Summary Index Research Articles

Exercise-Induced Functional Changes in People with Parkinson's Disease following External Cueing and Task-Based Intervention.

The purpose of this study was to evaluate change in motor function, gait speed, dynamic balance, balance confidence, and quality of life (QoL) in nine participants with Parkinson's disease (PwPD) completing Lee Silverman Voice Treatment BIG (LSVT-BIG), an external cueing and task-based intervention. Although supported as an efficacious treatment in PwPD, there is limited research examining clinically meaningful change in outcome measures related to external cueing and task-based interventions. This was a case series of nine PwPD (age range 64-76 years, 55% male) who completed the LSVT-BIG protocol. Disease duration ranged from 1 to 17 years and was classified as moderate in all participants (Hoehn and Yahr = 2 or 3). Outcome measures included motor function (MDS-UPDRS Part III Motor), gait speed, dynamic balance (MiniBEST), Activities-specific Balance Confidence (ABC), and Summary Index for PD Quality of Life 39 (PDQ-SI). Assessments were completed at baseline (BASE), end of treatment (EOT), and 4 weeks after EOT (EOT+4). Minimal detectable change (MDC) or minimal clinical important difference (MCID) was observed in one or more outcome measures in 8 of 9 participants at EOT and EOT+4 across domains of motor function (67%, 78%), gait speed (78%, 67%), balance confidence (44%, 33%), quality of life (44%, 78%), and dynamic balance (22%, 22%). Discussion. In this case series, 8 of 9 participants showed MDC or MCID changes across multiple functional domains. Improvements were observed immediately post (EOT) and 4-week post-treatment (EOT+4) suggesting a temporal component of the LSVT-BIG impact on functional change. Future research should include clinical trials to examine additional external cueing and task-based intervention efficacy with consideration of intensity, frequency, and mode of delivery across disease severity.

Quality of life assessment when considering the introduction of device-assisted therapies in advanced Parkinson's disease: A retrospective observational cross-sectional study

IntroductionDevice-aided therapy (DAT) is an established treatment for improving the quality of life (QOL) in individuals with advanced Parkinson's disease (APD). Criteria for starting DAT, including motor and non-motor symptoms, have been proposed. However, it remains unclear whether QOL differences among patients with APD influence DAT introduction. Therefore, we aimed to investigate QOL differences between patients with and without DAT introduction. MethodsThis retrospective observational cross-sectional study included 245 patients with PD who were followed up between January 1, 2020, and June 30, 2022. We defined cases that underwent DAT introduction after evaluation as “planned-DAT” and those that did not as “not-planned-DAT.” We performed between-group comparisons of the PD questionnaire-39 (PDQ-39) summary index (SI) in patients with APD who met the 5–2-1 criteria (≥5 times the oral levodopa dose/day, ≥2 h of “off” symptoms/day, and ≥ 1 h of troublesome dyskinesia/day). ResultsSeventy-nine patients met the inclusion criteria for APD (median age: 68 [61.0–73.0] years; 62.8% [N = 52] women). The PDQ-39 SI scores were higher in the planned-DAT group (N = 12) than in the not-planned-DAT group (N = 67) (29.2 [22.1–33.6] vs. 19.0 [10.3–49.6] points, P < 0.05). After propensity-score matching according to age and sex, the PDQ-39 SI scores remained higher in the planned-DAT (N = 9) than in the not-planned-DAT group (N = 18) (40.0 [25.4–60.0] vs. 18.5 [7.9–46.8] points, P < 0.05). ConclusionsOur results suggest that QOL assessment using PDQ-39 can be used to identify patients eligible for DAT.

A randomized controlled pilot study of a cognitive-behavioral video game intervention for the promotion of active aging.

Due to the accessibility barriers of in-person programs for active aging, the development of programs that use innovative technologies is needed. Video games can be an engaging tool for disseminating active aging interventions. The objective of this pilot study was to analyze the feasibility of a cognitive-behavioral intervention to promote active aging administered through a video game. Fifty-five participants (63.6% women, mean age = 53.0 years) were randomly assigned to a cognitive-behavioral intervention to promote active aging administered through an interactive multimedia online video game with a complementary app (CBI-V; n = 29) or to a control group that received nonspecific online information (CG; n = 26). Only 3.6% of the participants dropped out of the study (6.9% in CBI-V and 0.0% in CG; without significant differences between groups). The mean number of modules completed was 7.6 (SD = 0.9) out of 8 in the CBI-V and 7.9 (SD = 0.5) in the control group (CG), without significant between-group differences. In the CBI-V, the mean total time dedicated to the game was 516.8 min (SD = 94.3), including 143.2 min (SD = 31.6) of cognitive training tasks, and the mean of completed tasks was 206.2 (SD = 33.7) out of 259. Participants were highly engaged (M = 39.9, SD = 8.6) and satisfied (M = 25.8, SD = 4.5) with the intervention. After the intervention, the CBI-V group significantly improved on SF-36 dimensions of General Health (p = .0386), Vitality (p = .0283), Social Functioning (p = .0130), and Physical Summary Index (p = .0370) compared to the CG, with medium effect sizes (d = 0.56-0.75). The results demonstrate the feasibility of the video game intervention to promote active aging and encourage conducting a large-scale randomized controlled trial.

Study of urban soil collected from a future residential complex area from Galati, Romania

In this paper, soil samples collected from an area where a real estate will develop were studied. The study presents a qualitative and quantitative XRF analysis of samples from an oil factory, Prutul S.A. and old industrial establishment, S.C. Intfor S.A. To assess the level of pollution there were calculated by using Microsoft Excel: total contamination index (HC), Saet summary index after the hazard index (ZC), total pollution index (ZCT) and ecological risk factor (ER). The conclusion for location Prutul S.A. is that the majority of the samples had concentrations below the limits proposed by legislation. In this case, the exceptions are the elements Cr, Ni, and As. Regarding S.C. Intfor S.A., due to the main area of activity, a significant amount of Zn was present, directly affecting the environmental health. Moreover, the presence of Hg, Pb, Cu, Cr, As, V, etc., makes from location F a highly polluted place.

Wellbeing Rankings

Combining data on around four million respondents from the Gallup World Poll and the US Daily Tracker Poll we rank 164 countries, the 50 states of the United States and the District of Colombia on eight wellbeing measures. These are four positive wellbeing measures—life satisfaction, enjoyment, smiling and being well-rested—and four negative wellbeing variables—pain, sadness, anger and worry. Pooling the data for 2008–2017 we find country and state rankings differ markedly depending on whether they are ranked using positive or negative affect measures. The United States ranks lower on negative than positive affect, that is, its country wellbeing ranking looks worse using negative affect than it does when using positive affect. Combining rankings on all eight measures into a summary ranking index for 215 geographical locations we find that nine of the top ten and 16 of the top 20 ranked are US states. Only one US state ranks outside the top 100—West Virginia (101). Iraq ranks lowest—just below South Sudan. The Nordic countries that traditionally rank high using life satisfaction do not rank as highly on other measures. Country-level rankings on the summary wellbeing index differ sharply from those reported in the World Happiness Index and are more comparable to those obtained with the Human Development Index. The state level rankings on the summary index look very different from those just based on positive affect measures and look more similar to rankings based on objective wellbeing measures.

Assessing the content validity of the Manchester–Oxford Foot Questionnaire in surgically treated ankle fracture patients: a qualitative study

BackgroundRoughly 10% of fractures in adults are ankle fractures. These injuries are found in both sexes and present with different fracture characteristics. The treatment varies with the patients’ biology and fracture type, and the goals are to restore stability, prevent pain and maintain ankle function. Clinicians generally use outcomes like assessment of radiography, pain level, or function. The use of patient-reported outcome measures is increasing, and the Manchester–Oxford Foot Questionnaire (MOXFQ) has been shown to have good measurement properties when validated in patients with foot and ankle disorders. However, the instrument has not been validated for ankle fracture patients. This study aims to assess the content validity of the items in MOXFQ in surgically treated ankle fracture patients.MethodsA qualitative deductive design was used to investigate patients’ response process of the MOXFQ. Individual interviews were conducted using cognitive interviewing based on the theoretical framework of the 4-step model by Tourangeau. Adult patients that were surgically treated for an ankle fracture between four weeks and 18 months were purposively sampled, and interviews followed a semi-structured interview guide. The predetermined categories were comprehension, retrieval, judgement, and response.ResultsSeventeen respondents (65% females) were interviewed. Respondents’ age ranged from 27 to 76 years. Some of the respondents in the early recovery phase were limited by post-operative restrictions and did not find the items in the walking/standing domain relevant. Respondents that were allowed weight-bearing as tolerated (WBAT) were able to recall relevant information for most items. Respondents with time since surgery more than 12 months had less pain and remembered fewer relevant episodes in the recall period. Items in the social interaction domain contained ambiguous questions and were generally considered less important by respondents. The summary index score lacked important concepts in measuring overall quality of life.ConclusionsPain was a central concept in the post-operative recovery of ankle fracture patients. The MOXFQ-subscales for pain and walking/standing had acceptable content validity in patients that were allowed WBAT. The social interaction-subscale and the summary index score had insufficient content validity for this patient population.

THE SYSTEM OF INDICATORS FOR EVALUATING REGIONAL INVESTMENT PROJECTS FINANCED FROM BUDGETARY FUNDS

The purpose of the study. The article deals with the issues of a comprehensive assessment of regional investment projects implemented at the expense of budgetary funds. In accordance with this, the purpose of the article is to form a system of indicators that takes into account the main and additional criteria for the economic and socio-environmental effectiveness of the implementation of regional investment projects through the prism of assessing the investment attractiveness of the project and its performers. To achieve this goal , the following tasks have been set and solved: 1) the main and additional criteria for evaluating a regional investment project have been identified; 2) a system of indicators for assessing the investment attractiveness of the project and its potential performers has been developed; 3) a summary index of the feasibility of state financing of the project has been proposed; 4) calculations of indicators and a summary index have been carried out on a specific example. Conclusions. In order for the state customer to make an informed decision on the budget financing of a regional investment project, a multiplicative index of the expediency of state financing has been developed, which includes indices of the investment attractiveness of the project itself and its performer. Each index is determined on the basis of basic and additional indicators that characterize, on the one hand, the utility, economic, budgetary, social and environmental effectiveness of the project itself, and on the other hand, economic efficiency, resource potential, compliance with ESG principles of doing business and the business image of the project executor. The results obtained can be used by state and municipal authorities to make an informed decision on the appropriateness of budgetary financing of regional investment projects and their potential performers selected on the basis of the author's system of indicators and the proposed integral index.

Loneliness, belonging and psychosomatic complaints across late adolescence and young adulthood

Abstract Loneliness and a sense of belonging refer to social connectedness and are associated with young people's health; however, the relationship between these constructs and their impact on health is still being discussed. The dual continuum model has been suggested (Lim et al., 2021) where these two constructs are regarded as independent but related. Four groups of individuals are defined in the model depending on the level of loneliness and belonging: socially fulfilled (low loneliness, high belonging), socially searching (high loneliness, high belonging), socially distressed (high loneliness, low belonging), and socially indifferent (low loneliness, low belonging). Swedish cohort data collected among late adolescents (age 17-18 at baseline in 2019) who were followed up in young adulthood (age 20-21 in 2022) (n = 2684) was used to examine the association between these distinct groups of individuals and psychosomatic complaints. Three psychosomatic complaints were measured: stomach aches, headaches, and sleeping difficulties, and a summary index (range 3-15) was calculated. Linear regression analyses showed that loneliness and a sense of belonging were cross-sectionally associated with psychosomatic complaints (additional adjustment for sociodemographic characteristics barely affected the estimates). The socially fulfilled group reported fewer psychosomatic complaints compared with the other groups, while the socially distressed group reported the highest level of psychosomatic complaints. Furthermore, the socially indifferent group reported fewer psychosomatic complaints than the socially searching group. The prospective analysis supported these patterns; however, after adjustment for earlier psychosomatic complaints, only the socially distressed group showed a significant positive association with subsequent psychosomatic complaints. These findings confirm that the dual continuum model reflects the complexity of social needs and their association with health complaints. Key messages • The categorisation of the conjoint relationship of loneliness and belonging helps to reveal more nuanced links between these two constructs and psychosomatic complaints in young people. • Knowledge of the more nuanced links between loneliness, belonging, and health complaints can be beneficial for developing specific, targeted public health recommendations and interventions for youth.

Subjective Cognitive and Communicative Complaints and Health-Related Quality of Life in Parkinson's Disease with and without Mild Cognitive Impairment

IntroductionMild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients’ subjective cognitive and communicative difficulties has not been explored. ObjectiveWe aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints. MethodsWe included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted. ResultsPD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores. ConclusionsHRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD.

Patients' perspective of quality-of-care and its correlation to quality-of-life following spontaneous coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of myocardial infarction. We aimed to investigate SCAD survivors' perceptions of their quality-of-care and its relationship to quality-of-life. An anonymous survey was distributed online to SCAD survivors involved in Australian SCAD support groups, with 172 (95.3% female, mean age 52.6 ± 9.2 years) participants in the study. The survey involved assessment of quality-of-life using a standardized questionnaire (EQ-5DTM-3L). Respondents rated the quality-of-care received during their hospital admission for SCAD with a median of 8/10 [interquartile range (IQR) 7-10]. Respondents ≤ 50 years vs. >50 years were more likely to perceive that their symptoms were not treated seriously as a myocardial infarction (χ2 = 4.127, df = 1, P < 0.05). Participants rated clinician's knowledge of SCAD with a median of 4/10 (IQR 2-8) and 7/10 (IQR 3-9) for Emergency and Cardiology clinicians, respectively (P < 0.05). The internet was the most selected source (45.4%) of useful SCAD information. The mean EQ-5DTM summary index was 0.79 (population norm 0.87). A total of 47.2% of respondents reported a mental health condition diagnosis, with 36% of these diagnosed after their admission with SCAD. Quality-of-life was significantly associated with perceived quality-of-care: EQ-5DTM index/(1-EQ-5DTM index) increased by 13% for each unit increase in quality-of-care after adjusting for age and comorbidities (P < 0.001). While SCAD survivors rated their overall hospital care highly, healthcare providers' knowledge of SCAD was perceived to be poor, and the most common source of SCAD information was the internet. Mental health conditions were common, and a significant association was observed between perceived quality-of-care and SCAD survivors' quality-of-life.

Health-Related Predictive Factors of Brazilian Children With Early Onset Scoliosis Using the EOSQ-24 and CHQ-PF50 Questionnaires.

Assessing the quality of life (QOL) of children with early onset scoliosis (EOS) has been discussed recently. Therefore, the study aimed to apply and correlate the 24-item Early Onset Scoliosis Questionnaire (EOSQ-24) with the 50-item Childhood Health Questionnaire (CHQ-PF50) to find predictive factors impacting QOL. Cross-sectional study involving a population of caregivers of patients with EOS. The sample consisted of 72 patients. Two research assistants applied the Portuguese version of the EOSQ-24 and CHQ-PF50 in 3 treatment centers. The EOSQ-24 assesses the subjective response of children with EOS from the parent's point of view. The CHQ is a self-administered questionnaire or parental proxy assessment of the psychological and social status of children aged 5 to 18 years. Of 72 patients, 41 (56.9%) were females, mean age of 11.9 ± 4.2 years. The most common scoliosis was of neuromuscular origin (32%). The CHQ-PF50 showed that family-related items had significant scores. The most affected subcategory was physical function (45.5), and the least affected was mental health (90.8). Thus, the CHQ-PF50 PhS summary index was 27, and the CHQ-PF50 PsS was 71.7. Moreover, the critical categories for the EOSQ-24 questionnaire were daily life and physical function (45.1 and 47.8, respectively), and the least affected categories were transfer and pulmonary function (70.8 and 68.9, respectively). Four subcategories showed a strong correlation between both questionnaires: general health (r = 0.749, P < 0.001), physical function (r = 0.645, P < 0.001), bodily pain (r = 0.714, P < 0.001), and mental health (r = 0.424, P < 0.001). Using CHQ-PF50 as a dependent variable in multiple regression analysis (P = 0.028), the only variable affecting the scores was syndromic scoliosis (P = 0.019; 95% CI -27.4 to -2.5). A strong correlation between both questionnaires was seen for general health, physical function, bodily pain, and mental health. Syndromic scoliosis was a predictor of worse QOL according to the CHQ-PF50.

Physical function and mental health trajectories in COVID-19 patients following invasive mechanical ventilation: a prospective observational study

This prospective observational cohort study was performed to investigate the physical function and mental health trajectories of novel coronavirus disease 2019 (COVID-19) patients requiring invasive mechanical ventilation (IMV) after discharge from the intensive care unit (ICU). The study population consisted of 64 patients (median age, 60 years; 85.9% male; median IMV duration, 9 days). At ICU discharge, 28.1% of the patients had Medical Research Council (MRC) sum score < 48 points, and prolonged IMV was significantly associated with lower MRC sum score and handgrip strength. Symptoms were similar between groups at ICU discharge, and the symptoms most commonly reported as moderate-to-severe were impaired well-being (52%), anxiety (43%), tiredness (41%), and depression (35%). Although muscle strength and mobility status were significantly improved after ICU discharge, Edmonton Symptom Assessment System score did not improve significantly in the prolonged IMV group. EuroQol five-dimension five-level summary index was significantly lower in the prolonged than short IMV group at 6 months after ICU discharge. We found substantial negative physical function and mental health consequences in the majority of surviving COVID-19 patients requiring IMV, with prolonged period of IMV showing greater negative effects not only immediately but also at 6 months after discharge from the ICU.

Validation of a comorbidity questionnaire in patients with neurological disorders

RationalSeveral tools exist to assess comorbidities in neurological disorders, the most widely used being the Charlson Comorbidity Index (CCI), but it has several limitations. The Comorbidity and General Health Questionnaire...

The Effects of Deep Brain Stimulation on Mood and Quality of Life in Parkinson's Disease: A Systematic Review and Meta-Analysis.

Deep brain stimulation (DBS) is extensively used to treat motor and non-motor symptoms in Parkinson's disease (PD). The aim of this study was to investigate the difference between subthalamic (STN) and globus pallidus internus (GPi) DBS on mood and quality of life with reference to minimal clinically important differences (MCID). A systematic literature search for articles published until November 2022 yielded 14 studies meeting the eligibility criteria, with a total of 1,088 patients undergoing STN (n=571) or GPi (n=517) stimulation. Baseline patient and clinical characteristics were comparable between the two groups. Results showed that GPi stimulation demonstrated a greater reduction in the Beck depression inventory (mean difference (MD)=1.68) than STN stimulation (MD=0.84). Hospital anxiety and depression scale showed a 2.69- and 3.48-point decrease by the GPi group in the depression and anxiety categories, respectively. The summary index (SI) of the PD questionnaire depicted a greater improvement in the GPi group from baseline (mean=41.01, 95% CI 34.89, 47.13) to follow-up (mean=30.85, 95% CI 22.08, 39.63) when compared to the STN group (baseline mean=42.43, 95% CI 34.50, 50.37; follow-up mean=34.21, 95% CI 25.43, 42.99). The emotions category also demonstrated a similar trend. However, STN stimulation showed greater reductions in motor symptoms and medication than GPi stimulation. This meta-analysis demonstrated that GPi stimulation seems to offer an advantage over STN stimulation in improving mood and quality of life in PD, but those effects must be further validated by larger studies.

A novel summary index derived from Kinect to evaluate the severity of postural abnormalities in patients with Parkinson’s Disease

A novel summary index derived from Kinect to evaluate the severity of postural abnormalities in patients with Parkinson’s Disease

The Rhetoric of Solidarity: Nature and Measurement of Social Cohesion in the Self-representation of Civil Society Organizations

Scholars have called to study how social cohesion is discursively negotiated and produced in communication behavior. However, empirical evidence remains scarce. In this study, we investigate to what extent and how civil society organizations (CSOs), part of the backbone of social integration in modern democracies, make references to social cohesion in their public self-portrayals. We develop a standardized measure for content analyzing the manifestation of social cohesion along three theoretical dimensions: social relations, connectedness, and orientation towards the common good. We apply our innovative content measure to the external communication of an original sample of nearly 800 CSOs in Germany, using their websites. Subsequently, we use data from an accompanying organizational survey of these institutions to investigate whether and how certain organizational features help explain variance in social cohesion rhetoric. Findings suggest that CSOs’ external communications employ themes from all key dimensions of social cohesion, revealing a fair amount of variation on all three subdimensions and a summary index of the overall strength social cohesion rhetoric. These different emphases are contingent upon various organizational characteristics, namely the spheres in which CSOs are primarily active, their locations, and their target groups. Whereas culturally and media-oriented organizations as well as sports clubs are largely reluctant to make references to social cohesion, politically active CSOs and those addressing socially disadvantaged communities tend to push more in this direction. The latter tend to operate in more professionalized structures, indicating that referencing social cohesion legitimizes these groups’ political and social purposes in the public sphere.

Levodopa Carbidopa Intestinal Gel in Advanced Parkinson's Disease: DUOGLOBE Final 3-Year Results.

Levodopa-carbidopa intestinal gel (LCIG) improves motor and non-motor symptoms in patients with advanced Parkinson's disease (aPD). To present the final 36-month efficacy and safety results from DUOGLOBE (DUOdopa/Duopa in Patients with Advanced Parkinson's Disease - a GLobal OBservational Study Evaluating Long-Term Effectiveness; NCT02611713). DUOGLOBE was an international, prospective, long-term, real-world, observational study of patients with aPD initiating LCIG in routine clinical care. The primary endpoint was change in patient-reported "Off" time to Month 36. Safety was assessed by monitoring serious adverse events (SAEs). Significant improvements in "Off" time were maintained over 3 years (mean [SD]: -3.3 hours [3.7]; p < 0.001). There were significant improvements to Month 36 in total scores of the Unified Dyskinesia Rating Scale (-5.9 [23.7]; p = 0.044), Non-Motor Symptoms Scale (-14.3 [40.5]; p = 0.002), Parkinson's Disease Sleep Scale-2 (-5.8 [12.9]; p < 0.001), and Epworth Sleepiness Scale (-1.8 [6.0]; p = 0.008). Health-related quality of life and caregiver burden significantly improved through Months 24 and 30, respectively (Month 24, 8-item Parkinson's Disease Questionnaire Summary Index, -6.0 [22.5]; p = 0.006; Month 30 Modified Caregiver Strain Index, -2.3 [7.6]; p = 0.026). Safety was consistent with the well-established LCIG profile (SAEs: 54.9% of patients; discontinuations: 54.4%; discontinuations due to an adverse event: 27.2%). Of 106 study discontinuations, 32 patients (30.2%) continued LCIG outside the study. DUOGLOBE demonstrates real-world, long-term, reductions in motor and non-motor symptoms in patients with aPD treated with LCIG.

Potential effect modifiers for treatment with chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7–14 years: development of and results from a secondary analysis of a randomised clinical trial

BackgroundA recent randomized controlled trial (RCT) investigating the effect of chiropractic manipulation in 199 children aged 7–14 years with recurrent headaches demonstrated a significant reduction of number of days with headache and a better global perceived effect (GPE) in the chiropractic manipulation group compared to a sham manipulation group. However, potential modifiers for the effectiveness of chiropractic manipulation of children with recurrent headaches have never been identified. The present study is a secondary analysis of data from that RCT and will investigate potential effect modifiers for the benefit of chiropractic manipulation for children with headache.MethodsSixteen potential effect modifiers were identified from the literature and a summary index was prespecified based on clinical experience. Relevant variables were extracted from baseline questionnaires, and outcomes were obtained by means of short text messages. The modifying effect of the candidate variables was assessed by fitting interaction models to the data of the RCT. In addition, an attempt to define a new summary index was made.ResultsThe prespecified index showed no modifying effect. Four single variables demonstrated a treatment effect difference of more than 1 day with headache per week between the lower and the upper end of the spectrum: intensity of headache (p = 0.122), Frequency of headache (p = 0.031), sleep duration (p = 0.243), and Socioeconomic status (p = 0.082). Five variables had a treatment effect difference of more than 0.7 points on the GPE scale between the lower and the upper end of the spectrum: Frequency of headache (p = 0.056), Sport activity (p = 0.110), Sleep duration (p = 0.080), History of neck pain (p = 0.011), and Headache in the family (0.050). A new summary index could be constructed giving highest weight to History of neck pain and Headache in the family and Frequency of headache. The index suggests a difference of about 1 point in GPE between low and high values of the index.ConclusionChiropractic manipulation offers a moderate benefit for a broad spectrum of children. However, it cannot be excluded that specific headache characteristics, family factors, or a history of neck pain may modify the effect. This question must be addressed in future studies.Trial registration: ClinicalTrials.gov (Albers et al in Curr Pain Headache Rep 19:3–4, 2015), identifier NCT02684916, registered 02/18/2016—retrospectively registered.

Comprehensive green growth indicators across countries and territories

A sustainable transition to green growth is crucial for climate change adaptation and mitigation. However, the lack of clear and consistent definitions and common measures for green growth implies a disagreement on its determinants which hampers the ability to proffer valuable guidance to policymakers. We contribute to the global debate on green economic development by constructing green growth measures from 1990 to 2021 across 203 countries. The pillars of green growth are anchored on five dimensions namely natural resource base, socio-economic outcomes, environmental productivity, environmental-related policy responses, and quality of life. Contrary to the aggregated methods used in constructing indices in the extant literature, we employ a novel summary index technique with generalized least squares attributed-standardized-weighted index that controls for highly correlated variables and missing values. The constructed indicators can be used for both country-specific and global data modeling on green economic development useful for policy formulation.

Somatic Symptoms of Depression Lose Association with Mortality upon Adjustment for Frailty: Analysis from the Fitness Haemodialysis Cohort.

The somatic symptom component of depression is associated with increased hospitalisation and mortality and poorer health-related quality of life (HRQOL). However, the relationship of subsets of depression symptoms with frailty and outcomes is not known. This study aimed to (1) explore the relationship between the Clinical Frailty Scale (CFS) and components of depression and (2) their association with mortality, hospitalisation, and HRQOL in haemodialysis recipients. We conducted a prospective cohort study of prevalent haemodialysis recipients, with deep bio-clinical phenotyping including CFS and PHQ-9 somatic (fatigue, poor appetite, and poor sleep) and cognitive component scores. EuroQol EQ-5D summary index assessed HRQOL at the baseline. Electronic linkage to English national administration datasets ensured robust follow-up data for hospitalisation and mortality events. Findings. Somatic (β = 0.067; 95% C.I. 0.029 to 0.104; P < 0.001) and cognitive (β = 0.062; 95% C.I. 0.034 to 0.089; P<0.001) components were associated with increased CFS scores. Both somatic (β = -0.062; 95% C.I. -0.104 to -0.021; P<0.001) and cognitive (β = 0.052; 95% C.I. -0.081 to -0.024; P < 0.001) scores were associated with lower HRQOL. Somatic scores lost mortality association on addition of CFS to the multivariable model (HR1.06; 95% C.I. 0.977 to 1.14; P=0.173). Cognitive symptoms were not associated with mortality. Neither the component score was associated with hospitalisation on multivariable analyses. Both somatic and cognitive depression symptoms are associated with frailty and poorer HRQOL in haemodialysis recipients but were not associated with mortality or hospitalisation when adjusted for frailty. The risk profile of depression somatic scores may be related to overlap with symptoms of frailty.