Individual Health Research Articles (Page 1)

Background and objectives: Exerkines are signalling factors that are released from organs throughout the body during physical exercise (El-Sayes et al., 2019). Some of these exerkines are thought to contribute to the well-documented benefits of exercise on brain health and cognitive function, potentially delaying age-related cognitive decline (Erickson et al., 2011). However, research is still far from establishing a mechanism-based, evidence-driven exercise programme to prevent such decline. To date, most studies have focused on endurance training, leaving other training modalities underexplored. Moreover, few studies have simultaneously examined exercise-induced effects on blood, brain, and cognitive domains, limiting more holistic understanding of the underlying mechanisms. Research has also primarily involved healthy adults, whereas older adults at risk of Mild Cognitive Impairment (MCI) are less frequently studied. Importantly, the effects of exercise on cognition have never been investigated in persons with Spinal Cord Injury (SCI), a population with an elevated risk of age-related cognitive decline and dementia. The primary objective of the dissertation was therefore to gain a more comprehensive understanding of the mechanisms underlying the beneficial effects of exercise training, specifically resistance exercise in older adults and Neuromuscular Electrical Stimulation (NMES) in individuals with SCI, on brain health and cognitive function, with a particular focus on the role of exerkines in (exercise-induced) neuroplasticity. Methods: Eleven studies were conducted. Study 1 was a literature review describing exerkine release following acute and chronic endurance or resistance exercise and their effects on neuroplasticity via long-term synaptic potentiation. Study 2 summarised the findings from transcriptome and secretome studies identifying muscle-derived exerkines (myokines). Studies 3 and 4 were cross-sectional studies in older adults (n = 74) investigating the relationships between participant characteristics, blood (inflammatory and neurotrophic) and brain biomarkers (neurometabolites, regional grey matter volumes), and cognitive function. Studies 5–8 evaluated the effect of a single bout (n = 37) and a 12-week resistance exercise programme (n = 74) on blood and brain biomarkers and cognitive function in older adults. Studies 6 and 7 further compared outcomes between cognitively healthy older adults and those at elevated risk of MCI (based on the Montreal Cognitive Assessment). Study 9 systematically reviewed evidence on the effects of exercise interventions on cognitive performance in individuals with SCI and highlighted factors underlying their elevated risk of cognitive decline. Study 10 tested the effect of a single bout of NMES on exerkines and cognitive performance in persons with SCI. Study 11 described the protocol of a 12-week NMES intervention in individuals with SCI to examine the effect on exerkines and cognitive outcomes. Results: Study 1 identified 16 exerkines with known (in)direct effects on long-term synaptic potentiation. Study 2 reported 1,126 putative myokines, most with still unknown effects on the brain and body. Study 3 found associations between the circulating inflammatory marker kynurenine and signs of neuroinflammation and neurodegeneration in older adults. Study 4 showed that older adults with normal-to-slightly-elevated body weight and greater handgrip strength maintained larger brain volumes. Study 5 demonstrated improved working memory performance in older adults immediately after a single session of resistance exercise training compared to control group. Study 6 suggested hippocampal volume preservation over time in the resistance exercise group, and Study 7 revealed executive function improvements in older adults at elevated risk of MCI after 12 weeks of resistance training compared with control group. Study 8 demonstrated neurometabolic changes in older adults who contracted COVID-19 during participation. Study 9 confirmed that no prior studies have investigated exercise effects on cognitive function in individuals with SCI. Study 10 found increases in lactate levels, but no changes in cognitive performance after a single NMES session in persons with SCI. Study 11 described the design for a future 12-week NMES intervention study for individuals with SCI. Conclusions: The dissertation advances the understanding of exercise effects on brain health and cognition in older adults and individuals with SCI, providing a neurobiological basis for future research. Kynurenine levels, handgrip strength, and a healthy body weight emerged as potential biomarkers of brain health for older adults. The findings underscore the importance of monitoring cognitive functioning in persons with SCI. Although further research is needed to clarify the effect of different exercise modalities across populations with varying cognitive risk profiles, the present evidence reinforces the notion that physical exercise benefits brain function. A multimodal, enjoyable, and sustainable exercise programme maintained throughout life is likely to be the most effective strategy to mitigate or delay age-related cognitive decline. Keywords: aging, cognition, myokines, exercise, spinal cord injury

Editorial: The influence of flourishing and its associated factors on the mental health and well-being of individuals

Normal Weight obesity, characterized by normal-range body mass index accompanied by elevated adiposity, poses a potential health challenge among female college students. This demographic exhibits heightened susceptibility to psychological disturbances and sleep disorders. High-Intensity Interval Training (HIIT) appears to have potential in managing metabolic dysregulation. However, its efficacy in improving mental health and sleep quality in individuals with normal weight obesity remains uncertain. This randomized controlled trial enrolled female college students (N = 35) who met the criteria for normal weight obesity, defined as a body mass index between 20 and 23kg/m² and a body fat percentage greater than 30%. The intervention group (n = 17) participated in a 4-week HIIT protocol, consisting of five sessions per week at greater than 90% VO2max, while the control group (n = 18) received standard health education. Validated instruments were utilized to assess depression (PHQ-9), anxiety (GAD-7), and sleep quality (PSQI). ChiCTR2100050711 Registered 3 September 2021 Retrospectively registered, https//www.chictr.org.cn/showproj.html? proj=132,914. The HIIT intervention significantly reduced PHQ-9 scores from 5.8 ± 4.2 to 3.2 ± 2.7 (p < 0.01) and GAD-7 scores from 5.1 ± 5.3 to 2.8 ± 2.9 (p < 0.05), while also improving PSQI scores from 5.1 ± 3.4 to 3.5 ± 2.5 (p < 0.01). Post-intervention analyses revealed a strong correlation between sleep quality and levels of depression (R = 0.813, p < 0.001) and anxiety (R = 0.739, p < 0.001) in the HIIT group, whereas no significant change in sleep quality was observed among the control group. This study demonstrates the therapeutic efficacy of HIIT in improving psychological disturbances and sleep architecture in female students with normal weight obesity. It may serve as a time-efficient intervention. The observed correlation between sleep quality and psychological parameters warrants further investigation into the underlying mechanisms.

The adoption of the Internet of Things (IoT) for the application of smart health is an effective method for distributed and intelligent automated diagnosis systems. Fetal movement is a basic index of fetal well being. IoT based fetal health classification leverages IoT technology to remotely assess and monitor fetal well being in real time. Continuous data streams including uterine contractions, fetal heart rate (FHR), and movement patterns can be gathered and analyzed by incorporating sensors with cloud machine learning (ML) and computing algorithms. This allows prompt diagnosis of distress indicators or abnormalities, simplifying quick measures to optimize prenatal care outcomes. Furthermore, IoT based systems provide an opportunity for personalized monitoring of individual pregnancies, enhancing fetal and maternal health monitoring through gestation. On the other hand, the present technology in medical applications could not offer an easily accessible, long term, and effective way for fetal movement monitoring. Lately, ML and deep learning (DL) approaches have been considered appropriate for the automatic classification of fetal health. This study presents an IoT assisted Fetal Health Detection and Classification using the Mother Optimization Algorithm with Deep Learning (AFHDC MOADL) method. The goal of the AFHDC MOADL technique is to accurately classify fetal health into three different classes such as normal, suspect, and pathological. In the AFHDC MOADL technique, a multi faceted process is involved. Primarily, the AFHDC MOADL technique involves IoT devices for the data acquisition process which collects fetal health related data. Besides, the AFHDC MOADL technique undergoes data pre processing in two ways such as K nearest neighbor (KNN) based data imputation and standard scaler. The AFHDC MOADL technique designs a mother optimization algorithm (MOA) to decrease the high dimensionality problem, which selects an optimal subset of features. A graph convolutional neural network (GCN) model is exploited for the fetal health classification. Finally, the root mean square propagation (RMSProp) optimizer can be utilized for optimum hyper parameter selection of the GCN technique. The simulation outcomes of the AFHDC MOADL algorithm can be assessed on the Fetal Health Classification dataset from the Kaggle dataset. The experimental validation highlighted the significant performance of the AFHDC MOADL technique over recent DL approaches.

Exercise is a critical determinant of both immediate and long-term health for individuals with congenital heart disease (CHD). While pediatric cardiologists increasingly recognize the importance of promoting physical activity, formal training in exercise counseling remains limited. Exercise cardiology is an evolving subspecialty, with growing educational and training opportunities for congenital cardiologists to develop diagnostic and therapeutic approaches and expand access to exercise resources for patients with CHD. As part of this effort, the Global Coalition for Fitness and CHD (GloCo) convened a multi-institutional Education Working Group to develop practical, evidence- and consensus-based guidance for exercise counseling in children, adolescents, and young adults with CHD. This guide outlines foundational elements of exercise counseling, including strategies for obtaining an exercise history, performing cardiac risk assessments, shared decision-making, and tailoring exercise recommendations to individual patient needs. Exercise counseling in CHD must be personalized, taking into consideration the patient's medical status, psychosocial context, and available resources. Core components include risk assessment through multimodal imaging, rhythm monitoring, and exercise assessment, including but not limited to cardiopulmonary exercise tests. Based on these evaluations, clinicians can provide or recommend general physical activity promotion, formal exercise prescriptions, or structured programs such as cardiac fitness and rehabilitation. Importantly, the aim is not simply meeting physical activity targets but fostering positive attitudes toward lifelong exercise and instilling the confidence to sustain it. By aligning exercise plans with patient and family preferences, motivations, goals, and resources, clinicians can promote sustainable engagement and improved overall fitness. This guide aims to support pediatric and congenital cardiologists in providing safe and effective exercise counseling to their patients with CHD to help them achieve optimal physical and psychosocial well-being.

Background. The growing number of losses due to war, the COVID-19 pandemic, and social crises underscores the need to differentiate between normal and pathological grief. Delayed diagnosis of prolonged grief disorder (PGD) increases the risk of depression, suicidality, and psychosomatic disorders. Objective: to systematize theoretical concepts and empirical research for distinguishing normal and pathological grief, and to analyze the mental health of individuals who lost a loved one due to the full-scale Russian invasion of Ukraine, with a subsequent assessment of potential mental disorders and the effectiveness of modern therapeutic approaches, including pharmacological interventions. Materials and methods. This study integrates a review of scholarly literature from various scientific databases (2014–2024) and findings of own clinical observations. A total of 96 patients aged 25–55 who had experienced a loss were clinically examined. The Traumatic Grief Inventory-Self Report Plus (TGI-SR+) was used for initial scre-ening. 58 patients met the criteria for PGD according to the TGI-SR+ and were further evaluated using the Montgomery-sberg Depression Rating Scale (MADRS) to assess depressive symptoms. Results. PGD was confirmed as a distinct diagnostic category with well-defined criteria. Its core features include persistent emotional suffering, anxiety symptoms, and social maladjustment persisting six months after the loss. The literature review supports the effectiveness of combining psychotherapeutic and pharmacological interventions. In this study, PGD patients were stratified into two subgroups based on MADRS scores: group 1 — moderate depression (n = 31; MADRS 24.42 ± 2.17), group 2 — mild depression (n = 37; MADRS 12.41 ± 2.82). All patients received escitalopram: up to 20 mg in group 1 and up to 10 mg in group 2. One month after treatment initiation, MADRS scores significantly decreased in both groups: to 8.06 ± 1.80 in group 1 and to 4.68 ± 1.48 in group 2 (p &lt; 0.05). Conclusions. A deeper understanding of loss and the grieving process enables timely diagnosis of pathological grief. Under wartime conditions, families of the deceased and mis-sing people often experience intense grief that, when prolonged, can develop into PGD. In such cases, antidepressant support may be appropriate. Escitalopram proved effective in alleviating depressive symptoms associated with PGD.

Interest in capturing chronic disease prevention impacts on broader economic and societal outcomes is growing; however, this has been challenging to date. We present a comprehensive framework to support assessment of prevention value from a range of stakeholder perspectives, using obesity as an illustrative example. We identified three domains in which to group value components: individual health/health system, societal, and government. Longlisting and shortlisting of value components was supported by a targeted literature review, quality assessment against four criteria and review by six health economic and policy experts. Worked examples illustrate the applicability of the framework using two UK-based hypothetical intervention effects: a 5% obesity incidence reduction and a 0.5-unit improvement in SF-12 scores. Twenty-nine value components were identified: 7 related to individual health/healthcare system, 18 to societal and 4 to government value. Of these, 17 were shortlisted into 9 categories: individual health, healthcare system, productivity, family impact, health equity and social mobility, environmental, income-related benefits, sickness benefits, and income tax. We also identified six components for future consideration, where current data and methodologies are limited. We propose a value framework that goes beyond traditional health benefit measures to holistically assess chronic disease prevention value. While data limitations prevented the quantification of all shortlisted components, this does not preclude a qualitative discussion of these components in evaluating a preventative intervention. The framework should now be tested with live interventions and key stakeholders to standardise methodologies and enhance future acceptability and use.

Migration profoundly impacts the health and well-being of individuals and communities worldwide, yet little attention has been given to the concept of mistrust within immigrant healthcare contexts. This article presents a thematic literature review analyzing peer-reviewed articles to explore the nuanced dimensions of mistrust among immigrant populations receiving healthcare. The thematic analysis then carried out reveals that mistrust is mobilized in different ways and four key themes were analyzed: (1) the definition of mistrust given by the authors; (2) their study population, more particularly, who was mistrusting and who/what the object of their mistrust was; (3) the main sources of mistrust identified by the authors and rooted in various life situations and interactions; and finally, (4) the effects of mistrust reported by the authors, which included effects on beliefs, emotions, and behaviors. Understanding and addressing the roots and effects of mistrust are crucial for fostering trust-based healthcare relationships and improving health outcomes for immigrant populations. This research underscores the importance of culturally competent care, effective communication strategies, and policies aimed at reducing systemic biases and discrimination within healthcare systems to build trust and promote health equity among immigrant communities.

The general objective of this study was to determine whether there are differences in the contribution of professional help-seeking behavior to mental health status based on the level of mental health literacy in the community's work area, Community Health Center X, Sungai Penuh City. This study was quantitative. The research approach used was correlational. Correlational analysis is a quantitative data analysis technique used to analyze two or more variables and examine the relationship between them. Based on the results of the study, it was found that professional help-seeking behavior did not significantly influence the mental health status of the community in the Community Health Center X, Sungai Penuh City, whether among high, medium, or low mental health literacy groups. This means that professional help-seeking behavior did not predict an individual's mental health status. Mental health literacy also did not strengthen either variable. Therefore, it can be concluded that neither professional help-seeking behavior nor mental health literacy are dominant factors in predicting mental health status, so other, more complex variables are needed to predict mental health status

ABSTRACT This study investigates the influence of individual and community-level factors on high-risk drinking among Korean adults, emphasizing gender differences. Utilizing data from the 2019 Korea Community Health Survey (n = 228,909), the research employed generalized multilevel models and spatial analysis. Results indicate men have higher rates of high-risk drinking. Stress positively, and depression negatively, correlated with high-risk drinking. Community-level factors such as social trust and pub density significantly influenced behavior, with a stronger effect observed in women. These findings underscore the importance of gender-sensitive approaches and community-based strategies in addressing high-risk drinking through targeted prevention and health promotion programs.

Studies have long demonstrated the physical and mental benefits of physical exercise for the general population. While these are great studies, further research focusing on the physical health of individuals with special/support needs is warranted as existing literature on this topic is scarce. The aims of this study were to demonstrate the measurable performance impacts that a 12-week physical fitness program can have for those with special needs. Data from the FITforALL Program, a local Gainesville program, was utilized. Participants, adults with special needs, engaged in the physical fitness program 2-3 times per week; their level of activity was recorded each session. Several measurements including weight, sit and reach, and blood pressure were taken pre-and post-intervention were analyzed. This study demonstrated marked improvements in several areas of physical health. We recorded marked improvements in cardio fitness based on endurance in cardio exercises such as treadmill, stairs, and ellipticals. We also recorded marked improvements in flexibility, BMI, and strength training. The results of this study, in conjunction with other studies, demonstrate the importance of physical activity to overall wellness and fitness for those with special needs. Hence, exercise programs should be included in their intervention plans.

Introduction: Metabolic dysregulation is posited to underlie observed links between chronic distress and higher cardiometabolic disease risk. We recently identified a plasma metabolite-based distress score (MDS) related to prevalent depression and associated with increased risk of incident diabetes and cardiovascular disease. This study leverages repeated metabolomics measures in an ongoing cohort of women to assess the longitudinal relationship between depression and MDS. Hypotheses: We hypothesized that (1) depression at baseline is associated with greater increase in MDS over follow-up and (2) more severe distress is associated longitudinally with higher MDS. Methods: This is a secondary analysis with participants drawn from a harmonized data source of nested case-control studies within the Nurses’ Health Study (N=1152). White women with metabolomics data, depression measured by the Mental Health Inventory (MHI-5), and covariate data at baseline (1990) and follow-up (2000) were included. Women who developed major health conditions within two years of blood draws were excluded. To test if baseline depression status (MHI-5 ≤ 52) was associated with changes in the MDS, we performed multiple linear regression analyses (H1). To assess if depression severity (continuous MHI-5 score) was associated with MDS levels longitudinally, we fitted linear mixed models with random individual intercepts (H2). Both analyses adjusted for potential confounders incrementally in nested models: (1) baseline MDS and matching factors, (2) medical covariates, and (3) biobehavioral covariates. Results: At baseline, the average age was 56 (sd = 7), 53 women (4.6%) had severe depression, and mean MDS (scaled to sd = 1) was -0.064, increasing to -0.026 at follow-up. After adjusting for all relevant covariates, severe depression at baseline was associated with larger increases in MDS (β=0.29, 95% CI [0.05, 0.53]). A one-point increase in MHI-5 (i.e., less severe depressive symptoms) was linked to lower MDS levels (-0.004, [-0.007, -0.0004]). Conclusions: We establish novel longitudinal explorations revealing that depression severity is associated with increased MDS. Depression earlier in life could potentially lead to adverse longitudinal changes of metabolic profiles linked to cardiometabolic health over the course of ten years, which may have important implications for screening and managing cardiometabolic health in individuals with psychological distress.

Background: Food insecurity is associated with chronic disease and remains a key focus for population health interventions. Most research has focused on food insecurity at an individual level, without recognizing the role the food environment in an individual’s neighborhood plays in development of chronic disease. This study examined the pathway between food access measured at a census tract level and stroke prevalence to identify targets for interventions and inform policy efforts at the population level. Methods: Census tract level data were combined to create a final analytic dataset of 11,457 census tracts. Structural racism was defined as historic residential redlining using Home Owners’ Loan Corporation (HOLC) residential security maps from the Mapping Inequality project (score between 1=best to 4=redlined). Food access was defined using the modified retail food environment index (mRFEI) calculated as the number of healthy food retailers divided by the number of healthy and less healthy food retailers per census tract. Prevalence of stroke in each census tract was based on CDC PLACES data. Direct and indirect relationships between redlining and stroke via food access was investigated using structural equation modeling run in Stata v17, controlling for population of each census tract. Results: Mean prevalence of stroke was 31.8%. Redlining (0.19, 95%CI 0.17, 0.21, p&lt;0.001) and lower food access (-0.10, 95%CI -0.12, -0.09, p&lt;0.001) were directly associated with higher prevalence of stroke. Redlining was also indirectly associated with stroke via lower food access within a census tract (-0.10, 95%CI -0.12, -0.08, p&lt;0.001). See Figure 1. Conclusions: Structural racism measured using historical redlining was directly and indirectly associated with the prevalence of stroke via food access in a census tract. Based on these results, interventions to improve access to healthy food options at the community level may help address the impact of structural racism on the health of individuals, particularly those at risk for stroke living in historically redlined neighborhoods.

Background: Incarceration is associated with worse cardiometabolic health at the individual level; however little has been done to examine pathways accounting for structural racism at the neighborhood level. This study examined the pathway between structural racism, incarceration, and cardiometabolic disease across US census tracks, using historic residential redlining as the measure for structural racism. Methods: Direct and indirect relationships between redlining and each cardiometabolic disease via incarceration was investigated using structural equation modeling run in Stata v17. The final analytic sample included 11,457 observations across 51 states, 104 counties, and 6,797 census tracts created by combining census tract level data from multiple sources. Neighborhood level incarceration was defined as the % of a census tract incarcerated. Historic residential redlining was defined based on Home Owners’ Loan Corporation (HOLC) residential security maps. Prevalence of disease was based on CDC PLACES data - coronary heart disease (CHD), diabetes (DM), obesity, high cholesterol (HC) and high blood pressure (HBP). Results: Mean prevalence of CHD 6.0%, DM 11.8%, stroke 3.6%, obesity 31.8%, HC 31.3%, HBP 31.9%. Redlining (0.22, p&lt;0.001) and lower food access (-0.11, p&lt;0.001) were directly associated with higher prevalence of DM. Redlining was significantly indirectly associated with CHD, DM, stroke, obesity, HC and HBP via incarceration (0.29, p&lt;0.001). Incarceration was directly associated with higher prevalence CHD (0.41, p&lt;0.001), DM (0.54, p&lt;0.001), stroke (0.59, p&lt;0.001), obesity (0.67, p&lt;0.001), HC (0.19, p&lt;0.001), and HBP (0.59, p&lt;0.001). In addition, redlining was directly associated with higher prevalence of CHD (0.02, p&lt;0.05), DM (0.09, p&lt;0.001), stroke (0.04, p&lt;0.001), and obesity (0.02, p&lt;0.01); and lower prevalence of HC (-0.08, p&lt;0.001) and HBP (-0.04, p&lt;0.001). Conclusions: Historic residential redlining is associated with higher prevalence of multiple cardiometabolic diseases via increased prevalence of incarceration within a census tract. Based on these results, high rates of incarceration within a neighborhood may be an underappreciated marker for risk of cardiometabolic disease. Interventions to address resource deprivation within a census tract and disproportionate rates of incarceration across communities may help address the impact of structural racism on the health of individuals at risk for cardiometabolic diseases.

Background: Caregiving is stressful, and caregivers commonly neglect self-care. We tested the effectiveness of virtual health coaching and demonstrated at 6 months that self-care, stress, and mental health-related quality of life (HRQL) improved significantly more in HF caregivers in the intervention group vs the control group. Objective: To determine if the benefits of health coaching on self-care, stress, and HRQL were sustained at 12 months. Method: Informal caregivers (N=250) were randomly assigned to receive virtual health coaching and health information or a control group receiving only health information. Caregivers in the intervention received ≤10 sessions of individual synchronous virtual health coaching promoting self-care. The primary outcome was self-care (Self-Care Inventory), secondary outcomes were stress (Perceived Stress Scale), mental and physical HRQL (SF-36). In this analysis of sustained effects, linear mixed effects models were used to estimate between-group differences in change from baseline to 12 months and 6 to 12 months, the post-intervention interval. Change in the intervention group from 6 to 12 months was also analyzed. Statistically significant effect sizes are reported. Results: When analyzing the change in self-care between groups, we found no significant intervention effect from baseline to 12 months (p=0.28) nor from 6 to 12 months (p=0.08). Self-care did not change significantly in the intervention group from 6 to 12 months (p=0.13). Compared to controls, the intervention group had a significantly greater mean decrease in stress from baseline to 12 months (M=-2.64, 95% CI [-4.82,-0.46], p=0.02), though not from 6 to 12 months (p=0.11). Stress did not change significantly in the intervention group from 6 to 12 months (p=0.45). We found no significant difference in the change in physical HRQL between groups from baseline to 12 months (p=0.42) nor from 6 to 12 months (p=0.052). However, physical HRQL increased significantly in the intervention group from 6 to 12 months (M=1.44,95% CI [0.02,2.85], p=0.047). Mental HRQL improvement did not differ significantly between treatment and control groups from baseline to 12 months (p=0.64) nor from 6 to 12 months (p=0.08). Mental HRQL did not improve significantly in the intervention group from 6 to 12 months (p=0.36). Conclusions: In informal HF caregivers, virtual health coaching led to sustained benefits in stress and physical HRQL, even 6 months after health coaching ended.

Introduction: Social determinants of health (SDOH) are key drivers of individual and population cardiovascular health. However, the relative effects of individual-level social determinants and neighborhood-level social vulnerability on new-onset major adverse cardiovascular events (MACE) have not been studied in a large primary prevention population in the US. Methods: We conducted a retrospective cohort study of adults (≥18 years) without atherosclerotic cardiovascular disease (ASCVD) and available SDOH information in the 2016–2023 HM-CV-LHS dataset. Patient-level SDOH (medication affordability, food insecurity, transportation, depression) were assessed using the Epic SDOH wheel and aggregated to create a composite 3-level risk index (optimal, low, high). Neighborhood vulnerability was assessed using the CDC Social Vulnerability Index (SVI) and categorized into quartiles. Multivariable Cox proportional hazards models were used to assess the association between SDOH, SVI, and incident MACE. Harrell’s C-statistics were used to compare discriminant validity of individual SDOH, SVI and co-occurring SDOH/SVI models. Results: Among 168,304 adults, 78% had optimal SDOH, 17% had low, and 5% had high SDOH burden. 8% lived in the least vulnerable (SVI-Q1) and 22% in the most vulnerable (Q4) neighborhoods. 12,268 MACE events were observed over 618,696 person-years follow-up. MACE incidence increased with higher SDOH and SVI burden (Figure 1). In fully adjusted models, individual-level SDOH burden had a relatively stronger effect on MACE risk (HR=1.94 [1.81–2.09] vs optimal SDOH) compared to neighborhood SVI burden (HR, Q4 vs Q1=1.30 [95% CI, 1.23–1.37]) (Figure 2), with the highest risk observed for combined SDOH/SVI model (HR=2.59 [95% CI, 2.30–2.92]). The models exhibited moderate discrimination: individual SDOH-only (C=0.727), SVI-only (C=0.722), co-occurring SDOH/SVI (C=0.729). Conclusion: Both individual- and area-level social risk are independent predictors of MACE, and portend over 150% higher risk with co-occurring social burden. Efforts to address SDOH should target both patient and neighborhood level factors in order to mitigate MACE risk.

Food is a crucial component affecting the health of individuals, which may have the potential to expand lifespan. It has been shown that a long lifespan may be related to fine-tuned autophagy. In general, suitable autophagy could play a significant role in the anti-aging biological exertion of the host. AMPK, a member of serine and threonine kinases, could play vital roles within the autophagy signaling pathway in various cells. In addition, alterations in the kinase activity of AMPK have been shown to be connected to several pathologies of aging-related diseases. Therefore, autophagy could control the lifespan-related homeostasis within the host from cells to a body via the modification of AMPK. The design of the diet and/or nutrition targeting the AMPK would be a possibility to expand the lifespan. Some analyses of the molecular biology underlying the autophagy suggest that supplementation of accurate nutraceuticals, as well as dietary restriction, mild fasting, and/or appropriate physical exercise, could modulate AMPK signaling, which may be advantageous for life extension with the alteration of autophagy. Remarkably, it has been revealed that several non-coding RNAs (ncRNAs) might also play significant roles in the regulation of autophagy. In addition, the production of some ncRNAs may be associated with the alteration of gut microbiota with certain diets. Therefore, the modulation of AMPK action with ncRNAs through choosing the relevant diet could be a therapeutic tactic for promoting longevity, which is also accompanied by a reduced risk for several aging-related diseases.

Emergency physicians have a core professional responsibility to provide expert consultative advice regarding emergency medical care, but it is unclear how their consultative role manifests in health systems and whether there is potential to expand those capacities. The purpose of this study is to identify, clarify, and map key concepts related to emergency physicians acting as consultants within health systems. This scoping review searched MEDLINE, Embase, Cochrane, CINAHL, and grey literature. No date restrictions were used and only articles in English were included. Two authors conducted screening of titles and abstracts followed by full texts independently and in duplicate. Data were narratively synthesized. We screened 8744 articles and included 67 articles which included data from 15 countries and were published between 1974 and 2023. Emergency physicians were reported to assume three main consulting roles: (1) real-time support to other clinicians providing emergency care, (2) rapid critical medical response, and (3) response to direct referrals. The most common consultation modes were via telemedicine (56 studies), activation of hospital protocols (6 studies), and referrals to the emergency department (six studies). Few studies contextualized these roles in relation to health systems or access to emergency care. Emergency physicians assume multiple consultative roles within health systems. We define "consultative emergency medicine" as a core competency of emergency physicians focused on the provision of advice to other care providers on individual patient care or health services for conditions that require rapid intervention to avert death or disability, or for which delays of minutes to hours render care less effective (i.e. emergency care). As emergency care develops globally, advancing "consultative emergency medicine" may be a tool to expand emergency care expertise to other providers requesting assistance with emergency care.

Healthy and sustainable diets promote individual health and well-being while minimizing environmental impact. Although the concept of sustainable diets has gained increasing attention, the extent to which nutritional adequacy aligns with overall dietary sustainability remains unclear, particularly in the Portuguese context, where dietary patterns reflect both Mediterranean and Western influences. The study aims to assess the association between sustainable and healthy diet adherence and nutritional adequacy among Portuguese adults. Data was gathered using a self-administered questionnaire between October and December 2022 from 347 adults. The Sustainable and Healthy Eating Diet index was used to assess adherence to a sustainable and healthy diet. A semi-quantitative food frequency questionnaire was used to record dietary consumption. Nutrient inadequacy was defined as an intake below the dietary reference values set by the European Food Safety Authority for 18 selected nutrients. The prevalence of inadequacy for dietary fibre, vitamins A, E, C, folate and potassium was higher in participants with low adherence to a sustainable and healthy diet. After adjusting for confounders, participants with higher adherence to a sustainable and healthy diet were less likely to have inadequate intake of dietary fibre (OR = 0.14, 95% CI: 0.06,0.32), vitamin A (OR = 0.11, 95% CI: 0.02, 0.54), vitamin E (OR = 0.13, 95% CI: 0.06, 0.29), B6 (OR = 0.26, 95% CI: 0.09, 0.81), folate (OR = 0.14, 95% CI: 0.06, 0.31), vitamin C (OR = 0.19, 95% CI: 0.09, 0.43), selenium (OR = 0.35, 95% CI: 0.12, 0.99), and potassium (OR = 0.19, 95% CI: 0.07, 0.51). Participants with higher adherence to a sustainable and healthy diet were also less likely to have six or more inadequacies in nutrient intake (OR: 0.08, 95% CI: 0.03, 0.23). Individuals who more closely follow a sustainable and healthy diet tend to achieve better nutritional adequacy.

Research on neighbourhood effects shows that social and physical environments can influence individual health, yet no national-level study has explored this relationship in Italy. This study examines the association between neighbourhood characteristics and both physical and mental health across Italy, combining subjective perceptions and objective measures. This research represents an initial exploration of this phenomenon due to the lack of available evidence specific to Italy. The ITA.LI survey gathered data from 8778 participants across 4900 households residing in 278 municipalities. Individual physical and mental health, measured through the SF-12, are the outcomes considered in this study. In studying the context, reference is made to both subjective perceptions and objective measures. Multilevel analysis is implemented considering a two-level structure in which individuals are nested in neighbourhoods (census blocks). Evidence suggests the existence of neighbourhood effects, especially on mental health conditions. The subjective perception of social cohesion is associated only with mental health, while the perceived neighbourhood disorder is related to both mental and physical health. Moreover, compositional characteristics are associated with worse physical health.