Search Results (14)

Background: The process and dynamics of post-stroke recovery can vary considerably across patient subgroups. However, few studies have explored long-term functional recovery profiles (an essential outcome indicator), particularly in relation to patients’ quality of life, and caregiver burden. This study aimed to identify distinct 12-month trajectories of functional recovery among stroke survivors, and to examine their associations with sociodemographic and clinical factors, as well as patient-reported outcomes. Methods: The study involved 225 patients with acute ischemic stroke, assessed at admission (T0), discharge (T1), and at 3 (T2) and 12 months (T3) post-discharge. Informal caregivers participated at T2 (n = 126) and T3 (n = 118). Functional status was measured using the modified Barthel Index, quality of life using the Stroke-Specific Quality of Life scale, and caregiver burden with the Caregiver Burden Scale. Latent growth mixture modelling (LGMM) was applied to identify recovery trajectories. Associations with sociodemographic and clinical variables, quality of life, and caregiver burden were analysed using ANOVA and χ² tests. Results: Three recovery trajectory classes were identified: Class 1 (moderate upward, 20.4%), Class 2 (low-stable, 4.9%), and Class 3 (high-functioning stable, 74.7%). Class 3 patients were younger, less impaired at baseline, and more frequently diagnosed with lacunar strokes. Class 2 comprised older, more impaired individuals and had the lowest proportion of males. Class 1 represented intermediate baseline profiles with gradual functional improvement over time. Patient-reported outcomes differed significantly between classes (p < 0.001): Class 3 had the highest quality of life and lowest caregiver burden whilst Class 2 consistently reported the poorest quality of life. Conclusions: This study demonstrates significant heterogeneity in post-stroke functional recovery and its associations with clinical, sociodemographic, and patient-reported outcomes. Identifying recovery trajectories may support more personalised stroke care and rehabilitation planning. Full article

Background/Objectives: Glioblastoma (GBM) exhibits heterogeneous, nonlinear invasion patterns that challenge conventional modeling and radiomic prediction. Most deep learning approaches describe the morphology but rarely capture the dynamical stability of tumor evolution. We propose an AI framework that approximates a latent attractor landscape of GBM morphodynamics—stable basins in a continuous manifold that are consistent with reproducible morphologic regimes. Methods: Multimodal MRI scans from BraTS 2020 (n = 494) were standardized and embedded with a 3D autoencoder to obtain 128-D latent representations. Unsupervised clustering identified latent basins (“attractors”). A neural ordinary differential equation (neural-ODE) approximated latent dynamics. All dynamics were inferred from cross-sectional population variability rather than longitudinal follow-up, serving as a proof-of-concept approximation of morphologic continuity. Voxel-level perturbation quantified local morphodynamic sensitivity, and proof-of-concept control was explored by adding small inputs to the neural-ODE using both a deterministic controller and a reinforcement learning agent based on soft actor–critic (SAC). Survival analyses (Kaplan–Meier, log-rank, ridge-regularized Cox) assessed associations with outcomes. Results: The learned latent manifold was smooth and clinically organized. Three dominant attractor basins were identified with significant survival stratification (χ² = 31.8, p = 1.3 × 10⁻⁷) in the static model. Dynamic attractor basins derived from neural-ODE endpoints showed modest and non-significant survival differences, confirming that these dynamic labels primarily encode the morphodynamic structure rather than fixed prognostic strata. Dynamic basins inferred from neural-ODE flows were not independently prognostic, indicating that the inferred morphodynamic field captures geometric organization rather than additional clinical risk information. The latent stability index showed a weak but borderline significant negative association with survival (ρ = −0.13 [−0.26, −0.01]; p = 0.0499). In multivariable Cox models, age remained the dominant covariate (HR = 1.30 [1.16–1.45]; p = 5 × 10⁻⁶), with overall C-indices of 0.61–0.64. Voxel-level sensitivity maps highlighted enhancing rims and peri-necrotic interfaces as influential regions. In simulation, deterministic control redirected trajectories toward lower-risk basins (≈57% success; ≈96% terminal distance reduction), while a soft actor–critic (SAC) agent produced smoother trajectories and modest additional reductions in terminal distance, albeit without matching the deterministic controller’s success rate. The learned attractor classes were internally consistent and clinically distinct. Conclusions: Learning a latent attractor landscape links generative AI, dynamical systems theory, and clinical outcomes in GBM. Although limited by the cross-sectional nature of BraTS and modest prognostic gains beyond age, these results provide a mechanistic, controllable framework for tumor morphology in which inferred dynamic attractor-like flows describe latent organization rather than a clinically predictive temporal model, motivating prospective radiogenomic validation and adaptive therapy studies. Full article

Neighbourhood variation in socioeconomic deprivation is recognised as a small but meaningful determinant of adolescent mental health, yet the mechanisms through which the effects operate remain poorly understood. This study used #BeeWell survey data collected from adolescents in Greater Manchester (England) in 2021–2023 (life satisfaction: N = 27,009; emotional difficulties: N = 26,461). Through Latent Growth Mixture Modelling, we identified four non-linear trajectories of life satisfaction (Consistently High (71.0%), Improving (8.7%), Deteriorating (6.3%), and Consistently Low (13.9%); entropy = 0.66) and three non-linear trajectories of emotional difficulties (Low/Lessening (53.7%), Sub-Clinical (38.3%), and Elevated/Worsening (8.0%); entropy = 0.61). Using a multi-level mediation framework we assessed (1) whether neighbourhood deprivation predicted trajectory class membership and (2) the extent to which effects of deprivation operate through aspects of Community Wellbeing, as measured by the Co-op Community Wellbeing Index (CWI). Greater deprivation increased the odds of following Deteriorating (OR = 1.081, [1.023, 1.12]) and Consistently Low (OR = 1.084, [1.051, 1.119]) life satisfaction trajectories and reduced the odds of following a Sub-Clinical emotional difficulties trajectory (OR = 0.975, [0.954, 0.996]). Mediation analyses revealed that the effects of deprivation on Consistently Low life satisfaction partially operate through Equality (ab = 0.016, [0.002, 0.029]) and Housing, Space, and Environment (ab = −0.026, [−0.046, −0.006]). Further indirect effects were observed for Housing, Space, and Environment, which reduced likelihood of Sub-Clinical emotional difficulties for those living in deprived neighbourhoods (ab = −0.026, [−0.045, −0.008]). The findings highlight the distinct effects of neighbourhood deprivation on affective and evaluative domains of adolescent mental health and the protective effect of housing and related environmental factors in disadvantaged contexts, advancing our understanding of the mechanisms underpinning neighbourhood effects on dual-state adolescent mental health. Full article

Background: High dietary diversity has been found to be associated with frailty. However, the trajectory of dietary diversity intake in relation to frailty is unclear. Methods: Using the latent class trajectory modeling approach, we identified distinctive dietary variety trajectory groups among 2017 participants based on the Chinese Longitudinal Healthy Longevity Survey acquired at four time points within a 10-year period. Frailty status was assessed using a frailty index comprising 37 health deficits. Dietary diversity was quantified using the dietary variety score (DVS), based on food category consumption frequency. Logistic regression analyses were employed to explore the association between DVS change trajectories and frailty. Results: This study identified two distinct DVS trajectories: “Moderate-Slow decline-Slow growth”, encompassing 810 (40.16%) individuals, and “Moderate-Slow growth-Accelerated decline”, including 1207 (59.84%) individuals. After adjusting for covariates, the odds ratio for DVS in the “Moderate-Slow decline-Slow growth” group was 1.326 (95% confidence interval: 1.075–1.636) compared to the “Moderate-Slow growth-Accelerated decline” group. The “Moderate-Slow decline-Slow growth” trajectory continued to decrease and was maintained at a low level in the early stages of aging. Conclusion: Sustaining a high dietary diversity trajectory over time, particularly in the early stages of aging, could potentially decrease the risk of frailty among older Chinese adults. Full article

Background: The COVID-19 pandemic had a widespread impact on families with dependent children. To better understand the impact of the pandemic on families’ health and relationships, we examined the association between mothers’ and children’s mental distress and family strain. Methods: Three waves of the COVID-19 Impact Survey were analyzed, collected from a subsample of mother–child pairs (n = 157) from the Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal cohort in Alberta, Canada. Latent class analyses were performed to determine patterns and group memberships in mothers’ and children’s mental distress and family strain. Multivariable logistic regression models were conducted to test associations between mothers’ and children’s mental distress and family strain trajectory classes. Results: Mothers with medium/high levels of mental distress were at increased odds of experiencing high family strain compared to those with low levels of distress (medium aOR = 3.90 [95% CI: 1.08–14.03]; high aOR = 4.57 [95% CI: 1.03–20.25]). The association between children’s mental distress and family strain was not significant (aOR = 1.75 [95% CI: 0.56–5.20]). Conclusion: Mothers’ mental distress, but not children’s, was associated with family strain during the pandemic. More distressed individuals experienced greater family strain over time, suggesting that this association may become a chronic problem. Full article

This cross-country four-year longitudinal study investigated the development of processing speed throughout primary school education. The analyses were conducted on data accumulated from 441 pupils in grades from 1 to 4 (aged 6.42 to 11.85 years) in Kyrgyzstan and Russia. Mixed effects growth modeling was applied to estimate average and individual growth trajectories for processing speed in two cross-country samples. Latent class growth modeling was conducted to describe various types of growth trajectories for processing speed and to compare the distribution of the types within the analyzed samples. According to the results, processing speed significantly increases across primary school years. The trajectory is described by nonlinear changes with most dynamic growth between grades 1 and 2, which slows down until grade 4. No significant cross-country differences were found in the initial score of processing speed or developmental changes in processing speed across primary school years. The development of processing speed is described by a model including three quadratic growth types but this minimally differs. It is concluded that in both samples, the development of processing speed may be characterized by homogeneity, with the most intensive growth from grade 1 to grade 2 and subsequent linear improvement until grade 4. Full article

Despite the serious emotional and social consequences of adolescents’ exposure to intimate-partner violence (IPV) and the high prevalence of this exposure, few analyses have focused on person-centered models or considered psychological IPV. Studies that address exposure to violence tend to focus on physical IPV. Therefore, in this study, we examine (across two waves) the trajectories of resilience among adolescents who have witnessed psychological IPV by conducting a latent transition analysis and predicting class membership through socio-demographic and individual-level protective factors. Using a sample of 879 (T1, fall 2020) and 770 (T2, spring 2022) adolescent Swiss students with mean ages of 11.74 (SD = 0.64) and 13.77 (SD = 0.53), we identified four distinct time-invariant resilience classes: comorbid-frustrated, internalizing-frustrated, comorbid-satisfied, and resilient. The classes characterized by some level of psychopathological symptoms and basic psychological-needs frustration were the most stable over time. Furthermore, we found the four typical resilience trajectories: recovery, chronic, delayed, and improving. Gender, socioeconomic background, and protective factors showed a significant prediction of class membership in wave 1, highlighting the importance of increasing sensitivity to psychological-IPV exposure on the one hand, and reinforcing the relevance of prevention in schools regarding the promotion of protective factors on the other. Full article

The aim of our study was to investigate adherence to lifestyle recommendations and lifestyle changes after diagnosis in patients with non-muscle invasive bladder cancer (NMIBC). Second, we aimed to identify distinct trajectories of lifestyle change and their correlates. We analysed data of 935 patients with NMIBC from a prospective cohort study at six weeks (evaluating pre-diagnostic lifestyle), three months, and fifteen months after diagnosis. An overall lifestyle score (range 0–7) was calculated based on the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations focusing on diet, body mass index, and physical activity. Linear mixed models were used to analyse absolute lifestyle changes over time. Distinct trajectories of change were identified with latent class trajectory models. We found an overall lifestyle score of 3.3 which remained constant over time. The largest lifestyle changes were observed for the consumption of red and processed meat (−96 g/week) and fruit and vegetables (−38 g/day). Two to four trajectory groups were identified for each single lifestyle behaviour. Correlates differed per trajectory group. In conclusion, adherence to the WCRF/AICR recommendations was low. Small to moderate changes in and different trajectories of single lifestyle behaviours were observed. Effective strategies for lifestyle improvement are warranted. Full article

Physical inactivity is a major public health problem, and there are concerns this might have increased during the COVID-19 pandemic. We aimed to identify distinct trajectories of physical activity over a 6-week period after the first restrictive measures and to explore determinants of these trajectories in a population-based cohort of middle-aged and elderly in the Netherlands (n = 5777). We observed that at least 59% of participants did not meet the World Health Organization recommendations for physical activity. Using latent class trajectory analyses over three time points, we identified five distinct trajectories, including four steady trajectories at different levels (very low, low, medium and high) and one increasing trajectory. Using multinomial logistic regression analyses, we observed that, compared to the ‘steadily high’ trajectory, participants in the ‘steadily very low’ trajectory were more often older, lower educated, reporting poorer physical health, more depressive symptoms, consuming a less healthy diet, smoking, and lower alcohol use, and were less often retired. A similar pattern of determinants was seen for those in the increasing trajectory, albeit with smaller effect sizes. Concluding, we observed low levels of physical activity that generally remained during the pandemic. The determinants we described can help identify groups that require additional preventive interventions. Full article

Sleep and functioning are associated with a risk of early workforce exit. However, patterns of change in sleep and functioning through time have not been investigated using person-oriented approaches to show what features of sleep and functioning are associated with an early exit. We examined the pattern of interactions between sleep and health functioning characterizing homogenous subgroups of employees and their associations with premature work exit. An additional aim was to provide a tutorial providing detailed description on how to apply these models, compared to traditional variable based risk factors. We analyzed data from 5148 midlife employees of the City of Helsinki, Finland, surveyed over three phases (2000–02, 2007, and 2012). Using repeated measures latent class analyses (RMLCA) we classified people into groups based on their trajectories in sleep and functioning. We identified four longitudinal groups: (1) Stable good sleep and functioning (reference), (2) Persistent sleep problems and good or moderate functioning, (3) Poor functioning with good sleep, and (4) Problematic sleep and health functioning. Compared to group 1, elevated risk was found in all classes with group 4 being the worst. In conclusion, focusing on person-orientated patterns of interactions between sleep and functioning helped produce qualitatively different and quantitatively stronger predictions than using conventional risk factor methodology. Thus, longitudinal person-oriented approaches may be a more powerful method for quantifying the role of sleep and health functioning as risks for premature exit from work. Full article

We identified distinct trajectories of temporal changes in employment status and investigated their association with self-rated health, perceived stress, and sleep. Data pertaining to 1228 respondents (age: 17–31 years) were extracted from the Korea Youth Panel (YP2007) survey (3rd–9th wave) datasets. Participants were either paid employees (permanent or precarious) or currently unemployed but seeking a job at baseline. Latent class growth analyses were employed to extract different classes based on the annual change in employment status (permanent/precarious/unemployed). Logistic regression analyses were performed using extracted classes as predictor variables and health-related variables at the final time-point as outcome variables. Five trajectories of employment status change were identified: stability sustained; gradually deteriorated; swiftly alleviated; gradually alleviated; instability sustained. Compared with the stability sustained group, the gradually deteriorated and gradually alleviated groups showed higher odds of perceived stress. The gradually deteriorated, instability sustained, and gradually alleviated groups showed significantly higher odds of shorter sleep than the stabilized group. We highlight the adverse health effects of prolonged unstable employment and the need for interventions to mitigate these effects. Full article

Objective: To study the trajectories of work ability and investigate the impact of multisite pain and working conditions on pathways of work ability over a six-year period. Methods: The longitudinal study was conducted with Finnish food industry workers (n = 866) with data collected every 2 years from 2003–2009. Questions covered musculoskeletal pain, physical and psychosocial working conditions (physical strain, repetitive movements, awkward postures; mental strain, team support, leadership, possibility to influence) and work ability. Latent class growth analysis and logistic regression were used to analyse the impact of multisite pain and working conditions on work ability trajectories (pathways). Results: Three trajectories of work ability emerged: decreasing (5%), increasing (5%), and good (90%). In the former two trajectories, the mean score of work ability changed from good to poor and poor to good during follow-up, while in the latter, individuals maintained good work ability during the follow-up. In the multivariable adjusted model, number of pain sites was significantly associated with higher odds of belonging to the trajectory of poor work ability (Odds ratio (OR) 4 pain sites 2.96, 1.25–7.03). Conclusions: A substantial number of employees maintained good work ability across the follow up. However, for employees with poor work ability, multisite musculoskeletal pain has an important influence, with effective prevention strategies required to reduce its prevalence. Full article

The aims of this study were to identify: (i) the proportion of women exceeding the caffeine intake guideline (>200 mg/day) during each trimester, accounting for point of pregnancy awareness; (ii) guideline adherence trajectories across pregnancy; (iii) maternal characteristics associated with trajectories; and (iv) association between adherence and growth restriction birth outcomes. Typical and maximal intake per consumption day for the first trimester (T1; pre- and post-pregnancy awareness), second (T2), and third trimester (T3) were recorded for a prospective cohort of pregnant Australian women with singleton births (n = 1232). Birth outcomes were birth weight, small for gestational age, and head circumference. For each period, participants were classified as abstinent, within (≤200 mg), or in excess (>200 mg). Latent class growth analyses identified guideline adherence trajectories; regression analyses identified associations between adherence in each trimester and birth outcomes. The percentage of participants who reported caffeine use declined between T1 pre- and post-pregnancy awareness (89% to 68%), and increased in T2 and T3 (79% and 80%). Trajectories were: ‘low consumption’ (22%): low probability of any use; ‘within-guideline’ (70%): high probability of guideline adherence; and ‘decreasing heavy use’ (8%): decreasing probability of excess use. The latter two groups were more likely to report alcohol and tobacco use, and less likely to report planning pregnancy and fertility problems. Exceeding the guideline T1 pre-pregnancy awareness was associated with lower birth weight after covariate control (b = −143.16, p = 0.011). Overall, high caffeine intake pre-pregnancy awareness occurs amongst a significant minority of women, and continued excess use post-pregnancy awareness is more common where pregnancy is unplanned. Excess caffeine consumption pre-pregnancy awareness may increase the risk for lower birth weight. Increasing awareness of the guideline in pregnancy and preconception health care may be warranted. Full article

Background and objective: The relationship between income and health in late life is well established, but the link between subjective financial wellbeing (SFW) and self-rated health (SRH) has been relatively ignored, especially among elderly in Europe. Adopting a longitudinal person-oriented analytical approach this study investigates the relationship between SFW and SRH in late life in Italy.
Materials and methods: Analysis of the European Statistics on Income and Living Conditions survey (EU-SILC) for the period 2010–2013 in Italy examined these relationships at ages 65–78 (N = 1268). Latent class growth analysis and growth mixture modeling were used to identify latent trajectories of SFW. Post hoc analysis of variance examined how SFW latent groups differed in terms of SRH across time.
Results: A three-group latent trajectory model fitted the data best. The three SFW groups were named average-decreasing (n = 238), low-stable (n = 216), and high-stable (n = 814). Repeated measures analysis of variance indicated a significant multivariate effect of SFW latent trajectory class on SRH, controlling for age, gender, and presence of chronic diseases. Post hoc analyses revealed that levels of SRH in the high-stable SFW group remained the highest compared to the other two groups and did not decrease over time, while the averagedecreasing group showed a decrease in SRH levels.
Conclusions: Results suggest that in late life longitudinal negative changes in perceptions of financial wellbeing may occur together with decreases levels of self-reported health. Future research on health inequalities in elderly should pay specific attention to the link between financial wellbeing and health from a self-reported perspective. Full article