Literature suggests that occupational stress is associated with a higher risk of metabolic syndrome; yet less is known whether other sources of stress have similar effects. This review aims to examine whether the relationship between psychological stress and metabolic syndrome differs by sources of stress. Three databases (PubMed, Web of Science, and CINAHL) were searched for eligible articles; metaanalyses were conducted using the random effects model. After controlling for covariates, adults in the high-stress groups had 45% higher chance of having metabolic syndrome than adults in the low-stress groups (odds ratio [OR] = 1.450; 95% confidence interval [CI], 1.211-1.735; P < .001). The subsequent meta-analysis based on cross-sectional studies suggested that occupational stress showed the strongest effect (OR = 1.692; 95% CI, 1.182-2.424; P = .004), while perceived general stress showed the weakest effect (OR = 1.217; 95% CI, 1.017-1.457; P = .032).Unfortunately, there is a lack of longitudinal studies for subsequent meta-analysis based on sources of stress. There is a need for continued research to examine the long-term relationship between different sources of stress and the risk of metabolic syndrome. Traditional recommendations for preventing metabolic syndrome (eg, low-fat diet and exercise) may not achieve the best outcome if clinicians overlook patients' psychosocial stress. KEYWORDS metabolic syndrome, occupational stress, perceived stress, psychological stress 1 | INTRODUCTION About 30% of adults have metabolic syndrome worldwide. 1,2 The economic burden of metabolic syndrome is substantial. For instance, the annual medical costs for Americans with metabolic syndrome are 60% higher than those without metabolic syndrome. [3][4][5] The development of metabolic syndrome is a multifaceted continuum of metabolic dysregulation, including hyperglycemia, hypertension, visceral adiposity, and atherogenic dyslipidemia. 6 Psychological stress has been linked to metabolic syndrome for decades, but its underlying mechanism is not yet fully understood.Allostasis refers to a normal physiological process where the brain activates the sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axes and stimulates adrenal glands to release stress hormones (eg, corticosteroids) and catecholamine (eg, epinephrine and norepinephrine) to combat against stressful environmental demands. 7 According to the allostatic load framework (ALF), the repeated cycles of activation and deactivation of allostasis over time, or a failure to disengage the stress response during and after each stressful life demand, could alter adults' diurnal cortisol rhythm and decrease the capacity of glucocorticoids to suppress endotoxin-stimulated cytokine production, resulting in a

Mobility-related nursing care activities are provided infrequently for older adults in inpatient practice. Accurate quantification of these activities is critical to understanding patterns of delivery of nursing care and developing or redesigning work processes to improve patients' outcomes. The current exploratory study compares two continuous data-collecting methods: (a) self-reporting and (b) time-and-motion (TAM) observation of mobility-related nursing care activities for hospitalized older adults. A total of 84 patient-level data were captured by observing 43 8-hour shifts of 14 RNs by trained research observers. RNs continuously documented all types of nursing care activities that occurred during observation shifts. The frequency and duration of mobility activities between data obtained from RNs' self-reports and the TAM observations had poor agreement. Compared to the data from the TAM observations, RNs underreported the frequency of their mobility-related nursing care activities and overreported the duration. The authors' data suggest that a continuous TAM observation method is recommended to obtain accurate data on nurses' provision of mobility-related care activities to older adults.

Background A decline in mobility leads to fall occurrence and poorer performance in instrumental activities of daily living, which are widely proved to be associated with older adults' health-related quality of life. To inform potential predicaments faced by older adults at different age levels, predictors of this mobility change and falls along with the ageing process need to be further evaluated. Therefore, this study examined the risk factors associated with the longitudinal course of mobility difficulty and falls among community-dwelling middle-aged and older adults in the Taiwanese community. Methods We evaluated data for the period between 2003 and 2015 from the Taiwan Longitudinal Study on Aging; the data cover 5267 community-based middle-aged and older adults with approximately 12 years of follow-up. In terms of mobility, the participants self-reported difficulties in mobility tasks (eg, ambulation) and whether they used a walking device. We employed linear mixed-effects regression models and cumulative logit models to examine whether personal characteristics are associated with mobility difficulty and falls. Results Mobility difficulty significantly increased over time for the participants aged ≥ 60 years. Perceived difficulties in standing, walking, squatting, and running became apparent from a younger age than limitations with hand function. The probability of repeated falls increased significantly with older age at 70 (p = .002), higher level of mobility difficulty (p < .0001), lower cognitive status (p = .001), living alone (p = .001), higher number of comorbid illnesses (p < .001), walking device use (p = .003), longer time in physical activities (p < .011), and elevated depressive symptoms (p = .006). Although walking aid use increased the probability of falls, individuals with mobility difficulty had a reduced probability of repeated falls when using a walking device (p = .02). Conclusion Community-dwelling Taiwanese adults face an earlier mobility difficulty starting in 60 years old. Individuals with more leisure and physical activities in daily life were more likely to maintain mobility and walking safety. Long-term, regular, social, and physical activity could be a referral option for falls prevention program. The use of a walking device and safety precautions are warranted, particularly for individuals with walking difficulties.

Enterovirus-A71 (EV-A71) cyclically causes hand-foot-mouth disease (HFMD) epidemics in Asian children. An EV-A71 epidemic occurred in Southern Vietnam in 2011, but its scale is not clear. We collected residual sera from non-HFMD Vietnamese inpatients in 2012-2013 to determine seroprevalence of EV-A71 neutralizing antibodies, and measured cross-reactive neutralizing antibody titers against three EV-A71 genogroups. About 23.5% of 1-yearold children in Southern Vietnam has been infected by EV-A71, and the median age of infection was estimated to be 3 years. No significant antigenic variation could be detected among the three EV-A71 genogroups. The high seroprevalence of EV-A71 neutralizing antibody in children living in southern Vietnam indicates the necessity of introducing EV-A71 vaccines in southern Vietnam, particularly for children under 6 months of age. Moreover, it is critical to understand EV-A71 disease burden for formulating national vaccination policy. Author summaryEnterovirus-A71 (EV-A71), a member of the enterovirus genus, is a virulent pathogen causing neurological complications. EV-A71 mainly spreads through oral-fecal or oraloral transmission, as well as respiratory droplets. EV-A71 outbreaks have cyclically occurred throughout some Asian countries since 1997, with millions of people affected. The presence of serum neutralizing antibodies to EV-A71 can represent the prevalence of previous EV-A71 infections and seroprevalence studies are widely used to understand prevalence of infectious diseases. The results of our study demonstrate that about 50% of young children under 3 years of age were infected during the 2011 epidemic in southern Vietnam. The high seroprevalence of EV-A71 neutralizing antibody in children living in southern Vietnam indicates the necessity of introducing EV-A71 vaccines, particularly for children under 6 months of age. Moreover, it is critical to understand EV-A71 disease burden for formulating national vaccination policy in the future. PLOS NEGLECTED TROPICAL DISEASESPLOS Neglected Tropical Diseases | https://doi.

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