Cumulative Life Research Articles

Lifetime risk, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for psoriasis in Taiwan: a nationwide cohort followed from 2000 to 2017.

Patients with psoriasis have a significant disease burden throughout the life course. Nevertheless, the lifetime risk and disease burden of psoriasis across the entire lifespan is rarely quantified in an easily understandable way. To estimate the cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for incident psoriasis. Using real-world nationwide data from the National Health Insurance Research Database of Taiwan for 2000-2017, along with the life tables of vital statistics, we estimated cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for those with psoriasis using a semi-parametric survival extrapolation method. A total of 217,924 new psoriasis cases were identified. The lifetime risk of psoriasis in patients aged 18-80 for both sexes decreased in Taiwan with a cumulative incidence rate of 7.93% in 2000 to 3.25% in 2017. The mean (±standard error) life expectancy after diagnosis was 27.11 (± 1.15) and 27.14 (±1.17) years for patients with moderate-to-severe psoriasis and psoriatic arthritis, respectively. Patients with moderate-to-severe psoriasis and psoriatic arthritis had a mean (±standard error) loss-of-life expectancy of 6.41 (±1.16) and 6.48 (±1.17) due to psoriasis, respectively. Male patients have higher lifetime and annual lifetime healthcare expenditures than female. Mean life expectancy, loss-of-life expectancy, and lifetime cost were relatively higher for younger patients. Among psoriatic patients, patients with moderate-to-severe psoriasis and psoriatic arthritis had substantial years of life lost, particularly for younger patients. Our results provide a reliable estimation of lifetime disease burden, and these estimates will help health authorities in cost-effectiveness assessments of public health interventions and allocation of services resources to minimize loss-of-life expectancy, and lifetime healthcare expenditures in patients with psoriasis.

Dynamic Reliability Evaluation and Life Prediction of Transmission System of Multi-Performance Degraded Wind Turbine

Wind power is a kind of important green energy. Thus, wind turbines have been widely utilized around the world. Wind turbines are composed of many important components. Among these components, the failure rate of the transmission system is relatively high in wind turbines. It is because the components are subjected to aerodynamic loads for a long time. In addition, its inertial load will result in fatigue fracture, wear and other problems. In this situation, wind turbines have to be repaired at a higher cost. Moreover, the traditional reliability methods are difficult to deal with the above challenges when performing the reliability analysis of the transmission system of wind turbines. To solve this problem, a stress-strength interference model based on performance degradation is introduced. Based on considering the strength degradation of each component, the improved Monte Carlo method simulation based on the Back Propagation neural network is used to obtain the curve of system reliability over time. Finally, the Miner linear cumulative damage theory and the Carten-Dolan cumulative damage theory method are used to calculate the cumulative damage and fatigue life of the gear transmission system.

RESILIENCY AS A PROCESS: A QUALITATIVE INVESTIGATION INTO U.S. VETERANS’ EXPERIENCES AGING WITH HIV

Abstract U.S. military Veterans aging with HIV represent a unique special population. The aim of this qualitative study was to investigate risk and protective factors associated with Veterans’ ability to age well with HIV. Participants included 25 Veterans (≥ age 50) participating in the Veterans Aging Cohort Study who were recruited from the Atlanta Veterans Affairs (VA) Medical Center. This study conducted semi-structured interviews, social network mapping, and sociodemographic and health surveys. Participants ranged in age from 50 to 72, with a mean age of 59. Most (80%) were male, and more than half (60%) were African American. Findings showed that many participants experienced adversity in childhood or early adulthood, including military sexual violence, childhood abuse, and non-military domestic violence, as well as harassment based on sexual identity. Many also had histories of substance abuse. Although military life provided stability for some, most experienced some form of instability after leaving the service, including financial difficulties and loss of valued military ties. Timing of diagnosis, whether in the military or after the military, impacted resiliency. Receiving an HIV diagnosis was an important turning point in participants’ lives characterized by either maladaptive (e.g., suicide ideation) or therapeutic (e.g., health promoting behaviors) coping strategies. Positive social support, including close relationships many developed with providers at the VA HIV clinic, was an important protective factor. The sample experienced cumulative life events that shaped their ability to age with HIV. Findings have important implications for interventions to promote Veterans’ ability to age well with HIV.

Study on the Properties and Benefits of a Composite Separator Layer in Airport Cement Concrete Pavement

A composite separator layer in Portland cement concrete pavement, formed by a lower bearing layer and micro surfacing, was seldom used in airport pavement, but it has great application potential. This paper studied the properties of the composite separator layer and its benefits for pavement. The basic properties investigated in the study were resilient modulus and interlayer property between the separator layer and concrete. The resilient modulus of the micro surfacing was tested to calculate the modulus of the whole separation layer. The interlayer shearing test was done on core specimens using a self-developed facility that can apply load in the normal direction. Shearing test results show that temperature affects the shape of the shearing curve and normal stress linearly affects the stable shear force. Additionally, an in-situ erosion test was carried out to prove the anti-scouring property of the separator layer. Furthermore, a finite element model (FEM) model was established to study the influence of the composite separator layer. The FEM employed the modulus test results and the measured interlayer characteristic. The interlayer characteristic was simplified into a two-stage constitutional model. Monitored data on the mechanical response of the pavement structure in an airport validated the FEM model. Results show that the separator layer reduces the chance of contraction crack under the sudden temperature drop in the concrete slab before sawing. FEM results show that though the separator layer slightly increases the tensile stress of concrete, the tensile stress is greatly reduced if the slab develops voids in the future. The most significant benefit of the separation layer is it reduces the chance of void occurrence so that the lifespan of pavement with a separator layer is improved compared to regular pavements which frequently have voids beneath the slab. With the finite element model results and cumulative fatigue life equations, the separator layer was estimated to elongate the pavement service life for years, depending on the time voids appear.

Distinct Worst Pain Profiles in Oncology Outpatients Undergoing Chemotherapy.

While pain is a significant problem for oncology patients, little is known about interindividual variability in pain characteristics. The aims of this study were to identify subgroups of patients with distinct worst pain severity profiles and evaluate for differences among these subgroups in demographic, clinical, and pain characteristics and stress and symptom scores. Patients (n = 934) completed questionnaires 6 times over 2 chemotherapy cycles. Worst pain intensity was assessed using a 0- to 10-point numeric rating scale. Brief Pain Inventory was used to assess various pain characteristics. Latent profile analysis was used to identify subgroups of patients with distinct pain profiles. Three worst pain profiles were identified (low [17.5%], moderate [39.9%], severe [42.6%]). Compared with the other 2 classes, severe class was more likely to be single and unemployed and had a lower annual household income, a higher body mass index, a higher level of comorbidity, and a poorer functional status. Severe class was more likely to have both cancer and noncancer pain, a higher number of pain locations, higher frequency and duration of pain, worse pain quality scores, and higher pain interference scores. Compared with the other 2 classes, severe class reported lower satisfaction with pain management and higher global, disease-specific, and cumulative life stress, as well as higher anxiety, depression, fatigue, sleep disturbance, and cognitive dysfunction scores. Unrelieved pain is a significant problem for more than 80% of outpatients. Clinicians need to perform comprehensive pain assessments; prescribe pharmacologic and nonpharmacologic interventions; and initiate referrals for pain management and psychological services.

Significant healthcare burden and life cost of spinal muscular atrophy: real-world data.

The aim of this study is to quantify the mortality rate, direct healthcare costs, and cumulative life costs of pediatric patients with spinal muscular atrophy (SMA) type 1, type 2, and type 3 born in Hong Kong. Data were collected from genetically confirmed SMA patients born in or after 2000 from the Hospital Authority medical database. Patients were followed up from birth until they died, left Hong Kong, reached 18years, or initiated disease-modifying treatment. Study outcomes included incidence risks of mortality, cumulative direct medical costs-attendances of special outpatient clinics, emergency department, allied health services, and mean length of stay in hospitals over time. Total direct medical costs were calculated as unit costs multiplied by utilization frequencies of corresponding healthcare services at each age. Seventy-one patients with SMA were included. Over a median follow-up period of 6years, the overall incidence rate of death was 5.422/100 person-years (95%CI 3.542-7.945/100 person-years). 67.7% and 11% of deaths occurred in SMA1 and SMA2 groups, respectively. The median age of death was 0.8years in SMA1 and 10.9years in SMA2. The mean cumulative direct medical costs in overall SMA, SMA1, SMA2 and SMA3 groups per patient were US$935,570, US$2,393,250, US$413,165, and US$40,735, respectively. Our results confirmed a significantly raised mortality and extremely high healthcare burden for patients with SMA especially SMA type 1 and 2 without disease-modifying treatment. Study evaluating health and economic impact of newborn screening and early treatment is needed.

Does gabapentin provide benefit for patients with knee OA? A benefit-harm and cost-effectiveness analysis

Gabapentin can treat neuropathic pain syndromes and has increasingly been prescribed to treat nociplastic pain. Some patients with knee osteoarthritis (OA) suffer from both nociceptive and nociplastic pain. We examined the cost-effectiveness of adding gabapentin to knee OA care. We used the Osteoarthritis Policy Model, a validated Monte Carlo simulation of knee OA, to examine the value of gabapentin in treating knee OA by comparing three strategies: 1) usual care, gabapentin sparing (UC-GS); 2) targeted gabapentin (TG), which provides gabapentin plus usual care for those who screen positive for nociplastic pain on the modified PainDETECT questionnaire (mPD-Q) and usual care only for those who screen negative; and 3) universal gabapentin plus usual care (UG). Outcomes included cumulative quality-adjusted life years (QALYs), lifetime direct medical costs, and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually. We derived model inputs from published literature and national databases and varied key input parameters in sensitivity analyses. UC-GS dominated both gabapentin-containing strategies, as it led to lower costs and more QALYs. TG resulted in a cost increase of $689 and a cumulative QALY reduction of 0.012 QALYs. UG resulted in a further $1,868 cost increase and 0.036 QALY decrease. The results were robust to plausible changes in input parameters. The lowest TG strategy ICER of $53,000/QALY was reported when mPD-Q specificity was increased to 100% and AE rate was reduced to 0%. Incorporating gabapentin into care for patients with knee OA does not appear to offer good value.

Could Targeted Pharmacotherapies Exert a "Disease Modification Effect" in Patients with Chronic Plaque Psoriasis?

Chronic plaque psoriasis is an immune-mediated skin disease with a chronic relapsing course, affecting up to ~2-3% of the general adult population worldwide. The interleukin (IL)-23/Th17 axis plays a key role in the pathogenesis of this skin disease and may represent a critical target for new targeted pharmacotherapies. Cutaneous lesions tend to recur in the same body areas, likely because of the reactivation of tissue-resident memory T cells. The spillover of different pro-inflammatory cytokines into systemic circulation can promote the onset of different comorbidities, including psoriatic arthritis. New targeted pharmacotherapies may lead to almost complete skin clearance and significant improvements in the patient's quality of life. Accumulating evidence supports the notion that early intervention with targeted pharmacotherapies could beneficially affect the clinical course of psoriatic disease at three different levels: (1) influencing the immune cells infiltrating the skin and gene expression, (2) the prevention of psoriasis-related comorbidities, especially psoriatic arthritis, and (3) the improvement of the patient's quality of life and reduction of cumulative life course impairment. The main aim of this narrative review is to summarize the effects that new targeted pharmacotherapies for psoriasis may have on the immune scar, both at the molecular and cellular level, on psoriatic arthritis and on the patient's quality of life.

Character Strength and Mental Health Problems among Children from Low-Income Families in South Korea.

This study was conducted to understand the association between character strength and mental health problems among children in early adolescence from low-income families in South Korea. This study used a cross-sectional and descriptive study design with 214 fifth- and sixth-grade elementary school children from low-income families enrolled in 20 community centers and receiving government financial assistance. A bivariate probit model was used to examine the association between character strength and mental health problems in the children. We found that character strength lowers the likelihood of developing hyperactivity–inattention and emotional symptoms among children from low-income families. Additionally, adverse life events were associated with increased mental health problems, whereas adverse life events were not significantly correlated with character strength in the current study. Specific interventions should be developed to cultivate character strength among children in early adolescence from low-income families who are at a high risk of mental health problems under cumulative adverse life events.

Development and Validation of the Weighted Index for Childhood Adverse Conditions (WICAC).

Background: Adverse experiences in childhood are a major public health concern, promoting social inequality in health through biopsychosocial mechanisms. So far, no known measures comprehend the complexity and variations of severity of adverse events. This study aims to develop and validate a new index: the Weighted Index for Childhood Adverse Conditions (WICAC). Methods: The population consists of 7493 randomly invited men and women aged 18–72 years. Data were collected in 2012–2015 as part of the Danish Study of Functional Disorders (DanFunD). Content and construct validation of the WICAC was performed with the hypothesis testing of multiple biopsychosocial outcomes: cardiovascular disease, cancer, poor health, back pain, BMI, obesity, anxiety, depression, low vitality, subjective social status, lower education, smoking, and alcohol consumption. Data were analysed with binominal and linear regression models with risk ratios (RR) and mean differences (MD). Results: Content validation is fitting for WICAC. The strongest associations observed were for most severe adversity: Poor Health RR = 2.16 (1.19–2.91), Anxiety RR = 3.32 (2.32–4.74), Heavy Drinking RR = 4.09 (1.85–9.04), and Subjective Social Status MD = −0.481 (−0.721–(−0.241)). Similar results were found for the remaining outcomes. Discriminative validation was undecided. Conclusions: WICAC is an adequate instrument for measuring cumulative adverse life events in childhood and adolescence for research purposes.

New horizontal inequalities in Japanese education? Examining socioeconomic selectivity in pre-college study abroad intent and participation

The literature on social inequality in study abroad almost exclusively focuses on university students. This paper systematically examines the role of socioeconomic status (SES) for study abroad intent (SAI) and uptake across all levels of pre-college education in Japan, thereby also providing a first in-depth empirical study on pre-college study abroad (PSA) in this country. Drawing on theories of social inequality (especially the effectively maintained inequality (EMI) thesis) in combination with elements from cumulative advantage and life course research, we understand the intention and final decision to study abroad as an outcome of SES-specific differences in educational biographies, with higher SES families seeking transnational education for their children to achieve status advantages. Using large-scale cross-sectional data for Japan ( N = 15,450) for children aged three to eighteen years, binary and generalized ordered logit regressions show that children from high SES families are generally more likely to (1) express SAI (especially for college) and take up PSA; and (2) choose more exclusive forms of PSA, i.e. earlier and more lengthy stays. Findings further indicate that (3) the SES-gap in the likelihood to show SAI or take up PSA is highest at the pre- and high school levels. Applying the KHB method we found that (4) the percentage of SES effects on SAI mediated through earlier PSA experience is marginal or even reversed at times. We conclude that early PSA experience is positively related to further SAI, with high SES students likely accumulating transnational human capital to a greater extent, possibly acquiring status advantages. In sum, our results support the EMI and cumulative advantage perspectives, indicating undetected first- and second-level horizontal inequalities in Japanese education and call for similar research in other national contexts. • The likelihood for pre-college study abroad intent and uptake is higher for children from higher SES backgrounds. • SES effects on short- and long-term pre-college stays abroad are always significant, but highest at pre- and high school. • Prior study abroad hardly mediates SES effects on study abroad intent indicating a widening SES gap in future study abroad. • Our findings point to first- and second-level horizontal inequalities in study abroad uptake in Japan.

Cumulative life course adversity, mental health, and cognition in the UK biobank

The association between adversity and cognition varies according to the specific adversity, when the adversity was experienced, and the cognitive domains investigated. Disentangling the effect of adversity and the underlying mechanistic pathway is therefore difficult. The association between adversity (i.e., maltreatment) accumulated over the life course and cognitive flexibility, as well as two potential mediators (i.e., intra-individual variability in reaction time and depression) of this association, were investigated. Data stem from the baseline population of the UK Biobank study (N = 73,489, Mdnage = 56, SDage = 7.628, 55.740% of women). Cumulative life course adversity (specifically maltreatment) was measured with items based on the Childhood Trauma Questionnaire (CTS-5) and items adapted from the British Crime Survey. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9). Intra-individual variability in reaction time was measured with a reaction time test “snap game” and the Trail Making Test A and B were used as a measure of cognitive flexibility. A path analysis was performed on these data. Higher cumulative adverse experiences were associated with lower performance in cognitive flexibility (β = .016, p < .001, 95% CI [0.009, 0.024]), and this effect was partly mediated by the level of depression (22.727% of the total effect of cumulative life course adversity on cognitive flexibility was mediated by depression (β = .005, p < .001, 95% CI [0.004, 0.007])). No association between cumulative life course adverse experiences and intra-individual variability in reaction time was found, nor was any indirect association between cumulative life course adversity and performance in cognitive flexibility via intra-individual variability in reaction time. The association between cumulative life course adversity, depression, and performance in cognitive flexibility has been highlighted. In contrast, no indirect effect between cumulative life course adversity and performance in cognitive flexibility via intra-individual variability in reaction time was found, suggesting that it is not a potential mechanism underlying the association between cumulative life course adversity and executive function.

The effect of cumulative early life adversities, and their differential mediation through hair cortisol levels, on childhood growth and cognition: Three-year follow-up of a birth cohort in rural India.

Background: Early adversities negatively impact children's growth and development, putatively mediated by chronic physiological stress resulting from these adverse experiences. We aimed to estimate the associations between prospectively measured cumulative early adversities with growth and cognition outcomes in rural Indian preschool children and to explore if hair cortisol concentration (HCC), a measure of chronic physiological stress, mediated the above association. Methods: Participants were recruited from the SPRING cRCT in rural Haryana, India. Adversities experienced through pregnancy and the first year of life were measured in 1304 children at 12-months. HCC was measured at 12-months in 845 of them. Outcome measures were height-for-age-z-score (HAZ), weight-for-age-z-score (WAZ) and cognition, measured in 1124 children followed up at 3-years. Cognition was measured using a validated tablet-based gamified tool named DEEP. Results: Cumulative adversities at 12-months were inversely associated with all outcomes measures at 3-years. Each unit increase in adversity score led to a decrease of 0·08 units [95% confidence interval (CI):-0·11,-0·06] in DEEP-z-score; 0·12 units [-0·14,-0·09] in HAZ and 0·11 units [-0·13,-0·09] in WAZ. 12-month HCC was inversely associated with DEEP-z-score (-0·09 [-0·16,-0·01]) and HAZ (-0·12 [-0·20,-0·04]), but the association with WAZ was not significant (p = 0·142). HCC marginally mediated the association between cumulative adversities and HAZ (proportion mediated = 0·06, p = 0·014). No evidence of mediation was found for the cognition outcome. Conclusions: Cumulative early adversities and HCC measured at 12-months have persistent negative effects on child growth and cognition at 3-years. The association between adversities and these two child outcomes were differentially mediated by HCC, with no evidence of mediation observed for the cognitive outcome. Future studies should focus on other stress biomarkers, and alternate pathways such as the immune, inflammation and cellular ageing pathways, to unpack key mechanisms underlying the established relationship between early adversities and poor child outcomes.

Old, Lost, and Forgotten Rural Materialities: Old Local Irrigation Channels and Lost Local Walking Trails

Geo-historical studies have essentially focused on analyzing the historical evolution of the landscape and the processes of material resistance of rural landscapes against the dynamics of rural change. Historical landscapes are cumulative life micro-worlds. In the present contribution, the historical evolution of lost and disappeared rural roads and caceras—old local irrigation channels—is analyzed in a comparative way. The case studies were the Berbedillo river cacera system in the north of the province of Guadalajara and the Bustar path in the municipality of Bustarviejo in the province of Madrid. The methodology was based on a variety of research sources: written and archival documents, oral testimonies of the elderly, and micro-territorial recognition. The roads and caceras are lost but can continue to be represented, even if they can no longer be used for the life of rural communities. A new history of depopulation, restructuring, and loss is possible to (re)write based on spectral agrarian (im)materialities.

The effect of cumulative early life adversities, and their differential mediation through hair cortisol levels, on childhood growth and cognition: Three-year follow-up of a birth cohort in rural India

Background: Early adversities negatively impact children’s growth and development, putatively mediated by chronic physiological stress resulting from these adverse experiences. We aimed to estimate the associations between prospectively measured cumulative early adversities with growth and cognition outcomes in rural Indian preschool children and to explore if hair cortisol concentration (HCC), a measure of chronic physiological stress, mediated the above association. Methods: Participants were recruited from the SPRING cRCT in rural Haryana, India. Adversities experienced through pregnancy and the first year of life were measured in 1304 children at 12-months. HCC was measured at 12-months in 845 of them. Outcome measures were height-for-age-z-score (HAZ), weight-for-age-z-score (WAZ) and cognition, measured in 1124 children followed up at 3-years. Cognition was measured using a validated tablet-based gamified tool named DEEP. Results: Cumulative adversities at 12-months were inversely associated with all outcomes measures at 3-years. Each unit increase in adversity score led to a decrease of 0·08 units [95% confidence interval (CI):-0·11,-0·06] in DEEP-z-score; 0·12 units [-0·14,-0·09] in HAZ and 0·11 units [-0·13,-0·09] in WAZ. 12-month HCC was inversely associated with DEEP-z-score (-0·09 [-0·16,-0·01]) and HAZ (-0·12 [-0·20,-0·04]), but the association with WAZ was not significant (p = 0·142). HCC marginally mediated the association between cumulative adversities and HAZ (proportion mediated = 0·06, p = 0·014). No evidence of mediation was found for the cognition outcome. Conclusions: Cumulative early adversities and HCC measured at 12-months have persistent negative effects on child growth and cognition at 3-years. The association between adversities and these two child outcomes were differentially mediated by HCC, with no evidence of mediation observed for the cognitive outcome. Future studies should focus on other stress biomarkers, and alternate pathways such as the immune, inflammation and cellular ageing pathways, to unpack key mechanisms underlying the established relationship between early adversities and poor child outcomes.

Environmental, energy, and economic impact assessment of sludge management alternatives based on incineration

In this study, different management strategies for sewage sludge disposal were evaluated associated with environmental, energy, and economic impact, using life cycle assessment (LCA), cumulative energy demand (CED) and life cycle costing (LCC) approaches. Four scenarios, including mono-incineration, co-incineration in municipal solid wastes (MSW) incineration plant, co-incineration in coal-fired power plant and co-incineration in cement kiln, were assessed. The environmental burdens generated from the sludge incineration contributed primarily to the global warming, followed by eutrophication, marine aquatic ecotoxicity, and human toxicity potential across the four scenarios. Furthermore, mono-incineration scenario appeared to be the most environmentally unfriendly, energy and economy intensive alternative, with the LCA, CED and LCC value of 5.41E-09, 1736 MJ and 1.84 million CNY, respectively. By contrast, co-incineration in cement kiln exhibited the lowest CED (368 MJ), LCC (0.59 million CNY), and environmental burdens (1.02E-09). In addition, the sensitivity analysis indicated that four scenarios were sensitive to the changes in the electricity efficiency and the moisture content contained in sewage sludge, suggesting that it was of great significance to enhance the efficiency of sludge dewatering and thermal drying The findings of this study can provide scientific reference for selecting the optimal strategies for the most environmentally and economically friendly sewage sludge management with optimum energy efficiency.

Stressful Life Events and Chronic Fatigue Among Chinese Government Employees: A Population-Based Cohort Study.

BackgroundCurrently, evidence on the role of stressful life events in fatigue among the Chinese working adults is lacking. This study aimed at exploring the prospective associations between stressful life events and chronic fatigue among Chinese government employees.MethodsFrom January 2018 to December 2019, a total of 16206 government employees were included at baseline and they were followed-up until May 2021. A digital self-reported questionnaire platform was established to collect information on participants' health and covariates. Life events were assessed by the Life Events Scale (LES), fatigue was assessed by using a single item, measuring the frequency of its occurrence. Binary logistic regression analysis was used for the data analysis.ResultsOf the included 16206 Chinese government employees at baseline, 60.45% reported that they experienced negative stressful life events and 43.87% reported that they experienced positive stressful life events over the past year. Fatigue was reported by 7.74% of the sample at baseline and 8.19% at follow-up. Cumulative number of life events at baseline, and cumulative life events severity score at baseline were positively associated with self-reported fatigue at follow up, respectively. After adjusting sociodemographic factors, occupational factors and health behavior related factors, negative life events at baseline (OR: 2.06, 95% CI: 1.69–2.51) were significantly associated with self-reported fatigue at follow-up. Some specific life events including events related to work and events related to economic problems were significantly associated with self-reported fatigue. Specifically, work stress (OR = 1.76, 95%CI: 1.45–2.13), as well as not satisfied with the current job (OR = 1.95, 95%CI: 1.58–2.40), in debt (OR = 1.75, 95%CI: 1.40–2.17) were significantly associated with self-reported fatigue. The economic situation has improved significantly (OR = 0.62, 95%CI: 0.46–0.85) at baseline was significantly associated with lower incidence of self-reported fatigue.ConclusionNegative stressful life events were associated with fatigue among Chinese government employees. Effective interventions should be provided to employees who have experienced negative stressful life events.

Бремя атопического дерматита в современных условиях

The prevalence and increase in morbidity of the atopic dermatitis make possible to consider it to become actual and relevant in nearest future. The pilot study analyzed using the Delphi method allowed identifying the most significant areas for further detailed research and development of programs reducing the disease burden of atopic dermatitis in the country. The study showed that the Cumulative Life Course Impairment associated with this disease is mediated by its systemic nature and a complex of concomitant diseases. The social burden of the disease is primarily associated with missed opportunities of patients even after the onset of spontaneous remission due to education and socialization issues from the period of schooling. Almost all adult patients report a decrease in the quality of life and experiencing problems with communication and sports. The economic burden of the disease is associated with household spending on medicines and a decrease in income as a result of changing or losing work, primarily in families with sick children in addition to healthcare system expenditures. The COVID‑19 pandemic has led to a decrease in the volume of medical care for atopic dermatitis adult patients and also there is a possibility of developing previously unknown complications in patients with atopic dermatitis.

Real-Time Schedule of Microgrid for Maximizing Battery Energy Storage Utilization

This paper proposes a real-time schedule model of a microgrid (MG) for maximizing battery energy storage (BES) utilization. To this end, a BES life model is linearized using piece-wise linearization and big-M method to assess the BES life loss (BLL) in a real-time manner. The cost-effective schedule model of the MG with multiple energy resources aims to maximize BES utilization while ensuring its sufficient lifespan. Corresponding to the optimization model, approximate dynamic programming (ADP) for maximizing BES utilization (ADP-MBU) in the real-time schedule is proposed to optimize the system under stochastic environments. In ADP-MBU, a new value function approximation method employing the BES cumulative life loss (BCLL) is developed to improve the optimality and applicability. The proposed ADP-MBU algorithm can achieve satisfactory approximate optimality while reflecting the variation of real-time BLL. Case studies validate the applicability of the proposed MG schedule model and the advantages of the proposed ADP-MBU algorithm.

Chronic and Cumulative Adverse Life Events in Women with Primary Ovarian Insufficiency: An Exploratory Qualitative Study.

Background and PurposePrimary ovarian insufficiency (POI) has serious physical and psychological consequences due to estradiol deprivation, leading to increased morbidity and mortality. However, the causes of most POI cases remain unknown. Psychological stress, usually caused by stressful life events, is known to be negatively associated with ovarian function. It is important to explore high-frequency adverse life events among women with POI for future interventions.MethodsForty-three women (mean age=33·8 years) were recruited who were newly- diagnosed with idiopathic POI (FSH levels >40 IU/L) to participate in semi-structured interviews through convenience sampling. The main questions covered by the topic guide were designed to explore adverse life events prior to POI diagnosis. Interviews were audio recorded, transcribed and analyzed thematically. Data were analyzed from June 2019 to August 2020.ResultsAmong the women with POI, mean age at diagnosis of POI was 33·8 years (range from 19 to 39 years), and the average time between the onset of irregular menstruation and POI diagnosis was 2.3 years. These women with POI had a relatively normal menstrual cycle before the diagnosis. A number of stressful life events prior to POI diagnosis were discussed by them as important factors influencing their health. Four core themes emerged: 1) persistent exposure to workplace stress, 2) persistent exposure to family-related adverse life events, 3) sleep problem/disturbance existed in women with POI before diagnosis, and 4) participants’ general cognition and concerns about POI.ConclusionsPersistent exposures to adverse life events related to work stress, family stress and sleep problem existed in women with POI. Our findings are consistent with the hypothesis that adverse life events play a role in the development of POI. Future research should investigate how social environmental factors influence POI disease risks, and whether provision of tailored interventions (i.e. preventing or mitigating impact of adverse life events) aimed at high-risk populations may help prevent new POI cases and improve conditions of women with POI. We gained an in-depth understanding of the experiences of these women via 1:1 qualitative method, and find adverse life events are frequent in women with POI prior to the diagnosis.