Age Times Research Articles

IJCM_82A: Behavioral and Functional Changes Due to Smartphone Over-usage among Under-five Children in Rural Puducherry- A Community-Based Cross-Sectional Study

Background: Smartphone have revolutionized, and become an integral part of a child’s life. The child’s interaction with these modern devices needs to be assessed because it could have an enormous effect on their behavior, sleep habits, and psychological addiction. Objective: The objective of this study is to determine the pattern of exposure to smartphone, and the association between the exposure and behavioral, functional changes among under-five children in rural Puducherry Methodology: This community based cross-sectional study was done in the field practice area of a private medical college in Puducherry. A multistage sampling technique was used to select 340 eligible participants. A semi- structured questionnaire was used to assess the pattern of exposure, physical, social, and behavioral changes among study participants. The data were analyzed using SPSS software, and p-value of Results: Among 340 children, more than half of participants 180(52.9%) were female. Interestingly, around half of the study participants parents 181(53.2%) accepted that, their children were exposed to smartphone for entertainment purposes, and around one-tenth 35 (10.3%) of the participants viewed screen for more than the recommended screen time for age. Increased smartphone exposure was statistically associated with behavioral, and functional changes. Conclusion: Measures must be undertaken to prevent the deleterious behavioral and functional changes in under-five children due to excessive smartphone usage. Health education sessions and social behavioral change communication should be planned for the parents to protect the budding generation from the negative effects of smartphone usage.

Psychological predictors of vaping uptake among non-smokers: A longitudinal investigation of New Zealand adults.

Demographic and health factors are known to predict vaping. Less is known about psychological predictors of vaping uptake, particularly among non-smoking adults using longitudinal designs. We aimed to model how psychological factors related to personality and mental health predicted the likelihood of vaping uptake over time in non-smoking adults ages 18+ using longitudinal data. Longitudinal regression models utilised data from the 2018-2020 waves of the New Zealand Attitudes and Values Study to assess how the Big Five personality traits, mental distress and self-control predicted who began vaping over time among non-users (non-vapers and non-smokers), controlling for gender, age, ethnicity and economic deprivation. Analyses included 36,309 adults overall (ages 18 to 99; M = 51.0). The number of non-users who transitioned into current vaping was small (transitioned from 2018 to 2019, n = 147; 0.48%; 2019 to 2020, n = 189, 0.63%). Fully adjusted models showed that adults with higher mental distress (adjusted odds ratio [aOR] 1.43; 95% confidence interval [CI] 1.09-1.88), lower self-control (aOR 0.79; 95% CI 0.69-0.89) and higher extraversion (aOR 1.09; 95% CI 1.06-1.13) were more likely to begin vaping at the next time point compared to adults who remained non-users. Higher neuroticism and lower conscientiousness also predicted vaping uptake in initial models, but inclusion of mental distress and self-control superseded these traits. Psychological factors related to mental distress, impulse control and sociability predicted who was more likely to begin vaping as non-smoking adults. Harm prevention interventions could target these factors to reduce vaping uptake in non-smokers.

Water and food insecurity and linkages with physical and sexual intimate partner violence among urban refugee youth in Kampala, Uganda: cross-sectional survey findings

Abstract Water insecurity (WI) and food insecurity (FI), each associated with violence exposure, are understudied in urban humanitarian settings. We conducted a cross-sectional survey with urban refugee youth in Kampala, Uganda to examine: (a) social-ecological correlates of WI, FI, and concurrent FI and WI; (b) associations between WI and FI with recent sexual and physical intimate partner violence (IPV); and (c) associations between an Index of Vulnerability (IoV) comprised of social-ecological stressors (e.g., FI, WI) and recent physical/sexual IPV. Among participants (n = 340; mean age: 21.1 years, standard deviation: 2.6) almost half (47.8%) reported WI and two-thirds (65.0%) FI. In adjusted analyses, time in Uganda, age, and insecure housing were associated with increased odds of WI and concurrent FI and WI; household toilet sharing and insecure housing were associated with increased odds of FI. In adjusted analyses, WI, concurrent FI and WI, housing insecurity, and parenthood were associated with higher sexual IPV odds. FI and parenthood were associated with increased odds of physical IPV. IoV scores were associated with physical/sexual IPV, and IoV scores accounted for more variance in physical/sexual IPV than any individual indicator. Future research can address WI and co-occurring resource insecurities to reduce gender-based water-related violence risks.

Parental use of routines, setting limits, and child screen use during COVID-19: findings from a large Canadian cohort study

BackgroundAn increase in child screen time has been observed throughout the COVID-19 pandemic. Home environment and parenting practices have been associated with child screen time. The purpose of this study was to examine associations between parental use of routines, limit setting, and child screen time during the (COVID-19) pandemic to inform harm-reducing strategies to limit the potential harms ensued by excessive screen use.MethodsA cohort study was conducted in 700 healthy children (3,628 observations) aged 0–11 years though the TARGet Kids! COVID-19 Study of Children and Families in Toronto, Canada from May 2020-May 2021. The independent variables assessed were parent-reported use of routines and setting limits. Outcomes were parent-reported child daily screen time in minutes and whether the Canadian 24-Hour screen time guideline was met, defined as 0 for <1 years, 60 or less for 1–5 years, and 120 or less for >5 years. Linear and logistic mixed-effects models were fitted using repeated measures of independent variables and outcomes with a priori stratification by developmental stages (<3, 3–4.99, ≥5 years).ResultsA total of 700 children with 3,628 observations were included in this study [mean age = 5.5 (SD = 2.7, max = 11.9) years, female = 47.6%]. Mean change in child screen time before vs. during the pandemic was +51.1 min/day and level of parental use of routines and setting limits remained stable. Lower use of routines was associated with higher child screen time (β = 4.0 min; 95% CI: 0.9, 7.1; p = 0.01) in ages ≥5 years and lower odds of meeting the screen time guideline in ages <3 years and ≥5 years (OR = 0.59; 95% CI: 0.38, 0.88; p = 0.01; OR = 0.76; 95% CI: 0.67, 0.87; p < 0.01). Lower use of limit setting was associated with higher child screen time and lower odds of meeting the screen time guideline in ages ≥5 years (β = 3.8 min; 95% CI: 0.69, 6.48; p < 0.01; OR = 0.86; 95% CI: 0.78, 0.94; p < 0.01).ConclusionsLower parental use of routines and limits during the COVID-19 pandemic were associated with higher screen time and lower odds of meeting the screen time guideline among school-age children. Results may help inform strategies to promote healthy screen use in this age group.

Impacts of Changing Livestock Farming Practices on the Biocultural Heritage and Landscape Configuration of Italian Anti-Apennine

This research article focuses on the evolution of a Mediterranean landscapes and the intricate interplay between natural and human-induced processes in the context of the Italian Anti-Apennine mountains. The study employs a multi-temporal approach to analyze changes in land use and landscape ecology, livestock activities, and agro-pastoral practices over seven decades. We noted a 18% decrease in animal units, particularly in goat and pig farming, accompanied by a 10% reduction in horse populations. Farmers’ adaptation strategies involve increasing animals per farm, aligning with broader agricultural trends toward intensification and specialization. In parallel, we observed a 22% reduction in grassland surfaces juxtaposed with an overall 15% increase in woodlands and shrublands, a 13% decreasing trend in habitat edge, and an overall 18% increase in patches aggregation at the landscape scale. The decline in anthropogenic pressures linked to depopulation triggered secondary successions, resulting in a 25% increase in homogeneous closed woodlands. These landscape alterations contribute to a 19% decrease in ecosystem heterogeneity and complexity, favoring ecological connectivity for forest-linked species but posing challenges for open meadow species. This, coupled with the loss of biocultural heritage, including traditional settlements dating back to the Bronze Age and Roman times, as well as pastoral traditions and knowledge, underscores the need to rethink future development strategies with a focus on retaining younger generations and preventing the loss of crucial ecosystem services.

Recurrent upper respiratory tract infections in early childhood: a newly defined clinical condition

BackgroundRecurrent Upper Respiratory Tract Infections (R-URTIs) pose a significant challenge in pediatric healthcare, affecting both children and their families. This study aimed to investigate the prevalence, risk factors, and clinical implications of R-URTI in children aged 0–5 years.MethodsThis observational study involved a sample of 483 children aged 0–5 years, focusing on establishing a practical and dynamic definition of R-URTI. Family pediatricians prospectively collected socio-demographic information, medical history, and recorded the occurrence of URTI episodes. Children were followed from recruitment until March 2021, predating the COVID-19 outbreak.ResultsA substantial prevalence of R-URTIs was found, estimating it at 5–10% among this age group. To define R-URTI, a practical and dynamic criterion was proposed: children experiencing a minimum of four URTI episodes, each lasting four days or more, within a six-month period, with intervals of well-being in between.ConclusionsThe study highlighted that specific risk factors for R-URTI were elusive, suggesting that this condition may affect children regardless of their family or clinical history. Moreover, the study’s stratification by age group and times of observation facilitated patient-specific clinical decision-making. The proposed definition may represent a valuable tool for clinicians in diagnosing and addressing R-URTI cases.

Evaluating immaturity risk in young stands of the serotinous knobcone pine (Pinus attenuata)

AbstractAs wildfire becomes increasingly frequent, many serotinous plant populations risk local extirpation if fire recurs prior to sufficient seed accumulation in the canopy (i.e., “immaturity risk”). Following two 2018 wildfires in northwestern California, we studied seed viability, cone production, and postfire regeneration of a serotinous conifer, knobcone pine (Pinus attenuata), with stand ages (time since fire) ranging from 6 to 79 years. Cone density per tree was more strongly associated with tree diameter than age, and cone density was positively related to postfire seedling regeneration. Most of the postfire knobcone pine regeneration established during the first year with high survivorship in the following first postfire year. Adjusting for survivorship, the estimated minimum age for knobcone pine to promote self‐replacement (one recruit per tree) was 9.5 years (or 4.6‐cm dbh) and the probability of reburning at the modern fire rotation of 43 years was 19.8%. Based on our results, we found that immaturity risk was currently low for knobcone pine. Our approach provides a quantitative method to assess immaturity risk in knobcone pine and other serotinous conifer species that can be used to evaluate future risk under rapidly changing climate and fire conditions.

Trends in full-time working in general practice: a repeated cross-sectional study.

There is little evidence and no agreement on what constitutes full-time working for GPs. This is essential for workforce planning, resource allocation, and accurately describing GP activity. To clarify the definition of full-time working for GPs, how this has changed over time, and whether these changes are explained by GP demographics. Data were obtained from repeated cross-sectional national surveys for GPs, which were conducted between 2010 and 2021. A comparison was undertaken of three measures of working time commitments (hours and sessions per week and hours per session) plus a measure of workload intensity across survey years. Multiple regression was used to adjust the changes over time for age, sex, ethnicity, contract type, area deprivation, and rurality. Unadjusted hours and sessions per week were compared with definitions of full-time working. Average hours and sessions per week reduced from 40.5 (95% confidence interval [CI] = 38.5 to 42.5) to 38.0 (95% CI = 36.3 to 39.6) and 7.3 (95% CI = 7.2 to 7.3) to 6.2 (95% CI = 6.2 to 6.3) between 2010 and 2021, respectively. In 2021, 54.6% of GPs worked at least 37.5 hours per week and 9.5% worked at least nine sessions. Hours per session increased from 5.7 (95% CI = 5.7 to 5.7) to 6.2 (95% CI = 6.2 to 6.3) between 2010 and 2021. Partners worked more hours, sessions, and hours per session. Adjustments expanded the increase in hours per session from 0.54 to 0.61. At the current average duration of sessions, six sessions per week aligns with the NHS definition of full-time hours. However, hours per week is a more consistent way to define full-time work for GPs.

Long-term survival experience of tuberculosis patients in a rural district of Ghana

There are limited epidemiological studies on the survival of Tuberculosis (TB) patients in Ghana despite the high endemicity of TB in the country. The present study estimated the overall survival time of TB patients and developed a model to determine co-variates associated with death. This was a retrospective cohort study that employed a complete enumeration technique to review patient data from the TB register of the Ajumako Enyan Essiam District, Central Region, Ghana, between August and October 2023. All patients registered for TB care between 1st January 2018 and 31st December 2022, excluding patients with incomplete data and drug-resistant cases were included. We applied descriptive statistics, Kaplan-Meier survival analysis, Log-rank test, and a Cox proportional hazard model for multivariate analysis. Out of the 226 eligible patients, 149 (65.9%) were males, 205 (90.7%) were new cases and 37 (17.3%) were TB/HIV co-infected. Those who experienced death were 37 (16.4%), with an overall survival time of 5.5 months (95% CI = 5.4 – 5.7). Older age (aHR=2.6; 95% CI: 1.1-6.3), male gender (aHR=4.9; 95% CI: 1.7-14.3), relapsed TB patients (aHR=5.2; 95% CI: 2.4-10.9), and TB/HIV co-infected patients (aHR=7.1; 95% CI: 3.6-13.9) were implicated as plausible predictors for survival time to death of TB patients. We concluded there was a significantly low overall survival time for older age, male gender, relapsed TB patients, and TB/HIV co-infected patients. The provision of enhanced training for targeted health professionals and tailored community awareness creation can boost early case detection, treatment adherence, and improve overall survival.

Некоторые подходы к формированию представлений о времени у дошкольников с недостатками речевого развития

<p><em>Being originally a philosophical category, the concept of time plays an important role in human activity. The planning, organization, and control of activities is based on the time aspect. Time is the basis of the formation of the psyche, is inextricably linked with communication. The formation of ideas about time in preschool age is extremely difficult due to the fact that the category of time is abstract. Preschool children with special educational needs also have significant difficulties in assimilating time representations. The basis for the development of ideas about the time of children of this group is a qualitative purposeful diagnosis, the results of which determine the main direction and differentiated content of correctional and developmental work. The article presents blocks of tasks for the study and formation of time representations in preschoolers with speech development disorders. Examples of the use of individual calendars for the formation of ideas about parts of the day, days of the week, times and months of the year when working with preschool children enrolled in an Adaptive educational program for children with severe speech disorders are given.</em></p>

Patient Characteristics Associated With Phone and Video Visits at a Tele-Urgent Care Center During the Initial COVID-19 Response: Cross-Sectional Study.

Health systems rapidly adopted telemedicine as an alternative health care delivery modality in response to the COVID-19 pandemic. Demographic factors, such as age and gender, may play a role in patients' choice of a phone or video visit. However, it is unknown whether there are differences in utilization between phone and video visits. This study aimed to investigate patients' characteristics, patient utilization, and service characteristics of a tele-urgent care clinic during the initial response to the pandemic. We conducted a cross-sectional study of urgent care patients using a statewide, on-demand telemedicine clinic with board-certified physicians during the initial phases of the pandemic. The study data were collected from March 3, 2020, through May 3, 2020. Of 1803 telemedicine visits, 1278 (70.9%) patients were women, 730 (40.5%) were aged 18 to 34 years, and 1423 (78.9%) were uninsured. There were significant differences between telemedicine modalities and gender (P<.001), age (P<.001), insurance status (P<.001), prescriptions given (P<.001), and wait times (P<.001). Phone visits provided significantly more access to rural areas than video visits (P<.001). Our findings suggest that offering patients a combination of phone and video options provided additional flexibility for various patient subgroups, particularly patients living in rural regions with limited internet bandwidth. Differences in utilization were significant based on patient gender, age, and insurance status. We also found differences in prescription administration between phone and video visits that require additional investigation.

Effects of Sandbag-Free Follow-up After Manual Compression in Patients Who Underwent Transfemoral Access for Percutaneous Intervention.

Femoral access site complications (ASC) are frequent yet significant conditions associated with percutaneous intervention procedures that affect patient-physician comfort. In this study, we compared ASC rates between patients who received compression with a sandbag, the standard practice in many clinics, and patients monitored solely with bedrest without sandbag compression. This study included patients undergoing any transfemoral percutaneous intervention (mostly coronary interventions) between April 2019 and May 2023 at our clinic. Patients were classified into two groups: those monitored without a sandbag (n = 160) and those with a sandbag (n = 158). ASC rates (ecchymosis, pseudoaneurysm, hematoma, bleeding) were compared between the two groups. No differences were observed between the two groups in gender, age, sheath size, and bed rest times. Complications were observed in 16.9% (n = 27) of patients without sandbags and 25.3% (n = 40) of patients with sandbags. The most common complication was ecchymosis, seen in 10.6% (n = 17) of the no-sandbag group and 13.9% (n = 22) of the sandbag group. Following manual compression after femoral sheath removal, patients receiving bedrest without sandbag use are less likely to develop ASC. Additionally, dismissing sandbag use leads to a significant increase in patient comfort.

In cases of humeral diaphyseal fractures, is lateral approach surgery without radial nerve exploration as effective and safe as conventional surgery?

This study compares the efficacy and safety of lateral approach surgery with and without radial nerve dissection in treating humeral diaphyseal fractures. It assesses clinical, radiological, and complication outcomes, providing a description of the surgical methods and perioperative benefits. We retrospectively analyzed data from 71 patients admitted between May 2015 and December 2022 who underwent lateral approach surgery for humeral diaphyseal fractures. Group 1, consisting of 34 patients without radial nerve dissection, and Group 2, comprising 37 patients with radial nerve dissection, were compared. Parameters such as age, gender, fracture side (right/left), fracture type, follow-up time, surgical duration, blood loss, radiological and clinical evaluations (including Shoulder-Elbow range of motion [ROM] and Quick Disabilities of the Arm, Shoulder, and Hand score [Q-DASH]), and complications were examined. Surgical techniques and outcomes were documented. Both groups exhibited comparable distributions in age, gender, fracture types, and follow-up times (p>0.05). Group 1 demonstrated significantly lower surgical duration and blood loss compared to Group 2 (p<0.05 for both). Clinical assessment revealed satisfactory shoulder and elbow ROM within functional limits for all patients, with no instances of infection. Q-DASH scores were similar between groups. Postoperative radial nerve palsy occurred in one patient in Group 1 and three patients in Group 2, with all cases resolving uneventfully during outpatient follow-ups. Radiological assessment confirmed uneventful union in all patients. Lateral approach surgery without radial nerve dissection for humeral diaphyseal fractures offers comparable effectiveness and safety to conventional surgery, with potential perioperative advantages such as reduced operation time and blood loss.

Logical Resolving-Based Methodology for Efficient Reliability Analysis.

With the CMOS technology downscaling to the deep nanoscale, the aging effects of devices degrade circuit performance and even lead to functional failure. The stress analysis is critical to evaluate the influence of aging effects on digital circuits. Some related analytical work has recently focused on reliability-aware circuit analysis. Nevertheless, the aging dependence among different devices is not considered, which will induce errors of degradation evaluation in the digital circuit. In order to improve the accuracy of reliability-aware static timing analysis, an improved analytical method is proposed by employing logical resolving. Experimental results show that the proposed method has a better evaluation accuracy of aging path delay than traditional strategies. For aging timing evaluation on aging paths, excessive pessimism can be reduced by employing the proposed method. And, a 378× speedup is achieved while having a 0.56% relative error compared with precise SPICE simulation. Moreover, the circuit performance sacrifice of an aging-aware synthesis flow with the proposed method can be decreased. Due to the high efficiency and high accuracy, the proposed method can meet the speed demands of large-scale digital circuit reliability analysis while achieving transistor simulation accuracy.

Cost-effectiveness of primary human papillomavirus triage approaches among vaccinated women in Norway: A model-based analysis.

As Norway considers revising triage approaches following their first adolescent cohort with human papillomavirus (HPV) vaccination entering the cervical cancer screening program, we analyzed the health impact and cost-effectiveness of alternative primary HPV triage approaches for women initiating cervical cancer screening in 2023. We used a multimodeling approach that captured HPV transmission and cervical carcinogenesis to evaluate the health benefits, harms and cost-effectiveness of alternative extended genotyping and age-based triage strategies under five-yearly primary HPV testing (including the status-quo screening strategy in Norway) for women born in 1998 (ie, age 25 in 2023). We examined 35 strategies that varied alternative groupings of high-risk HPV genotypes ("high-risk" genotypes; "medium-risk" genotypes or "intermediate-risk" genotypes), number and types of HPV included in each group, management of HPV-positive women to direct colposcopy or active surveillance, wait time for re-testing and age at which the HPV triage algorithm switched from less to more intensive strategies. Given the range of benchmarks for severity-specific cost-effectiveness thresholds in Norway, we found that the preferred strategy for vaccinated women aged 25 years in 2023 involved an age-based switch from a less to more intensive follow-up algorithm at age 30 or 35 years with HPV-16/18 genotypes in the "high-risk" group. The two potentially cost-effective strategies could reduce the number of colposcopies compared to current guidelines and simultaneously improve health benefits. Using age to guide primary HPV triage, paired with selective HPV genotype and follow-up time for re-testing, could improve both the cervical cancer program effectiveness and efficiency.

Free-living physical activity and executive function: A multi-study analysis of age groups and times of day

BackgroundExecutive Function (EF) is a potential mechanism linking physical activity (PA) and mental health. However, evidence regarding the association between free-living PA and EF is limited with mixed results. Across two studies, we examined associations between accelerometer-assessed moderate-to-vigorous PA (MVPA) and facets of EF in different age groups (Study 1) and at different times of day (Study 2). MethodIn Study 1, we tested the association between MVPA and verbal fluency across seven days in 285 participants (children, adults, older adults). In Study 2, we tested between- and within-person associations between MVPA and working memory (afternoon, evening, next morning) across three 18-day bursts in 64 preadolescents. ResultsStudy 1 showed no association between MVPA and verbal fluency overall, but there was an interaction by age group: a positive association was evident in older adults only. In Study 2, we observed a positive between-person association between MVPA and subsequent afternoon and next morning working memory, but not within-person. In the evening, MVPA was not related to working memory. ConclusionsThe association between free-living PA and EF differs between age groups and times of day. Future research should consider these factors when examining the association and its role for mental health.

Evolution of education as a constitutional and legal paradigm: historical context and philosophical discourse

This article is devoted to the study of the evolution of education as a constitutional and legal paradigm in the historical context and philosophical discourse. Within the framework of the work, the historical path of education development is considered, starting from primitive and ancient times and ending with the present. Emphasis is placed on the development of the educational paradigm from the point of view of philosophical and cultural changes that had an impact on the perception and regulation of the educational process.&#x0D; In particular, the historical gradation of the development and establishment of education as a constitutional and legal category is proposed to be considered through the prism of the following chronological framework:&#x0D; Stage I: The Age of the Ancient World (Primitive Age and Ancient times);&#x0D; Stage II: The Age of the Middle Ages;&#x0D; III stage: Age of Enlightenment;&#x0D; IV stage: The period of industrial revolution and modernization;&#x0D; Stage V: Modernity.&#x0D; The article examines the role of great philosophers and ancient jurists, such as Aristotle, Democritus, Plato, Seneca, Socrates, Ulpian, Cicero, etc., in shaping the concepts of the right to education.&#x0D; Special attention is paid to how the history of education reflects social and cultural changes. From primitive forms of learning to modern education systems, this article shows how education has always been not only a right, but also an important factor in social evolution.&#x0D; Emphasis is placed on the works of the following famous philosophers, the American - J. Dewey, the Brazilian - P. Freire and the domestic - P. Kulish, who had an impact on the formation and development of the philosophy of modern education.&#x0D; The conclusions of the article emphasize that the right to education is determined not only by legal norms, but also by the social context and philosophical views. They emphasize the importance of understanding the historical development of education for the modern understanding of the constitutional and legal paradigm of education, which reflects the dynamics of society and its needs for education and development

Simulating atrial fibrillation patterns and screening strategies using virtual patient-level models

Abstract Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased morbidity and mortality. However, early detection and treatment of AF are hampered by highly variable occurrence and duration of AF episodes, heterogenous patterns of AF progression, and poor symptom-rhythm correlation present in many patients. Purpose To develop a computational patient-level model for simulating individual AF episodes, AF progression, and associated clinical outcomes, and to compare the effectiveness of systematic or symptom-based 1-minute electrocardiography (ECG) or 14-day Holter screening using this model. Methods We developed a Markov model with 7 different rhythm and/or clinical states (sinus rhythm (SR), asymptomatic and symptomatic AF, each with or without previous stroke, and death) and age/sex-dependent transition probabilities estimated based on clinical data (Figure 1A). Additionally, transitions between SR and AF states were modulated by AF-related remodeling, which itself was controlled by the time in AF and age. Results The virtual patient-level model enabled the simulation of changes in rhythm status and clinical outcomes during an entire lifetime with minute-level resolution (Figure 1B). Age/sex-specific AF prevalence / incidence, the proportion of symptomatic episodes and mortality in 4000 virtual patients were in good agreement with clinical data (Figure 1C). We employed the perfect knowledge about rhythm status at any moment in time provided by the model to evaluate systematic and symptom-based 1-minute ECG and 14-day Holter screening for AF in this population. In total, 2372 virtual patients &amp;gt;65 years developed AF. Systematic yearly 1-minute ECG recordings only identified 58 (2.4%) patients. In contrast, 14-day Holter-monitoring detected 18% of AF patients over 65 with a median of 532 days earlier than their clinical AF diagnosis, and identified 11.8% of AF patients who were either completely asymptomatic or only had symptomatic episodes &amp;lt;3 hours. Short-term (2-week) screening after a first symptom had a very low yield, which increased with increasing screening frequency and duration of follow-up (Figure 2). The majority of the remaining AF patients could be diagnosed when their symptoms lasted ≥3 hours, providing time for a traditional clinical diagnosis. Conclusion Our novel patient-level AF model can simulate individual AF patterns and clinical outcomes such as stroke and death in large cohorts of virtual patients. The model highlights the variability of AF episodes that makes effective early detection of asymptomatic AF with short-term monitoring challenging, and provides a tool for future studies into AF progression, screening and prevention of AF-related stroke and mortality.Figure 1Figure 2

Quantifying Facial Feminization Surgery's Impact: Focus on Patient Facial Satisfaction.

Facial feminization surgery (FFS) has been associated with improving gender dysphoria in transgender patients. This study aimed to quantify the impact of surgery on patient facial satisfaction, using the FACE-Q and a quality-of-life (QoL) survey. Transgender female patients were recruited to complete the FACE-Q and the World Health Organization's QoL Scale-Short Form (WHOQOL-BREF) if they were planning to or had undergone FFS at our institution. FACE-Q modules completed included "Satisfaction with Facial Appearance Overall," individual facial attributes (forehead/eyebrows, nose, cheeks, cheekbone, chin, jawline, and neck), and the WHOQOL-BREF, which assesses patient QoL through four domains (physical, psychological, social relations, and environment). Both matched and unmatched analyses of preoperative versus postoperative cohorts were performed. Overall, 48 patients participated in our study and completed 31 FACE-Q surveys preoperatively and 37 postoperatively. On average, patients were 37.2 ± 12.5 years old. FACE-Q scores increased significantly for all facial attributes and for Satisfaction with Facial Appearance Overall between cohorts (P < 0.05). The facial attribute with the greatest increase in satisfaction was the jawline, followed by the nose. The WHOQOL-BREF's psychological and physical domains both improved significantly (P < 0.05). Wait time for surgery of less than 6 months (b = 22.42, P = 0.02) was associated with higher overall facial satisfaction, whereas age at surgery (b = -1.04, P < 0.01) was associated with lower overall facial satisfaction. Transgender female patients experienced significant improvements in facial satisfaction and QoL after FFS. Undergoing surgery at a younger age and shorter wait times for surgery were associated with increased overall facial satisfaction.

Effects of endometriosis on pregnancy outcomes in Fujian province.

Endometriosis is a common gynecological disease, affecting 5 to 10% of women of childbearing age. We analyzed pregnancy complications and neonatal outcomes of patients with pregnancies complicated with endometriosis. The aim of the study was to explore the effects of endometriosis on pregnancy and to evaluate the potential pregnancy risks associated with this disease. The retrospective study included 3,809 parturients who were routinely examined, hospitalized and underwent cesarean section delivery in Fujian Maternal and Child Health Hospital from January 2014 to December 2020. Among them, 1,026 parturients were diagnosed with endometriosis after the cesarean section (endometriosis group), and 2,783 parturients without endometriosis comprised the control group. The endometriosis group was further divided into subgroups according to the severity of the disease: 882 parturients with stage Ⅰ or Ⅱ of endometriosis, and 144 parturients with stage Ⅲ or Ⅳ of endometriosis. General data of all patients and medical records of pregnancy complications and neonatal outcomes for each group were collected and retrospectively analyzed. There were no statistically significant differences in the age, gestational age, gestation, and parity times between all groups (p>0.05). The incidence of preeclampsia and placenta previa in the endometriosis group was higher than that in the control group (p<0.05). There was no significant difference in rates of other pregnancy complications, such as chronic hypertension with pregnancy, preeclampsia with chronic hypertension, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PGDM), intrahepatic cholestasis of pregnancy (ICP), premature rupture of membranes or placental abruption between the two groups. The incidence of placenta previa in the group of patients with stage III/IV endometriosis was higher than in patients with stage I/II endometriosis (p<0.05). However, there was no significant difference in the incidence of other pregnancy complications. The amount of postpartum hemorrhage (1,000-1,500 ml) in the endometriosis group was greater than that in the control group, and the difference was statistically significant (p<0.05). However, there was no significant difference in the incidence of postpartum hemorrhage in patients with pregnancies complicated with endometriosis at different stages. In pregnant women, endometriosis is associated with an increased incidence of placenta previa that correlates with the severity of the disease. Pregnant women with endometriosis have higher rates of preeclampsia and postpartum hemorrhage, compared to women without endometriosis.