E-bibliotherapy for improving the psychological well-being of informal caregivers of people with dementia: a randomized controlled trial protocol.

BACKGROUND: Providing informal care for individuals with dementia is frequently a challenging and demanding experience that can have detrimental effects on the psychological well-being of caregivers. Regrettably, community-based caregiver services often prove inadequate, highlighting the necessity for innovative approaches to support caregivers. AIM: To test the efficacy of e-bibliotherapy in improving the psychological well-being of informal caregivers of people with dementia. METHOD: The study is divided into two phases. In phase 1, the research team will co-design the e-bibliotherapy app with caregivers. In phase 2, a randomized controlled trial will be conducted among 192 informal caregivers of people with dementia in Hong Kong. Caregivers will be randomly assigned to either the e-bibliotherapy group or the control group using simple randomization. Outcome measures will encompass caregivers' psychological well-being, caregiving appraisal, mental health, saliva cortisol levels as an indicator of stress, and health-related quality of life for caregivers. Data will be collected at baseline, immediately post intervention, and 3 months and 6 months post intervention. General linear mixed model will be employed to analyze intervention effects. Qualitative interviews will be undertaken to explore caregiver experiences within this study and evaluate intervention acceptability using conventional content analysis methods. DISCUSSION: This study represents a pioneering effort in utilizing e-bibliotherapy to enhance the psychological well-being of informal caregivers of individuals with dementia, addressing the existing gap in caregiver services and facilitating knowledge dissemination within the community. TRIAL REGISTRATION: The trial has been registered on ClinicalTrial.gov (Ref: NCT05927805).

An AI-empowered indoor digital contact tracing system for COVID-19 outbreaks in residential care homes.

An AI-empowered indoor digital contact-tracing system was developed using a centralized architecture and advanced low-energy Bluetooth technologies for indoor positioning, with careful preservation of privacy and data security. We analyzed the contact pattern data from two RCHs and investigated a COVID-19 outbreak in one study site. To evaluate the effectiveness of the system in containing outbreaks with minimal contacts under quarantine, a simulation study was conducted to compare the impact of different quarantine strategies on outbreak containment within RCHs. The significant difference in contact hours between weekdays and weekends was observed for some pairs of RCH residents and staff during the two-week data collection period. No significant difference between secondary cases and uninfected contacts was observed in a COVID-19 outbreak in terms of their demographics and contact patterns. Simulation results based on the collected contact data indicated that a threshold of accumulative contact hours one or two days prior to diagnosis of the index case could dramatically increase the efficiency of outbreak containment within RCHs by targeted isolation of the close contacts. This study demonstrated the feasibility and efficiency of employing an AI-empowered system in indoor digital contact tracing of outbreaks in RCHs in the post-pandemic era.

Diagnostic Criteria and Measurement Techniques of Sarcopenia: A Critical Evaluation of the Up-to-Date Evidence.

Sarcopenia, a geriatric syndrome characterized by progressive skeletal muscle mass and function decline, poses a significant health risk among the elderly, contributing to frailty, falls, hospitalization, loss of independence and mortality. The prevalence of sarcopenia varies significantly based on various factors, such as living status, demographics, measurement techniques and diagnostic criteria. Although the overall prevalence is reported at 10% in individuals aged 60 and above, disparities exist across settings, with higher rates in nursing homes and hospitals. Additionally, the differences in prevalence between Asian and non-Asian countries highlight the impact of cultural and ethnic factors, and variations in diagnostic criteria, cut-off values and assessment methods contribute to the observed heterogeneity in reported rates. This review outlines diverse diagnostic criteria and several measurement techniques supporting decision making in clinical practice. Moreover, it facilitates the selection of appropriate tools to assess sarcopenia, emphasizing its multifactorial nature. Various scientific groups, including the European Working Group of Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS), the Asian Working Group on Sarcopenia (AWGS), the American Foundation for the National Institutes of Health (FNIH) and the Sarcopenia Definition and Outcomes Consortium (SDOC), have published consensus papers outlining diverse definitions of sarcopenia. The choice of diagnostic criteria should be aligned with the specific objectives of the study or clinical practice, considering the characteristics of the study population and available resources.

Tai Chi for the prophylaxis of episodic migraine: protocol of a non-inferiority randomized controlled trial with mechanism exploration.

BACKGROUND: Migraine is a complex neurovascular disorder with considerable clinical, social and economic issues. Tai chi has the potential to be an alternative prophylactic treatment for migraine with high safety since the adverse effects and limited efficacy of available medications. AIMS: The proposed study aims to compare the prophylaxis efficacy of 24-week Tai Chi training on migraine attacks with the standard prophylactic medication; and to explore the mechanism of Tai Chi in preventing migraine attacks by analyzing the associations between changes of migraine attacks and changes of neurovascular functions and inflammatory makers. METHOD: This is a two-arm parallel non-inferiority randomized controlled trial. In total 220 Hong Kong Chinese women aged 18-65 years with diagnosis of episodic migraine will be recruited and randomized to either the Tai Chi training group or the standard prophylactic medication group with 1:1 ratio, and receive the 24 weeks of modified 33-short form Yang-style Tai Chi training and the standard prophylactic medications, respectively. A 24-week follow-up will be implemented for both groups. For efficacy examination, the primary outcome was the frequency of migraine attacks measured by the migraine diary; and for the mechanism exploration, the primary outcome was the volume and number of white matter hyperintensity (WMH) measured by magnetic resonance imaging (MRI). The measurements will be conducted at the baseline, 24th weeks, and 48th weeks. Linear mixed model will be adopted to comprehensively analyze the changes of variables within and between groups. DISCUSSION: Given the importance of reducing disease burden and financial cost of migraine attacks, the findings of this study will provide new insights regarding the role of Tai Chi in alleviating migraine burden and further shed light on the mechanism action of Tai Chi on preventing headache attacks. TRIAL REGISTRATION: ClinicalTrials.gov NCT05690737. Registered on January 28, 2023.

Adherence to the Mediterranean Diet during Pregnancy: Associations with Sociodemographic and Anthropometric Parameters, Perinatal Outcomes, and Breastfeeding Practices.

Background and Objectives: The Mediterranean diet (MD) has been recognized as a beneficial nutritional pattern that promotes human health, decreasing the risks of a variety of human disorders and pathological states, including adverse pregnancy outcomes. In this aspect, the current survey aimed to assess the potential association of compliance with the MD during gestation with various sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Materials and Methods: This was a cross-sectional study performed on 5688 pregnant women from 10 distinctive Greek areas. Face-to-face interviews with qualified questionnaires and thorough retrievals of medical records were performed to collect data concerning the participants' sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Results: Elevated compliance with the MD during pregnancy was independently related with older age, higher educational status, and better economic status as well as decreased incidences of pre-pregnancy overweight/obesity and excess gestational weight gain and a lower likelihood of gestational diabetes. Moreover, greater adherence to the MD was independently associated with an increased prevalence of delivering vaginally and a greater prevalence of exclusive breastfeeding for at least 16 weeks postpartum. Conclusions: A higher level of compliance with the MD for the period of gestation was associated with several favorable lifestyle factors that may promote maternal health. Further studies with a prospective design as well as studies exploring the potential effects of maternal compliance with the MD for the period of pregnancy on the health of children should be performed. Future studies should also be extended beyond the MD by assessing the potential beneficial effects of adopting a Mediterranean lifestyle on maternal and child health.

Association of Maternal Pre-Pregnancy Overweight and Obesity with Childhood Anthropometric Factors and Perinatal and Postnatal Outcomes: A Cross-Sectional Study.

BACKGROUND: Pre-pregnancy overweight and obesity in reproductive-aged women becomes a growing tendency in middle- and high-income populations. This study aimed to evaluate whether maternal excess body mass index (BMI) before gestation is associated with children's anthropometric characteristics, as well as perinatal and postnatal outcomes. METHODS: This was a cross-sectional study performed on 5198 children aged 2-5 years old and their paired mothers, assigned from 9 different areas of Greece. Maternal and childhood anthropometric data, as well as perinatal and postnatal outcomes, were collected from medical history records or validated questionnaires. RESULTS: Prevalences of 24.4% and 30.6% of overweight/obesity were recorded for the enrolled children and their mothers 2-5 years postpartum. Maternal pre-pregnancy overweight/obesity was more frequently observed in older mothers and female children, and was also associated with high childbirth weight, preterm birth, high newborn ponderal index, caesarean section delivery, diabetes type 1, and childhood overweight/obesity at pre-school age. In multivariate analysis, maternal pre-pregnancy overweight/obesity was independently associated with a higher risk of childhood overweight/obesity at pre-school age, as well as with a higher increased incidence of childbirth weight, caesarean section delivery, and diabetes type 1. CONCLUSIONS: Maternal overweight/obesity rates before gestation were related with increased childhood weight status at birth and 2-5 years postpartum, highlighting the necessity of encouraging healthy lifestyle promotion, including healthier nutritional habits, and focusing on obesity population policies and nutritional interventions among women of reproductive age.

Corrigendum: Burden of musculoskeletal disorders in the gulf cooperation council countries, 1990-2019: findings from the global burden of disease study 2019.

[This corrects the article DOI: 10.3389/fmed.2022.855414.].

Constructing the concept of healthy ageing and examining its association with loneliness in older adults.

BACKGROUND: World Health Organization (WHO) has defined healthy ageing by highlighting five functional ability domains to (meet basic needs, make decisions, be mobile, build and maintain relationships, and contribute to society), which also emphasized the importance of addressing loneliness as priorities within United Nations Decade of Healthy Ageing initiative. However, the level and determinants of healthy ageing and its association with loneliness are rarely examined. This study aimed to construct a healthy ageing index to verify the WHO healthy ageing framework, measure five domains of functional ability of older adults and examine the relationship between functional ability domains and loneliness. METHODS: A total of 10,746 older adults from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were included. A healthy ageing index ranging from 0 to 17 was constructed using 17 components related to functional ability domains. Univariate and multivariate logistic regression analyses were utilized to determine the association between loneliness and healthy ageing. The STROBE guidelines with the RECORD statement for observational studies using routinely collected health data were observed. RESULTS: The factor analysis verified the five functional ability domains for healthy ageing. After adjusting for confounders, being mobile, building and maintaining relationships, and learning, growing and making decisions were significantly associated with lesser loneliness among participants. CONCLUSIONS: The healthy ageing index of this study can be utilized and further modified with respect to large-scale research with relevant healthy ageing topics. Our findings will support healthcare professionals to provide patient-centered care when identifying their comprehensive abilities and needs.

Exploring the concept of psychological frailty in older adults: a systematic scoping review.

OBJECTIVES: We reviewed the existing definitions of psychological frailty and provided a comprehensive overview of the concept and associated measurements. STUDY DESIGN AND SETTING: We followed the PRISMA guidelines for scoping reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. The eligibility criteria for including studies were developed based on the participants-concept-context framework. We searched the Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, Web of Science and PsycINFO databases, and other sources for relevant studies published between January 2003 and March 2022. RESULTS: The final scoping review included 58 studies. Of these, 40 defined psychological frailty, seven provided a novel definition, and 11 focused on the components defining psychological frailty. We proposed four groups of components to better characterize psychological frailty: mood, cognitive, other mental health, and fatigue-related problems. We identified 28 measuring tools across studies, and the Tilburg Frailty Indicator was the most frequently used (46.6%). CONCLUSION: Psychological frailty is a complex concept whose definition seems to lack consensus. It could include both psychological and physical features. Depression and anxiety are commonly used to define it. This scoping review outlined future research directions for refining the concept of psychological frailty.

The Effects of Immersive Virtual Reality Applications on Enhancing the Learning Outcomes of Undergraduate Health Care Students: Systematic Review With Meta-synthesis.

BACKGROUND: Immersive virtual reality (IVR) applications are gaining popularity in health care education. They provide an uninterrupted, scaled environment capable of simulating the full magnitude of sensory stimuli present in busy health care settings and increase students' competence and confidence by providing them with accessible and repeatable learning opportunities in a fail-safe environment. OBJECTIVE: This systematic review aimed to evaluate the effects of IVR teaching on the learning outcomes and experiences of undergraduate health care students compared with other teaching methods. METHODS: MEDLINE, Embase, PubMed, and Scopus were searched (last search on May 2022) for randomized controlled trials (RCTs) or quasi-experimental studies published in English between January 2000 and March 2022. The inclusion criteria were studies involving undergraduate students majoring in health care, IVR teaching, and evaluations of students' learning outcomes and experiences. The methodological validity of the studies was examined using the Joanna Briggs Institute standard critical appraisal instruments for RCTs or quasi-experimental studies. The findings were synthesized without a meta-analysis using vote counting as the synthesis metric. A binomial test with P<.05 was used to test for statistical significance using SPSS (version 28; IBM Corp). The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation tool. RESULTS: A total of 17 articles from 16 studies totaling 1787 participants conducted between 2007 and 2021 were included. The undergraduate students in the studies majored in medicine, nursing, rehabilitation, pharmacy, biomedicine, radiography, audiology, or stomatology. The IVR teaching domains included procedural training (13/16, 81%), anatomical knowledge (2/16, 12%), and orientation to the operating room setting (1/16, 6%). The quality of the 75% (12/16) of RCT studies was poor, with unclear descriptions of randomization, allocation concealment, and outcome assessor blinding procedures. The overall risk of bias was relatively low in the 25% (4/16) of quasi-experimental studies. A vote count showed that 60% (9/15; 95% CI 16.3%-67.7%; P=.61) of the studies identified similar learning outcomes between IVR teaching and other teaching approaches regardless of teaching domains. The vote count showed that 62% (8/13) of the studies favored using IVR as a teaching medium. The results of the binomial test (95% CI 34.9%-90%; P=.59) did not show a statistically significant difference. Low-level evidence was identified based on the Grading of Recommendations Assessment, Development, and Evaluation tool. CONCLUSIONS: This review found that undergraduate students had positive learning outcomes and experiences after engaging with IVR teaching, although the effects may be similar to those of other forms of virtual reality or conventional teaching methods. Given the identification of risk of bias and low level of the overall evidence, more studies with a larger sample size and robust study design are required to evaluate the effects of IVR teaching. TRIAL REGISTRATION: International prospective register of systematic reviews (PROSPERO) CRD42022313706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=313706.

Government interventions and control policies to contain the first COVID-19 outbreak: An analysis of evidence.

BACKGROUND: The overarching aim of this study was to evaluate the effectiveness over time of government interventions and policy restrictions and the impact of determinants on spread and mortality during the first-wave of the COVID-19 pandemic, globally, regionally and by country-income level, up to 18 May 2020. METHODS: We created a global database merging World Health Organization daily case reports (from 218 countries/territories) with other socio-demographic and population health measures from 21 January to 18 May 2020. A four-level government policy interventions score (low to very high) was created based on the Oxford Stringency Index. RESULTS: Our results support the use of very high government interventions to suppress both COVID-19 spread and mortality effectively during wave one globally compared to other policy levels of control. Similar trends in virus propagation and mortality were observed in all country-income levels and specific regions. CONCLUSIONS: Rapid implementation of government interventions was needed to contain the first wave of the COVID-19 outbreak and to reduce COVID-19-related mortality.

Relation of Maternal Pre-Pregnancy Factors and Childhood Asthma: A Cross-Sectional Survey in Pre-School Children Aged 2-5 Years Old.

Background and Objectives: Asthma constitutes a constant, prolonged, inflammation-related pulmonary disorder in childhood with serious public health concerns. Several maternal risk factors can enhance the prevalence of its development in this stage of life; however, the currently available data remain contradictory and/or inconsistent. We aim to evaluate the potential impacts of mothers' sociodemographic, anthropometric and prenatal and perinatal factors on the prevalence of developing asthma in pre-school children. Materials and Methods: This is a retrospective cross-sectional survey, which includes 5133 women and their matched pre-school children. Childhood asthma was diagnosed using validated questionnaires. Statistical analysis was accomplished to evaluate whether maternal sociodemographic, anthropometric and prenatal and perinatal factors can increase the probability of childhood asthma in pre-school age. Results: A prevalence of 4.5% of childhood asthma was recorded in pre-school age. Maternal age and pre-pregnancy overweight and obesity, caesarean section, gestational diabetes and hypertension and not breastfeeding were associated with childhood asthma after adjustment for multiple confounding factors. Conclusion: Our research showed that several maternal factors increase the prevalence of childhood asthma in pre-school age. Suitable and effective health policies and strategies should be taken into account to confront the predominant maternal factors that increase its prevalence in pre-school age.

Long-term effects of e-Health secondary prevention on cardiovascular health: a systematic review and meta-analysis.

AIMS: Despite the well-documented short-to-medium-term effectiveness of e-Health (electronic health) secondary prevention interventions on patients with cardiovascular disease (CVD), there is limited empirical evidence regarding long-term effectiveness. This review aims to evaluate the long-term effects of e-Health secondary prevention interventions on the health outcomes of patients with CVD. METHODS AND RESULTS: This systematic review and meta-analysis followed Cochrane Handbook for Systematic Reviews of Interventions. EMBASE, Medline, Web of Science, and Scopus were searched from 1990 to May 2022. Randomized controlled trials investigating the effects of e-Health secondary prevention on health outcomes of CVD patients that collected endpoint data at ≥ 12 months were included. RevMan 5.3 was used for risk of bias assessment and meta-analysis. Ten trials with 1559 participants were included. Data pooling suggested that e-Health programmes have significantly reduced LDL cholesterol [n = 6; SMD = -0.26, 95% confidence interval (CI): (-0.38, -0.14), I2 = 17%, P < 0.001]; systolic blood pressure [n = 5; SMD = -0.46, 95% CI: (-0.84, -0.08), I2 = 90%, P = 0.02]; and re-hospitalization, reoccurrence, and mortality [risk ratio = 0.36, 95% CI: (0.17, 0.77), I2 = 0%, P = 0.009]. Effects on behavioural modification, physiological outcomes of body weight and blood glucose, and quality of life were inconclusive. CONCLUSION: e-Health secondary prevention is effective in improving long-term management of risk factors and reducing the reoccurrence of cardiac events in patients with CVD. Results are inconclusive for behaviour modification and quality of life. Exploring, implementing, and strengthening strategies in e-Health secondary prevention programmes that focus on maintaining behaviour changes and enhancing psychosocial elements should be undertaken. REGISTRATION: PROSPERO CRD42022300551.

A GBD 2019 study of health and Sustainable Development Goal gains and forecasts to 2030 in Spain.

This study aimed to report mortality, risk factors, and burden of diseases in Spain. The Global Burden of Disease, Injuries, and Risk Factors 2019 estimates the burden due to 369 diseases, injuries, and impairments and 87 risk factors and risk factor combinations. Here, we detail the updated Spain 1990-2019 burden of disease estimates and project certain metrics up to 2030. In 2019, leading causes of death were ischaemic heart disease, stroke, chronic obstructive pulmonary disease, Alzheimer's disease, and lung cancer. Main causes of disability adjusted life years (DALYs) were ischaemic heart disease, diabetes, lung cancer, low back pain, and stroke. Leading DALYs risk factors included smoking, high body mass index, and high fasting plasma glucose. Spain scored 74/100 among all health-related Sustainable Development Goals (SDGs) indicators, ranking 20 of 195 countries and territories. We forecasted that by 2030, Spain would outpace Japan, the United States, and the European Union. Behavioural risk factors, such as smoking and poor diet, and environmental factors added a significant burden to the Spanish population's health in 2019. Monitoring these trends, particularly in light of COVID-19, is essential to prioritise interventions that will reduce the future burden of disease to meet population health and SDG commitments.

Burden of musculoskeletal disorders in the gulf cooperation council countries, 1990-2019: Findings from the global burden of disease study 2019.

Objective: The purpose of this study was to investigate the burden of musculoskeletal (MSK) health conditions in Gulf Cooperation Council (GCC) countries based on the Global Burden of Disease (GBD) data. Methods: The data for GCC countries were obtained from the 2019 GBD study to evaluate the burden of MSK disorders which include the following countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). The main outcome measures were age-standardized prevalence and years of life lived with disability (YLDs) associated with MSK disorders. The burden of MSK disorders attributable to the category of behavioral, metabolic, or environmental/occupational was reported to estimate the risk-attributable fractions of disease. Results: MSK disorders prevalence ranked fifth in Kuwait, sixth in Bahrain, Oman, Qatar, and UAE, and seventh in Saudi Arabia among all the diseases in 2019. For all GCC countries, MSK disorders were ranked the second leading cause of disability as measured by YLDs for the years 1990 and 2019. The age-standardized prevalence of MSK disorders in 2019 for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE was 18.56% (95% UI: 17.51­19.66), 19.35% (18.25­20.52), 18.23% (17.14­19.36), 18.93% (17.81­20.06), 19.05% (17.96­20.22), and 18.26% (17.18­19.38), respectively. The age-standardized YLDs per 100,000 individuals of MSK disorders in 2019 for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE were 1,734 (1,250­2,285), 1,764 (1,272­2,322), 1,710 (1,224­2,256), 1,721 (1,246­2,274), 1,715 (1,230­2,274), and 1,681 (1,207­2,235), respectively. For risk factors, high body mass index (BMI) had the highest contribution to MSK disorders YLDs in most GCC countries (Bahrain, Kuwait, Oman, and Saudi Arabia), followed by the exposure to occupational ergonomic factors which had the highest contribution to MSK disorders YLDs in Qatar and UAE. Conclusion: There was an increase in both age-standardized prevalence of MSK disorders and YLDs between 1990 and 2019 that was observed for all GCC countries. Some risk factors such as higher BMI and exposure to occupational ergonomic factors were highly associated with YLDs due to MSK disorders. The results of this study provide guidance for the potential nature of preventative and management programs to optimize the individual's health.

The health-adjusted dependency ratio as a new global measure of the burden of ageing: a population-based study.

BACKGROUND: The old-age dependency ratio (OADR), which is the ratio of older people (aged ≥65 years) to working age people (aged 20-64 years), is the most common way to assess and compare the burden of population ageing in different countries. However, the relationship between chronological age and dependency varies widely across countries. We therefore present the health-adjusted dependency ratio (HADR), a new measure of ageing burden based on the ageing-related health of the adult population. METHODS: In this population-based study we used health data for diseases and injuries for 2017 from the Global Burden of Disease project and population data for 2017 from the UN's Population Division to identify the number of adults (aged >20 years) in each country who have the same or higher ageing-related disease burden as the global average 65-year-old. We then calculated the HADR as the ratio of adults who were less healthy than the average 65-year-old (dependent population) to those in better health (supporting population) and compared the HADR with the OADR for 188 countries. We also used cross-sectional, bivariate regression analysis to investigate whether the HADR is a more powerful predictor of changes in per capita health-care expenditure than the OADR as a measure of predictive validity. FINDINGS: Many demographically younger populations have an earlier onset of ageing-related disease, and many demographically older populations have a later onset. For instance, Pakistan has an OADR of 0·09 and an HADR of 0·19, and France has an OADR of 0·35 and an HADR of 0·13. Relative to the OADR, the HADR suggests that Asia, western Europe, and North America have a lower ageing burden, whereas central Asia, southern Asia, and Africa have a greater burden. While Japan and countries in western Europe have the highest OADR, Russia, Papua New Guinea, and countries in southeast Europe have the highest HADR. Relative to the OADR, the HADR suggests that there is much less variation in the burden of ageing across countries than has previously been assumed. HADR was also more closely associated with growth in health spending than the OADR. A 0·1 increase in the HADR was associated with a 2·9 percentage points larger growth rate in per capita spending (p=0·0001), and a 0·1-point increase in the OADR was associated with a 1·8 percentage point larger growth rate. INTERPRETATION: The OADR probably overestimates the burden of population ageing in many demographically older countries and underestimates the ageing burden in many demographically younger countries, which implies that the challenges associated with ageing are more universal than previously thought, and that the world cannot easily be divided in a young and an old groups of nations. FUNDING: None.

Pre-Pregnancy Excess Weight Association with Maternal Sociodemographic, Anthropometric and Lifestyle Factors and Maternal Perinatal Outcomes.

BACKGROUND: Pre-pregnancy excess weight is an important factor for adverse maternal perinatal outcomes; however, data for Greek women remain limited. Therefore, the aim of the present work was to evaluate the relation between pre-pregnant weight status and sociodemographic, anthropometric and lifestyle factors and maternal perinatal outcomes. METHODS: In the present cross-sectional study, 5133 healthy women were enrolled from nine different Greek regions after applying specific inclusion and exclusion criteria. Validated questionnaires were used to assess the sociodemographic characteristics and certain lifestyle factors of the study population. Anthropometric and clinical data were retrieved from medical history files of the women, including measured weight in the first weeks of pregnancy and right before delivery, and maternal perinatal outcomes. Women's weights and heights were also measured 2-5 years postpartum by trained nutritionists. Non-adjusted and adjusted statistical analysis was performed to assess whether pre-pregnancy weight status was associated with sociodemographic, anthropometric and lifestyle factors and maternal perinatal outcomes. RESULTS: In pre-pregnancy, 17.5% of the women were overweight, and 4.9% were classified as obese. These rates were increased 2-5 years postpartum, reaching 21.0% for overweight and 9.6% for obese women. Pre-pregnancy overweight/obesity were associated with older maternal age, higher prevalence of overweight/obesity at 2-5 years postpartum and nonexclusive breastfeeding, as well as increased rates for preterm birth and pregnancy-induced hypertension after multiple adjustments. CONCLUSIONS: Overweight and obesity rates were high among women of childbearing age in Greece. These findings highlight the urgent need for healthy lifestyle promotion and targeted obesity prevention and intervention schemes among women of reproductive age.

COVID-19 Mortality in Europe, by Latitude and Obesity Status: A Geo-Spatial Analysis in 40 Countries.

On 30 January 2020, the World Health Organization (WHO) declared the current novel coronavirus disease 2019 (COVID-19) as a public health emergency of international concern and later characterized it as a pandemic. New data show that excess body mass and vitamin D deficiency might be related to the disease severity and mortality. The aim of this study was to evaluate whether latitude, as a proxy of sunlight exposure and Vitamin D synthesis, and prevalent obesity among European populations, is related to COVID-19 spread and severity. European COVID-19 data (incidence and fatality), including information on the prevalence of obesity, social distancing, and others were obtained by the "Our World in Data" website on 17 April 2021. Adjusted analysis showed that higher COVID-19 incidence and fatality were pictured in countries being in higher latitude, both during the whole period, as well as, during the time period 1 November 2020-31 March 2021. Higher incidence and fatality of COVID-19 were observed where the prevalence of overweight/obesity was higher during the whole time period, whereas during the time period 1 November 2020-31 March 2021, only COVID-19 incidence was higher but not a fatality. The present results provide insights for targeted interventions and preventive strategies against COVID-19.

Epidemiological changes, demographic drivers, and global years of life lost from suicide over the period 1990-2019.

OBJECTIVE: To quantify the contributions of epidemiological changes (age- and gender-specific suicide rates) and demographic forces (population growth and aging) to global changes in years of life lost (YLLs) from suicide over the last 30 years. METHOD: A decomposition analysis was used to assess the impacts of population growth, population aging, and suicide prevalence on global changes in YLLs from suicide between 1990 and 2019. RESULTS: From 1990 to 2019, global YLLs from suicide reduced by 2,073,714 years (5.9%), from 35,246,316 years to 33,172,602 years. This was mainly due to the decline in age-specific suicide rates, which reduced the overall YLLs from suicide by 20,185,691 years (973.4%). However, this decline was offset by the impacts of population growth and population aging, which increased global YLLs from suicide by 14,949,110 years (-720.9%) and 3,442,074 years (-166.0%), respectively. The combined effects of epidemiological and demographic drivers were also reflected in different trends in YLLs from suicide across genders and World Bank income level regions, with particularly notable increases in low- income and lower-middle income countries and the aging population. CONCLUSIONS: With the significant effects of epidemiological and demographic drivers, global and regional YLLs from suicide may be expected to change greatly in the future. Efforts to reduce the burden of suicide require appropriate allocation of resources for suicide-prevention strategies and further consideration of demographic factors.