Follow-up Waves Research Articles

Openness to experience and cognitive functioning and decline in older adults: The mediating role of cognitive reserve

ObjectiveOpenness to experience has been consistently associated with better cognitive functioning in older people, but its association with cognitive decline is less clear. Cognitive reserve has been proposed as a mechanism underlying this relationship, but previous studies have reported mixed findings, possibly due to the different ways of conceptualizing cognitive reserve. We aimed to analyze the potential mediating role of cognitive reserve in the association between openness and cognitive functioning and decline in healthy older people. MethodIn Wave 1 and at the four-year follow-up (Wave 2), 87 healthy older people (49.4% women; M age = 65.08, SD = 4.54) completed a neuropsychological battery to assess cognitive functioning and a questionnaire to assess cognitive reserve. Openness was measured with the NEO- Five-Factor Inventory. Mediation models were proposed to investigate the relationship between openness and cognitive function or decline through cognitive reserve or its change. ResultsCognitive reserve mediated the openness-cognitive functioning association. Thus, individuals with higher openness showed greater cognitive reserve, and this greater cognitive reserve was associated with better cognitive functioning. Moreover, greater cognitive reserve at baseline also mediated the association between higher openness and slower cognitive decline. However, change in cognitive reserve did not mediate the association between openness and change in cognitive functioning. ConclusionsCognitive reserve is a mechanism underlying the association between openness and cognitive functioning and decline. These findings support the differential preservation hypothesis, suggesting that healthy older adults who engage in more cognitively stimulating activities would show less age-related cognitive decline.

Mentally-passive sedentary behavior and incident depression: Mediation by inflammatory markers

BackgroundSedentary behavior (SB; time spent sitting, as distinct from lack of exercise or physical activity) is associated with depression, yet little is known about the relationship between different types of SB (e.g., mentally-passive versus mentally-active) with depression and potential biological mediators of these associations. MethodsWe used cohort data from the 1958 National Child Development Study (n = 4607; 50.4 % women), conducted in UK, employing the 44 y and 46 y waves as baseline, and the 50 y and 55 y waves as follow-up. Participants reported time spent in TV viewing and watching videos (mentally-passive SB); and, time sitting while doing light activities such as deskwork or driving a car during worktime (mentally-active SB). Depression diagnosis was self-reported during the initial and follow-up waves. Waist circumference, C-reactive protein, and glycated hemoglobin were examined as potential mediators. ResultsMentally-passive SB was associated with incident depression (HR: 1.43; 95%CI: 1.19; 1.71), while there was no association for mentally-active SB. Waist circumference (coefficient: −0.03; 95%CI: −0.05; −0.01; 9.2 %) and C-reactive protein (coefficient: −0.03; 95%CI: −0.04; −0.01; 8.3 %), but not glycated hemoglobin, partly mediated the association for mentally-passive SB. ConclusionsIn the relationship of mentally-passive SB with incident depression, the mediating contributions of waist circumference and C-reactive protein point to possible inflammatory-related mechanisms.

Social isolation in the oldest-old: determinants and the differential role of family and friends

PurposeTo examine the association of sociodemographic and health-related determinants with social isolation in relation to family and friends in the oldest-old.MethodsDatabase was the multi-center prospective AgeCoDe/AgeQualiDe cohort study assessed at follow-up wave 5 (N = 1148; mean age 86.6 years (SD 3.0); 67% female). Social isolation was assessed using the short form of the Lubben Social Network Scale (LSNS-6). The LSNS-6 contains two sets of items establishing psychometrically separable subscales for isolation from family and friends (ranges 0–15 points), with lower scores indicating higher isolation. Cross-sectional linear (OLS) regression analyses were used to examine multivariate associations of sociodemographic and health-related determinants with social isolation from family and friends.ResultsOverall, n = 395 participants (34.6%) were considered socially isolated. On average, isolation was higher from friends (mean 6.0, SD 3.8) than from family (mean 8.0, SD 3.5). Regression results revealed that in relation to family, males were more socially isolated than females (β = − 0.68, 95% CI − 1.08, − 0.28). Concerning friends, increased age led to more isolation (β = − 0.12, 95% CI − 0.19, − 0.05) and functional activities of daily living to less isolation (β = 0.36, 95% CI 0.09, 0.64). Independent of the social context, depression severity was associated with more social isolation, whereas cognitive functioning was associated with less social isolation.ConclusionsDifferent determinants unequally affect social isolation in relation to family and friends. The context of the social network should be incorporated more strongly regarding the detection and prevention of social isolation to sustain mental and physical health.

Association of Self-Reported Nighttime Sleep Duration with Chronic Kidney Disease: China Health and Retirement Longitudinal Study

Introduction: The cohort study aimed to assess the association of nighttime sleep duration and the change in nighttime sleep duration with chronic kidney disease (CKD) and whether the association between nighttime sleep duration and CKD differed by daytime napping. Methods: This study included 11,677 individuals from the China Health and Retirement Longitudinal Study (CHARLS) and used data from the 2011 baseline survey and four follow-up waves. Nighttime sleep duration was divided into three groups: short (<7 h per night), optimal (7–9 h), and long nighttime sleep duration (>9 h). Daytime napping was divided into two groups: no nap and with a nap. We used Cox proportional hazards model to examine the effect of nighttime sleep duration at baseline and change in nighttime sleep duration on incident CKD and a joint effect of nighttime sleep duration and nap time on onset CKD. Results: With a follow-up of 7 years, the incidence of CKD among those with short, optimal, and long nighttime sleep duration was 9.89, 6.75, and 9.05 per 1,000 person-years, respectively. Compared to individuals with optimal nighttime sleep duration, short nighttime sleepers had a 44% higher risk of onset CKD (hazard ratio [HR]: 1.44, 95% confidence interval [CI]: 1.21–1.72). Compared to participants with persistent optimal nighttime sleep duration, those with persistent short or long nighttime sleep duration had an increased risk of incident CKD (HR: 1.44, 95% CI: 1.15–1.80). We found a lower incidence of CKD in participants with short nighttime sleep duration and a nap (HR: 0.74, 95% CI: 0.60–0.93), compared to those with short nighttime sleep duration and no nap. Conclusion: Short nighttime sleep duration and persistent long or short nighttime sleep duration were associated with a higher risk of onset CKD. Keeping persistent optimal nighttime sleep duration may help reduce CKD risk later in life. Daytime napping may be protective against CKD incidence.

Associations between cooking fuels and hypertension prevalence in Chinese adults: A prospective cohort analysis focusing on fuel transitioning

BackgroundUsing polluting cooking fuels is a suggested risk factor for hypertension. Transitioning to clean cooking fuels has occurred widely in China in the past 30 years. This provides an opportunity to examine whether the transition could reduce hypertension risk and to ascertain the inconsistent literature on the relationship between cooking fuels and hypertension prevalence. MethodsInitiated in 1989, the China Health and Nutrition Survey (CHNS) enrolled participants from 12 provinces in China. By 2015, nine waves of follow-up have been conducted. Based on self-reported cooking fuels, participants were classified into persistent clean fuel users, persistent polluting fuel users and those who transitioned from polluting fuels to clean fuels. Hypertension was defined as having systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or self-reported current use of antihypertension medication. FindingsAmong 12,668 participants, 3963 (31.28%) were persistent polluting fuel users; 4299 (33.94%) transitioned to clean fuels; and 4406 (34.78%) were persistent clean fuel users. During the period of follow-up (7.8 ± 6.1 years), hypertension was diagnosed in 4428 participants. Compared to persistent clean fuel users, persistent polluting fuel users had a higher risk for hypertension (hazard ratio [HR] 1.69, 95%CI 1.55–1.85), while those transitioned to clean fuels did not. The effects were consistent by gender and urbanicity, respectively. The HRs for hypertension were 1.99 (95%CI 1.75–2.25), 1.55 (95%CI 1.32–1.81) and 1.36 (95%CI 1.13–1.65) among those persistent polluting fuel users aged 18–44, 45–59 and ≥60 years old, respectively. InterpretationTransitioning from using polluting fuels to clean fuels prevented an increase in hypertension risk. The finding highlights the importance of promoting the fuel transition as a risk-reduction strategy for reducing the disease burden from hypertension.

Longitudinal associations between exclusive, dual, and polytobacco use and asthma among US youth

Little is known about the respiratory health effects of dual (two products) and polytobacco (three or more products) use among youth in the United States. Thus, we followed a longitudinal cohort of youth into adulthood using data from Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study, examining incident asthma at each follow-up (Waves 2–5). We classified past 30-day tobacco use as 1) no products (never/former use), 2) exclusive cigarettes, 3) exclusive electronic nicotine delivery systems (ENDS), 4) exclusive other combustible (OC) tobacco products (cigars, hookah, pipe), 5) dual cigarettes/OC and ENDS, 6) dual cigarettes and OCs, and 7) polytobacco use (cigarettes, OCs, and ENDS). Using discrete time survival models, we analyzed the incidence of asthma across Waves 2–5, predicted by time-varying tobacco use lagged by one wave, and adjusted for potential baseline confounders. Asthma was reported by 574 of the 9141 respondents, with an average annual incidence of 1.44% (range 0.35% to 2.02%, Waves 2–5). In adjusted models, exclusive cigarette use (HR: 1.71, 95% CI: 1.11–2.64) and dual cigarette and OC use (HR: 2.78, 95% CI: 1.65–4.70) were associated with incident asthma compared to never/former use, while exclusive ENDS use (HR: 1.50, 95% CI: 0.92–2.44) and polytobacco use (HR: 1.95, 95% CI: 0.86–4.44) were not. To conclude, youth who use cigarettes with or without OCs had higher risk of incident asthma. Further longitudinal studies on the respiratory health effects of ENDS and dual/polytobacco use are needed as products continue to evolve.

Association of child neurodevelopmental or behavioural problems with maternal unemployment in a population-based birth cohort

PurposeTo estimate associations between suspected or diagnosed neurodevelopmental or behavioural problems in 7-year-old children and maternal unemployment at child age 7 and 10, in a Portuguese birth cohort.MethodsWe evaluated 5754 mothers and their children of the population-based birth cohort Generation XXI in Porto, Portugal. Data on suspected and diagnosed child neurodevelopmental and behavioural problems (exposures)—learning, attention and language problems, externalising behaviours, developmental delay, autism spectrum disorders, and other neurodevelopmental problems—were retrieved at 7 years of age by interviewing caregivers. Maternal employment status (outcome) was collected at the 7- and 10-year follow-up waves. Robust Poisson regression models were used to estimate associations.ResultsAfter adjustment for maternal and household characteristics, women were more likely to be unemployed at child age 10 if the child had, up to age 7, any of the following suspected problems: an autism spectrum disorder (PR = 1.73; 95% CI 1.07, 2.79), developmental delay (PR = 1.58; 95% CI 1.20, 2.06), externalising behaviours (PR = 1.29; 95% CI 1.11, 1.50) or learning problems (PR = 1.26; 95% CI 1.07, 1.48). When the exposure was restricted to clinically diagnosed disorders, the magnitude of associations remained similar but estimates were less precise. Associations with unemployment were stronger at child age 10 (prospective analyses), than at child age 7 (cross-sectional).ConclusionHaving a child with learning, developmental or behavioural problems, or an autism spectrum disorder up to age 7 was associated with maternal unemployment three years later, even in a less affluent European economy where the dual-earner family structure is often necessary to make ends meet.

Youth Screen Media Activity Patterns and Associations With Behavioral Developmental Measures and Resting-state Brain Functional Connectivity

Screen media activity (SMA) consumes considerable time in youth's lives, raising concerns about the effects it may have on youth development. Disentangling mixed associations between SMA of youth and developmental measures should move beyond overall screen time and consider types and patterns of SMA. This study aimed to identify reliable and generalizable SMA patterns among youth and examine their associations with behavioral developmental measures and developing brain functional connectivity. Three waves of Adolescent Brain and Cognitive Development (ABCD) data were examined. The Lifespan Human Connectome Project inDevelopment (HCP-D) was interrogated as an independent sample. ABCD participants included 11,876 children at baseline. HCP-D participantsincluded 652 children and adolescents. Youth-reported SMA and behavioral developmental measures (neurocognitive performance, behavioral problems, psychotic-like experiences, impulsivity, and sensitivities to punishment/reward) were assessed with validated instruments. We identified SMA patterns in the ABCD baseline data using K-means clustering and sensitivity analyses. Generalizability and stability of the identified SMA patterns were examined in HCP-D data and ABCD follow-up waves, respectively. Relations between SMA patterns and behavioral and brain (resting-state brain functional connectivity) measures were examined using linear mixed effects modeling with false discovery rate (FDR) correction. SMA data from 11,815 children (mean [SD] age= 119.0 [7.5] months; 6,159 [52.1%] boys) were examined; 3,151 (26.7%) demonstrated a video-centric higher-frequency SMA pattern, and 8,664 (73.3%) demonstrated a lower-frequency pattern. SMA patterns were validated in similarly aged HCP-D youth. Compared with the lower-frequency SMA pattern group, the video-centric higher-frequency SMA pattern group showed poorer neurocognitive performance (β=-.12, 95% CI [-0.08,-0.16], FDR-corrected p< .001), more total behavioral problems (β= .13, 95% CI [0.09, 0.18], FDR-corrected p< .001), and more psychotic-like experiences (β= .31, 95% CI [0.27, 0.36], FDR-corrected p< .001). The video-centric higher-frequency SMA pattern group demonstrated higher impulsivity, more sensitivity to punishment/reward, and altered resting-state brain functional connectivity among brain areas implicated previously in cognitive processes. Most of the associations persisted with age in the ABCD data, with more participants (n= 3,378, 30.4%) in the video-centric higher-frequency SMA group at 1-year follow-up. A social communication-centric SMA pattern was observed in HCP-D adolescents. Video-centric SMA patterns are reliable and generalizable during late childhood. A higher-frequency video entertainment SMA pattern group showed altered resting-state brain functional connectivity and poorer developmental measures that persisted longitudinally. The findings suggest that public health strategies to decrease excessive time spent by children on video entertainment-related SMA are needed. Further studies are needed to examine potential video-centric/social communication-centric SMA bifurcation to understand dynamic changes and trajectories of SMA patterns and related outcomes developmentally. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Association of biomass fuel use with the risk of vision impairment among Chinese older adults: a cohort study

Cooking with biomass fuels has been reported to have adverse effects on health. This study aims to explore the association between cooking with biomass fuels and vision impairment among Chinese older adults aged 65years and above. This cohort study drew on data from the 2011/2012 wave and the 2014 follow-up wave of the Chinese Longitudinal Healthy Longevity Survey. Participants' visual function was examined through a vision screening test. Exposure to indoor biomass fuels was self-reported. Cox proportional hazards models were applied to explore the relationship between biomass fuel use and vision impairment. Additionally, we compared the risk of vision impairment between participants who switched cooking fuel types and those who did not. Subgroup and interaction analyses were conducted to explore the potential effect modifiers. A total of 4711 participants were included in this study. During the follow-up, 1053 (22.35%) participants developed vision impairment. Cooking with biomass fuels increased the risk of vision impairment by 40% (hazard ratio [HR]: 1.40, 95% confidence interval [CI]: 1.21-1.61). Participants who switched from clean fuels to biomass fuels had a greater risk of vision impairment than persistent clean fuel users (HR: 1.44, 95% CI: 1.03-2.00). Greater effect estimates were found in participants who lived in eastern and central China and urban residents. Cooking with biomass fuels resulted in a greater risk of vision impairment among Chinese older adults. This risk also existed in those who changed their cooking fuels from clean fuels to biomass fuels. Further studies with an objective assessment of biomass fuel combustion are required to confirm our findings.

Examination of Lifetime Established Use Criteria for Adult Tobacco Product Users

Background: Lifetime established use criteria are essential to distinguish tobacco product experimental and established users; however, these criteria are not as well defined for some tobacco product categories. The objective of this analysis is to examine various lifetime use criteria to facilitate an objective characterization of experimental versus established use behaviors. Methods: Our analyses were conducted using the Population Assessment of Tobacco and Health (PATH) Study Waves 1 to 5 datasets. We first examined the level of agreement between non-numerical (having smoked/used the product fairly regularly) and numerical ( having smoked/used the product 20/50/100 times (e.g., use occasions) or product units) lifetime established use criteria among ever-, current-, and former-tobacco product users of various tobacco products. Logistic regression models were constructed to compare demographics, socioeconomic status, and tobacco product use patterns among current experimental versus current established users. Longitudinal analyses were performed to investigate the association between numerical or non-numerical criteria and discontinuation of past 30-day use at follow-up waves. Results: For tobacco product categories other than cigarette, we identified the following numerical thresholds as the objective characterization of established use: 50 for cigars and pipe products and 20 times for hookah, electronic nicotine products, smokeless, snus, and dissolvable tobacco products, based on level of agreement with the non-numerical criterion (kappa coefficients ranging from 0.3 to 0.6) and also with consideration of existing consensus. Significant differences were observed in demographics, socioeconomic status, tobacco product use and discontinuation of past 30-day use patterns when comparing current experimental and current established users with either non-numerical or numerical criteria. Conclusions: This study is the first PATH data analysis to derive quantitative thresholds of lifetime established use criteria to characterize experimental versus established use behaviors. Consistent applications of the lifetime established use criteria in data analysis and reporting would improve harmonization in research findings.

Association of Sarcopenia with Cognitive Function and Dementia Risk Score: A National Prospective Cohort Study

The relationship between skeletal muscle and cognitive disorders has drawn increasing attention. This study aims to examine the associations of sarcopenia with cognitive function and dementia risk score. Data on 1978 participants (aged 65 years and older) from the 2011 wave of the China Health and Retirement Longitudinal Study, with four follow-up waves to 2018, were used. Cognitive function was assessed by four dimensions, with a lower score indicating lower cognitive function. Dementia risk was assessed by a risk score using the Rotterdam Study Basic Dementia Risk Model (BDRM), with a higher score indicating a greater risk. Sarcopenia was defined when low muscle mass plus low muscle strength or low physical performance were met. We used generalized estimating equations to examine the associations of sarcopenia. In the fully adjusted models, sarcopenia was significantly associated with lower cognitive function (standardized, β = -0.15; 95% CIs: -0.26, -0.04) and a higher BDRM score (standardized, β = 0.42; 95% CIs: 0.29, 0.55). Our findings may provide a new avenue for alleviating the burden of cognitive disorders by preventing sarcopenia.

Health trajectories across the work exit transition in the 1990s, 2000s, and 2010s: the role of working conditions and policy

PurposeWe examined health trajectories of Dutch older workers across their exit from the workforce in the 1990s, 2000s, and 2010s, testing the hypothesis that pre-post-exit health trajectories of workers with favourable and unfavourable working conditions increasingly diverged over time due to policy measures to extend working life.MethodsThe Longitudinal Aging Study Amsterdam includes baseline samples in 1992/1993, 2002/2003 and 2012/2013 with two 3-year follow-up waves each. Selected respondents were aged 55 years and over who exited from a paid job within the first or second 3-year interval, up to and including the statutory retirement age (N = 522). Pre-post-exit trajectories were modelled using Generalized Estimating Equations with outcomes self-rated health and physical limitations and determinants physical demands, psychosocial demands, and psychosocial resources.ResultsAverage work exit age rose from 60.7 in the 1990s to 62.9 in the 2010s. On average, self-rated health decreased somewhat over successive periods and did not show pre-post-exit change; average physical limitations increased substantially both over successive periods and from pre- to post-exit. No support is found for our hypothesis. However, regardless of work exposures, we found sharp pre-post-exit increases in physical limitations in the 2010s.ConclusionAlthough these findings provide no support for our hypothesis of diverging health trajectories over time based on work exposure, they show that exiting at a higher age is linked to poorer pre- and post-exit health and to pre-post-exit increases in physical limitations, suggesting greater health care costs in the near future.

Egg consumption reduces the risk of depressive symptoms in the elderly: findings from a 6-year cohort study

BackgroundAccumulating evidence showed that dietary habits might modify the risk of depression. This study aimed to evaluate the longitudinal association of egg consumption with depressive symptoms in the Chinese elderly.MethodsWe analyzed the data from Zhejiang Ageing and Health Cohort Study including 8289 participants. The Patient Health Questionnaire-9 scale (PHQ-9) was used to assess depressive symptoms at baseline and three waves of follow-up (2015, 2016, and 2019–2020). A PHQ-9 cut-off score ≥ 5 was used to define depressive symptoms. The participants with depressive symptoms at baseline were excluded. Egg consumption was evaluated through the diet habits section of the baseline questionnaire. Self-reported egg consumption was measured as the number of eggs per week and categorized into three categories. Log-binomial regression models with Generalized Estimating Equations were utilized to evaluate the association of egg consumption with depressive symptoms and estimate relative risks (RRs).ResultsThe mean age of included participants was 68.6 years. After 6 years of follow-up, 1385 (16.7%) participants were indicated with depressive symptoms by PHQ-9 at least once. Compared with non-consumers or less-than-weekly consumers, participants consuming < 3 eggs/week and ≥ 3 eggs/week had 30% (RR = 0.70, 95%CI 0.62–0.80) and 38% (RR = 0.62, 95%CI 0.54–0.71) lower risks of depressive symptoms, respectively. A linear association was confirmed (P for trend < 0.01), and each egg increment per week was associated with a 4% lower risk of depressive symptoms (RR = 0.96, 95%CI 0.93–0.99). Sensitivity analyses yielded consistent results to the main analyses.ConclusionsEgg consumption is prospectively related to a lower risk of depressive symptoms in the Chinese elderly. More prospective studies are needed to verify the association.

Clinical Research Updates.

Clinical Research Updates.

Participation in Household Physical Activity Lowers Mortality Risk in Chinese Women and Men.

The health benefits of sport and physical exercise (SPE) have been well documented, while the influence of household physical activity (HPA) on health has received much less research attention. This study aims to provide epidemiologic insight into the role HPA plays in the development of all-cause, cardiovascular disease (CVD), respiratory disease (RESP), and cancer mortality in a nationwide cohort of Chinese adults. We conceived a prospective cohort comprising 30,791 participants aged ≥16 years from 25 provinces of China using data derived from baseline (2010) and 4 waves of follow-up (2012-2018) investigations of the China Family Panel Studies. Self-reported times of HPA and SPE were collected by interviewing participants with a standard questionnaire. Cox proportional hazard models were used to assess the associations of HPA and SPE with all-cause, CVD, RESP, and cancer mortality, adjusting for demographic and socioeconomic factors, lifestyle behaviors, and health status. A restricted cubic spline smoother was used to investigate the dose-response relationships of HPA and SPE with mortality outcomes. Sex subgroup analyses were conducted to examine the potential effect disparity between men and women. To investigate the interactive effects of HPA and SPE, we calculated the relative excess risk due to the interaction and attributable proportion of additive effects to the total observed effects. During a median follow-up of 7.2 years, a total of 1,649 deaths occurred, with 209 cases from CVD, 123 from RESP, and 323 from cancer. HPA was identified to be associated with reduced mortality outcomes, suggesting remarkably reduced risks of 43-60% in all-cause mortality, 42-50% in CVD mortality, 36-71% in RESP mortality, and 38-46% in cancer mortality. In general, higher levels of HPA tended to be associated with lower risks. An approximately inverted J-shape association was identified between HPA and all-cause and cause-specific mortality, suggesting strong evidence for potential nonlinearity. Women performing HPA had a lower risk of all-cause, CVD, and cancer mortality. We did not identify significant evidence for additive interaction between HPA and SPE. HPA is independently associated with a reduced risk of mortality in Chinese women and men. More biological studies are needed to validate our findings and clarify the mechanisms underlying the association.

Alcohol use as a predictor of the course of major depressive disorder: a prospective population-based study.

There are indications that problematic alcohol use may negatively impact the course of major depressive disorder (MDD). However, most studies on alcohol use and adverse MDD outcomes are conducted amongst MDD populations with (severe) alcohol use disorder in psychiatric treatment settings. Therefore, it remains unclear whether these results can be generalised to the general population. In light of this, we examined the longitudinal relationship between alcohol use and MDD persistence after a 3-year follow-up amongst people with MDD from the general population. Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a psychiatric epidemiological prospective study comprising four waves amongst the adult Dutch general population (n = 6.646). The study sample (n = 642) consisted of those with 12-month MDD who participated at the follow-up wave. The outcome was 12-month MDD persistence after the 3-year follow-up, which was assessed via the Composite International Diagnostic Interview version 3.0. Weekly alcohol consumption was operationalised as non-drinking (0 drinks), low-risk drinking (⩽7 drinks; reference), at-risk drinking (women 8-13 drinks, men 8-20 drinks) and high-risk drinking (women ⩾14, men ⩾21 drinks). We performed univariate and multiple logistic regression analyses, which were adjusted for various socio-demographic and health-related factors. The majority (67.4%) of the MDD sample were female, while the mean age was 47.1 years. Amongst these, 23.8% were non-drinkers, 52.0% were low-risk drinkers and 14.3% and 9.4% were at-risk and high-risk drinkers, respectively. Around one-quarter of the sample (23.6%) met the criteria for a persistent MDD after 3-year follow-up. No statistically significant association was found between alcohol use and MDD persistence, either for the crude model or the adjusted models. In comparison to low-risk drinking, the full adjusted model showed no statistically significant associations between MDD persistence and non-drinking (odds ratio (OR) = 1.15, p = 0.620), at-risk drinking (OR = 1.25, p = 0.423), or high-risk drinking (OR = 0.74, p = 0.501). Contrary to our expectations, our findings showed that alcohol use was not a predictor of MDD persistence after 3-year follow-up amongst people with MDD from the general population.

Influence of age on the association between the triglyceride-glucose index and all-cause mortality in patients with cardiovascular diseases.

In patients with cardiovascular diseases, it is reported that the triglyceride-glucose index (TGI) potentially indicates prognosis. However, the results are controversial. Moreover, whether age has an impact on the predictive value of TGI remains unclear. Participants with cardiovascular diseases were enrolled using the China Health and Retirement Longitudinal Study (CHARLS) registry. TGI was calculated as ln (triglyceride×glucose/2). The survival status was recorded every 2 years in the follow-up waves. Multivariate regression analysis was carried out to determine the relationship between TGI levels and long-term all-cause mortality in patients grouped by different age. Patients younger than 65 years old were regarded as middle-aged group. Otherwise, they were classified as old group. In total, 2923 patients with cardiovascular diseases and baseline blood test results were included. After 7 years of follow-up, 242 (8.91%) patients died. Cox regression analysis revealed that higher TGI levels were associated with a higher risk of long-term all-cause mortality in middle-aged participants (hazard ratio [HR], 3.64; 95% confidence interval [CI] 1.44-9.22, P = 0.006) but not in old participants (HR 1.20, 95% CI 0.62-2.32, P = 0.594, P for interaction = 0.017), after adjusting physical activity and other factors. Kaplan-Meier estimate analysis and restricted cubic spline curves showed similar results. TGI was a promising marker for predicting all-cause mortality in middle-aged patients after cardiovascular diseases. Patients younger than 65 years old who have a higher level of TGI may develop a higher risk of all-cause mortality, and they are encouraged to control vascular risk factors and take more physical activity to improve their prognosis. Additionally, whether intervention in regulating TGI levels is beneficial for the prognosis of these patients needs further investigation.

Adaption and validation of the Perceived Control of Internal States Scale (PCOISS) in Chinese adults: a cross-sectional study

BackgroundPerceived control of internal states is important for disease prevention, stress buffering and life adaptability. However, there is no psychometric scale to measure control beliefs over internal states in China. This study aimed to adapt and validate the Perceived Control of Internal States Scale (PCOISS) in a large sample of Chinese adults.MethodsData was collected through a big project, in which a cross-sectional online survey was conducted nationwide in China using a powerful Chinese online survey platform named WenJuanXing (https://www.wjx.cn/). We translated the PCOISS into Chinese (C-PCOISS) with the forward–backward translation procedure. For the first time of the survey, a sample of 2709 participants (Sample 1) was valid for final analysis. Sample 1 was split into two datasets for principal component analysis (PCA) (nA = 1355) and confirmatory factor analyses (CFA) (nB = 1354) to determine potential factor structure. The scale’s validity (i.e., discriminant validity, convergent validity, criterion validity) and internal consistency reliability were evaluated. Among the 1354 respondents (nB), 761 (nC = 761) participated in the follow-up second wave of the survey to assess a cross-sectional test–retest reliability.ResultsThe C-PCOISS retained 14 items. PCA yielded a three-factor model which was supported with the best fit indices in CFA. The C-PCOISS had satisfactory internal consistency with Cronbach’s alpha coefficients of 0.86, 0.78 and 0.72 for three subscales, respectively. The scale also showed adequate test–retest reliability (Pearson correlations coefficient of 0.64, 0.62 and 0.54 with p < 0.001 for three subscales, respectively). Three factors of the C-PCOISS were positively associated with positive affect, and negatively associated with negative affect, depression, compulsion-anxiety and perceived stress.ConclusionsThe C-PCOISS is reliable and valid for measuring control beliefs over internal states in Chinese adults.

Asymptomatic orthostatic hypotension and risk of falls in community-dwelling older people.

Many older people with orthostatic hypotension (OH) may not report typical symptoms of dizziness, light-headedness or unsteadiness. However, the relationships between OH and falls in the absence of typical symptoms are not yet established. Continuous orthostatic blood pressure (BP) was measured during active stand using a Finometer at Wave 1 of The Irish Longitudinal Study on Ageing in participants aged ≥ 70years.OH, with and without dizziness, was defined as a sustained drop in systolic BP ≥ 20 and/or diastolic BP ≥ 10mm Hg at 30, 60 and 90seconds post-standing.The association between symptoms of dizziness and orthostatic BP was assessed with multi-level mixed-effects linear regression; logistic regression models assessed the longitudinal relationship between OH and falls at 6-year follow-up (Waves 2-5). Almost 11% (n = 934, mean age 75years, 51% female) had OH, two-thirds of whom were asymptomatic.Dizziness was not associated with systolic BP drop at 30 (β = 1.54 (-1.27, 4.36); p = 0.256), 60 (β = 2.64 (-0.19, 5.47); p = 0.476) or 90seconds (β = 2.02 (-0.91, 4.95); p = 0.176) after standing in adjusted models.Asymptomatic OH was independently associated with unexplained falls (odds ratio 2.01 [1.11, 3.65]; p = 0.022) but not explained falls (OR 0.93 [0.53, 1.62]; p = 0.797) during follow-up. Two-thirds of older people with OH did not report typical symptoms of light-headedness. Dizziness or unsteadiness after standing did not correlate with the degree of orthostatic BP drop or recovery. Participants with asymptomatic OH had a significantly higher risk of unexplained falls during follow-up, and this has important clinical implications for the assessment of older people with falls.

E-cigarettes and smoking cessation among adolescent smokers

Smokers of any age can reap substantial health benefits from quitting or reducing their smoking. E-cigarettes have been promoted as a potentially promising product for tobacco harm reduction because e-cigarettes deliver nicotine vapor without many of the hazardous chemical combustion byproducts produced by combustible cigarette smoking. However, there remains an ongoing debate on whether the use of e-cigarettes is effective in combustible cigarette smoking cessation or reduction in both adolescents and adults. Our study uses data from the 2015 (baseline) and from the 2017 (follow-up) waves of the Taiwan Adolescent to Adult Longitudinal Study (TAALS), which is a large nationwide representative cohort study of health behaviors among adolescents in Taiwan. We analyzed the data using logistic regression and multivariate regression with a post-stratification weighting procedure. Among the 474 adolescent combustible cigarette users at baseline, the use of e-cigarettes had no association with smoking cessation (aRR = 0.99, 95% CI = 0.66, 1.50). Furthermore, the use of e-cigarettes was also not associated with change in combustible cigarette consumption among all adolescent combustible cigarette users at follow-up (Coef. = 0.62, 95% CI = − 36.85, 38.09). In summary, our findings suggest that e-cigarettes may not aid tobacco control among adolescent smokers. Policy makers should be cautious of the potential harms that e-cigarette may bring to young people when they are developing e-cigarette regulations.