The two frameworks at the heart of the study are related but distinct. Successful aging, a concept with deep roots in gerontological research, emphasizes physical health, the avoidance of disease and disability, and the maintenance of high cognitive and physical function. Active aging, a broader model promoted heavily in European policy circles, extends the picture to include social participation, security, and continued engagement with life. The researchers set out to determine how health literacy, often described as a vital tool for achieving good outcomes in later life, relates to both paradigms simultaneously, and to identify which factors are associated with higher levels of active aging in a real-world community setting.

The study was designed as a descriptive and cross-sectional survey, conducted between October 2024 and May 2025 at the Metropolitan Municipality’s Active Aging Service Center in Antalya. Participants were 306 adults aged 65 and over, with an average age of 67.79 years and a standard deviation of 3.56. The sample was predominantly female, with women making up 79.4 percent of participants, and highly educated, as 70.6 percent were university graduates. Data were collected through a demographic information form and three validated instruments: the Active Ageing Scale, the Successful Ageing Scale, and the Turkish Health Literacy Scale.

The statistical toolkit was conventional but comprehensive. Descriptive statistics summarized the sample, independent samples t-tests and Chi-square tests explored group differences, Pearson correlation analysis quantified the relationships between the three main constructs, and multiple linear regression identified the independent predictors of active aging. This combination allowed the team to move beyond simple associations and estimate how much each factor contributed to active aging when all others were held constant.

The portrait that emerged of the participants was one of a relatively health-engaged group of older adults. A majority, 66.0 percent, reported living with a chronic illness, and 64.7 percent took medication regularly, reflecting the disease burden typical of this age group. Yet the same participants reported high levels of protective behavior: 58.5 percent engaged in regular physical exercise and an impressive 80.7 percent engaged in regular mental activities. The mean total score on the Active Ageing Scale was 190.10 with a standard deviation of 39.37, the Successful Ageing Scale mean was 57.74 with a standard deviation of 7.61, and the Health Literacy Index mean was 32.97 with a standard deviation of 9.53.

The bivariate analyses revealed a consistent pattern. Higher levels of education and income were significantly associated with better health literacy and better aging outcomes, as were regular physical exercise and regular mental activity, with all of these associations reaching statistical significance at the p < 0.05 level. More striking still, the researchers found positive correlations among active aging, successful aging, and health literacy that were significant at the p < 0.01 level. In other words, older adults who understood health information better tended to score higher on both aging frameworks, and the two frameworks themselves rose and fell together, supporting the idea that they capture complementary dimensions of a single underlying phenomenon.

The regression analysis provided the study’s headline result. The full model statistically significantly predicted active aging and explained 56.4 percent of the total variance, a substantial proportion for research in this field, with an R² of 0.564 and p < 0.05. Within that model, three variables stood out as significant predictors: age, mental activity, and health literacy. Perhaps the most intriguing finding was what fell away. Education and regular physical exercise, both strongly associated with aging outcomes in the bivariate analyses, were no longer significant once health literacy and the other variables were accounted for. This suggests that health literacy may sit on the causal pathway through which education and exercise exert their influence, or at least that it captures something those measures miss.

Why would the ability to navigate health information matter so much for how people age? The technical literature offers several plausible mechanisms. Older adults with stronger health literacy are better equipped to understand medication instructions, interpret symptoms, evaluate prevention advice, and communicate with health professionals, which supports the disease management that successful aging demands. The same skills may also underpin the confidence and autonomy that fuel social participation, a core component of active aging. Conversely, limited health literacy can create a cascade of misunderstanding, poor adherence, and disengagement that erodes both physical health and social connection over time. The Antalya findings cannot prove causation, since the design was cross-sectional, but the strength and consistency of the correlations, together with the regression results, make health literacy a compelling target for intervention.

The study also carries a pointed message for the institutions that serve older adults. The authors conclude that health literacy is a key factor of active and successful aging, and that older adult care centers should prioritize health literacy if they want to promote active aging. That recommendation is notable because active aging service centers are precisely the kind of community infrastructure where health literacy can be built: through accessible health education, plain-language communication, and programs that teach older adults how to evaluate and apply health information in daily life. The Antalya center’s own participants, with their high rates of mental and physical activity, illustrate the kind of engaged population such centers can cultivate.

The researchers were transparent about the study’s boundaries. The perspectives of individuals registered with the Active Aging Service Center who have lived experience were sought during the analysis and validation of the research data, helping interpret the findings from a real-world perspective, though there was no direct patient or public involvement in the study’s initial design, conduct, or writing. The sample, drawn from a single municipal center in a city where most participants were university-educated women, may not represent the broader older population, and the cross-sectional design means the direction of the relationships cannot be established with certainty. Ethics approval was obtained from the Akdeniz University Clinical Research Ethics Committee, and all participants provided verbal and written informed consent. The study received no external funding, and the authors declare no competing interests. Even with those caveats, the core result stands out: in a statistical model explaining more than half of the variance in active aging, health literacy was among the significant predictors, while more commonly cited advantages like education lost their edge. As populations across the world age at unprecedented speed, the study suggests that one of the most powerful investments societies can make in their older members is not more medical care but better health understanding, delivered in the community spaces where aging actually happens.

Subject of Research: The relationship between health literacy and active and successful aging among older adults attending an active aging service center

Article Title: The relationship between health literacy and active and successful aging: a cross-sectional study of active aging service center

Article References: Akdeniz, Ş., & Wolf-Ostermann, K. (2026). The relationship between health literacy and active and successful aging: a cross-sectional study of active aging service center. BMC Geriatrics, 26(1), Article 1232. https://doi.org/10.1186/s12877-026-08341-6

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08341-6

Keywords: health literacy, active aging, successful aging, older adults, geriatrics, gerontology, public health, cross-sectional study, health education, social participation, chronic illness, healthy aging

The research team, led by investigators affiliated with Beirut Arab University, recruited 299 adults with confirmed heart failure from outpatient clinics and primary healthcare services across all major regions of Lebanon between January 2024 and October 2025. Participants were Arabic-speaking adults aged 30 to 80 years with either reduced ejection fraction of 40 percent or less, or symptomatic preserved ejection fraction confirmed by echocardiography, diagnosed for at least three months according to the Framingham criteria. Of 475 people initially screened, some were excluded because their understanding of the term heart failure was distorted, a striking detail in itself: many patients who had undergone open-heart surgery misinterpreted the diagnosis, underlining how much work remains in patient education. After removing cases with missing data, 299 participants formed the analytical sample.

The burden carried by this group was considerable. More than 90 percent had hypertension, roughly 60 percent had diabetes, and the average Charlson Comorbidity Index was 5.58, indicating substantial multimorbidity. Depression had been formally diagnosed in 35.5 percent of participants. The mean left ventricular ejection fraction was 37.52 percent, nearly half the sample was in New York Heart Association functional class III, and participants had lived with heart failure for an average of 5.3 years. Most were unemployed, nearly half reported a monthly household income between 200 and 500 US dollars, and almost all relied on a family caregiver, most often a spouse or an adult child. These socioeconomic realities matter, because in Lebanon out-of-pocket medication costs and repeated hospital admissions place enormous financial pressure on households already battered by currency collapse and inflation.

To measure the study’s central construct, the researchers used the Connor-Davidson Resilience Scale, a 25-item instrument covering domains such as personal competence, trust in one’s instincts, positive acceptance of change, control, and spiritual influences, scored from 0 to 100. In this Lebanese sample the scale showed exceptional internal consistency, with a Cronbach’s alpha of 0.965. Quality of life was assessed with the Arabic-validated Minnesota Living with Heart Failure Questionnaire, depressive symptoms with the Patient Health Questionnaire-9, and self-care with the Revised Self-Care Heart Failure Index version 7.2, which captures self-care maintenance, symptom monitoring, and self-care management as distinct subscales. All instruments had been previously translated and psychometrically evaluated for the Lebanese population, and reliability coefficients in the current study ranged from 0.86 to 0.965.

The headline result was a picture of a population split almost exactly in two. The mean resilience score was 58.41, just above the developer’s suggested cut-off of 55, and 51.2 percent of participants were classified as resilient while 48.8 percent were not. Depressive symptoms averaged 13.76 on the PHQ-9, corresponding to moderate depression, with more than half of the sample falling into the moderate to severe categories. Self-care maintenance and monitoring scores were low at 62.68 and 64.71, below the conventional adequacy threshold of 70, but self-care management scored 78.24, the only subscale to surpass the cut-off. Quality of life, at 56.07 on the Minnesota questionnaire, reflected moderate impairment. Statistically, resilience correlated negatively with depression and positively with all three self-care subscales, with the strongest correlation, r = 0.540, linking resilience to self-care maintenance.

The multivariable regression model identified four independent predictors of resilience, explaining 36.1 percent of the variance in resilience scores. Higher self-care maintenance and higher self-care management each independently predicted greater resilience, with unstandardized coefficients of 0.248 and 0.282 respectively. Male participants scored higher than female participants after adjustment, a gender difference of just over four points on the CD-RISC. Perhaps most intriguingly, participants taking loop diuretics showed resilience scores more than eight points higher than those not taking this class of medication, a finding that likely reflects the association between being on guideline-directed therapy and being engaged with care rather than a pharmacological effect on psychological coping. Bivariate analyses added further texture: resilient patients were more likely to have received influenza and COVID-19 vaccinations, to be current with medical follow-up, to have higher education, and to be cared for by a spouse rather than a child.

One of the most provocative findings is the negative, though statistically non-significant, correlation between resilience and quality of life, which runs counter to virtually all of the published literature, including studies from Egypt, Iraq, and general populations worldwide. The authors argue that no prior research has examined a population exposed to the compounded burden of simultaneous health, political, social, and economic crises as Lebanon has experienced since 2019, encompassing currency devaluation, hyperinflation, the Beirut Port explosion, and continuing regional instability. In such a context, the usual relationship between adaptation and wellbeing may be distorted: patients who have been forced into self-reliance by a failing system may report functional resilience even as their perceived quality of life erodes. The team also notes that quality-of-life scores among Lebanese heart failure patients nearly doubled between 2018 and 2022 before stabilising, a trajectory that mirrors the country’s crisis timeline.

The self-care management result tells a parallel story. In earlier Lebanese studies, self-care management was consistently the weakest subscale, with mean scores around 47. In the present sample it exceeded 78, suggesting a growing culture of self-reliance in disease management driven by necessity, as patients navigate medication shortages, costly follow-up visits, and disrupted continuity of care. This shift occurred despite previously documented deficiencies in discharge education. For nursing science, the implication is that resilience is not a fixed trait but a modifiable domain that can be assessed, monitored, and supported through education, counselling, family-inclusive care planning, and community-based follow-up, particularly in resource-constrained settings where nurses and advanced practice nurses are often the most accessible point of contact.

The authors are careful to acknowledge the limitations of a cross-sectional design, which cannot establish causal direction between resilience and self-care, along with the possibility of social desirability bias in self-reported questionnaires and the constraints of convenience sampling. Even so, the study stands as the first to document resilience and its predictors among heart failure patients living through sustained national collapse, and its patterns may generalise to Lebanese diaspora communities and to other populations enduring protracted instability. The practical message for clinicians is concrete: screening for low resilience, reinforcing self-care maintenance behaviours, supporting female patients who carry lower resilience scores, ensuring guideline-directed medication including diuretic therapy, leveraging spousal caregivers, and promoting vaccination and regular follow-up may together form the scaffolding that keeps chronically ill patients upright when the systems meant to support them cannot.

Subject of Research: Predictors of psychological resilience among patients living with heart failure during prolonged sociopolitical and economic crises in Lebanon

Article Title: Predictors of Resilience Among Patients Living With Heart Failure Amid Escalating Sociopolitical Challenges: A Cross‐Sectional Approach

Article References: Deek, H., Massouh, A. R., & Shatila, W. (2026). Predictors of Resilience Among Patients Living With Heart Failure Amid Escalating Sociopolitical Challenges: A Cross‐Sectional Approach. Nursing Open, 13(9), Article e70816. https://doi.org/10.1002/nop2.70816

Image Credits: AI Generated

DOI: 10.1002/nop2.70816

Keywords: heart failure, resilience, self-care, Lebanon, depression, quality of life, nursing, cross-sectional study, Connor-Davidson Resilience Scale, chronic illness, sociopolitical crisis, cardiology

The World Health Organization’s definition of health as a state of complete physical, mental, and social well-being has driven decades of frameworks built around the social determinants of health. Income, education, housing, and employment all feature prominently in these models. Time, however, remains largely absent, treated instead as a technical parameter within epidemiology. It appears in calculations of disability-adjusted life years, in critical periods of vulnerability, or as an implicit resource that people need to exercise, eat well, attend appointments, and maintain relationships. But this framing assumes everyone has roughly comparable access to time, an assumption the new paper argues is demonstrably false.

Sociology offers a richer picture. Time is not only measured by clocks and calendars but lived as duration, pace, and anticipation, all shaped by economic relations and the finite span of human life. Critically, perceptions of time are tied to identity and a person’s sense of control over their own existence. When people report lacking time, they are not simply reporting an insufficient number of hours; they are describing how their time is structured, valued, and constrained by forces beyond their individual choosing. Reframing time this way transforms it from a methodological convenience into a structural exposure—one that can be measured, modeled, and, in principle, changed through policy.

The paper identifies two interrelated dimensions through which time operates on health: availability and intensity. Availability refers to the absolute quantity of discretionary time a person commands. Intensity captures the lived experience of rushing, acceleration, and constant pressure. In many market-driven societies, emphases on productivity have accelerated daily rhythms at work and at home, intensified by technological change, urbanization, and flexible labor markets that blur the boundary between employment and the rest of life. The result is what researchers describe as boundaryless work—employment that seeps into evenings, weekends, and mental space—alongside the persistent devaluation of unpaid care.

Within labor markets, temporal pressure is organized through two dimensions of working time: control and variability. Working time control describes how much autonomy employees have over when, where, and how they work, which shapes their capacity to protect time for rest, care, and other non-market activities. Working time variability captures how much hours fluctuate, reflecting the predictability of daily rhythms. Evidence from across Europe shows that higher variability, especially when combined with low control, is associated with worse self-rated health, more psychosomatic complaints, and more frequent sleep problems. Meanwhile, indicators such as discretionary time, subjective time scarcity, time poverty, and time excess appear to mediate the well-documented association between socioeconomic status and health—and the health consequences of time poverty differ sharply between high- and low-income groups.

The burdens are not distributed equally. People working multiple jobs, and those combining paid employment with caregiving, face severe constraints on both the amount and the intensity of their time. Women are overrepresented in these situations and globally spend on average 2.8 more hours per day than men on unpaid care and domestic work. Because women, particularly those with lower incomes, perform the largest share of unpaid domestic and care labor, inequalities in time constitute a key mechanism through which social and gender disparities in health are reproduced. Migration, armed conflict, and economic instability deepen these patterns further, as uncertainty and chronic temporal strain become defining features of everyday life.

The relationship between time and health is also bidirectional, creating cycles that entrench disadvantage. Time constraints limit engagement in health-promoting behaviors such as physical activity or preparing nutritious meals, while fostering fatigue, negative mood, and stress-related physiological responses. Conversely, living with illness or disability reshapes how people can use and control their time, restricting participation in paid work, caregiving, and social life. Research on treatment burden shows that managing chronic illness entails substantial unpaid labor—information seeking, medication management, appointments, self-monitoring, lifestyle changes, financial tasks, and navigating health systems. These burdens are socially patterned too: most treatment burden measures were developed in high-income settings and may fail to reflect the experiences of people with lower health literacy or greater socioeconomic constraints. The result is a self-reinforcing loop in which poor health consumes time, and scarce time worsens health.

Healthcare systems themselves are built on temporal assumptions that often fail patients. Care is organized around clock time, standardized schedules, and linear treatment trajectories that rarely match the lived temporalities of chronic illness, disability, or long-term care. Patients juggling paid work and caregiving, or living with limited material resources, must navigate overlapping temporal scales and trade present time for uncertain future benefits. The misalignment disproportionately harms the socially disadvantaged. One promising response is coordinated care that aligns multiple appointments or services within a single visit, reducing the time costs of fragmented care—a model with demonstrated potential for patients with multimorbidity.

Making time visible in epidemiology has direct methodological consequences. Conventional models that treat time as neutral or exogenous obscure how temporal scarcity, acceleration, and uncertainty function as socially patterned exposures, and may systematically misattribute responsibility to individual behavior in ways that reproduce inequity. Existing infrastructures already make measurement feasible: the Harmonised European Time Use Surveys and the Multinational Time Use Study provide harmonised 24-hour diary data on paid work, unpaid care, personal care including sleep, travel, and leisure, alongside sociodemographic information. Incorporating these temporal dimensions into study design would allow research to better reflect lived experience across social groups and countries.

At the level of primordial prevention, the paper calls for engagement through public health diplomacy—advocating health in all policies beyond the health sector. That includes social protection systems that buffer economic uncertainty, labor policies regulating working hours and job security, housing policies shaping residential stability and commuting time, and transport infrastructure that reduces time poverty. Family-related policies such as paid parental leave, accessible childcare, and elder care support can ease the temporal pressures on working-age adults caring across generations. The ultimate claim is ambitious but straightforward: ensuring that people have the temporal conditions necessary to exercise choice, participate in society, and live healthy lives is not a luxury but a prerequisite for health equity, and reclaiming time as a determinant of health is fundamental to advancing population well-being.

Subject of Research: Time as a socially structured determinant of health and health equity

Article Title: Reclaiming time as a fundamental determinant of health equity

Article References: Reclaiming time as a fundamental determinant of health equity. (n.d.). https://doi.org/10.1016/j.ssmph.2026.101939

Image Credits: AI Generated

DOI: 10.1016/j.ssmph.2026.101939

Keywords: health equity, social determinants of health, time poverty, working time, unpaid care work, gender inequality, treatment burden, chronic illness, public health policy, epidemiology, time use surveys, social acceleration

The study, carried out by Ikechukwu Frank Ogbonna of the Department of Pediatrics at the Federal Medical Centre, Umuahia, in Abia State, set out to answer a deceptively simple question: does the effect of worsening asthma severity on a child’s mental health depend on how well the asthma is controlled? Clinical guidelines, including those of the Global Initiative for Asthma, treat severity and control as related but distinct dimensions of the disease. Severity reflects the intrinsic intensity of the condition, while control describes how well symptoms and exacerbations are managed over time. The researchers hypothesized that these two dimensions might interact, jointly amplifying psychological risk in ways that neither alone could fully explain.

To test that hypothesis, the team conducted a cross-sectional analytical survey involving 101 children with asthma aged between 6 and 17 years, recruited from the hospital’s pediatric asthma clinic, alongside 101 age- and sex-matched controls drawn from the surrounding community. Matching the comparison group by age and sex was a deliberate methodological choice, since both variables are known to influence mental health scores in childhood and could otherwise confound the analysis. Mental health status in both groups was assessed using the Strengths and Difficulties Questionnaire, a widely validated screening instrument that generates a total difficulty score across emotional, conduct, hyperactivity, peer-relationship and prosocial domains.

Among the children with asthma, disease severity was classified using the Asthma Severity Scale, while the degree of symptom control was measured with the Asthma Control Test, a patient-reported instrument that captures daytime symptoms, nighttime awakenings, activity limitation and rescue medication use. The study’s central hypothesis was tested at a significance threshold of P less than 0.05, and the interaction between severity and control was examined using a multivariate logistic regression model, a statistical technique that allows researchers to estimate the independent contribution of each factor while holding the other constant.

The first and most striking result was that children with asthma scored significantly worse on mental health screening than their peers. The median total difficulty score of the asthma group was significantly higher than that of the matched controls, with a P value of 0.001. In practical terms, this means that even before any analysis of severity or control, the children attending the asthma clinic were already carrying a measurably heavier psychological burden than children of the same age and sex without the disease—a pattern consistent with a growing international literature linking chronic childhood illness to emotional and behavioral difficulties.

When the researchers turned to the interaction question, however, the answer was negative. There were no significant interaction effects of asthma severity and control on the mental health of the children with asthma. In the adjusted model, the relationship between mental health problems and asthma severity did not reach statistical significance, yielding an adjusted odds ratio of 8.13 with a 95 percent confidence interval of 0.85 to 101.17 and a P value of 0.10. The very wide confidence interval reflects the limited precision of the estimate in a sample of this size, but the key point is that severity, on its own, could not be shown to independently predict psychological difficulty once other factors were accounted for.

Asthma control told a different story. In the same adjusted model, only asthma control showed a significant effect on mental health: children with poorly controlled asthma had higher odds of developing mental health problems, with an adjusted odds ratio of 4.08, a 95 percent confidence interval of 1.03 to 16.13, and a P value of 0.04. In other words, a child whose asthma was poorly controlled faced roughly four times the odds of screening positive for psychological difficulties compared with a child whose disease was brought under command—regardless of how severe the underlying condition was classified to be.

The authors conclude that there is no interaction effect of asthma severity and control on the mental health of children with asthma, because mental health problems were associated only with poor asthma control, irrespective of severity. This distinction matters clinically. Severity is largely a fixed characteristic of the disease, determined by the intensity of the underlying inflammation and airway physiology, whereas control is the modifiable outcome of treatment adherence, inhaler technique, trigger avoidance and follow-up care. If poor control is the psychological culprit, then improving day-to-day asthma management may offer a direct route to protecting children’s mental health, even for those whose disease is intrinsically mild.

The practical recommendation that flows from the study is the integration of child mental health services into existing asthma management programs. In many low- and middle-income countries, including Nigeria, pediatric asthma clinics focus almost exclusively on respiratory outcomes—symptom scores, peak expiratory flow readings and exacerbation rates—while psychological screening is rarely performed. The findings from Umuahia suggest that this narrow focus may miss a substantial share of the disease burden. A child whose inhaler technique is poor and whose symptoms persist at night is not only at risk of a physical exacerbation; the same child is also at markedly elevated risk of emotional and behavioral problems that can undermine schooling, friendships and family life.

The study also carries lessons for research design. By recruiting matched controls and using validated instruments on both the respiratory and psychological sides, the work demonstrates that rigorous psychosocial measurement is feasible in a tertiary hospital setting in South-Eastern Nigeria, where such data have historically been scarce. The single-author design, funded entirely by the researcher’s personal contribution, underscores both the resourcefulness and the resource constraints of clinical research in the region. The study was approved by the Institutional Review Board and Health Research Ethics Committee of the Federal Medical Centre, Umuahia, in June 2021, with informed consent obtained from caregivers and assent from children aged eight and above, in line with the ethical principles of the Declaration of Helsinki.

For clinicians and policymakers, the message is straightforward but consequential. Screening for mental health problems should become a routine component of pediatric asthma follow-up, and interventions that improve asthma control—better adherence support, patient and caregiver education, and reliable access to controller medications—should be recognized as having potential psychological as well as respiratory benefits. Conversely, the finding that severity alone did not significantly predict mental health outcomes cautions against assuming that only children with severe disease need psychological attention. A child with mild asthma that is badly controlled may be more psychologically vulnerable than a child with severe asthma that is well managed. As childhood asthma continues to affect millions of families across Africa and beyond, studies like this one help redirect attention from what a disease is to how well it is lived with—and that shift, the evidence now suggests, could shape not only children’s lungs but their minds.

Subject of Research: The interaction of asthma severity and control on the mental health of children with asthma in South-Eastern Nigeria.

Article Title: Interaction effects of asthma severity and control on the mental health of children with asthma: findings from a South-Eastern Nigeria Tertiary Hospital

Article References: Ogbonna, I. F. (2026). Interaction effects of asthma severity and control on the mental health of children with asthma: findings from a South-Eastern Nigeria Tertiary Hospital. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07670-0

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07670-0

Keywords: asthma, asthma control, asthma severity, mental health, children, pediatrics, Nigeria, Strengths and Difficulties Questionnaire, Asthma Control Test, child health, chronic illness, BMC Pediatrics