Longitudinal Regression Research Articles

Trauma-informed acceptance and commitment therapy with peer coaching for college students: A pilot randomized controlled trial.

The current pilot randomized controlled trial evaluated the acceptability, feasibility, and preliminary efficacy of a mental health promotion intervention for college students based on trauma-focused acceptance and commitment therapy (Harris, 2021). This hybrid intervention combined web-based modules with peer coaching in a research lab setting. Seventy-eight students were randomized to either the intervention group, "Present and Open for Values" training, or an active control group, "Crash Course" training. Psychological distress and life satisfaction levels were assessed at baseline, postintervention, and 3 months postintervention. Open-ended feedback, rating scales, and completion rates suggested that both conditions were well-received and feasible. Longitudinal mixed-effects regression models with subject-specific intercepts were used to examine intervention effects. Participants in the Present and Open for Values condition reported significantly greater reductions in psychological distress levels compared to the control group, both at the end of the intervention and 3-month follow-up. Additionally, they reported significantly greater improvements in life satisfaction levels at these same intervals compared to baseline measurements. No significant changes in these outcomes were observed for the control condition. These findings suggest that the Present and Open for Values intervention with peer coaching is a promising approach for addressing mental health issues among college students, with the potential to be scaled up for broader implementation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Insular monoaminergic deficits in prodromal α-synucleinopathies.

This study assessed data from two cohorts of patients with alpha-synucleinopathies (University of Brescia and University of Rome Tor-Vergata cohorts). Consecutive participants with video-polysomnography-confirmed iRBD, Parkinson's disease (PD), dementia with Lewy bodies (DLB) and controls underwent neurological, clinical and 123I-FP-CIT SPECT imaging assessments. Individuals with iRBD were longitudinally monitored to collect clinical phenoconversion to PD or DLB. The main outcome was to identify whole brain 123 I-FP-CIT SPECT measures reflecting monoaminergic deficits in each clinical group as compared to controls. The cohort (n = 184) included 45 patients with iRBD, 47 PD, 42 DLB and 50 age-matched controls. Individuals with iRBD were categorized as RBD-DAT- (n = 32) and RBD-DAT+ (n = 13), according to nigrostriatal assessment used in clinical practice. Compared to controls, RBD-DAT- showed an early involvement of the left insula, which increased in RBD-DAT+, and was present in patients with Parkinson's disease and dementia with Lewy bodies. Longitudinal cox regression analyses revealed a higher risk of phenoconversion in individuals with iRBD and insular monoaminergic deficits [HR = 3.387; CI 95%: 1.18-10.27]. In this study, altered insular monoaminergic binding in iRBD was associated with phenoconversion to DLB or PD. These findings may provide a helpful stratification approach for future pharmacological or non-pharmacological interventions.

A 3-Wave Longitudinal Study of eHealth Literacy and Older People's Health-Related Quality of Life in China: The Mediating Role of General Self-Efficacy

Background and ObjectivesHealth-related quality of life (HRQoL) is an important indicator to reflect the independence and well-being of older adults in their later life. Improving the HRQoL of older adults is of great importance for achieving healthy aging. The internet provides extensive health information and being able to effectively use the electronic health (eHealth) resources (reflected as “eHealth literacy”) potentially empowers older adults to manage health and improve HRQoL. However, there is limited evidence about the relationship between eHealth literacy and HRQoL in this population. This study aims to examine the longitudinal association and temporal relationship between eHealth literacy and HRQoL among older adults, and to explore potential underlying mechanisms. DesignA 3-wave longitudinal study. Setting and ParticipantsChinese older adults aged 55 or older in Jiangxi Province, China. MethodsData were collected at baseline (T1) and 3-month (T2) and 6-month (T3) follow-ups during February to December 2022, using online self-reported questionnaires. eHealth literacy, HRQoL, and general self-efficacy were measured using validated tools. Statistical analyses, including longitudinal Tobit regression, cross-lagged panel model (CLPM), and longitudinal mediation analysis were performed. ResultsA total of 611 participants were included at T1, and 464 (75.9%) completed both 3- and 6-month follow-ups. Longitudinal Tobit regression suggested that older individuals with higher eHealth literacy showed better HRQoL over time (adjusted β, 0.023; 95% CI, 0.011–0.035; P < .001), after accounting for covariates. The CLPM supported that higher eHealth literacy significantly predicts improved HRQoL over time (standardized β, 0.09, P = .008), but not the reverse. In addition, general self-efficacy at T2 fully mediated the relationship from eHealth literacy at T1 and HRQoL at T3, with mediated proportion of 28.3%. Conclusions and ImplicationsThis study highlighted the importance of eHealth literacy and self-efficacy in improving HRQoL among older adults, supporting the development of tailored interventions to promote their HRQoL.

The Impact of Loneliness and Social Relationship Dissatisfaction on Clinical and Functional Outcomes in Dutch Mental Health Service Users

The relationship between reduced social connectedness and mental health outcomes is increasingly acknowledged. Yet, relatively little is known about how two crucial subjective aspects of social disconnectedness - loneliness and social relationship dissatisfaction (SRD) - are related to clinical and functional recovery. This cohort study aimed to investigate the association of loneliness and SRD with various mental health outcomes among 15,512 outpatients from a Dutch mental health service. Demographics and data on loneliness, SRD, symptomatic distress, suicidal ideation, and role functioning, as well as treatment duration, and mortality, were collected. The study analyzed the association between these factors overall and by diagnostic group, gender, and age, using cross-sectional and longitudinal regression, while controlling for relevant covariates. Findings revealed significant, independent, associations between loneliness, SRD, symptomatic distress, and role functioning across different diagnostic groups. Particularly strong associations were noted in bipolar and psychosis-related disorders. Gender did not significantly influence the strength of associations. In older patients, lower levels of loneliness and SRD were observed, but the impact on clinical and functional outcomes was consistent across ages. Higher loneliness and SRD were associated with longer treatment durations, regardless of age, gender or diagnosis. This study indicates the wide-reaching effects of perceived social disconnectedness on recovery and emphasizes interventions targeting loneliness and SRD to enhance outcomes.

Hospital stays and probable dementia as predictors of relocation to long-term care facilities.

This study aims to investigate the relocation of older adults in the US from community living to long-term care facilities (LTCFs). Specifically, it examines the predictive roles of possible and probable dementia and hospital stays in this complex health care transition. Utilizing data from the National Health and Aging Trends Study, a longitudinal cohort study (2011-2019), we employed a panel data approach, which consists of multiple observations over time for the same participants, allowing us to account for both cross-sectional variations (differences between participants) and time-series variations (changes in the same participant over time). The analysis involved longitudinal logistic regression models. Using the AD8 dementia screening interview, clock drawing test, immediate and delayed word recall test, orientation, and history of dementia diagnosis, we placed participants into categories of having no dementia, possible dementia, and probable dementia. A survey asked about hospital stays in the past year. Relocation to LTCFs was examined based on the changes to the living location. The proportion of individuals transitioning to LTCFs tripled between 2011 and 2019, emphasizing the need to understand and manage this health care transition. Hospital stays significantly increased the probability of moving to LTCFs, especially nursing homes. Probable dementia demonstrated a 3-fold increase, aligning with the rising prevalence of Alzheimer disease. Difficulty walking and climbing stairs significantly increased relocation probabilities. The study findings emphasize complexity in late-life relocations influenced by dementia and hospital stays. Screening for cognitive function among community-dwelling older adults, particularly those with a history of hospital stays and mobility difficulties, can inform interventions and policies. Implications extend to health care policy, geriatric care, and the imperative for targeted interventions considering demographic variations. Future research should explore additional variables and address limitations to refine our understanding of the relocation process.

Financial Hardship Among Patients With Early-Stage Colorectal Cancer

The degree of cancer patients' financial hardship is dynamic and can change over time. To assess longitudinal changes in financial hardship among patients with early-stage colorectal cancer. In this prospective longitudinal cohort study, English-speaking adult patients with a new diagnosis of stage I to III colorectal cancer being treated with curative intent at National Cancer Institute (NCI) Community Oncology Research Program (NCORP) practices between May 2018 and July 2020 and who had not started chemotherapy and/or radiation were included. Data analysis was conducted from March to December 2023. Patients completed surveys at baseline as well as at 3, 6, 12, and 24 months after enrollment. Cost-related care nonadherence and material hardship, as adopted by Medical Expenditure Panel Survey, were measured. Factors associated with financial hardship were assessed using longitudinal multivariable logistic regression models with time interaction. A total of 451 patients completed baseline questions, with 217 (48.1%) completing the 24-month follow-up. Mean (SD) age was 61.0 (12.0) years (210 [46.6%] female; 33 [7.3%] Black, 380 [84.3%] White, and 33 [7.3%] American Indian or Alaska Native, Asian, multiracial, or Native Hawaiian or Other Pacific Islander individuals or those who did not report race or who had unknown race). Among 217 patients with data at baseline and 24 months, 19 (8.8%) reported cost-related care nonadherence at baseline vs 20 (9.2%) at 24 months (P = .84), and 125 (57.6%) reported material hardship at baseline vs 76 (35.0%) at 24 months (P < .001). In multivariable analysis, lower financial worry (odds ratio [OR], 0.90; 95% CI, 0.87-0.93), higher education (OR, 0.34; 95% CI, 0.15-0.77), and older age (OR, 0.94; 95% CI, 0.91-0.98) were associated with lower nonadherence. Receipt of chemotherapy was associated with higher material hardship (OR, 2.68; 95% CI, 1.15-6.29), while lower financial worry was associated with lower material hardship (OR, 0.83; 95% CI, 0.80-0.96). Over 24 months, female sex was associated with lower nonadherence (OR, 0.90; 95% CI, 0.85-0.96), while higher education was associated with higher nonadherence (OR, 1.09; 95% CI, 1.03-1.17). Being employed was associated with lower material hardship (OR, 0.85; 95% CI, 0.78-0.93), while receipt of care at safety-net hospitals was associated with higher hardship (OR, 1.09; 95% CI, 1.01-1.17). In patients with early-stage colorectal cancer, material hardship was more common than cost-related cancer care nonadherence and decreased over time, while nonadherence remained unchanged. Early and longitudinal financial screening and referral to intervention are recommended to mitigate financial hardship.

Examining the Relationship Between Local Governmental Expenditures on the Social Determinants of Health and County-Level Overdose Deaths, 2017-2020.

Prior studies have examined the social determinants of health (SDOH) characteristics of counties with elevated rates of overdose deaths. However, this research often ignores variation in upstream governmental investment in these SDOH categories. To examine the association of local governmental investments in SDOH with drug overdose mortality at the county level, controlling for demographic and socioeconomic characteristics. Longitudinal analysis from 2017 to 2020. United States counties. 3126 counties. The primary study outcome was county overdose death rates per 100000 population taken from the Centers for Disease Control and Prevention. The main predictor of interest was the per capita average of local governmental expenditures in public health, social service, and education drawn from the U.S. Census of Governments, categorized into quartiles. Covariates included county-level socioeconomic and demographic characteristics as well as county-level SUD services from the AHRQ SDOH Database. In longitudinal multivariate linear regression models with state and year fixed effects, counties in the highest 3 quartiles of SDOH spending had significantly lower rates of overdose deaths compared with counties in the lowest quartile of SDOH spending; in particular, counties in quartile 2 had an average of 9.09 fewer overdose deaths per 100000 population (95% CI: -12.58, -5.60), counties in quartile 3 had an average of 13.18 fewer deaths per 100000 population (95% CI: -17.56; -8.80), and counties in quartile 4 had an average of 13.92 deaths per 100000 population (95% CI: -19.16, -8.68). Our findings demonstrate that higher levels of local governmental investments in SDOH were associated with significantly lower rates of overdose death in U.S. counties after controlling for socioeconomic and demographic characteristics. Going forward, research should focus on determining causality in this relationship, the mechanisms through which this relationship occurs, as well as assess the impact of local public health expenditures allocated toward SUD prevention and treatment specifically on substance use outcomes at the local level.

The association between erythema nodosum and pyoderma gangrenosum and pediatric inflammatory bowel disease.

The objectives of this study is to estimate rates and identify factors associated with erythema nodosum (EN) and pyoderma gangrenosum (PG) in pediatric patients with inflammatory bowel disease (IBD). This cohort study examined longitudinal visits of patients aged ≤ 21 years from the ImproveCareNow (ICN) registry. We evaluated the association of factors at the patient-level (demographics and IBD diagnosis age) and visit-level (IBD severity scores, markers and phenotypes, comorbidities, and treatment) with the presence of EN and PG, using longitudinal logistic regression models adjusted for time and within-patient clustering. A total of 285,913 visits from 32,497 patients aged ≤ 21 years from the ICN registry were analyzed. The occurrence of EN was 1.57% (95% confidence interval [95% CI]: 1.43%-1.71%) and the occurrence of PG was 0.90% (95% CI: 0.80%-1.00%). Co-occurrence of EN and PG was reported in 0.30% (95% CI: 0.25%-0.37%) patients. Both EN and PG were associated (p < 0.0001) with worse intestinal disease, lower remission, higher inflammatory markers, and extraintestinal manifestations (EIMs) arthritis and uveitis. EN and PG were associated with increased disease severity and other noncutaneous EIMs (arthritis and uveitis). A small subset of patients had developed both EN and PG.

Multilevel Longitudinal Functional Principal Component Model.

Sensor devices, such as accelerometers, are widely used for measuring physical activity (PA). These devices provide outputs at fine granularity (e.g., 10-100Hz or minute-level), which while providing rich data on activity patterns, also pose computational challenges with multilevel densely sampled data, resulting in PA records that are measured continuously across multiple days and visits. On the other hand, a scalar health outcome (e.g., BMI) is usually observed only at the individual or visit level. This leads to a discrepancy in numbers of nested levels between the predictors (PA) and outcomes, raising analytic challenges. To address this issue, we proposed a multilevel longitudinal functional principal component analysis (mLFPCA) model to directly model multilevel functional PA inputs in a longitudinal study, and then implemented a longitudinal functional principal component regression (FPCR) to explore the association between PA and obesity-related health outcomes. Additionally, we conducted a comprehensive simulation study to examine the impact of imbalanced multilevel data on both mLFPCA and FPCR performance and offer guidelines for selecting optimal methods.

Impact of Cystic Fibrosis Transmembrane Conductance Regulator Modulators on Maternal Outcomes During and After Pregnancy

Cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulators are available to the majority of people with CF in the United States; little is known about pregnancy outcomes with modulator use. The aim of this retrospective study was to determine the impact of CFTR modulators on maternal outcomes. Does pregnancy differentially affect outcomes in female subjects with CF with and without CFTR modulator exposure? Data on pregnancies from 2010 to 2021 were collected from 11 US adult CF centers. Multivariable longitudinal regression analysis was performed to assess whether changes in percent predicted FEV1 (ppFEV1), BMI, pulmonary exacerbations (PEx), and Pseudomonas aeruginosa prevalence differed from prior to, during, and following pregnancy according to CFTR modulator use while adjusting for confounders. Infant outcomes are also described based on maternal modulator use. Among 307 pregnancies, mean age at conception was 28.5 years (range, 17-42 years), prepregnancy ppFEV1 was 74.2, and BMI was 22.3kg/m2. A total of 114 pregnancies (37.1%) had CFTR modulator exposure during pregnancy (77 with highly effective modulator therapy [HEMT] and 37 with other modulators). The adjusted mean change in ppFEV1 from prepregnancy to during pregnancy was -2.36 (95%CI, -3.56 to -1.16) in the unexposed group and 2.60 (95%CI, 0.23 to 4.97) in the HEMT group, with no significant change from during pregnancy to 1 year postpregnancy. There was an overall decline in ppFEV1 from prepregnancy to postpregnancy in the no modulator group (-2.56; 95%CI, -3.62 to -1.49) that was not observed in the HEMT group (1.10; 95%CI, -1.13 to 3.34). PEx decreased from prepregnancy to postpregnancy in the HEMT group, and BMI increased from prepregnancy to during pregnancy in all groups but with no significant change postpregnancy. Missing infant outcomes data precluded firm conclusions. We observed superior pregnancy and postpregnancy pulmonary outcomes in individuals who used HEMT, including a preservation of ppFEV1, compared with those unexposed to HEMT.

Investigations on machine learning, deep learning, and longitudinal regression methods for global greenhouse gases predictions

Investigations on machine learning, deep learning, and longitudinal regression methods for global greenhouse gases predictions

The effects of 7-week participation in football on personal well-being among male asylum seekers in a UK hotel

BackgroundThis study examines the impact of participating in a seven-week football programme on the personal well-being of male asylum seekers residing in contingency accommodation in the UK. MethodsThis repeated measures study included a cohort of participants who engaged in weekly football sessions and completed a well-being questionnaire (ONS4) over a continuous seven-week period. Longitudinal linear regression analysis using generalized estimating equations (GEE) was used to assess the relationship between personal well-being and weekly minutes of football participation (M1). A second model incorporating the total number of non-football activity sessions in the past week as a covariate was also implemented (M2). ResultsOf the 73 participants who completed the questionnaire, 23 responded twice or more across the study period and were subsequently included in the analysis. Results revealed that 2 h of football participation within 7 days significantly improved aspects of personal well-being when compared with no football participation, including improved life satisfaction, feeling life is worthwhile, and happiness. Both models demonstrated a shift from ‘low’ to ‘medium’ ONS4 categorical score. Anxiety levels remained unchanged regardless of participation and model. ConclusionWe provide important evidence on the potential benefits of football participation for promoting personal well-being among male asylum seekers residing in contingency accommodation.

One-year predictors of PTSD symptoms, anxiety, and depression in SARS-CoV-2 survivors: psychological flexibility and major life events as main predictive factors.

The COVID-19 pandemic held considerable health-related outcomes worldwide, including mental health challenges, with elevated risk of psychiatric sequelae. This study aimed to test the longitudinal (1 year) predictive role of psychosocial factors on post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms in SARS-CoV-2 survivors (N = 209 at T1; N = 61; attrition rate 70.83%), through Pearson's correlation analyses and longitudinal multiple regression analyses. Participants (age M = 35.4, SD = 10.1) completed online self-report questionnaires of psychosocial variables, PTSD, anxiety, and depression. Depression and anxiety symptoms were increased, and 42% of survivors presented clinically meaningful PTSD symptoms. PTSD symptoms were longitudinally predicted by having children (β = 0.32, p < 0.01), number of recent major life events (β = 0.34, p < 0.01), and psychological flexibility (β = -0.36, p < 0.01). Number of major life events (β = 0.29, p < 0.05) and psychological flexibility (β = -0.29, p < 0.05) predicted anxiety. Number of recent major life events (β = 0.32, p < 0.01) was the sole predictor of depressive symptoms. Psychosocial variables contribute to the long-term harmful effects of the COVID-19 pandemic on psychopathological symptoms. These results suggest that, during the pandemic, mental health was impacted by both socio-contextual factors and individual self-regulatory skills, namely the ability to respond flexibily to contextual cues and guide behavior according to the direct experience. Specifically, results point out the importance of societal incentives to reduce parental burden and socioeconomic losses, as well as to promote adaptive psychological skills such as psychological flexibility.

Cervical orthosis does not improve postoperative pain following posterior cervical fusion: a randomized controlled trial.

To determine whether postoperative neck pain in the first 4 weeks following multi-level posterior cervical fusion (PCF) with orthosis is equivalent to multi-level PCF without orthosis. Patients were randomly assigned in a 1:1 ratio to postoperative orthosis (CO) for 6 weeks or no orthosis (NO). Randomization was stratified by indication (traumatic vs. degenerative), and preoperative opioid use. A model of longitudinal regression for repeated measures was used. The two-sided 95% confidence interval (CI) was used to test equivalence. If the CI lay between the pre-determined margin of equivalence (-2.0 to + 2.0 pain score) the two groups were considered equivalent. A multiple imputation procedure was used to replace missing data. Thirty-one patients were enrolled in each group. At baseline, the CO group had more neck pain (5.3 vs. 3.2, p = 0.013). The Four week post-operative neck pain intensity score was 4.6 ± 0.3 for the CO group vs. 4.9 ± 0.3 for the NO group. The 95% confidence interval (-1.2 to 0.6) was within the pre-determined equivalence margin. Neck Disability Index, quality-of-life scores, and arm pain were similar. Eleven patients in the CO group and 12 patients in the NO group had an adverse event. The CO group had reduced range of motion at 6 weeks. Pain scores over the first 4 weeks after surgery were equivalent for patients undergoing multi-level PCF treated with or without a cervical orthosis. Our findings do not support the routine use of a postoperative cervical orthosis for postoperative pain control. Clinical Trials Registration Number NCT04308122, April 22, 2020.

Association of body mass index-adjusted calf circumference with appendicular skeletal muscle mass and fall risk in older adults.

This study aims to evaluate the utility of body mass index (BMI)-adjusted calf circumference (CC) in estimating skeletal muscle mass and diagnosing sarcopenia, as well as its association with falls, a common adverse event in sarcopenia. This study used cross-sectional and longitudinal designs. The CC cut-off values and the diagnosis of sarcopenia were based on valid diagnostic criteria. BMI-adjusted CC was based on previous studies, with muscle mass measured by dual-energy X-ray absorptiometry. To evaluate the diagnostic performance of BMI-adjusted CC for low muscle mass and sarcopenia, receiver operating characteristic curves were generated, and the area under the curve (AUC) values were compared using DeLong's test. Over a 1year follow-up period, factors associated with falls were examined using logistic regression analysis. In the study of 901 older adults (77.6 ± 6.1years, 63.6% women), 38.1% of men and 42.1% of women had a BMI outside the 18.5-24.9kg/m2 range. BMI-adjusted CC significantly lowered the AUC values for diagnosing low skeletal muscle mass and sarcopenia in both sexes (P < 0.001). Longitudinal univariate logistic regression analysis in women revealed that unadjusted CC was not significantly associated with fall risk, whereas BMI-adjusted CC significantly reduced fall risk at higher values. However, this association was no longer present in the multivariate analysis. The utility of BMI-adjusted CC in assessing skeletal muscle mass was not confirmed. The potential value of BMI-adjusted CC has been suggested regarding falls. Further research is warranted to better elucidate these findings.

The association between toenail metals and extracellular MicroRNAs (ex-miRNAs) among the participants of the Normative Aging study (NAS)

BackgroundMechanistic studies of the effects of environmental risk factors have been exploring the potential role of microRNA(miRNAs) as a possible pathway to clinical disease. In this study we examine whether levels of toenail metals are associated with changes in extracellular miRNA(ex-miRNA) expression. MethodsWe used data derived from the Normative Aging Study from 1996 to 2014 to conduct our analyses. We looked at associations between measured toenail metals: arsenic, cadmium, lead, manganese, and mercury and 282 ex-miRNAs in this population using canonical correlation analyses (CCAs) and longitudinal median regression. We adjusted for covariates such as age, education, body mass index, drinking and smoking behaviors, diabetes, and where available, seafood consumption. The p-values obtained from regression analyses were corrected for multiple comparisons. Ex-miRNAs identified to be associated with toenail metal levels were further examined using pathway analyses. ResultsOur dataset included 937 observations from 589 men with an average age of 72.9 years at baseline. Both our correlation and regression analyses identified lead and cadmium as exposures most strongly associated with ex-miRNA expression. Numerous ex-miRNAs were identified as being associated with toenail metal levels. miR-27b-3p, in particular, was found to have high correlation with the first canonical dimension in the CCA and was significantly associated with cadmium in the regression analysis. Pathway analyses revealed messenger RNA (mRNA) targets for the ex-miRNAs that were associated with a number of clinical disorders including cancer, cardiovascular disease, and neurological disorders, etc. ConclusionToenail metals were associated with changes in ex-miRNA levels in both correlational and regression analyses. The ex-miRNAs identified can be linked to a variety of clinical disorders. Further studies are required to validate these findings.

Examining Coping Strategies and Mental Health during the COVID-19 Pandemic: Evidence for the Protective Role of Problem-Focused Coping.

Early in the COVID-19 pandemic, studies documented a marked decline in mental health and well-being when compared with prepandemic levels. This study examined how different coping styles were associated with anxiety, depression, and sleep problems among U.S. adults March-April 2020 during the COVID-19 pandemic. Data from 535 U.S. adults across three time points were analyzed using longitudinal multilevel logistic and linear regression modeling. Avoidant-emotional coping was associated with greater odds of experiencing anxiety (OR = 1.65, p < .001). Both avoidant- and active-emotional coping were associated with greater odds of experiencing depression (OR = 1.67, p < .001, and OR = 1.09, p = .022, respectively) and sleep problems (b = 0.05, p < .001, and b = 0.01, p = .005, respectively). Alternatively, problem-focused coping was associated with lower odds of depression (OR = 0.86, p < .001). Results converge with previous evidence suggesting the perniciousness of avoidant-emotional coping during the pandemic, but also underscore that problem-focused coping strategies may represent one important source of resilience for adults to adapt despite such challenges.

Assessing heterogeneity in treatment initiation guidelines in longitudinal randomized controlled trials

Treatment initiation guidelines are essential in healthcare, dictating when patients begin therapy. These guidelines are typically assessed through randomized controlled trials (RCTs) to measure their average effect on a population. However, this method may not fully account for patient heterogeneity. We introduce a refined analysis methodology that accounts for diverse times to treatment initiation (TTI) arising from these guidelines. We offer a more detailed perspective on the guidelines’ impact by analyzing homogeneous subpopulations based on their TTI. We develop a longitudinal regression model with smooth time functions to capture dynamic changes in average guideline effects on subpopulations (AGES). A unique weighting mechanism creates pseudo-subpopulations from RCT data, enabling consistent and precise estimation of smooth functions. The efficacy of our approach is validated through theoretical and numerical studies, underscoring its capacity to provide insightful statistical inferences. We exemplify the utility of our methodology by applying it to an RCT of the World Health Organization (WHO) guideline for adults with HIV. This analysis promises to enhance the evaluation of treatment initiation guidelines, leading to more personalized and efficient patient care.

Inequalities in accelerated cognitive decline: Resolving observational window bias using nested non-linear regression.

Limited observational windows lead to conflicting results in studies examining educational differences in Alzheimer's disease and related dementias (ADRD) risk, due to observational window bias relative to onset of accelerated cognitive decline. This study tested a novel model to address observational window bias and tested for the presence and sources of disparities in accelerated cognitive declines due to ADRD. The sample examined 167,314 cognitive assessments from 32,441 Health and Retirement Study participants. We implemented a parametric non-linear nested longitudinal regression and reported multivariable-adjusted nodal incidence ratios (aNIR). University degrees were associated with lower incidence (aNIR=0.253, 95% confidence interval [CI]=[0.221 to 0.289], p<0.001), while black participants had a higher incidence (aNIR=1.995, [1.858 to 2.141], p<0.001) of accelerated cognitive decline, adjusting for demographic, sociobehavioral, and medical risk factors. Sex-stratified analyses identified diminished educational returns for women and increased incidence among minoritized women. Addressing observational window bias reveals large social inequalities in the onset of accelerated cognitive declines indicative of ADRD. This study identifies observational window bias as a source of conflicting results among previous studies of educational achievement in Alzheimer's disease and related dementias (ADRD) disparities. The study locates preclinical accelerated cognitive decline, which is indicative of ADRD while occurring 10+ years prior to symptom onset, as a site to study ADRD disparities that mitigates observational window bias. A novel method, nested non-linear regression, is developed to test for differences in the onset of accelerated cognitive decline. Educational and racial/ethnic disparities are demonstrated in the onset of accelerated cognitive decline, as are their intersecting differences with sex/gender.

Characterization of oral biomarkers during early healing at augmented dental implant sites.

The aim of this study is to assess early wound healing expression of local angiogenic biomarkers following connective tissue graft (CTG) at dental implant sites. Twenty-eight subjects with single dental implants exhibiting a soft tissue dehiscence were included and randomly treated with CTG, either with coronally advanced flap (CAF) or with tunnel technique (TUN). Peri-implant crevicular fluid (PICF) was collected at the midfacial and midlingual aspect of the implant sites at baseline and at 3, 7, 14, 30, and 90 days after the surgical intervention. The expression of angiogenin (ANG), fibroblast growth factor-2 (FGF-2), platelet-derived growth factor (PDGF), tissue inhibitor of metalloproteinases-2 (TIMP-2), and vascular endothelial growth factor (VEGF) was investigated over a period of 3 months. Patient-reported outcomes, clinical measurements, and ultrasonography scans at multiple time points were also evaluated. The longitudinal regression revealed a significant difference in the expression of VEGF and TIMP-2 between CAF- and TUN-treated sites over 3 months (p = .033 and p = .004, respectively), whereas no significant differences were observed for ANG, FGF-2 and PDGF between the two groups. At 7 days, a direct correlation was observed between ANG levels and ultrasonographic color velocity in the CAF group (p < .001) and between ANG levels and ultrasonographic color power in the TUN group (p = .028). VEGF levels and ultrasonographic mean perfused area of the CTG were significantly correlated at the 7-day time point (p < .001 for both CAF and TUN). The expression of VEGF at 7 days was directly associated with mucosal thickness gain at 1 year (p < .001 for both groups). Early TIMP-2 expression showed an inverse correlation with time to recovery (p = .002). TIMP-2 levels at 3 months exhibited inverse correlations with mean dehiscence coverage (p = .004) and the rate of complete dehiscence coverage (p = .012). PICF biomarkers can be used to monitor early wound healing events following soft tissue grafting at implant sites. VEGF and TIMP-2 showed correlations with the 1-year clinical and volumetric outcomes, as well as with post-operative patient-reported outcomes and Doppler Ultrasonographic tissue perfusion-related parameters.