Understanding the Experiences of COVID-19 Public Health Measures and Well-Being: A Qualitative Study Among Older Adults in Quebec, Canada.

This interpretative descriptive study explores how public health measures implemented during the first wave of the COVID-19 pandemic in Quebec, Canada, affected the well-being of older adults. Twenty-six participants aged 60-81 took photographs to depict how COVID-19 public health measures affected their well-being and were invited to discuss their photographs in virtual focus groups. Data were analyzed using thematic analysis. The impacts of health measures on the well-being of participants were framed according to three overarching themes. First, participants endured an intensification of ageism, feeling diminished and excluded from their social spheres. Second, they faced a burden of loneliness due to the loss of connections with their communities, particularly for those who were single and without children. Third, participants highlighted navigating a degradation of social cohesion. This manifested through tensions and distrust in both the public and private spheres, as well as acts of resistance in response to rules deemed unjust. While public health measures were essential to prevent onward transmission of COVID-19 and mortality, they negatively impacted older adults' self-image, loneliness, and trust in society. This study argues for a rethinking of public health norms specific to older adults to address potential sources of inequality. In particular, a greater emphasis is needed on social connectedness and addressing the unique needs of older adults during pandemics.

Social class and the risk of dementia: A systematic review and meta-analysis of the prospective longitudinal studies.

BACKGROUND: The association between belonging to a disadvantaged socio-economic status or social class and health outcomes has been consistently documented during recent decades. However, a meta-analysis quantifying the association between belonging to a lower social class and the risk of dementia has yet to be performed. In the present work, we sought to summarise the results of prospective, longitudinal studies on this topic. METHODS: We conducted a systematic review and meta-analysis of prospective, longitudinal studies measuring the association between indicators of social class and the risk of all-cause/Alzheimer's dementia. The search was conducted in four databases (Medline, Embase, Web of Science and PsychInfo). Inclusion criteria for this systematic review and meta-analysis were: (a) longitudinal prospective study, (b) aged ⩾60 years at baseline, (c) issued from the general population, (d) no dementia at baseline and (e) mention of social class as exposure. Exclusion criteria were: (a) study of rare dementia types (e.g. frontotemporal dementia), (b) abstract-only papers and (c) articles without full text available. The Newcastle-Ottawa scale was used to assess the risk of bias in individual studies. We calculated the overall pooled relative risk of dementia for different social class indicators, both crude and adjusted for sex, age and the year of the cohort start. RESULTS: Out of 4548 screened abstracts, 15 were included in the final analysis (76,561 participants, mean follow-up 6.7 years (2.4-25 years), mean age at baseline 75.1 years (70.6-82.1 years), mean percentage of women 58%). Social class was operationalised as levels of education, occupational class, income level, neighbourhood disadvantage and wealth. Education (relative risk (RR)=2.48; confidence interval (CI) 1.71-3.59) and occupational class (RR=2.09; CI 1.18-3.69) but not income (RR=1.28; CI 0.81-2.04) were significantly associated with the risk of dementia in the adjusted model. Some of the limitations of this study are the inclusion of studies predominantly conducted in high-income countries and the exclusion of social mobility in our analysis. CONCLUSIONS: We conclude that there is a significant association between belonging to a social class and the risk of dementia, with education and occupation being the most relevant indicators of social class regarding this risk. Studying the relationship between belonging to a disadvantaged social class and dementia risk might be a fruitful path to diminishing the incidence of dementia over time. However, a narrow operationalisation of social class that only includes education, occupation and income may reduce the potential for such studies to inform social policies.

How is the COVID-19 pandemic impacting our life, mental health, and well-being? Design and preliminary findings of the pan-Canadian longitudinal COHESION study.

BACKGROUND: With the advent of the COVID-19 pandemic, in-person social interactions and opportunities for accessing resources that sustain health and well-being have drastically reduced. We therefore designed the pan-Canadian prospective COVID-19: HEalth and Social Inequities across Neighbourhoods (COHESION) cohort to provide a deeper understanding of how the COVID-19 pandemic context affects mental health and well-being, key determinants of health, and health inequities. METHODS: This paper presents the design of the two-phase COHESION Study, and descriptive results from the first phase conducted between May 2020 and September 2021. During that period, the COHESION research platform collected monthly data linked to COVID-19 such as infection and vaccination status, perceptions and attitudes regarding pandemic-related measures, and information on participants' physical and mental health, well-being, sleep, loneliness, resilience, substances use, living conditions, social interactions, activities, and mobility. RESULTS: The 1,268 people enrolled in the Phase 1 COHESION Study are for the most part from Ontario (47%) and Quebec (33%), aged 48 ± 16 years [mean ± standard deviation (SD)], and mainly women (78%), White (85%), with a university degree (63%), and living in large urban centers (70%). According to the 298 ± 68 (mean ± SD) prospective questionnaires completed each month on average, the first year of follow-up reveals significant temporal variations in standardized indexes of well-being, loneliness, anxiety, depression, and psychological distress. CONCLUSIONS: The COHESION Study will allow identifying trajectories of mental health and well-being while investigating their determinants and how these may vary by subgroup, over time, and across different provinces in Canada, in varying context including the pandemic recovery period. Our findings will contribute valuable insights to the urban health field and inform future public health interventions.

The Potential of Social Policies in Preventing Dementia: An Ecological Study Using Systematic Review and Meta-Analysis.

Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer's disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.

Better understanding care transitions of adults with complex health and social care needs: a study protocol.

BACKGROUND: Adults with chronic conditions who also suffer from mental health comorbidities and/or social vulnerability require services from many providers across different sectors. They may have complex health and social care needs and experience poorer health indicators and high mortality rates while generating considerable costs to the health and social services system. In response, the literature has stressed the need for a collaborative approach amongst providers to facilitate the care transition process. A better understanding of care transitions is the next step towards the improvement of integrated care models. The aim of the study is to better understand care transitions of adults with complex health and social care needs across community, primary care, and hospital settings, combining the experiences of patients and their families, providers, and health managers. METHODS/DESIGN: We will conduct a two-phase mixed methods multiple case study (quantitative and qualitative). We will work with six cases in three Canadian provinces, each case being the actual care transitions across community, primary care, and hospital settings. Adult patients with complex needs will be identified by having visited the emergency department at least three times over the previous 12 months. To ensure they have complex needs, they will be invited to complete INTERMED Self-Assessment and invited to enroll if positive. For the quantitative phase, data will be obtained through questionnaires and multi-level regression analyses will be conducted. For the qualitative phase, semi-structured interviews and focus groups will be conducted with patients, family members, care providers, and managers, and thematic analysis will be performed. Quantitative and qualitative results will be compared and then merged. DISCUSSION: This study is one of the first to examine care transitions of adults with complex needs by adopting a comprehensive vision of care transitions and bringing together the experiences of patients and family members, providers, and health managers. By using an integrated knowledge translation approach with key knowledge users, the study's findings have the potential to inform the optimization of integrated care, to positively impact the health of adults with complex needs, and reduce the economic burden to the health and social care systems.

Description of Participation in Daily and Social Activities for Individuals with COPD.

This study described the participation in daily and social activities and the perceived barriers and facilitators to participation of individuals with chronic obstructive pulmonary disease (COPD). Individuals, recruited from outpatient clinics, responded to a survey on their participation in, and barriers and facilitators towards, 26 daily and social activities, divided into 3 categories: (1) physical activity and movement (PAM); (2) self-care; and (3) social engagement. For each activity, chi-square analyses were used to examine participation differences by individuals': quartiles of airflow obstruction [percent predicted forced expiratory volume in 1 second (FEV1%predicted)] and breathlessness burden and exacerbation risk. Of the 200 participants (47% women; mean ± standard deviation age = 68 ± 9 years), most wanted to increase their participation in PAM activities (range 21-75%) and significant differences were found in 5/10 PAM activities for individuals' breathlessness burden and exacerbation risk (e.g., more individuals than expected in group A (modified Medical Research Council breathlessness score <2 and 0-1 exacerbations in past 12 months) participated in regular exercise as much as they wanted (χ(9)2=20.43, Cramer's V=.23)). Regardless of the degree of airflow obstruction or breathlessness burden and exacerbation risk, the most common barrier to participation was breathlessness (p<.001, η2p=.86) and the most common facilitator was engaging as part of their routine (p<.001, η2p=.75). Individuals with COPD want to increase their participation in daily and social activities but are limited by breathlessness. Strategies to alleviate breathlessness should be identified/prioritized and incorporated into individuals' daily routines to meet their self-reported participation objectives in daily and social activities.

Novel clinical scores for occupational asthma due to exposure to high-molecular-weight agents.

OBJECTIVE: Specific inhalation challenge (SIC) as the reference diagnostic test for occupational asthma (OA) is not widely available worldwide. We aimed to develop non-SIC-based models for OA. METHODS: Of 427 workers who were exposed to high-molecular-weight agents and referred to OA clinic at Montréal Sacré-Cœur Hospital between 1983 and 2016, we analysed 160 workers who completed non-specific bronchial hyper-responsiveness (NSBHR) tests and still worked 1 month before SIC. OA was defined as positive SIC. Logistic regression models were developed. The accuracy of the models was quantified using calibration and discrimination measures. Their internal validity was evaluated with bootstrapping procedures. The final models were translated into clinical scores and stratified into probability groups. RESULTS: The final model, which included age ≤40 years, rhinoconjunctivitis, inhaled corticosteroid use, agent type, NSBHR, and work-specific sensitisation had a reasonable internal validity. The area under the receiver operating characteristics curve (AUC) was 0.91 (95% CI 0.86 to 0.95), statistically significantly higher than the combination of positive NSBHR and work-specific sensitisation (AUC=0.84). The top 70% of the clinical scores (ie, the high probability group) showed a significantly higher sensitivity (96.4%vs86.9%) and negative predictive value (93.6%vs84.1%) than the combination of positive NSBHR and work-specific sensitisation (p value <0.001). CONCLUSIONS: We developed novel scores for OA induced by high-molecular-weight agents with excellent discrimination. It could be helpful for secondary-care physicians who have access to pulmonary function test and allergy testing in identifying subjects at a high risk of having OA and in deciding on appropriate referral to a tertiary centre.

Exercise interventions to improve balance for young people with intellectual disabilities: a systematic review and meta-analysis.

AIM: To conduct a systematic review and meta-analysis of the effects of exercise interventions designed to improve balance in young people with intellectual disabilities. METHOD: A systematic literature search was performed on 10 databases. Studies in press or published in English in a peer-reviewed journal were included if: (1) participants were young people with intellectual disabilities; (2) exercise interventions were designed to improve balance; and (3) they used quasi-experimental or experimental designs. Studies focusing only on a specific subpopulation of young people with intellectual disabilities or having a specific physical characteristic were excluded. Risk of bias was assessed for randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases. RESULTS: The search strategy identified 937 articles and 15 studies, published between 1991 and 2017, that met the inclusion criteria. Exercise intervention groups showed a significant and larger improvement in static (pooled effect size, Hedges' g=0.98) and dynamic (g=1.34) balance compared with the control groups. However, although the pooled improvement of static-dynamic balance was large (g=2.80), the result was non-significant. None of the subgroup analyses were significant, except for the improvement in: (1) static balance (higher in quasi-experimental than in experimental studies); and (2) dynamic balance (higher in young people with a mild vs a mild-moderate intellectual disability). INTERPRETATION: The reviewed exercise interventions seem to represent an effective means for improving the static and dynamic balance of young people with intellectual disabilities. However, the present findings should be considered as preliminary given the small number of studies and their limitations. WHAT THIS PAPER ADDS: Exercise intervention results in large and significant improvements in static and dynamic balance in young people with intellectual disabilities. Exercise intervention results in a large but non-significant improvement in static-dynamic balance. Static balance improvement was significantly higher in quasi-experimental versus experimental studies. Dynamic balance improvement was significantly higher in young people with mild versus mild-moderate intellectual disability. No significant differences related to age group, balance measures, and components of exercise intervention were found.

EJERCICIOS PARA MEJORAR EL EQUILIBRIO EN JÓVENES CON DISCAPACIDAD INTELECTUAL: UNA REVISIÓN SISTEMÁTICA Y UN METAANÁLISIS: OBJETIVO: Realizar una revisión sistemática y un metaanálisis sobre los efectos del ejercicio diseñado para mejorar el equilibrio en jóvenes con discapacidad intelectual. METODO: Se realizó una búsqueda sistemática en 10 bases de datos. Fueron incluidos estudios impresos o publicados en ingles en publicaciones revisadas por sus pares; que a su vez : (1) los participantes eran jóvenes con discapacidad intelectual, (2) las intervenciones a través del ejercicio fueron diseñados para mejorar el equilibrio, (3) fueron usados diseños experimentales o cuasi experimentales. Los estudios que se enfocaron únicamente a una subpoblación de jóvenes con discapacidad intelectual y los que tenían características físicas específicas fueros excluidos. El riesgo de sesgo fue evaluado para detectar randomización, ocultamiento de secuencia de alocación, estudios ciegos, datos de resultado incompletos, reporte de resultados seleccionados y otros sesgos RESULTADOS: La estrategia de búsqueda identificó 937 artículos y 15 estudios, publicados entre 1991 y 2017, que cumplieron los criterios de inclusión. El grupo con intervención de ejercicios mostró una mejora significativa en el balance estático (tamaño del efecto agrupado, g=0.98) y balance dinámico (g=1.34) comparado con el grupo control. Sin embargo, aunque la mejoría combinada del balance estático y dinámico fue grande (g=2.80), el resultado no es significativo. Ninguno de los subgrupos analizados fue significativo, excepto por la mejora en: (1) balance estático (mayor en los estudios cuasi-experimentales que en los experimentales) y (2) balance dinámico (mayor en gente joven con discapacidad intelectual leve que en gente con discapacidad intelectual leve -moderado). INTERPRETACION: La revisión de intervenciones con ejercicio parece representar un método eficaz para mejorar el equilibrio estático y dinámico en jóvenes con discapacidad intelectual. Sin embargo, los hallazgos deben ser considerados como preliminares por la pequeña cantidad de estudios y sus limitaciones.

INTERVENÇÕES COM EXERCÍCIOS PARA MELHORAR O EQUILÍBRIO PARA JOVENS COM DEFICIÊNCIA INTELECTUAL: UMA REVISÃO SISTEMÁTICA E METANÁLISE: OBJETIVO: Conduzir uma revisão sistemática e metanálise sobre os efeitos das intervenções com exercícios desenhadas para melhorar o equilíbrio em jovens com deficiência intelectual. MÉTODO Uma revisão sistemática da literature foi realizada em 10 bases de dados. Estudos in press ou publicados em inglês em revistas revisadas por pares foram incluídos se: 1) os participantes fossem jovens com deficiência intellectual; 2) intervenções com exercícios foram aplicadas visando melhorar o equilíbrio e 3) usaram desenhos experimentais ou quasi-experimentais. Estudos com enfoque em apenas uma sub-população específica de jovens com deficiência intelectual ou que tinham alguma característica física específica foram excluídos. O risco de viés foi avaliado para randomização, sequência de alocação selada, cegamento, resultados incompletes, relato seletivo de resultados, e outros vieses. RESULTADOS: A estratégia de busca identificou 937 artigos e 15 estudos, publicados entre 1991 e 2017, que atenderam aos critérios de inclusão Os grupos sob intervenção com exercícios mostraram significativa e maior melhora no equilíbrio estático (tamanho do efeito agrupado de Hedges g=0,98) and dinâmico (g=1,34) comparados com os grupos controle. Entretanto, embora a melhora agrupada no equilíbrio estático-dinâmico tenha sido grande (g=2,80), o resultado não foi significativo. Nenhuma das análises de subrupos foi significativa, exceto para a melhora em: (1) equilíbrio estático (maior nos estudos quasi-experimentais que nos experimentais) e (2) equilíbrio dinâmico (maior em jovens com deficiência intelectual leve versus leve-moderada). INTERPRETAÇÃO: As intervenções com exercícios revisadas parecem representar um meio efetivo de melhorar o equilíbrio estático e dinâmico de jovens com deficiência intelectual. No entanto, os achados presentes devem ser considerados preliminaries dado o pequeno número de estudos e suas limitações.

Self-concept research with school-aged youth with intellectual disabilities: A systematic review.

BACKGROUND: Research on the self-concept of youth with intellectual disabilities has not been summarized in more than four decades. The present systematic review addresses this gap. METHOD: A systematic literature search was performed in nine databases and 21 studies, published between 1979 and 2017, met our inclusion criteria. RESULTS: Significant differences between the self-concepts of youth with intellectual disabilities and typically developing (TD) youth were found in: (a) cognitive-academic self-concept in disfavour of youth with intellectual disabilities; (b) global self-concept and cognitive-academic self-concept in disfavour of children with intellectual disabilities; and (c) global, behavioural, and cognitive-academic self-concept in disfavour of youth with intellectual disabilities schooled in a special class. Additionally, except for age, intellectual functioning and school placement, no significant relations were found between the self-concept dimensions and academic achievement and sex. CONCLUSION: Studies on self-concept research with school-aged youth with intellectual disabilities have several weaknesses that need to be advanced in future research.

Optimizing screening for depression among adults with asthma.

OBJECTIVE: The Beck Depression Inventory II (BDI-II) is one of the most frequently used tools to screen for depression in patients with chronic diseases such as cardiovascular disease and asthma. However, its original cut-off score has not been validated in adult asthmatics. The present study aimed to determine the optimal BDI-II cut-off score and to verify the impact of various patient sociodemographic and clinical characteristics on performance accuracy of the BDI-II. METHODS: A total of 801 adult asthmatic outpatients (mean ± SD, age 49 ± 14 years, 60% female) completed the BDI-II and a structured psychiatric interview (used as the standard referent to determine presence of major depressive disorder [MDD]). The sensitivity and specificity of the BDI-II were computed to determine the optimal cut-off score for identifying MDD. The optimal cut-off scores were also verified across covariate subgroups (e.g., sex, age, smoking status, asthma control levels). RESULTS: According to the structured psychiatric interview, 108 (13%) patients had current MDD. The overall optimal BDI-II cut-off score was 12 (sensitivity = 85%, specificity = 79%). However, subgroup analyses revealed that this score could range from 11 to 15 depending on the characteristics of the individual. CONCLUSIONS: Results suggest that the BDI-II is an appropriate screening tool for MDD in asthma populations. However, the cut-off score is influenced by the sociodemographic and clinical characteristics of patients. These findings highlight the importance of validating generic questionnaires for depression in specific populations in order to improve the accuracy of their usage.

Interaction effect of psychological distress and asthma control on productivity loss?

Little is known about the potential synergistic effect of comorbid psychological distress (PD) and uncontrolled asthma (UA) on productivity loss. We estimated the productivity loss associated with the combination of these two potentially preventable conditions in employed adults with asthma. A population-based random sample of 300 adults with asthma in British Columbia, Canada, was prospectively recruited between Dec 2010 and Aug 2012. PD and productivity loss due to absenteeism and presenteeism was measured using validated instruments, and asthma control was ascertained using 2010 Global Initiative for Asthma management strategy. We used two-part regression models to study the contribution of UA and PD to productivity loss. Compared with reference group (controlled asthma (CA)+noPD), those with UA+noPD had CAD$286 (95%CI $276-297) weekly productivity loss, and those with CA+PD had CAD$465 ($445-485). Those with UA+PD had CAD$449 (437-462) in productivity loss. There was no significant interaction effect of PD with asthma control levels on productivity loss (p=0.22). In patients without PD, uncontrolled asthma was associated with a higher productivity loss than controlled asthma, but this was not the case in patients with PD. This finding can be explained by the fact that the contribution of PD to productivity loss is so large that there is no room for synergy with asthma control. Future studies should assess the impact of interventions that modify PD in patients with asthma.

Clinical impact of time of day on acute exercise response in COPD.

The purpose of this pilot study was to determine the impact of time of day on the acute response to incremental exercise in chronic obstructive pulmonary disease (COPD). Fourteen subjects (nine men) aged 71 ± 7 years with moderate to severe airflow obstruction (FEV1: 58 ± 13% predicted) followed a counterbalanced randomized design, performing three symptom-limited incremental cycling tests at 8:00, 12:00, and 16:00 hours on different days, each preceded by a spirometry. COPD medications were withdrawn prior to testing. No overall time effect was found for peak exercise capacity (p = 0.22) or pulmonary function (FEV1, p = 0.56; FVC, p = 0.79). However, a large effect size (f = 0.48) was observed for peak exercise capacity and several pulmonary function parameters. For peak exercise capacity, the average within-subject coefficient of variation was 5.5 ± 3.9% and the average amplitude of change was 7 ± 5W. Seven subjects (50%) showed diurnal changes at levels equal to or beyond the minimal clinically important difference for both peak exercise capacity and pulmonary function. In this sub-group, peak exercise capacity was greatest at 16:00 hours (p = 0.03, ƒ = 1.04). No systematic time-of-day effect on peak exercise capacity was obtained in COPD patients in the present pilot study. However, based on the observed effect size and on the average amplitude of change and within-subject variations seen across testing times, the guidelines recommendation that time of day be standardized for repeat exercise testing in COPD should be maintained.

The Dynamic Model of Health Assets: a model development.

AIM: Epidemiological research on resistance and resilience can build on models of health developed in health promotion. Nevertheless, these models need to be adjusted to approaches currently employed in epidemiology; namely, included concepts should be easy to operationalize, and links between them should be simple enough to enable statistical modeling. In addition, these models should include both individual and environmental assets. The objective of this study is to consolidate the current knowledge on health assets, adjust them to epidemiological research needs, and propose a new model of health assets for epidemiological studies on health. DESIGN: The conceptual paper was conducted according to the guidelines for the model development. METHODS: The development of the new model was made from the perspective of salutogenesis - the branch of health promotion studying the origins of health. The analysis of literature on health promotion, public health, and positive psychology was conducted to find the links connecting individual and environmental assets. RESULTS: The newly developed Dynamic Model of Health Assets circularly links individual characteristics, actions, environments, and support. Each preceding component of the model contributes to the following one; each component also independently contributes to resistance and resilience. The new model may guide large-scale epidemiological research on resistance and resilience. The model's components are easy to operationalize; the model allows for constructing multilevel models and accounting for the dynamic nature of the relationships between components. It is also generic enough to be adjusted to studying contributors to resistance and resilience to different specific diseases. CONCLUSION: The new model can guide epidemiological studies on resistance and resilience.

Household and housing determinants of sleep duration during the COVID-19 pandemic: Results from the COHESION Study.

BACKGROUND: Public health measures in response to the COVID-19 pandemic forced individuals to spend more time at home. We sought to investigate the relationship between housing characteristics and sleep duration in the context of COVID-19. METHODS: Our exploratory study was part of the COvid-19: Health and Social Inequities across Neighborhoods (COHESION) Study Phase-1, a pan-Canadian population-based cohort involving nearly 1300 participants, launched in May 2020. Sociodemographic, household and housing characteristics (dwelling type, dissatisfaction, access to outdoor space, family composition, etc.), and self-reported sleep were prospectively collected through COHESION Study follow-ups. We explored the associations between housing and household characteristics and sleep duration using linear regressions, as well as testing for effect modification by income satisfaction and gender. RESULTS: Our study sample involved 624 COHESION Study participants aged 50 ± 16years (mean±SD), mainly women (78%), White (86%), and university graduates (64%). The average sleep duration was 7.8 (1.4) hours. Sleep duration was shorter according to the number of children in the household, income dissatisfaction, and type of dwelling in multivariable models. Sleep was short in those without access to a private outdoor space, or only having a balcony/terrace. In stratified analyses, sleep duration was associated with housing conditions dissatisfaction only in those dissatisfied with their income. CONCLUSION: Our exploratory study highlights the relationship between housing quality and access to outdoor space, family composition and sleep duration in the context of COVID-19. Our findings also highlight the importance of housing characteristics as sources of observed differences in sleep duration.

Smoking cessation, depression, and exercise: empirical evidence, clinical needs, and mechanisms.

INTRODUCTION: Smoking is significantly more common among persons with major depressive disorders (MDDs). Furthermore, smokers with MDD report more difficulties when they quit smoking (greater withdrawal symptoms, higher probability of relapse). The aim of this narrative review is to describe research on exercise and depression and exercise and smoking cessation. METHODS: We have critically reviewed various smoking cessation intervention programs for depressive smokers examining (a) the protective effect of exercise against relapse for smokers with MDD and (b) the benefits of exercise for treating withdrawal symptoms. We have also reviewed the current literature investigating the mechanisms between exercise-depression and exercise-smoking. RESULTS: This review suggests that exercise may reduce depressive symptoms following cessation and provide a useful strategy for managing withdrawal symptoms in smokers with MDD. Various psychological, biological, and genetic hypotheses have been tested (e.g., distraction hypothesis, expectations hypothesis, cortisol hypothesis) and few have obtained significant results. CONCLUSIONS: It might be beneficial for health professionals to recommend physical activity and promote supervised exercise sessions for smokers with MDD during smoking cessation. Future research needs to examine relationships between exercise, smoking, and depression with transdisciplinary and ecological momentary assessment.

Impact of anxiety and depression on chronic obstructive pulmonary disease exacerbation risk.

Chronic obstructive pulmonary disease (COPD) exacerbations contribute significantly to morbidity and mortality. COPD is also associated with high levels of psychological distress, which has been linked with higher exacerbation rates. At a recent American Thoracic Society conference symposium titled "Depression and Obstructive Lung Disease: State of the Science and Future Directions" held in 2010 in New Orleans, clinicians and researchers identified a number of important research priorities related to psychiatric comorbidities, including the need to better understand their impact on COPD outcomes, such as exacerbations. This article reviews the current literature and quantifies the prospective impact of anxiety and depression on exacerbation risk in patients with COPD. The limitations of the existing literature and the perspectives for future research are addressed.

Definitions of positive health: a systematic scoping review.

An agreed definition, model, and indicators of positive health would contribute to a better understanding and wider use of the term, thus favoring the development of the positive health approach in public health. However, there is no consensus even on the definition of positive health. In this study, we systematically reviewed its definitions. We conducted a scoping review as per PRISMA guidelines. We queried the MEDLINE, Embase, PsychINFO, and Web of Science databases. The PubMed search equation was: 'positive health' [Title/Abstract] AND ('health' [MeSH] OR 'health status' [MeSH] OR 'health status indicators' [MeSH]). Definitions of positive health referring to a 'one-dimensional' conceptualization of health are: (i) positive health as a state 'far beyond a mere absence of disease'; (ii) positive health as wellbeing; and those referring to a 'two-dimensional' conceptualization are (iii) positive health as resilience and (iv) positive health as (a reserve in) capacities. This work contributes to the refining of the salutogenic vocabulary. At this stage of the ongoing discussion on health promotion vocabulary, we propose the 'reserve in capacities' as the candidate for the definition of positive health.

Resilience among older adults during the COVID-19 pandemic: A photovoice study.

Older adults faced significant challenges during the COVID-19 pandemic but also demonstrated great resilience. Investigating these strengths may enhance and inform strategies to mitigate the impacts of the pandemic. To gain insight into the resilience processes of older adults during the first year of the pandemic, we conducted a photovoice study with 26 older adults (aged over 60) in the province of Quebec, Canada. Participants met online weekly for three weeks in small groups to discuss their photographs and share their resilience strategies. The thematic analysis revealed three interrelated themes. First, participants distanced themselves from the pandemic by engaging in activities that took their focus away from COVID-19 and that afforded much-needed respite. Second, participants regained their bearings by reorganizing their schedules and establishing new routines that bolstered occupation rather than rumination. Third, participants used the pandemic to self-reflect and revise their priorities, leveraging the pandemic as an opportunity for growth. Together, these themes demonstrate the strengths, coping strategies and resilience of older adults and contrast the stereotypes of older adults as vulnerable and resourceless. These findings have the potential to inform the implementation of strength-based health promotion initiatives to mitigate the harms of the pandemic.

Age- and sex-specific associations between obstructive sleep apnea risk and cognitive decline in middle-aged and older adults: A 3-year longitudinal analysis of the Canadian longitudinal study on aging.

BACKGROUND: Whether obstructive sleep apnea (OSA) increases the risk of cognitive decline and how sex and age influence this association is not clear. Here, we characterized the sex- and age-specific associations between OSA risk and 3-year cognitive change in middle-aged and older adults. METHODS: We included 24,819 participants aged 45-85 (52% women) from the Canadian Longitudinal Study on Aging. OSA risk was measured at baseline using the STOP combined to body mass index (STOP-B). Neuropsychological tests assessed memory, executive functioning, and psychomotor speed at baseline and at 3-year follow-up. We conducted age- and sex-specific linear mixed models to estimate the predictive role of baseline STOP-B score on 3-year cognitive change. RESULTS: Men at high-risk for OSA aged 45-59 years showed a steeper decline in psychomotor speed (+13.2 [95% CI: -1.6, 27.9]) compared to men at low-risk. Men at high-risk for OSA aged 60-69 showed a steeper decline in mental flexibility (-1.2 [-1.9, -0.5]) and processing speed (+0.6 [0.3, 0.9]) than those at low-risk. Women at high-risk for OSA aged 45-59 showed a steeper decline in processing speed (+0.1 [-0.2, 0.4]) than women at low-risk, while women at high-risk ≥70 years had a steeper decline in memory (-0.2 [-0.6, 0.1]) and processing speed (+1.0 [0.4, 1.5]). CONCLUSIONS: Associations between OSA risk and cognitive decline over 3 years depend on age and sex. Being at high-risk for OSA is associated with a generalized cognitive decline in attention and processing speed, while a memory decline is specific to older women (≥70 years).

Individual and combined impact of cigarette smoking, anxiety, and mood disorders on asthma control.

INTRODUCTION: Despite the availability of effective therapies, research indicates that more than 50% of asthmatics are poorly controlled. Poor asthma control has been linked to behavioral (i.e., cigarette smoking) and psychological factors (i.e., anxiety and depression). However, little is known about the individual versus combined impact of cigarette smoking and anxiety or mood disorders in adult asthmatics on asthma control. METHODS: A total of 796 confirmed adult asthma patients completed a sociodemographic and medical history interview and underwent a psychiatric interview using the Primary Care Evaluation of Mental Disorders. Asthma control was evaluated using the Asthma Control Questionnaire. RESULTS: After adjusting for age, sex, and dose of inhaled corticosteroids, general linear model analyses indicated a significant main effect of current smoking on asthma control (B [SE] = 0.156 [0.059], p = .008) and main effects of anxiety disorders (B [SE] = 0.408 [0.095], p = < .001) and mood disorders (B [SE] = 0.448 [0.098], p = < .001) on asthma control. Pack-years were not associated with asthma control, and there were no interaction effects of current smoking or pack-years with either anxiety or mood disorders on asthma control. CONCLUSIONS: Findings suggest that current smoking, having an anxiety disorder, and having a mood disorder are independently associated with poorer asthma control but that cumulative smoking history (i.e., pack-years) was not associated with worse asthma control. These results indicate that smoking cessation may have a positive impact on asthma control levels in spite of past smoking intensity and highlight the importance of interventions that target anxiety and mood disorders in adult asthmatics.