To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Prior analyses have repeatedly documented the association between individual health behaviours and health outcomes. Nonetheless, few studies have taken a health lifestyle theory approach to examine how health lifestyle behaviours have shaped Chinese older adults’ health status. Using the most recent 2011–2012 data released by the Chinese Longitudinal Healthy Longevity Survey (CLHLS), latent class analysis was applied to identify predominant health lifestyles among Chinese older adults aged 65–105. Four distinct classes representing health lifestyles emerged. Furthermore, the research found the way in which the four classes representing older adults’ health lifestyles can be predicted by the respondent's demographic and socio-economic characteristics. In addition, health lifestyles were found to be strongly associated with Chinese older adults’ health outcomes which were measured by self-rated health, functional independence, cognitive function and chronic diseases, even after controlling for demographic features as well as individual and parental socio-economic disadvantage. Findings supported the cumulative disadvantage theory in health. The research highlighted the importance of promoting health lifestyles to improve older adults’ health outcomes.
Self-reported health is a predictive measure of morbidity and mortality across populations. A comprehensive understanding of the factors that shape self-reported health among community-dwelling older adults, a growing population globally, is lacking. The aim of this review was to summarize the factors that are associated with self-reported health among this population and identify key areas for future research. Accordingly, we conducted a scoping review using the stage-wise framework developed by Arksey and O’Malley. We summarized 42 factors, as identified in 30 publications, and organized them into four categories. Key factors shaping self-reported health included the presence of chronic conditions and depressive symptoms. As the population of community-dwelling older adults continues to increase, there remains a need to understand how these identified factors shape self-reported health. To date, empirical research has been limited to observational and cross-sectional designs. There is a need to further explore these factors in longitudinal data.
To analyse the association between food consumption according to the degree of processing and incidence of hypertension in CUME project participants.
Longitudinal study in which food consumption was evaluated according to the percentage contribution of daily energetic intake (%/d) of each NOVA classification group (unprocessed/minimally processed foods and culinary preparations (U/MPF&CP); processed foods and ultra-processed foods (UPF)). Hypertension was defined according to American College of Cardiology/American Heart Association (ACC/AHA) criteria. Adjusted relative risks (RR) and their 95% confidence intervals (95 % CI) were estimated by Poisson regression models with robust variances.
1221 graduates classified as non-hypertensive at baseline and monitored for 2 years.
Daily energetic percentage from each group according to degree of processing was 64·3 (sd 12) % for U/MPF&CP; 9·9 (sd 5·8) % for processed foods and 25·8 (sd 11) % for UPF. Incidence of hypertension was high (152/1000 person-years; n 113, 193/1000 person-years in males and n 257, 138/1000 person-years in females). After adjusting for potential confounders, participants in the upper quintile of daily energetic intake of U/MPF&CP presented a reduced risk of hypertension (RR: 0·72; 95 % CI 0·52, 0·98), while those in the upper quintile of daily energetic intake of UPF presented an increased risk of the outcome (RR: 1·35; 95 % CI 1·01, 1·81).
In this prospective cohort of Brazilian middle-aged adult university graduates, the highest consumptions of U/MPF&CP and UPF were associated with, respectively, reduced and increased risk of hypertension. Additional longitudinal studies are needed to confirm our results.
The current study aims to describe the Mediterranean diet (MD) adherence across the US regions, and explore the predictive factors of MD adherence among US adults.
Cross-sectional secondary data analysis. MD adherence score (0–9) was calculated using the Block 98 FFQ. Hot spot analysis was conducted to describe the geospatial distribution of MD adherence across the US regions. Logistic regression explored predictors of MD adherence.
Nationwide community-dwelling residency in the USA.
Adults aged ≥45 years (n 20 897) who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment during January 2003 and October 2007.
The mean of MD adherence score was 4·36 (sd 1·70), and 46·5 % of the sample had high MD adherence (score 5–9). Higher MD adherence clusters were primarily located in the western and northeastern coastal areas of the USA, whereas lower MD adherence clusters were majorly observed in south and east-north-central regions. Being older, black, not a current smoker, having a college degree or above, an annual household income ≥ $US 75K, exercising ≥4 times/week and watching TV/video <4 h/d were each associated with higher odds of high MD adherence.
There were significant geospatial and population disparities in MD adherence across the US regions. Future studies are needed to explore the causes of MD adherence disparities and develop effective interventions for MD promotion in the USA.
Low socioeconomic status (SES) is often associated with various health related problems. Therefore, this paper aims to review the available literatures to identify the prevalence of malnutrition, prevalence of poor diet quality and its associated risk factors among older adults with low SES. A literature search was performed using four databases namely PUBMED, Google Scholar, Springer and Science Direct. The search terms used were “diet quality”, “nutritional status”, “dietary intake”, “overweight”, “obesity”, “underweight”, “older people” and “low socioeconomic status (SES)”. The overall prevalence of undernutrition among older adults with low SES worldwide was in the range of 28.9% to 48%, while overnutrition was reported to be between 8.1% to 28.2%. In Asia, the prevalence of undernourished older adults ranged from 3% to 64.9%, while 2.5% to 32.8% were overnourished. Most of the studies (60%) included in this review used BMI as the tool to identify malnutrition, but none of the nutritional screening tools were considered to be the ‘gold standard’. For dietary assessment, food frequency questionnaire (FFQ) and multiple 24-hour dietary recall (24HR) improved the estimation of individual dietary intake. Risk factors for poor diet quality included financial hardship, functional limitation, sex, place of residence, smoking and oral health. Poor nutritional status especially lack of good quality diet and thinness are prevalent among older adults with low SES. Hence, it is important to establish nutrition-related programmes and intervention studies among this group of people for improving their health status and quality of life.
To investigate the association between energy drink (ED) use and sleep-related disturbances in a population-based sample of young adults from the Raine Study.
Analysis of cross-sectional data obtained from self-administered questionnaires to assess ED use and sleep disturbance (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire (FOSQ-10) and the Pittsburgh Sleep Symptoms Questionnaire–Insomnia (PSSQ-I)). Regression modelling was used to estimate the effect of ED use on sleep disturbances. All models adjusted for various potential confounders.
Males and females, aged 22 years, from Raine Study Gen2–22 year follow-up.
Of the 1115 participants, 66 % were never/rare users (i.e. <once/month) of ED, 17·0 % were occasional users (i.e. >once/month to <once/week) and 17 % were frequent users (≥once/week). Compared with females, a greater proportion of males used ED occasionally (19 % v. 15 %) or frequently (24 % v. 11 %). Among females, frequent ED users experienced significantly higher symptoms of daytime sleepiness (FOSQ-10: β = 0·93, 95 % CI 0·32, 1·54, P = 0·003) and were five times more likely to experience insomnia (PSSQ-I: OR = 5·10, 95 % CI 1·81, 14·35, P = 0·002) compared with never/rare users. No significant associations were observed in males for any sleep outcomes.
We found a positive association between ED use and sleep disturbances in young adult females. Given the importance of sleep for overall health, and ever-increasing ED use, intervention strategies are needed to curb ED use in young adults, particularly females. Further research is needed to determine causation and elucidate reasons for gender-specific findings.
Only a few studies have analyzed the effects of physical and psychiatric conditions on the risk of chronic fatigue syndrome (CFS). Therefore, the goal of this exploratory case-control study was to investigate the associations of physical and psychiatric conditions with CFS in almost 19 800 adults from Germany.
This study included patients diagnosed for the first time with CFS in one of 1238 general practices in Germany between 2010 and 2017 (index date). Controls without CFS were matched (1:1) to cases with CFS by sex, age, index year, and practice. Physical and psychiatric conditions diagnosed in the year prior to the index date were included if they were present in at least 3% of patients with CFS. Associations between physical and psychiatric conditions (33 potential independent variables) and CFS (dependent variable) were analyzed in an adjusted conditional logistic regression model, and physical and psychiatric disorders were included in the model using forward stepwise selection.
This study included 9896 cases with CFS and 9896 controls without CFS [65.1% women; mean (standard deviation) age 49.5 (18.3) years]. Seven conditions were associated with CFS in the adjusted regression model. The disorders displaying the strongest relationship with CFS were cancer [odds ratio (OR) = 2.57, 95% confidence interval (CI) = 2.24–2.95], sleep disorders (OR = 1.88, 95% CI = 1.66–2.12) and depression (OR = 1.77, 95% CI = 1.61–1.95).
Cancer, sleep disorders, and depression were strongly and positively associated with CFS. Additional studies are needed to gain a better understanding of the mechanisms underlying these relationships.
Cardiac fibroma is a rare benign primary tumour of the heart. In the paediatric population, it has been reported as the second most common benign cardiac tumour following rhabdomyoma. However, the prevalence of cardiac fibroma is rarely reported in the adult population. Signs and symptoms are nonspecific, including palpitations, cardiac murmur, arrhythmias, dyspnoea, cyanosis, chest pain, and sudden mortality, whereas, a number of patients with cardiac fibroma are asymptomatic. Surgical resection should be considered as the best option in symptomatic patients. This study reported four surgical cases of adults with cardiac fibroma arising from the left ventricle and a literature review regarding the clinical and pathological features, diagnostic modalities, therapeutic aspects, and prognosis of this rare entity.
The ageing population has been rapidly growing over recent years. Theoretically, religion seemingly plays an important role in improving older people's health. This study examines whether believing in religion is related to better health conditions among Chinese older adults through a meta-analysis. Two researchers independently extracted the studies from a comprehensive database and grey literature search and evaluated their scientific quality. From the 3,777 potentially eligible papers, just 76 were selected. The pooled effect size detected no significant difference between Chinese religious and non-religious older adults’ overall health and wellbeing. Dividing the outcomes into different categories, religious older adults reported both a higher level of anxiety (Hedge's g = −0.392, 95% confidence interval (CI) = −0.494, −0.290; p = 0.004) and yet a higher level of happiness (Hedge's g = 0.342, 95% CI = 0.074, 0.610; p = 0.018). Having a higher proportion of females in the sample is related to a smaller effect size in overall health outcomes (β = −2.205, 95% CI = −3.800, −0.613; p = 0.007) and social support specifically (β = −4.660, 95% CI = −6.261, −3.058; p < 0.0001). This study is among the first to synthesise the quantitative evidence regarding health differences between older religion believers and non-believers in China. It calls for future studies investigating the pathways underlying the religion–health relationship.
Adults with CHD have reduced work participation rates compared to adults without CHD. We aimed to quantify employment rate among adult CHD patients in a population-based registry and to describe factors and barriers associated with work participation.
We retrospectively identified adults with employment information in the North Carolina Congenital Heart Defects Surveillance Network. Employment was defined as any paid work in a given year. Logistic regression was used to examine patients’ employment status during each year.
The registry included 1,208 adult CHD patients with a health care encounter between 2009 and 2013, of whom 1,078 had ≥1 year of data with known employment status. Overall, 401 patients (37%) were employed in their most recent registry year. On multivariable analysis, the odds of employment decreased with older age and were lower for Black as compared to White patients (odds ratio = 0.78; 95% confidence interval: 0.62, 0.98; p = 0.030), and single as compared to married patients (odds ratio = 0.50; 95% confidence interval: 0.39, 0.63; p < 0.001).
In a registry where employment status was routinely captured, only 37% of adult CHD patients aged 18–64 years were employed, with older patients, Black patients, and single patients being less likely to be employed. Further work is needed to consider how enhancing cardiology follow-up for adults with CHD can integrate support for employment.
Many studies demonstrate that marriage protects against risky alcohol use and moderates genetic influences on alcohol outcomes; however, previous work has not considered these effects from a developmental perspective or in high-risk individuals. These represent important gaps, as it cannot be assumed that marriage has uniform effects across development or in high-risk samples. We took a longitudinal developmental approach to examine whether marital status was associated with heavy episodic drinking (HED), and whether marital status moderated polygenic influences on HED. Our sample included 937 individuals (53.25% female) from the Collaborative Study on the Genetics of Alcoholism who reported their HED and marital status biennially between the ages of 21 and 25. Polygenic risk scores (PRS) were derived from a genome-wide association study of alcohol consumption. Marital status was not associated with HED; however, we observed pathogenic gene-by-environment effects that changed across young adulthood. Among those who married young (age 21), individuals with higher PRS reported more HED; however, these effects decayed over time. The same pattern was found in supplementary analyses using parental history of alcohol use disorder as the index of genetic liability. Our findings indicate that early marriage may exacerbate risk for those with higher polygenic load.
User involvement is increasingly common in health-care research, and the ideal is user participation and influence during all research stages. Here we describe and reflect on the processes and outcomes associated with advisory group–researcher collaboration from a person-centred perspective. When planning a study in which older adults’ experiences of reablement were investigated, older adults with previous first-hand experience of reablement participated in an advisory group. We found that the fostering of healthful relationships, in which experiential and research knowledge are considered complimentary and equitable, and all members have the power to exercise their unique roles, seems to be a prerequisite for the co-creation of knowledge. Also, practical arrangements and social relationships constitute important details that are crucial to ensuring contribution from older adults with health-related conditions. While such individuals may be unable to participate during all stages of a research project, their involvement on an advisory level during the initial stages can increase study quality and relevance. Input from the advisory group members contributed to the improvement of the language in the study information sheet, improvement of the study design, development and validation of the interview guide, and insight into how the interviews should be conducted. The personal knowledge and expertise of the advisory group members, which emanated from their immediate sensitivity, contributed to the person-centredness in the study.
To review the currently available data on the use of ketamine in the treatment of depression among older adults from randomized controlled studies.
Randomized controlled trials.
60 years and older with depression.
Change in Montgomery–Asberg Depression Rating Scale (MADRS) scores.
Two studies met the inclusion criteria. The first study showed a significant reduction in depression symptoms with use of repeated subcutaneous ketamine administration among older adults with depression. The second study failed to achieve significance on its primary outcome measure but did show a decrease in MADRS scores with intranasal ketamine along with a higher response and remission rates in esketamine group compared with the placebo group. The adverse effects from ketamine generally lasted only a few hours and abated spontaneously. No cognitive adverse effects were noted in either trial from the use of ketamine.
The current evidence for use of ketamine among older adults with depression indicates some benefits with one positive and one negative trial. Although one of the trials did not achieve significance on the primary outcome measure, it still showed benefit of ketamine in reducing depressive symptoms. Ketamine was well tolerated in both studies with adverse effects being mild and transient.
CVD is the most common chronic condition and the highest cause of mortality in the USA. The aim of the present work was to investigate diet and sedentary behaviour in relation to mortality in US CVD survivors. The National Health and Nutrition Examination Surveys conducted between 1999 and 2014 linked to the US mortality registry updated to 2015 were investigated. Multivariate adjusted Cox regression was used to derive mortality hazards in relation to sedentary behaviour and nutrient intake. A multiplicative and additive interaction analysis was conducted to evaluate how sedentariness and diet influence mortality in US CVD survivors. A sample of 2473 participants followed for a median period of 5·6 years resulted in 761 deaths, and 199 deaths were due to CVD. A monotone increasing relationship between time spent in sedentary activities and mortality risk was observed for all-cause and CVD mortality (hazard ratio (HR) = 1·20, 95 % CI 1·09, 1·31 and HR = 1·19, 95 % CI 1·00, 1·67, respectively). Inverse mortality risks in the range of 22–34 % were observed when comparing the highest with the lowest tertile of dietary fibre, vitamin A, carotene, riboflavin and vitamin C. Sedentariness below 360 min/d and dietary fibre and vitamin intake above the median interact on an additive scale influencing positively all-cause and CVD mortality risk. Reduced sedentariness in combination with a varied diet rich in dietary fibre and vitamins appears to be a useful strategy to reduce all-cause and CVD mortality in US CVD survivors.
Pregnancy outcomes impact subsequent contraceptive behaviour. The purpose of this study was to assess the relationship between previous pregnancy outcomes and subsequent contraceptive behaviours among unmarried young women intending to delay childbearing. Using data from the 2014 Ghana Demographic and Health Survey, among 1118 sexually experienced, fecund and non-pregnant unmarried women aged 15–24 years, the study assessed how childbirth and abortion are related to sexual abstinence and use of modern contraception. While about 70% of unmarried young women were nulligravid, approximately 11% had had an abortion and 18.2% were postpartum. The majority of respondents were sexually abstinent while 21% and 27% were using and not using contraception, respectively. Postpartum women were more likely than nulligravid and post-abortion women to use contraceptives. Post-abortion women were least likely to be sexually abstinent. Number of years since the respondent’s sexual debut was positively associated with the likelihood of using modern contraception, particularly among postpartum women, and negatively associated with sexual abstinence among those who had aborted. The findings show that prior pregnancy outcomes have significant implications for secondary abstinence and contraceptive use among unmarried young women in Ghana. Post-abortion women are more likely than postpartum women to be sexually active but less likely to use contraceptives. Efforts must be strengthened towards increasing access to modern contraceptives for young women who present for abortion in Ghana.
Given a large number of community-based older adults with mild cognitive impairment, it is essential to better understand the relationship between unmet palliative care (PC) needs and mild cognitive impairment in community-based samples.
Participants consisted of adults ages 60+ receiving services at senior centers located in New York City. The Montreal Cognitive Assessment (MoCA) and the Unmet Palliative Care Needs screening tool were used to assess participants’ cognitive status and PC needs.
Our results revealed a quadratic relationship between unmet PC needs and mild cognitive impairment, controlling for gender, living status, and age. Participants with either low or high MoCA scores reported lower PC needs than participants with average MoCA scores, mean difference of the contrast (low and high vs. middle) = 2.15, P = 0.08.
Significance of results
This study is a first step toward elucidating the relationship between cognitive impairment and PC needs in a diverse community sample of older adults. More research is needed to better understand the unique PC needs of older adults with cognitive impairment living in the community.
The Cognitive Abilities Screening Instrument (CASI) is a screening test of global cognitive function used in research and clinical settings. However, the CASI was developed using face validity and has not been investigated via empirical tests such as factor analyses. Thus, we aimed to develop and test a parsimonious conceptualization of the CASI rooted in cognitive aging literature reflective of crystallized and fluid abilities.
Secondary data analysis implementing confirmatory factor analyses where we tested the proposed two-factor solution, an alternate one-factor solution, and conducted a χ2 difference test to determine which model had a significantly better fit.
Data came from 3,491 men from the Kuakini Honolulu-Asia Aging Study.
The Cognitive Abilities Screening Instrument.
Findings demonstrated that both models fit the data; however, the two-factor model had a significantly better fit than the one-factor model. Criterion validity tests indicated that participant age was negatively associated with both factors and that education was positively associated with both factors. Further tests demonstrated that fluid abilities were significantly and negatively associated with a later-life dementia diagnosis.
We encourage investigators to use the two-factor model of the CASI as it could shed light on underlying cognitive processes, which may be more informative than using a global measure of cognition.
COVID-19 outbreak has surfaced as an imminent threat for the public health. Because India is a populous country, it is important for Indians to be aware of the basic modes of prevention that can diminish the spread of the coronavirus disease 2019 (COVID-19) infection.
The present questionnaire study was carried out among the undergraduate students to assess the awareness regarding the spread and control of COVID-19.
The questionnaire was circulated among the undergraduate students as a Google form.
The study included responses of 868 undergraduate students belonging to 2 university colleges. The majority of the participants were females (63%; n = 547) in the age range of 18-23 y. Approximately 98.3% (853) had awareness regarding COVID-19. Approximately 94.7% (822) were washing their hands after visiting public places, out of which only 90.6% (786) were aware of proper steps to be followed in hand washing. It was concluded that it is required to create awareness among 20.8% (181) of our study participants regarding the importance of hand washing to control COVID-19.
Awareness regarding COVID-19 among study participants was good. However, a small part of the study population is required to be educated on proper steps to be followed in hand washing.
The coronavirus disease 2019 (COVID-19) pandemic and associated lockdown could be considered a ‘perfect storm’ for increases in emotional distress. Such increases can only be identified by studies that use data collected before and during the pandemic. Longitudinal data are also needed to examine (1) the roles of previous distress and stressors in emotional distress during the pandemic and (2) how COVID-19-related stressors and coping strategies are associated with emotional distress when pre-pandemic distress is accounted for.
Data came from a cohort study (N = 768). Emotional distress (perceived stress, internalizing symptoms, and anger), COVID-19-related stressors, and coping strategies were measured during the pandemic/lockdown when participants were aged 22. Previous distress and stressors were measured before COVID-19 (at age 20).
On average, participants showed increased levels of perceived stress and anger (but not internalizing symptoms) during the pandemic compared to before. Pre-COVID-19 emotional distress was the strongest predictor of during-pandemic emotional distress, followed by during-pandemic economic and psychosocial stressors (e.g. lifestyle and economic disruptions) and hopelessness, and pre-pandemic social stressors (e.g. bullying victimization and stressful life events). Most health risks to self or loved ones due to COVID-19 were not uniquely associated with emotional distress in final models. Coping strategies associated with reduced distress included keeping a daily routine, physical activity, and positive reappraisal/reframing.
In our community sample, pre-pandemic distress, secondary consequences of the pandemic (e.g. lifestyle and economic disruptions), and pre-pandemic social stressors were more consistently associated with young adults' emotional distress than COVID-19-related health risk exposures.
Data on average iodine requirements for the Chinese population are limited following implementation of long-term universal salt iodisation. We explored the minimum iodine requirements of young adults in China using a balance experiment and the ‘iodine overflow’ hypothesis proposed by our team. Sixty healthy young adults were enrolled to consume a sequential experimental diet containing low, medium and high levels of iodine (about 20, 40 and 60 μg/d, respectively). Each dose was consumed for 4 d, and daily iodine intake, excretion and retention were assessed. All participants were in negative iodine balance throughout the study. Iodine intake, excretion and retention differed among the three iodine levels (P < 0·01 for all groups). The zero-iodine balance derived from a random effect model indicated a mean iodine intake of 102 μg/d, but poor correlation coefficients between observed and predicted iodine excretion (r 0·538 for μg/d data) and retention (r 0·304 for μg/d data). As iodine intake increased from medium to high, all of the increased iodine was excreted (‘overflow’) through urine and faeces by males, and 89·5 % was excreted by females. Although the high iodine level (63·4 μg/d) might be adequate in males, the corresponding level of 61·6 μg/d in females did not meet optimal requirements. Our findings indicate that a daily iodine intake of approximately half the current recommended nutrient intake (120 μg/d) may satisfy the minimum iodine requirements of young male adults in China, while a similar level is insufficient for females based on the ‘iodine overflow’ hypothesis.