Double Photoionization of Nitrosyl Chloride by Synchrotron Radiation in the 24-70 eV Photon Energy Range

The behavior of nitrosyl chloride (ClNO) exposed to ionizing radiation was studied by direct probing valence-shell electrons in temporal coincidence with ions originating from the fragmentation process of the transient ClNO²⁺. Such a molecular dication was produced by double photoionization with synchrotron radiation in the 24-70 eV photon energy range. The experiment has been conducted at the Elettra Synchrotron Facility of Basovizza (Trieste, Italy) using a light beam linearly polarized with the direction of the polarization vector parallel to the ClNO molecular beam axis. ClNO molecules crossing the photon beam at right angles in the scattering region are generated by effusive expansion and randomly oriented. The threshold energy for the double ionization of ClNO (30.1 ± 0.1 eV) and six dissociation channels producing NO⁺/Cl⁺, N⁺/Cl⁺, N⁺/O⁺, O⁺/Cl⁺, ClN⁺/O⁺, NO⁺/Cl²⁺ ion pairs, with their relative abundance and threshold energies, have been measured.

Examining existing strategies to prevent multimorbidity – a scoping review

Multimorbidity has been acknowledged as the “defining challenge” for health systems around the world, but current research and policy are primarily focused on the management of multimorbidity after it occurs or the prevention of adverse events in those individuals who are already living with multimorbidity. There is still a significant need to develop and establish effective and equitable primary prevention strategies in order to avoid the occurrence of multimorbidity across populations. This scoping review aims to identify existing strategies, programs and policies that are focused on the prevention of multimorbidity across various settings and countries around the world. To identify relevant publications, two databases will be searched: PubMed and Embase. The search strategies will be adjusted for each database and will include variations of the keywords multimorbidity, prevention and strategy. This review will specifically include publications that are original research, focused on multimorbidity and published in English. However, there will be no restrictions on the location of the research or the age of the target sample or population. For the full text screening phase, more specific criteria will apply and information will be extracted from the final set of retained studies. This information will be summarized and will include key factors such as study design, study setting, type of prevention programs, scope of programs (e.g. national, regional, local, etc.) and target population (e.g. age groups, socioeconomic groups, etc.). This scoping review will describe existing prevention programs and highlight areas of gaps and opportunities in the prevention of multimorbidity.

Association between functional limitation and quality of life among older adults with multimorbidity in Luxembourg

Introduction

Multimorbidity, defined as the co-existence of two or more chronic conditions, is affecting an increasing number of Europeans, leading to poorer quality of life (QoL). This study assessed how functional limitation affects the QoL trajectories in a cohort of older individuals having multimorbidity, and whether there are any gender differences in these effects.

Methods

We used a longitudinal cohort of 906 multimorbid respondents 50 years of age or older from Luxembourg who participated in four waves of the Survey of Health, Ageing, and Retirement in Europe (2013-2020). We used the Control, Autonomy, Self-Realization, and Pleasure scale (CASP-12) to assess QoL and the Global Activity Limitation Indicator (GALI) to measure functional limitation. Multigroup latent growth curve (LGC) modeling techniques were employed to assess how the measures of functional limitation over time are related to QoL trajectories and whether or not these effects are different by sex.

Results

In 2013, over 60% of older residents of Luxembourg were affected by multimorbidity. The results from the LGC models suggest that both men and women with multimorbidity experienced a statistically significant decline in QoL between 2013 and 2020 at a constant rate; there were no significant differences in the rate of this change between men and women. The level of QoL at baseline and over time was significantly lower for individuals reporting functional limitation. However, functional limitation had no significant impact on the rate of decline in QoL for both men and women.

Discussion and conclusions

As an increasing number of individuals in Europe are becoming vulnerable to more years lived with multiple chronic conditions, there is a growing need to identify factors that may lead to improvements in QoL among people affected by multimorbidity. Gaining more knowledge on the role of functional limitation may be particularly important for planning comprehensive care for patients with multimorbidity.

Obesity, body weight stigma and biomedical oversimplification: moving beyond BMI

Body Mass Index (BMI) is one of the most important factors considered to analyse health status. High BMI scores are usually associated with physical or mental disorders, such as cardiovascular disease, diabetes, inflammation, dyslipidemia and depression. However, obesity is usually characterised by the presence of various comorbidities that should be addressed as part of a unique, more complicated picture. Emerging evidence suggests that a deeper acknowledgment of the complexity of obesity as disease, including its comorbidities, should take place in the near future. Overweight, obesity and related disorders have been associated with direct healthcare-related costs and the indirect costs of productivity loss, mostly due to the presence of comorbidities rather than to body weight in general. The belief that weight loss is the best recommendation for people with high BMI as the only path to health could be questioned. In fact, it would seem that weight loss in some subjects does not necessarily coincide with any health improvement. Thus, the relationship between weight status and health expenditure is complex with particular reference to the fact that costs of disease are higher in high-comorbid profiles independently of weight status. Over the last years, researchers have also studied some conditions, such as metabolically healthy overweight and obesity. Recent studies deal with alternatives to conventional weight-loss approaches that could be more effective in health terms. Conventional methods of weight loss are based on calorie restriction and increased energy expenditure instead of unconventional methods, such as the weight-neutral program, which is based on the crucial concept of “mindfulness” to underline the importance of intuitive eating, self-care, pleasurable exercise and size-acceptance. The health benefits related to such types of approaches include physical, psychological and behavioural improvements.

Multimorbidity in Large Canadian Urban Centres

Introduction

Although health outcomes are related to the characteristics of the geographic areas in which people live, there is limited knowledge on how the prevalence of multimorbidity varies within and across major Canadian urban centres. Our goal was to assess the level of between-neighbourhood variation in the prevalence of multimorbidity in Canada's large urban centres, controlling for compositional effects associated with demographic and socioeconomic factors.

Methods

Cross-sectional data from the 2015-2018 cycles of the Canadian Community Health Survey (CCHS) were used. Respondents (20 years and older) residing in one of the 35 census metropolitan areas (CMAs) were included (N = 100,803). Census tracts (CTs), relatively small and stable geographic areas nested within CMAs, were used as a measure of neighbourhood. To assess the between-neighbourhood differences in multimorbidity prevalence, we fitted sequential random intercept logistic regression models.

Results

During the 2015-2018 period, 8.1% of residents of large urban centres in Canada had multimorbidity. The results from the unadjusted model indicate that 13.4% of the total variance in multimorbidity could be attributed to the between-neighbourhood differences. After adjustment for overall characteristics of the CMAs in which these neighbourhoods are located, as well as for individual-level demographic and socioeconomic factors related to compositional effects, 11.0% of the individual variance in multimorbidity could still be attributed to the between-neighbourhood differences.

Discussion and Conclusions

There is significant and substantial geographic variation in multimorbidity prevalence across neighbourhoods in Canada's large urban centres. Residing in some neighbourhoods could be associated with increased odds of having multimorbidity, even after accounting for overall characteristics of the CMAs in which these neighbourhoods are located, as well as individual-level factors.

Anharmonic Aspects in Vibrational Circular Dichroism Spectra from 900 to 9000 cm-1 for Methyloxirane and Methylthiirane

Vibrational circular dichroism (VCD) spectra and the corresponding IR spectra of the chiral isomers of methyloxirane and of methylthiirane have been reinvestigated, both experimentally and theoretically, with particular attention to accounting for anharmonic corrections, as calculated by the GVPT2 approach. De novo recorded VCD spectra in the near IR (NIR) range regarding CH-stretching overtone transitions, together with the corresponding NIR absorption spectra, were also considered and accounted for, both with the GVPT2 and with the local mode approaches. Comparison of the two methods has permitted us to better describe the nature of active “anharmonic” modes in the two molecules and the role of mechanical and electrical anharmonicity in determining the intensities of VCD and IR/NIR data. Finally, two nonstandard IR/NIR regions have been investigated: the first one about ≈2000 cm^–1, involving mostly two-quanta bending mode transitions, the second one between 7000 and 7500 cm^–1 involving three-quanta transitions containing CH-stretching overtones and HCC/HCH bending modes.

Electronic state influence on selective bond breaking of core-excited nitrosyl chloride (ClNO)

The potential for selective bond breaking of a small molecule was investigated with electron-spectroscopy and electron-ion coincidence experiments on ClNO. The electron spectra were measured upon direct valence photo-ionization and upon resonant core-excitation at the N 1s- and O 1s-edges followed by emission of resonant Auger (RA) electrons. The RA spectra were analyzed with particular emphasis on the assignment of the participator and spectator states. The latter are of special relevance for investigations of how distinct electronic configurations influence selective bond breaking. The electron-ion coincidence measurements provided branching fractions of the produced ion-fragments as a function of electron binding energy. It explicitly demonstrates the influence of the final electronic states created after the photo-ionization and RA decay, on the fragmentation. In particular, we observe a significantly different branching fraction for spectator states compared with participator states. The bonds broken for the spectator states are also found to correlate with the anti-bonding character of the spectator-electron orbital.

An experimental and theoretical characterization of the electronic structure of doubly ionised disulfur

Using time-of-flight multiple electron and ion coincidence techniques in combination with a helium gas discharge lamp and synchrotron radiation, the double ionisation spectrum of disulfur (S\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$_2$$\end{document}2) and the subsequent fragmentation dynamics of its dication are investigated. The S\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$_2$$\end{document}2 sample was produced by heating mercury sulfide (HgS), whose vapour at a suitably chosen temperature consists primarily of two constituents: S\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$_2$$\end{document}2 and atomic Hg. A multi-particle-coincidence technique is thus particularly useful for retrieving spectra of S\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$_2$$\end{document}2 from ionisation of the mixed vapour. The results obtained are compared with detailed calculations of the electronic structure and potential energy curves of S\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$_2^{2+}$$\end{document}22+ which are also presented. These computations are carried out using configuration interaction methodology. The experimental results are interpreted with and strongly supported by the computational results.

Basic features of Ne*-HX (X = Cl, Br) chemi-ionization reactions

Total and partial ionization cross sections for Ne*(³P_2,0)–HX (X = Cl, Br) are presented in a comparative way as a function of the collision energy between 0.02–0.5 eV. New mass spectrometric data on Ne*–HBr chemi-ionization are discussed and analyzed with already published data on Ne*–HCl, highlighting similarities and differences of the collisional stereodynamics of the two systems. Basic features of the interaction potentials, driving reactive collisions, suggest that reaction channels, leading to the formation of parent HX⁺ ions in the ground and excited electronic state and to the formation of associated NeHX⁺ ions as well as of NeH⁺ proton transfer species, are selectively opened within angular cones exhibiting different orientation and acceptance.

Ionization cross sections for Ne*(³P_2,0)–HX (X = Cl, Br) chemi-ionizations are presented in the 0.02–0.5 eV collision energy range.

Single photon double and triple ionization of allene

Double and triple ionization of allene are investigated using electron-electron, ion-ion, electron-electron-ion and electron-electron-ion-ion (ee, ii, eei, eeii) coincidence spectroscopies at selected photon energies. The results provide supporting evidence for a previously proposed roaming mechanism in H₃⁺ formation by double ionization. The lowest vertical double ionization energy is found to be 27.9 eV, while adiabatic double ionization is not accessed by vertical ionization at the neutral geometry. The triple ionization energy is found to be close to 50 eV in agreement with theoretical predictions. The doubly charged parent ion is stable up to about 2 eV above the threshold, after which dissociations by charge separation and by double charge retention occur with comparable intensities. Fragmentation to H⁺ + C₃H₃⁺ starts immediately above the threshold as a slow (metastable) decay with 130.5 ± 9.9 ns mean lifetime.

The impact of the epidemiology of multimorbidity on health policy across settings and countries

Issue/Problem

The epidemiology of multiple health conditions (also known as multimorbidity) is increasingly being studied across many settings and countries around the world. More specifically, prevalence and predictors of multimorbidity are being explored among clinical and population-based samples from high-, middle- and low-income countries in rural and urban settings. While the prevalence of multimorbidity tends to increase among ageing populations, a growing proportion of adults under the age of 65 years are also living with multimorbidity, indicating a need for effective interventions.

Description of Problem

There is a need to identify consistent and distinct epidemiological patterns of multimorbidity across different settings and countries. More specifically, the prevalence and consequence of multimorbidity may have different implications in high-, middle- and low-income countries, as well as between rural and urban settings. This understanding can be informed by extracting information from relevant publications and conducting a survey of multimorbidity researchers on the impact of this research on subsequent health policy priorities and decisions in their specific setting or country.

Intended Results

The responses and insights provided by multimorbidity researchers from the completion of the survey (consisting of both open- and closed-ended questions) will be presented, including how the epidemiology of multimorbidity has been conducted to date and how this research may or may not be informing policy priorities and decisions in their respective countries. As well, the focus of interventions to prevent multimorbidity occurrence will be explored across settings.

Lessons

Overall, this presentation will aim to summarize key patterns in both epidemiology and policy responses to multimorbidity occurrence and implications across settings and countries. This work will also aim to create a more formal community of multimorbidity researchers around the world.

Sleep and its effect on mental health among adolescent and adult population

The global prevalence of mental disorders is on the rise and sleep disorders have been recognized among one of the major contributors affecting well-being and longevity of both young and adult population. Sleep habits are multifaceted and arise from complex interactions between socio-environmental, behavioral, and psychological factors, and any disruptions in the balance of the previous may negatively alter sleep duration and sleep quality leading to sleep disorders, however this phenomenon may vary by age and sex. Emerging evidence suggest that adolescents entering pubertal development face many sleep changes due to biological factors like delay in circadian rhythm and decreased homeostatic sleep pressure as well as due to social factors which may lead to sleep disorders subsequently affecting adolescents' mental health. Sleep hygiene among young population is of primary importance especially as chronic sleep disruption may be a risk factor for mental disorders and multimorbidity along the lifespan, and importantly these association have been proved to be bi-directional. Thus, public health initiatives and guidelines to promote sleep hygiene should emerge in order increase the awareness of sleep disorders and their role in prevention and management of mental disorders.

POS0531 FACTORS ASSOCIATED WITH BASELINE HYPERTENSION IN EARLY RHEUMATOID ARTHRITIS: DATA FROM A REAL-WORLD LARGE INCIDENT COHORT

Background:

It is not well understood why hypertension (HTN) is so common in rheumatoid arthritis (RA) patients. Reported prevalence of HTN in RA patients ranges from 4-73%.(1)

Objectives:

This study explored the prevalence of HTN at time of RA diagnosis and which demographic, behavioural and clinical factors were associated with HTN.

Methods:

Data from the Canadian Early Arthritis Cohort (CATCH), a prospective inception cohort of patients with RA <1 year duration, were used to analyze baseline demographic, behavioural and clinical characteristics associated with HTN, which was reported by physicians. Univariate logistic regression models were created to explore associations with baseline HTN. A multivariate logistic regression model was built based on goodness of fit indicated by likelihood ratio tests. Variables included in the model were age, sex, race, body mass index (BMI), education, smoking, alcohol servings, seropositivity, disease activity and comorbidities.

Results:

In total, 2052 subjects were included with mean (±SD) age of 55 (±14) years and symptom duration 5.60(5.47, 5.73) months, 71% of subjects were female and 85% were Caucasian. HTN was reported in 26% of subjects at baseline. Hypertensive subjects were older and more likely to be male. Other factors significantly associated with HTN at baseline were lower education, ever smoking, high BMI, diabetes, hyperlipidemia, worse RA disease activity, longer duration of RA symptoms, being seropositive, as well as the use of NSAIDs and/or corticosteroids (Table 1). In multivariable analysis HTN was associated with older age, overweight and obese BMI, diabetes, and hyperlipidemia. Expression of anti-citrullinated protein antibodies was inversely associated with HTN (Table 1). Other RA disease factors and treatments were not significantly associated with HTN on multivariable analysis.

Table 1.

Results of univariate and multivariate logistic regression analyses exploring the association between baseline characteristics and HTN in early RA.

Univariate Logistic RegressionMultivariable Logistic RegressionVariableCrude OR (95% CI)Adjusted OR (95% CI)Socio-Demographic20-39 years old0.15 (0.07, 0.26)0.14(0.05, 0.34)40-59 years oldReference60-79 years old2.81 (2.26, 3.50)2.26(1.65, 3.11)80-99 years old5.87 (3.36,10.25)3.80(1.53, 9.41)Female0.55 (0.45, 0.68)1.10(0.78, 1.54)Lifestyle/BehaviouralNormal weight (18.5- 24.9kg/m2)ReferenceOverweight (25-29.9 kg/m2)2.33(1.74, 3.11)1.63(1.10, 2.43)Obese (30+ kg/m2)3.19(2.38, 4.27)2.84(1.91, 4.23Ever-smoking1.41(1.15, 1.73)1.02(0.75, 1.40)Post-secondary education0.58(0.47, 0.71)0.88(0.65, 1.20)Clinical CharacteristicsSymptom duration0.99(0.99, 0.99)1.00(1.00, 1.00)DAS-281.09(1.09, 1.17)1.02(0.92, 1.13)ACPA+0.68(0.56, 0.85)0.64(0.44, 0.92)Corticosteroid use pre-baseline1.37(1.04, 1.81)OmittedNSAID use at baseline0.68(0.55, 0.84)OmittedDiabetes5.62(4.09, 7.73)3.20(1.99, 5.15)Hyperlipidemia4.75(3.74, 6.03)2.80(1.94, 4.02),CVD15.59(3.35, 72.64)Omitted

DAS-28; Disease activity score 28, ACPA; Anti-citrullinated protein antibody, CVD; Cardiovascular disease. Pre-baseline is 29 to 365 days before entering the cohort. Baseline is within 28 days before entering the cohort. Omitted variables either failed likelihood ratio test or were colinear. Additional variables tested but found insignificant: race, alcohol servings, depression, RF+, and use of DMARDs.

Conclusion:

Approximately 1 in 4 diagnosed with RA had HTN reported by their rheumatologists, which is similar to that of the general population. This suggests that increased risk of HTN in RA patients may develop as RA disease or treatment time progresses. Factors that may be predictive of this excess risk will be explored in further analysis.

References:

[1]Panoulas VF, Metsios GS, Pace AV, et al. Hypertension in rheumatoid arthritis. Rheumatology (Oxford) 2008;47:1286-98.

Acknowledgements:

The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013;, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019,Gilead Sciences Canada since 2020 and Fresenius Kabi Canada Ltd. since 2021. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, Sanofi Genzyme from 2016-2017, and Eli Lilly Canada from 2016-2020.

Disclosure of Interests:

Brook Hadwen: None declared, Saverio Stranges: None declared, Neil Klar: None declared, Kuriya Bindee: None declared, Janet Pope Speakers bureau: UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, BMS, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB;, Grant/research support from: Abbvie, BMS, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Gilles Boire Speakers bureau: Merck, BMS, Pfizer, Janssen, Grant/research support from: Amgen, Abbvie, BMS, Eli Lilly, Merck, Novartis, Pfizer, Sandoz, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Consultant of: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis., Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis., Carol Hitchon Grant/research support from: Pfizer and UCB Canada, Glen Hazlewood: None declared, Edward Keystone Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Consultant of:: AbbVie, Amgen, AstraZeneca Pharma, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Grant/research support from: AbbVie, Amgen, Gilead Sciences, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, PuraPharm, Sanofi, Orit Schieir: None declared, Carter Thorne Speakers bureau: Medexus/Medac, Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Grant/research support from: Amgen, Pfizer, Abbvie, Celgene, CaREBiodam, Novartis, Diane Tin: None declared, Marie-France Valois: None declared, Vivian Bykerk Consultant of: Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB, NIH, Lillian Barra: None declared

High-gain harmonic generation with temporally overlapping seed pulses and application to ultrafast spectroscopy

Collinear double-pulse seeding of the High-Gain Harmonic Generation (HGHG) process in a free-electron laser (FEL) is a promising approach to facilitate various coherent nonlinear spectroscopy schemes in the extreme ultraviolet (XUV) spectral range. However, in collinear arrangements using a single nonlinear medium, temporally overlapping seed pulses may introduce nonlinear mixing signals that compromise the experiment at short time delays. Here, we investigate these effects in detail by extending the analysis described in a recent publication (Wituschek et al., Nat. Commun., 11, 883, 2020). High-order fringe-resolved autocorrelation and wave packet interferometry experiments at photon energies > 23 eV are performed, accompanied by numerical simulations. It turns out that both the autocorrelation and the wave-packet interferometry data are very sensitive to saturation effects and can thus be used to characterize saturation in the HGHG process. Our results further imply that time-resolved spectroscopy experiments are feasible even for time delays smaller than the seed pulse duration.

Multimorbidity patterns and quality of life across European populations: Results from SHARE database

An increasing number of people living with multimorbidity may receive suboptimal care since health systems are not well prepared to respond to their complex needs. Identifying which conditions most commonly group together could support better care for patients with multiple diseases. This is particularly critical for conditions that have the most deteriorating effect on quality of life (QoL). The aim of the study was to: 1) identify multimorbidity patterns in Europe and 2) assess their impact on QoL. This was a cross-sectional analysis performed on the Survey of Health, Ageing and Retirement in Europe (SHARE) among adults aged 50+, in eighteen countries (n = 67,179). The Control, Autonomy, Self-Realization and Pleasure (CASP-12v1) scale assessed QoL. Exploratory factor analysis (using 17 conditions) based on tetra-choric correlations, was applied to identify multimorbidity patterns. Associations between patterns and QoL were estimated with multilevel mixed-effects linear regression. The analyses were adjusted for socio-economic, clinical and psycho-social factors, and stratified by sex. Three multimorbidity patterns were found: 1) cardio-metabolic [frequency in men (27.7%); women (25.9%)], 2) psycho-geriatric [1.4%; 0.3%] and 3) mixed [11.7%; 17.4%]. Sample adequacy was confirmed by the Kaiser-Meyer-Olkin test [0.81; 0.84, for men and women, respectively]. The patterns showed slight sex differences. The frequency of all patterns increased with age, while patterns overlapped significantly in the population. The psycho-geriatric pattern had the most deteriorating effect on QoL [-4.5(95%CI:-6.2;-2.8) for men; -5.0(95%CI: -9.5; -0.5) for women]. Recognizing the most common disease patterns may allow more targeted planning and provision of care, including development of clinical guidelines, enhancing collaboration between health professionals, and creation of prevention plans to reduce complications and preserve the best QoL for patients with multimorbidity.

Key messages

First large population-based study on multimorbidity patterns and their impact on QoL across Europe, using SHARE database. The findings can serve to support better care for multimorbid patients.

Sleep difficulties and alcohol use behaviors in adolescents and young adults: a systematic review

Background

Sleep disturbances and substance abuse are prevalent in adolescents, often associated with adverse behavioral outcomes and daytime dysfunction. While sleep problems are often seen as consequences to alcohol use, they are risk factors for alcohol misuse and related consequences. However, current evidence in adolescents and young adults (AYA) is mostly observational and is not well-documented in recent years. This systematic review aims to assess the literature surrounding sleep difficulties and their effects on subsequent alcohol misuse in AYA.

Methods

Medline, PsycINFO, and EMBASE were searched for observational studies assessing alcohol consumption, alcohol-related consequences, and self-reported sleep difficulties in AYA aged 16-25. Studies with clinical samples and randomized trials were excluded. Data on measurement tools, measures of association, and sample characteristics were recorded using a standardized form. Associations between sleep difficulties and alcohol misuse were qualitatively summarized by study type (cross-sectional and longitudinal studies). Risk of bias was assessed using CLARITY tools.

Results

Of 7706 records retrieved from databases, 24 studies met the inclusion criteria. Cross-sectional studies (n = 17) found insomnia-like symptoms (difficulties falling/staying asleep, frequent night-time awakenings) were significantly associated with alcohol use frequency and intensity (n = 16) and subsequent intoxication (n = 6). Among longitudinal studies (n = 7), persistent erratic sleep behaviors at baseline were associated with frequent binge-drinking (n = 2) and increased odds of interpersonal problems (n = 2) and risky behaviors at follow-up (n = 1).

Conclusions

The present review assesses the role of sleep difficulties in alcohol use behaviors and related consequences in AYA. Sleep inadequacies are involved in alcohol misuse, prompting investigations to clarify sleep's etiological role in alcohol use behaviors to prevent negative consequences in AYA.

Key messages

Sleep disturbances need to be investigated further as possible risk factors for incident alcohol misuse in young adults. Addressing sleep hygiene and promoting healthy sleep behaviors are important in evaluating the overarching public health issue of alcohol addiction and misuse in adolescents.

Nutritional Supplements and Chronic Disease: Bridging the Gap between Myth and Reality

Several studies have appraised the role of vitamin and mineral supplements in primary or secondary prevention of chronic disease have consistently found null results or possible harms. Evidence involving tens of thousands of people randomly assigned in many clinical trials shows that β-carotene, vitamin E, and possibly high doses of vitamin A supplements increase mortality and that other antioxidants, folic acid, B and D vitamins, and multivitamin supplements have no clear benefit.

The large body of accumulated evidence has important public health and clinical implications. Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action. The message is simple: most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries.

The evidence also has implications for research. Antioxidants, folic acid, and B vitamins are harmful or ineffective for chronic disease prevention, and further large prevention trials are no longer justified. Vitamin D supplementation, however, is an open area of investigation, particularly in deficient persons. However, clinical trials have been equivocal and sometimes contradictory. Finally, implications on the clinical management and public health recommendations concerning the use of nutritional supplements in chronic disease will be addressed. Likewise, issues around the marketing and advertising of these supplements in the general public will be also discussed.

Night shift work, sleep quality and risk of endocrine-related cancer: a systematic review

Background

Cancer is a major public health concern as it is a leading cause of death worldwide. The risk of endocrine-related cancers may be associated with suboptimal sleep quality due to disruptions in circadian rhythm. However, the extent of this relationship is not clear and warrants a review summarizing recent research findings. This systematic review aims to provide an updated summary of the literature surrounding the association between night shift work, sleep quality, circadian rhythm disruption and the risk of endocrine-related cancers.

Methods

MEDLINE, EMBASE, CINAHL, and Web of Science databases have been searched for related cohort, case-control, and cross-sectional studies. The search was limited to studies published in English, after the year 2000. Non peer-reviewed literature and randomized control trials, were excluded. Reviewers will independently extract data on study characteristics, sleep quality measures, circadian rhythm measures, cancer diagnosis, and outcome measures. Risk of bias assessment will be performed using the CLARITY tools.

Results

Data synthesis is ongoing. Associations between sleep quality, night shift work, circadian disruption and risk of endocrine-related cancer will be summarized and risk estimates will be reported for four endocrine-related cancers: breast, prostate, thyroid, ovarian, and endometrial cancer. If data are available, subgroup analyses will be carried out by cancer type, study design, and age group.

Conclusions

This review qualitatively synthesizes current literature to determine the extent of the association between sleep quality, night shift work, circadian rhythm disruption and the risk of endocrine-related cancers. These findings can contribute to population-level cancer prevention efforts and aid public health promotion of healthier sleep-related behaviours.

Key messages

The relationship between sleep quality and endocrine-related cancers should be explored further in public health research due to inconclusive evidence from current literature. The findings of this project can help promote healthy sleep behaviours and population-level cancer prevention.

Photoionization Dynamics of the Tetraoxo Complexes OsO4 and RuO4

The photoionization dynamics of OsO₄ and RuO₄, chosen as model systems of small-size mononuclear heavy-metal complexes, has been theoretically studied by the time-dependent density functional theory (TDDFT). Accurate experimental measurements of photoionization dynamics as a benchmarking test for the theory are reported for the photoelectron asymmetry parameters of outer valence ionizations of OsO₄, measured in the 17–90 eV photon energy range. The theoretical results are in good agreement with the available experimental data. The observed dynamical behavior of partial cross sections and asymmetry parameters has been related to both the coupling to the continuum of discrete excited states, giving strong modulations in the photon energy dependency, and the atomic composition of the initial ionized states, which determines the rate of decay of ionization probability for increasing excitation energies. Overall, an extensive analysis of the photoionization dynamics for valence and core orbitals is presented, showing good agreement with all the available experimental data. This provides confidence for the validity of the TDDFT approach in describing photoionization of heavy transition element compounds, with the perspective of being used for larger systems. Further experimental work is suggested for RuO₄ to gather evidence of the sensitivity of the theoretical method to the nature of the metal atom.

In this work, the time-dependent density functional theory is used to calculate the photoionization dynamics of the valence and core ionizations of OsO₄ and RuO₄ complexes, which are chosen as model systems of small-size mononuclear heavy-metal complexes. Accurate experimental measurements of the branching ratios and photoelectron asymmetry parameters of outer valence ionizations of OsO₄ provide a sound benchmark of the computational methodology.

Time-resolved formation of excited atomic and molecular states in XUV-induced nanoplasmas in ammonia clusters

High intensity XUV radiation from a free-electron laser (FEL) was used to create a nanoplasma inside ammonia clusters with the intent of studying the resulting electron-ion interactions and their interplay with plasma evolution. In a plasma-like state, electrons with kinetic energy lower than the local collective Coulomb potential of the positive ionic core are trapped in the cluster and take part in secondary processes (e.g. electron-impact excitation/ionization and electron-ion recombination) which lead to subsequent excited and neutral molecular fragmentation. Using a time-delayed UV laser, the dynamics of the excited atomic and molecular states are probed from -0.1 ps to 18 ps. We identify three different phases of molecular fragmentation that are clearly distinguished by the effect of the probe laser on the ionic and electronic yield. We propose a simple model to rationalize our data and further identify two separate channels leading to the formation of excited hydrogen.

Concordance between health administrative data and survey-derived diagnoses for mood and anxiety disorders

OBJECTIVE

To assess whether estimates of survey structured interview diagnoses of mood and anxiety disorders were concordant with diagnoses of these disorders obtained from health administrative data.

METHODS

All Ontario respondents to the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH) were linked to health administrative databases at ICES (formerly known as the Institute for Clinical Evaluative Sciences). Survey structured interview diagnoses were compared with health administrative data diagnoses obtained using a standardized algorithm. We used modified Poisson regression analyses to assess whether socio-demographic factors were associated with concordance between the two measures.

RESULTS

Of the 4157 Ontarians included in our sample, 20.4% had either a structured interview diagnosis (13.9%) or health administrative diagnosis (10.4%) of a mood or anxiety disorder. There was high discordance between measures, with only 19.4% agreement. Migrant status, age, employment, and income were associated with discordance between measures.

CONCLUSIONS

Our findings indicate that previous estimates of the 12-month prevalence of mood and anxiety disorders in Ontario may be underestimating the true prevalence, and that population-based surveys and health administrative data may be capturing different groups of people. Understanding the limitations of data commonly used in epidemiologic studies is a key foundation for improving population-based estimates of mental disorders.

Relationship between sleep patterns and multimorbidity in the Canadian Longitudinal Study on Aging

Background

Sleep difficulties are an unmet public health problem, affecting large segments of the population around the world. Poor sleep quality and reduced sleep duration impact over half of older adults and are associated with adverse health outcomes like multiple chronic diseases (multimorbidity) and reduced longevity.

Methods

A cross-sectional analysis of the Canadian Longitudinal Study on Aging (CLSA), a national health survey of community-dwelling adults and older adults. A total of 30,011 participants had physiological and psychosocial data collected at baseline. Sleep measures included self-reported sleep duration (short: &lt;6 hours, normal: 6-8 hours, long: &gt;8 hours) and sleep quality (dissatisfied/very dissatisfied, neutral, satisfied/very satisfied). To capture multimorbidity, a primary definition was operationalized with 17 chronic conditions, whereas a secondary definition was operationalized with 9 chronic conditions to capture both the primary care and public health perspective.

Results

In our sample, 50.9% were female (average age: 62.7 years) and 49.1% were male (average age: 63.2 years). The majority reported a normal sleep duration and approximately half reported being either satisfied or very satisfied with sleep quality. About 70% were living with multimorbidity using the primary care definition (females: 71.7%; males 64.3%), while about 30% were living with multimorbidity using the public health definition (females: 34.8%; males: 28.9%). The adjusted analyses indicated the odds of multimorbidity increased for those who reported short or long sleep duration, as well as dissatisfaction with sleep quality, across age groups and both females and males.

Conclusions

Disrupted sleep may be an additional behavioural risk factor for a number of chronic diseases, in the context of aging populations. It is necessary to understand the potential impact of sleep on the risk of multimorbidity, and this research will build knowledge in this important area.

Key messages

This research will utilize a national health survey to examine and report the characteristics of sleep quality and sleep duration among approximately 30,000 community-dwelling adults in Canada. This research will explore relationships between sleep duration, sleep quality and multimorbidity (controlling for confounding factors) among community-dwelling adults in Canada.

Multimorbidity and quality of life: longitudinal analysis of the European SHARE database

Key messages

First longitudinal study to address this research questions across wide range of European countries using SHARE. Study accounts for large number of confounding factors owing to the abundance of collected information.

Sleep and Mental Health Among Older Adults in the Canadian Longitudinal Study on Aging

Background

Global studies have demonstrated consistent associations between sleep problems and mental health and well-being in older adults, however Canadian data are lacking. We investigated associations between sleep quantity and quality with both mental illness symptoms and well-being among older adults in Canada.

Methods

We used cross-sectional baseline data from the Canadian Longitudinal Study on Aging, a national survey of 30,097 community-dwelling adults aged 45 years and older. Self-reported sleep measures included average past-week sleep duration (short [&lt;6h], normal [6-8h], long [&gt;8h]), and sleep quality (satisfied or dissatisfied vs neutral). Mental illness outcomes included depressive symptoms and psychological distress. Mental well-being outcomes included self-rated mental health and satisfaction with life. We used modified Poisson regression models with adjustment for sociodemographic, behavioural, and clinical factors, and stratification by sex and age to explore effect modification.

Results

In the unadjusted analysis, short and long sleep duration and sleep dissatisfaction were associated with higher mental illness symptoms and lower well-being across all outcomes. Sleep satisfaction was associated with a lower likelihood of mental illness symptoms and better well-being. Short sleep duration was associated with the largest effects on mental health outcomes. Self-rated mental health and depressive symptoms had the largest associations with sleep measures. Effects were larger in males and the 45 to 54 year age group.

Conclusions

Preliminary evidence suggests sleep duration and quality are associated with symptoms of depression, psychological distress, and poor mental well-being among older adults. We are unable to determine whether sleep problems are a cause or consequence of poor mental health. Nonetheless, sleep may be an important target for public health initiatives to improve mental health and well-being among older adults.

Key messages

Our findings contribute further evidence that sleep difficulties are associated with adverse health outcomes including higher mental illness symptoms and lower well-being among older adults. Sleep disturbances are an unmet public health problem, and may be an important target for public health initiatives to improve mental health and well-being among older adults.

Epidemiological and nutritional transition in low- and middle-income countries

Issue/problem

In the last decades, the number of deaths from non-communicable diseases in developing countries has risen to those observed in developed countries.

Description of the problem

Nutritional research in developing countries has primarily focused on under-nutrition, particularly among vulnerable population subgroups such as women and children. However, while economic growth has a significant social impact at population level, there is suggestive evidence of an ongoing nutritional transition leading to concurrent under- and over-nutrition in the population.

Results

The ongoing nutritional transition in these settings has been mostly linked to the rapid process of urbanisation and westernization. Data from several developing countries suggest that improvements in developmental indicators is accompanied by higher availability of highly processed poorly nutritious foods. Regarding socioeconomic factors, results demonstrated that better education and better living standards were associated with higher odds of overweight/obesity after adjusting for confounders, including urban vs. rural setting. This is likely a consequence of the ongoing nutritional and epidemiological transition occurring in these settings. In fact, developing countries have not yet reached the same phase of nutritional transition as an economically affluent country, and while high-calorie diets comprising fast-food are the more economically affordable option in the latter, such diets are still reserved for the more affluent individuals in some developing countries, where economic growth has only just begun to allow affluent individuals to afford fast-food.

Conclusions

Understanding the underlying ecological and socioeconomic roots of both extremes of the nutritional status is vital to design successful public health interventions.

Angular Distribution of Ion Products in the Double Photoionization of Propylene Oxide

A photoelectron-photoion-photoion coincidence technique, using an ion imaging detector and tunable synchrotron radiation in the 18.0–37.0 eV photon energy range, inducing the ejection of molecular valence electrons, has been applied to study the double ionization of the propylene oxide, a simple prototype chiral molecule. The experiment performed at the Elettra Synchrotron Facility (Trieste, Italy) allowed to determine angular distributions for ions produced by the two-body dissociation reactions following the Coulomb explosion of the intermediate (C₃H₆O)²⁺ molecular dication. The analysis of the coincidence spectra recorded at different photon energies was done in order to determine the dependence of the β anisotropy parameter on the photon energy for the investigated two-body fragmentation channels. In particular, the reaction leading to CH3+ + C₂H₃O⁺ appears to be characterized by an increase of β, from β ≈ 0.00 up to β = 0.59, as the photon energy increases from 29.7 to 37.0 eV, respectively. This new observation confirms that the dissociation channel producing CH3+ and C₂H₃O⁺ final ions can occur with two different microscopic mechanisms as already indicated by the bimodality obtained in the kinetic energy released (KER) distributions as a function of the photon energy in a recent study. Energetic considerations suggest that experimental data are compatible with the formation of two different stable isomers of C₂H₃O⁺: acetyl and oxiranyl cations. These new experimental data are inherently relevant and are mandatory information for further experimental and theoretical investigations involving oriented chiral molecules and linearly or circularly polarized radiation. This work is in progress in our laboratory.

P5308Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease: Cochrane systematic review and meta-analysis of randomised clinical trials

Background

Observational studies have confirmed the benefits of adherence to a Mediterranean dietary pattern on cardiovascular disease (CVD) but the randomised controlled trial (RCT) evidence is limited.

Objective

To determine the effectiveness of a Mediterranean-style diet for the primary and secondary prevention of CVD.

Methods

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, DARE, HTA, NHS EED and trial registers (September 2018). We selected RCTs in healthy adults and adults at high risk of CVD (primary prevention) and those with established CVD (secondary prevention). Both of the following key components were required for our definition of a Mediterranean-style diet: high monounsaturated/saturated fat ratio and a high intake of plant based foods, including fruits, vegetables, and legumes. The intervention could be dietary advice, provision of relevant foods or both. The comparison group received either no intervention, minimal intervention, usual care or another dietary intervention. Outcomes included clinical events and CVD risk factors. We included only studies with follow-up periods of 3 months or more.

Results

Overall, 30 RCTs (12,461 participants randomised) and 7 ongoing trials met our inclusion criteria, whereas 22 primary prevention trials and 6 secondary prevention trials were analysed. Low quality evidence shows little or no effect of the PREDIMED (7747 randomised) intervention (advice to follow a Mediterranean diet plus supplemental extra virgin olive oil or tree nuts) compared to a low fat diet on CVD mortality (HR 0.81 (95% CI 0.5, 1.32)) or total mortality (HR 1.0 (95% CI 0.81, 1.24)) over 4.8 years. There was however a reduction in the number of strokes with the PREDIMED intervention (HR 0.6 (95% CI 0.45, 0.8), moderate quality evidence). For secondary prevention, in the Lyon Diet Heart Study (605 CVD patients), there was moderate quality evidence of a reduction in CVD mortality (HR 0.35 (95% CI 0.15, 0.82)) and total mortality (HR 0.44 (95% CI 0.21, 0.92)) with the intervention, over 46 months. For CVD risk factors, in primary prevention trials, there was low quality evidence for a possible small reduction in total cholesterol (−0.16 mmol/L (95% CI −0.32, 0.00), and moderate quality evidence for a reduction in SBP (−2.99 mmHg (95% CI −3.45, −2.53)) and DBP (−2.0 mmHg (95% CI −2.29, −1.71)). In secondary prevention trials, there was moderate quality evidence of no effect of a Mediterranean-style diet on lipid levels and low or very low quality evidence for blood pressure.

Conclusions

Despite the relatively large number of studies included in this review, there is still some uncertainty regarding the effects of a Mediterranean-style diet on clinical endpoints and CVD risk factors for both primary and secondary prevention. The ongoing studies may provide more certainty in the future.

Real-Time Dynamics of the Formation of Hydrated Electrons upon Irradiation of Water Clusters with Extreme Ultraviolet Light

Free electrons in a polar liquid can form a bound state via interaction with the molecular environment. This so-called hydrated electron state in water is of fundamental importance, e.g., in cellular biology or radiation chemistry. Hydrated electrons are highly reactive radicals that can either directly interact with DNA or enzymes, or form highly excited hydrogen (H^{*}) after being captured by protons. Here, we investigate the formation of the hydrated electron in real-time employing extreme ultraviolet femtosecond pulses from a free electron laser, in this way observing the initial steps of the hydration process. Using time-resolved photoelectron spectroscopy we find formation timescales in the low picosecond range and resolve the prominent dynamics of forming excited hydrogen states.

Double photoionization of propylene oxide: A coincidence study of the ejection of a pair of valence-shell electrons

Propylene oxide, a favorite target of experimental and theoretical studies of circular dichroism, was recently discovered in interstellar space, further amplifying the attention to its role in the current debate on protobiological homochirality. In the present work, a photoelectron-photoion-photoion coincidence technique, using an ion-imaging detector and tunable synchrotron radiation in the 18.0-37.0 eV energy range, permits us (i) to observe six double ionization fragmentation channels, their relative yields being accounted for about two-thirds by the couple (C₂H₄⁺, CH₂O⁺) and one-fifth by (C₂H₃⁺, CH₃O⁺); (ii) to measure thresholds for their openings as a function of photon energy; and (iii) to unravel a pronounced bimodality for a kinetic-energy-released distribution, fingerprint of competitive non-adiabatic mechanisms.

Subtraction of subcutaneous fat to improve the prediction of visceral adiposity: exploring a new anthropometric track in overweight and obese youth

BACKGROUND

The efficiency of traditional anthropometric measurements such as body mass index (BMI) or waist circumference (Waist C) used to replace biomedical imaging for assessing visceral adipose tissue (VAT) is still highly controversial in youth.

HYPOTHESIS AND OBJECTIVES

We evaluated the most accurate model predicting VAT in overweight/obese youth, using various anthropometric measurements and their correlation with different body fat compartments, especially by testing, for the first time in youth, the hypothesis that subtracting the anthropometric measurement the most highly correlated with subcutaneous abdominal adipose tissue (SAAT) and less correlated possible with VAT from an anthropometric abdominal measurement highly correlated with visceral and total abdominal adipose tissue (TAAT), predicts VAT with higher accuracy.

SUBJECTS AND METHODS

VAT and SAAT data resulted from magnetic resonance imaging (MRI) analysis performed on 181 boys and girls (7-17 y) from Diabetes & Endocrinology Care Paediatrics Clinic in Luxembourg. Height, weight, abdominal diameters, waist, hip, and thigh circumferences were measured with a view to developing the anthropometric VAT predictive algorithms.

RESULTS

In girls, subtracting proximal thigh circumference (Proximal Thigh C), the most closely correlated anthropometric measurement with SAAT, from Waist C, the most closely correlated anthropometric measurement with VAT was instrumental in improving VAT prediction, in comparison with the most accurate single VAT anthropometric surrogate. [Formula: see text] Residual analysis showed a negligible estimation error (5 cm² ). In boys, Waist C was the best VAT predictor.

CONCLUSIONS

Subtraction of abdominal subcutaneous fat is important to predict VAT in overweight/obese girls.

Single Photon Thermal Ionization of C_{60}

We report on experiments which show that C_{60} can ionize in an indirect, quasithermal boiloff process after absorption of a single photon. The process involves a large number of incoherently excited valence electrons and yields electron spectra with a Boltzmann distribution with temperatures exceeding 10^{4}  K. It is expected to be present for other molecules and clusters with a comparatively large number of valence electrons. The astrophysical consequences are briefly discussed.