Explore the vast range of titles available.

Introduction This study applies a novel algorithm to longitudinal amyloid positron emission tomography (PET) imaging to identify age‐heterogeneous amyloid trajectory groups, estimate the age and duration (chronicity) of amyloid positivity, and investigate chronicity in relation to cognitive decline and tau burden. Methods Cognitively unimpaired participants (n = 257) underwent one to four amyloid PET scans (Pittsburgh Compound B, PiB). Group‐based trajectory modeling was applied to participants with longitudinal scans (n = 171) to identify and model amyloid trajectory groups, which were combined with Bayes theorem to estimate age and chronicity of amyloid positivity. Relationships between chronicity, cognition, clinical progression, and tau PET (MK‐6240) were investigated using regression models. Results Chronicity explained more heterogeneity in amyloid burden than age and binary amyloid status. Chronicity was associated with faster cognitive decline, increased risk of abnormal cognition, and higher entorhinal tau. Discussion Amyloid chronicity provides unique information about cognitive decline and neurofibrillary tangle development and may be useful to investigate preclinical Alzheimer's disease.

Objective The objective of the study was to characterize the longitudinal, dynamic intracranial pressure (ICP) trajectory in acute brain injury (ABI) patients admitted to intensive care unit (ICU) and explore whether it added sights over traditional thresholds in predicting outcomes. Methods ABI patients with ICP monitoring were identified from two public databases named Medical Information Mart for the Intensive Care (MIMIC)‐IV and eICU Collaborative Research Database (eICU‐CRD). Group‐based trajectory modeling (GBTM) was employed to identify 4‐h ICP trajectories in days 0–5 post‐ICU admission. Then, logistic regression was used to compare clinical outcomes across distinct groups. To further validate previously reported thresholds, we created the receiver operating characteristic (ROC) curve in our dataset. Results A total of 810 eligible patients were ultimately enrolled in the study. GBTM analyses generated 6 distinct ICP trajectories, differing in the initial ICP, evolution pattern, and number/proportion of spikes >20/22 mmHg. Compared with patients in “the highest, declined then rose” trajectory, those belonging to the “lowest, stable,” “low, stable,” and “medium, stable” ICP trajectories were at lower risks of 30‐day mortality (odds ratio [OR] 0.04; 95% confidence interval [CI] 0.01, 0.21), (OR 0.04; 95% CI 0.01, 0.19), (OR 0.08; 95% CI 0.01, 0.42), respectively. ROC analysis demonstrated an unfavorable result, for example, 30‐day mortality in total cohort: an area under the curve (AUC): 0.528, sensitivity: 0.11, and specificity: 0.94. Conclusions This study identified three ICP trajectories associated with elevated risk, three with reduced risks for mortality during ICU hospitalization. Notably, a fixed ICP threshold should not be applied to all kinds of patients. GBTM, a granular method for describing ICP evolution and their association with clinical outcomes, may add to the current knowledge in intracranial hypertension treatment. To summarize, a novel ICP trajectory that could enable us to move the treatment of ABI from a fixed threshold approach to a more individualized treatment was proposed. ICP values and variability differed across these six identified trajectory groups with favorable vs. unfavorable outcomes. The epidemiological shift toward a larger proportion of physiologically fragile elderly patients calls for more attention.

Trajectory modelling techniques have been developed to determine subgroups within a given population and are increasingly used to better understand intra- and inter-individual variability in health outcome patterns over time. The objectives of this narrative review are to explore various trajectory modelling approaches useful to epidemiological research and give an overview of their applications and differences. Guidance for reporting on the results of trajectory modelling is also covered. Trajectory modelling techniques reviewed include latent class modelling approaches, ie, growth mixture modelling (GMM), group-based trajectory modelling (GBTM), latent class analysis (LCA), and latent transition analysis (LTA). A parallel is drawn to other individual-centered statistical approaches such as cluster analysis (CA) and sequence analysis (SA). Depending on the research question and type of data, a number of approaches can be used for trajectory modelling of health outcomes measured in longitudinal studies. However, the various terms to designate latent class modelling approaches (GMM, GBTM, LTA, LCA) are used inconsistently and often interchangeably in the available scientific literature. Improved consistency in the terminology and reporting guidelines have the potential to increase researchers' efficiency when it comes to choosing the most appropriate technique that best suits their research questions.

ObjectiveTo identify the evolution trajectory of systolic pulmonary artery pressure (sPAP) in patients with systemic lupus erythematosus-related pulmonary arterial hypertension (SLE-PAH) and to evaluate its prognostic significance.MethodIn this study, 81 SLE-PAH patients from the Chinese SLE Treatment and Research Group-Pulmonary Arterial Hypertension (CSTAR-PAH) cohort of the Second Affiliated Hospital of Nanchang University were included for a retrospective cohort study. A group-based trajectory model was used to identify the trajectories of sPAP over time. Baseline factors related to trajectory assignment were analyzed through multiple logistic regression. Univariate and multivariate Cox regression and Kaplan–Meier analysis were used to evaluate the prognostic value of trajectory groups for all-cause mortality, and to analyze the related influencing factors of all-cause mortality.ResultsFour distinct sPAP trajectories were identified: trajectory 1 (n = 17, 20.9%; high initial sPAP with rapid decrease), trajectory 2 (n = 44, 54.3%; moderate initial sPAP with slow decrease), trajectory 3 (n = 13, 16.0%; low initial sPAP with slow decrease), and trajectory 4 (n = 7, 8.6%; high initial sPAP with rapid increase). Longer 6-minute walking distance (6MWD) was independently associated with trajectories 2 (OR = 3.077, p < 0.001) and 3 (OR = 11.106, p < 0.001), whereas shorter 6MWD (OR = 0.220, p < 0.001), elevated B-type natriuretic peptide (OR = 2.159, p < 0.001), higher IL-1β (OR = 1.412, p < 0.001), higher TNF-α (OR = 1.751, p < 0.001), and higher mean pulmonary artery pressure (OR = 1.067, p < 0.001) independently predicted trajectory 4 membership. During follow-up, trajectory 4 remained a strong independent predictor of mortality (HR = 8.843, p = 0.037) after multivariable adjustment, together with higher systemic lupus erythematosus disease activity index (HR = 1.502, p = 0.032), elevated IL-6 (HR = 1.031, p=0.029), higher systemic inflammation response index (HR = 1.828, p = 0.019), and shorter 6MWD (HR = 0.795, p = 0.028). Patients in trajectory 4 exhibited significantly worse survival (log-rank p < 0.0001).ConclusionsPAP trajectories capture clinically meaningful heterogeneity in SLE-PAH, with the rapid−progression trajectory identifying a high−risk phenotype characterized by pronounced inflammation, right ventricular strain, and functional compromise. Trajectory−based phenotyping enhances risk stratification and may guide personalized management in SLE-PAH.

Background Adolescent depression prevention research has focused on mean intervention outcomes, but has not considered heterogeneity in symptom course. Here, we empirically identify subgroups with distinct trajectories of depressive symptom change among adolescents enrolled in two indicated depression prevention trials and examine how cognitive‐behavioral (CB) interventions and baseline predictors relate to trajectory membership. Methods Six hundred thirty‐one participants were assigned to one of three conditions: CB group intervention, CB bibliotherapy, and brochure control. We used group‐based trajectory modeling to identify trajectories of depressive symptoms from pretest to 2‐year follow‐up. We examined associations between class membership and conditions using chi‐square tests and baseline predictors using multinomial regressions. Results We identified four trajectories in the full sample. Qualitatively similar trajectories were found in each condition separately. Two trajectories of positive symptom course (low‐declining, high‐declining) had declining symptoms and were distinguished by baseline symptom severity. Two trajectories of negative course (high‐persistent, resurging), respectively, showed no decline in symptoms or decline followed by symptom reappearance. Participants in the brochure control condition were significantly more likely to populate the high‐persistent trajectory relative to either CB condition and were significantly less likely to populate the low‐declining trajectory relative to CB group. Several baseline factors predicted trajectory classes, but gender was the most informative prognostic factor, with males having increased odds of membership in a high‐persistent trajectory relative to other trajectories. Conclusions Findings suggest that CB preventive interventions do not alter the nature of trajectories, but reduce the risk that adolescents follow a trajectory of chronically elevated symptoms.

Purpose With housing costs increasing faster than incomes and a limited supply of social housing options, many households face unaffordable housing. Housing affordability problems may negatively impact mental health; however, longitudinal evidence is limited. This study investigates the association between trajectories of housing affordability problems and mental health. Methods We used data from 30,025 households from Understanding Society, a longitudinal household survey from the UK. Participants spending 30% or more of household income on housing were categorised as facing housing affordability problems. We estimated group-based trajectories of housing affordability problems from 9 waves of data (2009–2019). We used linear regression to calculate the association between the trajectories and mental health problems, as measured by General Health Questionnaire (GHQ) score in Wave 10 (2018–2020). Results We found six distinct trajectories of housing affordability problems. Those in the ‘stable low’ group had a consistently low probability of affordability problems, whilst those in ‘high falling’ group had a sustained high probability in the earlier waves of the study, subsequently decreasing over time. The adjusted analysis showed that trajectory group membership over the first nine waves of data predicted GHQ score in 2018–2020 (Wave 10). Compared to the ‘stable low’ group, those in the ‘high falling’ group had a GHQ score that was 1.06 (95% CI 0.53–1.58) points higher. Conclusion This study provides evidence that sustained exposure to housing affordability problems is associated with long-term worse mental health, even in the absence of more recent problems.

There is increasing interest in modelling longitudinal dietary data and classifying individuals into subgroups (latent classes) who follow similar trajectories over time. These trajectories could identify population groups and time points amenable to dietary interventions. This paper aimed to provide a comparison and overview of two latent class methods: group-based trajectory modelling (GBTM) and growth mixture modelling (GMM). Data from 2963 mother–child dyads from the longitudinal Southampton Women’s Survey were analysed. Continuous diet quality indices (DQI) were derived using principal component analysis from interviewer-administered FFQ collected in mothers pre-pregnancy, at 11- and 34-week gestation, and in offspring at 6 and 12 months and 3, 6–7 and 8–9 years. A forward modelling approach from 1 to 6 classes was used to identify the optimal number of DQI latent classes. Models were assessed using the Akaike and Bayesian information criteria, probability of class assignment, ratio of the odds of correct classification, group membership and entropy. Both methods suggested that five classes were optimal, with a strong correlation (Spearman’s = 0·98) between class assignment for the two methods. The dietary trajectories were categorised as stable with horizontal lines and were defined as poor (GMM = 4 % and GBTM = 5 %), poor-medium (23 %, 23 %), medium (39 %, 39 %), medium-better (27 %, 28 %) and best (7 %, 6 %). Both GBTM and GMM are suitable for identifying dietary trajectories. GBTM is recommended as it is computationally less intensive, but results could be confirmed using GMM. The stability of the diet quality trajectories from pre-pregnancy underlines the importance of promotion of dietary improvements from preconception onwards.

BackgroundNew-onset diabetes is the most common sequela of acute pancreatitis (AP). Yet, prospective changes in glycaemia over time have never been investigated comprehensively in this study population. The primary aim was to determine the cumulative incidence of new-onset prediabetes and new-onset diabetes after AP over 24 months of follow-up in a prospective cohort study. The secondary aim was to identify trajectories of glycaemia during follow-up and their predictors at the time of hospitalisation.MethodsPatients with a prospective diagnosis of AP and no diabetes based on the American Diabetes Association criteria were followed up every 6 months up to 24 months after hospital discharge. Incidence of new-onset prediabetes/diabetes over each follow-up period was calculated. Group-based trajectory modelling was used to identify common changes in glycaemia. Multinomial regression analyses were conducted to investigate the associations between a wide array of routinely available demographic, anthropometric, laboratory, imaging, and clinical factors and membership in the trajectory groups.ResultsA total of 152 patients without diabetes were followed up. The cumulative incidence of new-onset prediabetes and diabetes was 20% at 6 months after hospitalisation and 43% over 24 months of follow-up (p trend < 0.001). Three discrete trajectories of glycaemia were identified: normal-stable glycaemia (32%), moderate-stable glycaemia (60%), and high-increasing glycaemia (8%). Waist circumference was a significant predictor of moderate-stable glycaemia. None of the studied predictors were significantly associated with high-increasing glycaemia.ConclusionsThis first prospective cohort study of changes in glycaemia (determined at structured time points in unselected AP patients) showed that at least one out of five patients develops new-onset prediabetes or diabetes at 6 months of follow-up and more than four out of ten—in the first 2 years. Changes in glycaemia after AP follow three discrete trajectories. This may inform prevention or early detection of critical changes in blood glucose metabolism following an attack of AP and, hence, reduce the burden of new-onset diabetes after acute pancreatitis.

Studies on the association between anemia and postpartum hemorrhage (PPH) mostly use the hemoglobin (Hb) levels in a single trimester, thereby failing to capture the dynamic changes of Hb levels during pregnancy. This study aims to assess the trajectories of Hb during pregnancy and evaluate their association with PPH. The study population consisted of 4296 women who gave birth in a tertiary hospital after 28 weeks of gestation between January 2024 and February 2025. Group-based trajectory modelling was used to identify hemoglobin trajectories. Logistic regression models were applied for evaluating the associations between hemoglobin trajectories and PPH. Three trajectories of maternal Hb were identified. In trajectory 1 (decline-stable, 20.41%), maternal Hb levels were higher than those in trajectory 2 in the first trimester, and rapidly declined across pregnancy with the lowest point at 35 weeks. In trajectory 2 (decline-rise, 73.16%), maternal Hb decreased during the first and second trimesters, and slightly increased during the third trimester. In trajectory 3 (stable-rise, 6.42%), maternal Hb remained stable in early and mid-pregnancy and increased in late pregnancy. Compared with trajectory 2, trajectory 1 was associated with a 2.36-fold higher risk of PPH (95% CI: 1.59-3.47), while trajectory 3 showed no significant association (OR: 0.79, 95% CI: 0.27-1.81), after adjustment. The area under the receiver operating characteristic curve was 0.74 (95% CI: 0.70-0.79). Compared with women with Hb ≥116 g/L at 28-32 weeks, women with Hb <116 g/L had a 1.64-fold higher risk of PPH (95% CI: 1.08-2.52). Women who are not anemic in early pregnancy but experience a rapid decline in Hb during pregnancy, especially those with Hb <116 g/L in the early third trimester, are at high risk for PPH.

OBJECTIVES: While psychosocial working conditions have been associated with morbidity, their associations with mortality, especially cause-specific mortality, have been less studied. Additionally, few studies considered the time-varying aspect of exposures. We aimed to examine trajectories of job demand–control status in relation to all-cause and cause-specific mortality, including cardiovascular diseases (CVD), suicide, and alcohol-related mortality. METHODS: The study population consisted of around 4.5 million individuals aged 16-60 years in Sweden in 2005. Job control and demands were respectively measured using job exposure matrices (JEM). Trajectories of job control and demands throughout 2005–2009 were identified using group-based trajectory modelling, and job demand–control categories were subsequently classified. Deaths in 2010–2019 were recorded in the national cause of death register. Cox regression models were used. RESULTS: A total of 116 242 individuals died in 2010–2019. For both job control and demands, we identified four trajectories, which were parallel to each other and represented four levels of exposures. Low control and passive jobs were associated with higher all-cause, CVD, and suicide mortality among both men and women. High strain jobs were associated with higher all-cause and CVD mortality among men, while low control, passive jobs, and high strain jobs were associated with higher alcohol-related mortality among women. CONCLUSIONS: The trajectories identified may suggest stable levels of job control and demands over time. Poor psychosocial working conditions are related to all-cause and cause-specific mortality, and these patterns vary to some extent between men and women.