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.

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.

Objectives Information concerning physical growth among small-scale populations remains limited, yet such data are critical to local health efforts and to foster basic understandings of human life history and variation in childhood development. Using a large dataset and robust modeling methods, this study aims to describe growth from birth to adulthood among the indigenous Shuar of Amazonian Ecuador. Methods Mixed-longitudinal measures of height, weight, and BMI were collected from Shuar participants (n = 2,463; age 0–29 years). Centile growth curves and tables were created for each anthropometric variable of interest using GAMLSS. Pseudo-velocity and LMS curves were generated to further investigate Shuar patterns of growth and to facilitate comparison with U.S. CDC and multinational WHO growth references. Results The Shuar are small throughout life and exhibit complex patterns of growth that differ substantially from those of international references. Similar to other Amazonians, Shuar growth in weight compares more favorably to references than growth in height, resulting in BMI curves that approximate international medians. Several additional characteristics of Shuar development are noteworthy, including large observed variation in body size early in life, significant infant growth faltering, extended male growth into adulthood, and a markedly early female pubertal growth spurt in height. Phenotypic plasticity and genetic selection in response to local environmental factors may explain many of these patterns. Conclusions Providing a detailed reference of growth for the Shuar and other Amazonian populations, this study possesses direct clinical application and affords valuable insight into childhood health and the ecology of human growth.

Objectives: The COVID-19 pandemic has led to unprecedented levels of unemployment and financial strain for many Americans. Among the individuals impacted by financial strain are pregnant women, for whom added financial stress may be particularly impactful due to the costs associated with prenatal care and providing for a newborn. Financial stress has been previously associated with elevated depression symptoms among pregnant women, which could have significant impacts on birth outcomes and long-term offspring health. However, the impacts of COVID-19-associated financial stress on maternal depression in pregnancy has not been investigated. Methods: Here, we evaluated whether COVID-19-associated financial stress was associated with increased likelihood of a clinically significant depression score (Edinburgh Postnatal Depression Score ≥ 15) among pregnant women living in the United States during the COVID-19 pandemic. Data come from an online survey administered to a convenience sample in April 2020 (N = 2099). Results: Forty-three percent of participants reported experiencing financial stress as a result of the pandemic, while 24% of participants had a clinically significant depression score. COVID-19-related financial stress was significantly associated with increased likelihood of a clinically significant depression score, even after adjustment for covariates including participant education and income (adjusted Odds Ratio: 2.23, 95% CI = 1.80, 2.77, P < .001). Conclusions: Financial stress caused by the COVID-19 pandemic is associated with more than two times the likelihood of depression during pregnancy, which could impact birth outcomes and long-term offspring health.

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Background Market integration (MI) – increasing production for and consumption from a market-based economy – is drastically altering traditional ways of life and environmental conditions among indigenous Amazonian peoples. The effects of MI on the biology and health of Amazonian children and adolescents, however, remain unclear. Aim This study examines the impact of MI on subadult body size and nutritional status at the population, regional, and household levels among the Shuar of Amazonian Ecuador. Subjects and Methods Anthropometric data were collected between 2005 and 2014 from 2,164 Shuar (age 2-19 years) living in two geographic regions differing in general degree of MI. High-resolution household economic, lifestyle, and dietary data were collected from a subsample of 631 participants. Analyses were performed to investigate relationships between body size and year of data collection, region, and specific aspects of household MI. Results Results from temporal and regional analyses suggest that MI has a significant and overall positive impact on Shuar body size and nutritional status. However, household-level results exhibit nuanced and heterogeneous specific effects of MI underlying these overarching relationships. Conclusion This study provides novel insight into the complex socio-ecological pathways linking MI, physical growth, and health among the Shuar and other indigenous Amazonian populations.

Soil-transmitted helminth (STH) infections can result in a variety of negative health outcomes (e.g., diarrhea, nutritional deficiencies). Market integration (MI; participation in market-based economies) has been suggested to alter levels of STH exposure due to associated changes in diet, sanitation, and behavior, but the effects are complicated and not well understood. Some effects of economic development result in decreased exposure to certain pathogens, and other factors can lead to higher pathogen exposure. With geographic location used as a proxy, the present study investigates the effects of economic development on parasite load among an indigenous population at multiple points along the spectrum of MI. This research has many implications for public health, including an increased understanding of how social and economic changes alter disease risk around the world and how changing parasite load affects other health outcomes (i.e., allergy, autoimmunity). Specifically, this study examines the prevalence of intestinal helminths among the Shuar, an indigenous group in the Morona-Santiago region of Ecuador, from 2 geographically/economically separated areas, with the following objectives: (1) report STH infection prevalence and intensity among Shuar; (2) explore STH infection prevalence and intensity as it relates to age distribution in the Shuar population; (3) compare STH infection patterns in geographically and economically separated Shuar communities at different levels of MI. Kato-Katz thick smears were made from fresh stool samples and examined to determine STH presence/intensity. Results indicate that 65% of the 211 participants were infected with at least 1 STH. Twenty-five percent of the sample had coinfections with at least 2 species of helminth. Infection was more common among juveniles (<15 yr) than adults. Infection prevalence and intensity was highest among more isolated communities with less market access. This study documents preliminary associations between STH infection and exposure to MI, with implications for public health research and interventions.