Longitudinal Study Research Articles

Early childhood risk factors for later onset of pediatric chronic pain: a multi-method longitudinal study

BackgroundPediatric chronic pain (i.e., pain lasting ≥ 3 months) is prevalent, disabling, and costly. It spikes in adolescence, interrupts psychosocial development and functioning, and often co-occurs with mental health problems. Chronic pain often begins spontaneously without prior injuries and/or other disorders. Prospective longitudinal cohort studies following children from early childhood, prior to chronic pain onset, are needed to examine contributing factors, such as early pain experiences and mental health. Using data from a longitudinal community pregnancy cohort (All Our Families; AOF), the present study examined the associations between early developmental risk factors, including early childhood pain experiences and mental health symptoms, and the onset of pediatric chronic pain at ages 8 and 11 years.MethodsAvailable longitudinal AOF data from child age 4 months, as well as 1, 2, 3, 5, 8, and 11 years, were used. Mothers reported their child’s pain experiences (e.g., hospitalizations, vaccinations, gut problems) at each timepoint from 4 months to 8 years, child chronic pain at age 8, and child mental health symptoms at ages 5 and 8 years. Children reported their chronic pain frequency and interference at age 11. Adaptive least absolute shrinkage and selection operator (LASSO) regressions were used to select predictor variables. Complete case analyses were complemented by multiple imputation using chained equation (MICE) models.ResultsGut problems, emergency room visits, frequent pain complaints, and headaches at age 5 or earlier, as well as female sex, were associated with increased risk of maternal reported child chronic pain at age 8. Maternal reported chronic pain at age 8 was associated with higher levels of child-reported pain frequency and pain interferences at age 11. Boys self-reported lower levels of pain interference at age 11.ConclusionsSome, but not all, painful experiences (e.g., gut problems, ER visits, pain complaints) in early life contribute to pediatric chronic pain onset and should be considered for screening and early intervention.

Outcomes and Survival for Early-Stage Non-Small Cell Lung Cancer Following Wedge Resection or Lobectomy: A Propensity Score-Matched Analysis Using a Novel Peruvian Registry.

Using a previously unreported Peruvian registry of patients treated for early-stage non-small cell lung cancer (NSCLC), this study explored whether wedge resection and lobectomy were equivalent regarding survival and impact on radiologic-pathologic variables. This observational, analytical, longitudinal study used propensity score-matched (PSM) analysis of a single-center retrospective registry of 2,570 patients with pathologic stage I-II NSCLC who were treated with wedge resection (n=1,845) or lobectomy (n=725) during 2000-2020. After PSM, 650 cases were analyzed (resection, n=325; lobectomy, n=325) through preoperative and clinical variables, including patients with ≥1 lymph node removed. Kaplan-Meier curves and multivariable Cox proportional hazard models were created for 5-year overall survival (OS), disease-free survival (DFS), and locoregional-recurrence-free survival (LRFS). The principal complication was operative pain persisting >7 days for lobectomy versus wedge resection (58% vs. 23%, p=0.034) and shorter hospital stays for resection than for lobectomy (5.3 days vs. 12.8 days, p=0.009). The 5-year OS (84.3% vs. 81.2%, p=0.09) and DFS (79.1% vs. 74.1%, p=0.07) were similar and statistically insignificant between resections and lobectomies, respectively. LRFS was worse overall following wedge resection than lobectomy (79.8% vs. 91.1%, p<0.02). Nevertheless, in the PSM analysis, both groups experienced similar LRFS when the resection margin was >10 mm (90.9% vs. 87.3%, p<0.048) and ≥4 lymph nodes were removed (82.8% vs. 79.1%, p<0.011). Both techniques led to similar OS and DFS at 5 years; however, successful LRFS required a wedge resection with a surgical margin and adequate lymph node removal to obtain outcomes similar to lobectomy.

Cardiometabolic criteria as predictors and treatment targets of liver-related events and cardiovascular events in metabolic dysfunction-associated steatotic liver disease.

The diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) requires at least one of five cardiometabolic criteria. It is unclear whether these criteria can be used as predictors and treatment targets for complications including liver-related events and major adverse cardiovascular events (MACE). To investigate the relationship between cardiometabolic criteria and complications. We conducted a nationwide, population-based study of 979,352 patients with MASLD. We investigated relationships between a number of criteria at baseline and liver-related events or MACE risks. In a separate longitudinal analysis, we included patients with five criteria at baseline and investigated the relationship between improving the criteria and the incidence of complications after 1 year. The cumulative incidence of MACE, but not liver-related events, increased with increasing baseline cardiometabolic criteria. In the longitudinal study, multivariable analysis using patients with five criteria (no improvement) as the reference, adjusted hazard ratios (95% confidence interval) of MACE in patients with 4, 3, 2, and 0-1 criteria (1 to 4-5 criteria improvement) were 0.55 (0.52-0.58, p < 0.001), 0.20 (0.17-0.22, p < 0.001), 0.13 (0.11-0.16, p < 0.001), and 0.06 (0.02-0.3, p < 0.001), respectively. The risk of MACE decreased as the cardiometabolic criteria improved. There was no significant association between improvement of the criteria and liver-related events. Cardiometabolic criteria can be used as predictors and treatment targets for cardiovascular event risk in MASLD. Developing predictors and therapeutic targets for liver-related events is a future challenge.

Mepolizumab depletes inflammatory but preserves homeostatic eosinophils in severe asthma.

Eosinophils are key therapeutic targets in severe asthma that are suppressed by IL5 (mepolizumab) and IL5 receptor (benralizumab) blockade. The effect of IL5 pathway biologics on recently described homeostatic (hEOs) and inflammatory (iEOs) eosinophil subsets is unknown. We aimed to determine the relative impact of mepolizumab and benralizumab treatment on eosinophil subset and phenotype, and explore clinical associations of eosinophil subsets with severe asthma characteristics and treatment response. We performed a cross-sectional observational study of severe asthma (eosinophilic n = 32, non-eosinophilic n = 23, mepolizumab-treated n = 25), with longitudinal follow-up of 30 eosinophilic participants at two timepoints (4-24 weeks, >24 weeks) post-commencement of mepolizumab (n = 20) or benralizumab (n = 10). Blood hEOs and iEOs were measured by flow cytometry assessment of surface CD62L protein. iEO proportion was significantly lower in mepolizumab-treated participants in both the cross-sectional and longitudinal study. Mepolizumab and benralizumab depleted iEOs to a similar extent, however a significantly greater number of hEOs remained in mepolizumab participants at follow-up. Greater iEO proportion correlated with poorer asthma control in eosinophilic but not non-eosinophilic asthma. Higher residual iEO proportion correlated with poorer asthma control in mepolizumab-treated individuals. Reduced blood eosinophil viability was observed in around half of mepolizumab-treated participants, which was associated with significantly better asthma control and spirometry. Mepolizumab depletes iEOs and reduces circulating eosinophil viability in severe asthma but preserves a residual population of circulatory hEOs. In contrast benralizumab depleted both iEOs and hEOs. Higher iEO abundance and eosinophil viability are associated with poorer clinical outcomes following mepolizumab-treatment. Monitoring circulating eosinophil phenotype and viability may be useful to predict biologic treatment response in severe asthma.

Informing the management of the post-COVID condition: insights from the Western Australian experience comparing those who tested positive and negative to early COVID-19 strains.

ObjectiveThis study aimed to compare the relative physical recovery and symptoms after SARS-CoV-2 infection between groups confirmed positive or negative to early strains of COVID-19.MethodsA prospective, longitudinal cohort study compared outcomes of metropolitan adults polymerase chain reaction-tested for COVID-19 between March and November 2020 in Western Australia. Control matching was attempted: inpatients (gender, age) and ambulatory clinic (gender, age, asthma, chronic pulmonary disease). One-year follow-up involved three repeated measures: physical function (grip strength and 1-min sit-to-stand) and patient-reported outcomes (Fatigue Severity Scale, modified Medical Research Council dyspnoea scale and Euroqol-5D-5L).ResultsThree hundred and forty-four participants were recruited (154 COVID+, age 54±18years, 75 females [49%]); 190 COVID-, age 52±16years, 67 females [35%]) prior to national vaccination roll-out. No between-group differences in physical function measures were evident at any time point. Fatigue (OR 6.62, 95% CI 2.74-15.97) and dyspnoea (OR 2.21, 95% CI 1.14-4.30) were higher in the COVID+ group at second assessment (T2). On Euroqol-5D-5L, no between-group differences were evident in the physical function domains of self-care, mobility or usual activities at any time point. However, COVID+ participants were less likely to report an absence of anxiety or depression symptoms at T2 (OR 0.41, 95% CI 0.19-0.89).ConclusionsNeither statistical nor clinically meaningful differences in physical function were evident between COVID+ and COVID- participants to 12-months after acute illness. Symptoms of fatigue, dyspnoea, anxiety or depression were more prevalent in the COVID+ group til ~8months after illness with between-group differences no longer evident at 1 year.

Development and psychometric properties of the Japanese version of Child and Youth Resilience Measure-Revised (CYRM-R) among Japanese youth

Objectives Resilience is the ability to navigate adversity and recover from challenging situations. Developing resilience at a young age promotes mental health and provides benefits throughout one's lifespan. Validated measures for assessing resilience at a young age are required in both clinical practice and epidemiological studies. The Child and Youth Resilience Measure-Revised (CYRM-R) is a tool used worldwide to assess resilience in children and young people. The objective of this study was to develop a Japanese version of the CYRM-R and investigate its psychometric properties.Methods Children in grades 5-9 were recruited via a two-stage cluster random sampling taken from the Japan Adolescent and Youth (JAY) Longitudinal Cohort Study. The participants completed the Japanese version of the CYRM-R . The CYRM-R consists of two subscales, personal resilience and caregiver resilience, with a total of 17 items. The linguistic validity of the Japanese version of the CYRM-R was ensured through translation and back-translation.Cronbach's alpha coefficients were examined for the total score and the two subscales to assess the internal consistency of the Japanese version of the CYRM-R scale. In addition, correlation coefficients of the subscales were calculated. For factorial validity, a confirmatory factor analysis was conducted on the same two-factor structure as in the original version to assess the model's goodness of fit. Results A total of 2,266 children (50.0% male) were included in the study. The overall Cronbach's alpha of the Japanese version of the CYRM-R obtained from this sample was 0.956; For the personal resilience subscale, Cronbach's alpha was 0.932; for the caregiver resilience subscale, it was 0.919. Significant positive correlations were also found between subscales (r = 0.827, p < 0.001). A confirmatory factor analysis was conducted using a two-factor structure for validity. The model fit was good (RMSEA = 0.085, SRMR = 0.041, CFI = 0.934).Conclusion The Japanese version of the CYRM-R maintained the same two-factor structure as the original version. The study findings showed that the Japanese version of the CYRM-R had adequate internal consistency and factorial validity for assessing resilience in children and youth. Therefore, this scale is a valuable tool for identifying individuals or groups at risk in terms of children's resilience and for evaluating the effectiveness of support and interventions.

Association of Free Thyroxine with Progression-Free Survival in Intermediate and High Risk Differentiated Thyroid Cancer.

Supraphysiologic thyroxine (T4) doses are used in intermediate and high-risk patients with differentiated thyroid cancer (IR/HR-DTC) to suppress tumor progression by thyrotropin (TSH). However, preclinical data suggest that T4 can also act as a growth stimulus for cancer, but there is no clinical evidence supporting this claim. We analyzed the association between free T4 (FT4) and progression-free survival (PFS) in patients with IR/HR-DTC. This longitudinal cohort study, approved by multi-institutional review board, included patients with IR/HR-DTC treated uniformly with total thyroidectomy, radioiodine (RAI), and TSH suppression therapy, with at least three TSH and FT4 values available. Association between FT4 and PFS at landmarks 6, 12, and 18 months was assessed by Kaplan-Meier survival curves, while competing risks were assessed through Cox proportional hazards model. From 739 screened patients 382 met the inclusion criteria and were characterized by a median age of 46 (34-59) years, 64.1% women, treated with a median RAI dosage of 159 (110-410) mCi. During follow up of 7.1 (3.4-12.7) years 34.6% experienced disease progression.Elevated FT4, observed in 29.3% of patients, was not associated with worse PFS (HR 0.9, CI 0.54-1.5, p=0.69), while age (HR 1.02, CI 1.004-1.04, p=0.01), tumor size (HR 1.15, CI 1.04-1.28, p=0.01), and metastases to the lateral neck lymph nodes (HR 2.9, CI 1.7-4.74, p<0.001), bones (HR 4.87, CI 1.79-13.3, p=0.002), and brain (HR 5.56, CI 2.54-12.2, p<0.001) were associated with shorter PFS. Contrary to preclinical evidence, elevated FT4 levels do not affect PFS in patients with IR/HR-DTC.

Prevalence and associated factors of napping among older adults in the Philippines.

The aim of the study is to estimate the prevalence and associated factors of insomnia among older adults in the Philippines. In all, 5206 cross-sectional nationally representative data from older adults (≥ 60 years) of the 2018 Longitudinal Study on Ageing and Health in the Philippines (LSAHP) was analysed. Napping frequency and duration were assessed by self-report. The prevalence of regular nappers was 35.7%, low or moderate napping (1-59min) was 10.5% and long napping (≥ 60min) duration was 25.2%. In the final adjusted model, older age was not significantly associated with low or moderate napping duration but older age was positively associated with long napping duration. High wealth status, physical activity and late insomnia were positively associated with low or moderate napping duration. High wealth status, urban residence, daily activity limitations, and physical activity were positively associated, and currently working status, poor self-rated health status and current alcohol use were negatively associated with long napping duration. One in four older adults reported long napping duration. Sociodemographic, health status and behaviour and sleep parameters were associated with low or moderate and/or long napping duration.

Loneliness as health risk: anarrative review

Loneliness is increasingly recognized as asignificant health risk. This review provides an overview of current research on the impact of loneliness on mental and physical health. The findings indicate that loneliness is asignificant risk factor of both mental and physical health. Previous reviews focusing on mental health effects reveal that loneliness is associated with the onset of depression, social anxiety, and cognitive decline. Furthermore, loneliness can impede recovery from mental disorders in general, which can be partly attributed to the bidirectional interplay between loneliness and mental health. Regarding physical health, consequences of loneliness have been mostly studied in relation to cardiovascular diseases. Loneliness predicts the onset of cardiovascular diseases and impedes recovery from them. Reviews also highlight that loneliness enhances the likelihood of suicidality and mortality. However, this article also points out the shortage of longitudinal studies, complicating the investigation into how loneliness causally affects future health problems. The health implications of loneliness outlined in this review, some of which are irreversible and can induce suffering and impairment, underscore the importance of interventions aimed at alleviating loneliness as apreventive strategy against both mental and physical illnesses.

Longitudinal Relations among Self-Compassion, Self-Esteem, and Depressive Symptoms in College Students: Disentangling the Within-Person Process from Stable Between-Person Differences.

Although previous studies have shown that self-compassion is associated with self-esteem and depressive symptoms, little is known about the intra-individual processes and the temporal dynamics of these variables. This study used a longitudinal design to explore the association between self-compassion, self-esteem and depressive symptoms among 5785 college students (aged 17-22 years; Mage = 18.63, SD = 0.88; 48.2% females). The participants were assessed six times in a six-month interval over three years. The random intercept cross-lagged panel models (RI-CLPMs) were used to disentangle within-person processes from stable between-person differences. Results of RI-CLPMs indicated that at the within-person level, self-compassion can positively predict subsequent self-esteem and negatively predict subsequent depressive symptoms, and vice versa. Self-esteem played a longitudinal mediating role in the prediction from self-compassion to depressive symptoms at the within-person level. These results indicate that cultivating self-compassion in college students is crucial as it can bolster their self-esteem and alleviate depressive symptoms.

Outcomes 10-years after traumatic spinal cord injury in Botswana - a long-term follow-up study

Study designProspective follow-up study.ObjectivesTo describe outcomes, survival, and attendance to routine follow-up visits 10 years post-SCI.SettingThe national SCI-rehabilitation center in Botswana.MethodsAll persons who were admitted with traumatic SCI during a 2-year period, 2011–2013, and survived up to 2 years post-injury were included. Data were collected from the medical records from the follow-up assessment closest to 10 years post-SCI and included demographic and clinical characteristics, functional outcomes, and secondary complications. Data regarding mortalities were received from relatives. Statistical comparisons were made, when possible, between those who attend follow-up assessment and those who did not, and between those who survived up to 10 years post-SCI and those who died.ResultsThe follow-up rate was 76% (19/25) of known survivors. No statistically significant factors were found to affect the follow-up rate. Secondary complications rates were for pressure ulcers and urinary tract infections 21%. Self-catheterisation and suprapubic catheter were the preferred methods to manage neurogenic bladder dysfunction. Ten persons (26%) had deceased since 2nd follow-up assessment. The causes of death were probably SCI-related in more than half of the cases.ConclusionsThis was a follow-up study at year 10 after acute TSCI in Botswana conducted at the national SCI-rehabilitation center. The study supports previous reports regarding the importance of that having specialized SCI units and the need of structured follow-ups, a responsible person in charge of scheduling, and updated patient registers. We found high follow-up rate, low rates of complications and of patients being lost to follow-up.

Identification and prediction of frailty among community-dwelling older Japanese adults based on Bayesian network analysis: a cross-sectional and longitudinal study

BackgroundFrailty is a multifactorial syndrome; through this study, we aimed to investigate the physiological, psychological, and social factors associated with frailty and frailty worsening in community-dwelling older adults.MethodsWe conducted a cross-sectional and longitudinal study using data from the “Community Empowerment and Well-Being and Healthy Long-term Care: Evidence from a Cohort Study (CEC),” which focuses on community dwellers aged 65 and above in Japan. The sample of the cross-sectional study was drawn from a CEC study conducted in 2014 with a total of 673 participants. After excluding those who were frail during the baseline assessment (2014) and at the 3-year follow-up (2017), the study included 373 participants. Frailty assessment was extracted from the Kihon Checklist, while social relationships were assessed using the Social Interaction Index (ISI). Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and their predictive abilities were tested. Factors associated with frailty status and worsening were identified through the Maximum-min Hillclimb algorithm applied to Bayesian networks (BNs).ResultsAt baseline, 14.1% (95 out of 673) participants were frail, and 24.1% (90 out of 373) participants experienced frailty worsening at the 3-years follow up. LASSO regression identified key variables for frailty. For frailty identification (cross-sectional), the LASSO model’s AUC was 0.943 (95%CI 0.913–0.974), indicating good discrimination, with Hosmer–Lemeshow (H–L) test p = 0.395. For frailty worsening (longitudinal), the LASSO model’s AUC was 0.722 (95%CI 0.656–0.788), indicating moderate discrimination, with H–L test p = 0.26. The BNs found that age, multimorbidity, function status, and social relationships were parent nodes directly related to frailty. It revealed an 85% probability of frailty in individuals aged 75 or older with physical dysfunction, polypharmacy, and low ISI scores; however, if their social relationships and polypharmacy status improve, the probability reduces to 50.0%. In the longitudinal-level frailty worsening model, a 75% probability of frailty worsening in individuals aged 75 or older with declined physical function and ISI scores was noted; however, if physical function and ISI improve, the probability decreases to 25.0%.ConclusionFrailty and its progression are prevalent among community-dwelling older adults and are influenced by various factors, including age, physical function, and social relationships. BNs facilitate the identification of interrelationships among these variables, quantify the influence of key factors. However, further research is required to validate the proposed model.

Handgrip Strength and Clinical Evolution of People Living with HIV: A Mini Narrative Review.

HIV infection is a worldwide epidemic. Antiretroviral therapy allows people living with HIV (PLHIV) increased longevity and a better quality of life. Among the various ways of monitoring the clinical evolution of PLHIV, handgrip strength (HGS) is a promising strategy, as this test can be used to assess the health condition quickly and at a low cost. In this sense, the present study aims to describe, through a literature review, the relationship between HGS and the clinical evolution of PLHIV, especially with morbimortality. Initially, it is highlighted that aging, HIV infection, and excess body fat are related to the loss of HGS in PLHIV. Furthermore, PLHIV is more likely to present cardiometabolic diseases that can be aggravated by reduced HGS. Thus, in people without positive HIV serology, low HGS indirectly, through the presence of risk factors or cardiometabolic diseases, or directly increases the chance of mortality. In conclusion, the lack of studies on this topic for PLHIV is highlighted, and more longitudinal studies, including control groups, are needed.

Causal evidence of the association between green and blue spaces (GBS) and maternal and neonatal health: a systematic review and meta-analysis protocol

IntroductionPrevious systematic reviews investigating the effects of green and blue space (GBS) on maternal and neonatal health have mainly focused on cross-sectional evidence, limiting potential causal inferences. The last review...

Brain Punch: K-1 Fights Affect Brain Wave Activity in Professional Kickboxers.

Kickboxing is a popular striking combat sport, and K-1 is a type of kickboxing. Direct head blows can cause significant long-term injury and affect brain wave activity. We aim to compare the changes in brain wave activities of fighters during a K-1 kickboxing contest to those in a control group, who were striking a punching bag and were not hit by another K-1 athlete. A total of 100 professional Polish K-1 kickboxers were split evenly into experimental (n = 50, age 25.5 ± 4.63years) and control (n = 50, age 26.6 ± 5.22years) groups. We used quantitative electroencephalography (QEEG) to assess the spectrum of brain wave activity (delta, theta, alpha, sensorimotor rhythm (SMR), beta-1 and beta-2) before and after an intervention (experimental: K-1 contest, control: simulated contest), with eyes open and then closed. The number of direct blows to the head was also recorded for all bouts. Comparative and statistical analyses between selected variables were performed. K-1 fighters showed elevated baseline brain activity for the entire delta band (p < 0.001). There was significant variation in brain activity among the experimental group following the intervention and compared with the control group for all wave types (p < 0.001). No significant variation in activity was found in the control group. The number of direct head blows was positively correlated with brain activity, at delta and beta-2 wave frequencies. K-1 kickboxing is associated with detectable changes in brain wave activity. It is presently unclear what the long-term effects of these changes in brain wave activities are, and longitudinal studies are necessary to study the brain health of kickboxers.

Developing a new measure of retrospective body dissatisfaction: links to postnatal bonding and psychological well-being

ABSTRACT Background Pregnancy is a transformative time for women and their bodies, and therefore thoughts and feelings about the body understandably change during this period. While previous research has established the impact of body dissatisfaction on factors like antenatal attachment and maternal mental health, there is a notable gap in understanding its long-term effects on postnatal factors. This is often due to high attrition rates in longitudinal studies. Using retrospective measures could address this issue, however a measure of retrospective pregnant body dissatisfaction has not yet been identified. Aims This paper aimed to create a retrospective measure of pregnancy body dissatisfaction by adapting a previously validated measure. It also aimed to investigate the relationship between retrospective accounts of body dissatisfaction during pregnancy and postnatal anxiety, depression, and bonding. Method Cross-sectional online survey data was collected from women postnatally (N = 404). Findings An exploratory and confirmatory factor analysis identified a two-factor model of retrospective body dissatisfaction, adapted from the Body Understanding Measure for Pregnancy Scale, which was equivalent to two of the original subscales. Using this factor structure, linear regressions demonstrated that higher levels of retrospective pregnant body dissatisfaction were associated with elevated rates of postnatal anxiety and depression and lower bonding scores. Conclusions This study successfully established a measure for assessing retrospective pregnant body dissatisfaction, potentially aiding future research. Additionally, it has highlighted the link between pregnant body dissatisfaction and postnatal levels of depression, anxiety, and bonding. Thus, improving the pregnant bodily experience may have the potential to enhance the postnatal experience.

VIVALDI ASCOT and Ethnography Study: protocol for a mixed-methods longitudinal study to evaluate the impact of COVID-19 and other respiratory infection outbreaks on care home residents’ quality of life and psychosocial well-being

IntroductionOlder adults in care homes experienced some of the highest rates of mortality from SARS-CoV-2 globally and were subjected to strict and lengthy non-pharmaceutical interventions, which severely impacted their daily...

Depression and anxiety in the context of the COVID-19 pandemic: A 6-waves longitudinal study in the Argentine population.

The pandemic has caused stress due to isolation, loss of loved ones, work and learning changes, financial instability, fear of infection, and uncertainty. It has negatively impacted mental health, particularly increasing anxiety, and depression symptoms. This study analyzed anxiety and depression symptoms over the first 25months of the COVID-19 pandemic, considering age group, socioeconomic status, and gender. A longitudinal study with 6 repeated measures was conducted, involving 988 adult participants from Argentina. Adapted versions of the BDI-II and STAI were administered through online questionnaires at 2, 14, 50, 130, 390, and 750days since the start of the lockdown. The results showed a sustained increase in anxiety and depression symptoms up to 390days, followed by a decrease in anxiety below initial levels at 750days. Depressive symptoms significantly decreased after 750days but remained higher than initial levels. Women consistently scored higher than men, lower socioeconomic status individuals reported more symptoms, and younger individuals had higher anxiety and depression, which decreased with age. Surprisingly, older individuals displayed better mental health indicators compared to the rest of the population.

Impact of a drug allergy education course for non-specialists: Findings from ADAPT-A randomized crossover trial.

The consequences of drug allergy remain a global health concern. Drug allergy is often a neglected topic and many non-specialists lack sufficient knowledge or confidence in evaluating or managing this common condition. Evidence-based interventions to better equip non-specialists to tackle drug allergy are needed. The aim of the study is to evaluate the effectiveness of an intensive educational course on drug allergy knowledge and practice of non-specialists. A randomized crossover trial (NCT06399601) was conducted among practicing physicians and nurses participating in an intensive drug allergy course-Advances in Drug Allergy & Penicillin Testing (ADAPT). Participants' baseline knowledge and self-reported practices were assessed with standardized questionnaires (scored from 0 to 100, with "satisfactory" defined as ≥60/100). Participants were randomized into two cohorts and attended ADAPT at different time points. Serial responses before and after the course were compared within and between cohorts. Seventy participants (25 physicians, 45 nurses) randomized into two groups completed the course. Baseline drug allergy knowledge (58.0 ± 19.9) and self-reported practice (36.9 ± 24.3) were unsatisfactory among non-specialists, with significantly lower scores from nurses than physicians in both domains (knowledge: 49.0 ± 17.4 vs. 74.0 ± 12.7; practice: 32.1 ± 21.3 vs. 53.3 ± 23.1; all p < 0.001). Following completion of ADAPT, participants demonstrated significant improvements in knowledge (58.0 ± 19.9 vs. 77.7 ± 15.9, p < 0.001) and self-reported practice (36.9 ± 24.3 vs. 71.0 ± 20.2, p < 0.001). All participants (100%) and 99% of participants agreed that the course improved their clinical knowledge and practice, respectively. ADAPT, an intensive drug allergy educational course was effective in improving drug allergy knowledge and practice for non-specialists. Further longitudinal studies are required to evaluate long-term impact.

Association Between Physical Activity Levels and Cognitive Function in Older Adults: A Replication Cohort Analysis Using the Brazilian Longitudinal Study of Aging

Introduction: Few studies address the complex relationship between physical activity and cognitive function in aging individuals. This topic has gained significant attention in recent years, as cognitive decline poses a substantial public health challenge. There is a lack of research focusing on the effect of physical activity on cognitive function in the Brazilian population. Purpose: Our study aims to replicate the findings of Lautenschlager et al. using a Brazilian cohort from the ELSI study, a comprehensive longitudinal study capturing aging processes and determinants among individuals in Brazil. Method: In line with the reference study, our analysis focused on individuals aged 50 and older without depression and dementia. The primary outcome was cognitive function, assessed using a summary score obtained from the ELSI study to replicate the ADAS-Cog, as in the original study. Participants were categorized into two groups: those engaging in moderate to vigorous exercise (exercise) and those who did not meet this exercise threshold (no exercise). To evaluate the relationship between exercise and cognitive function, we performed three linear regression models: one without adjustments for covariates, a second model adjusting for sex, education, and race (main model), and a third model with multiple adjustments. A sensitivity analysis using Cohen's D was also conducted. Results: In this study from the ELSI cohort, data from 7,292 individuals were available, and 6,147 met the inclusion criteria for analysis. A total of 935 individuals were excluded due to depression, and 98 were excluded due to dementia. Baseline characteristics were not well balanced between groups. The mean age in the exercise group was 64 years compared to 67 years in the no exercise group, with a higher percentage of males (48% vs. 39%) and a higher education level (12% with university education vs. 6%). In the unadjusted linear regression, there was a positive correlation between exercise and cognitive function (2.19, 95% CI 1.89-2.48, p&lt;0.001). In the second model, which emulated the reference trial by including sex, race, and educational status, the positive correlation persisted, though with a lower effect size (1.53, 95% CI 1.25-1.82, p&lt;0.001). A third model with additional adjustments was employed to assess the consistency of the association, which was maintained (1.92, 95% CI 1.62-2.23, p&lt;0.001). Conclusion: Our study reaffirms the potential benefits of moderate to vigorous exercise on cognitive function in older adults with mild cognitive impairment.