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Background: Lower urinary tract symptoms particularly affect older men and their quality of life. General practitioners currently have no easily available assessment tools to diagnose lower urinary tract symptom causes. Referrals to urology specialists are increasing. General practitioner access to simple, accurate tests and clinical decision tools could facilitate management of lower urinary tract symptoms in primary care. Objectives: To determine which of several index tests in combination, best predicted three diagnoses (detrusor overactivity, bladder outlet obstruction and/or detrusor underactivity) in men presenting with lower urinary tract symptoms in primary care. To develop and validate three diagnostic prediction models, and a prototype primary care clinical decision support tool. Design: Prospective diagnostic accuracy study. Two participant cohorts, for development and validation, underwent simple index tests and a reference standard (invasive urodynamics). Setting: General practices in England and Wales. Participants: Men (16 years and over) consulting their general practitioner with lower urinary tract symptoms. Sample size: Separate calculations for model development and validation cohorts, from literature estimates of detrusor overactivity, bladder outlet obstruction and detrusor underactivity prevalences of 57%, 31% and 16%, respectively. Predictors and index tests: Twelve potential predictors considered for three diagnostic models. Main outcome measures: The primary outcome was diagnostic model sensitivity and specificity for detecting bladder outlet obstruction, detrusor underactivity and detrusor overactivity, with 75.0% considered minimum clinically useful performance. Statistical analysis: Three separate logistic regression models generated with index test variables to predict the presence of bladder outlet obstruction, detrusor overactivity, detrusor underactivity conditions in men with lower urinary tract symptoms. Results: One model each was developed and validated for bladder outlet obstruction and detrusor underactivity, two for detrusor overactivity (detrusor overactivity main, detrusor overactivity sensitivity analysis 2). Age, voiding symptoms subscore, prostate-specific antigen level, median maximum flow rate, median voided volume were predictors for bladder outlet obstruction. Median maximum flow rate and post-void residual volume were predictors for detrusor underactivity. Age, post-void residual volume and median voided volume were included in detrusor overactivity main model, while age and storage symptoms subscore predicted detrusor overactivity sensitivity analysis 2. For all four models, sensitivity of 75.0% could be achieved with a specificity of 74.2%, 47.3%, 45.6% and 46.2% for bladder outlet obstruction, detrusor underactivity, detrusor overactivity main and detrusor overactivity sensitivity analysis 2 models, respectively. Similarly, a specificity of 75.0% could be achieved with a sensitivity of 71.3%, 39.8%, 33.3% and 62.7% for bladder outlet obstruction, detrusor underactivity, detrusor overactivity main and detrusor overactivity sensitivity analysis 2 models, respectively. The prototype tool (not yet intended for use in practice) is available at Primary care Management of lower Urinary tract Symptoms decision aid for lower urinary tract symptoms (shinyapps.io). General practitioner feedback during tool development and small-scale user-testing in simulated consultation scenarios was favourable. Patients supported such management in primary care. Strengths/limitations: This was a prospective, multicentre study in an appropriate primary care population. Most of the index tests are possible routinely in primary care or at home by patients. The diagnostic models were validated in a separate cohort from the same population. Limitations include that target condition prevalences may differ in other populations. Conclusion: We identified sensitivities and specificities of diagnostic models for detrusor overactivity, bladder outlet obstruction and detrusor underactivity in routine United Kingdom practice and developed a prototype clinical decision support tool. Future work: Economic modelling, a feasibility trial and powered randomised controlled trial are needed to evaluate the Primary care Management of lower Urinary tract Symptoms tool in practice. Study registration: Current Controlled Trials ISRCTN10327305. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/40/05) and is published in full in Health Technology Assessment; Vol. 29, No. 1. See the NIHR Funding and Awards website for further award information.

Urinary symptoms such as a weak flow and frequent urination are common in older men and often bothersome. Men visiting their general practitioner with these symptoms are often referred to a specialist because good diagnostic tools are not available in primary care. Three common causes of symptoms are: bladder obstruction due to non-cancerous growth of the prostate, reduced power of the bladder muscle and bladder overactivity. We aimed to create a tool to help general practitioners manage men with urinary symptoms. This required first to develop mathematical models, which combined results from several simple tests that general practitioners could organise. The web-based tool then constructed would indicate the most likely diagnosis and provide recommendations for treating and managing the condition. The tests included prostate examination, prostate-specific antigen blood test, symptoms questionnaires and home-based urine flow measurements. To develop the mathematical models, 350 men with urinary symptoms underwent the simple tests and a specialist invasive test called urodynamics, which is currently regarded as providing the best diagnosis. A second group of 251 men also had the simple tests and urodynamics. Their results were used to measure the performance of the models. The model to diagnose bladder obstruction performed well (close to the invasive urodynamics 'gold standard' test), and those to diagnose reduced power of the bladder muscle and bladder over-activity performed moderately but less well. A prototype version of the web-based tool was developed. We consulted patients and general practitioners to assess the tool's acceptability. General practitioners confirmed their enthusiasm because they find managing bladder symptoms challenging, and patients said they would prefer to be managed in primary care. We received good feedback about the prototype tool and gained ideas for refining it. Following this project, it would be valuable to estimate the cost, benefits and practicalities of implementing the tool, aided by data from the study, and trial its effectiveness compared with current care.

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BACKGROUND: Adolescence through emerging adulthood represents a critical period associated with changes in lifestyle behaviors. Understanding the dynamic relationships between cognitive, social, and environmental contexts is informative for the development of interventions aiming to help youth sustain physical activity and limit sedentary time during this life stage. Ecological momentary assessment (EMA) is an innovative method involving real-time assessment of individuals' experiences and behaviors in their naturalistic or everyday environments; however, EMA compliance can be problematic due to high participant burdens. OBJECTIVE: This systematic review synthesized existing evidence pertaining to compliance in EMA studies that investigated wake-time movement behaviors among adolescent and emerging adult populations. Differences in EMA delivery scheme or protocol, EMA platforms, prompting schedules, and compensation methods-all of which can affect participant compliance and overall study quality-were examined. METHODS: An electronic literature search was conducted in PubMed, PsycINFO, and Web of Science databases to select relevant papers that assessed movement behaviors among the population using EMA and reported compliance information for inclusion (n=52) in October 2022. Study quality was assessed using a modified version of the Checklist for Reporting of EMA Studies (CREMAS). RESULTS: Synthesizing the existing evidence revealed several factors that influence compliance. The platform used for EMA studies could affect compliance and data quality in that studies using smartphones or apps might lessen additional burdens associated with delivering EMAs, yet most studies used web-based formats (n=18, 35%). Study length was not found to affect EMA compliance rates, but the timing and frequency of prompts may be critical factors associated with missingness. For example, studies that only prompted participants once per day had higher compliance (91% vs 77%), but more frequent prompts provided more comprehensive data for researchers at the expense of increased participant burden. Similarly, studies with frequent prompting within the day may provide more representative data but may also be perceived as more burdensome and result in lower compliance. Compensation type did not significantly affect compliance, but additional motivational strategies could be applied to encourage participant response. CONCLUSIONS: Ultimately, researchers should consider the best strategies to limit burdens, balanced against requirements to answer the research question or phenomena being studied. Findings also highlight the need for greater consistency in reporting and more specificity when explaining procedures to understand how EMA compliance could be optimized in studies examining physical activity and sedentary time among youth. TRIAL REGISTRATION: PROSPERO CRD42021282093; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282093.

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BACKGROUND: Transgender, nonbinary, and gender diverse (TGD) people experience stigma in healthcare settings impacting healthcare utilization, including avoidance of care due to anticipated discrimination. Gender-affirming care refers to care for medical gender affirmation, such as gender-affirming hormones and surgery, as well as general care that affirms and respects TGD patients. This study sought to explore the experiences of TGD adults to inform gender-affirming care delivery and develop an actionable framework for practice. METHODS: Between May-October 2021, one-time individual in-depth interviews were conducted with 27 TGD adults receiving any healthcare in the greater Boston Massachusetts area to gather data about gender-affirming care. Interviews were semi-structured, explored prior and current experiences in healthcare and ideal gender-affirming care models, and conducted virtually via a secure Zoom platform. Analyses were conducted using immersion crystallization and reflexive thematic analysis; interview transcripts were double coded by two coders. RESULTS: Participants had a mean age of 28.5, ranging 18-45 years, and were: 7 transgender men, 6 transgender women, 8 nonbinary, 3 genderqueer, 1 agender, and 2 gender not specified. Themes about gender-affirming care coalesced into the acronym AFFIRM: (1) Affirms in individual interactions: Participants called for affirmation of TGD identity, lived expertise, and competent TGD providers and staff. (2) Flexible and accessible: Participants expressed the need for gender-affirming care to be available beyond urban population-specific clinics, in a timely fashion without long wait lists, and in a community-centered manner such as offering non-traditional times and settings. (3) Fights systemic oppression: Participants emphasized the need for providers and health systems to eliminate gatekeeping practices for gender-affirming care and create care models that resist intersecting oppressive systems such as racism and cisgenderism. (4) Interacts with community: Patients desired intentional interaction with TGD community to holistically address health and unmet gender affirmation needs. (5) Retains patients in care: Patients shared the need to collaboratively identify and problem-solve obstacles to gender-affirming care with providers and healthcare systems to optimize TGD-specific retention strategies. (6) Multidisciplinary: Patients called for interdisciplinary teams with co-located services such as primary care and mental healthcare with letter-writing for surgical care, and incorporation of peer navigators to meet the broader social, health, and well-being needs of TGD people. CONCLUSIONS: Findings from this study and the AFFIRM Framework which emerged from TGD patient narratives can be applied to improve current care and set benchmarks for high-quality gender-affirming care delivery and practice.

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Anxiety is highly prevalent among adults. Evidence suggests that perceived stress controllability and emotional growth mindsets are associated with decreased anxiety. However, whether these positive factors synergistically contribute to reducing the impact of stress on anxiety remains unclear, especially within everyday stress contexts. Multilevel models were used to investigate how perceived stress controllability and emotional growth mindsets interacted to mitigate the adverse impact of daily stress on anxiety, differentiating within- and between-person effects. Overall, 198 participants completed ecological momentary assessments of perceived stress intensity and controllability, emotional growth mindsets, and anxiety four times daily over 10-12 consecutive days. The within-person analyses showed that high emotional growth mindsets buffer the link between perceived stress intensity and anxiety. More importantly, the between-person and cross-level results suggested that the synergistic effect of emotional growth mindsets and perceived stress controllability maximally buffered the correlation between perceived stress intensity and anxiety. Additionally, these results highlighted that the positive association between perceived stress intensity and anxiety was most pronounced among participants with low emotional growth mindsets and perceived stress controllability. These findings further support a synergistic intervention approach that emphasizes anxiety alleviation through enhanced perceived stress controllability and the development of emotional growth mindsets.

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BACKGROUND: Alcohol spatial availability is linked with public health issues, with disadvantaged populations experiencing disproportionate harm. This study examined the association between alcohol spatial availability and area-level measures of disadvantage and sociodemographic characteristics in Québec, Canada. METHODS: We conducted a cross-sectional analysis using 2021 liquor register and census data across 15 Québec urban areas. Measures included outlet counts within 800 m buffers and a spatial access index. Multilevel regression models assessed associations with composite measures of area-level disadvantage and single-item measures of area-level sociodemographic characteristics. FINDINGS: On average, Québec areas exhibited higher offsite than onsite alcohol outlet availability. We found a J-shaped relationship between offsite alcohol availability and material disadvantage, with the most disadvantaged areas having 25 % more offsite outlets (95 % CI: 1.14-1.37) than the least disadvantaged. Conversely, onsite availability was 24 % lower (95 % CI: 0.67-0.87) in the most materially disadvantaged areas. Social disadvantage was associated with higher availability of both offsite and onsite outlets, with the highest socially disadvantaged areas having nearly 15 times as many onsite outlets (IRR 14.77, 95 % CI: 13.05-16.72) compared to the least disadvantaged. Higher population density and higher percentages of young adults, new immigrants, and recent movers were also associated with higher availability. CONCLUSION: Alcohol availability differed by outlet type and disadvantage dimension. Offsite outlets were more common in both highly and minimally materially disadvantaged areas, while onsite outlets were more common in minimally disadvantaged areas. Socially disadvantaged areas had higher availability of both types of outlets. These findings suggest the need for targeted policies to reduce alcohol outlet availability, particularly in socially disadvantaged areas.

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OBJECTIVE: Ultrasound-guided salivary gland Botulinum toxin A (Botox) injections are often used in pediatric patients with refractory sialorrhea, performed with or without general anesthesia. This study aims to compare outcomes and costs between these methods. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary children's hospital. METHODS: Patients with chronic sialorrhea refractory to medical therapy who underwent Botulinum toxin A injections between 2012 and 2023 under general anesthesia (n = 50; 126 injections) were compared to those performed without general anesthesia (n = 31; 116 injections). Sociodemographic factors, clinical history, and injection regimen were recorded. Available billing data from this time period was used to compare costs. RESULTS: Pediatric patients who underwent Botulinum toxin A injections without general anesthesia did not have statistically significant differences in post-injection cessation of anticholinergic medications (AOR = 0.980, [0.29, 3.29]), family-reported improvement in sialorrhea (AOR = 3.25, [0.58, 18.1]), admissions for aspiration pneumonia within the year (Coefficient = 0.260, [-0.22, 0.75]), or progression to sialorrhea surgery (AOR = 0.374, [0.07, 2.16]) compared to those performed under general anesthesia. Amongst patients who underwent repeat injections, there were no significant differences in the average number of injections (p = 0.41) or time between injections (p = 0.16). Botulinum toxin A injections performed in the outpatient setting ($1374.49) had significantly lower costs compared to injections performed under general anesthesia ($5077.13) (p < 0.001). CONCLUSION: Pediatric patients undergoing Botulinum toxin A injections with and without general anesthesia have similar efficacy and quality outcomes. Exploring the advantages of Botulinum toxin A injections without general anesthesia could lead to improved access, reduced risks of general anesthesia, and reduced costs to the medical system.

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Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by loss of B cell tolerance to self antigens resulting in the production of a wide variety of auto antibodies. The objective of this study was the assessment of serum free light chains (FLC) assay in patients with SLE. In this study, 156 patients (142 women and 14 men, mean age 35.6 years) and 60 healthy subjects (55 women and 5 men, mean age 36.4 years) were included. The kappa (κ) and lambda (λ) FLC were measured by turbidimetry method. The analysis of our results showed that the FLC rates κ and λ were significantly higher in patients compared to controls (44.52 vs. 8,55 mg/L, P = 0.0001 for FLC κ and 33.43 vs. 12,99 mg/L, P = 0.0001 for FLC λ). In addition, significant associations were noted between the increase in FLC κ, λ and disease activity (P = 0.006 and P = 0.008 respectively), as well as with the presence of lupus nephritis (P = 0.044 and p = 0.045). The increase of the serum FLC during SLE could be a useful marker for assessing the disease activity and the risk of lupus nephritis.

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PURPOSE: The number of patients with childhood cancer (CC) in sub-Saharan Africa is expected to rise over the coming years. According to the WHO Initiative for Childhood Cancer, access to care is crucial and must be guided by the needs of patients and their families. Our study explored barriers to CC treatment from a patient's perspective to guide the health care providers. METHODS: From February to September 2021, we conducted a multinational cross-sectional study with a sample from nine population-based cancer registries in nine sub-Saharan countries. Inclusion criteria comprised a cancer diagnosis according to the International Classification of Childhood Cancer, age 0-19 years, and year of diagnosis 2017-2019. A questionnaire was administered asking families about self-perceived barriers accessing surgery, radiotherapy, and chemotherapy. To assess associated factors, we conducted a multivariable regression analysis presenting the results as odds ratios (ORs). RESULTS: A total of 224 patients with CC was included. The fear of treatment effects and the perceived (poor) health of the child were named most frequently as barriers for all treatment modalities (78.9% and 75.5%, respectively). For chemotherapy, respondents who indicated themselves as rich had lower odds of perceiving the (poor) health of the child as a barrier (OR, 0.06 [95% CI, 0.01 to 0.36]). For radiotherapy, long waiting time and (limited) availability in the country were more commonly barriers (OR, 7.53 [95% CI, 3.38 to 16.78]; OR, 11.11 [95% CI, 2.04 to 60.46], respectively) than for chemotherapy. CONCLUSION: Despite known barriers such as the availability of therapy, our study additionally indicates the importance of the patients' and families' perceptions of the disease and its treatment. Further expanding measures of social support for affected families should be regarded as one of the main pillars to assure access to care.

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OBJECTIVE: To integrate patient perspectives into Health Technology Assessment (HTA) by exploring the perceived benefits, barriers, and expectations of diabetes patients and their caregivers in Malaysia regarding the use of CGMS. METHODS: This qualitative study employed focus group discussions (FGDs) with 30 participants, including adults, adolescents, and caregivers managing insulin-requiring diabetes, conducted between May and September 2023 in Kuala Lumpur and Putrajaya, Malaysia. Participants were recruited through purposive sampling. Data were collected using semi-structured interviews and analyzed thematically to capture insights into CGMS benefits, barriers, and expectations. RESULTS: Participants highlighted CGMS as a transformative tool, offering real-time data, improving glycemic control, and enhancing quality of life by reducing anxiety and the burden of frequent glucose checks. Despite these benefits, significant barriers were identified, including high costs, limited access, technical issues, and social stigma, particularly among adolescents. There was a strong call for government subsidies, better technical support, and healthcare provider training to optimize CGMS use. Patient perspectives were integrated into the HTA alongside systematic reviews and economic evaluations, directly informing policy recommendations, including prioritizing CGMS for high-risk T1DM patients and exploring subsidy frameworks to improve affordability. CONCLUSIONS: Patient perspectives serve as a vital voice in HTA, offering real-world insights that enhance the understanding of CGMS in diabetes management. Addressing financial, technical, and social barriers is crucial to improving CGMS accessibility and usability. By embedding patient perspectives into HTA and strengthening partnerships across healthcare systems, patient perspectives become instrumental in shaping patient-centered policies and informing equitable decision-making on CGMS utilization in Malaysia.

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Objective: This study aimed to explore the participation of patients with severe mental disorders in community health service management and its influencing factors in Wuxi. Methods: The data of patients with severe mental disorders were extracted from the Jiangsu Provincial Management System between 2019 and 2021. The participation of patients in community health service management was analyzed. A univariate stratified analysis will be used to assess the impact of various factors on inclusion in community management. Logistic regression modeling will be employed to identify influencing factors. Ultimately, negative factors affecting participation in community health management will be identified, followed by targeted qualitative analysis through interviews. Results: A total of 27,977 individuals were included in the analysis, with 25,744 participants enrolled in community health service management, resulting in a management rate of 92.02%. Multivariate logistic regression analysis revealed the following negative factors influencing participation in community health service management: Age group 31-40 years (OR = 0.532, 95% CI: 0.434-0.653), Age group 41-50 years (OR = 0.557, 95% CI: 0.468-0.663), Age group 51-60 years (OR = 0.746, 95% CI: 0.635-0.877), Age group >60 years (OR = 0.840, 95% CI: 0.719-0.969), Duration of illness 6-10 years (OR = 0.376, 95% CI: 0.307-0.461), Duration of illness 11-15 years (OR = 0.312, 95% CI: 0.249-0.390), Duration of illness 16-20 years (OR = 0.702, 95% CI: 0.529-0.932), Duration of illness >20 years (OR = 0.701, 95% CI: 0.514-0.957), Education level of college or above (OR = 0.719, 95% CI: 0.560-0.923), Current student status (OR = 0.565, 95% CI: 0.419-0.760), Absence of social welfare benefits (OR = 0.643, 95% CI: 0.572-0.723), History of violent or harmful behavior (OR = 0.553, 95% CI: 0.442-0.692), Non-participation in community rehabilitation activities (OR = 0.170, 95% CI: 0.101-0.284). Conversely, the following factors were identified as positive influences on participation: Being a farmer (OR = 1.423, 95% CI: 1.215-1.665), Widowhood (OR = 2.355, 95% CI: 1.583-3.503), Divorce (OR = 2.992, 95% CI: 2.093-4.278). Qualitative analysis indicated that stigma associated with the illness, concerns over information disclosure, lack of social support, impacts on family members (e.g., children's education or marriage prospects), perceived ineffectiveness of community services, lack of awareness about available community health services, and the belief that services were unnecessary contributed to non-participation in community health service management. Conclusion: The participation rate of patients with severe mental disorders in health service management is relatively low in the Wuxi. Special attention should be given to patients with severe mental disorders who exhibit negative factors, such as being middle-aged or young, having a long duration of illness, a history of violent or harmful behavior, higher education levels (college and above), student status, or lack of social welfare benefits. Efforts should focus on providing social support activities, reducing stigma associated with the illness, and further improving the management rate.

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Background: Organ donation in Palestine is influenced by a unique blend of legal, religious, and socioeconomic factors compounded by the region's political and economic instability. Despite the increasing need for organ transplantation, public hesitation and misconceptions hinder participation. This study aimed to explore these dynamics, identify barriers, and provide insights into improving organ donation practices in Palestine. Methods: A quantitative survey was conducted among 639 Palestinian adults residing on the West Bank. The survey assessed participants' attitudes, awareness, and perceptions of organ donation across three domains: religious/psychological, medical, and legal. The data were analyzed using chi-square tests and three-way ANOVA to explore differences in attitudes based on demographic factors such as sex, academic level, and place of residence. Results: The study revealed significant variability in public attitudes toward organ donation, with 43.4% willing to donate organs after death but 30% still opposed. Religious and psychological awareness significantly influenced participants' attitudes, with 40.35% agreeing that organ donation aligns with their beliefs. Medical awareness was higher, with 48.8% feeling informed about the process. Legal awareness was moderate, with 44.85% understanding of the legal framework. The analysis showed no significant demographic differences in attitudes toward organ donation. Conclusion: Public awareness, religious beliefs, and socioeconomic conditions play crucial roles in shaping organ donation attitudes in Palestine. This study highlights the need for targeted educational campaigns that integrate religious perspectives and raise awareness about the legal and medical aspects of organ donation. Strengthening legal frameworks and healthcare infrastructure will be key to improving organ donation rates and ensuring ethical practices in the region.

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INTRODUCTION: The dissemination of information to caregivers of pediatric cancer patients in Chilean hospitals is now sporadic and contingent upon available time, underscoring the need for a systematic education program. This study assesses caregivers' perceptions of the information provided by healthcare teams to support the development of a national education program tailored to their needs. METHODS: A descriptive, prospective, multicenter study was conducted from June 2021 to March 2022 across six public hospitals in Chile. The study included caregivers of children undergoing cancer treatment. Caregivers completed a survey assessing the education received and their preferred educational methods. Data were analyzed using STATA 18 and Graph Pad 6.0, with qualitative responses analyzed through an iterative coding process. RESULTS: Of 173 respondents, 94% rated the education received as very good or good. While 51% felt well-informed at hospital discharge, 28% desired more information. Caregivers preferred information from healthcare teams (88%), websites (55%), and written materials (51%). Significant differences were found in preferred educational content based on cancer type and the time elapses since diagnosis. CONCLUSION: Caregivers generally rated the education provided positively but expressed a need for more structured and targeted information. The findings inform the design of a national education program, emphasizing the need for tailored content and improved communication strategies to enhance caregiver support.

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Over the past three decades, there has been a well-documented shortage of child and adolescent psychiatric medical providers while demand continues to rise. Youth from minority racial and ethnic backgrounds, low-income families, and rural settings are disproportionately affected, increasing disparity in access and quality of services. While psychiatric mental health nurse practitioners (PMHNP) can deliver a full range of mental health care services across the lifespan, there are discrepancies across training programs in exposure to child and adolescent cases and high quality training. To address workforce capacity needs and to improve access to psychiatric treatment for underserved youth, a PMHNP post-graduate fellowship program in community child and adolescent psychiatry was established in 2020. During the one-year program, fellows rotate in emergency settings, specialty partial hospitalization clinics, collaborative care settings, and outpatient clinics treating a wide range of psychiatric disorders. Psychiatric clinical training, didactic curriculum, and supervision cover core nurse practitioner competencies, child-adolescent, and community-public sector psychiatry. Implementation strategies are discussed in detail including financing, stakeholder input, sustainability, barriers, and successes.

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We investigated how adolescents' time allocation across daily activities influences their body mass index and well-being by paying explicit attention to gender and activities relevant to low- and middle-income countries (LMICs). We hypothesized that the inequitable domestic burden shouldered by girls adversely affects their health and well-being. Using data from three waves of the Young Lives Longitudinal Survey (2009, 2013, and 2016) tracking 1891 children aged 8, 12, and 15 from predominantly rural, low-income households from South India, we analyzed gendered time use patterns and their implications. Girls spent more time on caregiving, housework, and studying at home, while boys allocated more time to school, leisure, and sleep. Random effects models revealed that time spent on caregiving and housework increased the likelihood of being overweight or obese among girls, whereas leisure time reduced it. Time in school was positively associated with girl's thinness, as was time spent on sleep for both boys and girls. Gender moderated the effects of time spent on housework and unpaid economic tasks on thinness, reducing its likelihood for girls. Subjective well-being improved with time spent in school and studying for all adolescents. Fixed effects models revealed it worsened for girls engaged in paid work and boys engaged in leisure. Longer sleep hours improved boys' well-being. These findings underscore that gendered time use patterns, particularly girls' unequal burden of domestic responsibilities, contribute to their increased risk of overweight and obesity. Addressing these disparities is crucial for improving adolescents' health and well-being in resource-poor settings in LMICs.

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Precise: This study investigates global trends in burns among children and adolescents using data from the Global Burden of Disease Study 2019. Analyzing incidence and YLD rates across 204 countries from 1990 to 2019 reveals a general decline in burn-related injuries, with age and sex influencing trends. Notably, in high-SDI regions, incidence rates initially increased before reversing. These findings highlight the need for targeted public health policies and resource allocation to reduce burn-related risks in vulnerable populations. Background: Given the lack of long-term trend studies on global burns among children and adolescents, this study examined trends in the global burden of burns among children and adolescents. Methods: The Global Burden of Disease (GBD) Study 2019 provided the statistical data. Sex, age, region, and SDI were used as stratification variables in the study to evaluate the prevalence of burns injuries among kids and teenagers across 204 nations and territories between 1990 and 2019. YLD rates per 100,000 people and incidence rates together with their respective average annual percentage changes (AAPC) were computed to evaluate burden trends. Furthermore, AAPC in YLD rates and incidence rates spanning various age cohorts were analyzed using the Joinpoint software. Results: The worldwide burns incidence and YLD rates of burns among kids and teenagers exhibited a general declining trend between 1990 and 2019. Concerning the general trend in new cases, incidence rates, and YLD rates, age was positively associated. In 2019, the incidence rate for females surpassed that of males, while YLD rates for females were consistently higher than those of males. New Zealand, Czechia, and Australia rank as the top three among the 204 countries studied. Interestingly, in the high SDI range, the expected values based on incidence rates reversed after first rising with the SDI. Conclusion: Overall, the incidence and YLD rates of burns among children and adolescents have declined globally, though significant disparities exist across age groups, sexes, regions, and countries. These findings could help guide the development of more targeted strategies to reduce the burn burden in this population.

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BACKGROUND: As a female-specific health problem, pelvic organ prolapse (POP) causes serious damage to the physical and psychological health of numerous women, which poses a significant challenge to women's health care worldwide, especially in developing countries. We conducted an in-depth analysis of trends in the incidence of POP over the past 30 years globally and in Brazil, Russia, India, China, and South Africa (BRICS countries). MATERIALS AND METHODS: Data on the incidence of POP were obtained by location (5 countries), age (15-94 years old), year (1990-2019) from the Global Burden of Disease Study 2019. Age-period-cohort model was used to estimate the net drift, local drift, age effects, period and cohort effects between 1990 and 2019. RESULTS: The all-age incidence rate for POP in 2019 increased from 283.28/100,000 (95% UI: 229.97, 340.34) in China to 444.81/100,000 (369.92, 526.15) in Brazil, whereas the age-standardized incidence rate in 2019 was highest in India 400.06/100,000 (325.98, 476.91) and lowest in China 187.74/100,000 (154.21, 224.43). There was an emerging transition of incidences from the young population (15-39 years) to the middle and older population (≥ 40 years) in Brazil and India. The current findings reflect the different age, period, and cohort effects on POP incidence trends at global and BRICS levels. CONCLUSIONS: The BRICS countries have made different progress in reducing the prevalence of POP. We fully recognize the diversity of internal environments in the BRICS countries and suggest an incremental approach to advancing POP prevention matters based on possible policy-driven human and financial resources in a given setting.

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The error-related negativity (ERN) is a frontocentral deflection in the human EEG that is sensitive to error commission. Past research indicates that the ERN is modulated by individual differences in socioeconomic status (SES) and parenting style; however, there is limited research examining sex-differences in how these factors influence the ERN. The present study aimed to elucidate the relations among SES, parenting style, sex, and the ERN. In this study, 176 participants from a relatively large longitudinal study performed a Flanker task at age 15 years to measure the ERN. At the same assessment time, parenting style was assessed via parent report using the Parenting Styles and Dimension Questionnaire (PSDQ). Parents reported on their highest level of education which was used as an indicator of household SES. Authoritarian and permissive parenting scores each significantly moderated the relation between maternal education and ERN amplitudes, but in both cases this moderation differed by child sex. There were no significant direct associations between maternal education and ERN amplitude or between parenting scores and ERN amplitude. Overall, findings may suggest sex differences in the impact of social context on error monitoring development. This study highlights (1) that parenting behaviors may modulate the impact of SES on cognitive control and and (2) the importance of considering sex differences when examining the interplay between SES, parenting, and cognitive control.

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Bone age assessment (BAA) is a widely used clinical practice for the biological development of adolescents. The Tanner Whitehouse (TW) method is a traditionally mainstream method that manually extracts multiple regions of interest (ROIs) related to skeletal maturity to infer bone age. In this paper, we propose a deep learning-based method for fully automatic ROIs localization and BAA. The method consists of two parts: a U-net-based backbone, selected for its strong performance in semantic segmentation, which enables precise and efficient localization without the need for complex pre- or post-processing. This method achieves a localization precision of 99.1% on the public RSNA dataset. Second, an InceptionResNetV2 network is utilized for feature extraction from both the ROIs and the whole image, as it effectively captures both local and global features, making it well-suited for bone age prediction. The BAA neural network combines the advantages of both ROIs-based methods (TW3 method) and global feature-based methods (GP method), providing high interpretability and accuracy. Numerical experiments demonstrate that the method achieves a mean absolute error (MAE) of 0.38 years for males and 0.45 years for females on the public RSNA dataset, and 0.41 years for males and 0.44 years for females on an in-house dataset, validating the accuracy of both localization and prediction.

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Recent studies have highlighted the potential association between common benign epilepsy syndromes in children and the development of partial cognitive impairment. We established a comprehensive database of cognitive, structural magnetic resonance imaging (sMRI), and resting-state functional magnetic resonance imaging (rsfMRI) data obtained from a cohort of 36 Chinese paediatric volunteers. The participants, aged 5-16 years, were specifically diagnosed with either benign epilepsy with centrotemporal spikes (BECTs) or childhood absence epilepsy by certified paediatric neurologists. All imaging data were collected by qualified clinicians, and cognitive data were collected within 1 year of magnetic resonance imaging data collection. This database allows researchers to perform more detailed analyses using multimodal data to explore the relationship between cognitive impairment and brain mechanisms in children with common epilepsy syndromes.

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BACKGROUND: Low back pain (LBP) is very common in women of child bearing age (WCBA) and is a major burden on individuals and society, but studies about it have not been reported. METHODS: Trend analyses were based on data from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. We investigated global trends in the number of prevalence cases, prevalence and the years lived with disability (YLDs), and the YLDs rate for LBP in the WCBA. We used joint point regression analyses to report average annual changes and identify the most variable years in the global trend. Simultaneously, we further analyzed these trends by stratifying them by the region, nation, and age. RESULTS: Globally, the number of the prevalence and the YLDs for LBP increased substantially from 1990 to 2021(the prevalence: 39.65%) (the YLDs: 39.53%), whereas the prevalence and the YLDs rate of WCBA LBP decreased (the prevalence: AAPC: -0.1355 [95% CI -0.1419 to -0.1288) (the YLDs: AAPC: -0.1365 [95% CI -0.1427 to -0.1302]). Regionally, the prevalence and the YLDs rate of LBP among WCBA in the medium socio-demographic index region showed an increasing trend(the prevalence: AAPC: 0.1291 [95% CI: 0.118 to 0.1396]) (the YLDs: AAPC: 0.1371 [95% CI: 0.1251 to 0.1499]). Nationally, Thailand and Vietnam were the countries with the largest increases in YLD rates(Thailand: AAPC: 0.7742 [95% CI: 0.7589 to 0.7904]) (Vietnam: AAPC: 0.7364 [95% CI: 0.7263 to 0.7468]). In age patterns, the highest prevalence and YLDs rates of LBP were found among women in the 45-49 age group(the prevalence: 14,412.77 per 100,000 in 2021 [95% UI: 10,482.27 to 19,077.3]) (the YLDs: 1,639.56 per 100,000 population (95% UI: 1,035.24 to 2,494.9]). CONCLUSION: Despite declines in the prevalence and YLDs of WCBA LBP, the burden remains high. Age- and region-specific prevention and healthcare strategies should be optimized to meet the needs of WCBA and reduce the burden of disease.