Association between long-term exposure to PM2.5 chemical components and metabolic syndrome in middle-aged and older adults.

Background: Previous studies indicated that exposure to ambient fine particulate matter (PM2.5) could increase the risk of metabolic syndrome (MetS). However, the specific impact of PM2.5 chemical components remains uncertain. Methods: A national cross-sectional study of 12,846 Chinese middle-aged and older adults was conducted. Satellite-based spatiotemporal models were employed to determine the 3-year average PM2.5 components exposure, including sulfates (SO4 2-), nitrates (NO3 -), ammonia (NH4 +), black carbon (BC), and organic matter (OM). Generalized linear models were used to investigate the associations of PM2.5 components with MetS and the components of MetS, and restricted cubic splines curves were used to establish the exposure-response relationships between PM2.5 components with MetS, as well as the components of MetS. Results: MetS risk increased by 35.1, 33.5, 33.6, 31.2, 32.4, and 31.4% for every inter-quartile range rise in PM2.5, SO4 2-, NO3 -, NH4 +, OM and BC, respectively. For MetS components, PM2.5 chemical components were associated with evaluated risks of central obesity, high blood pressure (high-BP), high fasting glucose (high-FBG), and low high-density lipoprotein cholesterol (low-HDL). Conclusion: This study indicated that exposure to PM2.5 components is related to increased risk of MetS and its components, including central obesity, high-BP, high-FBG, and low-HDL. Moreover, we found that the adverse effect of PM2.5 chemical components on MetS was more sensitive to people who were single, divorced, or widowed than married people.

Role of intergenerational connections in cognitive aging: Evidence from a Chinese longitudinal study.

Objective: To explore the impact of intergenerational connections on cognitive function in middle-aged and older adults (45-60 years and over 60 years, respectively) and analyze the urban-rural and sex differences in the effects of intergenerational connections on cognitive function. Method: Based on China Health and Retirement Longitudinal Study data (CHARLS), this study conducted ID matching for four waves of data from 2011, 2013, 2015, and 2018. Cognitive function was measured via Telephone Interview for Cognitive Status-modified (TICS-m), word recall, and imitation drawing. Using a combination of cross-sectional and longitudinal research, we constructed the cross-lagged panel model (CLPM) with a sample of 1,480 participants to explore the relationship between intergenerational connections and cognitive function. Results: This study examines the impact of intergenerational connections on cognitive function in middle-aged (45-60 years) and older adults (over 60 years) using data from the CHARLS. It identifies urban-rural and sex differences, with notable effects among rural female participants. The frequency of meeting with one child negatively predicts cognitive function (ß = -0.040, p = 0.041), and the frequency of communication with one child positively predicts cognitive function (ß = 0.102, 0.068, 0.041, p < 0.001, p = 0.001, 0.045). Meanwhile, intergenerational connections with multiple children positively predicts cognitive function (ß = 0.044, p = 0.031), (ß = 0.128, 0.084, and 0.056, p < 0.001, 0.001, p = 0.008). There are urban-rural and sex differences in the effects of intergenerational connections on cognitive function; additionally, the effects of intergenerational connections on cognitive function are significant in rural female middle-aged and older adults. Discussion: This study proposes the theory of skewed intergenerational support, which suggests that as middle-aged and older adults age, the responsibility for intergenerational support is skewed toward one child. This leads to conflicts between middle-aged and older parents and the child, which further affects cognitive function. In addition, this study put forward the boat-carrying theory of intergenerational relations and "to hold a bowl of water level" is the art of dealing with intergenerational relationships.

[Relationship Between Physical Activity and Depressive Symptoms Among Middle-Aged and Older Adults in Chengdu,Sichuan,China].

Objective To investigate the current status of physical activity and depressive symptoms among middle-aged and older adults in Chengdu,Sichuan and explore the relationship between physical activity and depressive symptoms. Methods Multi-stage proportional stratified random sampling was employed to select middle-aged and older adults aged ≥45 years as the participants,and face-to-face interviews were carried out to collect data.Logistic regression was adopted to explore the relationship between physical activity and depressive symptoms in middle-aged and older adults.The trend test was performed for the relationship between different levels of physical activity and depressive symptoms.The subgroup analysis and the test for multiplicative interactions were conducted for the relationship between physical activity and depressive symptoms. Results A total of 4376 middle-aged and older adults were included.Among them,14.58% (638/4376),25.98% (1137/4376),and 27.83% (1218/4376) had depressive symptoms,failed to reach the guideline-recommended standards of physical activity,and were at low levels of physical activity,respectively.There was a negative association between reaching guideline-recommended physical activity standard and depressive symptoms in middle-aged and older adults (OR=0.713,95%CI=0.589-0.861,P<0.001).In addition,moderate levels (OR=0.714,95%CI=0.586-0.871,P=0.001) and high levels of physical activity (OR=0.705,95%CI=0.548-0.906,P=0.006) had negative associations with the presence of depressive symptoms.The trend test revealed that the negative association between physical activity and depressive symptoms in middle-aged and older adults enhanced as the level of physical activity increased (Pfor trend=0.001).The subgroup analysis and the test for multiplicative interactions revealed that neither reaching guideline-recommended physical activity standards or not nor the physical activity level had an interaction with each of the subgroups (all Pfor interaction>0.05). Conclusion The current status of depressive symptoms among middle-aged and older adults in Chengdu,Sichuan needs to be ameliorated.A negative association existed between reaching the guideline-recommended physical activity standard and presence of depressive symptoms,and the negative association enhanced as the physical activity level elevated.

Breaking Down Barriers to a Suicide Prevention Helpline: Web-Based Randomized Controlled Trial.

Background: Every month, around 3800 people complete an anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. Although 70% score high on the severity of suicidal thoughts, <10% navigate to the web page about contacting the helpline. Objective: This study aimed to test the effectiveness of a brief barrier reduction intervention (BRI) in motivating people with severe suicidal thoughts to contact the suicide prevention helpline, specifically in high-risk groups such as men and middle-aged people. Methods: We conducted a fully automated, web-based, randomized controlled trial. Respondents with severe suicidal thoughts and little motivation to contact the helpline were randomly allocated either to a brief BRI, in which they received a short, tailored message based on their self-reported barrier to the helpline (n=610), or a general advisory text (care as usual as the control group: n=612). Effectiveness was evaluated using both behavioral and attitudinal measurements. The primary outcome measure was the use of a direct link to contact the helpline after completing the intervention or control condition. Secondary outcomes were the self-reported likelihood of contacting the helpline and satisfaction with the received self-test. Results: In total, 2124 website visitors completed the Suicidal Ideation Attributes Scale and the demographic questions in the entry screening questionnaire. Among them, 1222 were randomized into the intervention or control group. Eventually, 772 respondents completed the randomized controlled trial (intervention group: n=369; control group: n=403). The most selected barrier in both groups was "I don't think that my problems are serious enough." At the end of the trial, 33.1% (n=122) of the respondents in the intervention group used the direct link to the helpline. This was not significantly different from the respondents in the control group (144/403, 35.7%; odds ratio 0.87, 95% CI 0.64-1.18, P=.38). However, the respondents who received the BRI did score higher on their self-reported likelihood of contacting the helpline at a later point in time (B=0.22, 95% CI 0.12-0.32, P≤.001) and on satisfaction with the self-test (B=0.27, 95% CI 0.01-0.53, P=.04). For male and middle-aged respondents specifically, the results were comparable to that of the whole group. Conclusions: This trial was the first time the helpline was able to connect with high-risk website visitors who were hesitant to contact the helpline. Although the BRI could not ensure that those respondents immediately used the direct link to the helpline at the end of the trial, it is encouraging that respondents indicated that they were more likely to contact the helpline at a later point in time. In addition, this low-cost intervention provided greater insight into the perceived barriers to service. Follow-up research should be focused on identifying the added value of other components (eg, video or photo material) in the BRI and increasing its effectiveness, especially for men and middle-aged people.

Internet access during COVID-19 and depressive symptoms in middle-aged and older adults: Evidence from a quasi-experimental study in China.

BACKGROUND: Amid the COVID-19 pandemic, the mental health of middle-aged and older adults has become an increasing concern, and the role of the internet in addressing this public health crisis has drawn the attention of researchers. This study evaluated the impact of internet access during COVID-19 on depressive symptoms among middle-aged and older adults. METHODS: Data were derived from China Health and Retirement Longitudinal Study (CHARLS) 2018 and 2020. Difference-in-differences analysis was performed to compare changes in depressive symptoms between the internet users during COVID-19 and those who didn't have access to the internet before and during the pandemic. RESULTS: We found that internet access during COVID-19 pandemic significantly reduced middle-aged and older adults' depressive symptoms. Further investigation identified the underlying mechanisms through which internet access helps in alleviating depressive symptoms by reducing the likelihood of experiencing negative emotions about COVID-19. Heterogeneity analyses showed that rural residents and middle-aged individuals benefited more from internet access during the pandemic. CONCLUSIONS: Since internet access can alleviate middle-aged and older adults' depressive symptoms amidst public health crisis, policy makers should focus on enhancing their access to the internet.

Self-concealment scale (SCS) in middle-aged people: psychometric features and cross-age equivalence test.

BACKGROUND: Individuals' concealment of negative information and privacy may lead to impaired social interactions and threatened health conditions. This study aimed to investigate the effectiveness of the Self-Concealment Scale (SCS) in the middle-aged Chinese population and to examine the equivalence of the SCS among different age groups. METHODS: The current research adopted the SCS, Distress Disclosure Index (DDI), Revised Cheek and Buss Shyness Scale (RCBS), Social Interaction Anxiety Scale (SIAS), Social Phobia Scale (SPS), UCLA Loneliness Scale (ULS-8), and Kessler Psychological Distress Scale (K10) to survey 1124 middle-aged people. To explore the factor structure of the SCS, the study employed exploratory factor analysis and confirmatory factor analysis. The reliability of the SCS was measured based on Cronbach's α coefficients, McDonald's Omega coefficients, and split-half reliability. Correlation analysis was applied to examine the relationship between SCS and RCBS, SIAS, SPS, ULS-8, and K10. Moreover, this study recruited 1458 emerging adults and 1104 older adults to identify the cross-age invariance of the SCS. RESULTS: Exploratory factor analysis of the middle aged adults' data supported a single factor model. The factor loadings of SCS items ranged from 0.62 to 0.73, the commonality ranged from 0.39 to 0.53, and the single-factor model fitted well. The scale showed a Cronbach's α coefficient value of 0.895, McDonald's Omega coefficient of 0.893, and a split-half reliability coefficient value of 0.861. In addition, the SCS demonstrated invariance in emerging adults, middle-aged adults, and older adults. Further analysis showed that the scores of the SCS (F = 3.55, p = 0.029) among emerging adults (M = 26.43, SD = 7.96) were significantly higher than among middle-aged (M = 25.77, SD = 7.79), and older cohort (M = 25.69, SD = 7.91). CONCLUSION: The SCS revealed favorable psychometric characteristics among the middle-aged Chinese population. The degree of self-concealment among emerging adults was higher than that of middle-aged and older people.

Physical Frailty, Genetic Predisposition, and Incident Heart Failure.

Background: There is growing interest in the intersection of frailty and heart failure (HF); however, large-sample longitudinal studies in the general population are lacking. Objectives: The goal of this study was to examine the longitudinal relationship between frailty and incident HF, and whether age and genetic predisposition could modify this association. Methods: This prospective cohort study included 340,541 participants (45.7% male; mean age 55.9 ± 8.1 years) free of HF at baseline in the UK Biobank. Frailty was assessed by using the Fried frailty phenotype and included weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength. The weighted polygenetic risk score was calculated. Cox models were used to estimate these associations and the interaction between the 2 factors. Results: During a median 14.1 years of follow-up, 7,590 patients with HF were documented. Compared with nonfrail participants, both prefrail and frail participants had a positive association with the risk of incident HF (prefrail HR: 1.40 [95% CI: 1.17-1.67]; frail HR: 2.07 [95% CI: 1.67-2.57]). Exhaustion (HR: 1.21; 95% CI: 1.03-1.43), slow gait speed (HR: 1.62; 95% CI: 1.39-1.90), and low grip strength (HR: 1.31; 95% CI: 1.14-1.51) were associated with a greater risk of incident HF. Furthermore, genetic susceptibility did not significantly modify the associations (P interaction = 0.094), and the association was significantly strengthened in younger participants (P interaction = 0.008). Conclusions: Frailty status was associated with a higher risk of incident HF independent of genetic risk. A younger population may be more susceptible to HF when exposed to frailty. Whether the modification of frailty status represents another avenue for preventing HF warrants further investigation.

[Migration background and loneliness among middle-aged and older adults in Germany]. / Migrationshintergrund und Einsamkeit im mittleren und hohen Alter in Deutschland.

BACKGROUND: Currently, there is limited knowledge about the association between a migration background and loneliness among middle-aged and older individuals in Germany. The aim was therefore to examine the association between migration background and loneliness in this group. METHODS: Data were taken from the German Ageing Survey (Wave 7, November 2020 to March 2021), a representative sample of middle-aged and older individuals. The sample comprised 4145 individuals, and the mean age was 63.8 years. Of the respondents, 93.2% had no migration background, approximately 5.9% had a migration background with personal migration experience, and 0.9% had a migration background but no personal migration experience. The De Jong Gierveld tool was used to quantify loneliness. RESULTS: Multiple linear regressions showed that individuals with a migration background and their own migration experience have significantly higher levels of loneliness (ß = 0.15, 95% confidence interval (CI): 0.004 to 0.30, p < 0.05) compared to individuals without a migration background, whereas individuals with a migration background without their own migration experience have significantly lower levels of loneliness (ß = -0.27, 95% CI: -0.52 to -0.02 p < 0.05). CONCLUSIONS: Individuals with a migration background and their own migration experience appear to represent a risk group for high loneliness among middle-aged and older adults in Germany. In this respect, this group should be given special consideration in corresponding measures. Against the background of current (and potential future) migration movements, the results are of great importance as these groups in particular could be affected by loneliness.

Traditional Chinese medicine constitution and sarcopenia: a cross-sectional study.

Objective: Sarcopenia is a gradually advancing systemic disorder affecting skeletal muscles, primarily distinguished by diminished muscle mass and functional decline. As of present, a universally accepted diagnostic criterion for sarcopenia has yet to be established. From the perspective of the constitution theory in traditional Chinese medicine (TCM), the Yin-deficiency constitution is believed to have a significant correlation with the development of sarcopenia. The primary objective of this study was to examine the potential association between sarcopenia and Yin-deficiency constitution. Methods: The present study is a cross-sectional analysis. The Asian Working Group for Sarcopenia (AWGS) recommended a diagnostic criterion for sarcopenia. A total of 141 participants over 50 years of age were diagnosed with sarcopenia. To determine the constitution of each patient, classification and determination standards were used in traditional Chinese medicine. In this study, a combination of logistic regression and propensity score matching (PSM) was employed to analyze a dataset comprising 1,372 eligible observations. The diagnostic efficacy of the test in distinguishing sarcopenia was assessed through receiver operating characteristic (ROC) curve analysis. Results: The relationship between Yin-deficiency constitution and sarcopenia was examined using logistic regression analysis. In the crude model, the odds ratio (OR) was found to be 3.20 (95% confidence interval [CI]: 1.70-6.03). After adjusting for various confounding factors, including gender, sex, 6 m walking test/(m/s), SMI, and maximum grip strength/kg, the OR increased to 9.70 (95% CI: 3.20-69.38). The associations between seven other biased traditional Chinese medicine (TCM) constitutions and sarcopenia were not found to be statistically significant in the fully adjusted model. The propensity score matching (PSM) analysis yielded consistent results with the logistic regression analysis. Receiver operating characteristic (ROC) curve analysis showed that the AUC of the Yin-deficiency constitution combined with age and gender reached 0.707. Conclusion: Among the nine TCM constitutions examined, the Yin-deficiency constitution demonstrates an independent association with sarcopenia. Yin-deficiency constitution may serve as a potential risk factor for the development of sarcopenia. To establish a causal relationship, further experimental investigations are warranted. The diagnostic performance of sarcopenia is effectively demonstrated by the Yin-deficiency constitution combined with age and gender.

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 10-Year Follow-up of a Prospective, Randomized Controlled Trial.

BACKGROUND: Short- and midterm evaluations of arthroscopic meniscal surgery have shown little or no effect in favor of surgery, although long-term effects, including radiographic changes, are unknown. PURPOSE: To compare the 10-year outcomes in middle-aged patients with meniscal symptoms between a group that received an exercise program alone and a group that received knee arthroscopy in addition to the exercise program with respect to the prevalence of radiographic and symptomatic osteoarthritis (OA), patient-reported outcomes, and clinical status. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to undergo either 3 months of exercise therapy (nonsurgery group) or knee arthroscopy in addition to the exercise therapy (surgery group). Surgery usually consisted of partial meniscectomy (n = 56) or diagnostic arthroscopy (n = 8). Radiographs were assessed according to the Kellgren-Lawrence score at the baseline and 5- and 10-year follow-ups. Patient-reported outcome measures were reported at the baseline and 1-, 3-, 5-, and 10-year follow-ups. Clinical status was assessed at a 10-year follow-up. The primary outcomes were radiographic OA and changes in the Knee injury and Osteoarthritis Outcome Score Pain subscale (KOOSPAIN) from the baseline to the 10-year follow-up. The primary analysis was performed using the intention-to-treat approach. RESULTS: At the time of the 10-year follow-up, eight patients had died, leaving 142 eligible patients. Radiographic OA was assessed for 95 patients (67%), questionnaires were answered by 110 (77%), and the clinical status was evaluated for 95 (67%). Radiographic OA was present in 67% of the patients in each group (P≥ .999); symptomatic OA was present in 47% of the nonsurgery group and 57% of the surgery group (P = .301). There were no differences between groups regarding changes from baseline to 10 years in any of the KOOS subscales. CONCLUSION: Knee arthroscopic surgery, in most cases consisting of partial meniscectomy or diagnostic arthroscopy, in addition to exercise therapy in middle-aged patients with meniscal symptoms, did not increase the rates of radiographic or symptomatic OA and resulted in similar patient-reported outcomes at the 10-year follow-up compared with exercise therapy alone. Considering the short-term benefit and no long-term harm from knee arthroscopic surgery, the treatment may be recommended when first-line treatment-including exercise therapy for ≥3 months-does not relieve patient's symptoms. REGISTRATION: Clinical Trials NCT01288768 (ClinicalTrials.gov identifier).

Identifying the most crucial factors associated with depression based on interpretable machine learning: a case study from CHARLS.

Background: Depression is one of the most common mental illnesses among middle-aged and older adults in China. It is of great importance to find the crucial factors that lead to depression and to effectively control and reduce the risk of depression. Currently, there are limited methods available to accurately predict the risk of depression and identify the crucial factors that influence it. Methods: We collected data from 25,586 samples from the harmonized China Health and Retirement Longitudinal Study (CHARLS), and the latest records from 2018 were included in the current cross-sectional analysis. Ninety-three input variables in the survey were considered as potential influential features. Five machine learning (ML) models were utilized, including CatBoost and eXtreme Gradient Boosting (XGBoost), Gradient Boosting decision tree (GBDT), Random Forest (RF), Light Gradient Boosting Machine (LightGBM). The models were compared to the traditional multivariable Linear Regression (LR) model. Simultaneously, SHapley Additive exPlanations (SHAP) were used to identify key influencing factors at the global level and explain individual heterogeneity through instance-level analysis. To explore how different factors are non-linearly associated with the risk of depression, we employed the Accumulated Local Effects (ALE) approach to analyze the identified critical variables while controlling other covariates. Results: CatBoost outperformed other machine learning models in terms of MAE, MSE, MedAE, and R2metrics. The top three crucial factors identified by the SHAP were r4satlife, r4slfmem, and r4shlta, representing life satisfaction, self-reported memory, and health status levels, respectively. Conclusion: This study demonstrates that the CatBoost model is an appropriate choice for predicting depression among middle-aged and older adults in Harmonized CHARLS. The SHAP and ALE interpretable methods have identified crucial factors and the nonlinear relationship with depression, which require the attention of domain experts.

Changes in patterns of multimorbidity and associated with medical costs among Chinese middle-aged and older adults from 2013 to 2023: an analysis of repeated cross-sectional surveys in Xiangyang, China.

Background: Multimorbidity has become a major public health problem among Chinese middle-aged and older adults, and the most costly to the health care system. However, most previous population-based studies of multimorbidity have focused on a limited number of chronic diseases, and diagnosis was based on participants' self-report, which may oversimplify the problem. At the same time, there were few reports on the relationship between multimorbidity patterns and health care costs. This study analyzed the multimorbidity patterns and changes among middle-aged and older people in China over the past decade, and their association with medical costs, based on representative hospital electronic medical record data. Methods: Two cross-sectional surveys based on representative hospital data were used to obtain adults aged 45 years and older in Xiangyang in 2013 (n = 20,218) and 2023 (n = 63,517). Latent Class Analysis was used to analyze changes in the patterns of multimorbidity, gray correlation analysis and ordered logistics model were used to assess the association of multimorbidity patterns with medical expenses. The diagnosis and classification of chronic diseases were based on the International Classification of Diseases, Tenth Revision codes (ICD-10). Results: The detection rate of chronic disease multimorbidity has increased (70.74 vs. 76.63%, p < 0.001), and multimorbidity patterns have increased from 6 to 9 (2013: Malignant tumors pattern, non-specific multimorbidity pattern, ischemic heart disease + hypertension pattern, cerebral infarction + hypertension pattern, kidney disease + hypertension pattern, lens disease + hypertension pattern; new in 2023: Nutritional metabolism disorders + hypertension pattern, chronic lower respiratory diseases + malignant tumors pattern, and gastrointestinal diseases pattern) in China. The medical cost of all multimorbidity patients have been reduced between 2013 and 2023 (RMB: 8216.74 vs. 7247.96, IQR: 5802.28-15,737 vs. 5014.63-15434.06). The top three specific multimorbidity patterns in both surveys were malignancy tumor pattern, ischemic heart disease + hypertension pattern, and cerebral infarction + hypertension pattern. Hypertension and type 2 diabetes are important components of multimorbidity patterns. Compared with patients with a single disease, only lens disorders + hypertension pattern were at risk of higher medical costs in 2013 (aOR:1.23, 95% CI: 1.03, 1.47), whereas all multimorbidity patterns were significantly associated with increased medical costs in 2023, except for lens disorders + hypertension (aOR:0.35, 95% CI: 0.32, 0.39). Moreover, the odds of higher medical costs were not consistent across multimorbidity patterns. Among them, ischemic heart disease + hypertension pattern [adjusted odds ratio (aOR):4.66, 95%CI: 4.31, 5.05] and cerebral infarction + hypertension pattern (aOR: 3.63, 95% CI: 3.35, 3.92) were the two patterns with the highest risk. Meanwhile, men (aOR:1.12, 95CI:1.09, 1.16), no spouse (aOR:1.09, 95CI: 1.03, 1.16) had a positive effect on medical costs, while patients with total self-pay (aOR: 0.45, 95CI: 0.29, 0.70), no surgery (aOR: 0.05, 95CI: 0.05, 0.05), rural residence (aOR: 0.92, 95CI: 0.89, 0.95), hospitalization days 1-5 (aOR: 0.04, 95CI: 0.04, 0.04), and hospitalization days 6-9 (aOR: 0.15, 95CI: 0.15, 0.16) had a negative impact on medical costs. Conclusion: Multimorbidity patterns among middle-aged and older adults in China have diversified over the past decade and are associated with rising health care costs in China. Smart, decisive and comprehensive policy and care interventions are needed to effectively manage NCDS and their risk factors and to reduce the economic burden of multimorbidity on patients and the country.

Association of sleep timing, sleep duration, and sleep latency with metabolic syndrome in middle-aged adults in Korea: A cross-sectional and longitudinal study.

OBJECTIVE: Sleep is a potential risk factor for metabolic syndrome. We investigated the associations of various sleep characteristics with the status and incidence of metabolic syndrome in middle-aged Koreans. METHODS: Using data from a community-based Korean Medicine Daejeon Citizen Cohort study on participants aged 30-50years, cross-sectional (n = 1984) and longitudinal (n = 1216, median follow-up: 2.1years) analyses were performed. To study the association of metabolic syndrome and five components with various sleep characteristics, measured using the Pittsburgh Sleep Quality Index, we used Poisson and logistic regression and Cox proportional hazard regression analyses, adjusting for covariates. RESULTS: Of 1984 participants, 66%, 19%, and 15% belonged to the non-metabolic syndrome, pre-metabolic syndrome, and metabolic syndrome groups, respectively. After covariate adjustments, the pre-metabolic syndrome group was associated with late mid-sleep time (≥5:00; prevalence ratios 1.61, 95% confidence interval 1.01-2.54) and late bedtime (≥2:00; prevalence ratios 1.55, 95% confidence interval 1.03-2.34), and the metabolic syndrome group was associated with long sleep latency (prevalence ratios 1.33, 95% confidence interval 1.03-1.73), poor sleep quality (prevalence ratios 1.38, 95% confidence interval 1.07-1.78), and early wake time (<6:00; prevalence ratios 1.29, 95% confidence interval 1.01-1.63). Longitudinal analysis of participants without metabolic syndrome at baseline indicated a significant increase in metabolic syndrome risk associated with very short sleep duration (<6 hours; hazard ratio 1.72, 95% confidence interval 1.06-2.79), long sleep latency (>30 minutes; hazard ratio 1.86, 95% confidence interval 1.1-3.12), and early wake time (<6:00 o'clock; hazard ratio 1.73, 95% confidence interval 1.01-2.97). CONCLUSION: Sleep characteristics, such as short duration, long latency, and early wake time, were associated with an increased risk of metabolic syndrome in middle-aged adults.

A Wrist-Worn Wearable Device Can Identify Frailty in Middle-Aged and Older Adults: The UK Biobank Study.

OBJECTIVES: Digital gait biomarkers collected from body-worn devices can remotely and continuously collect movement types, quantity, and quality in real life. This study assessed whether digital gait biomarkers from a wrist-worn device could identify people with frailty in a large sample of middle-aged and older adults. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A total of 5822 middle-aged (43-64 years) and 4344 older adults (65-81 years) who participated in the UK Biobank study. MEASURES: Frailty was assessed using a modified Fried's frailty assessment and was defined as having ≥3 of the 5 frailty criteria (weakness, low activity levels, slowness, exhaustion, and weight loss). Fourteen digital gait biomarkers were extracted from accelerometry data collected from wrist-worn sensors worn continuously by participants for up to 7 days. RESULTS: A total of 238 (4.1%) of the middle-aged group and 196 (4.5%) of the older group were categorized as frail. Multivariable logistic regression analysis revealed that less daily walking (as assessed by step counts), slower maximum walking speed, and increased step time variability best-identified people with frailty in the middle-aged group [area under the curve (95% CI): 0.70 (0.66-0.73)]. Less daily walking, slower maximum walking speed, increased step time variability, and a lower proportion of walks undertaken with a manual task best-identified people with frailty in the older group [0.73 (0.69-0.76)]. CONCLUSIONS AND IMPLICATIONS: Our findings indicate that measures obtained from wrist-worn wearable devices worn in everyday life can identify individuals with frailty in both middle-aged and older people. These digital gait biomarkers may facilitate screening programs and the timely implementation of frailty-prevention interventions.

Correlation between psychological traits and the use of smart medical services in young and middle-aged adults: An observational study.

BACKGROUND: Psychological problems affect economic development. However, there is a huge gap between mental health service resources and mental health service needs. Existing mental health service technology and platforms cannot meet all the diverse mental health needs of people. Smart medicine is a new medical system based online that can effectively improve the quality and efficiency of medical services and make mental health services accessible. AIM: To explore the level of intelligent medical use among young and middle-aged people and its correlation with psychological factors. METHODS: Convenience sampling was used to select 200 young and middle-aged patients with medical experience at the Third People's Hospital of Chengdu between January 2022 and January 2023 as the research subjects. The general condition Questionnaire, Eysenck Personality Questionnaire, Symptom Checklist-90, General Health Questionnaire, and Smart Medical Service Use Intention Questionnaire were used to collect data. Pearson's correlation was used to analyze the correlation between the participants' willingness to use smart medical services and their personality characteristics, psychological symptoms, and mental health. RESULTS: The results revealed that the mental health of young and middle-aged people was poor, and some had psychological problems such as anxiety, depression, and physical discomfort. Familiarity, acceptance, and usage of smart healthcare in this population are at a medium level, and these levels correlate with psychological characteristics. Acceptance was positively correlated with E, and negatively correlated with P, anxiety, fear, anxiety/insomnia, and social dysfunction. The degree of use was negatively correlated with P, obsessive-compulsive symptoms, depression, anxiety, hostility, paranoia, and somatic symptoms. CONCLUSION: The familiarity, acceptance, and usage of smart medical services among the middle-aged and young groups are related to various psychological characteristics.

Promoting vigorous intermittent lifestyle physical activity (vilpa) in middle-aged adults: an evaluation of the movsnax mobile app.

BACKGROUND: Most adults fail to meet the moderate to vigorous physical activity-based recommendations needed to maintain or improve health. Vigorous Intermittent Lifestyle Physical Activity (VILPA) refers to short (1-2 min) high-intensity activities that are integrated into activities of daily living. VILPA has shown strong potential to improve health and addresses commonly reported barriers to physical activity. However, it is unknown how VILPA can best be promoted among the adult population. This study aimed to evaluate the usability, user engagement, and satisfaction of a mobile application (MovSnax) designed to promote VILPA. METHODS: A concurrent mixed methods design was used. It comprised four parts. Part A was a survey with n = 8 mHealth and physical activity experts who had used the app over 7-10 days. Part B was think-aloud interviews with n = 5 end-users aged 40-65 years old. Part C was a survey with a new group of 40-65-year-old end-users (n = 35) who had used the MovSnax app over 7-10 days. Part D was semi-structured interviews with n = 18 participants who took part in Part C. Directed content analysis was used to analyze the results from Parts A, B, and D, and descriptive statistics were used to analyze findings from Part C. RESULTS: Participants reported positive views on the MovSnax app for promoting VILPA but also identified usability issues such as unclear purpose, difficulties in manual data entry, and limited customization options. Across the different data collections, they consistently emphasized the need for more motivational features, clearer feedback, and gamification elements to enhance engagement. Quantitative assessment showed satisfactory scores on objective measures but lower ratings on subjective aspects, possibly due to unfamiliarity with the VILPA concept and/or technical barriers. CONCLUSIONS: The MovSnax app, tested in the present study, is the world's first digital tool aimed specifically at increasing VILPA. The findings of the present study underscore the need for further app refinement, focusing on clarifying its purpose and instructions, boosting user engagement through personalization and added motivational elements, enhancing accuracy in detecting VILPA bouts, implementing clearer feedback mechanisms, expanding customization choices (such as font size and comparative data), and ensuring transparent and meaningful activity tracking.

Relationship between cognitive function and sleep quality in middle-aged and older adults for minimizing disparities and achieving equity in health: Evidence from multiple nationwide cohorts.

BACKGROUND: Cognitive decline, a heavy burden on middle-aged and older adults as global aging is aggravated, was found to be associated with sleep quality. However, the country-between heterogeneity of the association prevented us from quantifying underlying relationship and identifying potential effect modifiers for vulnerable populations and targeted interventions. METHODS: We collected data from 79,922 eligible adults in five nationwide cohorts, examined the respective relationships between cognitive function and sleep quality, synthesized underlying average relationships by meta-analysis, and explored effect modifiers by meta-regressions. Additionally, we conducted subgroup and interaction analyses to identify vulnerable populations and to determine their disparities in vulnerability. RESULTS: Although country-between disparities exist, cognitive function is robustly associated with sleep quality in middle-aged and older adults worldwide, with an effect (ß) of 0.015 [0.003, 0.027]. Executive function is the subdomain most relevant to sleep quality. Disparities in the effects of sleep quality on subdomains exist in populations with different sexes (orientation: ßfemale/ßmale = 1.615, P = 0.020), marital statuses (orientation: ßunmarried/ßmarried = 2.074, P < 0.001), education levels (orientation:ßuneducated/ßeducated = 2.074, P < 0.001) and chronic disease statuses (memory: ßunhealthy/ßhealthy = 1.560, P = 0.005). CONCLUSIONS: Cognitive function decreases with worsening sleep quality in middle-aged and older adults. Vulnerability to poor sleep generally persists in singles, females, the uneducated and people with chronic diseases. To minimize disparities and achieve health equity, we advocate for targeted interventions, i.e., encouraging socialization in singles, confirming effectiveness of hormone replacement therapy in females, employing compulsory education in middle-aged and older adults.

Association Between Nonalcoholic Fatty Liver Disease and the Risk of Cardiovascular Disease in the Middle-Age and Elderly Population of Northern China: A Cross-Sectional Study.

Background: Nonalcoholic fatty liver disease (NAFLD) has become a major global health burden, which increases the risk of extra-hepatic complications such as type 2 diabetes mellitus (T2DM), dyslipidemia, metabolic syndrome (MetS), and cardiovascular disease (CVD). However, NAFLD remains underappreciated and underdiagnosed. Our study aimed to explore the prevalence of NAFLD and the association between NAFLD and CVD events among adults aged 40 and older in Northern China. Methods: This study was conducted in the Shijingshan district of Beijing, China from November 2011 to August 2012. A total of 18891 subjects were recruited in the study. The information including demographical information, lifestyle, previous history of diabetes, hypertension, dyslipidemia, CVD, and liver disease were gathered. Data on physical examination, blood lipid profile, fasting blood glucose, and 2-hour blood glucose were recorded. Determination of MetS was according to T2DM guideline of Chinese Diabetes Society (2020 edition). The association between CVD and NAFLD was evaluated by multivariate logistic regression. Results: The prevalence of NAFLD was 15.2%. After adjustment for age, smoking status, alcohol intake, WC, hypertension, dyslipidemia and hyperglycemia, the odds ratios (ORs) of CVD in men were 1.622 (95%CI: 1.345-1.957) and 1.990 (95%CI: 1.709-2.316) in women with NAFLD, compared with the subjects without NAFLD. Conclusions: NAFLD is independently associated with increased risk of CVD development.

Association between physical activity level and diabetes incidence among Chinese middle-aged and older adults: a cross-sectional study from the China health and retirement longitudinal study.

Background: It has been shown that diabetes is associated with insufficient physical activity among middle-aged and older adults, but the association between different physical activity levels (PAL) and diabetes incidence needs to be further explored. Objective: This study aims to explore the correlation and dose-response relationship between different PAL and the diabetes incidence in middle-aged and older adults. Methods: Utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), this cross-sectional analysis included 17,226 middle-aged and older adults aged 45 and above. Binary logistic regression models and restricted cubic spline (RCS) were used to explore the correlation and dose-response relationship between different PAL and the incidence of diabetes in the total middle-aged and older adults population as well as in subgroups. Sensitivity analyses were also performed to verify the robustness of the findings. Results: In the entire study population, compared with the lowest PAL, participants in the third and fourth quartiles PAL saw diabetes incidence significantly reduced by 16% (p = 0.005) and 33% (p < 0.001), respectively (p for trend < 0.001). In subgroup analyses, the fourth quartile PAL significantly reduced the diabetes incidence among females, individuals aged 60-69, and rural residents by 25% (p = 0.011), 38% (p < 0.001) and 28% (p < 0.001), respectively. For males, middle-aged (45-59 years), and urban residents, the third quartile PAL reduced diabetes incidence by 22% (p = 0.004), 24% (p = 0.012), 21% (p = 0.013), respectively. When the fourth quartile PAL was reached, the diabetes incidence was significantly reduced in these populations by 41% (p < 0.001), 39% (p < 0.001), and 41% (p < 0.001), respectively. There was a negative dose-response relationship between physical activity and diabetes incidence in specific Chinese middle-aged and older adults population. In addition, sensitivity analyses indicated the robustness of the findings. Conclusion: Higher PAL was associated with lower diabetes incidence in specific Chinese middle-aged and older adults population. It is feasible to use physical activity to predict diabetes incidence in this demographic, and high PAL may be an effective means of preventing and controlling diabetes.