Effects of beetroot juice on blood pressure in hypertension according to European Society of Hypertension Guidelines: A systematic review and meta-analysis.

AIMS: It has been suggested that nitrate-rich beetroot juice (BRJ) reduces blood pressure (BP) in various populations. We aimed to investigate the effect of BRJ on BP in adults with hypertension according to the European Society of Hypertension Guidelines (clinical BP ≥ 140/≥ 90 mmHg) and whether BRJ can be considered as an adjunct to hypertension drug treatment, by conducting a meta-analysis of randomized controlled trials. DATA SYNTHESIS: PubMed, SCOPUS, Medline Ovid, Cinahl, Cochrane Library and Web of Science were searched from inception until April 13, 2024 to identify randomized controlled trials of BRJ versus placebo, water, or no intake. Risk of bias was assessed using a standardized appraisal instrument from the Swedish Agency for Health Technology and Assessment of Social Services, which is based on the Cochrane risk-of-bias tool for randomized trials. The pooled BP effect size was calculated using random effects models and meta-regression. Certainty of evidence was assessed using GRADE. Eleven trials (349 patients) were included. BRJ yielded a significant reduction in clinical systolic BP compared with placebo mean difference (MD) -5.31 mmHg (95% CI -7.46, -3.16; I2 = 64%, GRADE ⊕⊕OO). There was no significant effect on clinical diastolic BP or 24-h BP outcomes, and the heterogeneity was moderate to high. CONCLUSIONS: Daily ingestion of 200-800 mg of nitrate from BRJ may reduce clinical systolic BP in hypertensive individuals with no sign of development of tolerance. Certainty of evidence is low, and results should be interpreted with caution.

Awareness of somatisation disorder among Swedish physicians at emergency departments: a cross-sectional survey.

BACKGROUND: Somatisation is a highly prevalent psychiatric syndrome in both women and men, in which psychological distress is manifested in physical symptoms without a medical explanation. Many patients with somatisation disorder are high healthcare utilisers, particularly at emergency departments. Unnecessary investigations and diagnostic operations occur frequently, which cause both patient suffering and a significant burden on the healthcare system. Emergency department physicians' awareness of somatisation and its manifestations has not previously been studied. This study aimed to investigate awareness about somatisation disorder among physicians working at emergency departments in western Sweden, and to explore differences between gender, specialty, and work experience. METHODS: A web-based, cross-sectional survey consisting of six dichotomous questions about somatisation disorder was conducted, in December 2021 - January 2022, among licensed physicians of various specialties working at emergency departments in western Sweden. Descriptive analyses and comparative analyses were performed to investigate differences between gender, type of specialty, and years of practice. Data were analysed using chi2 tests and Fisher's exact test. RESULTS: Of the 526 eligible physicians who received the survey, 241 responded; response rate 45.8%. The majority of the respondents (56.4%) were women, and most (35.3%) were specialised in obstetrics/gynaecology. Average years of work experience was 11.1 (SD 8.7) years. Although 71% of respondents were aware of the diagnosis, only 7% knew the diagnostic criteria and only 6% had ever diagnosed a patient with somatisation disorder. Female physicians were more aware of underlying factors than their male colleagues (55.7% vs. 38.2%; p = .010). Type of specialty or years of practice did not affect awareness. CONCLUSIONS: Awareness of somatisation disorder is low among physicians working at emergency departments in western Sweden. The findings suggest a need to increase awareness and knowledge and provide training in diagnosing the condition, to ensure correct decisions and optimal patient management. Clinical guidelines need to be developed to support diagnosis, investigation, and treatment, in Sweden as well as internationally.

The protective effects of Swedish COVID-19 pandemic strategies on adolescents' mental health: a longitudinal cohort study.

AIM: The aim of this study was to investigate a cohort of Swedish eighth graders' mental health and experiences during the COVID-19 pandemic. METHODS: Participants were 157 eighth graders recruited in junior high schools during 2020 who completed a depression questionnaire and a survey about their psychosocial health in relation to the COVID-19 pandemic, alongside a follow-up assessment in 2021. Analyses were conducted using latent change score and cross-lagged models. RESULTS: Participants' depressive symptoms did not substantially increase during the COVID-19 pandemic. The level of depressive symptoms in 2020 was significantly associated with participants' perceptions of the pandemic in 2020 and spring 2021. Participants with higher depression scores reported worse experiences of the pandemic. CONCLUSIONS: The stable level of depressive symptoms among this cohort of eighth graders suggested that keeping schools open during a nationwide lockdown could mitigate some mental health consequences. Adolescents in this study with higher self-assessed depressive symptoms were more likely to experience increased depression after 6 months and had worse experiences during the pandemic than others. This suggests that the pandemic may not immediately affect mental well-being, but those at risk may be affected over time.

Physical activity on prescription in Swedish primary care: a survey on use, views, and implementation determinants amongst general practitioners.

INTRODUCTION: Swedish Physical Activity on Prescription (PAP) has been shown to increase physical activity levels, which is known to lead to positive health effects. PAP is being implemented in Swedish healthcare to various extents. However, there is a lack of knowledge about how Swedish general practitioners (GPs) work with PAP and what hinders and facilitates wider implementation. AIMS: This study aimed to survey GPs' use and views of PAP, identify barriers and facilitators for implementing PAP, and explore associations to gender, practice location, and experience. METHODS: The study was framed by the Normalization Process Theory. A survey was sent to 463 GPs at 69 different healthcare centres in Region Västra Götaland. Data were analysed using multiple logistic and linear regressions. RESULTS: A total of 143 GPs completed the survey (response rate 31%). Views on PAP were generally positive amongst respondents, but only 27% reported using PAP regularly. The most prominent reported barriers were insufficient training and resources. Positive views and willingness to collaborate in using PAP were identified as facilitators. Responding GPs in Gothenburg used PAP more often (OR 6.4; 95% CI 2.7-14.8) and were significantly more positive to the method than GPs in other areas of the region. GPs with more than 10 years of practice used PAP more often (OR 2.5; 95% CI 1.1-6.0) than less experienced GPs. Few of the investigated variables were associated with gender. CONCLUSIONS: The positive views amongst responding GPs are helpful, but more education, training and resources are needed for successful implementation of PAP in Swedish primary health care.

Implementation of physical activity on prescription (PAP) in Swedish healthcare has been ongoing for many years, but is implemented to various extents across and within regions.Views on PAP are generally positive, but use is not widespread amongst general practitioners in Region Västra Götaland who responded to the survey.The method is more frequently used in Gothenburg, where the most extensive implementation work has been done, and amongst more experienced general practitioners.Education and training in using PAP need to increase for successful implementation.

Retirement and Sexual Satisfaction.

BACKGROUND AND OBJECTIVES: Although interest in sexuality in older age has increased over the last decades, few studies have focused on longitudinal change in sexual satisfaction around retirement age. In the present study, we studied change in sexual satisfaction across retirement in a sample of Swedish older adults with a partner. RESEARCH DESIGN AND METHODS: Our analyses were based on n = 759 participants (359 male, 400 female) from the longitudinal Health, Aging, and Retirement Transitions in Sweden study. For this study, we used 5 waves spanning over a period of 4 years. RESULTS: On average, sexual satisfaction did not change significantly before retirement, but decreased after retirement. Interestingly, women showed higher sexual satisfaction than men, as well as a more positive development of both pre- and postretirement sexual satisfaction. Individuals with higher relationship satisfaction had a higher sexual satisfaction until retirement, but their sexual satisfaction also decreased faster after retirement, whereas those with lower relationship satisfaction showed a stable but lower sexual satisfaction. DISCUSSION AND IMPLICATIONS: Sexual satisfaction can change in the retirement transition in several important ways and further studies on the impact of retirement and other late-life stage transitions are warranted.

Can Clinical Postpartum Muscle Assessment Help Predict the Severity of Postpartum Pelvic Girdle Pain? A Prospective Cohort Study.

OBJECTIVE: The purpose of this study was to evaluate whether the clinical assessment of pelvic floor muscles and the diastasis recti abdominis could predict the severity of pelvic girdle pain during the first year postpartum. METHODS: Between 2018 and 2020, 504 women were recruited to this prospective longitudinal cohort study. At 2 to 3 months postpartum, their pelvic floor muscles and diastasis recti abdominis were assessed using vaginal palpation, observation, and caliper measurement. The participants completed the Pelvic Girdle Questionnaire (PGQ) at 2 to 3, 6, 9, and 12 months postpartum. Mixed-effect models were used to determine how the results of pelvic floor muscle and diastasis recti abdominis assessments predicted the PGQ score. A sub-analysis for middle to high PGQ scores was conducted. RESULTS: Maximal voluntary pelvic floor muscle contractions ≥3 (Modified Oxford Scale, scored from 0 to 5) predicted a decreased PGQ score (ß = -3.13 [95% CI = -5.77 to -0.48]) at 2 to 3 months postpartum, with a higher prediction of a middle to high PGQ score (ß = -6.39). Diastasis recti abdominis width did not have any significant correlation with the PGQ score. A sub-analysis showed that a diastasis recti abdominis width ≥35 mm predicted an increased PGQ score (ß = 5.38 [95% CI = 1.21 to 9.55]) in women with pelvic girdle pain. CONCLUSION: The distinction between weak and strong maximal voluntary pelvic floor muscle contractions is an important clinical assessment in women with postpartum pelvic girdle pain. The exact diastasis recti abdominis width, measured in millimeters, showed no clinical relevance. However, a diastasis recti abdominis width ≥35 mm was associated with a higher PGQ score, and further research about this cutoff point in relation to pain is needed. IMPACT: This study highlights the importance of clinical assessment of pelvic floor muscles in patients with postpartum pelvic girdle pain. A better understanding of the role of this muscle group will enable more effective physical therapist treatment of pelvic girdle pain.

A Coordinated Multi-study Analysis of the Longitudinal Association Between Handgrip Strength and Cognitive Function in Older Adults.

OBJECTIVE: Handgrip strength, an indicator of overall muscle strength, has been found to be associated with slower rate of cognitive decline and decreased risk for cognitive impairment and dementia. However, evaluating the replicability of associations between aging-related changes in physical and cognitive functioning is challenging due to differences in study designs and analytical models. A multiple-study coordinated analysis approach was used to generate new longitudinal results based on comparable construct-level measurements and identical statistical models and to facilitate replication and research synthesis. METHODS: We performed coordinated analysis on 9 cohort studies affiliated with the Integrative Analysis of Longitudinal Studies of Aging and Dementia (IALSA) research network. Bivariate linear mixed models were used to examine associations among individual differences in baseline level, rate of change, and occasion-specific variation across grip strength and indicators of cognitive function, including mental status, processing speed, attention and working memory, perceptual reasoning, verbal ability, and learning and memory. Results were summarized using meta-analysis. RESULTS: After adjustment for covariates, we found an overall moderate association between change in grip strength and change in each cognitive domain for both males and females: Average correlation coefficient was 0.55 (95% CI = 0.44-0.56). We also found a high level of heterogeneity in this association across studies. DISCUSSION: Meta-analytic results from nine longitudinal studies showed consistently positive associations between linear rates of change in grip strength and changes in cognitive functioning. Future work will benefit from the examination of individual patterns of change to understand the heterogeneity in rates of aging and health-related changes across physical and cognitive biomarkers.

A Multi-study Coordinated Meta-analysis of Pulmonary Function and Cognition in Aging.

BACKGROUND: Substantial research is dedicated to understanding the aging-related dynamics among individual differences in level, change, and variation across physical and cognitive abilities. Evaluating replicability and synthesizing these findings has been limited by differences in measurements and samples, and by study design and statistical analyses confounding between-person differences with within-person changes. In this article, we conducted a coordinated analysis and summary meta-analysis of new results on the aging-related dynamics linking pulmonary function and cognitive performance. METHODS: We performed coordinated analysis of bivariate growth models in data from 20,586 participants across eight longitudinal studies to examine individual differences in baseline level, rate of change, and occasion-specific variability in pulmonary and cognitive functioning. Results were summarized using meta-analysis. RESULTS: We found consistent but weak baseline and longitudinal associations in levels of pulmonary and cognitive functioning, but no associations in occasion-specific variability. CONCLUSIONS: Results provide limited evidence for a consistent link between simultaneous changes in pulmonary and cognitive function in a normal aging population. Further research is required to understand patterns of onset of decline and differences in rates of change within and across physical and cognitive functioning domains, both within-individuals and across countries and birth cohorts. Coordinated analysis provides an efficient and rigorous approach for replicating and comparing results across independent longitudinal studies.

Gamma-Glutamyltransferase (GGT) as a biomarker of cognitive decline at the end of life: contrasting age and time to death trajectories.

ABSTRACTBackground:A recently published study suggests that Gamma-Glutamyltransferase (GGT) in midlife is related to an increased risk of dementia. In the present longitudinal study, we explore the effects of serum GGT on cognitive decline and dementia also in more advanced ages. METHODS: We analyzed GGT in a sample of 452 individuals, aged 80 years and older at baseline, with the purpose to explore subsequent effects on cognitive performance. We specifically modeled GGT to cognitive change, time to death, and dementia. RESULTS: Our main finding is that a higher level of GGT is associated with cognitive decline prior to death and vascular dementia in late life. These findings were evident across cognitive domains. CONCLUSIONS: This is the first longitudinal study to report on significant associations in late life between GGT, cognitive performance and dementia. Further research is needed to examine the underlying mechanisms of GGT as a marker of age-related cognitive decline.

I forgot when I lost my grip-strong associations between cognition and grip strength in level of performance and change across time in relation to impending death.

An association between level of cognitive function and grip strength is well established, whereas evidence for longitudinal associations of change in the 2 functions is still unclear. We examined associations between cognition and grip strength in levels of performance and in longitudinal change in late life in a population-based sample, aged ≥80 years at baseline, followed until death. The sample consisted of 449 nondemented individuals drawn from the OCTO-Twin Study. A test battery assessing 6 cognitive domains and grip strength was administered at 5 occasions with measurements intervals of 2 years. We fitted time to death bivariate growth curve models, adjusted for age, education, and sex which resulted in associations between grip strength and cognition in both levels of performance (across all cognitive domains) and rates of change (in 4 of 6 domains). These results show that cognition and grip strength change conjointly in later life and that the association between cognition and grip strength is stronger before death than earlier in life.