Externalizing and internalizing behavioral problems occurs at a high rate among children. However, this has rarely been examined among Japanese children using a person-oriented method. Hence, this study aims to explore its subtypes and clarify their association with family-based group activities. We conducted a cross-sectional survey in a typical community-based suburban area for all families with primary school children in Japan. We investigated children’s internalizing and externalizing behaviors based on the Japanese version of the Strengths and Difficulties Questionnaire (SDQ), and different types of activities that family members frequently engaged in. Data from 206 families were collected and used for the analysis. The subtypes were explored using latent class analysis (LCA). The relationship between family activities and latent class membership was analyzed using a logistic regression model. Moreover, three latent class models and their probabilities were identified, namely, risk group (31.3%), moderate group (44.9%), and normal group (23.8%). Frequent family activities including play sports, traveling or hiking, watching TV and communicating, cooking or making a dessert, and doing housework, which were significantly related to the normal group. These results would add evidence to potential types of children’s behavioral problems and preventive childcare practices needed in the primary gate of families.

Strong relationship exists between loneliness and depression in older adults. However, the effect of multifaceted social relationships on the relationship between loneliness and depression has not been explored. The purpose of the current study was to find out how multifaceted social relationships affect the aforementioned processes. We investigated and evaluated the loneliness status, depression symptoms, social relationships, and demographic information of 1116 older adults aged ≥65 years living in rural Japan. The final 555 participants were included in the analysis. Statistical evidence showed a direct effect between loneliness and depression symptoms. Additionally, the mediation model found that social curiosity and participation acted as mediators between loneliness and depression symptoms. Further, independence and participation, independence, and feeling safe played a conditional moderating role in the model of loneliness–social curiosity–depression symptoms and loneliness–participation–depression symptoms, respectively. Interaction can be an individual moderator in the link between loneliness and depression symptoms without any mediator. The moderated mediation model suggests that social curiosity and participation could mediate the association between loneliness and depression symptoms. In this process, independence, participation, and feeling safe may act as moderators.

Purpose: This study aimed to explore the correlation of frailty status with disease characteristics and patient-reported outcomes (PROs) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and determine the sensitivity and specificity of modified COPD PRO scale (mCOPD-PRO) for detecting frailty. Patients and Methods: This cross-sectional study surveyed 315 inpatients with AECOPD from a tertiary hospital in China from August 2022 to June 2023. Patient frailty and PROs were assessed using the validated FRAIL scale and mCOPD-PRO, respectively. Spearman’s ρ was used to assess the relevance of lung disease indicators commonly used in clinical practice, and ordinal logistic regression analyses were used to identify the variables associated with frailty status. The validity of mCOPD-PRO in discriminating frail or non-frail individuals was determined using the receiver operating characteristic curve. Results: The participants (N=302, mean age 72.4± 9.1 years) were predominantly males (73.2%). Among them, 43 (14.3%) patients were not frail, whereas 123 (40.7%) and 136 (45.0%) patients were pre-frail and frail, respectively. The FRAIL scale was moderately correlated with the mCOPD-PRO scores (Spearman’s rank correlation coefficient [Rs]=0.52, P< 0.01) for all dimensions (Rs=0.43– 0.49, P< 0.01). Patients residing in rural areas (odds ratio [OR], 1.67; 95% confidence interval [95% CI], 1.01– 2.76) and with higher mCOPD-PRO scores (OR, 4.78; 95% CI, 2.75– 8.32) were more likely to be frail. Physically active patients (OR, 0.42; 95% CI, 0.21– 0.84) were less likely to be frail. In addition, mCOPD-PRO had good discriminate validity for detecting frailty (area under the curve=0.78), with a sensitivity and specificity of 84.6% and 60.8%, respectively. The optimal probability threshold for mCOPD-PRO was ≥ 1.52 points. Conclusion: In patients with AECOPD, frailty is closely related to PROs and disease characteristics. Additionally, the mCOPD-PRO score can distinguish well between frail and non-frail patients. Our findings provide support for interventions targeting frail populations with AECOPD. Plain Language Summary: Patients with chronic obstructive pulmonary disease often have concomitant frailty that may lead to disease deterioration such as acute exacerbations, hospital readmissions, disability, and premature death. Patient-reported outcomes are often used in clinical practice to measure patients’ disease characteristics and overall status. Whether patients’ frailty state is associated with patient-reported outcomes and if so, which factors are associated with frailty remain unclear. This study, conducted in China, examined their relationship as well as identified factors associated with frailty states. 302 hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease completed a questionnaire answering questions about disease severity, frailty state, anxiety, and depression. The findings suggest that people who live in rural areas, self-reported more severe overall conditions, and are physically inactive are more likely to be frail. Patient-reported outcomes can distinguish between frail and non-frail patients. Therefore, patient-reported outcomes can be used to assess the extent of frailty; early screening of AECOPD combined frailty population and implementation of interventions can help mitigate the adverse effects of frailty.

Purpose: Chronic obstructive pulmonary disease (COPD) exhibits heterogeneous symptom profiles across individuals. This study aimed to identify subgroups of patients with stable COPD according to physiological, psychological, and environmental symptoms; assess differences in their characteristics; and examine the association of symptom patterns with frailty. Patients and Methods: We analyzed data from the second wave of a cohort study involving patients with COPD reassessed 6 months after hospitalization for acute exacerbations. Frailty and patient-reported outcomes were measured using the FRAIL and Modified COPD–Patient-Reported Outcome (mCOPD–PRO) scales. Latent profile analysis identified subgroups based on mCOPD–PRO symptom patterns. Differences across symptom severity subgroups were assessed using post-hoc trend analyses and chi-square tests for trends. Multinomial logistic regression quantified the magnitude of differences between subgroups. The relationship between subgroups, clinical factors, and frailty was examined through linear regression. Results: Among 308 patients with stable COPD, three subgroups were identified: “low-symptom” (27.9%), “moderate-symptom” (51.3%), and “severe-symptom” (20.8%). Body mass index, Global Initiative for Chronic Obstructive Lung Disease stage (GOLD), COPD Assessment Test (CAT) score, modified Medical Research Council (mMRC) score, and physical activity exhibited significant linear trends across subgroups of increasing symptom severity. Frailty scores differed significantly: 0.50 ± 0.78 in the low-symptom group, 1.34 ± 0.96 in the moderate-symptom group, and 2.72 ± 0.95 in the severe-symptom group. Multivariate analysis identified severe-symptom group (β coefficient [β]=0.62, 95% confidence interval [CI]: 0.21– 1.03), rural residence (β=0.21, 95% CI: 0.04– 0.39), GOLD (β=0.23, 95% CI: 0.07– 0.39), mMRC (β=0.17, 95% CI: 0.03– 0.31), and CAT score (β=0.04, 95% CI: 0.02– 0.06) associated with frailty. Conclusion: Patients with stable COPD can be categorized based on patient-reported outcomes, with differences in demographic and disease characteristics across subgroups. Patients with severe COPD symptoms revealed higher levels of frailty compared to those with low symptoms. Plain Language Summary: Patients with chronic obstructive pulmonary disease (COPD) often experience a variety of symptoms, including physical, psychological, and environmental challenges, which may affect their health status and increase frailty risk. Patient-reported outcomes (PROs) are valuable tools in clinical practice that allow patients to report their symptoms and thus reflect on their health status. However, the relationship between distinct symptom patterns, sociodemographic and disease-related factors, and frailty among patients with stable COPD remains unclear. This study conducted in a large tertiary care institution in Sichuan Province of China, analyzed data from 308 patients with stable COPD who were evaluated six months after discharged from the hospital for acute exacerbations. Frailty was assessed by the FRAIL scale, and symptom patterns were measured through the Modified COPD Patient-Reported Outcome (mCOPD-PRO). Latent profile analysis identified three subgroups: “low-symptom”, “moderate-symptom”, and “severe-symptom”. The results of the study showed that the severe-symptom group had higher levels of frailty compared to the low-symptom group. Furthermore, patients in the severe-symptom group tend to be physically inactive and have poorer health characteristics, such as higher disease severity and symptom burden. These results emphasize the need for early screening and targeted interventions for patients with severe symptoms to mitigate frailty and its associated risks. By identifying symptom patterns and their relationship with frailty, this study highlights the importance of PROs in understanding patient experiences and guiding clinical strategies to improve care for patients with COPD.

The current study aimed to investigate the prevalence of pre-frailty and frailty for hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and to quantify their relationship with Activities of Daily Living (ADL) and length of hospitalization. We investigated frailty status, ADL ability, and length of hospitalization for 295 patients with AECOPD who were admitted to the respiratory department of a large tertiary care institution in Sichuan Province, China, between August 2022 and June 2023. Descriptive statistical methods were used to describe their demographic characteristics, frailty prevalence, ADL ability, and length of hospitalization. Following this, we developed two linear regression models to explore the cross-sectional association between different frailty statuses and ADL ability, as well as the longitudinal association between frailty status and length of hospitalization. Statistical evidence indicated that 39.3% and 46.1% of the patients exhibited pre-frailty and frailty, respectively. A multivariate linear regression model, which adjusted for significant variables, indicated that pre-frailty (coefficient [β] = 1.90, confidence interval [CI] = 0.76–3.04) and frailty (β = 2.02, CI = 0.84–3.20) were significantly associated with longer hospital stays, even in a fully adjusted model. Additionally, although pre-frailty (β = –4.79, CI = –8.98 to –0.60) and frailty (β = –4.48, CI = –8.81 to –0.15) were associated with worse ADL in a significant variable-adjusted model, the fully adjusted model indicated that no significant association was found between frailty and ADL. Patients with AECOPD have a high prevalence of pre-frailty and frailty. More frail patients tend to have longer hospitalizations, and pre-frailty is associated with poorer ADL. However, the association of frailty with ADL requires further validation.