We aimed to estimate the impact of social isolation on cognitive function and mental health among older adults during the two-year-and-a-half COVID-19 period. Pubmed Central, Medline, CINAHL Plus and PsychINFO were searched between March 1, 2020, and September 30, 2022. We included all studies that assessed proportions of older adults with the mean or the median with a minimum age above 60 reporting worsening cognitive function and mental health. Thirty-two studies from 18 countries met the eligibility criteria for meta-analyses. We found that the proportions of older adults with dementia who experienced worsening cognitive impairment and exacerbation or new onset of behavioral and psychological symptoms of dementia (BPSD) were approximately twice larger than that of older adults with HC experiencing SCD and worsening mental health. Stage of dementia, care options, and severity of mobility restriction measures did not yield significant differences in the number of older adults with dementia reporting worsening cognitive impairment and BPSD, while the length of isolation did for BPSD but not cognitive impairment. Our study highlights the impact of social isolation on cognitive function and mental health among older adults. Public health strategies should prioritize efforts to promote healthy lifestyles and proactive assessments.

Trust in governments and public institutions as a determinant of public health outcomes has gained increased attention since the COVID-19 pandemic. Provided historically low confidence in vaccines in Japan, investigating the role of trust in information sources and actual COVID-19 vaccination uptake behavior will be invaluable for future vaccine promotion policymaking. Therefore, the objective of this study was to elucidate the determinants of COVID-19 vaccination uptake and evaluate the relationship between trust in different information sources and COVID-19 vaccination behavior in Japan. For this study, we leveraged a longitudinal series of web-based surveys of 19,174 individuals in Japan conducted between 2021 and 2022 which asked questions regarding a wide range of sociodemographic and psychographic characteristics related to the COVID-19 pandemic. Determinant analysis for vaccination (at least one dose of a COVID-19 vaccine) was conducted via multiple logistic regression, and odds ratios (OR) with 95% confidence intervals (CI) were estimated. After adjustment for sociodemographic determinants of vaccine uptake, aggregate trust in the systems and institutions of vaccine approval (OR: 1.42, 95% CI: 1.30-1.56), and trust in information about the COVID-19 pandemic coming from government sources (OR: 1.27, 95% CI: 1.12-1.44) were found to be consistently powerful predictors of COVID-19 vaccination. Trust in media sources including traditional media (OR: 1.21, 95% CI: 1.07-1.36), and the internet (OR: 0.77, 95% CI: 0.66-0.89) had significant and opposing effects. Our findings support the broader hypothesis that trust in governments and public health institutions remains a powerful determinant for COVID-19 vaccine uptake in Japan. We also found that vaccination decision-making is a multifactorial process that includes the synthesis of trust in public institutions and media, and its interaction with psychosocial determinants such as prosociality and health literacy. We hope to apply this study's findings towards future vaccine programs for contagious diseases.

Objective This paper provides an in-depth examination of public attitudes towards salt reduction across seven culturally diverse countries: the USA, the UK, France, Japan, Indonesia, Thailand, and Brazil. Design Cross-sectional regression analysis with questionnaire data. Setting An analysis of questionnaire study in seven countries. Participants The study’s questionnaire collected responses from 7090 participants across seven countries with the mean age of respondents being 46.06 years (SD 16.96). The gender distribution encompassed 3473 men (49.12%), 3582 women (50.66%), 24 non-binary individuals (0.34%) and 11 who identified as ‘other’ (0.16%). Primary and secondary outcome measures Attitudes toward sodium reduction were measured on a seven-point Likert scale. Results Regression analysis revealed significant associations between attitudes towards sodium reduction and various factors across countries. Gender was a significant factor in France, with women showing less awareness than men (coefficient −0.123, 95% CI −0.237 to −0.008). Age was a significant factor in Japan and Thailand, with older generations exhibiting stronger awareness. Occupation was a significant factor in France (grocery, 0.678, 0.229 to 1.127) and Japan (food service, 0.792, 0.300 to 1.283). In France (0.090, 0.033 to 0.146) and Brazil (0.092, 0.040 to 0.144), attitudes towards reducing sugar intake were positively associated with sodium reduction attitudes. Government interventions showed varying impacts, with positive associations in Thailand (0.004, 0.001 to 0.008) and negative associations in France (−0.003 –0.005 to −0.000). Conclusion Our study reveals a complex array of factors shaping attitudes towards sodium reduction across seven countries. These findings support the need for nuanced, country-specific approaches in formulating sodium reduction strategies. Future research should validate these findings, explore further determinants and understand how attitudes translate into dietary behaviours.

Background: Globally, an estimated 1.4 billion people had hypertension in 2014, yet only just over 20% had controlled blood pressure, and about 580 million remained undiagnosed. Evidence indicates that salt substitutes facilitate meaningful blood-pressure reductions, yet their implementation remains restricted by social and healthcare constraints. The comparative effectiveness of alternative sodium-reduction interventions for elevated blood pressure remains unclear, limiting their introduction across diverse clinical and public health contexts. This study is registered with PROSPERO (CRD420251130153). Methods: We systematically searched PubMed, MEDLINE, and supplementary sources for randomised controlled trials (RCTs) published between 2000 and 2025. All behavioural sodium-reduction interventions among populations with elevated blood pressure, including hypertension, were included. The mean difference in systolic blood pressure (SBP) was the primary outcome, as evidence indicates that intensive control of SBP to levels below 120–130 mmHg is significantly associated with a reduced risk of major cardiovascular disease (CVD) and all-cause mortality. Network and subgroup pairwise meta-analyses were performed, with sensitivity analyses conducted to assess robustness of the findings and subgroup analyses used to explore clinical and public health factors influencing intervention effectiveness (clinical factors: blood pressure stage, trial duration, and medication status; public health factors: setting, implementation period, and country income level). Results: Of 10,404 records identified, 42 studies (46 trials, n = 46,771) were included. While the use of salt substitutes was ranked the most effective intervention in the network meta-analysis, with reductions of −6.78 mmHg (95% CI, −8.42, −5.14) compared to no intervention and −5.35 mmHg (95% CI, −7.89, −2.81) compared to conventional health education, self-monitoring devices and low-sodium diets, when combined with health education, demonstrated similar magnitudes of SBP reductions. Digital health education showed a larger point estimate for SBP reduction by −3.59 mmHg (95% CI −7.40 to 0.22) than conventional education (−1.43 mmHg; 95% CI −3.49 to 0.63), but both confidence intervals crossed zero, indicating no statistically significant difference. Subgroup analyses indicated that, except for trial duration, intervention setting, and country income level in specific intervention comparisons, clinical and public health factors did not generally account for differences in SBP reduction. No evidence of publication bias was observed, except between salt substitutes and no intervention and low-sodium diets and no intervention. Conclusions: Network meta-analysis ranked the use of salt substitutes as the most effective intervention, yet self-regulated interventions, such as low-sodium diets and self-monitoring devices, when combined with education-based sodium-reduction approaches, showed comparable point estimates for SBP reductions. Digital health education showed promise as a supportive adjunct to self-regulated interventions, although its effects were variable and require further quantification. These findings underscore the need for alternative sodium-reduction interventions supported by digital or conventional health education to improve blood pressure control. Health education on sodium reduction, including clinical counselling, should be viewed primarily as a complementary component that enhances other interventions.