Smoking and Neuropsychiatric Disease-Associations and Underlying Mechanisms

Combined healthy lifestyles and risk of depressive symptoms: A baseline survey in China

BACKGROUND

Little evidence exists about whether a combination of healthy lifestyle factors is associated with a lower risk of depressive symptoms among Chinese population. We aimed to investigate the association between combined healthy lifestyle factors and risk of depressive symptoms.

METHODS

We conducted a baseline survey from July 2021 to December 2023, including 53,642 Chinese adults from general population. A healthy lifestyle score was constructed based on six lifestyle factors (physical activity, smoking status, alcohol consumption, diet, sleep duration, and body mass index). Logistic regression models were used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) adjusted for confounding variables.

RESULTS

Each additional healthy lifestyle score was associated with a 20 % lower risk of having depressive symptoms (OR (95 % CI): 0.80 (0.78-0.81)). Compared with individuals with ≤2 healthy lifestyle factors, individuals with all the six healthy lifestyle factors had a 58 % reduced risk of having depressive symptoms (0.42 (0.37-0.47)). After stratification by gender, education and urbanization, the significant inverse association with healthy lifestyle score was stronger in women, individuals with high education, and urban residents. Besides, the significant negative association between healthy lifestyle score and depressive symptoms remained for different severity of depressive symptoms.

LIMITATIONS

Given the cross-sectional nature of data, we cannot make causal inferences.

CONCLUSIONS

Our study indicated that adherence to healthy lifestyle factors was associated with a reduced risk of having depressive symptoms among Chinese adults. The observed associations were modified by gender, education and urbanization. These findings warrant further verification in interventional studies.

SMAD4 promotes EMT in COPD airway remodeling induced by cigarette smoke through interaction with O-GlcNAc transferase

Cigarette smoke (CS) is a prevalent chemical indoor air contaminant known to be the primary cause of EMT during airway remodeling in COPD. While some evidence indicates the involvement of SMAD4 in EMT across certain diseases, its specific role in CS-induced EMT in airway remodeling associated with COPD is not established. In our research, we observed a substantial upregulation in SMAD4 expression, O-GlcNAcylation and EMT in patients with COPD, as well as in vitro and in vivo COPD models induced by CS, than those of the controls. Downregulation of SMAD4 resulted in a reduction in CS-induced EMT in vitro and in vivo. As a post-translational modification of proteins, O-GlcNAcylation is dynamically controlled by the duo of enzymes: O-linked N-acetylglucosamine (O-GlcNAc) transferase (OGT) and O-GlcNAcase (OGA). We further discovered the enhancement of O-GlcNAcylation levels induced by CS was due to an elevated OGT expression, as the expression of OGA remained unchanged. Using an OGT inhibitor (OSMI-1) counteracted the effects of SMAD4 on EMT. Whereas, overexpressing OGT increased SMAD4 expression and promoted EMT. OGT-mediated SMAD4 O-GlcNAcylation shielded SMAD4 from proteasomal degradation by reducing its ubiquitination, thereby aiding in SMAD4 stabilization in response to EMT induced by CS. Overall, this research uncovers a fresh pathway for CS-induced EMT in the airway remodeling of COPD and offers valuable insights.

Joint effect of docosahexaenoic acid intake and tobacco smoke exposure on learning disability in children and adolescents: a cross-sectional study from the NHANES database

BACKGROUND

Docosahexaenoic acid (DHA) has been reported to be associated with the children's neurodevelopment, who may be exposed to tobacco smoke simultaneously. The evidence about joint effect of DHA intake and tobacco smoke exposure on children and adolescents' learning disabilities (LD) was limited. The objective of this study was to assess the joint effect of DHA intake and tobacco smoke exposure on children and adolescents' LD.

METHODS

A cross-sectional analysis of the NHANES 1999-2004 was performed. Children and adolescents aged 6-15 years old were included. The outcome was diagnosed by parental report of ever health professionals or school representative-identified LD. Dietary DHA intake data were obtained by food frequency questionnaire and tobacco smoke exposure levels were evaluated by serum cotinine levels. Weighted univariable and multivariate logistic regression analyses were conducted to determine the joint effect of DHA intake and tobacco smoke exposure on LD in children and adolescents, with odds ratios (ORs) and 95% confidence intervals (CIs). This joint association was further assessed after stratification by age, gender, body mass index, the history of attention deficit disorder and seen mental health professional.

RESULTS

We identified 5,247 children and adolescents in present study, of whom 593 (11.30%) had LD. After adjusting covariates, we observed children and adolescents with DHA intake (OR = 0.76, 95%CI: 0.61-0.96) was related to lower incidence of LD; children who exposure to tobacco smoke was related to higher incidence of LD (OR = 1.54, 95%CI: 1.07-2.23); children and adolescents who exposure to tobacco smoke and without DHA intake were related to highest odds of LD (OR = 2.08, 95%CI: 1.37-3.17, P for trend = 0.042), that was, DHA and tobacco smoke exposure may have a joint effect on the odds of LD in children and adolescents. Subgroup analyses suggested this joint effect was robust especially among children and adolescents with normal & underweight BMI and without the history of attention deficit disorder and seen mental health professional.

CONCLUSION

Increasing the DHA intake and reducing tobacco smoke exposure may have a potential role in the prevention of LD in children and adolescents. This joint effect warrants further investigation by large-scale prospective study.

Prospective comparison of risk factors for firearm suicide and non-firearm suicide in a large population-based cohort of current and former US service members: findings from the Millennium Cohort Study

Background

Suicide is a leading cause of death among service members and veterans. Among suicide methods, firearms are the most lethal and commonly used method among military populations. Limited research has compared risk factors for the various suicide methods. This study evaluated and compared risk factors for firearm versus non-firearm suicides using data from the Millennium Cohort Study, a large longitudinal military cohort.

Methods

Using a competing risk approach, we identified factors associated with each suicide method. Risk factors included demographics, mental health diagnoses, mental health symptoms, military-specific characteristics, health behaviors, and psychosocial factors. Cause of death was assessed from July 1, 2001, through December 31, 2018.

Findings

Among 201,565 eligible participants with a mean [SD] age of 29.0 [58.1] years, there were 139,789 (69.3%) male, 61,776 (30.7%) female, 15,927 (7.9%) Hispanic, 24,667 (12.3%) non-Hispanic Black, 14,138 (7.0%) Asian, Pacific Islander, American Indian or Multiracial, and 146,736 (72.8%) non-Hispanic White participants. During the study period, 330 died by firearm suicide and 168 died by non-firearm suicide. Overall, effect estimates for risk factors were similar across both methods of suicide. After adjustment, men (HR: 3.69, 95% CI: 2.59, 5.24) and those who screened positive for depression (HR: 1.97, 95% CI: 1.36, 2.87) had an elevated risk for firearm suicide. In contrast, those who self-reported a history of bipolar diagnosis (HR: 3.40, 95% CI: 1.76, 6.55) had significantly increased risk for non-firearm suicide.

Interpretation

Findings suggest that prevention and intervention strategies overall may not need to be differentiated by specific demographic, military, or health factors. Targeted interventions that consider sex and mental health screens might have relative utility in preventing firearm related suicide risk compared with non-firearm suicide.

Funding

Military Operational Medicine Research Program, Defense Health Program, and Department of Veterans Affairs.

Unveiling the Long-Term Lung Consequences of Smoking and Tobacco Consumption: A Narrative Review

Smoking and tobacco use present significant public health challenges due to their association with high morbidity and mortality rates worldwide. Despite reductions in smoking rates in many developed countries, global tobacco consumption remains high, especially in developing regions. This review examines the chronic effects of smoking on the respiratory system, detailing the pathological changes in the lungs and the resultant respiratory illnesses such as chronic obstructive pulmonary disease and lung cancer. Additionally, the review explores the impact of smoking on other body systems, including cardiovascular, immune, gastrointestinal, nervous, and reproductive systems. The extensive health implications of smoking emphasize the need for comprehensive public health interventions to reduce tobacco use and mitigate its adverse effects on health.

Association of vitamin D and cognition in people with type 2 diabetes: a systematic review

CONTEXT

There is a high prevalence of vitamin D deficiency and impaired cognitive function in people with type 2 diabetes mellitus (T2DM).

OBJECTIVE

To critically and systematically review the literature on the association between vitamin D status and cognitive performance in people with type 2 diabetes.

DATA SOURCES

This review was conducted according to PRISMA recommendations. MEDLINE, SCOPUS, the Cochrane Library, and Web of Science databases were searched using the terms "Diabetes Mellitus, Type 2", "Cognitive Function", and "Vitamin D".

DATA EXTRACTION

Eight observational and 1 randomized study were included, containing data of 14 648 adult and elderly individuals (19-74 y). All extracted data were compiled, compared, and critically analyzed.

DATA ANALYSIS

There is no strong evidence that lower serum concentrations of vitamin D and vitamin D-binding protein are associated with worsening cognitive function in individuals with T2DM. Vitamin D supplementation (12 wk) improved the scores of some executive functioning tests, although there was no difference between low doses (5000 IU/wk) and high doses (50 000 IU/wk).

CONCLUSIONS

There is no high-quality evidence demonstrating an association between vitamin D status and cognitive function, or clinical benefits on cognition from vitamin D supplementation in individuals with T2DM. Future studies are needed. Systematic Review Registration: PROSPERO registration no. CRD42021261520.

Determinants of multimorbidity in older adults in Iran: a cross-sectional study using latent class analysis on the Bushehr Elderly Health (BEH) program

BACKGROUND AND OBJECTIVES

Multimorbidity, defined as the presence of two or more long-term health conditions in an individual, is one of the most significant challenges facing health systems worldwide. This study aimed to identify determinants of classes of multimorbidity among older adults in Iran.

RESEARCH DESIGN AND METHODS

In a cross-sectional sample of older adults (aged ≥ 60 years) from the second stage of the Bushehr Elderly Health (BEH) program in southern Iran, latent class analysis (LCA) was used to identify patterns of multimorbidity. Multinomial logistic regression was conducted to investigate factors associated with each multimorbidity class, including age, gender, education, household income, physical activity, smoking status, and polypharmacy.

RESULTS

In 2,426 study participants (mean age 69 years, 52% female), the overall prevalence of multimorbidity was 80.2%. Among those with multimorbidity, 3 latent classes were identified. These comprised: class 1, individuals with a low burden of multisystem disease (56.9%); class 2, individuals with predominantly cardiovascular-metabolic disorders (25.8%) and class 3, individuals with predominantly cognitive and metabolic disorders (17.1%). Compared with men, women were more likely to belong to class 2 (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.52-2.54) and class 3 (OR 4.52, 95% CI 3.22-6.35). Polypharmacy was associated with membership class 2 (OR 3.52, 95% CI: 2.65-4.68) and class 3 (OR 1.84, 95% CI 1.28-2.63). Smoking was associated with membership in class 3 (OR 1.44, 95% CI 1.01-2.08). Individuals with higher education levels (59%) and higher levels of physical activity (39%) were less likely to belong to class 3 (OR 0.41; 95% CI: 0.28-0.62) and to class 2 (OR 0.61; 95% CI: 0.38-0.97), respectively. Those at older age were less likely to belong to class 2 (OR 0.95).

DISCUSSION AND IMPLICATIONS

A large proportion of older adults in Iran have multimorbidity. Female sex, polypharmacy, sedentary lifestyle, and poor education levels were associated with cardiovascular-metabolic multimorbidity and cognitive and metabolic multimorbidity. A greater understanding of the determinants of multimorbidity may lead to strategies to prevent its development.

Secondhand Smoke Exposure and Risk of Dementia in Nonsmokers: A Population-Based Cohort Study

BACKGROUND

Large population-based prospective studies are necessary to provide clarification on the associations of panoramic secondhand smoking burden, including prenatal and postnatal secondhand smoke (SHS) exposure, with the risk of developing dementia.

METHODS

Our study comprised a sample of 353,756 dementia-free individuals from the UK Biobank who were nonsmokers had data on the exposure of maternal smoking as well as SHS exposure in daily life, which was quantified in terms of hours per week (h/week) and whether they lived with household smokers. Multivariable Cox regression models were utilized to analyze the independent and joint associations of maternal smoking and daily life SHS exposure with dementia risk.

RESULTS

During a median follow-up of 11.8 years, 4,113 participants developed dementia. Compared with those who lived in the environment without smokers, multivariable-adjusted hazard ratios (HRs) (95% CIs) were 1.11 (1.02, 1.20) and 1.31 (1.13, 1.52) for those who exposed to SHS for >0 but ≤4 h/week and >4 h/week, respectively, and was 1.25 (1.13, 1.39) for those who lived with smokers in the household. A positive history of maternal smoking was associated with a modestly higher risk of dementia (HR = 1.07; 95% CI: 1.01, 1.15). Furthermore, compared with participants with neither history of maternal smoking nor exposure to SHS, a particularly higher risk of dementia was observed among those with both exposures (HR = 1.48; 95% CI: 1.18, 1.86). Additionally, the HR (95% CI) was 1.32 (1.10, 1.59) when comparing participants with a history of maternal smoking who lived with smokers in their households with those who had neither exposures.

CONCLUSIONS

Having a history of maternal smoking, longer exposure to SHS, and living with smokers in the household were each associated with an increased risk of developing dementia. Individuals who were simultaneously exposed to maternal smoking and SHS or lived with household smokers had a particularly higher dementia risk.

Depression and associated factors among Brazilian adults: the 2019 national healthcare population-based study

BACKGROUND

Mental disorders represent a major public health challenge worldwide, affecting 80% of people living in low- and middle-income countries. Depression, a mental disorder, is a chronic disease of long duration that causes changes in the brain, resulting from a combination of genetic, physiologic, environmental, and behavioral factors. The aim of this study was to investigate possible factors associated with depression in Brazilian adults.

METHODS

A population-based, cross-sectional study was carried out using the public domain database of the 2019 National Health Survey, conducted in Brazil. Depression was considered the dependent variable, and through hierarchical analysis, predictor variables were investigated such as, at the distal level-socioeconomic variables, at the intermediate level-variables related to lifestyle behavior, health condition, and history, and at the proximal level-demographic variables. Logistic regression analysis was used to obtain the adjusted Odds Ratio and the respective 95% confidence interval to identify possible factors associated with depression.

RESULTS

The study included 88,531 participant records with 10.27% diagnosed with depression. The adjusted association measurements, after selecting the independent variables in the hierarchical analysis, showed the following factors associated with depression with differing magnitudes: age, brown and white race/skin color, female sex, poor, very poor, or regular self-reported health condition, diagnosis of cardiovascular disease, work-related musculoskeletal disorder, history of smoking habit, and macroeconomic region.

CONCLUSIONS

An effective strategy for preventing and managing depression in Brazilian adults must include the control of health status and lifestyle behavior factors, with actions and programs to reduce people's exposure to these factors, understanding that socioeconomic-demographic differences of each population can potentially reduce the disease burden.

Neurobiological associations between smoking and internalizing disorders

People with severe mental disorders have a higher mortality rate due to preventable conditions like cardiovascular diseases and respiratory diseases. Nicotine addiction is a preventable risk factor, with tobacco use being twice as high in people with mental disorders. An integrative model that divides mental disorders into externalising, internalising, and thought disorders could be useful for identifying common causalities and risk factors. This review aims to examine the interface between smoking and internalising disorders, specifically schizophrenia, depressive disorders, and anxiety disorders. The review finds that there is a clear association between smoking behaviour and these disorders. Schizophrenia is associated with polymorphisms that result in an imbalance between glutamate and GABA release and abnormalities of dopaminergic pathways. Nicotine improves dopaminergic signalling and balances glutamatergic and GABAergic pathways, improving symptoms and increasing the risk of nicotine dependence. In depressive disorders, smoking is associated with functional changes in brain regions affected by smoking and self-medication. In anxiety disorders, there is a bidirectional relationship with smoking, involving the amygdala and changes in dopaminergic pathways and cortisol production. Smoking poses a threat to people living with psychiatric disorders and calls for further research to assess the interactions between nicotine dependence and internalising and thought disorders.

CircRNA_0026344 via miR-21 is involved in cigarette smoke-induced autophagy and apoptosis of alveolar epithelial cells in emphysema

Cigarette smoke (CS), a main source of indoor air pollution, is a primary risk factor for emphysema, and aberrant cellular autophagy is related to the pathogenesis of emphysema. Circular RNAs (circRNAs) affect the expression of mRNAs via acting as microRNA (miRNA) sponges, but their role in emphysema progression is not established. In the present investigation, CS, acting on alveolar epithelial cells, caused higher levels of miR-21, p-ERK, and cleaved-caspase 3 and led to lower levels of circRNA_0026344 and PTEN, which induced autophagy and apoptosis. miR-21 suppressed the expression of PTEN, which was involved in the regulation of autophagy and apoptosis. Further, in alveolar epithelial cells, overexpression of circRNA_0026344 blocked cigarette smoke extract (CSE)-induced autophagy and apoptosis, but this blockage was reversed by upregulation of miR-21 with a mimic. These results demonstrated that, in alveolar epithelial cells, CS decreases circRNA_0026344 levels, which sponge miR-21 to inhibit the miR-21 target, PTEN, which, in turn, activates ERK and thereby promotes autophagy and apoptosis, leading to emphysema. Thus, for emphysema, circRNA_0026344 regulates the PTEN/ERK axis by sponging miR-21, which is associated with the CS-induced autophagy and apoptosis of alveolar epithelial cells. In sum, the present investigation identifies a novel mechanism for CS-induced emphysema and provides information useful for the diagnosis and treatment of CS-induced emphysema.

Urinary tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and cognitive functioning in older adults: The National Health and Nutrition Examination Survey 2013-2014

INTRODUCTION

Tobacco contains carcinogens called tobacco-specific nitrosamines. Among the tobacco-specific nitrosamines, is nicotine-derived nitrosamine ketone (NNK) which produces the metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). We aimed to examine the association between urinary tobacco-specific NNAL and cognitive functioning among older adults.

METHODS

A total of 1673 older adults aged ≥60 years from the National Health and Nutrition Examination Survey 2013-2014 were included. Urinary tobacco-specific NNAL was analyzed in the laboratory. Cognitive functioning was measured using the Consortium to Establish a Registry for Alzheimer's Disease Word Learning subtest (CERAD-WL) immediate and delayed memory tests, the Animal Fluency test (AFT), and the Digit Symbol Substitution Test (DSST). Test-specific and global cognition z-scores were calculated based on means and standard deviations of the cognitive test scores. Multivariable linear regression models were constructed to examine the independent association between quartiles of urinary tobacco-specific NNAL and cognitive test-specific and global cognition z-scores controlling for age, sex, race/ethnicity, education level, depressive symptoms, body mass index, systolic blood pressure, urinary creatinine, hypertension, diabetes, alcohol use, and smoking status.

RESULTS

About half of the participants (mean age 69.8 years) were female (52.1%), non-Hispanic White (48.3%), and completed some college and above (49.7%). Multivariable linear regression results showed that participants in the 4th quartile (highest quartile) of urinary NNAL, compared with those in the 1st quartile (lowest quartile), had lower DSST z-scores (β= -0.19; 95% CI: -0.34 - -0.04).

CONCLUSIONS

Tobacco-specific NNAL was negatively associated with processing speed, sustained attention, and working memory in older adults.

Advanced Materials Design for Adsorption of Toxic Substances in Cigarette Smoke

Cigarettes, despite being economically important legal consumer products, are highly addictive and harmful, particularly to the respiratory system. Tobacco smoke is a complex mixture containing over 7000 chemical compounds, 86 of which are identified to have "sufficient evidence of carcinogenicity" in either animal or human tests. Thus, tobacco smoke poses a significant health risk to humans. This article focuses on materials that help reduce the levels of major carcinogens in cigarette smoke; these include nicotine, polycyclic aromatic hydrocarbons, tobacco-specific nitrosamines, hydrogen cyanide, carbon monoxide, and formaldehyde. Specifically, the research progress on adsorption effects and mechanisms of advanced materials such as cellulose, zeolite, activated carbon, graphene, and molecularly imprinted polymers are highlighted. The future trends and prospects in this field are also discussed. Notably, with advancements in supramolecular chemistry and materials engineering, the design of functionally oriented materials has become increasingly multidisciplinary. Certainly, several advanced materials can play a critical role in reducing the harmful effects of cigarette smoke. This review aims to serve as an insightful reference for the design of hybrid and functionally oriented advanced materials.

Cigarette smoking and risk of suicide in bipolar disorder: a systematic review

Objective

Bipolar disorder (BD) is a highly prevalent, chronic and recurrent mental illness. The smoking rates in patients with BD are much higher than those of the general population, and BD is associated with an increased risk of suicide. An association between smoking and suicidal behavior has been found in the general population, this systematic review examines whether there is evidence of an association between smoking and suicide behavior in patients with BD.

Method

A database search was carried out in Medline, Embase, The Cochrane Library, Scopus, and Web of Science, updated until December 31st, 2021, according to the 2020 PRISMA guidelines. We identified prospective and retrospective studies that included patients diagnosed with BD types I, II, and not otherwise specified, and in which smoking and suicidal behavior were correlated. Articles that focused exclusively on other mental disorders were excluded. The Ottawa-Newcastle scale was used to assess the methodological quality of the included articles.

Results

Fifteen articles (n = 7,395) met all the inclusion criteria. In nine of these articles, the authors found an association between smoking and suicidal behavior in BD, while in the remaining six articles, this association was not found. A great deal of variability was observed between articles, particularly in the measurement of suicidal behavior and tobacco consumption. The risk of bias, as assessed by the NOS, was high for most of the included articles, except for two papers, whose risk was low.

Conclusion

It was not possible to establish a clear relationship between tobacco use and the risk of suicide in BD patients due to the heterogeneity of the articles included in this systematic review, which had different sample sizes and methodological issues. However, both conditions are highly prevalent and have a negative impact on the prognosis of BD. Therefore, a systematic approach is needed, based on accurate measurement of a patient's smoking habits and their risk of suicidal behavior, in order to establish an appropriate therapeutic plan.

Additional information

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors and was registered on PROSPERO with the CRD42022301570 on January 21th 2022.

Smoking Habits and Attitudes toward Smoking in Patients with Severe Mental Illness in Residential Facilities in Insular Greece

Smoking may contribute to increased cardiovascular morbidity and mortality in patients with schizophrenia spectrum disorders. The objective of the present study is to explore the attitudes toward smoking in patients with severe mental illness in residential rehabilitation facilities in insular Greece. The patients (n = 103) were studied with the use of a questionnaire based on a semi-structured interview. Most of the participants (68.3%) were current regular smokers, had been smoking for 29 years and started smoking at an early age. The majority (64.8%) reported having tried to quit smoking in the past, and only half had been advised by a physician to quit. The patients agreed on the rules for smoking and believed that the staff should avoid smoking in the facility. The years of smoking were statistically significantly correlated to the educational level and the treatment with antidepressant medication. A statistical analysis showed that longer stay period in the facilities correlates with current smoking, an effort to quit and increased belief that smoking causes harm to health. Further research on the attitudes of patients in residential facilities toward smoking is needed, which could guide interventions for smoking cessation and should be assumed by all health professionals who are involved in the care of those patients.

The shared genetic landscape of blood cell traits and risk of neurological and psychiatric disorders

Phenotypic associations have been reported between blood cell traits (BCTs) and a range of neurological and psychiatric disorders (NPDs), but in most cases, it remains unclear whether these associations have a genetic basis and, if so, to what extent genetic correlations reflect causality. Here, we report genetic correlations and Mendelian randomization analyses between 11 NPDs and 29 BCTs, using genome-wide association study summary statistics. We found significant genetic correlations for four BCT-NPD pairs, all of which have prior evidence for a phenotypic correlation. We identified a previously unreported causal effect of increased platelet distribution width on susceptibility to Parkinson's disease. We identified multiple functional genes and regulatory elements for specific BCT-NPD pairs, some of which are targets of known drugs. These results enrich our understanding of the shared genetic landscape underlying BCTs and NPDs and provide a robust foundation for future work to improve prognosis and treatment of common NPDs.

Associations of lifestyle with physical, hearing, visual, and mental functional impairments among older adults: Findings from two prospective cohort studies

OBJECTIVE

To examine the associations between lifestyle habits and functional impairments among older adults.

METHODS

The study includes 20,545 women and 14,374 men aged 70 years or older at the time of the function assessment. Participants were from two prospective cohort studies: the Shanghai Women's Health Study (SWHS, enrollment from 1996 to 2000) and the Shanghai Men's Health Study (SMHS, enrollment from 2002 to 2006). Lifestyle information was collected at study enrollment and a healthy lifestyle score (HLS) was derived. Functional impairment information was collected at the follow-up survey conducted in 2012-2017. Logistic regression analyses were applied to estimate the associations of HLS with functional impairments.

RESULTS

The average age at lifestyle and functional impairment assessment was 62.3 (range: 49.9-70.9) and 77.7 (range: 70.0-89.4) for women and 67.5 (range: 55.1-74.9) and 77.4 (range: 70.0-88.6) for men. After a median follow-up of 14.4 years, we found that the HLS was inversely associated with overall severe functional impairment: odds ratio (95% confidence interval), 0.78(0.71-0.86) and individual severe functional impairment: 0.67(0.62-0.73) for independent walking, 0.85(0.77-0.94) for hearing/vision, 0.79(0.70-0.88) for memory, and 0.74(0.67-0.82) for decision-making impairment, comparing the highest with the lowest HLS categories. Such associations were similar among individuals with/without cardiometabolic diseases at baseline. The associations between each lifestyle factor and functional impairments differed.

CONCLUSION

A healthy lifestyle was associated with reduced odds of physical and mental impairment among older Chinese adults, emphasizing the importance of promoting and maintaining a healthy lifestyle to prevent or postpone age-related functional impairments.

Maternal iron status during pregnancy and attention deficit/hyperactivity disorder symptoms in 7-year-old children: a prospective cohort study

Evidence suggests that iron status may be linked to symptoms of childhood attention deficit/hyperactivity disorder (ADHD), but there is little data available on the relationship between iron status in pregnancy and the risk of developing ADHD. And the data that does exist is inconsistent. Our aim here is to assess the effect of maternal serum ferritin (SF) and haemoglobin (Hb) levels during pregnancy on manifestations of ADHD in children at 7 years of age. This prospective study analysed data from 1204 mother-child pairs from three Spanish cohorts participating in the INMA project. Maternal SF and Hb levels during pregnancy and other mother and child characteristics were collected. The children's ADHD behaviours were reported by their parents using Conners' Parent Rating Scale-Revised Short Form (CPRS-R:S). In the unadjusted regression analysis, maternal SF was positively associated with children's T-scores on the subscales Cognitive problems/Inattention (β: 0.63, 95%CI 0.06-1.19; p = 0.029) and ADHD index (β: 0.72, 95%CI 0.20-1.24; p = 0.007). These associations were not present after multivariate adjustment or stratification by first and second trimester of pregnancy. The Hb levels were not related to any of the CPRS-R:S subscales in unadjusted or multivariate-adjusted models. We observed no association between maternal SF or Hb levels and the risk of ADHD symptomatology (T-score ≥ 65 for CPRS-R:S subscales). Our results suggest that neither maternal SF nor Hb levels during pregnancy are related to ADHD symptoms in 7-year-old children.

The association of smoking and smoking cessation with prevalent and incident symptoms of depression, anxiety, and sleep disturbance in the general population

BACKGROUND

Smoking is a well-established risk factor for chronic non-communicable diseases. However, the relationship between cigarette smoking and the risk of developing mental health conditions remains largely elusive. This study examined the relationship between cigarette smoking as well as smoking cessation and prevalent and incident symptoms of depression, anxiety, and sleep disturbance in the general population.

METHODS

In a cohort of 15,010 individuals from the Gutenberg Health Study (aged 35-74 years at enrollment), prevalent (at baseline from 2007 to 2012) and incident symptoms (at follow-up from 2012 to 2017) of depression, anxiety, and sleep disturbance were determined by validated questionnaires and/or medical records. Smoking status, pack-years of smoking in current and former smokers, and years since quitting smoking in former smokers were assessed by a standardized computer-assisted interview.

RESULTS

In multivariable logistic regression models with comprehensive adjustment for covariates, smoking status was independently associated with prevalent and incident symptoms of depression (Patient Health Questionnaire-9 ≥ 10), whereas this association was weaker for anxiety (Generalized Anxiety Disorder Scale-2 ≥ 3) and sleep disturbance (Patient Health Questionnaire-9 > 1). Among current and former smokers, smoking ≥30 or ≥10 pack-years, respectively, yielded in general the highest effect estimates. Smoking cessation was weakly associated with the prevalence and incidence of all outcomes, here consistent associations were observed for prevalent symptoms of depression.

LIMITATIONS

The observational nature of the study does not allow for causal inferences.

CONCLUSIONS

The results of the present study suggest that cigarette smoking is positively and that smoking cessation is negatively associated with symptoms of common mental health conditions, in particular of depression.

First-onset major depression during the COVID-19 pandemic: A predictive machine learning model

BACKGROUND

This study longitudinally evaluated first-onset major depression rates during the pandemic in Italian adults without any current clinician-diagnosed psychiatric disorder and created a predictive machine learning model (MLM) to evaluate subsequent independent samples.

METHODS

An online, self-reported survey was released during two pandemic periods (May to June and September to October 2020). Provisional diagnoses of major depressive disorder (PMDD) were determined using a diagnostic algorithm based on the DSM criteria of the Patient Health Questionnaire-9 to maximize specificity. Gradient-boosted decision trees and the SHapley Additive exPlanations technique created the MLM and estimated each variable's predictive contribution.

RESULTS

There were 3532 participants in the study. The final sample included 633 participants in the first wave (FW) survey and 290 in the second (SW). First-onset PMDD was found in 7.4% of FW participants and 7.2% of the SW. The final MLM, trained on the FW, displayed a sensitivity of 76.5% and a specificity of 77.8% when tested on the SW. The main factors identified in the MLM were low resilience, being an undergraduate student, being stressed by pandemic-related conditions, and low satisfaction with usual sleep before the pandemic and support from relatives. Current smoking and taking medication for medical conditions also contributed, albeit to a lesser extent.

LIMITATIONS

Small sample size; self-report assessment; data covering 2020 only.

CONCLUSIONS

Rates of first-onset PMDD among Italians during the first phases of the pandemic were considerable. Our MLM displayed a good predictive performance, suggesting potential goals for depression-preventive interventions during public health crises.

Investigating the reciprocal temporal relationships between tobacco consumption and psychological disorders for youth: an international review

OBJECTIVE

To investigate reciprocal temporal relationships between tobacco consumption and psychological disorders for youth.Design: Review DATA SOURCES: Five databases (PubMed, Embase, Scopus, CINAHL and PsycINFO) on 26 September 2019 and updated on 11 May 2021, indexing tobacco, mental illness and longitudinal.Study selection: Methods used consensus and multiple reviewers.

INTERVENTIONS

Cohort studies (n=49) examining tobacco and selected psychological disorders (depression, anxiety, bipolar, psychosis, borderline personality disorder) among youth, and systematic reviews (n=4) of these relationships met inclusion criteria.

PRIMARY AND SECONDARY OUTCOME MEASURES

Effect of tobacco on psychological disorders and effect of psychological disorders on tobacco.

DATA EXTRACTION AND SYNTHESIS

Independent extraction by the first author and checked by final author. Joanna Briggs Institute Critical Appraisal Tools were used for all studies.Included studies had moderate-to-high appraisal scores. We synthesised findings using vote counting for effect direction and descriptive data.

RESULTS

Fifty-three studies were included in the review. Thirteen of 15 studies showed a positive effect direction of tobacco on depression (p<0.001). Six of 12 studies showed a positive effect direction of depression on tobacco (p=0.016). Six of eight studies showed a positive effect direction of tobacco on anxiety (p=0.016). Eleven of 18 studies showed a positive effect direction of anxiety on tobacco (p=0.003). No effect between tobacco and bipolar, or tobacco and psychosis was found. No studies examined tobacco and borderline personality disorder.

CONCLUSIONS

Reciprocal relationships existed between tobacco and both depression and anxiety for youth, though causality is unconfirmed. No positive effect direction was found between tobacco and psychosis, perhaps because nicotine has conflicting effects on psychosis. For other relationships examined, evidence was weak because of low number of studies. More research to inform prevention and early intervention is needed.

PROSPERO REGISTRATION NUMBER

CRD42020150457.

How to Improve the Drafting of Health Profiles

Delineating patients' health profiles is essential to allow for a proper comparison between medical care and its results in patients with comorbidities. The aim of this work was to evaluate the concordance of health profiles outlined by ward doctors and by epidemiologists and the effectiveness of training interventions in improving the concordance. Between 2018 and 2021, we analyzed the concordance between the health profiles outlined by ward doctors in a private hospital and those outlined by epidemiologists on the same patients' medical records. The checks were repeated after training interventions. The agreement test (Cohen's kappa) was used for comparisons through STATA. The initial concordance was poor for most categories. After our project, the concordance improved for all categories of CIRS. Subsequently, we noted a decline in concordance between ward doctors and epidemiologists for CIRS, so a new training intervention was needed to improve the CIRS profile again. Initially, we found a low concordance, which increased significantly after the training interventions, proving its effectiveness.

Physical Activity in Polluted Air-Net Benefit or Harm to Cardiovascular Health? A Comprehensive Review

Both exposure to higher levels of polluted air and physical inactivity are crucial risk factors for the development and progression of major noncommunicable diseases and, in particular, of cardiovascular disease. In this context, the World Health Organization estimated 4.2 and 3.2 million global deaths per year in response to ambient air pollution and insufficient physical activity, respectively. While regular physical activity is well known to improve general health, it may also increase the uptake and deposit of air pollutants in the lungs/airways and circulation, due to increased breathing frequency and minute ventilation, thus increasing the risk of cardiovascular disease. Thus, determining the tradeoff between the health benefits of physical activity and the potential harmful effects of increased exposure to air pollution during physical activity has important public health consequences. In the present comprehensive review, we analyzed evidence from human and animal studies on the combined effects of physical activity and air pollution on cardiovascular and other health outcomes. We further report on pathophysiological mechanisms underlying air pollution exposure, as well as the protective effects of physical activity with a focus on oxidative stress and inflammation. Lastly, we provide mitigation strategies and practical recommendations for physical activity in areas with polluted air.