Female Age Research Articles

Telehealth-Delivered Radically Open Dialectical Behavior Therapy for Adolescents (RO DBT-A): A Pilot Mixed-Methods Study.

Disorders related to overcontrol frequently first appear during adolescence, are highly comorbid, and show limited treatment response, necessitating the adaptation of radically open dialectical behavior therapy (RO DBT; a transdiagnostic treatment targeting overcontrol) for adolescents (RO DBT-A). This study tested the preliminary efficacy of telehealth-delivered RO DBT-A in a heterogeneous clinical sample of youths. The sample consisted of 20 female participants ages 13-21 with elevated overcontrol; most were White (75%) and non-Hispanic/Latino (80%). RO DBT-A was provided over 20 weeks via skills group and individual sessions (N=13 participants). Participants seeking other treatment or no treatment formed the control group (N=7). Outcomes included self-reported symptoms and overcontrol. Follow-up interviews were analyzed by using inductive, contextualist thematic analysis to examine participant perceptions and reasons for dropout. The RO DBT-A group showed significant improvements in depression (t=-1.78, df=10, p=0.011) and quality of life (QOL; Wilcoxon W=75, p=0.021) compared with the control group. From baseline to posttreatment, youths receiving RO DBT-A demonstrated significant improvements in maladaptive overcontrol (t=2.76, df=12, p=0.043), anxiety (t=2.91, df=12, p=0.043), depression (Wilcoxon signed rank V=82.5, p=0.043), and QOL (t=-3.01, df=12, p=0.043). Qualitative analysis revealed themes related to treatment barriers, facilitators, and timing. The findings provide preliminary evidence supporting telehealth-delivered RO DBT-A in targeting overcontrol, decreasing symptomatology, and improving QOL in a heterogeneous clinical sample of youths. Qualitative follow-ups highlighted that dropout was driven by barriers related to therapy (e.g., structure- and therapist-related issues) and the timing of RO DBT-A compared with other treatments.

Frequency of vitamin D deficiency in children with iron deficiency anaemia and factors associated with vitamin D deficiency

Objective: To evaluate vitamin D deficiency in children with iron-deficiency anaemia, and to identify the risk factors for such deficiency. Method: The cross-sectional study was conducted at the Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from October 2021 to March 2022, and comprised children aged 1-5 years who had been diagnosed with iron-deficiency anaemia. Quantitative variables, like age, height, weight, gender, socioeconomic status and sibling status, were controlled by stratification. Data was compared to assess the risk factors of vitamin D deficiency among the subjects. Data was analysed using SPSS 22. Results: Of the 236 children with iron-deficiency anaemia, 159(67.5%) also had vitamin D deficiency; 95(59%) girls and 65(41%) boys. Overall, 104(65.4%) subjects were aged 4-5 years and 55(34.6%) were aged 1-3 years. Vitamin D deficiency had significant association with female gender, older age, height and weight <5th centiles, educated parents, low to middle socioeconomic status, urban residence and higher number of siblings (p<0.05). Conclusion: The prevalence of vitamin D deficiency among children with iron-deficiency anaemia was found to be high. Key Words: Anaemia, IDA, Vitamin D deficiency, Micronutrients deficiency, Risk factors.

Environmental exposure to polycyclic aromatic hydrocarbons: An underestimated risk factor for systemic lupus erythematosus onset and progression

ObjectiveTo investigate the link between systemic lupus erythematosus (SLE) incidence and exposure to environmental polycyclic aromatic hydrocarbons (PAH). MethodsA case-control study (ChiCTR2000038187) involving 316 SLE patients and 851 healthy controls (HCs) was executed. Environmental exposure was assessed via a questionnaire, stratified by gender and age (females <35 and ≥35 years, males). Blood samples collected from 89 HCs, 85 inactive, and 95 active SLE patients were used to measure serum benzo[a]pyrene diol epoxide -albumin (BPDE-Alb) adducts and PAH concentrations, indicating long-term and short-term exposure respectively. Intergroup comparisons and statistical analyses were conducted using R version 4.3.1. ResultsDiverse patterns were found in how environmental factors affect SLE onset across different demographics. Lifestyle exposure factors were found to be a stronger determinant of SLE onset than occupational exposure factors in women under 35. Indoor air pollution had a significant impact on SLE incidence, potentially comparable to outdoor air pollution. Lifestyle-related PAH exposure had a greater impact on SLE than occupational PAH exposure. PAH exposure levels progressively increase from HCs to inactive and active SLE patients. Active SLE patients show markedly higher BPDE-Alb levels than HCs. ConclusionsEnvironmental PAH, particularly lifestyle-related, are significant, yet under-recognized, risk factors for SLE. Statement of environmental implicationWe examined the relationship between exposure to environmental polycyclic aromatic hydrocarbons (PAH) and the incidence of systemic lupus erythematosus (SLE). PAH, prevalent in sources such as cigarette smoke, air pollution, and charred food, pose significant health hazards. This study is the first to investigate specific PAH exposure levels in SLE patients. We determined actual PAH exposure levels in both SLE patients and healthy individuals and indicated that long-term PAH exposure biomarker is more reliable for evaluating exposure in non-occupationally exposed groups like SLE, compared to short-term markers. These findings provide valuable insights for future research on similar non-occupationally exposed populations.

Effects of 8 Weeks Conditioning Exercises on Muscular Endurance: A Cross-Sectional Study of Female Cadets of Ghana Immigration Service Academy, Assin Fosu, Ghana

Physical conditioning enables athletes to meet all the physical requirements of their sport, perform well, and minimize their risk of injury. This study aims to determine the effects of eight (8) weeks conditioning training on the muscular endurance of Female Cadets of the Ghana Immigration Service Academy. The Army Physical Training Fitness Test (APFT) was used to evaluate muscular endurance levels of the Female Cadets. The quasi-experimental pre-test post-test study design was used to conduct the study. A total of 60 female cadets were randomly stratified into two groups based on APFT age categories (22-26) and (27-31) years. Data was analyzed using descriptive statistics and paired sample t-test and independent sample t-test was used to test the hypothesis. Higher upper body muscular endurance performance as measured by the APFT was observed in the age group (27-31) years compared to age group (22-26) years. Significant difference was found in muscular endurance in the females age groups (22-26) and (27-31) years (P&amp;lt;0.05). Significant positive effect on muscular endurance after conditioning exercises for female Cadets in both age categories, (22-26) and (27-31) years (P&amp;lt;0.05) was observed. Conditioning exercises had a significant impact on APFT upper body muscular endurance performance in the age categories of (22-26) and (27-31) years.

Patient Risk-Benefit Preferences for Transcatheter Versus Surgical Mitral Valve Repair.

Transcatheter edge-to-edge repair (TEER) of mitral regurgitation is less invasive than surgery but has greater 5-year mortality and reintervention risks, and leads to smaller improvements in physical functioning. The study objective was to quantify patient preferences for risk-benefit trade-offs associated with TEER and surgery. A discrete choice experiment survey was administered to patients with mitral regurgitation. Attributes included procedure type; 30-day mortality risk; 5-year mortality risk and physical functioning for 5 years; number of hospitalizations in the next 5 years; and risk of additional surgery in the next 5 years. A mixed-logit regression model was fit to estimate preference weights. Two hundred one individuals completed the survey: 63% were female and mean age was 74 years. On average, respondents preferred TEER over surgery. To undergo a less invasive procedure (ie, TEER), respondents would accept up to a 13.3% (95% CI, 8.7%-18.5%) increase in reintervention risk above a baseline of 10%, 4.6 (95% CI, 3.1-6.2) more hospitalizations above a baseline of 1, a 10.7% (95% CI, 6.5%-14.5%) increase in 5-year mortality risk above a baseline of 20%, or more limited physical functioning representing nearly 1 New York Heart Association class (0.7 [95% CI, 0.4-1.1]) over 5 years. Patients in general preferred TEER over surgery. When holding constant all other factors, a functional improvement from New York Heart Association class III to class I maintained over 5 years would be needed, on average, for patients to prefer surgery over TEER.

Harnessing the power within: engineering the microbiome for enhanced gynecologic health.

Although numerous studies have demonstrated the impact of microbiome manipulation on human health, research on the microbiome's influence on female health remains relatively limited despite substantial disease burden. In light of this, we present a selected review of clinical trials and preclinical studies targeting both the vaginal and gut microbiomes for the prevention or treatment of various gynecologic conditions. Specifically, we explore studies that leverage microbiota transplants, probiotics, prebiotics, diet modifications, and engineered microbial strains. A healthy vaginal microbiome for females of reproductive age consists of lactic acid-producing bacteria predominantly of the Lactobacillus genus, which serves as a protective barrier against pathogens and maintains a balanced ecosystem. The gut microbiota's production of short-chain fatty acids, metabolism of primary bile acids, and modulation of sex steroid levels have significant implications for the interplay between host and microbes throughout the body, ultimately impacting reproductive health. By harnessing interventions that modulate both the vaginal and gut microbiomes, it becomes possible to not only maintain homeostasis but also mitigate pathological conditions. While the field is still working toward making broad clinical recommendations, the current studies demonstrate that manipulating the microbiome holds great potential for addressing diverse gynecologic conditions. Manipulating the microbiome has recently entered popular culture, with various diets thought to aid the microbes that live within us. These microbes live in different locations of our body and accordingly help us digest food, modulate our immune system, and influence reproductive health. The role of the microbes living in and influencing the female reproductive tract remains understudied despite known roles in common conditions such as vulvovaginal candidiasis (affecting 75% of females in their lifetime), bacterial vaginosis (25% of females in their lifetime), cervical HPV infection (80% of females in their lifetime), endometriosis (6-10% of females of reproductive age), and polycystic ovary syndrome (10-12% of females of reproductive age). Here, we review four different approaches used to manipulate the female reproductive tract and gastrointestinal system microbiomes: microbiota transplants, probiotics, prebiotics, and dietary interventions, and the use of engineered microbial strains. In doing so, we aim to stimulate discussion on new ways to understand and treat female reproductive health conditions.

Still Here? Aging Female Vocalities in Musical Theatre.

Musical theatre has a complex relationship with ageing (and especially female ageing). As youth has always been at the forefront of musicals, essentialist approaches to ageing in articulation and enactment of ageing musical characters often lead to aesthetic peripheries and creative stagnation. Aiming for a deeper understanding of how female ageing vocalities are perceived, dramaturged and performed in musical theatre, the article takes under consideration viewpoints from ‘outsiders’/ageing performers who work ‘at the centre’ of the musical theatre industry (West End and Broadway).Through a close analysis of two ageing female characters (Madame Armfeldt and Grandma) in the musicals A Little Night Music and Billy Elliot, this article discusses and critiques preconceptions of ageing in the dramaturgy and performance of these roles, and it argues that musicals frequently fail to give agency to the voice of their ageing women.

Interlimb kinetic asymmetries during the tuck jump assessment are more exposed following kinetic stabilization

ObjectiveTo analyse interlimb kinetics and asymmetries during the tuck jump assessment (TJA), before and after kinetic stabilization, to identify injury risk in healthy female athletes. DesignCross-sectional study. SettingLaboratory. ParticipantsTwenty-five healthy females (age 21.0 ± 1.83 yrs; height 1.68 ± 0.06 m; body mass 69.4 ± 10.7 kg). Main outcome measuresKinetics were measured during 10-s trials of the TJA and absolute asymmetries compared, before and after kinetic stabilization using paired sample t-tests. Statistical parametric mapping (SPM) compared vertical ground reaction force (VGRF) data for each limb during the jumping cycles before and after stabilization. ResultsSmall to moderate increases in interlimb asymmetries were observed after stabilization for VGRF, relative vertical leg stiffness, average loading rate, total and propulsive impulse, peak braking and propulsive force (p < 0.05). SPM revealed significant interlimb differences between 77-98% and 83–99% of ground contact for the jumping cycles pre- and post-stabilization respectively. ConclusionsLarger asymmetries were evident after kinetic stabilization, with increased VGRF in the non-dominant limb. We speculate that participants sacrificed interlimb landing symmetry to achieve kinetic stability, which may reflect a primal landing strategy that forgoes movement quality. Assessing lower limb biomechanics using the TJA should involve examining kinetic stability and interlimb kinetic asymmetries.

Safety of high-risk diabetic patients during Ramadan at a tertiary care hospital in Pakistan, practicing updated IDF DAR guidelines

Objective: To determine trend of following medical advice and safety of high-risk diabetic patients during Ramadan practicing updated IDF DAR guidelines.&#x0D; Methods: The cross-sectional study was conducted at Outpatient Department of Diabetes, Endocrinology and Metabolic Disorders Hayatabad Medical Complex Peshawar, Pakistan from April to June 2022, and comprised of high-risk diabetic patients (&gt;6.0) based on updated IDF-DAR guidelines 2022 intending to fast. A questionnaire was designed to document patient risk factors score, type and duration of diabetes, HbA1c, comorbidities and complications developed during Ramadan. Data was analyzed using SPSS 20.&#x0D; Results: Among all 130 participants, 78(60%) followed medical advice and did not fast and 52(40%) patients fasted against medical advice during month of Ramadan. Out of 130 participants, 89.2% were having type-2 diabetes Mellitus, 55.4% were female and mean age of participants was 52+14.6.40%. In fasting group, 57.7% were in the age range of 16 to 50 years while in non-fasting group 69.2% participants were more than 50 years old (P-value 0.031). There were 80.8% female participants in fasting group versus 38.5% in non-fasting group (P-value 0.001). Hypoglycemia occurred in 58.3% patients in fasting group and 29.3% non-fasting group. (P-value 0.021). On the other hand, 27.8% patients in fasting group and 55.2% of non-fasting group had hyperglycemia (P-value 0.025).&#x0D; Conclusion: Despite advised against fasting in these high-risk patients as per IDF DAR guidelines, almost half of patients fasted considering fasting a religious obligation. Those who fasted had significant hypoglycemia despite adjustment of medications as in guidelines. There is need of more intensive education before fasting, especially in high-risk diabetic patients.&#x0D; doi: https://doi.org/10.12669/pjms.40.5.8007&#x0D; How to cite this: Farooq Q, Ghaffar T, Malik SE, Aamir AH. Safety of high-risk diabetic patients during Ramadan at a tertiary care hospital in Pakistan, practicing updated IDF DAR guidelines. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.8007&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Seroprevalence of Toxoplasma gondii Antibodies and Associated Risk Factors Among Women in Zakho City, Iraq.

Toxoplasmosis, an infectious disease caused by the obligate intracellular protozoan parasite, poses varying degrees of risk, ranging from asymptomatic cases in immunocompetent individuals to severe, life-threatening conditions in immunocompromised individuals and developing fetuses, especially when infection occurs during early pregnancy. While the disease is endemic in Iraq, there is a notable lack of precise information regarding its seroprevalence among females of childbearing age and pregnant women, along with associated risk factors in the Zakho district. This cross-sectional study aimed to address this gap by determining the prevalence of anti-Toxoplasma gondii IgG and IgM antibodies using the ELISA assay. The study involved 610 females aged 18-79 years from various residential areas within Zakho district, Iraq. The findings revealed a seroprevalence of 32.46% for anti-Toxoplasma IgG antibodies and 8.86% for IgM antibodies. Significant variations in IgG antibody seroprevalence were observed across different age groups (P=0.008), with the highest prevalence noted among those aged 46-55 years (47.73%). Conversely, IgM antibody seroprevalence, while non-significant (P>0.05), displayed the highest rate of 10.05% among ages 18-25 years. The study identified residence as a variable significantly associated with toxoplasmosis. Additionally, contact with cats, marital status, a history of abortion, and the consumption of homemade food showed significant associations with anti-Toxoplasma IgM antibodies only. These findings strongly suggest that Toxoplasma gondii is a prevalent causative agent of infection in Zakho city, Iraq. This study contributes valuable insights into the seroprevalence and associated risk factors, providing a foundation for targeted interventions and further research in this region.

Lifestyle-Driven Variations in Nutrimiromic MicroRNA Expression Patterns across and beyond Genders.

The importance of diet and lifestyle in maintaining overall health has long been recognised. MicroRNAs (miRNAs) have emerged as key players in the intricate interplay between health and disease. This study, including 305 participants, examined the role of miRNAs from capillary blood as indicators of individual physiological characteristics, diet, and lifestyle influences. Key findings include specific miRNAs associated with inflammatory processes and dietary patterns. Notably, miR-155 was associated with subjects with metabolic diseases and upregulated in age. Additionally, the study revealed diet-related miRNA expressions: high consumption of vegetables, fruits, and whole grains correlated with increased levels of miR-let-7a and miR-328, both implicated in anti-inflammatory pathways, and decreased expression of pro-inflammatory miR-21. In the context of smoking, we found a significant decrease in miRNA-142, known for its downregulation in lung cancer. We observed a sex-biased expression of various miRNAs with significant upregulation of miR-151a in females and a higher expression of miR-155 in ageing females, representing a possible mechanism for the increased susceptibility to autoimmune diseases. In conclusion, the study underscores the significant influence of lifestyle, nutrition, and sex on miRNA profiles. Circulating miRNAs demonstrate significant potential as biomarkers in personalized medicine, highlighting their utility in tailoring healthcare to individual needs.

Predictors of mortality in acute encephalitis syndrome in children

Encephalitis is an important cause of morbidity, mortality and neurological sequelae in children globally. Causes are diverse and include viral and non-viral etiology as well as autoimmune processes. In the west autoimmune encephalitis are now most common than any single infectious cause, but in India infectious causes are still most common. It is critical to evaluate the immediately to reduce mortality and sequalae in Acute Encephalitis Syndrome (AES) patients. This study has been done to find out different predictors of mortality in outcome of AES at the end of hospital stay. To find out the predictors of mortality in children with acute encephalitis syndrome between age group of 1 month to 14 years. This was a cross sectional analytical study conducted over a period of two years. A total of 310 subjects were included in the study. Different clinical and laboratory parameters were taken to know the different significant predictors of mortality. A total of 310 cases were taken for the study from the age group of 1 month to 14 years. Out of these AES cases 22.5% cases died and 77.5% patients were discharged. Higher mortality was seen in 11-14 years of age group and females had higher mortality as compared to males. Only 5 variables that is refractory seizure, GCS&amp;#60;8, features of raised ICT, shock and requirement of ventilatory support were found to be significant (p&amp;#60;0.05) in predictors of mortality. Other variables like age, sex, socioeconomic status, fever altered sensorium, seizure, meningeal sign, laboratory investigations like serum sodium, total leucocyte count, serum creatinine, duration of hospitalisation were not found to be significant(p&amp;#62;0.05). AES is a disorder of multiple and varying etiology with significant mortality and morbidity. Early diagnosis, appropriate investigation, prompt management go a long way in reducing mortality and sequalae in AES. Refractory seizure, Glasgow Coma Score&amp;#60;8, features of raised Intracranial Tension, Shock and requirement of ventilatory support prognosticate the outcome of Acute Encephalitis Syndrome.

T-cell count and T-cell telomere length in patients with severe COVID-19.

Lymphocyte telomere length (TL) is highly variable and shortens with age. Short telomeres may impede TL-dependent T-cell clonal expansion with viral infection. As SARS-CoV-2 infection can induce prolonged and severe T-cell lymphopenia, infected adults, and particularly older adults with short telomeres, may display severe T-cell lymphopenia. To examine the relationship between T-cell TL parameters and T-cell counts, we studied 40 patients hospitalized with severe COVID-19. T-cells were isolated from lymphocytes, counted using flow cytometry, and their TL parameters were measured using the Telomere Shortest Length Assay. The cohort (median age = 62 years, 27% female) was racially and ethnically diverse (33% White, 35% Black, and 33% Other). On intensive care unit study day 1, T-cell count (mean=1.03 x109/L) was inversely related to age (p=0.007) and higher in females than males (p=0.025). Mean TL was 3.88 kilobases (kb), and 45.3% of telomeres were shorter than 3 kb. Using multiple regression analysis and adjusting for age and sex, T-cell count decreased with increased proportion of T-cell telomeres shorter than 3 kb (p=0.033) and increased with mean TL (p=0.052). Our findings suggest an association between the buildup of short telomeres within T-cells and explain in part reduced peripheral blood T-cell counts in patients with severe COVID-19. Shortened T-cell telomeres may be a risk factor for COVID-19-associated T-cell lymphopenia.

Preoperative Opioid Use and Postoperative Outcomes in Patients Undergoing Microvascular Decompression for Trigeminal Neuralgia.

The prescription of opioid analgesics for trigeminal neuralgia (TN) is controversial, and their effect on postoperative outcomes for patients with TN undergoing microvascular decompression (MVD) has not been reported. We aimed to describe the relationship between preoperative opioid use and postoperative outcomes in patients with TN undergoing MVD. We reviewed the records of 920 patients with TN at our institution who underwent an MVD between 2007 and 2020. Patients were sorted into 2 groups based on preoperative opioid usage. Demographic information, comorbidities, characteristics of TN, preoperative medications, pain and numbness outcomes, and recurrence data were recorded and compared between groups. Multivariate ordinal regression, Kaplan-Meier survival analysis, and Cox proportional hazards were used to assess differences in pain outcomes between groups. One hundred and forty-five (15.8%) patients in this study used opioids preoperatively. Patients who used opioids preoperatively were younger (P = .04), were more likely to have a smoking history (P < .001), experienced greater pain in modified Barrow Neurological Institute pain score at final follow-up (P = .001), and were more likely to experience pain recurrence (P = .01). In addition, patients who used opioids preoperatively were more likely to also have been prescribed TN medications including muscle relaxants and antidepressants preoperatively (P < .001 and P < .001, respectively). On multivariate regression, opioid use was an independent risk factor for greater postoperative pain at final follow-up (P = .006) after controlling for variables including female sex and age. Opioid use was associated with shorter time to pain recurrence on Kaplan-Meier analysis (P = .005) and was associated with increased risk for recurrence on Cox proportional hazards regression (P = .008). Preoperative opioid use in the setting of TN is associated with worse pain outcomes and increased risk for pain recurrence after MVD. These results indicate that opioids should be prescribed cautiously for TN and that worse post-MVD outcomes may occur in patients using opioids preoperatively.

Earthquake as a Trigger of Acute Attacks in People with Hereditary Angioedema

Objectives: Two major earthquakes with 7.7 and 7.6 magnitudes struck the southeastern region of Turkey on February 6th, 2023. Hereditary angioedema (HAE) is an inherited disease that can be worsened by psychological factors and physical trauma.Our study aimed to evaluate the effect of earthquake and earthquake-related anxiety, depression and stress factors in HAE patients.&#x0D; Methods: The study was conducted on patients with HAE who are located in the southeastern region of Turkey.The mental-health-status was evaluated with Depression-Anxiety-Stress-Scale(DASS-21).&#x0D; Results: Sixty-three HAE patients were includedin the study. More than half(n:33, 52.4%) were female andthe median age was 31(26-42) years. DASS-Stress, DASS-Anxiety,and DASS-Depression scores revealed that 25(39.7%), 37(58.7%) and 32(50.8%) patients had abnormal stress, anxiety and depression status, respectively. The numbers of post-earthquake attacks and icatibant injections were significantly higher than the ones in the pre-earthquake period(p

Incidence, Prevalence, Risk Factors, and Clinical Treatment for Children with Developmental Dysplasia of the Hip in Saudi Arabia. A Systematic Review.

Developmental dysplasia of the hip (DDH) leads to pain, joint instability, and early degenerative joint disease. Incidence, prevalence, and management strategies of DDH have been well-documented in several countries, but not in Saudi Arabia. We synthesized the current evidence regarding incidence, prevalence, risk factors, and clinical treatment for children with DDH in Saudi Arabia. We searched 3 databases to locate studies. Studies that included children with DDH in Saudi Arabia; reported either incidence rate, prevalence, risk factors, and/or clinical practice; and were available in English or Arabic were included. We excluded reviews, case studies, or animal studies. Two independent authors reviewed potential studies and assessed study's quality. Our search yielded 67 potential studies, of which 16 studies were included (total DDH sample = 3,127; age range = 2.5 to 86.4 months). Three studies reported incidence rates ranging from 3.1 to 4.9 per 1000 births, and 3 studies reported prevalence ranging from 6 to 78%. Nine studies reported that female sex, breech position, family history, and age less than 3 years were risk factors associated with DDH. Four studies reported that brace applications and closed reduction were conservative treatments, and 9 studies reported that open hip reduction, adductor tenotomy, and/or pelvic osteotomy were surgical approaches to treat DDH. In Saudi Arabia, the Incidence and prevalence rates of DDH are 3.1 to 4.9 per 1,000 births, and 6-78%, respectively (differ from what has been reported in other countries), but the risk factors of DDH in Saudi Arabia appear to be similar in comparison to other countries (female, breech presentation, family history of DDH).

Influence of social determinants of health in the evolution of the quality of life of older adults in Europe: A comparative analysis between men and women

Population aging is a global phenomenon due to declining birth rates and increased life expectancy. This demographic shift poses a challenge to society, requiring adaptation of policies, economies, and healthcare systems to safeguard the well-being of older individuals. Health inequalities, influenced by social determinants such as education, economic status, and place of residence, impact this population group, with notable differences between men and women. Several studies have demonstrated that social determinants of health (SDH) affect the quality of life (QoL) of older individuals, especially women. In general, women report lower quality of life indicators, lower educational levels, and poorer health compared to men. This study aims to examine how social determinants of health can influence the quality of life of the population aged 50 or older in different European countries, from a sex perspective, through a longitudinal approach. The main SDHs associated with poorer QoL were female sex advanced age, economic hardship, educational level, and geographic location within Europe. Depression in women and men in Southern Europe was associated with a decrease in QoL scores.

Barriers to Cardiac Rehabilitation among Patients Diagnosed with Cardiovascular Diseases-A Scoping Review.

Cardiovascular diseases (CVDs) are a rising global burden. Preventative strategies such as cardiac rehabilitation (CR) have shown a marked reduction in disease burden. Despite this, CR is underutilized worldwide. This study aims to identify the barriers to CR among patients diagnosed with CVD. A scoping review of the literature was conducted following the Joanna Briggs Institute (JBI) guidelines. Four major databases, including CINAHL, PubMed, EBSCOhost, and Scopus, were used to obtain studies published between 2010 and 2023. Search terms such as "Cardiac rehab*", "Barrier*", "Cardiovascular", "Disease", and "diagnosis*" were utilized in order to obtain subject-specific studies relevant to the research question. From the initial 2098 studies, only 14 were included in the final analysis, consisting of both qualitative and quantitative designs. The thematic analysis included "healthcare system-related factors", "Socioeconomic factors", and "individual characteristics". Healthcare system-related factors were mostly related to the poor availability of CR programs, lack of proper referral strategies, inadequate knowledge of CR provider and inter-provider communication issues, and lack of alternative methods of CR delivery. The socioeconomic barriers were lack of education, longer distance to CR facilities, high cost of care, unemployment, and poor income status. The identified individual characteristics were female gender, older age, and comorbidities. Lack of resources, poor access, educational attainment, and high cost of care were some of the barriers to CR, particularly in low- and middle-income countries (LMICs). Health policymakers and healthcare providers should implement strategies incorporating the issues identified in this scoping review. Systematic reviews may be required to confirm these findings.

Effects of total gonadotropin dose on embryo quality and clinical outcomes with AMH stratification in IVF cycles: a retrospective analysis of 12,588 patients

BackgroundRecent studies about the effect of gonadotropin (Gn) dose on the clinical outcomes of IVF are still controversial, and no studies have analyzed the relationship between Gn dose and embryo quality. Since AMH is a strong predictor of oocyte quality, we aim to evaluate the relationship between total Gn dose and embryo quality and clinical outcomes at different AMH levels in IVF cycles.MethodsA total of 12,588 patients were enrolled in the retrospective study. The included cycles were categorized by serum AMH levels (AMH ≤ 1 ng/ml, 1 ng/ml < AMH ≤ 3 ng/ml, 3 ng/ml < AMH ≤ 5 ng/ml, AMH > 5 ng/ml), total Gn dosage (< 1875 IU, 1875–3750 IU and ≥ 3750 IU) and female age (< 35 years and 35–42 years). The embryo quality and clinical outcomes were the measure outcomes.ResultsThe top-day3 embryos rate decreased with the increase of total Gn dose in nearly all age and AMH subgroups, but this trend was not obvious in the AMH > 5 ng/ml group and AMH ≤ 1 ng/ml group. The blastocyst formation rate and high-quality blastulation rate had a negative relationship with Gn does for women aged < 35 years in the AMH ≤ 5 ng/ml groups, except for the AMH > 5 ng/ml group (P < 0.001). However, when women were 35–42 years old, regardless of AMH levels, the blastocyst formation rate and high-quality blastulation rate decreased as Gn dose increased. Clinical outcomes (implantation rate, clinical pregnancy rate and live birth rate) decreased with the increase of Gn dose in all ages and AMH stratifications.ConclusionsThe total dose of Gn may have different effects on embryo quality at different serum AMH levels, and the negative effects of total dose of Gn on clinical outcomes may be realized by impairing both embryo quality and endometrium.

Explaining and predicting the increased thorax injury in aged females: age and subject-specific thorax geometry coupled with improved bone constitutive models and age-specific material properties evaluated in side impact conditions.

Predicting and understanding thorax injury is fundamental for the assessment and development of safety systems to mitigate injury risk to the increasing and vulnerable aged population. While computational human models have contributed to the understanding of injury biomechanics, contemporary human body models have struggled to predict rib fractures and explain the increased incidence of injury in the aged population. The present study enhanced young and aged human body models (HBMs) by integrating a biofidelic cortical bone constitutive model and population-based bone material properties. The HBMs were evaluated using side impact sled tests assessed using chest compression and number of rib fractures. The increase in thoracic kyphosis and the associated change in rib angle with increasing age, led to increased rib torsional moment increasing the rib shear stress. Coupled with and improved cortical bone constitutive model and aged material properties, the higher resulting shear stress led to an increased number of rib fractures in the aged model. The importance of shear stress resulting from torsional load was further investigated using an isolated rib model. In contrast, HBM chest compression, a common thorax injury-associated metric, was insensitive to the aging factors studied. This study proposes an explanation for the increased incidence of thorax injury with increasing age reported in epidemiological data, and provides an enhanced understanding of human rib mechanics that will benefit assessment and design of future safety systems.