Sample Of Adults Research Articles

A profile approach to physical activity levels: what’s intensity got to do with reasons and motives for exercise?

BackgroundDespite the well-known benefits of physical activity (PA), non-communicable disease and premature mortality rates among adults continue to rise. The relationship between adults’ goals and exercise-specific motivation on the type of PA intensity one engages remains unclear. The purpose of this study was to identify physical activity (PA) profiles based on frequency and intensity (i.e., levels of PA) in an adult sample. A secondary purpose was to examine how the PA profiles differ on the reasons people have for exercising and behavioral regulation.MethodsA Cross-sectional survey was conducted with 1,169 (46.8 ± 16.7 years) participants solicited from a hospital-affiliated wellness center, social media promotions, and a research volunteer registry. The International PA Questionnaire (IPAQ) was used to determine frequency, intensity, and time spent engaging in PA. Additionally, the Reasons to Exercise (REX-2) scale, the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3), and demographics were assessed. K-cluster analyses were performed to identify profiles based on PA levels using the IPAQ guidelines. Multivariate analysis of variance (MANOVA) was used to assess profile differences.ResultsFive distinct PA clusters were derived, and defined as: a Low, Walking, Moderate Intensity, High Intensity, and Sitting cluster (p < .001). These clusters differed significantly (p < .001) from each other with respect to motivation, the reasons adults have for exercise, and PA levels.ConclusionThe results from this study support the important role of psychological factors such as motivation and reasons for exercise on behavioral outcomes (i.e., physical activity). For future research investigating adults PA- related behaviors, whether it be on adults starting a new exercise program or for PA maintenance, it may be beneficial to develop programs that encourage participants to reflect on the reasons they identify as important for exercising, and how such reasons contribute to their overall PA engagement behaviors.

The association of physical resilience and post-discharge adverse events among older adults with dementia

Objectives Post-discharge adverse events, such as falls, hospitalizations, and death, are more prevalent among older adults with dementia, compared to their cognitively intact counterparts. This study aimed to test the association between physical resilience and post discharge adverse events in a sample of older adults with dementia. Method Through phone calls with caregivers over one year, we obtained data on physical resilience and post-discharge adverse events through caregiver report among a sample of 314 recently discharged older adults with dementia. We performed negative binomial regression (falls and hospitalizations) and logistic regression (death), controlling for covariates. Results Greater physical resilience at one month post discharge was significantly associated with less falls, hospitalizations, and death within one year. Conclusion This study highlights a particular patient profile, recently discharged older adults living with dementia who have low physical resilience, that could be targeted for intervention when discharged from the hospital.

Spinal pain prevalence and associated determinants: A population-based study using the National Survey for Wales.

Spinal pain (SP) remains the leading cause of disability worldwide. The present study aimed to establish a current prevalence of SP and associated determinants in Wales by retrospectively analyzing data from the National Survey for Wales Dataset (NSWD). The NSWD is a large-scale cross-sectional, representative sample of adults across Wales, UK. A univariable and multivariable regression analysis was carried out on self-reported answers to health and well-being questions contained within the NSWD (2016-2020) to determine the strength of association of various determinants and comorbidities related to spinal pain. A total population of 38,954 of adults were included in the analysis. The study population included interview responses of 21,735 females and 17,219 males. The prevalence of SP in Wales was 4.95% (95% CI: 4.74%-5.15%) with a total of 847 males (4.92%, CI: 4.60%-5.24%) and 1082 females (4.98%, CI: 4.69%-5.27%) reporting spinal pain. The age group with the highest prevalence of SP was in the 70+ years age group for both males (5.44%, CI: 4.82%-6.07%) and females (5.95%, CI: 5.37%-6.54%). The strength of association between age and SP reaches its peak at 50-59 years with an adjusted Odds Ratio (aOR) of 3.74 (p = <0.001), that decreases slightly at 60-69 years and 70+ years. For various comorbidities included in the NSWD, significant associations with SP were confirmed for: mental illness (aOR = 1.42, p = <0.001), migraine (aOR = 2.73, p = <0.001), nervous system issues (aOR = 1.61, p = <0.001), arthritis (aOR = 1.30, p = <0.001) and issues with bones/joints/muscles (aOR = 1.93, p = <0.001). For lifestyle factors, associations were confirmed for current smokers (aOR = 1.41, p = <0.001) and ex-smokers (aOR = 1.23, p = 0.003). This study demonstrates a low prevalence of SP in Wales when compared to global estimates and strong associations to a variety of determinants. This still represents a significant societal burden and these findings may help inform public health initiatives to encourage prevention and evidence-based interventional strategies and ultimately, improve the quality of life for those suffering with SP in Wales.

Factors Influencing Health Literacy among South Korean Adults: A Nationwide Study

Abstract Background Health literacy is crucial for health knowledge, behaviors, and outcomes, but research on health literacy has been limited to specific populations and settings in South Korea. This study aimed to identify factors influencing health literacy in a nationally representative sample of South Korean adults to inform public policies. Methods This cross-sectional study utilized data from the 2020 Korea Health Panel survey (10,262 adults aged 18-84 years). Sociodemographic factors (age, gender, education level, monthly household income, employment status, marital status, household characteristics, and region) and health (subjective health status, presence of chronic diseases, depression, and health insurance status) factors were examined. Health literacy was assessed using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16). Linear regression analysis was performed to identify factors associated with health literacy. Results The mean health literacy score was 9.1 (SD 1.60), with significant differences across age groups (p &amp;lt; 0.001). Linear regression analysis (adjusted R2=0.287, F = 322.83, P &amp;lt; 0.001) revealed that higher age, female gender, lower education, lower household income, being single, living outside a metropolitan area, having chronic diseases, lower subjective health, depression, and being uninsured or receiving medical aid were significantly associated with lower health literacy (all p &amp;lt; 0.001). Conclusions This study identified several socio-economic and health-related factors significantly associated with health literacy among South Korean adults. The findings suggest that older individuals, who may require more time to understand and use health information, are particularly vulnerable to low health literacy. These results provide valuable insights for developing targeted interventions and public health policies aimed at promoting health literacy and successful aging in the context of a rapidly aging society. Key messages • Various socio-economic and health-related factors significantly influence health literacy among South Korean adults. • Older individuals are particularly vulnerable to low health literacy, which has implications for successful aging in a rapidly aging society.

Stressors and symptoms explaining sexual orientation inequalities in mental health services usage: A longitudinal study with young adults

Abstract Background Sexual minority (i.e., lesbian, gay, and bisexual [LGB], and other non-heterosexual) individuals are more likely to use mental health services than heterosexuals; however, evidence is scarce about factors contributing to this difference. Methods This study uses longitudinal data from a population-based sample of young adults (aged 18- 36) in Sweden (N = 1,137). We use mediation analysis to examine whether common mental health symptoms (i.e., depressive, anxiety and social anxiety symptoms, suicidality, and alcohol use) mediate sexual orientation differences in mental health services use; and to understand whether adding general stressors (i.e., low social support, loneliness, and perceived stress) to these models increases the total effect explained. Afterwards, we use logistic regression models to understand how minority-specific stressors (e.g., family reaction and dimensions of sexual minority identity) predict mental health service use among sexual minority individuals (N = 498), adjusting for common mental health symptoms. Results Common mental health symptoms only partially mediate the associations and the direct effect for sexual orientation remain significant (β = 0.11, p &amp;lt; 0.01). Adding general stressors to these models only slightly increase the total effect explained and the direct effect remained significant (β = 0.11, p &amp;lt; 0.01). Among sexual minority individuals, after adjusting for common mental health symptoms, a difficult process of coming out (β = 0.12, p &amp;lt; 0.05) and negative family reaction towards one’s sexual orientation (β = 0.15, p &amp;lt; 0.05) predicted use of mental health services. Conclusions Overall, these results show that minority-specific stressors contribute to help-seeking behaviours among sexual minority individuals, regardless of psychiatric morbidity, highlighting the potential role of mental health services empowering sexual minority individuals to cope with minority stress.

The relationship between sleep quality and emotional eating during the pandemic in Croatian adults

Abstract Background Social isolation during pandemics has adverse effects on sleep quality which in connection with COVID-19 distress facilitates the development of emotional eating patterns in various populations. This study aimed to evaluate the interconnection between sleep quality and emotional eating in the Croatian adult population during the COVID-19 pandemic. Methods This cross-sectional questionnaire study was conducted from February to June 2021 period. A validated, anonymous questionnaire that contained questions regarding demographic data, data on eating habits, and the Pittsburgh Sleep Quality Index (PSQI), was self-administered to a convenient sample of Croatian adults from central and northwestern Croatia. Results The study sample included 939 subjects with, a median age of 42 years (interquartile range 35-48), 35.4% males, and 64.6% females. At the PSQI 22.6% of subjects presented sleep disturbances. Sleep disturbances were more frequent among females (p &amp;lt; 0.001), and inhabitants of the Croatian capital Zagreb (p = 0.001). Subjects with sleep disturbances detected by PSQI during pandemics consumed a larger amount of food than usual (p &amp;lt; 0.001), consumed snacks more frequently (p &amp;lt; 0.001), and cooked more in their households (p = 0.006). Conclusions Poor sleep quality caused by the COVID-19 pandemic led to emotional eating patterns in the Croatian adult population. Health promotion programs directed toward healthy lifestyle choices need to be implemented to successfully tackle observed poor health indicators in the studied population. Key messages • Following the COVID-19 pandemic the obvious deterioration of sleep quality and eating habits is seen in the Croatian general population. • Comprehensive health promotion programs directed toward healthy lifestyle choices adoption are needed.

Hospital satisfaction among older adults by European Union health system clusters

Abstract Background Health systems are influenced by political, historical, cultural and socio-economic factors and differ across countries. Classification of EU health systems into 5 clusters has allowed for international comparison and policy recommendations. This study is based on the Andersen’s Behavior Model, that predicts that a sequence of predisposing, enabling and need factors influence satisfaction and utilization of healthcare services. Aim Examine the nature and relationship of predisposing, enabling and need factors associated with hospital satisfaction of older adults across EU nations by health system classification clusters. Methods Data from Wave 9, of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of older adults from 10 EU countries. Analysis: Non-parametric one-way ANOVA (Kruskal- Wallis test) and Multinominal Logistics regression were performed to test the null hypothesis that (1) hospital satisfaction is equal across all clusters, and (2) predisposing, enabling, and need factors, are not predictors of hospital satisfaction. Findings There was a statistically significant difference in hospital satisfaction by cluster [Chi Square= 231.44, df = 21; p&amp;lt; .001]. Age, mental health, technology and chronic disease are predictors of healthcare facilities satisfaction. [Chi Square 50.94, df = 3, p&amp;lt; .001], Among those that reported to be highly unsatisfied with healthcare facilities, [chronic disease (Beta = -2.64) and mental health (Beta = -4.41) df = 1 p&amp;lt; .001] significantly predicted hospital satisfaction. Implications for Policy and Practice: Initiatives for the care of older adults should not only aim to increase access to care but also provide targeted services for sub populations such as older adults with mental health and chronic diseases. Further, significant investment is required in technology infrastructure within hospitals and technological assistance or training should be provided to older adults. Key messages • Older adults satisfaction with hospitals varies by health system clusters and is predicted by age, mental health, use of technology and chronic disease. • Chronic disease and mental health are strong predictors of hospital dissatisfaction among older adults.

Do discrepancies between subjective and objective health shift over time in later life? A markov transition model

Subjective health (SH) deteriorates less rapidly than objective health (OH) in older adults. However, scant evidence exists regarding if discrepancies between SH and OH shift in the same individuals over time. We explore whether such discrepancies change over time in a sample of older adults living in England, through a prospective, observational cohort study design. Using data from the English Longitudinal Study of Ageing, we followed a sample of 6803 older adults, aged 60+ years at baseline, over three waves of data collection (2002–2007), yielding two wave transitions. A ‘health asymmetry’ metric classified older adults into four categories at each wave, based on the level of agreement between their SH and OH scores (‘health pessimist’, ‘health optimist’, ‘good health realist’ and ‘poor health realist’). First-order Markov transition and generalised logit models yielded estimated transition probabilities and odds ratios for health asymmetry transitions over time. At baseline, 36.84% of the sample were ‘good health realists’, 33% were ‘poor health realists’, 14.54% were ‘health optimists’, and 15.62% were ‘health pessimists’. Good and poor health realists were likely to remain health realistic over time. Good health realists who did transition however, were likely to become health optimists. Subsequently, the proportion of health optimists in the sample increased over time. Health pessimists had a high probability of being lost to study attrition. In conclusion, health optimism (i.e. where SH is rated better than OH) becomes more prevalent over time, in later life. Future research should investigate if promoting positive SH appraisals among health pessimists and poor health realists can optimise health and survival outcomes.

Association of childhood mental health and cardiovascular risk in adolescence and young adulthood

Abstract Introduction Mental health (MH), and in particular depression, is linked bi-directionally to cardiovascular disease through biological as well as behavioral pathways. Low MH has been associated with behaviors associated closely with cardiovascular risk (CVR) factors, such as reduced physical activity and sleep disturbances. It is not clear at what age the relation between MH and CVR begins to manifest and if MH in the young is also associated with vascular remodeling, operationalized as carotid-intima media thickness (CIMT). Methods We investigated the longitudinal association between childhood MH problems (age 3 to 17) and CVR factors as well as CIMT from carotid sonography in 4,361 14 to 28-year-olds of the KiGGS cohort. Using linear regression analyses adjusted for socioeconomic status, we analyzed the association of the Strength and Difficulties Questionnaire (SDQ) score with systolic blood pressure (SBP), body mass index (BMI), total cholesterol (TC), and CIMT in z-scores by sex and age. Additional cross-sectional analyses included scores of the Mental Health Inventory (MHI-5) and Patient Health Questionnaire (PHQ-9) in young adulthood. Results Childhood SDQ scores were significantly associated with SBP, BMI and TC one decade later (-0.03 ≤ ß ≥ 0.02). Cross-sectionally, no association of MHI-5 scores in young adults with CVR factors was found. PHQ-9 scores in young adults were associated significantly with SBP and BMI (-0.26≤ ß≥ 0.01). The investigated MH problems from childhood to young adulthood were not linked to CIMT. Conclusions Our results confirm an early association of MH with the examined CVR factors. However, we could not find evidence for an association between MH and vascular remodeling in this population-based sample of adolescents and young adults. Our results emphasize the importance of prevention strategies focusing on both, physical and MH of the young, in order to prevent vascular damage later in life. Key messages • Our results show an early association of childhood mental health with the examined cardiovascular risk factors systolic blood pressure, body mass index and total cholesterol one decade later. • Our results confirm the importance of prevention strategies focusing on both, physical and mental health of the young.

Defining high risk in the cardiovascular-kidney-metabolic syndrome and associated cardiovascular disease outcomes

Abstract Background The American Heart Association (AHA) recently developed the cardiovascular-kidney-metabolic (CKM) syndrome construct with stages 0-4 to comprehensively characterize the spectrum of cardiovascular disease (CVD) risk [1]. CKM Stage 3 is defined by subclinical CVD or high (≥20%) estimated 10-year CVD risk according to the newly-derived PREVENT models [2]. However, within CKM Stage 3, the burden of subclinical atherosclerosis equivalent to a ≥20% estimated CVD risk, and long-term CVD outcomes associated with CKM Stage 3, are not known. Purpose To (1) characterize the distribution of subclinical atherosclerosis by coronary artery calcium (CAC) according to PREVENT estimated CVD risk categories, and (2) quantify long-term CVD risk associated with CKM Stage 3, in two international cohorts of adults without prior CVD. Methods In participants of the Multi-Ethnic Study of Atherosclerosis (MESA, age 45-84 years) and the Rotterdam Study (age ≥55 years), the burden of CAC was calculated across estimated 10-year CVD risk (low, 0 to &amp;lt;5%; borderline 5 to &amp;lt;7.5%; intermediate, 7.5 to &amp;lt;20%; high, ≥20%). Participants were categorized into CKM stages according to CVD risk factors (body mass index, waist circumference, glycemic status, blood pressure, lipids, kidney function), estimated 10-year CVD risk (by AHA PREVENT model), and presence of CAC. The association of CKM syndrome stage with fatal or nonfatal CVD outcomes was evaluated with covariate-adjusted proportional hazards regression. Results Among 6,123 MESA participants (52% female, mean age 61.4 years) and 1,691 Rotterdam Study participants (46% female, mean age 67.1 years), the distribution of CAC across absolute 10-year CVD risk categories is shown in Figure 1. In high (≥20%) CVD risk adults, CAC score ≥100 was present in 50% of MESA participants and 48% of Rotterdam Study participants. Most participants were classified as CKM Stage 3 (53% in MESA, 83% in Rotterdam). Over a median follow-up of 17.5 years in MESA, CVD events occurred in 5% of CKM Stage 0, 6% of Stage 1, 9% of Stage 2, and 26% of Stage 3 participants. Over a median follow-up of 10.2 years in the Rotterdam Study, CVD events occurred in 0% of CKM Stage 0 and 1, 8% of Stage 2, and 17% of Stage 3 participants (Figure 2). The risk of total CVD was significantly higher in CKM Stage 3 participants relative to CKM Stage 0-2 (MESA: adjusted HR 2.74, 95% CI 2.32, 3.23; Rotterdam: adjusted HR 2.18, 95% CI 1.34, 3.54). Conclusions In an international, multi-ethnic sample of middle-aged adults, adults with high (≥20%) absolute 10-year CVD risk by PREVENT had substantial burden of CAC. Adults in CKM Stage 3 had approximately 2.2- to 2.7-times higher risk for CVD, compared with adults in lower CKM stages. Accounting for estimated CVD risk and burden of cardiovascular, kidney, and metabolic risk factors informs prevention of subclinical and clinical CVD.

Free fatty acids and mortality among adults in the United States: a report from US National Health and Nutrition Examination Survey (NHANES)

Abstract Introduction Free fatty acids (FFAs) serve as vital energy sources in multiple body tissues and they have been associated with elevated cardiovascular disease risk and mortality. There is a scarcity of prospective studies examining the associations between specific FFAs and long-term health outcomes. Purpose To examine the correlation between different FFAs types and all-cause or cardiovascular mortality in a large, nationally representative sample of adults in the United States (US), and examine how different concentrations and types of FFAs may mediate this association. Methods This cohort study included 3719 and 3900 participants in the unsaturated fatty acids (USFAs) and saturated fatty acids (SFAs) populations, respectively, who participated in the US National Health and Nutrition Examination Survey (NHANES) from 2011-2014. Multiple model calibration was performed using univariate and multivariate cox regression analysis to explore the associations between circulating FFAs and all-cause or cardiovascular mortality. Results The UFAs (myristoleic acid (14:1 n-5), palmitoleic acid (16:1 n-7), cis-vaccenic acid (18:1 n-7), nervonic acid (24:1 n-9), eicosatrienoic acid (20:3 n-9), docosatetraenoic acid (22:4 n-6), and docosapentaenoic acid (22:5 n-6)) were associated with an elevated risk of all-cause mortality ((hazard ratio (HR) 1.02 [1.006-1.034]; P=0.004), (HR 1.001 [1.001–1.002]; P＜ 0.001), (HR 1.006 [1.003–1.009]; P＜ 0.001), (HR 1.007 [1.002–1.012]; P = 0.003), (HR 1.027 [1.009–1.046]; P= 0.003), (HR 1.024 [1.012–1.036]; P＜ 0.001) and (HR 1.019 [1.006–1.032]; P = 0.005), respectively), whereas docosahexaenoic acid (22:6 n-3) was linked to a lower risk (HR 0.998 [0.996–0.999]; P = 0.007). Among SFAs, palmitic acid 16:0 was associated with a higher all-cause risk (HR 1.00 [1.00–1.00]; P = 0.022), while tricosanoic acid (23:0) and lignoceric acid (24:0) were associated with lower risks (HR 0.975 [0.959–0.991]; P = 0.002) and (HR 0.992 [0.984–0.999]; P = 0.036). Kaplan–Meier survival curves according to FFAs quartiles shown the highest risk for all-cause mortality was observed in the group with the highest concentration, except serum 23:0. The association between FFAs concentration and cardiovascular mortality in the multivariate analysis indicated that only 22:6 n-3 (HR 0.997 [0.994-1.000]; P=0.035) had a lower risk of cardiovascular mortality in the USFAs group, while none of the SFAs was found to be associated with cardiovascular mortality. While, the relationship between 22:6 n-3, and cardiovascular mortality was characterized by neither a linear nor nonlinear association (P-linear = 0.215; P-nonlinear = 0.260). Conclusion In this cohort of US adults, the types and concentrations of FFAs exhibited significant associations with risk of all-cause mortality. Achieving optimal concentrations of specific FFAs effectively lowered this risk of all-cause mortality, but this benefit was not observed in regards to cardiovascular mortality.FFA and all-cause mortality

Gendered trends in unpaid labour by educational level in Sweden 2004-2022

Abstract Background Unpaid labour has recently been recognised as an important yet neglected social determinant of health. Our aim was to investigate the gendered trends in unpaid labour/domestic work by educational level in prime working-age Swedish adults (30-49 years) from 2004-2022. Methods The study is based on a postal survey sent to a random general population sample of adults from central Sweden in 2004, 2008, 2012, 2017 and 2022. The 30-49-year age group included between 5,500 and 12,200 respondents depending on the survey year. Trends in hours spent in domestic work and in experiencing domestic work as burdensome by gender and educational level were estimated by age-standardised proportions with corresponding 95% confidence intervals. Results Women reported spending more time in domestic work than men throughout every survey period from 2004 to 2022. For example, in 2022, 31% of women spent more than 20 hours per week in domestic work compared to 20% of men. Over time, hours spent in domestic work decreased in women whereas no trend was observed in men. Among women, educational level appeared to make no difference to prevalence of high domestic work time whereas, among men, it was consistently greater among those with higher educational levels. In general, women experienced domestic work as burdensome to a higher degree than men did. Conclusions As gender differences in unpaid labour/domestic work persist in Sweden, more effort is needed to implement social policies to increase men’s participation in domestic work, especially among men with low and middle educational levels, which has the potential to reduce gendered health inequities. Key messages • Amongst Swedish adults aged 30-49 years, the gender gap in unpaid labour has declined during the last two decades, but this is only due to women reducing their domestic work time. • For men, prevalence of high domestic work time was consistently greater among those with higher educational levels, whereas no difference was observed among women.

Knowledge and beliefs about dietary inorganic nitrate in a representative sample of adults from the United Kingdom.

Evaluate knowledge and beliefs about dietary nitrate among United Kingdom (UK)-based adults. An online questionnaire was administered to evaluate knowledge and beliefs about dietary nitrate. Overall knowledge of dietary nitrate was quantified using a 21-point Nitrate Knowledge Index. Responses were compared between sociodemographic groups. UK. A nationally representative sample of three hundred adults. Only 19% of participants had heard of dietary nitrate prior to completing the questionnaire. Most participants (∼70%) were unsure about the effects of dietary nitrate on health parameters (e.g., blood pressure, cognitive function, cancer risk) or exercise performance. Most participants were unsure of the average population intake (78%) and acceptable daily intake (ADI) (83%) of nitrate. Knowledge of dietary sources of nitrate was generally low, with only ∼30% of participants correctly identifying foods with higher/lower nitrate contents. Almost none of the participants had deliberately purchased, or avoided purchasing, a food based around its nitrate content. Nitrate Knowledge Index scores were generally low (median[IQR]: 5[8]), but were significantly higher in individuals who were currently employed vs. unemployed (median[IQR]: 5[7]vs.4[7]; p<0.001), in those with previous nutrition education vs. no nutrition education (median[IQR]: 6[7]vs.4[8]; p=0.012), and in individuals who had heard of nitrate prior to completing the questionnaire vs. those who had not (median [IQR]: 9[8]vs.4[7]; p<0.001). This study demonstrates low knowledge around dietary nitrate in UK-based adults. Greater education around dietary nitrate may be valuable to help individuals make more informed decisions about their consumption of this compound.

Levels of adherence to the Planetary Health Diet of current diets in Italian adults

Abstract Despite the efforts in the direction towards the identification of healthy and sustainable diets, little is known about the environmental impact associated with current diets. The aim of this study was to validate the application of the Planetary Health Diet Index (PHDI) to dietary habits currently adopted in a sample of adults living in southern Italy and background variables associated. Dietary intake from nearly 2000 individuals was assessed through a validated 110-item food frequency questionnaire. The PHDI was applied by considering the energy contribution of 16 different components with a gradual scoring system. For the estimation of the environmental impact, carbon and water footprint data for food commodities were extracted from the SU-EATABLE LIFE database and matched with the FFQ items. An energy-adjusted linear association between the PHDI scores and the majority of food groups included in the analysis was found; when considering the level of food processing, ultra-processed food consumption was inversely associated with PHDI scores. Among nutrients, PHDI scores were directly associated with fiber, antioxidant vitamins, potassium, plant-derived omega-3 poly-unsaturated fats, and inversely with sodium, total, saturated, mono- and poly-unsaturated fats, cholesterol, and protein. A significant difference in carbon and water footprint was observed across quartiles of PHDI scores as well as a linear direct association. After adjustment for potential confounding factors, 1-point increase in the PHDI score was associated with lower likelihood of being overweight or obese (OR = 0.99, 95% CI: 0.98-0.99). A linear inverse association between PHDI scores and waist and hip circumferences and, partially, with BMI but not with body weight was found. In conclusion, the PHDI seems to properly identify an environmentally friendly diet with a good nutritional quality. Key messages • An environmental-friendly dietary pattern resulted also having a good nutritional profile. • Adherence to the Planetary Health Diet is associated with parameters of central obesity.

The Theory of Dyadic Morality and Moral Identity Explain the Public's Response to Harm Done by Government and Organisations

ABSTRACTHarm functions complexly in moral judgement but has been treated differently in the Social Intuitionist Model (SIM) and the Theory of Dyadic Morality (TDM). Both the SIM and TDM see felt harm as an outcome of experienced negative moral emotions (e.g., disgust), but the SIM regards harm as a kind of epiphenomenon in the sense that it does not affect moral judgement or behaviour, whereas the TDM interprets harm as an essential mediator of the link between negative moral emotions and immorality. The TDM also develops an explanation for how harm functions to initiate reactions to triggering events marked by an intentional agent causing injury to a vulnerable social actor. Here norms serve a regulatory function modulating the effects of harm committed by the agent on negative moral emotions. We conduct two experiments on representative samples of adults () and address two different moral contexts (companies doing badly and government doing badly with respect to a threatened health crisis), two different normative moderators (moral identity and belief in conspiracies) and two different moral action tendencies (intentions and word of mouth). Harm is found to have direct and contingent mediated effects on moral action tendencies, in accord with the TDM. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Antisocial personality traits as potential risk factors for cyberstalking: only aspects of psychopathy and narcissism matter

Cyberstalking is defined as the repeated pursuit of an individual using the Internet. The current study examined the relationship between Dark Triad constructs and cyberstalking among a large sample of adults (N = 1724) while addressing several limitations of previous research. Each construct was assessed using a validated measure; a newer measure of Machiavellianism was used to ensure that psychopathy and Machiavellianism could be distinguished; and separate models were run for each trait to avoid interpreting residuals from multivariate models. After controlling for age and sex, only the antisocial facet of psychopathy (early and repeated antisocial behaviour; odds ratio, OR = 2.74, 95% confidence interval, CI [1.73, 4.36]) and grandiose narcissism (inflated self-esteem and antagonism; OR = 1.27, 95% CI [1.08, 1.50]) were significantly related to cyberstalking perpetration within the past 12 months. While psychopathy and narcissism may be important factors for understanding antisocial behaviour, Machiavellianism appears to have limited predictive and practical utility.

Preventing dementia is possible. The fraction of cases attributable to modifiable factors in Italy

Abstract Background Worldwide, approximately 50 million people live with dementia. The Lancet Commission, in its latest report in 2020, identifies 12 ‘modifiable’ risk factors associated with dementia, estimating that they account for about 40% of overall dementia cases. The study aimed to estimate the population attributable fraction (PAF) of dementia cases in Italy due to these factors. Methods Relative risks (RR) of each factor and formulas for estimating PAF are derived from the Lancet Commission’s report. Prevalence data were obtained from the Italian surveillance systems PASSI and PASSI d’Argento (PdA), which provide information on 11 of the 12 identified risk factors. The total sample 2017-19 included 86,494 individuals aged 18-64 and 48,516 individuals aged over 65. The Communality, used for ‘weighted’ estimates of PAFs, was calculated via principal components analysis of the inter-risk-factor tetrachoric correlation matrix, using data derived from the overall PASSI and PdA sample. Results In Italy, it is estimated that 39.5% of dementia cases are attributable to 11 of the 12 modifiable risk factors, equivalent to 445,150 out of 1,126,961 estimated cases as of January 1, 2023. Among the risk factors with the greatest impact are hypertension before the age of 65 (weighted PAF=6.3%); sedentariness after the age of 65 (weighted PAF=5.9%); low education in youth (weighted PAF = 5%); depression and social isolation after the age of 65 (weighted PAF=4.5% and 4.4%), as well as diabetes (weighted PAF=3.9%) and smoking (weighted PAF=2.4%). Conclusions Although it is necessary to to gather further evidence on the role and mechanisms of action of each factor, the importance of prevention and promotion of health and social well-being in the field of dementia is now evident. Key messages • Having an overall national sample of adults and elderly people is a unique tool that allows an estimation of dementia cases attributable to modifiable risk factors. • Dementia prevention may also be possible by acting on modifiable risk factors.

The Relationship of Duffy Gene Polymorphism with High-Sensitivity C-Reactive Protein, Mortality, and Cardiovascular Outcomes in Black Individuals

Background: Black adults have higher incidence of all-cause mortality and worse cardiovascular disease (CVD) outcomes when compared to other U.S. populations. The Duffy chemokine receptor is not expressed on erythrocytes in a large majority of Black adults, but the clinical implications of this are unclear. Methods: Here, we investigated the relationship of Duffy receptor status, high-sensitivity C-reactive protein (hs-CRP), and mortality and incident CVD events (coronary heart disease, stroke, and heart failure) in self-identified Black members of three contemporary, longitudinal cohort studies (the Women’s Health Initiative, Jackson Heart Study, and Multi-Ethnic Study of Atherosclerosis). Data on 14,358 Black participants (9023 Duffy-null and 5335 Duffy-receptor-positive, as defined using single-nucleotide polymorphism (SNP) rs2814778) were included in this analysis. Results: Duffy null was strongly associated with higher hs-CRP (meta-analysis p = 2.62 × 10−9), but the association was largely attenuated, though still marginally significant (p = 0.005), after conditioning on known CRP locus alleles in linkage disequilibrium with the Duffy gene. In our discovery cohorts, Duffy-null status appeared to be associated with a higher risk of all-cause mortality and incident stroke, though these associations were attenuated and non-significant following adjustment for traditional risk factors including hs-CRP. Moreover, the association of Duffy-null status with mortality could not be replicated in an independent sample of Black adults from the UK Biobank. Conclusions: These findings suggest that the higher levels of hs-CRP found in Duffy-null individuals may be in part independent of CRP alleles known to influence circulating levels of hs-CRP. During the follow-up of this community-based sample of Black participants, Duffy-null status was not associated with mortality or incident CVD events independently of traditional risk factors including hs-CRP.

High Blood Pressure Associated with Depression, Not Anxiety: Results from the Tabriz Older People Survey (TOPS)

Objectives: To investigate the relationship between depression/anxiety and hypertension (HTN) in a large population-based sample in Iran. Design: A cross-sectional study. Setting: Tabriz, the capital of East Azerbaijan province in northwest Iran. Participants: A total of 1362 individuals were chosen from a representative sample of community-dwelling older adults aged 60 and above, residing in Tabriz. Participants were selected using the probability proportional to size sampling method. Outcome measures: A structured survey was used to measure socio-demographic variables, along with the hospital anxiety and depression scale. Blood pressure (BP) was measured using a standard mercury sphygmomanometer. Results: The results of a multiple logistic regression revealed that age (70-79 years old; P=0.01), employment status (housewives; P=0.02), level of education (illiterate; P&lt;0.01), smoking status (having quit smoking; P&lt;0.01), and depression (P=0.02) were related to HTN among these older adults. Conclusions: These findings highlight the critical importance of integrating mental health assessments and interventions in HTN management and prevention strategies, particularly for older populations.

The association between dietary polyphenol intake and the odds of metabolic syndrome

Oxidative stress plays a role in the pathophysiology of metabolic syndrome (MetS), and one of the most important features of polyphenols is their antioxidant properties. However, there is no universal consensus on the effectiveness of polyphenols in treating Mets. Therefore, the present study aimed to investigate the association between polyphenols and MetS in an Iranian sample. This cross-sectional study was conducted on an adult population sample from Shiraz, in southern Iran. MetS was calculated using the criteria of the Adult Treatment Panel III (ATP III), which defines MetS as the presence of three or more of the specified risk factors. A validated food frequency questionnaire (FFQ) was used to measure the participant’s food intake. The association between polyphenol intake and the odds on MetS and its components was assessed using logistic regression. In both univariate and multivariate models, the association between polyphenol intake and the risk of MetS was not significant. However, after adjusting for potential confounders in the multivariate model, each unit change in flavonol, flavanone and isoflavones intake was associated with a lower, higher, and higher odds of MetS, respectively (flavonols: odds ratio (OR) = 0.926, 95% confidence interval (CI) 0.891–0.963, P < 0.001—flavanones: OR = 1.007, 95% CI: 1.001–1.014, P = 0.034—isoflavones: OR = 4.920, 95% CI: 1.057–22.894, P = 0.042). Additionally, no significant association was found between polyphenol intake and the risk of MetS components. However, in the multivariate model, after adjusting for potential confounders, a significant association was observed between polyphenol intake and lower odds of high waist circumference (OR = 0.998, 95% CI: 0.996–0.999, P = 0.032). The present study did not reveal a significant association between overall polyphenol intake and the odds of MetS. However, certain subclasses of polyphenols appear to be associated with the likelihood of MetS and its components.