Negative wealth shocks and subsequent depressive symptoms and trajectories in middle-aged and older adults in the USA, England, China, and Mexico: a population-based, multinational, and longitudinal study.

BACKGROUND: The association between negative wealth shocks and depression among middle-aged and older individuals remains unclear. Our study aimed to assess the association between negative wealth shocks and depression and its trajectories, and to explore cross-national differences in these associations. METHODS: Our sample included 21 999 participants, of which 9519 were from the Health and Retirement Study (2012-2020), 4936 from the English Longitudinal Study of Ageing (2012-2020), 2520 from the China Health and Retirement Longitudinal Study (2011-2020), and 5024 from the Mexican Health and Aging Study (2012-2021). We used latent class trajectory models to identify depressive trajectories, alongside mixed-model logistic regression and multinomial logistic regression to evaluate associations. RESULTS: In the USA (OR 1.73, 95% CI 1.40-2.16), England (OR 1.71, 95% CI 1.09-2.70), and China (OR 1.38, 95% CI 1.09-1.75), negative wealth shocks were associated with subsequent depressive symptoms, but not in Mexico (OR 1.06, 95% CI 0.86-1.29). Additionally, negative wealth shocks were associated with several depressive trajectories in the USA and China. This association occurred only in increasing-decreasing trajectory in England, while no significant association was found across any trajectory in Mexico. CONCLUSIONS: Negative wealth shocks were associated with subsequent depressive symptoms, with significant associations observed in some specific depressive trajectories. These associations exhibited cross-national differences, underscoring the importance of considering country-specific contexts when addressing the mental health impacts of wealth shocks.

Linking head and heart health: the association between psychiatric outcomes for patients with major depressive disorder and myocardial ischemia - a systematic review.

INTRODUCTION: The development of depression after myocardial infarction is associated with a 2- to 2.5-fold increased risk of all-cause mortality, cardiovascular mortality, and cardiovascular events. The objective of this study was to investigate, through a broad search of the literature, whether major depression is associated with worse psychiatric outcomes in middle-aged patients with myocardial ischemia. METHODS: An extensive search for studies on the association between major depression and myocardial ischemia was conducted in the PubMed, Embase, PsycINFO, and Web of Science databases. Randomized clinical trials of middle-aged patients with myocardial ischemia and concomitant depressive symptoms were included. RESULTS: The 14 articles included in this systematic review did not confirm an association between myocardial ischemia and depression with worse psychiatric outcomes in middle-aged patients. However, worse cardiovascular outcomes have been observed in patients with depression after myocardial infarction. CONCLUSIONS: The findings of this study suggest that major depression increases cardiovascular risk in patients after acute myocardial infarction, possibly because of a more pronounced increase in inflammatory markers. REGISTRATION: This systematic review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO) under the number CRD: 511650.

Exploring the effect of sedentary behavior on increased adiposity in middle-aged adults.

BACKGROUND: Sedentary behavior is linked to excess fat mass; however, this association may be inconclusive due to potential measurement errors in self-reported sedentary behavior. OBJECTIVE: To assess the association between changes in sedentary behavior and fat mass in a Cohort of Health Workers (HWCS) from 2004 to 2010. METHODS: A total of 1,285 adults participating in the Cohort of Health Workers were evaluated in 2004 and 2010. Fat mass (kg) was measured by dual X-ray absorptiometry. A self-administered questionnaire was used to estimate the sedentary behavior. Sedentary behavior was also estimated using accelerometry in a sample of 142 health workers. Accelerometry data were used to correct self-reported sedentary behavior using a generalized linear model, which included values for sleeping time, age, sex, sedentary behavior, glucose, and triglycerides. Concordance between both methods was assessed using a kappa and Bland-Altman analysis. Once sedentary behavior was corrected, the values were used to evaluate the association between changes in sedentary behavior and body fat mass using a fixed effect model in the cohort, adjusting for confounders. RESULTS: Self-reported sedentary behavior was 2.8 ± 1.8 and 2.3 ± 1.6 h/day, and body fat mass was 24.9 ± 8.1 and 26.8 ± 8.5 kg in 2004 and 2010, respectively. After applying the correction model, the self-reported sedentary behavior was 7.6 ± 1.2 and 7.5 ± 1.2 h/day in 2004 and 2010, respectively. For every hour increase in corrected sedentary behavior, there was an observed increase of 0.847 (p > 0.001) kg in body fat mass during the 6.8 years in the Cohort of Health Workers from 2004 to 2010. Conversely, non-corrected self-reported sedentary behavior was associated with a non-significant reduction of 0.097 kg (p = 0.228) for every hour of sedentary behavior. CONCLUSIONS: Increased sedentary behavior was associated with increased body fat mass when corrected self-reported sedentary behavior was used. Implementing public health strategies to reduce sedentary behavior is imperative.

Estratégias de educação alimentar e nutricional em um grupo intergeracional: um relato de experiência / Food and nutrition education strategies in an intergenerational group: an experience report / Estrategias de educación alimentaria y nutricional en un grupo intergeneracional: un reporte de experiencia

O Brasil vive uma transição demográfica que favorece o aparecimento e desenvolvimento de doenças crônicas não transmissíveis (DCNT). Em um cenário em que as DCNT estão entre as principais causas de mortes, reforçar a importância de uma alimentação saudável é imprescindível, e medidas preventivas tomam lugar de destaque. Pensando nisso, foram realizadas 11 intervenções de educação alimentar e nutricional em um grupo de atividade física intergeracional, com o objetivo de promover autonomia alimentar. O estudo contou com 25 participantes, na faixa etária de 37 a 83 anos, sendo a maior incidência de 61 a 69 anos (n=12) e predominância de pessoas do gênero feminino (92%). Os parâmetros para avaliar o grupo foram os feedbacks das(os) participantes e o grau de adesão, no qual houve aumento significativo ao longo do período interventivo. Destaca-se a importância de ampliar a abordagem dos hábitos alimentares saudáveis em diversos ambientes, sendo os grupos de atividades físicas um campo fértil, que requer a adaptação da linguagem e formato das atividades, considerando o nível de escolaridade das(os) participantes. Assim, a educação alimentar e nutricional pode ser usada como ferramenta efetiva para a promoção da saúde, a prevenção e o tratamento de DCNT.

Brazil is undergoing a demographic transition that favors the onset and development of chronic non-communicable diseases (NCDs). In a scenario where NCDs feature among the main causes of death, reinforcing the importance of healthy eating is essential and preventive measures should take place. Consequently, eleven Food and Nutritional Education interventions were conducted with an intergenerational physical activity group to promote food autonomy. A total of 25 individuals aged 37 to 83 years participated in the study, with the highest prevalence of 61 to 69 years (n=12) and women (92%). Evaluation parameters were participant feedback and the degree of adherence, which increased significantly over the interventional period. Results highlight the importance of broadening the approach to healthy eating habits in various environments, with physical activity groups being a fertile setting which requires adapting language and the format of activities according to participants' schooling level. Nutritional Food Education can be used as an effective tool for health promotion, prevention and treatment of NCDs.

Brasil vive una transición demográfica que favorece la aparición y desarrollo de enfermedades crónicas no transmisibles (ECNT). En un escenario en que entre las principales causas de muerte están las ECNT, se hace imprescindible reforzar la importancia de una alimentación saludable; para ello se destacan las medidas preventivas. Así, se realizaron 11 intervenciones de educación alimentaria y nutricional en un grupo de actividad física intergeneracional, con el objetivo de promover la autonomía alimentaria. Este estudio contó con una muestra de 25 participantes, en la franja etaria de 37 a 83 años, siendo la mayor prevalencia de los de entre 61 y 69 años (n=12), y predominancia de personas del género femenino (92%). Los parámetros que evalúan al grupo fueron las respuestas de las(los) participantes y el grado de adhesión, en el cual hubo un aumento significativo a lo largo de la intervención. Se destaca la importancia de ampliar el foco en los hábitos alimentarios saludables en diversos ambientes, y los grupos de actividades físicas son un campo fértil que requiere la adaptación del lenguaje y el formato de las actividades, considerando el nivel de escolaridad de las(los) participantes. Así, la educación alimentaria nutricional puede ser utilizada como herramienta efectiva para la promoción de la salud, la prevención y el tratamiento de las ECNT.

A Associação de Pressão Arterial Definida pelas Diretrizes ACC/AHA de 2017 e Risco de Doença Cardiovascular para Pessoas de Meia-Idade e Idosas na China: Um Estudo de Coorte / The Association of Blood Pressure Defined by the 2017 ACC/AHA Guidelines and Cardiovascular Disease Risk for Middle-Aged and Elderly People in China: A Cohort Study

Resumo Fundamento A doença cardiovascular (DCV) é uma série de doenças que afetam o coração ou os vasos sanguíneos. Objetivos Avaliar a relação entre os níveis de pressão arterial (PA) definidos pelo American College of Cardiology/American Heart Association (ACC/AHA) de 2017 diretriz e risco de DCV/doença cardiovascular aterosclerótica (DCVA) para pessoas de meia-idade e idosos na China. Métodos Um total de 6.644 pessoas de meia-idade e idosas do Estudo Longitudinal de Saúde e Aposentadoria da China CHARLS (China Health and Retirement Longitudinal Study) foram finalmente incluídas. De acordo com a diretriz ACC/AHA de 2017, todos os indivíduos foram divididos em quatro grupos: PA normal, PA elevada, hipertensão estágio 1 e hipertensão estágio 2. O desfecho deste estudo foi considerado o risco de DCV e DCVA. Modelos de regressão COX univariados e multivariados foram adotados para examinar a relação da classificação de PA ACC/AHA de 2017 com o risco de DCV. Modelos de regressão logística univariada e multivariada foram utilizados para investigar a associação entre os níveis de PA e o risco de DCVA. Foram realizadas análises de subgrupos baseadas em idade, sexo e uso de medicamentos anti-hipertensivos. P<0,05 foi aceito como estatisticamente significativo. Resultados Após ajustar todas as covariáveis, em comparação com pacientes de meia-idade e idosos com PA normal, descobrimos que pacientes com hipertensão estágio 1/2 estavam associados a um maior risco de DCV, separadamente. Simultaneamente, também observamos uma associação positiva entre indivíduos com PA elevada, hipertensão estágio 1, hipertensão estágio 2 e maior risco de DCVA no modelo totalmente ajustado. O resultado das análises de subgrupos indicou que a relação entre hipertensão estágio 1/2 e DCV/DCVA alta foi robusta em diferentes idades e sexos, e participantes sem uso de medicamentos anti-hipertensivos. Conclusão A classificação da PA de acordo com as diretrizes de PA da ACC/AHA de 2017 pode ser aplicada à população chinesa.

Abstract Background Cardiovascular disease (CVD) is a series of diseases affecting the heart or blood vessels. Objectives To assess the relationship between blood pressure (BP) levels defined by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline and CVD/atherosclerotic cardiovascular disease (ASCVD) risk for middle-aged and elderly people in China. Methods A total of 6,644 middle-aged and elderly people from the China Health and Retirement Longitudinal Study (CHARLS) were finally included. According to the 2017 ACC/AHA guideline, all subjects were divided into four groups: normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension. The outcome of this study was considered as the risk of CVD and ASCVD. Univariate and multivariate COX regression models were adopted to examine the relationship of the 2017 ACC/AHA BP classification with the risk of CVD. Univariate and multivariate logistic regression models were used to investigate the association between BP levels and ASCVD risk. Subgroup analyses based on age, gender, and use of antihypertensive drugs were performed. P<0.05 was accepted as statistically significant. Results After adjusting all covariates, compared to middle-aged and elderly patients with normal BP, we found that patients with stage 1/2 hypertension were associated with a higher risk of CVD, separately. Simultaneously, we also observed a positive association between individuals with elevated BP, stage 1 hypertension, stage 2 hypertension, and higher ASCVD risk in the fully adjusted model. The result of subgroup analyses implied that the relationship between stage 1/2 hypertension and CVD/ high ASCVD was robust in different ages and genders, and participants without using antihypertensive drugs. Conclusion BP classification under the 2017 ACC/AHA BP guidelines may apply to the Chinese population.

Age and Sex Differences in the Contribution of Mean Arterial Pressure to Pulse Pressure Before Middle Age.

INTRODUCTION: A lower ability to buffer pulse pressure (PP) in the face of increasing mean arterial pressure (MAP) may underlie the disproportionate increase in systolic blood pressure (SBP) in women from young adulthood through middle-aged relative to men. AIM: To evaluate the contribution of MAP to the change in PP and pressure wave contour in men and women from young adulthood to middle age. METHODS: Central pressure waveform was obtained from radial artery applanation tonometry in 312 hypertensive patients between 16 to 49 years (134 women, mean age 35 ± 9 years), 185 of whom were on antihypertensive treatment. RESULTS: Higher MAP levels (≥ 100 mmHg) were significantly associated with higher brachial and central SBP (P < 0.001), PP (P < 0.001), incident wave (P = 0.005), AP (P < 0.001), and PWV (P < 0.001) compared to lower MAP levels. The relationship between MAP and brachial PP (P < 0.001), central PP (P < 0.001), incident wave (P < 0.001), and AP (P < 0.01), but not PWV, strengthens with age. The age-related increase in the contribution of MAP to brachial PP (P < 0.001), central PP (P < 0.001), and incident wave (P < 0.001) was more prominent in women than in men beginning in the fourth decade. In multiple regression analyses, MAP remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of age, heart rate, and antihypertensive treatment. In turn, age remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of MAP, heart rate, and antihypertensive treatment. CONCLUSIONS: Women of reproductive age showed a steeper increase in PP with increasing MAP, despite comparable increases in arterial stiffness in both sexes. The difference was driven by a greater contribution of MAP to the forward component of the pressure wave in women.

Monitoring risk factors for dementia in middle-aged and older adults: a longitudinal study.

Given the importance of dementia syndrome and its impacts on the population, interest in studying modifiable risk factors for dementia is growing. Objective: To compare the prevalence of risk factors for dementia in middle-aged and older adults over a two-year period and to identify what variables in baseline were predictive of cognitive decline in the follow-up. Methods: Longitudinal and quantitative study, with follow-up evaluation after two years, conducted with 200 participants aged 45 years or more, registered in Primary Care Units. In the baseline (2018/2019) and follow-up (2021) assessments, sociodemographic data were collected, and cognitive performance and risk factors for dementia were evaluated (education, hearing loss, head trauma, high blood pressure, alcohol use, obesity, smoking, depressive symptoms, social isolation, physical inactivity, and diabetes mellitus). Data were compared using the McNemar's test. Individual multinomial logistic regression models were performed to identify the factors associated with cognitive decline after two years. Results: The percentages of low education, traumatic brain injury, and smoking remained the same in both assessments. There was a significant increase in the prevalence of high blood pressure (from 55.0 to 62.0%) and physical inactivity (from 58.5 to 74.5%) and a significant reduction in social isolation (from 25.0 to 18.0%). Participants with depressive symptoms in baseline had a higher risk of cognitive decline in follow-up. Conclusion: There was an increase in the prevalence of high blood pressure and physical inactivity and a reduction in social isolation after two years. Depressive symptoms predict cognitive decline.

Dada a importância da síndrome demencial e de seus impactos na população, cresce o interesse em estudar os fatores de risco modificáveis para a demência. Objetivo: Comparar a prevalência de fatores de risco para demência em adultos de meia-idade e pessoas idosas, em um período de dois anos, e identificar quais fatores de risco na avaliação de base predizem o declínio cognitivo na avaliação de acompanhamento. Métodos: Estudo longitudinal e quantitativo, com avaliação de acompanhamento após dois anos, realizado com 200 participantes com 45 anos ou mais, cadastrados na Atenção Básica. Nas avaliações de base (2018/2019) e de acompanhamento (2021) foram coletados dados sociodemográficos, foram feitas avaliação cognitiva e avaliação dos fatores de risco para demência (escolaridade, perda auditiva, traumatismo craniano, hipertensão arterial, uso de álcool, obesidade, tabagismo, sintomas depressivos, isolamento social, inatividade física, diabetes mellitus). Os dados foram comparados pelo teste de McNemar. Modelos de regressão logística multinominal individuais foram conduzidos para identificar quais fatores estavam associados ao declínio cognitivo após dois anos. Resultados: Os percentuais de baixa escolaridade, traumatismo craniano e tabagismo mantiveram-se os mesmos nas duas avaliações. Houve aumento significativo da prevalência de hipertensão arterial (de 55,0 para 62,0%) e inatividade física (de 58,5 para 74,5%), e redução significativa do isolamento social (de 25,5 para 18,0%). Participantes com sintomas depressivos na avaliação de base apresentaram maior risco de declínio cognitivo no acompanhamento. Conclusão: Houve aumento das prevalências de hipertensão arterial e inatividade física; e redução do isolamento social. Sintomas depressivos predizem declínio cognitivo.

Association of handgrip strength with suicidal ideation among adults aged ≥50 years from low- and middle-income countries.

INTRODUCTION: This study aimed to investigate the association between handgrip strength and suicidal ideation in representative samples of adults aged ≥50 years from six LMICs (China, Ghana, India, Mexico, Russia, and South Africa). METHODS: Cross-sectional, community-based data from the World Health Organization's Study on Global Aging and Adult Health were analyzed. Handgrip strength quintiles by sex were created based on the average value of two handgrip measurements of the dominant hand. Self-reported information on past 12-month suicidal ideation was collected. Multivariable logistic regression analysis was conducted to assess associations. RESULTS: Data on 34,129 individuals were analyzed [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 52.1% females]. After adjustment for potential confounders, in the overall sample, compared to the handgrip strength quintile with the highest values [Quintile 1 (Q1)], Q2, Q3, Q4, and Q5 were associated with significant 2.15 (95% CI = 1.05-4.39), 2.78 (95% CI = 1.06-7.32), 3.53 (95% CI = 1.68-7.42), and 6.79 (95% CI = 2.80-16.48) times higher odds for suicidal ideation. CONCLUSIONS: Lower handgrip strength was significantly and dose-dependently associated with higher odds for suicidal ideation in adults aged ≥50 years from LMICs. Future longitudinal studies are needed to understand the underlying mechanisms, and whether increasing general muscular strength and physical function may lead to reduction in suicidal ideation.

Effects of resistance training on heat shock response (HSR), HSP70 expression, oxidative stress, inflammation, and metabolism in middle-aged people.

Resistance training (RT) can increase the heat shock response (HSR) in the elderly. As middle-aged subjects already suffer physiological declines related to aging, it is hypothesized that RT may increase the HSR in these people. To assess the effects of resistance training on heat shock response, intra and extracellular HSP70, oxidative stress, inflammation, body composition, and metabolism in middle-aged subjects. Sixteen volunteers (40 - 59 years) were allocated to two groups: the trained group (n = 7), which performed 12 weeks of RT; and the physically inactive-control group (n = 9), which did not perform any type of exercise. The RT program consisted of 9 whole-body exercises (using standard gym equipment) and functional exercises, carried out 3 times/week. Before and after the intervention, body composition, muscle mass, strength, functional capacity, and blood sample measurements (lipid profile, glucose, insulin, oxidative damage, TNF-α, the HSR, HSP70 expression in leukocytes, and HSP72 in plasma) were performed. The HSR analysis demonstrated that this response is maintained at normal levels in middle-aged people and that RT did not cause any improvement. Also, RT increases muscle mass, strength, and functional capacity. Despite no additional changes of RT on the antioxidant defenses (catalase, glutathione peroxidase, and reductase) or inflammation, lipid peroxidation was diminished by RT (group x time interaction, p = 0.009), indicating that other antioxidant defenses may be improved after RT. HSR is preserved in middle-aged subjects without metabolic complications. In addition, RT reduces lipid peroxidation and can retard muscle mass and strength loss related to the aging process.

Monitoring risk factors for dementia in middle-aged and older adults: a longitudinal study / Monitoramento de fatores de risco para demência em adultos de meia-idade e pessoas idosas: um estudo longitudinal

ABSTRACT. Given the importance of dementia syndrome and its impacts on the population, interest in studying modifiable risk factors for dementia is growing. Objective: To compare the prevalence of risk factors for dementia in middle-aged and older adults over a two-year period and to identify what variables in baseline were predictive of cognitive decline in the follow-up. Methods: Longitudinal and quantitative study, with follow-up evaluation after two years, conducted with 200 participants aged 45 years or more, registered in Primary Care Units. In the baseline (2018/2019) and follow-up (2021) assessments, sociodemographic data were collected, and cognitive performance and risk factors for dementia were evaluated (education, hearing loss, head trauma, high blood pressure, alcohol use, obesity, smoking, depressive symptoms, social isolation, physical inactivity, and diabetes mellitus). Data were compared using the McNemar's test. Individual multinomial logistic regression models were performed to identify the factors associated with cognitive decline after two years. Results: The percentages of low education, traumatic brain injury, and smoking remained the same in both assessments. There was a significant increase in the prevalence of high blood pressure (from 55.0 to 62.0%) and physical inactivity (from 58.5 to 74.5%) and a significant reduction in social isolation (from 25.0 to 18.0%). Participants with depressive symptoms in baseline had a higher risk of cognitive decline in follow-up. Conclusion: There was an increase in the prevalence of high blood pressure and physical inactivity and a reduction in social isolation after two years. Depressive symptoms predict cognitive decline.

RESUMO. Dada a importância da síndrome demencial e de seus impactos na população, cresce o interesse em estudar os fatores de risco modificáveis para a demência. Objetivo: Comparar a prevalência de fatores de risco para demência em adultos de meia-idade e pessoas idosas, em um período de dois anos, e identificar quais fatores de risco na avaliação de base predizem o declínio cognitivo na avaliação de acompanhamento. Métodos: Estudo longitudinal e quantitativo, com avaliação de acompanhamento após dois anos, realizado com 200 participantes com 45 anos ou mais, cadastrados na Atenção Básica. Nas avaliações de base (2018/2019) e de acompanhamento (2021) foram coletados dados sociodemográficos, foram feitas avaliação cognitiva e avaliação dos fatores de risco para demência (escolaridade, perda auditiva, traumatismo craniano, hipertensão arterial, uso de álcool, obesidade, tabagismo, sintomas depressivos, isolamento social, inatividade física, diabetes mellitus). Os dados foram comparados pelo teste de McNemar. Modelos de regressão logística multinominal individuais foram conduzidos para identificar quais fatores estavam associados ao declínio cognitivo após dois anos. Resultados: Os percentuais de baixa escolaridade, traumatismo craniano e tabagismo mantiveram-se os mesmos nas duas avaliações. Houve aumento significativo da prevalência de hipertensão arterial (de 55,0 para 62,0%) e inatividade física (de 58,5 para 74,5%), e redução significativa do isolamento social (de 25,5 para 18,0%). Participantes com sintomas depressivos na avaliação de base apresentaram maior risco de declínio cognitivo no acompanhamento. Conclusão: Houve aumento das prevalências de hipertensão arterial e inatividade física; e redução do isolamento social. Sintomas depressivos predizem declínio cognitivo.

Executive function performance in middle-aged adults.

Executive functions have been widely studied in the extreme of ages, but studies in middle-aged adults remain largely neglected. Education and gender are known to influence cognitive performance; however, their effect on executive function in middle-aged adults remains unclear. Objective: The study aimed to observe the effect of hierarchy of educational qualifications (graduate, postgraduate, and PhD) and gender on various executive function tests across middle-aged adults with or without comorbidity. Methods: A total of 66 middle-aged individuals volunteered for the study (mean age=48.45±5.45 years; 20 graduates, 28 postgraduates, and 18 PhD; 36 males and 30 females; 38 healthy adults and 28 adults with comorbidities). Each subject performed a test assessing short-term memory, spatial working memory, and multitasking abilities on the Cambridge Neuropsychological Test Automated Battery with rest periods in no specific order of tests. Key parameters of cognitive tests were analyzed for differences in educational qualifications (ANOVA), gender (t-test), and the effect of comorbidity as a covariate (ANCOVA). Results: PhDs performed significantly better (p<0.05) in multitasking than graduates and had superior visuospatial working memory (fewer errors). Differences in simultaneous matching abilities, lower incongruence cost and multitasking cost were statistically significant in healthy females than in males. Conclusion: On considering adults with comorbidity, those with higher educational attainment retained the ability to multitask compared to their healthy counterparts, which was not seen in the group with lower educational attainment. Thus, higher educational attainment attenuated the influence of comorbidities and deterioration of executive functions in general in middle-aged adults.

As funções executivas têm sido amplamente estudadas no extremo das idades, mas os estudos na meia-idade permanecem amplamente negligenciados. Educação e gênero são conhecidos por influenciar o desempenho cognitivo, no entanto, seu efeito na função executiva em adultos de meia-idade ainda não está claro. Objetivo: O estudo teve como objetivo observar o efeito da hierarquia de qualificações educacionais (graduação, pós-graduação e doutorado) e gênero em vários testes de função executiva em adultos de meia-idade com ou sem comorbidade. Métodos: Sessenta e seis indivíduos de meia idade se voluntariaram para participar do estudo (idade média=48,45±5,45 anos, 20 graduados, 28 pós-graduados e 18 doutores; 36 homens e 30 mulheres; 38 saudáveis e 28 adultos com comorbidades). Cada sujeito realizou um teste avaliando memória de curto prazo, memória de trabalho espacial e habilidades multitarefa na Bateria Automatizada de Testes Neuropsicológicos de Cambridge (Cambridge Neuropsychological Test Automated Battery ­ CANTAB) com períodos de descanso em nenhuma ordem específica de testes. Os principais parâmetros dos testes cognitivos foram analisados quanto às diferenças nas qualificações educacionais (ANOVA), sexo (teste t) e efeito da comorbidade como uma covariável (ANCOVA). Resultados: Os doutores tiveram desempenho significativamente melhor (p<0,05) em multitarefa do que os graduados e tiveram memória de trabalho visual-espacial superior (menos erros). As diferenças nas habilidades de correspondência simultânea, menor custo de incongruência e custo de multitarefa foram estatisticamente significativas em mulheres saudáveis do que em homens. Conclusão: Ao considerar os adultos com comorbidade, aqueles com maior escolaridade mantiveram a capacidade de multitarefa como seus pares saudáveis, o que não foi observado no grupo com menor escolaridade. Assim, maior escolaridade atenuou a influência de comorbidades e deterioração das funções executivas em geral, em adultos de meia-idade.

Validation of the Scale of Perceived Risk of Sexually Transmitted Infections in Middle-aged and Older Adults

Background: Middle-aged and older adults often mistakenly underestimate the risk to which they are exposed when they engage in risky sexual behaviors. Furthermore, a reliable and valid measurement of the construct is necessary to capture its scope and meaning. Objective: To validate the structure of the Perceived Risk Scale for STIs in middle-aged and older adults, identify their perceived risk of STIs, and identify their relationship with some sociodemographic characteristics. Methods: The sample was composed of 295 middle-aged and older adults. A virtual online sampling was used. Males and females aged 50 years and older, sexually active in the last 12 months, were included. To measure the perceived risk of STIs, the scale of perceived risk for human immunodeficiency virus (HIV) was adapted, and a confirmatory factor analysis of the proposed three-factor structure was carried out. Results: The proposed structure of the scale was found to present acceptable adjustment rates (X 2= 48.283, p <.001; CFI = .962, RMSEA = .079, GFI = .963, TLI = .938). 28.1% of the participants presented low perceived risk; 46.8%, medium perceived risk; and 25.1%, high perceived risk. Association between marital status and perceived risk of STIs was identified. Conclusion: The Perceived Risk Scale for STIs is a reliable and valid instrument for capturing perceived risk of STIs in middle-aged and older adults. An appropriate measurement is considered important to accurately examine the relationship between perceived risk and behavior.

Antecedentes: Los adultos de mediana y tercera edad suelen subestimar erróneamente el riesgo al que se exponen cuando realizan conductas sexuales de riesgo, además, es necesaria una medición fiable y válida del constructo para captar su alcance y significado. Objetivo: Validar la estructura de la Escala de Riesgo Percibido a las ITS en adultos de mediana y tercera, identificar su riesgo percibido a las ITS e identificar su relación con algunas características sociodemográficas. Métodos: La muestra estuvo compuesta por 295 adultos de mediana y tercera edad. Se utilizó un muestreo virtual en línea. Se incluyeron hombres y mujeres de 50 años o más, se-xualmente activos en los últimos 12 meses. Para medir el riesgo percibido a las ITS se adaptó la escala de riesgo percibido al Virus de Inmunodeficiencia Humana (VIH) y se realizó un análisis factorial confirmatorio de la estructura propuesta conformada por tres factores. Resultados: Se comprobó que la estructura propuesta de la escala presentaba mostró índices de ajuste aceptables (X2 = 48.283, p <.001; CFI = .962, RMSEA = .079, GFI = .963, TLI = .938). El 28.1% de los participantes presentó un riesgo percibido bajo, el 46.8% un riesgo percibido medio y el 25.1% un riesgo percibido alto. Se identificó la asociación entre el estado civil y el riesgo percibido de ITS. Conclusiones: La Escala de Riesgo Percibido de ITS es un instrumento fiable y válido para captar el riesgo percibido a las ITS en adultos de mediana y tercera edad. Se considera importante una medición adecuada para examinar con precisión la relación entre el riesgo percibido y la conducta.

Prevalence, Risk Factors and Vaccine Response against Hepatitis B in People Aged 50 Years or Older.

Universal immunization against hepatitis B has contributed to reducing incidence of the disease, but older individuals remain susceptible to acquiring the hepatitis B virus worldwide. Thus, this study aimed to investigate the epidemiology of HBV infection in individuals aged 50 years and over in central Brazil and to evaluate the immunogenicity of the monovalent vaccine against hepatitis B in this age group using two vaccine regimens. METHOD: Initially, a cross-sectional and analytical study was carried out to investigate the epidemiology of hepatitis B. Then, individuals without proof of vaccination for hepatitis B were recruited for a phase IV randomized and controlled clinical trial using two vaccine regimens: Intervention Regimen (IR) (three doses of 40 µg at months 0, 1 and 6) vs. Comparison Regimen (CR) (three doses of 20 µg at months 0, 1 and 6). RESULTS: The overall prevalence of exposure to HBV was 16.6% (95% CI: 14.0%-9.5%). In the clinical trial, statistical differences in protective titers were observed (p = 0.007; IR 96% vs. CR 86%) and the geometric mean of anti-HBs titers was higher in individuals who received the IR (518.2 mIU/mL vs. 260.2 mIU/mL). In addition, the proportion of high responders was higher among those who received the IR (65.3%). CONCLUSION: reinforced doses should be used in individuals aged 50 years or older to overcome the lower efficacy of the vaccine against hepatitis B.

Frailty Index as a Predictor of Mortality in Middle-Aged and Older People: A Prospective Analysis of Chilean Adults.

We aimed to investigate the association between frailty status and all-cause mortality in middle-aged and older people. We included 2661 individuals aged ≥ 35 from the Chilean National Health Survey 2009−2010. Mortality was determined through linkage with the Chilean Civil Registry and Identification. A 36-item frailty index (FI) was used to assess the frailty status. Associations between frailty status and all-cause mortality were assessed using Kaplan−Meier and Cox proportional hazard models adjusted for sociodemographic and lifestyle factors. A non-linear association was investigated using penalized cubic splines fitted in the Cox models. During an 8.9 median follow-up (interquartile range of 8.6−9.0), 308 individuals died (11.5%). Lower survival rates were observed in frail individuals compared to pre-frail and robust people (log-rank < 0.001). Compared with robust individuals, frail people had a higher mortality risk (HR: 2.35 [95% CI: 1.57 to 3.51]). Frail middle-aged individuals had a higher risk of dying independently of major risk factors.

Reduced grip strength potentially indicates depression: Investigating multicontinental databases.

BACKGROUND: Multi-national studies in the association between handgrip strength and depression in middle and older aged adults are limited. Hence, Brazil, China, Europe, Korea, United Kingdom (UK) and United States (US) datasets were utilized to investigate this association. METHODS: A cross-sectional study was conducted with 51,285 participants aged >45 years. Handgrip strength scores were divided into quartiles, groups 1 (highest) to 4 (lowest) in each database, and depression measures converted to binary scores. RESULTS: Males in China and UK reported higher adjusted odds ratios (aORs) of depression for groups 2, 3, and 4 than for group 1. Brazil, US, and Korea reported greater aORs in groups 3 and 4 whereas Europe demonstrated increased aORs for group 4 only. Among females, China, Brazil, US, and Korea showed high aORs across all groups, while UK and Europe reported increased aORs for group 4 only. Highest ORs were reported from Korea in group 4 for males (aOR: 3·09; 95 % CI: 2·15-4·43; p < 0·001) and females (aOR: 3·74; 95 % CI: 2·78-5·03; p < 0·001). When removing the regional factor, aORs were higher in lower groups, with the highest reported from group 4 for males (aOR: 2·32; 95 % CI: 2·09-2·58; p < 0·001) and females (aOR: 2·11; 95 % CI: 1·95-2·29; p < 0·001). LIMITATIONS: Being a cross-sectional study, the results were not able to establish the causal direction between handgrip strength and depression. CONCLUSION: Lower handgrip strength was associated with an increased likelihood of depression. Early assessment of handgrip strength may identify populations at-risk for depression among middle and older aged adults.

Relationship between depressive symptoms, social isolation, visual complaints and hearing loss in middle-aged and older adults.

The prevalence of chronic diseases, especially depression, has been increasing worldwide. Health professionals have an important role in screening and early detection of the disorder, to prevent possible damage such as disability and dependence. With aging, sensory impairments can occur, such as visual and hearing losses, which can lead to isolation contributing to the development of depressive symptoms. The objective of this study was to analyze the relationship between depressive symptoms, social isolation, and self-perception of visual complaints and hearing loss in middle-aged and older adults. It was a cross-sectional quantitative study, in Três Lagoas, state of Mato Grosso do Sul, Brazil, with 300 participants of both sexes, aged 45 years and over, registered in the Primary Health Care network. Data were collected using a structured questionnaire with sociodemographic data and the questions "Do you consider yourself socially isolated?", "Do you have a vision and/or a hearing problem capable of stopping you from performing a daily life activity?" and "If yes, do you use a hearing aid and/or glasses or contact lenses?". Depressive symptoms were assessed using the Center for Epidemiological Studies - Depression (CES-D) scale with a cut-off score adapted for age. Data were analyzed with binary logistic regression, with the presence of depressive symptoms being the dependent variable. Values of p≤0.05 were considered significant. The majority of the sample were women (65.7%), with an average age of 60.9 years, 56.7% were classified with depressive symptoms, 27.0% considered themselves socially isolated, 84.7% reported visual acuity loss (70.7% used glasses) and 17.3% reported hearing loss (2.3% used hearing aids). Social isolation (OR = 6.0), visual complaints (OR = 3.85), and hearing loss (OR = 4.67) were related to the presence of depressive symptoms. Moreover, being married (OR = 0.51) was a protective factor in these participants. The results showed the importance of early diagnosis of depressive symptoms. The correction of visual and hearing deficits is highlighted, as these may be related to symptoms of depression. Health professionals in Primary Health Care should be able to monitor depressive symptoms, visual and hearing complaints, and to promote social interaction.

Avaliação comportamental do processamento auditivo na idade adulta: população de interesse e testes - uma revisão sistemática / Behavioral assessment of auditory processing in adulthood: population of interest and tests - a systematic review

RESUMO Objetivo Identificar os testes comportamentais utilizados para a avaliação do processamento auditivo ao longo da vida adulta, com enfoque nas características da população alvo enquanto grupo de interesse. Estratégia de pesquisa As bases de dados consultadas foram o PubMed, CINAHL, Web of Science e Scielo, a partir dos descritores: "auditory perception" or "auditory perception disorders" or "auditory processing" or "central auditory processing" or "auditory processing disorders" or "central auditory processing disorders" com adults OR aging. Critérios de seleção Incluiu-se estudos com humanos, que abordaram a população adulta de 18 a 64 anos, que realizaram pelo menos um teste comportamental para avaliação do processamento auditivo, na ausência de perda auditiva. Análise dos dados Realizou-se a extração de dados de forma independente, a partir de um protocolo desenvolvido pelos autores incluindo diferentes tópicos, principalmente os testes auditivos comportamentais realizados e os resultados encontrados. Resultados Dos 867 registros identificados, 24 foram selecionados como contendo as informações necessárias para responder às perguntas de pesquisa. Conclusão Quase a totalidade dos estudos foi conduzida com objetivo de verificar o desempenho em um ou dois testes de processamento auditivo; a população alvo foi heterogênea, as mais frequentes foram diabetes, gagueira, transtorno do processamento auditivo e exposição ao ruído. Há poucas informações sobre os padrões de referência para os testes na respectiva faixa etária.

ABSTRACT Purpose To identify the behavioral tests used to assess auditory processing throughout adulthood, focusing on the characteristics of the target population as an interest group. Research strategies PubMed, CINAHL, Web of Science, and Scielo, databases were searched with descriptors: "auditory perception" or "auditory perception disorders" or "auditory processing" or "central auditory processing" or "auditory processing disorders" or "central auditory processing disorders" with adults OR aging. Selection criteria Studies with humans included, the adult population from 18 to 64 years old, who performed at least one behavioral test to assess auditory processing in the absence of hearing loss. Data analysis Data extraction was performed independently, using a protocol developed by the authors that included different topics, mainly the behavioral auditory tests performed and the results found. Results Of the 867 records identified, 24 contained the information needed to answer the survey questions. Conclusion Almost all studies were conducted verify performance in one or two auditory processing tests. The target target population was heterogeneous, with the most frequent persons with diabetes, stuttering, auditory processing disorder, and noise exposure. There is little information regarding benchmarks for testing in the respective age groups.

Executive function performance in middle-aged adults / Desempenho da função executiva em adultos de meia-idade

ABSTRACT. Executive functions have been widely studied in the extreme of ages, but studies in middle-aged adults remain largely neglected. Education and gender are known to influence cognitive performance; however, their effect on executive function in middle-aged adults remains unclear. Objective: The study aimed to observe the effect of hierarchy of educational qualifications (graduate, postgraduate, and PhD) and gender on various executive function tests across middle-aged adults with or without comorbidity. Methods: A total of 66 middle-aged individuals volunteered for the study (mean age=48.45±5.45 years; 20 graduates, 28 postgraduates, and 18 PhD; 36 males and 30 females; 38 healthy adults and 28 adults with comorbidities). Each subject performed a test assessing short-term memory, spatial working memory, and multitasking abilities on the Cambridge Neuropsychological Test Automated Battery with rest periods in no specific order of tests. Key parameters of cognitive tests were analyzed for differences in educational qualifications (ANOVA), gender (t-test), and the effect of comorbidity as a covariate (ANCOVA). Results: PhDs performed significantly better (p<0.05) in multitasking than graduates and had superior visuospatial working memory (fewer errors). Differences in simultaneous matching abilities, lower incongruence cost and multitasking cost were statistically significant in healthy females than in males. Conclusion: On considering adults with comorbidity, those with higher educational attainment retained the ability to multitask compared to their healthy counterparts, which was not seen in the group with lower educational attainment. Thus, higher educational attainment attenuated the influence of comorbidities and deterioration of executive functions in general in middle-aged adults.

RESUMO. As funções executivas têm sido amplamente estudadas no extremo das idades, mas os estudos na meia-idade permanecem amplamente negligenciados. Educação e gênero são conhecidos por influenciar o desempenho cognitivo, no entanto, seu efeito na função executiva em adultos de meia-idade ainda não está claro. Objetivo: O estudo teve como objetivo observar o efeito da hierarquia de qualificações educacionais (graduação, pós-graduação e doutorado) e gênero em vários testes de função executiva em adultos de meia-idade com ou sem comorbidade. Métodos: Sessenta e seis indivíduos de meia idade se voluntariaram para participar do estudo (idade média=48,45±5,45 anos, 20 graduados, 28 pós-graduados e 18 doutores; 36 homens e 30 mulheres; 38 saudáveis e 28 adultos com comorbidades). Cada sujeito realizou um teste avaliando memória de curto prazo, memória de trabalho espacial e habilidades multitarefa na Bateria Automatizada de Testes Neuropsicológicos de Cambridge (Cambridge Neuropsychological Test Automated Battery — CANTAB) com períodos de descanso em nenhuma ordem específica de testes. Os principais parâmetros dos testes cognitivos foram analisados quanto às diferenças nas qualificações educacionais (ANOVA), sexo (teste t) e efeito da comorbidade como uma covariável (ANCOVA). Resultados: Os doutores tiveram desempenho significativamente melhor (p<0,05) em multitarefa do que os graduados e tiveram memória de trabalho visual-espacial superior (menos erros). As diferenças nas habilidades de correspondência simultânea, menor custo de incongruência e custo de multitarefa foram estatisticamente significativas em mulheres saudáveis do que em homens. Conclusão: Ao considerar os adultos com comorbidade, aqueles com maior escolaridade mantiveram a capacidade de multitarefa como seus pares saudáveis, o que não foi observado no grupo com menor escolaridade. Assim, maior escolaridade atenuou a influência de comorbidades e deterioração das funções executivas em geral, em adultos de meia-idade.

Effects of resistance exercise on physical health in middle-aged and elderly women / Efeitos do exercício de resistência sobre a saúde física de mulheres de meia-idade e idosas / Efectos del ejercicio de resistencia en la salud física de mujeres de mediana y avanzada edad

ABSTRACT Introduction: Several methods of sports training are applied to improve physical health in middle-aged and elderly women. Among the emerging ones is resistance exercise, despite little evidence about its effects in this population group. Objective: Explore the effects of resistance exercise on promoting muscle health and reducing cardiovascular risk in middle-aged and elderly women. Methods: A questionnaire on the level of muscle health and cardiovascular risk factors of 100 middle-aged and elderly women was conducted. A total of 20 middle-aged and elderly women were randomly selected as participants, and the experimental group performed resistance exercise training, while the control group performed simple exercise training. Results: In the muscle health indicators of the experimental group, BMI decreased by 0.3%, body fat decreased by 1.3%, waist-to-hip ratio decreased by 0.01, fat decreased by 1.7 kg, lean weight increased by 2.8 kg, and protein decreased by 0.9 kg. The changes in cardiovascular health indicators in the experimental group were greater than those in the control group. Conclusion: Resistance exercise can effectively improve muscle health in middle-aged and elderly women, reducing cardiovascular risk. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Diversos métodos de treinamento esportivo são aplicados para melhorar a saúde física de pessoas de meia-idade e idosas. Dentre os emergentes está o exercício de resistência, apesar de pouca evidência sobre seus efeitos neste grupo populacional. Objetivo: Explorar os efeitos do exercício de resistência na promoção da saúde muscular e na redução do risco cardiovascular em pessoas de meia-idade e idosas. Métodos: Foi realizado um questionário sobre o nível de saúde muscular e fatores de risco cardiovascular de 100 mulheres de meia-idade e idosas. Um total de 20 mulheres de meia-idade e idosas foram selecionadas aleatoriamente como participantes, e o grupo experimental realizou treinamento com exercícios resistidos, enquanto o grupo controle realizou treinamento com exercícios simples. Resultados: Nos indicadores de saúde muscular do grupo experimental, o IMC diminuiu 0,3%, a gordura corporal diminuiu 1,3%, a relação cintura/quadril diminuiu 0,01, a gordura diminuiu 1,7 kg, o peso magro aumentou 2,8 kg, e a proteína diminuiu 0,9 kg. As mudanças nos indicadores de saúde cardiovascular no grupo experimental foram maiores do que as do grupo de controle. Conclusão: O exercício de resistência pode efetivamente melhorar a saúde muscular em mulheres de meia-idade e idosas, reduzindo o risco cardiovascular. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Se aplican varios métodos de entrenamiento deportivo para mejorar la salud física de las personas de mediana y avanzada edad. Entre los emergentes se encuentra el ejercicio de resistencia, a pesar de la poca evidencia sobre sus efectos en este grupo poblacional. Objetivo: Explorar los efectos del ejercicio de resistencia en la promoción de la salud muscular y la reducción del riesgo cardiovascular en personas de mediana edad y ancianas. Métodos: Se realizó un cuestionario sobre el nivel de salud muscular y los factores de riesgo cardiovascular de 100 mujeres de mediana edad y ancianas. Un total de 20 mujeres de mediana edad y ancianas fueron seleccionadas aleatoriamente como participantes, y el grupo experimental realizó entrenamiento con ejercicios de resistencia, mientras que el grupo de control realizó entrenamiento con ejercicios simples. Resultados: En los indicadores de salud muscular del grupo experimental, el IMC disminuyó un 0,3%, la grasa corporal disminuyó un 1,3%, la relación cintura-cadera disminuyó un 0,01, la grasa disminuyó 1,7 kg, el peso magro aumentó 2,8 kg y las proteínas disminuyeron 0,9 kg. Los cambios en los indicadores de salud cardiovascular del grupo experimental fueron mayores que los del grupo de control. Conclusión: El ejercicio de resistencia puede mejorar eficazmente la salud muscular en mujeres de mediana y avanzada edad, reduciendo el riesgo cardiovascular. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Intervención de cuidados enfermeros en adultos medios con diabetes mellitus tipo 2 según Kristen Swanson

Introducción: La diabetes mellitus se considera un problema de salud a nivel mundial. Esto se debe a sus crecientes y elevadas tasas de incidencia y prevalencia. Objetivo: Evaluar la intervención de cuidados enfermeros en adultos medios con diabetes mellitus tipo 2 según Kristen Swanson. Métodos: Se realizó un estudio de intervención y desarrollo en el Centro de Salud del municipio Cuito y provincia Bie, país Angola desde el año 2021 al 2022. Realizado a 98 adultos medios, fueron utilizadas variables como: sexo, escolaridad, años de control de la enfermedad, antecedentes de diabetes en la familia y estado de salud. Se utilizó entrevista estructurada, después de aplicada la intervención se compararon las proporciones poblacionales mediante la prueba de McNemar. Resultados: Recibieron un cuidado aceptable, el 80,61 % de los adultos. Tenía familiares con antecedentes de diabetes 37,75 %, escolaridad básica 57,14 %. Los años de control de la diabetes, 38,77 % de los encuestados manifestaron eran controlados desde hacía 3-5 años y el estado de salud de los adultos fue alto con un 79,59 %. Conclusiones: La intervención de cuidados enfermeros en adultos medios con diabetes mellitus tipo 2 según la teoría de Kristen Swanson fue efectiva al modificar el cuidado y el estado de salud de los que participaron en el estudio.

Introduction: Diabetes mellitus is considered a global health problem. This is due to its increasing and high incidence and prevalence rates. Objective: To evaluate the nursing care intervention in middle adults with type 2 diabetes mellitus according to Kristen Swanson. Methods: An intervention and development study was carried out in the Health Center of the Cuito municipality and Bie province, Angola country from 2021 to 2022. It was carried out on 98 middle adults, the used variables were: Sex, education, years of disease control, history of diabetes in the family, health status. A structured interview was used, after the intervention was applied, the population proportions were compared using the McNemar test. Results: 80.61% of adults received acceptable care. 37.75% had family members with a history of diabetes, 57.14% had basic education. The years of diabetes control, 38.77% of those surveyed stated that they had been controlled for 3 to 5 years and the health status of adults was high at 79.59%. Conclusion: The nursing care intervention in middle adults with type 2 diabetes mellitus according to Kristen Swanson's theory was effective in modifying the care and health status of those who participated in the study.