Manipulating the exposome to enable better ageing.

The sum total of life course exposures creates an exposome that has a significant impact on age-related health. Understanding the interplay between exposome factors and the (epi) genome, offers pertinent insights into the ageing process and its relationship with the accumulation of allostatic load. We propose to exploit this to develop a biomimetic approach that will provide insight into how evolution through natural selection in other species has solved many age related human health issues. In particular, we will emphasise the need to reconnect a more mechanistic approach to medical science with a broader natural sciences approach, using biomimetics to mitigate the global burden of age related ill health. In particular, we will discuss how such an approach indicates leverage of the activities of the Nrf 2 gene to enhance health span via reintroduction of the classical 'Food as Medicine' concept, including modulation of the microbiome and the creation of more salutogenic and biophilic environments. Additionally, we will discuss how this approach integrates with novel and developing senotherapies.

Rapid and sound assessment of well-being within a multi-dimensional approach: The Well-being Numerical Rating Scales (WB-NRSs).

The assessment of well-being remains an important topic for many disciplines including medical, psychological, social, educational, and economic fields. The present study assesses the reliability and validity of a five-item instrument for evaluating physical, psychological, spiritual, relational, and general well-being. This measure uniquely utilizes a segmented numeric version of the visual analog scale in which a respondent selects a whole number that best reflects the intensity of the investigated characteristic. In study one, 939 clinical (i.e., diagnosed with cancer and liver disease with cirrhosis) and non-clinical (i.e., undergraduate students and their family and acquaintances) participants between the ages of 18 to 87 years (M = 47.20 years, SD = 19.62, 54% males) were recruited. Results showed items have strong discriminant ability and the spread of threshold parameters attests to the appropriateness of the response categories. Moreover, convergent and discriminant validity were found with other self-report measures (e.g., depression, anxiety, optimism, well-being) and the measure showed responsiveness to two separate interventions for clinical populations. In study two, 287 Canadian (ages ranged from 18 to 30 years; M = 20.78, SD = 3.32; 23% males) and 342 Italian undergraduate psychology students (age ranged from 18 to 29 years, M = 21.21 years, SD = 1.73, 38% males) were recruited to complete self-report questionnaires. IRT-based differential item functioning analyses provided evidence that the item properties were similar for the Italian and English versions of the scale. Additionally, the validity results obtained in study one were replicated and similar relationships between criterion variables were found when comparing the Italian- and the English-speaking samples. Overall, the current study provides evidence that the Italian and English versions of the WB-NRSs offer added value in research focused on well-being and in assessing well-being changes prompted by intervention programs.

On shaping expectations of "new normals" for living in a post-COVID-19 world.

I begin with my impressions of a narrative of redemption that is caught up in the formation of new environmental, social, and political aspirations for the aftermath of the COVID-19 pandemic. I then reflect on, first, pre-pandemic scholarship on "biosecurity" and, second, taking up a variation of the syndemic approach to understanding the COVID-19 pandemic. I end by arguing that we should not expect to live with "new normals" for living in a post-COVID-19 world that leaves intact "old normals" that have historically contributed to the rise of anthropogenic environmental harms and inegalitarian social arrangements in the world today.

Omega-3 Long-Chain Polyunsaturated Fatty Acids: Are They Beneficial for Physical and Cognitive Functioning in Older Adults?

BACKGROUND: There is equivocal evidence about beneficial properties of omega-3 long-chain polyunsaturated fatty acids (ω-3 LCPUFA) for older adults. OBJECTIVE: This study investigated the relationship between circulating ω-3 LCPUFA, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) levels and their corresponding dietary intakes with cognition and physical function in a cohort of community-dwelling older adults at risk of dementia. METHODS: A cross-sectional analysis was conducted among 142 community-dwelling older adults (60-85 years) with subjective memory complaints. Erythrocyte fatty acids (ω-3 LCPUFA) and the omega-3 index were measured; dietary DHA and EPA were assessed with a LCPUFA specific questionnaire. Cognition was measured using the Cogstate computerised battery and Trail-making tests. Muscle strength was assessed by grip strength and physical function via the four-square step test, 30-second sit-to-stand, timed up-and-go test, and 4-m walk test. Multiple regression analysis was used to assess the relationship between erythrocyte ω-3 LCPUFA, dietary intake, cognitive and physical function. RESULTS: Higher dietary DHA and EPA were associated with better global cognitive function (DHA: ß=0.164, p=0.042; EPA: ß=0.188, p=0.020). Higher dietary EPA was associated with better attention/psychomotor composite scores (ß=0.196, p=0.024), mobility (four-square step test: ß=-0.202, p=0.015) and gait speed (4m walk test: ß=-0.200, p=0.017). No associations were found between erythrocyte ω-3 LCPUFA and cognitive or functional performance measures. CONCLUSIONS: In community-dwelling older adults with subjective memory complaints, higher dietary ω-3 LCPUFA intake was associated with better cognitive and physical function, supporting the evidence that ω-3 fatty acids play a role in optimising physical and cognitive health during ageing.

The Healthy Microbiome-What Is the Definition of a Healthy Gut Microbiome?

Use of microbiome-based biomarkers in diagnosis, prognosis, risk profiling, and precision therapy requires definition of a healthy microbiome in different populations. To determine features of the intestinal microbiota associated with health, however, we need improved microbiome profiling technologies, with strain-level resolution. We must also learn more about how the microbiome varies among apparently healthy people, how it changes with age, and the effects of diet, medications, ethnicity, geography, and lifestyle. Furthermore, many intestinal microbes, including viruses, phage, fungi, and archaea, have not been characterized, and little is known about their contributions to health and disease.Whether a healthy microbiome can be defined is an important and seemingly simple question, but with a complex answer in continual need of refinement.

A Novel Promising Frontier for Human Health: The Beneficial Effects of Nutraceuticals in Cardiovascular Diseases.

Cardiovascular diseases (CVDs) such as hypertension, atherosclerosis, myocardial infarction, and diabetes are a significant public health problem worldwide. Although several novel pharmacological treatments to reduce the progression of CVDs have been discovered during the last 20 years, the better way to contain the onset of CVDs remains prevention. In this regard, nutraceuticals seem to own a great potential in maintaining human health, exerting important protective cardiovascular effects. In the last years, there has been increased focus on identifying natural compounds with cardiovascular health-promoting effects and also to characterize the molecular mechanisms involved. Although many review articles have focused on the individual natural compound impact on cardiovascular diseases, the aim of this manuscript was to examine the role of the most studied nutraceuticals, such as resveratrol, cocoa, quercetin, curcumin, brassica, berberine and Spirulina platensis, on different CVDs.

The bidirectional relationship between physical health and memory.

Individuals typically experience changes in physical health and cognitive ability across the life span. Although these constructs dynamically relate to one another, the temporal ordering of dynamic changes in physical health and cognitive ability is not well-established. Therefore, we examined the temporal ordering of the dynamic, bidirectional relationship between physical health and memory across ages 50-87 with Bivariate Dual Change Score Models (BDCSM). Employing a model-comparison approach, we tested whether inclusion of specific directional coupling parameters resulted in a meaningful improvement in model fit, controlling for education, gender, and race. The current sample included 9,103 individuals who participated in Waves 4-11 (1998-2012) of the Health and Retirement Study. Results indicated that both memory and physical health declined across ages 50-87. Furthermore, level of memory at a given time point was positively associated with subsequent change in physical health, meaning higher memory was linked to less decline in physical health by the subsequent time point. The opposite effect, namely physical health predicting memory, was much weaker. Age differences were also evident in the bidirectional coupling model, indicating that old-old individuals (i.e., ages 75-87) exhibited a much stronger coupling effect from memory to change in physical health than younger individuals (i.e., ages 50-74). In conclusion, memory buffers decline in physical health across mid-to-later life, and this effect is especially strong at older ages. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Redefining proteostasis transcription factors in organismal stress responses, development, metabolism, and health.

Eukaryotic organisms have evolved complex and robust cellular stress response pathways to ensure maintenance of proteostasis and survival during fluctuating environmental conditions. Highly conserved stress response pathways can be triggered and coordinated at the cell-autonomous and cell-nonautonomous level by proteostasis transcription factors, including HSF1, SKN-1/NRF2, HIF1, and DAF-16/FOXO that combat proteotoxic stress caused by environmental challenges. While these transcription factors are often associated with a specific stress condition, they also direct "noncanonical" transcriptional programs that serve to integrate a multitude of physiological responses required for development, metabolism, and defense responses to pathogen infections. In this review, we outline the established function of these key proteostasis transcription factors at the cell-autonomous and cell-nonautonomous level and discuss a newly emerging stress responsive transcription factor, PQM-1, within the proteostasis network. We look beyond the canonical stress response roles of proteostasis transcription factors and highlight their function in integrating different physiological stimuli to maintain cytosolic organismal proteostasis.

Pharmacovigilance of thalidomide in the Brazilian Health System and patient safety

In Brazil, thalidomide is manufactured by a public laboratory, distributed by the Unified Health System (SUS), and regulated by the National Health Surveillance Agency (Anvisa). Despite the concerns regarding the adverse effects of thalidomide, few drug utilization studies have been conducted to describe processes and outcomes related to this drug. The aim of this study was to elucidate the issues related to the utilization and control of thalidomide, and patient safety within the scope of SUS. In this cross-sectional study, we evaluated the articulation between an outpatient dermatology service of a referral hospital in infectology, the manufacturer, and Anvisa. Four data sources were used: i) interviews with health professionals; ii) data from the Customer Service of the manufacturer, iii) data on adverse events reported to Anvisa, and iv) adverse events identified in outpatient service. Most health professionals interviewed knew the major thalidomide-related adverse effects. None of them ever reported adverse events to Anvisa or contacted the Customer Service. For over three years, there were 330 calls concerning thalidomide at Customer Service, 7% of which were related to adverse events. During a period of six years, Anvisa was notified of only 15 adverse events. Health professionals were aware of the adverse events associated with thalidomide, but not the necessity to report them. The low number of notifications recorded by Anvisa and the information obtained from Customer Service show that pharmacovigilance remains incipient. A pharmacovigilance system that integrates all the services associated with thalidomide is required to strengthen this activity within the SUS to improve patient safety.

Protein Engineering for Improved Health: Technological Perspectives.

Protein engineering has enabled development of novel proteins aimed at disease diagnosis, alleviation and improved health attributes. The present article provides an overview of recent approaches and techniques used to modify proteins at diverse levels, which find therapeutically relevant applications. There is immense interest among researchers to discover new and increasingly valuable solutions for various health related issues and protein engineering could be a possible venue to sort out such problems. In this mini review we have tried to decipher some of the novel aspects of protein engineering in terms of protein-based therapeutics and diagnostics, in-silico tools and related approaches. A special emphasis has been given for some innovative aspects of protein-nanoparticle conjugates; use of artificial intelligence (AI)- based tools and post-translational modifications. Utilization of such approaches in protein engineering might be ground breaking in future research endeavor of researchers across the world.

The Effect of Age upon the Interrelationship of BMI and Inpatient Health Outcomes.

OBJECTIVES: There is growing evidence that the relationship between body mass index (BMI - defined as weight in kilograms divided by height in metres squared) and patient outcomes is age-dependent; specifically, a raised BMI may have a protective effect in older adults. This has been demonstrated clearly in the community setting; less clear is the effect of age on this relationship in the inpatient setting. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Retrospective analysis of 22,903 electronic records for patients discharged from two large public hospitals in South Australia between January 2015 and September 2018 inclusively. Records were retained if the patient's height and weight had been recorded during the admission, BMI was between 10-99 kg/m2 and it was the patient's first admission during that time. Patients were grouped by BMI (<18.5 kg/m2 ("underweight"), 18.5-24.9 kg/m2 ("normal weight"), 25-29.9 kg/m2 ("overweight"), >30 kg/m2 ("obese")) and age (18-59 years, 60-79 years, > 80 years); for each group we measured the relative stay index (RSI) (actual length of stay divided by predicted length of stay), death in hospital and composite adverse outcome after discharge (unplanned readmission within 30 days and/or death within 30 days). RESULTS: Underweight patients across all age groups generally experienced significantly poorer outcomes compared to those not underweight. In those aged 18-59 years there were no significant differences in outcomes between the normal weight, overweight and obese groups. In those aged 60-79 years overweight patients had a significantly reduced risk of RSI > 2 compared to those of normal weight (p=0.014), and both overweight and obese patients had a significantly reduced risk of adverse outcome after discharge when compared to those of normal weight (p=0.028 and p=0.009 respectively). In those aged 80 years or older, both overweight and obese patients had a significantly reduced risk of adverse outcome after discharge when compared to those of normal weight (p=0.028 and p=0.013 respectively), and obese patients had a significantly reduced risk of inpatient mortality and RSI >2 when compared to those of normal weight (p=0.027 and p=0.037 respectively). CONCLUSION: A BMI > 25 kg/m2 in older patients is associated with reduced risk of prolonged admission, inpatient mortality and adverse outcomes following discharge. This adds to growing evidence that age-specific BMI guidelines are required for adults because the healthiest BMI in the older hospital patient is seemingly not in the range 18.5-24.9 kg/m2.

Disposición inadecuada de medicamentos por pacientes o consumidores en su hogar; una revisión sistematica / Inadequate disposal of medications by patients or consumers in your home; a systematic review

Introducción: Cada año se incrementan los volúmenes de medicamentos utilizados, ocasionando una acumulación en los hogares de pacientes y clientes, que luego son desechados de manera inadecuada, convirtiéndose en un riesgo para el ambiente y la salud pública. Se han encontrado residuos en pequeñas cantidades de productos farmacéuticos en medios acuáticos y suelos, los cuales se acumulan en tejidos de seres vivos y producen efectos tóxicos que promueven enfermedades. Objetivo: Realizar una revisión sistemática de estudios basados en encuestas de hogares sobre la disposición de medicamentos en el hogar, así como del conocimiento sobre el daño potencial al ambiente, con un aporte para la reducción o remediación del problema. Método: Fueron revisados 442 estudios que investigaron la disposición de medicamentos vencidos, dañados o sin uso, por pacientes o consumidores en sus casas. Se utilizó la metodología de Campbell Collaboration con búsquedas en bases de datos y mediante palabras claves, se identificaron 47 publicaciones que por un proceso de inclusión y exclusión, fueron seleccionados 20 trabajos que contienen un análisis estadístico de resultados de encuestas en hogares. Resultados: Se presentan resultados de encuestas a 8 267 hogares, donde en promedio el 87,7 % mantienen medicamentos en sus casas, siendo el 57,4 % sin uso o vencidos, y 74,6 % son dispuestos inadecuadamente. Conclusiones: Existe un desconocimiento del impacto ambiental de la disposición inapropiada de medicinas en el hogar, sin embargo, al tomar conciencia del peligro, hay interés de participar en programas para reducir el problema.

A gap analysis of SDG 3 and MDG 4/5mortality health targets in the six Arabic countries of North Africa: Egypt, Libya, Tunisia, Algeria, Morocco, and Mauritania.

BACKGROUND: The United Nations Assembly adopted the Sustainable Development Goals to succeed the Millennium Development Goals in September 2015. From a European perspective, the development of health in the countries of North Africa are of special interest as a critical factor of overall social development in Europe's Mediterranean partners. In this paper, we address the mortality related SDG-3 targets, the likelihood to achieve them until 2030 and analyze how they are defined. METHODS: We projected mortality trends from 2000-2015 to 2030, based on mortality estimates by inter-agency groups and the WHO in mother and child health, non-communicable diseases, and road traffic mortality. The gap analysis compares the time remaining until 2030 to the time needed to complete the target assuming a linear trend of the respective indicator. A delay of not more than 3.75 years is considered likely to achieve the target. RESULTS: The SDG-3 targets of a Maternal Mortality Ratio below 70 per 100 000 live births and an U5MR below 25 per 1 000 live births have been achieved by Egypt, Libya, and Tunisia. Libya and Tunisia have also achieved the target for Newborn Mortality with Egypt close to achieving it as well. Algeria and Morocco are generally on track for most of the indicators, including deaths from non-communicable diseases and suicide rates; however, all of the countries are lagging when it comes to deadly Road Traffic Injuries for 2030. Mauritania is the only North African country which is not likely to reach the 2030 targets for any of the mortality indicators. CONCLUSIONS: Although mortality statistics may be incomplete there is an impressive gradient from East to West showing Mauritania and deadly road traffic injuries as the most problematic areas. Given the large differences between countries baselines, we consider it preferable to set realistic targets to be achieved until 2030.

Perceived Discrimination, Coping Mechanisms, and Effects on Health in Bisexual and Other Non-Monosexual Adults.

Bisexual individuals experience unique discrimination related to their sexual orientation, which may increase their risk of adverse health outcomes. The study goal was to investigate how bisexual and other non-monosexual individuals experience discrimination, understand how they perceive discrimination to affect their health, and examine the ways in which they cope with discrimination by analyzing responses to open-ended survey questions. The sample included 442 bisexual and other non-monosexual adults, ages 18-68 years (M = 28.97, SD = 10.30), who either reported a bisexual identity or reported attractions to more than one gender. Gender identities included women (n = 347), men (n = 42), and transgender/non-binary individuals (n = 53); 29% of participants were currently located outside of the U.S. Participants completed an online survey, including three open-ended questions regarding their experiences with discrimination, how discrimination affects their health, and methods used to cope with discrimination. Themes related to perceived discrimination included: double discrimination of bisexuals and other non-monosexual individuals by heterosexuals, lesbian and gay individuals; bisexual invalidation and erasure; and sexual victimization. Themes related to the perceived effects of discrimination on health included: impact on mental health; impact on physical health; and effect of discrimination in healthcare. Themes related to coping with discrimination included: social support; resilience; and identity-specific media consumption. Findings demonstrate that bisexual and other non-monosexual individuals' experiences of discrimination can be additive, based on other marginalized facets of identity, including race/ethnicity, gender, and socioeconomic status. Our findings have implications for advancing bisexual health research from an intersectionality framework.

Translating research to policy at the NCSE 2017 symposium "Microbiology of the Built Environment: Implications for Health and Design".

Here, we summarize a symposium entitled "Microbiology of the Built Environment: Implications for Health and Design" that was presented at the National Council for Science and the Environment (NCSE) 17th National Conference and Global Forum in January 2017. We covered topics including indoor microbial exposures and childhood asthma, the influence of hospital design on neonatal development, the role of the microbiome in our premise (i.e., building) plumbing systems, antibiotic resistance, and quantitative microbial risk assessment. This symposium engaged the broader scientific and policy communities in a discussion to increase awareness of this critical research area and translate findings to practice.