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Metabolic disorders, as a global burden, have a detrimental effect on individuals’ health status, regardless of their weight. We aimed to assess the link between diet-related behaviors and metabolic health status as well as serum levels of adropin and brain-derived neurotrophic factor (BDNF). A cross-sectional investigation involving 527 adults with ages of 20 and 65 years was carried out in Isfahan, Iran. Using a pre-tested questionnaire, dietary habits were assessed in five domains including meal pattern, eating rate, meal-to-sleep interval, intra-meal fluid intake, and fatty food intake. To identify these dietary behaviors, latent class analysis was performed. Based on the lipid and glycemic profile, inflammation status, and insulin resistance (IR), participants were classified as having either metabolically healthy (MH) or metabolically unhealthy (MU) status. Serum concentrations of BDNF and adropin were evaluated by obtaining a blood sample from participants after an overnight fast. Metabolic unhealthy normal-weight and overweight/obese status were respectively prevalent in 8.7% and 33.8% of study population. We recognized three distinct eating rate classes: ‘moderate’, ‘fast’, and ‘slow’; two major meal pattern classes: ‘regular’ and ‘irregular’; two main meal-to-sleep interval classes: ‘short’ and ‘long’; two intra-meal fluid intake classes: ‘moderate’ and ‘more’; and two major fatty food intake classes: ‘high’ and ‘low’. After controlling for potential confounders, slow eating rate was related to lower odds of MU profile (OR=0.39, 95% CI: 0.17-0.91). Moreover, fast eating rate was positively associated with hyperglycemia (OR=3.55, 95% CI: 1.48-8.51). More intra-meal fluid intake was also associated with higher chance of MU profile (OR=2.21, 95% CI: 1.35-3.63), high HOMA-IR (OR=2.20, 95% CI: 1.06-4.58), hypertriglyceridemia (OR=2.23, 95% CI: 1.36-3.65), and hypertension (OR=1.66, 95% CI: 1.03-2.69). Serum BDNF or adropin was not associated with classes of diet-related habits. More intra-meal fluid intake was linked to higher chance of having MU profile, while slow eating rate was related to decreased odds of MU profile among Iranian adults.
Cohort studies of individuals with a suicide attempt are crucial for identifying risk and protective factors to prevent recurrence. The SURVIVE prospective cohort study aims to investigate the demographic and clinical profiles of individuals presenting with suicidal behaviour.
Methods
A total of 1,741 individuals (289 adolescents aged 12–17 and 1,443 adults aged 18 and older) were recruited from emergency departments at eight hospitals across five Spanish regions following a suicide attempt. Baseline data were collected using structured clinical interviews and validated self-report instruments. Sociodemographic and psychiatric variables were analysed.
Results
Most participants were female, and approximately 20% were migrants. Religious affiliation was reported by 35.6% of adolescents and 48.4% of adults. Depression and anxiety were the most prevalent psychiatric diagnoses, while trauma-related and eating disorders were more frequent in adolescents, and substance use disorders in adults. Non-suicidal self-injury was reported by 76.6% of adolescents and 40.1% of adults. The most common method of attempt was self-poisoning in both groups. Psychotropic medication use was widespread, with both groups receiving a similar number of prescriptions.
Conclusions
The SURVIVE study provides a detailed characterization of suicide attempters in Spain, highlighting age-specific clinical patterns and contextual risk factors such as migration and religion. These findings underscore the need for tailored prevention strategies that consider developmental stage, psychiatric comorbidity, and social vulnerability.
Smoking has been confirmed to induce systemic inflammation and oxidative stress (OS) and is associated with higher odds of chronic obstructive pulmonary disease (COPD). Dietary antioxidants can reduce inflammation and OS. This study seeks to score the dietary antioxidant intake and then assess its impact on the association between smoking and COPD in adults. The data extracted from the 2007–2012 National Health and Nutrition Examination Survey database were used. The Dietary Antioxidant Quality Score (DAQS) was evaluated by the total intake of vitamins A, C and E, Se, Zn and Mg in the daily diet. Smoking was used as the exposure variable and COPD as the outcome variable. Weighted multivariable logistic regression was conducted to evaluate the associations of DAQS with smoking and COPD, as well as their joint effects on the odds of COPD. The relationships between dietary antioxidant quality score, smoking status and COPD were subsequently assessed. Subgroup analyses were performed to explore associations between relevant covariates and smoking and COPD across DAQS strata. Current smoking was found to be linked to COPD (OR = 4·06, 95 % CI = 3·14, 5·27) in comparison to never smoking. Among smokers, significant associations were observed in both the medium-quality DAQS group (OR = 3·48, 95 % CI: 2·34, 5·17) and the low-quality DAQS group (OR = 5·60, 95 % CI: 3·58, 8·76). In conclusion, high DAQS levels are inversely related to the odds of COPD in adult smokers. Our findings provide valuable insights for management strategies for COPD.
This study examined gaps in adherence to preventive care recommendations for adults with Down Syndrome (DS) in Connecticut and explored the underlying factors collecting caregiver and primary care physician (PCP) perspectives.
Background:
Primary healthcare plays a vital role in preventing health issues. Despite well-defined clinical guidelines for adults with DS, studies show gaps in preventive care delivery for this population.
Methods:
A mixed-methods study included chart reviews, a focus group and a survey of PCPs. Chart reviews examined records of adults with DS who received care between January 1, 2017, and December 31, 2022, for adherence to recommended preventive services. The focus group explored caregivers’ experiences with preventive care, and the survey assessed PCPs’ knowledge of prevention needs for adults with DS.
Findings:
Chart reviews of 241 adults with DS found low adherence to preventive care guidelines. Only 2.1% met the wellness visit benchmark, and 30.7% met the thyroid test benchmark. Themes from the caregiver focus group included challenges accessing care, clinicians’ lack of DS-specific knowledge and difficulties maintaining health and wellness outside the office setting. Of 81 PCPs surveyed, most reported feeling inadequately prepared to care for adults with DS. Only 27% reported relevant training, and 53% were unaware of annual thyroid function test recommendations.
Results and Conclusions:
The study reveal gaps in preventive care for adults with DS and underlying reasons from a caregiver and provider perspective. Further analysis of care for adults with DS and targeted interventions will contribute to improved preventive care for this population.
This study is the first study in Middle Eastern population that aimed to investigate the association between global diet quality score (GDQS) and risk of hypertension (HTN) in Iranian adults.
Design:
This population-based cohort study was conducted on 5718 individuals aged ≥ 18 years from the third and fourth Tehran Lipid and Glucose Study surveys, who were followed until the sixth survey (mean follow-up: 7·8 years). Dietary data were collected using a validated FFQ to calculate GDQS as a novel food-based metric designed to assess diet quality across diverse populations. It evaluates the adequacy of healthy food groups (e.g. fruits, vegetables and whole grains) while monitoring the moderation of unhealthy or excessive intake (e.g. refined grains, processed meats and sugary foods).
Setting:
Tehran Lipid and Glucose Study.
Participants:
Iranian men and women.
Results:
Participants had a mean (sd) age of 37·7 (sd 12·8) years, BMI of 26·6 (sd 4·7) kg/m2 and GDQS of 25·3 (sd 4·4). During the 7·8-year follow-up, 1302 (18 %) new cases of HTN were identified. Higher GDQS and its healthy components were associated with reduced HTN risk (hazard ratio (HR): 0·83; 95 % CI: 0·70, 0·98; Ptrend = 0·034 and HR: 0·78; 95 % CI: 0·65, 0·92; Ptrend = 0·005, respectively), while unhealthy components of GDQS showed no association with HTN risk (HR: 1·14; 95 % CI: 0·98, 1·33; Ptrend = 0·059). These protective associations were observed across all weight categories and both genders, with stronger effects among obese individuals (for GDQS: HR: 0·75; 95 % CI: 0·58, 0·98; P = 0·041; for healthy components: HR: 0·75; 95 % CI: 0·57, 0·99; P = 0·044) and females (for GDQS: HR: 0·77; 95 % CI: 0·62, 0·97; P = 0·028; for healthy components: HR: 0·76; 95 % CI: 0·60, 0·96; P = 0·023).
Conclusions:
A higher GDQS was associated with a reduced risk of incident HTN among Iranian adults. Adherence to a high-quality diet, particularly focusing on the healthy dietary components of GDQS, may serve as an effective strategy for preventing HTN, especially among obese individuals and women.
Promoting fruit and vegetable (F&V) consumption is a public health priority. This study assessed compliance with the international recommendation of consuming at least 400g of F&V daily among Mexican adults and analysed its association with the five stages of behaviour change from the Transtheoretical Model (Precontemplation, Contemplation, Preparation for action, Action, and Maintenance). Using data from 5203 adults (ages 20–59) in the 2016 National Health and Nutrition Survey, dietary intake was collected via a food frequency questionnaire. Compliance was defined dichotomously (Yes/No), and readiness to change was assessed using a specific survey module. Multiple logistic regression models examined the association between stages of change and compliance, adjusting for demographic, socioeconomic, and health characteristics, as well as perceived barriers and self-efficacy. Nationally, 26.3% of adults met the F&V recommendation. Compliance was significantly higher among individuals in the Preparation for action (OR 3.62, 95% CI: 1.82–7.19), Action (OR 4.50, 95% CI: 1.8–11.25), and Maintenance (OR 9.54, 95% CI: 4.76–19.13) than those in the Precontemplation stage. Higher compliance was also significantly associated with greater self-efficacy (OR 1.86, 95% CI: 1.4–2.47), being in the highest socioeconomic tertile (OR 1.71, 95% CI: 1.25–2.33), and living in the central region (OR 1.70, 95% CI: 1.18–2.45). Conversely, individuals reporting a dislike for vegetables were less likely to meet recommendations (OR 0.67, 95% CI: 0.48–0.94). These findings highlight the value of developing stage-tailored interventions that consider both psychological and structural barriers to improve F&V consumption.
Understanding how suicide rates vary across age, sex, and geography is essential to designing effective prevention strategies. We examined long-term trends in suicide mortality across European countries over three decades, with a focus on age-specific trajectories.
Methods
Using the WHO mortality database, we computed annual sex- and age-specific suicide rates (10–14 to 85+ age groups) from 1990 to 2022, for the most populous European countries, and aggregated rates for the EU-27 and four geographical areas (North, West, South, and Centre-East Europe). We also calculated percentage differences across four time periods (1990–1994, 2000–2004, 2010–2014, and 2020–2022), according to data availability.
Results
Suicide rates increased with age, peaking in older individuals (85+) in most countries (e.g., 82.0/100,000 in France in 2020–2022, 77.1/100,000 in Germany among males, in 2020), except in the UK and Northern Europe, where rates peaked at middle age (∼22/100,000 at 45–49, in 2020). EU-27 suicide rates in 2020 ranged from 5.5/100,000 (age 15–19) to 58.2/100,000 (85+) among males, and from 2.6 (15–19) to 8.6/100,000 (85+) among females. Male suicide rates were 3 to 8 times higher than female rates across all ages. While overall rates declined since 1990 in most countries, youth suicide increased after 2010 in Western (e.g., +12%, girls 15–19), Southern (+24.5%, girls 15–19), and Northern (+44%, girls 15–19 and 20–24) Europe. Rates among young and middle-aged adults recently rose in Spain, the UK, and Northern Europe, while they declined in Eastern Europe after the 1990s.
Conclusions
Despite overall declines, our findings highlight marked heterogeneity in sex- and age-specific trends in suicide mortality across Europe. These patterns call for age-tailored prevention strategies that address evolving psychosocial stressors and structural determinants across the lifespan.
The Body Image Matrix of Thinness and Muscularity (BIMTM; Arkenau et al., 2020; Steinfeld et al., 2020) is a figure rating scale that assesses perceptual body image. It is available in two separate versions, one for men (BIMTM-Male Bodies) and one for women (BIMTM-Female Bodies). It consists of an 8 x 8 grid with 64 colored and realistic-looking figures of White men or women that vary in body fat along the horizontal axis and muscle mass along the vertical axis. The BIMTM can be administered online or in-person to adults and is free to use. This chapter first discusses the development of the BIMTM and then provides evidence of its psychometrics with men and women. A two-dimensional (body fat and muscularity) is assumed. Test-retest reliability, ecological validity, convergent validity, and criterion validity support the use of both the male and female versions of the BIMTM. This chapter provides the BIMTM in its entirety, as well as its instructions for administration and scoring. Logistics of use, such as permissions, copyright, and citation information, are also provided for readers.
The 26-item Body Dissatisfaction Scale for Adults (BDS; Tariq & Ijaz, 2015) assesses dissatisfaction with different parts of body. The BDS can be administered online and/or in-person to young adults, and adults and is free to use in any setting. This chapter first discusses the development of the BDS and then provides evidence of its psychometrics. More specifically, the BDS has been found to have 4-factor structure for males and 3- factor structure for females within exploratory factor analyses and has been found to be mostly invariant across different cultures and languages (except 1 item). Internal consistency reliability, test-retest reliability, and concurrent validity, support the use of the BDS. Next, this chapter provides the BDS items in their entirety, instructions for administering the BDS to participants, the item response scale, and the scoring procedure. Logistics of use, such as permissions, copyright, and contact information, are provided for readers.
The Social Physique Anxiety Scale (SPAS) is a 12-item self-report questionnaire designed to measure social physique anxiety, a subtype of anxiety related to concerns about others observing or evaluating one’s body (Hart et al., 1989). The SPAS can be administered online or in-person to adolescents and adults and is free to use in any setting. The SPAS, originally unidimensional, has undergone several revisions to address factor structure and gender invariance, resulting in abbreviations with 7, 8, and 9 items. Reliability estimates for SPAS and its variations vary, with Cronbach’s alpha ranging from the high .60s to the low .90s, and test-retest reliability reaching .94. Convergent validity, discriminant validity, and criterion-related validity support the use of the SPAS. The 12-item SPAS, instructions for administration, the item response scale, and the scoring procedure are provided. Citations for abbreviated versions and known translations are provided. Logistics of use, such as permissions, copyright, and contact information, are provided for readers.
This study aims to provide an overview of evidence on factors affecting Mediterranean diet (MD) adherence across socio-ecological levels (individual, interpersonal and environmental) in Mediterranean countries, which can be target points for future interventions to promote MD adherence.
Design:
A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines and registered in the Prospero database (CRD42020189337). Literature was searched in PubMed, Web of Science and PsycINFO.
Setting:
The MD is one of the healthiest dietary patterns, reducing risk of chronic disease while promoting better health outcomes. However, adherence to the MD remains challenging, even in Mediterranean countries.
Participants:
Healthy adults aged 18 years and older, living in a Mediterranean country.
Results:
A total of thirty-seven cross-sectional studies were included, with 190 to 13 262 participants. Most studies (30/37) were conducted in European Mediterranean countries, primarily Italy (n 14), Spain (n 9) and Greece (n 6). All studies involved community-based samples; two studies included only women. Individual-level determinants were the most frequently examined. Higher socio-economic status, regular breakfast consumption, being unemployed, a job seeker or retired were linked to better MD adherence. Socio-cognitive and interpersonal factors were underexplored. At the environmental level, COVID-19 confinement boosted adherence, whereas the effects of economic crises were inconsistent. Effect sizes were mostly very small to small, and findings are based on low-quality studies.
Conclusions:
This systematic review highlighted several socio-economic and environmental factors potentially influencing MD adherence. However, more robust research is needed to better understand socio-cognitive and ecological factors.
The study aimed to develop and validate a food literacy tool for Tanzanian adults. The Tanzanian nutrition, food and health promotion experts evaluated the initial twenty-three-question food literacy tool for its relevance to the context, where its content validity was determined. The construct validity involved the analysis of food literacy information collected in a cross-sectional study involving 709 adults (484 females and 225 males) sampled from rural and urban Tanzania. Exploratory factor analysis was conducted to explore the underlying factor structure and identify the number of latent constructs. A confirmatory factor analysis using structural equation modelling verified the measurement model and confirmed the theoretical model’s validity and reliability. The descriptive statistics summarised the essential characteristics of the study sample. The final tool remained with fourteen questions after removing questions with low factor loadings < 0·5 and higher uniqueness above 0·60. The model achieved construct validity through convergent and discriminant validity and construct reliability through the composite reliability exceeding 0·60 and a Cronbach’s α value of 0·83 and above. The fourteen-question food literacy tool has been reviewed and evaluated by experts in food, nutrition and public health; therefore, it is a valid measure of food literacy among adults in Tanzania. It is suitable for designing nutrition education programmes and ensures accurate and reliable measurements for effective interventions and policy actions.
Because of the complexity of Alzheimer’s Disease (AD) clinical presentations across bio-psycho-social domains of functioning, data-reduction approaches, such as latent profile analysis (LPA), can be useful for studying profiles rather than individual symptoms. Previous LPA research has resulted in more precise characterization and understanding of patients, better clarity regarding the probability and rate of disease progression, and an empirical approach to identifying those who might benefit most from early intervention. Whereas previous LPA research has revealed useful cognitive, neuropsychiatric, or functional subtypes of patients with AD, no study has identified patient profiles that span the domains of health and functioning and that also include motor and sensory functioning.
Methods:
LPA was conducted with data from the Advancing Reliable Measurement in Alzheimer’s Disease and cognitive Aging study. Participants were 209 older adults with amnestic mild cognitive impairment (aMCI) or mild dementia of the Alzheimer’s type (DAT). LPA indicator variables were from the NIH Toolbox® and included cognitive, emotional, social, motor, and sensory domains of functioning.
Results:
The data were best modeled with a 4-profile solution. The latent profiles were most differentiated by indices of social and emotional functioning and least differentiated by motor and sensory function.
Conclusions:
These multi-domain patient profiles support and extend previous findings on single-domain profiles and highlight the importance of social and emotional factors for understanding patient experiences of aMCI/DAT. Future research should investigate these profiles further to better understand risk and resilience factors, the stability of these profiles over time, and responses to intervention.
This study investigated the factors influencing the mental health of rural doctors in Hebei Province, to provide a basis for improving the mental health of rural doctors and enhancing the level of primary health care.
Background:
The aim of this study was to understand the mental health of rural doctors in Hebei Province, identify the factors that influence it, and propose ways to improve their psychological status and the level of medical service of rural doctors.
Methods:
Rural doctors from 11 cities in Hebei Province were randomly selected, and their basic characteristics and mental health status were surveyed via a structured questionnaire and the Symptom Checklist-90 (SCL-90). The differences between the SCL-90 scores of rural doctors in Hebei Province and the Chinese population norm, as well as the proportion of doctors with mental health problems, were compared. Logistic regression was used to analyse the factors that affect the mental health of rural doctors.
Results:
A total of 2593 valid questionnaires were received. The results of the study revealed several findings: the younger the rural doctors, the greater the incidence of mental health problems (OR = 0.792); female rural doctors were more likely to experience mental health issues than their male counterparts (OR = 0.789); rural doctors with disabilities and chronic diseases faced a significantly greater risk of mental health problems compared to healthy rural doctors (OR = 2.268); rural doctors with longer working hours have a greater incidence of mental health problems; and rural doctors with higher education backgrounds have a higher prevalence of somatization (OR = 1.203).
Conclusion:
Rural doctors who are younger, male, have been in medical service longer, have a chronic illness or disability, and have a high degree of education are at greater risk of developing mental health problems. Attention should be given to the mental health of the rural doctor population to improve primary health care services.
This chapter provides an up-to-date review of the literature on the phonetic and phonological patterns of Welsh and their development. While typically developing children’s acquisition constitutes a major component, it also discusses socio-phonetic variation and adult second language acquisition, thereby approaching Welsh speech development from a lifespan perspective. The chapter is structured in four major sections. The first section introduces the reader to the segmental and suprasegmental properties of the two main varieties of Welsh: Northern and Southern Welsh. Subsequently, the second section considers methodological aspects of studies on Welsh phonology, while the third section focuses on children’s development of Welsh speech patterns, starting with evidence from studies on early word productions before moving on to a discussion of consonant and consonant cluster acquisition in preschool and school-aged children. The section concludes with an account of developmental error patterns. The final major section then reviews the literature on the speech patterns of different groups of Welsh speakers and the role that extra-linguistic variables, such as sex/gender and language dominance, play in shaping these. Finally, studies on the Welsh accents of second language learners will be discussed. The chapter concludes with suggestions for future research.
We conducted a systematic review and meta-analysis to quantify associations between overall and subtypes of CM, global/trait resilience, and five resilience domains (coping, self-esteem, emotion regulation, self-efficacy, and well-being) in adults, and to examine moderators and mediators of these associations. A systematic search was undertaken on 12 June 2024 to identify published peer-reviewed articles in five databases (PROSPERO-CRD42023394120). Of 15,262 records, 203 studies were included, comprising 145,317 adults (Mage = 29.62 years; 34.96% males); 183 studies and 557 effect sizes were pooled in random-effect meta-analyses. Overall CM and its subtypes were negatively associated with global/trait resilience and its domains (r = −0.081 to −0.330). Emotional abuse/neglect showed the largest magnitude of effect (r = −0.213 to −0.321). There was no meta-analytic evidence for an association between sexual abuse and coping, and physical abuse/neglect and self-esteem. Meta-regressions identified age, sample size, and study quality as moderators. Subgroup analyses found that associations between emotional abuse and emotion regulation were stronger, while associations between emotional abuse and self-esteem were weaker, in western versus non-western countries. No differences were found in associations between CM and resilience in clinical versus non-clinical samples. Narrative synthesis identified several mediators. Associations were of small magnitude and there were a limited number of studies, especially studies assessing CM subtypes, such as physical neglect, bullying, or domestic violence, and resilience domains, such as coping or self-efficacy, in males, and clinical samples. CM exposure negatively impacts resilience in adults, an effect observed across multiple maltreatment types and resilience domains. Interventions focused on resilience in adults with CM histories are needed to improve health and psychosocial outcomes.