Understanding the Positive Associations of Sleep, Physical Activity, Fruit and Vegetable Intake as Predictors of Quality of Life and Subjective Health Across Age Groups: A Theory Based, Cross-Sectional Web-Based Study

Formation Mechanisms, Interrelationships, and Effects of Cognitive Factors on Diet and Physical Activity During the Post-Bariatric Surgery Period: A Cross-Sectional Study Based on Compensatory Carry-Over Action Model

Background

Diet and physical activity (PA) are pivotal behaviors for managing energy balance post-bariatric surgery. Given the need for dual behavioral management, understanding the interplay of cognitive factors influencing these behaviors is crucial. This study applied the compensatory carry-over action model (CCAM) to explore the impact of cognitive factors on behaviors and their subsequent effects on subjective health outcomes.

Methods

This cross-sectional study was conducted among patients at the third month after bariatric surgery in China. Data on diet and PA status, behavioral cognitive factors (intention, self-efficacy, compensatory belief, transfer cognition), and subjective health outcomes (perceived stress, well-being, quality of life) were collected. Structural equation model (SEM) was employed to test hypotheses in CCAM and assess mediation relationships.

Results

Analysis of data from 239 patients revealed the following: (1) Among antecedent cognitive factors, only compensatory belief significantly influenced diet (P<0.001). (2) Intention and self-efficacy directly correlated with their respective behaviors, while compensatory belief affected intention, and transfer cognition impacted self-efficacy (P<0.05), aligning with CCAM hypotheses. (3) PA demonstrated significant influence only on perceived stress (P=0.004), whereas diet significantly affected all subjective health outcomes (P<0.05). (4) Mediation analysis indicated intention partially mediated the relationship between compensatory belief and diet and fully mediated the relationship between compensatory belief and PA. Self-efficacy completely mediated the relationship between transfer cognition and diet and PA.

Conclusion

Transfer cognition's carry-over effect did not directly influence behaviors among antecedent cognitions. Interventions should primarily target improving diet by mitigating compensatory belief. Moreover, diet exhibited a more pronounced impact on overall health compared to PA. Consequently, prioritizing dietary intervention over PA intervention is warranted based on the analysis of CCAM and the aim of promoting joint behaviors post-bariatric surgery.

Physical activity and nutrition in relation to resilience: a cross-sectional study

A healthy lifestyle is often discussed as being a characteristic of or a prerequisite for quality of life. In phases of high subjective stress (work overload, negative thoughts), however, its protective function can be limited. The two present survey studies examined two facets of a health-related lifestyle (physical activity and nutritional awareness), in particular, the correlations with general life satisfaction and their adaptive function in respect to stress (resilience). In addition, because episodes of increased stress can have a negative effect on eating, the interactions with the consumption of less healthy food were examined. Two cross-sectional studies were conducted successively with adults aged between 18 and 72 in Germany. Study 1 (N = 685) examined the research questions with correlations, moderated regression analyses, and structural equation models. Study 2 (N = 628) differentiated between sport, occupational and daily activities. Study 1 showed that the amount of physical activity and nutritional awareness are correlated with life satisfaction. The relationship between stress appraisals and general life satisfaction was moderated by physical activity and nutritional awareness (stress-buffer effect). Study 2 replicated the stress-buffer effects of nutritional awareness, daily activities, and occupational activities. Both studies showed that stress is associated with consumption of less healthy food and found interactions with physical activity and nutritional awareness. Discussed are the adaptive role of physical activity and nutritional awareness in times of stress.Trial Registration EK UniBw M 23-06, 12/16/2022.

Global status of research on gastrointestinal cancer patients' quality of life: A bibliometric and visual analysis from 2003 to 2023

Objective

To analyze the current research status, hotspots, and frontiers in the field of Gastrointestinal (GI) cancer and quality of life (QoL) through the bibliometrics method, and to provide references and guidance for future research.

Methods

Literature related to GI cancer and QoL from April 1, 2003 to March 31, 2023 was retrieved from the Web of Science Core Collection database. CiteSpace 6.2.R1 was performed for collaboration analysis, keyword co-occurrence analysis, and document co-citation analysis.

Results

A total of 1224 publications were included in this study. There has been a significant increase in the number of publications in this field over the past two decades. The United States, the Karolinska Institute and the University of Amsterdam, and Pernilla Lagergren are the most prolific country, institution, and author, respectively. The links between most of the research constituents were relatively thin (centrality <0.1). The keyword analysis indicates that the benefits of physical activity on QoL, the levels of psychological distress and its relationship with QoL, as well as the development and validation of QoL measurement tools have been the research hotspots. Open-label/double-blind trials exploring therapeutic interventions and more targeted new drugs or more effective drug combinations, and longitudinal studies determining the direction of the association between psychological distress and QoL at different time points, may be emerging trends in this field.

Conclusion

The cooperation among countries, institutions, and authors in this field should be strengthened. In addition, the health benefits of light physical activity, interventions for QoL, trajectory and direction of the relationship between psychological distress and QoL may be the focus of future research.

Machine-learning model predicting quality of life using multifaceted lifestyles in middle-aged South Korean adults: a cross-sectional study

BACKGROUND

In the context of population aging, advances in healthcare technology, and growing interest in healthy aging and higher quality of life (QOL), have gained central focus in public health, particularly among middle-aged adults.

METHODS

This study presented an optimal prediction model for QOL among middle-aged South Korean adults (N = 4,048; aged 30-55 years) using a machine-learning technique. Community-based South Korean population data were sampled through multistage stratified cluster sampling. Twenty-one variables related to individual factors and various lifestyle patterns were surveyed. QOL was assessed using the Short Form Health Survey (SF-12) and categorized into total QOL, physical component score (PCS), and mental component score (MCS). Seven machine-learning algorithms were used to predict QOL: decision tree, Gaussian Naïve Bayes, k-nearest neighbor, logistic regression, extreme gradient boosting, random forest, and support vector machine. Data imbalance was resolved with the synthetic minority oversampling technique (SMOTE). Random forest was used to compare feature importance and visualize the importance of each variable.

RESULTS

For predicting QOL deterioration, the random forest method showed the highest performance. The random forest algorithm using SMOTE showed the highest area under the receiver operating characteristic (AUC) for total QOL (0.822), PCS (0.770), and MCS (0.786). Applying the data, SMOTE enhanced model performance by up to 0.111 AUC. Although feature importance differed across the three QOL indices, stress and sleep quality were identified as the most potent predictors of QOL. Random forest generated the most accurate prediction of QOL among middle-aged adults; the model showed that stress and sleep quality management were essential for improving QOL.

CONCLUSION

The results highlighted the need to develop a health management program for middle-aged adults that enables multidisciplinary management of QOL.

Hypnosis Intervention for Sleep Disturbances in Individuals with Mild Cognitive Impairment: A Randomized Pilot Study

Poor sleep quality is highly prevalent among individuals with mild cognitive impairment (MCI). Further, poor sleep quality is associated with reduced quality of life, increased stress response, memory impairments, and progression to dementia among individuals with MCI. Pharmacological treatments for sleep have mixed efficacy and can lead to dependency. Therefore, alternatives to pharmacological treatments for improving sleep among individuals with MCI are needed. The present study reports on the feasibility of a non-pharmacological self-administered hypnosis intervention focused on sleep quality in adults with MCI. It was hypothesized that the hypnosis intervention program would be feasible and have acceptable levels of adherence to daily hypnosis practice. A two-armed randomized controlled pilot trial was conducted using a sample of 21 adults with MCI. Eligible participants were randomly assigned to listen to either hypnosis audio recordings or sham hypnosis recordings for five weeks. Program feasibility, program adherence, pain intensity, stress, and sleep quality were measured using a daily home practice log, questionnaires, and wrist actigraphy. The results found mid or higher levels of treatment satisfaction, ease of use, and perceived effectiveness at one-week follow-up, with participants in the hypnosis arm reporting greater perceived benefit. Adherence to assigned audio recordings and meetings were likewise within acceptable margins in both groups. No intervention-related adverse events were reported in either treatment condition. Significant improvements in sleep quality, sleep duration, and daytime sleepiness were found for the hypnosis intervention. The results of this study can be used to inform future research on the effects of hypnosis on sleep quality in adults with MCI.

Network Analysis of Health-related Behaviors, Insomnia, and Depression Among Urban Left-behind Adolescents in China

Mental health of urban left-behind adolescents (LBA) is a public issue of growing concern. This study aims to examine the symptom level associations among multiple health-related behaviors, insomnia, and depression in urban LBA. Data on a sample of urban LBA aged 11-19 (N = 3,601) from the Adolescent Mental Health Survey in Shenzhen, China, were used. Health-related behaviors (i.e., Internet use, physical inactivity, social jetlag, smoking, and alcohol consumption), insomnia, and depressive symptoms were assessed using a self-administered questionnaire. Graphical Gaussian Model (GGM) was used to describe key bridging nodes in an undirected network. Directed Acyclic Graph (DAG) was used to construct a directed network and estimate the most likely causal associations among behaviors/symptoms. In the undirected network, Internet use was identified as the key bridging node most strongly associated with insomnia and depression. Two other key bridging nodes include difficulty initiating sleep and appetite change. In the directed network, anhedonia emerged as the most pivotal symptom, which could cause insomnia symptoms and behavioral changes, either directly, or through triggering other depressive symptoms, such as low energy and appetite change. These findings have implications for understanding the occurrence and maintenance process of health-related behaviors, insomnia, and depression in urban LBA. In practice, Internet use should be considered a priority in targeting multiple health behavior interventions. Meanwhile, early screening and treatment for anhedonia are of great significance as well.

The link between unhealthy lifestyle behaviors and emotional and behavioral problems in children and adolescents: a latent class analysis

Unhealthy lifestyle behaviors (ULBs) in children and adolescents are relatively common. Previous studies have shown an association between a single ULBs and emotional and behavioral problems (EBPs); however, few studies have explored the connection between multiple behavioral patterns and EBPs in children and adolescents. Hence, we aimed to investigate the link between ULBs clusters and EBPs among Chinese children and adolescents. From April to May 2019, we used cluster sampling to investigate children and adolescents in grades 1-12 from 14 schools located across six streets of Bao'an District in the city of Shenzhen. We measured emotional and behavioral problems using the Strengths and Difficulties Questionnaire (SDQ). ULBs included the consumption of sugar-sweetened beverages, takeaway and fast food consumption, lack of sleep, low outdoor activity, and excessive screen time. We performed clustering of ULBs using the regression hybrid modeling method of latent class analysis (LCA). We analyzed the association between ULBs and EBPs using logistic regression. In total, 30188 children and adolescents remained for analysis, with an average age of 12.44 ± 3.47 years. The LCA revealed four distinct patterns of ULBs: (1) lowest risk; (2) high-risk unhealthy lifestyle behaviors; (3) high-risk dietary unhealthy lifestyle behaviors; and (4) highest risk. Compared to ULBs with the lowest risk, high-risk ULBs, high-risk dietary ULBs, and highest risk ULBs were positively correlated with EBPs, with an adjusted odds ratio (aOR) (95% confidence interval [CI]) of 1.27, 1.34 and 2.05, respectively. Children and adolescents who reported engaging in multiple ULBs were also more likely to have poorer EBPs status. This implies that school administrations should pay more attention to the management of dietary and lifestyle behaviors to prevent EBPs in children and adolescents. Our findings highlight the need to focus on multiple clusters of ULBs among adolescents in a preventive care system and to validate EBP that may occur in children who are exposed to ULBs.

Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: a parallel-group randomized controlled trial

BACKGROUND

Despite its efficacy in treating comorbid insomnia and depression, cognitive behavioral therapy for insomnia (CBT-I) is limited in its accessibility and, in many countries, cultural compatibility. Smartphone-based treatment is a low-cost, convenient alternative modality. This study evaluated a self-help smartphone-based CBT-I in alleviating major depression and insomnia.

METHODS

A parallel-group randomized, waitlist-controlled trial was conducted with 320 adults with major depression and insomnia. Participants were randomized to receive either a 6-week CBT-I via a smartphone application, proACT-S, or waitlist condition. The primary outcomes included depression severity, insomnia severity, and sleep quality. The secondary outcomes included anxiety severity, subjective health, and acceptability of treatment. Assessments were administered at baseline, post-intervention (week 6) follow-up, and week 12 follow-up. The waitlist group received treatment after the week 6 follow-up.

RESULTS

Intention to treat analysis was conducted with multilevel modeling. In all but one model, the interaction between treatment condition and time at week 6 follow-up was significant. Compared with the waitlist group, the treatment group had lower levels of depression [Center for Epidemiologic Studies Depression Scale (CES-D): Cohen's d = 0.86, 95% CI (-10.11 to -5.37)], insomnia [Insomnia Severity Index (ISI): Cohen's d = 1.00, 95% CI (-5.93 to -3.53)], and anxiety [Hospital Anxiety and Depression Scale - Anxiety subscale (HADS-A): Cohen's d = 0.83, 95% CI (-3.75 to -1.96)]. They also had better sleep quality [Pittsburgh Sleep Quality Index (PSQI): Cohen's d = 0.91, 95% CI (-3.34 to -1.83)]. No differences across any measures were found at week 12, after the waitlist control group received the treatment.

CONCLUSION

proACT-S is an efficacious sleep-focused self-help treatment for major depression and insomnia.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04228146. Retrospectively registered on 14 January 2020. http://www.w3.org/1999/xlink">https://clinicaltrials.gov/ct2/show/NCT04228146.

Adherence to the Mediterranean Diet Related to the Health Related and Well-Being Outcomes of European Mature Adults and Elderly, with an Additional Reference to Croatia

With the increase in life expectancy, expectation of a longer healthy life is also increasing. Importance of consumption of certain foods is confirmed to have a strong effect on quality of life. One of the healthiest dietary patterns consistently associated with a range of beneficial health outcomes is the Mediterranean diet (MD). The aim of this study was to assess MD adherence in the population over 50 years of age, in Europe, with special reference to Croatia, and to assess regional differences and investigate the association with health-related indicators (disease incidence, body mass index (BMI), grip strength measure, control, autonomy, self-realization, and pleasure scale (CASP-12)). This research uses data from the SHARE project for the population over 50 years of age. The frequency of individual responses was analyzed (frequencies, cross tables, and appropriate tests of significance, depending on the data set), and logistic regression was used to connect adherence to the Mediterranean diet with health indicators. The results of the study indicate a positive correlation between adherence to the principles of the Mediterranean diet with CASP and self-perception of health, which the followers of the MD pattern predominantly rate as "very good" or "excellent" (37.05%) what is significantly different (p < 0.05) from individuals which do not follow the patterns of MD (21.55%). The regression models indicate significant changes in the measure of maximum grip strength also among MD followers (ORMEDIUM = 1.449; ORHIGH = 1.293). Data for EU countries are also classified by regions (Central and Eastern; Northern, Southern and Western Europe), additionally allocating Croatia, and the trends in meat, fish and egg consumption showed the greatest differences for Croatian participants (39.6% twice a week) versus participants from four European regions. Data for Croatia deviates from the European average also in terms of the proportion of overweight and obese persons in all observed age groups, of which the largest proportion is in the 50-64 age group (normal BMI: only 30.3%). This study extended the currently available literature covering 27 European countries, placing the findings in a wider geographical context. The Mediterranean diet has once again proven to be an important factor related to health-related behavior. The presented results are extremely important for public health services, indicating possible critical factors in preserving the health of the population over 50 years old.

Engaging in physical activity instead of (over)using the smartphone: An experimental investigation of lifestyle interventions to prevent problematic smartphone use and to promote mental health

Aim

Tendencies of problematic smartphone use (PSU) have risen during the past decade. As PSU is consistently linked to mental health issues, measures to prevent its appearance and to promote mental health are urgently required.

Subject and Methods

The present study investigated the impact of three interventions on health behavior, PSU, positive mental health (PMH), and depression and anxiety symptoms. Overall, 503 persons from Germany (M age = 29.19, SD age = 10.51, range: 18-79) participated in the study. Over 14 days, the three experimental groups (a) reduced their daily smartphone use time by 60 minutes, (b) increased their daily level of physical activity by 30 minutes, and (c) combined both measures. The control group continued its behavior as usual. Outcomes were assessed via online surveys at five measurement time points (baseline, intermediate, post-intervention, and 1 and 3 months after the intervention).

Results

All interventions resulted in a significant increase in weekly physical activity and in reduced symptoms of PSU, depression, and anxiety. Furthermore, the smartphone reduction and the combination of both measures contributed to a significant reduction of participants' daily smartphone use and higher levels of PMH. The effects of the reduction of smartphone use time and its combination with increased physical activity were more stable in the longer term than the increase in physical activity only.

Conclusion

Combined with an increase in physical activity, the reduction of smartphone use time could serve as an efficient and cost-effective measure for the prevention of PSU and the promotion of mental health.

Health Status Stability of Patients in a Medical Rehabilitation Program: What Are the Roles of Time, Physical Fitness Level, and Self-efficacy?

BACKGROUND

Individuals' physical and mental health, as well as their chances of returning to work after their ability to work is damaged, can be addressed by medical rehabilitation.

AIM

This study investigated the developmental trends of mental and physical health among patients in medical rehabilitation and the roles of self-efficacy and physical fitness in the development of mental and physical health.

DESIGN

A longitudinal design that included four time-point measurements across 15 months.

SETTING

A medical rehabilitation center in Germany.

POPULATION

Participants included 201 patients who were recruited from a medical rehabilitation center.

METHODS

To objectively measure physical fitness (lung functioning), oxygen reabsorption at anaerobic threshold (VO2AT) was used, along with several self-report scales.

RESULTS

We found a nonlinear change in mental health among medical rehabilitation patients. The results underscored the importance of medical rehabilitation for patients' mental health over time. In addition, patients' physical health was stable over time. The initial level of physical fitness (VO2AT) positively predicted their mental health and kept the trend more stable. Self-efficacy appeared to have a positive relationship with mental health after rehabilitation treatment.

CONCLUSIONS

This study revealed a nonlinear change in mental health among medical rehabilitation patients. Self-efficacy was positively related to mental health, and the initial level of physical fitness positively predicted the level of mental health after rehabilitation treatment.

CLINICAL REHABILITATION

More attention could be given to physical capacity and self-efficacy for improving and maintaining rehabilitants' mental health.

Lifestyle health behavior correlates of intuitive eating in a population-based sample of men and women

The aim of this observational study was to examine how lifestyle health behaviors hypothesized to influence attunement to internal cues (breakfast consumption frequency, physical activity, yoga practice, sleep, and recreational screen time) are cross-sectionally related to intuitive eating (IE). Data from 765 men and 1009 women (M_age = 31.1 ± 1.7 years) who participated in Project EAT-IV (Eating and Activity in Teens and Young Adults) were analyzed with sex-stratified linear regression models adjusted for age, race/ethnicity, socioeconomic background, and parent status. Sociodemographic-adjusted mean levels of each health behavior by sex were generated at low (one standard deviation below the mean), average (at the mean), and high (one standard deviation above the mean) levels of IE to facilitate interpretation of regression results. Among women only, more frequent breakfast consumption (p = .02), more time spent practicing yoga (p = .03), more sleep (p = .004), and less recreational screen time (p = .01) were each significantly associated with higher IE after adjusting for sociodemographic characteristics. Compared to women with low IE, women with high IE reported, on average, eating breakfast 0.3 more days a week, practicing 12 more minutes of yoga per week, getting 12 more minutes of sleep per night, and engaging in 18 fewer minutes of recreational screen time per day. Results suggest that these modifiable health behaviors may be valuable targets for interventions to increase IE among women, though longitudinal research is needed to elucidate the temporality of these associations.

Lifestyle Behaviors and Quality of Life Among Older Adults After the First Wave of the COVID-19 Pandemic in Hubei China

Background: Older adult quality of life (QoL) is facing huge challenges during the COVID-19 pandemic. New normal lifestyle behaviors, including getting adequate physical activity (PA), consuming sufficient fruits and vegetables (FV) and enacting individual preventive behaviors (frequent hand washing, facemask wearing, and social distancing), as a significant determinant for QoL, have not been adequately addressed in older adults during the pandemic. This study aimed to investigate the characteristics of QoL in Chinese older adults after the first wave of the COVID-19 pandemic in Hubei China. The objective of the study was to examine any associations of lifestyle behaviors with QoL, and to identify the moderating role of socioeconomic indicators in the associations identified. Methods: A cross-sectional study was conducted in Hubei, China, from June 15, 2020, to July 10, 2020. Five hundred sixteen older adults completed an online survey (mean age = 67.6 ± 6.6; 57.9% women). The questionnaire consisted of demographic information, covariates (chronic diseases and infected cases of acquaintances), lifestyle behaviors [PA stage, FV intake (FVI) stage and three preventive behaviors], and QoL. T-tests, ANOVA tests, multiple linear regression models with simple slope analyses were used to test the hypotheses. Results: QoL significantly differed in relation to economic situation, chronic diseases, marital status, education, living situation, age group, and professional status. Participants' economic situation (βaverage vs. below average = 0.17, p < 0.01; βabove average vs. below average = 0.15, p < 0.01), chronic diseases (βyes vs. no = 0.19, p < 0.001), FVI stage (β = 0.21, p < 0.001), and preventive behaviors (β = 0.10, p < 0.05) indicated a significant association with QoL. Education level and economic situation significantly interacted with preventive behaviors on QoL, respectively (βpreventive behaviors × educational level = -1.3, p < 0.01; βpreventive behaviors × economic situation = -0.97, p < 0.05). Conclusions: Findings emphasize the importance of enhancing FVI and preventive behaviors on QoL improvement in older adults during the COVID-19 pandemic. Older adults who are in a lower economic situation with lower education levels should be given priority when implementing interventions to improve preventive behaviors and QoL in older adults.

Dietary Intake and Health Status of Elderly Patients With Type 2 Diabetes Mellitus: Cross-sectional Study Using a Mobile App in Primary Care

Background

Healthy dietary intake reduces the risk of complications of diabetes mellitus. Using assessment methods helps to understand these circumstances, and an electronic application may optimize this practice.

Objective

In this study, we aimed to (1) assess the dietary intake and health status of elderly patients with type 2 diabetes mellitus (T2DM) in primary care, (2) use a mobile app as a tool for data collection and analysis in the context of primary care, and (3) verify the perceptions of multidisciplinary health professionals regarding app use.

Methods

First, we developed a mobile app comprised of the questions of the Food and Nutrition Surveillance System (SISVAN) of Brazil, which includes a food frequency questionnaire of food categories with a recall of the previous 7 days. Thereafter, we used the app to collect data on the health status and dietary intake of 154 participants, aged 60-96 years, diagnosed with T2DM, and under treatment in primary care centers in the northern region of Rio Grande do Sul, Brazil. We also collected participants’ demographic, anthropometric, biochemical, and lifestyle variables. The associations between dietary intake and other variables were tested using chi-square tests with a 5% significance level. Regarding the app, we assessed usability and acceptance with 20 health professionals.

Results

Between August 2018 and December 2018, participants had an intake in line with recommended guidelines for raw salads (57.1%), fruits (76.6%), milk products (68.2%), fried foods (72.7%), savory biscuits (60.4%), cookies or sweets (72.1%), and sugary drinks (92.9%) Meanwhile, the consumption of beans (59.7%), pulses and cooked vegetables (73.4%), and processed meat products (59.7%) was not in line with the guidelines. There were statistically significant differences in meeting the recommended guidelines among participants of different genders (P=.006 and P=.035 for the intake of fried foods and sugary drinks, respectively), place of residence (P=.034 for the intake of cookies and sweets), family history of diabetes (P<.001 for the intake of beans), physical activity engagement (P=.003 for the intake fresh fruits), history of smoking (P=.001 for the intake of raw salads), and presence of coronary disease (P=.050 for the intake of pulses and cooked vegetables). The assessment of usability resulted in a mean score of 71.75 points. Similarly, the assessment of the 15 acceptance questions revealed high scores, and the qualitative questions revealed positive perceptions.

Conclusions

We identified that most participants complied with recommended intake guidelines for 7 of 10 categories in the SISVAN guidelines. However, most participants were overweight and had nutritional and clinical disorders, which justifies further investigations in this population. The app was well-rated by health professionals and considered a useful and promising tool for collecting and analyzing data in primary care settings.

Physical activity across life stages and sleep quality in adulthood - an epidemiological study

OBJECTIVE

To analyze the association between the continuous physical activity (PA) at different life stages with sleep quality in adults.

METHODS

This is an observational study with a cross-sectional design. A sample of 843 adults (61.7% female) with a mean age of 56.6 (±18.3) years was randomly selected. The PA at different life stages was assessed retrospectively in childhood and adolescence, and the current PA was assessed by Baecke Physical Activity Questionnaire. Sleep quality was assessed using the Mini-Sleep Questionnaire. Variables of sex, age group, ethnicity, socioeconomic status, and current physical activity were covariates. The association between continuous PA at different life stages with sleep quality was analyzed by binary logistic regression models.

RESULTS

Overweight adults who practiced PA in adolescence were 46% less likely to have poor sleep quality when compared to those who did not practice physical activity in this life stage (Odds ratio = 0.54, p = 0.031). Adults who continued to practice PA at youth and adulthood were 49% less likely to have poor sleep quality when compared to those without continuous PA (Odds ratio = 0.51, p = 0.009).

CONCLUSIONS

Poor sleep quality was negatively associated with continuous PA between youth and adulthood in overall sample and negatively associated with PA in adolescence among overweight adults.

Addressing the COVID-19 Mental Health Crisis: A Perspective on Using Interdisciplinary Universal Interventions

Mental health is reaching a crisis point due to the ramifications of COVID-19. In an attempt to curb the spread of the virus and circumvent health systems from being overwhelmed, governments have imposed regulations such as lockdown restrictions and home confinement. These restrictions, while effective for infection control, have contributed to poorer lifestyle behaviors. Currently, Positive Psychology and Lifestyle Medicine are two distinct but complimentary disciplines that offer an array of evidence-based approaches for promoting mental health and well-being across a universal population. However, these strategies for improving mental health are typically used in isolation. This perspective calls for a new paradigm shift to create and rollout well-designed interdisciplinary universal multicomponent mental health interventions that integrates the benefits of both disciplines, and uses innovative digital mental health solutions to achieve scalability and accessibility within the limitations and beyond the COVID-19 lockdown and restrictions.

Exercise and Fitness Neuroprotective Effects: Molecular, Brain Volume and Psychological Correlates and Their Mediating Role in Healthy Late-Middle-Aged Women and Men

Background: Although exercise is known to have a neuroprotective effect in aging, the mediators underlying the exercise-cognition association remain poorly understood. In this paper we aimed to study the molecular, brain, and behavioral changes related to physical activity and their potential role as mediators. Methods: We obtained demographic, physical activity outcomes [sportive physical activity and cardiorespiratory fitness (CRF)], plasma biomarkers (TNF-α, ICAM-1, HGF, SDF1-α, and BDNF), structural-MRI (brain volume areas), psychological and sleep health (mood, depressive and distress symptoms, and sleep quality), and multi-domain cognitive data from 115 adults aged 50-70 years. We conducted linear regression models and mediation analyses stratifying results by sex in a final sample of 104 individuals [65 women (age = 56.75 ± 4.96) and 39 men (age = 58.59 ± 5.86)]. Results: Women engaging in greater amounts of exercising showed lower TNF-α levels and greater dorsolateral prefrontal cortex and temporal lobe volumes. Men engaging in greater amounts of exercise showed greater temporal lobe volumes. CRF levels were not related to any of the analyzed outcomes in women but in men higher CRF was associated with lower TNF-α, HGF and ventricle volumes, greater volume of temporal and parietal lobes and fewer depressive symptoms and better mood. In men, reduced TNF-α and HGF levels mediated brain and cognitive CRF-related benefits. Conclusion: Our results show that exercise is a promising approach for influencing inflammation and brain volume and also contributes to ongoing discussions about the physiological mediators for the association between CRF and cognition in men.

A population-based study of health-promoting behaviors and their predictors in Iranian males, 2019

BACKGROUND

Health-promoting lifestyle (HPL) is any measure taken to maintain a person's health. The most important and influential factor in maintaining and enhancing health are health-promoting behaviors (HPB). This study aimed to determine HPB and their predictors among Iranian men.

METHODS

In this cross-sectional study, 783 Iranian men, living in Tehran, were selected, using multistage cluster sampling. The employed questionnaires, namely the sociodemographic questionnaire, Health-Promoting Lifestyle Profile II (HPLP-II), and the second part of the Personal Resource Questionnaire (PRQ 85-Part 2), were completed through interviews. The relationship between the dependent variables (HPLP-II and its subdomains) and independent variables (sociodemographic characteristics and social support) was investigated using the adjusted General Linear Model (GLM).

RESULTS

The mean ± standard deviation of the total HPLP-II score was 2.72 ± 0.44 in the range of 1-4. Among the six dimensions of the HPB, the participants achieved the highest score (3.00 ± 0.52) and lowest score (1.96 ± 0.56) in spiritual growth and physical activity, respectively. The Pearson test showed that the perceived social support was significantly correlated with HPLP-II (r = 0.23; p < 0.001) and all of its subdomains (r = 0.09-0.24; p < 0.001). Based on the adjusted general linear model, social support, age, job, and income adequacy were the predictors of HPL in men and could explain 30.9% of the variance of the HPL score.

CONCLUSIONS

The research findings confirmed the importance of social support and modifying variables (social and personal) in the incidence of HPB in men.

Sleep, Diet and Physical Activity Among Adults Living With Type 1 and Type 2 Diabetes

OBJECTIVES

Our aim in this work was to document sleep/insomnia, fruit and vegetable (FV) consumption and physical activity (PA) according to diabetes presence and type and biologic sex, as these 3 lifestyle habits may influence glycemic control and prevention of diabetes-related complications.

METHODS

Adults between 18 and 64 years of age were invited to complete validated web-based self-reported questionnaires assessing sleep, insomnia, FV consumption and PA. Pregnant women and shift workers were excluded from the study.

RESULTS

A total of 151 adults (80.1% women), of whom 54 had diabetes (type 1 [T1D], n=30; type 2 [T2D], n=24), completed the questionnaires. Sleep quality scores were significantly higher, indicating poorer sleep quality, according to diabetes presence (diabetes, 7.2±3.5; no diabetes, 5.4±3.5; p=0.0024) and type (T1D, 6.1±2.9; T2D, 8.7±3.8; p=0.0072). Sleep duration was significantly shorter among adults living with diabetes (diabetes, 7.0±1.7 hours/night; no diabetes, 7.8±1.3 hours/night; p=0.0019), regardless of type. More adults living with diabetes had moderate to severe clinical insomnia (diabetes, 25.9%; no diabetes, 10.4%; p=0.0129), especially those with T2D (T1D, 13.3%; T2D, 41.7%; p=0.0182). FV consumption and PA did not vary significantly according to diabetes presence and type. Only PA differed by biologic sex, with lower PA among women.

CONCLUSIONS

The results suggest that adults living with diabetes, especially those with T2D, are at higher risk for short and poor sleep quality, and clinical insomnia. Adults living with diabetes, especially those with T2D, should have access to effective sleep interventions to prevent complications associated with elevated glucose levels.

Sleep, Mild Cognitive Impairment, and Interventions for Sleep Improvement: An Integrative Review

Sleep disturbance in mild cognitive impairment (MCI) is associated with progression to Alzheimer's disease (AD), more severe AD symptoms, and worse health outcomes. The aim of this review was to examine the relationship between sleep and MCI, and the effectiveness of sleep improvement interventions for older adults with MCI or AD. An integrative review was conducted using four databases, and findings were analyzed using an iterative process. Findings from 24 studies showed that alterations in sleep increased the risk of MCI and that the sleep quality of individuals with MCI or AD was poorer than healthy controls. Changes in brain anatomy were also observed in healthy older adults with sleep disturbances. Examined interventions were shown to be effective in improving sleep. Screening for sleep disturbances in individuals with MCI/AD is crucial to mitigate neurodegenerative or neurobehavioral risks in this population.

Health-related quality of life in pilots of a Chinese commercial airline

Health-related quality of life (HRQOL) is currently an important issue in the medical industry. However, data on HRQOL in commercial airline pilots are lacking. This study aimed to investigate HRQOL and its related factors in a sample of commercial pilots. A purposive sample of 373 participants was recruited from a Chinese Commercial Airline. The median (IQR) score for physical health, psychological health and social relationship were 64.3 (75-53.6), 62.5 (70.8-54.2) and 75 (75-58.3), respectively. The mean (SD) score for Environment was 62.2 (16). After controlling for demographics, the multiple linear regression analyses showed that physical activity, fruit intake and vegetable intake were positively correlated with HRQOL score (p < .05), while time-zone flights, smoking, alcohol drinking and being dyslipidemic showed a negative correlation with HRQOL score (p < .05). Healthcare providers should consider time-zone flights, behavioral factors and dyslipidemia when planning related health promotion and disease prevention programs for commercial pilots in the future.

The Big Three Health Behaviors and Mental Health and Well-Being Among Young Adults: A Cross-Sectional Investigation of Sleep, Exercise, and Diet

BACKGROUND

Sleep, physical activity, and diet have been associated with mental health and well-being individually in young adults. However, which of these "big three" health behaviors most strongly predicts mental health and well-being, and their higher-order relationships in predictive models, is less known. This study investigated the differential and higher-order associations between sleep, physical activity, and dietary factors as predictors of mental health and well-being in young adults.

METHOD

In a cross-sectional survey design, 1,111 young adults (28.4% men) ages 18-25 from New Zealand and the United States answered an online survey measuring typical sleep quantity and quality; physical activity; and consumption of raw and processed fruit and vegetables, fast food, sweets, and soda, along with extensive covariates (including demographics, socioeconomic status, body mass index, alcohol use, smoking, and health conditions) and the outcome measures of depressive symptoms [measured by the Center for Epidemiological Depression Scale (CES-D)] and well-being (measured by the Flourishing Scale).

RESULTS

Controlling for covariates, sleep quality was the strongest predictor of depressive symptoms and well-being, followed by sleep quantity and physical activity. Only one dietary factor-raw fruit and vegetable consumption-predicted greater well-being but not depressive symptoms when controlling for covariates. There were some higher-order interactions among health behaviors in predicting the outcomes, but these did not survive cross-validation.

CONCLUSION

Sleep quality is an important predictor of mental health and well-being in young adults, whereas physical activity and diet are secondary but still significant factors. Although strictly correlational, these patterns suggest that future interventions could prioritize sleep quality to maximize mental health and well-being in young adults.

Problematic Internet Use and Perceived Quality of Life: Findings from a Cross-Sectional Study Investigating Work-Time and Leisure-Time Internet Use

Avoiding the potential negative impact brought by problematic internet use is becoming more important. To better understand public health and addiction, this study investigated to what extent work-time and leisure-time internet use relate to problematic internet use and perceived quality of life among college students and highly educated adults. An online cross-sectional survey with 446 individuals was assessed in Germany. Linear regression analyses were used to predict problematic internet use. Ordinal regression analyses were applied to predict perceived quality of life. Results showed that leisure-time internet use, but not work-time internet use, was positively associated with problematic internet use. Participants whose work-time internet use could be considered balanced (5–28 h/week in this study) indicated a higher perceived quality of life compared to individuals with little or large amount of internet use for work. The findings still emerged when taking negative feelings, perceived stress, smoking status and alcohol consumption into account. As both work-time and leisure-time internet use can be risk factors for mental health in terms of problematic internet use and perceived quality of life, well-controlled internet use rather than excessive use is recommended. This should be kept in mind when dealing with the Coronavirus pandemic and its aftermath.

Fruit and Vegetable Consumption is Protective from Short Sleep and Poor Sleep Quality Among University Students from 28 Countries

INTRODUCTION

The aim of the study was to investigate the association between fruit and vegetable (FV) consumption and sleep duration and sleep quality in university students.

METHODS

Using a cross-sectional study design, 21,027 university students with a median age of 20 years from 28 countries replied to self-reported measures of FV consumption and sleep duration and quality.

RESULTS

The prevalence of short and long sleep was 38.9% and 12.8%, respectively, and the prevalence of poor sleep quality was 9.6% and restless sleep 19.7%. There was a linear decrease in the prevalence of short sleep with increasing FV consumption beyond ≥2 FV servings/day (vs 0-1 FV servings/day). Consuming 2 FV servings/day (vs 0-1 FV servings/day) was associated with a 21% decreased (ARRR: 0.79, 95% CI: 0.70-0.80) and 7 or more FV servings/day with a 33% decreased odds (ARRR: 0.67, 95% CI: 0.55-0.81) for short sleep. Consuming 5 FV servings/day (vs 0-1 FV servings/day) was associated with a 34% decreased (ARRR: 0.79, 95% CI: 0.51-0.84) and 7 or more FV servings/day with a 34% decreased odds (ARRR: 0.66, 95% CI: 0.50-0.88) for long sleep. In the final adjusted logistic regression model, consuming 3 FV servings/day (vs 0-1 FV servings/day) was associated with a 49% decreased (AOR: 0.51, 95% CI: 0.42-0.0.62) and 7 or more FV servings/day with a 30% decreased odds (AOR: 0.70, 95% CI: 0.53-0.93) for poor sleep quality. Consuming 5 FV servings/day (vs 0-1 FV servings/day) was associated with a 34% decreased odds (AOR: 0.66, 95% CI: 0.54-0.81) for restless sleep.

CONCLUSION

The study extended previous findings of an association between inadequate FV consumption and short sleep and an inverse association between FV consumption and poor sleep quality and restless sleep.

Fruit and Vegetable Intake and Mental Health in Adults: A Systematic Review

The role of a properly balanced diet in the prevention and treatment of mental disorders has been suggested, while vegetables and fruits have a high content of nutrients that may be of importance in the case of depressive disorders. The aim of the study was to conduct a systematic review of the observational studies analyzing association between fruit and vegetable intake and mental health in adults. The search adhered to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42019138148). A search for peer-reviewed observational studies published until June 2019 was performed in PubMed and Web of Science databases, followed by an additional manual search for publications conducted via analyzing the references of the found studies. With respect to the intake of fruit and/or vegetable, studies that assessed the intake of fruits and/or vegetables, or their processed products (e.g., juices), as a measure expressed in grams or as the number of portions were included. Those studies that assessed the general dietary patterns were not included in the present analysis. With respect to mental health, studies that assessed all the aspects of mental health in both healthy participants and subjects with physical health problems were included, but those conducted in groups of patients with intellectual disabilities, dementia, and eating disorders were excluded. To assess bias, the Newcastle-Ottawa Scale (NOS) was applied. A total of 5911 studies were independently extracted by 2 researchers and verified if they met the inclusion criteria using a 2-stage procedure (based on the title, based on the abstract). After reviewing the full text, a total of 61 studies were selected. A narrative synthesis of the findings from the included studies was performed, which was structured around the type of outcome. The studies included mainly focused on depression and depressive symptoms, but also other characteristics ranging from general and mental well-being, quality of life, sleep quality, life satisfaction, flourishing, mood, self-efficacy, curiosity, creativity, optimism, self-esteem, stress, nervousness, or happiness, to anxiety, minor psychiatric disorders, distress, or attempted suicide, were analyzed. The most prominent results indicated that high total intake of fruits and vegetables, and some of their specific subgroups including berries, citrus, and green leafy vegetables, may promote higher levels of optimism and self-efficacy, as well as reduce the level of psychological distress, ambiguity, and cancer fatalism, and protect against depressive symptoms. However, it must be indicated that the studies included were conducted using various methodologies and in different populations, so their results were not always sufficiently comparable, which is a limitation. Taken together, it can be concluded that fruits and/or vegetables, and some of their specific subgroups, as well as processed fruits and vegetables, seems to have a positive influence on mental health, as stated in the vast majority of the included studies. Therefore, the general recommendation to consume at least 5 portions of fruit and vegetables a day may be beneficial also for mental health.

Bridging the Reciprocal Gap between Sleep and Fruit and Vegetable Consumption: A Review of the Evidence, Potential Mechanisms, Implications, and Directions for Future Work

A substantial burden of disease and mortality globally is attributable to both sleep disruption and low intakes of fruit and vegetable (FV) and there is increasing mechanistic and epidemiological evidence to support a reciprocal relationship between the two. This review provides an overview of experimental and observational studies assessing the relations between sleep and FV consumption from 52 human adult studies. Experimental studies are currently limited and show inconsistent results. Observational studies support a non-linear association with adults sleeping the recommended 7–9 hours/day having the highest intakes of FV. The potential mechanisms linking sleep and FV consumption are highlighted. Disrupted sleep influences FV consumption through homeostatic and non-homeostatic mechanisms. Conversely, FV consumption may influence sleep through polyphenol content via several potential pathways. Few human experimental studies have examined the effects of FV items and their polyphenols on sleep and there is a need for more studies to address this. An appreciation of the relationship between sleep and FV consumption may help optimize sleep and FV consumption and may reduce the burden of chronic diseases. This review provides implications for public health and directions for future work.

Pre-employment health lifestyle profiles and actual turnover among newly graduated nurses: A descriptive and prospective longitudinal study

BACKGROUND

Newly graduated nurses' pre-employment health lifestyles play particularly important roles in their smooth adaptation to and retention in clinical nursing; however, the longitudinal relationship between pre-employment health lifestyles and work outcomes, such as turnover, remains underexamined. To identify the health lifestyle profiles of specific populations of interest, recent studies have employed multifaceted approaches using health behaviors and/or statuses.

OBJECTIVES

To identify the pre-employment health lifestyle profiles of newly graduated nurses, and to examine the longitudinal relationships between health lifestyle profiles and actual turnover.

DESIGN

Descriptive and prospective longitudinal study design.

SETTINGS

One tertiary hospital in Seoul, South Korea.

PARTICIPANTS

A total of 464 newly graduated nurses who started work between September 2014 and December 2015.

METHODS

The outcome was actual turnover-whether participants had resigned from the organization and the days they worked up to December 31, 2017. We measured eight health lifestyle variables on the first day of orientation before ward placement (i.e., at baseline): quantity and quality of sleep, eating three meals a day, having a regular diet, alcohol consumption, moderate exercise, depression, and self-rated health. We employed latent class analysis to identify the health lifestyle profiles of new nurses, and used Cox proportional hazards regression to examine the longitudinal relationships between health lifestyle profiles and actual turnover.

RESULTS

We classified newly graduated nurses' pre-employment health lifestyle profiles into two groups: unhealthy lifestyle (15.6%) and discordant (84.4%). Compared with the new nurses in the discordant group, those in the unhealthy lifestyle group had significantly higher probabilities of resigning (HR = 2.38, 95% CIs of HR = 1.62-3.50); this relationship remained significant after adjusting for perceived job stress at six weeks of work (HR = 2.26, 95% CIs of HR = 1.50-3.39).

CONCLUSIONS

This study identified significant differences in the patterns of newly graduated nurses' pre-employment health lifestyles; our analysis showed that classification in the unhealthy lifestyle group was a turnover risk factor. Given that new nurses' health lifestyles affect work outcomes, hospitals should implement organizational and educational initiatives to encourage healthy lifestyles. In considering pre-employment health lifestyle profiles, hospitals should also monitor novice nurses' adaptation and wellness. Nursing education should include strategies to enhance nursing students' own health. Further extensive longitudinal studies should seek to identify the health lifestyle profiles of heterogeneous nurse populations.

Physical Activity, Sedentary Behaviours and Duration of Sleep as Factors Affecting the Well-Being of Young People against the Background of Environmental Moderators

Mental health problems during adolescence are becoming increasingly frequent. The purpose of this study was to evaluate the total impact of selected behavioural and environmental factors on the variability of mental well-being indexes of young people aged 15 to 17 years. The survey, conducted as part of the last round of the Health Behaviour in School-Aged Children (HBSC) 2017/18 study, covered 3693 secondary school students in Poland at the average age of 16.53 years (SD = 1.09). Dependent variables: depression (CES-DC), stress (Cohen scale), satisfaction with life (Cantril's Ladder), and self-efficacy in social relations (Smith and Betz scale). Independent variables included: physical activity; sedentary behaviours; length of sleep; and perception of the environment in which the respondent was raised. The analyses were adjusted by gender, age, and occurrence of chronic disease. It was demonstrated that gender, duration of sleep, and perception of the surrounding environment proved to be significant predictors of all four mental health indicators. The protective influence of physical activity appeared to be a particular advantage in a less-supportive environment. The intervention programmes aimed at improving the mental well-being of young people should include promoting physical activity and sufficient sleep; furthermore, environmental moderators should be taken into consideration.

Potential for the development of light therapies in mild traumatic brain injury

Light affects almost all aspects of human physiological functioning, including circadian rhythms, sleep-wake regulation, alertness, cognition and mood. We review the existing relevant literature on the effects of various wavelengths of light on these major domains, particularly as they pertain to recovery from mild traumatic brain injuries. Evidence suggests that light, particularly in the blue wavelengths, has powerful alerting, cognitive and circadian phase shifting properties that could be useful for treatment. Other wavelengths, such as red and green may also have important effects that, if targeted appropriately, might also be useful for facilitating recovery. Despite the known effects of light, more research is needed. We recommend a personalized medicine approach to the use of light therapy as an adjunctive treatment for patients recovering from mild traumatic brain injury.

Latent user groups of an eHealth physical activity behaviour change intervention for people interested in reducing their cardiovascular risk

EHealth behaviour change interventions that help participants to adhere to professional physical activity recommendations can help to prevent future events of cardiovascular diseases (CVD). Therefore, identifying user groups of such interventions based on stages of health behaviour change is of great importance to provide tailored content to users instead of one-size-fits-all approaches. Our study used Latent Class Analysis (LCA) to identify underlying classes of users of an eHealth behaviour change intervention based on stages of change and associated variables. We compared participants' self-allocated stage with their latent class stage membership to display the correlation and mean differences between the two approaches. This was done by analysing baseline data of N = 310 people interested in reducing their CVD risk. LCA identified a three-class solution: (non-)intenders (19.4%), non-habituated actors (43.2%) and habituated actors (37.4%). The interrelation between self-allocated and latent class stage membership was moderate (ρ(308) = .49, p < .001). Significant mean differences for (non-)intenders and non-habituated actors were found in social-cognitive variables. Results showed that self-allocated stage outcomes represent a pseudo stage model - linear trends can be reported for stage-associated social-cognitive variables. The study provides information on the validity of stage measures, which can inform future interventions.