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Purpose: FRAX® is a tool used for evaluation of risk of fracture in RA and non-RA patients and to identify those eligible for intervention. One of the limitations of FRAX in RA settings is that it does not consider factors known to contribute to osteoporosis such as autoantibodies. This study analysed the association of anti-mutated citrullinated vimentin antibody (anti-MCV), anti-cyclic citrullinated peptide antibody (anti-CCP), IgM rheumatoid factor (RF), IgA RF with 10-year risk of major osteoporosis and hip fracture. Methods: FRAX® tool was used to estimate 10-year risk of major osteoporosis fracture and hip fracture in 189 RA patients over 40 years of age. Anti-MCV, anti-CCP, IgM RF and IgA RF were tested using enzyme immunoassay and analysed at different levels. Results were adjusted for various confounders including disease activity. Results: Fifty-one (26.9%) RA patients had high (≥20%) 10-year risk of major osteoporosis fracture and 67 (35.4%) had high (>3%) 10-year risk of hip fracture. Among all the tested autoantibodies, only IgM RF at elevated levels was associated with high 10-year risk of major osteoporosis fracture (adjusted OR = 4.1, 95% CI = 1.5-11.3, p = 0.006) and of hip fracture (adjusted OR = 17.4, 95% CI = 3.7-81.3, p < 0.0001). There was no agreement between FRAX and femoral neck (FN) BMD. None of the autoantibodies tested were associated with FN osteopenia or osteoporosis including IgM RF at high levels. Conclusion: Our study highlights the importance of quantitative measurement of autoantibodies in assessment of risk for fractures among RA patients. Our preliminary findings need to be assessed in prospective studies to determine the actual predictive value of high IgM RF levels among patients with RA.

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While anemia constitutes a prevalent health issue among children in Vietnam, comprehensive aggregate data remain scarce. Consequently, the objective of this meta-analysis is to establish the pooled prevalence of anemia in the pediatric population of Vietnam. A comprehensive systematic search of existing prevalence studies was conducted up until June 2022, encompassing databases such as PubMed, Scopus, and the Cochrane Library, as well as reference list analysis. Pooled prevalence estimates, along with 95% confidence intervals (CIs), were calculated using a random-effects model. Publication bias was assessed using the Egger regression test and funnel plot inspection. Subgroup analyses were performed to identify potential variations in anemia prevalence across study groups. The pooled prevalence estimate for anemia among children under 10-year-olds amounted to 35.5% (95% CI = [23.9, 49.1]). Notably, gender-specific analyses unveiled distinct prevalence rates, with 37.8% among males and 33.4% among females. Furthermore, variations in anemia prevalence among Vietnamese children were evident across different demographic strata, encompassing gender, age groups, and rural or poor rural residency. The calculated pooled prevalence of anemia among children in Vietnam revealed a significant burden. Addressing this issue necessitates targeted interventions within specific regions and the implementation of government policies aligned with global targets for the eradication of childhood anemia.

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BACKGROUND: The excessive use of electronic devices among children is a global concern because of its negative impact on behavior. This cross-sectional study aimed to assess parents' awareness of their children's electronic device use and their perspective on how screen time affects behavior for 4-10-year-olds in Jordan. METHODS: A cross-sectional study was conducted to assess parents' awareness of their children's electronic device usage. The study included 807 mothers and fathers from Jordan with at least one child aged 4 to 10. The data collection instrument consisted of a self-administered survey with 43 questions, including sociodemographic characteristics and the Strength and Difficulties Questionnaire. Descriptive analysis, categorical Chi-square test, Independent t-test, and Mann-Whitney U test were used for statistical analysis. The study followed ethical standards and principles. RESULTS: A survey of 807 parents in Jordan found that gaming and videos were the most common content watched by children, and 61.3% used devices alone. Only 37.1% of parents believed that device use could improve their children's psychological growth, while 72.7% and 65.9% believed it could impact negatively their children's mental and psychological growth, respectively. The Strengths and Difficulties Questionnaire showed that 51.4% of children were normal, while 25.3% were borderline and 23.3% were abnormal. CONCLUSION: Children in the study used electronic devices excessively and this was linked to severe behavioral problems. Parents should follow AAP guidelines and spend more time with their children through non-electronic activities to improve their behavior.

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Pancreatic cancer (PC) is a prevalent gastrointestinal tumour known for its high degree of malignancy, resulting in a mere 10% five-year survival rate for most patients. Over the past decade, a growing body of research has shed light on the intricate bidirectional association between PC and Type 2 diabetes (T2DM). The collection of PC- and T2DM-related articles is derived from two comprehensive databases, namely WOS (Web of Science Core Collection) and CNKI (China National Knowledge Infrastructure). This article discusses the last 10 years of research trends in PC and T2DM and explores their potential regulatory relationship as well as related medications.

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OBJECTIVE: The aim: To develop, substantiate and experimentally test the methodology for the development of coordination abilities in 6-10 years old boys with postural disorders during their physical education training sessions. PATIENTS AND METHODS: Materials and methods: The experimental (EG) and the control groups (CG) were formed to organize the pedagogical experiment. The EG included 17 boys and the CG consisted of 19 boys. The EG was engaged in sports activities according the developed methodology and the CG followed the current school curricula on physical education. RESULTS: Results: The methodology for the development of coordination abilities in 6-10 years old boys with postural disorders in the process of their physical education has been developed. Its peculiarity lies in the accentuated influence on the vestibular, motor and visual analyzers with the help of a system of exercises aimed at controlling movements in space in static positions and during movement. CONCLUSION: Conclusions: The obtained results testify to the effectiveness of the developed methodology. The EG boys had significantly higher indicators of static balance and coordination abilities at body position change, as well as general coordination of movements (p ≤ 0.05) at the end of the academic year than those of the CG. In addition, the number of 6-10 years old boys with various postural disorders decreased by 7.4 % (from 26.8 % to 19.4 %).

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BACKGROUND: Going through a liver transplantation is by many recipients considered mentally and emotionally burdensome. AIM: The aim of this study was to explore individuals' mental, emotional and existential experiences living with a liver transplant during a period of approximately ten years. METHODOLOGICAL DESIGN: The methodology in this study is based on Gadamer's hermeneutics. Galvin and Todres' conceptual framework on well-being was applied in the interpretation process. RESEARCH METHODS: Both researchers conducted interviews, which took the form of conversations. We made use of Brinkmann and Kvales' three types of interpretation. ETHICAL ISSUES AND APPROVAL: The study was approved by the Ombudsman for Privacy of the Norwegian Social Data Services and is based on informed consent and confidentiality. RESULTS: Three themes emerged through interpretation: 1. From great suffering to gratitude and a humble attitude towards life. 2. From living in uncertainty to leading a normal life. 3. From hopelessness and anxiety to an indifferent attitude towards life. CONCLUSION: This study showed that the process of receiving a new liver and living with it, had changed most of the participants' attitudes towards life in a humble way. Some persons struggled with life and experienced depression anxiety, as well as lack of energy.

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Aims: A family history of coronary heart disease increases one's own risk of experiencing cardiovascular disease and death. An implication of the hereditary nature of the disease is that individuals are provided information about their own risk when a parent is affected, potentially leading them to engage in behaviors that reduce their own risk. In this study, we assessed how a 10-year risk of a cardiovascular event, measured by SCORE, changes for the offspring in response to a parent experiencing a myocardial infarction. Methods: We analyzed 19,995 individuals from the general population in the Copenhagen City Heart Study of whom 2,071 had a parent, who suffered from a myocardial infarction during four decades of observation using fixed-effects regressions. Results: Following a parental myocardial infarction, individuals reduced their 10-year risk by 0.16 percentage points constituting a 7.1% reduction of baseline risk. Male participants had the largest change in the risk SCORE following an event of the mother, with a 12.4% reduction from the baseline risk. The degree of response contingent on their own level of risk was found to be the largest for individuals with a 10-year risk between 5% and 10%, who also showed a reduction in systolic blood pressure following paternal myocardial infarction. Parental myocardial infarction was associated with an increased smoking rate in individuals with a baseline risk above 10%, while reductions in risk were seen for individuals with a lower baseline risk. Conclusion: Following a parental event, individuals reduced their 10-year risk with the largest reductions in their own risk, as observed in men and individuals experiencing a maternal event. The response was the largest for individuals with a 10-year risk for myocardial infarction between 5 and 10%.

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Background Although most TKR surgeries are cemented, the interest in cementless TKR has increased dramatically during the last few years because of the new generation of cementless prostheses and the increased number of young patients who need TKR. Methods Ten years of retrospective reviews of 80 patients who had cementless, complete rotating platform TKR (DePuy Synthes, Warsaw, Indiana) were performed. Patients were divided into two groups according to their age (above and below 70 years old). Functional outcomes at the final follow-up were evaluated clinically by filling out a satisfaction form, and the Oxford Knee Score as well as all medical and surgical complications were recorded for each patient. Results The 10-year cumulative implant survival rate was 100%, i.e. no patients had revision surgeries with no significant statistical difference between the two age groups. The 10-year evaluation rate was 90%. Conclusion The use of cementless TKA exhibited good survivability, long-term clinical and functional results, and no implant revision in various age groups, as well as a high satisfaction rate. There was no statistically significant difference between the results of different age groups.

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Background and Purpose: The aim of our study is to assess the long-term outcomes and safety of bipolar transurethral plasma enucleation of the prostate (B-TUEP) in patients with lower urinary tract symptoms (LUTS) in a single-center cohort study. Our focus is to evaluate the impact on outcomes after 10 years of follow-up (FUP) in terms of recurrence, LUTS, and patients' quality of life after B-TUEP in prostates between 30 and 80 cc. Materials and Methods: Between May 2010 and December 2011, all consecutive patients with benign prostatic hyperplasia undergoing B-TUEP were prospectively enrolled in our study. Data on patients' history, physical examination, prostate volumes, erectile function, prostate-specific antigen levels, International Prostate Symptoms Score (IPSS), and uroflowmetry were collected at 0, 1, 3, 6, 12, 24, 36, 60, and 120 months. Early and long-term complications were recorded. Results: A total of 50 consecutive patients underwent B-TUEP in our facility, all performed by a single surgeon (R.G.). Twelve patients were excluded during the 10 years. No patients had persistent bladder outlet obstruction (BOO) requiring reoperation. In terms of results, the improvement in IPSS was sustained throughout 5 years, and the mean difference from baseline at 5 years was 17 points, with similar results at 10 years. Erectile function was also slightly improved after surgery and maintained for the next 5 years, with a slight age-related decrease at 10 years. Furthermore, the improvements in maximum urine flow rate (Qmax) were maintained at 5 years, with a mean improvement of 16 mL/s, while at 10 years, it settled on a mean improvement from baseline of 12 mL/s. Conclusions: In our 10 years' experience, B-TUEP is a safe and highly effective technique for relieving BOO, with excellent outcomes and no recurrence at 10 years of FUP. Further multicenter studies should confirm our results.

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BACKGROUND AND PURPOSE: The aim was to investigate the effect of modifiable vascular risk factors on the risk of first and recurrent bleeding for patients with a cavernous malformation (CM) of the central nervous system (CNS) over a 10-year period. METHODS: A retrospective review of our CM institutional database was performed spanning from 2003 to 2021. The inclusion criteria were non-missing serial magnetic resonance imaging studies and clinical baseline metrics such as vascular risk factors. The exclusion criteria were patients who underwent surgical CM removal and patients with less than a decade of follow-up. Kaplan-Meier and Cox regression analyses were performed to determine the cumulative risk (10 years) of hemorrhage. RESULTS: Eighty-nine patients with a CM of the CNS were included. Our results showed a non-significant increased risk of hemorrhage during 10 years of follow-up in patients using nicotine (hazard ratio 2.11, 95% confidence interval 0.86-5.21) and in patients with diabetes (hazard ratio 3.25, 95% confidence interval 0.71-14.81). For the presence of modifiable vascular risk factors at study baseline different cumulative 10-year risks of bleeding were observed: arterial hypertension 42.9% (18.8%-70.4%); diabetes 66.7% (12.5%-98.2%); hyperlipidemia 30% (8.1%-64.6%); active nicotine abuse 50% (24.1%-76%); and obesity 22.2% (4%-59.8%). Overall cumulative (10-year) hemorrhage risk was 30.3% (21.3%-41.1%). CONCLUSIONS: The probability of hemorrhage in untreated CNS CM patients increases progressively within a decade of follow-up. None of the modifiable vascular risk factors showed strong indication for an influence on hemorrhage risk, but our findings may suggest a more aggressive course in patients with active nicotine abuse or suffering from diabetes.

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BACKGROUND: Complex surgical resection and reconstruction for rare thoracic cancers (RTCs) represent a major challenge, given their very low frequency, extreme variability of presentation, multi-modality treatment options and inadequate outcome prediction. We analysed the experience of a tertiary referral centre on a consecutive series of patients with thoracic germ cell tumours, thymomas and sarcomas, with the aim of reporting the long-term outcome by cancer type and complexity of surgical procedures. METHODS: From Jan 2003 to Dec 2018, 768 surgical procedures were performed with curative intent on 644 RTC patients. Study endpoints were: post-operative hospital stay (Pod), 30-day and 90-day mortality, 5-year and 10-year overall survival (OS). Median follow-up of alive patients was 7.2 years. RESULTS: Median Pod was 7 days, with a 1.2% 30-day and 2.9% 90-day mortality. OS was 90.8% at one year, 74.2% at five years and 62.8% at 10 years. Ten-year OS was 73.0% in low, 65.3% in intermediate, and 55.6% in high complexity score (Log-rank tests p<0.0001); 66.6% in patients with one or two reconstructions and 46.4% in patients with three or more reconstructions (p<0.0001); 46.0% with vascular and 50.0% with chest wall reconstruction; 71.8% in germ cell tumours, 64.6% in thymoma and 51.3% in sarcoma (p<0.0001). CONCLUSION: Complex surgical resection and reconstruction was associated with acceptable 90-day mortality and good 10-year survival in all RTC types. A predictive score based on surgical complexity and cancer type can help the clinical decision making.

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BACKGROUND: In the United Arab Emirates (UAE), cardiovascular diseases (CVDs) are the leading cause of mortality, and the incidence of premature coronary heart diseases (CHDs) is about 10-15 years earlier than that in people of western countries. AIM: The current cross-sectional study aims to describe the prevalence of CVD risk factors and estimate the 10-years risk for CHDs in the population of Abu Dhabi, UAE. OBJECTIVE: The main objective was to report the 10-years risk for CHD in a sample of the UAE population. METHODS: We have analyzed the dataset from the Abu Dhabi Screening Program for Cardiovascular Risk Markers (AD-SALAMA), a population-based cross-sectional survey conducted between 2009 and 2015 (a sample of 1002, 20 to 79 years old without CVDs or diabetes). RESULTS: 18.0% of our sample have had hypertension (HTN), 26.3% were current smokers, 33% have had total cholesterol ≥200 mg/dL, 55.0% have had non-high-density lipoprotein (non-HDL) levels ≥130 mg/dL, 33.1% have had low-density lipoprotein cholesterol (LDL-C) levels ≥130 mg/dL, calculated by ß-quantification as 112.3 ± 47.1 mg/dL. 66.8% were overweight or obese, and 46.2% had a sedentary lifestyle. Nearly 85% of our sample has had one or more major cardiovascular risk factors. The estimated 10-year risk of cardiovascular disease according to different risk assessment tools was as follows: 7.1% according to the national cholesterol education program Framingham risk score (FRAM-ATP), 2.9% according to Pooled Cohort Risk Assessment Equation (PCRAE) , 1.4% according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and 1.1% according to Reynolds Risk Score. Despite the fact that our sample population have had exhibited major risk factors, the above-mentioned international scoring systems underestimate the 10-year risk of cardiovascular diseases, given the high prevalence at younger ages. CONCLUSION: The proportion of modifiable risk factors has been found to be high in the UAE population, and the majority of them have had one or more risk factors with a higher 10-years risk for CHDs.

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PURPOSE: Consensus and uncertainty in early onset scoliosis (EOS) treatment were evaluated in 2010. It is currently unknown how treatment preferences have evolved over the past decade. The purpose of this study was to re-evaluate consensus and uncertainty among treatment options for EOS patients to understand how they compare to 10 years ago. METHODS: 11 pediatric spinal surgeons (similar participants as in 2010) were invited to complete a survey of 315 idiopathic and neuromuscular EOS cases (same cases as in 2010). Treatment options included the following: conservative management, distraction-based methods, growth guidance/modulation, and arthrodesis. Consensus was defined as ≥ 70% agreement, and uncertainty was < 70%. Associations between case characteristics and consensus for treatments were assessed via chi-squared and multiple regression analyses. Case characteristics associated with uncertainty were described. RESULTS: Eleven surgeons [31.7 ± 7.8 years of experience] in the original 2010 cohort completed the survey. Consensus for conservative management was found in idiopathic patients aged ≤ 3, whereas in 2010, some of these cases were selected for surgery. There is currently consensus for casting idiopathic patients aged 1 or 2 with moderate curves, whereas in 2010, there was uncertainty between casting and bracing. Among neuromuscular cases with consensus for surgery, arthrodesis was chosen for patients aged 9 with larger curves. CONCLUSION: Presently, preferences for conservative management have increased in comparison to 2010, and casting appears to be preferred over bracing in select infantile cases. Future research efforts with higher levels-of-evidence should be devoted to elucidate the areas of uncertainty to improve care in the EOS population. LEVEL OF EVIDENCE: Level V.

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In the Netherlands, the avian influenza outbreak in poultry in 2003 and the Q fever outbreak in dairy goats between 2007 and 2010 had severe consequences for public health. These outbreaks led to the establishment of an integrated human-veterinary risk analysis system for zoonoses, the Zoonoses Structure. The aim of the Zoonoses Structure is to signal, assess and control emerging zoonoses that may pose a risk to animal and/or human health in an integrated One Health approach. The Signalling Forum Zoonoses (SO-Z), the first step of the Zoonoses Structure, is a multidisciplinary committee composed of experts from the medical, veterinary, entomology and wildlife domains. The SO-Z shares relevant signals with professionals and has monthly meetings. Over the past 10 years (June 2011 to December 2021), 390 different signals of various zoonotic pathogens in animal reservoirs and humans have been assessed. Here, we describe the Zoonoses Structure with examples from signals and responses for four zoonotic events in the Netherlands (tularaemia, Brucella canis, West Nile virus, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)). This may serve as an example for other countries on how to collaborate in a One Health approach to signal and control emerging zoonoses.

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Type 1 pseudohypoaldosteronism (PHA-1) is a rare genetic syndrome of unresponsiveness to aldosterone and presents in the neonatal period with hyperkalemia, hyponatremia and metabolic acidosis. The mortality rate can be high and multidisciplinary team is needed for optimal management and adequate growth and development of these patients. Many genotype-phenotype correlations remain uncertain, and the description of the evolution of cases can increase scientific knowledge about the psychomotor development and severity of the different mutations. We report the follow-up for the last 10 years of a patient, with previously unrecognized genetic findings identified. In addition, we reviewed the literature and compared it with other pediatric cases.

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BACKGROUND: Health literacy (HL) enables a person to make good decisions regarding health care, disease prevention, and health promotion to maintain and improve health. In Thailand, most existing studies focus on adults' HL rather than children. This research aimed to determine the influence of sociocultural and health knowledge on HL among children ages 9-10 years in Thailand. MATERIALS AND METHODS: A cross-sectional study was conducted among 1650 children aged 9-10 years. The respondents were recruited using multistage random sampling from 39 primary schools of 13 provinces in all four regions of Thailand. A self-administered structured questionnaire was used to collect the required data. The multilevel analysis was used to determine the association between sociocultural, health knowledge, and HL while controlling the effects of covariates. The result was presented as adjusted odd ratios and its 95% confidence interval (CI). RESULTS: Of the total 1650 respondents, 86.24% (95% CI: 84.49%-87.82%) had adequate and excellent levels of HL. The multivariable analysis indicated factors that were significantly associated with adequate and excellent levels HL including adequacy of per diem (adjusted odds ratio [adj. OR] = 6.78; 95% CI: 3.54-12.97) and had good relationship with teachers (adj. OR = 2.19; 95% CI: 1.55-3.09). Sources of health education which were received health education from parents (adj. OR = 3.51; 95% CI: 2.39-5.14), from teachers (adj. OR = 2.03; 95% CI: 1.43-2.89), and from the Internet (adj. OR = 1.83; 95% CI: 1.12-2.99) were also significantly associated with HL. Another significant factor was had good level of health knowledge (adj. OR = 1.86; 95% CI: 1.30-2.66) when control clustering effect of region, provinces, school, and classroom size. CONCLUSIONS: More than 85% of children ages 9-10 years in Thailand had adequate and excellence levels of HL. Sociocultural and health knowledge had influence on children HL.

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Canine vector-borne pathogens (CVBPs) represent a challenge for veterinary transfusion medicine, since some can be transmitted by blood transfusion and are of zoonotic concern. Epidemiological data on CVBPs, obtained during 10 years of pre-donor screening (2012−2021) by a veterinary blood bank in central Italy, were used to conduct a retrospective epidemiological longitudinal survey. The results were obtained using the Immunofluorescent Antibody Test (IFAT) conducted on sera in order to assess IgG antibodies against Leishmania infantum, Ehrlichia canis, Anaplasma phagocythophilum, Babesia canis, and Rickettsia conorii; the modified Knott's test and an ELISA kit were used to detect Dirofilaria immitis and Dirofilaria repens. In total, 324 out of the 1260 canine blood donors (25.71%) tested seropositive for at least one pathogen. The highest overall positive rate was detected for L. infantum (12.22%), followed by E. canis (2.30%), A. phagocytophilum (1.19%), D. repens (0.95%), D. immitis (0.32%), and B. canis (0.16%). From 2012 to 2014, a prevalence of 20.12% was recorded for R. conorii. Mixed infections were recorded in 21 dogs. For all the CVBPs investigated, significant differences (p < 0.05) were not observed over the period studied. The results evidenced a non-negligible prevalence of CVBPs in canine donors, which were selected based on strict criteria concerning regular endo- and ectoparasite controls. The results confirmed that the blood bank could be a reliable local epidemiological observatory. The need for implemented screening is discussed.

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El sobrepeso es una condición de salud limitante para el desempeño humano, esto se debe a las complicaciones de salud que derivan o están asociadas a esta condición tales como: Insulinorresistencia, Diabetes mellitus tipo 2, enfermedades cardiovasculares, complicaciones ortopédicas y de índole traumatológicas, así como afecciones de tipo psicosociales. El sobrepeso fue considerado por la Organización Mundial de la Salud (OMS) como una epidemia mundial, emergente, de efectos inmediatos en la población infantil y es a su vez estimado en el área de salud pública por tener las implicaciones anteriormente descritas. Objetivo: Describir los factores que influyen en el sobrepeso de los escolares de 5 a 10 años. Materiales y métodos: Estudio tipo cualitativo, con una metodología descriptiva, donde se recopila información bibliográfica de publicaciones vía web y artículos científicos, relevante con el tema en estudio. Las etapas de elaboración del estudio contemplan, lectura y revisión de la información reciente, análisis del contenido, organización y resumen y redacción para plasmar una perspectiva de la situación con transcriptores relacionados con las palabras claves: sobrepeso, escolares entre 5-10 años. Conclusiones: Un número importante de la población infantil está siendo afectada por el sobrepeso y la obesidad, lo que se traduce en adultos con sobrepeso y obesidad si no son corregidos los hábitos alimenticios y la conducta ante los estilos de vida. Tener en consideración y abordar los aspectos relacionados con este tema es de vital importancia debido a que constituye un grave problema de salud a nivel mundial y sus implicaciones de salud en el transcurso de la vida, donde el persona se afecta por la condición de salud generada, que en la mayoría de los casos crea individuos con discapacidades o disfuncionales(AU)

Overweight is a limiting health condition for human performance, this is due to health complications that derive or are associated with this condition such as: insulin resistance, type 2 diabetes mellitus, cardiovascular diseases, orthopedic and trauma complications. as well as psychosocial conditions. Overweight was considered by the World Health Organization (WHO) as a global, emerging epidemic with immediate effects on the child population and is in turn estimated in the area of public health for having the implications described above. Objective: To describe the factors that influence overweight in schoolchildren aged 5 to 10 years. Materials and methods: Qualitative type study, with a descriptive methodology, where bibliographic information of publications via the web and scientific articles, relevant to the subject under study, is collected. The stages of elaboration of the study contemplate, reading and review of recent information, content analysis, organization and summary and writing to capture a perspective of the situation with transcriptionists related to the keywords: overweight, schoolchildren between 5-10 years. Conclusions: A significant number of the child population is being affected by overweight and obesity, which translates into overweight and obese adults if eating habits and behavior towards lifestyles are not corrected. Taking into consideration and addressing the aspects related to this issue is of vital importance because it constitutes a serious health problem worldwide and its health implications throughout life, where the person is affected by the health condition generated, which in most cases creates disabled or dysfunctional individuals(AU)

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BACKGROUND: Previous studies have found a negative effect of depression and insomnia on the psychological health domain of quality of life (QOL) among earthquake survivors. However, little is known about the symptom-to-symptom interactions among the above psychological outcomes. This study thus aimed to assess the interplay among the above three variables in survivors 10 years after the Wenchuan earthquake at the symptom level. METHODS: A total of 744 survivors completed the questionnaire at 10 years post-earthquake, reporting depressive symptoms, insomnia symptoms, and the psychological health domain of QOL. All network structures were estimated and compared using the network analysis approach in R version 4.1.1. RESULTS: Among the 744 survivors, 593 individuals did not have significant depressive and insomnia symptoms, while 151 individuals reported depressive and/or insomnia symptoms. "Little energy", "Suicidal ideation", and "Spirituality" were the key highest bridge symptoms in the three networks, respectively. Additionally, there were significant differences in network global strength, network structure, and individual edge weights between individuals with and without depression and/or insomnia. CONCLUSIONS: Intervention programs aimed at treating symptoms, such as exercise therapy, cognitive behavioural therapy, and spirituality education, may improve the QOL of survivors following an earthquake.

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