Adult Group Research Articles

Adapting the Tree of Life group for adults with intellectual disabilities: a feasibility and acceptability study

Adapting the Tree of Life group for adults with intellectual disabilities: a feasibility and acceptability study

Comparison Between Ecological Momentary Assessment and Self-Report of Awake Bruxism Behaviours in a Group of Healthy Young Adults.

The aim of this investigation was to compare the self-reported frequency of awake bruxism (AB) behaviours by means of a validated single-observation point questionnaire (i.e., Oral Behaviour Checklist [OBC]) with the frequency reported in real-time with an Ecological Momentary Assessment (EMA) over 1 week. One hundred healthy young adults took part in the study. The frequency of some activities belonging to the spectrum of AB behaviours (i.e., teeth contact, mandible bracing, teeth clenching, teeth grinding) was evaluated using the EMA approach with smartphone technology support over 1 week. The OBC questionnaire was used to evaluate the self-reported frequency of the same AB behaviours. Spearman's rank correlation coefficient was adopted to test the correlation between the average score of each OBC question considered (i.e., teeth contact, mandible bracing, teeth clenching, teeth grinding) and the average frequency of the corresponding EMA item. Statistical analysis showed a weak-to-moderate level of correlation between the two different AB assessment methods. Mandible bracing showed the highest level of correlation, while teeth grinding had the lowest one. While the OBC represents a valid and easy-to-administer screening tool for evaluating bruxism behaviours, the EMA approach provides a more detailed real-time report on AB behaviours.

Learning to ‘sit in the fire’: Staying with the discomfort of transformative learning

In view of the deep social and ecological crises of our time, many scholars are calling for forms of learning and change that are predicated on establishing qualitatively different relationships between human beings, and between humans and the rest of the living world, as well as on a deeper awareness of systemic social justice issues. This is notably advocated within the field of Transformative Learning. This article investigates how such forms of transformation may happen, and what factors may enable them, in the under-researched context of small and self-directed adult inquiry groups. Through the case study of a social learning evaluation conducted within one such group, enabling factors for transformative learning and the fostering of critical social consciousness are examined. The role of particular individuals within the group – ‘key enablers’ of transformative learning – is highlighted as an important social learning element in this regard, which may be particularly helpful in situations of discomfort within self-directed groups.

The association of multidimensional frailty with metabolic syndrome and low-grade inflammation in community-dwelling older adults in the Netherlands: a Lifelines cohort study.

Preventing metabolic syndrome (MetS) and frailty in older adults is crucial for healthy aging. The association between MetS and physical frailty is well-documented, with low-grade inflammation as potential explanation. However, the association between MetS and frailty as a multidimensional concept, and the association of low-grade inflammation with presence of MetS and frailty, is yet unclear. Therefore, we examined these associations low-grade inflammation in a large cohort of community-dwelling older adults. This cross-sectional study was performed among adults aged ≥ 65 years enrolled in the Dutch Lifelines population cohort. MetS was defined according to the Joint Interim Statement of 2009. Frailty was measured by the Groningen Frailty Indicator (GFI), which consists of 15 self-reported items on both physical and psychosocial functioning, with a score ≥ 4 indicating presence of frailty. The association between MetS and its five components and frailty was assessed using logistic regression models. Low-grade inflammation was represented by high-sensitivity C-reactive protein (hsCRP) level. The association of hsCRP level with presence of MetS and frailty was assessed using multinomial logistic regression in a sub-cohort with available hsCRP measurements. Of 11,552 adults (52.1% women) included, the prevalences of MetS and frailty were 28% and 15%, respectively. MetS was positively associated with frailty after adjusting for relevant covariates (OR: 1.37; 95% CI: 1.22-1.53). MetS components elevated blood pressure was most strongly associated with frailty. In the sub-cohort of 3896 participants, high hsCRP was associated with presence of MetS and frailty (OR: 1.31; 95% CI: 1.15-1.51), and MetS alone (OR: 1.44; 95% CI: 1.33-1.56), but not to frailty alone. A higher hsCRP level was associated with a higher score on the physical domain of frailty (b: 0.06; 95% CI: 0.03-0.08). Presence of MetS is associated with presence of frailty indicated by a multidimensional index in a large group of Dutch older adults. Low-grade inflammation, indicated by plasma hsCRP level, was found to be associated with both presence of MetS and frailty and presence of MetS alone. Increased hsCRP levels were associated with the physical component of frailty, but not with frailty as a multidimensional concept.

The Effects of Virtual Reality-Based Reminiscence Therapies for Older Adults With Cognitive Impairment: Systematic Review.

Reminiscence therapy (RT) is a commonly used nonpharmaceutical treatment for cognitive impairment. Artifacts or conversations are used in RT to recall individuals' memories and past experiences. Virtual reality (VR) has increasingly been used as an assistive technology during RT. However, the effects of VR-based RT (VR-RT) methods remain unclear, and insights into the related benefits and challenges are urgently needed. The study aims to systematically review the effects of VR-RTs for older adults with cognitive impairment. Seven databases (MEDLINE, Academic Search Premier, CINAHL, Web of Science, PubMed, the Cochrane Central Register of Controlled Trials, and ScienceDirect) were searched to identify relevant articles published from inception to August 10, 2023. Peer-reviewed publications that assessed the effect of VR-RTs (ie, using virtual clues to evoke participants' memories or past experiences) on cognitive-related outcomes were included. Two independent researchers conducted the literature search, review, and data extraction processes. A narrative synthesis approach was used to analyze the extracted data. Of the 537 identified articles, 22 were ultimately included in the data analysis. The results revealed that VR-RTs could maintain cognitive status (4/4, 100%) and reduce anxiety (2/2, 100%) in older adults with cognitive impairment. Nevertheless, one study found a cognitive improvement after VR-RTs, whereas cognitive degradation was observed at a 3- to 6-month follow-up measure. Around 88% (7/8) of the included studies indicated that VR-RTs improved memory; however, the evidence regarding the beneficial effects of VR-RTs was limited in improving quality of life (1/4, 25%) and reducing apathy (0/2, 0%) and depression (1/3, 33%). The results indicated that VR-RTs are safe, engaging, acceptable, and satisfying for older adults with cognitive impairment. In VR scenarios, personalized stimulus materials related to the users' youth experiences were more effective for treating cognitive impairment than other stimulus materials. The results of this systematic review demonstrate the potential benefits of VR-RT for older adults with cognitive impairment, especially in improving emotion and memory and maintaining cognitive status. VR-RT is also safe and enjoyable for older adults. However, due to the trial heterogeneity of included studies, we can only provide qualitative results instead of performing meta-analysis to quantify the effect size of VR-RTs. Thus, more randomized controlled trials are required to examine the designs and effects of VR-RTs for groups of older adults with specific needs.

Comparison of inflammatory mediator cytokine responses to inactivated virus platform COVID-19 vaccines between elderly and young adult populations

The coronavirus disease 2019 (COVID-19) pandemic has encouraged global vaccine research, yet vaccine effectiveness in the elderly remains a concern due to immunosenescence. The aim of this study was to compare the cytokine response elicited by an inactivated virus-based COVID-19 vaccine between elderly and young adults, focusing on key cytokines involved in cellular and humoral immunity: tumor necrosis factor-alpha (TNF-α), interleukin (IL)-2, IL-6, IL-10, and interferon-gamma (IFN-γ). A cross-sectional study was conducted in the Jakarta-Bogor region of Indonesia from January 2023 to December 2023. The study population was divided into two age cohorts: elderly (60−85 years) and younger adults (30−40 years). Blood samples were collected twice, after the first booster dose and four weeks after the second booster dose. Serum cytokine concentrations were measured using Luminex assays with microparticles conjugated to monoclonal antibodies against TNF-α, IL-2, IL-6, IL-10, and IFN-γ. Comparisons of the cytokine levels were conducted using Student’s t-tests or Mann-Whitney U tests as appropriate. A total of 74 individuals were included, with 37 each in the elderly and young adult groups. The results showed significant differences in cytokine responses between the two age groups. After the first booster, the levels of IL-6 and IFN-γ were significantly higher in young adults compared to the elderly. After the second booster, the levels of IL-6 were still significantly higher in the young adult group compared to the elderly group (p=0.001). Data indicated that after the second booster dose, the levels of TNF-α increased significantly in the young adult group only (p=0.004), while the levels of IL-2 (p=0.040) and IFN-γ (p=0.006) increased in the elderly group only compared to after the first dose. IL-10 levels increased in both groups (both had p=0.020). This study highlights that young adults had stronger pro-inflammatory responses, while the elderly relied more on IL-2 and IFN-γ for T-cell immunity, suggesting the need for vaccination strategies for the elderly to optimize immune responses.

Explaining deep learning models for age-related gait classification based on acceleration time series

BackgroundGait analysis holds significant importance in monitoring daily health, particularly among older adults. Advancements in sensor technology enable the capture of movement in real-life environments and generate big data. Machine learning, notably deep learning (DL), shows promise to use these big data in gait analysis. However, the inherent black-box nature of these models poses challenges for their clinical application. This study aims to enhance transparency in DL-based gait classification for aged-related gait patterns using Explainable Artificial Intelligence, such as SHapley Additive exPlanations (SHAP). MethodsIn this cross-sectional study, a total of 244 participants, comprising 129 adults and 115 older adults (age>65), were included. They performed a 3-min walking task while accelerometers were affixed to the lumbar segment L3. DL models, convolutional neural network (CNN) and gated recurrent unit (GRU), were trained using 1-stride and 8-stride accelerations, respectively, to classify adult and older adult groups. SHAP was employed to explain the models' predictions. ResultsCNN achieved a satisfactory performance with an accuracy of 81.4 % and an AUC of 0.89, and GRU demonstrated promising results with an accuracy of 84.5 % and an AUC of 0.94. SHAP analysis revealed that both CNN and GRU assigned higher SHAP values to the data from vertical and walking directions, particularly emphasizing data around heel contact, spanning from the terminal swing to loading response phases. Furthermore, SHAP values indicated that GRU did not treat every stride equally. ConclusionCNN accurately distinguished between adults and older adults based on the characteristics of a single stride's data. GRU achieved accurate classification by considering the relationships and subtle differences between strides. In both models, data around heel contact emerged as most critical, suggesting differences in acceleration and deceleration patterns during walking between different age groups.

Detailed statistical analysis plan for a guided self-determination intervention versus an attention control for outpatients with type 2 diabetes in the randomised OVERCOME trial

BackgroundAutonomy-supporting interventions may be a prerequisite to achieve better long-term management of type 2 diabetes. Evidence suggests that the guided self-determination (GSD) method might improve haemoglobin A1c and diabetes distress in people with type 1 diabetes. The evidence of an effect of a GSD intervention compared with an attention control group in adults with type 2 diabetes is unknown.Methods/designThe trial is designed as a pragmatic, investigator-initiated, dual-centre, randomised, parallel-group, assessor-blinded, superiority clinical trial of persons with type 2 diabetes. A nurse will administer GSD intervention versus an attention control. The primary outcome is diabetes distress, and secondary outcomes are quality of life, depressive symptoms, and non-serious adverse events. Exploratory outcomes are haemoglobin A1c, motivation, and serious adverse events. Participants are assessed at baseline, 5-, and 12-month follow-up. Here, we present a detailed, comprehensive plan of all statistical analyses, including methods to handle missing data, and assessments of the underlying statistical assumptions. The statistical analyses will be conducted independently by two statisticians following the present plan.DiscussionTo mitigate the risk of analysis bias and increase the validity of the OVEROME trial, this statistical analysis plan was developed prior to unblinding of the trial results in concordance with the Declaration of Helsinki and the Conference on Harmonization of Good Clinical Practice Guidelines.Trial registrationClinicalTrials.gov NCT 04601311. Registered on October 2020.

A Personalized Data Dashboard to Improve Compliance with Ecological Momentary Assessments in College Students: Protocol for a Microrandomized Trial.

Ecological momentary assessments (EMA) are ideal for capturing the dynamic nature of young adult substance use behavior in daily life and identifying contextual risk factors that signal higher-risk episodes. These methods could provide a signal to trigger real-time intervention delivery. Study compliance and engagement are common barriers to participation but may be improved by personalizing messages. This study compares compliance outcomes between one group of young adults receiving standard (generic) prompts at each assessment and another group that received additional personalization and an updated data dashboard (DD) showing study progress to date at 1 randomly selected prompt per day. The primary objectives are to (1) develop a real-time DD for giving participants personalized updates on their progress in the study and (2) examine its preliminary overall effects on study compliance and experiences. Secondary objectives are to identify person-, day-, and moment-level characteristics associated with study compliance and person-level characteristics associated with perceived usefulness of the DD. This is a protocol for Project ENGAGE, a 2-arm randomized controlled trial. Arm 1 (EMA group) is engaged in a standard EMA protocol, and arm 2 (EMA+DD group) is engaged in the same study but with additional personalization and feedback. Inclusion criteria are (1) previous participation in a recent college student survey about health behavior and mental health who indicated willingness to participate in future research studies and (2) indicated past-month alcohol use; lifetime marijuana, hashish, or Delta-8-tetrahydrocannabinol (THC) use; or some combination of these on that survey. All participants in this study completed a baseline survey; EMA at 11 AM, 2 PM, 5 PM, and 8 PM each day for 21 days; and an exit survey. Participants in arm 2 engaged in a microrandomized trial, receiving a personalized DD at 1 randomly selected prompt per day. Primary outcomes include whether a survey was completed, time to complete a survey, and subjective experiences in the study. Primary analyses will compare groups on overall study compliance and, for arm 2, use marginal models to assess the momentary effect of receiving 1 updated DD per day. Approval was granted by the university's institutional review board on February 8, 2023. Recruitment via direct email occurred on March 30 and April 6, 2023; data collection was completed by April 29, 2023. A total of 91 individuals participated in the study. Results have been accepted for publication in JMIR Formative Research. Results from the evaluation of this study will indicate whether providing (at randomly selected prompts) real-time, personalized feedback on a participant's progress in an EMA study improves study compliance. Overall, this study will inform whether a simple, automated DD presenting study compliance and incentives earned to date may improve young adults' compliance and engagement in intensive longitudinal studies. DERR1-10.2196/57664.

Ambiguous pronoun resolution in Greek-speaking preschool children

ABSTRACT Research on the resolution of ambiguous null and overt subject pronouns in child speakers of null subject languages has found that school-aged children do not exhibit robust preference for either subject or object referents, further suggesting that the operations underlying anaphora processing are still in development and have not yet attained adult-like status even at age 11. In addition to school-aged children, sensitivity to the properties of null and overt subject pronouns in early childhood remains to a large extent underexplored. The current study has investigated ambiguous null and overt pronoun resolution preferences in a group of 38 Greek-speaking children aged 4;0 to 5;9 and a group of monolingual adults. The study used a picture verification task that examined participants’ preferences for subject, object, and extra-sentential referents of null and overt pronouns. The children’s lexical abilities were also assessed through an expressive vocabulary task. According to the results, children did not show a strong preference for either subject or object referents, which were preferred at equally low rates across both null and overt pronoun trials. However, there was strong preference for the extra-sentential referent that seemed to be attenuated with increase in the children’s chronological age and vocabulary skills. The current study contributes to the discussion regarding the instability in children’s pronoun processing system and the way it is affected by maturation and language ability. Our findings show that sensitivity to the discourse constraints regulating the comprehension of null and overt subject pronouns has not yet been attained in preschool-aged children.

A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study.

Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. The result of this study is a modular intervention web application named RØST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users' motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design.

Nicotine-Containing Electronic Nicotine Delivery Systems (ENDS) Use in the United States, Stratified by Age, National Survey on Drug Use and Health, 2021

Background: Electronic nicotine delivery system (ENDS) use is prevalent in the United States, especially among youth and young adults. It is important to monitor current ENDS use and identify at-risk groups, particularly among tobacco naïve individuals. Methods: Using data from the 2021 National Survey on Drug Use and Health, we examined the prevalence of past 30-day nicotine/tobacco ENDS use and correlates, stratified by age. Results: The prevalence of past 30-day ENDS use was as follows: ages 12-17 (5.0%), ages 18-20 (13.5%), ages 21-25 (14.6%), ages 26-34 (7.2%), and ages ≥35 (2.5%). Among youth ages 12-17, female respondents were more likely to report past 30-day ENDS use compared to male respondents (aOR = 1.41, 95% CI = 1.01-1.97). Among all adult age groups, current cigarette smoking status was associated with an increased likelihood of current ENDS use, versus never smoking. Among all age groups, those reporting non-Hispanic Black, non-Hispanic Other, and Hispanic race/ethnicity had a decreased likelihood of past 30-day ENDS use versus non-Hispanic White respondents, while past-year drug/alcohol use disorder, versus no use disorder, was associated with an increased likelihood of past 30-day ENDS use. Conclusions: ENDS use was most prevalent among young adults and least prevalent among persons ages ≥35. Most youth who reported ENDS use also reported never smoking cigarettes—compared to adults who reported ENDS use, who primarily reported current or former cigarette smoking. Our findings—which have identified characteristics of those most likely to use ENDS products—have the potential to inform screening and targeted intervention efforts aimed at reducing ENDS use.

Differential proteomic profiles of exosomes in pediatric and adult adamantinomatous craniopharyngioma cyst fluid.

Adamantinomatous craniopharyngiomas (ACPs), commonly seen in pediatrics and adults often present with large cystic cavities that can compress surrounding tissues, causing severe visual and endocrine symptoms. Complete resection of cystic ACP is challenging, frequently leading to postoperative recurrence. The composition of the cystic fluid is complex, and to date, there has been limited research focusing on exosomes within ACP cyst fluid. We collected cyst fluid from 12 ACP patients and confirmed the presence of exosomes. Subsequently, we conducted exosomal proteomic analysis using LC-MS/MS. The patients were divided into pediatric and adult groups for the analysis of differential protein enrichment, followed by comprehensive bioinformatics analysis, including GO analysis, KEGG analysis, and PPI network analysis, among other functional pathway and protein interaction analyses. Immunohistochemistry was used to determine the tissue expression distribution of the differential protein APOA1. In our data analysis, 64 significantly differentially expressed proteins were identified, with 37 being overexpressed in the pediatric group and 27 in the adult group. Our results revealed that exosomal proteins in the pediatric group were predominantly enriched in modules and pathways related to high-density lipoprotein particle, apolipoprotein receptor binding, and the PPAR signaling pathway. Additionally, APOA1, as the hub protein with the highest connectivity in the differential protein interaction network, may play a critical role in β-amyloid metabolism pathways in pediatric ACP. This study is the first to construct a proteomic map of ACP cyst fluid exosomes, suggesting significant differences in the tumor microenvironment's lipid metabolism between pediatrics and adults.

Comparison of Pediatric and Adult Mandibular Fractures: Identifying Differences in Presentation and Management Using a National Trauma Database.

Facial fractures in children are less common than in adults but can lead to significant long-term complications, including growth abnormalities and functional issues. Mandibular fractures are the most common facial fractures in both age groups, yet there is no consensus on optimal management strategies. This study investigates the epidemiology, presentation, treatment, and outcomes of mandibular fractures in pediatric versus adult populations. The authors conducted a retrospective, population-based study using 2016 to 2019 data from the National Trauma Data Bank. Patients with mandibular fractures were categorized into pediatric (below 18y) and adult (18y or above) groups. The authors analyzed demographics, fracture mechanism, treatment modality, hospital outcome, and complication data. Of the 42,866 patients with operative mandibular fractures, 3968 were pediatric (mean age: 13.3y), and 38,898 were adult (mean age: 36.2y). The primary fracture etiology for both groups was being struck, followed by motor vehicle incidents and falls. Pediatric patients were more frequently treated at level I trauma centers, had shorter times for surgical intervention, and were more frequently transferred to other facilities compared to adults. Antibiotic use was similar between groups, and hospital complications were infrequent, with low rates of infection and unplanned return to the operating room. Mandibular fractures in children, though less common than in adults, exhibit unique epidemiological and management characteristics. Children were more frequently transferred for care and received surgical intervention sooner than adults. Antibiotic use and complication rates were low and similar across both groups. Further research is needed to establish specific treatment guidelines for pediatric mandibular fractures.

HyProCure for Flatfoot Deformity: A Clinical Characteristics Analysis in China.

Flatfoot is a common foot disorder involving progressive foot deformity of the three-dimensional structures of the forefoot, midfoot, and hindfoot. Currently, Chinese surgeons and patients favor subtalar arthroereisis (SA) due to its minimally invasive and low-damage characteristics. HyProCure device is widely used. However, there is limited analysis of large sample sizes. This study utilized statistical evaluation with a large sample size to analyze clinical characteristics trends of SA for flatfoot, including baseline indicators, selection of HyProCure size and surgical strategy, complications, and implant removal. This study will enhance the understanding of SA in China. A retrospective analysis of 732 patients (1008 ft) who underwent SA from June 2015 to June 2023, with 509 pediatric and adolescent patients (772 ft) and 223 adult patients (236 ft). Based on the patient's age, patients aged ≤ 18 were included in the children and adolescent group, while adult acquired flatfoot deformity (AAFD) patients aged > 18 were included in the adult group. General data was collected, including patient sex, age, side, body mass index (BMI), surgery date, HyproCure size, and surgical data, and trends were analyzed. Postoperative complications and HyProCure removal were collected as outcome measures during follow-up. The age of patients treated with SA was gradually getting younger, with male patients predominating, mainly concentrated in the 11-14 age group. HyProCure 7 has the highest usage rate. In the children and adolescent group, 288 ft (37.31%) only underwent SA. In the adult group, 18 ft (7.63%) only underwent SA. Complications include sinus tarsi pain, peroneal spasms, achilles tendon tension, and muscle strength decline. The complication rate in the children and adolescent group was 5.05%, while in the adult group it was 28.81%. Overall, it was 10.62%. The removal rate of HyProCure in the children and adolescent group is 1.04%, in the adult group is 15.25%, and overall is 4.37%. The trend in flatfoot treated with SA was towards children and adolescent male patients, and sinus tarsi pain was the most common complication after SA. The complication rate and removal rate in the children and adolescent group were lower than those in the adult group. HyProCure can be removed without additional adverse effects.

DETERMINATION OF DIAGNOSTIC REFERENCE LEVEL (DRL) AND STUDY OF EXPOSURE PARAMETER SELECTION IN HEAD AND ABDOMEN CT SCAN AT BANGIL REGIONAL HOSPITAL

A study has been conducted to determine the local diagnostic reference level (DRL) value of CT scans at Bangil Regional Hospital. The determination and calculation of the DRL value are based on the measurement of the patient's dose, namely using the CT scan examination results in the form of CTDIVol values and DLP values. The DRL value is determined from the CTDIVol and DLP data distribution in quartile 3. Patient dose data uses a Toshiba 16-slice CT scan and a Canon 160-slice CT scan. Seven hundred twenty data were obtained, distinguished by 680 adults and 40 children. The local DRL value at Bangil Regional Hospital for CT scans of the Head without contrast for the adult group CTDIVol 47.5 mGy and DLP 1162 mGy.cm. CT scans of the Head with contrast for the adult group CTDIVol 47.22 mGy and DLP 2784.38 mGy.cm. DRL on CT scan Abdomen without contrast adult age group at Bangil Hospital CTDIVol 3.7 mGy and DLP 179.9 mGy.cm. CT scan of Abdomen with contrast CTDIVol 3.9 mGy and DLP 774.92 mGy.cm. When compared to the National DRL value, this value is still below the National DRL value. However, the nature of DRL is dynamic, so each period is expected to be lower. Efforts should focus on achieving lower DRL values by considering the selection of parameters and the skills of radiographers that influence the dose administered to patients. Values that exceed the DRL value are evaluated using the choice of parameters. Factors that affect the DRL value include kV, mAs, rotation time, pitch, iterative reconstruction, and number of phases. The parameters used in CT scans at Bangil Hospital must be adjusted to provide optimal doses to patients. Keywords: diagnostic reference level (DRL), dose length product (DLP), CT dose index (CTDI), CT Head, CT Abdomen, dose delivery parameters.

Neurocognitive dysfunction in adolescents with recent onset major depressive disorder: a cross-sectional comparative study.

The aim of this study was to examine the neurocognitive deficits associated with the first episode of major depressive disorder (recent onset depression, ROD) in adolescents as compared to adult patients. Cross-sectional neurocognitive data from the baseline assessments of the PRONIA study with N = 650 (55.31% females) were analyzed. Based on a principal component analysis of eleven neurocognitive tests, we constructed an overall neurocognitive performance (NP) score. We examined mean score differences in NP between the groups of healthy controls (HC) and ROD and between adolescents (15-21years) and adults (22-40years) within a GLM approach. This accounts for unbalanced data with focus on interaction effects while controlling for effects of medication and educational years. Our results show lower NP for the ROD as compared to the HC group (d = -0.29, p = .046) and lower NP for the adolescent group as compared to the adult group (d = -0.29; p < .039). There was no interaction between these two group effects (F = 1.11; p = .29). Our findings suggest that the detrimental effect of ROD on neurocognitive functioning is comparable in adolescent and adult patients, since lower scores in adolescent patients are explained by effects of age and education. Neurocognitive impairment is an under addressed issue in clinical treatment guidelines for adolescent MDD. We suggest efficient monitoring in clinical practice by using an aggregate of the Digit Symbol Substitution Test and the Trail Making Test B, which highly correlated with the overall score of NP (r = 0.82).

Logistic Regression Model on Nutritional Status Based on Body Mass Index (BMI) in Women of Reproductive Age (WRA) in Indonesia

The aggregate analysis of Riskesdas data in Indonesia revealed that nearly all provinces face a serious double burden of malnutrition. Both undernutrition and overnutrition negatively affect the quality of human resources, especially when they occur in adolescent girls, Women of Reproductive Age (WRA), and pregnant and breastfeeding women, as this can lead to intergenerational nutritional problems. Body Mass Index (BMI) is a nutritional status measurement technique recommended by WHO. Nutritional problems occur when BMI is abnormal or not ideal, categorized as underweight (&lt;18.5 kg/m²), pre-obesity (25-29.9 kg/m²), obesity class I (30-34.9 kg/m²), obesity class II (35-39.9 kg/m²), and obesity class III (&gt;40 kg/m²). Data from laboratory results completed up to 2017, based on selected samples from the 2013 Basic Health Research (Riskesdas), were used to assess the nutritional status of the Indonesian population. This study used 9,418 respondent data samples from 33 provinces in Indonesia. Logistic regression analysis was applied because the response variable in this study is binary, representing ideal BMI (1) and non-ideal BMI (0). The independent variables used in this study include Hemoglobin level, Ferritin level, CRP level, age group, physical activity, living location, marital status, education, and risky food consumption patterns. All independent variables are categorical. The study found that the factors influencing nutritional status based on BMI in WRA are Hemoglobin level, Ferritin level, CRP level, age, and location. The resulting logit model is logit (π)=0.27695-0.1491 (Non-anemic Hemoglobin level)-0.1721 (Normal Ferritin level)+0.741 (Non-infectious CRP level)-0.2933 (Adult age group)-0.0976 (rural location). logit (π)=0.27695-0.1491 (Non-anemic Hemoglobin level)-0.1721 (Normal Ferritin level)+0.741 (Non-infectious CRP level)-0.2933 (Adult age group)-0.0976 (rural location). The largest odds ratio The largest odds ratio was produced by the CRP level variable, indicating that CRP level is the most influential factor affecting nutritional status based on BMI in WRA, where non infectious CRP compared to infectious CRP increases the likelihood of WRA having an ideal BMI.

Identification of sensitive periods of weight status transition over the lifespan in Chinese population

BackgroundThe prevalence of high body mass index (BMI) is increasing in both children and adults worldwide. However, it is unclear whether vulnerabilities to maintenance and transition of weight status vary throughout the lifespan.ObjectiveWe aimed to characterize dynamic transitions of weight statuses across different life stages and to identify the sensitive periods for maintenance, onset, and resolution of obesity.MethodsThis longitudinal study included a total of 23,179 participants aged 6–80 years with 95,994 BMI measurements from the China Health and Nutrition Survey 1989–2015. To examine the heterogeneity in transitions of weight statuses across different life stages, we divided participants into 8 sub-cohorts based on baseline ages by 10-year intervals, i.e., 6–10 years, 11–20 years, 21–30 years, 31–40 years, 41–50 years, 51–60 years, 61–70 years, and 71–80 years. We estimated the probabilities of transitioning between weight statuses at a given follow-up year by baseline age using generalized linear mixed-effects models.ResultsThe predicted prevalence of obesity decreased from 6 years, bottomed at around 20 years, increased thereafter, peaked at around 55 years, and then decreased gradually. In general, participants with underweight had lower probabilities of maintaining the same status compared to those with normal weight, overweight, or obesity for all age groups. For 10-year follow-up, individuals aged 21–30 years had the highest probabilities of transitioning from normal weight to obesity and transitioning from overweight to obesity compared to those in other age groups. Individuals aged 6–20 years had the highest probabilities of transitioning from obesity to normal weight and transitioning from overweight to normal weight. Individuals in all adult age groups had higher probabilities of maintaining obesity status than children and adolescents.ConclusionsYoung adulthood is the most sensitive period for obesity onset, whereas childhood and adolescence are the most sensitive periods for obesity resolution. The findings suggest the heterogeneity of susceptibilities to weight status transitions across different life stages and highlight the importance of the development of age-appropriate approaches for the prevention and intervention of obesity.

Adolescent microsurgical varicocelectomy and changes in sperm parameters: A matched cohort analysis.

Varicocele, a common vascular abnormality surrounding the testis, is known to be associated with impaired semen parameters and male infertility in adults. However, its impact on the adolescent and young adult (AYA) population is less well known. The study aimed to assess the improvement in sperm parameters following varicocelectomy in the AYA population, comparing them to matched adult counterparts, and investigating potential advantages of early intervention. A retrospective analysis was conducted using a comprehensive database at the University of Miami spanning from 2012 to 2023. We included AYA (under 25 years of age) men who underwent varicocelectomy. To ensure comparability, they were matched with adult patients (over 30 years of age) based on preoperative follicle-stimulating hormone (FSH) values and varicocele grade in a 1:2 ratio. Semen parameters were evaluated before and after surgery, including sperm count, motility, morphology, and overall semen quality. We included 45 patients in the Adolescents and Young Adults (AYA) category, and matched them with 116 adults based on FSH and varicocele grade, all of whom underwent microsurgical varicocelectomy. The AYA group exhibited greater improvements post-varicocelectomy compared to the matched cohort. Furthermore, postoperative sperm concentration in the AYA men demonstrated a remarkable increase, with a 1.7-fold increase in mean concentration compared to the adult group (p<0.001). Additionally, motility also displayed significant enhancement among the AYA men, with a final mean total motile sperm count (TMSC) improvement of 2.25-fold compared to the adult cohort (p=0.002). This study highlights the potential benefits of varicocelectomy as a viable treatment option for adolescents and young adults with varicocele, particularly those with impaired semen parameters. By intervening at an earlier stage of development, patients in this age group can achieve significant improvements in semen quality, as compared to their adult counterparts. These findings underscore the importance of considering varicocelectomy as a valuable therapeutic approach for the younger demographic, potentially alleviating future fertility concerns.