The academic recognition that work-family roles are relevant determinants of health over the life course requires more empirical evidence from contexts in the Global South, such as China, where rapid social changes and widening health inequalities among the older population coexist. This research aims to explore the associations between combined work-family trajectories and health outcomes among Chinese older adults from life course and gender perspectives. Using data from the China Health and Retirement Longitudinal Study (CHARLS), this study used sequence and cluster analysis on individuals' work-family trajectories from age 16-50 among those born between 1935 and 1964. Multivariate linear regressions were then utilized to assess associations between work-family trajectories and health outcomes (chronic diseases and depressive symptoms). Results show that distinctive life course paths underlie health inequalities at older ages, with varying effects on men and women. Individuals following work-family trajectories characterized by protective roles and transitions-such as employment in non-agricultural occupations and enduring marriages-experience better health outcomes in later life. Conversely, trajectories involving disadvantageous roles, including employment in agricultural occupations, economic inactivity, higher fertility, and unmarried childbearing, are associated with poorer health. Notably, health variations across work-family trajectories are greater for women than men, and women face worse health outcomes than men, though this gender disparity narrows with employment in non-agricultural occupations.

To understand the impact of and subsequent reactions to exposure to extreme violence in young adults in South Africa exposed during school years. In particular, to get an in-depth understanding of its immediate consequences and factors that ameliorate or exacerbate it. An exploratory qualitative research design was used, using purposive sampling. Semi-structured interviews with 21 young South African adults aged 19-31 were conducted online. Transcripts were analysed using thematic analysis. Violence exposure was found to result in trauma reactions with themes of a continued sense of being unsafe, feeling damaged and defective because of having these reactions, and mistrust towards others. In terms of coping reactions, a theme of avoidance and/or reacting with aggressive behaviour was identified, which likely exacerbated the challenges they experienced. By contrast, a more positive theme was identified in some, focused on having a sense of community and connectedness, which was experienced as ameliorating these challenges. Exposure to community and school violence in childhood has a lasting impact on mental health and adjustment in later life. The impact is likely worsened by mistrust of others, a continued sense of feeling unsafe and counterproductive coping mechanisms, while connectedness and community seem to lessen the impact. Further research can refine these findings to build an understanding of these mechanisms to inform secondary prevention and treatment interventions in low- and middle-income countries.

Myasthenia gravis (MG) requires long-term therapeutic strategies that control symptoms while minimizing exposure to oral corticosteroids (OCS). Fast-acting treatments (FT), such as intravenous immunoglobulin (IVIG), are commonly used during exacerbations, whereas efgartigimod (EFG) has recently emerged as an alternative outpatient therapy. This study aimed to compare the efficacy and quality of life (QOL) outcomes of IVIG and EFG in patients with MG. A retrospective analysis was conducted in 67 patients with MG. Fifty-five patients continued IVIG during exacerbations (IVIG group), whereas 12 patients switched from IVIG to EFG (Switched-EFG group). The primary outcome was the achievement of minimal manifestations (MM) or MM with prednisolone ≤ 5 mg/day (MM-5 mg). The secondary outcomes included changes in the Myasthenia Gravis Activities of Daily Living scale (MG-ADL) scores and reduction of prednisolone (PSL) dose between the two groups. The number of hospitalizations and scores on the Japanese version of the Myasthenia Gravis Quality of Life 15-Item Scale-Revised (MG-QOL15r-J) were compared before and after EFG initiation. No significant differences were observed between the groups in MM, MM-5 mg, ΔMG-ADL, or ΔPSL scores. In the Switched-EFG group, the number of hospitalizations was significantly decreased, whereas the MG-QOL scores improved following EFG initiation. The questionnaire responses consistently favored EFG, particularly in supporting family roles, work participation, and social activities. Notwithstanding the study's limited sample size and observational nature, Switching to EFG yielded notable therapeutic benefits compared with IVIG, while additionally reducing the hospitalization rate and enhancing QOL. Therefore, EFG may be a valuable outpatient treatment option for refractory MG.

To evaluate the effectiveness of the Smart Post-Discharge Elderly Health Management Platform on health-related quality of life and self-management after hospital discharge. The global aging population has increased challenges in post-discharge care for older adults, particularly due to chronic conditions and the need for continuous care. Cluster randomised controlled trial. The trial enrolled 383 elderly patients assigned to a platform-based intervention or standard telephone follow-up, with health-related quality of life, self-management, usability and economic outcomes assessed over 6 months. This study was reported in accordance with the CONSORT guidelines. Repeated measures analyses showed significantly greater improvements in HRQoL in the intervention group over 6 months (p = 0.026), with significant improvements across multiple physical and mental health domains (p = 0.002-0.021). Self-management total scores increased significantly (p < 0.001). Platform usability was rated highly by 96.35% of users, and 70.83% reported reduced healthcare costs. Providing a practical framework for integrating technology into nursing practice for aging populations, this platform shows promise for post-discharge elderly care by strengthening nurse-led digital health delivery, care continuity, self-management and health outcomes beyond hospital settings. ChiCTR2400089720.

Psychosocial outcomes of low-dose computed tomography screening for lung cancer in high-risk populations: A systematic review update.

Digital twin technology represents a transformative innovation in healthcare, creating virtual replicas of physical entities that enable real-time monitoring, prediction, and personalised intervention. People living with disability face multifaceted healthcare challenges requiring continuous monitoring, adaptive assistive technologies, and individualised treatment approaches. The convergence of digital twin technology with disability healthcare presents unprecedented opportunities for enhancing quality of life, independence, and clinical outcomes. This review examines the current applications, benefits, challenges, and future directions of digital twin technology in healthcare delivery for people living with disability. A narrative review methodology was employed, synthesising literature from academic databases including PubMed, IEEE Xplore, Scopus, and Web of Science. The review encompassed peer reviewed articles, conference proceedings, and technical reports published between 2015 and 2025, focusing on digital twin implementations in disability healthcare contexts. Digital twin applications in disability healthcare span multiple domains, including rehabilitation, assistive device optimisation, cognitive support systems, mobility enhancement, and chronic condition management. The technology demonstrates significant potential in personalising interventions, predicting health deteriorations, optimising assistive technologies, and facilitating remote monitoring. Key applications include virtual prosthetic fitting, wheelchair optimisation, rehabilitation progress tracking, and predictive analytics for secondary complications. However, implementation faces challenges including data privacy concerns, technological accessibility, interoperability issues, and cost barriers. Digital twin technology offers transformative potential for disability healthcare, enabling personalised, predictive, and preventive care models. Successful implementation requires addressing technological, ethical, and accessibility challenges whilst ensuring equitable access for diverse disability populations. Critical research priorities include large-scale clinical trials, cost-effectiveness analyses, longitudinal outcomes studies, and ethical frameworks balancing surveillance concerns with care benefits.

Fatigue in chronic viral hepatitis may be associated with decreased health-related quality of life and other patient-reported outcomes (PROs). We evaluated the relationship between fatigue and PROs in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC). Patients with CHB and CHC enrolled in the Global Liver Registry completed PRO instruments: FACIT-F, CLDQ (for CHB), CLDQ-HCV (for CHC), and WPAI:SHP. Fatigue was defined as FACIT-F Fatigue Scale (FS) score < 30 (scale range: 0-52). Among 2888 patients from 14 countries, 1561 had CHB (mean age 47 ± 13 years; 60% male; 13% advanced fibrosis; 13% depression; 17% fatigue) and 1327 had CHC (50 ± 13 years; 47% male; 21% advanced fibrosis; 18% depression; 28% fatigue). CHB-fatigue was associated with younger age, female, obesity, anxiety, depression (all p < 0.01) and worse PRO scores: CLDQ (scale 1-7): 4.1 ± 0.9 vs. 5.8 ± 0.9; FACIT score (range 0-108): 67.6 ± 14.5 vs. 87.7 ± 13.7; work productivity impairment (range 0-1): 0.33 ± 0.29 vs. 0.11 ± 0.22 (all p < 0.0001). Multivariable analysis confirmed the association of fatigue with lower PRO scores, impairment up to -23% (p < 0.01). CHC-fatigue was associated with female sex, obesity, type 2 diabetes, anxiety, depression (all p < 0.05) and worse PRO scores: CLDQ-HCV: 3.8 ± 1.0 vs. 5.5 ± 1.0; FACIT: 61.8 ± 14.1 vs. 85.6 ± 14.5; work productivity impairment: 0.49 ± 0.32 vs. 0.17 ± 0.25 (all p < 0.0001). In multivariable models, fatigue remained associated with reduced PRO scores, impairment up to -33% (p < 0.01). Almost one in five patients with chronic viral hepatitis report significant fatigue, which is associated with substantial PRO and work productivity impairment. Routine assessment for and management of fatigue in CHC or CHB care is essential.

Psychological and health-related quality of life outcomes in children with developmental and epileptic encephalopathy with spike-wave activation in sleep (D/EE-SWAS): A single-center prospective study

The effect of digital health interventions in older adults with frailty: a systematic review and meta-analysis.

Traditional approaches to evaluating transport network vulnerability primarily focus on technical performance metrics or economic costs, often overlooking the societal and human impacts of disruptions. This paper addresses this gap by proposing a novel framework that integrates the Capability Approach (CA) into flood-vulnerability assessment of transport networks, thus linking individuals’ real freedoms to pursue valued life outcomes. A metric, Capability-Link-Dependency is used to quantify how transport disruptions can potentially constrain individual capabilities to access essential services such as healthcare, food, education and emergency services. A case study in Fingal County, Ireland, demonstrates how communities may experience severe accessibility losses even when located outside flood zones. The findings highlight that vulnerability assessments should incorporate wellbeing to ensure equitable resilience planning. This approach identifies both critical links and socially vulnerable populations and provides a transferable framework that can be expanded to other hazards and geographic contexts.

This review synthesizes current evidence on how endometrial polyps, leiomyomas, adenomyosis, and endometriosis influence endometrial receptivity, emphasizing phenotype-specific effects, molecular mechanisms, and implications for embryo transfer outcomes. Impaired endometrial receptivity, when present, is mediated by a limited set of convergent pathways, including Homeobox gene (HOX) A10/HOXA11 suppression, inflammatory cytokine dysregulation, and progesterone resistance. Leiomyomas and adenomyosis alter decidualization through paracrine signaling, including TGF-β-mediated pathways. Adenomyosis is consistently associated with defective decidualization and altered estrogen-progesterone signaling. Endometriosis alone appears to have limited direct effects on receptivity, and many studies are confounded by unrecognized coexisting adenomyosis. Clinical benefit from polypectomy and myomectomy is phenotype-dependent, with the strongest support for submucous fibroids and selected polyps. Commercial receptivity assays (e.g. BCL6-based testing) remain insufficiently validated to guide clinical decision-making. These pathologies do not uniformly impair endometrial receptivity. When impairment occurs, it is phenotype-specific and mediated through shared molecular pathways. Current evidence supports targeted surgical intervention in selected phenotypes, but at present, there are no available tests, such as those assessing relevant endometrial expressions, to guide more specific case selection. Future work should link phenotype-specific treatment to restoration of validated molecular markers and live birth outcomes.

Long term outcomes of the antegrade continence enema in children with an anorectal malformation - a systematic review.

The optimal reconstructive approach following neoadjuvant immunochemotherapy (NICT) and surgery for locally advanced oral squamous cell carcinoma (OSCC) remains debated. This study compared pedicled submental island flap (SIF) and free flap (FF) reconstruction in this contemporary treatment setting. We conducted a retrospective comparative study of 212 consecutive patients with locally advanced OSCC treated with NICT followed by surgery. Propensity score matching (1:1) yielded a balanced cohort of 54 SIF and 54 FF patients. Outcomes included disease-free survival (DFS), overall survival (OS), operative time, complications, recovery milestones, and patient-reported quality of life (QoL) assessed via EORTC QLQ-C30/H&N35 at baseline, 3, 6, and 12 months. Operative time and hospital stay were significantly shorter for SIF (4.5 ± 1.1 vs. 6.3 ± 1.4 h, p < 0.001; 8.1 ± 2.5 vs. 11.8 ± 3.1 days, p < 0.001). Flap survival and major complication rates were comparable (p > 0.05). Median follow-up was 38.5 months. No significant differences were observed in DFS (HR = 0.90, 95% CI: 0.41-1.98, p = 0.796) or OS (HR = 0.83, 95% CI: 0.34-2.00, p = 0.678). However, QoL recovery was superior in the SIF group, with significantly greater improvements in Global QoL (81.5 ± 8.2 vs. 73.9 ± 10.1, p < 0.001), physical and social functioning, and head and neck-specific symptoms (swallowing, speech) at 12 months. Linear mixed models confirmed a favorable SIF trajectory over time (time-by-group interaction p < 0.001). In patients with locally advanced OSCC undergoing NICT, SIF reconstruction offers comparable oncologic safety to FF while facilitating faster surgical recovery and yielding superior long-term functional and quality of life outcomes.

Type 1 diabetes (T1D) requires lifelong insulin therapy. Although multiple daily injections (MDI) remain widely used, advanced technologies, such as continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) system have demonstrated benefits in glycemic control and quality of life (QoL). However, comparative data on these modalities in pediatric population are still limited. This study examined the associations between therapy type, clinical outcomes, and health-related QoL (HRQoL) in children and adolescents with T1D. Demographic, anthropometric, and clinical data were collected from 262 children and adolescents with T1D. HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module. Among participants, 62% were treated with MDI, 11% with CSII, and 27% with AID, without significant differences between children and adolescents. In adolescents, MDI users showed significantly higher mean HbA1c values and suboptimal glycemic control (p-value < 0.001), higher daily insulin requirements (p-value = 0.003), and lower estimated glomerular filtration rate (eGFR) (p-value < 0.001) compared with CSII and AID users. While, in children only eGFR was associated with therapy type (p-value < 0.001). Only female adolescents reported better QoL when treated with CSII, with therapy type associated with HRQoL domains related to Worry (p-value = 0.031), Management (p-value = 0.050), and total HRQoL (p-value = 0.034). Overall, adolescent females also showed poorer HRQoL than males, particularly in domains related to worry about diabetes complications (p-value =0.002), and communication difficulties (p-value < 0.001). The use of modern insulin delivery technologies was associated with improved clinical outcomes, including early renal markers. However, HRQoL were limited and predominantly observed in female adolescents, who nevertheless reported lower overall QoL than their male peers. These findings suggest that while technological advances can enhance clinical outcomes, they may not fully address the psychosocial challenges of living with T1D, especially during female adolescence, a period of heightened emotional vulnerability. Integrating gender- and age-sensitive psychosocial support alongside technological innovations may be crucial to achieving holistic diabetes care.

Callous-unemotional (CU) traits in early childhood are risk markers for persistent antisocial behaviour, with marked adverse life outcomes. However, associations of CU traits with broader psychosocial characteristics are not well understood, particularly in early childhood. To examine developmental and psychosocial profiles of pre-school children according to their levels of CU traits and conduct problems (CPs) in a large, population-based cohort from southern Brazil. The 2015 Pelotas Birth Cohort includes 4,275 children followed from birth. At age 4 years, CU traits and CP were assessed via parent-report questionnaires, and 19 other psychosocial characteristics were examined mostly in task-based assessments regarding: neurodevelopment, language, executive functioning, emotion recognition, theory of mind, social information processing and empathy/prosocial behaviours. These 19 psychosocial characteristics were compared across four groups of children with varying levels of CU/CP, and regression models were used to test for independent associations with CU traits and CP, adjusting for sociodemographic factors at birth. At age 4 years, 14.8% of children had elevated CU traits only, 14.2% had CP only, and 16.3% had both high CU + CP. Compared to children without CU traits or CP, children with higher CU traits had poorer performance across multiple domains of development, including language, motor development, emotion recognition and prosocial behaviour. In contrast, children with CP-only showed more circumscribed deficits, mainly in self-control and emotional functioning. In regression analyses, CU traits were associated with broader neurodevelopmental impairments, whereas CP was more specifically linked to behaviour regulation. Elevated CU traits in early childhood are associated with broad developmental difficulties, whereas CPs relate more specifically to emotional and self-regulation challenges. These findings underscore the need for holistic approaches to understanding early manifestations of CU traits and interventions in the context of CP behaviours.

Survivors of pediatric intensive care often experience prolonged morbidity, but recovery trajectories and features associated with impairment in general PICU populations remain uncertain. We aimed to explore the trajectory of health-related quality of life (HRQoL) and fatigue in critically ill children over the first year following PICU discharge, and to identify baseline and PICU factors associated with worse outcomes. OCEANIC is a multicenter prospective cohort study across 10 English PICUs. Children aged 1month-17years with PICU stay ≥ 48h were enrolled (2019-2022) and followed for 12-months (to 2023). HRQoL (PedsQL™ 4.0 Acute Versions) and fatigue (PedsQL™ Multidimensional Fatigue) were assessed at baseline (pre‑admission), PICU discharge, and 1, 3, 6 and 12 -months. We used Random Forest models with SHapley Additive exPlanations (SHAP) to identify features associated with below‑baseline HRQoL at each timepoint. Of 326 children enrolled, 220 had ≥ 3 HRQoL assessments. Mean PedsQL fell from 73.3 (SD 20.99) at baseline to 54.3 (SD 23.52) at discharge, then rose to 62.9 (1-month, SD 21.73) and 67.1 (3-months, SD 20.38), stabilizing thereafter (70.4 (SD 21.34) at 6-months; 69.8 (SD 22.46) at 12-months; p < 0.001 across time). At discharge, 71.8% were below their baseline HRQoL. Among 12‑month respondents, 58.1% remained below their baseline. Physical and school functioning showed persistent impairment, with cognitive functioning returning to baseline by 1-month. Fatigue largely normalized by 6-months. Higher baseline HRQoL and older age were consistently influential features with worse HRQoL, with physiological/illness markers important features across timepoints. At 12-months, 58% of responding children remained below their pre-PICU baseline HRQoL, with persistent impairment most evident in physical and school functioning. Modelling identifies population-level subgroups of children characterized by higher baseline or lower discharge HRQoL, older age, and prolonged PICU exposure who may warrant closer multidisciplinary follow‑up after PICU discharge. ISRCTN28072812 14/02/2020.

While Dark Patterns—interface design strategies that influence users’ choices to increase companies’ profit or data collection—are widely discussed in both legislation and academia, little is known about the characteristics that make people more or less vulnerable to these designs. Personality traits shape many life outcomes and choices, including potentially harmful buying behaviors (e.g., impulsive purchases). Because Dark Patterns are known to affect users’ decision-making, it is important to understand the role of personality traits in susceptibility to Dark Patterns, however, current research on the intersection between Dark Patterns and personality traits is limited. To address this gap, we developed a theoretical framework linking personality traits to Dak Patterns susceptibility and tested it in a preregistered experiment (N = 964). Results showed that participants high in Emotionality and Disintegration and low in Honesty–Humility were more susceptible to certain Dark Patterns, which aimed to increase purchase intentions. These results suggest that individual differences in personality can be used to reveal and potentially exploit vulnerability to Dark Patterns. We discussed how companies might exploit such tendencies through personality-based profiling and highlight potential legislative gaps concerning the use of inferred psychological data.

Quality of Life and Clinical Outcomes After Large Bore Mechanical Thrombectomy for Submassive Pulmonary Embolism.

The impact of maternal age on assisted reproductive technology (ART) outcomes is well established, whereas the contribution of paternal age remains less clearly defined, particularly among men with normal semen parameters. To evaluate the association between paternal age and live birth outcomes in couples undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) when the male partner is normospermic. We conducted a retrospective cohort study based on a prospectively maintained clinical database including 6262 couples undergoing their first fresh embryo transfer between 2018 and 2024 at a tertiary reproductive medicine centre. Normospermia was defined according to World Health Organization (WHO) 2021 criteria. The association between paternal age and live birth was assessed using multivariable logistic regression models adjusted for maternal age. Sensitivity analyses included additional adjustment for anti-Müllerian hormone (AMH) and Poisson regression with robust standard errors. Missing data were handled using multiple imputation. Among the 6262 couples, 2678 (42.8%) involved normospermic men. In multivariable logistic regression analyses, advancing paternal age was significantly associated with lower odds of live birth (OR: 0.943 per year; 95% CI, 0.932-0.955; p < 0.001). The association remained consistent after multiple imputation (OR: 0.941; 95% CI, 0.931-0.952; p < 0.001) and in sensitivity analyses including AMH (OR: 0.969; 95% CI, 0.950-0.987; p = 0.003). No significant interaction was observed between paternal age and fertilisation technique (IVF vs. ICSI). Advancing paternal age is associated with a reduced probability of live birth in ART, even among normospermic men and after accounting for maternal age. This effect, although modest on a yearly basis, may translate into a clinically meaningful cumulative decline in reproductive success over time. These findings highlight paternal age as a clinically relevant factor in reproductive counselling and prognostic assessment.

Tooth loss and edentulism are common consequences of oral diseases and may compromise quality of life, yet population-level evidence remains heterogeneous. This systematic review and meta-analysis evaluated the association between tooth loss, edentulism, and quality of life outcomes in adults using population-based epidemiological studies. MEDLINE, Embase, Scopus, and CENTRAL were searched for observational studies of representative adult populations assessing associations between tooth loss or edentulism and oral health-related quality of life (OHRQoL) or general quality of life (QoL), measured using validated instruments. Risk of bias was assessed using the Newcastle-Ottawa Scale (including adaptations for cross-sectional studies), and certainty of evidence was evaluated using GRADE. Random-effects meta-analyses were conducted for comparable adjusted effect estimates, stratified by estimand and exposure definition. For binary OHRQoL outcomes, pooling was based on study-specific dichotomizations reported by the original studies. Fifty articles comprising 55 population-based cohorts (287 750 participants from 37 countries) were included. Among these, four were prospective cohort studies, and the remaining had cross-sectional designs. Thirteen articles contributed to the quantitative synthesis. Individuals with nonfunctional dentition had approximately twice the odds of impaired OHRQoL compared with those with functional dentition [pooled adjusted odds ratio (OR) = 2.08; 95% CI 1.72-2.52; I2 = 70.6%]. This association remained robust in analyses restricted to studies using the OHIP-14 instrument (OR = 2.03; 95% CI 1.65-2.50; I2 = 65.9%). Overall associations between edentulism and impaired OHRQoL were heterogeneous; however, when restricted to OHIP-14-based studies, edentulism was associated with impaired OHRQoL (OR = 3.99; 95% CI 2.62-6.10; I2 = 0.0%). Reduced posterior occlusal support was also associated with worse OHRQoL, although the supporting evidence remains limited. Certainty of evidence for OHRQoL outcomes was rated as moderate. In population-based adult samples, tooth loss, particularly when resulting in nonfunctional dentition or reduced occlusal support, is consistently associated with poorer OHRQoL. Associations with general QoL are less consistent, reflecting broader determinants and instrument sensitivity. Preserving functional dentition and access to effective prosthetic rehabilitation may yield meaningful quality-of-life benefits at the population level.