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There is a current lack of consensus on defining metabolically healthy obesity (MHO). Limited data on dietary and lifestyle factors and MHO exist. The aim of this study is to compare the prevalence, dietary factors and lifestyle behaviours of metabolically healthy and unhealthy obese and non-obese subjects according to different metabolic health criteria. Cross-sectional sample of 1,008 men and 1,039 women aged 45-74 years participated in the study. Participants were classified as obese (BMI ≥ 30 kg/m(2)) and non-obese (BMI < 30 kg/m(2)). Metabolic health status was defined using five existing MH definitions based on a range of cardiometabolic abnormalities. Dietary composition and quality, food pyramid servings, physical activity, alcohol and smoking behaviours were examined. The prevalence of MHO varied considerably between definitions (2.2% to 11.9%), was higher among females and generally increased with age. Agreement between MHO classifications was poor. Among the obese, prevalence of MH was 6.8% to 36.6%. Among the non-obese, prevalence of metabolically unhealthy subjects was 21.8% to 87%. Calorie intake, dietary macronutrient composition, physical activity, alcohol and smoking behaviours were similar between the metabolically healthy and unhealthy regardless of BMI. Greater compliance with food pyramid recommendations and higher dietary quality were positively associated with metabolic health in obese (OR 1.45-1.53 unadjusted model) and non-obese subjects (OR 1.37-1.39 unadjusted model), respectively. Physical activity was associated with MHO defined by insulin resistance (OR 1.87, 95% CI 1.19-2.92, p = 0.006). A standard MHO definition is required. Moderate and high levels of physical activity and compliance with food pyramid recommendations increase the likelihood of MHO. Stratification of obese individuals based on their metabolic health phenotype may be important in ascertaining the appropriate therapeutic or intervention strategy.

Objective methods like accelerometers are feasible for large studies and may quantify variability in day-to-day physical activity better than self-report. The variability between days suggests that day of the week cannot be ignored in the design and analysis of physical activity studies. The purpose of this paper is to investigate the optimal number of days needed to obtain reliable estimates of weekly habitual physical activity using the wrist-worn GENEActiv accelerometer. Data are from a subsample of the Mitchelstown cohort; 475 (44.6% males; mean aged 59.6±5.5 years) middle-aged Irish adults. Participants wore the wrist GENEActiv accelerometer for 7-consecutive days. Data were collected at 100Hz and summarised into a signal magnitude vector using 60s epochs. Each time interval was categorised according to intensity based on validated cut-offs. Spearman pairwise correlations determined the association between days of the week. Repeated measures ANOVA examined differences in average minutes across days. Intraclass correlations examined the proportion of variability between days, and Spearman-Brown formula estimated intra-class reliability coefficient associated with combinations of 1-7 days. Three hundred and ninety-seven adults (59.7±5.5yrs) had valid accelerometer data. Overall, men were most sedentary on weekends while women spent more time in sedentary behaviour on Sunday through Tuesday. Post hoc analysis found sedentary behaviour and light activity levels on Sunday to differ to all other days in the week. Analysis revealed greater than 1 day monitoring is necessary to achieve acceptable reliability. Monitoring frame duration for reliable estimates varied across intensity categories, (sedentary (3 days), light (2 days), moderate (2 days) and vigorous activity (6 days) and MVPA (2 days)). These findings provide knowledge into the behavioural variability in weekly activity patterns of middle-aged adults. Since Sunday differed from all other days in the week this suggests that day of the week cannot be overlooked in the design and analysis of physical activity studies and thus should be included in the study monitoring frames. Collectively our data suggest that six days monitoring, inclusive of Saturday and Sunday, are needed to reliably capture weekly habitual activity in all activity intensities using the wrist-worn GENEActiv accelerometer.

This study aimed to assess the prevalence and persistence of key maternal morbidities - urinary incontinence, faecal incontinence, pelvic girdle pain, sexual health problems, depression, and anxiety - after the births of a first and second baby. Its longitudinal design distinguishes it from previous research by examining a range of morbidities over two childbirths and stratifying results based on women's prior health history. A prospective cohort of 3,047 nulliparous women completed surveys in early pregnancy and at 3, 6, 9, and 12-months postpartum after their first birth. Of these, 254 women who had a second baby and consented to follow-up completed additional surveys at 6-months and/or 12-months postpartum after their second baby's birth. Prevalence of each morbidity was reported at each time point, 3, 6, 9, 12-months after the first birth; and 6 and/or 12-months after the second birth. Persistence was defined as reporting the morbidity at 6 and/or 12-months after the first birth and again at 6 and/or 12-months after the second birth. Among 91 women reporting urinary incontinence after their first baby's birth, persistence was 100% (n = 5/5) for those who experienced it in the 12-months prior to their first pregnancy and 39.5% (n = 34/86) for those without (RR 2.53, 95% CI (1.95-3.29)). For pelvic girdle pain (n = 86), persistence was 98.1% (n = 52/53) who experienced it in the 12-months prior to their first pregnancy and 97.0% (n = 32/33) for those without (RR 1.01, 95% CI (0.94-1.09)). Sexual health problems persisted in 100% (n = 76/76) of those who experienced it in the 12-months prior to their first pregnancy versus 89.6% (n = 43/48) without (RR 1.12, 95% CI (1.02-1.23)). Depression persisted in 50% (n = 4/8) of those who experienced it in the 12 months prior to their first pregnancy versus 19.0% (n = 15/79) without (RR 2.63, 95% CI (1.15-6.03)); and anxiety persisted in 100% (n = 1/1) of those who experienced it in the 12-months prior to their first pregnancy versus 13.5% (n = 12/89) without anxiety (RR 7.42, 95% CI (4.38-12.55)). These findings underscore the need for early identification and intervention to mitigate long-term health issues, highlighting the importance of targeted pregnancy and postpartum care for women with prior maternal morbidities.

Alterations in the human intestinal microbiota are linked to conditions including inflammatory bowel disease, irritable bowel syndrome, and obesity. The microbiota also undergoes substantial changes at the extremes of life, in infants and older people, the ramifications of which are still being explored. We applied pyrosequencing of over 40,000 16S rRNA gene V4 region amplicons per subject to characterize the fecal microbiota in 161 subjects aged 65 y and older and 9 younger control subjects. The microbiota of each individual subject constituted a unique profile that was separable from all others. In 68% of the individuals, the microbiota was dominated by phylum Bacteroides, with an average proportion of 57% across all 161 baseline samples. Phylum Firmicutes had an average proportion of 40%. The proportions of some phyla and genera associated with disease or health also varied dramatically, including Proteobacteria, Actinobacteria, and FAECALIBACTERIA: The core microbiota of elderly subjects was distinct from that previously established for younger adults, with a greater proportion of Bacteroides spp. and distinct abundance patterns of Clostridium groups. Analyses of 26 fecal microbiota datasets from 3-month follow-up samples indicated that in 85% of the subjects, the microbiota composition was more like the corresponding time-0 sample than any other dataset. We conclude that the fecal microbiota of the elderly shows temporal stability over limited time in the majority of subjects but is characterized by unusual phylum proportions and extreme variability.

Suicide is a significant public health issue with almost one million people dying by suicide each year worldwide. Deliberate self harm (DSH) is the single most important risk factor for suicide yet few countries have reliable data on DSH. We developed a national DSH registry in the Republic of Ireland to establish the incidence of hospital-treated DSH at national level and the spectrum and pattern of presentations with DSH and repetition. Between 2003 and 2009, the Irish National Registry of Deliberate Self Harm collected data on DSH presentations to all 40 hospital emergency departments in the country. Data were collected by trained data registration officers using standard methods of case ascertainment and definition. The Registry recorded 75,119 DSH presentations involving 48,206 individuals. The total incidence rate fell from 209 (95% CI: 205-213) per 100,000 in 2003 to 184 (95% CI: 180-189) per 100,000 in 2006 and increased again to 209 (95% CI: 204-213) per 100,000 in 2009. The most notable annual changes were successive 10% increases in the male rate in 2008 and 2009. There was significant variation by age with peak rates in women in the 15-19 year age group (620 (95% CI: 605-636) per 100,000), and in men in the 20-24 age group (427 (95% CI: 416-439) per 100,000). Repetition rates varied significantly by age, method of self harm and number of previous episodes. Population-based data on hospital-treated DSH represent an important index of the burden of mental illness and suicide risk in the community. The increased DSH rate in Irish men in 2008 and 2009 coincided with the advent of the economic recession in Ireland. The findings underline the need for developing effective interventions to reduce DSH repetition rates as a key priority for health systems.

Long-term blood pressure variability (BPV) has been associated with cardiovascular events but the prognostic significance of short-term BPV remains uncertain, including its influence on the presence of target-organ damage, specifically left-ventricular hypertrophy. A meta-analysis exploring the correlation between short-term BPV and left-ventricular mass index was performed. Studies were identified by systematic searches in Pubmed and EMBASE. Any summary measure of short-term BPV obtained from ambulatory blood pressure monitoring was included. Twelve studies were included. Average real variability (ARV), s.d., weighted s.d. and coefficient of variation across 24 h/day/night periods were identified as measures of variability. Meta-analysis showed the pooled subgroup correlation coefficients of LVMI with 24 h systolic blood pressure (SBP) s.d., day SBP s.d., weighted s.d. SBP and 24 h ARV SBP were 0.22 (95% confidence interval (CI): 0.12-0.31), 0.19 (95% CI: 0.15-0.25), 0.23 (95% CI: 0.13-0.33), 0.37 (95% CI: 0.01-0.65), respectively. This meta-analysis suggests there is a weak positive correlation, between BPV and LVMI.

To estimate the 10-year risk of fatal cardiovascular disease (CVD) in the 40 to 69 year old general population in Germany stratified by sex and to analyze differences between socio-economic status (SES), region and community size in individuals without CVD. The analysis is based on the newly recalibrated SCORE Deutschland risk charts and considered other comorbidities for the classification of the high CVD risk group according to the guidelines of the European Society of Cardiology. In 3,498 participants (40-69 years) from the German Health Examination Survey for Adults 2008-2011 (DEGS1) without a history of CVD (myocardial infarction, coronary heart disease, heart failure, stroke) we estimated the proportion with a low (SCORE <1%), moderate (SCORE 1-<5%) and high 10-year CVD mortality risk (SCORE ≥5% or diabetes, renal insufficiency, SBP/DPB ≥180/110 mmHg or cholesterol >8 mmol/l). The prevalence of low, moderate and high risk was 42.8%, 38.5% and 18.8% in men and 73.7%, 18.1% and 8.2% in women. The prevalence of high risk was significantly lower in women with a high compared to a low SES (3.3% vs. 11.2%) and in communities with ≥100.000 inhabitants compared to <20.000 inhabitants (5.4% vs.10.9%). There were no significant associations between predicted CVD mortality risk and SES or community size in men and regions in men and women. Among the high risk group, 58.2% of men and 9.8% of women had SCORE ≥5%, leaving the majority of women (60.1%) classified as high risks due to diabetes and SCORE <5%. Our results suggest the persistence of socioeconomic disparities in predicted cardiovascular mortality in women and support the need of large-scale prevention efforts beyond individual lifestyle modification or treatment. Furthermore, the importance of additional comorbidities for the high risk group classification is highlighted.

Estimation of absolute risk of cardiovascular disease (CVD), preferably with population-specific risk charts, has become a cornerstone of CVD primary prevention. Regular recalibration of risk charts may be necessary due to decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for fatal CVD risk assessment were first calibrated for Germany with 1998 risk factor level data and 1999 mortality statistics. We present an update of these risk charts based on the SCORE methodology including estimates of relative risks from SCORE, risk factor levels from the German Health Interview and Examination Survey for Adults 2008-11 (DEGS1) and official mortality statistics from 2012. Competing risks methods were applied and estimates were independently validated. Updated risk charts were calculated based on cholesterol, smoking, systolic blood pressure risk factor levels, sex and 5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower according to the updated risk charts compared to the first calibration for Germany. In a nationwide sample of 3062 adults aged 40-65 years free of major CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated charts was lower by 29% and the estimated proportion of high risk people (10-year risk > = 5%) by 50% compared to the older risk charts. This recalibration shows a need for regular updates of risk charts according to changes in mortality and risk factor levels in order to sustain the identification of people with a high CVD risk.

Objective Poor-quality diet, regarded as an important contributor to health inequalities, is linked to adverse health outcomes. We investigated sociodemographic and lifestyle predictors of poor-quality diet in a population sample. Design A cross-sectional analysis of the Survey of Lifestyle, Attitudes and Nutrition (SLÁN). Diet was assessed using an FFQ (n 9223, response rate = 89 %), from which a dietary score (the DASH (Dietary Approaches to Stop Hypertension) score) was constructed. Setting General population of the Republic of Ireland. Subjects The SLÁN survey is a two-stage clustered sample of 10 364 individuals aged 18 years. Results Adjusting for age and gender, a number of sociodemographic, lifestyle and health-related variables were associated with poor-quality diet: social class, education, marital status, social support, food poverty (FP), smoking status, alcohol consumption, underweight and self-perceived general health. These associations persisted when adjusted for age, gender and social class. They were not significantly altered in the multivariate analysis, although the association with social support was attenuated and that with FP was borderline significant (OR = 1·2, 95 % CI 1·03, 1·45). A classical U-shaped relationship between alcohol consumption and dietary quality was observed. Dietary quality was associated with social class, educational attainment, FP and related core determinants of health. Conclusions The extent to which social inequalities in health can be explained by socially determined differences in dietary intake is probably underestimated. The use of composite dietary quality scores such as the DASH score to address the issue of confounding by diet in the relationship between alcohol consumption and health merits further study.

Background In the past decade, the Republic of Ireland has undertaken significant reconfiguration programmes to improve emergency services. During this time the public healthcare system experienced a large real decrease in resources. This study assesses national and regional population outcomes over the period 2002–2014, and whether changes coincide with system reconfiguration and the financial restrictions imposed by the 2008 recession. Methods Case fatality ratios (CFRs) were constructed for emergency conditions for 2002–2014. Total emergency conditions and individual condition trends were analysed nationally using joinpoint analysis. National results informed the investigation of trends at a regional and county level using an inverse standard error weighted generalised linear model with a log link to construct funnel plots. County-level CFRs were compared for the first and last 3 years of the period to further investigate the changes to county results over the 13 year period, specifically in comparison to the national-level CFR. Results Nationally, there was an annual fall in CFRs (2.1%). The decline was faster from 2002 to 2007 (annual percentage change = − 3.4; 95% CI-4.4, − 2.4), compared to 2007–2014 (annual percentage change = − 1.2; 95% CI -1.9, − 0.5). The South-East had a lower rate of decrease and the West had a higher rate. Cross sectional analysis of two periods (2002–2004 and 2012–2014) showed high consistency in the counties performance relative to the national CFR in both periods. Conclusion Change in the national trend coincided with the onset of economic stress on the public health system. Attributing the decline in CFR improvement to economic factors is weakened by the uneven nature of the trend change. No distinct pattern of change was identified among regions which underwent substantial reconfiguration of emergency services.