Longitudinal Study Research Articles

P59 Multicentric osteolysis nodulosis and arthropathy syndrome: a case report in Erbil - Iraq

Abstract Introduction Multicentric osteolysis nodulosis and arthropathy (MONA) is inherited in an autosomal recessive manner. At conception, each sib of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Once the MMP2 pathogenic variants have been identified in an affected family member, it is a skeletal dysplasia characterized by progressive osteolysis (particularly of the carpal and tarsal bones), osteoporosis, subcutaneous nodules on the palms and soles, and progressive arthropathy (joint contractures, pain, swelling, and stiffness). Case description The patient is a 15-year-old female living in Erbil, Kurdistan. Her condition started when she was 10 months old, as she began walking and experienced recurrent sore throat. At age 4 year, she had a history of falling, developed stiffness and contracture in her elbow that made it difficult to move. A few months later, she developed a painful swelling/mass in her left foot that interfered with her walking. She had delayed tooth eruption, with only 2 teeth appearing per 2 years, her fontanelle did not close until age 3 years. At age 4, she had a fall that caused stiffness in her right hand. Over the next few years, she developed masses/swelling and pain/stiffness in her feet, hands, elbows, knees, and ankles, leading to deformities. She did not have any hearing problems but missed 3 years of school due to her condition. Back pain started 3 years ago and has been decreasing Family History: Her sister, at age 4, had pain and mild swelling in her hands and feet, along with facial abnormalities. Another 4-year-old child in the family was admitted to the ICU with similar symptoms. Complete blood count, serum biochemistry, rheumatoid profile was normal. Ultrasound of abdomen and ECHO was normal. On radiological imaging done for hands, feet, spine, in which in hands has diffuse generalized osteopenia, decrease joint spaces, resorptions of the phalanges, or cortical thinning and expansion of the phalangeal, metacarpal and metatarsal bone with deformity, and in x-ray of spine shows osteopenia with scoliosis. Dexa scan done for hip and spine which reveals (-6) severe osteoporosis. The results of genetic testing on 26th of October, led to the diagnosis of MONA syndrome. The patient was started on supportive treatment (alendronate tablet 70 mg per week, Vit D tablet 5000 IU per day, NSAID for pain and physiotherapy). Discussion The existing literature on MONA syndrome has broadly characterized the skeletal manifestations in the hands and feet. However, more detailed information is needed regarding specific skeletal involvement, ray involvement (which fingers/toes are affected), type and number of joints affected, laterality (whether the involvement is symmetrical or asymmetrical), type and severity of deformities, characteristic sparing of individual joints, if any longitudinal studies could help track the chronological order of joint involvement, especially in the larger or proximal joint Research on MONA syndrome has described the skeletal manifestations in the hands and feet, but further study is needed to understand the specifics of ray involvement, joint involvement, laterality, and severity of deformity. Longitudinal studies can help track the progression of joint involvement, particularly in larger joints. The recurrence of symptoms after orthopedic surgery in one patient highlights the progressive nature of the syndrome and suggests that early surgical intervention may not be effective. Due to the rarity of MONA syndrome, it is difficult to fully understand the pattern of the syndrome’s phenotype. Furthermore, reported correlations between the syndrome’s genetic and phenotypic characteristics have been inconsistent and inconclusive The treatment for MONA syndrome is primarily supportive and includes physical therapy to slow the development of contractures and prolong mobility. Pain relief may not be achieved through medication unless the pain is caused by secondary osteoarthritis or contractures. Additionally, daily recommended supplementation of vitamin D and calcium; standard management of congenital heart defects; management of scoliosis and kyphosis per orthopedist. Key learning points • The complicated diagnostic process for MONA syndrome necessitates a re-review of the reported phenotype-genotype correlations. By expanding the understanding of the phenotype, including the detailed skeletal manifestations, the goal is to reach a consensus on the diagnostic criteria for MONA syndrome. The aim of this case report was to systematically describe the clinical manifestations, with a focus on the skeletal features, in children with molecularly confirmed MONA syndrome, and to establish relevant phenotype-genotype correlations.

Spiritual and Emotional Care Among Clergy as First Responder-Victims in Puerto Rico: A Longitudinal Qualitative Study.

A longitudinal qualitative study was conducted to explore the experiences of church leaders (10 priests, pastors, and pastors' wives) who provided disaster spiritual/emotional care (DSEC) to the island of Puerto Rico during a period of intense and repeated crises from 2017 to 2022. Utilizing a narrative inquiry approach, 18 in-depth interviews were conducted and analyzed. Findings indicated that the participants engaged in psychological, social, and religious coping strategies to actively cope with the stress and trauma of being first responder rescuer/victims. Regional, cultural and contextual factors are considered in an effort to understand and enhance services to populations where disaster is the new normal.

Sensory processing and child appetitive traits: findings from the ROLO longitudinal birth cohort study

BackgroundOral sensory hypersensitivity has been linked with fussy eating predominantly in non-typically developing children. We hypothesized that child ‘Oral’ (touch, smell and taste in the mouth) and ‘Social-Emotional’ (response to social expectations) sensory processing are associated with child appetitive traits in typically developing preteen children. Additionally, we explored relationships between maternal sensory profiles and their offspring’s sensory profile.MethodsThis is secondary analysis of 130 mother-child dyads from the 9–11-year-old follow-up of the ROLO longitudinal birth cohort study. The Dunn Sensory Profile (Adolescent/Adult) and the Dunn Child Sensory Profile 2 were used to assess maternal and child sensory profiles, respectively. The Children’s Eating Behaviour Questionnaire was used to assess child appetitive traits. Multiple linear regression examined associations between ‘Oral’ and ‘Social-Emotional’ segments of the child sensory profile and child appetitive traits. Associations between maternal and child sensory profiles were examined using sensory profile quadrants (Dunn’s sensory processing framework). These refer to four distinct patterns of sensory processing that indicate how an individual responds to sensory input.ResultsIn total, 130 mother-child dyads were included. In adjusted analysis child ‘Oral’ sensory processing was associated with higher mean scores in the appetitive traits ‘Desire to Drink’ (B = 0.044, 95% CI = 0.025,0.062) and ‘Food Fussiness’ (B = 0.080, 95% CI = 0.059,0.101) and with lower mean scores in ‘Enjoyment of Food’ (B=-0.038, 95% CI -0.055,-0.022). Child ‘Social-Emotional’ responses were associated with higher mean scores in ‘Desire to Drink’ and ‘Food Fussiness’. Higher scores in the maternal sensory profile quadrants of ‘Sensitivity’, ‘Avoiding’ and ‘Registration’ were positively associated with higher scores in the corresponding child sensory profile quadrants.ConclusionOur findings suggest that in typically developing children presenting with fussy eating, oral sensory hypersensitivity and higher scores in social-emotional responses to sensory processing may be an underlying determinant. The relationship observed between ‘Oral’ and ‘Social-Emotional’ sensory processing segments and ‘Desire to Drink’ requires further research to ascertain the type of drinks being consumed and how this impacts appetite. Further research is also required to explore the influence of maternal sensory profile on their offsprings response to sensory input.

Determinants of Between-Person Variation in Shoulder Pain in Individuals With Spinal Cord Injury: A Population-Based Cohort Study.

The aim of the study was to evaluate determinants of between-person variation in shoulder pain ("yes"/"no") in individuals with spinal cord injury living in Switzerland. This longitudinal study used data from the Swiss Spinal Cord Injury Cohort community surveys 2012, 2017, and 2022. Logistic regression analyses were used to identify determinants of between-person variability in shoulder pain while controlling for within-person variability. The prevalence of shoulder pain was 34.4% (95% CI = 33.0-35.9) when studying 4393 completed questionnaires. Significant determinants for between-subject variability revealed higher likelihoods for shoulder pain in females as compared with males (odds ratio: 1.57; 95% CI = 1.21-2.05), and when spasticity (1.49; 1.14-1.95), contractures (2.77; 2.21-3.48), and depression (1.39; 1.02-3.48) were present. In addition, shoulder pain presented highest likelihoods in individuals with incomplete tetraplegia (1.81; 1.32-2.48) versus incomplete paraplegia, in individuals over 26 yrs since injury (1.65; 1.15-2.37) versus up to 5 yrs since injury, and in individuals using a manual (2.17; 1.53-3.08) or electrical (2.16; 1.41-3.31) wheelchair versus no aids. There were significant interaction effects for gender with time since injury, contractures, and depression. Determinants of between-subject variability in shoulder pain were female gender, lesion severity, time since injury, specific health conditions, and wheelchair use.

Lifestyle-specific association between adversity dimensions with group-based mental health trajectories.

Childhood adversity (CA) has a substantial correlation with mental health problems. Keeping a healthy lifestyle is essential for mental health interventions; it is unclear, however, how healthy lifestyle affect the relationship between CA and persistent mental health problems. This longitudinal study (n=1112, 54.5% male) collected the data on CA (measured through three dimensions: threat, deprivation and unpredictability), mental health problems, and lifestyle factors. Group-based multi-trajectory modeling (GBMTM) was utilized to estimate trajectories for three mental health problems (i.e., depression, ADHD and overanxiety). Close friendships, regular physical activity, appropriate sleep duration, shorter screen time, and healthy eating were combined to establish a healthy lifestyle score (which ranges from 0 to 5). Higher scores indicated a healthier lifestyle. Three trajectories of mental health problems were identified: persistently low risk (24.9%), persistently medium-high risk (50.0%), and persistently high risk (25.1%). Multinomial logistic regression showed that high adversity (high-threat: β=2.01, P<0.001; high-deprivation: β=1.03, P<0.001; high-unpredictability: β=0.83, P=0.001; high-overall adversity: β=1.64, P<0.001) resulted in a persistently high risk of mental health problems; these outcomes were maintained after robust control for covariates. Further lifestyle stratification, null associations were observed among children with a healthy lifestyle, irrespective of their gender; however, after controlling for covariates, the above associations remained relatively stable only among boys. The generalizability of our findings is restricted by 1) limited racial diversity and 2) missing data. This finding underscores the benefits of promoting a healthy lifestyle in children to prevent persistent mental health problems caused by CA.

Microstomia- A Review Of Published Case Reports On The Proposed Management Of Microstomia

Introdcution: microstomia, or the reduction of oral opening, can indeed present challenges for patients across various contexts, from eating and speech to prosthetic treatment. It's essential for clinicians to understand the underlying causes and tailor their approach accordingly. By synthesizing existing evidence, this review aims to provide insights into the effectiveness and feasibility of different prosthetic interventions, thereby guiding clinicians in their decision-making process for optimal patient care. Materials and methods: published case reports and case series reporting on prosthetic rehabilitation of microstomia patients were included in the present review. Only cases with a reduction in the size of the oral aperture were included, and cases with reduced mouth opening with a normal oral aperture (e.g., oral submucous fibrosis, temporal-mandibular joint ankylosis, etc.) Were excluded. Case reports: (case report1) a 93-year-old woman without teeth was referred from the local hospital to the department of oral rehabilitation at the faculty of dentistry, university of otago, dunedin, new zealand. The woman's surgeries on her lower lip resulted in a significant reduction in the vertical opening distance between her upper and lower lips, now at 30 mm. This condition, known as microstomia. (case report 2) a 62-year-old male patient, completely without teeth, presented to the prosthodontic department due to functional difficulties. Discussion: a planned and step-by-step approach is crucial when dealing with cases of microstomia. The outcome greatly depends on the complexity of the case and the utilization of recommended materials and equipment hence, diagnosis and treatment planning play pivotal roles in the management process. Conclusion: although the utilization of flexible denture materials holds promise in enhancing patient comfort and treatment outcomes, further research is warranted to evaluate their long-term success rates. Longitudinal studies can furnish valuable insights into the durability, stability, and overall performance of these materials over time, assisting clinicians in decision-making and optimizing patient care.

Validation of intrinsic capacity and healthy sleep pattern in middle-aged and older adults: a longitudinal Chinese study assessing healthy ageing

ObjectivesIntrinsic capacity (IC), a multidimensional construct encompassing mental and physical capacities, has been established in the aging framework by the World Health Organization. However, the detailed relationship between IC and Chinese sleep patterns (nighttime sleep and post-lunch naps) remains inadequately elucidated. MethodsParticipants in this study were individuals aged ≥45 years residing in China, included in the China Health and Retirement Longitudinal Study (CHARLS). We analyzed 4 years of CHARLS data from the first wave (May 2011–March 2012) to the second wave (July 2015–January 2016). Data from these waves were utilized for longitudinal analysis. Self-reported data included nighttime sleep and nap duration, along with other baseline characteristics. The IC evaluation involved physical examinations and blood tests. Initially, linear regression was used to assess the relationship between total sleep duration, nighttime sleep duration, nap duration, and IC change between the two waves that were determined by marginal effects (ME) and their corresponding 95% confidence intervals (CIs). Regression splines were employed to explore potential nonlinear associations. Subgroup and sensitivity analyses were conducted to investigate the heterogeneity of IC change under specific conditions and the robustness of our results. Mediation analysis was performed to identify potential factors mediating the relationship between sleep patterns and IC change. ResultsBoth excessive (>10 h) (total, ME: −1.12; 95% CI: −1.61, −0.64; nighttime, ME: −1.44; 95% CI: −2.29, −0.59) and insufficient (<6 h) sleep duration (total, ME: −0.43; 95% CI: −0.68, −0.18; nighttime, ME: −0.50; 95% CI: −0.73, −0.27) negatively impacted IC change. Moderate naps (≤60 min) mitigated the decline in IC change (ME: 0.28; 95% CI: 0.07, 0.49). IC values decreased at the slowest rate when nap time constituted one-seventh of total sleep time. The onset of dyslipidemia partially mediated the association between naps (≤60 min) and IC change (P = 0.02). ConclusionsThese findings suggest that maintaining a healthy sleep pattern of 6−8 h of nighttime or total sleep, along with a post-lunch nap of ≤60 min, helps preserve optimal IC or delay its decline. This is particularly beneficial for cognitive, psychological, and locomotion performance among middle-aged and older adults.

Is development and persistence of multiple physical symptoms associated with coping? A longitudinal study over a decade

ObjectiveTo examine the development and persistence of multiple physical symptoms (MPS) over a decade including the associations with sociodemographics and coping strategies. MethodA longitudinal study of 16,405 individuals aged 20–64 years participating in the Danish Symptom Cohort (DaSC) was conducted in 2012 with follow-up data in 2022 (DaSC II). MPS were assessed according to the unifying diagnostic construct of bodily distress syndrome, and coping was measured with the Brief Approach/Avoidance Coping Questionnaire. Descriptive statistics and multivariable logistic regression analyses were performed. ResultsAmong individuals not having MPS in 2012, 17 % had developed MPS in 2022. Among individuals having MPS in 2012, 57 % had persistence of MPS in 2022. Individuals who developed or had persistence of MPS at follow-up were more likely to be female, have lower educational level, be immigrant, redeem antidepressants, have lower approach scores as well as higher diversion and resignation scores. ConclusionsIndividuals responding to stressful situations with low approach, high diversion, and high resignation may be at higher risk of developing MPS and have persistence of MPS. As coping can be targeted through psychotherapy, it is important to focus on maladaptive strategies, especially in high-risk groups for developing and maintaining MPS.

Exploring the association between sleep problems and loneliness in adolescents: Potential mediating effects of rumination and resilience.

Sleep problems positively predict loneliness to a large extent, which would harm adolescent health. However, little is known about the underlying mechanism. This research investigates the potential mediating roles of rumination and resilience in the relation among adolescents and further examines the changing relationships. In Study 1, 1056 adolescents from two schools completed self-reported measures of sleep problems, loneliness, rumination, and resilience. We found that sleep problems were positively associated with loneliness, and that rumination and resilience mediated this relationship, both individually and sequentially. To examine the varying relationship between rumination, resilience, and loneliness, Study 2 adopted the cross-lagged design in a long-term longitudinal study of 131 students and found that rumination and resilience at T1 significantly predict loneliness at T2. To further directly explore the changing relationship between sleep problems and loneliness, we performed a short-term longitudinal study across 7weeks of 242 adolescents in Study 3. The results replicated the findings of Study 2 and found sleep problems at T1 positively predicted loneliness at T2. These results underscore the significance of sleep problems in contributing to loneliness through mediating mechanisms and unveil the possible causal relationships, offering robust insights to alleviate adolescent loneliness.

Delirium and frailty in older adults: Clinical overlap and biological underpinnings.

Frailty and delirium are two common geriatric syndromes sharing several clinical characteristics, risk factors, and negative outcomes. Understanding their interdependency is crucial to identify shared mechanisms and implement initiatives to reduce the associated burden. This literature review summarizes scientific evidence on the complex interplay between frailty and delirium; clinical, epidemiological, and pathophysiological commonalities; and current knowledge gaps. We conducted a PubMed systematic search in June 2023, which yielded 118 eligible articles out of 991. The synthesis of the results-carried out by content experts-highlights overlapping risk factors, clinical phenotypes, and outcomes and explores the influence of one syndrome on the onset of the other. Common pathophysiological mechanisms identified include inflammation, neurodegeneration, metabolic insufficiency, and vascular burden. The review suggests that frailty is a risk factor for delirium, with some support for delirium associated with accelerated frailty. The proposed unifying framework supports the integration and measurement of both constructs in research and clinical practice, identifying the geroscience approach as a potential avenue to develop strategies for both conditions. In conclusion, we suggest that frailty and delirium might be alternative-sometimes coexisting-manifestations of accelerated biological aging. Clinically, the concepts addressed in this review can help approach older adults with either frailty or delirium from a different perspective. From a research standpoint, longitudinal studies are needed to explore the hypothesis that specific pathways within the biology of aging may underlie the clinical manifestations of frailty and delirium. Such research will pave the way for future understanding of other geriatric syndromes as well.

Association between toothbrushing behavior and cardiometabolic multimorbidity among middle aged and older adults in North China: a cross-section study

ObjectivesTo evaluate the association between toothbrushing behavior and cardiometabolic multimorbidity (CMM) among middle-aged and older adults.MethodsData from the Beijing Health Service Survey were used to estimate the association between toothbrushing behavior and the risk of CMM using multilevel logistic models (N = 18,158).ResultsThere were 554 patients with CMM, with a prevalence of 3.05%. We found a higher risk of CMM for those with toothbrushing once or less (OR = 2.16, 95%CI: 1.80, 2.59) compared with those brushed two or more times per day in the crude model. After adjusting for confounding factors, the association between the two remained significant (OR = 1.68, 95%CI: 1.39, 2.04). The effect size was higher in adults with a higher education level (OR = 2.32) compared to those with a lower education level (OR = 1.39, P forinteraction<0.01).ConclusionsPoor toothbrushing practices were associated with CMM among middle-aged and older people. Longitudinal study can be considered to explore the causal association between the two and whether good toothbrushing habits can predict CMM and its progression.

Association of the Life's Essential 8 cardiovascular health score with periodontitis among US adults.

To investigate whether cardiovascular health (CVH) is associated with periodontitis. We used data from the 2009 to 2014 National Health and Nutrition Examination Survey. We quantified CVH using Life's Essential 8, which includes four health behaviours (diet, smoking, physical activity and sleep) and four health factors (body mass index, blood cholesterol, glucose and pressure). We categorized scores as low (0-49), moderate (50-79) and high (80-100). We calculated subscores of health behaviours and factors and categorized them as low, moderate and high. We used logistic regression to assess the association of CVH with periodontitis, adjusting for age, gender, race/ethnicity, education, poverty index, marital status and health insurance. We computed odds ratios (ORs) and 95% confidence intervals (CIs). This study included 9296 adults ≥30 years old. Multivariable-adjusted models showed that subjects with moderate (OR, 0.62; 95% CI: 0.52-0.74) or high (OR, 0.43; 95% CI: 0.33-0.57) CVH had significantly lower odds of periodontitis compared to those with low CVH. These results were consistent in the health behaviours model, but the estimates in the health factors model were not significant. Improving CVH may help prevent periodontitis. Longitudinal studies are needed to confirm our findings.

Adherence to Physical Activity Guidelines in Manual Wheelchair Users With Spinal Cord Injury and the Association With Shoulder Pain.

The aim of the study is to investigate the association between adherence to spinal cord injury-specific physical activity guidelines in manual wheelchair users with spinal cord injury and shoulder pain prevalence. This is a cross-sectional analysis of the SwiSCI Community Survey 2022 data, assessing aerobic activity and muscle strength training adherence in manual wheelchair users with spinal cord injury and shoulder pain prevalence. Logistic regression analysis was used to identify the association between meeting the physical activity guidelines and shoulder pain. Low adherence to aerobic activity and strength training guidelines are observed, with 46% and 64% of the study sample not meeting the respective guidelines. The low adherence to physical activity guidelines contrasts with the general Swiss population from which around 75% is physically active for more than 2.5 hrs a week. Manual wheelchair users present a high prevalence of shoulder pain (40%) and nonadherence to aerobic guidelines in the study sample correlates with 1.55-1.97 higher odds of having shoulder pain. Aerobic activity adherence is associated with lower shoulder pain prevalence, emphasizing its potential for injury prevention. Overall, the presented findings necessitate further longitudinal studies and interventions for a comprehensive understanding and effective management of shoulder pain in manual wheelchair users with spinal cord injury.

The association between triglyceride-glucose index combined with obesity indicators and stroke risk: A longitudinal study based on CHARLS data

Background and objectiveThe triglyceride-glucose (TyG) index, a surrogate marker for insulin resistance, has been proposed as a predictor of cardiovascular events. However, the combined impact of the TyG index and obesity indicators, such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), on stroke risk was not fully understood. This study aimed to investigate the association between the TyG index combined with these obesity indicators and stroke risk in the Chinese population.Materials and methodsData on 17,708 participants aged 45 years or older for this study were collected from the China Health and Retirement Longitudinal Study (CHARLS) from baseline (2011) to the Wave 5 follow-up (2020). Cox proportional hazards model, restricted cubic spline (RCS) and receiver operating characteristic (ROC) analysis were employed to examine the association between the TyG index and its combined obesity-related indicators with stroke. Mediation analysis was conducted to explore the mutual potential mediating role of TyG and obesity indicators in the above relationships.ResultsA total of 8,207 participants with an average age of 58.2 years were investigated, of which 11.0% were stroke individuals, 44.80% were men and 84.6% were from rural areas. TyG, TyG-BMI, TyG-WHtR, TyG-WC were significantly higher in stroke subjects than in the non-stroke subjects (P < 0.001), and were significantly and positively associated with stroke in all 3 models (P < 0.05). Restricted cubic spline models revealed nonlinear associations between TyG and TyG-BMI with stroke (P-overall < 0.001, P-nonlinear = 0.003 for TyG, and P-overall < 0.001, P-nonlinear = 0.028 for TyG-BMI), while TyG-WC and TyG-WHtR (P-overall < 0.001 and P-nonlinear > 0.05) demonstrated linear associations with stroke after adjusting for covariates. TyG-WHtR, TyG-BMI and TyG-WC had more robust predictive power than TyG for risk of stroke. TyG-WHtR or TyG-WC had the highest predictive power for stroke (AUC:0.696, 95% CI 0.677–0.715), slightly higher than the other indicators. Associations between TyG, TyG-WC, TyG-WHtR, and TyG-BMI with stroke were found to be stronger among individuals who were ≥ 55 years of age, male. The relationship between TyG and stroke was significantly mediated by BMI, WHtR and WC (15.79%, 21.72%, and 24.06% respectively), while the relationship between these obesity measures and stroke was significantly mediated by TyG (18.48%, 14.45%, and 14.70% respectively).ConclusionThe combination of TyG and obesity-related indicators was significantly associated with stroke risk, and could improve predictive power for stroke compared to the single TyG. Obesity indicators and TyG mediated each other in their respective associations with stroke risk.

Gender cognitions before and after graduating from single-sex versus coeducational high schools: A longitudinal study using propensity score matching.

Gender cognitions before and after graduating from single-sex versus coeducational high schools: A longitudinal study using propensity score matching.

Association between masticatory function and depression in older adults: Results from NHANES 2009 to 2018.

Depression is prevalent among older adults. Although the number of missing teeth is considered to be associated with depression, the relationship between masticatory function, which is usually indicated by functional tooth units (FTUs), and depression in older adults remains unclear. This study used data from the National Health and Nutrition Examination Survey (NHANES) 2009-2018. The number of FTUs was defined as pairs of opposing natural and artificial teeth. Depression was accessed using the Patient Health Questionnaire (PHQ-9), and participants who scored ≥10 on PHQ-9 were diagnosed with depression. Logistic regression analyses, propensity score matching (PSM) analyses and subgroup analyses were conducted to assess the association between FTU and depression. The analysis included 5764 individuals over 60 years. An association between FTU and the risk of depression among older adults was detected (odds ratio [OR] = 0.951, 95% confidence interval [CI] 0.915-0.989), suggesting protective roles of more FTUs. Significant increase in the risk of depression in 0 ≤ FTUs ≤ 3 was observed compared with 10 ≤ FTUs ≤ 12 (OR = 1.819, 95% CI 1.157-2.858). However, no significant increase in the risk of depression in 4 ≤ FTUs ≤ 9 was found. After PSM, significant increase in the risk of depression in 0 ≤ FTUs ≤ 3 was still detected compared with 4 ≤ FTUs ≤ 12 (OR = 1.484, 95% CI 1.030-2.136). Subgroup analyses demonstrated consistent results in all subgroups, except for individuals aged 76-80 and drinking regularly. The findings suggested the association between impaired masticatory function and the risk of depression among older adults. Longitudinal studies are needed to elucidate the role of masticatory function impairment in the development of depression further.

Participation in Social and Community Life Before and After Spinal Cord Injury/Disease: Factors Influencing Changes in Short-Term and Long-Term Participation.

Examining changes in participation frequency (productive, leisure, and social activities) from pre-spinal cord injury/disorder to at least 2 yrs post-spinal cord injury/disorder and identifying sociodemographic and spinal cord injury/disorder characteristics associated with significant shifts in participation frequency. The study used a longitudinal design, using data from the Swiss Spinal Cord Injury Cohort study. Pre-spinal cord injury/disorder participation frequency was assessed retrospectively 12 wks after spinal cord injury/disorder and prospectively 1 and at least 2 yrs after spinal cord injury/disorder. Linear mixed-effects model trees were used to identify subgroups with participation changes and related sociodemographic and spinal cord injury/disorder characteristics. The study involved 550 individuals (median age at spinal cord injury/disorder onset: 53 yrs, 30% female, 63.9% with traumatic etiology, and 5.6 yrs since onset). Pronounced decrease was observed prominently in productive activities. Education and age at spinal cord injury/disorder onset served as initial variables to split the tree at first level for each of the participation dimensions. This research identified participation dimensions most susceptible to changes during the initial years after spinal cord injury/disorder and pinpointed subgroups displaying clinically meaningful longitudinal variations across productive, leisure, and social activities. These findings have the potential to enhance the efficiency of rehabilitation programs, leading to improvements in long-term participation levels for individuals with spinal cord injury/disorder.

The future of physiological research: A greater understanding of female master athletes and aging?

High caliber master athletes provide a valuable model for studying inherent physiological aging and performance capacity, without the confounding factor of physical inactivity. Despite the remarkable achievements of female master athletes, their participation rates remain significantly lower than those of their male counterparts, particularly at more advanced ages. This review examines the biological sex gap in sports participation among master athletes and the subsequent disparity in empirical research, thereafter exploring possible contributing factors. It highlights the importance of studying female master athletes to better understand the aging process and offers recommendations to address current evidence gaps. The need for more comprehensive mechanistic data on highly trained older women, novel cataloguing and analysis of real-world datasets, case studies/series, and longitudinal research are also emphasized. Although analyzing the records of female master athletes as a surrogate to determine age-related physiological and performance changes is a common approach, the process may be hindered by the considerably lower participation rates of women. Therefore, an important step toward bridging these gaps is the longitudinal, integrative study of female athletes engaged in lifelong exercise. Such analyses would improve our understanding of senescence in women and may inform interventions targeting the promotion of physical function in older adults.

Economic inequalities in adolescents’ internalising symptoms: longitudinal evidence from eight countries

Research, mainly conducted in Europe and North America, has shown an inequitable burden of internalising mental health problems among adolescents from poorer households. We investigated whether these mental health inequalities differ across a diverse range of countries and multiple measures of economic circumstances. In this longitudinal observational cohort study, we analysed data from studies conducted in eight countries (Australia, Ethiopia, India, Mexico, Peru, South Africa, the UK, and Viet Nam) across five global regions. All studies had self-reported measures of internalising symptoms using a validated scale at two timepoints in adolescence; a measure of household income, household consumption expenditure, or subjective wealth; and data collected between 2000 and 2019. Household income (measured in four countries), consumption expenditure (six countries), and adolescents' subjective assessment of household wealth (five countries) were measured in mid-adolescence (14-17 years). The primary outcome (internalising symptoms, characterised by negative mood, affect, and anxiety) was measured later in adolescence between age 17 and 19 years. Analyses were linear regression models with adjustment. Effect estimates were added to random-effects meta-analyses to aid understanding of cross-country differences. The overall pooled sample of eight studies featured 18 910 adolescents (9568 [50·6%] female and 9342 [49·4%] male). Household income had a small or null association with adolescents' internalising symptoms. Heterogeneity (I2 statistic) was 71·04%, falling to 39·71% after adjusting for baseline symptoms. Household consumption expenditure had a stronger association with internalising symptoms (decreases of 0·075 SD in Peru [95% CI -0·136 to -0·013], 0·034 SD in South Africa [-0·061 to -0·006], and 0·141 SD in Viet Nam [-0·202 to -0·081] as household consumption expenditure doubled). The I2 statistic was 74·24%, remaining similar at 74·83% after adjusting for baseline symptoms. Adolescents' subjective wealth was associated with internalising symptoms in four of the five countries where it was measured. The I2 statistic was 57·09% and remained similar after adjusting for baseline symptoms (53·25%). We found evidence for cross-country differences in economic inequalities in adolescents' internalising symptoms, most prominently for inequalities according to household consumption expenditure. Subjective wealth explained greater variance in symptoms compared with the objective measures. Our study suggests that economic inequalities in adolescents' mental health are prevalent in many but not all countries and vary by the economic measure considered. Variation in the magnitude of inequalities suggests that the wider context within countries plays an important role in the development of these inequalities. Wellcome Trust.

The Potential Impact of SGLT2-I in Diabetic Foot Prevention: Promising Pathophysiologic Implications, State of the Art, and Future Perspectives—A Narrative Review

The impact of diabetic foot (DF) on the healthcare system represents a major public health problem, leading to a considerable clinical and economic burden. The factors contributing to DF’s development and progression are strongly interconnected, including metabolic causes, neuropathy, arteriopathy, and inflammatory changes. Sodium–glucose cotransporter 2 inhibitors (SGLT2-i), novel oral hypoglycemic drugs used as an adjunct to standard treatment, have recently changed the pharmacological management of diabetes. Nevertheless, data about the risk of limb amputation, discordant and limited to canagliflozin, which is currently avoided in the case of peripheral artery disease, have potentially discouraged the design of specific studies targeting DF. There is good evidence for the single immunomodulatory, neuroprotective, and beneficial vascular effects of SGLT2-i. Still, there is no clinical evidence about the early use of SGLT2-i in diabetic foot due to the lack of longitudinal and prospective studies proving the effect of these drugs without confounders. This narrative review aims to discuss the main evidence about the impact of SGLT2-i on the three complications of diabetes implicated in the development of DF, the state of the art, and the potential future implications.