Initial Age Research Articles

Система контроля качества и безопасности оказания медицинской помощи как один из ключевых элементов достижения целей расширенного неонатального скрининга в Российской Федерации

After analyzing the Russia-wide Extended neonatal screening (ENS) system for hereditary and/or congenital diseases results it became necessary to change the ENS tasks ranking: the highest priority among them as yet is an increase in the congenital and/or hereditary diseases detection level and a decrease in the therapy initiation age. The results of an on-site audit conducted in 20 Russia regions in 2024 showed significant differences from the target indicators that in its turn had made it possible to determine the control points and roadmap operational procedures as necessary elements for the ENS system improvement with the purpose of medical care quality and safety monitoring in order to increase the congenital and/or hereditary pathology detection level, to reduce the time span from birth to the therapy initiation and to increase the effectiveness of patient treatment.

Alterations in surface-based brain morphometry in men with opioid use disorder

ABSTRACT Background: Cortical differences in thickness, folding, and complexity may reflect synaptic pruning and myelination alterations. Individuals with opioid use disorder (OUD) may demonstrate differences in these cortical metrics due to neurodevelopmental aberrations or early opioid exposure. Objectives: We compared the cortical metrics between individuals with OUD and controls. The influence of age and duration of opioid exposure were considered indirect evidence for preexisting or opioid-exposure-based structural aberrations. Methods: Sixty-nine treatment-naïve men with OUD (52 heroin, 17 non-heroin) and 25 age and education-matched non-drug-using male controls were recruited from a treatment center and community, respectively. 3-Tesla Siemens Magnetom Verio scanner and Computational Anatomy Toolbox 12 were used for image acquisition and processing. Cortical parcellation was performed using Destrieux atlas. Surface-based morphometry (SBM) metrics were cortical thickness, sulcal depth, fractal dimension, and gyrification index. Results: Only two cortical areas survived corrections for multiple comparisons: persons with OUD had greater sulcal depth in the right lateral orbital sulcus (p = .0003, Glass’s delta = 0.98) and lower gyrification index in the left frontal middle gyrus (p = .0005, Glass’s delta = 0.67) than controls. The group-by-age interaction effect on the cortical thickness was non-significant. Lower age of initiation of opioid use was associated with larger cortical thickness in the inferior frontal (r = -0.36, p = .002) and anterior cingulate (r = -0.35, p = .003) regions. Duration of OUD negatively correlated with cortical thickness in frontal and occipital areas (r > −.30, p = .004–.007). Conclusion: Cortical abnormalities may stem from altered synaptic pruning and myelination, possibly due to neurodevelopmental aberrations or early opioid exposure.

Frequency is not enough: Characterizing heterogenous patterns of cannabis use intensity among reservation-area American Indian youth

BackgroundReservation-area American Indian (AI) youth use cannabis at significantly higher rates than their national counterparts. This discrepancy is concerning, as cannabis use—particularly heavy use—can negatively impact adolescents’ health. Studies primarily use frequency to classify cannabis use intensity; however, frequency alone may not fully capture heterogenous patterns of use. This study aimed to classify AI adolescents’ cannabis use based on multiple intensity indicators, and to investigate interclass differences in problematic characteristics and outcomes of use. MethodsParticipants were 799 reservation-area AI youth (7–12th grade) reporting 12-month cannabis use. Latent Class Analysis (LCA) was used to distinguish cannabis use intensity patterns based on frequency, typical intoxication levels and duration. Auxiliary tests using R3STEP and BCH 3-step procedures were used to assess class predictors (age, initiation age, sex) and interclass differences in simultaneous drug use, stress-motivated use, problems quitting and cannabis-related consequences. ResultsFour classes emerged: Light Use (LU; 19 %), Occasional Intoxication (OI; 32 %), Mid-frequency Use(MU; 28 %), and Heavy Use (HU; 21 %). Age and initiation age correlated with membership odds in a heavier use class. Interclass differences in problematic characteristics and outcomes occurred between all classes, particularly for stress-motivated use and cannabis-related consequences—with HU reporting the most problematic characteristics and negative outcomes. ConclusionThese findings suggest that accounting for multiple dimensions of usage intensity may be important in studies examining cannabis use and related problems among AI adolescents. Tailoring intervention programming to address complex cannabis use patterns, with particular focus on stress-coping skills and harm reduction, can ensure AI youth most at risk for cannabis problems gain maximal benefit from prevention efforts.

New 40Ar/39Ar Dating and Paleomagnetism of the Pana Formation Rocks From the Linzhou Basin, Lhasa Block: Implications for the India‐Asia Collision

AbstractThe India‐Asia collision onset and cessation of the Neo‐Tethyan oceanic subduction are pivotal for understanding the collision processes, Tibetan Plateau uplift and global climate change, yet they remain hotly debated. The mostly cited ∼60–50 Ma initial collision age would require a ca. 20 Ma delay of the orogenic responses in Asia. Besides, the majority of the Cretaceous and Paleogene paleomagnetic data from the Lhasa Block (LB) indicates a “Greater” and “Quiescent” Asia prior to the India‐Asia collision, conflicting with the widely observed latest Cretaceous intense deformation within the block. To address these paradoxes, we present new paleomagnetic results on the Pana Formation volcanic rocks from the Linzhou basin, southern LB, with 40Ar/39Ar dating results indicating emplacement around ∼53 Ma. Combined with previous paleomagnetic results, the updated mean ChRM direction indicates the LB at 31.4°N (28.9–33.9°N) in the early Eocene. This indicates a minimal amount of crustal shortening (1.2 ± 3.8° or 0.9 ± 3.8°) in the northern Plateau since the early Eocene, and a substantial N‐S distance of 1,880 ± 420 km between the Indian and Asian leading margins at that time. Reassessed paleomagnetic data from LB, in conjunction with current knowledge on the original size of Greater India, fit well with a two‐stage collision model. This model suggests a ∼55 Ma collision between India and an intra‐oceanic arc, followed by a ∼34 Ma final collision between India and Asia, aligning well with the collision‐related responses in the plateau.

Frequent drug use and average age of initiation, associated with gender, age groups, and family income in university students of Health Sciences in Arequipa, Peru

Frequent drug use and average age of initiation, associated with gender, age groups, and family income in university students of Health Sciences in Arequipa, Peru

Unequal Uptake: Insurance-Related Disparities in Prenatal Genetic Counseling and Screening at a Quaternary Medical Center.

The purpose of this study was to evaluate the association between the type of insurance coverage and the uptake of prenatal genetic counseling and aneuploidy screening. This was a retrospective analysis of pregnant people who sought prenatal care at a quaternary medical system from August 1, 2017 to August 29, 2019. The primary exposure was insurance status, while the outcomes of interest were the uptake of genetic counseling and aneuploidy screening. Characteristics of the four insurance coverage groups were compared using simple comparisons and multivariable logistic regression models estimating odds of receiving genetic counseling and screening. A total of 8774 births were included. There were significant differences among insurance groups in race, ethnicity, language, parity, and gestational age at the first visit. Pregnant people differed significantly by payer status with regard to the uptake of both counseling and aneuploidy screening. In adjusted models, those without insurance or who were self-paid were significantly less likely to have genetic counseling and aneuploidy screening as compared to those with public or private insurance. In adjusted models, those who were older, spoke English, and were in their first pregnancy were significantly more likely to receive genetic counseling and aneuploidy screening. This analysis contributes to the understanding of how insurance mechanisms within the United States can contribute to the uptake of prenatal genetic counseling and screening. However, there is a complex interplay between payer status and other patient-level characteristics such as age, language, and timing of initiation of prenatal care. Future studies that assess both system-level and patient-level characteristics are crucial.

Examining the potential causal relationships among smoking behaviors, blood DNA methylation profiles, and the development of coronary heart disease and myocardial infarction

BackgroundSmoking has been identified as a standalone risk factor for coronary heart disease (CHD) and myocardial infarction (MI), but the precise underlying mechanisms remain incompletely elucidated.ResultsIn this study, we conducted a two-sample Mendelian randomization analysis to examine the impact of smoking behaviors (including smoking initiation, age of smoking initiation, cigarettes per day, and smoking cessation) and smoking-related DNA methylation at CpG sites on CHD and MI based on the UK Biobank dataset. Additionally, we included the FinnGen and Biobank Japan datasets as replications and performed a meta-analysis to combine the results from different data sources. We further validated our results using genetic colocalization analysis. In genomic analysis, we provided compelling evidence on the association between genetically predicted smoking initiation and increased susceptibility to CHD and MI. In epigenetic analysis, we identified 11 smoking-related CpG sites linked to CHD risk and 10 smoking-related CpG sites associated with the risk of MI based on the UK Biobank dataset. Subsequently, some of these CpG sites were further replicated using the FinnGen or BBJ datasets. Ultimately, a meta-analysis was conducted to integrate findings from various data sources (3 for CHD, and 2 for MI), revealing that 7 of 11 CpG sites were linked to CHD risk; whereas, 7 of 10 CpG sites were associated with MI risk. Furthermore, we performed genetic colocalization analysis and found that cg19744173 (FBLN7), cg00395063 (ARHGEF12), and cg16822035 (MCF2L) exhibited robust evidence of colocalization with coronary heart disease; whereas, cg19529732 (DIABLO), cg26405020 (FES), and cg08940075 (CNN3) demonstrated strong colocalization evidence with the risk of myocardial infarction.ConclusionsOur research offers a novel insight into the impact of smoking on the susceptibility to CHD and MI through the lens of epigenetic DNA methylation.

Psychological problems and work ability in unemployed people diagnosed with a mental illness.

Research shows that unemployed individuals are more often affected by mental illness, and that mental illness can impede an individual's work ability, creating a significant obstacle to (re)entering the workforce. The objective of this study is to examine the relationships between psychological symptoms and work ability in unemployed individuals with mental illnesses (UMIs). This will enable us to identify the symptoms that are most relevant for future research and application. Our study is based on a sample from the project LIPSY, which aims to maintain and/or restore the employability of UMIs. We conducted regression analyses with the outcome variable work ability in a sample of unemployed individuals with a mental illness (ICD-10: F-diagnosis). In the initial analysis, age, gender, education, and cohabitation status were used as predictors; in the final model, all nine symptom dimensions (SCL-90) were added, that is, (1) Somatization, (2) Obsessive-Compulsive, (3) Interpersonal Sensitivity, (4) Depression, (5) Anxiety, (6) Anger-Hostility, (7) Phobic Anxiety, (8) Paranoid Ideation, and (9) Psychoticism. Our sample comprised 402 participants, with a mean age of 35.7 years, 52.5% were female. In the final analysis, we found significant positive associations between education, Paranoid Ideation, and work ability, and a significant negative one between Depression and work ability, but no other significant associations. The elevated scores on all SCL-90 dimensions, along with the associations between two dimensions and work ability, underscore the need for psychological screening, diagnosis, prevention, and therapy (Depression) as well as additional public health attention and research (Paranoid Ideation) in this high-risk population.

Associations of sociodemographic and smoking characteristics with intention to quit among Chinese adults aged 20–69 years who smoke: Findings from nationwide China Health Literacy Survey during 2018–19

ObjectiveTo identify factors influencing the intention to quit (ItQ) among Chinese who smoke, focusing on 10th Revision of the International Classification of Diseases (ICD-10) Nicotine dependence. Additionally, to estimate the number of individuals with ItQ, supporting optimal allocation of cessation resources. MethodsThis study used data from the 2018 China Health Literacy Survey, a nationally representative cross-sectional study with 20,288 participants who smoke currently aged 20–69 years. The ItQ proportions were estimated overall and by subgroup. Logistic regression was employed to estimate ORs and 95 % CIs for ItQ. The number of people who smoke with ItQ was estimated based on the census data. ResultsIn China, 41.34 % of individuals who smoke had ItQ, higher in females (44.89 %) than males (41.34 %). Provincial proportions ranged from 23.53 % to 63.56 %. ItQ was significantly associated with smoking characteristics, including occasional smoking (OR = 2.08, 95 % CI = 1.88–2.20), fewer pack-years (OR = 0.70, 95 % CI = 0.68–0.73), older smoking initiation age (OR = 1.22, 95 % CI = 1.18–1.27), and ICD-10 Nicotine dependence (OR = 1.12, 95 % CI = 1.06–1.19), as well as age, sex, socioeconomic factors, and health status. Withdrawal symptoms were positively associated with ItQ in individuals who smoke without ICD-10 Nicotine dependence but negatively in those with ICD-10 Nicotine dependence. An estimated 100.3 million adults aged 20–69 in China have ItQ, with 52.14 million suffering from ICD-10 Nicotine dependence. ConclusionsThe intention to quit smoking among Chinese who smoke is low and varies by ICD-10 Nicotine dependence and region, underscoring the need for targeted smoking cessation interventions across diverse smoking populations.

Ear Correction of Newborn Ear Deformity.

Otoplasty has been described for nearly 200 years for children and adults. Although auricular deformity has been recognized in newborns, treatment options were lacking. With the development of ear molding techniques, newborn ear deformities can now be corrected nonsurgically. However, these techniques have distinct limitations with much dependent on the age of initiation of treatment and deformities present. Awareness of these early interventions is therefore crucial to initiate treatment in the early developmental period when the ear is still malleable. During the first few weeks of life, the ears are malleable, and the ears are rapidly growing, relatively. Therefore, the neonatal period provides a unique opportunity to contour the ears properly. Different techniques have been developed. However, the premise is that the ears are stabilized in a favorable contour continuously for several weeks to hold into proper position. This procedure carries minimal risk and can be quite efficacious, preventing a child from needing surgery later in life.

Polygenic Risk for Substance Use Disorders as Predictors of Substance Use Initiation Among African American Youth.

Despite adverse health consequences associated with early substance use initiation, less is known about the influence of genetic risk on initiation and environmental characteristics that may moderate these associations, particularly among African Americans. We examined whether genetic risk for alcohol and cannabis use disorder, and nicotine dependence, is associated with age of initiation of these substances, and whether community disadvantage and parental monitoring moderate these associations in a sample of African American youth. Participants (n=1,017; 56% female) were initially recruited for an elementary school-based universal prevention intervention trial. At age ~20, participants reported on age of initiation of alcohol, tobacco, and cannabis use and provided a saliva or blood sample. At age ~12, caregiver reports on parental monitoring were obtained, along with census-tract data to measure community disadvantage. Hypotheses were tested using Cox Proportional Hazard Models. Higher alcohol use disorder PRS was associated with later alcohol initiation (HR=0.78, 95% CI =0.65-0.94). Cannabis use disorder and nicotine dependence PRSs were not associated with initiation of these substances. We observed an interaction between the cannabis use disorder PRS and parental monitoring; among individuals with high cannabis use disorder PRS, high monitoring was associated with earlier cannabis initiation, whereas among individuals with low PRS, low monitoring was associated with earlier initiation. Findings largely indicate that PRS for substance use disorders are not associated with age of initiation among African American youth. Parental monitoring may influence the association between cannabis use disorder PRS and age of cannabis initiation, but replication of our findings is warranted.

Age of tobacco, nicotine and cannabis use initiation in Switzerland: a sequence analysis among adolescents and young adults.

To explore at what age youth start using tobacco and/or nicotine products, which product is used first, product initiation sequences, and whether some socio-demographic characteristics are associated with substance use initiation. Data were collected from an online questionnaire disseminated through social media and professional partners, targeting youth aged 14-25 in French-speaking Switzerland in August 2022. The final sample included 1362 participants. Respondents were asked whether they had already used cigarettes, e-cigarettes, hookah, snus, or cannabis at least once in their life (yes/no) and the age of the first time was asked for each substance when the answer was positive. Additionally, participants were asked about their substance use in the past 30 days. Respondents were classified according to age at onset of each tobacco/nicotine and cannabis product, and comparisons were made based on sociodemographic variables, including gender (cisgender female/cisgender male/transgender), perceived socioeconomic status (below average/average/above average), and age. Overall, in addition to those who reported no consumption, four distinct initiation profiles emerged from the classification. Cigarettes remain the most commonly used first product with an average age of 15.7 years. While cigarettes and hookah are present in all profiles, the order of first consumption varies from one profile to another, with cigarettes coming first in two profiles, hookah in one and e-cigarettes in the last. Furthermore, while the most common profile contains experimental consumption of the five products considered, some profiles do not contain cannabis, e-cigarettes and/or snus, for example. When divided by age groups, both 14-17-year-olds and 18-21-year-olds reported cigarette as their first product of initiation. Across the separate age groups (14-17, 18-21, 22-25), cigarettes consistently emerge as the primary used on average. Cigarettes remain the first product to be used, but the younger the respondents, the earlier they start using e-cigarettes, and very close to cigarettes. Regarding current consumption patterns, e-cigarettes are becoming increasingly prominent.

Age of Cafeteria Diet Onset Influences Obesity Phenotype in Mice in a Sex-Specific Manner.

We investigated the influence of sex and the age of obesogenic diet initiation on the obesity phenotypes at a later age. C57Bl mice started the Cafeteria Diet (CafD, with increased fat and carbohydrates, ad libitum, from 7 weeks of age (7CafD, pre-puberty) or 17 weeks of age (7CafD, post-puberty) while control C57Bl mice were fed regular chow. At 27 weeks of age, 7CafD males (n = 9) compared to 17CafD males (n = 7) had lower body weight, white adipose tissue (WAT) relative weight, and plasma cholesterol levels, and a higher expression of thermogenic genes in WAT and brown adipose tissue (BAT), and fatty acid oxidation (FAO) and insulin signalling genes in muscles. The 7CafD females (n = 8), compared to 17CafD females (n = 6), had higher plasma triglyceride levels and hepatic glycogen content, but lower insulin sensitivity and hepatic expression of FAO and insulin signalling genes. The 7CafD females, compared to 7CafD males, had more WAT, and a reduced expression of FAO genes in muscles and thermogenic genes in WAT. The 17CafD females, compared to 17CafD males, had lower plasma leptin and insulin levels, and higher insulin sensitivity and expression of insulin signalling genes in the liver and muscles. Thus, the initiation of the obesogenic diet before puberty led to a more adaptive metabolic phenotypes in males, and after puberty, in females.

Comparison of Sport Type on the Handgrip Strength Change in Young Athletes.

Whether or not an athlete plays with sports equipment in their hands may influence handgrip strength (HGS) changes during development, but longitudinal studies have not confirmed this. This study compared one-year HGS changes between two sports types (soccer vs. kendo) in children and adolescent athletes. One hundred sixty-eight young athletes (86 kendo boys and 82 soccer boys) had two HGS measurements separated by 1 year. A 2 (sports) by 2 (timepoints 1 and 2) repeated measures ANOVA was used to determine whether HGS changed differently between sports. There was no evidence for a sport × time interaction in HGS (p = 0.14); however, the mean difference and 95% CI were in the direction of favoring a greater change in kendo athletes [difference of 0.6 (95% CI: -0.2, 1.5) kg]. There was a main effect of time and sport. Kendo athletes had a 4.6 (95% CI: 1.8, 7.5) kg greater HGS than soccer athletes. There was no evidence that the change in HGS between sports depended on the initial age of the athlete (p = 0.205). Using sports equipment during play may positively affect HGS.

Assessment of e-cigarette dependence and influencing factors among Palestinian young adults: a cross-sectional study

E-cigarette use is a growing public health concern, especially because of the potential health risks it poses. This study focuses on assessing e-cigarette dependence and the factors associated with it among Palestinian young adults. A cross-sectional survey was conducted from January to May 2023 among university students in the West Bank. A self-administered questionnaire was used to collect demographic data, knowledge, and attitudes regarding e-cigarettes. E-cigarette dependence was assessed using the Penn State Electronic Cigarette Dependence Index. The study included 386 university students who used e-cigarettes. Many of them started using e-cigarettes at a young age, and 54.7% were dual users of e-cigarettes and traditional tobacco. High levels of dependence were reported in 11.4% of participants, and moderate dependence in 28.8%. Several factors were identified through multivariate linear regression as significantly associated with e-cigarette dependence: a higher monthly allowance (β = 0.116, 95% CI: 0.128- 1.124, p = .014), having a father who uses tobacco (β = 0.095, 95% CI: 0.030- 1.638, p = .042), having a close friend who smokes traditional cigarettes (β = 0.095, 95% CI: 0.019- 1.667, p = .045), using e-cigarettes in areas where traditional smoking is prohibited (β = 0.175, 95% CI: 0.689–2.330, p < .001), using e-cigarettes to quit other forms of tobacco (β = 0.134, 95% CI: 0.434–2.314, p = .004), and a more negative attitude score (β = − 0.210, 95% CI: − 0.285- − 0.112, p < .001). The study revealed high levels of e-cigarettes dependence among the participants among young adults, with associated variables such as monthly allowance, attitudes, and age of e-cigarette initiation. Policymakers, educators, and healthcare professionals should collaborate to address e-cigarette dependence among young adults, taking into consideration social, environmental, and socioeconomic factors.

Abstract 4136799: Disparities in Diagnosis and Treatment of Heterozygous Familial Hypercholesterolemia

Introduction: The prevalence of heterozygous familial hypercholesterolemia (HeFH) is 1:250. Untreated individuals have up to a 20-fold increased risk for premature coronary artery disease (CAD). In adults, low socioeconomic status (SES) individuals, bear a disproportionate share of the CAD burden. In this context, we sought to examine the association of social determinants of health and age at HeFH diagnosis and treatment. Methods: We performed a retrospective single-center study of children with HeFH who presented to the Lipid Heart Clinic at the Children’s Hospital of Philadelphia (2012-2022). The primary outcome was age at HeFH diagnosis. The secondary outcome was age at statin initiation. Multivariable linear regression models were used to examine the association between the primary exposure of interest, Child Opportunity Index (COI) and the outcomes. Secondary exposures included race, ethnicity, health insurance, and primary language. To explore potential referral bias, we compared the COI of the study cohort to that of the institution’s catchment area, defined as within a two-hour drive of the primary clinic. Results: We evaluated 577 patients. The median age at presentation was 12 (9, 14) years and the median LDL-C was 199 (169, 235) mg/dL; 58% were prescribed a statin with a median age of statin initiation of 13 (10, 15) years. The median COI for the cohort was 84 (62, 95). There was no association between COI, ethnicity, health insurance, or primary language and the age at HeFH diagnosis or statin initiation. On multivariable analysis, black race was associated with older age at HeFH diagnosis compared to white race (adjusted estimate 1.2 +/- 0.49 yrs, p = 0.014). There was no difference in age at statin initiation by race. Higher LDL-C, male sex, and lower BMI percentile were associated with younger age at statin initiation. The COI distribution of the study cohort was significantly different than that of the catchment area (p &lt; 0.001). 70% of the study cohort were of high and very high COI compared to 57% of the catchment area. Conclusion: Black race was associated with older age at HeFH diagnosis, however, there were no disparities in age at statin initiation. The COI of the cohort was significantly higher than that of the catchment area suggesting that low COI populations are under-referred for HeFH evaluation. Future efforts should focus on improving barriers to universal screening and identifying obstacles to HeFH diagnosis and referrals.

In utero, childhood, and adolescence tobacco smoke exposure, physical activity, and chronic kidney disease incidence in adulthood: evidence from a large prospective cohort study

BackgroundThe adverse effects of early-life tobacco smoke exposure on chronic kidney disease (CKD) risk remain unclear. This study aimed to investigate the associations of early-life tobacco smoke exposure with CKD incidence in adulthood, and further explore the modification effects of physical activity (PA).MethodsA total of 352,883 participants were included from the UK Biobank. The information on early-life tobacco smoke exposure was assessed by employing in utero tobacco smoke exposure and age of smoking initiation. Weekly moderate-to-vigorous physical activity (MVPA) was calculated for each individual. Cox proportional hazard regression was fitted to estimate the hazard ratio (HR) and 95% confidence interval (CI) of CKD risk, and to investigate the modification effects of MVPA.ResultsCKD incidence significantly increased in participants with in utero tobacco smoke exposure (HR: 1.08, 95% CI: 1.04, 1.12). Compared with never-smokers, we found a monotonic increase in the risk of CKD with smoking initiation across adulthood (HR: 1.21, 95% CI: 1.16, 1.27), adolescence (HR: 1.29, 95% CI: 1.24, 1.35), and childhood (HR: 1.34, 95% CI: 1.25, 1.43) (P trend < 0.001). Additionally, we identified joint cumulative effects of MVPA and early-life tobacco smoke exposure on incident CKD. Compared with never-smokers with recommended MVPA, prenatal or childhood tobacco smokers without recommended MVPA had the highest CKD risk, and the HRs (95% CIs) were 1.17 (1.10, 1.24) and 1.51 (1.36, 1.68), respectively.ConclusionsEarly-life tobacco smoke exposure may contribute to CKD incidence in adulthood, and the observed associations could be modified by MVPA. These findings provide important information on CKD prevention in the participant’s early life while urging a more rapid and powerful need for tobacco control among pregnant couples, children, and adolescents.

Study to Evaluate the Comparative Efficacy of Medhya Rasayana (Pharmacological) Versus Nonpharmacological Interventions in Management of Gadget Addiction in Children: Protocol for Parallel, Triple-Arm, Randomized Clinical Trial.

Gadget addiction is a common behavioral problem among children. It is known to hamper social and academic life as well as adversely affect the lives of children. Ayurveda offers many therapeutic modalities and Ayurvedic medicines that can be used in the management of gadget addiction in children. The purpose of this study is to evaluate and compare the effectiveness of nonpharmacological therapies and the pharmaceutical intervention Medhya Rasayana in treating childhood gadget addiction. This study aims to provide a detailed description of the study methodology that will be used to compare the efficacy of nonpharmacological versus pharmaceutical interventions in the treatment of children's gadget addiction. A randomized, parallel, triple-arm interventional study will be conducted on diagnosed participants of gadget addiction with an age group of 6- to 16-year-old children, which will be selected and equally distributed in 2 groups. Group P will be given Medhya Rasayana (pharmacological intervention), group N will be nonpharmacological Ayurveda intervention, and group C (cognitive behavioral therapy) will be an external group. The Study duration is 180 days with assessment at baseline, midpoint, and endpoint Appropriate statistical techniques, such as ANOVA and regression analysis, will be used to examine the data and evaluate the efficacy of the 3 groups' interventions. We will perform subgroup analysis according to initial addiction severity, gender, and age. Primary outcome measures include a reduction in gadget addiction and changes in the psychosocial well-being of participants. Standardized questionnaires and instruments will be used to collect data. In December 2023, the randomized controlled study got underway. Since participants may begin at any time, our goal is for everyone to be finished by December 2024. This research will provide crucial new information about the relative effectiveness of Ayurveda nonpharmacological therapies and Medhya Rasayana in treating children's gadget addiction. The results will guide evidence-based treatments aimed at reducing the negative impact of excessive gadget use on this susceptible population's psychosocial development. In the end, the findings are meant to help policy makers and medical professionals create sensible plans to deal with the rising issue of childhood gadget addiction. PRR1-10.2196/51833.

Characterization of electronic device use among children and adolescents aged 6 to 14

Introduction: Children and adolescents use computers, cell phones, and tablets, among other electronic devices, daily in non-aca- demic activities. It is essential to characterize the impact these devices have on the socialization, interaction, and learning processes in this population segment. We should also investigate possible harmful effects that may be related to their use. The objective was to characterize how these devices are used and their impact on school performance, behavior, and physical activity in children and adolescents from 6 to 14 years of age. Materials and methods: This is a cross-sectional analytic study of 510 schoolchildren ages 6 to 9 and 10 to 14 from Bogotá and Cun- dinamarca, Colombia. They were surveyed with a 38-question survey characterizing the use of the devices and the symptoms of anxiety and depression, conflict resolution, sleep, and school performance. Results: The average age for initiation on the use of devices was four years. Cell phones were the most used in both groups (56.3% and 78.04%). Parents monitor the use of the device in 80% of cases. 40% of the time, device usage was greater than 90 minutes per day. About 16% reported sleep disturbance, frustration (48%), emotional lability (20%), and suicidal ideations (11%) also were reported. 19% did not play with their peers, and 7% did not report having close friends. Conclusions: This study shows the high exposure to electronic devices from an early age and their relation to behavioral factors. Fu- ture studies should explore the relationship between these factors and electronic devices in depth.

Relationship between high levels of D-dimer and prognosis in patients with spontaneous supratentorial cerebral haemorrhage: A retrospective study and double validation

ObjectiveThe aim of this study was to investigate the correlation between D-Dimer and unfavorable outcome after surgery for spontaneous supratentorial intracerebral hemorrhage(SSICH) MethodsA total of 557 patients with spontaneous supratentorial intracerebral hemorrhage underwent surgical treatment, which included craniotomy evacuation of hematoma and puncture and drainage. Based on the modified Rankin Scale (mRS) bifurcation, the patients were divided into two subgroups: favorable outcome (mRS score 0–2) and unfavorable outcome (mRS score 3-5). D-dimer levels were measured within 24 h of admission, monitored until discharge, and grouped by quartiles (Q1-Q4). We collected and calculated D-dimer levels at different periods of time: (1) at admission (pre-surgery); (2) average post-surgery level; (3) average level during hospitalization; and (4) peak level during hospitalization. Two methods were used for validation, the first using a traditional multifactorial Logsitic regression equation, and the second where we chose baseline clinical, laboratory, and other variables and constructed a prognostic model through multivariate logistic regression. ResultsStatistical results showed statistically significant differences in age, Glasgow Coma Score (GCS) on admission, high levels of D-dimer, and bleeding. Predictive models developed on the basis of initial age, GCS, and D-Dimer showed good discriminatory power ConclusionsD-dimer is an independent risk factor for the development of poor postoperative prognosis in patients with SSTICH, and a prognostic model developed on the basis of D-Dimer predicts the development of poor postoperative prognosis in patients with SSTICH. The model needs to be validated in larger studies conducted at other institutions.