The role of health literacy in the association between social support and self-rated health: a Danish population-based study in 10,787 individuals with a long-term condition.

BACKGROUND: Managing a long-term condition requires higher health literacy. Social networks may play a crucial role for self-management. However, the pathway is not entirely understood. This study aimed to examine whether the association between social support and self-rated health is mediated by health literacy among individuals with a long-term condition. METHODS: This cross-sectional study used data from the "How are you?" 2021 survey in Central Denmark Region. Social support was assessed using a single question, health literacy with two dimensions from the Health Literacy Questionnaire (HLQ): 'Understanding health information' and 'Engaging with healthcare providers', and self-rated health with a single question from SF-36. Multiple logistic regression analyses were used to examine the associations, and multiple mediation analyses were performed using the Karlson-Holm-Breen method. RESULTS: A total of 10,787 individuals with a long-term condition were included in the study, whereas 6% (n = 595) reported a low level of social support. Both health literacy scales mediated the association between social support and self-rated health, particularly the ability to engage with healthcare providers, accounting for 25% of the variance. After adjustment for sociodemographic factors, individuals with a low level of social support had significantly higher odds of reporting difficulties in understanding health information (OR 2.53 (95% CI: 1.84-3.48)) and engaging with healthcare providers (OR 3.77 (95% CI: 2.96-4.79)). CONCLUSIONS: Health literacy, particularly the ability to engage with healthcare providers, was a mediator between social support and self-rated health. Additionally, a low level of social support was associated with higher odds of reporting lower health literacy. These findings suggest that strategies to enhance health literacy, improve health outcomes, and reduce health inequities may benefit from strengthening individuals' social network, particularly focusing on those with limited support.

Probiotic Strain Lactobacillus plantarum GCLP4 Derived From the Gut of Ctenopharyngodon idella Modulates Growth, Digestive Enzymes and Immune-Biochemical Parameters of Labeo rohita Fingerlings.

The present study was carried out to isolate, identify, and characterize bacterial probiotic strain from the gut of Ctenopharyngodon idella (Grass carp) and then to study its effect on growth, digestive enzymes and immunity of Labeo rohita fingerlings. A total of 6 gram-positive bacteria belonging to the genus Lactobacillus spp. (3), Bacillus spp. (2) and Staphylococcus spp. (1), were identified biochemically. Based on the biochemical results, the isolate GCLP4 was selected for molecular confirmation and BLAST analysis showed maximum homology with Lactobacillus plantarum (100% ident). Fish were fed for 60 days with diet containing 0 (T0), 105 (T1), 107 (T2), 109 (T3) cfu/g diet of L. plantarum GCLP4 and 105 (T4) of commercial probiotics. Results shows that supplementation of GCLP4 had significantly (p < 0.05) improve weight gain (%), specific growth rate (SGR) and feed conversion ratio (FCR) of L. rohita with better values in T3 group. The immunological parameters (white blood cell, red blood cell, haemoglobin, total protein, albumin and globulin were significantly higher (p < 0.05) with 107 and 109 Lactobacillus GCLP4 cfu/g diet. The digestive enzyme activities (protease, amylase and lipase) were significantly (p < 0.05) higher, particularly, with 109 Lactobacillus GCLP4 cfu/g of diet. All the groups supplemented with GCLP4 including the commercial probiotics have lower (p < 0.05) activities of serum transaminase enzymes along with lower (p < 0.005) level of glucose as compared to the control group. The results of the study collectively suggest that dietary L. plantarum GCLP4 at 109 cfu/g is an effective probiotic obtained from grass carp having potency to promote growth, digestive enzymes and immune-biochemical indices of L. rohita fingerlings in present culture condition.

A Scoping Review of Social Determinants of Health and Pain Outcomes in Sickle Cell Disease.

BACKGROUND: Sickle cell disease (SCD) is a hereditary blood disorder with chronic pain that affects over 100,000 people in the United States. Previous research suggests a complex interaction between SCD pain outcomes and social determinants of health (SDOH). OBJECTIVE: To explore the impact of SDOH on pain outcomes in SCD. DESIGN: We used a scoping review design to explore the broad topic of social factors that affect SCD pain. DATA SOURCES: We searched the PubMed/MEDLINE, CINAHL, and Embase databases using combined search and Medical Subject Headings terms ("social determinants of health," "sickle cell," and "pain"). REVIEW METHODS: We used a content analysis with a summative approach to identify and describe interactions between SDOH and SCD pain outcomes. FINDINGS: Eight articles reporting studies with 7,992 total participants and a focus on SCD pain outcomes met the inclusion criteria. Three themes related to SDOH and pain were produced: education and employment, social and emotional functioning, and healthcare access. CONCLUSION: The key findings highlight the complex interplay between socioeconomic, psychological, and biological factors in SCD pain experiences. This underscores the need for nursing care to consider SDOH in an integrated, holistic approach to SCD pain. IMPLICATIONS FOR NURSING: To improve pain management among their SCD patients, nurses can assess pain holistically, develop customized individual pain management plans with educational and health literacy support options, and strengthen social support.

The Health of Those Who Feed Us: An Assessment of Health Inequities Along the United States Food Chain.

While the health of all depends on the food chain, few studies have focused systematically on the health of food chain workers themselves (production, manufacturing, wholesale, retail, and commercial and institutional services). In this study we used 2018 and 2019 data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine health-related metrics of food chain workers, combined and by industry sector, compared to non-food chain workers, among 32 U.S. states. Logistic regression indicated U.S. food chain workers had higher prevalences of barriers to health care access, smoking, no physical exercise, and poor self-reported health than all other workers. Patterns were similar among food chain workers in all industry sectors except wholesale. Additionally, commercial food services workers had higher prevalence of poor mental health, while institutional food services workers had higher prevalences of obesity, diabetes, and hypertension than all other workers. We discuss implications of these results for interventions, with specific attention to improving employment conditions. Food chain worker health is critical for food system sustainability and population health equity.

A Study of the Connection Between Health Insurance Literacy and Health Status: Evidence from the US Healthcare Reform Monitoring Survey.

This study examines the relationship between health insurance literacy, as indicated by confidence in comprehending health insurance terms, and health status using cross-sectional data from 8 waves of the Health Reform Monitoring Survey (HRMS), covering 61,895 individuals from 2013 to 2017. An ordered logistic regression model was employed with self-rated health status on a five-point Likert scale as the dependent variable and the score of confidence in understanding health insurance terms as the primary independent variable. The model adjusts for variables such as access to care, insurance status, concerns about affordability leading to missed care, household size, family income, employment, education, race, marital status, and gender. Results suggest a positive association between higher confidence in understanding health insurance and superior health statuses. These findings underscore the significance of improving health insurance literacy and advocating for potential policy interventions to enhance public understanding of health insurance benefits and coverage options.

Understanding of Maternal Health Status in Different Social Groups in India Using NFHS Data.

Maternal health is a major public health concern in India. MMR of India has declined significantly but maternal health status has not much improved. The prevalence of anemia and low Body Mass Index (BMI) is more severe among the women belonging to the Scheduled Caste (SC) and Scheduled Tribe (ST) categories. In this paper, attempts have been made to examine the maternal health status and to identify the factors responsible for poor health status among SC and ST women. The study is purely based on secondary data taken from latest 3 rounds of NFHS (2005-6, 2015-16 & 2019-21). Multivariate analysis have been carried out using panel regression model to understand the impact of determinants on maternal healthcare. The study found that the SC and ST women are more prone to anemia than others (GENERAL category women). Maternal health status is mostly controlled by per capita health expenditure and health infrastructure variables like no. of hospitals and nurses, irrespective of social class. Thus poor maternal health status in India, especially among socially disadvantaged groups of society, have been major concern. The government should be more focused on existing policies related to maternal healthcare.

Association of health status and hospitalization risk for peripheral artery disease in the PORTRAIT registry.

BACKGROUND: Healthcare utilization for patients with peripheral artery disease (PAD) is high, but stratifying patients' risk of hospitalization at initial evaluation is challenging. We examined the association between health status at PAD presentation and risk of (1) combined all-cause hospital admissions and emergency department (ED) visits and (2) all-cause hospital admissions. METHODS: Patients with claudication enrolled at US sites in the PORTRAIT registry were included. Health status was assessed using the Peripheral Artery Questionnaire (PAQ), a PAD-specific patient-reported outcome measure. Crude overall and cause-specific hospital admissions and ED visits were reported by PAQ overall summary score (PAQ-OS) ranges (0-24, 25-49, 50-74, and 75-100). Kaplan-Meier survival and unadjusted and adjusted Cox proportional hazards models examined the association between baseline PAQ scores and (1) combined all-cause hospital admissions or ED visits and (2) all-cause hospital admissions over 12 months. RESULTS: Of 796 patients, 349 (44%) had a hospital admission or ED visit over 12 months. Patients in the lowest (PAQ-OS = 0-24) versus the highest range (PAQ-OS = 75-100) had higher rates of 12-month (53.3% vs 22.4%) hospital admission and ED visits. In the adjusted model, each 10-point decrease in PAQ-OS was associated with a higher risk of all-cause hospital admission and ED visits (HR = 1.1, 95% CI 1.1-1.2, p < 0.0010) and all-cause hospital admission (HR = 1.1, 95% CI 1.1-1.2, p < 0.0010) at 12 months. CONCLUSION: PAD-specific health status is associated with an increased risk of healthcare utilization. Baseline health status may help stratify risk in patients with PAD, although replication and further validation of results are necessary.

The Effect of Health Literacy on Health Status in Patients with Heart Failure: A Path Analysis.

Background: Managing heart failure (HF) is challenging because of its complexity and high rates of hospitalization, morbidity, and mortality. Effective management requires coordination between patients' abilities and healthcare services; however, low health literacy among patients with heart failure can adversely affect their health status. Therefore, the understanding relationship between health literacy and health status would provide the evidence for developing future intervention. Methods: This analytical study explored multilevel factors influencing health literacy and health status in patients with heart failure (HF) who underwent health service delivery at outpatient clinics. The sample consisted of 453 patients with HF from 12 hospitals located in five regional areas (north, south, east, northeast, central, and Bangkok) in Thailand. A hypothetical model was used to test the association between comorbidity, social support, patient-centered care, health service delivery, health literacy, and health status. Path analysis was used to analyze the data. Results: The results indicated that 40.8% of patients with HF exhibited low or inadequate levels of health literacy, yet perceived their health status as good, with an average of 25.2±19.8 points. Health service delivery by a cardiologist and nurse case manager directly influences health literacy. Comorbidity had a direct impact on health status, whereas social support, patient-centered care, and the aforementioned health service delivery indirectly affected health status through health literacy. Importantly, health literacy status directly influences health status. Conclusion: Comorbidity, social support, patient-centered care, and health service delivery were related with health literacy and high level of health literacy could influence the better health status. To increase the quality of health care services, health care providers should promote health literacy and integrate the concept of patient-centered care for HF patients at outpatient clinics. Recommendations include the training of nurses as case managers.

Education level is associated with the occurrence and timing of hysterectomy: A cohort study of Canadian women.

INTRODUCTION: Hysterectomy is a common surgery with discernible practice variations that could be influenced by socioeconomic factors. We examined the association between level of educational attainment and the occurrence and timing of hysterectomy in Canadian women. MATERIAL AND METHODS: We conducted a prospective cohort study of 30 496 females in the Alberta's Tomorrow Project (2000-2015) followed approximately every 4 years using self-report questionnaires. Educational attainment was defined as high school diploma or less, college degree, university degree (reference group), and postgraduate degree. We used logistic regression analyzing hysterectomy occurrence at any time and before menopause, separately, and flexible parametric survival models analyzing hysterectomy timing with age as the time scale. Multivariable models controlled for race/ethnicity, rural/urban residence, parity, oral contraceptive use, and smoking. RESULTS: Overall, 39.1% of females reported a high school diploma or less, 28.9% reported a college degree, 23.5% reported a university degree, and 8.5% reported a postgraduate degree. A graded association was observed between lower education and higher odds of hysterectomy (high school or less: adjusted odds ratio [AOR] 1.68, 95% CI 1.55-1.82; college degree: AOR 1.58, 95% CI 1.45-1.72); results were similar for premenopausal hysterectomy. A graded association between lower education and earlier timing of hysterectomy was also observed up to approximately age 60 (e.g., at age 40: high school or less adjusted hazard ratio [AHR] 1.61, 95% CI 1.49-1.75; college degree AHR 1.53, 95% CI 1.40-1.67). CONCLUSIONS: Women with lower levels of education were more likely to experience hysterectomy, including hysterectomy before menopause and at younger ages.

Effects of the teach-back method on the health status of patients with chronic obstructive pulmonary disease: a real-world community-based cluster-randomized controlled trial.

Background: The teach-back method (TBM), also known as the "show-me" method, is a technique for verifying patients' understanding of health-related information that has been recommended for improving health literacy. However, the research on TBM effect on the outcomes of chronic obstructive pulmonary disease (COPD) patients is limited. Therefore, the aim of this study was to examine the effect of a TBM intervention on the health status of COPD patients. Methods: This real-world community-based cluster-randomized controlled trial enrolled 1,688 patients with COPD from 18 communities in China. Participants received either TBM plus usual care (UC) or UC only. General practitioners were trained in TBM before the intervention. The primary outcomes were depression and anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes were health-related quality of life and dyspnea, as measured by the COPD Assessment Test (CAT). Dyspnea was assessed using the modified Medical Research Council (mMRC) dyspnea scale. Data on acute exacerbations and deaths were extracted from medical records. Lung function was expressed as the forced expiratory volume in 1 second as a percentage of the predicted value [FEV1 (% pred)]. Results: In total, 336 of the 853 COPD patients in the intervention group (TBM plus UC) had comorbid depression, compared with 329 of the 835 in the control group (UC only). The TBM group showed a significantly greater improvement in HADS depression and anxiety subscale scores (HADS-D and HADS-A, respectively) than the UC group at12 months (t =8.34, P<0.001; t=12.18, P<0.001). The CAT and mMRC scores were significantly lower in the TBM than UC group at 12 months (t=8.43, P<0.001; t=7.23, P<0.001). The numbers of acute exacerbations and deaths were significantly lower in the TBM than UC group at 12 months (mean MCF values were 0.35 and 0.56, respectively [difference of 0.22; 95% confidence interval (CI): -0.41, -0.02; χ2=9.63, P<0.001]. The FEV1 (% pred) was significantly higher in the TBM than UC group at 12 months (t=7.45, P<0.001). Conclusions: General practitioners can use TBM interventions to effectively reduce anxiety, depression, and dyspnea symptoms, decrease the frequency of exacerbations and likelihood of death, and improve health-related quality of life and pulmonary function in patients with COPD. Trial Registration: The trial was registered on the Chinese Clinical Trials Registry (reference: ChiCTR-TRC-12001958).

Effects of Sotagliflozin on Health Status in Patients With Worsening Heart Failure: Results From SOLOIST-WHF.

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve health status in heart failure (HF) across the left ejection fraction ejection spectrum. However, the effects of SGLT1 and SGLT2 inhibition on health status are unknown. OBJECTIVES: These prespecified analyses of the SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients with Type 2 Diabetes Post Worsening Heart Failure) trial examined the effects of sotagliflozin vs placebo on HF-related health status. METHODS: SOLOIST-WHF randomized patients hospitalized or recently discharged after a worsening HF episode to receive sotagliflozin or placebo. The primary endpoint was total number of HF hospitalizations, urgent HF visits, and cardiovascular death. Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) score was a prespecified secondary endpoint. This analysis evaluated change in the KCCQ-12 score from baseline to month 4. RESULTS: Of 1,222 patients randomized, 1,113 (91%) had complete KCCQ-12 data at baseline and 4 months. The baseline KCCQ-12 score was low overall (median: 41.7; Q1-Q3: 27.1-58.3) and improved by 4 months in both groups. Sotagliflozin vs placebo reduced the risk of the primary endpoint consistently across KCCQ-12 tertiles (Ptrend = 0.54). Sotagliflozin-treated patients vs those receiving placebo experienced modest improvement in KCCQ-12 at 4 months (adjusted mean change: 4.1 points; 95% CI: 1.3-7.0 points; P = 0.005). KCCQ-12 improvements were consistent across prespecified subgroups, including left ventricular ejection fraction <50% or ≥50%. More patients receiving sotagliflozin vs those receiving placebo had at least small (≥5 points) improvements in KCCQ-12 at 4 months (OR: 1.38; 95% CI: 1.06-1.80; P = 0.017). CONCLUSIONS: Sotagliflozin improved symptoms, physical limitations, and quality of life within 4 months after worsening HF, with consistent benefits across baseline demographic and clinical characteristics. (Effect of Sotagliflozin on Cardiovascular Events in Participants With Type 2 Diabetes Post Worsening Heart Failure [SOLOIST-WHF]; NCT03521934).

Health-Related Behaviors and Perceived Health Status According to Water and Sugar-Sweetened Beverage Intake in Korean Adolescents.

The objective of this study was to determine the relationship between water and sugar-sweetened beverage (SSB) intake, health behaviors, and self-perceived health status using data from the 2019 Korea Youth Risk Behavior Web-based Survey (KYRBS). The subjects included in this analysis were 57,302 Korean adolescents from the 7th to 12th grades. The intake patterns of water and SSBs were categorized into four groups: Group I, adequate water intake (≥4 cups/day) and low frequency of SSB intake (≤1-2 times/week); Group II, adequate water intake and high frequency of SSB intake; Group III, inadequate water intake (<4 cups/day) and low frequency of SSB intake; Group IV, inadequate water intake and high frequency of SSB intake (≥3 times/week). Complex sample analyses were used for considering strata, clusters, and weights for samples. Significant differences were observed in the distribution of sociodemographic characteristics between the water and SSB intake groups. As grade levels increased or if students were female, there was a significant increase in the proportion of students characterized by low water intake and high consumption of SSB. Adolescents with healthier beverage habits, characterized by adequate water intake and low frequency of SSB consumption (Group I), generally abstained from smoking and alcohol, were more physically active, and maintained a desirable diet, reporting a better perceived health status. In contrast, those with higher SSB consumption and inadequate water intake (Group IV) were more likely to perceive their health as poor, with higher rates of smoking and alcohol use, lower physical activity levels, and poorer dietary habits compared to Group I. In conclusion, adolescents with desirable beverage consumption habits differed by sex and grade and they reported positive health behaviors and better overall health status. This suggests that there is a need for more active education and intervention in schools and families, as well as increased efforts by adolescents to promote healthy beverage habits.

Discrete Homogeneous and Non-Homogeneous Markov Chains Enhance Predictive Modelling for Dairy Cow Diseases.

Modelling and predicting dairy cow diseases empowers farmers with valuable information for herd health management, thereby decreasing costs and increasing profits. For this purpose, predictive models were developed based on machine learning algorithms. However, machine-learning based approaches require the development of a specific model for each disease, and their consistency is limited by low farm data availability. To overcome this lack of complete and accurate data, we developed a predictive model based on discrete Homogeneous and Non-homogeneous Markov chains. After aggregating data into categories, we developed a method for defining the adequate number of Markov chain states. Subsequently, we selected the best prediction model through Chebyshev distance minimization. For 14 of 19 diseases, less than 15% maximum differences were measured between the last month of actual and predicted disease data. This model can be easily implemented in low-tech dairy farms to project costs with antibiotics and other treatments. Furthermore, the model's adaptability allows it to be extended to other disease types or conditions with minimal adjustments. Therefore, including this predictive model for dairy cow diseases in decision support systems may enhance herd health management and streamline the design of evidence-based farming strategies.

Oral health status and dental treatment needs in children with autism spectrum disorder.

Objective: To evaluate oral health care practices, health status, and dental treatment needs in children with Autism Spectrum Disorder (ASD). Methods: This cross-sectional study included 96 children diagnosed with ASD per the DSM-V criteria and 96 typically developing healthy children. The WHO form assessed oral health status and dental treatment needs. Results: Over 50 % of ASD children had mild/moderate autism, 35.4 % had severe autism, and 13.5 % had autistic traits. ASD children experienced more toothbrushing difficulties compared to non-ASD children. Based on Nyvad's criteria and decayed/filled teeth (dft) index, non-ASD children had higher caries prevalence than ASD children, indicating less need for restorative treatments in the ASD group. However, ASD children had poorer plaque scores than non-ASD children. A significantly higher percentage of ASD children exhibited harmful oral behaviors, including mouth breathing, lip biting, bruxism, nail biting, object biting, and self-injury (p < 0.001). ASD children also showed increased traumatic dental injuries compared to non-ASD children. Conclusion: Compared to non-ASD peers, children with ASD have lower dental caries prevalence and less need for restorations, yet poorer plaque control. They also demonstrate more frequent oral self-injuries. ASD status appears related to toothbrushing difficulties. These findings highlight the need for tailored oral health interventions for children with ASD.

The association of calligraphy activities with peace of mind, stress self-management, and perceived health status in older adults.

Introduction: Calligraphy, as a form of mindful practice, encourages focus, creativity, and relaxation, which collectively contribute to a more peaceful mental state. Through regular engagement in calligraphy, older adults can develop better coping mechanisms for stress, leading to more effective self-management of daily stressors. This enhanced ability to manage stress can reduce the overall burden on their mental and physical health, promoting a more positive outlook on life. Methods: This study employed convenience sampling and snowball sampling to select 246 older adults aged 60-70 from Changsha, China, in March 2024 as valid samples. AMOS v.23 was used to construct a structural equation model to validate the hypotheses. Results: The study found a significant positive correlation between calligraphy activities and peace of mind/stress self-management. There is also a significant positive correlation between peace of mind/stress self-management and perceived health status. Additionally, peace of mind and stress self-management act as mediators between calligraphy activities and perceived health status. Discussion: This indicates that calligraphy activities not only contribute to the psychological well-being of older adults but also indirectly enhance their positive perception of their own health by improving their mental state. Consequently, such activities can be an integral part of holistic health interventions aimed at enhancing the quality of life and overall health of older adults.

Delayed oral health care due to cost among US adults with diabetes, 2018-2019.

BACKGROUND: Although untreated periodontitis increases the risk of developing diabetic complications, people with diabetes are less likely to use dental services. The authors estimated the prevalence of reporting delayed needed oral health care due to cost and associated risk indicators by diabetes status. METHODS: The authors analyzed data for 43,291 adults who participated in the 2018 and 2019 Medical Expenditure Panel Surveys. The authors used t tests to compare crude estimates of delayed oral health care by diabetes status. Adjusted estimates were obtained from logistic regression models that controlled for sociodemographic, medical and dental insurance, health status, and geographic variables. Multivariable logistic regression models were run separately for adults with and without diabetes to identify factors that were associated with delayed oral health care. RESULTS: After controlling for covariates, the difference in delayed oral health care prevalence between adults with diabetes (18%) and without diabetes (16%) remained significant. Lack of medical insurance and fair or poor self-rated health status were the highest predictors of delayed oral health care among those with diabetes. CONCLUSIONS: Despite guidelines, factors other than biology and perceived need may impede access to oral health care for people with diabetes. PRACTICAL IMPLICATIONS: For uninsured adults, policies should prioritize enhancing access to regular ambulatory care and promoting awareness about the importance of preventing and treating dental conditions. In addition, addressing the medical and psychosocial aspects of diabetes in affected patients could affect positively their overall sense of well-being and self-rated health status, potentially encouraging greater use of oral health care services.

Multicomponent versus aerobic exercise intervention: Effects on hemodynamic, physical fitness and quality of life in adult and elderly cardiovascular disease patients: A randomized controlled study.

Objective: Cardiovascular diseases (CVDs) remain a leading cause of mortality globally, emphasizing the need for effective preventive measures. This study aimed to investigate the effects of a multicomponent compared to an aerobic training program on the hemodynamic parameters, physical fitness, psychophysical health status and quality of life (QoL) of adults and elderly with stabilized CVDs. Methods: Thirty-three subjects (19M and 14F; age 69.5 ± 4.9 years; BMI 27.34 ± 4.95 kg/m2) suffering from CVDs voluntarily participated in this 10-week randomized controlled study and were allocated into three groups: multicomponent training group (MTG; 6M, 6F; cardiorespiratory, resistance, flexibility and breathing exercises; 60', 2d·wk-1), aerobic training group (ATG; 7M, 5F; aerobic-only training; 60', 2d·wk-1) or a wait-list control group (CG; 6M, 3F; no PA). Hemodynamic parameters were assessed through resting hearth rate (RHR) and peripheral-systolic and diastolic blood pressure (P-SBP/P-DBP). Physical fitness was assessed via a 30" chair stand test (30CST), timed up and go (TUG) test, handgrip strength (HGS) test, and 2' step test (TMST). The health status, QoL and enjoyment were evaluated with short form-12 (SF-12), world health organization quality of life-bref (WHOQoL-bref) and physical activity enjoyment scale (PACES), respectively. Results: After the intervention, MTG showed significant improvements in hemodynamic parameters (95 % CI, RHR: 2.76 to 9.07; P-SBP: 3.28 to 13.71; P-DBP: 3.56 to 8.94; p < 0.001), physical fitness (95 % CI, 30CST: 4.42 to -1.90; TUG: 0.56 to 1.58; TMST: 35.24 to -18.58; Dominant HGS: 4.00 to -1.65; Undominant HGS: 2.87 to -0.79, p < 0.001) and enjoyment (PACES: 15.18 to -5.48, p < 0.001) compared to CG; ATG showed significant improvement in hemodynamic parameters (95 % CI, RHR: 1.76 to 8.07; P-SBP: 3.19 to 13.63; P-DBP: 4.47 to 9.85, p < 0.001), physical fitness (95 % CI, 30CST: 2.59 to -0.07; TUG: 0.03 to 1.05; Dominant HGS: 2.42 to -0.07, p < 0.05; TMST: 36.08 to -19.41, p < 0.001) and enjoyment (PACES: 14.68 to -4.98, p < 0.001) compared to CG. No significant changes were observed in QoL and SF-12 (p > 0.05). Significant differences between MTG and ATG were only found in physical fitness variables (95 % CI, 30CST: 3.21 to -0.45, p < 0.01; Dominant HGS: 0.00 to 3.00, p < 0.05). Conclusions: Findings showed significant improvements in hemodynamic parameters and physical fitness suggesting the effectiveness of the multicomponent exercise program, similar to aerobic-only training, and greater efficacy for lower limb strength and dominant hand grip strength in adults and elderly with stabilized CVDs. Both exercise groups showed similar levels of enjoyment.

The influence of the psychosocial stress on oral health status in the conditions of being in Ukraine during the prolonged state of martial law.

OBJECTIVE: Aim: To study the presence of clinical and biochemical correlations between psycho-emotional stress, level of cortisol and periodontal oral health status of the patients in Ukraine during prolonged martial law. PATIENTS AND METHODS: Materials and Methods: The comprehensive clinical and laboratory study covered 49 persons, including 20 patients with Gingivitis (40.8%) and 29 with Periodontitis (59.2%). Biochemical blood test was performed to determine the level of "stress hormone" - cortisol. Patients filled out the questionnaire by the method of V. Zung (low mood-subdepression scale) to determine psycho-emotional state in the conditions of prolonged martial law in Ukraine. RESULTS: Results: The research results showed that in the conditions of martial law in Ukraine, "stabilization" and "improvement" of the process of patients with Gingivitis was established in 50%, with Periodontitis - only in 41.4% of patients. In 54% of patients, a significant deterioration of clinical indices was established, compared to the indicators before the war. In patients with Periodontitis, РВІ index was 1.33 (0.62-1.43) score, which was not statistically significantly different from the initial level (p>0.05). Biochemical blood tests revealed an increased level of the hormone cortisol in 18% of patients. According to the method by V. Zung scale of mental states, the majority of patients (87%) showed low mood and emotional instability within the medium level (range 2 and 3). Correlation was identified, according to the Spearman coefficient (R=0.39, р<0.05), between scale assessments by V.Zung and the blood level of cortisol. CONCLUSION: Conclusions: Psycho-emotional stress is one of the leading pathogenetic factors in the deterioration of oral health status and the development of periodontal diseases, especially in people in Ukraine during prolonged martial law. Indicators of method by V. Zung scale of mental states and the level of cortisol are optimal markers of the need to correct the psycho-emotional state. For patients with increased levels of stress and fear, it is necessary to create special treatment-prevention schemes, taking into account greater attention to motivation to maintain the health of the oral cavity, as well as more frequent hygiene procedures.