Generalized Estimating Equations Research Articles

Balancing typicality and novelty in ceramic design: A study on consumer aesthetic preferences

This study addresses the challenge of balancing typicality and novelty in ceramic design to optimise consumer aesthetic preferences. The objective is to analyse how these two dimensions—typicality, which provides familiarity, and novelty, which introduces cognitive interest—influence aesthetic appeal using the Unified Model of Aesthetics (UMA) framework. Employing a sample of 120 Chinese participants, the methodology involved evaluating ten ceramic designs on a seven-point Likert scale. Data analysis was conducted using Repeated Measures Analysis of Variance (ANOVA), partial correlation, and Generalized Estimation Equations (GEE) to assess the roles of typicality and novelty. Results reveal that while typicality strongly influences aesthetic preference, novelty provides moderate cognitive engagement, aligning with the MAYA (Most Advanced Yet Acceptable) principle. Age and gender showed minimal impact on preferences, suggesting design elements as primary determinants of aesthetic appeal. This study underscores the importance of balancing typicality and novelty in ceramic design, offering practical insights for designers to enhance consumer satisfaction through controlled innovative elements.

Maternal pesticide exposure and risk of birth defects: a population-based cross-sectional study in China

ObjectiveThis study aimed to examine the association between maternal pesticide exposure during the periconceptional period and birth defects in their offspring.MethodsA survey was conducted among 29,204 women with infants born between 2010 and 2013 in Shaanxi Province, Northwest China. All cases of birth defects were diagnosed using the International Classification of Diseases, Tenth Revision (ICD-10). Given the multistage sampling design, the generalized estimating equation (GEE) binomial regression models with log link and exchangeable correlation structures were used to analyze the association between maternal pesticide exposures and birth defects.ResultsAmong the 29,204 subjects, 562 mothers had children with birth defects, resulting in an incidence rate of 192.44 per 10,000 live births. The incidence of birth defects was higher in the pesticide-exposed group compared to the control group (737.46/10,000 vs. 186.04/10,000). After adjusting for baseline demographic characteristics, fertility status, nutritional factors, and environmental factors in the GEE model, the results indicated that the risk of birth defects and cardiovascular system defects in mothers exposed to pesticides during the periconceptional period was 2.39 times (95% CI: 1.84–3.10) and 3.14 times (95% CI: 1.73–5.71) higher, respectively, compared to the control group.ConclusionThis study demonstrated that maternal exposure to pesticides during the periconceptional period was associated with an increased risk of birth defects, particularly cardiovascular system defects in offspring. Consequently, it would be beneficial to avoid pesticide exposure from three months before pregnancy through the first trimester to lower birth defects in infants.

Investigating the effect of the educational intervention based on the Health Belief Model on the knowledge and beliefs of Yemeni teachers in the use of breast cancer screening: a randomized controlled trial study

BackgroundBreast cancer (BC) is the most prevalent cancer among women. Teachers play a crucial role in promoting healthy behaviors, including breast cancer screening (BCS). This study aimed to assess the impact of an Health Belief Model (HBM)-based educational intervention on BCS uptake, knowledge, and beliefs among female Yemeni teachers in Klang Valley, Malaysia.MethodsA cluster-randomized controlled trial was conducted with 180 participants from 12 schools, randomly assigned to intervention or control groups. The intervention group participated in a 90-minute educational session, with follow-up assessments at baseline, and at 1, 3, and 6 months’ post-intervention, using validated Arabic questionnaires. Data analysis was performed using SPSS version 22.0, with Generalized Estimating Equations (GEE) applied to assess differences within and between groups over time. Statistical significance was set at P < 0.05.ResultsAt baseline, there were no significant differences between groups. Post-intervention, the intervention group showed significantly higher rates of breast self-examination (BSE) and clinical breast examination (CBE) compared to the control group, with adjusted odds ratios (AOR) of 17.51 (CI: 8.22–37.29) for BSE and 2.75 (CI: 1.42–5.32) for CBE. Over six months, BSE performance in the intervention group increased, with AORs improving from 11.01 (CI: 5.05–24.04) to 18.55 (CI: 8.83–38.99). Similarly, CBE uptake rose from 1.60 (CI: 1.02–2.52) to 2.27 (CI: 1.44–3.58). Secondary outcomes revealed significant gains in knowledge and beliefs in the intervention group, including increased confidence in performing BSE and reduced perceived barriers.ConclusionsThe HBM-based educational intervention effectively enhanced BCS uptake, improved knowledge, and decreased barriers to BCS among Yemeni teachers in Malaysia, highlighting the potential of targeted educational programs to promote cancer screening behaviors in underserved populations.Clinical trial registrationRetrospectively registered, ANZCTR (ACTRN12618000173291). Registered on February 02, 2018.

Association of changes in the number of teeth on psychological distress among community-dwelling older adults in Taiwan.

Aging populations worldwide face a substantial burden of psychological distress that affects their quality of life and overall health. Oral health is associated with psychological distress; however, the effect of changes in the number of teeth on psychological distress remains unknown. This study aimed to evaluate the association of changes in the number of teeth with the development of psychological distress among community-dwelling older adults in Taipei City. From 2005 to 2013, 62,119 community-dwelling individuals aged 65 years and older participated in the physical examination program in Taipei. We collected data on the number of teeth during each examination. Psychological distress was defined as a score of ≥6 on the Brief Symptoms Rating Scale. A generalized estimating equation (GEE) model was used to examine the longitudinal relationship between changes in the number of teeth and the development of psychological distress. The participants lost an average of 6.6 teeth during the follow-up, with 9.9% of oral examination records showing the loss of ≥5 teeth compared with the previous examination. After GEE analysis with adjustment for multiple covariates, participants were at higher risk of developing psychological distress if they lost 1-4 teeth, 5-9 teeth, or ≥10 teeth compared to that at their previous oral examination. Subgroup analysis revealed that participants with ≥20 teeth at baseline and those who used dentures to compensate for the tooth loss had a lower risk of developing psychological distress than those who experienced tooth loss and did not use dentures. A rapid decrease in the number of teeth is associated with an increased risk of psychological distress in older adults. Regular dental checkups, nutritional counseling, and the use of dentures are critical in mitigating the adverse psychological effects of the tooth loss.

Trends and determinants of child stunting in Ethiopia: a longitudinal analysis of sociodemographic factors and regional disparities

Stunting remains a critical issue affecting child health in Ethiopia, with significant implications for growth and development. Despite efforts to address stunting, understanding its determinants and trends over time is essential for developing effective interventions. The objective of this study is to examine the trends and determinants of child stunting in Ethiopia, focusing on sociodemographic factors and regional disparities. This longitudinal observational study utilized data from the Young Lives project covering the period from 2002 to 2016. An ordinal logistic regression model with generalized estimating equation (GEE) was used to analyse 7,680 observations from 1,536 children across Ethiopia. Variables included sociodemographic factors, access to resources, and parental education levels. Over the study period, there were notable improvements in child stunting rates, influenced by variables such as household wealth, maternal education, access to safe drinking water, and urban versus rural residence. Children in households with higher wealth and maternal education levels experienced lower rates of stunting. Regional disparities were evident, with a greater prevalence in Amhara and lower rates in Addis Ababa.The findings underscore the importance of targeted interventions to address socioeconomic disparities and improve resource access. Enhancing maternal education, ensuring access to safe water, and addressing regional disparities are critical to reducing child stunting rates in Ethiopia.

A Cross-Sectional Evaluation of the Association between Orthodontic Treatment, Retention Modality and the Prevalence of Gingival Recession.

The prevalence of gingival recession in orthodontically treated patients and the relative impact of retainer type on its occurrence remain poorly understood. The objective of this study was to investigate the association between previous orthodontic treatment and retainer type on the long-term prevalence of gingival recession and to evaluate the role of other patient-related factors, such as gender, age, smoking and gingival phenotype. We included subjects both with and without a history of previous orthodontics (at least 5 years post-treatment). The periodontal status assessment and the presence of gingival recession were recorded. A generalised estimating equation (GEE) logistic regression model was used to examine the effect of the mode of retention and tooth type on recession adjusted for age, smoking, gender and gingival phenotype. A total of 251 individuals (mean age of 32 ± 9.43 years) were included. Ninety-nine (39.4%) had a history of orthodontics with an observation period of 15.7 years. Those undergoing orthodontics followed by fixed retention had the highest prevalence and magnitude of recession; a history of orthodontics was statistically associated with the occurrence of recession (odds ratio: 2.40; 95% CI: 1.52; 3.82; P 0.001). Both age and the presence of a thin gingival phenotype were significant predictors for recession (P 0.001). The adjusted probabilities of recession per tooth indicated that the mandibular central incisors had the highest probability for recession, with either a fixed or removable retainer. Based on this observational study, the provision of orthodontic treatment followed by removable or fixed retention had a bearing on the occurrence of recession. The aetiology of gingival recession is multifactorial with a thin periodontal phenotype, age and smoking history being risk factors, while mandibular central incisors are particularly susceptible.

Hospital readmissions following catheter ablation for atrial fibrillation with THERMOCOOL™ STSF/ THERMOCOOL™ ST catheter with CARTO™ 3 system versus TactiCath™ catheter with EnSite™ system.

Aim: Radiofrequency (RF) catheter ablation (CA) is a mainstay treatment for atrial fibrillation (AF). RF catheters with contact force (CF) sensing technology and electroanatomical mapping systems enable real-time assessment of catheter tip-tissue interface CF, facilitating individualized and precise CA. This study examined inpatient hospital readmissions in patients with AF treated with THERMOCOOL™ ST/ THERMOCOOL™ STSF catheter with the CARTO™ 3 System versus TactiCath™ catheter with the EnSite™ System. Materials & methods: Patients undergoing CA for AF between 1 July 2019 to 30 November 2021 were identified from the Premier Healthcare Database and grouped based on use of THERMOCOOL ST/STSF or TactiCath™. Study outcomes were all-cause, cardiovascular (CV)-, and AF-related inpatient readmission at 91-365-day post-CA. Inverse probability of treatment weighting of propensity scores balanced baseline patient, comorbidity and hospital characteristics. A weighted generalized estimating equation (GEE) model examined differences in readmission outcomes. Results: A total of 15,518 patients met inclusion criteria (THERMOCOOL ST/STSF, n=13,001; TactiCath™, n=2517). Patient characteristics were generally well-balanced after weighting. Patients treated with THERMOCOOL ST/STSF+CARTO 3 had a 20% lower likelihood of all-cause inpatient readmissions (7.8 vs 9.3%, chi-square p=0.041; odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.66-0.96, GEE p=0.019) and a 21% lower likelihood of CV-related inpatient readmission (5.2 vs 6.2%, chi-square p=0.133, OR: 0.79, 95% CI: 0.62-0.99, GEE p=0.043) in 91-365-days post-CA versus those treated with TactiCath™+ Ensite. No significant differences were observed for AF-related readmissions. Conclusion: Patients undergoing CA for AF treated with THERMOCOOL ST/STSF+CARTO 3 had a significantly lower risk of all-cause and CV-related inpatient hospital readmission versus those treated with TactiCath™+Ensite.

The impact of a lifestyle promotion program on anthropometric and clinical manifestations in adolescents with polycystic ovarian syndrome: a randomized controlled trial

BackgroundLifestyle modification can have beneficial effects on improving symptoms of ovary syndrome and anthropometric changes, particularly in obese individuals… However, it is not clear whether these affects in obese adolescents with PCOS are the same as non-PCOS adolescents. We had a study question” Can lifestyle promotion programs, which focus on changing behavioral habits, have an effect on anthropometric parameters and the manifestation of polycystic ovary syndrome (PCOS) in adolescents?”MethodsThis was a cluster randomized trial (CRT) that started from January 2021 and follow-up ended in March 2022. 128 participants included adolescent girls (from 14 to 18 years old). The status of PCOS was determined for the participants, following which both the PCOS-afflicted and non-PCOS cohorts were subjected to randomization to either partake in a lifestyle promotion program or to proceed without it. This program included eight sessions that were designed to be implemented for two months. This intervention provides recommendations for a balanced diet and regular exercise, as well as advice on behavior change for adolescents, including those with PCOS, regardless of their weight. All participants were followed up for 12 months and were evaluated at three time points: baseline, 6 and 12 months. Outcomes included changes in the anthropometric indices (weight, hip and waist circumstance), regularity of menstrual cycle, hirsutism score by the modified-Ferriman-Gallwey scale, acne score by the Investigator’s Global Assessment Scale, hair loss scores by the Sinclair Graphic Instrument and then physical activity by the Caspian tool and dietary intake status by the Food Frequency Questionnaire. Data was analyzed using the non-parametric Mann-Whitney test for variables with two-time point assessments and generalized estimation equations (GEE) for variables with three time point assessments.ResultsIn the study, the intervention group of girls with PCOS exhibited a significant reduction in weight and waist circumference, with an average decrease of 3.14 kg and 4.68 cm, respectively (P < 0.001), compared to the PCOS control group. Similarly, the non-PCOS intervention group showed a decrease in these factors by 2.60 kg and 4.95 cm (P < 0.001) when compared to the non-PCOS control group. After 12 months of intervention, the odds ratio (OR) for menstrual regularity in the PCOS intervention group increased to 3.30 (95% CI: 2.06, 5.25), and the acne score significantly decreased with an OR of 0.46 (95% CI: 0.31, 0.70). In contrast, the non-PCOS intervention group experienced an increase in the OR for menstrual regularity to 2.45 (95% CI: 1.33, 4.25) and an improved in acne score with an OR of 0.44 (95% CI: 0.28, 0.69). No notable differences were observed in the nutritional status among all groups post-intervention. However, a significant increase in physical activity levels, measured in metabolic equivalent minutes per week (met/min/week), was recorded in both intervention groups (p < 0.05).ConclusionManifestations of PCOS in adolescents are improved by a lifestyle promotion program and high schools are considered an appropriate setting to identify those with PCOS and the implementation of a lifestyle modification program. This program was also shown to promote healthy lifestyles for non-PCOS adolescents.Trial registrationTrial registration number: irct.ir number: IRCT20200114046123N1.

The association between foot morphology and foot loading during gait

The perceived association between foot type and injury risk has inspired the development of many foot typing methods. The purpose of this study was to determine how well different foot typing methods explained variations in regional foot loading in asymptomatic adults during gait, while considering age, sex, and walking speed as covariates. Six methods were used to determine foot type in 92 asymptomatic adults. An insole pressure sensor system measured peak force and force-time integral during treadmill walking at a self-selected pace. The foot was divided into nine regions and the association between foot type and foot loading was analyzed using generalized estimating equations (GEE) while accounting for the covariates. Over an average of 250 steps per individual, the results demonstrated variability in the association between regional foot loading and foot type. Specifically, Arch Index and X-Ray Arch Type correlated with hindfoot and midfoot loading, while Foot Posture Index correlated with medial midfoot, forefoot, and toe loading. Calcaneal Pitch and Meary’s Angle correlated with medial hindfoot, midfoot, and forefoot loading, while Varus/valgus angle correlated with loading in the forefoot and toes. The location and direction of associations were generally similar for Calcaneal Pitch, Meary’s Angle, and X-Ray Arch Type, and opposite of Arch Index. The analyses demonstrated that walking speed, age, and sex were all important factors that affected the relationship between plantar loading and foot type. Specific foot type methods correlate better with loading in specific foot regions, potentially making them better to evaluate injury risk in those regions.

Impact of Sodium-Glucose Co-Transporter Type-2 Inhibitors on Alanine Aminotransferase Levels in Type-2 Diabetes Patients Having Features of Nonalcoholic Fatty Liver Disease: A Retrospective Cohort Study in Pakistan.

We aimed to elucidate the effectiveness of Sodium-glucose co-transporter-2 inhibitors (SGLT2-I) in the reduction of ALT among Type-2 diabetes patients (T2DM) with Non-alcoholic fatty liver disease (NAFLD). We retrospectively collected data from 120 files of T2DM, aged 30-60 years, with elevated ALT, and documented follow-up for one year from August 2018 - July 2019. The effects of SGLT2Is (Dapagliflozin and Empagliflozin) were evaluated using Generalized Estimating Equation (GEE) for analysis. The overall mean age was 48.9 ± 7.3 years, 57.5% were females, and the mean duration of diabetes was 8.5 ± 5.6 years. At baseline, the mean BMI was 32.5 ± 5.7 kg/m2, mean ALT was 51.6 IU/L ± 17.8 IU/L, and mean HbA1c was 8.5% ± 1.5%. There was a statistically significant reduction in mean ALT of 2.2 IU/L (p-value 0.02) with every 10 mg/dl increase in LDL among females using 10 mg Empagliflozin as compared to males not on SGLT2i. We observed an average reduction in mean ALT levels when SGLT2Is was initiated in T2DM patients having NAFLD. Apart from encouraging diet and lifestyle modification, early intervention with SGLT2Is may decrease liver-related morbidity and mortality resulting from NAFLD.

Profiling vivax malaria incidence, residual transmission, and risk factors using reactive case detection in low transmission settings of Ethiopia

BackgroundIdentification of local Plasmodium vivax transmission foci and its hidden reservoirs are crucial to eliminating residual vivax malaria transmission. This study assessed whether reactive case detection (RCD) could better identify P. vivax cases and infection incidences in Arjo-Didessa, Southwestern Ethiopia.MethodsA RCD survey was conducted from November 2019 to October 2021 in Arjo-Didessa and the surrounding vicinity in southwestern Ethiopia. RCD was performed at 0, 30, and 60 days following reports of P. vivax infections by health facilities to detect further cases and potential transmission networks. Household members of the index case and neighbours living within 200 m of the index household were screened for P. vivax. Households 200–500 m away are considered controls and were also screened for P. vivax. Plasmodium vivax was detected by microscopy, rapid diagnostic testing (RDT), and quantitative polymerase chain reaction (qPCR). Risk factors associated with vivax malaria were analysed using generalized estimating equations (GEE).ResultsA total of 3303 blood samples were collected from the index (n = 427), neighbouring (n = 1626), and control (n = 1240) household in the three rounds of follow-up visits for malaria infection, the overall positivity rate of P. vivax malaria was 1.6% (95% CI 1.2–2.2%), 1.9% (95% CI 1.5–2.4), and 3.9% (95% CI 3.2–4.6%) by microscopy, RDT, and qPCR, respectively. Microscopy and RDT detected 41.5% (54 of 130) and 49.1% (64 of 130) of the qPCR-confirmed P. vivax cases, respectively. Of qPCR-positive samples, 77.7% of the total P. vivax infections circulated in the index and neighbouring households, while control households accounted for 23.3% of the infections. Of the P. vivax infections detected 81.0% (95% CI 72.9–87.1%) were asymptomatic. In this study, P. vivax infection incidence was higher in index case households (53.8 cases per 1000 person-months) and (44.0 cases per 1000 person-months) in neighbouring households compared to the control households (25.1 cases per 1000 person-months) with statistical difference (p = 0.02). In index case households, children < 5 years and school-age children were at higher risk of P. vivax infection (AOR: 6.3, 95% CI: 2.24–18.02, p = 0.001 and AOR: 2.7, 95% CI: 1.10–6.64, p = 0.029).ConclusionsThis study found clustering of asymptomatic and sub-microscopic P. vivax infections in the index case household and their neighbours using RCD and molecular methods. Children under 5 years and of school age were more likely to have P. vivax infection in index households. Thus, tailored RCD approaches and targeted interventions for interrupting residual P. vivax transmission networks are needed to eliminate P. vivax malaria in low transmission settings.

Striding beyond numbness: a non-randomized controlled study of an exercise program for breast cancer patients with chemotherapy-induced peripheral neuropathy.

To investigate the effectiveness of a 13-week combined supervised and home-based exercise program in alleviating the symptoms of chemotherapy-induced peripheral neuropathy (CIPN) in patients with breast cancer (BC). In this non-randomized controlled study, 77 patients with BC selected after applying the inclusion and exclusion criteria were allocated to the intervention (n = 37) or control (n = 40) group. Patients in the intervention group underwent a 13-week exercise program consisting of health education and hand and foot exercises combined with aerobic, resistance, and balance training, while those in the control group received usual care. The symptoms of CIPN were assessed at baseline (T0), post-intervention (T1), and 3months post-intervention (T2). Physical fitness and finger flexibility were assessed at T0 and T1. A generalized estimating equation (GEE) model was used to analyze the repeated measures data. The results of GEE showed a significant group effect, indicating significant intergroup differences in the total CIPN score and the dimensions of occurrence, severity, disruption, and frequency (all P < 0.05). Moreover, the two groups showed significant differences in finger flexibility and balance at T1 (all P < 0.05). The exercise program was effective in alleviating the symptoms of CIPN and improved balance and finger dexterity in comparison with the control group. Randomized controlled trials with larger sizes are required to validate these findings.

Association of sarcopenia and its prognostic value in symptomatic knee osteoarthritis among older people in China: the first longitudinal evidence from CHARLS

BackgroundSarcopenia and knee osteoarthritis (KOA) are two common musculoskeletal disorders, often coexisting in aged population and potentially influencing each other. However, the underlying relationship between two conditions remains unclear and controversial. To fill this knowledge gap, we aimed to investigate the longitudinal association among the older Chinese population.MethodsData were attracted from 2 waves of the China Health and Retirement Longitudinal Study (CHARLS), and 6212 individuals aged ≥ 60 years were included. Sarcopenia status was defined by the Asian Working Group for Sarcopenia 2019 criteria. Multivariate logistic regression and generalized estimation equation models were applied to estimate the impact of sarcopenia on KOA. A prognostic nomogram was developed through train-test cross-validation.ResultsAt baseline in CHARLS 2015, the prevalence of symptomatic KOA was 12.7% (792/6212) in total population, 9% (270/2996) in no-sarcopenia group, 17.5% (286/1638) in possible sarcopenia group, and 15.0% (236/1578) in sarcopenia group. Over a 3-year follow-up, 4980 respondents were included, with incident KOA cases identified as 56 (2.2%), 38 (3.0%), and 43 (3.6%) in no-sarcopenia, possible sarcopenia, and sarcopenia groups, respectively. Sarcopenia was significantly associated with increased new-onset KOA compared to no-sarcopenia peers in the fully adjusted model (OR: 1.91, 95% CI: 1.15–3.18), whereas this association was non-significant for possible sarcopenia. In females, low muscle mass alone significantly increased the incident risk of KOA (OR: 2.58, 95% CI: 1.05–6.49). The final prognostic model and nomogram, including sarcopenia status, age, gender, body mass index, self-reported health status, comorbidities, history of falls and physical activity, had a considerable discrimination (AUC = 0.744, C-index = 0.660). The calibration curve indicated significant agreement between predicted and actual observations. Decision curve analysis revealed net benefits for clinical intervention at a probability threshold of 1–17%.ConclusionsSarcopenia was associated with a higher incident risk of symptomatic KOA, wherein low muscle mass may play an important role. The inferior prognosis of sarcopenia in KOA needs more attention in clinical practice.

Effectiveness of smartphone-based virtual reality relaxation (SVR) for enhancing comfort in cancer patients undergoing chemotherapy: a randomized controlled trial.

Comfort, anxiety, and pain significantly impact the quality of life and treatment adherence in cancer patients undergoing chemotherapy. Virtual reality (VR) technology offers a novel non-pharmacological intervention to address these primary concerns. While vital signs provide objective physiological data, they are considered secondary outcomes that may reflect changes in patients' subjective experiences. This study aims to evaluate the effectiveness of smartphone-based virtual reality relaxation (SVR) interventions on improving comfort and reducing anxiety and pain (primary outcomes) in patients with cancer undergoing chemotherapy. Additionally, it assesses the impact on blood pressure and pulse rate (secondary outcomes). This prospective, two-arm, randomized controlled trial involved 99 cancer patients undergoing chemotherapy who were randomized into the SVR group (n = 50) and control group (n = 49) from March to May 2023. The SVR group received a 10-min immersive VR experience featuring 360-degree natural scenery videos with relaxing sounds, while participants in the control group received standard care and guided imagery leaflets. The primary outcomes-comfort, anxiety, and pain-were evaluated at various time points: comfort was assessed at baseline and post-chemotherapy, while anxiety and pain were assessed at four stages (pre-chemotherapy, pre-VR, immediate post-intervention, and post-chemotherapy). Secondary outcomes included vital signs (blood pressure and pulse rate), which were assessed at the same four stages. Cybersickness symptoms were examined post-chemotherapy. Data analysis involved independent t tests, linear regression, and Generalized Estimating Equations (GEE). Among 99 randomized patients, the SVR group reported significantly higher comfort levels (p = 0.01; Cohen's d = 0.4), reduced anxiety (p = 0.01; Cohen's d = 0.50), and pain (p = 0.015; Cohen's d = 0.35) compared to the control group. No significant differences were found in heart rate (p = 0.92), systolic blood pressure (p = 0.36), or diastolic blood pressure (p = 0.95). The majority of participants (66-96%) in the SVR group did not report cybersickness symptoms. SVR shows promise as an intervention for improving comfort and reducing anxiety and pain in cancer patients undergoing chemotherapy. Healthcare providers at chemotherapy centers should consider incorporating VR devices and curated content into patient care routines. ClinicalTrials.gov: NCT05756465, registered on January 22, 2023.

Effects of a 12-Week Physical Activity Intervention on Psychological Symptoms in Adolescents

Participation in regular physical activity (PA) is associated with numerous health benefits, including improvement in adolescents’ mental health. The current study aimed to assess the effects of a 12-week physical activity intervention on psychological symptoms of adolescents. The sample of this controlled randomized study was composed by 150 adolescents aged 12 to 15 years old. PA intervention is an adaptation of the ActTeens Program, which includes structured PA sessions delivered during Physical Education classes. The Strengths and Difficulties Questionnaire (SDQ) was used to measure psychological symptoms. To analyze the effects of the intervention on psychological symptoms, generalized estimating equations (GEEs) models were constructed. After 12 weeks, there were no significant intervention effects for emotional problems (mean difference: −0.14; 95% IC: −1.1–0.82), conduct problems (mean difference: 0.14; 95% IC: −0.6–0.8), attention deficit/hyperactivity disorder (mean difference: −0.66; 95% IC: −1.4–0.1), peer problems (mean difference: 0.2; 95% IC: −0.6–1.0), prosocial behavior (mean difference: 0.00; 95% IC: −0.8; 0.8) and overall mental health score (mean difference: 0.15; 95% IC: −2.0; 2.3). No improvement in psychological symptoms was observed after 12 weeks of PA intervention. Future studies should explore how PA in different dimensions and contexts may impact positively on adolescents’ mental health.

Post-recovery quality of life (QoL) of the healthcare professionals affected by COVID-19: a longitudinal study in Bangladesh

PurposeThe study investigated the enduring impacts on the quality of life (QoL) of healthcare workers (HCWs) recovered from the coronavirus disease 2019 (COVID-19) over 12 months.MethodsThe study was conducted among 371 HCWs from November 2021 to January 2022, using the WHOQOL-BREF tool to evaluate the disparities in participants' QoL scores between the two interviews. Descriptive statistics, paired-sample analyses, Generalized Estimation Equation (GEE) analysis, and multivariable logistic regression analyses were performed using R Studio (version 2022.07.1).ResultsThe average physical domain score notably declined between the interviews, contrasting with substantial rises in other QoL domain scores (p < 0.001). After adjusting for other factors, the changes in individuals' QoL scores were considerably linked with multiple characteristics, including older age, female, higher education, higher monthly income, married, active smokers, number of comorbidities, and hospital admission during the COVID-19 pandemic. According to the regression analysis, the occurrence of new chronic illnesses was related to the lower physical domain score (AOR: 2.42, 95%CI 1.10, 5.35). Similarly, a reduced psychological domain score was correlated with a monthly family income > 60000 BDT (AOR: 3.26, 95%CI 1.39, 7.65), past smoking status (AOR: 3.42, 95%CI 1.21, 9.67) and COVID-19 re-infection (AOR: 3.94, 95%CI 1.91, 8.16). Meanwhile, being married (AOR: 3.55, 95%CI 1.47, 8.57), having at least one chronic disease (AOR: 2.07, 95%CI 1.17, 3.69), and COVID-19 re-infection (AOR: 2.81, 95%CI 1.37, 5.79) were significant with social domain scores. Subsequently, compared to nonsmokers, active smokers (AOR: 2.12, 95%CI 1.0, 4.49) had drastically decreased environmental domain scores.ConclusionsAfter 12 months of recovery, the overall QoL of HCWs improved in all domains between the interviews except the physical domain. Participants' monthly income, marital status, smoking history, onset of new chronic diseases, and COVID-19 re-infection were accountable for altering the QoL index of the HCW.

Prematurity and Genetic Liability for Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by diverse presentations and a strong genetic component. Environmental factors, such as prematurity, have also been linked to increased liability for ASD, though the interaction between genetic predisposition and prematurity remains unclear. This study aims to investigate the impact of genetic liability and preterm birth on ASD conditions. We analyzed phenotype and genetic data from two large ASD cohorts, the Simons Foundation Powering Autism Research for Knowledge (SPARK) and Simons Simplex Collection (SSC), encompassing 78,559 individuals for phenotype analysis, 12,519 individuals with genome sequencing data, and 8,104 individuals with exome sequencing data. Statistical significance of differences in clinical measures were evaluated between individuals with different ASD and preterm status. We assessed the rare variants burden using generalized estimating equations (GEE) models and polygenic load using ASD-associated polygenic risk score (PRS). Furthermore, we developed a machine learning model to predict ASD in preterm children using phenotype and genetic features available at birth. Individuals with both preterm birth and ASD exhibit more severe phenotypic outcomes despite similar levels of genetic liability for ASD across the term and preterm groups. Notable, preterm ASD individuals showed an elevated rate of de novo variants identified in exome sequencing (GEE model with Poisson family, p-value = 0.005) in comparison to the non-ASD preterm group. Additionally, a GEE model showed that a higher ASD PRS, preterm birth, and male sex were positively associated with a higher predicted probability for ASD, reaching a probability close to 90%. Lastly, we developed a machine learning model using phenotype and genetic features available at birth with limited predictive power (AUROC = 0.65). Preterm birth may exacerbate the multimorbidity present in ASD, which was not due to the ASD genetic factors. However, increased genetic factors may elevate the likelihood of a preterm child being diagnosed with ASD. Additionally, a polygenic load of ASD-associated variants had an additive role with preterm birth in the predicted probability for ASD, especially for boys. We propose that incorporating genetic assessment into neonatal care could benefit early ASD identification and intervention for preterm infants.

Isolated and Combined Effects of Sedentary Behaviour and Physical Activity on Muscle Strength in Older Adults: AProspective Cohort Study.

We aim the isolated and combined effects of sedentary behaviour exposure time and physical activity levels on muscle strength in older adults. This prospective observational cohort study, analytical in nature, using exploratory survey methods and physical performance testing. With 5-year longitudinal follow-up (2015-2020). A total of 459 older adults participated in the baseline, with a total of 224 being included/located again in the follow-up. We evaluate muscle strength using handgrip tests and sit-to-stand tests. The international physical activity questionnaire was used to measure physical activity and sedentary behaviour. Generalised Estimation Equations tested both independent and combined effects, reporting results as β coefficients and confidence intervals. Older adults exhibiting low sedentary behaviour displayed enhanced handgrip strength compared to those with high sedentary behaviour. Notably, older adults who were sufficiently active with low sedentary behaviour, sufficiently active with high sedentary behaviour, and insufficiently active with low sedentary behaviour showed increased handgrip strength compared to their counterparts who were insufficiently active with high sedentary behaviour. This trend was consistent for lower limb strength. Interventions that encourage a reduction in sedentary behaviour and an increase in physical activity are essential to maintain muscle strength among older adults. The findings of this study underscore the importance of addressing both sedentary behaviour and physical activity levels in clinical interventions aimed at preserving muscle strength in older adults. Routine assessments of physical activity and sedentary behaviour could help tailor personalised exercise programs, potentially enhancing functional independence and reducing the risk of frailty and disability in older patients. Patients were involved in the sample of the study. This study was conducted in accordance with the Strengthening Research in Observational Studies in Epidemiology (STROBE) guidelines.

Addressing psychological resilience and its determinants among university students during the COVID-19 pandemic: a three-wave longitudinal study in Shandong Province, China

BackgroundThe relationship between public health emergencies and psychological distress had been well known, yet none research had been conducted on the trend in psychological resilience and its longitudinal determinants during the pandemic. This study aimed to explore the changes of psychological resilience of university students during COVID-19 pandemic, and further clarify the longitudinal relationship between family factors, mental health, social mentality and psychological resilience.MethodsQuestionnaires were distributed to students from five universities in Shandong Province, China during the COVID-19. A total of 1635 students were finally included in this three-wave follow-up study using stratified random sampling method. Mental health was assessed by Depression Anxiety Stress Scale, social mentality was measured by the Bi-Dimensional Structure Questionnaire of Social Mentality, psychological resilience was evaluated by the Chinese version of the Psychological Resilience Scale. Repeated-measures analysis of variance was used to analyze the longitudinal changes of psychological resilience, generalized estimating equation (GEE) was conducted to estimate the determinants of psychological resilience.ResultsPsychological resilience changed from 28.37 in Wave 1, 29.10 in Wave 2, and 29.15 in Wave 3 among the university students. The students who majored in Art (β = 0.872, P = 0.032), parents (mother β = 0.546, P = 0.035; father β = 0.718, P = 0.012) had a greater influence on children’s personality, and positive social mentality (β = 5.725, P < 0.001) were more likely to report a higher psychological resilience. Being female (β=-0.932, P < 0.001), not being a student leader (β=-0.911, P < 0.001), being anxious (β=-1.845, P < 0.001) and depressed (β=-1.846, P < 0.001), and negative social mentality (β=-0.803, P < 0.001) were less likely to report a higher psychological resilience.ConclusionsThe psychological resilience of the university students in Shandong Province, China increased significantly from Wave 1 to Wave 3 during the COVID-19 pandemic. Majoring in Art, parents having a greater influence on children’s personality, better mental health, positive social mentality were more likely to report a higher psychological resilience, while female, not student leader, worse mental health, and negative social mentality were less likely to report a higher the psychological resilience.

Longitudinal Trajectories of Psychological Distress and Its Influence Factors in Young and Middle-Aged Patients With Colorectal Cancer.

To identify the longitudinal trajectories of psychological distress and to explore the predictive factors of different trajectories among young and middle-aged colorectal cancer patients from diagnosis to 6 months postoperation. A longitudinal study was conducted, guided by the STROBE checklist. A total of 214 patients were recruited from July 2021 to May 2022 at a cancer hospital in Guangzhou, China. Data were collected from diagnosis to 6 months post-surgery, using the Brief Symptom Inventory-18, Distress Disclosure Index, Connor-Davidson Resilience Scale and Social Support Rating Scale. We also collected socio-demographic and clinical characteristics at baseline. General estimation equation (GEE) was used to analyse the overall trend of psychological distress. To identify distinct distress trajectories, growth mixture modelling (GMM) and latent class growth modelling (LCGM) were both used. Longitudinal trajectories of psychological distress: the average score of psychological distress at different time points were 12.02 ± 9.87, 17.40 ± 9.73, 15.91 ± 10.05, 16.28 ± 11.24 and 16.31 ± 11.66. GEE showed four unique trajectories of psychological distress: chronic distress, no distress, steady increase and significantly increased. With reference to resilient group, multinomial logistic regression showed that education level, monthly income, minor offspring, stoma, residence, self-disclosure and psychological resilience were predictive factors of chronic distress class or increase-distress class. From diagnosis to 6 months post-surgery, psychological distress increased at discharge, gradually stabilising thereafter. Meanwhile, results revealed heterogeneity in this population. To effectively alleviate distress, it is crucial to identify high-risk individuals through predictive factors and implement tailored interventions. This study offers the trajectory and predictors of psychological distress in the process of diagnosis and treatment, and can be used in the clinical identification and monitoring of high-risk patients. The findings suggest that healthcare providers should regularly monitored and identified the psychological distress of patients, and took individualised intervention measures. This study is reported using the STROBE guidelines. No patient or public engagement.