Poorer subjective mental health among girls: Artefact or real? Examining whether interpretations of what shapes mental health vary by sex.

BACKGROUND: Despite reporting poorer self-rated mental health (SRMH) than boys, girls exhibit greater resilience and academic achievement, and less risk taking or death by suicide. Might this apparent paradox be an artefact arising from girls' and boys' different interpretations of the meaning of SRMH? We examined whether the indicator, SRMH, had a different meaning for girls and boys. METHODS: In 2021-2, we circulated social media invitations for youth age 13-18 to complete an online survey about their mental health, and which of 26 individual and social circumstances shaped that rating. All data were submitted anonymously with no link to IP addresses. After comparing weightings for each characteristic, factor analyses identified domains for the whole group and for girls and boys. RESULTS: Poor SRMH was reported by 47% of 506 girls and 27.8% of 216 boys. In general, circumstances considered important to this rating were similar for all, although boys focussed more on sense of identity, self-confidence, physical well-being, exercise, foods eaten and screen time, while girls paid more attention to having a boyfriend or girlfriend, comparisons with peers, and school performance. With factor analysis and common to boys and girls, domains of resilience, behavior/community, family, relationships with peers and future vision emerged. Girls' poorer SRMH did not arise from a more expansive interpretation of mental health. Instead, it may reflect perceived or real disadvantages in individual or social circumstances. Alternatively, girls' known greater resilience may propel lower SRMH which they use intuitively to motivate future achievement and avoid the complacency of thinking that 'all is well'. CONCLUSIONS: The relative similarity of attributes considered before rating one's mental health suggests validity of this subjective measure among girls and boys.

Descriptive regression tree analysis of intersecting predictors of adult self-rated health: Does gender matter? A cross-sectional study of Canadian adults.

BACKGROUND: While self-rated health (SRH) is a well-validated indicator, its alignment with objective health is inconsistent, particularly among women and older adults. This may reflect group-based differences in characteristics considered when rating health. Using a combination of SRH and satisfaction with health (SH) could capture lived realities for all, thus enabling a more accurate search for predictors of subjective health. With the combined measure of SRH and SH as the outcome we explore a range of characteristics that predict high SRH/SH compared with predictors of a low rating for either SRH or SH. METHODS: Data were from the Canadian General Social Survey 2016 which includes participants 15 years of age and older. We performed classification and regression tree (CRT) analyses to identify the best combination of socioeconomic, behavioural, and mental health predictors of good SRH and health satisfaction. RESULTS: Almost 85% of the population rated their health as good; however, 19% of those had low SH. Conversely, about 20% of those reporting poor SRH were, none-the-less, satisfied. CRT identified healthy eating, absence of a psychological disability, no work disability from long-term illness, and high resilience as the main predictors of good SRH/SH. Living with a spouse or children, higher social class and healthy behaviours also aligned with high scores in both self-perceived health measures. Sex was not a predictor. CONCLUSIONS: Combining SRH and SH eliminated sex as a predictor of subjective health, and identified characteristics, particularly resilience, that align with high health and well-being and that are malleable.

Gender-Specific Associations between Late-Life Disability and Socioeconomic Status: Findings from the International Mobility and Aging Study (IMIAS).

Disability is a dynamic process and can be influenced by a sociocultural environment. This study aimed to determine whether the associations between socioeconomic status and late-life disability differ by gender in a multi-sociocultural sample from different countries. A cross-sectional study was developed with 1362 older adults from The International Mobility in Aging Study. Late-life disability was measured through the disability component of the Late-Life Function Disability Instrument. Level of education, income sufficiency and lifelong occupation were used as indicators of SES. The results indicated that a low education level ß = -3.11 [95% CI -4.70; -1.53] and manual occupation ß = -1.79 [95% -3.40; -0.18] were associated with frequency decrease for men, while insufficient income ß = -3.55 [95% CI -5.57; -1.52] and manual occupation ß = -2.25 [95% CI -3.89; -0.61] played a negative role in frequency for women. For both men ß = -2.39 [95% -4.68; -0.10] and women ß = -3.39 [95% -5.77; -1.02], insufficient income was the only factor associated with greater perceived limitation during life tasks. This study suggested that men and women had different late-life disability experiences. For men, occupation and education were associated with a decrease in the frequency of participation, while for women this was associated with income and occupation. Income was associated with perceived limitation during daily life tasks for both genders.

Inequities in home care use among older Canadian adults: Are they corrected by public funding?

BACKGROUND: Although care use should parallel needs, enabling and predisposing circumstances including the socio-demographic inequities of socioeconomic status (SES), gender, or isolation often intervene to diminish care. We examine whether availability of state-funded medical and support services at home can rebalance these individual and social inequities, and do this by identifying if and how intersecting social identities predict homecare use among older Canadian adults. METHODS: Using the Canadian Longitudinal Study on Aging (CLSA) of 30,097 community-dwelling adults aged 45 to 85, we performed recursive partitioning regression tree analysis using Chi-Squared automatic interaction detection (CHAID). Combinations of individual and social characteristics including sociodemographic, family-related, physical and psychological measures and contextual indicators of material and social deprivation were explored as possible predictors of formal and informal care use. RESULTS: Diminished function i.e. increased need, indicated by Activities of Daily Living, was most strongly aligned with formal care use while age, living arrangement, having no partner, depression, self-rated health and chronic medical conditions playing a lesser role in the pathway to use. Notably, sex/gender, were not determinants. Characteristics aligned with informal care were first-need, then country of birth and years since immigration. Both 'trees' showed high validity with low risk of misclassification (4.6% and 10.8% for formal and informal care, respectively). CONCLUSIONS: Although often considered marginalised, women, immigrants, or those of lower SES utilised formal care equitably. Formal care was also differentially available to those without the financial or human resources to receive informal care. Need, primarily medical but also arising from living arrangement, rather than SES or gender predicted formal care, indicating that universal government-funded services may rebalance social and individual inequities in formal care use.

Women suffer but men die: survey data exploring whether this self-reported health paradox is real or an artefact of gender stereotypes.

BACKGROUND: Despite consistently reporting poorer health, women universally outlive men. We examine whether gender differences in lived circumstances considered, and meaning attributed to SRH by women and men might explain this paradox. METHODS: In an online survey 917 adults rated their health (SRH) and mental health (SRMH) and reflected upon what life experiences they considered in making their ratings. Descriptive findings were sex-disaggregated. The multiple experiences listed were then subject to factor analyses using principal components methods and orthogonal rotation. RESULTS: Women reported poorer SRH and SRMH. They considered a wider range of circumstances, weighing all but self-confidence and behaviors as more important to SRH than did men. Two underlying components, psychosocial context and clinical status were identified overall. Physical health and pain were more important elements of men's clinical status and behaviors. Comparisons with others of the same age played a larger role in male psycho-social context. Two components also underpinned SRMH. These were clinical problems and psycho-social circumstances for which self-confidence was only important among men. CONCLUSIONS: Women's and men's common interpretation of measures like SRH suggests that women's health disadvantage is neither artefactual nor determined by gendered meanings of measures and does not explain the paradox. SRH and SRMH captured social circumstances for all. Convergence of characteristics women and men consider as central to health is evidence of the dynamism of gender with evolving social norms. The remaining divergence speaks to persisting traditional male stereotypes.

Cohort Trajectories by Age and Gender for Informal Caregiving in Europe Adjusted for Sociodemographic Changes, 2004 and 2015.

OBJECTIVES: We present a dynamic view of gender patterns in informal caregiving across Europe in a context of sociodemographic transformations. We aim to answer the following research questions: (a) has the gender gap in informal caregiving changed; (b) if so, is this due to changes among women and/or men; and (c) has the gender care gap changed differently across care regimes? METHODS: Multilevel growth curve models are applied to gendered trajectories of informal caregiving of a panel sample of 50+ Europeans, grouped into 5-year cohorts and followed across 5 waves of the Survey of Health, Ageing and Retirement in Europe survey, stratified by sex and adjusted for several covariates. RESULTS: For men in cohorts born more recently, there is a decrease in the prevalence of informal care outside the household, whereas cohort trajectories for women are mostly stable. Prevalence of care inside the household has increased for later-born cohorts for all without discernible changes to the gender care gap. Gender care gaps overall widened among later-born cohorts in the Continental cluster, whereas they remained constant in Southern Europe, and narrowed in the Nordic cluster. DISCUSSION: We discuss the cohort effects found in the context of gender differences in employment and care around retirement age, as well as possible demographic explanations for these. The shift from care outside to inside the household, where it mostly consists of spousal care, may require different policies to support carers, whose age profile and possible care burden seem to be increasing.

A Regression Tree Analysis to Identify Factors Predicting Frailty: The International Mobility in Aging Study.

INTRODUCTION: Frailty is a complex geriatric syndrome with a multifaceted etiology. We aimed to identify the best combinations of risk factors that predict the development of frailty using recursive partitioning models. METHODS: We analyzed reports from 1,724 community-dwelling men and women aged 65-74 years participating in the International Mobility in Aging Study (IMIAS). Frailty was measured using frailty phenotype scale that included five physical components: unintentional weight loss, weakness, slow gait, exhaustion, and low physical activity. Frailty was defined as presenting three of the above five conditions, having one or two conditions indicated prefrailty and showing none as robust. Socio-demographic, physical, lifestyle, psycho-social, and life-course factors were included in the analysis as potential predictors. RESULTS: 21% of pre-frail and robust participants showed a worse stage of frailty in 2014 compared to 2012. In addition to functioning variables, fear of falling (FOF), income, and research site (Canada vs. Latin America vs. Albania) were significant predictors of the development of frailty. Additional significant predictors after exclusion of functioning factors included education, self-rated health, and BMI. CONCLUSIONS: In addition to obvious risk factors for frailty (such as functioning), socio-economic factors and FOFs are also important predictors. Clinical assessment of frailty should include measurement of these factors to identify high-risk individuals.

Cohort-specific disability trajectories among older women and men in Europe 2004-2017.

As the population of Europe grows older, one crucial issue is how the incidence and prevalence of disabilities are developing over time in the older population. In this study, we compare cohort-specific disability trajectories in old age across subsequent birth cohorts in Europe, during the period 2004-2017.We used data from seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Mixed effects logistic regression models were used to model trajectories of accumulation of ADL limitations for subsequent birth cohorts of older women and men in different European regions. The results showed that there were sex differences in ADL and IADL limitations in all regions for most cohorts. Women reported more limitations than men, particularly in Eastern and Southern rather than Northern and Western Europe. Among men in Eastern, Northern and Western Europe, later born cohorts reported more disabilities than did earlier born birth cohorts at the same ages. Similar patterns were observed for women in Northern and Western Europe. In contrast, the risk of disabilities was lower in later born cohorts than in earlier born birth cohorts among women in Eastern Europe. Overall, results from this study suggest that disability trajectories in different cohorts of men and women were by and large similar across Europe. The trajectories varied more depending on sex, age and region than depending on cohort. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00684-4.

Gender differences in access to community-based care: a longitudinal analysis of widowhood and living arrangements.

Persistent inequalities in access to community-based support limit opportunities for independent living for older people with care needs in Europe. Our study focuses on investigating how gender, widowhood and living arrangement associate with the probability of receiving home and community-based care, while accounting for the shorter-term associations of transitions into widowhood (bereavement) and living alone, as well as the longer-term associations of being widowed and living alone. We use comparative, longitudinal data from the Survey of Health, Ageing and Retirement in Europe (collected between 2004 and 2015 in 15 countries) specifying sex-disaggregated random-effects within-between models, which allow us to examine both cross-sectional and longitudinal associations among widowhood, living arrangements and community-based care use. We find widowhood and living alone are independently associated with care use for both older women and men, while bereavement is associated with higher probability of care use only for women. Socio-economic status was associated with care use for older women, but not for men in our sample. The gender-specific associations we identify have important implications for fairness in European long-term care systems. They can inform improved care targeting towards individuals with limited informal care resources (e.g. bereaved older men) and lower socio-economic status, who are particularly vulnerable to experiencing unmet care needs. Gender differences are attenuated in countries that support formal care provision, suggesting gender equity can be promoted by decoupling access to care from household and family circumstances. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00717-y.

A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults.

OBJECTIVE: Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF. METHODS: Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (≥65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis. RESULTS: Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of -0.34 (95% CI = -0.44 to -0.23). CONCLUSION: This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials. IMPACT: These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.

The intersectional impact of sex and social factors on subjective health: analysis of the Canadian longitudinal study on aging (CLSA).

BACKGROUND: Self-rated health (SRH) is a widely validated measure of the general health of older adults. Our aim was to understand what factors shape individual perceptions of health and, in particular, whether those perceptions vary for men and women and across social locations. METHODS: We used data from the Canadian Longitudinal Study on Aging (CLSA) of community-dwelling adults aged 45 to 85. SRH was measured via a standard single question. Multiple Poisson regression identified individual, behavioural, and social factors related to SRH. Intersections between sex, education, wealth, and rural/urban status, and individual and joint cluster effects on SRH were quantified using multilevel models. RESULTS: After adjustment for relevant confounders, women were 43% less likely to report poor SRH. The strongest cluster effect was for groupings by wealth (21%). When wealth clusters were subdivided by sex or education the overall effect on SRH reduced to 15%. The largest variation in SRH (13.6%) was observed for intersections of sex, wealth, and rural/urban status. In contrast, interactions between sex and social factors were not significant, demonstrating that the complex interplay of sex and social location was only revealed when intersectional methods were employed. CONCLUSIONS: Sex and social factors affected older adults' perceptions of health in complex ways that only became apparent when multilevel analyses were carried out. Utilizing intersectionality analysis is a novel and nuanced approach for disentangling explanations for subjective health outcomes.

The role of multiparity and maternal age at first pregnancy in the association between early menarche and metabolic syndrome among middle-aged and older women.

OBJECTIVE: To analyze whether maternal age at first pregnancy and parity are mediators of the association between early menarche and metabolic syndrome in a sample of middle-aged and older women. METHODS: Cross-sectional study of 428 women (40 to 80 y), who had experienced a pregnancy in their lifetime, was performed between 2014 and 2016. Age at first pregnancy, parity, and early menarche were self-reported. Metabolic syndrome was assessed using the criteria described by the National Cholesterol Education Program's Adult Treatment Panel III. The association between metabolic syndrome and early menarche was assessed by logistic regression analysis. The mediating role of age at first pregnancy and multiparity in the relationship between early menarche and metabolic syndrome was assessed through mediation analysis, adjusted for covariates. RESULTS: According to adjusted logistic regression models, early menarche was associated with higher odds of prevalent metabolic syndrome (OR: 2.26; 95% CI: 1.15-4.46). Mediation analysis showed a significant direct effect of early menarche on metabolic syndrome (ß: 0.808; 95% CI: 0.107-1.508). Of the two mediators tested, age at first pregnancy was significant (ß: 0.065; 95% CI: 0.004-0.221), ie, participants with and without early menarche differ, on average, by 0.879 SDs in the log odds of MetS (total effect), of which 0.065 SDs (8%), on average, would be attributable to the effect of early menarche on age at first pregnancy (indirect effect), which, in turn, affects MetS. CONCLUSIONS: Age at first pregnancy may partially contribute to the association between early menarche and metabolic syndrome among middle-aged and older women who had experienced a pregnancy over their lifetime.

Frailty syndrome and risk of cardiovascular disease: Analysis from the International Mobility in Aging Study.

OBJECTIVE: To investigate the association between frailty and a summary cardiovascular risk measure (Framingham Risk Score, FRS) in a sample of older adults from different epidemiologic contexts participating in the multicenter International Mobility in Aging Study (IMIAS). MATERIAL AND METHODS: This cross-sectional study used data from the IMIAS, which is composed of older adults from four different countries (Canada, Albania, Colombia and Brazil). A total of 1724 older adults aged 65-74 years were assessed. Frailty was defined as the presence of 3 or more of the following criteria: unintentional weight loss in the last year, exhaustion, muscle weakness, slowness in gait speed, and low levels of physical activity. The FRS was calculated to estimate the 10-year risk for cardiovascular disease (CVD), based on: sex, age, systolic blood pressure (SBP), and treatment for hypertension, total and high-density lipoprotein (HDL) cholesterol, diabetes mellitus status and smoking habits. Confounders included measures of childhood social and economic adversity, as well as mid-life and adult adversity. RESULTS: After adjustment for adversities which occurred during in early, adult or current life, frail individuals presented higher FRS values (ß = 3.81, 95 %CI: 0.97-6.65, p-value <0.001) when compared to robust participants. A statistically significant relationship was also observed in prefrail participants with FRS (ß = 1.61, 95 % CI: 0.72-3.02, p-value <0.05). CONCLUSION: Frailty and prefrailty were associated to FRS, independent of life course adversities. Screening cardiovascular risk factors should be a target, mainly in those who present frailty syndrome.

Falls and life-space mobility: longitudinal analysis from The International Mobility in Aging Study.

OBJECTIVES: To investigate a 4-year longitudinal relationship between falls, recurrent falls, and injurious falls, according to different levels of life-space mobility (LSM). METHODS: Longitudinal analysis of an international cohort study. The participants were older adults from the International Mobility in Aging Study (IMIAS) aged between 65 and 74 years at baseline. Three waves of data (2012, 2014, 2016) were used. Fall history during the past year was recorded. Recurrent fallers were identified as those who fell at least twice and injurious fallers as participants who required medical attention. LSM measurements included Total Life-Space (LS-C), Maximal Life-Space (LS-M), Assisted Life-Space (LS-A), Independent Life-Space (LS-I) and Restricted Life-space (LS-ID) scores. Generalized estimation equation (GEE) models were used to determine whether life-space mobility measures and their change over time differed between recurrence of falls and injurious falls. RESULTS: At baseline, the prevalence of falls in the last year was 28%. 11.8% reported recurrent falls and 2.6% had serious injurious falls in the last year preceding the assessments. Recurrent fallers were more likely to be female, with insufficient income and, with comorbidities. GEE models showed that life-space mobility was lower among those with recurrent falls or serious injurious falls compared to those who never fell, but the rate of change did not differ over the 4-year follow-up except for the LS-A and LS-I scores, where some improvements were observed over time. CONCLUSIONS AND IMPLICATIONS: Falls were independently associated with a decrease in LSM over 4 years. Targeting older adults with recurrent and injurious falls with appropriate interventions may improve community mobility and social participation.

The Link Between Difficulty in Accessing Health Care and Health Status in a Canadian Context.

Much of the Canadian population reports some level of difficulty in accessing health care services. Despite being a recognized determinant of health, the relationship between access to health care and overall health has not been examined extensively. This study is an analysis of the Canadian Community Health Survey 2016 database. A composite score for difficulty in accessing health care was constructed based on several survey questions. Self-rated health (SRH), the measure of general health status, was compared between individuals with and without difficulty in accessing health care services by estimating prevalence rate ratios adjusting for age, sex, education, income, urban/rural status, race, and Indigenous status. After adjustment for pertinent confounders, difficulty in accessing health care was not statistically significantly associated with SRH. However, in stratified models, difficulty accessing health care was associated with a 12% lower probability of reporting good SRH among non-white individuals. Test of interactions for other social determinants was not significant. For racial minorities, inequalities in access to health care are associated with lower self-rated health. Further research to investigate causes underlying difficulties in accessing health care could lead to public health programs ensuring all Canadians receive equal health care services.

Life-Space and Cognitive Decline in Older Adults in Different Social and Economic Contexts: Longitudinal Results from the IMIAS Study.

Psychosocial, socioeconomic and sociocultural aspects can influence cognitive function among community-dwelling older adults. Life-space restriction is potentially related to cognitive status. We examined the longitudinal association between life-space mobility and changes in cognitive function in community-dwelling older adults in different social settings of North and South America and Europe. We used data from 1486 participants of the International Mobility in Aging Study (IMIAS) conducted at five sites: Tirana (Albania), Natal (Brazil), Manizales (Colombia), Kingston and Saint-Hyacinthe (Canada). Life-space mobility was assessed using the Life-Space Assessment (LSA) questionnaire at baseline (2012), and the Leganes Cognitive Test was used to evaluate cognitive function at baseline and follow-up (2016). The Quantile regressions (QR) were used to evaluate the factors associated with cognitive score in 2016 by adjusting for the cognitive score in 2012, with two distinct models for analyzing variables. A decrease in the cognitive function was observed at all research sites, except in Manizales. Participants with more restricted life-space at baseline had a decrease in their cognitive function 4 years later (ß = -0.79, 95% CI: -1.400 to -0.18, p value<0.01) compared to those with the highest level. This decrease was independent of gender, age, research site, education, income sufficiency, social support, depression, cognitive function at baseline, chronic conditions and physical performance. Restriction in life-space is an important prognostic factor for cognitive function. Maintaining life-space can be a goal in public policies aimed at encouraging healthy aging, and might be useful in clinical practice to promote health status and to monitor older people at higher risk of cognitive decline.

Assessing the relationship between multimorbidity and depression in older men and women: the International Mobility in Aging Study (IMIAS).

Objectives: Our study aims to assess whether multimorbidity is an independent risk factor for the development of depression in older adults living in Canada, Brazil, Colombia, and Albania and examines differences in incidence of depression regarding social and psychosocial characteristics.Methods: The longitudinal International Mobility Aging Study (IMIAS) collected information from adults between 65-74 years old. Depression was defined by a 16 or higher score assessed by the Centre for Epidemiological Studies Depression (CES-D) Scale. Multimorbidity was defined as having two or more chronic conditions, which were self-reported by participants using a list of eight physical chronic conditions. Poisson regression was performed to estimate the relative risk of depression in older adults with multimorbidity compared to those living with 0-1 chronic conditions, adjusting for sex, age, education, number of doctor visits, degree of assistance needed, social support, and smoking status. The analysis was stratified by study region (Canada; Latin America; Albania).Results: Crude and adjusted models showed no statistically significant associations between multimorbidity and the incidence of depression in any of the study regions, confirmed by sensitivity analyses. However, the incidence of depression varied across study region, confirmed by the intra-class correlation coefficient which indicated that 13% of variations in depression incidence were due to geographic differences.Conclusion: Multimorbidity does not appear to increase the risk of developing depression in older adults between 65-74. Higher rates of depression in Latin America and Albania (compared to Canada) may be attributed to lifecourse exposures to social and economic adversity in these regions.

A Regression Tree for Identifying Risk Factors for Fear of Falling: The International Mobility in Aging Study (IMIAS).

BACKGROUND: We determine the best combination of factors for predicting the risk of developing fear of falling (FOF) in older people via Classification Regression Tree (CaRT) analysis. METHODS: Community-dwelling older adults living in Canada, Albania, Brazil, and Colombia were from International Mobility in Aging Study (IMIAS). In 2014, 1,725 participants (aged 65-74) were assessed. With a retention rate of 81%, in 2016, 1,409 individuals were reassessed. Risk factors for FOF were entered into the CaRT: age, sex, education, self-rated health, comorbidity, medication, visual impairment, frailty, cognitive deficit, depression, fall history, Short Physical Performance Battery (SPPB), walking aid use, and mobility disability measured by the Nagi questionnaire. RESULTS: The classification tree included 12 end groups representing differential risks of FOF with a minimum of two and a maximum of five predictors. The first split in the tree involved impaired physical function (SPPB scores). Respondents with less than 8 in SPPB score and mobility disability had 82% risk of developing FOF at the end of 2-year follow-up. Between 23.2% and 82.3% of the risk of developing FOF in 2 years of follow-up were explained by only five variables: age, sex, self-rated health, functional impairment measured by SPPB, and mobility disability. In those with no functional impairment or mobility disability, levels of education, sex, and self-rated health were important predictors of FOF in the future. CONCLUSION: This classification tree included different groups based on specific combinations of a maximum of five easily measurable predictors with emphasis on impaired physical functioning risk factors for developing FOF.

Metabolic syndrome (MetS) and associated factors in middle-aged women: a cross-sectional study in Northeast Brazil.

We determined the prevalence of Metabolic Syndrome (MetS) and associated factors in 419 women (aged 40 to 65 years) in Northeast Brazil in a cross-sectional study conducted from April to November 2013. We defined MetS using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Socio-demographic variables, reproductive factors, lifestyle factors, anthropometrics, body composition, quality of life, and physical performance were assessed for their associations. We constructed multivariate Poisson regression models to estimate prevalence rate ratios (PRR) and 95% confidence intervals (CI). We identified 275 (65.6%) cases of MetS. The three most prevalent indicators were obesity (73.5%), reduced high-density lipoprotein level (63.0%), and elevated blood pressure (60.9%). In the final adjusted model, black race (PR 1.30, 95% CI: 1.07-1.57), lower grip strength/body mass index (PR 1.31, 95% CI: 1.15-1.50), and low estradiol levels (PR 1.17, 95% CI: 1.00-1.35) were associated with MetS. MetS is a long-term threat to the health of middle-aged women and a potential public health burden. These results may help in developing health promotion strategies to prevent morbidity and mortality associated with MetS in this vulnerable population.

Alcohol Consumption and Risk of Liver Cirrhosis: A Systematic Review and Meta-Analysis.

OBJECTIVES: To systematically summarize the risk relationship between different levels of alcohol consumption and incidence of liver cirrhosis. METHODS: MEDLINE and Embase were searched up to March 6, 2019, to identify case-control and cohort studies with sex-specific results and more than 2 categories of drinking in relation to the incidence of liver cirrhosis. Study characteristics were extracted and random-effects meta-analyses and meta-regressions were conducted. RESULTS: A total of 7 cohort studies and 2 case-control studies met the inclusion criteria, providing data from 2,629,272 participants with 5,505 cases of liver cirrhosis. There was no increased risk for occasional drinkers. Consumption of one drink per day in comparison to long-term abstainers showed an increased risk for liver cirrhosis in women, but not in men. The risk for women was consistently higher compared to men. Drinking ≥5 drinks per day was associated with a substantially increased risk in both women (relative risk [RR] = 12.44, 95% confidence interval [CI]: 6.65-23.27 for 5-6 drinks, and RR = 24.58, 95% CI: 14.77-40.90 for ≥7 drinks) and men (RR = 3.80, 95% CI: 0.85-17.02, and RR = 6.93, 95% CI: 1.07-44.99, respectively). Heterogeneity across studies indicated an additional impact of other risk factors. DISCUSSION: Alcohol is a major risk factor for liver cirrhosis with risk increasing exponentially. Women may be at higher risk compared to men even with little alcohol consumption. More high-quality research is necessary to elucidate the role of other risk factors, such as genetic vulnerability, body weight, metabolic risk factors, and drinking patterns over the life course. High alcohol consumption should be avoided, and people drinking at high levels should receive interventions to reduce their intake.