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Background: Higher Dietary Inflammatory Index (DII®) scores are associated with increased morbidity and mortality. However, little is known about the effects of DII on mortality in Mediterranean countries. Therefore, in the present study, we aimed to investigate the potential association between DII scores and overall, cancer and cardiovascular disease (CVD) mortality in people living in a Mediterranean area. Methods: DII scores were calculated using a validated food‐frequency questionnaire. DII scores were then categorised into tertiles. Mortality was ascertained via death certificates. The association between DII scores with overall and cause‐specific mortality was assessed via a multivariable Cox's regression analysis and reported as hazard ratios (HRs) with their 95% confidence intervals (CIs). Results: The study included 1565 participants (mean age 65.5 years; females 44.7%). After a median follow‐up of 12 years (2005–2017), 366 (23.4%) participants died. After adjusting for 17 potential confounders, people with higher DII scores had an increased risk of death compared to those in the lowest (most anti‐inflammatory) tertile (HR = 1.38; 95% CI = 1.04–1.82 for the second tertile; HR = 1.38; 95% CI = 1.03–1.86 for the third tertile). Each 1 SD increase in DII score increased the risk of death by 13%. No association was found between DII scores and cancer or CVD death when considered separately. Conclusions: Higher DII scores were associated with a significantly higher mortality risk, whereas the association with cause‐specific mortality was less clear. These findings highlight the potential importance of diet in modulating inflammation and preventing death. [ABSTRACT FROM AUTHOR]

Summary: In this study, during 8 years of follow-up, we reported that higher dietary inflammatory index values were associated with a higher risk of incident fractures in women, but not in men, after adjusting for potential confounders. Introduction: Inflammation is a key risk factor for many adverse outcomes in older people. While diet is a potential source of inflammation, little is known about the impact of inflammatory diet on fractures. Thus, we investigated whether higher Dietary Inflammatory Index (DII)™ ® scores are associated with fractures in a cohort of North American people. Methods: This longitudinal study with a follow-up of 8 years included 3648 participants (1577 males and 2071 females; mean age = 60.6 years) with/at risk of knee osteoarthritis participating with in the Osteoarthritis Initiative. DII scores were calculated using the validated Block Brief 2000 Food Frequency Questionnaire, categorized into sex-specific quintiles. Information on fractures was obtained through self-reported history of fractures at hip, spine, and forearm. The relationship between baseline DII score and incident fracture was assessed through a Cox's regression analysis, adjusted for potential baseline confounders, and reported as hazard ratios (HRs). Results: During 8 years of follow-up, 560 individuals developed fractures (15.4%). Adjusting for 10 potential confounders, women in the highest DII score quintile (i.e., most pro-inflammatory diet) had a significantly higher risk for fractures (HR = 1.46; 95% CI = 1.02-2.11) compared to women in the lowest quintile. An increase in one standard deviation of DII scores significantly predicted fracture onset in women (adjusted HR = 1.14; 95% CI = 1.02-1.27). The association between DII score and fractures was not significant among men or in the sample as whole. Conclusion: Pro-inflammatory diet is associated with a higher incidence of fractures in women but not men. [ABSTRACT FROM AUTHOR]

Objective To provide meta-analytical evidence of bone mineral density ( BMD), fractures, and osteoporosis rates in eating disorders ( ED) vs. healthy controls ( HCs). Method Three independent authors searched major electronic databases from inception till August 2015 for cross-sectional studies reporting BMD in people with ED (anorexia nervosa, ( AN); bulimia nervosa, ( BN); eating disorders not otherwise specified, ( EDNOS)) vs. HCs. Standardized mean differences ( SMDs) ±95% and confidence intervals ( CIs) were calculated for BMD, and odds ratios ( ORs) for osteopenia, osteoporosis, and fractures. Results Overall, 57 studies were eligible, including 21 607 participants ( ED = 6485, HCs = 15 122). Compared to HC, AN subjects had significantly lower BMD values at lumbar spine ( SMD = −1.51, 95% CI = −1.75, −1.27, studies = 42), total hip ( SMD = −1.56, 95% CI = −1.84, −1.28, studies = 23), intertrochanteric region ( SMD = −1.80, 95% CI = −2.46, −1.14, studies = 7), trochanteric region ( SMD = −1.05, 95% CI = −1.44, −0.66, studies = 7), and femoral neck ( SMD = −0.98, 95% CI = −1.12, −0.77, studies = 20). Reduced BMD was moderated by ED illness duration and amenorrhea ( P < 0.05). AN was associated with an increased likelihood of osteoporosis ( OR = 12.59, 95% CI = 3.30-47.9, P < 0.001, studies = 4) and fractures ( OR = 1.84, 95% CI = 1.17-2.89, I2 = 56, studies = 6). No difference in BMD was found between BN and EDNOS vs. HC. Conclusion People with AN have reduced BMD, increased odds of osteoporosis and risk of fractures. Proactive monitoring and interventions are required to ameliorate bone loss in AN. [ABSTRACT FROM AUTHOR]

Background: The extranodal extension (ENE) of nodal metastasis (i.e. the extension of tumor cells through the nodal capsule into the perinodal adipose tissue) has recently emerged as an important prognostic factor in different types of malignancies. However, the tumor-node-metastasis (TNM) staging system for colorectal cancer does not consider it as a prognostic parameter. Therefore, we conducted a systematic review and meta-analysis to determine the prognostic role of ENE in patients with lymph node-positive colorectal cancer. Materials and methods: Two independent authors searched PubMed and SCOPUS until 7 January 2015 without language restrictions. Prospective studies reporting data on prognostic parameters in subjects with colorectal cancer, comparing participants with the presence of ENE (ENE+) versus only intranodal extension (ENE-) were eligible. Data were summarized using risk ratios (RRs) for the number of deaths/recurrences and hazard ratios (HRs) together with 95% confidence intervals (CIs) for time-dependent risk related to ENE+, adjusted for potential confounders. Results: Thirteen studies including 1336 patients were identified with a median follow-up of 4.7 years. ENE was associated with a higher T stage and tumor grading. In addition, ENE was associated with a significantly increased risk of all-cause mortality (RR=1.75; 95% CI 1.42-2.16, P< 0.0001, I² = 60%; HR=1.69, 95% CI 1.32-2.17, P< 0.0001, I² = 46%) and of recurrence of disease (RR = 2.07, 95% CI 1.65-2.61, P < 0.0001,I² = 47%; HR = 2.31, 95% CI 1.54-3.44, P< 0.0001,I² = 48%). Conclusions: Based of these results, in colorectal cancer, ENE should be considered from the gross sampling to the pathology report, as well as in future oncologic staging systems. [ABSTRACT FROM AUTHOR]

Body mass index ( BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic Pub Med/ EMBASE/ CINAHL/ SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5-24.9, 25-29.9, ≥30 kg/m2), the most adjusted hazard ratios ( HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI = 1.26-1.58) for underweight, 0.85 (95% CI = 0.73-0.99) for overweight and 0.74 (95% CI = 0.57-0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections ( HR = 1.65 [95% CI = 1.13-2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting. [ABSTRACT FROM AUTHOR]

Purpose Among the risk factors for osteoporosis and fractures, gynecological history (fertile period, parity and breastfeeding) play an important part. Changes in calcium metabolism to enable an adequate mineral transfer to the milk have a prominent role in bone loss during breastfeeding. Data on the influence of breastfeeding in postmenopausal osteoporosis are inconsistent. The aim of the present study was to identify any association between duration of breastfeeding and vertebral fractures in postmenopausal women. Methods All patients underwent the following tests: bone mineral density measurements of the lumbar spine (L1–L4) and the total and femoral neck using dual-energy X-ray absorptiometry and antero-posterior and lateral radiography of the thoracic and lumbar spine to identify vertebral fractures. Results The study involved 752 women with a mean age of 64.5 ± 9.3; 23% of them reported vertebral osteoporotic fractures. The women with vertebral fractures had breastfed for longer periods (11.8 ± 12.9 vs. 9.3 ± 11.2 months, p = 0.03) and had more pregnancies (2.6 ± 2.2 vs. 2.2 ± 1.3, p = 0.002). Breastfeeding for more than 18 months was associated with a two-fold risk of developing vertebral fractures (OR 2.12, 95% CI 1.14–5.38, p = 0.04), particularly in those without current or past use of drugs positively affecting bone. Conclusions Our study showed an association between long periods of breastfeeding and vertebral fractures, supporting a role for lengthy lactation as a risk factor for osteoporotic fractures after menopause. Bearing in mind all the benefits of breastfeeding, this finding suggests the importance of an adequate calcium and vitamin D intake during pregnancy and breastfeeding, with the aid of dietary supplements if necessary. [ABSTRACT FROM AUTHOR]

A retrospective cohort study conducted in Germany examined the association between diverticular disease (DD) and the risk of dementia. The study included patients aged 60 years and older with an initial DD diagnosis and no prior diagnosis of dementia. After matching patients with and without DD, the study found that DD was associated with a slightly decreased risk of dementia. However, the authors noted methodological differences with a previous study and recommended further research to verify the association between DD and dementia. [Extracted from the article]

Summary: The use of buffered soluble alendronate 70 mg effervescent tablet, a convenient dosing regimen for bisphosphonate therapy, seems a cost-effective strategy compared with relevant alternative treatments for postmenopausal women with osteoporosis aged 60 years and over in Italy. Introduction: To assess the cost-effectiveness of buffered soluble alendronate (ALN) 70 mg effervescent tablet compared with relevant alternative treatments for postmenopausal osteoporotic women in Italy. Methods: A previously validated Markov microsimulation model was adjusted to the Italian healthcare setting to estimate the lifetime costs (expressed in €2019) per quality-adjusted life-years (QALY) of buffered soluble ALN compared with generic ALN, denosumab, zoledronic acid and no treatment. Pooled efficacy data derived from the NICE network meta-analysis were used for bisphosphonate treatments. Two treatment duration scenarios were assessed: 1 year using persistence data derived from an Italian prospective observational study including 144 and 216 postmenopausal osteoporotic women on buffered soluble ALN and oral ALN, respectively, and 3 years. Analyses were conducted for women 60–80 years of age with a bone mineral density T-score ≤ − 3.0 or with existing vertebral fractures. Results: In all simulated populations, buffered soluble ALN was dominant (more QALYs, lower costs) compared to denosumab. The cost per QALY gained of buffered soluble ALN compared to generic ALN and no treatment always falls below €20,000 per QALY gained. In the 1-year treatment scenario, zoledronic acid was associated with more QALY than buffered soluble ALN but the cost per QALY gained of zoledronic acid compared with buffered soluble ALN was always higher than €70,000, while buffered soluble ALN was dominant in the 3-year treatment scenario. Conclusion: This study suggests that buffered soluble ALN represents a cost-effective strategy compared with relevant alternative treatments for postmenopausal osteoporosis women in Italy aged 60 years and over. [ABSTRACT FROM AUTHOR]

BackgroundDepression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs.MethodsCommunity-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted.ResultsThe prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 [95% confidence interval (CI) 1.83–2.55], 1.45 (95% CI 1.22–1.73), and 2.11 (95% CI 1.87–2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54–4.37).ConclusionDepression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research. [ABSTRACT FROM PUBLISHER]

To explore the association between physical activity (PA) and urinary incontinence (UI) in Spain. Cross-sectional data from the Spanish National Health Survey 2017 were analyzed. The International Physical Activity Questionnaire (IPAQ) short form was used to measure level of PA (exposure), and sufficient PA corresponded to at least 600 MET-minutes/week. UI (outcome) was self-reported in response to the question "Have you ever been diagnosed with UI?". Multivariable logistic regression was used to assess associations overall, by sex, and by age group (15–40, 41–64, 65–69 years). Logistic regression models were adjusted for sex (except sex-stratified analyses), age, marital status, education, smoking, alcohol, obesity, hypertension, diabetes, osteoarthritis, chronic back pain, injury, asthma, thyroid dysfunction, depression, and anxiety. This study included 17,777 participants [48.0% of males; mean (SD) age 45.8 (14.1) years]. The prevalence of sufficient PA and UI was 69.8% and 2.4%, respectively. After adjustment for potential confounders, doing at least 600 MET-minutes/week of PA was negatively associated with UI [odds ratio (OR) = 0.67; 95%CI = 0.55–0.83]. This finding was corroborated in women (OR = 0.62; 95%CI = 0.48–0.80), participants aged 15–40 years (OR = 0.40; 95%CI = 0.20–0.79) and those aged 41–64 years (OR = 0.71; 95%CI = 0.55–0.93), but not in men (OR = 0.81; 95%CI = 0.57–1.16) and those age 65–69 years (OR = 0.72; 95%CI = 0.47–1.09). Participation in PA is negatively associated with UI. Although further research is needed to explore the direction of this association, PA should be promoted in people with UI, especially in women and young and middle-aged adults. [ABSTRACT FROM AUTHOR]

BackgroundDespite the known heightened risk and burden of various somatic diseases in people with depression, very little is known about physical health multimorbidity (i.e. two or more physical health co-morbidities) in individuals with depression. This study explored physical health multimorbidity in people with clinical depression, subsyndromal depression and brief depressive episode across 43 low- and middle-income countries (LMICs).MethodCross-sectional, community-based data on 190 593 individuals from 43 LMICs recruited via the World Health Survey were analysed. Multivariable logistic regression analysis was done to assess the association between depression and physical multimorbidity.ResultsOverall, two, three and four or more physical health conditions were present in 7.4, 2.4 and 0.9% of non-depressive individuals compared with 17.7, 9.1 and 4.9% among people with any depressive episode, respectively. Compared with those with no depression, subsyndromal depression, brief depressive episode and depressive episode were significantly associated with 2.62, 2.14 and 3.44 times higher odds for multimorbidity, respectively. A significant positive association between multimorbidity and any depression was observed across 42 of the 43 countries, with particularly high odds ratios (ORs) in China (OR 8.84), Laos (OR 5.08), Ethiopia (OR 4.99), the Philippines (OR 4.81) and Malaysia (OR 4.58). The pooled OR for multimorbidity and depression estimated by meta-analysis across 43 countries was 3.26 (95% confident interval 2.98–3.57).ConclusionsOur large multinational study demonstrates that physical health multimorbidity is increased across the depression spectrum. Public health interventions are required to address this global health problem. [ABSTRACT FROM PUBLISHER]

Purpose: As studies examining the association between bone mineral density (BMD) and airflow limitation (AL) have produced conflicting results, the current one set out to analyze if and to what degree there are any correlations between these variables in a population of fit elderly women. Methods: One hundred and twenty-one non-smoking, fit and healthy women (age ≥ 65 years) underwent anthropometric assessment, laboratory testing (serum 25-hydroxy vitamin D, parathormone, and cytokine levels), pulmonary function testing (PFT), and dual-energy X-ray absorptiometry to evaluate BMD values of the lumbar and femoral regions. Results: A significant positive association was found between FEV/FVC ratio (Tiffeneau index), a sensitive index of AL, and lumbar and femoral BMD; a 10 % increase in the FEV/FVC ratio resulted in a significant increase of 0.025 g/cm in the total hip ( p = 0.05), 0.027 g/cm in the femoral neck ( p = 0.02), 0.028 g/cm in the femoral trochanter ( p = 0.01), and 0.047 g/cm in the lumbar ( p = 0.03) BMDs. Binary logistic analyses demonstrated more than a threefold higher risk of low BMD values for the lowest FEV/FVC quartile in the lumbar (OR 4.62, 95 % CI 1.48-14.40, p = 0.008), total hip (OR 4.09, 95 % CI 1.28-13.05, p = 0.02 for the second quartile), and femoral trochanter regions (OR 3.90, 95 % CI 1.25-12.20, p = 0.02 for the third quartile). Conclusions: AL was associated with a higher risk of reduced BMD in healthy, fit elderly women. [ABSTRACT FROM AUTHOR]

Background: To date there is limited literature on the prevalence of chronic skin conditions and its association with levels of physical activity (PA) in Spain. Aim: To determine the prevalence of chronic skin disease and to compare levels of PA between people with and without chronic skin disease in a large representative sample of Spanish adults aged 15–69 years. Methods: Data from the Spanish National Health Survey 2017 were analysed. Chronic skin disease was assessed using a yes/no question. PA was measured using the short form of the International Physical Activity Questionnaire. Total PA metabolic equivalent of task min/week were calculated, and PA was included in the analyses as a continuous and a five‐category variable. Results: This cross‐sectional study included 17 777 adult participants (52.0% women; mean ± SD age 45.8 ± 14.1 years), of whom 940 (5.3%) had chronic skin disease. After adjusting for several potential confounders, there was a negative association between chronic skin disease and PA (OR = 0.87, 95% CI 0.76–1.00, P = 0.05), which was significant for men (OR = 0.76, 95% CI 0.62–0.93, P = 0.01) but not for women (OR = 0.97, 95% CI 0.81–1.16, P = 0.72). Conclusions: In this large representative sample of Spanish adults, the prevalence of chronic skin disease was low. Levels of PA were lower in men with than in men without chronic skin conditions, but this association was not seen in women. [ABSTRACT FROM AUTHOR]

This review aims to: (1) map the use of sonification in human movement tasks for physical therapy; (2) identify methods of data capture, tasks and its effects on human subjects; (3) suggest future research directions. Sonification can be described as a technique to translate data into sound. It has been used for human motion analysis tasks even if it is not part of most physical therapist's lexicon. Identify and analyze publications where sonification was used as an audio-feedback technique for physical therapy. Thirty-five papers were included, 13 randomized-control-trials. Thirteen papers reported an investigation on a specific dysfunction, while upper limb movements were investigated in fifteen papers. Inertial measurement units were the most commonly used technology to capture human movement, 10 papers reported improvements in motor control and/or movement quality. Gaps in the literature were identified: (1) absence of sonification framework for rehabilitation, (2) no long-term comparison with gold-standard interventions for specific populations, (3) approaches for cardio-respiratory physical therapy and injury prevention were absent. Sonification has the potential to support rehabilitation for physical therapy. Effects of sonification were varied and ranged from improvements in movement quality/control, increased movement and body-awareness and improvements in performance when compared with activities with audio-visual or non-specific audio-feedback among others. Data for sonification was mainly captured using inertial measurement units, smartphones and optical tracking devices but others are also commonly used. Well-designed clinical trials supported by current promising results need to be developed. We recommend testing different sonification techniques in common physical therapy disfunctions using significant outcome measures to understand and maximize its effects on motor learning and control while scoping for further benefits. [ABSTRACT FROM AUTHOR]

Summary: Guidance is provided in an international setting on the assessment and specific treatment of postmenopausal women at low, high and very high risk of fragility fractures. Introduction: The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2019. This manuscript seeks to apply this in an international setting, taking additional account of further categorisation of increased risk of fracture, which may inform choice of therapeutic approach. Methods: Clinical perspective and updated literature search. Results: The following areas are reviewed: categorisation of fracture risk and general pharmacological management of osteoporosis. Conclusions: A platform is provided on which specific guidelines can be developed for national use to characterise fracture risk and direct interventions. [ABSTRACT FROM AUTHOR]

Erectile dysfunction may be common among men with diabetes, but its prevalence is still debated. We aimed to assess the relative prevalence of erectile dysfunction in diabetes searching major databases from inception to November 2016 for studies reporting erectile dysfunction in men with Type 1 and Type 2 diabetes mellitus. We conducted a meta-analysis of the prevalence [and 95% confidence intervals (95% CIs)] of erectile dysfunction in diabetes compared with healthy controls, calculating the relative odds ratios ( ORs) and 95% CIs. A random effect model was applied. From 3747 initial hits, 145 studies were included representing 88 577 men (age: 55.8 ± 7.9 years). The prevalence of erectile dysfunction in diabetes overall was 52.5% (95% CI, 48.8 to 56.2) after adjusting for publication bias, and 37.5%, 66.3% and 57.7% in Type 1, Type 2 and both types of diabetes, respectively ( P for interaction < 0.0001). The prevalence of erectile dysfunction was highest in studies using the Sexual Health Inventory for Men (82.2%, 17 studies, P for interaction < 0.0001). Studies with a higher percentage of people with hypertension moderated our results (beta = 0.03; 95% CI, 0.008 to 0.040; P = 0.003; R2 = 0.00). Compared to healthy controls ( n = 5385) men with diabetes ( n = 863) were at increased odds of having erectile dysfunction ( OR 3.62; 95% CI, 2.53 to 5.16; P < 0.0001; I2 = 67%, k = 8). Erectile dysfunction is common in diabetes, affecting more than half of men with the condition and with a prevalence odds of approximately 3.5 times more than controls. Our findings suggest that screening and appropriate intervention for men with erectile dysfunction is warranted. [ABSTRACT FROM AUTHOR]

Objective To conduct a systematic review and meta-analysis of studies that measured cytokine and chemokine levels in individuals with major depressive disorder ( MDD) compared to healthy controls ( HCs). Method The PubMed/MEDLINE, EMBASE, and PsycINFO databases were searched up until May 30, 2016. Effect sizes were estimated with random-effects models. Result Eighty-two studies comprising 3212 participants with MDD and 2798 HCs met inclusion criteria. Peripheral levels of interleukin-6 ( IL-6), tumor necrosis factor ( TNF)-alpha, IL-10, the soluble IL-2 receptor, C-C chemokine ligand 2, IL-13, IL-18, IL-12, the IL-1 receptor antagonist, and the soluble TNF receptor 2 were elevated in patients with MDD compared to HCs, whereas interferon-gamma levels were lower in MDD (Hedge's g = −0.477, P = 0.043). Levels of IL-1β, IL-2, IL-4, IL-8, the soluble IL-6 receptor ( sIL-6R), IL-5, CCL-3, IL-17, and transforming growth factor-beta 1 were not significantly altered in individuals with MDD compared to HCs. Heterogeneity was large ( I2: 51.6-97.7%), and sources of heterogeneity were explored (e.g., age, smoking status, and body mass index). Conclusion Our results further characterize a cytokine/chemokine profile associated with MDD. Future studies are warranted to further elucidate sources of heterogeneity, as well as biosignature cytokines secreted by other immune cells. [ABSTRACT FROM AUTHOR]

Objective Physical activity ( PA) is good for health, yet several small-scale studies have suggested that depression is associated with low PA. A paucity of nationally representative studies investigating this relationship exists, particularly in low- and middle-income countries ( LMICs). This study explored the global association of PA with depression and its mediating factors. Method Participants from 36 LMICs from the World Health Survey were included. Multivariable logistic regression analyses were undertaken exploring the relationship between PA and depression. Results Across 178 867 people (mean ± SD age = 36.2 ± 13.5 years; 49.9% male), the prevalence of depression and the prevalence of low PA were 6.6% and 16.8% respectively. The prevalence of low PA was significantly higher among those with depression vs. no depression (26.0% vs. 15.8%, P < 0.0001). In the adjusted model, depression was associated with higher odds for low PA ( OR = 1.42; 95% CI = 1.24-1.63). Mediation analyses demonstrated that low PA among people with depression was explained by mobility limitations (40.3%), pain and discomfort (35.8%), disruptions in sleep and energy (25.2%), cognition (19.4%) and vision (10.9%). Conclusion Individuals with depression engage in lower levels of PA in LMICs. Future longitudinal research is warranted to better understand the relationships observed. [ABSTRACT FROM AUTHOR]

Summary: Our meta-analysis demonstrates that people with nephrolithiasis have decreased bone mineral density, an increased odds of osteoporosis, and potentially an elevated risk of fractures. Introduction: People with nephrolithiasis might be at risk of reduced bone mineral density (BMD) and fractures, but the data is equivocal. We conducted a meta-analysis to investigate if patients with nephrolithiasis have worse bone health outcomes (BMD), osteoporosis, and fractures versus healthy controls (HCs). Methods: Two investigators searched major databases for articles reporting BMD (expressed as g/cm or a T- or Z-score), osteoporosis or fractures in a sample of people with nephrolithiasis, and HCs. Standardized mean differences (SMDs), 95 % confidence intervals (CIs) were calculated for BMD parameters; in addition odds (ORs) for case-control and adjusted hazard ratios (HRs) in longitudinal studies for categorical variables were calculated. Results: From 1816 initial hits, 28 studies were included. A meta-analysis of case-control studies including 1595 patients with nephrolithiasis (mean age 41.1 years) versus 3402 HCs (mean age 40.2 years) was conducted. Patients with nephrolithiasis showed significant lower T-scores values for the spine (seven studies; SMD = −0.69; 95 % CI = −0.86 to −0.52; I = 0 %), total hip (seven studies; SMD = −0.82; 95 % CI = −1.11 to −0.52; I = 72 %), and femoral neck (six studies; SMD = −0.67; 95 % CI = −−1.00 to −0.34; I = 69 %). A meta-analysis of the case-controlled studies suggests that people with nephrolithiasis are at increased risk of fractures (OR = 1.15, 95 % CI = 1.12-1.17, p < 0.0001, studies = 4), while the risk of fractures in two longitudinal studies demonstrated trend level significance (HR = 1.31, 95 % CI = 0.95-1.62). People with nephrolithiasis were four times more likely to have osteoporosis than HCs (OR = 4.12, p < 0.0001). Conclusions: Nephrolithiasis is associated with lower BMD, an increased risk of osteoporosis, and possibly, fractures. Future screening/preventative interventions targeting bone health might be indicated. [ABSTRACT FROM AUTHOR]

ObjectivesGrowing interest focuses on the association between 5-HTTLPR polymorphism and eating disorders (ED), but published findings have been conflicting.MethodsThe Italian BIO.VE.D.A. biobank provided 976 samples (735 ED patients and 241 controls) for genotyping. We conducted a literature search of studies published up to 1 April 2015, including studies reporting on 5HTTLPR genotype and allele frequencies in obesity and/or ED. We ran a meta-analysis, including data from BIO.VE.D.A. – comparing low and high-functioning genotype and allele frequencies in ED vs. controls.ResultsData from 21 studies, plus BIO.VE.D.A., were extracted providing information from 3,736 patients and 2,707 controls. Neither low- nor high-functioning genotype frequencies in ED patients, with both bi- and tri-allelic models, differed from controls. Furthermore, neither low- nor high-functioning allele frequencies in ED or in BN, in both bi- and triallelic models, differed from control groups. After sensitivity analysis, results were the same in AN vs. controls. Results remained unaltered when investigating recessive and dominant models.Conclusions5HTTLPR does not seem to be associated with ED in general, or with AN or BN in particular. Future studies in ED should explore the role of ethnicity and psychiatric comorbidity as a possible source of bias. [ABSTRACT FROM PUBLISHER]

Introduction: Data about the prevalence of borderline personality (BPD) and bipolar (BD) disorders comorbidity are scarce and the boundaries remain controversial. We conducted a systematic review and meta-analysis investigating the prevalence of BPD in BD and BD in people with BPD.Methods: Two independent authors searched MEDLINE, Embase, PsycINFO and the Cochrane Library from inception till November 4, 2015. Articles reporting the prevalence of BPD and BD were included. A random effects meta-analysis and meta-regression were conducted.Results: Overall, 42 papers were included: 28 considering BPD in BD and 14 considering BD in BPD. The trim and fill adjusted analysis demonstrated the prevalence of BPD among 5273 people with BD (39.94 ± 11.78 years, 44% males) was 21.6% (95% CI 17.0-27.1). Higher comorbid BPD in BD were noted in BD II participants (37.7%, 95% CI 21.9-56.6, studies=6) and North American studies (26.2%, 95% CI 18.7-35.3, studies=11). Meta regression established that a higher percentage of males and higher mean age significantly (p<0.05) predicted a lower prevalence of comorbid BPD in BD participants. The trim and fill adjusted prevalence of BD among 1814 people with BPD (32.22 ± 7.35 years, 21.5% male) was 18.5% (95% CI 12.7-26.1).Limitations: Paucity of longitudinal/control group studies and accurate treatment records.Conclusions: BPD-BD comorbidity is common, with approximately one in five people experiencing a comorbid diagnosis. Based on current diagnostic constructs, and a critical interpretation of results, both qualitative and quantitative syntheses of the evidence prompt out the relevance of differences rather similarities between BD and BPD. [ABSTRACT FROM AUTHOR]

Background/objectives: The objective of this study was to ascertain the effect of weight loss over the course of 1 year on 5-year mortality in old nursing home (NH) residents in different classes of body mass index (BMI).Subjects/methods: A longitudinal study was conducted on 161 NH residents aged ⩾ 70 years at the Istituto di Riposo per Anziani, Padova, Italy. Data were collected using a comprehensive geriatric assessment at baseline and at a 1-year follow-up visit. Mortality was recorded over a 5-year follow-up. We divided our sample into four groups using as cutoffs a BMI of 25 and a weight gain or loss of 5% at 1 year (BMI ⩾ 25 and weight stable/gain, BMI ⩾ 25 and weight loss, BMI<25 and weight stable/gain and BMI <25 and weight loss).Results: People with a BMI ⩾ 25 and weight loss suffered the worst decline in activities of daily living, whereas those with a BMI <25 and weight loss had the most significant decline in nutritional status, which coincided with the worst decline in the Multidimensional Prognostic Index among the groups whose weight changed. Compared with those with a BMI ⩾ 25 and weight stable/gain (reference group), those with a BMI <25 were at the highest risk of dying (in association with weight loss: hazard ratio HR=3.60, P=0.005; in association with weight stable/gain: HR=2.45, P=0.01), and the mortality risk was also increased in people with a BMI ⩾ 25 and weight loss (HR=1.74, P=0.03).Conclusions: In conclusion, weight loss increases the mortality risk in frail, disabled NH residents, even if they are overweight or obese. [ABSTRACT FROM AUTHOR]

The article 'Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures',written by J. A. Kanis, was originally published Online First without Open Access. After publication in volume [#], issue [#] and page [#-#], the author decided to opt for Open Choice and to make the article an Open Access publication. [ABSTRACT FROM AUTHOR]