Adult Outcomes Research Articles

Predictors of successful transition of adolescents and young adults living with HIV from pediatric to adult-oriented care in southern Ethiopia: a retrospective cohort study

BackgroundThe introduction of highly active antiretroviral therapy has significantly improved the life expectancies of children and adolescents living with HIV, leading to an increased number transitioning to adult care. However, there has been a lack of studies in Ethiopia focusing on factors influencing the success of this transition. Therefore, this study aimed to determine predictors of a successful transition from pediatric to adult HIV clinics among adolescents and young adults living with HIV in health facilities in southern Ethiopia.MethodsA retrospective cohort study included 337 adolescents and young adults who transitioned to adult-oriented HIV care. Successful transition was defined as having a viral load of less than 1000 copies/ml and maintaining care during the first year post-transition. Patients’ antiretroviral therapy (ART) cards and monitoring charts were reviewed. Secondary data analysis was conducted using a multivariable binary logistic regression model to identify predictors of a successful transition. Using the variance inflation factor, we checked for multi-collinearity between variables and assessed model fitness with the Hosmer and Lemeshow goodness-of-fit test. Adjusted Odds Ratio (AOR) with 95% confidence intervals (CI) and P-value ≤ 0.05 measured the strength of association and statistical significance.ResultsOf 337 participants, 230 (68.25%) successfully transitioned (95% CI = 63.25, 73.25). Transitioning at age 18 or older (AOR = 4.25; 95% CI = 2.29, 7.87), residing in an urban area (AOR = 1.78; 95% CI = 1.04, 3.02), and being on antiretroviral therapy for more than two years (AOR = 4.25; 95% CI = 1.17, 4.94; P < 0.017) were identified as positive predictors and opportunistic infection (AOR = 0.34; 95% CI = 0.15, 0.75; P < 0.008) was identified as a negative predictor for a successful transition from pediatric to adult ART clinic.ConclusionThis study sheds light on the challenges faced by HIV patients transitioning from pediatric to adult care, with less than 70% successfully navigating this critical phase. Factors such as age at transition, residence, duration of ART, and the presence of opportunistic infections were identified as key predictors of successful transition. The findings underscore the urgent need for tailored interventions, including standardized transition plans that address age and urban/rural disparities, to enhance transition outcomes for adolescents and young adults living with HIV in the region.

Effects of Mobile Applications on Weight-Related, Behavior and Metabolic Outcomes for Adults with Overweight and Obesity: A Systematic Review and Meta-Analysis.

The meta-analysis aimed to explore the effects of mobile phone applications on weight-related, behavior, and metabolic outcomes among adults with overweight and obesity. Six databases were searched for relevant randomized controlled trials (RCTs) published between January 1, 2010 and November 7, 2023 in English. Two independent authors conducted study selection, data extraction, quality assessment. The effect size of interventions was calculated using mean difference. A random-effects model was applied for data analysis. A total of 27 studies were included. The results indicated that mobile phone application intervention reduced weight (MD=-1.38 kg, P<0.001, 95% CI -1.97 to -0.80), BMI (MD=-0.44 kg/m2, P<0.001, 95% CI -0.57 to -0.30), WC (MD=-2.13 cm, P=0.004, 95% CI -3.57 to -0.69), fat mass, and DBP (MD=-2.04 mmHg, P=0.01, 95% CI -3.65 to 0.44) with statistical significance. Future studies could consider how to optimize app interventions through behavior change strategies to enhance their overall effectiveness.

Advancing pediatric bone sarcoma care: navigating complications and innovating solutions in limb salvage and reconstruction-why, when, and how to treat limb length inequalities.

Pediatric bone sarcomas, particularly osteosarcomas, present unique challenges in the realm of orthopedic oncology, given their predilection for the metaphyseal regions of long bones and the intricate balance required between achieving oncologic control and preserving limb function. This abstract encapsulates findings from a comprehensive review aimed at advancing pediatric bone sarcoma care, focusing on navigating the complications and innovating solutions for complications of limb salvage and reconstruction focusing on limb length inequalities and accompanying bone defects. Advancements in imaging, surgical techniques, and adjuvant therapies have shifted the paradigm from amputation to limb-sparing surgeries, albeit with significant challenges, especially in young patients where growth potential complicates reconstructive outcomes. The series highlights the complexity of managing limb length discrepancies (LLD), the cornerstone of limb salvage challenges, and the innovative approaches to address them, including modular endoprosthetic reconstruction with expandable prostheses, magnetic lengthening nails and biological reconstruction strategies like vascularized fibula grafts. This review underlines the importance of a multidisciplinary approach in managing pediatric bone sarcomas, where the aim extends beyond mere survival to ensuring quality of life through functional limb preservation. It highlights the need for ongoing innovation in surgical and reconstructive techniques tailored to the pediatric population's unique needs, emphasizing the potential of emerging technologies and methodologies to improve outcomes. Future research should aim to fill the existing knowledge gaps, particularly in comparing pediatric and adult surgical outcomes, to refine treatment protocols and improve patient care in this challenging domain.

The impact of pediatric post-cardiac arrest care on survival: A multicenter review from the AHA get with the Guidelines®-resuscitation post-cardiac arrest care registry

AimAdherence to post-cardiac arrest care (PCAC) recommendations is associated with improved outcomes for adults. We aimed to describe the survival impact of meeting American Heart Association (AHA) PCAC guidelines in children after cardiac arrest. MethodsWe conducted a retrospective study using Get With The Guidelines® Resuscitation’s (GWTG®-R) registry to describe the PCAC of patients ≤ 18 years old who suffered an in-hospital or out-of-hospital cardiac arrest (IHCA or OHCA). We evaluated the association between the absence of hypotension and fever in the initial 24 h following return of circulation (ROC) with survival to hospital discharge. We reviewed the utilization of monitoring/evaluation tools recommended in pediatric PCAC guidelines: electrocardiogram (ECG), electroencephalogram (EEG), and neuro-imaging. ResultsWe found 385 pediatric patients who suffered an IHCA or OHCA from 2015 through 2019 and survived at least 6 h post-ROC. Sixty-six percent of patients survived to hospital discharge. Following ROC, 56% of patients had EEG monitoring, 80% had an ECG performed, 47% had a head CT, and 26% had a cerebral MRI. In the initial 24 h post-ROC, 92% of patients did not have hypotension and 79% were afebrile. Patients without hypotension in the initial 24 h post-ROC had higher odds of survival to hospital discharge than those with hypotension (aOR 4.96; 95% CI 2.07, 11.90; p = 0.0003), adjusting for age and cardiac arrest location. Patients without hypotension and without fever in the initial 24 h post-ROC had higher odds of survival to hospital discharge compared to patients who had either hypotension or fever or both (aOR 1.98; 95% CI 1.06,3.71; p = 0.034). ConclusionIn this retrospective multicenter registry study, absence of both post-cardiac arrest hypotension and fever were associated with increased odds of survival to hospital discharge. Further research is needed to understand the full impact of PCAC recommendation compliance on survival outcomes.

Older adults’ subjective aging perceptions, mentalization, and social relationships: a micro-longitudinal study

Objectives Social relationships are associated with various positive physical, psychological, and emotional outcomes in older adults. In line with the growing understanding of the role of subjective views of aging (VoA) for older adults’ quality of life, the current work examines how daily fluctuations in VoA affect social relationships. Moreover, as the ability to mentalize others’ states of mind (i.e. Theory of Mind) considerably enhances such relationships, this study assesses whether mentalization abilities mediate the VoA-social relationships link. Method Eighty-two Israeli older adults (mean age = 73.44, SD = 8.64, range = 60–95) completed a baseline online questionnaire containing background information, and subsequently filled out daily online questionnaires assessing ageist attitudes, subjective age, mentalization abilities, and positive social relationships for 14 consecutive days. Results Positive VoA (reduced ageist attitudes and/or a young subjective age) were associated with enhanced mentalization and positive relationships on a given day and in time-lagged analyses. Moreover, mentalization mediated the effect of previous-day VoA on next-day positive social relationships. VoA also mediated the effect of previous-day mentalization on next-day positive social relationships. Conclusion The study highlights the importance of mentalization capabilities for maintaining positive VoA/social relationships and expands the understanding of underlying factors associated with meaningful and close relationships in older adults.

Multiple myeloma refractory to lenalidomide: A systematic literature review of trials and real-world evidence.

The growing use of frontline lenalidomide treatment in multiple myeloma (MM) is increasing the proportion of lenalidomide-refractory patients, which may limit the efficacy of subsequent lines of treatment (LOT). This systematic literature review (January 2008-October 2023) of clinical trials (CT) and real-world studies (RW) assessed treatment outcomes in adults with relapsed/refractory MM (RRMM) who were previously treated with ≥1 LOT, progressed and were lenalidomide-refractory. Medline, EMBASE and additional electronic databases were searched for articles published in English. Primary outcomes included progression-free survival (PFS), overall survival (OS) and overall/objective response rate (ORR); 24 CT and 19 RW were included. For CT, the population-weighted mean of median PFS (CT = 14) and OS (CT = 6) were shorter in the lenalidomide-refractory cohort (months: 8.8 [n = 2699] and 21.7 [n = 1066], respectively) than the intent-to-treat population (months: 13.8 [n = 5380] and 35.9 [n = 2264], respectively); the population-weighted (N = 2142) mean ORR for lenalidomide-refractory patients (CT = 18) was 56.0%. RW reported considerable variation in PFS (RW = 7), OS (RW = 8) and ORR (RW = 8); and median PFS (RW = 2; months) was lower in lenalidomide/bortezomib-refractory (5.5/5.5; n = 81/n = 25) versus lenalidomide-refractory (7.3/8.0; n = 81/n = 61) patients. These data provide evidence that clinical trials and real-world outcomes are suboptimal in lenalidomide-refractory patients with RRMM, highlighting the need to improve treatment options for this population.

Expanding the phenotype of neurofibromatosis type 1 microdeletion syndrome.

Neurofibromatosis type 1 (NF-1) microdeletion syndrome accounts for 5 to 11% of individuals with NF-1. The aim of our study was to characterize a large cohort of individuals with NF-1 microdeletion syndrome and expand its natural history. We conducted a retrospective chart review from 1994 to 2024 of individuals with NF-1 microdeletion syndrome followed at two large Neurofibromatosis Clinics. This cohort consists of 57 individuals with NF-1 microdeletion syndrome (28 type-1, 4 type-2, 2 type-3, 9 atypical deletions, and 14 indeterminate). We note 38/56 (67.9%) with describable facial features, 25/57 (43.8%) with plexiform neurofibromas, and 3/57 (5.2%) with malignant peripheral nerve sheath tumors within the observed period. The most reported neurodevelopmental manifestations from school-age or older individuals included 39/49 (79.6%) with developmental delays, 35/49 (71.4%) with expressive and/or receptive speech delays, 33/41 (80.5%) with learning difficulties, and 23/42 (54.8%) with attention-deficit/hyperactivity disorder. Full-scale IQ testing data was available for 22 individuals (range: 50-96). Of the 21 adults in this cohort, 14/21 (66.7%) graduated from high school, and 4/21 (19.0%) had some college experience. Many individuals received academic support (i.e., special education, individual education plan). In this cohort, neurocognitive outcomes in adults varied more than typically reported in the literature.

Young Adult Career Outcomes for Adolescents With ADHD, High Ability, or Twice-Exceptionality

The purpose of this study was to explore career outcomes in young adulthood among adolescents with ADHD and/or high abilities. The sample included respondents who had the ability and ADHD measures from Waves 1 (1995), 3 (2002), and 4 (2009) of the National Longitudinal Study of Adolescent and Adult Health in-home questionnaire. Using multiple group path analysis, we examined the pathways for three groups of individuals (i.e., ADHD, high ability, and both/twice-exceptional). We discovered financial and educational family background predicted occupational status and career goal attainment, as well as supports and barriers among various family and adolescent predictors (e.g., school attachment, educational aspiration, depressive symptoms). Knowledge about these trajectories will help professionals design tailored career and educational services for adolescents with high ability, ADHD, and both.

A Preliminary Analysis of Stress Burden and Cognitive Function and Clinically Adjudicated Cognitive Outcomes in Black American Adults.

The combination of exposure to multiple stressors and psychological distress may contribute to the disproportionate burden of dementia risk among Black Americans. This study estimates the effect of an index of stress and psychological distress (ie, "stress burden") on cognitive function and clinically adjudicated cognitive outcomes among older Black American adults, and examines sleep as a mediator. The sample included 204 Black adults (79% female; mean age = 64 years) from Pittsburgh, PA, USA. Stress burden comprised 3 self-reported stress and distress measures assessed in 2016: discrimination, psychological distress, and posttraumatic stress. Potential mediators included actigraphy-assessed sleep duration and efficiency from 2018. Cognitive battery and clinical adjudication in 2019 assessed cognitive function and clinically adjudicated outcomes. Causal mediation analysis estimated the direct effect between stress burden and cognitive outcomes, and indirect effects through sleep, after adjusting for sociodemographics and hypertension. Higher stress burden had a significant direct effect on lower executive functioning and visuospatial performance. However, there were no significant indirect effects (ie, mediation) by sleep disturbances on any domain of cognitive function assessed. Also, there were no significant direct or indirect effects on clinically adjudicated outcomes. Multiple stressors often co-occur and may contribute to racial disparities in cognitive health. Findings suggest that higher stress burden had negative effects on functioning in executive and visuospatial domains in this community-based sample of older Black American adults. However, there was no evidence of mediation by sleep. Findings highlight the importance of continued work to identify modifiable pathways between stress burden and cognitive health disparities.

Gait Assessment Using Smartphone Applications in Older Adults: A Scoping Review.

Spatiotemporal parameters such as gait velocity and stride length are simple indicators of functional status and can be used to predict major adverse outcomes in older adults. A smartphone can be used for gait analysis by providing spatiotemporal parameters useful for improving the diagnosis and rehabilitation processes in frail people. The aim of this study was to review articles published in the last 20 years (from 2004 to 2024) concerning the application of smartphones to assess the spatiotemporal parameters of gait in older adults. This systematic review was performed in line with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), and original articles were identified by searching seven electronic databases: SciVerse (ScienceDirect), Excerpta Medica Database (EMBASE), Medline, Scopus, PubMed, Web of Science and the Cochrane Library. Studies were rigorously screened using the inclusion criteria of smartphones and mobile apps, older adults and spatiotemporal gait parameters, and results were narratively synthesized. Seventy-three articles were initially identified while searching the scientific literature regarding this topic. Eleven articles were selected and included in this review. Analysis of these studies covered information about gait assessment using mobile apps recorded in 723 older adults and 164 control cases. Analysis of data related to the application of smartphones to assess spatiotemporal parameters of gait in older adults showed moderate-to-excellent test-retest reliability and validity (ICCs around 0.9) of gait speed, the most common parameter reported. Additionally, gait speeds recorded with mobile apps showed excellent agreement when compared to gold standard systems. Smartphones and mobile apps are useful, non-invasive, low-cost and objective tools that are being extensively used to perform gait analysis in older adults. Smartphones and mobile apps can reliably identify spatiotemporal parameters related to adverse outcomes, such as a slow gait speed, as predictors and outcomes in clinical practice and research involving older adults.

Diet and the Gut Microbiome as Determinants Modulating Metabolic Outcomes in Young Obese Adults.

Obesity, along with metabolic disorders such as dyslipidemia and insulin resistance, increases the risk of cardiovascular disease, diabetes, various cancers, and other non-communicable diseases, thereby contributing to higher mortality rates. The intestinal microbiome plays a crucial role in maintaining homeostasis and influencing human metabolism. This study enrolled 82 young obese individuals, who were stratified into groups with or without metabolic disturbances. No significant differences in the alpha or beta diversity of the microbiota were observed among the groups. Insulin resistance was characterized by an increase in the number of Adlercreutzia and Dialister as well as a decrease in Collinsella, Coprococcus and Clostridiales. The dyslipidemia and dyslipidemia+insulin resistance groups had no significant differences in the gut microbiota. Dietary patterns also influenced microbial composition, with high protein intake increasing Leuconostoc and Akkermansia, and high fiber intake boosting Lactobacillus and Streptococcus. The genus Erwinia was associated with increases in visceral fat and serum glucose as well as a decrease in high-density lipoprotein cholesterol. Our findings highlight a significant association between gut microbiota composition and metabolic disturbances in young obese individuals, and they suggest that dietary modifications may promote a healthy microbiome and reduce the risk of developing metabolic disorders.

House dust metagenome and pulmonary function in a US farming population

BackgroundChronic exposure to microorganisms inside homes can impact respiratory health. Few studies have used advanced sequencing methods to examine adult respiratory outcomes, especially continuous measures. We aimed to identify metagenomic profiles in house dust related to the quantitative traits of pulmonary function and airway inflammation in adults. Microbial communities, 1264 species (389 genera), in vacuumed bedroom dust from 779 homes in a US cohort were characterized by whole metagenome shotgun sequencing. We examined two overall microbial diversity measures: richness (the number of individual microbial species) and Shannon index (reflecting both richness and relative abundance). To identify specific differentially abundant genera, we applied the Lasso estimator with high-dimensional inference methods, a novel framework for analyzing microbiome data in relation to continuous traits after accounting for all taxa examined together.ResultsPulmonary function measures (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio) were not associated with overall dust microbial diversity. However, many individual microbial genera were differentially abundant (p-value < 0.05 controlling for all other microbial taxa examined) in relation to FEV1, FVC, or FEV1/FVC. Similarly, fractional exhaled nitric oxide (FeNO), a marker of airway inflammation, was unrelated to overall microbial diversity but associated with differential abundance for many individual genera. Several genera, including Limosilactobacillus, were associated with a pulmonary function measure and FeNO, while others, including Moraxella to FEV1/FVC and Stenotrophomonas to FeNO, were associated with a single trait.ConclusionsUsing state-of-the-art metagenomic sequencing, we identified specific microorganisms in indoor dust related to pulmonary function and airway inflammation. Some were previously associated with respiratory conditions; others were novel, suggesting specific environmental microbial components contribute to various respiratory outcomes. The methods used are applicable to studying microbiome in relation to other continuous outcomes.3hzq1LfdnyTZVYvBm7QT8RVideo

Adult Child Financial Disadvantage and the Cognitive Trajectories Among Older Parents in the United States.

Adult child socioeconomic status (SES) has been identified as a predictor of older parents' cognitive aging. However, studies have primarily relied on educational attainment as the sole measure of adult child SES. We evaluated the relationship between adult children's financial disadvantage and cognitive outcomes of older parents in the United States. We used data from U.S. Health and Retirement Study (2000-2014, n = 15,053 respondents ≥51 years with at least 1 adult child). Adult child financial disadvantage was measured with 3 indicators of extremely low income, unemployment, and lack of homeownership. We used linear mixed models to estimate the association between adult child financial disadvantage and the rate of decline in verbal memory scores, controlling for respondents' sociodemographic characteristics. Having at least 1 adult child (vs no adult children) with extremely low income was found to be associated with lower verbal memory (b = -0.041, 95% confidence interval [CI]: -0.043, -0.039) at baseline. There was a small but significant association with the rate of decline in verbal memory z-scores (b = 0.004, 95% CI: 0.000, 0.008) and some evidence of heterogeneity by parent gender, marital status, and SES. Offspring financial disadvantage may be influential for older parents' initial level of memory function, although evidence of associations with memory decline was weak. Public policy interventions aimed at improving the economic conditions of adult children may indirectly benefit the cognitive performance of disadvantaged parents in theirlater life.

Beyond the mind: Understanding the influence of mental health on youth NEET status in Europe-A systematic literature review.

In the fields of labor market and education research, there is a vast interest in mental health factors affecting unsuccessful school-to-work transitions, dropout from school and labor market disconnections for young people. Young people who are not in employment, education or training are conceived of as NEET. To get an overview we conducted a systematic review of the present literature on the influence of mental health on the likelihood of becoming NEET in Europe. A Systematic literature search was conducted in four databases on February 21, 2023, with an update on January 15, 2024. 33,314 articles were screened whereas 41 studies involving 8,914,123 individuals were included. Poor mental health such as attention deficit hyperactive disorder, autism, depression, borderline, and psychosis during childhood and adolescence is strongly associated with becoming NEET. Mental health issues, whether mild or severe, heighten significant the risk of adverse education and employment outcomes in early adulthood, extending to young individuals with personality disorders, borderline personality disorder, and psychoses. These observations inform early intervention strategies for children and young people grappling with mental health challenges. Timely treatment is essential. Future research should focus on the gap in research like specific disorders such as eating disorders and anxiety.

Effectiveness of an interdisciplinary home care approach for older adults with chronic conditions: A systematic review and meta-analysis.

The effectiveness of interdisciplinary home healthcare service consisting of at least two or more healthcare providers, such as a nurse, physician and physiotherapist, for community-dwelling older adults remains unclear. This systematic review assesses the effects of interdisciplinary home care on quality of life (QOL) and health outcomes in older adults with chronic conditions using validated tools. Databases were searched using CINAHL Plus with Full Text, PubMed, EMBASE, CENTRAL, PsycINFO, and OpenGrey from inception to January 25, 2021. Eligibility criteria included (i) an interdisciplinary home care approach, (ii) participants aged 65 years and older with chronic conditions, (iii) randomized controlled trials (RCTs), and (iv) original literature in English. The study reviewer's dyad independently screened the literature and assessed the study quality using the Cochrane's Risk of Bias 2 tool. The analysis employed qualitative and quantitative integration and Grading of Recommendations Assessment, Development, and Evaluation. This study included 13 RCTs with 4709 participants. Four RCTs indicated that interdisciplinary home healthcare services reduced hospital admissions during the initial 6 months after the start of home care interventions (risk ratio [RR] = 0.73; 95% confidence interval [CI] = 0.61-0.88; p < 0.001; I2 = 0%). However, evidence certainty was moderate; QOL and mortality showed low certainty; and institutionalization and adherence showed moderate certainty of evidence. This study suggests that the interdisciplinary home care approach reduces hospital admissions but lacks effects on other outcomes. More robust studies are required to evaluate this evidence. Geriatr Gerontol Int 2024; ••: ••-••.

Virtual reality-based reminiscence therapy for older adults to improve psychological well-being and cognition: A systematic review.

Virtual reality-reminiscence therapy (VR-RT) has increasingly been applied to older adults to improve psychological well-being and cognition. This review aims to identify (1) the design characteristics of conducting a VR-RT and (2) the effects of VR-RT on the user experience, cognitive outcomes and psychological well-being. Systematic review. Eligible studies were sourced across nine electronic databases, trial registries, grey literature and hand-searching of the reference list. A narrative synthesis was conducted. Twenty-two studies were included, and most were appraised as high quality. Most of the VR-RTs were highly immersive and personalised, with participants having the autonomy of control. VR-RT has the potential to improve anxiety and depression, and cognitive outcomes for older adults. Overall, VR-RT was reported to be an enjoyable experience for older adults. VR-RT is a promising innovation that can improve older adults' psychological well-being and cognition without significant side effects, including cybersickness and with the potential for scalability across various settings. More randomised controlled studies are needed to evaluate the effectiveness of VR-RT and its features and treatment dosage. These studies could also examine the effectiveness of VR-RT as an intervention to promote independence in activities of daily living and physical rehabilitation. VR-RT is a promising intervention for older adults in community settings to enhance psychological well-being and cognition. VR's versatility enables personalised experiences within dynamic virtual environments, possibly enhancing engagement and therapeutic outcomes. This systematic review did not directly involve patient or public contribution to the manuscript.

Association between the level of social participation and depressive symptoms among older Japanese adults: a cross-sectional survey.

Social participation is recommended for older adults to remain actively involved in daily life. Social participation is a broad concept, ranging from 'interacting with others without doing a specific activity with them' to 'actively contributing to society.' However, previous studies have not taken into account the components of social participation. Depressive symptoms are significant outcomes in older adults. Social participation mitigates these risks owing to its association with reduced mortality and enhanced quality of life. This study aimed to examine the association between the level of social participation and depressive symptoms in community-dwelling older adults. We included 17 040 individuals aged ≥65 years. Social participation was categorised into Level 3, interacting with others without doing a specific activity with them; Level 4, engaging in an activity with others; Level 5, helping others; and Level 6, contributing to society, based on a previous study by Levasseur et al. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale. Logistic regression models were used to examine the association between the level of social participation and depressive symptoms. Overall, 15 069 older adults met the inclusion criteria. A higher level of social participation was associated with lower odds ratios (ORs) for depressive symptoms (Level 6 = OR: 0.43, 95% confidence interval (CI): 0.37-0.50; Level 5 = OR: 0.50, 95% CI: 0.41-0.60; and Level 4 = OR: 0.60, 95% CI: 0.52-0.69). Subgroup analyses based on age and sex yielded similar results across all participants. Among older adults in Japan, a higher level of social participation was associated with lower rates of depressive symptoms. The relationship between depressive symptoms and the levels of social participation may help develop measures to reduce or prevent depressive symptoms in older adults.

Bullying experiences in childhood and health outcomes in adulthood.

This study examines whether the experience of being bullied at school has a long-term impact on three health outcomes in adulthood in Japan: subjective health, mental health, and activity restriction due to health conditions. We employed a random effects model and the Karlson-Holm-Breen method to decompose the total effect of being bullied at school on health inequality into a direct effect and an indirect effect working through intervening factors including education, marriage, economic well-being, and social networks. We used the Japanese Life Course Panel Surveys 2007-2020 (waves 1-14), a nationally representative panel data set that includes 2,260 male and 2,608 female respondents. The results demonstrate that for both men and women, the direct effect of being bullied at school was strong and significant. Bullying experiences in childhood had a long-term impact on health outcomes in adulthood, regardless of social background and mediating factors of education, marriage, economic well-being, and social networks. Bullying victimization increased the risk of poor subjective health, low mental health scores, and activity restriction due to health conditions. Intervening factors (especially economic well-being and friendship) mediated the association between bullying experiences and all health outcomes, but their contributions were modest. Policy measures not only to prevent bullying during childhood but also to alleviate its negative consequences in adulthood should be considered to help people who have encountered adverse childhood experiences.

Joint and Individual Mitochondrial DNA Variation and Cognitive Outcomes in Black and White Older Adults.

Mitochondrial dysfunction manifests in neurodegenerative diseases and other age-associated disorders. In this study, we examined variation in inherited mitochondrial DNA (mtDNA) sequences in Black and White participants from 2 large aging studies to identify variants related to cognitive function. Participants included self-reported Black and White adults aged ≥70 years in the Lifestyle Interventions and Independence for Elders (LIFE; N = 1319) and Health Aging and Body Composition (Health ABC; N = 788) studies. Cognitive function was measured by the Digit-Symbol Substitution Test (DSST), and the Modified Mini-Mental State Examination (3MSE) at baseline and over follow-up in LIFE (3.6 years) and Health ABC (10 years). We examined the joint effects of multiple variants across 16 functional mitochondrial regions with cognitive function using a sequence kernel association test. Based on these results, we prioritized meta-analysis of common variants in Black and White participants using mixed effects models. A Bonferroni-adjusted p value of <.05 was considered statistically significant. Joint variation in subunits ND1, ND2, and ND5 of Complex I, 12S RNA, and hypervariable region (HVR) were significantly associated with DSST and 3MSE at baseline. In meta-analyses among Black participants, variant m.4216T>C, ND1 was associated with a faster decline in 3MSE, and variant m.462C>T in the HVR was associated with a slower decline in DSST. Variant m.5460G>C, ND2 was associated with slower and m.182C>T in the HVR was associated with faster decline in 3MSE in White participants. Among Black and White adults, oxidative phosphorylation Complex I variants were associated with cognitive function.

European Society of Cardiology quality indicators update for the care and outcomes of adults with heart failure. The Heart Failure Association of the ESC.

To update the European Society of Cardiology (ESC) quality indicators (QIs) for the evaluation of the care and outcomes of adults with heart failure. The Working Group comprised experts in heart failure including members of the ESC Clinical Practice Guidelines Task Force for heart failure, members of the Heart Failure Association, and a patient representative. We followed the ESC methodology for QI development. The 2023 focused guideline update was reviewed to assess the suitability of the recommendations with strongest association with benefit and harm against the ESC criteria for QIs. All the new proposed QIs were individually graded by each panellist via online questionnaires for both validity and feasibility. The existing heart failure QIs also underwent voting to 'keep', 'remove' or 'modify'. Five domains of care for the management of heart failure were identified: (1) structural QIs, (2) patient assessment, (3) initial treatment, (4) therapy optimization, and (5) patient health-related quality of life. In total, 14 'main' and 3 'secondary' QIs were selected across the five domains. This document provides an update of the previously published ESC QIs for heart failure to ensure that these measures are aligned with contemporary evidence. The QIs may be used to quantify adherence to clinical practice as recommended in guidelines to improve the care and outcomes of patients with heart failure.