The joint contribution of physical activity,insomnia symptoms,and smoking to the cost of short‐term sickness absence

Physical inactivity has been associated with both insomnia symptoms and smoking. Further, they are all independently associated with increased sickness absence (SA) from work. However, joint contribution of either physical activity (PA) with insomnia symptoms or with smoking to SA and, especially, their direct cost for the employer is poorly understood. Therefore, we aimed to examine these joint associations with short‐term (<15 days) SA cost. The Helsinki Health Study is a cohort of midlife employees of the City of Helsinki, Finland (baseline n = 8960, response rate 67%). During 2000‐2002, the participants were mailed a survey questionnaire that gathered information on health behavior and sociodemographic characteristics. SA, salary, and time of employment were followed up through the employer's personnel register between 2002 and 2016 for those with a written consent to the use of their register data (78% of the participants). Individual salary data were used to calculate the direct cost of short‐term SA. Data were analyzed with a two‐part model. Inactive participants with frequent insomnia symptoms had 2526€ (95% CI 1736€‐3915€) higher cost of short‐term SA than vigorously active participants without insomnia symptoms. Furthermore, inactive smokers had 4166€ (95% CI 2737€‐5595€) higher cost for the employer over the follow‐up than vigorously active non‐smokers. In conclusion, this study showed that PA and insomnia symptoms as well as PA and smoking are jointly associated with short‐term SA cost. The results emphasize encouraging employers to improve work environments so that they promote active lifestyle, good sleep, and non‐smoking in order to reduce the cost of SA.     

Pharmacotherapy for the treatment of depression in patients with alzheimer’s disease: a treatment-resistant depressive disorder

Introduction: Pharmacotherapy for the treatment of depressive disorders in Alzheimer’s Disease (AD) represents a clinical challenge. pharmacological options are often attempted after a period of watchful waiting (8–12 weeks). monoaminergic antidepressant drugs have shown only modest or null clinical benefits, maybe because the etiology of depressive symptoms in ad patients is fundamentally different from that of nondemented subjects.

Areas covered: The following article looks at the selective serotonin reuptake inhibitor sertraline, which is one of the most frequently studied antidepressant medications in randomized controlled trials (RCTs). It also discusses many other pharmacological approaches that have proven to be inadequate (antipsychotics, acetylcholinesterase inhibitors, anticonvulsants, hormone replacement therapy) and new drug classes (mainly affecting glutamate transmission) that are being studied for treating depression in AD. It also gives discussion to the phase II RCT on the alternative drug S47445 and the potential effect on cognition of the multimodal antidepressant vortioxetine in older depressed patients. Finally, it discusses the N-methyl-D-aspartate antagonist ketamine.

Expert opinion: The present RCT methodologies are too disparate to draw firm conclusions. Future studies are required to identify effective and multimodal pharmacological treatments that efficiently treat depression in AD. Genotyping may boost antidepressant treatment success.     

2022年美国运动医学会《2型糖尿病患者的运动/身体活动指南》解读及启示

2型糖尿病（T2DM）是一种常见的慢性代谢性疾病。近年来,随着国内外相关指南的不断更新,T2DM患者的身体活动建议日趋完善,但在日常活动过程中仍有难点有待解决。2022年2月,美国运动医学会（ACSM）和美国糖尿病协会（ADA）在2010年《运动和2型糖尿病》的基础上进行了更新,针对不同年龄段T2DM患者的身体活动、最佳活动时机、医疗干预与身体活动的有效性、身体活动和饮食注意事项等方面提供了新的临床指导建议。本文对2022年指南的主要内容及重点更新内容进行解读,并提出对我国临床工作者开展T2DM患者运动/身体活动干预的建议。     

The Impact of an Immersive Elective on Learners’ Understanding of Lifestyle Medicine and Its Role in Patients’ Lives

Objective. To design an immersive, active learning, lifestyle medicine (LM) elective and evaluate its impact on a pharmacy learners’ ability to understand the challenges of implementing lifestyle changes.Design. A 3-credit elective was developed that incorporated goal setting and immersion into the realm of LM as experienced by both the patient and the practitioner. Learners were assessed via a survey instrument, formal assignments, reflections, and the Presidential Fitness Challenge.Assessment. Learners reported that their ability to initiate LM as a primary intervention within a care plan significantly increased after taking this course. They also improved their overall health.Conclusion. By identifying and implementing self-identified lifestyle modifications, learners increased confidence in their abilities to produce evidence-based outcomes for patients. Learners were able to understand the challenges of trying to change their daily habits as they undertook their own personal goals.     

A New Operational Definition of Frailty: The Frailty Trait Scale

ObjectivesTo provide a new instrument to diagnose frailty, the Frailty Trait Scale (FTS), that allows a more precise assessment and monitoring of individuals.DesignProspective population-based cohort study.SettingThe Toledo Study for Healthy Aging, Spain.ParticipantsA total of 1972 men and women aged 65 years or older.MeasurementsWe identified 7 frailty dimensions (energy balance–nutrition, physical activity, nervous system, vascular system, strength, endurance, and gait speed) represented by 12 items. Each item was pondered based on the quintiles of its distribution in the study population. Validity was evaluated by testing its association with factors related to frailty and its predictive value for adverse events. This predictive capacity was further compared with the capacity of 2 well-established frailty models (the frailty phenotype and the Frailty Index).ResultsFTS score was associated with several comorbidities and biomarkers classically associated with frailty. The FTS was associated with the incidence of hospitalization and mortality (hazard ratio associated with a score in the highest quartile [versus the first quartile] = 2.3, 95% confidence interval [CI] 1.6–3.4, and 2.5, 95% CI 1.8–3.6, respectively). Compared with Fried et al's definition, the FTS showed a better predictor for hospitalization in persons younger than 80 (area under the curve [AUC] = 0.65 vs 0.62, P = .01), and for mortality in the oldest group (AUC = 0.77 vs 0.72, P = .02). FTS showed similar predictive value to the Frailty Index.ConclusionFTS associates with many of the factors linked to frailty and has a similar predictive capacity to that provided by the classical instruments. Its characteristics offer some advantages over them, with potential utility in research and clinical practice.     

全民健康生活方式示范社区创建对居民健康知识知晓的影响

目的了解全民健康生活方式行动示范社区创建对深圳市南山区某社区居民健康生活方式相关知识知晓率的影响。方法2012年5-7月对南山区某社区居民开展为期3个月的全民健康生活方式示范社区创建活动,内容包括组织管理、环境建设、活动开展以及效果评估4个方面。采用单纯随机抽样法,分别于示范社区创建前后抽取该社区1560名及1280名≥8岁的常住居民．用现场面对面问卷调查的方式对居民健康知识知晓情况进行创建前后的效果分析。问卷内容包括健康生活方式、控油限盐、合理运动以及BMI4个方面的10个问题。结果创建前获得有效问卷1534份,其中男性729人,女性805人,平均年龄40岁;创建后获得有效问卷1272份,其中男性619人,女性653人,平均年龄43岁。创建前后抽取的调查人群在性别、年龄等人口学特征上均衡可比（P〉0．05）,创建后调查人群对健康生活方式知识的总知晓率为57．94％（7370／12720）,其中10个问题的知晓率在41．35％～76．57％之间,较创建前总知晓率（41．17％,6316／15340）有明显提高（P〈0．01）。创建后,女性、男性的总知晓率分别为60．17％、55．59％,分别与创建前的42．12％、40．12％相比有明显升高（均P〈0．01）,其中女性、男性分别有9、6个问题的知识知晓率有明显提高（P〈0．05或P〈0．01）,其中两者不同表现为女性在“不健康生活方式与疾病的关系”、“日行一万步的内涵”以及“身体活动的内涵”方面知识的知晓率明显提高。0—18、19～59以及≥60岁年龄段人群在创建后的总知晓率分别为55．00％、57．15％和68．70％,分别与创建前的19．00％、42．45％和36．74％相比有明显升高（均P〈0．01）,其中3个年龄组分别有7、8、9个问题的知晓率有明显提高（P〈0．05或P〈0．01）。结论全民健康生活方式行动示范社区创建提高了该地区居民健康知识的知晓率,应加强≤18岁居民健康知识的宣传教育。