The Impact of the Financial Crisis on Lifestyle Health Determinants Among Older Adults Living in the Mediterranean Region: The Multinational MEDIS Study (2005-2015)

Post-lockdown changes in diet in Italy and the USA: Return to old habits or structural changes?

This study analyses the impacts of the COVID-19 pandemic on food consumption at the end of the first lockdown in the New York State (USA) and in Italy (spring 2020). The results of our study show that important changes occurred in food habits in these two countries, in which lockdown was very similar. Three models of response to the shock of the lockdown were noted in both countries. The first model (40%) includes individuals who largely increased their food consumption, the second model (26%) showed a more virtuous and responsible behaviour, while the third model (34%) displayed no change in food consumption. Diet quality in terms of healthiness and sustainability declined in the USA, while in Italy, approximately one-third of the sample showed an improvement in diet in these same areas. The use of sociodemographic, motivational, and behavioural variables to profile subjects who adhered to each food model has made it possible to obtain information that can be used to develop communication campaigns and policies for a healthier and more sustainable diet.

Nutritional status and associated factors of older persons in sub-Saharan Africa: a scoping review

BACKGROUND

The older person population is rapidly increasing globally, including sub-Saharan Africa (SSA). Concurrently, malnutrition is also increasing among older persons in SSA, with a dearth of empirical evidence on nutritional status and associated factors among the older persons in the region to inform effective interventions to promote healthy ageing.

AIM/OBJECTIVE

This review assessed the nutritional status and associated factors among older persons in SSA.

METHOD

PubMed, Google Scholar, and Cochrane Library electronic databases were searched for published articles from 2010 to 2021 using keywords and Boolean logic. Also, we carried out a free web-based search to retrieve other relevant evidence that assesses the older persons' nutritional status. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart was used to appraise the research articles that responded to the study's research questions.

FINDINGS

Twenty studies met the inclusion criteria, from which data were extracted as findings. The malnutrition prevalence was between 6 to 54% among older persons in SSA. We found that the prevalence of malnutrition vary and could be as high as 28.4% in a low socio-economic status area. Of these studies, twelve (12) provided data on undernutrition with prevalence ranging from 2.9 to 41%;10 provided data on overweight (8.1-54.1%) and 5 on obesity (2.7-44.7%). Seventeen of the studies evaluated factors associated with malnutrition; 4 studies revealed the association between socioeconomic status and malnutrition, 7 studies reported a significant association between dietary habits and malnutrition. Four studies showed an association between educational status and malnutrition. Disease conditions associated with malnutrition were reported in four of the studies.

CONCLUSION

This review shows that malnutrition is a problem among older persons in SSA coupled with many risk factors which should be given critical attention. We recommend nutrition education for older persons as well as the development of nutrition interventions for this vulnerable group.

A Generation Shift in Mediterranean Diet Adherence and Its Association with Biological Markers and Health in Dalmatia, Croatia

Previous studies have confirmed the beneficial effect of a Mediterranean diet in mitigating health issues related to cardiovascular disease, diabetes and obesity. However, rapid changes in the traditional way of life and the “westernization” of the diet in Mediterranean populations, especially in younger generations, has led to progressive abandonment of healthy dietary patterns. In order to investigate the generation shift in dietary patterns and lifestyle habits in the Mediterranean part of Croatia, we compared two cohorts of 610 women (266 pregnant and 344 non-pregnant) from the same region, but from different age groups. The MDSS score was derived from food frequency questionnaires. The results showed that the young, reproductively active generation (pregnant women) in Dalmatia, Croatia, although having a higher education and socioeconomic status, exhibits a more adverse eating behaviour (lower adherence to the Mediterranean diet) and lifestyle (excessive smoking in pregnancy) than the older population from the same region. Lower MDSS scores across aggregated age groups in both cohorts showed significant association with higher blood lipid levels and higher smoking frequency. In conclusion, Mediterranean diet adherence is associated with biological markers (age, lipid profile) and lifestyle (smoking) in our study, with a more adverse trend observed in the younger generation.

Changes in lifestyle, diet, and body weight during the first COVID 19 'lockdown' in a student sample

Changes in lifestyle and body weight were examined retrospectively in students at a German university during the first COVID-19 lockdown period (March 12- May 3, 2020) using an online survey. Data from a total of 827 participants was used. Almost half of the students reported perceived body weight changes with about 27% gaining weight and around 22% losing weight. Regression analyses showed that consumption changes in the following food categories: fruits, sweets and cakes, bread and bakery products, pasta, savoury snacks, and meats and sausages were predictive of weight changes. Additionally, changes in the frequency of cooking with fresh ingredients, physical activity, exercise, smoking, and alcohol consumption as well as pre-lockdown BMI were all predictive of weight changes. Given the continuous global pandemic, increased and innovative public health efforts to support this population group are needed.

Household food spending, parental and childhood's diet quality, in financial crisis: a cross-sectional study in Greece

BACKGROUND

Over the past decade, the financial crisis has affected harshly the household income of Greek people. This study aimed to investigate whether the effect of the financial crisis on food spending has affected the dietary habits in the family environment.

METHODS

Under a cross-sectional study conducted during 2014-2016, 1145 children and their parents completed questionnaires examining socio-economic and dietary characteristics. The MedDietScore and the KIDMED Score were used to assess parental and childhood adherence to the Mediterranean diet, respectively.

RESULTS

The parents who reported that the financial crisis has affected food spending used to consume weekly fewer fruits (3.26 ± 0.94 vs. 3.41 ± 0.90, P = 0.016), carbohydrate foods (3.16 ± 0.57 vs. 2.99 ± 0.55, P < 0.001) and legumes (3.28 ± 0.76 vs. 3.14 ± 0.67, P = 0.001) and more nutrient-poor/energy-dense foods (2.55 ± 0.98 vs. 2.20 ± 0.82, P < 0.001) compared with non-affected parents. Their children showed a decreased weekly consumption of vegetables (2.82 ± 0.90 vs. 2.97 ± 0.98, P = 0.019) and increased weekly consumption of nutrient-poor/energy-dense foods (2.38 ± 0.97 vs. 2.19 ± 0.80, P < 0.001). The affected parents had a lower MedDietScore than non-affected parents (25.76 ± 8.10 vs. 27.03 ± 8.11, P = 0.034). No difference was revealed on the KIDMED Score (P = 0.294).

CONCLUSIONS

The constrained food spending due to financial crisis has an independent and inverse impact on parent's diet quality while keeping unaffected preadolescent's diet quality. This finding highlights the role of parents as a protective 'wall' against the deterioration of their children's diet quality. The modification on the prices of healthy food and the provision of food aid particularly in economically disadvantaged households is underlined.

Impacts of the 2008 Great Recession on dietary intake: a systematic review and meta-analysis

Background

The 2008 Great Recession significantly impacted economies and individuals globally, with potential impacts on food systems and dietary intake. We systematically reviewed evidence on the impact of the Great Recession on individuals’ dietary intake globally and whether disadvantaged individuals were disproportionately affected.

Methods

We searched seven databases and relevant grey literature through June 2020. Longitudinal quantitative studies with the 2008 recession as the exposure and any measure of dietary intake (energy intake, dietary quality, and food/macronutrient consumption) as the outcome were eligible for inclusion. Eligibility was independently assessed by two reviewers. The Newcastle Ottawa Scale was used for quality and risk of bias assessment. We undertook a random effects meta-analysis for changes in energy intake. Harvest plots were used to display and summarise study results for other outcomes. The study was registered with PROSPERO (CRD42019135864).

Results

Forty-one studies including 2.6 million people met our inclusion criteria and were heterogenous in both methods and results. Ten studies reported energy intake, 11 dietary quality, 34 food intake, and 13 macronutrient consumption. The Great Recession was associated with a mean reduction of 103.0 cal per adult equivalent per day (95% Confidence Interval: − 132.1, − 73.9) in high-income countries (5 studies) and an increase of 105.5 cal per adult per day (95% Confidence Interval: 72.8, 138.2) in middle-income countries (2 studies) following random effects meta-analysis. We found reductions in fruit and vegetable intake. We also found reductions in intake of fast food, sugary products, and soft drinks. Impacts on macronutrients and dietary quality were inconclusive, though suggestive of a decrease in dietary quality. The Great Recession had greater impacts on dietary intake for disadvantaged individuals.

Conclusions

The 2008 recession was associated with diverse impacts on diets. Calorie intake decreased in high income countries but increased in middle income countries. Fruit and vegetable consumption reduced, especially for more disadvantaged individuals, which may negatively affect health. Fast food, sugary products, and soft drink consumption also decreased which may confer health benefits. Implementing effective policies to mitigate adverse nutritional changes and encourage positive changes during the COVID-19 pandemic and other major economic shocks should be prioritised.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01125-8.

The CASSIOPEA Study (Economic Crisis and Adherence to the Mediterranean diet: poSSIble impact on biOmarkers of inflammation and metabolic PhEnotypes in the cohort of the Moli-sAni Study): Rationale, design and characteristics of participants

BACKGROUND AND AIMS

The CASSIOPEA Study was designed to evaluate whether the economic downturn during the late 2000s was a contributing factor to the observed decrease in adherence to Mediterranean diet (MD).

METHODS AND RESULTS

The study protocol consists of two steps: A) recall of 7406 men and women who, between 2005 and 2006, had been randomly recruited in the Moli-sani Study from the general population of Molise, to assess possible economic hardship (EH) related to the economic crisis initiated in 2007; B) re-examination, between 2017 and 2020, of available subjects identified in Step 1 as poorly or harder hit by EH to test the hypothesis that EH is associated with a decrease in MD adherence, possibly resulting in increased inflammation. The results of Step 1 are reported here. From the initial sample of individuals re-examined after 12.6 years (median; IQR = 12.1-13.0 y), 3646 were finally analysed. An Economic Hardship Score (EHS; range 0-14) was obtained by scoring three domains: 1) change in employment status; 2) financial hardship and 3) financial hardship for health expenditures. Overall, 37.8% of the sample reported high EHS (≥3), whilst 32% scored 0 (no EH). Those with high EHS were prevalently women and younger, with low socioeconomic status.

CONCLUSIONS

High economic hardship was prevalently reported by weaker socioeconomic groups. Longitudinal analysis (step 2) will examine whether the economic crisis had an effect on adherence to Mediterranean diet with consequent potential impact on inflammation, one of the main biological pathways linking MD to health outcomes. CLINICALTRIALS.

GOV IDENTIFIER

NCT03119142.

Consumers' attitude toward dietary supplements and functional food: a prospective survey in a Greek population sample

PURPOSE

The main objective of the present study was to investigate the attitudes among a sample of educated Greek consumers toward the use of dietary supplements (DS) and functional foods (FF) given that attitudes and behaviors as regards DS/FF have not been sufficiently evaluated in Southern Europe, where their penetration is lower as compared to northern countries.

METHOD

An online questionnaire was completed by 358 individuals (n = 358, 55.6% females, 44.4% males, and 82% of the total with higher education). Questionnaire reliability was assessed by Cronbach's alpha coefficient while independence among qualitative variables was assayed by Pearson's chi-squared test or Fisher's exact test. The different groups of questions were analyzed by factor analysis, with principal component analysis and Varimax rotation, applied after a factor analysis and Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy test. Finally, a hierarchical cluster analysis based on Ward's method, using the squared Euclidean distance as a measure, was performed in order to identify and classify cases.

RESULTS

Our results revealed that the majority of responders were aware of the principles of healthy eating, considering DS/FF as valid additives conferring beneficial effects. A surprising finding is that consumers, independently of the use of DS/FF, tend to prepare food at home and to adhere strongly to the Mediterranean diet and its principles. In addition, they express a certain degree of wariness as to product labeling and health claims, following instead the recommendations of health professionals and scientific evidence. Finally, they prefer to purchase DS/FF from pharmacies.

CONCLUSION

Our findings provide valuable data concerning active Greek consumers' attitudes toward these relative new products, which could be extended to other Mediterranean and South European populations.

Impact of a Moderately Hypocaloric Mediterranean Diet on the Gut Microbiota Composition of Italian Obese Patients

Although it is known that the gut microbiota (GM) can be modulated by diet, the efficacy of specific dietary interventions in determining its composition and diversity in obese patients remains to be ascertained. The present work aims to evaluate the impact of a moderately hypocaloric Mediterranean diet on the GM of obese and overweight patients (OB). The GM of 23 OB patients (F/M = 20/3) was compared before (T0) and after 3 months (T3) of nutritional intervention (NI). Fecal samples were analyzed by Illumina MiSeq sequencing of the 16S rRNA gene. At baseline, GM characterization confirmed typical obesity-associated dysbiosis. After 3 months of NI, patients presented a statistically significant reduction in body weight and fat mass, along with changes in the relative abundance of many microbial patterns. In fact, an increase in the abundance of several Bacteroidetes taxa (i.e., Sphingobacteriaceae, Sphingobacterium, Bacteroides spp., Prevotella stercorea) and a depletion of many Firmicutes taxa (i.e., Lachnospiraceae members, Ruminococcaceae and Ruminococcus, Veillonellaceae, Catenibacterium, Megamonas) were observed. In addition, the phylum Proteobacteria showed an increased abundance, while the genus Sutterella, within the same phylum, decreased after the intervention. Metabolic pathways, predicted by bioinformatic analyses, showed a decrease in membrane transport and cell motility after NI. The present study extends our knowledge of the GM profiles in OB, highlighting the potential benefit of moderate caloric restriction in counteracting the gut dysbiosis.

Does lockdown reduce air pollution? Evidence from 44 cities in northern China

Responding to the ongoing novel coronavirus (agent of COVID-19) outbreak, China implemented "the largest quarantine in human history" in Wuhan on 23 January 2020. Similar quarantine measures were imposed on other Chinese cities within days. Human mobility and relevant production and consumption activities have since decreased significantly. As a likely side effect of this decrease, many regions have recorded significant reductions in air pollution. We employed daily air pollution data and Intracity Migration Index (IMI) data form Baidu between 1 January and 21 March 2020 for 44 cities in northern China to examine whether, how, and to what extent travel restrictions affected air quality. On the basis of this quantitative analysis, we reached the following conclusions: (1) The reduction of air pollution was strongly associated with travel restrictions during this pandemic-on average, the air quality index (AQI) decreased by 7.80%, and five air pollutants (i.e., SO₂, PM_2.5, PM₁₀, NO₂, and CO) decreased by 6.76%, 5.93%, 13.66%, 24.67%, and 4.58%, respectively. (2) Mechanism analysis illustrated that the lockdowns of 44 cities reduced human movements by 69.85%, and a reduction in the AQI, PM_2.5, and CO was partially mediated by human mobility, and SO₂, PM₁₀, and NO₂ were completely mediated. (3) Our findings highlight the importance of understanding the role of green production and consumption.

Adherence to the Mediterranean diet and weight status in children: the role of parental feeding practices

The study examines Parental Feeding Practices (PFP) in relation to adherence to the Mediterranean Diet (MD) and children's weight status. It's a cross-sectional study of 402 parents (68.4% mothers), with children aged 2-12 years. Parents completed the Comprehensive Parental Feeding Questionnaire and the Mediterranean Diet Quality Index for children and adolescents (KIDMED), evaluating children's adherence to the MD. Logistic regression showed that in children aged 2-<6 years, "emotion regulation/food as reward" and "pressure" decrease MD adherence (OR = 0.186, p < 0.0001 and OR = 0.496, p = 0.004), and "monitoring" decrease excess body weight (OR = 0.284, p = 0.009). In older children (6-12 years), "healthy eating guidance" and "monitoring" increase MD adherence (OR = 3.262, p = 0.001 and OR = 3.147, p < 0.0001), "child control" decreases MD adherence (OR = 0.587, p = 0.049), "pressure" decrease excess body weight (OR = 0.495, p < 0.0001) and "restriction" increase excess body weight (OR = 1.784, p = 0.015). "Healthy eating guidance" and "monitoring" seem to be the best PFP employed, in terms of children's MD adherence and weight status.

Economic crises, behavioral changes and hospitalization due to affective disorders in Brazil between 2003 and 2017: a nationwide cross-sectional study

Our aim was to analyze hospitalization due to affective disorders in Brazil from 2003 to 2017 and the possible association with economic indicators during crises. We used data on hospitalizations due to affective disorders within the Brazilian National Health System, obtained from DATASUS; data on health-related behavior (television-viewing and physical activity) from the VIGITEL database; and economic data from the World Bank database. We found that the numbers of hospitalizations increased one year after the 2009 crisis and one year after the 2016 crisis. Negative changes in health-related behavior also followed changes in the numbers of hospitalizations due to affective disorders.

Alarming endoscopic data in young and older asymptomatic people: Results of an open access, unlimited age colonoscopic screening for colorectal cancer

There is a lack of a national organized screening program for colorectal cancer in Greece, and asymptomatic detection is usually the result of individual decisions. The collection of epidemiologic endoscopic data from a population of interest would therefore provide valuable information for future treatment guidance, especially during periods of economic austerity. The current cross-sectional study included 380 asymptomatic, average risk individuals undergoing screening colonoscopy for the first time, during the period of one year in a tertiary public hospital in Athens. Descriptive and analytic epidemiologic data were analyzed. The prevalence of adenomas and advanced lesions were compared between the younger and older cohort, and a regression model was applied for risk evaluation. The mean age of participants was 63 years, and 53% were male. A significant proportion of patients presented with polyps (51.5%) and 25% of them had lesions in the proximal colon. The prevalence of adenomas and advanced adenomas was 29.5 and 11.8%, respectively. Similar high prevalence rates of lesions were identified in the cohort of individuals <50 years of age and the older cohort (>50 years of age). Regression models identified age, number and size of polyps as the major risk factors for the detection of adenomas. The increase of advanced lesions in the older and younger cohort requires confirmation by larger studies. Overall, the results of the present study indicate the requirement for a well-organized screening colonoscopy program starting from as early as 40 years of age. This program may confer an additional endoscopic burden with socioeconomic consequences in a country with limited health resources.

Changes in the Provision of Family Care to Frail Older People in Familistic Welfare States: Lessons From Israel and Italy

Objective: Our article aims to investigate changes in the rate of informal care provision, which occurred in Israel and Italy in the last decade. In addition, we analyze typology and magnitude of the main factors contributing to explain the probability of providing informal care. Method: We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE) at two selected time points (2006/2007 and 2015). Results: The probability of offering social support to elder family members who live outside the household has been trending down substantially over the years. The likelihood of providing unpaid care is significantly higher when one performs volunteer or charitable work and/or engages in leisure activities, and the importance of these two variables has been growing over the years. Discussion: Israel and Italy have experienced over the years a remarkable decline in the share of older adults providing informal care. The article helps to identify which factors have been associated with this phenomenon.

Socioeconomic and psychosocial determinants of adherence to the Mediterranean diet in a general adult Italian population

BACKGROUND

To evaluate the adherence to Mediterranean diet (MD) and its major socioeconomic and psychosocial determinants in a large sample of the Italian population, covering three main geographical areas of the Country (Southern, Central and Northern).

METHODS

Data were obtained from the Italian Nutrition & Health Survey (INHES), including a total of 7, 430 participants (age >20) recruited from all over Italy (2010-13). Dietary information was collected by the European Food Propensity Questionnaire. Adherence to MD was assessed by using the MedDietScore based on 11 food groups. Associations were tested by multivariable logistic regression analysis (Odds ratio [OR] with 95% CI).

RESULTS

Adherence to MD was higher in Southern Italy as compared with the Northern (OR = 1.34; 95% CI 1.18-1.53), and was closely associated with adult age (OR= 2.40; 1.61-3.58 for those aged > 75 years as compared with 20-34 years) and higher educational level (OR = 1.77; 1.40-2.24 for post-secondary education as opposed to lowest educational attainment). Subjects reporting adverse life events and those with family-related stress were less likely to show an optimal adherence to MD (OR = 0.55; 0.46-0.67 and OR = 0.44; 0.28-0.69, for highest vs. lowest tertile, respectively) as compared with adequate controls. A number of eating behaviours were also inversely associated with MD, such as consuming higher amount of alcohol in the weekend than in week days.

CONCLUSIONS

Adherence to MD is strongly determined by age, geographical area and educational level. Psychosocial factors and several eating behaviours are also closely associated.

Dietary Patterns and Their Association with Anxiety Symptoms among Older Adults: The ATTICA Study

By 2050, the global population aged 60 years and over is expected to reach nearly 2.1 billion and affective disorders might be also expected to increase. Although nutrition has been related with affective disorders, there is a lack of studies assessing the relation between dietary habits and anxiety among European and Mediterranean older populations. In the present study, we aimed to evaluate the association between dietary habits, energy intake, and anxiety symptoms using data from 1128 Greek older adults (>50 years) without pre-existing cardiovascular disease (CVD) or any other chronic disease who participated in the ATTICA study. Various socio demographic lifestyle, bio-clinical (e.g., blood pressure), and psychological (e.g., depression) characteristics were used, and dietary habits as well as energy intake were calculated using standard procedures. Older people with anxiety were more likely to be sedentary, to be smokers, and to show symptoms of depression. The saturated fat and added sugars (SFAS) dietary pattern was associated with higher anxiety levels (non-standardized b (95% CI): 5.82 (0.03 to 11.61)). No association between energy intake tertiles and anxiety levels pictured in the later regression model. Moreover, female gender, family status, and depression were positively related to anxiety. Therefore, promoting healthy dietary habits could reduce anxiety symptoms of the older adults.

Socioeconomic inequalities in relation to health and nutrition literacy in Greece

Poor health literacy (HL) is associated with poor health behaviours and outcomes. The aim of the study was to investigate the effect of socioeconomic status on HL and nutrition literacy (NL) in Greece. This is a cross-sectional study which took place in Attica, Greece. 1281 individuals, aged ≥18 years of both sexes, participated. The European Health Literacy Questionnaire and the Greek version of the Nutrition Literacy Scale were used. Linear regression analysis revealed that education was significantly positively associated with HL (p = 0.002) and medium annual income was significantly associated with higher HL (p = 0.024), in contrast to low annual income. Education (p < 0.001) was significantly positively associated with NL. Unskilled particpants had lower NL compared to skilled paricipants (p = 0.021) and participants with medium annual income had significantly higher NL (p = 0.003) in comparison to participants with low annual income. Socioeconomic inequalities seem to negatively associate with HL and NL in Greece.

Demographic-Specific Rates for Life Events in the Cardiovascular Health Study and Comparisons With Other Studies

Purpose of the Study

(1a) We use the Cardiovascular Health Study (CHS), a multi-site heterogeneous sample of Medicare enrollees (N = 5,849) to provide rates for specific life events experienced within 6 months; (1b) We present rates for 29 other studies of community-residing older adults (N = 41,308); (2) For the CHS, we provide demographic-specific rates and predicted probabilities for age [young-old (65-75) vs old-old (≥75)], gender, race, marital status, and education.

Design/Methods

The CHS sample is 57.6% women, 84.2% white (15.8% black), and 66.3% married. Mean age is 72.8 years (standard deviation [SD] = 5.6, range = 65-100) and education is 13.7 years (SD = 4.8). Life events were interviewer-assessed. Regressions estimated associations of life event rates with demographic groups (e.g., age), controlling for other demographic variables (e.g., gender, etc.).

Results

(1a) CHS rates ranged from 44.7% (death of someone close) to 1.1% (retirement/work changes). (1b) Most life event studies used total scores and only 5 that met our inclusion criteria used time intervals <1 year; longer intervals were associated with higher rates. (2) In the CHS, the life event for illnesses was related to 5 demographic variables (net the other 4 demographic variables), difficulties caregiving to 4, and worse relationships to 3 demographic variables. Race was related to 8 life events, marital status to 7, education to 6, and age to 4 events.

Implications

By identifying demographic groups at highest risk for life events, this research focuses on older adults at greatest risk for health problems. These data are necessary for translating research into interventions, practice, and policy.

Impact of the financial crisis on COPD burden: Greece as a case study

Poverty and low socioeconomic status have been associated with chronic obstructive pulmonary disease (COPD). The current financial crisis has forced millions back into poverty. Greece is one of the countries hit the hardest, and is in the middle of a deep ongoing collapse. There have been early reports stating the apparent effects of the Greek downturn on respiratory health. This review summarises the overall impact of the financial crisis on COPD burden throughout the period of economic downturn by analysing the case study of Greece. In all levels of the healthcare system, current economic restrictions have reduced the capacity to prevent, diagnose and treat COPD in parallel with current higher detection rates of COPD. Remarkably, expenditure on healthcare has been reduced by >25%, resulting in major healthcare equipment shortages. Lower wages (by up to 20%) and higher co-payments of up to 25% of a drug's purchase price have led to patients struggling to afford inhaled medications. Treatment nonadherence has been reported, resulting in 11.5% more exacerbations and 14.1% more hospitalisations annually, while the mean cost per severe COPD exacerbation has been approximated as €2600. Greece is a noteworthy example illustrating how COPD burden, quality of care and patients' outcome can be affected by economic crisis.

Ten-Year Trends (1999-2010) of Adherence to the Mediterranean Diet among the Balearic Islands' Adult Population

The aim of this work was to assess ten-year trends (1999–2010) of adherence to the Mediterranean dietary pattern (MDP) among the Balearic Islands’ adult population. Two independent cross-sectional dietary surveys (1999–2000, n = 1200 and 2009–2010 n = 1388, including participants aged 16–65 years) were carried out in the Balearic Islands, Spain. Dietary habits were assessed by means of two 24 h diet recalls and a validated semi-quantitative food-frequency questionnaire that covers 145 food items. Adherence to the MDP was defined according to a score constructed considering the consumption of nine MDP characteristic components: high monounsaturated fatty acids:saturated fatty acids (MUFA:SFA) ratio, moderate ethanol consumption, high legumes, cereals and roots, fruits, vegetables, and fish consumption, and low consumption of meat and milk. Socio-economic status, education level, lifestyle factors and health status were also assessed. Adherence to the MDP was 43.1% (SD 5.8) in 1999–2000 and 44.6% (SD 8.3) in 2009–2010. Higher age was directly associated with higher adherence to the MDP, and this association was stronger in males than in females. Young generations and smokers showed the lowest adherence to MDP, whereas people with higher educational and socio-economic level, and who were physically active showed the highest adherence. According to the place of birth, the increase in the percentage of the adherence to the MDP was observed to be smaller among the Balearic Island’s natives than among people born abroad. In 2009–2010, individuals in the MDP’s fourth quartile were more likely to be older (aged 46–65 years), and were less likely to have a low occupational level, to have a light physical activity level and to be smoker than in 1999–2000. The adherence to the MDP has been stabilized and slightly recovered among the Balearic Islands’ adult population in the last decade.

The prevalence of depression in rheumatoid arthritis in China: A systematic review

This systematic review is to explore the prevalence of depression in patients with rheumatoid arthritis (RA) in China. Articles of prevalence rates for depression in adult RA patients published before October 2015 were identified from PubMed, Embase, The Cochrane Library, CNKI, CBM, VIP, and Wanfang database and other internet databases. Relevant journals and the recommendations of expert panels were also searched manually. Two independent reviewers searched and assessed the literature. Therelevant data were applied with Meta-Analyst 3.13 software, and the forest plot and funnel plot were performed. 21 studies with a total of 4447 patients were selected to be enrolled in this study. The prevalence of depression by analyzing the effect size was 48% [95% CI (41%, 56%)]. The prevalence of minor depression and dysthymic disorder was 30% [95%CI (23%, 38%)], and the moderate or major depression was 18% [95%CI (11%, 29%)], respectively. Subgroup analysis showed that the depression rate of female RA patients was higher than male. The depression rate in the central and western areas were higher than that of the eastern region of China, the prevalence level estimated by the Geriatric Depression Scale (GDS) was higher than estimated by other tools. Sensitivity analysis showed that the pooled effect size had good stability and reliability, To be conclusive, the prevalence rate of depression in RA patients is 48%, which suggesting that medical staff should pay more attention to depression in adult patients with RA.