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The female advantage in life expectancy sits uneasily with female disadvantage in health and well-being in later life compared to their male counterparts. This health disparity has been suggested to rest on sex difference in allostatic load (AL). We aim to delineate the sex-specific age trajectories of AL among midlife and older adults in China and to interpret the contradiction between the female advantage in life expectancy and their disadvantage in health in later life from the perspective of physiological dysregulation. Using data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011 and 2015, we included 3,836 male and 3,308 female Chinese adults aged 45 and older. Two-level mixed-effects models were fitted to examine how AL changed over time. Missing values were addressed by performing multiple imputations using chained equations. Results show AL increases with age for both sexes, with a steeper rise in females and a slight decline in males after adjusting for the sex-age interaction. Older males born before the People's Republic of China (PRC) exhibited different AL trajectories from younger cohorts. The sex-specific trajectories converge around the late 60s, with females surpassing males, aligning with the life expectancy-health paradox. The presence of a healthier older male cohort in CHARLS suggests future studies should account for cohort effects. [ABSTRACT FROM AUTHOR]

Cancer is a disease characterized by the uncontrolled growth and spread of abnormal cells in an organ of the human body. Asia is the continent that has the most significant number of new cases of cancer, with a percentage of 49.3% of the number of cancer patients in the world. Preventive action to deal with the spread of cancer is the responsibility of the government to improve the quality of health in the country, so it is necessary to take action to prevent the spread of cancer and help archieve the Sustainable Development Goals (SDGs) at the third point in the field of health. One of them is by determining the characteristics of the cancer and clustering countries in Asia based on their characteristics. This article will discuss the clustering of countries in Asia using fuzzy clustering in the form of fuzzy k-means, fuzzy Gustafson-Kessel babushka and fuzzy k-medoids. the results obtained from the analysis show that using fuzzy k-means will have a more excellent fuzzy silhouette index value compared to fuzzy Gustafson-Kessel babushka and fuzzy k-medoids, which is 0.6313.

Objective To review the evidence on the impact on measurable outcomes of performance-based incentives for community health workers (CHWs) in low- and middle-income countries. Methods We conducted a systematic review of intervention studies published before November 2020 that evaluated the impact of financial and non-financial performance-based incentives for CHWs. Outcomes included patient health indicators; quality, utilization or delivery of health-care services; and CHW motivation or satisfaction. We assessed risk of bias for all included studies using the Cochrane tool. We based our narrative synthesis on a framework for measuring the performance of CHW programmes, comprising inputs, processes, performance outputs and health outcomes. Findings Two reviewers screened 2811 records; we included 12 studies, 11 of which were randomized controlled trials and one a nonrandomized trial. We found that non-financial, publicly displayed recognition of CHWs' efforts was effective in improved service delivery outcomes. While large financial incentives were more effective than small ones in bringing about improved performance, they often resulted in the reallocation of effort away from other, non-incentivized tasks. We found no studies that tested a combined package of financial and non-financial incentives. The rationale for the design of performance-based incentives or explanation of how incentives interacted with contextual factors were rarely reported. Conclusion Financial performance-based incentives alone can improve CHW service delivery outcomes, but at the risk of unincentivized tasks being neglected. As calls to professionalize CHW programmes gain momentum, research that explores the interactions among different forms of incentives, context and sustainability is needed. Objectif Examiner les preuves attestant de l'impact des incitants lies aux performances sur les resultats mesurables des agents de sante communautaires (ASC) dans les pays a faible et moyen revenu. Methodes Nous avons effectue une revue systematique des etudes d'intervention publiees avant novembre 2020 et evaluant l'impact, sur les ASC, des incitants financiers et non financiers lies aux performances. Les resultats observes concernaient notamment les indicateurs de sante des patients; la qualite, l'utilisation ou la fourniture de soins de sante; et le degre de motivation ou de satisfaction des ASC. Nous avons employe l'outil Cochrane afin de calculer le risque de biais pour toutes les etudes selectionnees. Notre synthese narrative repose sur un cadre mesurant les performances des programmes d'ASC, en ce compris les moyens disponibles, les processus et les resultats en termes de performances et de sante. Resultats Deux reviseurs ont passe au crible 2811 documents; nous avons retenu 12 etudes, dont 11 essais randomises controles et un essai non randomise. Nous avons constate que le fait d'afficher ouvertement une reconnaissance non financiere des efforts consentis par les ASC entrainait une amelioration des prestations de service. En outre, bien que l'efficacite des incitants financiers soit proportionnelle au montant octroye lorsqu'il s'agissait d'obtenir de meilleures performances, cette evolution se faisait souvent aux depens des taches ne donnant pas droit a des mesures incitatives. Nous n'avons trouve aucune etude ayant teste un ensemble d'incitants financiers et non financiers. La logique derriere la conception des incitants lies aux performances ou l'explication des interactions entre incitants et facteurs contextuels n'etaient que rarement communiques. Conclusion Les incitants financiers lies aux performances suffisent a ameliorer les prestations des ASC, mais risquent de detourner l'attention des taches ne faisant pas l'objet d'incitants. De plus en plus de voix s'elevent pour reclamer une professionnalisation des programmes d'ASC; il devient donc essentiel de mener des recherches afin d'explorer les interactions entre les differentes formes d'incitants, le contexte et la perennisation. Objetivo Revisar la evidencia sobre el impacto en los resultados medibles de los incentivos basados en el rendimiento para el personal sanitario comunitario (PSC) en paises de ingresos bajos y medios. Metodos Se realizo una revision sistematica de los estudios de intervention, publicados antes de noviembre de 2020, que evaluaban el impacto de los incentivos financieros y no financieros basados en el rendimiento para el PSC. Los resultados incluyeron indicadores de salud de los pacientes; calidad, utilization o prestacion de servicios de atencion sanitaria; y motivation o satisfaction del PSC. Se evaluo el riesgo de sesgo para todos los estudios incluidos mediante Cochrane. La sintesis narrativa se baso en un marco para medir el rendimiento de los programas de PSC, que comprende aportaciones, procesos, resultados de rendimiento y resultados de salud. Resultados Dos revisores examinaron 2811 informes; se incluyeron 12 estudios, 11 de los cuales eran ensayos controlados aleatorios y uno no aleatorio. Se encontro que el reconocimiento no financiero, mostrado publicamente, de los esfuerzos del PSC fue efectivo para mejorar los resultados de la prestacion de servicios. Si bien los incentivos financieros grandes fueron mas eficaces que los pequenos para lograr un mejor rendimiento, a menudo dieron lugar a la reasignacion de esfuerzos de otras tareas no incentivadas. No encontramos ningun estudio que probara un paquete combinado de incentivos financieros y no financieros. Rara vez se informo de la justification del diseno de los incentivos basados en el rendimiento o de la explication de como los incentivos interactuaban con los factores contextuales. Conclusion Los incentivos financieros basados en el rendimiento por si solos pueden mejorar los resultados de la prestacion de servicios del PSC, pero con el riesgo de que se descuiden las tareas no incentivadas. A medida que los llamamientos a la profesionalizacion de los programas de PSC cobran impulso, es necesario realizar investigaciones que exploren las interacciones entre las diferentes formas de incentivos, el contexto y la sostenibilidad., Introduction Community health workers (CHWs) play an important role in fulfilling global commitments to strengthen primary health-care systems and achieve universal health coverage. A CHW is a member of the [...]

Background: Frailty is characterised by a decline in physical, cognitive, energy, and health reserves and is linked to greater functional dependency and higher social care utilisation. However, the relationship between receiving care, or receiving insufficient care among older people with different frailty status and the risk of unplanned admission to hospital for any cause, or the risk of falls and fractures remains unclear. Methods and findings: This study used information from 7,656 adults aged 60 and older participating in the English Longitudinal Study of Ageing (ELSA) waves 6–8. Care status was assessed through received care and self-reported unmet care needs, while frailty was measured using a frailty index. Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for demographic and socioeconomic confounders. Around a quarter of the participants received care, of which approximately 60% received low levels of care, while the rest had high levels of care. Older people who received low and high levels of care had a higher risk of unplanned admission independent of frailty status. Unmet need for care was not significantly associated with an increased risk of unplanned admission compared to those receiving no care. Older people in receipt of care had an increased risk of hospitalisation due to falls but not fractures, compared to those who received no care after adjustment for covariates, including frailty status. Conclusions: Care receipt increases the risk of hospitalisation substantially, suggesting this is a group worthy of prevention intervention focus. [ABSTRACT FROM AUTHOR]

Objectives: Hearing and vision impairments are associated with cognitive decline and dementia risk. Explanations for this include age‐related processes impacting on sensory and cognitive function (common cause), or sensory impairments having a direct or indirect impact on cognition via social engagement, depression and physical activity (cascade). We tested whether associations between hearing, vision and episodic memory were mediated by allostatic load, social engagement, depression and physical activity. Methods: We used structural equation modelling with cross‐sectional data from the USA (n = 4746, aged 50–101), England (n = 4907, aged 50–89) and Ireland (4292, aged 50–80) to model factors related to the common cause (indexed by allostatic load) and the cascade hypothesis with respect to cognitive ability (episodic memory). Results: Poorer hearing/vision was associated with lower social engagement, depression and sedentary lifestyle. Poor vision was not related to allostatic load, and poor hearing was associated with allostatic load in only one data set, contributing to a common‐cause hypothesis. Lower social engagement, depression and a sedentary lifestyle were associated with poorer episodic memory, contributing to the cascade hypothesis. Using effect estimates to calculate the proportion of the total effects mediated by the combined mediator variables, up to two fifths of the relationship between hearing and vision with episodic memory can be explained by the mediators. Conclusions: The association between hearing, vision and episodic memory is mediated by allostatic load, social engagement, depression, and physical activity. The finding that social engagement, depression, and physical activity mediate the association between sensory abilities and cognitive function supported the cascade hypotheses. Interventions to improve healthy lifestyle, reduce depression and foster social engagement of older people with sensory impairments are likely to be beneficial in preventing cognitive decline and dementia. [ABSTRACT FROM AUTHOR]

Background Hearing and vision difficulties are some of the most common deficits experienced by older adults. Having either visual or hearing difficulties increases the risk of comorbidity, disability, and poor quality of life. So far, however, few studies have examined the association between vision and hearing difficulties on life expectancy without activities of daily living (ADL) or instrumental ADL (IADL) limitations (LEWL). Methods Data came from the English Longitudinal Study of Ageing and the Health and Retirement Study in the United States from 2002 to 2013. The outcome was defined as reporting 2+ limitations with ADL/IADL. Life expectancy was estimated by discrete-time multistate life table models for hearing and vision difficulties separately as well as for combined vision and hearing difficulties by sex and age. Results Thirteen percent of men in England and the United States had ADL/IADL limitations, whereas, for women, it was 16% and 19% in England and the United States. At all ages, either vision or hearing difficulty was associated with shorter LEWL compared to no difficulties. Dual sensory difficulty (vision and hearing) reduced LEWL by up to 12 years in both countries. At the ages of 50 and 60 in England, hearing difficulty was associated with fewer years lived without ADL/IADL limitations than vision difficulty. In contrast, in the United States, vision difficulty led to fewer years lived without ADL/IADL limitations than hearing difficulty. Conclusions The implementation of strategies to reduce the prevalence and incidence of vision and hearing difficulties has the potential to increase the number of years spent without ADL/IADL limitations. [ABSTRACT FROM AUTHOR]

Hypertension and diabetes are two medical conditions that are often associated with athletes' health. Hypertension or high blood pressure is a condition where the blood pressure in the arteries becomes too high. Meanwhile, diabetes is a condition where the body cannot produce or use insulin properly, thereby causing high blood sugar levels. Athletes' health is very important because they need optimal physical conditions to be able to compete effectively. Hypertension and diabetes can affect athletes' health and their performance. Socio-demographic and anthropometric factors are believed to play an important role in the development of both conditions. The aim of this study is to determine the relationship between socio-demographic and anthropometric factors on the incidence of hypertension and diabetes in prospective athletes in athletics and determine whether prospective athletes pass the initial screening process. This study integrates bivariate logistic regression models and decision trees to analyze data collected from 200 athlete selection participants. The univariate logistic regression model showed that waist circumference, father's occupation, and salary category 2 had a significant influence on hypertension, while BMI had a significant influence on diabetes. Meanwhile, the bivariate logistic regression model found that BMI and salary category 2 had a significant effect on hypertension. The optimal classification tree was formed using variables such as BMI, Salary Category 2, Hypertension, and Diabetes. The accuracy of the prediction data was 72%, indicating that the optimal tree is well-formed and suitable for classifying athletes' data. This study concludes that there is a significant relationship between sociodemographic and anthropometric factors and the incidence of hypertension and diabetes in prospective athletes. This study provides valuable insight into physiological adaptation, fitness, recovery, and other factors that influence athlete performance. [ABSTRACT FROM AUTHOR]

Background: Attention to open innovation is more important for future research. The impact of the globalization era in health care means that nursing staff are required to be competitive and more professional with the use of increasingly developing technology. Innovation performance is an important determinant of organizational success. Objective: The substantial for this study is analysing key factors which effect the relationship between competence, motivation to innovate the performance of nursing with organizational commitment as mediating. Method: This research adopted cross-sectional research. The total respondents in this study was 60 nurses at Jasmine Room RSST Klaten with a census. This study used a hypothesis for applying path analysis, validity reliability for questioner, Statistic-test, and also coefficient determination with correlation. Results: Path 1 show that competence (Co) and motivation (Mt) have positive significance on organizational commitment (Z). Path 2 shows that competence (Co), motivation (Mt), and organizational commitment (Z) have positive significance. Highlighting the findings, nurse behaviour in innovation is based on competence. The support of hospital organizational commitment has an impact on strengthening nurses' ability in innovation behaviour. Improving the behaviour of nursing personnel in innovating will realize public health needs, and the need for understanding in healthy behaviour. In nursing staff, both those at a young or old age who will retire, competence becomes a factor that cannot be ruled out by funds to innovate. For the motivation, it does not have much meaning for nursing personnel who are old and about to retire. Conclusion: The spotlight on findings shows the behaviour of nurses in innovation is based on competence. The support of hospital organizational commitment has the impact of strengthening the ability of nurses in innovation behaviour. Increasing the behaviour of nursing personnel in innovating will realize public health needs, and the need for understanding healthy behaviour. [ABSTRACT FROM AUTHOR]