Chronic Physical Conditions, Multimorbidity, and Mild Cognitive Impairment in Low- and Middle-Income Countries

Objectives: To assess the association between chronic physical conditions and multimorbidity and mild cognitive impairment (MCI) in low‐ and middle‐income countries (LMICs). Design: Nationally representative, cross‐sectional, community‐based study. Setting: Six countries that participated in the World Health Organization Study on Global Ageing and Adult Health. Participants: Individuals aged 50 and older (N=32,715; mean age 62.1 ± 15.6; 51.7% female). Measurements: The definition of MCI was based on the recommendations of the National Institute on Ageing and Alzheimer's Association. Ten chronic conditions were assessed (angina pectoris, arthritis, asthma, cataract, chronic lung disease, diabetes mellitus, edentulism, hearing problems, hypertension, stroke). Multivariable logistic regression analysis was conducted to assess the association between chronic physical conditions, multimorbidity (≥2 chronic conditions), and MCI. Results: The prevalence of multimorbidity was 49.8% (95% confidence interval (CI)=48.1–51.5%) and of MCI was 15.3% (95% CI=14.4–16.3%). After adjustment for potential confounders, edentulism (odds ratio (OR)=1.24), arthritis (OR=1.24), chronic lung disease (OR=1.29), cataract (OR=1.33), stroke (OR=1.94), hearing problems (OR=2.27), and multimorbidity (OR=1.40) were significantly associated with MCI. There was a gradual increase in the likelihood of MCI (1 condition: OR=1.21, 95% CI=1.03–1.42; ≥4 conditions: OR=2.07, 95% CI=1.70–2.52). Conclusion: These results highlight the need to investigate the underlying mechanisms linking chronic conditions and MCI and whether prevention or treatment of chronic conditions or multimorbidity can reduce the onset of cognitive decline and subsequent dementia, especially in LMICs

Association between depression and smoking: a global perspective from 48 low- and middle-income countries

Background: Smoking is a leading modifiable cause of global morbidity and mortality. Research from high-income countries has found a high prevalence of smoking among people with depression and suggested that this may partially contribute to the increased premature mortality in this population. Limited research has investigated smoking behaviors across the depression spectrum and in low- and middle-income countries (LMICs). This study explored the relationship between depression and smoking across 48 LMICs. Methods: We conducted a cross-sectional, community-based study comprising 242,952 people [mean age 38.4 (SD=16.1) years, 50.8% females] from the World Health Survey. Multivariable binary logistic regression analyses were performed to investigate the relationship between depression (including subsyndromal, brief depressive episode and depressive episodes) and smoking behaviours. Results: Overall, the prevalence of current smoking was lowest in Africa (13.5%) and highest in Asia (32.2%). A depressive episode was present in 6.7% of the sample. Compared to people without depression, subsyndromal depression, brief depressive episode, and depressive episodes were all significantly associated with smoking with similar effect sizes (ORs: 1.36-1.49). Countrywide meta-analysis found that the pooled overall OR for smoking in depression was 1.42 (95%CI=1.32-1.52, I2=39.7%). Furthermore, alcohol consumption and male gender were consistently associated with smoking across all regions and smoking was consistently less common in those who were wealthier and had a higher education. Conclusion: These data suggest the depression spectrum is consistently associated with high levels of smoking behaivours in LMICs. Given that most of the world’s smokers reside in LMICs, future smoking cessation interventions are required to target people with depression

Bullying victimization and suicide attempt among adolescents aged 12-15 years from 48 countries

Objective: Adolescent suicide is a global public health problem. Bullying is a risk factor for suicidality in adolescence; however, global data on its association with suicide attempts are lacking, and data from low- and middle-income countries (LMICs) and non-Western settings are scarce. Thus, we assessed the association between bullying victimization and suicide attempts using data from 48 countries (predominantly LMICs) across multiple continents. Method: Data from the Global School-based Student Health Survey were analyzed. Data on past 12-month suicide attempts and past-30 day bullying victimization were collected. Multivariable logistic regression and meta-analysis with random effects were conducted to assess the associations. Results: The final sample consisted of 134,229 adolescents aged 12-15 years. The overall prevalence of suicide attempts and bullying victimization were 10.7% and 30.4%, respectively. After adjustment for sex, age, and socioeconomic status, bullying victimization was significantly associated with higher odds for a suicide attempt in 47 of the 48 countries studied with the pooled OR being 3.06 (95%CI=2.73-3.43). Greater number of days bullied in the past month was dose-dependently associated with higher odds for suicide attempts. The past-year prevalence of suicide attempts ranged from 5.9% for the “no bullying” group up to 32.7% for the “being bullied for 20-30 days/month” group [OR=5.51 (95%CI=4.56-6.65)]. Conclusion: Bullying victimization may be an important risk factor of suicide attempts among adolescents globally. Thus, there is an urgent need to implement effective and evidence-based interventions to address bullying in order to prevent suicides and suicide attempts among adolescents worldwide

Violence and Obesogenic Behavior among Adolescents aged 12-15 years from 62 Countries: A Global Perspective

Exposure to violence may be associated with increased risk for obesogenic behavior among adolescents but studies providing a global perspective are lacking. The aim of this work was to assess the relationship between violence and obesogenic behaviors among young adolescents from 62 countries. Cross-sectional data from the Global School-based Student Health Survey 2009-2016 were analyzed. Information on violence (intentional injury, physical attack, physical fight) and obesogenic behavior (anxiety-induced sleep problems, low physical activity, sedentary behavior, fast-food consumption, carbonated soft-drink consumption) were self-reported. Associations were analyzed using meta-analysis based on country-wise multivariable logistic regression analyses. A total of 165,380 adolescents aged 12-15 years [mean (SD) age 13.8 (1.0) years; 50.9% boys] were included in the analysis. All types of violence were positively associated with higher odds for all types of obesogenic behavior with the exception of low physical activity. Associations were particularly pronounced for anxiety-induced insomnia. In contrast, intentional injury (OR=0.72; 95%CI=0.64-0.81) and physical fight (OR=0.90; 95%CI=0.86-0.95) were associated with lower odds for low physical activity. In this large global sample of adolescents, exposure to violence was associated with all obesogenic behaviors apart from low physical activity. Multidimensional government programs and policies addressing exposure to violence among young adolescents may lead to reduction in obesogenic behavior and hence curtail the global obesity epidemic

Prevalence, Correlates and Misperception of Depression Symptoms in the United States, NHANES 2015-2018

Purpose: To update the prevalence of depression in the US and identify whether misperception exists in depression assessed by self-report versus validated tools administered by trained professionals. Methods: We extracted data on sociodemographic characteristics, lifestyle factors, medical conditions, self-reported depression, and depressive symptoms from National Health and Nutrition Examination Survey (NHANES) study 2015-2018. We calculated the weighted prevalence and 95% CI of self-reported depression and depressive symptoms assessed by a validated tool PHQ-9 (score≥10) respectively. Then, we performed multivariable logistic regressions to identify the sociodemographic and lifestyle correlates. Finally, we calculated the agreement between depressive symptoms and self-reported depressive feeling to examine possible misperception. Results: The present analysis included a total of 10,257 adults (Weighted N= 215,964,374) aged 20 years and older. Prevalence of depressive symptoms (PHQ-9 score ≥10) were 8.0 % from 2015 to 2018 in the US. 19.7 % and 11.3 % adults reported feeling depressed at least once a month and at least once a week, respectively. Depressive experience was largely misperceived in the US (Kappa agreement=50.98%, Cohen’s Kappa=0.16, p<0.001). Particularly, an estimated 1.1 million US adults had depressive symptoms but never felt being depressed. Several consistent demographic and behavioral correlates were identified across the two measures, namely: age, sex, race/ethnicity, poverty and sitting time. Conclusions: A high prevalence of depression was found, and misperception of depression exists among large US adult population. Our findings highlight an urgent need for health professionals to reduce the burden of depression with considering patients’ socioeconomic status and lifestyle factors

Second-hand smoking and obesity among non-smoking adolescents aged 12-15 years from 38 low- and middle-income countries

Introduction: Second-hand smoking (SHS) may be a risk factor for obesity in adolescence but data on the association between SHS and obesity are scarce, especially from low- and middle-income countries (LMICs). Therefore, the aim of this study was to assess the association between SHS and obesity among adolescents aged 12-15 years from 38 LMICs. Methods: Cross-sectional data from 38 LMICs that participated in the Global School-based Student Health Survey (GSHS) were analyzed. Body mass index was calculated based on measured weight and height. The 2007 WHO Child Growth reference was used to define obesity. SHS was categorized as no exposure, non-daily exposure (i.e., 1-6 days), and daily exposure (i.e., 7 days) based on the number of days exposed to second-hand smoke in the past 7 days. Multivariable logistic regression and meta-analyses were conducted to assess the associations. Results: The analyzed sample consisted of 88,209 adolescents aged 12-15 years who never smoked. The overall prevalence of non-daily and daily SHS was 34.2% and 15.7%, respectively. After adjustment for potential confounders, compared with no SHS, there was no significant association between non-daily SHS and obesity (OR=0.94; 95%CI=0.86-1.02) but adolescents who reported daily SHS were significantly more likely to have obesity (OR=1.19; 95%CI=1.06-1.34). Conclusions: The prevalence of SHS was high among adolescents in LMICs and daily SHS was associated with a significant increase in odds of obesity. Future studies with longitudinal designs are warranted to assess causality and whether prevention of SHS can reduce risk of obesity in adolescence

Associations between mental and oral health in Spain: a cross-sectional study of more than 23,000 people aged 15 years and over

Background: This study aimed to investigate associations between mental health and several parameters of oral health, controlling for a variety of important covariates, in a large representative sample of Spanish people. Methods: Data from the Spanish National Health Survey 2017 were analysed. Mental (i.e., depression, chronic anxiety, other psychiatric disorders) and oral health (i.e., dental caries, dental extraction, dental filling, gingival bleeding, tooth movement, dental material, missing tooth) were evaluated. Control variables included sex, age, marital status, education, smoking, alcohol consumption, and physical multimorbidity. Associations between psychiatric conditions (independent variables) and the number of poor oral health outcomes (dependent variable) were assessed using Poisson regression models. The associations were investigated in the overall population, in married participants and in those who were single/widowed/divorced/separated. Results: There were 23,089 participants [54.1% women; mean (standard deviation) age 53.4 (18.9) years]. The prevalence of at least one psychiatric condition was 15.4% in the overall sample, while the mean (standard deviation) number of poor oral health outcomes was 2.9 (1.4). There was a positive association between any psychiatric condition and the number of poor oral health outcomes [incidence rate ratio (IRR)=1.10; 95% confidence interval: 1.07-1.12], and there was a significant interaction between any psychiatric condition and marital status. The association was stronger in those participants who were single/widowed/divorced/separated. Limitations: Cross-sectional study. Oral and mental health were assessed with Yes/No questions. Exposure, outcome and covariates were self-reported. Conclusions: Those with poor mental health have worse oral health but being married has some protective benefits

Handgrip strength is associated with hippocampal volume and white matter hyperintensities in major depression and healthy controls: a U.K. Biobank study

Objectives: Emerging evidence suggests that handgrip strength (a proxy for muscular fitness) is associated with better cognitive performance in people with major depressive disorder (MDD). The underlying processes are unclear, although hippocampal volume (HCV) reductions and white matter hyperintensities (WMHs) have been implicated. Therefore, we investigated the associations between maximal handgrip strength and volume of various brain regions and WMHs in MDD and healthy controls (HCs). Methods: We conducted cross-sectional analysis of handgrip strength and neuroimaging data from the U.K. Biobank. Generalised linear models assessed the relationship between grip strength and grey matter, white matter, total brain volume, left and right hippocampus volume and WMHs in MDD and HCs, adjusting for age, sex, education and bodyweight. Results: The final sample included 527 people with MDD (54.3 years, 37.2% male) and 1764 HCs (56.6 years, 53% male). In MDD, stronger handgrip was significantly associated with increased left (Coefficient±S.E= 109.5±27.4) and right (76.6±30.2) HCV. In HCs, only right HCV related to handgrip strength (44.8±17.9). Interaction analyses found stronger associations between grip strength and HCV in MDD compared to HCs, for both hippocampal regions. Stronger handgrip was associated with reduced WMHs in people with MDD (-839.0±277.6) and HCs (-394.1±175.5). Maximal handgrip strength was not associated with grey matter, white matter or total brain volumes in either group. Conclusions: Stronger grip strength is associated with greater left and right HCV and reduced WMHs in MDD. Future research should investigate directionality and consider if interventions targeting strength/muscular fitness can improve brain health and reduce the neurocognitive abnormalities associated with MDD

Physical multimorbidity and wish to die among adults aged ≥65 years: a cross-sectional analysis of the Irish Longitudinal Study on Ageing

Background- Physical multimorbidity (i.e., ≥2 chronic conditions) may induce feelings of wish to die (WTD), but there is limited literature on this topic, while the mediators in this association are largely unknown. Thus, the aim of the present study was to investigate this association and its mediators among older Irish adults. Methods- Cross-sectional, nationally representative data from Wave 1 of the Irish Longitudinal Study on Ageing 2009–2011 were analyzed. Information on self-reported lifetime diagnosis of 14 chronic physical conditions were obtained. WTD was defined as answering affirmatively to the question “In the last month, have you felt that you would rather be dead?” Multivariable logistic regression and mediation analyses were conducted. Results- Data on 2941 adults aged ≥65 years [mean (SD) age 73.2 (5.2) years; 45.0 % males] were analyzed. Physical multimorbidity was associated with 3.39 (95%CI 1.58, 7.28) times higher odds for WTD. This association was largely explained by pain (% mediated 28.1 %), followed by depression (19.4 %), sleep problems (18.4 %), perceived stress (13.0 %), loneliness (10.4 %), anxiety (8.1 %), and disability (7.2 %). Conclusions- Multimorbidity was associated with increased odds for WTD among Irish older adults. Addressing the identified mediators may contribute to reducing feelings of WTD among older adults with multimorbidity

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<div> <div> <div> <p>Differences in lipid variables between normal volunteers (NV) and participants with mild cognitive impairment (MCI) and Alzheimers’s disease (AD). </p> </div> </div> </div