Adult Outcomes Research Articles

The contribution of attention-deficit/hyperactivity disorder polygenic load to metabolic and cardiovascular health outcomes: a large-scale population and sibling study

AbstractEmerging evidence suggests that ADHD is associated with increased risk for metabolic and cardiovascular (cardiometabolic) diseases. However, an understanding of the mechanisms underlying these associations is still limited. In this study we estimated the associations of polygenic scores (PGS) for ADHD with several cardiometabolic diseases and biomarkers. Furthermore, we investigated to what extent the PGS effect was influenced by direct and indirect genetic effects (i.e., shared familial effects). We derived ADHD-PGS in 50,768 individuals aged 18–90 years from the Dutch Lifelines Cohort study. Using generalised estimating equations, we estimated the association of PGS with cardiometabolic diseases, derived from self-report and several biomarkers measured during a physical examination. We additionally ran within-sibling PGS analyses, using fixed effects models, to disentangle direct effects of individuals’ own ADHD genetic risk from confounding due to indirect genetic effects of relatives, as well as population stratification. We found that higher ADHD-PGS were statistically significantly associated with several cardiometabolic diseases (R-squared [R2] range = 0.03–0.50%) and biomarkers (related to inflammation, blood pressure, lipid metabolism, amongst others) (R2 range = 0.01–0.16%) (P < 0.05). Adjustment for shared familial factors attenuated the associations between ADHD-PGS and cardiometabolic outcomes (on average 56% effect size reduction), and significant associations only remained for metabolic disease. Overall our findings suggest that increased genetic liability for ADHD confers a small but significant risk increase for cardiometabolic health outcomes in adulthood. These associations were observable in the general population, even in individuals without ADHD diagnosis, and were partly explained by familial factors shared among siblings.

Young adults’ circulating FGF23 and α-klotho and their relationship with habitual dietary acid load and phosphorus intake during growth

AbstractThe bone-derived hormone FGF23, primarily secreted by osteocytes, is a major player in the regulation of phosphate homeostasis. It becomes upregulated by increased circulating phosphate concentration, e.g. due to elevations in phosphorus intake (P-In) or alterations in habitual dietary acid load. The present study aimed to investigate whether long-term endogenous acid production or a habitual high phosphorus intake during childhood and adolescence may be prospectively related with altered adult levels of FGF23 and the FGF23-related metabolite α-klotho. Urinary phosphate excretion (PO4-Ex), net acid excretion (NAE), and potential renal acid load (uPRAL) were analyzed in 24-h urine samples (n = 3369) collected from 343 healthy 3–17 years old participants of the DONALD Study (Dortmund, Germany) to assess, biomarker-based, P-In and habitual dietary acid load. Circulating FGF23, α-klotho, and further blood parameters were additionally examined in young adulthood. Individual means of standard-deviation-scores were calculated for 24-h urinary biomarker excretions and anthropometrics longitudinally determined between ages 3–17 years. Multivariable linear regression was used to analyze the prospective relations of pre-adulthood PO4-Ex, NAE, and uPRAL with the adulthood outcomes FGF23 and α-klotho. After adjusting for growth period-related covariates and adulthood confounders only for P-In during growth, i.e., PO4-Ex, but not for NAE and uPRAL, a significant positive association (p = 0.03) with FGF23 and an inverse trend (p = 0.10) with the FGF23-α-klotho ratio were observed. Neither PO4-Ex, nor NAE or uPRAL were associated with soluble α-klotho levels in adulthood. The prospective relationships of long-term assessed 24-h phosphaturia and habitual dietary acid load during growth with adult circulating, phosphate-adjusted FGF23 strongly suggest that children´s habitually higher P-In does unfavorably affect adult FGF23–α-klotho axis.

Abstract 4117397: SGLT2i And Cardio-Renal Outcomes In Type 2 Diabetes Mellitus: A Systematic Review And Meta Analysis.

Background: Diabetes Mellitus (DM) significantly impacts global health through cardiovascular and renal complications. SGLT2 inhibitors (SGLT2i) have emerged as beneficial for cardiovascular outcomes in Type 2 Diabetes Mellitus (T2DM). However, only few studies report outcomes related to renal function. Aim: This study aims to analyse the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM. Methods: A systematic review and meta-analysis, following PRISMA-2020 guidelines was conducted. We evaluated the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM. We included randomized controlled trials(RCT) and post hoc analyses that compared SGLT2i with placebo, focusing on cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalizations, and renal outcomes such as the progression of albuminuria and the decline of eGFR. Dichotomous outcomes were calculated using relative risk (RR) with 95% confidence interval (CI). Results: We identified 2753 studies, registered in PubMed(=788), Embase(n=538), WoS(n=369), Scopus(n=908), and Cochrane(n=150). We included 11 studies 6 RCT and 7 Post Hoc Analysis, sample size of 50.653 patients. Meta-analysis showed that SGLT2i improve cardiovascular outcomes such as reduced cardiovascular mortality (RR 0.84 [95% CI 0.73–0.97] p=0.02), heart failure hospitalizations (RR 0.65 [95%CI 0.54–0.77]p<0.00001), and their composites outcomes. Furthermore, renal outcomes with SGLT2i significantly improve Urinary Albumin-to-Creatinine Ratio (RR1.10 [95%CI 1.03–1.18]p=0.004), Improvement of the decline of the eGFR (RR1.08 [95%CI 1.04–1.11] p<0.00001) and progression of albuminuria (RR 0.69[95%CI 0.66–0.72]p<0.00001). Slower Doubling of serum creatinine (RR 0.71 [95% CI 0.61–0.82] p<0.00001), end-stage kidney disease (RR 0.66 [95% CI 0.53–0.83] p=0.0003). Reduced Acute Kidney Injury (RR 0.72 [95% CI 0.58–0.89] p=0.002) and renal impairment (RR 0.57 [95% CI 0.34–0.95] p=0.03). Regarding death from renal causes, we identified a 46% relative reduction in the risk in SGLT2i group, although was not statistically significant (RR 0.54 [95% CI: 0.23, 1.27] p=0.16). The observed heterogeneity across studies calls for careful application of these results to individual patients. Conclusion: SGLT2i confers notable advantages in managing cardiorenal complications in T2DM, demonstrating a reduction in cardiovascular mortality and heart failure hospitalizations and offering a nephroprotective effect.

Abstract 4138672: Blood Pressure and Cardiovascular Outcomes in Adults with Diabetes and Chronic Kidney Disease

Background: Most international guidelines recommend intensive blood pressure (BP) targets (e.g., <130/80 mm Hg) for patients with chronic kidney disease (CKD). However, the data supporting these recommendations are limited, particularly for those with concomitant diabetes. Hypothesis: Systolic BP (SBP) <130 mm Hg and diastolic BP (DBP) <80 mm Hg are associated with a reduced risk of cardiovascular disease (CVD) in adults with diabetes and CKD. Aims: To determine the association of BP with incident CVD risk among adults with diabetes and CKD. Methods: From a Korean nationwide health screening database, we identified 373,966 adults aged 20-79 with both diabetes and CKD who: (1) underwent baseline health examinations in 2009-2013; (2) had ≥3 BP measurements; and (3) did not have CVD at baseline. The associations of baseline average SBP and DBP with CVD risk were assessed using multivariable-adjusted cause-specific Cox models. The primary outcome was CVD event, defined as a composite of myocardial infarction, stroke, heart failure, or death from CVD. Results: The median (Q1-Q3) age of the participants was 62 (53-70) years; 40.8% were female. Over a median follow-up of 10.2 years, a total of 40,781 incident CVD events occurred. Compared with SBP 130 to <140 mm Hg as the referent group, the multivariable-adjusted HRs (95% CIs) for CVD event in the SBP ≥150 mm Hg, 140 to <150 mm Hg, 120 to <130 mm Hg, and <120 mm Hg groups were 1.34 (1.29-1.39), 1.11 (1.08-1.14), 0.89 (0.87-0.91), and 0.77 (0.74-0.80), respectively. Compared with DBP 80 to <90 mm Hg as the referent group, the HRs (95% CIs) in the DBP ≥100 mm Hg, 90 to <100 mm Hg, 70 to <80 mm Hg, and <70 mm Hg groups were 1.70 (1.56-1.85), 1.19 (1.15-1.24), 0.88 (0.86-0.90), and 0.83 (0.80-0.87), respectively (Figure A). SBP <130 mm Hg and DBP <80 mm Hg were each associated with a reduced CVD risk in a log-linear manner (Figure B, Figure C). The findings were consistent when examining kidney instead of cardiovascular outcomes. Conclusion: Among patients with diabetes and CKD, SBP below 130 mm Hg and DBP below 80 mm Hg were associated with a reduced risk of CVD.

Clinical and Biochemical Outcomes in Transgender Individuals Undergoing Hormone Therapy: Protocol for a Systematic Review

Background Monitoring of various clinical outcomes and parameters, such as lipid levels, is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform these recommendations is scarce. Objective This study aims to conduct a systematic review and meta-analysis to synthesize evidence from existing literature on the effect of exogenous hormone therapy on clinical and biochemical outcomes for transgender adolescents and adults. Methods We will search multiple electronic databases and will include prospective and retrospective observational studies with and without a control group. The study population will include transgender individuals undergoing hormone therapy with testosterone or estrogen. Comparisons will include age-matched, cisgender individuals and changes from baseline. Primary outcomes include changes in or the development of abnormal lipid parameters. Secondary outcomes include BMI, weight, height, and blood pressure for age, serum testosterone or estrogen levels, and development of disease including hypertension, diabetes, fatty liver disease, obesity, adverse cardiac events, as well as all-cause mortality. The meta-analysis will pool the studies where applicable, and meta-regressions will be conducted to evaluate effect modifiers. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach will be used to evaluate the overall certainty of evidence. Results We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. Data collection is ongoing, and the paper is expected to be published in Spring 2025. Conclusions This systematic review will summarize and evaluate the evidence of the clinical and biochemical outcomes associated with hormone therapies for transgender individuals. Trial Registration PROSPERO CRD42024483138; https://tinyurl.com/yc4sfvnb International Registered Report Identifier (IRRID) PRR1-10.2196/57931

Abstract 4126650: Prognostic Value of Femoral-Ankle Pulse Wave Velocity for Cardiovascular Outcomes in Older Adults: The Atherosclerosis Risk in Communities (ARIC) study

Background: Carotid-femoral pulse wave velocity (cfPWV) is a representative measure of central arterial stiffness and an independent predictor of cardiovascular disease (CVD). Femoral-ankle PWV (faPWV) represents peripheral arterial stiffness, but its association with CVD has not been specifically studied. Aim: To compare faPWV and cfPWV regarding their associations with CVD outcomes. Methods: We analyzed 3,402 ARIC participants without prior heart failure (HF), coronary heart disease (CHD), or stroke at visit 5 (2011-13) (mean age 74.8 [SD 4.9] years, 36.1% male, and 78.0% White). faPWV and cfPWV were measured by Omron VP-1000 Plus. The outcomes of interest were composite and individual outcomes of CVD (HF, CHD, and stroke). We ran unadjusted and multivariable Cox proportional hazards models. Results: During a median follow-up of 9.0 years, there were 607 CVD events. Overall, faPWV showed an inverse association with CVD (Table). P-for-trend reached statistical significance in Models 1 and 2 and was borderline significant in Model 3 (p=0.077). In contrast, as anticipated, cfPWV was positively associated with CVD in all Models, although the association was somewhat attenuated in Model 3 (p-for-trend=0.045 and hazard ratio [HR] for top vs. bottom quartile 1.22 [95%CI 0.95-1.56]). Given their opposite patterns, we explored the ratio of cfPWV and faPWV (“cf/fa ratio”) and found that its association with CVD appeared stronger (p-for-trend=0.004 and HR for top vs. bottom quartile 1.37 [1.08-1.74]) than cfPWV. When each CVD subtype was examined separately, HF showed most consistent associations with our stiffness measures, and only the cf/fa ratio remained significant for HF up to Model 3 (p-for-trend=0.010 and HR for top vs. bottom quartile 1.40 [1.03-1.90]). Conclusions: faPWV was inversely associated with CVD, and cf/fa ratio appeared more strongly associated with CVD compared to cfPWV. Our findings indicate distinct prognostic implications of central vs. peripheral arterial stiffness and suggest cf/fa ratio as a new stiffness measure predicting CVD.

Abstract Su804: Use of Machine Learning Models to Predict Neurologically Intact Survival for Advanced Age Adults Following Out-of-hospital Cardiac Arrest

Background: We recently published a multivariable logistic regression model that successfully predicted neurologic outcomes in advanced age adults (≥ 65 years old) who achieve return of spontaneous circulation following out-of-hospital cardiac arrest (OHCA). Prior to externally validating this model, we sought to compare the predictive performance of our logistic regression model against common machine learning (ML) algorithms using the same dataset. Methods: We performed a retrospective observational analysis of the Cardiac Arrest Registry to Enhance Survival database from 2013-2021. All non-traumatic OHCA occurring in adults (≥65 years) who survived to hospital admission were included. The primary outcome measure was neurologically intact survival defined as a cerebral performance category (CPC) score of 1 or 2 at hospital discharge. Our original logistic regression model was compared to Boosted Trees and Decision Tree ML algorithms and assessed using accuracy, Area Under the Receiver Operating Characteristic Curve (AUC-ROC) and Area Under the Precision-Recall Curve (AUC-PR). The model variables included age, gender, race/ethnicity, location, witnessed status, who initiated cardiopulmonary resuscitation, whether an automated external defibrillator was applied prior to emergency medical services arrival, and first monitored rhythm. Results: A total of 83,561 OHCA were included. Median age was 75 years (IQR 69-82), 58.9% were male, 53% were White, 67% experienced an OHCA at home, 52% were witnessed by a bystander, 44% received bystander CPR, and 34% were found in shockable rhythm. Neurologically intact survival (CPC 1 or 2) occurred in 23% of patients. The logistic regression model had an accuracy of 79.6%, AUC-PR 0.542, and AUC-ROC of 0.774. The Boosted Trees model had an accuracy of 79.2%, AUC-PR 0.555, and AUC-ROC of 0.774. The Decision Tree Model had an accuracy of 79.3%, AUC-PR 0.490, and AUC-ROC of 0.717. Conclusion: Boosted Trees and Decision Tree ML models performed comparably to the logistic regression model in predicting favorable versus unfavorable neurological outcomes following successful resuscitation from OHCA in advanced-age adults. Given their similar performance, logistic regression may be preferred for its simplicity and interpretability over alternative ML models. Future efforts to improve and ultimately externally validate the model are warranted.

Abstract 4137620: Serum Acylcarnitines Predict Longitudinal Deteriorations in Cardiac Function and Adverse Outcomes in Older Adults

Background: Circulating acylcarnitines (ACs), biomarkers of mitochondrial β-oxidative function, are linked to cardiovascular diseases (CVD) yet the extent to which ACs relate to prospective cardiac aging remains uncertain. We investigate the longitudinal associations between ACs, cardiac function, and clinical outcomes. Methods: A population-based sample of community older adults without CVD underwent baseline serum metabolomic profiling and interval echocardiography at five years. Incident hospitalizations were prospectively tracked from 2014 to 2021. Multiple linear regression adjusted for significant clinical variables. Results: Of 202 participants (baseline 65±11.9 years, 49.3% women), we observed interval increases in risk factors (hypertension 39% vs 52.2% p<0.001; dyslipidemia 39% vs 50% p=0.034; diabetes 11.7% vs 18.8% p=0.035; smoking 13.2% vs 24.7% p=0.003; waist circumference 81±10.1 vs 86±9.9cm p<0.001) during follow-up (4.9±0.4 years). These changes paralleled E/e’ increases (8.9±2.6 vs 11.1±3.3 p<0.001) and E/A decreases (1.09±0.4 vs 1.0±0.4 p<0.001). Baseline C8:1 (β=0.182 p=0.011), C22:3 (β=0.148 p=0.047), C22:5 (β=0.210 p=0.003), C5:1 (β=-0.142 p=0.048), and C16-OH (β=-0.156 p=0.028) levels were associated with E/e’ change over time while C6 (β=0.163 adj. p=0.019), C8:1 (β=0.137 adj. p=0.047), C10:2 (β=0.153 adj. p=0.035), C14:3 (β=0.147 adj. p=0.031), and C16:1-OH/C14:1-DC (β=0.158 adj. p=0.022) were associated with E/A change. At follow-up, baseline C8:1 (β=0.178 adj. p=0.006) and C10:3 (β=0.145 adj. p=0.024) were associated with E/e’ while C4-DC/C6-OH (β=-0.004 adj. p=0.034) was associated with E/A. Baseline C22:2 predicted incident hospitalizations (HR=1.20 95%CI 1.03-1.39, adj. p=0.018). Conclusion: Circulating ACs independently predicted declining cardiac function and adverse outcomes over five years among older adults without CVD. The prognostic effect of ACs should be translated to strategies targeting mitochondrial health in cardiac aging prevention.

Personality trait change during adolescence as a predictor of later substance use, depressive symptoms, and perceived maturity

Adolescence is considered a critical period for understanding how individuals develop their self-concepts and personality dispositions, with the assumption that these changes presage important life outcomes. However, this tenet has been infrequently tested; few studies have included rigorous, frequent assessment of personality traits during adolescence, particularly from multiple rater perspectives. The current study utilizes data from the Oregon Youth Substance Use Project (OYSUP; N = 951), which followed students throughout their school years into early adulthood. Student- and teacher-reports of the Big Five personality traits were assessed yearly from grades 7 to 10, as well as drug use, well-being, and maturity outcomes later in emerging adulthood. Using latent growth curve models and true intraindividual change score models, results indicated that youth exhibited relative stability but significant trait changes on multiple domains during adolescence. Moreover, individual differences in these changes predicted likelihood for drug use and depressive symptoms later, as well as the students’ perceptions of their status as being developed adults, even when accounting for initial trait levels. Findings differed somewhat between youth- and teacher-reports of personality, with both demonstrating value for predicting young adult outcomes, indicating multiple perspectives of personality development are important.

What will my life be like when I am 25? How do children's social class contexts predict their imagined and actual futures?

AbstractChildren use school as a way to imagine and strive toward their futures. We analyzed thousands of essays written by children in Britain in the late 1960s about what their lives would be like as adults. We used a bottom‐up approach to explore naturally occurring topics in these essays and tested how these topics varied with children's social class context and their adult outcomes. Higher education was the most prevalent topic in these children's essays; children whose fathers—and maternal grandfathers—had higher‐status occupations were especially likely to write about this, as well as about interests in teaching, medicine, and the military. Children in lower class contexts were especially likely to write about making money, but also about family and daily responsibilities. We further found that—controlling for family background—children who wrote more about higher education and less about money‐making tended to achieve education, status, and income.

Stress tests and biomarkers of resilience: Proceedings of the second state of resilience science conference

AbstractThe “Stress Tests and Biomarkers of Resilience” conference, hosted by the American Geriatrics Society and the National Institute on Aging, marks the second in a series aimed at advancing the field of resilience science. Held on March 4–5, 2024, in Bethesda, Maryland, this conference built upon the foundational work from the first conference, which focused on defining resilience across various domains—physical, cognitive, and psychosocial. This year's gathering centered around three factors: the biology that underlies resilient outcomes; the social, environmental, genetic, and psychosocial factors that impact that resilience biology; and the biomarker testing and imaging that predicts resilient outcomes for older adults. The presentations and discussions around these topics were underscored by considerations around the many impacts of social determinants of health on resiliency interventions, and by advances in the modern training and research methodologies that influence data collection and experiment design.

Metabolic syndrome is associated with poorer outcomes in people with osteoarthritis participating in a rehabilitation program: an observational study

Purpose To determine the prevalence of metabolic syndrome and explore its association with clinical outcomes (pain, quality of life, and physical function) in adults participating in an education and exercise program (GLA:D®). Methods An observational study of adults with hip and/or knee osteoarthritis who participated in GLA:D® between 2019 and 2022. Metabolic syndrome status was determined through self-report. Differences in clinical outcomes among people with, at risk of (1–2 risk factors), or without metabolic syndrome were compared at baseline, 3-, and 12-months using linear mixed models (age, sex, and baseline outcomes as covariates). Results Of 6846 participants (aged 65(SD 9) years), 20% (n = 1337) had, and 68% (n = 4632) were at risk of metabolic syndrome. Adults with metabolic syndrome reported higher pain (0–100 VAS: 7.3, 95% CI 5.4–9.1), lower health-related quality of life (EQ5D 0–100, VAS: −8.6, 95% CI −10.2 to −7.0), and slower gait speed (−0.26 m/s, 95%CI -0.3 to −0.23) at baseline compared to those with no metabolic risk factors. Differences remained at 3- and 12-months for pain and quality of life. Conclusions Metabolic syndrome risk factors were common in adults with osteoarthritis. Clinical outcomes remain impaired in people with metabolic syndrome compared to those without after education and exercise, suggesting further intervention may be required.

Energy metabolism dysregulation, cerebrovascular aging, and time-restricted eating: Current evidence and proof-of-concept findings

Abstract Dysregulated energy metabolism is a hallmark of aging, including brain aging; thus, strategies to restore normal metabolic regulation are at the forefront of aging research. Intermittent fasting, particularly time-restricted eating (TRE), is one of these strategies. Despite its well-established effectiveness in improving metabolic outcomes in older adults, the effect of TRE on preserving or improving cerebrovascular health during aging remains underexplored. We explored how aging itself affects energy metabolism and contextualized these age-related changes to cerebrovascular health. We also conducted a literature search on PubMed and Scopus to identify and summarize current studies on TRE in older adults. Finally, we provided preliminary data from our proof-of-concept pilot trial on the effect of 6-month TRE on cerebrovascular health in older adults. Current evidence shows the potential of TRE to improve energy metabolism and physiological outcomes in older adults. TRE may improve cerebrovascular function indirectly due to its effect on glucose homeostasis. However, to date, direct evidence of the effect of TRE on cerebrovascular parameters is lacking. TRE is a well-tolerated and promising dietary intervention for promoting and maintaining cerebrovascular health in older adults. Further studies on TRE in older adults must be better controlled for energy balance to elucidate its independent effects from those of caloric restriction.

Osteosarcopenia in patients with cancer: A systematic review and meta-analysis

Background: Osteosarcopenia is frequent, and the relative risk of fracture is higher among patients with sarcopenia. It is a strong predictor of poor outcomes in older adults undergoing cancer treatment, suggesting that osteosarcopenia is important in an aging society. This study aimed to evaluate the overall survival (OS) and disease-free survival (DFS) of patients with cancer with and without osteosarcopenia. Methods: Five electronic databases—Embase, PubMed, Web of Science, Scopus, and CINAHL—were searched for relevant articles published before February 2024. Studies that met the criteria were used to evaluate the OS and DFS of patients with cancer with and without osteosarcopenia. From the 603 initially identified articles, 8 involving 1608 participants were included in the meta-analysis. Results: We observed that patients with cancer diagnosed with osteopenia, sarcopenia, or osteosarcopenia had worse DFS than those without these conditions. Specifically, osteopenia (pooled hazard ratio [HR] = 1.70, P = .01) and osteosarcopenia (pooled HR = 2.17, P = .0001) emerged as independent predictors of DFS. However, sarcopenia was significantly associated with DFS. The quality of the included studies was generally good, and no publication bias was detected among them for either OS or DFS. Conclusion: These meta-analysis results suggest that osteopenia and osteosarcopenia are associated with worse DFS among patients with cancer. The use of different case definitions appeared to be a major source of heterogeneity among studies. Further studies are warranted to confirm our findings, especially those regarding OS and DFS.

Improving health outcomes among older adults in India: effectiveness and implementability of a novel comprehensive geriatric assessment based intervention

Background There is significant evidence on the benefits of comprehensive assessment in older adults. But this evidence is primarily from western countries and in secondary care settings. National policies in India recognize this need and envision community-based screening and facility-based assessment programs integrated into the care pathways for the elderly. However, this is yet to translate into specific interventions, primarily due to lack of complex interventions necessary and evidence of their effectiveness. This study aims to design and pilot an integrated (Community + Facility) Elderly Health Status Assessment and Screening (EHSAS) intervention to improve health outcomes of older adults and assess its feasibility for implementation in Indian rural settings. Methods We propose a hybrid design where we will build the complex intervention, develop and validate the tools needed, pilot it using an exploratory cluster randomized trial and evaluate its implementatbility using the Exploration-Preparation-Implementation-Sustainment (EPIS) framework. Conclusions This study will fill critical gaps in evidence regarding the effectiveness of geriatric screening and assessment in community and primary care settings in low-middle income countries and provide validated tools and implementation models for adoption into national programs. Registration CTRI/2023/07/055661

Association between preterm birth and economic and educational outcomes in adulthood: A population-based matched cohort study.

Preterm birth (PTB) affects ~10% of births worldwide; however, most literature focused on short-term clinical outcomes, with much less focus on long-term socioeconomic outcomes after PTB. We examined associations between PTB and individuals' income, employment, and educational outcomes during early adulthood. We conducted a population-level matched cohort study including all live births in Canada between 1990 and 1996, followed until 2018. Outcomes included Employment income per year in 2018 CAD and employment between ages 18 and 28 years, postsecondary education enrollment (18-22 years), and maximum educational attainment at age 22-27 years. Mean differences and risk ratios (RR) and differences (RD) were estimated using generalized estimating equation regression models for economic outcomes and multinomial logistic regression models for educational outcomes. Of 2.4 million births, 7% were born preterm (0.3%, 0.6%, 0.8%, and 5.4% born extremely preterm (24-27 weeks), very preterm (28-31 weeks), moderately preterm (32-33 weeks), and late preterm (34-36 weeks) respectively). After matching on baseline characteristics (e.g., sex, province of birth, and parental demographics) and adjusting for age and period effects, preterm-born individuals, on average, had $958 CAD less employment income per year (95% CI: $854-$1062), 6% lower income per year, than term-born individuals, and were 2.13% less likely to be employed (1.98-2.29%). PTB was also negatively associated with university enrollment (RR 0.93 (0.91-0.94) and graduation with a university degree (RR 0.95 (0.94-0.97)). Mean income differences for those born 24-27 weeks were -$5,463 CAD per year (17% lower), and adjusted RR were 0.55 for university enrollment and graduation. In this population-based study, preterm birth was associated with lower economic and educational achievements at least until the late twenties. The associations were stronger with decreasing GA at birth. Policymakers, clinicians, and parents should be aware that the socioeconomic impact of PTB is not limited to the early neonatal period but extends into adulthood.

Identifying the Relationship Between Residential Type and Health Outcomes of the Community-Dwelling Thai Older Adults in the Baseline Analysis of a Cluster-Randomized Controlled Trial

Background/Objectives: As people age, their environment plays a critical role in shaping their health. With Thailand’s rapidly aging population, it is crucial to understand how different living environments affect the well-being of older adults. This study examines differences in biopsychosocial health indicators between older adults living in village communities and private housing estates in Chiang Mai, Thailand. Methods: A cross-sectional study was conducted using baseline data from the Community-Integrated Intermediary Care (CIIC) Service Model, a Cluster Randomized Controlled Trial in Thailand (TCTR20190412004). The study included 2788 older adults (aged 60+). Of these, 89.49% resided in village communities, and 10.51% in private housing estates. Validated instruments were used to assess health indicators. Descriptive statistics, multivariate analysis of variance, and multiple logistic regression analyses were performed. Results: Older adults in private housing estates had significantly lower odds of experiencing pain or discomfort (Adj OR: 0.64, 95% CI: 0.49–0.84) and were 1.36 times more likely to report positive perceived health. However, they had lower odds of perceiving themselves as physically and socially active (Adj OR: 0.74, 95% CI: 0.57–0.97) and were 0.30 times less likely to rate their quality of life higher (Adj OR: 0.30, 95% CI: 0.22–0.40) compared to their village community counterparts. Conclusions: The residential environment significantly influences older adults’ health and well-being. Tailored health promotion interventions should leverage the unique strengths of both village communities and private housing estates to enhance social connections, physical activity, and quality of life, promoting healthy, active aging across diverse settings.

Nudge theories and strategies influencing adult health behaviors and outcomes in COPD management: a systematic review

ObjectiveChronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with high prevalence and mortality, and self-management is a key component for better outcomes of COPD. Recently, nudging has shown promising potential in COPD management. In the present study, we conducted a systematic review to collate the list of nudges and identified the variables that influence nudging.MethodsWe undertook a systematic review. We employed database searches and snowballing. Data from selected studies were extracted. The risk of bias was assessed using the Cochrane Effective Practice and Organization of Care risk of bias tool. The study is registered with PROSPERO, CRD42023427051.ResultsWe retrieved 4,022 studies from database searches and 38 studies were included. By snowballing, 5 additional studies were obtained. Nudges were classified into four types: social influence, gamification, reminder, and feedback. Medication adherence, inhalation technique, physical activity, smoking cessation, vaccination administration, exercise capacity, self-efficacy, pulmonary function, clinical symptoms, and quality of life were analyzed as targeted health behaviors and outcomes. We found medication adherence was significantly improved by reminders via mobile applications or text materials, as well as feedback based on devices. Additionally, reminders through text materials greatly enhance inhalation techniques and vaccination in patients.ConclusionThis review demonstrates nudging can improve the health behaviors of patients with COPD and shows great potential for certain outcomes, particularly medication adherence, inhalation techniques, and vaccination. Additionally, the delivery modes, the patient characteristics, and the durations and seasons of interventions may influence the successful nudge-based intervention.Clinical trial registrationThis review has been registered in the international Prospective Registry of Systematic Evaluation (PROSPERO) database (identifier number CRD42023427051).

Life After High School: The Employment Experiences of Autistic Young Adults

The present study examined the employment landscape for 129 autistic young adults. Data were collected over multiple waves including high school and early adulthood. Parents participated in interviews and responded to questions regarding young adult employment outcomes, on-the-job supports, job match, and overall job satisfaction. The predictive relationship between in-school variables and employment outcomes was examined. Findings indicate over 50% of the sample had at least one job working independently in the community for pay. Parents reported the need for both formal and informal support to both obtain and sustain employment. Over half of the parents reported that the young adult’s job was aligned with their interests/strengths and that the young adult was satisfied. Predictive analyses indicated a relationship between work-based learning experiences in high school and general education involvement during high school and later paid employment in adulthood. Future research, limitations, and implications for practice are discussed.

The impact of exposure to green or bluespace on dietary intake and food choices among adults—A systematic literature review

AbstractExtensive research has shown that spending time in natural greenspaces has a positive impact on health. However, there is limited evidence regarding potential factors that may influence these effects. This review aimed to assess the strength of the evidence and potential impact of exposure to green and bluespaces on dietary outcomes in adults. Inclusion criteria for the review were based on the PICO criteria. Following PRISMA guidelines, an initial search of five databases was conducted: CINAHL, GreenFILE, AMED, Medline, and PubMed, accessed on 14th June 2021 and augmented by an updated rerun in January 2024. All studies used the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross‐Sectional Studies for quality assessment. Due to heterogeneity, a narrative synthesis was conducted to evaluate the relationships between the included studies. Four observational studies that reported diet‐related outcomes were included in the review, and participants within the studies ranged from 554 to >350,000 participants. Other health outcomes, including physical activity and obesity, were also reported. Two studies found that dietary patterns were not correlated with exposure to greenspace. Due to the small number of articles retrieved and the paucity of evidence, the findings must be interpreted cautiously. In conclusion, further research is essential to clarify the intricate mechanisms involved in greenspace‐related health benefits. Additionally, investigating the specific greenspace attributes influencing adult dietary intake and food choices is warranted. When devising public health interventions, it is crucial to account for the substantial health advantages associated with various socioeconomic groups.