Publications by authors named "Lee Smith"

596 Publications

Relationship between chronic gingivitis and subsequent depression in 13,088 patients followed in general practices.

J Psychiatr Res 2021 Mar 31;138:103-106. Epub 2021 Mar 31.

Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549 Frankfurt am Main, Germany. Electronic address:

Goal: The aim of this study was to analyze the association between chronic gingivitis and subsequent depression in patients aged ≥14 years who were followed up in general practices in the UK.

Methods: This study included patients aged ≥14 years who had received an initial diagnosis of chronic gingivitis in one of 256 general practices in the United Kingdom between January 2000 and December 2016 (index date). Patients without chronic gingivitis were matched (1:1) to those with chronic gingivitis by sex, age, index year, treating physician, and Charlson Comorbidity Index (CCI). For patients without chronic gingivitis, the index date was a randomly selected visit date between 2000 and 2016. The association between chronic gingivitis and the incidence of depression was investigated using Kaplan-Meier curves and Cox regression analyses.

Results: This study included 6544 patients with chronic gingivitis and 6544 patients without chronic gingivitis [49.2% were women; mean (standard deviation) age 40.3 (19.1) years]. A total of 16.3% of individuals with chronic gingivitis and 8.8% of those without chronic gingivitis received an initial diagnosis of depression within 10 years of the index date (log-rank p-value<0.001). There was a positive and significant association between chronic gingivitis and depression in the overall sample [hazard ratio (HR) = 1.82, 95% confidence interval (CI) = 1.55-2.48]. These findings were corroborated in men and women and in all age groups with the exception of patients aged >65 years.

Conclusions: Our study demonstrated an association between chronic gingivitis and subsequent depression.
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http://dx.doi.org/10.1016/j.jpsychires.2021.03.059DOI Listing
March 2021

The clinical implications and importance of anemia in older women.

Acta Clin Belg 2021 Apr 7:1-7. Epub 2021 Apr 7.

Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey.

: The objective of this study was to investigate associations between anemia with geriatric syndromes and comprehensive geriatric assessment (CGA) parameters in older women.: 886 older outpatient women were included . Anemia was defined as a hemoglobin concentration below 12 g/dL. patients were divided into two groups as anemic and non-anemic. The relationships between anemia and CGA parameters/geriatric syndromes were determined.: The mean age of the participants was 76.00 ± 8.91. The prevalence of patients with anemia was 15.35%. There was a significant difference between anemic and non-anemic groups in terms of age, Charlson Comorbidity Index, body mass index, the number of drugs used, and the presence of chronic renal failure (p < 0.05). After adjustment for these covariates, anemia was associated with Timed Up and Go test (OR: 1.10, 95% CI: 1.02-1.18), muscle strength (OR: 0.99, 95% CI: 0.83-0.99), dynapenia (OR: 1.92, 95% CI: 1.06-3.47), Mini Nutritional Assessment scores (OR: 0.88, 95% CI: 0.83-0.94), poor nutritional status (OR: 1.97, 95% CI: 1.10-3.48), Fried scores (OR: 1.42, 95% CI: 1.24-1.68), frailty (OR: 2.58, 95% CI: 1.42-4.69), falls (OR: 1.78, 95% CI: 1.10-2.92) and polypharmacy (OR: 2.31, 95% CI: 1.38-3.86).: In the present study anemia was associated with frailty, polypharmacy, poor nutritional status, falls, and decreased muscle strength. Therefore, anemia may be a sign of poor health status in older women. When anemia is detected in an older woman, CGA should be strongly considered if not routinely performed.
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http://dx.doi.org/10.1080/17843286.2021.1913388DOI Listing
April 2021

Recommendations for improving dental care for dentate home-based older people: A qualitative New Zealand study.

Gerodontology 2021 Apr 4. Epub 2021 Apr 4.

Department of Oral Sciences/Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand.

Background And Objective: A small number of national studies have explored the barriers to older people accessing dental care; however, to date none have investigated older people's recommendations for overcoming these barriers.

Methods: Semi-structured interviews were conducted with 40 dentate older people (65 years and over) who resided in New Zealand's Otago region and received home-support. A joint inductive thematic analysis was undertaken, based on the constant comparative method.

Results: Recommendations for boosting community-dwelling older people's access to dental care included publicly funding or subsiding the cost of dental care for older people, aligning the pension with the real cost of living, and making the environment at Work and Income less hostile and the emergency dental grant more readily available, making dental clinics more accessible, initiating domiciliary dental care, having mobile dental clinics visit neighbourhoods with high proportions of older people, as well as subsidised transport to the dental clinic. Other suggestions were having GPs, pharmacists and social workers emphasise oral health during appointments, along with dental education campaigns.

Conclusion: In order to boost the rates of dental care access among older New Zealanders who receive home support, multiple structural changes are necessary, but these should primarily focus on reducing the cost and increasing accessibility.
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http://dx.doi.org/10.1111/ger.12553DOI Listing
April 2021

Food insecurity (hunger) and fast-food consumption among 180,164 adolescents aged 12-15 years from 68 countries.

Br J Nutr 2021 Apr 5:1-23. Epub 2021 Apr 5.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona08830, Spain.

Food insecurity has been shown to be associated with fast-food consumption. However, to date, studies on this specific topic are scarce. Therefore, the aim of the present study was to investigate the association between food insecurity and fast-food consumption in adolescents aged 12-15 years from 68 countries (7 low-income, 27 lower middle-income, 20 upper middle-income, 14 high-income countries). Cross-sectional, school-based data from the Global School-based Student Health Survey were analyzed. Data on past 30-day food insecurity (hunger) and fast-food consumption in the past 7 days were collected. Multivariable logistic regression and meta-analysis were conducted to assess associations. Models were adjusted for age, sex, and body mass index. There were 180,164 adolescents aged 12-15 years [mean (SD) age 13.8 (1.0) years; 50.8% boys] included in the analysis. Overall, severe food insecurity (i.e., hungry because there was not enough food in home most of the time or always) was associated with 1.17 (95%CI=1.08-1.26) times higher odds for fast-food consumption. The estimates pooled by country-income levels were significant in low-income countries (adjusted odds ratio [aOR]=1.30; 95%CI=1.05-1.60), lower middle-income countries (aOR=1.15; 95%CI=1.02-1.29), and upper middle-income countries (aOR=1.26; 95%CI=1.07-1.49), but not in high-income countries (aOR=1.04; 95%CI=0.88-1.23). The mere co-occurrence of food insecurity and fast-food consumption is of public health importance. To tackle this issue, a strong governmental and societal approach is required to utilize effective methods as demonstrated in some high-income countries such as the implementation of food banks and the adoption of free school meals.
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http://dx.doi.org/10.1017/S0007114521001173DOI Listing
April 2021

COVID-19 Confinement and Sexual Activity in Spain: A Cross-Sectional Study.

Int J Environ Res Public Health 2021 03 4;18(5). Epub 2021 Mar 4.

The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK.

Restrictions of free movement have been proven effective in tackling the spread of COVID-19 disease. However, sensitive populations submitted to longer periods of restrictions may experience detrimental effects in significant areas of their lifestyle, such as sexual activity. This study examines sexual activity during the COVID-19 confinement in Spain. A survey distributed through an institutional social media profile served to collect data, whereas chi-squared tests, -tests, analyses of variance, and multiple logistic regression analysis were used to assess differences among sample subgroups. A total of 71.3% adults (N = 536) (72.8% female) reported engaging in sexual activity with a weekly average of 2.39 times (SD = 1.80), with significant differences favoring males, middle age, married/in a domestic relationship ( < 0.001), employed ( < 0.005), medium-high annual household income, living outside the Iberian Peninsula, and smoking and alcohol consumption. Analyses adjusted for the complete set of control variables showed significant odds for a lower prevalence of weekly sexual activity in women (OR = 0.44, 95% CI 0.27-0.72). Interventions to promote sexual activity in confined Spanish adults may focus on groups with lower sexual activity.
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http://dx.doi.org/10.3390/ijerph18052559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967360PMC
March 2021

Active Travel and Mild Cognitive Impairment among Older Adults from Low- and Middle-Income Countries.

J Clin Med 2021 Mar 17;10(6). Epub 2021 Mar 17.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, C/Dr.Antoni Pujadas 42, Sant Boi de Llobregat, 08830 Barcelona, Spain.

Active travel may be an easily achievable form of physical activity for older people especially in low- and middle-income countries (LMICs), but there are currently no studies on how this form of physical activity is associated with a preclinical state of dementia known as mild cognitive impairment (MCI). Therefore, we aimed to investigate the association between active travel and MCI among adults aged ≥50 years from six LMICs. Cross-sectional, community-based data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Active travel (minutes/week) was assessed with questions of the Global Physical Activity Questionnaire (GPAQ) and presented in tertiles. Multivariable logistic regression analysis was conducted to assess the association between active travel and MCI. Data on 32715 people aged ≥50 years (mean age 62.4 years; 52.1% females) were analyzed. Compared to the highest tertile of active travel, the lowest tertile was associated with 1.33 (95%CI = 1.14-1.54) times higher odds for MCI overall. This association was particularly pronounced among those aged ≥65 years (OR = 1.70; 95%CI = 1.32-2.19) but active travel was not associated with MCI among those aged 50-64 years. In conclusion, low levels of active travel were associated with a significantly higher odds of MCI in adults aged ≥65 years in LMICs. Promoting active travel among people of this age group in LMICs via tailored interventions and/or country-wide infrastructure investment to provide a safe environment for active travel may lead to a reduction in MCI and subsequent dementia.
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http://dx.doi.org/10.3390/jcm10061243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002501PMC
March 2021

Increase in Regular Leisure-Time Physical Activity in Spanish Adults Between 1987 and 2017.

Am J Prev Med 2021 Mar 27. Epub 2021 Mar 27.

Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.

Introduction: The prevalence of leisure-time physical activity has increased in recent decades, but values differ significantly among countries. Owing to the improvement of living standards, a higher frequency of leisure-time physical activity is expected in Western countries such as Spain, but there is a lack of research involving large, representative samples during a prolonged temporal frame to confirm this tendency.

Methods: Individual representative data from the 1987, 1993, 1995, 1997, 2001, 2011, and 2017 rounds of the Spanish National Health Survey were used. Statistical analyses were conducted from April 9, 2020 to May 5, 2020.

Results: A total of 114,813 participants (aged 43.9 [SD=16.7] years, 51.8% women) were included in the study. Crude linear trends in regular monthly and weekly leisure-time physical activity were estimated together using linear regression models across the survey years, which also served to estimate the regression coefficients (β) and 95% CIs for every year change. All age groups experienced significantly increased prevalence of regular leisure-time physical activity-either several times a month or several times a week-over time (p<0.001 for trend). Participants aged 16-17 years had the highest increase in the annual prevalence of regular leisure-time physical activity (β=0.8, 95% CI=0.7, 1.0). Additional adjusted multivariable logistic regression confirmed these trends.

Conclusions: This study shows an increase in regular leisure-time physical activity among the adult Spanish population during the period from 1987 to 2017. Younger participants consistently presented higher prevalence levels than older participants.
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http://dx.doi.org/10.1016/j.amepre.2021.02.001DOI Listing
March 2021

Testosterone regulation on quiescin sulfhydryl oxidase 2 synthesis in the epididymis.

Reproduction 2021 Mar 1. Epub 2021 Mar 1.

P Tsai, Veterinary Medicine, National Taiwan University, Taipei, Taiwan.

The epididymis is an androgen-responsive organ, whose structure and functions are modulated by the coordination between androgen and epididymal cues. Highly-regulated molecular interaction within the epididymis is required to support viable sperm development necessary for subsequent fertilization. In the present study, we extended our earlier findings on a promising epididymal protein, quiescin sulfhydryl oxidase 2 (QSOX2), and demonstrated a positive correlation between testosterone and QSOX2 protein synthesis through use of loss- and restore-of-function animal models. Moreover, based on transcriptomic analyses and 2-dimensional culture system, we determined that an additional polarized effect of glutamate is indispensable for the regulatory action of testosterone on QSOX2 synthesis. In conclusion, we propose non-canonical testosterone signaling supports epididymal QSOX2 protein synthesis, providing a novel perspective on the regulation of sperm maturation within the epididymis.
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http://dx.doi.org/10.1530/REP-20-0629DOI Listing
March 2021

Objectively measured far vision impairment and sarcopenia among adults aged ≥ 65 years from six low- and middle-income countries.

Aging Clin Exp Res 2021 Mar 28. Epub 2021 Mar 28.

Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.

Background: There are currently no studies on visual impairment and sarcopenia. We investigated the cross-sectional association between objectively measured far vision impairment and sarcopenia in a nationally representative sample of older adults aged 65 years and over from six low- and middle-income countries (LMICs).

Methods: Cross-sectional, community-based data from the study on global ageing and adult health (SAGE) were analyzed. Far vision acuity was measured using the tumbling E LogMAR chart and classified as: no vision impairment (6/12 or better); mild vision impairment (6/18 or better but worse than 6/12); moderate vision impairment (6/60 or better but worse than 6/18); severe vision impairment (worse than 6/60). Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Associations were assessed with multivariable logistic regression.

Results: Fourteen thousand five hundred and eighty five individuals aged ≥ 65 years were included in the analysis [mean (SD) age 72.6 (11.5) years; 54.1% females]. After adjustment for multiple potential confounders, compared to those with no vision impairment, the OR (95% CI) for sarcopenia in those with mild, moderate, and severe vision impairment were 1.10 (0.87-1.40), 1.69 (1.25-2.27), and 3.38 (1.69-6.77), respectively. The estimates for females and males were similar.

Conclusions: The odds for sarcopenia increased with increasing severity of far vision impairment among older people in LMICs. The mere co-occurrence of these conditions is concerning, and it may be prudent to implement interventions to address/prevent sarcopenia in those with far vision impairment through the promotion of physical activity and appropriate nutrition.
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http://dx.doi.org/10.1007/s40520-021-01841-yDOI Listing
March 2021

The use of laryngeal mask airway for tonsillectomy and adenoidectomy.

Int J Pediatr Otorhinolaryngol 2021 Mar 20;144:110691. Epub 2021 Mar 20.

Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, NY, 11549, USA; Division of Pediatric Otolaryngology, Steven and Alexandra Cohen Children's Medical Center of New York, 430 Lakeville Road, New Hyde Park, NY, 11042, USA. Electronic address:

Purpose: Patients undergoing tonsillectomy and adenoidectomy traditionally receive anesthesia with endotracheal intubation (ETT) for airway management. The laryngeal mask airway (LMA) may be used instead and may be associated with less airway stimulation and shorter operating room times. The purpose of this study was to report on a large cohort of patients undergoing tonsillectomy and/or adenoidectomy while using the LMA for airway maintenance during anesthesia.

Methods: Patients undergoing tonsillectomy and adenoidectomy between January 6, 2017 and January 6, 2020 with a LMA were reviewed for safety outcomes. We compared two cohorts of patients with LMA and ETT to analyze the effect on operating room times.

Results: Our study identified 1042 patients who met criteria for review. The incidence of cases requiring conversion to ETT (1.2%) and laryngospasm (0.3%) in our cohort is lower than previously suggested by the literature. The patients who underwent surgery with the LMA spent less time in the operating room (p = 0.004) compared to the ETT group.

Conclusion: The use of the LMA may be a safe and effective option for airway management during tonsillectomy and adenoidectomy. There may be a benefit of OR time reduction in patients undergoing anesthesia with an LMA compared to ETT.
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http://dx.doi.org/10.1016/j.ijporl.2021.110691DOI Listing
March 2021

Physical activity and visual difficulties in 36 low- and middle-income countries.

Eye (Lond) 2021 Mar 25. Epub 2021 Mar 25.

ICREA, Pg. Lluis Companys 23, Barcelona, Spain.

Background: Data on the association between visual difficulty and physical activity (PA) from low- and middle-income countries (LMICs) are scarce. Thus, the aim of the study was to investigate the association between visual difficulty and PA among adults from 36 LMICs, and to assess the mediators in this association.

Methods: Cross-sectional, community-based, predominantly nationally representative data from the World Health Survey were analysed. The final sample included 199,110 individuals aged ≥18 years [mean (SD) age 38.6 (16.1) years; 49.4% males]. Visual difficulty referred to having severe/extreme difficulties in seeing and recognizing a person that the participant knows across the road. Low PA was defined as not complying with PA recommendations of 150 min of moderate-vigorous PA per week. Multivariable logistic regression, meta-analysis, and mediation analysis were conducted to assess associations.

Results: Meta-analysis based on country-wise multivariable logistic regression analysis showed that overall, visual difficulty is associated with a 1.53 (95% CI = 1.38-1.71) times higher odds for low PA. Particularly strong associations were observed in males (OR = 1.72; 95% CI = 1.45-2.05) and adults aged ≥65 years (OR = 1.95; 95% CI = 1.67-2.29). Interpersonal activities, cognition, and sleep/energy explained >10% of the association between visual difficulty and low PA.

Conclusions: In conclusion, we found evidence that especially in the case of males and older adults with visual difficulties in LMICs, there were low levels of engagement with PA. Addressing issues such as interpersonal activities, cognition, and sleep/energy in people with visual difficulties may increase levels of PA.
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http://dx.doi.org/10.1038/s41433-021-01439-8DOI Listing
March 2021

Cardiorespiratory fitness in adolescents before and after the COVID-19 confinement: a prospective cohort study.

Eur J Pediatr 2021 Mar 17. Epub 2021 Mar 17.

Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, UK.

Long periods of free-movement restrictions may negatively affect cardiorespiratory fitness and health. The present study investigated changes after the COVID-19 confinement in maximal oxygen intake (VO max) levels in a sample of 89 Spanish school children aged 12 and 14 years at baseline (49.8% girls). The 20-m shuttle run test served to estimate VO max before and after the COVID-19 confinement. Paired t-tests estimated an overall difference of - 0.5 ml.kg.min (SD 0.3) (p = 0.12), whereas the highest significant reductions were observed for girls aged 14 years (- 1.5 ml.kg.min (SD 0.6) (p < 0.05)). Boys aged 14 years showed a slight increase (0.4 ml.kg.min (SD 0.5) (p = 0.44)), whereas boys aged 12 years presented an important decrease (- 1.2 ml.kg.min (SD 0.7) (p = 0.14)). Healthy Fitness Zone (HFZ) levels also experienced a decrease of - 3.4% as regards baseline levels over the examined period. All the examined subgroups showed lower levels in relation to a normal VO max rate development, although girls aged 14 and boys aged 12 years accounted for the highest part.Conclusion: The results indicate that COVID-19 confinement might delay the normal development of VO max in adolescents. Strategies to tackle this concerning decline are warranted. What is Known: • First study analyzing cardiorespiratory fitness levels in teenagers after COVID-19 confinement. What is New: • Important delay in maximal oxygen intake identified in a sample of Spanish teenagers. • These results should be considered to develop strategies of a more active lifestyle in teenagers during and after confinements.
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http://dx.doi.org/10.1007/s00431-021-04029-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968551PMC
March 2021

Metformin and health outcomes: An umbrella review of systematic reviews with meta-analyses.

Eur J Clin Invest 2021 Mar 11:e13536. Epub 2021 Mar 11.

Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.

Background: The objective was to capture the breadth of outcomes that have been associated with metformin use and to systematically assess the quality, strength and credibility of these associations using the umbrella review methodology.

Methods: Four major databases were searched until 31 May 2020. Meta-analyses of observational studies and meta-analyses of randomized controlled trials (RCTs) (including active and placebo control arms) were included.

Results: From 175 eligible publications, we identified 427 different meta-analyses, including 167 meta-analyses of observational studies, 147 meta-analyses of RCTs for metformin vs placebo/no treatment and 113 meta-analyses of RCTs for metformin vs active medications. There was no association classified as convincing or highly suggestive from meta-analyses of observational studies, but some suggestive/weak associations of metformin use with a lower mortality risk of CVD and cancer. In meta-analyses of RCTs, metformin was associated with a lower incidence of diabetes in people with prediabetes or no diabetes at baseline; lower ovarian hyperstimulation syndrome incidence (in women in controlled ovarian stimulation); higher success for clinical pregnancy rate in poly-cystic ovary syndrome (PCOS); and significant reduction in body mass index in people with type 1 diabetes mellitus, in women who have obesity/overweight with PCOS and in obese/overweight women. Of 175 publications, 166 scored as low or critically low quality per AMSTAR 2 criteria.

Conclusions: Observational evidence on metformin seems largely unreliable. Randomized evidence shows benefits for preventing diabetes and in some gynaecological and obstetrical settings. However, almost all meta-analyses are of low or critically low quality according to AMSTAR 2 criteria.
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http://dx.doi.org/10.1111/eci.13536DOI Listing
March 2021

Visual, hearing, and dual sensory impairment are associated with higher depression and anxiety in women.

Int J Geriatr Psychiatry 2021 Mar 10. Epub 2021 Mar 10.

Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, UK.

Objective: We investigated cross-sectional gender-specific associations with vision, hearing, and both (dual) impairment with depression and chronic anxiety using a large representative sample of Spanish adults.

Methods: The present study utilized data from the Spanish National Health Survey 2017. A total of 23,089 adults (15-103 years, 45.9% men) participated in this survey. Participants self-reported whether they had suffered depression and/or anxiety, and also whether they experience vision, hearing and both vision/hearing (dual) impairment. Multivariable logistic regression analyses were conducted to assess the associations between the three types of sensory impairment and anxiety or depression, in men and women.

Results: Across the whole sample (n = 23,089) the prevalence of depression and anxiety was between 2.00 and 2.56 times higher in women compared to men. Dual sensory impairment (hearing and vision) was associated with higher levels of depression (odds ratio [OR] = 2.980, 95% confidence interval [CI]: 2.170-4.091) and anxiety (OR = 2.636, 95% CI: 1.902-3.653) compared to single sensory impairment. Stratified associations by gender showed higher odd ratios for women with dual sensory loss (3.488 for depression and 3.478 for anxiety) compared to men (2.773 for depression and 1.803 for anxiety).

Conclusions: Dual sensory impairment (hearing and seeing) is are associated with increased depression and anxiety. Women with dual sensory impairment showed stronger associations compared to men among adults in Spain. Interventions are needed to address vision and/or hearing impairment in order to reduce anxiety and depression especially in women.
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http://dx.doi.org/10.1002/gps.5534DOI Listing
March 2021

Association between food insecurity and depression among older adults from low- and middle-income countries.

Depress Anxiety 2021 Apr 9;38(4):439-446. Epub 2021 Mar 9.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain.

Background: To examine the association between self-reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa).

Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self-reported past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations.

Results: In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta-analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82-3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65-3.57) times higher odds for depression.

Conclusions: In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food-insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted.
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http://dx.doi.org/10.1002/da.23147DOI Listing
April 2021

The Effect of Chair-Based Exercise on Physical Function in Older Adults: A Systematic Review and Meta-Analysis.

Int J Environ Res Public Health 2021 02 16;18(4). Epub 2021 Feb 16.

Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey BT37 0QB, UK.

Physical activity is an important determinant of health in later life. The public health restrictions in response to COVID-19 have interrupted habitual physical activity behaviours in older adults. In response, numerous exercise programmes have been developed for older adults, many involving chair-based exercise. The aim of this systematic review was to synthesise the effects of chair-based exercise on the health of older adults. Ovid Medline, EMBASE, CINAHL, AMED, PyscInfo and SPORTDiscus databases were searched from inception to 1 April 2020. Chair-based exercise programmes in adults ≥50 years, lasting for at least 2 weeks and measuring the impact on physical function were included. Risk of bias of included studies were assessed using Cochrane risk of bias tool v2. Intervention content was described using TiDieR Criteria. Where sufficient studies (≥3 studies) reported data on an outcome, a random effects meta-analysis was performed. In total, 25 studies were included, with 19 studies in the meta-analyses. Seventeen studies had a low risk of bias and five had a high risk of bias. In this systematic review including 1388 participants, results demonstrated that chair-based exercise programmes improve upper extremity (handgrip strength: MD = 2.10; 95% CI = 0.76, 3.43 and 30 s arm curl test: MD = 2.82; 95% CI = 1.34, 4.31) and lower extremity function (30 s chair stand: MD 2.25; 95% CI = 0.64, 3.86). The findings suggest that chair-based exercises are effective and should be promoted as simple and easily implemented activities to maintain and develop strength for older adults.
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http://dx.doi.org/10.3390/ijerph18041902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920319PMC
February 2021

Changes in dietary fat intake and associations with mental health in a UK public sample during the COVID-19 pandemic.

J Public Health (Oxf) 2021 Mar 1. Epub 2021 Mar 1.

Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, BT37 0QB, UK.

Background: Consumption of unhealthy foods may have changed during the COVID-19 pandemic. This study explored how dietary fat intake was impacted in a sample of the UK public who were social distancing during the COVID-19 pandemic.

Methods: Data were collected from a UK COVID-19 online survey. Fat intake was measured using the Dietary Instrument for Nutrition Education questionnaire. Anxiety and depressive symptoms were assessed using Becks' Anxiety and Depression Inventories, while the short-form Warwick-Edinburgh Mental Well-being Scale assessed mental well-being. Differences between individuals who increased versus decreased fat intake were explored using chi-square or independent sample t-tests. Association between fat intake and mental health was explored using adjusted linear regression models.

Results: Eight hundred and eighty-seven adults were included. Approximately, 34% recorded medium-to-high levels of fat consumption during social distancing. Around 48% reported decreased fat intake during social distancing compared to usual levels, while 41.3% documented increased fat intake. Fat intake was not significantly associated (P > 0.05) with any measures of mental health.

Conclusions: A higher proportion of a sample of UK adults social distancing during the COVID-19 pandemic recorded decreased fat intake when compared to levels prior to social distancing. There appeared to be no associations between fat intake and mental health.
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http://dx.doi.org/10.1093/pubmed/fdab009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989334PMC
March 2021

The association between objective vision impairment and mild cognitive impairment among older adults in low- and middle-income countries.

Aging Clin Exp Res 2021 Mar 4. Epub 2021 Mar 4.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830, Barcelona, Spain.

Aim: The association between visual impairment and mild cognitive impairment (MCI) has not been investigated to date. Thus, we assessed this association among older adults from six low- and middle-income countries (LMICs) (China, India, Ghana, Mexico, Russia, and South Africa) using nationally representative datasets.

Methods: Cross-sectional, community-based data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Visual acuity was measured using the tumbling ElogMAR chart, and vision impairment (at distance and near) was defined as visual acuity worse than 6/18 (0.48 logMAR) in the better-seeing eye. The definition of MCI was based on the National Institute on Aging-Alzheimer's Association criteria. Multivariable logistic regression was conducted.

Results: Data on 32,715 individuals aged ≥ 50 years [mean (SD) age 62.1 (15.6) years; 51.2% females] were analyzed. Compared to those without far or near vision impairment, those with near vision impairment but not far vision impairment (OR = 1.33; 95% CI = 1.16-1.52), and those with both far and near vision impairment (OR = 1.70; 95% CI = 1.27-2.29) had significantly higher odds for MCI. Only having far vision impairment was not significantly associated with MCI.

Conclusions: Visual impairment is associated with increased odds for MCI among older adults in LMICs with the exception of far vision impairment only. Future longitudinal and intervention studies should examine causality and whether improvements in visual acuity, or early intervention, can reduce risk for MCI and ultimately, dementia.
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http://dx.doi.org/10.1007/s40520-021-01814-1DOI Listing
March 2021

Efficacy and safety of peroral endoscopic myotomy in the management of recurrent achalasia after failed Heller myotomy: a systematic review and meta-analysis.

Ann Gastroenterol 2021 7;34(2):155-163. Epub 2020 Dec 7.

Division of Gastroenterology, University of Utah, Salt Lake City, UT (Stephanie McDonough, Douglas G. Adler).

Background: Heller myotomy (HM) is an established treatment for achalasia but can fail in up to 10-20% of patients. Peroral endoscopic myotomy (POEM) may be an appropriate treatment for patients with failed HM.

Methods: We searched several databases to identify non-comparative studies evaluating the efficacy and/or safety of POEM after failed HM and comparative studies comparing the efficacy and/or safety of POEM in patients with and without prior HM. Outcomes assessed included clinical success, technical success, adverse events, post-treatment gastroesophageal reflux disease (GERD), and presence of esophagitis on endoscopy. We calculated weighted pooled rates with 95% confidence intervals (CI) for all outcomes in patients undergoing POEM with prior HM. We calculated pooled odds ratios with 95%CI to compare the outcomes between patients with and without previous HM who underwent POEM.

Results: We included 11 observational studies with 1205 patients. Weighted pooled rates (95%CI) for overall clinical success and technical success in patients with failed HM were 87% (81-91%) and 97% (94-99%), respectively. Weighted pooled rates (95%CI) for major adverse events, new-onset GERD and presence of esophagitis on endoscopy were 5% (2-10%), 33% (26-41%), and 38% (22-58%), respectively. There were no differences in clinical success, adverse events, post-treatment GERD and esophagitis between patients with and without previous HM.

Conclusions: POEM is safe and effective in patients with failed HM and should be considered in patients with recurrent achalasia after HM. Outcomes of POEM are comparable in patients with and without prior HM.
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http://dx.doi.org/10.20524/aog.2020.0563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903572PMC
December 2020

Changes in body dysmorphic disorder, eating disorder, and exercise addiction symptomology during the COVID-19 pandemic: A longitudinal study of 319 health club users.

Psychiatry Res 2021 04 23;298:113831. Epub 2021 Feb 23.

Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, CB1 1PT, England.

The aim of this longitudinal study was to examine the effect of COVID-19 quarantines on morbid exercise, eating, and body image behaviours pre vs post COVID-19 lockdown. Participants (n=319; mean age 36.77 SD=11.75; 84% female) were recruited to complete a battery of questions with 14 month follow-up. Exercise addiction scores were significantly lower post-lockdown; eating disorder symptomology scores were significantly higher post-COVID-19 lockdown; and leisure-time exercise significantly increased post-COVID-19 lockdown. No differences in body dysmorphic disorder were found. If future lockdowns are enforced, practitioners working with people with suspected morbid eating habits should monitor this closely.
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http://dx.doi.org/10.1016/j.psychres.2021.113831DOI Listing
April 2021

Is loneliness associated with mild cognitive impairment in low- and middle-income countries?

Int J Geriatr Psychiatry 2021 Feb 19. Epub 2021 Feb 19.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain.

Background: Loneliness may be a risk factor for mild cognitive impairment but studies on this topic are scarce, particularly from low- and middle-income countries (LMICs). Therefore, the aim of the present study was to investigate the association between loneliness and mild cognitive impairment (MCI) in six LMICs (China, Ghana, India, Mexico, Russia and South Africa).

Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations.

Results: The final analytical sample consisted of 19,092 and 13,623 individuals aged 50-64 years (middle-aged adults) and ≥65 years (older adults), respectively. Among the middle-aged, overall, loneliness was associated with a non-significant 1.43 (95% confidence interval [CI] = 0.93-2.21) times higher odds for MCI although significant associations were observed in China (OR = 1.51; 95%CI = 1.08-2.09) and South Africa (OR = 3.87; 95%CI = 1.72-8.71). As for older adults, overall, there was a significant association between loneliness and MCI (OR = 1.52; 95%CI = 1.12-2.07).

Conclusion: In this large representative sample of middle-aged and older adults from multiple LMICs, findings suggest that loneliness is associated with MCI. It may be prudent to consider reducing loneliness in low-economic settings to aid in the prevention of MCI and ultimately dementia.
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http://dx.doi.org/10.1002/gps.5524DOI Listing
February 2021

Assocıatıons between mıld hyponatremıa and gerıatrıc syndromes ın outpatıent settıngs.

Int Urol Nephrol 2021 Feb 18. Epub 2021 Feb 18.

Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakıf University, Adnan Menderes Bulvarı (Vatan Street), Fatih, 34093, Istanbul, Turkey.

Purpose: The impact of mild hyponatremia on geriatric syndromes is not clear. Our aim was to determine associations between mild hyponatremia and results of comprehensive geriatric assessment tools in outpatient settings.

Methods: We reviewed medical records of 1255 consecutive outpatient elderly subjects and compared results of comprehensive geriatric assessment measures among patients with mild hyponatremia (serum Na 130-135 mEq/L) versus normonatremia (serum Na 136-145 mEq/L). The comprehensive geriatric assessment measures included the Basic and Instrumental Activities of Daily Living, Mini Mental State Examination, Geriatric Depression Score, Tinetti Mobility Test, the Timed Up&Go Test, the Mini Nutritional Assessment, the handgrip test, the Insomnia Severity Index, polypharmacy, recurrent falls, urinary incontinence, orthostatic hypotension, and nocturia.

Results: Of the 1255 patients, 855 were female (68.1%), and the mean age was 73.7 ± 8.3 years. Mild hyponatremia was detected in 108 patients (8.6%). The median serum sodium was 140.5 [interquartile range (IQR) 138.4-141.8] versus 133.8 [IQR, 132.3-134.2] in normonatremia and mild hyponatremia groups, respectively (p < 0.001). The only significant difference for comorbidities between normonatremia and mild hyponatremia groups was the frequency of hypertension (66.9% versus 76.7%, respectively (p = 0.041). None of the comprehensive geriatric assessment tools conferred a significant association with mild hyponatremia. Of the 1061 subjects with available survival data, 96 (9.0%) deceased within 3-4 years of follow-up (p = 0.742). Hyponatremia as an independent variable did not have a significant effect on mortality in univariate logistic regression analysis (OR 1.13, 95% CI 0.55-2.33, p = 0.742).

Conclusion: Mild hyponatremia does not apparently affect results of geriatric assessments significantly. Whether particular causes of hyponatremia may have different impacts should be tested in further studies.
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http://dx.doi.org/10.1007/s11255-021-02789-8DOI Listing
February 2021

Association between cardiorespiratory fitness and depressive symptoms in children and adolescents: A systematic review and meta-analysis.

J Affect Disord 2021 Mar 15;282:1234-1240. Epub 2021 Jan 15.

INISA, Federal University of Mato Grosso do Sul, Campo Grande, Brazil. Electronic address:

Background Higher cardiorespiratory fitness (CRF) is associated with lower depressive symptoms in adults. However, no systematic review with meta-analysis assessed the cross-sectional associations between CRF and depressive symptoms in children and adolescents. Therefore, this meta-analysis assessed the relationship between CRF and depressive symptom in these populations. Methods Cross-sectional data evaluating the correlation between CRF and depression were searched, from database inception through 21/05/2020, on PubMed, PsycINFO, Web of Science, and SPORTDiscus. Age, sex, CRF and depression assessments, and correlations were extracted. A random-effects meta-analysis was conducted, and the potential sources of heterogeneity were also explored through meta-regression analysis. Results Across 14 effects of 11 unique studies, including a total of 7,095 participants (median age=12.49) with nearly equal sex distribution (median=53% females), it was found that higher CRF was associated with lower depressive symptoms in children and adolescents (r =-0.174, 95%CI -0.221 to -0.126, p<0.001, I=75.09, Q value=52.19). No moderators were identified. Conclusion Available evidence supports the notion that higher CRF is inversely associated with depressive symptoms in children and adolescents. Physical activity and exercise interventions targeting improving CRF should be promoted for these populations. Further studies, including clinical populations, should be conducted to assess objective measures of aerobic fitness and body composition, while controlling for puberty status, to better characterize this association.
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http://dx.doi.org/10.1016/j.jad.2021.01.032DOI Listing
March 2021

Differences in health status, health behaviour and healthcare utilisation between Immigrant and native homeless people in Spain: An exploratory study.

Health Soc Care Community 2021 Feb 15. Epub 2021 Feb 15.

Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.

Few studies have examined the differences between immigrant and native-born homeless populations. Our aim was to conduct an exploratory study to examine the differences in health status, health behaviour and healthcare utilisation in a sample of Spanish immigrant and native homeless people. Study was conducted in eight different temporary accommodations in the Valencia region in August 2018. Overall, 86 participants were included in the analysis who answered questionnaires concerning socio-demographic characteristics, immigration status, health status and behaviour, healthcare utilisation and experienced discrimination in healthcare and health literacy. In total, 76.7% were men with a mean age of 41.91 (14.17) years, with 60.4% having immigration background with an average of 4.8 (4.2) years since arrival in Spain. No differences were found in the subjective health status, however, native homeless participants reported significantly higher prevalence of heart disease (87.5% vs. 12.5%), hypertension (84.6% vs. 15.4%), psychological illness (63.6% vs. 36.4%) and were also more often smokers (73.5% vs. 28.8%), reported smoking more cigarettes per day (12.0 vs. 7.4) and were more often illegal drug users (17.6% vs. 2.0%). Immigrant participants were significantly more often not insured, reported more problems in healthcare access and had lower rates of visits to general practitioners and less hospital admissions. Differences were also observed in social status with the native homeless more often reporting receiving income, and living in less crowded accommodations. Our results show a variety of issues that the immigrant homeless population in Spain is confronted with that also prevents adequate social inclusion and achieving good health. However, the immigrant population engaged less often in risky health behaviour. More, and continuous, monitoring of social, mental and physical health of the homeless population is necessary. Public health interventions aiming at health promotion in the immigrant homeless populations need to focus on increasing overall social integration.
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http://dx.doi.org/10.1111/hsc.13313DOI Listing
February 2021

Androgen Receptor Is Dispensable for X-Zone Regression in the Female Adrenal but Regulates Post-Partum Corticosterone Levels and Protects Cortex Integrity.

Front Endocrinol (Lausanne) 2020 21;11:599869. Epub 2021 Jan 21.

MRC Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom.

Adrenal androgens are fundamental mediators of ovarian folliculogenesis, embryonic implantation, and breast development. Although adrenal androgen function in target tissues are well characterized, there is little research covering the role of androgen-signaling within the adrenal itself. Adrenal glands express AR which is essential for the regression of the X-zone in male mice. Female mice also undergo X-zone regression during their first pregnancy, however whether this is also controlled by AR signaling is unknown. To understand the role of the androgen receptor (AR) in the female adrenal, we utilized a -Cre to specifically ablate AR from the mouse adrenal cortex. Results show that AR-signaling is dispensable for adrenal gland development in females, and for X-zone regression during pregnancy, but is required to suppress elevation of corticosterone levels post-partum. Additionally, following disruption to adrenal AR, aberrant spindle cell development is observed in young adult females. These results demonstrate sexually dimorphic regulation of the adrenal X-zone by AR and point to dysfunctional adrenal androgen signaling as a possible mechanism in the early development of adrenal spindle cell hyperplasia.
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http://dx.doi.org/10.3389/fendo.2020.599869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873917PMC
January 2021

Female Genital Mutilation in Sudan: is a new era starting?

Sex Cult 2021 Feb 8:1-6. Epub 2021 Feb 8.

The Cambridge Centre for Sport & Exercise Sciences, Anglia Ruskin University, Cambridge, UK.

The World Health Organisation (WHO) defines female genital mutilation or cutting (FGM/C) as a violation of human rights and includes all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons. Sudan has one of the highest rates of FGM/C in the world with 86.6% girls and women aged between 15-49 years affected. Although FGM/C is still widely practiced across all of Sudan, social attitudes and norms towards the practice are changing, especially in urban areas. On 22 April 2020, the transitional Sudanese government criminalised FGM/C in Sudan when the Sovereign and Ministerial Councils endorsed the amendment to Criminal Law Article 141. Sudan is beginning a new era in terms of FGM/C. In order to achieve effective and long-lasting effects, efficient mechanisms, specifically allocated financial resources, and broader partnerships that include governmental bodies, civil society, community-based organisations, and international actors, must be put in place.
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http://dx.doi.org/10.1007/s12119-021-09823-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868303PMC
February 2021

Physical activity behavior in people with asthma and COPD overlap residing in Spain: a cross-sectional analysis.

J Asthma 2021 Mar 1:1-9. Epub 2021 Mar 1.

Faculty of Sports Sciences, University of Murcia, Murcia, Spain.

Objectives: To identify levels of physical activity (PA) among the Spanish population with asthma and chronic obstructive pulmonary disease overlap (ACO). A further aim was to analyze differences in PA levels by sex, age, education, marital status, cohabiting, smoking habits, alcohol consumption and body mass index (BMI).

Methods: In this cross sectional study, data from the Spanish National Health Survey 2017 were analyzed. A total of 198 people with ACO aged 15-69 years were included in the analyses. The short version of the international physical activity questionnaire (IPAQ) was used to measure total PA (MET·min/week). PA was further classified as low, moderate and high, and analyzed according to sample characteristics. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis H test and chi squared test. Statistical significance was set at  < 0.05.

Results: People with ACO engaged in a mean volume of 2038.1 MET·min/week. Those aged 30-60 years and those with normal weight were significantly more active than those aged ≥60 and those with obesity. When classifying PA level in low, moderate and high, results showed no significant differences between sample characteristics. Overall, moderate and high levels of PA were the most and least frequent levels (48.0% and 16.2%, respectively).

Conclusions: More than three out of ten Spanish adults with ACO do not achieve PA recommendations. Therefore, it is recommended to implement programs that promote the importance and benefits of PA among the Spanish population with ACO, and such programs should focus on older adults and those who are obese.
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http://dx.doi.org/10.1080/02770903.2021.1888977DOI Listing
March 2021

Sperm proteins and cancer-testis antigens are released by the seminiferous tubules in mice and men.

FASEB J 2021 Mar;35(3):e21397

Hudson Institute of Medical Research, Clayton, VIC, Australia.

Sperm develop from puberty in the seminiferous tubules, inside the blood-testis barrier to prevent their recognition as "non-self" by the immune system, and it is widely assumed that human sperm-specific proteins cannot access the circulatory or immune systems. Sperm-specific proteins aberrantly expressed in cancer, known as cancer-testis antigens (CTAs), are often pursued as cancer biomarkers and therapeutic targets based on the assumption they are neoantigens absent from the circulation in healthy men. Here, we identify a wide range of germ cell-derived and sperm-specific proteins, including multiple CTAs, that are selectively deposited by the Sertoli cells of the adult mouse and human seminiferous tubules into testicular interstitial fluid (TIF) that is "outside" the blood-testis barrier. From TIF, the proteins can access the circulatory- and immune systems. Disruption of spermatogenesis decreases the abundance of these proteins in mouse TIF, and a sperm-specific CTA is significantly decreased in TIF from infertile men, suggesting that exposure of certain CTAs to the immune system could depend on fertility status. The results provide a rationale for the development of blood-based tests useful in the management of male infertility and indicate CTA candidates for cancer immunotherapy and biomarker development that could show sex-specific and male-fertility-related responses.
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http://dx.doi.org/10.1096/fj.202002484RDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898903PMC
March 2021

Designing Age-Friendly Communities: Exploring Qualitative Perspectives on Urban Green Spaces and Ageing in Two Indian Megacities.

Int J Environ Res Public Health 2021 Feb 4;18(4). Epub 2021 Feb 4.

Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey BT37 0QB, UK.

The World Health Organization and the United Nations have increasingly acknowledged the importance of urban green space (UGS) for healthy ageing. However, low- and middle-income countries (LMICs) like India with exponential ageing populations have inadequate UGS. This qualitative study examined the relationships between UGS and healthy ageing in two megacities in India. Participants were recruited using snowball sampling in New Delhi and Chennai and semi-structured interviews were conducted with consenting participants (N = 60, female = 51%; age > 60 years; fluent in English, Hindi, or Tamil). Interviews were recorded, transcribed, translated, and analysed using inductive and thematic analysis. Benefits of UGS included community building and social capital, improved health and social resilience, physical activity promotion, reduced exposure to noise, air pollution, and heat. Poorly maintained UGS and lack of safe, age-friendly pedestrian infrastructure were identified as barriers to health promotion in later life. Neighbourhood disorder and crime constrained older adults' use of UGS in low-income neighbourhoods. This study underscores the role of UGS in the design of age-friendly communities in India. The findings highlight the benefits of UGS for older adults, particularly those living in socially disadvantaged or underserved communities, which often have least access to high-quality parks and green areas.
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http://dx.doi.org/10.3390/ijerph18041491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914589PMC
February 2021