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Background Multimorbidity, characterised by the coexistence of multiple chronic conditions in an individual, is a rising public health concern. While much of the existing research has focused on cross-sectional patterns of multimorbidity, there remains a need to better understand the longitudinal accumulation of diseases. This includes examining the associations between important sociodemographic characteristics and the rate of progression of chronic conditions. Methods and findings We utilised electronic primary care records from 13.48 million participants in England, drawn from the Clinical Practice Research Datalink (CPRD Aurum), spanning from 2005 to 2020 with a median follow-up of 4.71 years (IQR: 1.78, 11.28). The study focused on 5 important chronic conditions: cardiovascular disease (CVD), type 2 diabetes (T2D), chronic kidney disease (CKD), heart failure (HF), and mental health (MH) conditions. Key sociodemographic characteristics considered include ethnicity, social and material deprivation, gender, and age. We employed a flexible spline-based parametric multistate model to investigate the associations between these sociodemographic characteristics and the rate of different disease transitions throughout multimorbidity development. Our findings reveal distinct association patterns across different disease transition types. Deprivation, gender, and age generally demonstrated stronger associations with disease diagnosis compared to ethnic group differences. Notably, the impact of these factors tended to attenuate with an increase in the number of preexisting conditions, especially for deprivation, gender, and age. For example, the hazard ratio (HR) (95% CI; p-value) for the association of deprivation with T2D diagnosis (comparing the most deprived quintile to the least deprived) is 1.76 ([1.74, 1.78]; p < 0.001) for those with no preexisting conditions and decreases to 0.95 ([0.75, 1.21]; p = 0.69) with 4 preexisting conditions. Furthermore, the impact of deprivation, gender, and age was typically more pronounced when transitioning from an MH condition. For instance, the HR (95% CI; p-value) for the association of deprivation with T2D diagnosis when transitioning from MH is 2.03 ([1.95, 2.12], p < 0.001), compared to transitions from CVD 1.50 ([1.43, 1.58], p < 0.001), CKD 1.37 ([1.30, 1.44], p < 0.001), and HF 1.55 ([1.34, 1.79], p < 0.001). A primary limitation of our study is that potential diagnostic inaccuracies in primary care records, such as underdiagnosis, overdiagnosis, or ascertainment bias of chronic conditions, could influence our results. Conclusions Our results indicate that early phases of multimorbidity development could warrant increased attention. The potential importance of earlier detection and intervention of chronic conditions is underscored, particularly for MH conditions and higher-risk populations. These insights may have important implications for the management of multimorbidity., Author(s): Sida Chen 1,*, Tom Marshall 2, Christopher Jackson 1, Jennifer Cooper 2, Francesca Crowe 2, Krish Nirantharakumar 2, Catherine L. Saunders 3, Paul Kirk 1, Sylvia Richardson 1, Duncan [...]

Background: Tai Ji Quan (TJQ) has broad appeal to people of all ages and backgrounds. This study aimed to examine a variety of individual and environmental factors in the dissemination of TJQ to diverse practicing communities in China. Methods: A mixed-methods approach was utilized in the research design. Quantitative data were collected via an online survey using a national sample (N = 737), whereas qualitative data came from focus groups and in-depth interviews. Analysis was performed along the RE-AIM dimensions of reach, efficacy, adoption, implementation, and maintenance. Results: We divided TJQ experience into 4 distinct categories (nonlearners, current learners, quitters, and retainers) and observed significant patterns of variation along lines of occupation groups and age cohorts. A significant male/female difference was detected in TJQ experience among college students but not the general public, and having practicing family members was an important predictor of personal TJQ history. Varied TJQ experience has a significant impact on perceptions of TJQ's miscellaneous values as well as level of satisfaction with its health outcomes. Conclusions: Both individual (personal) and environmental (settings) factors are important in shaping personal decisions in TJQ engagement. An ecological approach coordinating individual factors and settings resources is essential in promoting TJQ to the general population. [ABSTRACT FROM AUTHOR]

This study aims to revealing the relationship among retained austenite (RA) morphology, deformation‐induced transformation (DIPT) behavior, and surface wear behavior. The hardening and fatigue behavior during wear of continuous film‐like RA (CFRA), blocky RA (BRA), discontinuous film‐like RA (DFRA), and point or flocculent RA (PRA) achieved through different tempering processes was investigated using quasi‐in situ fatigue test and impact abrasive wear test. RA morphology exhibited a significant influence on hardening and fatigue behavior during wear. CFRA exhibited the best wear properties, owing to its excellent fatigue performance and hardening capacity. The BRA displayed relative high wear performance, with adequate hardening capacity but weak fatigue performance. DFRA demonstrated comparable wear resistance to BRA because of better fatigue performance. PRA exhibited deficient wear performance because of insufficient fatigue properties and low work‐hardening ability. Highlights: Retained austenite with diverse morphology forms via varied tempering in bainitic steel.Fatigue experiment unveils austenite evolution during fatigue.Austenite morphology impacts wear via hardening and fatigue behavior. [ABSTRACT FROM AUTHOR]