Editing selfies, eroding satisfaction: Random-intercept cross-lagged panel analyses of bidirectional links between photo-editing behaviors and body satisfaction in women.

Impact of Different Surveillance Intervals on Recurrence and Progression in Intermediate-Risk Non-Muscle-Invasive Bladder Cancer.

In China, information on individuals who test positive for islet autoantibodies (IAb), including single IAb-positive individuals and those with early-stage Type 1 diabetes (T1D), and their risk of progression to Stage 3 T1D is limited. The goal of this study is to assess the risk of progression to T1D in first-degree relatives (FDRs) of people with T1D in China. This prospective, longitudinal study, being conducted at approximately 50 hospitals in China, will screen FDRs of individuals with T1D to identify those at risk for developing the disease by testing for the presence of IAb in the blood. IAb-positive individuals will undergo further testing for up to 5 years, with the primary objective of assessing their risk of Stage 3 T1D onset. During the monitoring period, participants with single IAb-positivity will be tested for glycated haemoglobin (HbA1c) and IAb every year; those with multiple IAb-positivity will have an HbA1c and oral glucose tolerance test (OGTT) every year (Stage 1 T1D), or OGTT or random blood glucose test in alternate 6-monthly intervals and HbA1c every 3 months (Stage 2 T1D). Participants who develop Stage 3 T1D during monitoring can undergo extended follow-up to assess changes in β-cell function, glycaemic outcomes and IAb status during the first 12 months after diagnosis. The study plans to enrol 5500 participants; enrolment is ongoing. Through early screening and monitoring of disease progression in FDRs of T1D probands, this study will provide a comprehensive understanding of T1D progression in the Chinese population. Chinese Clinical Trial Registry identifier: ChiCTR2600119032.

Dynamics and variant-specific patterns of SARS-CoV-2 reinfection in Ethiopia: a prospective longitudinal cohort study.

Dental caries in the primary dentition remains a major concern, with Class II cavities in molars posing particular restorative challenges. BEAUTIFIL Flow Plus X, a giomer-based injectable composite, offers esthetic and mechanical benefits with fluoride release and easier placement in children, while EQUIA® Forte Fil HT, a glass hybrid restorative, provides enhanced strength for stress-bearing areas. Clinical evidence in primary teeth is still limited, and this study aimed to compare their performance in Class II restorations of primary molars to support material selection in pediatric dentistry. A total of 124 primary molars with Class II cavities were randomized with a 1:1 allocation ratio into two groups: Group I received (EQUIA FORTE HT Fil), while Group II received (BEAUTIFIL Flow Plus X F00). Restorations were placed according to manufacturer's instructions and evaluated for their esthetic, functional, and biological properties using FDI criteria at 3-, 6-, and 12-month intervals. Restorations with total scores of 4 (repair) or 5 (replacement) were recorded as failures. The trial was approved by the Institutional Research Ethical Committee, Faculty of Dentistry, Ain Shams University. Statistical analyses included the Mann-Whitney U test for intergroup and Wilcoxon signed-rank test for intragroup comparisons. The significance level was set at p ≤ 0.05. At 12 months, the clinical success rates were 88.3% for Equia Forte HT Fil and 93.4% for BEAUTIFIL Flow Plus X, with no statistically significant difference (p > 0.05). BEAUTIFIL Flow Plus X demonstrated superior esthetic outcomes, with statistically significant advantages in surface luster (p = 0.002) and color match (p < 0.001). Key functional FDI criteria, including fracture and retention as well as marginal adaptation, were comparable between groups, with no statistically significant differences. Biologically, both materials performed comparably with no significant differences and no observed recurrent caries or postoperative sensitivity in either group. Both restorative approaches demonstrated acceptable clinical performance in class II cavities of primary molars after 12 months. While functional and biological outcomes were comparable, BEAUTIFIL Flow Plus X provided superior esthetics. This RCT was registered at Clinical Trial.gov with registration number (NCT06000085) on the date of 11/8/2023.

Venous thromboembolism (VTE) is a leading cause of preventable death among patients undergoing systemic treatment for cancer. Studies suggest that treatment strategies such as direct oral anticoagulant administration can significantly reduce the likelihood of VTE. Therefore, identifying people at high risk is of critical importance. Leveraging electronic health records (EHRs) from the U.S. Veterans Affairs (VA) healthcare system, we developed a transformer model to predict VTE risk in 80,808 cancer patients following the initiation of systemic treatment. The model uses longitudinal diagnostic codes, laboratory values, and demographic data. The proposed transformer model dynamically predicts VTE risk in 3-month quarterly intervals over the year following systemic treatment, achieving progressively improved performance across quarters (AUC: 0.68-0.77). The model is similarly performant on the external validation cohort from the Harris Health System (HHS) with 9752 patients (AUC: 0.68-0.74). By improving its predictions as a patient's history evolves, this dynamic model surpasses prior static risk scores and better supports actionable decisions deeper into the treatment course.

Out-of-pocket (OOP) costs and healthcare utilization remain unknown for women facing breast conservation and mastectomy. Women aged 18-64 who underwent upfront breast cancer surgery were identified from the IBM MarketScan Commercial Claims Database (2014-2017). Surgical groups included lumpectomy+radiation; unilateral mastectomy + /-reconstruction, and bilateral mastectomy + /-reconstruction. Cumulative OOP payments were assessed at 12-month intervals over 4 years postoperatively and adjusted to 2017 USD$. Multivariable regression identified factors associated with increased OOP costs. Overall, 23,159 underwent lumpectomy with radiation (60%), unilateral mastectomy with (15%) and without (6%) reconstruction, and bilateral mastectomy with (17%) and without (2.6%) reconstruction. Women undergoing bilateral mastectomy+reconstruction were younger than other surgical groups (median age 49 vs. 50-55). In the first year after diagnosis, 1.24 million outpatient visits occurred, 27% of enrollees had inpatient admissions, 23% visited an E.R., and median OOP costs were $5669 (range $0 to $132 125). Cumulative costs were significantly higher in women < 45 yo and for those with greater comorbidities. Median OOP costs declined over time (0-12 months: $3661 vs 48 months: $486). OOP costs were 12% higher (8.9%-15.1%) with mastectomy+reconstruction than lumpectomy+radiation ($6529 vs $5333). Out-of-pocket costs and healthcare utilization differ between equally effective surgical treatment options; mastectomy + reconstruction is costlier for patients than breast conservation.

The longitudinal relationship between perceived co-parenting and problematic smartphone use among Chinese rural adolescents: A cross-lagged panel network analysis.

The bidirectional relationship between cumulative risk and psychological pain in Chinese early adolescents: The mediating role of future expectations.

This study aimed to compare different treatment strategies for rheumatoid arthritis (RA) patients following inadequate response to initial methotrexate (MTX) therapy, evaluating clinical outcomes, tolerability profiles, and factors influencing treatment decisions in real-world clinical practice. We retrospectively analysed 239 MTX non-responders from health records. Patients were grouped based on subsequent treatment: direct switch to biologic/targeted synthetic DMARDs (b/tsDMARDs) (n=45) or MTX dose escalation (n=194). Those failing dose escalation were further stratified into leflunomide (LEF) (n=37) or b/tsDMARD (n=57) groups. Treatment efficacy was assessed using modified EULAR Boolean criteria (3V-remission) at 6-month intervals. While direct b/tsDMARD initiation achieved higher 3V-remission rates than MTX dose escalation (62.2% vs. 35.0%, p<0.001), MTX dose optimisation still enabled remission in over one-third of patients. Similarly, among MTX dose escalation non-responders, LEF therapy achieved 3V-remission in 43.2% of patients, comparable to b/tsDMARDs (50.9%, p=0.469), despite higher discontinuation rates (21.6% vs. 1.8%). Importantly, sequential csDMARD optimisation did not compromise subsequent b/tsDMARD responsiveness, with similar remission rates regardless of prior treatment exposure (62.2% after initial MTX, 50.9% post-dose escalation, 46.1% post-LEF, p=0.417). While b/tsDMARDs demonstrated superior efficacy and tolerability, approximately one-third of patients achieved remission through MTX dose optimisation, possibly reflecting suboptimal initial dosing. Importantly, prior csDMARD optimisation did not compromise subsequent b/tsDMARD responsiveness. These findings underscore the importance of appropriate initial MTX dosing, while indicating that csDMARD optimisation before b/tsDMARD initiation should be considered, given the predominantly mild nature of observed adverse events.

Despite evidence that enhanced recovery protocols (ERPs) improve outcomes in adults undergoing surgery, adoption for pediatric populations has lagged. To assess the implementation and clinical effectiveness of a consensus-based ERP for pediatric patients undergoing elective gastrointestinal (GI) surgery. A prospective type 2 hybrid implementation-effectiveness, stepped-wedge, cluster-randomized by entry date into implementation phase, trial of pediatrics patients, 10 to 18 years of age, undergoing elective GI surgery at 18 US sites from September 2019 to June 2024. Sites were randomized into 3 groups, each spending at least 9 months in a control phase, with usual care, followed by an implementation phase at 6-month intervals that included a 21-element ERP supported by a structured Implementation Toolkit, based on 5 Active Implementation Frameworks (5AIFs), and a sustainment phase (12-24 months). Implementation was facilitated by a 1-year, group-based Learning Collaborative curriculum, a repository of tools, ERP adherence feedback, and implementation report cards. Site-level scores were created based on 5AIFs domains. ERP adherence was assessed by ERP elements delivered at patient and site level. The primary effectiveness outcome, postoperative length of stay (LOS), and secondary effectiveness outcomes (including opioid use, time to regular diet, complications, readmission, and patient-reported health-related quality of life [HRQOL]) were evaluated across study phases (baseline, implementation, and sustainability). Correlations between site-level implementation scores and fidelity were estimated. Of the 597 enrolled pediatric patients (median [IQR] age, 15 [13-17] years; 274 [45.9%] female; 323 [54.1%] male), 433 (72.5%) had inflammatory bowel disease. No significant differences were found by study phase in LOS or secondary outcomes, except shorter time to regular diet and decreased opioid use during hospitalization. Patients who received at least 13 ERP elements had shorter median LOS (-1.14 days [95% CI -2.01 to -0.27]) and fewer complications (adjusted odds ratio, 0.48 [95% CI, 0.28-0.82]). Patient-level adherence increased by study phase (number of ERPs: 11 [10-13], 14 [12-15], and 14 [13-15], [P < .001]). ERP integration into order sets and site culture were moderately correlated with fidelity. This stepped-wedge cluster-randomized trial found that despite multifaceted implementation strategies, a pediatric GI surgery ERP did not significantly reduce LOS. However, when accounting for implementation fidelity at the patient level, it resulted in significantly lower LOS and complications. ClinicalTrials.gov Identifier: NCT04060303.

Rotator cuff arthropathy is characterized by pain and pseudoparalysis, for which reverse shoulder arthroplasty (RSA) is an established treatment. Appropriate deltoid tensioning is critical to functional outcomes, yet objective radiographic surrogate measures of tensioning remain limited. This study aimed to evaluate the association between acromion to greater tuberosity distance (AGTD) as a surrogate for deltoid tension and postoperative motion, functional outcomes, and pain following RSA. We conducted an observational retrospective case series, examining 61 patients who underwent RSA. Patients were evaluated using Constant-Murley shoulder score, visual analog scale pain score, Oxford shoulder score, and the University of California, Los Angeles shoulder score. Postoperative assessments were performed at 6-month and 1-year intervals. The AGTD was measured by two independent observers based on postoperative plain radiographs. Mean patient age was 69.9±8.3 years. At 1 year postoperative, significant improvements were observed in forward flexion, abduction, pain, and all functional outcome scores (all P<0.001). Spline modeling demonstrated a non-linear association between AGTD and outcomes, with superior function and lower pain observed within an intermediate AGTD range centered near 45 mm. Both shorter and longer distances were associated with less favorable results. In our study, an intermediate AGTD centered near 45 mm was associated with more favorable functional outcomes, whereas shorter or longer distances demonstrated poorer results. Our findings provide further confirmation that RSA is a dependable treatment option for rotator cuff arthropathy. IV.

To compare a partially demineralized allogeneic cancellous bone plug (ACBP) with deproteinized bovine bone mineral (DBBM) for guided bone regeneration (GBR), focusing on CBCT-based dimensional outcomes and histomorphometric tissue composition at implant placement. In this prospective randomized controlled clinical trial, 25 adults requiring GBR for two common indications-posterior maxillary sinus floor elevation or mandibular posterior extraction socket preservation-were randomized to ACBP (n = 12) or DBBM (n = 13), with collagen membrane coverage in both groups. Radiographic endpoints were indication-specific and were reported separately for sinus and socket sites. CBCT was obtained at baseline and 6 months to assess augmented height (sinus sites) and ridge dimensions at standardized levels (socket sites). At 6 months (implant placement), a 3-mm trephine core was harvested for H&E staining and histomorphometric quantification of vital bone (VB, %) and residual graft material (RG, %). Between-group comparisons used independent-samples t tests (two-sided P < 0.05). All participants completed the 6-month follow-up. VB did not differ significantly between ACBP and DBBM (38.84 ± 8.37% vs. 32.18 ± 11.04%, P = 0.105), whereas RG was significantly lower with ACBP (11.18 ± 5.48% vs. 19.80 ± 8.23%, P = 0.006). CBCT outcomes were comparable between groups, with no significant differences in sinus height gain (7.82 ± 1.52mm vs. 8.21 ± 4.30mm, P = 0.852) or socket-related ridge dimensional changes (all P > 0.05). Within a 6-month healing interval, ACBP showed CBCT-based dimensional outcomes comparable to DBBM and a lower residual graft fraction with a similar vital bone fraction at implant placement, suggesting that the observed difference was more related to graft turnover than to greater bone formation. At routine implant timing (~ 6 months), use of ACBP was associated with a lower residual graft fraction at re-entry while maintaining short-term CBCT-based dimensional stability.

BackgroundDuring the early stages of the COVID-19 pandemic, prediction modelling was widely used to forecast infection rates while only few studies developed models to predict individual risk of infection for Omicron and subsequent variants. For such prediction models to perform well, it is important to carefully select predictors from a comprehensive set of potential factors, including prior infection and vaccination history, individual behaviors, and immunological markers.MethodsThis exploratory analysis aimed to develop and compare prediction models for Omicron infection to provide an evidence base for identifying key predictors of SARS-CoV-2 infections which can be used to inform future derivation and validation of predictive models. We used data from 710 participants from two ongoing, prospective population-based cohorts: the Zurich SARS-CoV-2 Cohort and the Zurich SARS-CoV-2 Vaccine Cohort (Switzerland). Participants were recruited between 2020 and 2021 and provided demographic data, vaccination history, self-reported infections, and longitudinal serological data (anti-S IgG, anti-S IgA, anti-N IgG antibodies) collected at 6-month intervals. Our main outcome was SARS-CoV-2 infection during the first Omicron wave (01.01.2022–31.03.2022) based on self-reported positive tests or a doubling in any of anti-S IgG, anti-S IgA or anti-N IgG. We used logistic regression models with backward stepwise selection based on the Akaike Information Criterion (AIC) to evaluate predictors and identify the best-fitting models.ResultsOnly 17.3% of participants reported a positive SARS-CoV-2 test result during the Omicron wave. However, when including serological testing, 37.2% of participants had evidence of infection, indicating substantial underdiagnosis. The best-performing model had an AUC of 0.69 (95%CI 0.66, 0.73) and included the following predictors: age, sex, compliance with COVID-19 prevention guidelines, smoking status, comorbidities, prior anti-N IgG antibody levels, and the sequence of previous infections and vaccinations. We found that older age (≥ 65 years) was associated with a 50–60% lower odds of Omicron infection across all our models, while having fewer prior exposures (through infections or vaccinations) increased the odds of infection.ConclusionThis explorative study highlights the importance of integrating comprehensive immunological, clinical and behavioral data to predict SARS-CoV-2 infection risk. Our study lays the foundation to develop and validate future prediction models that identify individuals at risk, particularly through the novel use of infection and prior vaccination sequence as an important predictor.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41512-026-00231-0.

A meaningless life, a meaningful phone: longitudinal associations among meaning in life, problematic mobile phone use, and metacognitions in adolescents.

In the internet era, eHealth literacy has become a recognized predictor of self-management in people with diabetes. Self-efficacy as a mediator of the relationship between eHealth literacy and self-management has been explored in cross-sectional studies only, which ignores its temporal sequence. Longitudinal studies on this mediated relationship in individuals with chronic diseases have not been previously conducted. The purpose of this study was to explore the longitudinal relationship between eHealth literacy and self-management via self-efficacy in patients with type 2 diabetes. A prospective longitudinal survey was conducted using an autoregressive cross-lagged model. Measurements were made at three time points separated by 3-month intervals in 390 adults with type 2 diabetes at an outpatient clinic in a university hospital from May 2022 to January 2024 using a questionnaire consisting of several scales (i.e., the Condition-Specific eHealth Literacy Scale, Diabetes Management Self-Efficacy Scale, and Diabetes Self-Management Scale). The data were analyzed using structural equation modeling. The autoregressive paths of all study variables were found to be significant across all time points, with eHealth literacy, self-efficacy, and self-management scores at each time point influencing their respective values at the subsequent time point ( β = .95-.62, p < .001). Also, all of the cross-lagged paths were found to be significant across the investigated time points ( β = .07-.21, p < .001). At the first time point, eHealth literacy was found to have a significant indirect effect on self-management at the third time point via self-efficacy at the second time point (bootstrap estimate B = 0.010, 95% confidence interval = [0.001, 0.028]). The results support that the longitudinal relationship between eHealth literacy and self-management is completely mediated by self-efficacy in people with type 2 diabetes. Health professionals should enhance the eHealth literacy of patients to boost their self-efficacy, making them better able to perform the regular tasks and behaviors required for diabetes self-management.

Given substantial reporting delays in overdose deaths, state health departments increasingly use nonfatal overdose data to inform geographically targeted rapid overdose response efforts. We evaluated the extent to which nonfatal overdose events were associated with concurrent and future overdose deaths in Rhode Island. We aggregated nonfatal overdose data from emergency medical services records (2019-2023) and fatal overdose data from the State Unintentional Drug Overdose Reporting System (2020-2023) in 1-, 3-, and 6-month intervals at census block group and census tract levels. Rates of fatal overdose were estimated, relative to nonfatal overdose lagged by 0-12months, using negative binomial regression, and relative to monthly spikes in nonfatal overdose burden, using zero-inflated Poisson regression. Estimation was implemented using integrated nested Laplace approximation. Each additional nonfatal overdose event per census block group was associated with fatal overdose rates that were 48% higher (95% credible interval, 1.37-1.59) than expected in concurrent months, with smaller associations at the census tract level, in wider time intervals, and when nonfatal overdose data were lagged. Spikes in nonfatal overdose activity were associated with elevated overdose mortality in concurrent periods with fine temporal and geographic granularity, but not in longer time frames and larger geographic areas.

The aim of this study was to elucidate the risk of developing voice disorders among peri- and post-menopausal female hormone replacement therapy (HRT) users. A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Females aged 40-60 years old were included and stratified into two cohorts: HRT users (n = 16,586) and HRT non-users (n = 248,725) while excluding for head and neck radiation/neoplasms, smoking, benign laryngeal lesions, thyroid disorders, gender dysphoria, and any other systemic hormone use. Voice and resonance disorders (VRD) and dysphonia were separately assessed at 3-month intervals post-HRT initiation after propensity score-matching for age, sex, race, and ethnicity. Odds ratios (ORs) with 95% confidence intervals (CIs) and risk differences (RD) were generated to compare outcomes. HRT users had significantly higher odds of dysphonia, but not VRD, within 0-9 months (OR 1.72; 95% CI (1.01-2.95), OR 1.66; 95% CI (0.99-2.79), respectively). For HRT users with elevated BMI, the 1-year VRD incidence was not significantly different than non-HRT users (RD 0.19%, p = 0.069). Overall, the incidence of VRD and dysphonia within 1 year in both groups was < 0.5% and showed no significant difference at most times between groups. HRT may not have any significant clinical impact on the peri- and post-menopausal voice. Although higher odds were noted earlier after treatment, HRT users did not have higher odds of voice issues after 1 year. This study highlights the lack of consensus in literature and urges future research to fully understand the impact of HRT on peri- and post-menopausal voice.

Infections in Patients Receiving Daratumumab for Newly Diagnosed Multiple Myeloma: A Pooled Analysis of MAIA and ALCYONE.

Advances in digital orthodontics and artificial intelligence (AI) planning have the potential to enhance treatment precision, but randomized evidence based on the Peer Assessment Rating (PAR) index remains limited. In this single-center, parallel-group randomized controlled trial registered retrospectively in the Chinese Clinical Trial Registry (ChiCTR2500108499), 140 patients aged 12-35 years with Angle Class I malocclusion were randomized to receive an AI-assisted digital workflow (Digital and AI group) or conventional fixed appliances (Conventional group). PAR scores were assessed at baseline (T0), 6-month intervals (T1), and immediately after treatment completion (T2) by calibrated, blinded examiners following British Standards Institute criteria. Analyses followed the intention-to-treat principle, applying independent t-tests, χ²/Fisher's exact tests, repeated-measures mixed-effects models, and multivariable linear regression. Effect sizes were expressed as mean difference (MD) or relative risk (RR) with 95% confidence intervals (CI). Baseline PAR scores did not differ significantly between groups (MD = 0.63, 95% CI: -0.13 to 1.40; p = 0.105). At T2, the Digital and AI group had lower mean PAR scores (4.88 ± 0.45) than the Conventional group (7.81 ± 0.70; MD = 2.93, 95% CI: 2.73-3.13; p < 0.001). A higher proportion of patients in the Digital and AI group achieved ≥70% PAR reduction (82.9% vs 50.0%; RR = 1.66, 95% CI: 1.27-2.17; p < 0.001). Repeated-measures mixed-effects analysis showed significant effects of intervention, time, and their interaction (all p < 0.001), indicating different improvement trajectories between groups. Multivariable regression identified allocation to the Digital and AI group, higher baseline PAR, and younger age as independent predictors of greater PAR reduction. No severe adverse events occurred, and no participants were lost to follow-up between T0 and T2. Under controlled trial conditions, the AI-assisted digital workflow produced greater short-term improvements in PAR-based occlusal outcomes than conventional fixed appliances. These findings suggest a potential benefit of integrating an AI-assisted digital system into orthodontic practice; however, conclusions are limited to short-term occlusal changes, and further multicenter studies with longer follow-up, patient-reported outcomes, and economic evaluation are warranted.