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Social frailty domains may play an important role in preventing physical decline and disability. The aim of this study is to examine the impact of social frailty as a risk factor for the future development of physical frailty among community-dwelling older adults who are not yet physically frail. A total of 1226 physically non-frail older adults were analyzed to provide a baseline. Participants completed a longitudinal assessment of their physical frailty 48 months later. Their baseline social frailty was determined based on their responses to five questions, which identified participants who went out less frequently, rarely visited friends, felt less like helping friends or family, lived alone and did not talk to another person every day. Participants with none of these characteristics were considered not to be socially frail; those with one characteristic were considered socially pre-frail; and those with two or more characteristics were considered socially frail. At the four-year follow-up assessment, 24 participants (2.0%) had developed physical frailty and 440 (35.9%) had developed physical pre-frailty. The rates of developing physical frailty and pre-frailty were 1.6% and 34.2%, respectively, in the socially non-frail group; 2.4% and 38.8%, respectively, in the socially pre-frail group; and 6.8% and 54.5%, respectively, in the socially frail group. Participants classified as socially frail at the baseline had an increased risk of developing physical frailty, compared with participants who were not socially frail (OR = 3.93, 95% CI = 1.02–15.15). Participants who were socially frail at the baseline also had an increased risk of developing physical pre-frailty (OR = 2.50, 95% CI = 1.30–4.80). Among independent community-dwelling older adults who are not physically frail, those who are socially frail may be at greater risk of developing physical frailty in the near future. Social frailty may precede (and lead to the development of) physical frailty.

Background: To determine the change in refractive error and the incidence of myopia among school-aged children in the Yongchuan District of Chongqing City, Western China. Methods: A population-based cross-sectional survey was initially conducted in 2006 among 3070 children aged 6 to 15 years. A longitudinal follow-up study was then conducted 5 years later between November 2011 and March 2012. Refractive error was measured under cycloplegia with autorefraction. Age, sex, and baseline refractive error were evaluated as risk factors for progression of refractive error and incidence of myopia. Results: Longitudinal data were available for 1858 children (60.5%). The cumulative mean change in refractive error was -2.21 (standard deviation [SD], 1.87) diopters (D) for the entire study population, with an annual progression of refraction in a myopic direction of -0.43 D. Myopic progression of refractive error was associated with younger age, female sex, and higher myopic or hyperopic refractive error at baseline. The cumulative incidence of myopia, defined as a spherical equivalent refractive error of -0.50 D or more, among initial emmetropes and hyperopes was 54.9% (95% confidence interval [CI], 45.2%-63.5%), with an annual incidence of 10.6% (95% CI, 8.7%-13.1%). Myopia was found more likely to happen in female and older children. Conclusions: In Western China, both myopic progression and incidence of myopia were higher than those of children from most other locations in China and from the European Caucasian population. Compared with a previous study in China, there was a relative increase in annual myopia progression and annual myopia incidence, a finding which is consistent with the increasing trend on prevalence of myopia in China.

Kidney transplant recipients have high cardiovascular risk, and vascular inflammation may play an important role. We explored whether the inflammatory state in the vessel wall was related to carotid intima-media thickness (c-IMT) and patient survival following kidney transplantation. In this prospective observational cohort study we measured c-IMT and expression of proinflammatory cytokines and adhesion molecules in the inferior epigastric artery in 115 kidney transplant candidates. Another c-IMT measurement was done 1-year post-transplantation in 107. By stepwise multiple regression analysis we explored factors associated with baseline c-IMT and their changes over time. Multivariate Cox regression analysis was constructed to identify risk factors for mortality. A worse cardiovascular profile (older age, smoker, diabetic, carotid plaque, systolic blood pressure and vascular calcification) and higher VCAM-1 levels were found in patients in the highest baseline c-IMT tertile, who also had a worse survival. Factors independently related to baseline c-IMT were age (β=0.369, P<0.0001), fasting glucose (β=0.168, P=0.045), smoking (β=0.228, P=0.003) and VCAM-1 levels (β=0.244, P=0.002). Independent factors associated with c-IMT measurement 1-year post-transplantation were baseline c-IMT (β=-0.677, P<0.0001), post-transplant diabetes (β=0.225, P=0.003) and triglycerides (β=0.302, P=0.023). Vascular VCAM-1 levels were associated with increased risk of mortality in bivariate and multivariate Cox regression. Notably, nearly 50% of patients showed an increase or maintenance of high c-IMT 1 year post-transplantation and these patients experienced a higher mortality (13 versus 3.5%; P=0.021). A worse cardiovascular profile and a higher vascular VCAM-1 protein levels at time of KT are related to subclinical atheromatosis. This could lead to a higher post-transplant mortality. Pre-transplant c IMT, post-transplant diabetes and triglycerides at 1-year post-transplantation may condition a high c-IMT measurement post-transplantation, which may decrease patient survival.

Urinary and defecatory dysfunction (UDD) is a significant concern among the aging population in China. However, there is a lack of longitudinal research exploring the risk factors of UDD severity in Chinese older adults. This study uses data from the China Health and Retirement Longitudinal Study spanning 2011 to 2020 to explore UDD risk factors in the middle-aged and older adult Chinese population, focusing on epidemiological characteristics and potential influences on severity. A longitudinal cohort of over 10,000 participants from the China Health and Retirement Longitudinal Study was analyzed across 5 waves using Bayesian logistic regression. This analysis examined associations between UDD severity and factors including demographic, lifestyle, and health-related factors, including comorbidities, BMI, and handgrip strength. Higher UDD prevalence was observed among female population, older adults, those with low education levels, and rural residents. Depression, arthritis, and low handgrip strength emerged as critical predictors of severe UDD. Additionally, abnormal BMI, both underweight (odds ratio [OR] 3.019, 95% CI 1.484-5.951; P=0.002) and obesity (OR 2.697, 95% CI 1.338-5.217; P=0.005), was strongly linked to increased severity and persistence of UDD. Participants aged 66 years and older exhibited the highest UDD prevalence, with both underweight and obese individuals facing the greatest risk of persistent and worsening symptoms. This study is the first to longitudinally examine the risk factors of UDD severity in China's middle-aging and aging population. The findings underscore the need for targeted interventions focusing on muscle strength rehabilitation and comorbidity management to mitigate UDD progression, contributing to improved quality of life for older individuals.

The rapid advancement of digital technologies has profoundly transformed communication practices. However, this technological revolution has also led to \"digital isolation,\" a form of social disconnection caused by limited or absent engagement with digital communication tools, including smartphones, computers, email, and the internet. This issue is particularly concerning for older adults, as it may increase their likelihood of developing mental health disorders, with depression being a primary concern. Although digital isolation has been studied less frequently than traditional social isolation, it may be a significant contributor to both the initiation and progression of depression in this population. This investigation seeks to assess longitudinal relationships between multidimensional digital disengagement (encompassing 4 dimensions: mobile device use, computer interaction, electronic correspondence, and web-based engagement) and incident depression among older adults, using longitudinal data from the nationally representative National Health and Aging Trends Study (NHATS). The analysis was conducted based on the NHATS dataset, a nationally representative longitudinal survey using multistage sampling to represent community-dwelling Medicare beneficiaries aged 65 years and older in the United States. We analyzed data from 2011 (Round 1) to 2018 (Round 8), including 8199 participants in the discovery and validation cohorts. Digital isolation was measured using a 4-item index based on self-reported nonuse of mobile phones, computers, email, and the internet. Participants were categorized into high (aggregate score ≥3) or low (aggregate score ≤2) digital isolation groups. Weighted Cox regression models with proportional hazards assumptions were used to quantify longitudinal associations between the digital isolation index (and its individual components) and incident depression, incorporating multivariable adjustment for sociodemographic characteristics (age, sex, and race or ethnicity), socioeconomic indicators (education level, family income, and marital status), and clinical profiles (tobacco use history and multimorbidity burden). Time-to-event analyses were visualized through Kaplan-Meier estimators, complemented by prespecified subgroup analyses evaluating effect modification patterns through interaction term testing. A high level of digital isolation, as measured by the composite index, was associated with a significantly greater risk of incident depression (fully adjusted model: hazard ratio 1.35, 95% CI 1.18-1.55; P<.001). Furthermore, analysis of the individual components showed that nonuse of computers, email, and the internet was each significantly associated with a higher depression risk, whereas mobile phone isolation had a weaker, nonsignificant association. The study revealed a robust association between increased digital isolation and a higher likelihood of depression in the older population. These results underscore the importance of implementing tailored public health strategies to address digital isolation, especially for older adults. To minimize its detrimental effects on mental health, policymakers should encourage digital literacy programs and strengthen mental health services.

Background Evidence on the association between multimorbidity and cognitive impairment in Chinese older population is limited. In addition, whether a healthy lifestyle can protect cognitive function in multimorbid older population remains unknown. Methods A total of 6116 participants aged ≥ 65 years from the Chinese Longitudinal Healthy Longevity Survey were followed up repeatedly. The number of coexisting chronic diseases was used for assessing multimorbidity and cardiometabolic multimorbidity. Three lifestyle statuses (unhealthy, intermediate, and healthy) were defined based on a lifestyle score covering smoking, alcohol drinking, body mass index, outdoor activities, and dietary pattern. Cognitive impairment was defined as the Mini-Mental State Examination score < 24. A modified Poisson regression model with robust error variance was used to assess the associations between multimorbidity, healthy lifestyle, and cognitive impairment. Results During a median follow-up period of 5.8 years, 1621 incident cases of cognitive impairment were identified. The relative risk (RR) of cognitive impairment associated with heavy multimorbidity burden (≥ 3 conditions) was 1.39 (95% confidence interval: 1.22–1.59). This association declined with age, with RRs being 3.08 (1.78–5.31), 1.40 (1.04–1.87), and 1.19 (1.01–1.40) in subjects aged < 70 years, ≥ 70 and < 80 years, and ≥ 80 years, respectively (P for interaction = 0.001). Compared to unhealthy lifestyle, a healthy lifestyle was related to an approximately 40% reduced risk of cognitive impairment regardless of multimorbidity burden. Among the 5 lifestyle factors assessed, daily outdoor activities and a healthy dietary pattern showed convincing protective effects on cognitive function. Conclusions The relationship between multimorbidity and cognitive impairment is age-dependent but remains significant in the population aged 80 years or older. A healthy lifestyle may protect cognitive function regardless of the multimorbidity burden. These findings highlight the importance of targeting individuals with heavy multimorbidity burden and promoting a heathy lifestyle to prevent cognitive impairment in Chinese older population.

Alcohol consumption, smoking and mood disorders are leading contributors to the global burden of disease and are highly comorbid. Yet, their interrelationships have remained elusive. The aim of this study was to examine the multi-cross-sectional and longitudinal associations between (change in) smoking and alcohol use and (change in) number of depressive symptoms. In this prospective, longitudinal study, 6646 adults from the general population were included with follow-up measurements after 3 and 6 years. Linear mixed-effects models were used to test multi-cross-sectional and longitudinal associations, with smoking behaviour, alcohol use and genetic risk scores for smoking and alcohol use as independent variables and depressive symptoms as dependent variables. In the multi-cross-sectional analysis, smoking status and number of cigarettes per day were positively associated with depressive symptoms ( < 0.001). Moderate drinking was associated with less symptoms of depression compared to non-use ( = 0.011). Longitudinally, decreases in the numbers of cigarettes per day and alcoholic drinks per week as well as alcohol cessation were associated with a reduction of depressive symptoms ( = 0.001-0.028). Results of genetic risk score analyses aligned with these findings. While cross-sectionally smoking and moderate alcohol use show opposing associations with depressive symptoms, decreases in smoking behaviour as well as alcohol consumption are associated with improvements in depressive symptoms over time. Although we cannot infer causality, these results open avenues to further investigate interventions targeting smoking and alcohol behaviours in people suffering from depressive symptoms.

Abstract Study Objectives To identify sleep multi-trajectories in children from age 1 to 5.5 years and their early correlates. Methods We collected early family, maternal, and child characteristics, including children’s nighttime sleep duration (NSD) and daytime sleep duration (DSD), night waking (NW), and sleep-onset difficulties (SOD), by parental phone interviews at age 2 months and 1-, 2-, 3.5-, and 5.5 years. Group-based multi-trajectory modeling identified sleep multi-trajectory groups. Multinomial logistic regression assessed associations with early factors. Results We identified five distinct sleep multi-trajectory groups for NSD, DSD, NW, and SOD in 9273 included children. The “Good sleepers” (31.6%) and “Long sleepers” (31.0%) groups had low NW and SOD prevalence and shorter NSD but longer DSD in “Good sleepers” than in “Long sleepers.” The “Good sleepers but few SOD” group (10.3%) had long NSD and DSD but a SOD peak at age 3.5 years; the “Improving NW and SOD” group (9.6%) showed short but rapidly increasing NSD to a plateau and high but decreasing NW and SOD; the “Persistent NW and SOD” group (17.5%) had persistent high NW and SOD. Maternal depression during pregnancy and sleep habits at age 1 (e.g. parental presence or feeding to fall asleep, sleeping at least part of the night away from own bed) were common risk factors associated with the most disordered sleep multi-trajectory groups. Conclusions We identified distinct sleep multi-trajectory groups and early life-associated factors in preschoolers. Most of the factors associated with the most sleep-disordered multi-trajectory groups are likely modifiable and provide clues for early prevention interventions. Graphical Abstract

BackgroundThe extensive heterogeneity between patients with amyotrophic lateral sclerosis (ALS) complicates the quantification of disease progression. In this study, we determine the value of remote, accelerometer-based monitoring of physical activity in patients with ALS.MethodsThis longitudinal cohort study was conducted in a home-based setting; all study materials were sent by mail. Patients wore the ActiGraph during waking hours for 7 days every 2–3 months and provided information regarding their daily functioning (ALSFRS-R). We defined four accelerometer-based endpoints that either reflect the average daily activity or quantify the patient’s physical capacity.ResultsA total of 42 patients participated; the total valid monitoring period was 9288 h with a 93.0% adherence rate. At baseline, patients were active 27.9% (range 11.6–52.4%) of their time; this declined by 0.64% (95% 0.43–0.86, p < 0.001) per month. Accelerometer-based endpoints were strongly associated with the ALSFRS-R (r 0.78, 95% CI 0.63–0.92, p < 0.001), but showed less variability over time than the ALSFRS-R (coefficient of variation 0.64–0.81 vs. 1.06, respectively). Accelerometer-based endpoints could reduce sample size by 30.3% for 12-month trials and 44.6% for 18-month trials; for trials lasting less than 9 months, the ALSFRS-R resulted in smaller sample sizes.ConclusionAccelerometry is an objective method for quantifying disease progression, which could obtain real-world insights in the patient’s physical functioning and may personalize the delivery of care. In addition, remote monitoring provides patients with the opportunity to participate in clinical trials from home, paving the way to a patient-centric clinical trial model.

Mismatch negativity (MMN) amplitude is reduced in psychotic disorders and associated with symptoms and functioning. Due to these robust associations, it is often considered a biomarker for psychotic illness. The relationship between MMN and clinical outcomes has been examined well in early onset psychotic illness; however, its stability and predictive utility in chronic samples are not clear. We examined the five-year stability of MMN amplitude over two timepoints in individuals with established psychotic disorders (cases; = 132) and never-psychotic participants (NP; = 170), as well as longitudinal associations with clinical symptoms and functioning. MMN amplitude exhibited good temporal stability (cases, = 0.53; never-psychotic, = 0.52). In cases, structural equation models revealed MMN amplitude to be a significant predictor of worsening auditory hallucinations ( = 0.19), everyday functioning ( = -0.13), and illness severity ( = -0.12) at follow-up. Meanwhile, initial IQ ( = -0.24), negative symptoms ( = 0.23), and illness severity ( = -0.16) were significant predictors of worsening MMN amplitude five years later. These results imply that MMN measures a neural deficit that is reasonably stable up to five years. Results support disordered cognition and negative symptoms as preceding reduced MMN, which then may operate as a mechanism driving reductions in everyday functioning and the worsening of auditory hallucinations in chronic psychotic disorders. This pattern may inform models of illness course, clarifying the relationships amongst biological mechanisms of predictive processing and clinical deficits in chronic psychosis and allowing us to better understand the mechanisms driving such impairments over time.