objectives: The Asia Working Group of Sarcopenia (AWGS) 2019 consensus proposed a new concept named "possible sarcopenia". The present study was to estimate the association between indoor air pollution by solid fuel usages for cooking and possible sarcopenia among middle-aged and older Chinese population. Methods: A longitudinal cohort analysis was carried out using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 17,708 participants were recruited and followed up in the CHARLS. Cox proportional hazards models were used to estimate the effects of cooking fuel usages on the new onset of possible sarcopenia. Stratified analyses were performed according to gender and age, and sensitivity analyses were performed using the complete dataset. Results: A total of 4,653 participants were included in the final cohort analysis. During the follow-up of 4 years (2011–2015), a total of 1,532 (32.92%) participants developed new-onset possible sarcopenia. Compared with clean fuel usages for cooking, solid fuel usages were associated with a higher risk of possible sarcopenia (HR = 1.37, 95% CI = 1.23—1.52, p-value < 0.001). After adjusting for potential confounders, there was a trend for association between solid fuel usages and an increased risk of possible sarcopenia. Stratified analyses by gender and age demonstrated a stronger association of the solid fuel usages with possible sarcopenia in the middle-aged female participants (Model 1: HR = 1.83, 95% CI = 1.24—2.69, p-value = 0.002; Model 2: HR = 1.65, 95% CI = 1.10—2.47, p-value = 0.016). Sensitivity analyses indicated that the results were robust. Conclusion: Indoor air pollution from solid fuel usages for cooking was a modifiable risk factor for sarcopenia, especially in middle-aged female population. These findings provide a new prevention strategy to reduce the growing burden of sarcopenia, especially for middle-aged female individuals using solid fuels for cooking. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether risk factors for presarcopenia can be identified in a sample of early middle-aged men and women. Prospective study. Longitudinal data from the Dunedin Multidisciplinary Health and Development Study were used to investigate the relationship between presarcopenia at age 45 years and selected early markers at ages 26, 32, and 38 years. Longitudinal data from N=899 participants from the Dunedin Multidisciplinary Health and Development Study. Not applicable. Presarcopenia was defined as low relative appendicular lean mass index assessed by dual energy x-ray absorptiometry and low strength assessed by grip strength. Logistic regressions were used to describe the association between selected markers and presarcopenia at age 45 years. Multivariate logistic regression revealed that a higher body mass index (BMI) at ages 26, 32, and 38 years was associated with lower likelihood of presarcopenia at age 45 years in both men and women (odds ratio [OR] range, 0.46-0.64). Higher age-normative grip strength at age 38 years in both men and women (OR range, 0.88-0.92) was also associated with lower likelihood for presarcopenia. Lastly, lower self-perceived physical fitness level in men at age 38 years was associated with an increased likelihood of presarcopenia at age 45 years (OR, 9.35; 95% confidence interval, 3.28-26.70). BMI and strength were associated with lower likelihood of presarcopenia during middle age. A higher likelihood of presarcopenia was associated with sex-specific lower self-perceived physical fitness. These modifiable biomarkers may serve as targets for clinical screening and early intervention aimed at slowing or preventing progression to sarcopenia in old age. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a serious health concern requiring effective diagnostic strategies, particularly since its symptoms overlap with those of other conditions. Despite extensive research on early diabetes detection across various age groups, middle-aged adults have been relatively underexplored. This study focuses on this demographic to examine symptom-diabetes associations, examine the influence of symptoms in diabetes prediction, and determine an optimal machine learning (ML) model for diabetes prediction. Materials and Methods: This study utilized data from a previous cohort study conducted in Bangladesh. The original dataset included demographic and symptom-related information from 520 patients visiting the ABC Hospital in Bangladesh, India. The participants comprised both diabetic and non-diabetic individuals showing diabetes-like symptoms. For our study, data from 296 middle-aged adults (aged 40–60 years) were extracted. Chi-square tests assessed diabetes-symptom associations, and the Boruta algorithm examined feature influence. Seven ML classification models were evaluated for predictive accuracy. Results: Results showed that 60% of the 296 participants were diabetic. Symptoms like polyuria, polydipsia, weakness, sudden weight loss, partial paresis, polyphagia, and visual blurring were significantly associated with diabetes. All demographic and symptom-related features were influential in diabetes prediction, with polyuria, polydipsia, gender, alopecia, and irritability emerging as the most influential. Among the ML models tested, the random forest model exhibited the highest sensitivity (98.59%) and outperformed others in accuracy (96.58%) and area under the curve score (96.00%), making it the most efficient model for predicting diabetes in middle-aged adults. Conclusion: Diabetes associated symptoms provide valuable diagnostic opportunities for early diabetes detection in middle-aged adults. Future research should explore genetic, lifestyle, and environmental factors to improve diagnostic accuracy.

Abstract Background Episodic memory naturally deteriorates with age, and its deficits are widely recognized as the most significant feature and the most sensitive indicator of cognitive decline. It has been suggested that adopting a healthy lifestyle can play a protective role in preserving episodic memory. This study aimed to systematically examine the relationship between lifestyle factors (social activities, leisure activities, physical activities, internet use, smoking, alcohol drinking, and sleep quality) and episodic memory in middle-aged and older adults. Methods The current study included 10,392 participants from the Chinese Health and Retirement Longitudinal Survey. A linear mixed model was used to explore the associations between lifestyle factors and episodic memory performance and the age- and sex-specific effects of the association. Results Low-frequency alcohol drinking, higher engagement in social, leisure, and physical activities, increased internet use, and improved sleep quality were associated with better episodic memory performance in middle-aged and older adults. Stratified analyses demonstrated that internet use significantly correlated with episodic memory performance in middle-aged adults but not in older adults. On the other hand, sleep quality showed a significant association with episodic memory performance in women but not in men. Conclusions This study highlights the association between various lifestyle factors and episodic memory performance, with variations observed based on age and sex. Adopting healthy lifestyle factors can have positive effects on episodic memory in middle-aged adults, emphasizing the importance of adhering to healthy lifestyles from middle age onwards to counteract episodic memory decline.

Background Method Results Conclusion Study Registration Many models and theories are used to increase the self‐management of individuals with type 2 diabetes. This study aims to examine the effect of information, motivation, behavioural skills (IMB) model‐based diabetes education and motivational interviewing program on health belief, self‐efficacy, self‐management, and metabolic control in adults with type 2 diabetes.The study is a single‐blind, randomised controlled trial. The study was conducted between 2021 and 2022 with intervention (n = 30) and control groups (n = 30). The intervention group applied the diabetes education and motivational interviews program for 12 weeks that was created based on the IMB model. The study data were collected with a socio‐demographic questionnaire, Diabetes Knowledge Scale, Health Belief Scale, Self‐Efficacy Scale, and Self‐Management Scale.In the post‐test and follow‐up measurements, the mean scores of the intervention group on the knowledge, health belief, self‐efficacy, and self‐management scale were significantly higher than those of the control group, while the HbA1c% and body mass index (BMI) values of the intervention group showed a significant decrease over time. However, there was no difference between the groups in the post‐test BMI and HbA1c% values.The nurse‐led intervention was found to be effective in increasing information, health belief, self‐efficacy, self‐management, and decreasing HbA1c%, BMI in adults with type 2 diabetes.The study was registered in ClinicalTrials NCT05030844. [ABSTRACT FROM AUTHOR]

Emerging evidence suggests that depressive symptoms may be a risk factor for the development of Chronic kidney disease (CKD). This study aimed to investigate the association between depressive symptoms and the incidence of CKD in middle-aged and older Chinese adults. We utilized data from the 2011–2020 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Incident CKD was defined based on the estimated glomerular filtration rate ≤ 60 mL/min/m2 or self-reported. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95 % confidence intervals (95 % CI) for incident CKD, adjusting for potential confounders. Among the 10,996 participants without baseline CKD, 890 developed CKD during a median follow-up of 9.0 years. After adjusting for potential covariates, participants with depressive symptoms had a significantly higher risk of developing CKD compared to those without depressive symptoms (HR: 1.450; 95 % CI: 1.249–1.682). The association remained statistically significant when the CES-D was scored according to the severity of depressive symptoms, i.e., quintiles. A linear positive association between total CES-D score and risk of incident CKD was also found using restricted cubic spline regression (P for non-linearity = 0.114). Depressive symptoms are significantly associated with an increased risk of incident CKD in middle-aged and older Chinese adults. These findings underscore the importance of mental health screening and interventions in preventing CKD in this population. [Display omitted] • Depressive symptoms and its severity significantly increase the risk of incident CKD. • Depressive score is linearly and positively associated with risk of developing CKD. • The association was more pronounced in males, self-reported good health status, or overweight participants. [ABSTRACT FROM AUTHOR]

Background: Episodic memory naturally deteriorates with age, and its deficits are widely recognized as the most significant feature and the most sensitive indicator of cognitive decline. It has been suggested that adopting a healthy lifestyle can play a protective role in preserving episodic memory. This study aimed to systematically examine the relationship between lifestyle factors (social activities, leisure activities, physical activities, internet use, smoking, alcohol drinking, and sleep quality) and episodic memory in middle-aged and older adults. Methods: The current study included 10,392 participants from the Chinese Health and Retirement Longitudinal Survey. A linear mixed model was used to explore the associations between lifestyle factors and episodic memory performance and the age- and sex-specific effects of the association. Results: Low-frequency alcohol drinking, higher engagement in social, leisure, and physical activities, increased internet use, and improved sleep quality were associated with better episodic memory performance in middle-aged and older adults. Stratified analyses demonstrated that internet use significantly correlated with episodic memory performance in middle-aged adults but not in older adults. On the other hand, sleep quality showed a significant association with episodic memory performance in women but not in men. Conclusions: This study highlights the association between various lifestyle factors and episodic memory performance, with variations observed based on age and sex. Adopting healthy lifestyle factors can have positive effects on episodic memory in middle-aged adults, emphasizing the importance of adhering to healthy lifestyles from middle age onwards to counteract episodic memory decline. [ABSTRACT FROM AUTHOR]

Audio-based exergames are beneficial in that they allow users to exercise in an eyes-free and hands-free environment. In this study, we explored two audio-based exergame elements, narrative features and thematic music, that can impact exercise amount (step count and duration) and exercise enjoyment. We conducted a two-week long between-subjects study with 43 young adults and 43 middle-aged adults using SPORTIFY, an audio-based exergame. Our experimental results showed that (1) Using narrative features had a significant main effect on exercise amount and exercise enjoyment both for young adults and middle-aged adults. (2) Using thematic music had no significant main impact on exercise amount and exercise enjoyment both for young adults and middle-aged adults. (3) A significant interaction effect for exercise amount was observed in middle-aged adults, whereas a significant interaction effect for exercise enjoyment was observed in young adults. [ABSTRACT FROM AUTHOR]

ObjectiveMethodsResultsConclusionOmega-3 polyunsaturated fatty acids (PUFAs) play a crucial role in maintaining and improving cognitive function and brain health. The aim of this study was to assess the association between omega-3 PUFA intake and cognitive function in middle-aged and older adults in Saudi Arabia.Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). The frequency and quantity of omega-3 PUFA intake were assessed using an omega-3 food frequency questionnaire.A total of 175 participants were recruited for this study. Participants in the lowest omega-3 PUFA tertile group scored significantly lower in the visuospatial/executive and attention cognitive domains (p < 0.05). After adjusting for confounders, the higher intake of alpha-linolenic acid (ALA) was significantly associated with higher scores in the visuospatial/executive domain (p = 0.02) and the higher intake of docosahexaenoic acid (DHA) was significantly associated with higher scores in the attention domain (p = 0.04). The participants who did not consume walnuts showed a significant lower MoCA score than those who did (p = 0.005). No significant differences were found with other omega-3 PUFA sources.Higher intake of omega-3 PUFAs was positively associated with visuospatial/executive and attention cognitive functions in middle-aged and older adults. [ABSTRACT FROM AUTHOR]

Ageism remains an obstacle to building an age-friendly environment. Although the rise of ageist microaggressions (i.e., subtle discrimination) threatens older adults from maintaining well-being, the mechanism of ageist microaggressions remains understudied. The present study examined ageist microaggressions using a transactional model. Specifically, we examined whether ageing and death anxieties contribute to self-ageism and influence benevolent and hostile ageism. These ageist beliefs might lead to benevolent and hostile ageist microaggressions, respectively. Cross-sectional data from 214 Hong Kong middle-aged adults (M age = 50.97) were obtained. The results from a structural equation model revealed that ageing anxiety, but not death anxiety, was a significant predictor of self-ageism, hostile ageism, and hostile ageist microaggressions. A revised model further suggested that benevolent and hostile ageism were predictive of hostile ageist microaggressions. The results highlight the importance of defying the conventional perception of ageing to reduce ageing anxiety, ageism and ageist microaggressions for an age-friendly society. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a serious health concern requiring effective diagnostic strategies, particularly since its symptoms overlap with those of other conditions. Despite extensive research on early diabetes detection across various age groups, middle-aged adults have been relatively underexplored. This study focuses on this demographic to examine symptom-diabetes associations, examine the influence of symptoms in diabetes prediction, and determine an optimal machine learning (ML) model for diabetes prediction. Materials and Methods: This study utilized data from a previous cohort study conducted in Bangladesh. The original dataset included demographic and symptom-related information from 520 patients visiting the ABC Hospital in Bangladesh, India. The participants comprised both diabetic and non-diabetic individuals showing diabetes-like symptoms. For our study, data from 296 middle-aged adults (aged 40–60 years) were extracted. Chi-square tests assessed diabetes-symptom associations, and the Boruta algorithm examined feature influence. Seven ML classification models were evaluated for predictive accuracy. Results: Results showed that 60% of the 296 participants were diabetic. Symptoms like polyuria, polydipsia, weakness, sudden weight loss, partial paresis, polyphagia, and visual blurring were significantly associated with diabetes. All demographic and symptom-related features were influential in diabetes prediction, with polyuria, polydipsia, gender, alopecia, and irritability emerging as the most influential. Among the ML models tested, the random forest model exhibited the highest sensitivity (98.59%) and outperformed others in accuracy (96.58%) and area under the curve score (96.00%), making it the most efficient model for predicting diabetes in middle-aged adults. Conclusion: Diabetes associated symptoms provide valuable diagnostic opportunities for early diabetes detection in middle-aged adults. Future research should explore genetic, lifestyle, and environmental factors to improve diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of our report was to use a Random Forest classification approach to predict the association between transcutaneous electrical nerve stimulation (TENS) and walking kinematics at the stride level when middle-aged and older adults performed the 6-min test of walking endurance. Methods: Data from 41 participants (aged 64.6 ± 9.7 yr) acquired in two previously published studies were analyzed with a Random Forest algorithm that focused on upper and lower limb, lumbar, and trunk kinematics. The four most predictive kinematic features were identified and utilized in separate models to distinguish between three walking conditions: burst TENS, continuous TENS, and control. SHAP analysis and linear mixed models were used to characterize the differences among these conditions. Results: Modulation of four key kinematic features--toe-out angle, toe-off angle, and lumbar range of motion (ROM) in coronal and sagittal planes--accurately predicted walking conditions for the burst (82%accuracy) and continuous (77% accuracy) TENS conditions compared with control. Linear mixed models detected a significant difference in lumbar sagittal ROM between the TENS conditions. SHAP analysis revealed that burst TENS was positively associated with greater lumbar coronal ROM, smaller toe-off angle, and less lumbar sagittal ROM. Conversely, continuous TENS was associated with less lumbar coronal ROM and greater lumbar sagittal ROM. Conclusions: Our approach identified four kinematic features at the stride level that could distinguish between the three walking conditions. These distinctions were not evident in average values across strides. [ABSTRACT FROM AUTHOR]

Background: The rapid increase in the aging population and the critical role of cognitive functioning in successful aging have shifted scholarly focus toward identifying its risk and protective factors. This study aimed to examine the protective correlates of cognitive functioning among middle-aged adults in Pakistan. Methodology: A correlational research design was employed, and purposive sampling was used to recruit participants. The sample size of 140 middle-aged adults (males = 43, females = 97), aged 35-55 years (M = 44.23, SD = 7.1), was calculated using G-power analysis. Data collection tools included the Montreal Cognitive Assessment (MoCA), the Islamic Practices subscale, and a demographic questionnaire. Statistical analyses were conducted using SPSS version 23. Results: Cognitive functioning was positively associated with education, number of friends, and participation in religious activities. In contrast, negative relationships were observed with age, number of children, obesity, hypertension, and comorbidities. Regression analysis indicated that education, social connections, and religious participation were significant positive predictors of cognitive functioning, while age and obesity emerged as significant negative predictors. Conclusion: The findings suggest that various modifiable protective factors can enhance cognitive functioning. These insights emphasize the importance of addressing modifiable factors to mitigate the effects of normal and pathological aging, offering valuable guidance for middle-aged adults and healthcare professionals. [ABSTRACT FROM AUTHOR]

Abstract Background Sedentary behavior is linked to excess fat mass; however, this association may be inconclusive due to potential measurement errors in self-reported sedentary behavior. Objective To assess the association between changes in sedentary behavior and fat mass in a Cohort of Health Workers (HWCS) from 2004 to 2010. Methods A total of 1,285 adults participating in the Cohort of Health Workers were evaluated in 2004 and 2010. Fat mass (kg) was measured by dual X-ray absorptiometry. A self-administered questionnaire was used to estimate the sedentary behavior. Sedentary behavior was also estimated using accelerometry in a sample of 142 health workers. Accelerometry data were used to correct self-reported sedentary behavior using a generalized linear model, which included values for sleeping time, age, sex, sedentary behavior, glucose, and triglycerides. Concordance between both methods was assessed using a kappa and Bland–Altman analysis. Once sedentary behavior was corrected, the values were used to evaluate the association between changes in sedentary behavior and body fat mass using a fixed effect model in the cohort, adjusting for confounders. Results Self-reported sedentary behavior was 2.8 ± 1.8 and 2.3 ± 1.6 h/day, and body fat mass was 24.9 ± 8.1 and 26.8 ± 8.5 kg in 2004 and 2010, respectively. After applying the correction model, the self-reported sedentary behavior was 7.6 ± 1.2 and 7.5 ± 1.2 h/day in 2004 and 2010, respectively. For every hour increase in corrected sedentary behavior, there was an observed increase of 0.847 (p > 0.001) kg in body fat mass during the 6.8 years in the Cohort of Health Workers from 2004 to 2010. Conversely, non-corrected self-reported sedentary behavior was associated with a non-significant reduction of 0.097 kg (p = 0.228) for every hour of sedentary behavior. Conclusions Increased sedentary behavior was associated with increased body fat mass when corrected self-reported sedentary behavior was used. Implementing public health strategies to reduce sedentary behavior is imperative.

Abstract Background This study aimed to investigate quality of life (QoL) in middle-aged adults living alone and identify comprehensive biological, psychological, interpersonal, and contextual factors related to QoL using the dynamic biopsychosocial model. As a secondary analysis, this study used data from the 2017 Korea Community Health Survey conducted by the Korea Disease Control and Prevention Agency. Methods Among the total 228,381 respondents, 10,639 middle-aged individuals aged 40–64 years from single-person households (5,036 men and 5,603 women) were included in the analysis. QoL was measured using the EuroQoL-5 Dimension (EQ-5D). The EQ-5D descriptive statistics were provided according to biological, psychological, interpersonal, and contextual factors. Considering the data structure of the multistage stratified cluster sampling method, a complex samples general linear model statistic was used to identify the predictors of QoL. Results QoL was lower in those who had undesirable psychological status (e.g., more depressive symptoms, poor subjective health, and higher perceived stress), less engagement in social networking (less frequent contact with friends and less frequent participation in social activities such as religious activities, friendship gathering, and leisure), and lower physical, behavioral, and socioeconomic factors. Conclusions This study’s findings indicate that psychological and interpersonal factors should be addressed and prioritized to improve the QoL of middle-aged adults living alone. By providing many opportunities for easily accessible social activities that meet the needs and interests of this demographic, their QoL can be improved through strengthening social support.

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

Love is a complex construct of undeniable importance for human beings and an area of research that has progressed over the past decades. The capacity to love, specifically, refers to the capacity for involvement, investment, and maintenance of a committed romantic relationship, resulting from complex developmental processes that begin in childhood and continue to be shaped throughout development. Despite its relevance, there is still little evidence of its relationships with indicators of positive human functioning. This study examines the link between the capacity to love and emotional, psychological, and social well-being. Furthermore, it delves into potential differences in the capacity to love based on life cycle stages (emerging adulthood and midlife) and gender. The research involved 535 participants, with 282 (52.7%) falling under the emerging adulthood category (18–25 years) and 253 (47.3%) classified as middle-aged adults (45–65 years). Multivariate variance analyses indicate emerging adults demonstrate a greater capacity to love in all dimensions except acceptance of loss, grief, and jealousy. Concerning gender, there were no significant differences. Prediction models indicate that age and acceptance of loss and grief are significant and positive predictors of all types of well-being, and basic trust is a significant and positive predictor of emotional well-being. Overall, this research sheds light on the vital role the capacity to love plays in human well-being and emphasizes the need for interventions that focus on nurturing and developing this aspect of human relationships. [ABSTRACT FROM AUTHOR]

Objective To establish a simple model for arteriosclerosis (AS) screening to provide a viable tool for the timely identification of AS risk among residents aged 40-65 years. Methods Data were obtained from the Sleep and Chronic Diseases Program in Fuquan City. The original dataset was divided into a training subset and a validation subset (80%: 20%). LASSO and logistic regression models were used to screen variables, perform multivariate regression analyses. Internal validation was performed using the Bootstrap method. Nomogram Plot was constructed, and risk score thresholds were determined based on ROC curves to classify high-risk populations. Results RS Model was established to include age, gender, napping, sleep efficiency, sleep disorders, hypertension and diabetes, with AUC = 74.80% and a model risk score threshold = 84.20. PHC Model was established to include age, gender, napping, sleep efficiency, systolic blood pressure, fasting blood glucose, and pulse variables, with AUC = 82.80% and a risk score threshold of 78.00. Decision curves showed that both models performed well in terms of calibration and actual benefits for health management. Conclusion The two AS screening models exhibit acceptable accuracy and differentiation. Therefore, it can be applied in residents' self-health management and in primary care organizations' screening work in a large scale. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate quality of life (QoL) in middle-aged adults living alone and identify comprehensive biological, psychological, interpersonal, and contextual factors related to QoL using the dynamic biopsychosocial model. As a secondary analysis, this study used data from the 2017 Korea Community Health Survey conducted by the Korea Disease Control and Prevention Agency. Methods: Among the total 228,381 respondents, 10,639 middle-aged individuals aged 40–64 years from single-person households (5,036 men and 5,603 women) were included in the analysis. QoL was measured using the EuroQoL-5 Dimension (EQ-5D). The EQ-5D descriptive statistics were provided according to biological, psychological, interpersonal, and contextual factors. Considering the data structure of the multistage stratified cluster sampling method, a complex samples general linear model statistic was used to identify the predictors of QoL. Results: QoL was lower in those who had undesirable psychological status (e.g., more depressive symptoms, poor subjective health, and higher perceived stress), less engagement in social networking (less frequent contact with friends and less frequent participation in social activities such as religious activities, friendship gathering, and leisure), and lower physical, behavioral, and socioeconomic factors. Conclusions: This study's findings indicate that psychological and interpersonal factors should be addressed and prioritized to improve the QoL of middle-aged adults living alone. By providing many opportunities for easily accessible social activities that meet the needs and interests of this demographic, their QoL can be improved through strengthening social support. [ABSTRACT FROM AUTHOR]

Despite theoretical accounts asserting the importance of children for the wellbeing of individuals as they age, research evidence suggests that children may be inconsequential when it comes to loneliness. Yet, there is reason to expect some subgroups may be more vulnerable to the impact of childlessness than others and this may also differ depending on the type of loneliness being assessed. This paper addresses the relationship between childlessness and social and emotional loneliness in middle and later life, including differential vulnerability associated with age, gender and marital/partner status. The study drew on data from three waves (2007, 2012 and 2018) of the Canadian General Social Survey for a nationally representative sample of adults aged 45 and older (N = 49,892). In general, childlessness assumed greater importance with regard to social than emotional loneliness. Women reported lower levels of social loneliness in conjunction with childlessness than men. Further, childlessness was associated with higher levels of overall and social loneliness among older than middle-aged adults. Fewer interactions were evident between marital/partner status and childlessness. Among women specifically, those who were co-habiting, separated/divorced or never married reported lower levels of social loneliness than their married counterparts. In contrast, childlessness was linked to greater emotional loneliness only among separated/divorced men and widowed women. Overall, our results suggest that having children available does matter for feelings of loneliness in middle and later life but that the relationship varies and is contingent on the social contexts (age, gender, marital/partner status) and the type of loneliness (social, emotional) involved. [ABSTRACT FROM AUTHOR]

Epidural Hematoma (EDH) is a common condition of traumatic brain injury. It has a good prognosis if prompt surgical intervention is conducted. There is a dearth of studies on neuropsychological assessment of executive functioning exclusively in post-operative EDH patients. Moreover, age as a variable in determining executive functions in patients post-head injury, has been studied mostly in the older adults. This cross-sectional case-control study assessed Executive Functions (EF) in 62 post-surgery patients with EDH and compared 57 healthy controls (HC) using standardized assessment tools of sustained attention, speed, working memory, fluency, set-shifting, perseveration, planning, and response inhibition. Further, executive functions in two phases of adulthood, viz. Early Adulthood (20–39 years) and Middle Adulthood (40–60 years) were compared in the EDH group (E-EDH and M-EDH) and HC (E-HC and M-HC). A two-way Analysis of Variance (ANOVA) and correlational analysis was conducted. Results showed a trend where the M-EDH group performed significantly poorer on executive function tests (viz a viz., time taken, errors, and correct responses), followed by E-EDH, M-HC, and E-HC. The main effect of age was found significant on Digit Symbol, Color Trail 1, N-Back 2, Animal Naming, and Stroop Effect (p < 0.01 level) while N-Back 1, WCST-PE, and Tower of London (p < 0.05 level). The findings have significant clinical and therapeutic implications. In addition, it gives guidance regarding planning specific neuropsychological tests and rehabilitation targeting specific areas of executive functions decline due to age in EDH post-surgery patients. [ABSTRACT FROM AUTHOR]

Physical inactivity and loneliness are both associated with health risks and can affect each other through various social and behavioral mechanisms. However, current evidence on this relationship is equivocal and mostly based on cross-sectional data. This longitudinal study aimed to determine whether current levels of physical activity (moderate and vigorous intensity) and loneliness are associated with future respective states of themselves and each other. We used data from waves 6-14 (2002-2018) of the Health and Retirement Study (n  = 20 134) in a mixed-effects and random-intercept cross-lagged panel model. Analysis showed that current loneliness and physical activity were associated with each future respective state. Additionally, weekly participation in moderate-intensity, but not vigorous-intensity, physical activity was associated with a lower likelihood of becoming lonely in the future (relative risk [RR] = 0.94; 95% CI, 0.90-0.99). However, changes in physical activity were not associated with deviation from a person's typical level of loneliness (for vigorous intensity, mean deviation [MD] = 0.00; 95% CI: −0.04 to 0.03; for moderate-intensity, MD = 0.01; 95% CI: −0.03 to 0.04). Loneliness was not associated with moderate- or vigorous-intensity physical activity in subsequent waves. This suggests that while lower physical activity levels can be associated with future loneliness, changing levels of physical activity has little impact on loneliness at the individual level. [ABSTRACT FROM AUTHOR]

Summary Sleep quality is fundamental to physical and mental health. Recent research shows that the COVID‐19 pandemic has affected individuals’ sleep quality. This study aims to investigate whether the containment and health policies (Oxford Coronavirus Government Response Tracker indexes) adopted by European countries and Israel during the pandemic are related to sleep problems in people aged 50 and over. A cross‐sectional study was conducted using a logistic regression analysis based on data from the Survey of Health, Ageing and Retirement in Europe, collected in 27 European countries and Israel, in 2021. The results show that containment and health policies affect older adults’ sleep, once we neutralise the influence of the sociodemographic, economic, and health characteristics of the individuals and close contact with COVID‐19. In fact, the more containment and health policies, the fewer chances of sleep problems. A possible explanation for this is that these policies give people over 50 a sense of safety and security in relation to COVID‐19, which may reduce sleep problems. [ABSTRACT FROM AUTHOR]

AbstractTobacco use poses significant public health concerns, linked to various mental and physical health outcomes. Iraq has a high prevalence of smoking, predominantly with traditional cigarettes, but there is also growing popularity of electronic cigarettes and waterpipes among younger and middle-aged adults. This study aims to explore the perceptions and usage of traditional cigarettes, electronic cigarettes, and waterpipes among this population in Iraq. A descriptive study was conducted among 402 young and middle-aged adults (50.25% females), aged between 18 and 45 years, with a mean age of 25.88 (SD = 7.27). For the data collection, an online questionnaire was developed utilizing distribution channels on common social networking platforms. The results showed that 41.79% of respondents have used traditional cigarettes, while 31.1% of participants reported that they use electronic cigarettes. Ninety-four per cent of respondents acknowledged that they use waterpipes. The results also indicated that a significant proportion believe that using electronic cigarettes is either much more harmful or more harmful than traditional cigarettes. Participants commonly perceived all three types of tobacco products as highly harmful, including secondhand smoke, addictive qualities, and popularity among peers. Additionally, significant differences in perceptions emerged between smokers and nonsmokers regarding electronic cigarettes and traditional cigarettes, although no such differences were observed for waterpipes. These findings contribute to understanding the attitudes toward different forms of tobacco use among respondents, highlighting the need for targeted interventions to address the perceived harm associated with tobacco products. [ABSTRACT FROM AUTHOR]

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

Introduction: This study aimed to investigate the association between handgrip strength and suicidal ideation in representative samples of adults aged ≥50 years from six LMICs (China, Ghana, India, Mexico, Russia, and South Africa). Methods: Cross‐sectional, community‐based data from the World Health Organization's Study on Global Aging and Adult Health were analyzed. Handgrip strength quintiles by sex were created based on the average value of two handgrip measurements of the dominant hand. Self‐reported information on past 12‐month suicidal ideation was collected. Multivariable logistic regression analysis was conducted to assess associations. Results: Data on 34,129 individuals were analyzed [mean (SD) age 62.4 (16.0) years; age range 50–114 years; 52.1% females]. After adjustment for potential confounders, in the overall sample, compared to the handgrip strength quintile with the highest values [Quintile 1 (Q1)], Q2, Q3, Q4, and Q5 were associated with significant 2.15 (95% CI = 1.05–4.39), 2.78 (95% CI = 1.06–7.32), 3.53 (95% CI = 1.68–7.42), and 6.79 (95% CI = 2.80–16.48) times higher odds for suicidal ideation. Conclusions: Lower handgrip strength was significantly and dose‐dependently associated with higher odds for suicidal ideation in adults aged ≥50 years from LMICs. Future longitudinal studies are needed to understand the underlying mechanisms, and whether increasing general muscular strength and physical function may lead to reduction in suicidal ideation. [ABSTRACT FROM AUTHOR]

Aim: To understand the experiences of individuals who undergo LEA due to DFU after disability. Design: A descriptive research design in qualitative research. Methods: Semi‐structured interviews were used in this qualitative descriptive study. Eleven middle‐aged patients (45–59 years) who underwent LEA due to DFU were purposively selected and interviewed. Qualitative data were thematically analysed. Results: Three themes and 10 subthemes were identified. The themes were (1) role function confusion, (2) self‐concept stress and (3) unreasonable objective support. Subthemes included (1) weakened career role, (2) family role reversal, (3) social role restriction, (4) over‐focusing on appearance, (5) immersion in patient experience, (6) living with faith, (7) polarization of independent consciousness, (8) low perceived benefits of peer support, (9) existence of treatment disruption and (10) poor participation in medical decision‐making. [ABSTRACT FROM AUTHOR]

This study explored how personality and serious leisure activities, such as playing pickleball, contribute to eudaimonic well-being in middle-aged and older adults. Data were collected at pickleball events at the 2017 Huntsman World Senior Games from a convenience sample of 250 players aged between 50 and 91 years (M = 65.11, SD = 7.49). Of the five personality dispositions examined, conscientiousness (β = 0.32, p <.001), neuroticism (β = −0.22, p <.01), and openness to experience (β = 0.18, p <.01) were discovered to be significant predictors of eudaimonic well-being. Serious leisure also contributed to eudaimonic well-being (β = 0.28, p <.01). The findings of this study enhance the understanding of the behaviors exhibited by older adults and elucidate the positive impact exerted on eudaimonic well-being by personality and serious leisure. [ABSTRACT FROM AUTHOR]

BACKGROUND: Difficulty performing basic daily activities such as bathing and dressing (functional impairment) affects more than 15% of middle-aged people, and this proportion is increasing. Little is known about the experiences and needs of individuals who develop functional impairment in middle age. OBJECTIVE: To examine the experiences and needs of adults who developed functional impairment in middle age. DESIGN: Qualitative study using semi-structured interviews. PARTICIPANTS: Forty patients aged 50-64 years who developed functional impairment in middle age, recruited from four primary care clinics in San Francisco. APPROACH: Interviews included open-ended questions about participants daily life, ability to perform activities of daily living (ADLs), and needs related to functional impairment. We analyzed interviews using qualitative thematic analysis. KEY RESULTS: Interviews revealed several themes related to the psychosocial and physical impacts of developing functional impairment in middle age. Participants noted that losses associated with functional impairment, such as loss of independence, control, and social roles, caused conflict in their sense of identity. To cope with these losses, participants used strategies including acceptance, social comparison, adjusting standards, and engaging in valued life activities. Participants reflected on the intersection of their functional impairment with the aging process, noting that their impairments seemed premature compared to the more natural aging process in older adults. In terms of physical impacts, participants described how a lack of accommodations in the built environment exacerbated their impairments. While participants used behavioral strategies to overcome these challenges, unmet needs remained, resulting in downstream physical and psychological impacts including safety risks, falls, frustration, and fear. CONCLUSIONS: Unmet psychosocial and physical needs were common among middle-aged adults with functional impairment and led to negative downstream effects. Eliciting and addressing unmet needs may help mitigate downstream health consequences for this growing population, optimizing function and quality of life.

Abstract Background Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults. Methods An analysis was performed on the data obtained from the PONS project (POlish-Norwegian Study), conducted in the Świętokrzyskie Province in Poland in 2010–2011. The research material included the cross-sectional data of 11,901 individuals aged 40–64 years (7967 women). Depressive symptoms, used as outcome variables, were assessed with a questionnaire. The participants provided the responses to questions concerning the occurrence of eight symptoms over the last 12 months. The answers were scored as 1 point or 0 points. The participants were divided into three tercile groups based on their total scores: no or mild (0–2 points), moderate (3–5 points), and severe depressive symptoms (6–8 points). The self-reported number of lost teeth was analysed according to the following categories: 0–4, 5–8, 9–27, and a complete lack of natural teeth. Multivariable logistic regression analysis for depressive symptoms was used in relation to the number of lost teeth. The following covariates were included in the adjusted model: age, sex, place of residence, education, marital status, BMI, diabetes status, stressful life events in the last year, use of antidepressants, smoking, and sugar and sweet consumption. Results The likelihood of both moderate (OR = 1.189; 95%CI: 1.028–1.376; p

Background: Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults. Methods: An analysis was performed on the data obtained from the PONS project (POlish-Norwegian Study), conducted in the Świętokrzyskie Province in Poland in 2010–2011. The research material included the cross-sectional data of 11,901 individuals aged 40–64 years (7967 women). Depressive symptoms, used as outcome variables, were assessed with a questionnaire. The participants provided the responses to questions concerning the occurrence of eight symptoms over the last 12 months. The answers were scored as 1 point or 0 points. The participants were divided into three tercile groups based on their total scores: no or mild (0–2 points), moderate (3–5 points), and severe depressive symptoms (6–8 points). The self-reported number of lost teeth was analysed according to the following categories: 0–4, 5–8, 9–27, and a complete lack of natural teeth. Multivariable logistic regression analysis for depressive symptoms was used in relation to the number of lost teeth. The following covariates were included in the adjusted model: age, sex, place of residence, education, marital status, BMI, diabetes status, stressful life events in the last year, use of antidepressants, smoking, and sugar and sweet consumption. Results: The likelihood of both moderate (OR = 1.189; 95%CI: 1.028–1.376; p <.020) and severe (OR = 1.846; 95%CI: 1.488–2.290; p <.001) depressive symptoms showed the strongest relationship with a total lack of natural teeth. A loss of more than 8 natural teeth was also significantly associated (OR = 1.315; 95%CI: 1.075–1.609; p <.008) with the occurrence of severe depressive symptoms. Conclusions: The loss of natural teeth was positively related to the occurrence of depressive symptoms in middle-aged adults. Thus, there is an urgent need to intensify stomatological prophylaxis, education and treatment for middle-aged individuals. [ABSTRACT FROM AUTHOR]

Introduction: A lower ability to buffer pulse pressure (PP) in the face of increasing mean arterial pressure (MAP) may underlie the disproportionate increase in systolic blood pressure (SBP) in women from young adulthood through middle-aged relative to men. Aim: To evaluate the contribution of MAP to the change in PP and pressure wave contour in men and women from young adulthood to middle age. Methods: Central pressure waveform was obtained from radial artery applanation tonometry in 312 hypertensive patients between 16 to 49 years (134 women, mean age 35 ± 9 years), 185 of whom were on antihypertensive treatment. Results: Higher MAP levels (≥ 100 mmHg) were significantly associated with higher brachial and central SBP (P < 0.001), PP (P < 0.001), incident wave (P = 0.005), AP (P < 0.001), and PWV (P < 0.001) compared to lower MAP levels. The relationship between MAP and brachial PP (P < 0.001), central PP (P < 0.001), incident wave (P < 0.001), and AP (P < 0.01), but not PWV, strengthens with age. The age-related increase in the contribution of MAP to brachial PP (P < 0.001), central PP (P < 0.001), and incident wave (P < 0.001) was more prominent in women than in men beginning in the fourth decade. In multiple regression analyses, MAP remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of age, heart rate, and antihypertensive treatment. In turn, age remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of MAP, heart rate, and antihypertensive treatment. Conclusions: Women of reproductive age showed a steeper increase in PP with increasing MAP, despite comparable increases in arterial stiffness in both sexes. The difference was driven by a greater contribution of MAP to the forward component of the pressure wave in women. [ABSTRACT FROM AUTHOR]

Atrioventricular block may be idiopathic or a secondary manifestation of an underlying systemic disease. Cardiac sarcoidosis is a significant underlying cause of high-grade atrioventricular block, posing diagnostic challenges and significant clinical implications. This study aimed to assess the prevalence and clinical characteristics of cardiac sarcoidosis among younger patients presenting with unexplained high-grade atrioventricular block. We evaluated patients aged between 18 and 65 years presenting with unexplained high-grade atrioventricular block, who were systematically referred for cardiac magnetic resonance imaging, positron emission tomography-computed tomography, or both, prior to pacemaker implantation. Subjects with suspected cardiac sarcoidosis based on imaging findings were further referred for tissue biopsy. Cardiac sarcoidosis diagnosis was confirmed based on biopsy results. Overall, 30 patients with high-grade atrioventricular block were included in the analysis. The median age was 56.5 years (interquartile range 53-61.75, years). In 37%, cardiac magnetic resonance imaging, positron emission tomography-computed tomography, or both, were suggestive of cardiac sarcoidosis, and in 33% cardiac sarcoidosis was confirmed by tissue biopsy. Compared with idiopathic high-grade atrioventricular block patients, all cardiac sarcoidosis patients were males (100% vs 60%, P =.029), were more likely to present with heart failure symptoms (50% vs 10%, P =.047), had thicker inter-ventricular septum on echocardiography (12.2 ± 2.7 mm vs 9.45 ± 1.6 mm, P =.002), and were more likely to present with right ventricular dysfunction (33% vs 10%, P =.047). Cardiac sarcoidosis was confirmed in one-third of patients ≤ 65 years, who presented with unexplained high-grade atrioventricular block. Cardiac sarcoidosis should be highly suspected in such patients, particularly in males who present with heart failure symptoms or exhibit thicker inter-ventricular septum and right ventricular dysfunction on echocardiography. [ABSTRACT FROM AUTHOR]

Recent World Health Organization records show that hypertension is more common in Africa than in other parts of the world, and remains a major common risk factor for cardiovascular diseases, stroke, renal diseases, and death. However, little is known about hypertension management strategies among people in rural areas. Therefore, this phenomenological study aimed to investigate knowledge of hypertension management strategies among middle-aged adults in rural areas of Anambra state. Focus group discussions were used to collect data from 40 middle-aged adults (20 males and 20 females). The data were analysed thematically. Results showed that the participants were all aware of hypertension but lacked in-depth knowledge of disease management strategies. Most of the participants did not believe that engaging in regular physical exercise/activity, and other factors like reduction in salt and alcohol intake could help in controlling high blood pressure. Social workers who are also social service providers are needed to raise awareness among middle-aged people in rural areas about hypertension management strategies. This can be done through the provision of social services like education, health services, and transport services, as this will go a long way in helping rural dwellers gain more knowledge of hypertension management strategies. With the provision of health services, the rural population will not only know management strategies for hypertension but will also be able to check their blood pressure regularly, while transport services will make it possible for the rural population who do not have health centres in their community and means of transporting themselves to the neighbouring community for treatment to do so. Future research should focus on the importance of welfare/home visits as an avenue for awareness creation on hypertension management strategies, as this will be an avenue for the provision of better social services for people in rural areas and an improvement in social service research. [ABSTRACT FROM AUTHOR]

Introduction: Strong evidence suggests that olfactory dysfunction (OD) can predict additional neurocognitive decline in neurodegenerative conditions such as Alzheimer's and Parkinson's diseases. However, research exploring olfaction and cognition in younger populations is limited. The aim of this review is to evaluate cognitive changes among non-elderly adults with non-COVID-19-related OD. Methods: We performed a structured comprehensive literature search of PubMed, Ovid Embase, Web of Science, and Cochrane Library in developing this scoping review. The primary outcome of interest was the association between OD and cognitive functioning in adults less than 60 years of age. Results: We identified 2878 studies for title and abstract review, with 167 undergoing full text review, and 54 selected for data extraction. Of these, 34 studies reported on populations of individuals restricted to the ages of 18–60, whereas the remaining 20 studies included a more heterogeneous population with the majority of individuals in this target age range in addition to some above the age of 60. The etiologies for smell loss among the included studies were neuropsychiatric disorders (37%), idiopathic cause (25%), type 2 diabetes (7%), trauma (5%), infection (4%), intellectual disability (4%), and other (18%). Some studies reported numerous associations and at times mixed, resulting in a total number of associations greater than the included number of 54 studies. Overall, 21/54 studies demonstrated a positive association between olfaction and cognition, 7/54 demonstrated no association, 25/54 reported mixed results, and only 1/54 demonstrated a negative association. Conclusion: Most studies demonstrate a positive correlation between OD and cognition, but the data are mixed with associations less robust in this young adult population compared to elderly adults. Despite the heterogeneity in study populations and outcomes, this scoping review serves as a starting point for further investigation on this topic. Notably, as many studies in this review involved disorders that may have confounding effects on both olfaction and cognition, future research should control for these confounders and incorporate non-elderly individuals with non-psychiatric causes of smell loss. [ABSTRACT FROM AUTHOR]

BackgroundFalls frequently occur among the older adult population. In this study, we examined the variations in fall incidence across different regions over time, focusing on the disparities between urban and rural areas among older adult Chinese individuals, Healthy aging is comprised of five dimensions: (1) absence of chronic diseases, (2) good physical functioning, (3) normal cognitive function, (4) active social participation, and (5) absence of depression. Additionally, we explored the relationship between healthy aging and the occurrence of falls in middle-aged and older adults. Falls are defined as events that occurred within the past two years.ResultsAmong 9,918 participants, 33.8% lived in urban areas and 23.0% achieved healthy aging. In contrast, 66.2% resided in rural areas with 16.5% achieving healthy aging. In 2011, rural residents had a higher fall incidence rate (17% in rural vs. 13.5% in urban); by 2020, the fall rate remained higher in rural areas (19.5% in rural vs. 17.3% in urban). Unhealthy aging (HR = 1.08, 95%CI: 1.00–1.16) were risk factors for falls. Subgroup analysis revealed that in rural areas, unhealthy aging increased the risk of falls. In urban areas, the increased risk of falls associated with unhealthy aging was not significant (Rural HR = 1.11, 95%CI:1.01–1.22; Urban HR = 1.05, 95%CI: 0.93–1.18).ConclusionHealthy aging may be more strongly associated with a lower risk of falls in rural areas, while this association might be less pronounced in urban areas due to different environmental and social factors. This highlights the need for environment-specific fall prevention strategies and targeted measures for the older adult.

Background: Cardiovascular problems are the leading cause of death among adults in our country. These illnesses primarily affect metropolitan populations, particularly in major cities. To prevent these diseases, efforts have focused on identifying and controlling cardiovascular risk factors such sedentary lifestyle. Aim: The study aimed to assess the exercise habits of cardiovascular risks middle-aged adults. Materials and Methods: The research approach used in this study was quantitative approach with descriptive design. Purposive sampling technique was used to select the samples. Totally 60 cardiovascular patients were recruited from Saveetha Medical College and Hospital Thandalam, Chennai. Data were gathered by using structured questionnaires and risk score calculator. Collected data were analyzed by using descriptive and inferential statistics. Results: The above Table 1 shows that 59 (98.33%) had moderate level of physical activity and 1 (1.67%) had high level of physical activity among middle-aged adults. The mean and standard deviation of physical activity among middle-aged adults was 62.26 ± 5.92. The median was 62.0 with minimum score of 38.0 and maximum score of 73.0. The demographic variable age (χ 2 = 6.610, P = 0.037) had statistically significant association with level of physical activity among middle-aged adults at P < 0.05 level and the other demographic variables had not shown statistically significant association with level of physical activity among middle-aged adults. Conclusion: Physical activity promotion and support should be a global priority because of the health benefits it provides for adults.

Abstract Aim To understand the experiences of individuals who undergo LEA due to DFU after disability. Design A descriptive research design in qualitative research. Methods Semi‐structured interviews were used in this qualitative descriptive study. Eleven middle‐aged patients (45–59 years) who underwent LEA due to DFU were purposively selected and interviewed. Qualitative data were thematically analysed. Results Three themes and 10 subthemes were identified. The themes were (1) role function confusion, (2) self‐concept stress and (3) unreasonable objective support. Subthemes included (1) weakened career role, (2) family role reversal, (3) social role restriction, (4) over‐focusing on appearance, (5) immersion in patient experience, (6) living with faith, (7) polarization of independent consciousness, (8) low perceived benefits of peer support, (9) existence of treatment disruption and (10) poor participation in medical decision‐making.

Rongcui Sui,1– 3 Jie Li,4 Yunhan Shi,1– 3 Shizhen Yuan,1– 3 Huijun Wang,1– 3 Jianhong Liao,1– 3 Xiang Gao,1– 3 Demin Han,1– 3 Yanru Li,1– 3 Xingjun Wang4 1Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, People’s Republic of China; 3Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People’s Republic of China; 4Department of Electronic Engineering, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, People’s Republic of ChinaCorrespondence: Demin Han; Yanru Li, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaominxiang, Dongcheng District, Beijing, People’s Republic of China, Email deminhan_ent@hotmail.com; liyanruru@aliyun.comPurpose: This study aimed to investigate the association between sleep spindle metrics and executive function in individuals with obstructive sleep apnea (OSA). Furthermore, we examined the association of age and education on executive function.Patients and Methods: A total of 230 (40.90 ± 8.83 years, F/M = 45/185) participants were enrolled. Overnight electroencephalogram (C3-M2) recording detected sleep spindles by a novel U-Net-type neural network that integrates temporal information with time-frequency images. Sleep spindle metrics, including frequency (Hz), overall density (events/min), fast density (events/min), slow density (events/min), duration (sec) and amplitude (μV), were measured. Executive function was assessed using standardized neuropsychological tests. Associations between sleep spindle metrics, executive function, and demographic factors were analyzed using multivariate linear regression.Results: In fully adjusted linear regression models, higher overall sleep spindle density (TMT-A, B=− 1.279, p=0.009; TMT-B, B=− 1.813, p=0.008), fast sleep spindle density (TMT-A, B=− 1.542, p=0.048; TMT-B, B=− 2.187, p=0.036) and slow sleep spindle density (TMT-A, B=− 1.731, p=0.037; TMT-B, B=− 2.449, p=0.034) were associated with better executive function. And the sleep spindle duration both during N2 sleep time (TMT-A, B=− 13.932, p=0.027; TMT-B, B=− 19.001, p=0.034) and N3 sleep time (TMT-B, B=− 29.916, p=0.009; Stroop-incongruous, B=− 21.303, p=0.035) was independently associated with better executive function in this population. Additionally, age and education were found to be highly associated with executive function.Conclusion: Specific sleep spindle metrics, higher overall density, fast density and slow density during N2 sleep time, and longer duration during N2 and N3 sleep time, are independent and sensitive indicators of better executive function in young adult and middle-aged patients with OSA. Further research is needed to explore the underlying mechanisms and clinical implications of these findings.Keywords: sleep spindle metrics, executive function, obstructive sleep apnea, young adults, middle-aged adults