Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study.

Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.

Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study.

Background: The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences. Methods: An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic. Results: Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction). Conclusions: Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.

Global impacts of COVID-19 on lifestyles and health and preparation preferences: An international survey of 30 countries.

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics.

Death anxiety in Lebanese college students in 1998 and 2015.

The present investigation sought to explore the difference in death anxiety between two different samples of students who studied at the same university in Lebanon in 1998 and 2015. Based on the changes in the social, economic, and political conditions that took place over these 17 years, it is possible to predict the change in death anxiety during this period. The participants in the 1998 study included 228 undergraduates, whereas the 2015 sample consisted of 292 students. All participants responded to Templer's Death Anxiety Scale (DAS). Sex-related differences on the DAS were statistically significant in the 1998 group where women obtained a higher mean than the men. The t-test was significant at 0.001. Among women, the 2015 group obtained a significantly lower mean score than did their female counterparts in the 1998 group, whereas the difference between the two years in men was not significant. In sum, the hypothesis of the study was partially verified, i.e., a change in death anxiety level in some groups has happened as a result of the passage of time and other factors. In this case, death anxiety may be considered a fluid entity influenced by different environmental conditions.

SATISFACTION WITH LIFE AMONG YOUNG ADULTS IN FOUR ARAB COUNTRIES.

This study sought to explore the sex and cultural differences in satisfaction with life between undergraduate men and women recruited from four Arab countries, i.e., Egypt, Kuwait, Lebanon, and Qatar (N = 1,322); ages ranged from 18 to 27 years. The participants responded to the Arabic version of the Satisfaction with Life Scale. Egyptian and Lebanese women obtained significantly higher mean scores on satisfaction with life than did their male counterparts, whereas there were no significant sex differences in the Kuwaiti and Qatari samples. For men, the Qatari and Kuwaiti samples obtained the high mean scores on satisfaction with life, whereas the Egyptian and Lebanese samples obtained the low mean scores. For women, the Qatari sample had the higher mean score, whereas the Egyptian sample obtained the lowest mean score. The results were explained in light of the positive association between gross domestic product and satisfaction with life.

Self-esteem among college students from four Arab countries.

This study had three objectives: (a) to compare undergraduates from four Arab countries on self-esteem, (b) to explore the sex-related differences in self-esteem in these four Arab countries, and (c) to examine the association of self-esteem with both per-capita income and unemployment rate. Four samples of 2,643 students were recruited from Egypt (n = 576), Kuwait (n = 674), Lebanon (n = 826), and Oman (n = 567). They responded to the Arabic version of the Rosenberg Self-Esteem Scale. Kuwaiti and Omani men had a significantly higher mean score on self-esteem than did Egyptian and Lebanese men. Egyptian women scored significantly lower than the Omani women, but the effect size was small. Regarding the sex-related differences in self-esteem, Kuwaiti men had a significantly higher mean score than did their female peers, but the effect size was small, whereas there were no significant sex differences in the other samples. The sex-related difference in self-esteem is a controversial result and it may not be replicable in different countries. It was suggested that self-esteem is associated with high per-capita income and low unemployment rate.