Long-term Negative Health Outcomes Research Articles

An objective neurophysiological study of subconcussion in female and male high school student athletes

Emerging evidence from neurophysiological brain vital sign studies show repeatable sensitivity to cumulative subconcussive impairments over a season of contact sports. The current study addressed the need for research comparing a low-contact control group to high-contact group. Importantly, the study also expanded the scope of neurophysiological changes related to repetitive head impacts to include female athletes in addition to male athletes. In total, 89 high school student athletes underwent 231 brain vital sign scans over a full calendar year. The results replicated prior subconcussive cognitive impairments (N400 delays) and sensory impairments (N100 amplitude reductions) in male athletes and demonstrated similar subconcussive impairments for the first time in female athletes. While there was no significant subconcussive difference between female and male athletes, female athletes show overall larger responses in general. The findings demonstrated that subconcussive impairments are detectable in a controlled experimental comparison for both female and male high school athletes. The study highlights the opportunity to monitor subconcussive changes in cognitive processing for both female and male athletes to help advance prevention, mitigation and management efforts aimed at reducing athletes’ risk of potential long-term negative health outcomes related to cumulative exposure to repetitive head impacts.

Genome-wide epigenetic profiling and transcriptome analysis in pediatric Obstructive Sleep Apnea: A focus on Black female children

Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder characterized by airway obstruction during sleep. Diagnosing pediatric OSA is challenging, particularly in underrepresented populations, leading to disparities in treatment and long-term negative health outcomes. Our study aimed to identify alternative diagnostic tools by investigating genome-wide epigenetic changes and associated transcriptomic alterations in Black female, pediatric patients with OSA. Whole-genome bisulfite sequencing and RNA sequencing were performed on saliva samples from healthy controls and children with OSA. Analysis of differential methylation and gene expression patterns revealed dysregulated inflammation and metabolism pathways in children with OSA. Chromosomes 19 and 22 exhibited elevated methylation signatures in this patient population. Integration of methylation and gene expression data identified specific molecular markers, including NAP1L4, CCR1, and LIF. The study emphasizes the need to consider both genetic and environmental factors in pediatric OSA, and the identified markers may offer avenues for further research.

Health disparities among in multicultural and non-multicultural families in South Korea

Abstract South Korea has experienced significant immigrant growth, with international marriages playing a key role in this demographic change. In 2019, international marriages accounted for 10.3% of all marriages, increasing the number of multicultural households. Multicultural families in Korea faced controversies over accepting new members in a society traditionally considered racially and ethnically homogenous. In rural areas, where patriarchal and conservative values prevail, there is greater discrimination and negative perception towards foreigners compared to urban areas, impacting access to healthcare. This potentially adversely affects the health of married immigrants. However, research on this issue is limited. This study aims to examine the differences in health behaviors, access to care, and health status between multicultural and non-multicultural families in rural and urban areas. Using a cross-sectional study design based on the 2023 Community Health Survey, the sample included 228,216 adults from non-multicultural families and 3,373 adults from multicultural families. Adjusted differences in outcome were estimated using regression models, including linear probability and logistic models. Overall, there were minimal or no differences in health behaviors and health status between adults from multicultural and non-multicultural families. However, significant differences were observed in access to care, such as annual health check-ups (0.72 [0.64, 0.81]) and vaccinations (0.84 [0.76, 0.94]). Non-multicultural families showed regional differences in all outcomes, whereas multicultural families exhibited minimal or no regional differences. These findings suggest that multicultural families may face barriers beyond regional environments, limiting their access to care and potentially leading to long-term negative health outcomes. Targeted policy development for multicultural families in Korea is necessary to address this issue. Key messages • Access to health care may vary for individual and local factors, especially for people with different ethnicities or cultures. • Multicultural families may encounter greater barriers than individual and regional characteristics, requiring the development of tailored policies for immigrants and multicultural families.

Home, but Homebound After Traumatic Brain Injury: Risk Factors and Associations With Nursing Home Entry and Death

ObjectiveTo examine risk factors associated with homeboundness 1-year after traumatic brain injury (TBI) and to explore associations between homebound status and risk of future mortality and nursing home entry. DesignSecondary analysis of a longitudinal prospective cohort study. SettingTBI Model Systems centers. ParticipantsCommunity-dwelling TBI Model Systems participants (n=6595) who sustained moderate-to-severe TBI between 2006 and 2016, and resided in a private residence 1-year postinjury. InterventionsNot applicable. Main Outcome MeasuresHomebound status (leaving home ≤1-2d per week), 5-year mortality, and 2- or 5-year nursing home entry. ResultsIn our sample, 14.2% of individuals were homebound 1-year postinjury, including 2% who never left home. Older age, having less than a bachelor's degree, Medicaid insurance, living in the Northeast or Midwest, dependence on others or special services for transportation, unemployment or retirement, and needing assistance for locomotion, bladder management, and social interactions at 1-year postinjury were associated with being homebound. After adjustment for potential confounders and an inverse probability weight for nonrandom attrition bias, being homebound was associated with a 1.69-times (95% confidence interval, 1.35-2.11) greater risk of 5-year mortality, and a nonsignificant but trending association with nursing home entry by 5 years postinjury (RR=1.90; 95% confidence interval, 0.94-3.87). Associations between homeboundness and mortality were consistent by age subgroup (±65y). ConclusionsThe negative long-term health outcomes among persons with TBI who rarely leave home warrants the need to re-evaluate home discharge as unequivocally positive. The identified risk factors for homebound status, and its associated negative long-term outcomes, should be considered when preparing patients and their families for discharge from acute and postacute rehabilitation care settings. Addressing modifiable risk factors for homeboundness, such as accessible public transportation options and home care to address mobility, could be targets for individual referrals and policy intervention.

Integration of medical legal services into a hospital-based violence intervention program: A survey and interview-based provider needs assessment.

Violent injury among trauma surgery patients is strongly associated with exposure to harmful social determinants of health and negative long-term health outcomes. Medical-legal partnerships in other settings successfully provide patients with legal services to address similar health-harming legal needs and may offer a promising model for the care of violently injured patients. An electronic survey tool was distributed to clinicians and staff affiliated with the hospital-based violence intervention program at a single urban level one trauma center. Semistructured follow-up interviews were conducted with participants, and interviews were coded using thematic analysis and grounded theory. Participants reported many health-harming legal needs among their violently injured patients. The most commonly identified needs were: health insurance denials (62.5%); difficulty accessing crime victims compensation funds (56.3%); trouble accessing official documents (50%); and problems with non-SSDI public benefits (50%). Participants reported inconsistent methods for learning about and responding to patients' health-harming legal needs. The most common barriers to addressing these needs included the following: lack of awareness that a lawyer could help with the issue (68.8%); prioritization of other needs (68.8%); previous negative legal experiences (62.5%); and cost (62.5%). Identified needs encompass issues traditionally addressed by MLPs as well as more novel challenges faced by violent injury survivors. This survey and interview-based study identifies complex health-harming legal needs present among violently injured trauma surgery patients. Medical-legal partnerships specially designed for the setting of violent injury appear well-suited to meet these needs, potentially reducing risk of violent reinjury, long-term negative health outcomes, and health care system costs. Prognostic and Epidemiological; Level IV.

The mediating role of child delay of gratification in the link between early and prolonged poverty exposure and adolescent allostatic load

Early and prolonged exposure to poverty disrupts biological processes associated with the body’s stress response system, leading to long-term negative health outcomes, including obesity, autoimmune disorders, and cardiovascular disease. Allostatic load (AL), a composite measure of chronic stress on the body, is a robust predictor of subsequent health outcomes. However, developmental research examining the associations of early poverty exposure with AL in adolescence, as well as the underlying mechanisms of influence is limited. Early poverty exposure also impedes healthy development of child self-regulation, which may increase risk for high AL in adolescence, but this mechanistic pathway has not yet been tested. We used data from the national Study of Early Child Care and Youth Development (SECCYD) to examine the longitudinal associations between prolonged poverty exposure in early childhood (0–3 years) and AL in adolescence (age 15). We also tested the mediating role of child delay of gratification, a behavioral measure of self-regulation (at age 54 months), in the potential association between early poverty exposure and adolescent AL. Accounting for model covariates (i.e., child biological sex and race-ethnicity) and individual differences in child delay of gratification, early and prolonged poverty exposure was significantly associated with higher AL at age 15. The indirect effect through child delay of gratification was not significant, but the individual pathways of the indirect effect were significant, and the overall direct association of early poverty exposure with adolescent AL was significant. Our findings show that prolonged exposure to poverty in early childhood (0–3 years) can have significant negative associations with both child delay of gratification (at 54 months) and AL (at age 15). Given that the detrimental impacts of poverty exposure can be detected at an early age, targeted prevention efforts (e.g., anti-poverty programs such as cash assistance programs) may be able to offset some of the risks of early poverty exposure on self-regulation and AL.

The timing of antenatal care access for adolescent pregnancies in Cape Town, South Africa.

Late antenatal care (ANC)-seeking among pregnant adolescents threatens their health outcomes, and the health outcomes of their new-borns. South Africa has experienced a rapid increase in adolescent pregnancies during the COVID-19 pandemic, adding to the existing concerns around adolescent pregnancy care-seeking behaviour. The main aim of this study was to investigate the causes and covariates of late ANC access among adolescents in the Cape Town Metropole, South Africa. Three public healthcare facilities in the Cape Town Metropole, 2018-2019. A retrospective, cross-sectional study on ANC seeking behaviour was conducted, surveying 202 adolescents. Late attendance was defined as attending ≥ 3 months. For this study, adolescents were defined as women aged 16-18 years. The sample was restricted to adolescents who used public healthcare facilities or who did not attend at all. Data were analysed using univariate, bivariate and multivariate methods. A total of 50.8% (n= 99/195) of the pregnant adolescents in the sample had their first ANC visit 3 months. 14.9% (n= 29/195) did not attend at all. Major contributors to delayed care-seeking include poor pregnancy identification (n= 45/99, 45.5%), and a lack of information about ANC. Age, education, and alcohol consumption were significant predictors of delayed care-seeking. Delayed ANC attendance contributes to negative long-term health outcomes for pregnant adolescents and their new-borns. Improving access to pregnancy tests in the public sector could benefit adolescents with earlier pregnancy identification. Adolescents need to be made aware of their care seeking options.Contribution:There is evidence of long-term health impacts of late ANC attendance by pregnant adolescents, but there is an absence of evidence on the timing and barriers of late care-seeking behaviour. In this study, late ANC attendance among adolescents was associated with late pregnancy identification and poor knowledge of care options.

Lifestyle factors, dietary patterns, and social determinants of social and eating jetlag: A cross-sectional survey

ABSTRACT Social jetlag (SJL) and, more recently, eating jetlag have been linked with an increased risk of non-communicable diseases. Here we aim to investigate lifestyle factors (diet, eating behavior, smoking, perceived stress, time spent sedentary/day) and social determinants (education level, employment status, and place of residence) associated with SJL corrected for sleep duration (SJLsc) and eating jetlag. Self-declared data on age, gender, lifestyle, and eating behavior were collected online from March 2021 to February 2022 of 432 adults. Principal component analysis was used to extract three dietary patterns (Prudent, Western, and Risky). Prevalence of SJLsc was 35.2%, with no significant difference between men and women (p = 0.558). Adults with SJLsc had significantly larger eating jetlag (56.0 min vs 41.2 min, p = 0.001). Increasing SJLsc duration was associated with an increased adherence to a Risky dietary pattern (standardized β coefficient = .165, p = 0.012); increasing eating jetlag duration was associated with an increased adherence to a Western dietary pattern (standardized β coefficient = .127, p = 0.039) and a shorter sleep duration (standardized βcoefficient = −0.147, p = 0.011). Among social determinants analyzed, only being a student or employed was associated with eating jetlag (standardized β coefficient = 0.125, p = 0.044), while none displayed any relationship with SJLsc. Our survey provides evidence on a risky behavior among young persons with SJLsc and eating jetlag, characterized by a higher alcohol consumption, and a diet rich in processed meat and high-fat food, eating during nights, and shorter sleep duration with potential long-term negative health outcomes.

Self-Management assistance for recommended treatment (SMART) IBD app randomized control trial in adolescents with IBD: Design and methodology

AimsAdherence to medical regimens, including medications and appointments, is a significant concern for adolescent populations that warrants behavioral interventions. Negative health behaviors during adolescence can persist into adulthood and lead to long-term negative health outcomes. Due to the limited availability and resources for behavioral self-management intervention, many youth do not receive evidence-based behavioral care and continue to struggle with managing their illness. Therefore, there is a need for easily accessible mHealth interventions targeting self-management in order to reduce health care barriers and provide more timely and effective behavioral care particularly during this developmental stage. MethodsWe provide a description of the design and methodology of the Self-Management Assistance for Recommended Treatment (SMART) IBD App randomized controlled pilot trial in pediatric inflammatory bowel disease (IBD) that aims to test the preliminary efficacy of the SMART IBD app compared to a usual care (UC) arm. Thirty participants 13–17 years of age will be recruited and randomized in the trial. Those randomized to the intervention arm will use the app for four weeks, each with one weekly challenge that focuses on self-management. Participants in both arms will complete baseline assessments, daily diaries for four weeks, and post-treatment assessments. ConclusionWe hypothesize that participants in the intervention arm will experience clinically significant improvements in their self-management compared to those in the UC arm at the post-treatment assessment. Findings from the current study could provide initial evidence to support self-management interventions in adolescents with health conditions via mobile health apps, thereby reducing health care barriers and strains on institutional and nursing resources. Mobile health apps may also be a preferred avenue to disseminate interventions to adolescents.

Demographic predictors of successful transition to adult survivorship care for survivors of pediatric cancer.

10050 Background: There is a growing number of childhood cancer survivors in the U.S. (Chow et al., 2020) who are at risk for experiencing negative long-term health outcomes (Oeffinger et al., 2006). Current guidelines state the importance of receiving risk-based follow-up at adult survivorship clinics, yet available estimates suggest that less than 50% of survivors receive yearly survivorship care (Landier et al., 2004; Daly et al., 2018). The transition from pediatric to adult care is a difficult process, with various factors acting as barriers (Devine et al., 2017). The present study sought to evaluate demographic predictors of successful transition to adult survivorship care in a Midwestern clinic serving a large urban and rural catchment area. Methods: The study includes adult survivors of childhood cancer (n = 203) who received pediatric or adult survivorship care in a Midwestern metropolitan area from 2015 to 2022. For this study, successful transition to adult care was defined as attending at least one appointment in the adult survivorship clinic. Dates of clinic attendance, cancer diagnosis, insurance data, and zip code were abstracted from the medical record. 86.2% of survivors had commercial insurance, 13.8% had government -sponsored insurance, self-pay or other insurance. Participant zip codes were 66.7% urban, 19.5% metropolitan (low and high commuting), 9.2% micropolitan, and 4.6% rural. Survivor ages ranged from 20 to 68 years (M = 29.48, SD = 7.74) and 53.2% were female. Participant-reported race/ethnicity was 90.1% White, 5.4% Hispanic, 3.4% Black and 1% Other. Results: 66% of the sample attended at least 1 appointment in the adult survivorship clinic. Chi-square analyses revealed a significant relationship between insurance type and attendance at the clinic, [Χ2(1) = 16.60, p < .001], such that a greater proportion of survivors with commercial insurance transitioned to adult survivorship care (71%), compared to government-assisted (Medicare), self-pay or other insurance (32%). Analyses revealed a significant relationship between rurality and transition, [Χ2(3) = 14.11, p < .01], such that a greater proportion of survivors from urban areas transitioned (74%) compared to rural areas (22%). Race/ethnicity, gender and cancer type were not significantly associated with transition. Conclusions: Results suggest that a lack of commercial insurance and rurality served as risk factors for not successfully transitioning to an adult survivorship clinic, highlighting opportunities for improvement in clinic reach.

0719 Association of subjective-objective discrepancy in sleep duration with all-cause mortality in community-dwelling older men

Abstract Introduction There is evidence for a mismatch between subjective and objective sleep durations not only in individuals with insomnia but also in healthy individuals . However, it is unclear how such discrepancy impacts long-term health outcomes. This study investigated whether and how the discrepancy between subjective and objective sleep duration affected all-cause mortality in a sample of community-dwelling older adult men, aged ≥ 65 years. Methods We conducted a secondary analysis of data obtained via the Osteoporotic Fractures in Men Sleep Study, a community-based, longitudinal, observational, and multicenter study. We included data from 2,674 individuals who underwent an in-home polysomnography, completed morning surveys to assess subjective sleep duration during the polysomnography, and for whom survival or death data were available. We assessed the longitudinal association between misperception index (MI), calculated as MI = (objective sleep duration – subjective sleep duration) / objective sleep duration, and all-cause mortality. MI was treated as both a continuous and categorical predictor: the lowest (≤ -0.19; the overestimation of sleep duration) and highest MI quartiles (> 0.08; the underestimation of sleep duration) were compared to the interquartile range of MI (-0.19 <, ≤ 0.08 ). Results During the follow-up with a mean (standard deviation) of 10.8 (4.2) years, 1,596 deaths (59.7%) were observed. As a continuous variable, MI showed a negative association with all-cause mortality after adjusting for multiple covariates, including polysomnography-measured objective sleep duration (fully adjusted hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.56–0.84). As a categorical variable, the lowest MI quartile (vs. the interquartile MI range) was associated with increased mortality (fully adjusted HR, 1.28; 95% CI, 1.12–1.46), whereas the highest MI quartile was not associated with mortality (fully adjusted HR, 0.97; 95% CI, 0.85–1.11). Conclusion The subjective overestimation (“reverse” misperception) of sleep duration, may be a risk factor for all-cause mortality in older men. Further investigations are needed to examine physiological mechanisms through which subjective overestimation of sleep duration leads to negative long-term health outcomes. Support (if any) This work was supported by the Ministry of Health, Labor and Welfare, Government of Japan (Grant numbers #19FA1009 and #21FA1002).

Food addiction and dietary restraint in postpartum women: The role of childhood trauma exposure and postpartum depression

The early postpartum period is a sensitive time for understanding women's high-risk eating (i.e., eating behavior associated with negative health outcomes) given potential long-term eating behavior implications for infants. Food addiction and dietary restraint are two high-risk eating phenotypes associated with long-term negative health outcomes that have been theoretically linked. Yet, no research has considered how much these constructs overlap during the early postpartum period. The present study sought to characterize these two high-risk eating phenotypes in postpartum women to examine whether these are distinct constructs with specific etiologies and to inform future targets of intervention. Women (N = 277) in the early postpartum period reported on high-risk eating, childhood trauma exposure, depression symptoms, and pre-pregnancy weight. Women's height was measured and pre-pregnancy BMI was calculated. We conducted bivariate correlations and path analysis to characterize the relationship between food addiction and dietary restraint, controlling for pre-pregnancy BMI. Results showed that food addiction and dietary restraint were not significantly associated and that women's childhood trauma exposure and postpartum depression were associated with food addiction but not dietary restraint. Sequential mediation revealed that higher levels of childhood trauma exposure were associated with worse postpartum depression and, in turn, greater food addiction during the early postpartum period. Findings suggest that food addiction and dietary restraint have distinct psychosocial predictors and etiological pathways, which suggests important construct validity differences between the two high-risk eating phenotypes. Interventions seeking to address food addiction in postpartum women and mitigate the impact of this high-risk eating phenotype on the next generation may benefit from treating postpartum depression, especially in women with histories of childhood trauma exposure.

Previous exposure to violence among emergency department patients without trauma-related complaints: A cross sectional analysis

IntroductionThe Emergency Department (ED) is a critical setting for the treatment of acute violence-related complaints and violent victimization is associated with numerous long-term negative health outcomes. A trauma-informed care framework can prevent re-traumatization of victims within the healthcare setting, but currently there are insufficient mechanisms to detect previous exposures to community violence within the ED. The current study sought to determine the prevalence of community violence and characterize the types of violence exposures among adult ED patients without trauma-related complaints to determine if there may be a need for expanded screening for previous exposure to violence for ED patients. MethodsThis was a prospective cross-sectional observational study of adult ED patients without a trauma-related chief complaint at an urban public hospital. Adult patients were approached by trained research staff and answered questions adapted from the Survey of Exposure to Community Violence (SECV), which measures lifetime exposure to community violence, including both witnessing and victimization. The SECV was modified for clarity, brevity, and to assess exposure to violence within the previous 3 months and 3 years from enrollment, in addition to lifetime exposure. Enrollment occurred from June 2019 to September 2022 with a 19-month gap due to the COVID-19 pandemic. Demographics and results within SECV domains were analyzed using descriptive statistics. Comparisons between males and females in types of violence experienced during one's lifetime were made by fitting logistic regression models adjusting for age. ResultsA total of 222 respondents completed some or all of the modified SECV. Ages ranged from 19 to 88, with 47.7% of respondents identifying as female and 50.9% as male. Of all respondents, 43.7% reported directly witnessing violence during their lifetime, 69.4% being personally victimized by violence, and 55.4% personally knowing someone killed by a violent act. Of those personally victimized, 47.4% occurred within the preceding 3 years and 20.1% within 3 months. Among all respondents, lifetime victimization was reported in the following domains: slapping, hitting, or punching (45.9%); robbings or muggings (33.8%); physical threats (28.8%); verbal or emotional abuse (27.5%); being shot at (18.0%); uncomfortable physical touch (15.3%); forced entry while home (14.4%); sexual assault, molestation, or rape (13.5%); or being attacked with a knife (13.5%). Comparing male and female respondents, 63.5% of females and 76.6% of males reported any violent victimization over their lifetime (aOR 1.88; 95% CI 1.04–3.43). Additionally, 31.7% of females and 56.3% of males reported witnessing violence (aOR 2.86; 95% CI 1.64–5.06). Males were more commonly exposed to physical violence, violence with weapons, and threats while females more commonly reported sexual assault, molestation, and rape. ConclusionBoth lifetime and recent exposure to community violence was common among adult ED patients without trauma-related complaints. Broader adoption of a trauma-informed care framework and the development of efficient ED screening tools for previous exposure to trauma is reasonable in areas where community violence exposure is highly prevalent.

Systematic review and meta-analysis of the effect of adverse childhood experiences (ACEs) on brain-derived neurotrophic factor (BDNF) levels

There is continued interest in identifying dysregulated biomarkers that mediate associations between adverse childhood experiences (ACEs) and negative long-term health outcomes. However, little is known regarding how ACE exposure modulates neural biomarkers to influence poorer health outcomes in ACE-exposed children. To address this, we performed a systematic review and meta-analysis of the impact of ACE exposure on Brain Derived Neurotrophic Factor (BDNF) levels - a neural biomarker involved in childhood and adult neurogenesis and long-term memory formation. Twenty-two studies were selected for inclusion within the systematic review, ten of which were included in meta-analysis. Most included studies retrospectively assessed impacts of childhood maltreatment in clinical populations. Sample size, BDNF protein levels in ACE-exposed and unexposed subjects, and standard deviations were extracted from ten publications to estimate the BDNF ratio of means (ROM) across exposure categories. Overall, no significant difference was found in BDNF protein levels between ACE-exposed and unexposed groups (ROM: 1.08; 95 % CI: 0.93–1.26). Age at sampling, analyte type (e.g., sera, plasma, blood), and categories of ACE exposure contributed to high between-study heterogeneity, some of which was minimized in subset-based analyses. These results support continued investigation into the impact of ACE exposure on neural biomarkers and highlight the potential importance of analyte type and timing of sample collection on study results.

Prevalence of malnutrition among old age people in Africa.

Background: Improved health care and rising life expectancy are creating a growing pool of old age people all over the world, including Africa. Malnutrition in the old age people is associated with both short- and long-term negative health outcomes. However, the reported burdens of malnutrition are fragmented and inconsistent, where more compiled evidence is warranted to aid decision-makers. Hence, this paper is aimed to estimate the pooled prevalence of malnutrition among old age people in Africa. Methods: A systematic search for research reporting the prevalence of malnutrition among old age people (aged above 60years) was conducted from HINARI/PubMed and Google Scholar databases using combination keywords. Published articles in English language starting from January 2000 to October 2021 were screened. We presented the results based on the standard for reporting systematic review and meta-analysis of observational studies. A random-effect meta-analysis was done to estimate the prevalence of malnutrition along with the 95% confidence intervals. The publication bias was assessed using the funnel plot. Results: A total of 1,442 studies were retrieved based on the search strategy, where only 36 studies (n = 15,266 participants) reported from 11 African countries were included for meta-analysis. The reported prevalence of malnutrition ranges from 2.2 to 77.3% across Africa. Overall, the pooled prevalence of malnutrition was 18% (95% CI: 15-22; I2 = 98.1; p < 0.001). The prevalence is higher in the Central Africa (3.8%; 95% CI: 3.2-4.4), in the community (3.1%; 95% CI: 2.7-3.7), and among advanced age (3.5%; 95% CI: 2.3-5.4). Conclusion: The prevalence of malnutrition in African old age people is high and differs by setting, assessment tool, and country of residence. Hence, due attention to geriatric nutrition is mandatory, and the need for a valid, reliable, and simple screening tool should be thought of.

P050 Sleep, Eat, Comment, Repeat: Understanding the influence of sleep on the eating behaviours of shiftworkers through comments on Facebook

Abstract Introduction Shiftworkers experience altered sleeping patterns and eating habits compared to dayworkers. This leads to long-term negative health outcomes. While characteristics of shiftwork, such as work hours and food availability, impact eating habits, the impact of altered sleeping on the eating behaviour of shiftworkers is unknown. The aim of this study was to explore how sleep patterns impact the eating behaviour of shiftworkers through the analysis of Facebook comments. Methods The Facebook search function was used to identify posts relating to shiftwork, sleep, and food on public pages. Comments were collected if they were posted by self-identified shiftworkers, relatives of shiftworkers, or partners of shiftworkers. Thematic analysis was conducted on all comments to identify themes relating to sleeping and eating. Results 144 comments were collected and analysed. Comments reported feelings of sleepiness as motivating the choice for unhealthy foods and the choice to eat large quantities of food. Multiple comments also discussed how unhealthy food on shift contributed to poor sleep post-shift. Discussion Given that, in a naturalistic environment like Facebook, shiftworkers display an understanding of an influence of sleepiness on food choice, interventions can move past making shiftworkers aware of poor sleeping and eating patterns and move to strategies that optimise the timing of these behaviours. Such strategies should consider the relationship between sleep and eating to inform strategies to promote healthy eating patterns together with healthy sleep, with the goal of improving shiftworker health and safety.

Exclusive Breastfeeding for at Least Four Months Is Associated with a Lower Prevalence of Overweight and Obesity in Mothers and Their Children after 2-5 Years from Delivery.

Introduction: Obesity is a current public health concern. Higher body weight is influenced by genetic and environmental parameters, and their interplay and is associated with a greater risk for several chronic diseases. Breastfeeding has been suggested as a preventive measure against obesity, which can further reduce long-term negative health outcomes for both women and children. Aim: The aim of the present study was to evaluate the role of breastfeeding on maternal and childhood overweight and obesity. Materials and Methods: This is a cross-sectional study conducted on 2515 healthy mothers and their children, aged 2–5 years, enrolled from nine different Greek rural and urban regions. Validated, standardized questionnaires were administrated that included anthropometric indices, socio-demographic characteristics of mothers and children, as well as breastfeeding practices. Results: Overall, 68% of participated women exclusively breastfed their children for at least 4 months. Mothers that exclusively breastfed showed a significantly lower prevalence of overweight and obesity after 2–5 years from delivery (p < 0.0001). Children that had exclusively been breastfed showed a significantly lower prevalence of overweight and obesity at the age of 2–5 years (p < 0.0001). Using multivariate regression analysis, exclusive breastfeeding for at least 4 months was associated with a two-fold lower risk for maternal and childhood overweight and obesity after 2–5 years from delivery, independent from maternal age, educational and economic status, and smoking habits (p < 0.0001). Conclusion: Exclusive breastfeeding for at least 4 months had a positive effect on childhood overweight and obesity, also contributing beneficially to post-natal maternal weight control. The beneficial effects of breastfeeding should be communicated to future and new mothers, while supportive actions for all mothers to initiate and continue breastfeeding their offspring should be implemented.

Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors.

Cancer diagnosis and treatment constitute profoundly stressful experiences involving unique and common challenges that generate uncertainty, fear, and emotional distress. Individuals with cancer must cope with multiple stressors, from the point of diagnosis through surgical and adjuvant treatments and into survivorship, that require substantial psychological and physiological adaptation. This can take a toll on quality of life and well-being and may also promote cellular and molecular changes that can exacerbate physical symptoms and facilitate tumor growth and metastasis, thereby contributing to negative long-term health outcomes. Since modifying responses tostressors might improve psychological and physiological adaptation, quality of life, and clinical health outcomes, several randomized controlled trials have tested interventions that aim to facilitate stress management. We review evidence for the effects of stress management interventions on psychological and physiological adaptation and health outcomes in cancer patients and survivors and summarize emerging research in the field to address unanswered questions.

P88. Psychological Resilience Protects Against Stress Effects on Insulin Resistance and Epigenetic Aging

Our society is experiencing more stress than ever before, and chronic stress has been linked to negative long-term health outcomes. This raises the possibility these consequences of stress might be the result of accelerated biological aging. While psychological resilience protects against the mental consequences, of stress it is unclear if it also protects against the physical effects as well. In this study, we examined whether psychological resilience affects stress-associated biological age acceleration.

Like ripples on a pond: The long-term consequences of parental separation and conflicts in childhood on adult children's self-rated health

ObjectiveThe aim of the study was to explore how different forms of conflict in childhood and parental separation additively and interactively predict self-rated health (SRH) in adulthood. Furthermore, a subsample analysis investigated how different family conflicts predict SRH in adulthood within the group of separated families, controlling for post-separation circumstances. BackgroundPrevious research shows that adult children from separated families have worse health compared to peers from intact families. Additionally, inter-parental conflicts are closely associated with parental separation and known to negatively influence children's health. Few studies have taken a broader perspective on conflicts and included conflicts beyond the inter-parental subsystem, such as within other family subsystems, into their analysis. MethodsData were based on Swedish Level of Living Survey (LNU). Using linear probability modelling the first analysis shows that SRH in adulthood varies depending on family type and the occurrence of conflict in childhood (n = 6,638). The study then explored variations in SRH within separated families (n = 934). ResultsThe results show that adult children from separated families and families with different types of conflicts have worse SRH compared to their peers in intact families and families with no conflicts. ConclusionParental separation has long-term consequences on children's SRH and this relationship is partly predicted by parent-child conflicts. ImplicationsThe results underline the importance of considering children's involvement when studying the separation process and its outcomes. They also suggest that interventions to help parents and children through a separation would benefit from a focus, not only on inter-parental conflicts but also, on parent-child conflicts, as well as parents' role modelling to prevent children from experiencing negative long-term health outcomes.