Background: In this study, we describe the change in protein intake, nutritional status, bone markers, and bone mineral density (BMD) in older patients recovering from a hip fracture, from post-surgery till 3 months. Additionally, we explore the association between protein intake with bone markers, quantitative ultrasound (QUS) and BMD, and nutritional status with QUS and BMD.
Methods: A 3-month prospective study in 96 adults aged ≥70 years with an acute hip fracture was conducted. Assessments after surgery and 3 months included protein intake (questionnaire), nutritional status [Mini Nutritional Assessment Short Form (MNA-SF)], procollagen type I N-terminal propeptide (PINP), C-terminal telopeptide of type I collagen (CTX), insulin-like growth factor 1 (IGF-1), parathyroid hormone (PTH) levels, QUS parameters, and BMD (dual-energy X-ray absorptiometry). Associations were assessed by adjusted linear mixed models.
Results: At baseline, half of the patients (mean age 84 years, 63% females) had a low protein intake (<0.8 g/kg/d), which did not change over time. The patients had significant weight loss (median 3.6 kg) and the prevalence of (being at risk of) malnutrition increased from 20% to 64%. The PINP and IGF-1 levels increased over time, the CTX level remained stable, and the PTH level decreased. The protein intake was only associated with a QUS parameter in females (estimate 0.123, 95% CI 0.022-0.223). A higher pre-fracture MNA-SF status was associated with higher BMD in the total body (estimate 0.048, 95% CI 0.015-0.080), spine (estimate 0.085, 95% CI 0.025-0.144), total hip (estimate 0.055, 95% CI 0.018-0.093), and trochanter (estimate 0.057, 95% CI 0.018-0.096). IGF-1 was associated with PINP (estimate 1.215, 95% CI 0.363-2.066).
Conclusions: A good nutritional status is associated with higher BMD in older hip fracture patients. The role of protein for bone health in these patients remains unclear. After a hip fracture, there is an increase in PINP.
Adolescence is a crucial developmental phase marked by major physical, cognitive, and psychosocial changes that shape self-perception and relationships, with lasting effects on mental and physical health. Personality functioning, a core concept in modern diagnostic systems, such as the International Classification of Diseases (ICD-11), offers a dimensional framework that incorporates key developmental domains such as identity, self-direction, empathy, and intimacy. Early detection of impairments in these areas is essential to promote mental and physical well-being and to prevent the onset of mental disorders. In addition, an improvement in physical fitness (PF) appears to be associated with a significantly lower risk of developing mental disorders. Thus, this study aimed to examine associations between the dimensions of personality functioning, health-related quality of life (HRQoL), and PF in adolescents. A total of 186 adolescents (48.3% girls; mean age 15.6 ± 0.6 years) completed the KIDSCREEN-10, the Levels of Personality Functioning Questionnaire (LoPF-Q) 12-18, and the standardized German motor fitness test (DMT 6-18). Significant negative moderate and large correlations were found between HRQoL and overall personality dysfunction, as well as the identity, self-direction, empathy, and intimacy development domains. Additionally, PF showed significant negative moderate correlations with overall personality dysfunction, particularly with intimacy. Multiple regression analyses revealed that self-direction and intimacy were significantly negatively associated with the HRQoL, while intimacy was negatively associated with PF. Impaired personality functioning, particularly in self-direction and intimacy, was strongly associated with reduced HRQoL and PF in adolescents. These findings highlight the importance of recognizing emerging personality difficulties early and providing timely support, as this can play a vital role in promoting both mental and physical health during adolescence and later in life.
Air pollution, comprising a complex mixture of gaseous and particulate pollutants, remains a major global health concern that disproportionately affects vulnerable populations. In this scoping review, we aim to systematically investigate the role of genetic susceptibility in health outcomes associated with exposure to air pollution, with a particular emphasis on fine particulate matter (PM2.5), particulate matter (PM10), nitrogen dioxide (NO2), and nitrogen oxides (NOx); key pollutants consistently linked to adverse health effects. By exploring the gene-environment interactions underlying air pollution-related conditions, this review offers new insights into how genetic factors may modulate individual responses to air pollutants and their implications for precision health. Analyzing 16 peer-reviewed studies published in the last decade, we highlight genetic markers and pathways involved in regulating oxidative stress, inflammation, and DNA repair, which are thought to influence individual variation in responses to PM2.5, PM10, NO2, and NOx. Although none of the included studies entailed multi-omics or machine learning approaches, we identified these tools as promising directions for future research aimed at elucidating mechanistic pathways and informing personalized strategies. These techniques could significantly improve the understanding of gene-environment interactions, and are suggested as emerging methodologies for future studies. However, the scarcity of longitudinal studies and the underrepresentation of diverse populations limit the generalizability of the current findings. Addressing these gaps will be essential for advancing research, improving environmental health equity, and informing policy in the context of air pollution and genetic susceptibility.
Non-communicable diseases (NCDs) pose a major public health challenge worldwide, particularly in low- and middle-income countries (LMICs) like Indonesia, driven by urbanization, lifestyle changes, and environmental risks. Challenges such as constrained healthcare resources and socio-economic disparities hinder the effectiveness of NCD prevention and management. In response, Indonesia has implemented the Community-Based Chronic Disease Management Program (Prolanis), designed to promote regular monitoring, medication adherence, lifestyle modifications, and health education through primary health centers. This scoping review aimed to identify and map the barriers to Prolanis implementation across different regions and communities in Indonesia. A comprehensive literature search was performed in Scopus, ScienceDirect, and PubMed for peer-reviewed publications between 2014 and 2024. After the screening process, 38 peer-reviewed works met the inclusion criteria and were analyzed thematically. Thematic analysis indicated five major categories of barriers, including infrastructure and staffing constraints, low coverage, participation and adherence, socioeconomic and cost barriers, cultural and health literacy barriers, and pandemic-related disruptions. Key issues included inadequate human resources, inconsistent medical supplies, geographic barriers, patient time conflicts, and a lack of perceived benefit. Additionally, socio-economic challenges such as out-of-pocket expenses and transportation costs further restricted participation. Addressing these identified barriers is critical for improving the effectiveness of Prolanis and enhancing chronic disease management in Indonesia. These findings also contribute valuable insights for the implementation of community-based NCD programs in other LMIC settings.
Background: Air pollution is a leading cause of premature deaths in developing countries compared to developed countries. We aimed to analyze and compare the economic loss due to premature deaths caused by air pollution in the USA and India.
Methods: Data on household and ambient air pollution, mortality, population, and GDP were collected from the WHO Global Health Observatory, the 2019 Global Burden of Disease Study, and World Development Indicators. The economic loss of premature deaths caused by air pollution were assessed for 2019 in India and the USA by calculating the adjusted labor output per worker, factoring in the likelihood of a person being employed. However, reported mortality cases of air pollution can be less than the actual cases, so the actual loss can be greater than that calculated in this study.
Results: The findings showed that in 2019, the total economic loss due to premature deaths caused by air pollution was $34.85 billion and $24.76 billion in India and the USA, respectively. In 2019, India and the USA lost around 1.67 million and 100,000 lives because of air pollution, respectively. However, the per capita loss amounted to $20,868 for India and $247,600 for the USA, highlighting the stark disparity in the per capita income. Despite significant socioeconomic variations, ambient air pollution is the leading cause of total premature deaths from air pollution, accounting for 58% and 80% in India and the USA, respectively.
Conclusions: Air pollution is rising in India and decreasing in the USA. The United States has implemented stringent laws and regulations, such as the Clean Air Act, to control air pollution, and India should benefit from this example. Moreover, monitoring the ground-level situation is important to reduce air pollution and associated fatalities.
Background: Hypertension is a critical modifiable risk factor for mortality in the elderly, yet optimal systolic blood pressure (SBP) targets for older adults remain unclear. This study examined the association between SBP trajectories and all-cause mortality in Chinese elderly individuals, aiming to identify age-adjusted SBP ranges for survival benefits.
Methods: A population-based prospective cohort study was conducted in Luzhou, China (2017-2023). A total of 390,100 participants aged ≥65 years were followed for 1,994,050 person-years, with 48,013 deaths analyzed. Cox proportional hazards and restricted cubic spline (RCS) Cox regression models were used to evaluate baseline SBP categories, 7-year mean SBP, and longitudinal trajectories (Class 1: ideal to elevated; Class 2: normal-high to elevated; Class 3: mild hypertension to elevated).
Results: Baseline SBP: Lowest mortality risk at 100-139 mmHg (HR < 1). 7-year mean SBP: Optimal range at 120-159 mmHg. Trajectories: Class 2 (normal-high to elevated) had the lowest all-cause mortality (HR: 0.90, 95% CI: 0.88-0.92). Class 1 showed the lowest cardiovascular mortality. Class 3 exhibited the lowest non-cardiovascular/cancer mortality.
Conclusions: Gradual SBP increases from normal (≤160 mmHg) with age are associated with reduced mortality in the elderly. These findings challenge strict hypertension control guidelines, advocating for age-adjusted SBP targets to optimize survival outcomes. Further validation across different ethnic groups and regions will be needed in the future.
Alexithymia is a personality trait with significant clinical impact worldwide. It is a relevant transdiagnostic risk factor for a wide range of psychopathologies, including depression, anxiety, eating and substance use disorders, and other psychosomatic conditions. This underscores the importance of having validated instruments to measure alexithymia, particularly brief scales suitable for quick and practical applications. The Perth Alexithymia Questionnaire (PAQ-S) has shown promising results in this context. However, few cross-cultural studies have validated its use, which is the aim of the present study. To this end, a sample of 2535 university students was recruited (mean age = 20.59 years; SD = 2.04; 26.75% males and 73.25% females) from Spain (n = 388), Italy (n = 376), Lebanon (n = 487), Nigeria (n = 561), Türkiye (n = 410), and Ukraine (n = 313). The PAQ-S and the Type D Personality Scale (DS-14) - designed to assess Negative Affectivity (NA) and Social Inhibition (SI) - were administered. The Classical Test Theory (CTT) and Network Analysis (NwA) were applied. The confirmatory factor analysis yielded satisfactory results in all cases, with an adequate internal consistency. Metric invariance was obtained between genders and cultures. Additionally, several of the analysed countries presented strict invariance. Therefore, the data obtained in these countries can be compared and their results extrapolated between them. The NwA supports the data obtained through the CTT, as well as the independence of alexithymia, NA, and SI constructs. Hence, the scale proved to be useful for its intended aim and may be useful to monitor alexithymia in large-scale health campaigns.
This study presents an Electroencephalography (EEG) emotion recognition using a long short-term memory (LSTM)-based method. Our proposed method selects window sizes and overlaps to divide the EEG data into segments, which optimally captures subtle signal changes. A Bidirectional LSTM (BiLSTM) layer is added to standard LSTM layers to better detect forward and backward patterns in the data. By using this dual-layer setup, we aim to improve both the feature extraction and the classification accuracy. The model was tested on the Database for Emotion Analysis using Physiological signals (DEAP) dataset and showed acceptable accuracy across emotional dimensions: arousal (94.0%), liking (98.9%), dominance (95.3%), and valence (99.6%). Our results suggest that the model better supports emotion recognition and has potential for mental health monitoring and adaptive therapy.
Background: Functioning, recognized as the third health indicator and a key metric for rehabilitation, can be assessed by measuring capacity and performance.
Objective: To quantify the prevalence of disability and cognitive impairment in individuals aged 50+ and evaluate the reliability and clinical relevance of capacity and performance qualifiers in the activity and participation domains of the international classification of functioning checklist (ICF checklist).
Methods: A cross-sectional study was conducted in a population from rural and urban areas of Aragón (Spain), including 1707 participants. Disability and cognitive impairment were assessed using the WHO Disability Assessment Schedule 12-item version (WHODAS 12) and mini-mental state examination. A randomly selected subsample (n = 129) underwent a detailed functional evaluation. The ICF checklist was used to compare capacity and performance, analyzing their agreement and differences.
Results: Disability was present in 50.6% of participants. Severe or total disability was most prevalent in general tasks/demands (10.1%) and domestic life (7.1%), reflecting significant daily functioning limitations. The largest capacity-performance discrepancies were in domestic life, self-care, and learning, indicating key intervention areas. Notably, 40.5% of participants had lower performance in domestic life, followed by learning/knowledge (28%) and mobility (17%). Conversely, performance exceeded capacity in community living (13.3%) and personal relationships (5.5%), highlighting the influence of environmental factors.
Conclusions: Disability is highly prevalent in adults aged 50+, notably affecting daily functioning. Gaps between ability and performance indicate environmental barriers, especially at home and in learning contexts. Improved outcomes in social domains suggest enabling conditions. Findings support the ICF checklist's clinical value and advocate for integrating environmental factors into disability care.
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