BackgroundChronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as ‘multimorbidity’. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs.MethodsData was obtained from the WHO’s Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries.ResultsThe prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases.ConclusionsFindings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0402-8) contains supplementary material, which is available to authorized users.

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A large literature proposes that preferences for exaggerated sex typicality in human faces (masculinity/femininity) reflect a long evolutionary history of sexual and social selection. This proposal implies that dimorphism was important to judgments of attractiveness and personality in ancestral environments. It is difficult to evaluate, however, because most available data come from largescale, industrialized, urban populations. Here, we report the results for 12 populations with very diverse levels of economic development. Surprisingly, preferences for exaggerated sex-specific traits are only found in the novel, highly developed environments. Similarly, perceptions that masculine males look aggressive increase strongly with development and, specifically, urbanization. These data challenge the hypothesis that facial dimorphism was an important ancestral signal of heritable mate value. One possibility is that highly developed environments provide novel opportunities to discern relationships between facial traits and behavior by exposing individuals to large numbers of unfamiliar faces, revealing patterns too subtle to detect with smaller samples.facial attractiveness | evolution | cross-cultural | aggression | stereotyping

Background: Alterations in sleep architecture are common among older adults. Previous studies have documented associations between sleep duration, sleep quality, and cognitive performance in older individuals, yet few studies have examined these trends using population-based samples from non-Western societies. The present cross-sectional study uses nationally representative datasets from six countries to test several hypotheses related to sleep patterns and cognitive function. Methods: Data were drawn from the fi rst wave of the World Health Organization's study on global ageing and adult health (SAGE), a longitudinal study using samples of older adults (≥ 50 years old) in 6 middle-income countries (China, Ghana, India, Russian Federation, South Africa, and Mexico). Selfreport data provided information on sleep quality and sleep duration over the previous 2 nights, and 5 cognitive tests (immediate and delayed verbal recall, forward and backward digit span, and verbal fl uency) were used to create a composite z-score of cognitive performance. Results: Individuals with intermediate sleep durations(> 6-9 h/night) exhibited signifi cantly higher cognitive scores than individuals with short sleep (0-6 h/night; p < 0.001) or long sleep duration (> 9 h/night; p < 0.001). Self-reported sleep quality was positively correlated with cognitive z-score (p < 0.05). Signifi cant sex differences were observed; men generally had higher sleep quality and cognitive scores, while women reported longer sleep durations. Discussion: This study documented positive correlations between cognitive scores and sleep quality, and between cognitive z-scores and intermediate sleep duration. These fi ndings are clinically important given the growing rates of dementia and aging populations globally. Keywords: cognitive function, aging, sleep duration, sleep quality, dementia Citation: Gildner TE, Liebert MA, Kowal P, Chatterji S, Snodgrass JJ. Associations between sleep duration, sleep quality, and cognitive test performance among older adults from six middle income countries: results from the study on global ageing and adult health (SAGE). J Clin Sleep Med 2014;10(6):613-621.http://dx.doi.org/10.5664/jcsm.3782 S C I E N T I F I C I N V E S T I G A T I O N SD etrimental changes in sleep duration and quality are more common with increasing age.1,2 These alterations include a phase advance in circadian rhythms, thought to be the result of deterioration in the suprachiasmatic nuclei region of the brain. Older adults also report an increased occurrence of sleep disorders associated with disrupted and fragmented sleep patterns. These conditions often reduce slow wave sleep (SWS) and REM sleep, the deepest and most restorative sleep stages. Disruption to SWS and REM sleep can lead to increased daytime sleepiness and a decreased ability to handle stress. Age-related changes in sleep may contribute to cognitive decline among older individuals, yet this issue has not been extensively studied. Both short and long sleep duration have been linked to reduced...

Immune function is an energetically costly physiological activity that potentially diverts calories away from less immediately essential life tasks. Among developing organisms, the allocation of energy toward immune function may lead to tradeoffs with physical growth, particularly in high-pathogen, low-resource environments. The present study tests this hypothesis across diverse timeframes, branches of immunity, and conditions of energy availability among humans. Using a prospective mixed-longitudinal design, we collected anthropometric and blood immune biomarker data from 261 Amazonian forager-horticulturalist Shuar children (age 4-11 y old). This strategy provided baseline measures of participant stature, s.c. body fat, and humoral and cell-mediated immune activity as well as subsample longitudinal measures of linear growth (1 wk, 3 mo, 20 mo) and acute inflammation. Multilevel analyses demonstrate consistent negative effects of immune function on growth, with children experiencing up to 49% growth reduction during periods of mildly elevated immune activity. The direct energetic nature of these relationships is indicated by () the manifestation of biomarker-specific negative immune effects only when examining growth over timeframes capturing active competition for energetic resources, () the exaggerated impact of particularly costly inflammation on growth, and () the ability of children with greater levels of body fat (i.e., energy reserves) to completely avoid the growth-inhibiting effects of acute inflammation. These findings provide evidence for immunologically and temporally diverse body fat-dependent tradeoffs between immune function and growth during childhood. We discuss the implications of this work for understanding human developmental energetics and the biological mechanisms regulating variation in human ontogeny, life history, and health.