Trajectories and influencing factors of cognitive function and physical disability in Chinese older people.

Introduction: Dementia and physical disability are serious problems faced by the aging population, and their occurrence and development interact. Methods: Based on data from a national cohort of Chinese people aged 60 years and above from the China Health and Retirement Longitudinal Survey from 2011 to 2018, we applied the group-based trajectory model to identify the heterogeneous trajectories of cognitive function and physical disability in participants with different physical disability levels. Next, multinomial logistic regression models were used to explore the factors affecting these trajectories. Results: The cognitive function trajectories of the Chinese older people could be divided into three characteristic groups: those who maintained the highest baseline level of cognitive function, those with a moderate baseline cognitive function and dramatic progression, and those with the worst baseline cognitive function and rapid-slow-rapid progression. The disability trajectories also fell into three characteristic groups: a consistently low baseline disability level, a low initial disability level with rapid development, and a high baseline disability level with rapid development. Compared with those free of physical disability at baseline, a greater proportion of participants who had physical disability at baseline experienced rapid cognitive deterioration. Education, income, type of medical insurance, gender, and marital status were instrumental in the progression of disability and cognitive decline in the participants. Discussion: We suggest that the Chinese government, focusing on the central and western regions and rural areas, should develop education for the older people and increase their level of economic security to slow the rate of cognitive decline and disability among this age group. These could become important measures to cope with population aging.

Associations between maternal exposure to air pollution during pregnancy and trajectories of infant growth: A birth cohort study.

OBJECTIVE: We examined the relationships between infants' growth trajectories and prenatal exposure to air pollution, which is still under-investigated. METHODS: A birth cohort study was constructed using medical records of pregnant women and infants born between 2015 and 2019 in Foshan, China. Using satellite-based spatial-temporal models, prenatal exposure to air pollutants including particulate matter with an aerodynamic dimension of < 2.5 µm (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) was assessed at each woman's residence. Latent class growth modeling was used to identify trajectories of physical (body length and weight) growth and neurodevelopment, which were repeatedly measured within 1 year after birth. Logistic regression models were used to investigate the associations between prenatal exposure to air pollution and the risks of growth disorders, adjusting for an array of potential confounders. RESULTS: We identified two growth trajectories for body length [normal: 3829 (93%); retardation: 288 (7%)], three for weight [normal: 2475 (59.6%); retardation: 390 (9.4%); overgrowth: 1287 (31%)], and two for neurodevelopment [normal: 956 (66.1%); retardation: 491 (33.9%)]. For exposure over whole pregnancy, SO2 was associated with an increased risk of body length retardation (OR for per 1 µg/m3 increment: 1.09, 95%CI: 1.01-1.17); PM2.5 (OR: 1.05, 95%CI: 1.03-1.07), SO2 (OR: 1.15, 95%CI: 1.08-1.22), and NO2 (OR: 1.05, 95%CI: 1.03-1.07) were positively associated with neurodevelopmental retardation. Such associations appeared stronger for exposures over the first and second trimesters. No significant associations were detected for weight growth. CONCLUSIONS: Maternal exposure to air pollution during pregnancy was associated with higher risks of impairments in both physical growth, particularly body length, and neurodevelopment.

Joint Developmental Trajectories of Novelty and Usefulness in Chinese Children's Creativity.

Creativity encompasses both novelty and usefulness, with novelty referring to the generation of unique and uncommon ideas, while usefulness pertains to the effectiveness and appropriateness of these ideas in addressing the given task. The comprehension of the process of coordinated development for children's novelty and usefulness, including the potential gender differences, is crucial; however, it still lacks clarity in the current academic discourse. To address these gaps, this study investigated the joint developmental trajectories of novelty and usefulness as well as the gender differences in trajectory group membership among Chinese children. A sample of primary school children (initial grade 3, N = 665; 46.4% girls; initial Mage = 8.60 years) were followed for three years. The results revealed a negative association between novelty and usefulness across all three time points. Through parallel-process latent class growth modeling, three distinct trajectories of novelty and usefulness were identified: the High Novelty Decline-Medium Usefulness Increase-Stability Group (66%), the Low Novelty Increase-High Usefulness Decline-Convergence Group (19%), and the Low Novelty Decline-High Usefulness Increase-Divergence Group (15%). These findings suggest that the development of children's creativity is influenced by a multifaceted pattern involving both novelty and usefulness. Moreover, gender differences in trajectory group membership were examined and discussed within the context of creativity development in Chinese children.

Study on the trajectory of depression among middle-aged and elderly disabled people in China: Based on group-based trajectory model.

Background: Previous studies have shown that middle-aged and elderly adults with disabilities are at higher risk for depressive symptoms. However, there are few studies on the long-term trajectories of depressive symptoms in the Chinese middle-aged and elderly disabled population. Objective: This study aimed to identify the different development trajectories of depressive symptoms and their influencing factors in middle-aged and elderly people with disabilities in China. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, a longitudinal cohort was formed for the study. A total of 2053 participants underwent at least two measures of depressive symptoms, assessed using the Center for Epidemiological Studies Depression Scale (CES-D10), a depression symptom assessment scale. We constructed a Group-Based Trajectory Model (GBTM) to identify the development trajectory of depressive symptoms in 2053 middle-aged and elderly disabled individuals, screened the potential predictors using lasso regression, and analyzed the factors affecting the development trajectory of depression through multivariate logistic regression. Results: We identified four depression symptom trajectories throughout the follow-up process: "low depressive symptom group", "worsening depressive symptom group", "relieved depressive symptom group", and "high depressive symptom group". We found that there were differences in basic characteristics among different subgroups of depression trajectory. However, middle-aged and elderly disabled women living in rural areas, with limited ADL or IADL, physical pain, poor self-reported health and self-reported memory, short sleep time, and no relatives and friends to take care of them were the key groups for the prevention and treatment of depressive symptoms. Conclusion: There is heterogeneity in the trajectories of depressive symptoms in the Chinese middle-aged and elderly disabled population, it is necessary to focus on the characteristics of the trajectories of different subgroups.

How final year high school students' depression develop during COVID-19 in China? A latent class growth modeling analysis.

Depression increased sharply during the initial months of COVID-19, but how it developed over time is rarely explored, especially for adolescents. The current study measured depression of 605 final year high school students in China over 11 months in 4 waves. The latent growth curve modeling (LGCM) was used to examine overall trends in depression and latent class growth modeling (LCGM) was used to identify potential subgroups of adolescents' depressive trajectories. At the same time, gender, life events, and rumination were included as time-invariant covariates. Overall, the development of depression in the final year of high school students showed a slight downward trend. Meanwhile, the depression trajectories showed heterogeneity, and three categories of depression trajectories were identified, which were low-stable (24.3%), depression-risk (67.9%), and high-stable (7.8%). Neuroticism, rumination, and life events such as punishment and loss were found to significantly predict these trajectories of depression. This study helps to characterize differential depression trajectories among adolescents throughout the COVID-19 pandemic and establish several related predictors of the trajectory of depression.

Being and becoming beginning military leaders: Implications for leadership learning.

The purpose of the study is to describe junior military officers' leadership development experiences and to draw implications for leadership learning in their professional development. The research uses a systematic grounded theory design. Through in-depth interviews of 19 military officers, the data were coded and analyzed with a paradigm model that was developed to describe the development of military officers' experiences as leaders. The findings show that military leadership development is a process that is defined by the experiences of establishing oneself as a vocational leader, developing confidence in leadership skills, and leading with mission clarity and genuine concern for their "subordinates." The results reinforce the notion that leadership development is a continuous learning process beyond formal program and other transient events. Results also imply that fundamental assumptions for formal leadership development programs must be conceptualized and conceived as a process of "being, becoming, and belonging." This non-positivist empirical study answers the call for more qualitative and interpretive approaches in leadership development research and contribute to the body of knowledge of leadership learning in military leadership development.

The longitudinal association between children's growth mindset in senior primary school and their parents' growth mindset.

Growth mindset plays a positive role in children's development, but few studies use longitudinal data to investigate the developmental trajectory of children's growth mindset. In addition, previous studies have shown that there may be no intergenerational transmission of mindset, but the influence of parents' growth mindset on the development and change of children's growth mindset cannot be denied. Based on the abovementioned factors, the present study used a sample of fourth-grade primary school students and their parents in Beijing (N = 4,004), and five waves of longitudinal data over two-and-a-half years were collected to identify the trajectories of growth mindset in senior primary school with latent growth modeling and to examine the effects of parents' growth mindset with a parallel process latent growth model. The results showed the following. (1) The growth mindset of the senior primary school children decreased over time, and there were significant individual differences in the initial level and growth of mindset. (2) Children in senior primary school showed higher levels of growth mindset after two-and-a-half years if their mothers reported higher levels of growth mindset in the beginning. Children showed higher levels of growth mindset after two-and-a-half years if their mothers' growth mindset declined slower during this period, while they showed lower levels if their mothers' growth mindset declined rapidly; when the mothers' growth mindset declines, the children's growth mindset would also show a downward trend during this time. Finally, (3) there was no significant relationship between both the initial level and the decline of the father's growth mindset and the development pattern of the children's growth mindset.

Latent Classification Analysis of Leisure Activities and Their Impact on ADL, IADL and Cognitive Ability of Older Adults Based on CLHLS (2008-2018).

This study aimed to research the trajectory of leisure activity and the health status of older adults and analyze the effects of leisure activity on the health status of older adults. Based on the longitudinal data of CLHLS (2008-2018), the latent growth curve model (LGCM) was used; we found that the leisure activities (LA), activities of daily living (ADL) ability, instrumental activities of daily living (IADL) ability, and cognitive ability (COG) of older adults show a nonlinear downward trend over time. Furthermore, the panel binary regression analysis is used to find that leisure activities have significant inhibitory effects on ADL disorder, IADL disorder, and cognitive impairment in the older population. In addition, by using latent profile analysis (LPA), the older population is classified into three groups according to the homogeneity of the older adults' choice of leisure activities, namely the types of relaxation, entertainment, and intellectual-learning, respectively. Based on the classification results, the analysis of one-way ANOVA shows that the rates of ADL disorder, IADL disorder, and cognitive impairment of older adults with different types are significantly different. Moreover, the inhibitory effect of leisure activities on the rate of ADL disorder, IADL disorder, and cognitive impairment of older adults is more significant in the middle-aged and high-aged groups. Therefore, older adults should be encouraged to increase leisure activities, especially those who are middle-aged and high-aged.

Development trajectory and influencing factors of pediatric medical traumatic stress in parents with children undergoing surgery: a latent growth mixture model / 中国实用护理杂志

Objective:To explore the development trajectory and influencing factors of pediatric medical traumatic stress in parents of children undergoing surgery, so as to provide reference for targeted intervention measures in the later stage.Methods:Adopting prospective research design, from January 2022 to August 2022, convenience sampling was used to recruit 199 parents of children undergoing surgery in the pediatric surgery ward of the First Affiliated Hospital of University of Science and Technology of China as subjects. The level of medical traumatic stress symptoms in parents was investigated by the PTSD Checklist for DSM-5 at one day before surgery, during postoperative recovery, after discharge and 3 months after discharge. The general data questionnaire, Parents′ Perception of Uncertainty Scale, Hospital Anxiety and Depression Scale, Simplified Coping Style Questionnaire and Perceived Social Support Scale were used to investigate the influencing factors of medical traumatic stress symptoms in parents one day before the operation.Latent growth mixture model and binary Logistic regression were used to analyze the data.Results:The development trajectory of pediatric medical traumatic stress in parents of children undergoing surgery was divided into two categories: the first was low-level decline (90.5%, 180/199) and the second was high-level stability (9.5%, 19/199). Binary Logistic regression analysis showed that postoperative complications, surgical type and negative coping styles of parents were the main influencing factors of pediatric medical traumatic stress trajectory in parents of surgical children(all P<0.05). Conclusions:The pediatric medical traumatic stress in parents of children undergoing surgery have group heterogeneity trajectory, medical staff can formulate targeted and individualized intervention programs according to their trajectories and influencing factors.

Turning Point of Cognitive Decline for Chinese Older Adults from a Longitudinal Analysis: Protective Factors and Risk Factors.

OBJECTIVES: To explore the turning point of cognitive decline in Chinese older adults and to explore the influencing factors including covariates. PARTICIPANTS: Aged 65 and older whose cognitive function was normal at their first test. METHODS: a secondary analysis that identified participants from the database of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Cohort-sequential design was used to categorize the data by age (rather than study wave), including the follow-up data of Chinese older adults aged 65-79 years and spanning 14 years. Cognitive function in 1278 participants was assessed using the Chinese Mini-Mental State Examination (CMMSE) in five waves over 14 years. Piecewise latent growth curve modeling was used to analyze the data. RESULTS: (1) The turning point of cognitive decline in Chinese older adults occurs between the ages of 68 and 70. (2) There are statistically significant individual differences in the initial level of cognitive function and the growth rate of cognitive function before and after the transition stage. (3) Factors influencing cognitive function include residence, education level, smoking, drinking, exercise, leisure activities, social activities, Activities of Daily Living (ADL), and Instrumental Activities for Daily Living (IADL). (4) Exercise and ADL are the main protective factors, while smoking and drinking are the main risk factors. CONCLUSIONS: There is a transition stage (68-70) in the decline of cognitive function in Chinese older adults and four main factors (such as smoking, drinking, exercise and ADL) have impacts on the cognitive decline. We should strengthen these protective factors (exercise and ADL) for the cognitive decline of older adults and avoid these risk factors (smoking, drinking). To prevent the decline of the cognitive function of older adults, the government should build more places conducive to activities for older adults and actively encourage older adults to improve their physical activity level. Given our findings, public health interventions centered on alcohol and tobacco cessation in older adults should be governmentally endorsed.

Effects of Leisure Activities on the Cognitive Ability of Older Adults: A Latent Variable Growth Model Analysis.

Based on the data of four periods of CLHLS (2008, 2011, 2014, 2018), the latent variable growth model (LGCM) was applied to 2344 older adults who completed four follow-up surveys, to study the trajectory of leisure activities and cognitive ability and explore the relationship between leisure activities and cognitive ability of older adults. The results showed that: (1) leisure activities and cognitive ability of older adults showed a non-linear downward trend; (2) leisure activities significantly and positively predicted the cognitive ability of older adults at every time point; (3) the initial level of leisure activity positively predicted the initial level of cognitive ability but negatively predicted the rate of cognitive decline; In addition, cognitive activities had a greater effect on cognitive ability than non-exercise physical activities; (4) the rate of decline of leisure activities also significantly and positively predicted the rate of decline of cognitive ability; (5) cross-lagged regression analysis further suggested the overall positive predictive effect of leisure activity on cognitive ability; (6) overall, education level had a significant contribution to cognitive ability, and the higher the education level, the slower the decline of cognitive ability; and (7) smoking could promote cognitive ability in older adults and no significant effect was found between alcohol drinking and cognitive ability. Accordingly, the government should encourage older adults to do more leisure activities, especially the cognitive activity, to effectively prevent cognitive decline.

Development trajectory for the temporal and spatial evolution of the resilience of regional tourism environmental systems in 14 cities of Gansu Province, China.

The rapid development of the urban economy in China and the accompanying income growth experienced by urban residents have increased demand for tourism and leisure, which has brought pressure on the urban tourism environment system (UTES), making the contradiction between tourism economic development and the ecological environment increasingly acute. While seeking to rationalize the economic, social, and ecological benefits of tourism, reducing the fragility of the UTES and improving its anti-interference and recovery capabilities have become attracted significant attention from scholars in China and elsewhere. This paper establishes a definition of resilience for an UTES and constructs an evaluation index system for it in terms of the social, economic, and ecological environments. It also establishes an entropy weight-TOPSIS resilience evaluation model to measure resilience in regional systems, using ArcGIS to analyze the standard deviation ellipse and center of the gravity track of the resilience. System dynamics was used to construct diagrams of causal relationships and stock flow for the constituent elements of UTES to show the mechanisms that promote its resilience. This paper investigates 14 cities of Gansu Province in particular to simulate the resilience model of a regional system.

Two-stage window screening and development trajectories in early identification of autism spectrum disorder among Han Chinese children.

OBJECTIVE: An understanding of the trajectory and norm of development in children is needed in order to understand the concept of the spectrum in the diagnosis of autism spectrum disorder (ASD). Children's developmental growth trajectory was measured from six to 66 months in the Taiwan Birth Cohort Study dataset (N = 11,145). Additionally, over 4 years of follow-up, the negative predictive value of using the Parental Concern Checklist and Taiwan Birth Cohort Study Developmental Instrument was also investigated as the first stage of screening in a two-stage window screening method for ASD diagnosis. RESULTS: The growth trajectory showed that children's language development began to increase at 18 months, and peaked at 36 months. On the other hand, social development showed steady growth from 18 to 66 months. The increase in the trajectory of children's language development prior to age three, when compared with other developmental dimensions, may increase the difficulty of diagnosing ASD. The two-stage window screening method can be used in settings where the screening sample is large, such as in community or primary care settings, and has been found to be time- and cost-efficient. Better understanding of children's developmental trajectory can enhance detection and intervention for ASD.

Cross-sectional exploration of brain functional connectivity in the triadic development model of adolescents.

Adolescence represents a transitional stage with increased risk taking and mood dysregulation. These vulnerabilities are accountable by developmental dynamics in the triadic functional brain networks underlying reward seeking (REW), emotional avoidance (EMO), and cognitive regulation (COG). However, these triadic dynamics, though conceptually established, have yet been investigated directly. Capitalizing on public database of resting-state fMRI from 222 adolescents (8-18 years old, 89F133M), this study examined cross-sectional development profiles of functional connectivity (FC) by jointly considering bilateral seeds of the ventral striatum, amygdala, and dorsal lateral prefrontal cortex in probing the networks of REW, EMO, and COG, respectively. Positive and negative FCs were considered separately for clarification of synergetic and suppressive interactions. While the REW and EMO mostly exhibited quadratic FC changes across age, suggesting reduced reward sensitivity and risk avoidance, the COG exhibited both linear and quadratic FC changes, suggesting both protracted maturation of cognitive ability and lowered top-down regulation. Additional age × gender effects were identified in the precentral gyrus and superior medial prefrontal cortex, which may associate risky action and emotion dysregulation to boys and girls, respectively. These results provide network evidence in substantiating the "triadic model" and deepening existing insights into neurodevelopmental mechanisms associated with adolescent behavior.

Prenatal exposure to ambient air multi-pollutants significantly impairs intrauterine fetal development trajectory.

BACKGROUND: Impaired in utero fetal growth trajectory may have long term health consequences of the newborns and increase risk of adulthood metabolic diseases. Prenatal exposure to air pollution has been linked to fetal development restriction; however, the impact of exposure to ambient air pollutants on the entire course of intrauterine fetal development has not been comprehensively investigated. METHODS: During 2015-2018, two cohorts of mother-infant dyads (N = 678 and 227) were recruited in Shanghai China, from which three categories of data were systematically collected: (1) daily exposure to six air pollutants during pregnancy, (2) fetal biometry in the 2nd (gestational week 24, [GW24]) and 3rd trimester (GW36), and (3) neonatal outcomes at birth. We investigated the impact of prenatal exposure to air pollutant mixture on the trajectory of fetal development during the course of gestation, adjusting for a broad set of potential confounds. RESULTS: Prenatal exposure to PM2.5, PM10, SO2 and O3 significantly reduced fetal biometry at GW24, where SO2 had the most potent effect. For every 10 µg/m3 increment increase of daily SO2 exposure during the 1st trimester shortened femur length by 2.20 mm (p = 6.7E-21) translating to 5.3% reduction from the average of the study cohort. Prenatal air pollution exposure also decreased fetal biometry at GW36 with attenuated effect size. Comparing to the lowest exposed quartile, fetus in the highest exposed quartile had 6.3% (p = 3.5E-5) and 2.1% (p = 2.4E-3) lower estimated intrauterine weight in GW24 and GW36, respectively; however, no difference in birth weight was observed, indicating a rapid catch-up growth in the 3rd trimester. CONCLUSIONS: To our knowledge, for the first time, we demonstrated the impact of prenatal exposure to ambient air pollutants on the course of intrauterine fetal development. The altered growth trajectory and rapid catch-up growth in associated with high prenatal exposure may lead to long-term predisposition for adulthood metabolic disorders.

Judicial outcome and follow up of abused child protection acts in a pediatric emergency department: 12-year experience in a third level pediatric hospital.

BACKGROUND: Italian laws allow the protection of a child who is suspected to be a victim of abuse through a procedure that can be put in motion by the attending physician in any Emergency Department (article nr. 403 Civil Code) with a temporarily suspension of parental authority. This study aims at evaluating both the appropriateness of the activation of the protection procedure by ED doctors in cases of suspected child abuse in terms of judicial confirmation and how it impacts children in the long-term. METHODS: We selected cases in which the procedure was activated due to suspected child abuse. The children were admitted to the ED of a tertiary children hospital from 2006 to 2018. We then reviewed the medical charts and collected data from the social services through a questionnaire concerning the long-term outcomes . RESULTS: Twenty-eight patients were included (75% females, mean age 13.8 years). In 90% of cases the activation of the procedure in the ED was followed by a Court confirmation. Evaluation of long term outcome was possible in 22 cases. Among them, a positive social outcome was achieved in 15 cases (68.2%). The remaining abandoned the program or had critical reintegration in the family. Eighteen percent of patients developed major issues such as aberrant behaviours, substance abuse or psychiatric disorders. CONCLUSIONS: This report identifies a good ability of ED doctors in the activation of an emergency procedure to protect the child. Overall, the social outcome was good for nearly 70% of the patients, highlighting the importance of activation of social support programs for child abuse.

Combined frontal and parietal P300 amplitudes indicate compensated cognitive processing across the lifespan.

In the present study the frontal and parietal P300, elicited in an auditory oddball paradigm were investigated in a large sample of healthy participants (N = 1572), aged 6-87. According to the concepts of the compensation-related utilization of neural circuits hypothesis (CRUNCH) it was hypothesized that the developmental trajectories of the frontal P300 would reach a maximum in amplitude at an older age than the amplitude of the parietal P300 amplitude. In addition, the amplitude of the frontal P300 was expected to increase with aging in adulthood in contrast to a decline in amplitude of the parietal P300 amplitude. Using curve-fitting methods, a comparison was made between the developmental trajectories of the amplitudes of the frontal and parietal P300. It was found that the developmental trajectories of frontal and parietal P300 amplitudes differed significantly across the lifespan. During adulthood, the amplitude of the parietal P300 declines with age, whereas both the frontal P300 amplitude and behavioral performance remain unaffected. A lifespan trajectory of combined frontal and parietal P300 amplitudes was found to closely resemble the lifespan trajectory of behavioral performance. Our results can be understood within the concepts of CRUNCH. That is, to compensate for declining neural resources, older participants recruit additional neural resources of prefrontal origin and consequently preserve a stable behavioral performance. Though, a direct relation between amplitude of the frontal P300 and compensatory mechanisms cannot yet be claimed.