Self-care Research Articles

How do children understand and respond to the EQ-5D-Y-3L? A mixed methods study in a community-based sample of 6–12-year-olds

BackgroundThe EQ-5D-Y-3L is widely used for measuring and valuing HRQoL in paediatric populations. This mixed methods study used the EQ-5D-Y-3L measure and applied a retrospective think-aloud approach to examine the self-report validity in children of varying chronological age.MethodsA mixed methods study was conducted in a community-based sample of 39 children aged 6–12 years. In a semi-structured interview, children self-completed the EQ-5D-Y-3L and then engaged in retrospective think-aloud. Conversations were audio-recorded and transcribed for analysis in NVivo using the Tourangeau four-stage response model framework to assess comprehension, judgment, recall, and response mapping issues. Fisher’s exact test was used to assess the differences between child-self reported HRQoL across subgroups. The inter-rater agreement between child-parent dyads was assessed with CCC for overall HRQoL and Gwet’s AC1 for dimension level HRQoL.ResultsOverall, response issues were detected in n = 18 (46%) children. Comprehension issues were apparent in the “having pain or discomfort” dimension where children found it challenging to understand ‘discomfort’. Recall-related issues were observed where children’s responses were influenced by their typical tendencies (e.g., being usually worried) or past incidences (e.g., feeling pain sometimes). Judgement-related issues were the most common, particularly in the “doing usual activities” dimension, where children tended to respond based on their self-perceived ability to engage in activities rather than health-related limitations. None of the participants were found to have problems with response mapping. A healthy lifestyle that included diet and exercise was a notable consideration in EQ VAS ratings.The younger age groups had a higher proportion of response issues (6–7 years: 64%, 8–10 years: 62%), compared to older children (11–12 years: 20%). Moreover, children with response issues demonstrated significantly lower EQ-5D-Y-3L scores (mean = 0.78, se = 0.04) as compared to those without (mean = 0.95, se = 0.02) (p-value < 0.001). The overall inter-rater agreement was higher for those without any response issues (CCC = 0.33) than those with (CCC = 0.14). Additionally, higher agreement was noted across all the five dimensions in the subgroup with no response issues relative to those with.ConclusionsChildren in the general community may have different perceptions of HRQoL when responding to the EQ-5D-Y-3L possibly due to their limited experience with health-related challenges. The retrospective think-aloud approach adopted highlighted the relatively higher prevalence of response issues in the younger children (ages < 11 years), indicating the need for careful interpretation of self-reported HRQoL using the current version of the EQ-5D-Y-3L in this population.

Impact of weight and health-behavior information on evaluations of girls' health.

The dominant public health narrative equates excess weight with poor health, and previous research has demonstrated that people judge adults with higher body weights as being in poor health, even when they engage in healthy lifestyles. The present study investigated whether the same pattern of beliefs holds for perceptions of children's health. Participants (n = 445) viewed the health profile of a female child that varied in terms of weight status (normal weight, obese), health behaviors (good, poor), and age (younger, older), and then rated the child's overall health and indicated their agreement with suggested behavior recommendations. For older children, targets with obesity were perceived as less healthy and were recommended to engage in more healthy and weight control behaviors than were the targets with normal weight. Health behaviors did influence perceptions of health and behavioral recommendations, but much less so for the target with obesity than for the target with normal weight. For younger children, participants placed a greater emphasis on health behaviors than on weight in their perceptions of the target's health and healthy behavior recommendations, but the target's weight did play a greater role in weight-control behavior recommendations. Overall, perceptions of older children reflect the mainstream weight-centric health beliefs that are perpetuated in public health messaging, whereas perceptions of younger children seem to be more aligned with the scientific evidence supporting the importance of health behaviors to overall health. Public health messaging, particularly messaging targeting parents, should be reframed to focus on the importance of engagement with health behaviors without reference to weight.

The impact of a lifestyle promotion program on anthropometric and clinical manifestations in adolescents with polycystic ovarian syndrome: a randomized controlled trial

BackgroundLifestyle modification can have beneficial effects on improving symptoms of ovary syndrome and anthropometric changes, particularly in obese individuals… However, it is not clear whether these affects in obese adolescents with PCOS are the same as non-PCOS adolescents. We had a study question” Can lifestyle promotion programs, which focus on changing behavioral habits, have an effect on anthropometric parameters and the manifestation of polycystic ovary syndrome (PCOS) in adolescents?”MethodsThis was a cluster randomized trial (CRT) that started from January 2021 and follow-up ended in March 2022. 128 participants included adolescent girls (from 14 to 18 years old). The status of PCOS was determined for the participants, following which both the PCOS-afflicted and non-PCOS cohorts were subjected to randomization to either partake in a lifestyle promotion program or to proceed without it. This program included eight sessions that were designed to be implemented for two months. This intervention provides recommendations for a balanced diet and regular exercise, as well as advice on behavior change for adolescents, including those with PCOS, regardless of their weight. All participants were followed up for 12 months and were evaluated at three time points: baseline, 6 and 12 months. Outcomes included changes in the anthropometric indices (weight, hip and waist circumstance), regularity of menstrual cycle, hirsutism score by the modified-Ferriman-Gallwey scale, acne score by the Investigator’s Global Assessment Scale, hair loss scores by the Sinclair Graphic Instrument and then physical activity by the Caspian tool and dietary intake status by the Food Frequency Questionnaire. Data was analyzed using the non-parametric Mann-Whitney test for variables with two-time point assessments and generalized estimation equations (GEE) for variables with three time point assessments.ResultsIn the study, the intervention group of girls with PCOS exhibited a significant reduction in weight and waist circumference, with an average decrease of 3.14 kg and 4.68 cm, respectively (P < 0.001), compared to the PCOS control group. Similarly, the non-PCOS intervention group showed a decrease in these factors by 2.60 kg and 4.95 cm (P < 0.001) when compared to the non-PCOS control group. After 12 months of intervention, the odds ratio (OR) for menstrual regularity in the PCOS intervention group increased to 3.30 (95% CI: 2.06, 5.25), and the acne score significantly decreased with an OR of 0.46 (95% CI: 0.31, 0.70). In contrast, the non-PCOS intervention group experienced an increase in the OR for menstrual regularity to 2.45 (95% CI: 1.33, 4.25) and an improved in acne score with an OR of 0.44 (95% CI: 0.28, 0.69). No notable differences were observed in the nutritional status among all groups post-intervention. However, a significant increase in physical activity levels, measured in metabolic equivalent minutes per week (met/min/week), was recorded in both intervention groups (p < 0.05).ConclusionManifestations of PCOS in adolescents are improved by a lifestyle promotion program and high schools are considered an appropriate setting to identify those with PCOS and the implementation of a lifestyle modification program. This program was also shown to promote healthy lifestyles for non-PCOS adolescents.Trial registrationTrial registration number: irct.ir number: IRCT20200114046123N1.

Exercise alleviates hematopoietic stem cell injury following radiation via the carnosine/Slc15a2-p53 axis

Ionizing radiation (IR) can cause severe dysfunction of hematopoietic stem cells (HSCs), leading to acute or prolonged myelosuppression. In recent years, physical exercise has been recognized as a healthy lifestyle as it can fight a variety of diseases. However, whether it provides protection against IR is not fully understood. In this study, we revealed that long-term moderate exercise mitigated IR-induced hematopoietic injury by generating carnosine from skeletal muscles. We found that exercised mice displayed reduced loss of HSC number and function after IR, accompanied by alleviated bone marrow damage. Interestingly, these effects were largely abrogated by specific deletion of carnosine synthase Carns1 in skeletal muscles. In contrast, carnosine treatment protected HSCs against IR-induced injury. Mechanistically, we demonstrated that exercise-generated carnosine was specifically transported to HSCs via Slc15a2 and then inhibited p53 transcriptional activity by directly interacting with its core DNA-binding domain, which led to downregulation of the p53 target genes p21 and Puma, thus promoting the proliferation and survival and inhibiting the senescence of irradiated HSCs. More importantly, a similar role of the carnosine/Slc15a2-p53 axis was observed in human cord blood-derived HSCs. Collectively, our data reveal that moderate exercise or carnosine supplementation may be potential antiradiation strategies.

Wisdom, Resilience, and Well-Being in Later Life

As the numbers of older adults continue to increase globally, the need for facilitating healthy aging has become critical. While a physically healthy lifestyle, including exercise and diet, is important, recent research has highlighted a major impact of psychosocial determinants of health, such as resilience, wisdom, positive social connections, and mental well-being, on whole health. This article focuses on keeping the mind and brain healthy with psychosocially active aging. It has six sections: Philosophy Concepts of Wisdom, Resilience, and Well-Being; Wisdom: Clinical, Neurobiological, and Evolutionary Perspectives; Resilience, Adaptation, and Augmentation; Psychological Resilience, Brain Health, and Whole Person Health; Preventing Depression and Promoting Resilience and Well-Being in Old Age; and The Centenarian as a Model of Resilience and Well-Being. We discuss the biopsychosocial mechanisms and effectiveness of healthy lifestyle strategies and propose a framework for future research and its practical implications for promoting wisdom, resilience, and well-being at the individual, societal, and policy levels.

Severe depression association with the addiction to fast food and smartphones in Jordanians: a cross-sectional study

BackgroundThe connection between psychiatry health, mental health, and lifestyle is under-studied in the Arab world. This study examined whether addictions to smartphones and fast food are associated with severe depressive symptoms in a cohort of Arab Jordanians.MethodThis research is cross-sectional. The Patient Health Questionnaire-9 was used to measure the severity of depression (PHQ-9), food addiction was assessed using the 9-item Modified Yale Food Addiction Scale (mYFAS), and smartphone addiction was assessed using the Arabic-validated Smartphone Addiction Scale. Using multivariable binary logistic regression, the relationship between food addiction, and depressive symptoms. Results: Data were analyzed from 426 participants, 264 participants (62.0%) reported being addicted to smartphones, and 156 (36.6%) reported severe depressive symptoms. The multivariable binary logistic regression revealed that severe depression was significantly associated with lower income (OR = 2.14, 95% Cl 1.34–3.41, P = 0.001), addiction to smartphones (OR = 2.15, 95% = 1.39–3.32, P = 0.001), and increased addiction to fast food (OR = 1.06, 95% = 1.04–1.08, P = < 0.001).ConclusionAddiction to smartphones, addiction to fast food, and low income were all associated with severe depression in Arab Jordanians, community awareness is highly required to adopt a healthy lifestyle.

Pengaruh Net Profit Margin, Debt Equity Ratio dan Current Ratio Terhadap Harga Saham Perusahaan Sektor Kesehatan yang Terdaftar di Bursa Efek Indonesia Tahun 2020 – 2023

This study is based on the large public attention to investment, especially to investment instruments such as stocks. In addition, the trend of a healthy lifestyle that is currently popular and the health transformation carried out by the government make the shares of health sector companies interesting to pay attention to. This study was aims to analyze and determine the effect of Net Profit Margin (NPM), Debt to Equity Ratio (DER) and Current Ratio (CR) simultaneously or partially on stock prices. The research method used in this study is a quantitative research method. The population used in this study were companies in the health sector listed on the Indonesia Stock Exchange in 2020-2023. There are 33 companies in the health sector listed on the Indonesia Stock Exchange. The sampling technique in this study used a purposive sampling technique with the number of selected company samples being 11 companies. The data used in this study are secondary data from financial data on the Indonesia Stock Exchange contained in the company's annual report. The variables tested in this study are Net Profit Margin (NPM), Debt to Equity Ratio (DER), Current Ratio (CR) and stock price. The data collection technique used in this study uses documentation techniques from the company's annual financial report. The data analysis technique used in this study is multiple linear regression.The results of this study show that Net Profit Margin (NPM), Debt to Equity Ratio (DER), and Curretn Ratio (CR) Simultaneously have a significant effect on stock prices. Partially, Net Profit margin (NPM) and Debt to Equity Ratio (DER) partially does not have a significant effect on stock prices. Meanwhile, Current Ratio (CR) partially have a significant effect on stock prices.

The association between moderate-to-vigorous physical activity and health-related quality of life in Chinese adolescents: the mediating roles of emotional intelligence and perceived stress

IntroductionChinese adolescents are facing tremendous academic pressure and challenges brought about by changes in the social environment, which pose a serious threat to their health-related quality of life (HRQOL). This cross-sectional survey uses convenience and snowball sampling to explore the relationship between adolescents’ HRQOL and their participation in moderate-to-vigorous physical activity (MVPA).MethodsThis study subjects include 440 adolescents aged 12 to 18, from four youth training centers and three schools in the central regions of Hunan, Hubei, and Henan provinces, chosen as representative samples for this study. We used AMOS v.26 to construct a structural equation model for data analysis and hypothesis testing.ResultsThe results indicated that active participation in MVPA helps reduce adolescents’ perceived stress and enhances their emotional intelligence and HRQOL levels. Specifically, MVPA weakens adolescents’ perceived stress through the mediating role of emotional intelligence (coefficient = −0.148, p &amp;lt; 0.001), and perceived stress also mediates the relationship between emotional intelligence and HRQOL (coefficient = 0.165, p &amp;lt; 0.001). Furthermore, the positive impact of MVPA on HRQOL is mediated by emotional intelligence and perceived stress (coefficient = 0.363, p &amp;lt; 0.001). The explanatory power of this study is R2 = 0.50.ConclusionThe study results indicate that MVPA has a positive impact on the HRQOL levels of Chinese adolescents. Physical activity, especially moderate-to-vigorous intensity exercise, should be considered a strategic approach to maintaining HRQOL among adolescents. Society, schools, and families should create an environment conducive to physical exercise to support adolescents in engaging in physical activities and developing a healthy lifestyle.

Healthy Diets and Lifestyles in the World: Mediterranean and Blue Zone People Live Longer. Special Focus on Gut Microbiota and Some Food Components.

Longevity has been associated with healthy lifestyles, including some dietary regimens, such as the Mediterranean diet (MedDiet) and the Blue Zone (BZ) diets. MedDiet relies on a large consumption of fruit, vegetables, cereals, and extra-virgin olive oil, with less red meat and fat intake. Four major BZ have been recognized in the world, namely, Ogliastra in Sardinia (Italy), Ikaria (Greece), the Peninsula of Nicoya (Costa Rica), and Okinawa (Japan). Extreme longevity in these areas has been associated with correct lifestyles and dietary regimens. Fibers, polyphenols, beta-glucans, and unsaturated fatty acids represent the major constituents of both MedDiet and BZ diets, given their anti-inflammatory and antioxidant activities. Particularly, inhibition of the NF-kB pathway, with a reduced release of pro-inflammatory cytokines, and induction of T regulatory cells, with the production of the anti-inflammatory cytokine, interleukin- 10, are the main mechanisms that prevent or attenuate the "inflammaging." Notably, consistent physical activity, intense social interactions, and an optimistic attitude contribute to longevity in BZD areas. Commonalities and differences between MedDIet and BZ diets will be outlined, with special reference to microbiota and food components, which may contribute to longevity.

Peer support and healthy lifestyle among adolescents in urban areas in Indonesia

Unhealthy lifestyles among adolescents in urban areas are still a problem. Peers are role models in adolescent's lifestyle. However, little is known about the peer support in eating behavior, sedentary lifestyle and physical activities, which thus needs to be explored. This study aims to analyze the relationship between peer support and adolescent lifestyle. This study used a cross-sectional design with a sample size of 105 adolescents using proportional stratified random sampling. Data were collected by questionnaire. The Spearman rho test was performed to identify the relationship between peer support within a sedentary lifestyle and eating behavior, while to identify the relationship between peer support and physical activity using pearson, the level of significance was determined as p≤0.05. The results showed that there was a relationship between peer support and eating behavior (p=0.012; r=0.243) as well as adolescents' physical activity (p=0.001; r=0.324). There is no relationship between peer support and a sedentary lifestyle both on weekdays (p=0.181; r=0.131) and on weekends (p=0.735; r=0.033). The results show that peers have an important role in improving healthy lifestyle patterns in adolescents, especially in eating behavior and physical activity, so peer involvement interventions to improve healthy lifestyles in adolescents are recommended.

Active Learning Through Video Conferencing to Maintain Physical Activity Among Older Adults: A Pilot Randomized Controlled Trial.

This randomized pilot trial investigated the feasibility of an active learning physical activity intervention through video conferencing and its preliminary effects. Participants comprised community-dwelling older adults who could use e-mail. The intervention group underwent a 12-week active learning intervention via video conferencing to promote a healthy lifestyle, particularly physical activity. The control group received information via e-mail once per week. The amount of physical activity and sedentary behavior was measured using an accelerometer at baseline, postintervention, and 24-week postintervention (36weeks). Of the 31 participants, 29 were eligible and randomized into two groups (15 for the intervention and 14 for the control). Adherence to the intervention was 83%-100% (mean, 97%). Compared with the control group, the intervention group showed moderate maintenance effects on total physical activity and sedentary behavior at 36weeks. Active learning physical activity intervention through video conferencing was found to be feasible and contributed to the prevention of physical activity decline in older adults.

Perceived Barriers to Healthy Lifestyle Adherence and Associated Factors Among Patients with Type 2 Diabetes Mellitus: Implications for Improved Self-Care

Perceived Barriers to Healthy Lifestyle Adherence and Associated Factors Among Patients with Type 2 Diabetes Mellitus: Implications for Improved Self-Care

Burden of disease attributable to risk factors: Estimates of the Global Burden of Disease from 1990 to 2021

ObjectivesAnalyze the burden of diseases attributable to risk factors (RF) in Brazil according to age, sex, and Brazilian states between 1990 and 2021. MethodsThis study used data from the Global Burden of Disease study 1990 to 2021. The metrics used in this analysis included: mortality rates, disability-adjusted life years (DALYs) and Summary Exposure Value (SEV). A ranking of the risk factors was created by highlighting the changes between 1990 and 2021, according to sex, age group, and Brazilian state. RF were analyzed according to the Socio-Demographic Index (SDI). ResultsDecline the risk factors of tobacco (−50.2 %), environmental: water, sanitation and hand washing (−58.0 %), and air pollution (−45.0 %), as well as an increase in the burden attributable to BMI (+78.4 %), alcohol consumption (+15.7 %). High systolic blood pressure ranked first in all states in 2021, followed by high blood glucose; tobacco ranking third in most states. The burden of diseases attributable to RFs in Brazil varied considerably between men and women, age groups, and states. Trends in the period from 1990 to 2021 showed a strong correlation with the SDI, better results being observed in states with higher SDI. ConclusionsHigh blood pressure, high BMI and tobacco are the main risk factors for mortality and DALYs in 2021. The burden of disease has a high correlation with socio-economic indicator (SDI). It is important to strengthen public policies that promote healthy lifestyles, thus reducing disease and death.

Parental support and influencing factors for school-age children's healthy movement behavior: a cross-sectional study

Introduction: Optimizing healthy lifestyles in children requires parental support for healthy movement behaviors. This study analyzed factors influencing parental support for school-age children's movement activities. Methods: This study employed an analytic descriptive design with a cross-sectional approach, involving a sample of 355 mothers with school-age children. The independent variables included family, child, and environmental factors, whereas the dependent variable was parental support for healthy movement behaviors, as assessed through a questionnaire. Data analysis was performed using binary logistic regression with backward elimination. Results: The factors that significantly influenced parental support for their children's engagement in light physical activities included the children's own level of participation in such activities (OR=2.52, 95% CI=0.76-6.67). Factors affecting support for moderate to vigorous activities were maternal exercise habits (OR=3.37; 95% CI=1.18-9.65), children's sports habits (OR=5.18; 95% CI=1.64-16.26), and the presence of personal gadgets (OR=0.45, 95% CI=0.23-0.86). Parental support for preventing sedentary behaviors was influenced by parental knowledge (OR=2.33; 95% CI=1.34-4.05), mother's sleep duration (OR=2.46; 95% CI=1.27-4.75), and gadgets (OR=0.55; 95% CI=0.31-0.95). Factors affecting support for adequate sleep included children's light activities (OR=3.42; 95% CI=1.27-9.23) and their ownership of personal gadgets (OR=0.44; 95% CI=0.24-0.79) Conclusions: Parental support is influenced by the knowledge and physical activity habits of both mother and child, as well as gadget use and maternal sleep patterns. Pediatric nurses can enhance this support through health education focused on promoting healthy movement behaviors within families.

Exploring the link between convergence insufficiency and electronic device use

Purpose: This literature review aims to explore the potential link between Convergence insufficiency (CI) and the use of electronic devices. CI is a common binocular vision disorder characterized by difficulty in maintaining proper eye alignment during near tasks. Method: Search the literature using keywords such as “Convergence insufficiency ", "electronic devices", "smartphones", "tablets" and "computer" in electronic databases such as PubMed, Scopus and Google Scholar. The review included studies examining the relationship between CI and electronics, including experimental and observational studies. Results: These used various methods, including surveys, clinical studies, and experimental designs. Findings suggest that prolonged and excessive use of electronic devices may lead to developing or worsening CI symptoms.. Factors such as close work, decreased frequency, and perceived fatigue associated with the use of electronic devices have been implicated as potential mechanisms behind this relationship. However, the evidence remains limited and inconclusive, as some studies report conflicting results. Conclusion: Although there is some evidence of a possible link between CI and electronics, more research is needed to establish a positive relationship. The results of this literature review highlight the importance of promoting healthy lifestyles and raising awareness of the risks associated with the overuse of electronic devices, especially for people with CI. Future research should focus on investigating prevention and interventions to reduce the negative effects of electronic devices on vision health.

“My Back Exercise App”—mHealth for Low Back Pain: Development and Usability Testing

Abstract Effective management of chronic low back pain (LBP) often relies on maintaining a healthy lifestyle. Mobile health (mHealth) applications provide a unique opportunity to support LBP sufferers by integrating evidence-based health education into daily routines. However, many existing mHealth apps lack scientific rigour in their development, limiting their impact. This study reports on developing and usability testing My Back Exercise, an mHealth app designed to support individuals managing chronic LBP through a user-centred, theory-based approach. The development followed the Double Diamond framework and Software Development Life Cycle (SDLC) model, focusing on behaviour change theory to promote healthy lifestyle habits. Usability testing involved ten users and employed the System Usability Scale (SUS) and Mobile App Rating Scale (MARS) to assess engagement, functionality, aesthetics, and information quality. Additionally, a think-aloud approach captured real-time feedback and guided iterative improvements. Results showed that the app was well-received, achieving a SUS mean score of 79 (total score of 100) and a MARS mean score of 3.7 (out of 5.0). Key intervention components included exercises, sleep management, diet, and pain education, contributing to a holistic self-management tool. This study provides a transparent roadmap for the development of evidence-based digital health tools. The My Back Exercise app offers an innovative, holistic approach to help people self-manage chronic LBP using evidence-based methods.

The Influence of the Availability of Environmentally Friendly Food on Consumers' Green Purchasing Behavior

For a long time, scientists, intellectuals, and environmentalists around the world have advocated for adopting an eco - friendly lifestyle. Unmindful human activities over the past few decades have caused irreversible damage to the Earth's ecosystem. Green marketing, or sustainable marketing, has emerged as a highly effective tool to address the problem of environmental degradation. The present era can be seen as a time of revelation and introspection regarding the impact of human activities on the environment. With the emergence of deadly diseases, it is imperative to recognize the importance of a healthy lifestyle. It is essential to motivate people to adopt products with green attributes by employing appropriate green marketing strategies. The present research paper attempts to analyses the impact of availability of eco - friendly food products on consumer buying behaviour.

Lifestyle factors and incident multimorbidity related to chronic disease: a population-based cohort study

Background: Multimorbidity is linked to poor quality of life, and increased healthcare costs, and multimorbidity risk is potentially mitigated by a healthy lifestyle. This study evaluated the individual and joint contributions of an extensive set of lifestyle factors to the development of multimorbidity. Methods: A prospective study of 133,719 adults (age 45.2 ± 12.9, range 18–93 years) from the Dutch Lifelines cohort assessed the influence of lifestyle factors on multimorbidity, defined as having at least two of four major chronic diseases, using Cox regression models and population attributable fractions (PAFs). Lifestyle-related factors included diet quality, physical activity, TV watching, substance use (alcohol, smoking), sleep (duration, medication), stress (acute, chronic) and social connectedness (social contacts, marital status). Results: Over a median follow-up of 3.4 years, 3687 (12.5%) of the 29,545 participants with a chronic disease at baseline developed multimorbidity, compared to 434 (0.4%) of the 104,174 without a chronic disease. Key lifestyle factors linked to multimorbidity included smoking, prolonged TV watching, and stress, with hazard ratios indicating a higher risk in both groups. Additionally, high alcohol consumption and inadequate sleep duration were found to increase multimorbidity risk specifically in those with a chronic disease. Lifestyle factors jointly accounted for 34.4% (PAF, 95%CI 28.8%–73.5%) (with baseline morbidity) and 55.6% (95%CI 17.2%–48.5%) (without) of multimorbidity cases, with smoking as the primary contributor. Conclusions: Lifestyle factors, particularly smoking, alcohol consumption, TV watching, stress, and sleep, significantly contribute to the development of multimorbidity. The study underscores the importance of targeted prevention in public health and healthcare settings to manage and prevent multimorbidity.

Exposure to multiple metals and leukocyte telomere length in children and adolescents: The mediating effect of thyroid hormones

Exposure to metals has been related to alterations in leukocyte telomere length (LTL), an aging marker. However, the evidence regarding this relationship in children and adolescents, as well as the underlying mechanisms, remains unclear. Therefore, we aimed to explore the individual and mixture effects of metals on LTL in children and adolescents and to assess the mediating role of thyroid hormones and the modifying effect of a healthy lifestyle. In a cross-sectional study performed in Liuzhou, China, we assessed 5 serum thyroid hormones, 18 urinary metals, and LTL among 1050 children and adolescents aged 6–18 years. We employed multivariate linear regression and weighted quantile sum (WQS) regression to assess the associations of urinary metals with LTL in children and adolescents. Mediation analyses were conducted to explore the effects of thyroid hormones on these relationships. Urinary cobalt (Co), nickel (Ni), strontium (Sr), mercury (Hg), cadmium (Cd), and thallium (Tl) were related to a shorter LTL in children and adolescents. The WQS regression showed a 6.31% (95% CI: −8.76%, −3.79%) decrease in LTL per quartile increase in the WQS index, and identified Ni (23.3%), Sr (21.7%), and Tl (18.0%) as the major contributors. Mediation analyses showed that triiodothyronine (T3) mediated 14.8% and 8.1% of the associations of urinary Sr and Hg with LTL, respectively, and suppressed 9.3% of the association with urinary Co. Furthermore, the inverse associations of Sr, Cd, and Tl with LTL were attenuated among participants who adopted a healthy lifestyle. Our findings suggested that exposure to Co, Ni, Sr, Cd, Hg, Tl, and their mixture were related to a shorter LTL in children and adolescents, potentially mediated by thyroid hormones. Additionally, adopting a healthy lifestyle may alleviate these adverse effects.

Corrigendum to “Using Mixed Methods Research to Optimize Healthy Lifestyle Intervention Adaptation for Web-Based Delivery: A Pragmatic Approach”

Corrigendum to “Using Mixed Methods Research to Optimize Healthy Lifestyle Intervention Adaptation for Web-Based Delivery: A Pragmatic Approach”