Community engagement and dementia risk: time-to-event analyses from a national cohort study

Background There is increasing interest in the potential health benefits of referring older adults to engage in community leisure activities (’social prescribing’) to help promote healthy cognitive ageing. However, it remains unclear whether beneficial effects of community engagement are independent of the wellknown protective effects of broader structural, functional and subjective social factors. Methods We analysed data from 9550 adults aged 50+ fromthe English Longitudinal Study of Ageing, with baseline from 2004 to 2005. We assessed associations between different types of community engagement and dementia incidence over a 12-year period. Specifically, we used Cox proportional hazards models, competing risk regressions models, and modified Fine and Gray subdistribution hazards models while controlling for all identified demographic, health-related, and social covariates. Results Community cultural engagement (eg, visiting museums, galleries, the theatre) was associated with a lower hazard of developing dementia in older age independent of demographic, health-related and a broad range of social factors, using all three statistical approaches (fully adjusted Cox models: HR 0.58, 95%CI 0.41 to 0.80). Community group engagement (eg, attending clubs or societies) was only associated with dementia prior to adjustment for social factors. Results were robust to sensitivity analyses considering reverse causality, over-adjustment and baseline cognitive function. Conclusion It is not just social factors that are associated with reduced risk of dementia onset, but community engagement may also be protective, particularly when relating to cultural activities. These findings are of relevance when considering the current interest in social prescribing to support healthy ageing

Systemic inflammation and emotional responses during the COVID-19 pandemic

The impact of the COVID-19 pandemic on population mental health is of global concern. Inflammatory processes are thought to contribute to mental ill-health, but their role in experiences of psychological distress during the pandemic has not been investigated. We tested the hypothesis that elevated inflammatory biomarkers (high-sensitivity plasma C-reactive protein [CRP] and plasma fibrinogen) measured pre-pandemic would be positively predictive of increased depressive symptoms experienced during the pandemic. Data were analysed from the English Longitudinal Study of Ageing (ELSA), with 3574 individuals aged >50 for CRP and 3314 for fibrinogen measured in waves 8 (2016/17) or 9 (2018/19). Depressive symptoms were measured with a short version of the Centre for Epidemiological Studies Depression Scale (CES-D) pre-pandemic (2016-2019) and during the pandemic (June/July 2020). Participants with higher baseline CRP concentrations had 40% higher odds of developing depressive symptoms during the pandemic (ORadjusted = 1.40, 95% CI 1.12-1.73, p = 0.003) after full adjustment. Fibrinogen concentrations were also associated with depressive symptoms during the pandemic (ORadjusted = 1.23, 95% CI 1.04-1.46, p = 0.019), but this association was no longer significant after controlling for lifestyle factors (smoking status, alcohol consumption and physical activity). In this large population study, systemic inflammation measured 1-3 years pre-pandemic was associated with greater depressed mood during the early months of the pandemic. This finding is consistent with the hypothesis that higher levels of inflammation increase the vulnerability of older people to impaired mental health in the presence of the widespread stress of the COVID-19 pandemic

Higher risk of dementia in English older individuals who are overweight or obese

Background: Several risk factors contribute to dementia, but the role of obesity remains unclear. This study investigated whether increased body weight or central obesity were associated with a higher risk of developing dementia in a representative sample of older English adults. / Methods: We studied 6582 participants from the English Longitudinal Study of Ageing (ELSA) who were aged ≥50 years and were dementia-free at baseline, that being either wave 1 (2002–2003) for study members who started at wave 1, or at either wave 2 (2004–2005) or 4 (2008–2009) for those who began the study as refreshment samples. Body mass index (BMI) was measured at baseline and categorized into normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). Central obesity was defined as a waist circumference (WC) >88 cm for women and >102 cm for men. Cumulative incidence of dementia was ascertained based on physician-diagnosed dementia, an overall score >3.38 on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Hospital Episodes Statistics (HES) data at every ELSA wave from baseline until wave 8 (2016–2017). Cox proportional hazards models were used to assess the association between baseline BMI levels or abdominal obesity in relation to dementia incidence during the mean follow-up period of 11 years. / Results: From the overall sample, 6.9% (n = 453) of participants developed dementia during the follow-up period of maximum 15 years (2002–2017). Compared with participants with normal weight, those who were obese at baseline had an elevated risk of dementia incidence [hazard ratio (HR) = 1.34, 95% confidence interval (CI) 1.07–1.61] independent of sex, baseline age, apolipoprotein E-ε4 (APOE-ε4), education, physical activity, smoking and marital status. The relationship was slightly accentuated after additionally controlling for hypertension and diabetes (HR = 1.31, 95% CI 1.03–1.59). Women with central obesity had a 39% greater risk of dementia compared with non-central obese women (HR = 1.39, 95% CI 1.12–1.66). When compared with a normal BMI and WC group, the obese and high WC group had 28% (HR = 1.28, 95% CI 1.03–1.53) higher risk of dementia. / Conclusions: Our results suggest that having an increased body weight or abdominal obesity are associated with increased dementia incidence. These findings have significant implications for dementia prevention and overall public health

Bi-directional associations between religious attendance and mental health: findings from a British Birth Cohort study

Background: There is evidence that religious attendance is associated with positive outcomes for mental health; however, there are few longitudinal studies, and even fewer, which take into account the possibility of bi-directional associations. This study aimed to investigate bi-directional associations between religious attendance and mental health. Methods: Participants were 2125 study members who provided data at age 68–69 from the Medical Research Council National Survey of Health and Development (1946 British birth cohort study). Mental health was assessed using the 28-item General Health Questionnaire at ages 53, 60–64 and 68–69. Religious attendance was measured using a 4-point scale (weekly=3, monthly=2, less than monthly=1 or never=0) at ages 43, 60–64 and 68–69. Cross-lagged path analysis was used to assess reciprocal associations between mental health and religious attendance, adjusting for gender and education. Results: Previous religious attendance was strongly related to later attendance (r=0.62–0.74). Similarly, mental health at baseline was strongly associated with subsequent mental health scores (r=0.46–0.54). Poor mental health at age 53 and 60–64 was associated with more frequent religious attendance at age 60–64 (b=0.04; 95% CI: 0.02 to 0.06; p<0.05), and 68–69 (b=0.03; 95% CI: 0.02 to 0.06; p<0.05), respectively. There was no evidence that religious attendance at age 43, 60–64 or 68–69 was associated with later or concurrent mental health. Conclusion: Using birth cohort data from the UK, it was found that poor mental health was associated with later religious attendance but not vice versa. Future research should confirm these novel findings and explore the underlying mechanisms between religious attendance and mental health

Inductive Verification of Data Model Invariants for Web Applications ∗

Modern software applications store their data in remote cloud servers. Users interact with these applications using web browsers or thin clients running on mobile devices. A key issue in dependability of these applications is the correctness of the actions that update the data store, which are triggered by user requests. In this paper, we present techniques for automatically checking if the actions of an application preserve the data model invariants. Our approach first automatically data store, from a given application using instrumented execution. The abstract data store identifies the sets of objects and relations (associations) used by the application, and the actions that update the data store by deleting or creating objects or by changing the relations among the objects. We show that checking invariants of an abstract data store corresponds to inductive invariant verification, and can be done using a mapping to First Order Logic (FOL) and using a FOL theorem prover. We implemented this approach for the Rails framework and applied it to three open source applications. We found four previously unknown bugs and reported them to the developers, who confirmed and immediately fixed two of them