Structural and functional properties of mSWI/SNF chromatin remodeling complexes revealed through single-cell perturbation screens.

The mammalian SWI/SNF (mSWI/SNF or BAF) family of chromatin remodeling complexes play critical roles in regulating DNA accessibility and gene expression. The three final-form subcomplexes-cBAF, PBAF, and ncBAF-are distinct in biochemical componentry, chromatin targeting, and roles in disease; however, the contributions of their constituent subunits to gene expression remain incompletely defined. Here, we performed Perturb-seq-based CRISPR-Cas9 knockout screens targeting mSWI/SNF subunits individually and in select combinations, followed by single-cell RNA-seq and SHARE-seq. We uncovered complex-, module-, and subunit-specific contributions to distinct regulatory networks and defined paralog subunit relationships and shifted subcomplex functions upon perturbations. Synergistic, intra-complex genetic interactions between subunits reveal functional redundancy and modularity. Importantly, single-cell subunit perturbation signatures mapped across bulk primary human tumor expression profiles both mirror and predict cBAF loss-of-function status in cancer. Our findings highlight the utility of Perturb-seq to dissect disease-relevant gene regulatory impacts of heterogeneous, multi-component master regulatory complexes.

Association between depression and incident dementia: Longitudinal findings from the share study.

BACKGROUND: The association between depression and dementia is still unclear, particularly regarding depression as a potential risk factor preceding dementia. Therefore, we aimed to verify if the presence of depression at baseline may increase the risk of dementia and cognitive impairment during 15 years of follow-up in the SHARE (Survey of Health, Aging and Retirement in Europe) study. METHODS: Depressive symptoms were defined using the EURO-D, with a score ≥4 indicative of depression. Incident dementia was ascertained using self-reported data and caregivers' information, cognitive impairment using objective cognitive tests. Cox regression analysis, adjusted for 10 baseline confounders, was run and hazard ratios (HRs), with their 95% confidence intervals, were estimated. RESULTS: In total 22,789 participants were included in the present analysis (mean age 64.2 years) and were predominantly female. The prevalence of depression at baseline was 24.9%. Over 15 years of follow-up, the onset of dementia occurred a median 2 years earlier in people with depression compared to those without. Depression at the baseline significantly increased the risk of dementia in the overall sample (HR = 1.74; 95% CI: 1.54-1.95) and the risk of cognitive impairment (HR = 1.15; 95% CI: 1.06-1.25). For dementia, the association was stronger in people less than 60 years (HR = 2.07; 95% CI: 1.42-3.02) than in participants aged ≥80 years (HR = 1.47; 95% CI: 1.14-1.91). A similar trend was observed for cognitive impairment. Among the single items of the EURO-D, loss of concentration was the strongest individual variable predicting the onset of dementia. CONCLUSIONS: Depression increased the risk of dementia and cognitive impairment, particularly in younger adults, whereas loss of concentration was the strongest individual predicting variable of dementia. These findings demonstrate the need for early detection of depression for preventing future cognitive worsening.

Collective loneliness: The impact of the social network on loneliness and depression during the coronavirus pandemic in older Europeans.

OBJECTIVES: We examined the impact of the social network before the coronavirus pandemic on loneliness and depressed mood during the pandemic in older European individuals, and how these relationships differ between different European countries. METHODS: Data of N = 19,999 persons (age: M = 69.18 years; 51% female) from the pan-European longitudinal survey of health, ageing and retirement in Europe, interviewed between October 2019 and March 2020 (Wave 8) and between June and August 2020 (Corona Questionnaire 1), were used. To test the models we employed path analyses, controlling for age, gender, education, and occupational status. Models were also run separately in collectivistic (Romania, Slovenia, Croatia, and Greece) and individualistic (Netherlands, Belgium, Denmark, and France) country groups. RESULTS: A larger social network before the pandemic reduced the probability of an increase in loneliness and depression. The negative association between social network size and increase in loneliness was stronger in collectivist countries than in individualist ones. Moreover, an increase in loneliness increased the probability of feeling depressed. CONCLUSIONS: It appears that pre-pandemic social networks served as a buffer to negative mental health consequences of the pandemic in older Europeans. In fact, this association was stronger in collectivist than for individualist countries. While this underscores the importance of social connectedness, it also stresses the vulnerability of socially isolated individuals regarding loneliness and depression. Future work should thus focus on supporting social networks in older adults.

Does the local government multi-objective competition intensify the transfer of polluting industries in the Yangtze River Economic Belt?

Exploring the effect of local government multi-objective competition on the transfer of polluting industries is of great practical significance for promoting the high-quality development in the Yangtze River Economic Belt. This paper adopted the extended shift-share analysis method to measure the scale of inter-provincial transfer of polluting industries in the Yangtze River Economic Belt from 2008 to 2020. Considering local governments' economic, innovation, talent and environmental protection competition, the paper examined the effects of local government multi-objective competition on the transfer of polluting industries in the region, and tested its spatial spillover effects. The results showed that: 1. Different competitions had different effects on the transfer of polluting industries. Economic competition intensified the transfer of polluting industries, while talent, innovation, and environmental protection competition all restrained it, among which environmental protection competition had the strongest restraining effect. 2. Compared with the transfer of polluting industries, the direction of economic competition and environmental protection competition on the transfer of industries did not change, but the degree of influence was reduced, talent competition instead promoted industrial transfer of the research region to some extent. 3. From the basin level, government competition in the upstream region more obviously intensified the transfer of polluting industries; while from the economic scale level, the restraining effect of government competition in the developed region on the transfer of polluting industries was much stronger. 4. Both innovation and environmental protection competition had positive spatial spillover effects. Therefore, it is necessary to optimize the promotion and assessment mechanism of local officials, adopt differentiated competitive constraint mechanisms in accordance with local conditions, guide local governments to transform their development concepts, promote the sharing and common use of technological innovations, and promote the orderly transfer of industries in the Yangtze River Economic Belt.

Relationship between multimorbidity, functional limitation, and quality of life among middle-aged and older adults: findings from the longitudinal analysis of the 2013-2020 Survey of Health, Ageing, and Retirement in Europe (SHARE).

PURPOSE: The increased burden of multimorbidity is restricting individuals' ability to live autonomously, leading to a poorer quality of life. This study estimated trajectories of functional limitation and quality of life among middle-aged (ages 50 to 64 years) and older (aged 65 years and older) individuals with and without multimorbidity. We also assessed differences in the relationship between these two trajectories by multimorbidity status and separately for each age cohort. METHODS: Data originated from the Survey of Health, Ageing, and Retirement in Europe (SHARE). In Luxembourg, data were obtained between 2013 and 2020, involving 1,585 respondents ≥ 50 years of age. Multimorbidity was defined as a self-reported diagnosis of two or more out of 16 chronic conditions; functional limitation was assessed by a combined (Instrumental) Activities of Daily Living (ADL/IADLI) scale; and to measure quality of life, we used the Control, Autonomy, Self-Realization, and Pleasure (CASP-12) scale. Latent growth curve modelling techniques were used to conduct the analysis where repeated measures of quality of life and functional limitation were treated as continuous and zero-inflated count variables, respectively. The model was assessed separately in each age cohort, controlling for the baseline covariates, and the estimates from the two cohorts were presented as components of a synthetic cohort covering the life course from the age of 50. RESULTS: Middle-aged and older adults living with multimorbidity experienced poorer quality of life throughout the life course and were at a higher risk of functional limitation than those without multimorbidity. At baseline, functional limitation had a negative impact on quality of life. Furthermore, among middle-aged adults without multimorbidity and older adults with multimorbidity, an increase in the number of functional limitations led to a decline in quality of life. These results imply that the impact of multimorbidity on functional limitation and quality of life may vary across the life course. CONCLUSION: Using novel methodological techniques, this study contributes to a better understanding of the longitudinal relationship between functional limitation and quality of life among individuals with and without multimorbidity and how this relationship changes across the life course. Our findings suggest that lowering the risk of having multimorbidity can decrease functional limitation and increase quality of life.

Time, age, gender and cultural measurement invariance of the CASP-12, a measure of psychological quality of life in adulthood.

PURPOSE: Whereas Quality of Life in older populations has long been conceptualized in regards to health or illness, the Control, Autonomy, Self-Realization and Pleasure scale (CASP-12) focuses on the positive facets of aging. Although the CASP is a widely used scale, its measurement invariance has seldom been examined. The present study aims to ascertain the measurement invariance of the CASP-12 over a period of 10 years and between age, culture and gender. METHODS: Secondary data analyses were conducted on the longitudinal data collected in four waves between 2006 and 2016-2017 of the Survey of Health, Ageing and Retirement in Europe study (SHARE). The factorial validity of the CASP-12 was examined and its measurement invariance was tested with a sample of 3684 men and 4955 women aged 30-99 years, coming from 10 different European countries. RESULTS: Results showed a strong theoretical and empirical dimensionality of the CASP-12, a well as invariance of time (10 years), age and culture. It was also found that the scale is gender invariant at the strict level. These results were replicated with two more waves of SHARE, measured six years apart. CONCLUSION: This study replicates the CASP-12 dimensional structure, factorial structure and factor loadings. The scale has demonstrated to be a reliable and valid measurement of the positive aspects of quality of life to be used across time, age, gender and culture. The Autonomy dimension of the scale warrants further investigation.

Social participation, loneliness, and physical inactivity over time: evidence from SHARE.

OBJECTIVES: We aimed to explore the reciprocal effects of social participation, loneliness, and physical inactivity over a period of 6 years in a representative sample of European adults over 50 years old. DESIGN: A longitudinal study with a six-year follow-up period was conducted. SETTING: Four waves of the Survey of Health, Ageing and Retirement in Europe project were used. PARTICIPANTS: This study includes 64,887 participants from Europe and Israel, who were aged 50 or older at the first time. MEASUREMENTS: The relationship between participation in social activities, loneliness and physical inactivity was analyzed, controlling for age, gender, and disability. A series of cross-lagged panel models (CLPMs) were applied to analyze the relationships among these variables. RESULTS: A CLPM with equal autoregressive cross-lagged effects across waves was the best fit to the data (χ2 = 7137.8, CFI = .972, RMSEA = .049, SRMR = .036). The autoregressive effects for the three variables showed high stability across waves, and all the cross-lagged effects in the model were statistically significant. Social activity and physical inactivity maintained a strong negative cross-lagged effect, while their cross-lagged effects on loneliness were comparatively smaller. Social activity had a positive cross-lagged effect on loneliness, while physical inactivity had a negative cross-lagged effect on loneliness. CONCLUSIONS: These findings highlight the importance of promoting physical activity and social participation and addressing loneliness through targeted interventions in older adults.

Volunteering and instrumental support during the first phase of the pandemic in Europe: the significance of COVID-19 exposure and stringent country's COVID-19 policy.

BACKGROUND: The COVID-19 control policies might negatively impact older adults' participation in volunteer work, instrumental support provision, and the likelihood of receiving instrumental support. Studies that quantify changes in these activities and the related factors are limited. The current study aimed to examine the level of volunteering, instrumental support provision and receipt before and during the first phase of the COVID-19 pandemic in Europe and to determine whether older adults' volunteering, instrumental support provision and receipt were associated with individual exposure to COVID-19 and the stringency of country's COVID-19 control policy during the first phase of the COVID-19 pandemic. METHODS: A cross-sectional survey using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) Corona Survey 1 was designed to focus on community-dwelling Europeans aged ≥50 years. History of participation in volunteering work and instrumental support provision or receipt was assessed from the previous SHARE Wave data. The country's COVID-19 control policy stringency index (S-Index) was from the Oxford COVID-19 Government Response Tracker database. A total of 45,669 respondents from 26 European countries were included in the volunteering analysis. Seventeen European countries were included in the analyses of instrumental support provision (N = 36,518) and receipt (N = 36,526). The multilevel logistic regression model was fitted separately to analyse each activity. RESULTS: The level of volunteering and instrumental support provision was lower during the pandemic, but instrumental support receipt was higher. The country S-Index was positively associated with support provision (OR:1.13;95%CI:1.02-1.26) and negatively associated with support receipt (OR:0.69;95%CI:0.54-0.88). Exposure to COVID-19 was positively associated with support receipt (OR:1.64;95%CI:1.38-1.95). COVID-19 exposure on close ones positively associated with volunteering (OR:1.47;95%CI:1.32-1.65), support provision (OR:1.28;95%CI:1.19-1.39), and support receipt (OR:1.25;95%CI:1.15-1.35). CONCLUSIONS: The COVID-19 pandemic impacted older Europeans' volunteering, instrumental support provision, and instrumental support receipt from outside their household. When someone close to them was exposed to COVID-19, older Europeans were likely to receive instrumental support and to volunteer and provide instrumental support. A stricter country's COVID-19 control policy might motivate older adults to provide instrumental support, but it prevents them from receiving instrumental support from outside their households.

Real-time procedure information sharing as a means to reduce perioperative anxiety in families of children undergoing elective surgery - a randomized controlled study.

OBJECTIVE: To investigate whether the surgical process information sharing system could alleviate the parental anxiety during a pediatric selective operation. DESIGN: Randomized controlled trial. METHODS: A questionnaire survey was conducted one day before surgery for the enrolled participants. Family members assigned to the intervention group received real-time process information sharing through service reminders during the surgical period, while the control group received standard perioperative education. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality during the perioperative period, and the State of Cohesion-13 Scale (SOC-13) and Self-rating Anxiety Scale (SAS) were used to assess anxiety levels. Satisfaction levels during the perioperative period were assessed through a follow-up survey conducted one day after surgery. RESULTS: The intervention group showed better scores in terms of PSQI, SOC-13, SAS, and postoperative satisfaction levels at various time points compared to the control group, with statistically significant differences observed (P < 0.05). CONCLUSION: Real-time process information sharing is effective in reducing perioperative sleep disorders and anxiety among family members of pediatric patients, as well as improving satisfaction levels. This approach not only establishes a process and mechanism for effective doctor-patient communication but also helps implement continuous perioperative care, thereby optimizing internet healthcare services.

Comparison of the market share of public and private hospitals under different Medical Alliances: an interrupted time-series analysis in rural China.

BACKGROUND: China initiated the Medical Alliances (MAs) reform to enhance resource allocation efficiency and ensure equitable healthcare. In response to challenges posed by the predominance of public hospitals, the reform explores public-private partnerships within the MAs. Notably, private hospitals can now participate as either leading or member institutions. This study aims to evaluate the dynamic shifts in market share between public and private hospitals across diverse MAs models. METHODS: Data spanning April 2017 to March 2019 for Dangyang County's MA and January 2018 to December 2019 for Qianjiang County's MA were analyzed. Interrupted periods occurred in April 2018 and January 2019. Using independent sample t-tests, chi-square tests, and interrupted time series analysis (ITSA), we compared the proportion of hospital revenue, the proportion of visits for treatment, and the average hospitalization days of discharged patients between leading public hospitals and leading private hospitals, as well as between member public hospitals and member private hospitals before and after the reform. RESULTS: After the MAs reform, the revenue proportion decreased for leading public and private hospitals, while member hospitals saw an increase. However, ITSA revealed a notable rise trend in revenue proportion for leading private hospitals (p < 0.001), with a slope of 0.279% per month. Member public and private hospitals experienced decreasing revenue proportions, with outpatient visits proportions declining in member public hospitals by 0.089% per month (p < 0.05) and inpatient admissions proportions dropping in member private hospitals by 0.752% per month (p < 0.001). The average length of stay in member private hospitals increased by 0.321 days per month after the reform (p < 0.01). CONCLUSIONS: This study underscores the imperative to reinforce oversight and constraints on leading hospitals, especially private leading hospitals, to curb the trend of diverting patients from member hospitals. At the same time, for private hospitals that are at a disadvantage in competition and may lead to unreasonable prolongation of hospital stay, this kind of behavior can be avoided by strengthening supervision or granting leadership.

Predictors of the onset of low handgrip strength in Europe: a longitudinal study of 42,183 older adults from 15 countries.

OBJECTIVES: A low handgrip strength (HGS) is a significant risk factor for multiple diseases. However, most relevant studies investigate the complications of a low HGS, while the risk potential of causative factors of low HGS remain poorly characterized. METHODS: We investigated the potentials of quality of life, depression, dyslipidaemia, diabetes mellitus, cancer, Alzheimer's disease, stroke, frailty, and difficulties performing daily activities in predicting low HGS (≤ 27 kg for men, ≤ 16 kg for women) in European older adults aged 50 or above from 15 countries (n = 42,183). All data was collected from four successive waves of survey of health, ageing, and retirement in Europe (SHARE) conducted between 2013 and 2020. Logistic models are applied, and estimated effects are presented as odds ratios and probabilities. RESULTS: Collectively, 3016 participants (men; n = 1395; 7.38%, women; n = 1621, 6.97%) developed low HGS during the 6.5 years study period. After adjusting for covariables, we identified an advancing age (1.6-48.1% points higher risk of low HGS), male gender (1.0%-point higher risk of low HGS), lower quality of life (1.6%-point higher), and stroke (1.5%-points) as significant risk factors for low HGS. We also found a dose-dependent association of Euro-D depression scores with the risk of low HGS, as the higher scores were associated with between 0.6- and 2.3%-points higher risk of developing low HGS than participants without depression. Among physical performance indicators, difficulty climbing stairs (2.0%-points higher low HGS risk) or rising from a chair (0.7%-points) were significantly associated with developing low HGS. Lastly, frailty (0.9%-points higher risk of low HGS) and the fear of falling down (1.6%-points higher risk) also increased the risk of developing low HGS. CONCLUSION: Altogether, we report several risk factors for developing low HGS. Our observations may help evaluating and monitoring high-risk population for developing low HGS in pre-clinical settings.

Constrained public benefits from global catch share fisheries.

Across publicly owned natural resources, the practice of recovering financial compensation, commonly known as resource rent, from extractive industries influences wealth distribution and general welfare of society. Catch shares are the primary approach adopted to diminish the economically wasteful race to fish by allocating shares of fish quotas-public assets-to selected fishing firms. It is perceived that resource rent is concentrated within catch share fisheries, but there has been no systematic comparison of rent-charging practices with other extractive industries. Here, we estimate the global prevalence of catch share fisheries and compare rent recovery mechanisms (RRM) in the fishing industry with other extractive industries. We show that while catch share fisheries harvest 17.4 million tons (19% of global fisheries landings), with a value of 17.7 billion USD (17% of global fisheries landed value), rent charges occurred in only 5 of 18 countries with shares of fish quotas primarily allocated free of charge. When compared with other extractive industries, fishing is the only industry that consistently lacks RRM. While recovering resource rent for harvesting well-governed fishery resources represents a source of revenue to coastal states, which could be sustained indefinitely, overcharging the industry might impact fish supply. Different RRM occurred in extractive industries, though generally, rent-based charges can help avoid affecting deployment of capital and labor to harvest fish since they depend on the profitability of the operations. Our study could be a starting point for coastal states to consider adapting policies to the enhanced economic condition of the fishing industry under catch shares.

In vivo axial load-share ratio measurement using a novel hexapod system for safe external fixator removal.

BACKGROUND: External fixation is widely used in the treatment of traumatic fractures; however, orthopedic surgeons encounter challenges in deciding the optimal time for fixator removal. The axial load-share ratio (LS) of the fixator is a quantitative index to evaluate the stiffness of callus healing. This paper introduces an innovative method for measuring the LS and assesses the method's feasibility and efficacy. Based on a novel hexapod LS-measurement system, the proposed method is to improve the convenience and precision of measuring LS in vivo, hence facilitating the safe removal of external fixators. METHODS: A novel hexapod system is introduced, including its composition, theoretical model, and method for LS measurement. We conducted a retrospective study on 82 patients with tibial fractures treated by the Taylor Spatial Frame in our hospital from September 2018 to June 2020, of which 35 took LS measurements with our novel method (Group I), and 47 were with the traditional method (Group II). The external fixator was removed when the measurement outcome (LS < 10%) was consistent with the surgeon's diagnosis based on the clinical and radiological assessment (bone union achieved). RESULTS: No significant difference was found in the fracture healing time (mean 25.3 weeks vs. 24.9 weeks, P > 0.05), frame-wearing duration (mean 25.5 weeks vs. 25.8 weeks, P > 0.05), or LS measurement frequency (mean 1.1 times vs. 1.2 times, P > 0.05). The measurement system installation time in Group I was significantly shorter compared to Group II (mean 14.8 min vs. 81.3 min, P < 0.001). The LS value of the first measurement in Group I was lower than that of Group II (mean 5.1% vs. 6.9%, P = 0.011). In Group I, the refracture rate was 0, but in Group II it was 4.3% (2/47, P > 0.05). CONCLUSION: The novel hexapod LS-measurement system and involved method demonstrated enhanced convenience and precision in measuring the LS of the external fixator in vivo. The LS measurement indicates the callus stiffness of fracture healing, and is applicable to evaluate the safety of removing the fixator. Consequently, it is highly recommended for widespread adoption in clinical practice.

Time and temperature abuse of milk in conditions representing a school cafeteria share table does not meaningfully reduce microbial quality.

Share tables (ST) are tables or stations in school cafeterias where students can return unopened foods and beverages, providing an opportunity to access these items at no cost. Currently, research suggests that milk is among the most wasted items in breakfast and lunch programs in the United States. Share tables present a simple solution for reducing milk waste, but research is needed to understand the microbial spoilage potential of milk in ST. To this end, uninoculated milk cartons and milk cartons inoculated with 2 to 3 log10(cfu/mL) Pseudomonas poae, a fast-growing psychrotroph, was exposed to ambient temperature during winter (mean temperature = 20.3°C) and summer (23.1°C) for 125 min, repeated over 5 d (the length of a school week). Microbial counts in the inoculated milk cartons increased linearly, exceeding the spoilage threshold of 6.0 log10(cfu/mL) after d 3 and after d 4 in the winter and summer season trials, respectively. In the winter trial, the microbial counts for uninoculated milk cartons never exceeded the lower limit of detection, 2.31 log10(cfu/mL), and in the summer trials, microbial counts never reached the spoilage threshold, indicating that initial contamination is a driving factor of microbial milk spoilage. Regardless of sharing status or seasonality, the greatest changes in counts for inoculated milk cartons occurred during overnight refrigeration, ranging from 0.56 to 1.4 log10(cfu/mL), while during the share table ranged from no observable change up to 0.29 log10(cfu/mL), emphasizing that school nutrition personnel should focus efforts on tightly controlling refrigeration temperatures and returning milk to refrigeration as soon as possible. A previously developed model for school cafeteria share tables was adapted to understand the typical residence time of milk in a simulated cafeteria with an ambient temperature share table for the summer and winter seasons over 1,000 wk. Milk was predicted to have a very short mean residence time (85 min) regardless of sharing status or season, with 99.8% of milk consumed, discarded, or donated within the first 2 d. As a result, only 3 out of 451,410 and 6 out of 451,410 simulated milks spoiled in the winter and summer seasons, respectively. The data generated here can be used to inform science-based decision-making for including milk in share tables, or applied to any system where one might have to accept short-term unrefrigerated storage of milk to meet a waste reduction or food security goal.

Patient and Public Willingness to Share Personal Health Data for Third-Party or Secondary Uses: Systematic Review.

BACKGROUND: International advances in information communication, eHealth, and other digital health technologies have led to significant expansions in the collection and analysis of personal health data. However, following a series of high-profile data sharing scandals and the emergence of COVID-19, critical exploration of public willingness to share personal health data remains limited, particularly for third-party or secondary uses. OBJECTIVE: This systematic review aims to explore factors that affect public willingness to share personal health data for third-party or secondary uses. METHODS: A systematic search of 6 databases (MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and SocINDEX) was conducted with review findings analyzed using inductive-thematic analysis and synthesized using a narrative approach. RESULTS: Of the 13,949 papers identified, 135 were included. Factors most commonly identified as a barrier to data sharing from a public perspective included data privacy, security, and management concerns. Other factors found to influence willingness to share personal health data included the type of data being collected (ie, perceived sensitivity); the type of user requesting their data to be shared, including their perceived motivation, profit prioritization, and ability to directly impact patient care; trust in the data user, as well as in associated processes, often established through individual choice and control over what data are shared with whom, when, and for how long, supported by appropriate models of dynamic consent; the presence of a feedback loop; and clearly articulated benefits or issue relevance including valued incentivization and compensation at both an individual and collective or societal level. CONCLUSIONS: There is general, yet conditional public support for sharing personal health data for third-party or secondary use. Clarity, transparency, and individual control over who has access to what data, when, and for how long are widely regarded as essential prerequisites for public data sharing support. Individual levels of control and choice need to operate within the auspices of assured data privacy and security processes, underpinned by dynamic and responsive models of consent that prioritize individual or collective benefits over and above commercial gain. Failure to understand, design, and refine data sharing approaches in response to changeable patient preferences will only jeopardize the tangible benefits of data sharing practices being fully realized.

Sensory impairments and depressive symptoms in Europe: a cross-national cohort study.

OBJECTIVES: To investigate the associations between sensory impairments and the development of depressive symptoms across sex, age, and European regions, and to examine the mediating role of cognitive function, activities of daily living (ADL), and physical activity. METHOD: A cohort study including 56,847 Europeans aged 50+ participating in at least two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Associations were analyzed using mixed effects logistic regression models considering several confounders. RESULTS: Overall, 17.8% developed depressive symptoms. Compared to participants with good vision and hearing, those with vision impairment (VI) (odds ratio (OR) = 1.35, 95% confidence interval (CI) 1.27-1.44), hearing impairment (HI) OR = 1.32, 95% CI 1.21-1.43, and dual sensory impairment (DSI, i.e. VI and HI) (OR = 1.93, 95% CI 1.75-2.13) had increased odds of depressive symptoms. The associations were consistent across sex and European regions but became stronger with advancing age among men. Dose-response relationships were found for all associations. Mediation analyses revealed that preventing cognitive decline, ADL limitations, and physical inactivity would eliminate 15.0%, 11.5%, and 21.4% of the total effect for VI, HI, and DSI, respectively. CONCLUSION: Our findings emphasize the importance of preventing sensory impairments to avoid depressive symptoms.

Do reductions of daily activities mediate the relationship between COVID-19 restrictions and mental ill-health among older persons in Europe?

OBJECTIVE: Previous research has shown that daily activities are crucial for mental health among older people, and that such activities declined during the COVID-19 pandemic. While previous studies have confirmed a link between stringent restrictions and an increase in mental ill-health, the role of daily activities as a mediator in this relationship remains underexplored. We analyzed whether reductions in daily activities mediated the impact of these COVID-19 restrictions on mental ill-health during the pandemic's initial phase. METHODS: We used data from Wave 8 SHARE Corona Survey covering 41,409 respondents from 25 European countries and Israel as well as data on COVID-19 restrictions from the Oxford Government Response Tracker (OxCGRT). Multilevel regression and multilevel-mediation analysis were used to examine the relationships between restrictions, daily activities and mental ill-health. RESULTS: Reductions in walking and shopping showed a notably stronger association with increases in mental ill-health compared to social activities. Furthermore, declines in walking could account for about a quarter of the relationship between restrictions and increased mental ill-health, but the mediating effects of the other activates were negligible. CONCLUSIONS: The study highlights the essential role of maintaining daily activities, particularly walking, to mitigate the negative psychological effects of pandemic-related restrictions among older populations in Europe.

Cognitive function among religious and non-religious Europeans: a cross-national cohort study.

OBJECTIVES: To examine the associations between several measures and categories of religiosity and cognitive function across sex and European regions. METHODS: We conducted a longitudinal study including 17,756 Europeans aged 50 and older who participated in the Survey of Health, Ageing and Retirement in Europe wave 1. Participants were followed for up to 15 years. Associations were analyzed using linear mixed effects models adjusted for several potential confounders. RESULTS: Religious service attendance was consistently associated with better cognitive function (coefficient: 1.04, 95% CI 0.71; 1.37) across sex and European regions. Praying was also associated with better cognitive function but only among men (coefficient: 0.55, 95% CI 0.15; 0.96). However, individuals who received religious education from their parents had poorer cognitive function (coefficient: -0.59, 95% CI -0.93; -0.25). The association persisted in women and among both sexes in Western Europe. Comparing different religious categories to the non-religious, participants who were religious in childhood showed an inverse association with cognitive function, while persistently religious men exhibited better cognitive function. CONCLUSIONS: Our findings indicate that religious service attendance and, to a certain extent, prayer is associated with better cognitive function. However, receiving religious education in childhood may be linked to lower cognitive function.

Diabetes self-management education on the sustainability of metabolic control in type 2 diabetes patients: Diabetes share care program in Taiwan.

BACKGROUND: Diabetes self-management education (DSME) improves glycemic and metabolic control. However, the frequency, duration and sustainability of DSME for improving metabolic control have not been well studied. METHODS: The Diabetes Share Care Program (DSCP) stage 1 provided DSME every 3 months. If participants entering DSCP stage 1 ≥ 2 years and HbA1c < 7%, they can be transferred to stage 2 (DSME frequency: once a year). Three-to-one matching between DSCP stage 1 and stage 2 groups based on the propensity score method to match the two groups in terms of HbA1c and diabetes duration. We identified 311 people living with type 2 diabetes in DSCP stage 1 and 86 in stage 2 and evaluated their metabolic control and healthy behaviors annually for 5 years. RESULTS: In the first year, HbA1c in the DSCP stage 2 group was significantly lower than that in the stage 1 group. In the first and the fifth years, the percentage of patients achieving HbA1c < 7% was significantly higher in the DSCP stage 2 group than the stage 1 group. There was no significant difference in other metabolic parameters between the two groups during the 5-year follow-up. Self-monitoring of blood glucose (SMBG) frequency was associated with a reduced HbA1c after 5 years (95% CI: -0.0665 to -0.0004). CONCLUSION: We demonstrated sustainable effects of at least 2-year DSME on achieving better glycemic control for at least 1 year. SMBG contributed to improved glycemic control. The results may be applied to the reimbursement strategy in diabetes education.

Ultrasound and ultrasound shear-wave elastography evaluation of ulceroglandular type of tularemia.

INTRODUCTION: Ultrasound (US) has an important place in imaging ulceroglandular type patients with tularemia. This study is a case series addressing the imaging findings of US and US shear-wave elastography in ulceroglandular type tularemia. DESCRIPTION: Three patients, two women, and one man, were included in our case series. The patients were admitted to our hospital with neck swelling, pain, and a palpable mass. After the diagnosis of tularemia was made as a result of the examinations performed on the patients, they were evaluated again with US and US shear-wave elastography. DISCUSSION: Since there are many diagnoses including ulceroglandular tularemia in the differential diagnosis of swelling, pain, and palpable mass in the neck, the patient must undergo a thorough evaluation process. US shear-wave elastography can provide significant benefits in identification and treatment follow-up in order to understand the ulceroglandular mass formation observed in the neck in tularemia and the stiffness and morphology of the tissues in the lymph nodes where involvement is observed and to distinguish them from the surrounding tissue.