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Background: The Developmental Origins of Health and Disease Hypothesis (DOHaD) suggests prenatal alcohol exposure (PAE) should have implications for adult physical and mental health. Since the health profile of older adults with PAE and diagnoses of fetal alcohol spectrum disorder (FASD) is unknown, the current study evaluates self‐reported health problems of midlife adults with and without a history of PAE to describe these outcomes. Methods: Participants (N = 357) recruited from longitudinal cohorts in Atlanta, GA and Seattle, WA completed a health survey assessing a range of physical conditions. Initial analysis compared the frequency of conditions between alcohol‐exposed and nonexposed groups. To identify patterns within groups, 10 problem areas were subjected to latent class analysis (LCA). Finally, the direct effect of PAE on health outcomes was evaluated using multilevel modeling, controlling for effects of other factors. Results: Compared with unexposed controls, individuals with PAE reported significantly higher frequencies of problems with hearing, dentition, heart, cancer, gastritis, kidney stones, bladder, diabetes, thyroid, skin, and seizures. LCA found that controls yielded two classes, with 45% reporting sleep and vision problems and 55% reporting sleep, vision, cardiovascular, endocrine, immune, and dental problems. The PAE group yielded three classes, with 13% endorsing few health problems, 43% reporting sleep, vision, immune, and dental problems, and 43% reporting sleep, vision, cardiovascular, urinary, endocrine, skin, immune, dental, and gastrointestinal problems. With multivariate analysis, controlling for other influences, PAE was associated directly with hearing, urinary, dental, and gastrointestinal problems. A similar pattern was found for alcohol‐exposed individuals who did and did not meet criteria for fetal alcohol syndrome (FAS). Discussion: Patients affected by alcohol may report greater frequency and range of health adversity. That PAE was only uniquely associated with a limited set of problems suggests that many health outcomes in midlife result from an initial vulnerability potentiated by postnatal stress resulting from other associated factors. [ABSTRACT FROM AUTHOR]

In about 400 Prudentius visited the shrine of St Cassian at Imola and wrote a poem describing his martyrdom. Cassian, a schoolmaster, had been killed by his own pupils using their styli and wax tablets. The story was popular throughout the Middle Ages and its medieval reception has attracted attention. In addition, and hitherto unnoticed, features of Cassian's death became motifs in narratives of violence in the medieval schoolroom, and this article explores these and reflects on what they can tell us about changes in the teacher–pupil relationship from Late Antiquity to the end of the twelfth century. [ABSTRACT FROM AUTHOR]

This article discusses a special type of narrative: encounters with named individuals in hell. The catchment is broad (Homer to Dante) but the focus is on the early Middle Ages. Philological and literary techniques elucidate and reinterpret a number of important visionary texts, Anglo‐Saxon, Merovingian, and Carolingian. Boniface, Ep. 115 re‐emerges as a woman's vision. Gregory of Tours, DLH 8.5 (Guntram's banquet of 585), where Chilperic is sighted, finds a place within the Roman tradition of the dark or terrifying banquet and the dangerous telling of dreams. In the Visio Pauperculae (terminus post quem = 3 October 818), Queen Irmengard's torture is reinterpreted by reference to the NT and to contemporary legal realia. An argument is made for an old emendation that required a romantic and courtly reading, including a fuzzy connection to Dante's Inferno 5. [ABSTRACT FROM AUTHOR]

Aim: This study aims to explore the association between declining lung function and depression in middle‐aged and older adults, with a special focus on the mediating role of cognitive function. Methods: This study utilizes self‐reported and physical examination data from 5345 individuals participating in the 2015 cycle of the China Health and Retirement Longitudinal Study (CHARLS) to explore the role of cognitive function changes in mediating the effects of diminished lung function on depression among middle‐aged and older adults. Results: Multivariate linear regression analysis revealed a positive correlation between pulmonary and cognitive functions (β = 0.003, 95% CI: 0.002∼0.003, P < 0.01) and a negative correlation between cognitive function and depression (β = −0.279, 95% CI: −0.330–0.228, P < 0.01). Cognitive function plays a mediating role in linking pulmonary function with depression, exhibiting a mediation effect of −0.0007 and a total effect of −0.0046, wherein the mediation effect contributes to 15.22% of the total effect. For females, the mediating effect of cognitive function was stronger (β = −0.0013, 95% CI: −0.0018∼–0.0008, P < 0.01) than it was for males (β = −0.0006, 95% CI: −0.0009∼–0.0003, P < 0.01). Conclusions: The study underscores the importance of monitoring lung and cognitive functions as interconnected factors contributing to the mental health of middle‐aged and older adults. It suggests that interventions aimed at improving pulmonary health and cognitive function may help mitigate depressive symptoms among middle‐aged and older adults. Further research is warranted to validate these findings across diverse cultural and demographic settings. Geriatr Gerontol Int 2024; 24: 1210–1217. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this longitudinal study was to evaluate the prevalence and correlates of and the factors contributing to meal‐skipping in middle‐aged and older adults in Thailand. Methods: We examined prospective cohort data from three consecutive waves of the Health, Aging and Retirement in Thailand (HART) study (analytic sample size = 2863) for participants 45 years of age and older. Meal‐skipping was assessed with a one‐ and two‐day recall of breakfast, lunch, and dinner. We used generalized estimating equations analysis to evaluate the longitudinal relationships between sociodemographic, lifestyle, and health indicators and meal‐skipping between 2015 (wave 1), 2017 (wave 2), and 2020 (wave 3). Furthermore, binary logistic regression was used to establish the longitudinal association between meal‐skipping and the incidence of multiple chronic conditions. Results: The prevalence of meal‐skipping was 6.2% in 2015, 16.2% in 2017, and 13.6% in 2020, and across study years the highest proportion of meal skipping was for lunch (6.0%), followed by breakfast (4.6%), and dinner (2.8%). In the final model, sociodemographic factors (higher education, urban residence, and lower subjective economic status), lifestyle factors (high alcohol use, current smoking, and obesity class II), and health indicators (probable depression and wearing dentures) were positively associated with meal‐skipping. In the adjusted logistic regression models, compared with no meal‐skipping, meal‐skipping in 2–3 study waves was associated with incident obesity and incident probable depression. Conclusion: Skipping meals was linked to a number of lifestyle variables and indicators of physical and mental illness. Geriatr Gerontol Int 2024; 24: 1196–1202. [ABSTRACT FROM AUTHOR]

Chronic diseases have become one of the most important factors threatening human health. Subjective life expectancy (SLE) describes an individual's expectation or subjective perception of lifespan. This article aims to explore the relationship between chronic diseases and SLE, as well as the differences among different age groups and different types of chronic diseases in this relationship. China Health and Retirement Longitudinal Study (CHARLS) is a nationwide longitudinal study that evaluates the social, economic, and health conditions of middle‐aged and older adult families and individuals aged 45 and above in China. In this study, CHARLS used probability proportional to size sampling (PPS sampling) to ensure the breadth and representativeness of the sample. This study selected cross‐sectional data from CHARLS 2018, removed missing values, and obtained a valid sample of 10,658 middle‐aged and older individuals, of whom 8564 had chronic diseases. After controlling demographic, health behavior, socioeconomic, psychological, and social security factors, an ordered logistic regression was performed to explore the relationship between chronic disease and SLE in middle‐aged and older adults. The results show that chronic diseases negatively correlate with SLE in middle‐aged and older adults. Middle‐aged and older adults with chronic diseases are 36.2% less likely to have high life expectancy than those without chronic diseases. Many different types of chronic diseases are negatively correlated with SLE. Cancer is most negatively correlated with SLE, far exceeding other chronic diseases. Chronic disease and SLE of middle‐aged and older adults have age‐heterogeneous differences. For middle‐aged people aged 45–59 and young older adults aged 60–79, there is a significant correlation between chronic diseases and SLE. However, there is no correlation between chronic diseases and subjective life expectancy in the older population aged 80 and above. The government and society should pay close attention to the prevention and treatment of chronic diseases among middle‐aged and older adults and adjust policies and measures according to the population's age structure. In addition, the government and society should pay attention to the spiritual needs of middle‐aged and older adults. The government and society should pay more attention to cancer patients. Finally, the scientific research team should also strengthen research on chronic diseases, research and development of specific drugs and vaccines, improve the cure rate of chronic diseases, promote people's health, and make people no longer afraid of diseases. [ABSTRACT FROM AUTHOR]

Background: This study investigated psychosocial factors related to preparedness for well‐dying among middle‐aged and older adults and verified a model that can predict it along with psychosocial factors and demographic profiles to provide useful information for intervention. Methods: The participants were 340 middle‐aged and older Korean adults aged 40–79 years. The predictive models were verified using stepwise regression and decision tree analyses. Results: The results revealed that personality, meaning of life, hardiness, intrinsic religiosity, death anxiety, family support, subjective well‐being, and expectations for future life were significantly correlated with preparedness for well‐dying among middle‐aged and older adults. A stepwise regression analysis revealed that meaning of life accounted for the greatest variance in preparedness for well‐dying. A decision tree model predicting preparedness for well‐dying included search for meaning, the presence of a spouse, family support, having a job, tenacity, conscientiousness, and positive emotions. Conclusion: These findings suggest that search for meaning and tenacity in middle‐aged and older adults as well as the presence of a spouse or occupation and family support may play important roles in preparing for well‐dying. [ABSTRACT FROM AUTHOR]

Objectives: To investigate associations between sociodemographic factors, pre‐existing chronic comorbidities, and general practitioner‐led diagnosis of long COVID. Design, setting, patients: We conducted a retrospective observational case–control study using de‐identified electronic general practice data, recorded between January 2020 and March 2023, from 869 general practice clinics across four primary health networks in Victoria and New South Wales. Main outcome measures: Sociodemographic factors and pre‐existing chronic comorbidities associated with general practitioner‐led diagnosis of long COVID. Results: A total of 1588 patients had a recorded general practitioner‐led long COVID diagnosis. Females exhibited a higher likelihood of general practitioner‐led long COVID diagnosis (adjusted odds ratio [aOR], 1.58; adjusted confidence interval [aCI], 1.35–1.85) compared with males. Patients aged 40–59 years had a higher likelihood of general practitioner‐led long COVID diagnosis (aOR, 1.68; aCI, 1.40–2.03) compared with patients aged 20–39 years. The diagnosis was more likely in patients of high socio‐economic status (aOR, 1.37; aCI, 1.05–1.79) compared with those of mid socio‐economic status. Mental health conditions (aOR, 2.69; aCI, 2.25–3.21), respiratory conditions (aOR, 2.25; aCI, 1.85–2.75), cancer (aOR, 1.64; aCI, 1.15–2.33) and musculoskeletal conditions (aOR, 1.50; aCI, 1.20–1.88) were all significantly associated with general practitioner‐led long COVID diagnosis. Conclusions: Female sex, middle age, high socio‐economic status and pre‐existing comorbidities, including mental health conditions, respiratory conditions, cancer and musculoskeletal conditions, were associated with general practitioner‐led long COVID diagnosis among general practice patients. These factors largely parallel the emerging international evidence on long COVID and highlight the patient characteristics that practitioners should be cognisant of when patients present with symptoms of long COVID. [ABSTRACT FROM AUTHOR]

Aging is often associated with changes in social, sexual, emotional and pain functioning, as well as with the increased prevalence of certain psychopathologies. However, the neurodevelopmental basis underpinning these age‐related changes remains to be determined. Considering the key roles of oxytocin (OTR) and μ‐opioid (MOPr) receptor systems in regulating social, sexual, pain, reward and emotional processing, it seems plausible that they are also implicated in age‐related behavioural alterations. Although the ontogeny of both receptors has been well characterized in rodent brains from early development till adulthood, little is known concerning the neuroadaptations occurring from middle age to old age. Therefore, we mapped the neuroadaptations in OTR and MOPr in the brains of mice at those developmental endpoints. Quantitative OTR and MOPr autoradiographic binding was carried out in the brains of male mice at 2, 6, 9, 12 and 18 months of age. A significant whole brain decline in OTR density was detected between 2 and 6 months of age, with no additional decline thereafter. Interestingly, for MOPrs, the decline in density was not detected until 9 months of age. Region‐specific age‐related decline in OTR density was concentrated in the lateral anterior olfactory nuclei (AOL) and, for MOPr, in the AOL and the nucleus accumbens for MOPr. Identifying the tipping point of these age‐related variations in both receptors may assist with our understanding of the neurobiology underlining age‐related changes in social, pain and emotional functioning/processing. It may also help us target interventions to specific developmental windows to abrogate certain age‐related psychopathologies. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting Population Methods Main Outcome Measures Results Conclusions To determine the association between unilateral oophorectomy (UO) and age at natural menopause.Secondary analysis of survey data from Alberta's Tomorrow Project (2000–2022).Prospective cohort study in Alberta, Canada.23 630 women; 548 experienced UO and 23 082 did not experience UO.Flexible parametric survival analysis was used to analyse age at natural menopause, and logistic regression was used to analyse early menopause and premature ovarian insufficiency by UO status, controlling for birth year, parity, age at menarche, past infertility, hormonal contraceptive use and smoking.Age at natural menopause occurred by a final menstrual period without medical cause and sub‐classified as early menopause (< 45 years) and premature ovarian insufficiency (< 40 years).Compared to no UO, any UO was associated with elevated risk of earlier age at natural menopause, which was strongest in early midlife (adjusted HR at age 40 1.71, 95% CI 1.31–2.19) and diminished over time. Compared to age 55 years at UO, risks of earlier age at natural menopause were largest and uniform in magnitude when UO occurred between approximately ages 20–40 years (adjusted HR for UO at age 30 2.32, 1.46–3.54) and then diminished as age at UO approached the average age at natural menopause. Any UO was associated with higher odds of early menopause (adjusted OR 1.90, 1.30–2.79) and premature ovarian insufficiency (adjusted OR 3.75, 1.72–8.16).Unilateral oophorectomy is associated with earlier age at natural menopause, particularly when performed before 40 years of age. [ABSTRACT FROM AUTHOR]

Objectives: Mild behavioral impairment (MBI) is a dementia risk indicator in older adults characterized by later‐life emergent and persistent neuropsychiatric symptoms. Quality of life (QoL) is a multi‐dimensional concept encompassing physical, spiritual, and emotional well‐being. QoL aims to measure and quantify perceptions of individual health, well‐being, standard of living, personal fulfillment, and satisfaction. As MBI symptoms may arise from early‐stage neurodegenerative disease, MBI may contribute to declining QoL before dementia onset. In this study, we investigated the relationship between symptoms of MBI and QoL in older adults. Methods: The sample comprised 1107 individuals aged ≥ 50 years from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behavior, Function, and Caregiving in Aging (CAN‐PROTECT). Multivariable linear regressions were used to model the associations between MBI symptom severity (exposure), measured using the MBI Checklist (MBI‐C), and QoL (outcome) assessed by the EuroQol‐5D (EQ‐5D, higher score = poorer QoL) and the novel Quality of Life and Function Five Domain Scale (QFS‐5) (QFS‐5, lower score = poorer QoL). Covariates were age, sex, cognition, education, ethnocultural origin, marital status, employment status, high blood pressure, heart disease, and diabetes. Moderation analysis explored potential sex differences. A sensitivity analysis was performed removing anxiety/depression items from the EQ‐5D score. Results: Across the sample (mean age = 64.4 ± 7.2, 79.4% female) every 1‐point increase in MBI‐C score was associated with a 0.06‐point standard deviation (SD) increase in EQ‐5D score (95% confidence interval (CI): 0.05–0.06, p < 0.001) and 0.08 SD decrease in QFS‐5 score (95% CI: −0.09 to −0.08, p < 0.001). Neither association depended on sex (p = 0.59 and p = 0.41, respectively). The association remained significant after removing anxiety/depression items from the EQ‐5D score (β = 0.04, 95% CI: 0.03– 0.04, p < 0.001). Conclusions: The study shows that MBI is associated with poorer QoL, independent of sex, on two QoL scales. We addressed depression/anxiety items in the EQ‐5D as a potential confounder for the observed MBI‐QoL association by conducting a sensitivity analysis that excluded those items from the EQ‐5D total score and by employing a novel measure of QoL (QFS‐5) that excludes psychiatric symptoms from measurement of QoL. Associations of MBI with the novel QFS‐5 were similar to associations between MBI and the EQ‐5D. Finding interventions to reduce the burden of MBI symptoms might improve quality of life. [ABSTRACT FROM AUTHOR]

Findings have revealed a strong link between exposure to child maltreatment (CM) and later chronic pain. Concurrently, other findings have been grounded in the understanding that CM consequences may not end with the exposed individual, rather, they extend to their offspring. However, little is known regarding the possible intergenerational transmission of chronic pain following CM. This study examines whether chronic pain among parents and their young adult offspring may be associated with parental exposure to CM. Three hundred ninety‐three parent‐offspring dyads (parents' mean age = 58, SD = 5.91 years; offspring's mean age = 27, SD = 3.91 years) completed self‐report questionnaires, assessing CM (CTQ), posttraumatic stress (PTS) and disturbances in self‐organisation (DSO) symptoms (ITQ), and chronic pain. CM was associated with chronic pain mediated by DSO symptoms among parents (indirect effect = 0.77; p = 0.007) and PTS symptoms among offspring (indirect effect = 0.285; p = 0.005). Offspring chronic pain was significantly associated with parental CM through two intergenerational paths: the mediation of parents' DSO symptoms and chronic pain (indirect effect = 0.298; p = 0.011), and through parents' PTS symptoms and offspring's PTS symptoms (indirect effect = 0.077; p = 0.004). This study's findings support the relevance of the intergenerational transmission of chronic pain following parental exposure to CM. Furthermore, the findings reveal complex PTS symptoms as a possible underlying mechanism for the intergenerational associations of chronic pain following CM. [ABSTRACT FROM AUTHOR]

Background: The association between arterial stiffness and alcohol consumption is still controversial. We investigated this relationship by performing continuous analysis in men drinking only beer/cider, and women drinking only red wine. Methods: This cross‐sectional study involved participants aged 40–69 years consisting of 9029 men who drank only beer/cider, and 6989 women drinking only red wine. Alcohol consumption was captured by self‐reported questionnaire and reported as units per week, where one unit is equal 10 mL pure ethanol. Arterial stiffness index (ASI) was estimated using photoplethysmography. Results: In men consuming a mean 17.8 (5th and 95th percentiles, 2.6–76.7) units/week, ASI increased by heptiles (sevenths) of alcohol captured from beer/cider consumption and after adjusting for age (9.14, 9.40, 9.51, 9.53, 9.80, 9.80, 10.00 m/s; p‐trend < 0.001) and after full adjustment (9.29, 9.46. 9.55, 9.55, 9.73, 9.73, 9.75 m/s; p‐trend = 0.013). Similarly, in women consuming a mean 8.1 (1.6–29.3) units/week, ASI increased by heptiles of alcohol captured from red wine consumption and after adjusting for age (8.05, 8.05, 8.05, 8.11, 8.17, 8.30, 8.45 m/s; p‐trend = 0.012) and borderline significant after full adjustment (8.05, 8.07, 8.05, 8.07, 8.11, 8.22, 8.43 m/s; p‐trend = 0.055). These associations were confirmed in multivariable‐adjusted regression analysis in all men, men younger and older than 50 years, and when consuming more than 14 units per week. Similarly, these associations were confirmed in all women, women older than 50 years, and in those consuming more than 14 units per week. Conclusions: Positive linear relationships exist between arterial stiffness and alcohol, irrespective of whether captured from beer/cider consumption in men or red wine consumption in women. No evidence existed to support the notion that our arteries benefit from any level of alcohol consumption. [ABSTRACT FROM AUTHOR]

This paper explores a new perspective on middle‐aged migrant women. Midlife has long been presumed to be the most networked stage of life for sedentary populations, but it has not been examined critically in the context of migration. This is an empty space that warrants research attention, because middle‐aged migrants often have lives that are temporally and spatially distinctive. Drawing on ethnographic fieldwork in Latvia and the United Kingdom (2018–2023), I argue that the lifecourses of middle‐aged migrant women resemble the transitions that young people go through for work but differ in terms of care. Although strong ties relatives and friends have long been thought to be key for transnational care relations, weak ties also become instrumental through shared notions of self‐actualization in midlife. I provide a novel understanding of how the concepts of linked lives and networks can be applied to processes that are pertinent to middle‐aged women. [ABSTRACT FROM AUTHOR]

Introduction: Evidence on the early life risk factors of adult CRS, and the history of asthma and allergies across the life course, is limited. Aim: To investigate relationships between respiratory infective/allergic conditions in childhood, and asthma and allergies across the life course and CRS in middle age. Methods: Data were from the population‐based Tasmanian Longitudinal Health Study (TAHS) cohort, first studied in 1968 when aged 6–7 years (n = 8583) and serially followed into middle age (n = 3609). Using a well‐accepted epidemiological definition, participants were assigned a CRS‐severity subtype at age 53: no sinusitis/CRS (reference); past doctor diagnosis only; current symptoms without doctor diagnosis; and doctor‐diagnosed CRS with current symptoms. Relationships with infective/allergic respiratory illnesses at age 7, and previously published asthma‐allergy trajectories from 7 to 53 years, were examined using multinominal regression. Results: In middle age, 5.8% reported current CRS symptoms with 2.5% doctor‐diagnosed. Childhood conditions associated with symptomatic doctor‐diagnosed CRS included frequent head colds (multinomial odds ratio [mOR] = 2.04 (95% confidence interval [95% CI]: 1.24, 3.37)), frequent tonsillitis (mOR = 1.61 [95% CI: 1.00, 2.59]) and current childhood asthma (mOR = 2.23 [95% CI: 1.25, 3.98]). Life course trajectories that featured late‐onset or persistent asthma and allergies were associated with all CRS subtypes in middle age; early‐onset persistent asthma and allergies (mOR = 6.74, 95% CI: 2.76, 16.4); late‐onset asthma allergies (mOR = 15.9, 95% CI: 8.06, 31.4), and late‐onset hayfever (mOR = 3.02, 95% CI: 1.51, 6.06) were associated with symptomatic doctor‐diagnosed CRS. Conclusion: Current asthma, frequent head colds and tonsillitis at age 7 could signal a susceptible child who is at higher risk for CRS in mid‐adult life and who might benefit from closer monitoring and/or proactive management. Concurrent asthma and allergies were strongly associated and are potential treatable traits of adult CRS. [ABSTRACT FROM AUTHOR]

Objectives: The burden of pain in middle‐aged and older adults is considerable and significantly increases healthcare expenditures. We aimed to investigate the roles of handgrip strength (HGS) weakness and asymmetry in predicting pain across four nationally representative cohorts. Methods: This longitudinal study utilized data from four major surveys: the Health and Retirement Study (HRS); the English Longitudinal Study of Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); and the China Health and Retirement Longitudinal Study (CHARLS). Multivariable cubic regression splines were employed to visually explore the nonlinear associations between HGS and pain in each cohort. The Cox proportional hazard model was applied to analyze the independent and combined relationship between HGS weakness and asymmetry and pain risk. Results: We included 41,171 participants in the final analysis, with a mean follow‐up period of 4.68 ± 2.61 years (50.7% female, mean age 64.3 ± 9.3 years). No nonlinear relationship was found between HGS and pain incidence (nonlinear p < 0.05 in ELSA and SHARE; >0.05 in CHARLS and HRS). After adjustment, the highest quartile groups had a significantly reduced risk of pain compared to the lowest quartile groups across all cohorts, with hazard ratios of 0.81 (0.74, 0.89) in CHARLS, 0.86 (0.77, 0.97) in HRS, 0.88 (0.77, 0.98) in ELSA, and 0.78 (0.73, 0.84) in SHARE. Participants with normal HGS had approximately 20% lower risk of pain compared to those with weak HGS. Each 5 kg increase in HGS was associated with decreased hazard ratios for pain: 0.95 (0.93, 0.97) in CHARLS, 0.97 (0.94, 0.99) in HRS, 0.96 (0.94, 0.99) in ELSA, and 0.94 (0.92, 0.95) in SHARE. The association between HGS asymmetry and pain risk was significant only in a few cohorts (HRS at 10%, 1.10 (1.03, 1.18); SHARE at 30%, 1.12 (1.05, 1.21)). No interaction effect between HGS weakness and asymmetry on pain risk was observed (all p‐values for interaction >0.05). Conclusions: Our findings suggest that HGS can be used as an independent predictor of pain in middle‐aged and older European, American, and Chinese populations. However, our results do not support the use of HGS asymmetry as an independent predictor of pain risk. It is necessary to establish appropriate criteria for HGS asymmetry across different populations. The use of both weak HGS and asymmetry as predictors of health outcomes requires further validation in more diverse populations. [ABSTRACT FROM AUTHOR]

Objective: This study describes the 2010–2019 trend of cervical cancer (CC) in women over 55 by socio‐demographic index (SDI) and geographical regions. Methods: We obtained data on CC annually from 2010 to 2019 from the 2019 Global Burden of Disease Study (GBD) to analyze the incidence, death and prevalence rates, and disability‐adjusted life years (DALYs) associated with CC across different parameters such as global trend, age groups, SDI, continents, World Bank Regions, World Health Organization (WHO) regions, GBD regions, and National and territorial division. This analysis covers data from 204 countries and territories from 1990 to 2019. Results: There were 236,228 CC incidence cases worldwide in 2019, which is a 1.27‐fold increase from 2010. Global CC deaths also increased to 169,304 cases in 2019, reflecting a 1.24‐fold increase. CC prevalence increased to 769,925 cases in 2019, representing a 1.4‐fold rise. The number of CC DALYs globally increased to 3,835,979 cases in 2019, reflecting a 1.24‐fold increase. Incidence, death, prevalence, and DALY numbers of CC increased across all age groups females in the 65–69 years age group experienced the highest increase. Middle SDI countries had the highest incidence, death, prevalence, and DALY numbers, while low SDI countries showed increasing trends. Asia exhibited the highest incidence, death, prevalence, and DALY numbers of CC. Upper middle‐income countries had the highest incidence, death, prevalence, and DALY numbers, with the highest decreases in these rates except the prevalence rate. The Western Pacific Region showed the highest incidence, death, prevalence, and DALY numbers, with declining rate trends. The Republic of Kiribati showed the highest incidence, death, prevalence, and DALY numbers. Conclusion: Based on the study results, it is clear that although the global trend of epidemiological indicators of CC is decreasing, the largest proportion of the decreasing trend is related to developing countries. But in regions of Africa and Asia that have a lower level of development, sometimes these indicators show upward trends, which shows the worsening of the problem in these regions and the need for serious policies and plans to implement comprehensive vaccination, screening, and promotion interventions. People's awareness is necessary in the field of better disease control. [ABSTRACT FROM AUTHOR]

Building on the rich array of literatures that explore women's ageing and employment, we conduct a comprehensive review of research on middle‐ and older‐age women and work (including menopause and post‐menopause). In reviewing these studies, we blend our interdisciplinary discussions across several domains. We reflect on the question: How are employed, middle‐ and older‐age women treated in organizations, and what are employers' perceptions of these workers? Through our analysis, we identify and critique two predominant, conflicting yet inter‐related themes. These are, namely, notions of constraint (and women's supposed/perceived reduced competencies as they age) versus ideas of flexibility (foregrounding assumptions that employed women experience fewer limitations as they age). As a theoretical lens for theorizing the constraints theme, we draw upon the concept of abjection, highlighting how employer perceptions of women's health as supposedly diminishing can lead to discriminatory treatment at work. In analysing theoretical assumptions regarding apparently enhanced flexibility among middle‐ and older‐age women, we note how women's differing circumstances and requirements might go unrecognized. We argue the need to deepen theoretical understandings about ideas of flexibility during women's middle and older age. Reflecting on the limitations of both themes, we consider the implications for future research agendas. [ABSTRACT FROM AUTHOR]

Aim: The association of overweight/obesity and metabolic dysfunction‐associated steatotic liver disease (MASLD) in young adulthood with subclinical atherosclerosis [coronary artery calcification (CAC) and abdominal aortic calcification (AAC)] by middle age is unknown. Method: In total, 2274 participants aged 28‐39 years from the coronary artery risk development in young adults study at year 10 (1995‐1996) who were re‐examined 15 years later were included. CAC and AAC were measured at year 25 using computed tomography. We examined the utility of three young adult phenotypes (lean group; overweight/obese group; overweight/obese MASLD group) at year 10 in predicting CAC or AAC by middle age. Modified Poisson regression was used to estimate the association between groups and CAC, and AAC. Independent determinates of CAC and AAC were determined with linear regression models. Results: Compared with individuals categorized as lean in young adulthood, the relative risk for CAC by middle age was 1.09 (95% confidence interval: 0.93‐1.28) for those with overweight/obesity and 1.32 (95% confidence interval: 1.08‐1.61) for those with overweight/obesity‐related MASLD. For AAC, no difference was observed between these three groups. Group, systolic blood pressure and group × systolic blood pressure interaction were all the independent determinates for CAC. Conclusion: In this study, young adults with overweight/obesity‐related MASLD have a higher risk of developing CAC by middle age. These abnormalities are only partially explained by traditional cardiovascular risk factors, and overweight/obesity‐related MASLD has an independent impact on CAC. Our study provides evidence for identifying young adults at higher risk of developing subclinical atherosclerosis. [ABSTRACT FROM AUTHOR]

Aim: To examine the associations between visceral adipose tissue (VAT) and brain structural measures at midlife and explore how these associations may be affected by age, sex and cardiometabolic factors. Methods: We used abdominal and brain magnetic resonance imaging data from a population‐based cohort of people at midlife in the UK Biobank. Regression modelling was applied to study associations of VAT volume with total brain volume (TBV), grey matter volume (GMV), white matter volume, white matter hyperintensity volume (WMHV) and total hippocampal volume (THV), and whether these associations were altered by age, sex or cardiometabolic factors. Results: Complete data were available for 17 377 participants (mean age 63 years, standard deviation = 12, 53% female). Greater VAT was associated with lower TBV, GMV and THV (P <.001). We found an interaction between VAT and sex on TBV (P <.001), such that the negative association of VAT with TBV was greater in men (β = −2.89, 95% confidence interval [CI] −2.32 to −10.15) than in women (β = −1.32, 95% CI −0.49 to −3.14), with similar findings for GMV. We also found an interaction between VAT and age (but not sex) on WMHV (P <.001). The addition of other cardiometabolic factors or measures of physical activity resulted in little change to the models. Conclusions: VAT volume is associated with poorer brain health in midlife and this relationship is greatest in men and those at younger ages. [ABSTRACT FROM AUTHOR]

Objectives: To examine patient, surgical and hospital factors associated with Day‐1 postoperative mobility after hip fracture surgery in older adults. Methods: A cohort study using Australia and New Zealand Hip Fracture Registry was conducted. Participants were aged older than 50 years and underwent hip fracture surgery between 1 January 2020 and 31 December 2020 inclusive. The outcome was standing and step transferring out of bed onto a chair and/or walking Day‐1 after hip fracture surgery. Results: Mean age was 82 years and 68% were women. Of 12,318 patients with hip fracture, 5981 (49%) actually mobilised Day‐1. Odds of actual first‐day mobilisation were lower for individuals usually walking with either stick or crutch (OR = 0.71, 95% CI 0.62–0.82) or two aids or frame (OR = 0.57, 95% CI 0.52–0.64) or wheelchair/bed bound (OR = 0.24, 95% CI 0.17–0.33); who had impaired cognition preadmission (OR = 0.57, 95% CI 0.51–0.64); from aged care facilities (OR = 0.59, 95% CI 0.52–0.67); had an American Society of Anaesthesiologists grade 2 (OR = 0.63, 95% CI 0.41–0.97), 3 (OR = 0.31, 95% CI 0.20–0.47) or 4 or 5 (OR = 0.21, 95% CI 0.14–0.32); surgery delay >48 h (OR = 0.81, 95% CI 0.71–0.91); and restricted/non‐weight‐bearing status immediately postoperatively (OR = 0.53, 95% CI 0.42–0.67). Conclusions: Both non‐modifiable and modifiable patient and surgical factors influence first‐day mobilisation after hip fracture surgery. Reducing time to surgery might assist future quality improvement efforts to increase Day‐1 postoperative mobility. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the feasibility and validity of measuring implicit attitudes towards dementia in adults and older adults and evaluate the impact of dementia‐friendly education using virtual reality (VR) on implicit attitudes. Methods: This study was a secondary analysis of data from a randomised controlled trial. Community members in Tokyo aged 20–90 years participated in dementia‐friendly education with or without VR. At the end of the dementia‐friendly education programs, implicit attitudes towards dementia were measured using the Implicit Relational Assessment Procedure (IRAP). Results: Of the 145 participants, 89 (61%) started the IRAP, and 21 (15%) completed it. Lower age was significantly associated with the start/completion of the IRAP, and the age thresholds at which 50% of participants would not start/complete it were estimated to be 72.3/44.8 years, respectively. Those who had experience interacting with people with dementia other than family members had lower IRAP scores than those who had no such experience. The intervention group participating in the VR program had lower IRAP scores than the control group (p =.09). Conclusions: Although measuring implicit attitudes using IRAP is deemed not feasible for people in their 70s and older, the differences in interaction experience would be evidence supporting the validity of the measurements of implicit attitudes towards dementia. The results suggest that dementia‐friendly education, using VR, improves implicit attitudes towards dementia. [ABSTRACT FROM AUTHOR]

Background and aims: The relationship between alcohol consumption and age-related diseases is inconsistent. Biological age (BA) serves as both a precursor and a predictor of age-related diseases; however, longitudinal associations between alcohol consumption and BA in middle-aged and older people remain unclear. We measured whether there was a longitudinal association between drinking frequency and pure alcohol intake with BA among middle-aged and older people. Design and setting and participants: This study involved two prospective cohort studies, set in Southwestern China and the United Kingdom. A total of 8046 participants from the China Multi-Ethnic Cohort study (CMEC) and 5412 participants from the UK Biobank (UKB), aged 30-79 years, took part, with complete data from two waves of clinical biomarkers. Measurements: BA was calculated by the Klemera Doubal's method. Accelerated BA equalled BA minus chronological age. Drinking frequency and pure alcohol intake were obtained through self-reported questionnaires. Drinking frequency in the past year was classified as current non-drinking, occasional (monthly drinking) and regular (weekly drinking). Findings: Compared with consistent current non-drinkers, more frequent drinkers [CMEC: β = 0.46, 95% confidence interval (CI) = 0.13-0.80; UKB: β = 0.65, 95% CI = 0.01-1.29)], less frequent drinkers (CMEC: β = 0.62, 95% CI = 0.37-0.87; UKB: β = 0.54, 95% CI = -0.01-1.09), consistent occasional drinkers (CMEC: β = 0.51, 95% CI = 0.23-0.79; UKB: β = 0.63, 95% CI = 0.13-1.13) and consistent regular drinkers (CMEC: β = 0.56, 95% CI = 0.17-0.95; UKB: β = 0.46, 95% CI = 0.00-0.91) exhibited increased accelerated BA. A non-linear relationship between pure alcohol intake and accelerated BA was observed among consistent regular drinkers. Conclusions: In middle-aged and older people, any change in drinking frequency and any amount of pure alcohol intake seem to be positively associated with acceleration of biological ageing, compared with maintaining abstinence. [ABSTRACT FROM AUTHOR]

Objectives: Flexibility is recognized as one of the components of physical fitness and commonly included as part of exercise prescriptions for all ages. However, limited data exist regarding the relationship between flexibility and survival. We evaluated the sex‐specific nature and magnitude of the associations between body flexibility and natural and non‐COVID‐19 mortality in a middle‐aged cohort of men and women. Design: Prospective cohort study. Methods: Anthropometric, health and vital data from 3139 (66% men) individuals aged 46–65 years spanning from March 1994 to October 2022 were available. A body flexibility score, termed Flexindex, was derived from a combination of 20 movements (scored 0–4) involving seven different joints, resulting in a score range of 0–80. Kaplan–Meier survival curves were obtained, and unadjusted and adjusted hazard ratios (HRs) for mortality estimated. Results: During a mean follow‐up of 12.9 years, 302 individuals (9.6%) comprising 224 men/78 women died. Flexindex was 35% higher in women compared to men (mean ± SD: 41.1 ± 9.4 vs. 30.5 ± 8.7; p < 0.001) and exhibited an inverse relationship with mortality risk in both sexes (p < 0.001). Following adjustment for age, body mass index, and health status, the HR (95% CI) for mortality comparing upper and bottom of distributions of Flexindex were 1.87 (1.50–2.33; p < 0.001) for men and 4.78 (1.23–31.71; p = 0.047) for women. Conclusions: A component of physical fitness—body flexibility—as assessed by the Flexindex is strongly and inversely associated with natural and non‐COVID‐19 mortality risk in middle‐aged men and women. Future studies should assess whether training‐induced flexibility gains are related to longer survival. [ABSTRACT FROM AUTHOR]

Background: Generalized joint hypermobility as a characteristic feature of Ehlers–Danlos syndromes (EDS) is among the factors contributing to temporomandibular disorders (TMD). Objective: To evaluate the prevalence of TMD symptoms and their risk factors among women born in Sweden or Finland who were 27‐ to 78‐year‐olds with diagnosed hypermobile EDS (hEDS). Methods: A cohort of women with confirmed hEDS (n = 185) was constructed from the members of the National EDS Associations in both countries. Based on questionnaire data, frequency of independent variables in terms of socio‐demographic, general health and oral health‐related factors, comorbid symptoms and psychological distress for self‐reported TMD symptoms as the dependent variables, were calculated first. Prevalence ratios (PR) and their 95% confidence interval (95% CI) were estimated for the association between independent and dependent variables. Results: Nearly all participants reported TMD symptoms (98%) with TMD pain (95%), TMJ clicking (90%) and jaw fatigue (80%) as the most common symptoms and TMJ crepitation (63%) and luxation (44%) as the least common symptoms. Risk factors for TMD among 27‐ to 50‐year‐olds participants were Finland as a country of birth, living alone and self‐reported worst pain in the body (not the joints). The respective risk factors among the 51‐ to 78‐year‐olds were Finland as a country of birth, family history of EDS, tinnitus and regularly taking contraceptives. Conclusions: Among adult women with confirmed hEDS, socio‐demographic and health‐related factors and comorbid symptoms were significantly associated with TMD but with differences regarding age group. Therefore, management of TMD requires a multidisciplinary approach among the affected. [ABSTRACT FROM AUTHOR]

Objectives: Parkinson disease (PD) is the third leading cause of mortality among middle‐aged and older individuals in China. This study aimed to explore the trends and distribution features of PD mortality in China from 2013 to 2021 and make predictions for the next few decades. Methods: Relevant data were obtained from the Chinese Center for Disease Control and Prevention Disease Surveillance Point system. The joinpoint regression model was used to evaluate trends. The R software was used to predict future trends. Results: Age‐standardized mortality rate (ASMR) of PD increased from 0.59 per 100,000 individuals to 1.22 per 100,000 individuals from 2013 to 2021, with an average annual percent change (AAPC) of 9.50 (95% CI: 8.24–10.78). The all‐age ASMR of PD were higher in male individuals than in female individuals, and ASMR increased with age. The number of deaths and ASMR increased gradually from west to east and from rural to urban areas. Furthermore, ASMR is expected to increase to 2.66 per 100,000 individuals by 2040. Conclusions: The heightened focus on the ASMR of PD among male individuals, urban areas, eastern China, and individuals aged ≥85 years has become a key determinant in further decreasing mortality, thereby exhibiting novel challenges to effective strategies for disease prevention and control. [ABSTRACT FROM AUTHOR]

Emotional intimacy is considered a fundamental factor contributing to the quality of marital relationships. However, marital strain can often limit intimacy. Thus, our first objective was to explore the intricate interplay between spouses' sense of intimacy and the levels of marital strain experienced by both themselves and their partners. In addition, the way partners respond to the challenges posed by marital strain can be pivotal in shaping the overall dynamics. Therefore, our second objective was to investigate whether and how the empathy exhibited by partners can protect the couple from the potential adverse effects of marital strain on emotional intimacy within the relationship. 96 midlife and older heterosexual couples reported on their sense of marital strain, emotional intimacy, and their level of empathy. We used Actor‐Partner Interdependence Model (APIM) to analyze the results. Negative associations were found between marital strain and emotional intimacy for both men and women. Men's empathy moderated the relationship between women's strain and intimacy, but women's empathy did not moderate the association between men's strain and intimacy. Assessing both spouses' strain is essential for understanding marital intimacy. Men's empathy can have a meaningful role in mitigating the experienced strain on marital outcomes. [ABSTRACT FROM AUTHOR]

Aims: The association of sleep traits (insomnia, sleep duration, chronotype, daytime sleepiness, and snoring) with benign prostatic hyperplasia (BPH) is unclear. This research aimed to examine the effects of sleep traits on BPH risk. Methods: A total of 170 241 men aged 38 to 73 years from UK Biobank were included. An overall healthy sleep score was created based on five sleep traits. A Cox regression model was utilized to compute adjusted hazard ratios (HRs) and population attributable fractions (PAFs) with 95% confidence intervals (CIs) for BPH risk in relation to sleep traits. Results: During a median of 12.0 years follow‐up, 13 026 incident BPH cases occurred. We observed that sleep duration (7–8 h/d; HR 0.95; 95% CI 0.92–0.99), no frequent insomnia (HR 0.71; 95% CI 0.69–0.74), and no frequent daytime sleepiness (HR 0.86; 95% CI 0.79–0.93) were significantly related to reduced BPH risk. Each one‐point increment of the healthy sleep score was related to a decreased BPH risk, with an adjusted HR of 0.90 (95% CI 0.89–0.92). The multivariable‐adjusted HR in men adopting five versus zero to one low‐risk sleep traits was 0.68 (95% CI 0.61–0.75) for BPH risk. Estimates of the PAF indicated that 9.1% (95% CI 5.8–12.5%) of BPH cases would be prevented if all individuals had adopted all five low‐risk sleep traits, assuming causality. Conclusions: Our study indicates an association between a healthy sleep pattern and a lower risk of BPH, emphasizing the importance of adhering to such patterns for potentially reducing BPH risk. Geriatr Gerontol Int 2024; 24: 675–682. [ABSTRACT FROM AUTHOR]

Objective: To examine associations between body mass index (BMI) in early pregnancy and gestational weight gain (GWG) with cardiovascular health in middle age using the 'Life's Essential 8' (LE8) concept of the American Heart Association (AHA). Design: Population‐based cohort study. Setting: Swedish CardioPulmonary bioImage Study (SCAPIS). Population: A total of 8871 women from SCAPIS were included. Methods: Information on cardiovascular health in middle age was collected from SCAPIS and linked to pregnancy weight data obtained from the Swedish Medical Birth Register, with an average follow‐up time of 24.5 years. An LE8 score between 0 and 100 was determined, where a score under 60 points was defined as poor cardiovascular health. Binary logistic regression and restricted cubic splines were used. Main outcome measures: Cardiovascular health according to LE8 in middle age. Results: The odds of having poor cardiovascular health in middle age were significantly higher in women who had overweight (adjusted odds ratio, aOR 3.30, 95% CI 2.82–3.88) or obesity (aOR 7.63, 95% CI 5.86–9.94), compared with women classified as being of normal weight in pregnancy. Higher odds were also found for excessive GWG (aOR 1.31, 95% CI 1.09–1.57), compared with women who gained weight within the recommendations. Conclusions: A high BMI in early pregnancy and excessive GWG were associated with greater odds of poor cardiovascular health in middle age. Although further studies are needed, our results highlight pregnancy as an important period to support long‐term cardiovascular health. [ABSTRACT FROM AUTHOR]

Objective: To investigate the bidirectional association between oral diseases and cognitive function comprehensively. Subjects and Methods: This cross sectional study utilized data from the National Health and Nutrition Examination Survey. Oral diseases include periodontitis, dental caries, and tooth loss (end point of oral disease resulting in tooth extraction). Cognitive function included three domains: memory, processing speed, and executive function. A global cognitive score was then derived from sum of the three cognitive domains. Oral cognition associations were examined using various statistical models: (1) Regress oral disease on cognitive function; (2) Regress cognitive function on oral disease; and (3) Structural equation modelling treating cognition and oral disease as latent variables. Results: There were 2508 participants aged 60+ who had both oral and cognitive information. Associations between various oral disease and global cognitive score were observed (Odds ratio ORcog‐>periodontitis 0.95, 95% Confidence Interval [0.92, 0.99]; βcog‐>caries −0.13, [−0.23, −0.04]; βcog‐>tooth loss −0.03 [−0.04, −0.01]; βtooth loss‐>cog −0.04 [−0.06, −0.02]; βcaries‐>cog −0.03 [−0.06, −0.01]; βperiodontitis‐>cog −0.39 [−0.69, −0.10]). Significant correlation was also found between these oral disease and cognitive function using structural equation model (r −0.22, [−0.34, −0.10]). Conclusions: This study found robust bidirectional associations between oral disease and cognitive function using various modelling approaches among the aging population. [ABSTRACT FROM AUTHOR]

Objective: Experiences of menopause and quality of life during menopause can vary extensively among women. While menopause has been associated with negative impacts on eating and body image, it is unclear to what extent quality of life differs by eating disorder risk status. The aim of this study was to explore how menopause symptoms and quality of life differ between those women at high‐ or low‐risk of an eating disorder and the potential protective role of body appreciation. Method: This cross‐sectional survey study explored differences in menopausal quality of life, body appreciation, and body dissatisfaction among women classified as high‐ or low‐risk of an eating disorder as part of a wider survey on aging, health, and psychological complaints during midlife. Participants were 255 females aged between 40 and 60 years. Participants were classified as high‐risk and low‐risk of an eating disorder based on Eating Attitudes Test‐26 (EAT‐26) scores. Differences between groups on the Menopause‐Specific Quality of Life Questionnaire (MENQOL), Body Shape Questionnaire (BSQ‐16), and Body Appreciation Scale–2 were analyzed. The predictive relationship between menopausal quality of life and body appreciation was also explored. Results: Participants in the high‐risk group (n = 111) reported significantly poorer menopausal quality of life compared to the low‐risk group (n = 144), scoring significantly higher on the sexual, physical, and psychosocial subscales of the MENQOL. The high‐risk group also had significantly greater body dissatisfaction and less body appreciation than the low‐risk group. Overall, menopausal quality of life was a significant predictor of body appreciation. Discussion: Women with greater eating disorder risk may be faring less well with menopause. Treating and preventing menopause‐related eating disorders will benefit from interventions aimed at not only reducing body dissatisfaction, but actively bolstering body appreciation and supporting the sexual, physical, and psychosocial aspects of the menopausal transition. [ABSTRACT FROM AUTHOR]

Purpose: To assess left atrial (LA) function in individuals with known paroxysmal atrial fibrillation (AF) compared with healthy and nonhealthy individuals without atrial fibrillation. Methods: The Akershus Cardiac Examination 1950 Study included 3,706 individuals all born in 1950. LA strain assessment of reservoir (LASr), conduit (LAScd) and contractile (LASct) functions were performed in all participants by investigators blinded to clinical data. Participants with cardiovascular disease, obesity, diabetes, pulmonary or renal disease were defined as nonhealthy, and those without as healthy. Patients with paroxysmal AF were identified through medical history and ECG documentation. Results: LA strain assessment was feasible in 3,229 (87%) of the participants (50% women). The healthy group (n = 758) had significantly higher LASr and LAScd than the nonhealthy (n = 2,376), but LASct was similar between the groups. Participants with paroxysmal AF had significantly lower values of all strain parameters than the other groups. Multivariable logistic regression showed a significantly reduced probability of having AF per standard deviation increase in LASr and LASct. A nonlinear restricted cubic spline model fitted better with the association of LASr with paroxysmal AF than the linear model, and LA strain values below the population mean associated with an increased probability of having AF, but for values above the population mean no such association was present. Conclusion: Compared to participants without AF, those with known paroxysmal AF had significantly lower values of all LA strain parameters during sinus rhythm. Lower values of LA strain were associated with a significantly increased probability of having AF. [ABSTRACT FROM AUTHOR]

Objectives: To investigate gender‐specific factors associated with case complexity in a population‐based sample of middle‐aged and older adults using a holistic approach to complexity. Methods: Data were derived from the 8‐year follow‐up home visits of the ESTHER study—a German population‐based study in middle‐aged and older adults. Cross‐sectional analyses were conducted for 2932 persons (aged 57–84). Complexity was assessed by the well‐established INTERMED for the elderly interview, which uses a holistic approach to the definition of case complexity. The association between various bio‐psycho‐social variables and case complexity was analyzed using gender‐specific logistic regression models, adjusted for sociodemographic factors (age, marital status, education). Results: Prevalence of complexity was 8.3% with significantly higher prevalence in female (10.6%) compared to male (5.8%) participants (p < 0.001). Variables associated with increased odds for complexity in both, women and men were: being divorced (odds ratio [OR] women: 1.86, 95% CI 1.05–3.30; OR men: 3.19, 1.25–8.12), higher total somatic morbidity (women: 1.08, 1.04–1.12; men: 1.06, 1.02–1.11), higher depression severity (women: 1.34, 1.28–1.40; men: 1.35, 1.27–1.44), and higher loneliness scores (women: 1.19, 1.05–1.36; men: 1.23, 1.03–1.47). Women (but not men) with obesity (Body mass index [BMI] ≥30) had higher odds (1.79, 1.11–2.89) for being complex compared to those with a BMI <25. High oxidative stress measured by derivatives of reactive oxygen metabolites in serum was associated with 2.02 (1.09–3.74) higher odds for complexity only in men. Conclusions: This study provides epidemiological evidence on gender differences in prevalence and factors associated with case complexity in middle‐aged and older adults. Moreover, this study adds to the holistic understanding of complexity by identifying novel variables linked to complexity among middle‐aged and older individuals. These factors include loneliness for both genders, and high oxidative stress for men. These findings should be confirmed in future longitudinal studies. Key points: Prevalence of complexity was found to be 8.3% with significantly higher prevalence in women (10.6%) compared to men (5.8%) (p < 0.001).Being divorced, higher total somatic morbidity, higher depression severity, and higher loneliness scores were associated with higher odds for complexity in both genders.Obesity was linked to higher odds for complexity only in women, while high oxidative stress was linked to complexity only in men.This study expands the holistic understanding of complexity by identifying novel variables associated with complexity in middle‐aged and older adults, including loneliness for both genders and high oxidative stress for men. [ABSTRACT FROM AUTHOR]

Cortisol and heart rate variability (HRV) are well‐established biomarkers of the human stress response system. While a relationship between cortisol and HRV is assumed, few studies have found evidence of their correlation within single study designs. One complication for isolating such a relationship may lie in individual variability in the cortisol response to stress such that atypical cortisol responding (i.e., elevated or blunted) occurs. To‐date, studies on the cortisol response have employed traditional mean‐difference‐based approaches to examine average magnitude change in cortisol over time. Alternatively, data‐driven trajectory modelling, such as latent growth mixture modelling, may be advantageous for quantifying cortisol based on patterns of response over time. Latent growth mixture modelling was used in N = 386 adults to identify subgroups based on trajectories of cortisol responses to stress. The relationship between cortisol and HRV was tested within subgroups. Results revealed a 'prototypical' subgroup characterised by expected rise and fall in cortisol response to stress (n = 309), a 'decline' subgroup (n = 28) that declined in cortisol after stress, and a 'rise' subgroup (n = 49) that increased in cortisol after stress. Within the 'prototypical' subgroup, greater HRV during stress was associated with decline in cortisol after stress from its maximum (r (306) = 0.19, p < 0.001). This relationship failed to emerge in the 'decline' and 'rise' subgroups (p > 0.271). Results document different patterns of cortisol response to stress; among those who exhibit a 'prototypical' response, changes in HRV during stress are related to changes in cortisol after stress. [ABSTRACT FROM AUTHOR]

Background: Social risks are common among cancer survivors who have the fewest financial resources; however, little is known about how prevalence differs by age at diagnosis, despite younger survivors' relatively low incomes and wealth. Methods: The authors used data from 3703 participants in the Detroit Research on Cancer Survivors (ROCS) cohort of Black cancer survivors. Participants self‐reported several forms of social risks, including food insecurity, housing instability, utility shut‐offs, not getting care because of cost or lack of transportation, and feeling unsafe in their home neighborhood. Modified Poisson models were used to estimate prevalence ratios and 95% confidence intervals (CIs) of social risks by age at diagnosis, controlling for demographic, socioeconomic, and cancer‐related factors. Results: Overall, 35% of participants reported at least one social risk, and 17% reported two or more risks. Social risk prevalence was highest among young adults aged 20–39 years (47%) followed by those aged 40–54 years (43%), 55–64 years (38%), and 65 years and older (24%; p for trend <.001). Compared with survivors who were aged 65 years and older at diagnosis, adjusted prevalence ratios for any social risk were 1.75 (95% CI, 1.42–2.16) for survivors aged 20–39 years, 1.76 (95% CI, 1.52–2.03) for survivors aged 40–54 years, and 1.41 (95% CI, 1.23–1.60) for survivors aged 55‐64 years at diagnosis. Similar associations were observed for individual social risks and experiencing two or more risks. Conclusions: In this population of Black cancer survivors, social risks were inversely associated with age at diagnosis. Diagnosis in young adulthood and middle age should be considered a risk factor for social risks and should be prioritized in work to reduce the financial effects of cancer on financially vulnerable cancer survivors. This report evaluates associations between age at diagnosis and the prevalence of social risks, such as food insecurity, housing instability, and forgoing care because of lack of transportation in a population‐based cohort of Black cancer survivors. Age at diagnosis was inversely associated with social risks, and young adult survivors reported the highest prevalence of any social risks, multiple social risks, and several individual social risks. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to examine associations among measures of stress, social support, and symptoms at midlife. Specifically, the study examined whether support buffered against the negative effects of stress on severity of symptoms grouped via factor analyses into emotional instability, vaso‐somatic symptoms, mood disturbances, and aches and pains. Methods: We used cross‐sectional data from n = 119 women aged 40–55 in Nagaland, India. Midlife symptoms were measured with the help of questionnaires, and factor analysis was used to identify latent factors. Stress and social support were measured by Perceived Stress Scale and Multidimensional Scale of Perceived Social Support, respectively. Chronic stress was measured by fingernail cortisol. Results: After adjusting for menopausal status, tobacco use, body mass index, and socioeconomic status, cortisol level was positively associated with emotional instability (p < 0.01), vaso‐somatic symptom score (p < 0.05), and total symptoms at midlife (p < 0.05). Familial support was negatively associated with emotional instability (p < 0.05) and total symptoms at midlife (p < 0.05). However, no significant associations were observed with spousal or friend support. Although no significant interactions between stress, social support, and symptoms at midlife were observed, spousal support when stratified as high and low support using the means, perceived stress and vaso‐somatic symptoms indicated an interaction. Conclusion: Cortisol level and support from family were independently associated with symptoms at midlife. The study highlights the importance of family ties and support for navigating the stressors of everyday life among women in Nagaland. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate prospective associations between participation in sports/recreational activities and the occurrence of moderate‐to‐severe psychological distress over 2 years in a sample of mid‐aged Australians. Methods: This prospective study used data from 6699 adults aged 40+ years, living in Brisbane in 2007, and surveyed in 2009, 2011 and 2013. Participants provided self‐reported data on frequency of participation in each of 11 sports/recreational activities in past 12 months and completed the Kessler Psychological Distress 6‐item Scale (K6). Generalized estimating equation (GEE) models with a 2‐year lag were used to assess the associations of participation in sports/recreational activities in 2009 and 2011 with new cases of moderate‐to‐severe psychological distress (K6 score ≥ 5) in 2011 and 2013. Results: From 2009 to 2013, 22.4% of participants without moderate‐to‐severe psychological distress at baseline (N = 4943) developed this outcome in at least one survey. Overall, there were no clear patterns of association between frequency of participation in sports and recreational activities and occurrence of moderate‐to‐severe psychological distress. In unadjusted models, weekly participation in some activities (e.g., tennis, golf, and exercise classes) was associated with reduced odds of moderate‐to‐severe psychological distress over the next 2 years, but these associations were attenuated in most adjusted models with sociodemographic, lifestyle, and health covariates. Participation in home‐based exercise and running/jogging were associated with higher odds of psychological distress. Conclusion: Our findings do not provide strong evidence of beneficial associations of frequency of sport/recreational activities with psychological distress but show surprising negative associations of home‐based exercise and running/jogging with occurrence of moderate‐to‐severe psychological distress over 2 years. [ABSTRACT FROM AUTHOR]

The article presents a study which examined and compared sociodemographic, physical, and mental health characteristics associated with cannabis use among middle-aged and older adults. Topics discussed include the use of cannabis to alleviate a variety of health conditions, sociodemographic, physical, and mental health characteristics by age group among the sample, and income and urbanicity associations with cannabis use by age group.

Objectives: Increasing obesity has been associated with a higher frequency of symptoms at midlife. Bothersomeness represents an important measure of perceived symptom severity, but has received relatively little consideration, and relationships between symptom bothersomeness and obesity are not known. We evaluated the association between body fat percentage (%BF) and the bothersomeness of symptoms at midlife. Methods: This cross‐sectional study included women aged 40–60 in Qatar (n = 841). Participants reported frequency and bothersomeness of midlife symptoms hypothesized to be related to body composition. Initially, we characterized the relationship between continuous %BF and presence (yes/no) and bothersomeness (yes/no) for each symptom using restricted cubic spline (RCS) models to test nonlinearity. Subsequently, we used multinomial logistic regressions to evaluate associations between %BF and multilevel symptom outcomes, where categories were: (a) no symptoms or bother, (b) symptoms without bothersomeness, and (c) symptoms with bothersomeness. Results: The highest frequency of bothersomeness was reported for aches/stiffness in joints (51%), followed by trouble sleeping (34%), night sweats (21%), urinary incontinence (18%), hot flashes (16%), and shortness of breath (15%). In unadjusted multinomial logistic regressions, aches/stiffness in joints with and without bothersomeness had the same significant relationship with %BF. Bothersome night sweats, urinary incontinence, and hot flashes were significantly associated with %BF (p <.05), but those same symptoms without bothersomeness were not significantly associated with %BF. Conclusions: Our findings suggest that bothersomeness is an important variable that tracks with body fat and gives different information than report of the presence/absence of a symptom alone. [ABSTRACT FROM AUTHOR]

Interest in mindfulness in the field of romantic relationships is growing. Drawing from a Self‐Determination Theory (SDT) perspective—which proposes that the basic psychological needs for autonomy, competence, and relatedness are foundational for well‐being—we attempted to map out the complex associations between mindfulness, self‐compassion, other‐compassion, basic need fulfillment in relationships, and increased relationship and sexual satisfaction. A sample of 640 midlife (40–59‐year‐old) married Canadians was recruited from a national panel. To test the associations at a systems‐level, we utilized psychological network analysis based on the premise that the relational and sexual effects of mindfulness are understood as part of a dynamic and multivariate network of associations with other variables. Need fulfillment in relationships (particularly relatedness needs) occupied a central position in the model, connecting mindfulness and self‐compassion with relationship satisfaction and sexual satisfaction. The findings underscored the major importance of SDT in relationships, and the overall structure of the network was consistent with growing theories of mindfulness in relationships. Future research employing longitudinal network models will aid in elucidating this system's operation over time. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Podiatrists and orthopedists should be vigilant for chronically evolving, hyperalgic soft lumps in the foot with vascular radiological features, prompting early detection of glomus tumor, timely mass removal, providing pain relief and improving patient's quality of life. Glomus tumors refers to a rare group of benign perivascular neoplasms that originate from a neuromyoarterial structure called a glomus body. These tumors are characterized by their painful nature and predominant distribution in the extremities mainly the fingers, the hands and the feet. Nonetheless, the diagnosis is usually made after several years of symptoms experience as the lesions are mostly small, not palpable, and have variable presentations. Radiological workup especially with magnetic resonance imaging is very useful for diagnosing the tumoral process, however, confirmation can only be obtained by histological analysis. The treatment is purely surgical, and it is successful in most cases. Herein, we describe a case of glomus tumor of the foot dorsal side among a middle age male patient. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Hydatid cyst is a sly disease that can manifest with a spectrum of symptoms in almost every part of the human body, so it is crucial to be familiar with different scenarios that a patient may present. The echinococcus granulosus parasite causes hydatid disease and is common in areas with animal husbandry and agriculture. Here, we report a middle age woman who presented with abdominal pain that further investigation revealed a cyst in subdiaphragmatic area. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Ultrasound‐guided core needle biopsy combined with immunohistochemistry and molecular testing could improve the diagnostic accuracy of bone metastases from follicular thyroid carcinoma, help to predict distant metastasis and prognosis. Metastatic thyroid follicular carcinoma presenting initially with bone lesion is uncommon, its prime symptom is gradual onset, localized pain. Patient with bone metastasis who were diagnosed before thyroidectomy had a higher rate of mortality, clinician should be cautious in eliciting the clinical history and this insidious symptom in middle age group, carry out further examination. We are presenting two case reports of a follicular thyroid carcinoma with bone metastasis, ultrasound‐guided core needle biopsy combined with immunohistochemistry (IHC) were carried out by our clinical team to determine the source and nature of the tumor, relevant literature was reviewed, molecular testing was discussed, we believe core needle biopsy combined with IHC and molecular testing improve the diagnostic accuracy of bone metastases from follicular thyroid carcinoma. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case presentation highlights the need to routinely monitor renal function in patients on Tenofovir Disoproxil Fumarate (TDF) due to its side effect of proximal tubule dysfunction. This is a case presentation of a 50‐year‐old African female who had been on a Tenofovir based regimen for 12 years and developed Fanconi syndrome. She recovered after discontinuation of the Tenofovir Disoproxil Fumarate (TDF). [ABSTRACT FROM AUTHOR]

Introduction: In vivo myeloarchitectonic mapping based on Magnetic Resonance Imaging (MRI) provides a unique view of gray matter myelin content and offers information complementary to other morphological indices commonly employed in studies of autism spectrum disorder (ASD). The current study sought to determine if intracortical myelin content (MC) and its age‐related trajectories differ between middle aged to older adults with ASD and age‐matched typical comparison participants. Methods: Data from 30 individuals with ASD and 36 age‐matched typical comparison participants aged 40–70 years were analyzed. Given substantial heterogeneity in both etiology and outcomes in ASD, we utilized both group‐level and subject‐level analysis approaches to test for signs of atypical intracortical MC as estimated by T1w/T2w ratio. Results: Group‐level analyses showed no significant differences in average T1w/T2w ratio or its associations with age between groups, but revealed significant positive main effects of age bilaterally, with T1w/T2w ratio increasing with age across much of the cortex. In subject‐level analyses, participants were classified into subgroups based on presence or absence of clusters of aberrant T1w/T2w ratio, and lower neuropsychological function was observed in the ASD subgroup with atypically high T1w/T2w ratio in spatially heterogeneous cortical regions. These differences were observed across several neuropsychological domains, including overall intellectual functioning, processing speed, and aspects of executive function. Conclusions: The group‐level and subject‐level approaches employed here demonstrate the value of examining inter‐individual variability and provide important preliminary insights into relationships between brain structure and cognition in the second half of the lifespan in ASD, suggesting shared factors contributing to atypical intracortical myelin content and poorer cognitive outcomes for a subset of middle aged to older autistic adults. These atypicalities likely reflect diverse histories of neurodevelopmental deficits, and possible compensatory changes, compounded by processes of aging, and may serve as useful markers of vulnerability to further cognitive decline in older adults with ASD. [ABSTRACT FROM AUTHOR]

Aims: To explore the feasibility and potential benefits of a peer support programme for adults with insulin‐treated type 2 diabetes (T2D) starting continuous glucose monitoring (CGM). Methods: This part of the Steno2tech study is an exploratory, single‐centre, open‐labelled, prospective, randomised controlled trial (RCT). A total of 60 participants were randomised 2:1 to 12 months of CGM with or without peer support. All participants received a 3‐h diabetes self‐management education course including a CGM part on how to use the CGM and interpret the CGM‐derived data. Peer support consisted of three 3‐h peer support meetings over the first 6 months of the study period with groups of three to six people. The exploratory outcomes included the acceptability and feasibility of the peer support intervention, and the between‐group difference in change in several glycaemic, metabolic and participant‐reported outcomes measured at baseline, 6 and 12 months. Results: The peer support intervention was found acceptable and feasible. Participants shared their experiences of using and interpreting CGM data and its association with health behaviour. While both groups had improvements in glycaemic, metabolic and participant‐reported outcomes, there were no significant between‐group differences. Conclusions: Although feasible, we found no measured additional benefits when adding a peer support programme after starting CGM in this exploratory RCT including adults with insulin‐treated T2D. Understanding the perceived effect of and preferences for a peer support intervention from the participants' points of view, including why individuals declined to participate, would be of value for future research. [ABSTRACT FROM AUTHOR]

Objective: Sarcopenia is a geriatric syndrome that occurs with age and is characterized by a gradual decline in muscle mass, power, and functionality. It serves as a prominent contributor to frailty, disability, and mortality among older individuals. Currently, no standardized global guidelines exist for the diagnosis of sarcopenia. This study aimed to establish the correlation between sarcopenia and the constitutions of traditional Chinese medicine (TCM), considering the connection between physical functioning and sarcopenia. Methods: A total of 1441 participants in this study were diagnosed with sarcopenia. The Asian Working Group for Sarcopenia (AWGS) proposed a sarcopenia definition algorithm. To determine the constitution of each participant, classification and determination standards were used in traditional Chinese medicine. This study evaluated the demographics, lifestyles, and self‐reported medical history of individuals diagnosed with sarcopenia through a self‐administered questionnaire. The constitution of the participants was determined using TCM classification and determination standards. Subsequently, we analyzed the results of univariate analysis and multivariate regression and constructed a receiver operating characteristic (ROC) curve. Results: Participants who were diagnosed with sarcopenia had substantially lower original Neutral constitution scores (P < 0.050). In comparison to those without sarcopenia, individuals with sarcopenia exhibited notably elevated original Qi‐deficiency, Yang‐deficiency, Yin‐deficiency, Blood‐stagnation, and Qi‐stagnation scores in contrast to those in the healthy group (P < 0.050). The identified risk factors associated with sarcopenia included the following: Neutral (OR = 0.903), Qi‐deficiency (in males, OR = 1.126), Yang‐deficiency (OR = 1.062), Phlegm‐dampness (in males, OR = 0.833), and Blood‐stagnation (in females, OR = 1.089). The highest area under the curve (AUC) was observed for the original neutral constitution score, followed by the Yang‐deficiency and blood‐stagnation scores (0.644, 0.613, and 0.611, respectively). Additionally, the AUC for the combined original scores of all nine constitutions among males reached 0.778. Conclusions: In this cross‐sectional study of older people with higher original Qi‐deficiency, Yin deficiency, Yang‐deficiency, Blood‐stagnation, and Qi‐stagnation were associated with sarcopenia. Notably, various TCM constitutions are significantly linked to sarcopenia. There was a significant occurrence of various body constitution types among individuals diagnosed with sarcopenia. The mixture of the nine original constitution scores exhibited good diagnostic performance for sarcopenia in males. [ABSTRACT FROM AUTHOR]

This paper contributes to an understanding of the tectono‐sedimentary evolution of the South Pyrenean foreland system by reviewing the chronostratigraphic framework of the basin infill in its eastern sector. Six sections are analysed and cross‐correlated to build a 6.5 km thick composite magnetostratigraphy that represents the complete record of the Cadí Nappe in the Ripoll Syncline. New and previous magnetostratigraphic sections are integrated with available biostratigraphy to provide a new age calibration of the sedimentary succession of the Cadí Nappe, encompassing from Palaeocene to Middle Lutetian age. The proposed correlation with the Geomagnetic Polarity Time Scale aims at best reconcile magnetostratigraphic data with the regional biochronology built on the marine Shallow Benthic Zonation (SBZ biozones), the continental mammalian biochronology (MP levels) and the newly collected charophyte data. A subsidence analysis was performed on the calibrated composite succession, resulting in two well‐defined intervals bounded by a hiatus. A Palaeocene to Early Eocene interval with low (11–21 cm/kyr) total subsidence rates, and an Early to Middle Eocene interval, characterised by high (70–75 cm/kyr) total subsidence rates. The detailed trends in both subsidence and sedimentation mark the development and evolution of the foreland depozones, from distal foreland depozones to foredeep and wedge‐top depozones, relative to the emplacement of the Pedraforca Nappe and Cadí Thrust Nappe. The most pronounced sedimentary shift in the Cadí Nappe occurred at 49 Ma, with the rapid drowning of the carbonate platforms and its transition into talus and deep basinal environments. Carbonate platforms collapsed and resedimented on the talus of the elongated trough, newly formed parallel to the orogenic front. This marked the onset of tectonic subsidence triggered by the submarine emplacement of the Lower Pedraforca Nappe. The emersion of the orogenic wedge drove the entry of siliciclastics, lagged by 1 Myr, into the Ripoll Trough. The foredeep filled rapidly (5.5 km thickness in less than 7 Myr) compared to other South Pyrenean regions, favoured by its semi‐enclosed palaeogeography. The emplacement of the Vallfogona Thrust as early as the Middle Lutetian (43 Ma) brought the Cadi Nappe into a wedge‐top setting. However, the Ripoll growth syncline continued acting as a temporary sink for alluvial sedimentation while a foredeep developed further south in the autochthonous Ebro Basin. The flexural response of the Iberian plate to the tectonic thickening of the Axial Zone counterbalanced for a period the local uplift of the Cadi Nappe, providing accommodation space for the top sediments filling the Ripoll Syncline. [ABSTRACT FROM AUTHOR]

Aim: To understand the experiences of individuals who undergo LEA due to DFU after disability. Design: A descriptive research design in qualitative research. Methods: Semi‐structured interviews were used in this qualitative descriptive study. Eleven middle‐aged patients (45–59 years) who underwent LEA due to DFU were purposively selected and interviewed. Qualitative data were thematically analysed. Results: Three themes and 10 subthemes were identified. The themes were (1) role function confusion, (2) self‐concept stress and (3) unreasonable objective support. Subthemes included (1) weakened career role, (2) family role reversal, (3) social role restriction, (4) over‐focusing on appearance, (5) immersion in patient experience, (6) living with faith, (7) polarization of independent consciousness, (8) low perceived benefits of peer support, (9) existence of treatment disruption and (10) poor participation in medical decision‐making. [ABSTRACT FROM AUTHOR]