Longitudinal Study Research Articles

Navigating academic and everyday life challenges in the US: the role of social media for international graduate students

Purpose This paper aims to explore the adaptive experiences of first-year international graduate students at a US university. It aims to understand the challenges they encounter, strategies they adopt with social media to navigate these challenges and tensions that emerge in their social media interactions. Design/methodology/approach This study uses a qualitative multiple-case research design to collect data from 22 semistructured interviews with 11 participants. Additionally, 110 social media artifacts were collected, focusing on international students’ use of social media in everyday and academic contexts. Findings This paper offers empirical insights into social media’s role in helping international students address practical challenges and fulfill learning needs in academic studies, assistantships, cultural understanding and the constructions of ethnic and peer groups for emotional and social support. Additionally, it identifies tensions such as addiction, distractions, emotional distress and the creation of filter bubbles. Research limitations/implications Given the qualitative approach of this paper, the generalizability of study findings is limited. Future studies can focus on different sites to explore context-related issues, students across different years or use a longitudinal research design to further explore international students’ experiences in relation to social media use and its role in their adaptation over time. Practical implications This paper proposes implementing social media curricula in universities to educate students on media literacy and digital competence and create peer groups to support international students beyond classrooms. Originality/value This paper adds value to informal learning literature focusing on international students.

Accurate prediction of all-cause mortality in patients with metabolic dysfunction-associated steatotic liver disease using electronic health records

Introduction and ObjectivesDespite the huge clinical burden of MASLD, validated tools for early risk stratification are lacking, and heterogeneous disease expression and a highly variable rate of progression to clinical outcomes result in prognostic uncertainty. We aimed to investigate longitudinal electronic health record-based outcome prediction in MASLD using a state-of-the-art machine learning model. Patients and Methodsn=940 patients with histologically-defined MASLD were used to develop a deep-learning model for all-cause mortality prediction. Patient timelines, spanning 12 years, were fully-annotated with demographic/clinical characteristics, ICD-9 and -10 codes, blood test results, prescribing data, and secondary care activity. A Transformer neural network (TNN) was trained to output concomitant probabilities of 12-, 24-, and 36-month all-cause mortality. In-sample performance was assessed using 5-fold cross-validation. Out-of-sample performance was assessed in an independent set of n=528 MASLD patients. ResultsIn-sample model performance achieved AUROC curve 0.74-0.90 (95% CI: 0.72-0.94), sensitivity 64%-82%, specificity 75%-92% and Positive Predictive Value (PPV) 94%-98%. Out-of-sample model validation had AUROC 0.70-0.86 (95% CI: 0.67-0.90), sensitivity 69%-70%, specificity 96%-97% and PPV 75%-77%. Key predictive factors, identified using coefficients of determination, were age, presence of type 2 diabetes, and history of hospital admissions with length of stay >14 days. ConclusionsA TNN, applied to routinely-collected longitudinal electronic health records, achieved good performance in prediction of 12-, 24-, and 36-month all-cause mortality in patients with MASLD. Extrapolation of our technique to population-level data will enable scalable and accurate risk stratification to identify people most likely to benefit from anticipatory health care and personalized interventions.

Induction cyclophosphamide with maintenance immunosuppression in high-risk myasthenia gravis: long-term follow-up and safety profile

BackgroundPatients with refractory or high-risk myasthenia gravis (MG) respond poorly to conventional immunosuppressive therapy, requiring rescue therapies and often experiencing treatment toxicity. Rescue and injectable therapies do not induce remission...

Association between osteocalcin and residual β-cell function in children and adolescents newly diagnosed with type 1 diabetes: a pivotal study.

This pivotal study aimed to evaluate circulating levels of bone remodeling markers in children and adolescents at the onset of type 1 diabetes (T1D). Additionally, we assessed their correlation with glucose control, residual β-cell function, and the severity of presentation. In this single-center cross-sectional study, we recruited children and adolescents newly diagnosed with T1D at our tertiary-care Diabetes Centre. Anamnestic, anthropometric, clinical, and biochemical data at T1D diagnosis were collected. Basal and stimulated C-peptide levels were assessed, along with the following bone remodeling biomarkers: osteocalcin (OC), alkaline phosphatase (ALP), parathormone (PTH), 25-OH Vitamin D (25OH-D), and the C-terminal cross-linked telopeptide of type 1 collagen (CTX). We enrolled 29 individuals newly diagnosed with T1D, with a slight male prevalence (51.7%). The mean age was 8.4 ± 3.7 years. A positive correlation between OC and stimulated C-peptide (R = 0.538; p = 0.026) and between PTH and serum HCO3- (R = 0.544; p = 0.025) was found. No other correlations between bone remodeling biomarkers and clinical variables were detected. Our data showed a positive correlation between OC levels and residual β-cell function in children and adolescents at T1D presentation. Further longitudinal studies evaluating OC levels in pediatric subjects with T1D are needed to better understand the complex interaction between bone and glucose metabolisms.

How School Burnout Affects Depression Symptoms Among Chinese Adolescents: Evidence from Individual and Peer Clique Level.

The impact of peer clique school burnout norms on adolescents' emotional adaptation is becoming increasingly prominent, but its underlying mechanisms remain unclear, especially in China where academic achievement is highly valued. The present study examined how clique burnout norms impact the relationship between school burnout, negative cognitive bias, and depressive symptoms. A total of 904 Chinese adolescents (57% boys; Mage = 12.73, SD = 0.43) participated in a two-wave longitudinal study (initiated in 2015, with approximately a 2-year interval). The results of multilevel models indicated that only in low clique burnout norms, adolescents with high school burnout at T1 would exhibit more negative cognitive bias and suffer from more depressive symptoms at T2, whereas the moderating effect was only observed in all-boys cliques. These findings reflect that a decrease in the overall level of burnout within a peer clique does not necessarily benefit every student, and the adaptation issues of students experiencing burnout still require attention even in a relatively healthy context.

Research article Quantifying physical resilience after knee or hip surgery in older Australian women based on long term physical functioning trajectories.

To improve outcomes after knee or hip surgery, better insight is needed in long-term recovery patterns in the context of ageing-related decline. We examined long-term trajectories of physical functioning (PF) in older women with and without hip and knee surgery, and described profiles of cases with higher and lower resilience after surgery. This observational study used data from 10,434 women (73-79 yrs) who completed survey 2 of the Australian Longitudinal Study on Women's Health. Data were used from surveys 2 (1999) to 6 (2011). Covariable-adjusted linear mixed models were run to examine the surgery-by-time (-12 to +12 yrs) interaction in association with PF (SF-36 subscale). The differences between observed and expected PF were calculated, with positive/negative values reflecting higher/lower resilience, respectively. Women with hip surgery (n=982) had lower PF than those without surgery (n=8117) (p<0.001). Among hip surgery patients, the decline was more rapid pre-surgery than post-surgery (Δslope=-0.7, p<0.001). Women with knee surgery (n=1144) had lower PF than those without surgery (n=7971), but with a slower rate of decline (p=0.01). Among knee surgery patients, the rate of decline was similar pre- and post-surgery (Δslope =-0.3, p=0.25). Both in hip and knee patients, women with higher resilience had fewer comorbidities and symptoms, and were more often physically active and independent in daily activities than those with lower resilience (all p<0.05). Compared with women without surgery, PF was lower and declined more rapidly around the time of hip surgery, but not for knee surgery. Women with better long-term recovery after surgery, had fewer health problems and were more independent around the time of surgery.

Labour Force Participation in Adults with Osteoarthritis (OA) or Joint Symptoms Typical of OA: Findings from a Canadian Longitudinal Study on Aging.

The purpose of the study is to examine the relationship between osteoarthritis (OA) and joint symptoms typical of OA and labour force participation. Data are from the baseline questionnaire of the Canadian Longitudinal Study on Aging for respondents aged 45-74 years at baseline (n=24,427). Individuals were categorized into one of five mutually exclusive arthritis status groups: diagnosed OA; diagnosed other type of arthritis; 2-3 symptomatic joint sites/no diagnosed arthritis; 1 symptomatic joint site/no diagnosed arthritis; no arthritis/no joint symptoms. Age-stratified robust log-Poisson regression analysis was used to examine the association between arthritis status and labour force participation. Overall 39% of the analytic sample reported being out of the labour force. Those with OA aged 45-54 and 55-64 years were significantly more likely to be out of the labour force than those with no arthritis/no joint symptoms, prevalence ratio (PR) 1.34 [95% CI 1.10-1.65] and PR 1.13 [95% CI 1.06-1.21] respectively, with similar results for those with 2-3 joint symptoms/no OA in the 45-54 year age group (PR 1.37 [95% CI 1.07-1.76]). There was no difference for those aged 65-74 years. Being an informal caregiver increased the likelihood of non-participation in the labour force for those aged 55-64 years, PR 1.09 [95% CI 1.04-1.15]. Our results suggest that an exclusive reliance on an OA diagnosis to understand impact on labour force participation may miss a large segment of the middle-aged population which may have undiagnosed OA or are at greater risk of OA because of joint problems.

Linear associations of Chinese visceral adiposity index and its change with hyperuricemia: A prospective cohort study

Background and aimsThis study aims to investigate the association of Chinese visceral adiposity index (CVAI) with incident hyperuricemia (HUA). Methods and resultsWe included 5186 adults aged ≥45 years from China Health and Retirement Longitudinal Study. Modified Poisson regression model was used to estimate the relative risks (RRs) of incident HUA associated with baseline CVAI, and logistic model was used to estimate the odds ratios (ORs) of HUA for CVAI change. Restricted cubic splines analysis was adopted to model the dose–response associations. The area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the predictive value of CVAI. During 4-year follow-up, a total of 510 (9.8%) HUA cases were identified. The RRs (95%CIs) of incident HUA were 3.75 (2.85–4.93) for quartile 4 versus quartile 1 and 1.56 (1.45–1.69) for per-standard deviation increase in baseline CVAI. For the analyses of CVAI change, compared with stable group, participants in decreased group had 34% lower risk (OR 0.66, 95%CI 0.49–0.87) and those in increased group had 35% (1.35, 1.03–1.78) higher risk of HUA. Linear associations of baseline CVAI and its change with HUA were observed (Pnonlinear >0.05). Besides, the AUC value for HUA was 0.654 (0.629–0.679), which was higher than other five obesity indices. ConclusionsOur study found linear associations between baseline CVAI and its change and risk of HUA. CVAI had the best predictive performance in predicting incident HUA. These findings suggest CVAI as a reliable obesity index to identify individuals with higher HUA risk.

WeChat usage and preservation of cognitive functions in middle-aged and older Chinese adults: indications from a nationally representative survey, 2018–2020

PurposeTo investigate the associations between the most popular social media platform WeChat usage and cognitive performance among the middle-aged and older Chinese population using data from a nationally representative survey.MethodsIn total, 17,472 participants (≥ 45 years old) from the China Health and Retirement Longitudinal Study (CHARLS, Wave 4, 2018) were analyzed. Cognitive performance including episodic memory and executive function was assessed using Mini-Mental Status Examination (MMSE). Other confounding variables included socio-economic characteristics, medical status, and lifestyle-related information. Multiple linear regression models were used to test the association between cognitive performance and WeChat usage by introducing covariates hierarchically. Subgroup analyses of age and gender were conducted to estimate the robustness of the primary findings.ResultsAfter adjusting for multiple confounders across all linear models, WeChat usage is significantly associated with executive function, episodic memory, and global cognitive performance (all p values<0.05). Such results remained robust in subgroup analyses, stratified by age and gender, and also verified according to longitudinal analyses. Compared to ‘Chat-only’ users who only used WeChat for online interpersonal communication, further usage of WeChat functions such as using ‘Moments’ appeared to be significantly associated with better cognitive performance, especially for episodic memory.ConclusionSocial media usage is significantly and positively associated with better cognitive performance among the middle-aged and older Chinese population. Along with point-to-point messaging, using ‘Moments’ and extended social media platform functions may correlate to better cognitive performance.

Phenotyping variability in early socio-communicative skills in young children with autism and its influence on later development.

Children with autism spectrum disorder (ASD) often face challenges in early social communication skills, prompting the need for a detailed exploration of specific behaviors and their impact on cognitive and adaptive functioning. This study aims to address this gap by examining the developmental trajectories of early social communication skills in preschoolers with ASD aged 18-60 months, comparing them to age-matched typically developing (TD) children. Utilizing the early social communication scales (ESCS), the research employs a longitudinal design to capture changes over time. We apply a principal component analysis (PCA) to ESCS variables to identify underlying components, and cluster analysis to identify subgroups based on preverbal communication profiles. The results reveal consistent differences in early social communication skills between ASD and TD children, with ASD children exhibiting reduced skills. PCA identifies two components, distinguishing objects-directed behaviors and social interaction-directed behaviors. Cluster analysis identifies three subgroups of autistic children, each displaying specific communication profiles associated with distinct cognitive and adaptive functioning trajectories. In conclusion, this study provides a nuanced understanding of early social communication development in ASD, emphasizing the importance of low-level behaviors. The identification of subgroups and their unique trajectories contributes to a more comprehensive understanding of ASD heterogeneity. These findings underscore the significance of early diagnosis, focusing on specific behaviors predicting cognitive and adaptive functioning outcomes. The study encourages further research to explore the sequential development of these skills, offering valuable insights for interventions and support strategies.

O-149 The Endometriosis Longitudinal Fertility Study (ELFS): Outcomes for women with moderate or severe endometriosis who are trying to conceive

Abstract Study question What are the pregnancy outcomes for women with moderate or severe endometriosis who are trying to conceive? Summary answer Preliminary pregnancy rates in women with moderate/severe endometriosis are 11% for natural conception cycles and 22% for ART cycles. This is consistent with previous literature. What is known already Endometriosis is associated with reduced pregnancy rates in women attempting both spontaneous and assisted conception. Monthly fecundity is approximately half that of women without endometriosis and reduces further with increasing severity of disease. At present, the effect of surgery on the fertility outcomes of women with moderate or severe endometriosis remains unanswered. Treatment decisions are complex, particularly in those without pain symptoms seeking to optimise fertility outcomes. Study design, size, duration ELFS is a prospective multi-site longitudinal cohort study being conducted over 5-years. This interim report summarises data from August 2021-January 2024 in participants &amp;lt;38 years with evidence of in-situ moderate or severe endometriosis desiring fertility immediately or in the future. ELFS prospectively measures and compares monthly clinical pregnancy and live birth rates in women having either surgical or conservative management of endometriosis. This report assesses outcomes for those trying to conceive naturally or with ART. Participants/materials, setting, methods Following consent and baseline questionnaire completion, participants install the purpose-built ELFS App to their mobile phone or use a web-based option to complete cyclical surveys. The timing of surveys is dependent on a learned logic within the App and based on menstrual cycle length and pregnancy status. Participants report attempted conception cycles and any ART treatments undertaken with IVF or intrauterine insemination (IUI). Pregnancy outcomes are recorded as well as surgery during the study period. Main results and the role of chance There are 124 participants enrolled in ELFS, 86 (69%) are in the surgical cohort and 38 (31%) in the conservative cohort. There are 45 participants (36%) who have indicated they are actively trying to conceive during the study and a total of 171 cycles have been recorded from these participants. Of those trying to conceive, 24 (53%) have elected to have surgery during the study period, compared to 23 (29%) who were not trying to conceive. The study has captured 126 cycles with attempted conception. Of these, 42 cycles (33%) utilised ART compared to 84 cycles (67%) of natural conception attempts. Of the ART cycles, 27 (75%) involved IVF with fresh or frozen embryo transfer and there were 9 (15%) IUI cycles. To date, there are 25 reported pregnancies. The pregnancy rate for ART cycles was 22% (8/36) compared to 11% (9/87) in the natural conception cycles. Of those who conceived following surgery, 47% (8/17) of pregnancies were following ART and 53% (9/17) were natural conceptions. There are 2 live births recorded, both from the cohort who had surgery during the study. A total of 5 miscarriages (20%) have been reported, 4 (80%) from the surgical cohort. Limitations, reasons for caution In the absence of data to guide management in this area, clinician scope of practice and concurrent pain symptoms are likely to influence recommendations for ART or surgery in those trying to conceive with moderate or severe endometriosis. Wider implications of the findings This preliminary data is consistent with the current literature showing reduced natural and assisted conception rates in women with moderate or severe endometriosis. Long-term data will be required to determine if fertility and pregnancy outcomes are influenced by surgical management of endometriosis. Trial registration number ACTRN12621000431820 (ANZCTR)

P-783 Factors associated with donor-conceived adolescents’ intention to request information about their open-identity oocyte or sperm donor

Abstract Study question Is adolescents’ intention to request information about their open-identity donor associated with donor type, family form, or adolescent gender? Summary answer Adolescent girls were less likely than boys to intend requesting information about their open-identity donor, irrespective of donor type (oocyte/sperm) and family form. What is known already Individuals conceived by open-identity gamete donation have the right to obtain identifying information about their donor. However, there is little knowledge about the level of interest in requesting such information as donor conceived (DC) persons approach the age when they can obtain this information, as well as their interest in contact with the donor and persons who share the same donor. The present study aims to investigate factors associated with adolescentś intention to request information about their open-identity donor and their interest in contact with the donor and donor-siblings. Study design, size, duration The study is based on the fifth wave of data collection in the prospective, longitudinal Swedish Study on Gamete Donation, conducted in 2022-2023. Participating parents provided consent to contact their donor conceived children (ages 13-16), who were approached with a postal/web-survey. A total of 98 adolescents participated (77% response rate): adolescents conceived with sperm donation in lesbian-couple (SD-lesb, n = 48) and heterosexual-couple families (SD-het, n = 27), and those conceived with oocyte-donation in heterosexual-couple families (OD-het, n = 23). Participants/materials, setting, methods The study was part of the longitudinal Swedish Study on Gamete Donation, including couples starting gamete donation treatment at university hospitals between 2005-2008. The current fifth wave of data collection is the first to include children self-report. Participating adolescents included 48 girls and 50 boys with a mean age of 14.44 for girls and 14.28 for boys. The survey comprised of socio-demographics, study-specific items and validated instruments. Data was analyzed with multinominal regression analysis. Main results and the role of chance Roughly half (56%) of the adolescents intended to request information about their open-identity donor, while 12% planned not to and 32% were unsure. Multinominal regression analysis showed a significant effect for gender, but not for family/donation type (SD-lesb, SD-het, OD-het). Girls were significantly more likely than boys to state that they did not intend to request donor information (OR = 4.66, 95% CI [1.13, 19.34]). Among those adolescents who planned to request identifying donor information, a subset stated that they intended to contact the donor (30% boys, 15% girls). Concerning interest in contact with persons who share the same donor, participants were evenly divided between an interest (29%) or no interest (27%) and remaining were unsure (44%). No differences were found with regard to groups or gender. Limitations, reasons for caution The relatively small sample size could affect the results of the statistical analysis, making it harder to get significant results and creating large confidence intervals. There is a possible attrition bias with less well-functioning families not participating. The study was conducted within the Swedish context of identity-release gamete donation. Wider implications of the findings Approaching adulthood, about half of donor-conceived individuals plan to request information about their open-identity donor, highlighting that many DC people want this possibility. The gender difference found contrasts with earlier research findings and points to the need to understand the specific motivations of different groups of DC adolescents. Trial registration number not applicable

O-193 Age-related normograms of AMH in women with polycystic ovary syndrome using three different assays

Abstract Study question To develop an age-specific percentile distribution of anti-Müllerian hormone (AMH) in patients with polycystic ovary syndrome (PCOS) measured by three different assays. Summary answer Our age-related normograms may help to interpret AMH levels in PCOS patients and facilitate the use of AMH as a diagnostic tool across age ranges. What is known already In the last years, AMH assessment has gained widespread use in the clinical settings of several conditions. However, several challenges still exist to adopt the AMH as a marker of polycystic ovary morphology (PCOM), as included in the recently updated international guideline. Although different evaluations of age- and assay-specific reference ranges have been published in the last years, these studies have mainly been conducted in normo-ovulatory or infertile women and little is known about the higher range of AMH levels, especially in women with PCOS. Study design, size, duration Retrospective single-center cross-sectional study, including 2,725 women with PCOS who consulted the Reproductive Endocrinology and Infertility Clinic of the Erasmus University Medical Center, Rotterdam, The Netherlands. Participants/materials, setting, methods A total of 2,725 women aged 20 to 40 years with PCOS were included. PCOS was diagnosed according to the Rotterdam Criteria. Serum AMH levels were measured using the following AMH assays: (1) Gen II AMH ELISA, 2) picoAMH assay, and 3) Elecsys AMH plus assay. Age-specific centile curves were constructed using the LMS method. The correlations between AMH with clinical, endocrine, and ultrasound features were also evaluated. Main results and the role of chance To our knowledge, this is the first study with real-world data reporting AMH age-specific percentile nomograms in a large population of PCOS women using three different assays. The 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles were calculated according to a population/based approach per age (years) for the Gen II, the picoAMH, and the Elecsys assays. We also considered the age-percentile values of AMH in PCOS patients for the Gen II, the picoAMH and the Elecsys assays according to the cut-offs previously proposed in literature for each specific assay. Interestingly, in our population, a high percentage of women with polycystic ovarian morphology (PCOM) showed AMH levels lower than the cut-offs proposed. Serum AMH levels were significantly higher in patients with phenotype A compared to all other phenotypes for all three assays. For all three assays, we found a statistically significant positive correlation between AMH levels and LH, LH/FSH ratio, testosterone, androstenedione, FAI, mean follicular number, and mean ovarian volume. In contrast, AMH levels were negatively correlated with BMI in all groups. Limitations, reasons for caution This is a retrospective cross-sectional study. Longitudinal studies with a large cohort of women that could be followed for many years are needed to validate our nomogram. Wider implications of the findings AMH threshold levels can be influenced by several variables, making it difficult to identify a general cut-off to diagnose PCOM. Further research should overcome the concept of a single cut-off value. The results of the present study may help clinicians interpret AMH levels in PCOS patients across age ranges. Trial registration number In this retrospective cross-sectional study, 2,725 women who consulted the Reproductive Endocrinology and Infertility Clinic of the Erasmus University Medical Center, Rotterdam, The Netherlands, were included. The Medical Ethical Review Board of the Erasmus University Medical Center Rotterdam approved retrospective studies within this patient population, which includes women with ovulatory dysfunction (MEC-2020-0534).

What is associated with painful polyneuropathy? A cross-sectional analysis of symptoms and signs in patients with painful and painless polyneuropathy.

It is still unclear how and why some patients develop painful and others painless polyneuropathy. The aim of this study was to identify multiple factors associated with painful polyneuropathies (NeuP). A total of 1181 patients of the multicenter DOLORISK database with painful (probable or definite NeuP) or painless (unlikely NeuP) probable or confirmed neuropathy were investigated clinically, with questionnaires and quantitative sensory testing. Multivariate logistic regression including all variables (demographics, medical history, psychological symptoms, personality items, pain-related worrying, life-style factors, as well as results from clinical examination and quantitative sensory testing) and machine learning was used for the identification of predictors and final risk prediction of painful neuropathy. Multivariate logistic regression demonstrated that severity and idiopathic etiology of neuropathy, presence of chronic pain in family, Patient-Reported Outcomes Measurement Information System Fatigue and Depression T-Score, as well as Pain Catastrophizing Scale total score are the most important features associated with the presence of pain in neuropathy. Machine learning (random forest) identified the same variables. Multivariate logistic regression archived an accuracy above 78%, random forest of 76%; thus, almost 4 out of 5 subjects can be classified correctly. This multicenter analysis shows that pain-related worrying, emotional well-being, and clinical phenotype are factors associated with painful (vs painless) neuropathy. Results may help in the future to identify patients at risk of developing painful neuropathy and identify consequences of pain in longitudinal studies.

Mortality among Veterans following Traumatic Brain Injury: A VA Traumatic Brain Injury Model Systems Study.

Few studies have examined long-term mortality following traumatic brain injury (TBI) in a military population. This is a secondary analysis of a prospective, longitudinal study that examines long-term mortality (up to 10 years) post-TBI, including analyses of life expectancy, causes of death and risk factors for death in service members and veterans (SM/V) who survived the acute TBI and inpatient rehabilitation. Among 922 participants in the study, the mortality rate was 8.3% following discharge from inpatient rehabilitation. The mean age of death was 54.5 years, with death occurring on average 3.2 years after injury, and with an average 7-year life expectancy reduction. SM/V with TBI were nearly 4 times more likely to die compared with the US general population. Leading causes of death were external causes of injury, circulatory disease, and respiratory disorders. Also notable were deaths due to late effects of TBI itself and suicide. Falls were a significant mechanism of injury for those who died. Those who died were also more likely to be older at injury, unemployed, non-active duty status, not currently married, and had longer post-traumatic amnesia, longer rehabilitation stays, worse independence and disability scores at rehabilitation discharge, and a history of mental health issues prior to injury. These findings indicate that higher disability and less social supportive infrastructure are associated with higher mortality. Our investigation into the vulnerabilities underlying premature mortality and into the major causes of death may help target future prevention, surveillance, and monitoring interventions.

Identification of commensal gut microbiota signatures as predictors of clinical severity and disease progression in multiple sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system and a leading cause of neurological disability in young adults. Clinical presentation and disease course are highly heterogeneous. Typically, disease progression occurs over time and is characterized by the gradual accumulation of disability. The risk of developing MS is driven by complex interactions between genetic and environmental factors, including the gut microbiome. How the commensal gut microbiota impacts disease severity and progression over time remains unknown. In a longitudinal study, disability status and associated clinical features in 58 MS patients were tracked over 4.2 ± 0.98 years, and the baseline fecal gut microbiome was characterized via 16S amplicon sequencing. Progressor status, defined as patients with an increase in Expanded Disability Status Scale (EDSS), were correlated with features of the gut microbiome to determine candidate microbiota associated with risk of MS disease progression. We found no overt differences in microbial community diversity and overall structure between MS patients exhibiting disease progression and non-progressors. However, a total of 41 bacterial species were associated with worsening disease, including a marked depletion in Akkermansia, Lachnospiraceae, and Oscillospiraceae, with an expansion of Alloprevotella, Prevotella-9, and Rhodospirillales. Analysis of the metabolic potential of the inferred metagenome from taxa associated with progression revealed enrichment in oxidative stress-inducing aerobic respiration at the expense of microbial vitamin K2 production (linked to Akkermansia), and a depletion in SCFA metabolism (linked to Oscillospiraceae). Further, as a proof of principle, statistical modeling demonstrated that microbiota composition and clinical features were sufficient to predict disease progression. Additionally, we found that constipation, a frequent gastrointestinal comorbidity among MS patients, exhibited a divergent microbial signature compared with progressor status. These results demonstrate a proof of principle for the utility of the gut microbiome for predicting disease progression in MS in a small well-defined cohort. Further, analysis of the inferred metagenome suggested that oxidative stress, vitamin K2, and SCFAs are associated with progression, warranting future functional validation and mechanistic study.

Prospective longitudinal relations among frequent social media use, nicotine vaping and experiencing internalizing mental health problems.

To compare four a priori rival mediated pathways of frequent social media use, electronic nicotine delivery systems (ENDS) use and internalizing mental health (MH) problems across five waves of nationally representative data. This was a longitudinal study using data drawn from waves 2-5 (October 2014-November 2019) of the Population Assessment of Tobacco and Health Study, a nationally representative cohort study spanning approximately 5years, conducted in the United States. The analytical sample of participants included those who were aged 12-14 years at wave 2 and who provided data in subsequent waves until wave 4.5 (n = 4627, 69.7% were White and 51.4% were male). Frequent social media use (several times a day), ENDS use (past 30-day use) and internalizing MH problems (endorsed symptoms on four items in the past year) were dichotomized for analysis. The weighted proportions of the three key variables increased over time. From wave 2 to wave 5, frequent social media use grew from 56.9 to 77.2%; internalizing MH problems from 18.9 to 29.0%; and ENDS use from 1.4 to 11.4%. In weighted logistic regressions using generalized linear mixed models with random effects, there was a significant within-person association between frequent social media use at time t and greater ENDS use at t +1 [adjusted odds ratio (aOR) = 1.87; 95% confidence interval (CI) = 1.47, 2.37] and worsened internalizing MH problems at t +1 (aOR = 1.19; 95% CI = 1.04, 1.37). A model-based causal mediation analysis and marginal structural models were fitted to estimate the average causal mediation effect. Among all four examined mediation pathways throughout the three constructs, partial mediation was observed, and all the pathways were significant for both boys and girls. Sex differences did not emerge in the examined prospective mediated pathways. Among youth in the United States, frequent social media use appears to mediate the prospective association between experiencing internalizing mental health problems and using electronic nicotine delivery systems.

COVID-19 Infection in a Group of Egyptian Children with Bronchial Asthma: A Single Center Study

Abstract Background Impact of asthma on COVID-19 severity and outcome in infants is not well investigated. Therefore, we sought to assess the presentation, severity and outcome of COVID-19 infection in a group of Egyptian asthmatic children. Patients and Methods We conducted an observational follow up study on 30 asthmatic children with probable/confirmed COVID-19, aged 6-10 years, who were enrolled consecutively from the Emergency department and Isolation Ward, Children`s Hospital, Ain Shams University, Egypt. COVID-19 clinical manifestations, severity and outcome were studied. Results The median age of the children was 9 years (IQR: 6-18 years). Out of the 30 studied patients, we had 9 boys and 21 girls. COVID-19 was asymptomatic in 2/30 (6.7%), mild in 20/30 (66.7%), and severe in 8/30 (26.7%). Clinical manifestations of COVID-19 included constitutional (22,73.3%), respiratory (21, 70%), gastrointestinal (7, 23%), cardio- vascular (5, 16.7%), and dermatological (1, 3.3%) manifestations. Multisystem inflammatory syndrome (MIS-c) was diagnosed in only one patient. Chest X-ray abnormalities were found in (36.7%). The median duration of hospital stay was 10 days, Complete resolution was the final outcome of all patients. Conclusion Asthma does not represent a risk of severe COVID-19 or poor outcome and COVID-19 course, and the outcome in asthmatic children is similar to the general pediatric population. However, our study is limited by the small sample size and short duration of follow-up. Further longitudinal studies are needed to investigate the exact impact of different SARS-CoV-2 variants with respect to asthma phenotypes and asthma biological treatments and allergen immunotherapies in children.

O-223 Can the theory of planned behavior predict parents’ disclosure of donor conception to their children within 5-9 years?

Abstract Study question Does application of the theory of planned behavior (TPB) help predict heterosexual-couple parents’ disclosure of donor conception (DC) to their children? Summary answer According to TPB, parents with a stronger will to act in accordance with social norms favoring disclosure were more likely to start the disclosure process. What is known already In contrast to same-sex couples and single mothers by choice, heterosexual couples need to make an active decision to disclose, or not disclose, their use of DC to their child. While disclosure at an early age is encouraged by international and national guidelines, many heterosexual-couple parents struggle with this. A previous study has found an association between parental scores of TPB factors and disclosure intention, but so far, no study has applied the TPB to predict parents’ de facto disclosure behavior. Study design, size, duration The present study is based on the fourth (2014-2017) and fifth (2022-2023) waves of data collection in the prospective, longitudinal Swedish Study on Gamete Donation (SSGD). The project collects survey data at five timepoints from acceptance to be donor-recipient, to the children were adolescents. Participating parents had conceived through identity-release oocyte donation (OD; n = 68, response rate 65%) and sperm donation (SD; n = 62, response rate 56%) as part of a heterosexual couple. Participants/materials, setting, methods The SSGD includes all parents seeking gamete donation treatment at Swedish university hospitals between 2005-2008, the present study including parents’ data when the children were 7-8 years (T4), and 13-17 years (T5). Parents completed the TPB Disclosure Questionnaire (TPB-DQ) at T4, and disclosure behavior was assessed at both T4 and T5. Data from the participants who had not yet disclosed at T4 were analyzed using survival analysis with Cox regressions. Main results and the role of chance Forty participants (31%) had not disclosed the DC to their children at T4 and out of these, 13 had still not disclosed at T5. The TPB-DQ consists of four factors affecting intent to disclose; Attitudes, Subjective norms, Perceived behavioral control and Behavioral intent. The use of Cox regression enabled us to estimate how the parents disclosing to their children related to TPB-DQ, as well as the effect of adjusting for possible confounders. We found a significant association between scores on the TPB-DQ factor Subjective norms at T4 and the subsequent disclosure behavior at T5 (HR = 2.019; 95% CI: 1.36 to 3.01). None of the other factors were significantly associated with disclosure behavior. Adjusting for potential confounders did not affect the outcomes. Our results show that parents with a stronger will to act in accordance with social norms favoring disclosure were more likely to start the disclosure process within the next 5-9 years. In particular, the co-parent’s opinion about disclosure was found to be an important motivating factor in disclosure behavior. Limitations, reasons for caution The present study concerns heterosexual-couple parents with children conceived following treatment with gametes from open-identity donors, which limits the generalizability of our findings to other groups and contexts. Other limitations include the risk of systematic attrition due to the longitudinal study design and decreased statistical power due to few participants. Wider implications of the findings Our findings highlight the importance of perceived subjective norms for parents’ disclosure behavior and indicate that the co-parent’s opinion about disclosure is particularly relevant. Counselors should focus on supporting prospective parents to initiate and maintain a healthy and open dialogue about concerns around family building with DC. Trial registration number Not applicable

P-499 Long term psychological health of gestational surrogates in a low-income setting: five years after birth

Abstract Study question How does psychological health and experiences of surrogates in a cross-border commercial surrogacy setting change from pregnancy, 4-6 months, and five years post-birth? Summary answer Longitudinally surrogates’ psychological health did not significantly change. Majority had still not met the parents, continued hiding surrogacy, and reported mixed feelings for the child. What is known already Commercial surrogacy was banned in India in 2017 due to concerns related to exploitation and psychological harm. Power differentials between surrogates and intending parents and commercialization raised concerns regarding the psychological health of surrogates in low-income settings. Post the ban, surrogacy hotspots moved to countries like Mexico and Georgia embroiled in similar practices. There is however no academic literature on long-term psychological health of surrogates from low-income settings. Previous research showed that surrogacy pregnancy and prenatal attachment did not significantly contribute psychological harm post-birth. Instead, socio-cultural practices related to support during pregnancy and stigma increased depression scores post-birth. Study design, size, duration The fieldwork was administered in Mumbai, India, where international cross-border, gestational, and commercial surrogacy was being practiced. Data was collected over three phases: 1) during pregnancy 2) 4-6 months post-birth and 3) 5-6 years after surrogacy. Being a mixed-method design, findings include quantitative data on psychological health of surrogates from all three phases and qualitative data from phase 3 of the research. The study spans from 2014 to 2021. Participants/materials, setting, methods In-depth semi-structured interviews and standardized questionnaires (anxiety, depression, stress scale) were administered to 50 surrogates during pregnancy, 45 surrogates 4-6 months post-birth, and 19 surrogates 5-6 years post-birth. In phase III, mothers also responded to the perceived social support scale. Interviews included questions related to narratives and feelings about the baby, intending parents, surrogate hostel, fertility clinic, potential financial gain, perceptions of stigma, and the new law banning surrogacy. Fieldwork was administered at the clinic. Main results and the role of chance Three one-way repeated measures ANOVA were administered which showed that anxiety, depression, and stress of surrogates did not significantly differ over the three time-points, suggesting that practicing surrogacy did not significantly contribute to psychological harm. It is important to note that financial gain did not significantly improve their psychological over time. Non-parametric tests also did not show significant differences. Mean scores show a downward trend for anxiety and depression, but an upward trend for stress. The perceived social support scale showed that participants received support from family and significant other and least support from friends. However, support from family positively correlated with the stress scores of surrogates. Perhaps an overwhelming involvement of family adds to stress. Most surrogates were not in touch with friends from the surrogate hostel. Majority reported still thinking about the baby frequently, had mixed feelings, and were still hiding surrogacy. Most of them had not met the parents and child, did not know if intending parents should disclose to the child about surrogacy. Majority did not appreciate the new law and wouldn’t consider becoming surrogates without a payment. Prenatal bonding from phase 1 did not have any relationship with psychological health observed in phase 3. Limitations, reasons for caution The study’s sample size raises generalizability concerns. Diminishing sample sizes and potential social bias may affect robustness. Limited psychological measures and homogeneity assumptions suggest a need for caution in interpreting results. Wider implications of the findings This is the first longitudinal study on surrogate mothers from low-income settings practicing commercial surrogacy. Findings advocate policy reassessment, enduring support structures for surrogates, educational initiatives for transparency, international collaboration on best practices, and future research exploring cultural nuances and the perspectives of intending parents in cross-border commercial surrogacy. Trial registration number N/A