The social restrictions resulting from the COVID-19 pandemic had a great impact on the routine of children and adolescents, with important consequences such as sleep, eating, and psychological/psychiatric disorders. Even though there are no studies on the subject, it is possible that these changes in habit and routine have also affected arterial stiffness (AS) in this population, which is an important predictor of cardiovascular risk. This study aimed to assess possible changes in AS, anthropometry, and quality of life (QoL) resulting from the COVID-19 pandemic in children and adolescents.A controlled observational cross-sectional study was performed with 193 children and adolescents aged 9 to 19 years, allocated into two groups: before the pandemic (BPG) and one year after the pandemic (APG), matched by age and sex. Cardiovascular parameters were measured non-invasively by brachial artery oscillometry with a portable device. The main AS indices evaluated were the augmentation index (AIx) and pulse wave velocity (PWV) derived from the aortic pulse wave. QoL was assessed using the Paediatric Quality of Life Inventory version 4.0 (PedsQL 4.0).Regarding QoL, the APG showed a worsening in emotional (p = 0.002) and school-related (p = 0.010) aspects. There was no statistically significant difference for most anthropometric parameters, except for the hip circumference, which was higher in the APG group (p < 0.001). The main predictor of AS in the paediatric population, AIx@75, was shown to be increased in the APG group (p < 0.001). Other cardiovascular parameters were also different, such as peripheral (p = 0.002) and central (p = 0.003) diastolic blood pressure, stroke volume (p = 0.010), and total vascular resistance (p = 0.002), which were shown to be decreased in the APG group, while the heart rate was increased (p < 0.001).Our results show that routine changes resulting from the period of social isolation increased cardiovascular risk in children and adolescents, evident by the increase in AIx@75, which is considered to be an important marker of cardiovascular risk in the paediatric population. The COVID-19 pandemic, which began in March 2020, is considered a global health crisis that, in addition to having resulted in millions of deaths, has had social and financial consequences for people around the world [According to data from the United Nations International Children’s Emergency Fund (UNICEF), approximately 2.34 billion children have been affected by restrictions in 186 countries .Evidence shows that cardiovascular diseases, such as hypertension, are increasing among young people. This likely relates to obesity and physical inactivity, conditions that have intensified during the COVID-19 pandemic . In a syIn addition, all the stress generated due to the uncertainties related to the pandemic can also have diverse repercussions on the homeostasis of various systems, including the cardiovascular system. Stress is usually approached from a medical or biological point of view, and it is well documented in the scientific literature that childhood stressors are related to increased cardiovascular morbidity in adulthood  and centIn addition to the impact of restrictive measures, we also have the possibility of direct changes promoted by SARSCoV-2 on cardiovascular health. Although we don’t have direct studies on the direct impact of SARS-CoV-2 infection on arterial stiffness in children and adults, the CARTESIAN study proposes to investigate the impact of COVID-19 infection in arterial stiffening . What isThe increase in blood arterial pressure in young patients is related to signs of premature vascular ageing, which is explained by the appearance of structural alterations in the arterial vessels, such as arterial stiffness . This teThe purpose of this study was to evaluate cardiovascular, anthropometric, and quality of life (QoL) parameters in children and adolescents, one year after the implementation of restrictive measures against the COVID-19 pandemic, and to compare them to a database obtained in the period before the pandemic. The opportunity to study a population that spent more than one year in unusual conditions may help to understand the cardiovascular and metabolic impact of routine change in children through these variables.This is a cross-sectional, observational study that compared cardiovascular and anthropometric parameters and the impact on the QoL of healthy children and adolescents, after more than one year of the pandemic, with a control group matched by age, sex, and socioeconomic class, evaluated in a pre-pandemic period.A total of 193 children and adolescents participated in this study, allocated into two groups: Pre-Pandemic (Before the Pandemic Group - BPG) and Post-Pandemic (After the Pandemic Group - APG). BPG consisted of 89 participants from a database consisting of children and adolescents of both sexes aged 9 to 19 years, who were students from public schools in the city of Belo Horizonte, Minas Gerais, Brazil and who participated in a previous study by Santos et al. [The socioeconomic class was determined as recommended by ABEP (Brazilian Association of Research Companies) . This clIn Belo Horizonte, schools remained closed throughout March 2020 to July 2022. In addition, parks, shopping malls and churches were also closed during this period, with drastic restrictions on socializing the population. In August 2021, public schools in Belo Horizonte created a protocol for the partial resumption of classes for high school and elementary school students. This protocol recommended that each child could attend one week per month of face-to-face classes in schools. Thus, it was possible to collect data for the APG group during this period. Although the schools involved in the study were the same, no participant from the BPG group was included in the APG group.Volunteers who reported acute or chronic, respiratory, cardiovascular and/or renal diseases, diabetes, smoking history, and systemic arterial hypertension were excluded. To investigate possible respiratory diseases, the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used, excluding volunteers with a score greater than or equal to 5 points . These c2 for BMI) [Weight, height, and waist and hip circumferences (WC and HC) were evaluated. Waist-to-hip (WC/HC) and waist-to-height ratios (WHtR) were also calculated. The World Health Organization (WHO) considers the WC/HC as a criterion to characterise metabolic syndrome and cardiovascular risk, with cut-off values of 0.90 for men and 0.85 for women . Also, ffor BMI) .The short version of the Physical Activity Questionnaire-Child was used to assess habitual physical activity level, which investigates the practice of physical activity in children and adolescents in the seven days prior to filling it out. The IPAQ-A and IPAC-C were used for children and adolescents, respectively. It consists of nine questions related to physical activity performed at school and during leisure time during the week and on weekends. Each question has scores from 1 to 5. Those who spent 150 min performing moderate physical activities during the week were considered active .Participants’ QoL was assessed using the Paediatric Quality of Life Inventory version 4.0 (Peds-QL 4.0). This questionnaire consisting of 23 questions that assess the perception of children and adolescents and is divided into two domains: physical (8 items), emotional—cognitive and intellectual (5 items), social (5 items), and school (5 items). Items were rated on a scale of points from zero to 100; where zero = 100 points; one = 75; two = 50; three = 25; four = 0. Then, the average of these items was measured. The higher the score, the better the perception of quality of life. . This quArterial stiffness was estimated by measuring PWV and AIx@75, using the Mobil-O-Graph® instrument , according to Santos et al. .This equThe device also allowed the evaluation of a series of other parameters such as peripheral systolic (pSBP) and diastolic (DBPp) blood pressures, peripheral mean arterial pressure (MAPp), and peripheral pulse pressure (PPp), as well as central diastolic (DBPc) and systolic (SBPc) blood pressures, and central pulse pressure (PPc). In addition, stroke volume (SV), cardiac output (CO), cardiac index, total vascular resistance (TVR), and heart rate (HR) were also obtained.Similar to the cardiac index, which allows comparison between different individuals, the relationship between SV and body surface area expressed in square metres was used.The classification of SBPp and SBPp were performed according to the recommended percentile of each age group. A blood pressure less than the 90th percentile is considered normal; between the 90th and 95th percentile designates prehypertension. For adolescents’ population, blood pressure equal to or exceeding 120/80 mmHg denotes prehypertension, even if this figure is less than the 90th percentile. This classification is in accordance to the recommendations of the National Institutes of Health National Heart and the VI Brazilian Guidelines for Hypertension , 34. TheCardiovascular parameters were performed according to previous studies by our group , 24, 35.The sample size was calculated to test the difference in the means of AIx@75 of children and adolescents in the pre- and post-pandemic period . To obtaThe formula used for the sample calculation was:Qualitative variables were presented as frequencies and quantitative variables as mean ± standard deviation (median). Quantitative variables were submitted to the Shapiro-Wilk normality test. The association between qualitative variables was assessed using the Chi-Square test. For the comparison of quantitative variables between two groups, the Student’s t-test was used for independent samples, as well as the Wilcoxon Mann-Whitney test. The analyses were developed in the R program version 4.0.5 and p < 0.05 was considered significant.2, and the mean value of WC was 71.6 ± 11.8 cm. Regarding the profile of habitual physical activity, 57.51% were sedentary. More than half, 67.4%, were from classes C, D, or E. As for quality of life, the physical and social aspects presented means over 80 , while the emotional and school aspects presented means greater than 70 . The individuals evaluated in the APG had higher mean values of HC (p < 0.001), and lower values of QoL in the emotional (p = 0.002) and school (p = 0.010) aspects , 51.8% of which were female. In the BPG, 89 cases (46.1%) were evaluated, and in the APG, 104 cases (53.9%). The BMI was 19.4 ± 3.6 kg/mThis study evaluated whether changes in the routine of children and adolescents during the period of social isolation resulting from the COVID-19 pandemic had any impact on anthropometric data, quality of life, and possible subclinical changes suggestive of arterial stiffness in this population. To the best of our knowledge, this is the first controlled study where cardiovascular variables and QoL were compared in similar populations in the pre- and post-pandemic periods. This study demonstrated that the main subclinical marker of arterial stiffness in the paediatric population, represented by AIx@75, which is a highly predictive variable of cardiovascular events , was incThe period of social isolation resulting from the COVID-19 pandemic can be considered a toxic childhood environment due to the various negative changes that occurred during the period, especially for children and adolescents . The linThe pandemic has drastically affected the routine and habits of the general population , 3. The When comparing the QoL domains between the study groups, we observed a significant worsening in the emotional and school domains in the APG in relation to the BPG. The worsening in these domains was expected as the impact of the COVID-19 pandemic on the mental health of children and adolescents has been demonstrated in numerous studies , 50, 51.We found two studies in the literature that correlated a worsening in QoL in children and adolescents with an increase in arterial stiffness. Santos et al. found no association between QoL in healthy children and adolescents and AIx@75 . In contThe main objective of the present study was to assess whether arterial stiffness indices, PWV and AIx@75, would be altered in the study population one year after the COVID-19 pandemic. Some studies have already evaluated non-invasive arterial stiffness markers in the young population, due to the high predictive value of this variable for the development of cardiovascular diseases. Shiraishi et al. showed that central blood pressure values measured with the Mobil-O-Graph® are accurate in children and hold promise as markers of cardiovascular risk in the paediatric population . SeveralIn the present study, we showed that the main determinant of arterial stiffness in children, AIx@75, was significantly higher in APG participants. Since our groups were matched by sex, age and socioeconomic class, our data suggest that conditions associated with routine changes resulting from the COVID-19 pandemic, such as changes in QoL due to alterations in eating habits, emotional changes, and decreased physical activity, could lead to early changes in vascular architecture and functioning. In addition to AIx@75, PWV has been shown to be a good marker of arterial stiffness. However, some authors have shown that PWV is not an adequate marker in the paediatric population, despite being important in adults , 62. SomIn the present study, an increase in HR was observed in the APG. Wilkinson et al. demonstrated that there is an inverse and linear relationship between AIx and HR resulting from changes in the time of the reflected wave caused by reductio in the duration of systole . This inAnother factor that may have also limited the increase in AIx@75 in the APG was the reduction in TVR. Kelly et al. demonstrated that vasodilator drugs that reduce TVR are related to a decrease in AIx@75 . AnotherThe non-observance of major anthropometric changes between the two study groups does not mean that social isolation and restrictive measures imposed by the pandemic have not actually contributed to an increase in the cardiovascular risk of children and adolescents in the study. In adult patients, anthropometric data, including BMI and abdominal and hip circumferences, are related to increased arterial stiffness and mortality from cardiovascular events . HoweverOur study has several strengths that should be highlighted. First, although our comparisons were made in two independent samples, children and adolescents were matched by sex and age and socioeconomic class. Second, according to the sample calculation, 60 participants would be needed in each group and our study eventually included 89 and 104 participants in the BPG and APG, respectively. One of the limitations of the study was the sample selection. The BPG was selected from nine representative regions of a large metropolitan city and the ABG was selected from only two regions. Another limitation was the use of BMI as a measure to interpret weight variation. Body composition can be highly variable and still yield the same BMI. In addition, BMI does not provide information on the regional distribution of body fat.Although volunteers who reported being positive for COVID-19 infection were excluded from the study, some children may have been previously infected and undiagnosed, as this type of infection shows few clinical signs in the paediatric population. This may have influenced the observed results.Our results show that routine changes resulting from the COVID-19 pandemic increased cardiovascular risk in children and adolescents during the period of social isolation, as evidenced by the increase in AIx@75, considered an important marker of cardiovascular risk in the paediatric population.Declarations.


This study examined the outcomes of a descriptive, longitudinal cohort consisting of 241 patients initially examined in a population study at the high secure State Hospital for Scotland and Northern Ireland in 1992–93. A partial follow-up focusing on patients with schizophrenia was conducted in 2000–01, followed by a comprehensive 20 year follow-up that began in 2014.To explore what happens to patients who required high secure care during a 20 year follow-up period.Previously collected data were amalgamated with newly collected information to examine the recovery journey since baseline. Various sources were employed, including patient and keyworker interviews, case note reviews, and extraction from health and national records, and Police Scotland datasets.Over half of the cohort (56.0%) with available data resided outside secure services at some point during the follow-up period (mean 19.2 years), and only 12% of the cohort were unable to transition out of high secure care. The symptoms of psychosis improved, with statistically significant reductions observed in reported delusions, depression, and flattened affect. Reported sadness [according to the Montgomery–Åsberg Depression Rating Scale (MADRS)] at baseline, first, and 20 year follow-up interviews was negatively correlated with the questionnaire about the process of recovery (QPR) scores at the 20 year follow-up. However, qualitative data depicted progress and personal development. According to societal measures, there was little evidence of sustained social or functional recovery. The overall conviction rate post-baseline was 22.7%, with 7.9% violent recidivism. The cohort exhibited poor morbidity and mortality, with 36.9% of the cohort dying, primarily from natural causes (91%).Overall, the findings showed positive outcomes in terms of movement out of high-security settings, symptom improvement, and low levels of recidivism. Notably, this cohort experienced a high rate of deaths and poor physical morbidity, along with a lack of sustained social recovery, particularly among those who had negotiated a path through services and who were current residents in the community. Social engagement, enhanced during residence in low secure or open ward settings, diminished significantly during the transition to the community. This is likely a result of self-protective measures adopted to mitigate societal stigma and the shift from a communal environment. Subjective depressive symptoms may impact broader aspects of recovery. Recovery is a key concept within the Mental Health Strategy for Scotland 2017–2027  . In ScotIn Scotland, service users advocated for a relatively loose concept of recovery that was person-centered and tailored, enabling, and empowering . The reaAs the process of recovery among users of general psychiatric services has changed over time, the concept of recovery within FMHS has also evolved.It was relatively straightforward within general psychiatric services to move beyond the biopsychosocial model of psychiatric disorders and to adopt a person-centered approach in support of recovery. However, there were concerns regarding how such an approach and the underlying principles of hope, control, and opportunity could be applied to secure environments . This waHowever, individuals in FMHS are subject to fundamentally the same recovery tasks as the users of general services. Individuals in FMHS need to undertake additional tasks regarding their offending behavior, with their legal status, and associated restrictions impacting upon their recovery experience . BalanciIn the context of Scottish FMHS and associated legislation, the Mental Health (Care and Treatment) (Scotland) Act 2003 , which iRehabilitation tasks such as compliance with appropriate medication, engagement with therapy, and skill development are the building blocks that support recovery. Recovery develops from rehabilitation; within the perspective of person-centered practice, it has been acknowledged that definitions of rehabilitation and recovery are individualistic. Recovery, however, is generally interpreted as enabling individuals to “pursue their own unique life goals in the presence or absence of continuing symptoms” . ConsideThe main objective of this study was to examine the recovery process of a group of patients over time, utilizing a descriptive longitudinal design. This cohort was initially identified as part of a whole population survey that had been conducted in 1992-3  and subsIn embracing the fact that recovery for individuals in FMHS involves additional offender or legal-related tasks, recovery was conceptualized in broad terms to examine all aspects of the movement from high secure care toward the community. For this study, clinical, functional, social, and personal recovery, as outlined by Drennan and Alred , were exDue to the historical grounding of the study, it was acknowledged that some elements may be more embedded within the concept of rehabilitation than recovery. The study provided information to evaluate and better target interventions to support FMHS users across the security levels in their recovery journey.The research question was as follows:What happened to patients who required high secure care in 1992/93 over a 20-plus year follow-up period?Sample baseline characteristics and the methodology adopted, including the process for tracing the previous participants, data collection tools, and data extraction from health and national data sets, were comprehensively described in previous studies and will only be summarized in this study , 19.The State Hospital Survey (SHS) described a whole population cohort of 241 patients, with 88.4% being men with a mean age of 35.8 years, and 11.6% being women, with a mean age of 32.4 years, who were detained within the high secure State Hospital, Carstairs, Scotland, at some point between 25th August 1992 and 13th August 1993 . Table 1At the 20 year follow-up, of the 241 cohort, 36.9% were noted as deceasedOf those who were approved by gatekeepers for approach and invited to participate, 75.9% consented to the study in some way (interview and/or case note review). Of those who consented, 72.3% agreed to be interviewed. In addition, 89.4% consented to Police Scotland, providing a summary of their criminal history from the baseline to December 2014. Permissions were obtained for case note information and Police Scotland data to be sourced for deceased cohort members.The authors assert that all procedures contributing to this study comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The study was approved by South East Scotland Regional Ethical Committee 01, reference 15/SS/0015. Supplemental approvals and the wider study protocol are detailed in a previous publication . WrittenAfter tracing the cohort members and their current care team using data provided by National Services Scotland (NSS) and the National Health Services Central Register (NHSCR), a gatekeeper approach was implemented .Consultant psychiatrists  determined whether the previous SHS participant was allocated to their service, possessed the capacity to consent, and was physically and/or mentally well enough to be invited to participate in the study. Only after receiving approval from the RMO or other suitable gatekeepers  was an invitation to participate extended.Considering the vulnerable participant group and research topic, the study was specifically designed to offer maximum flexibility and encourage participation. To build trust and rapport with potential participants, a single researcher conducted the study introduction, sought informed consent, and collected all data. The participants could consent to all or some of the following:Participant quantitative and/or qualitative interview ,Case note review and/or,Summary of criminal history since baseline.Baseline variables including; demographics, admission history and characteristics, medication, self-harm and abuse history, childhood development and family, mental health history, physical health, forensic history, drug and alcohol use, and functional ability within the ward environment were compared between those contributed data to the follow-up and those who were too unwell or lacked the capacity to consent, refused to participate, or were lost to the study cohort. Individuals from RUK and overseas were excluded from the analysis. Significant differences were observed in terms of age at baseline, the time in current high-security admission prior to baseline, and the total length of time as a psychiatric inpatient. The group that provided data for the study demonstrated higher median scores.The 20 year follow-up amalgamated, where possible, relevant case notes and interview data that had been previously gathered , 15 withFor participants who had provided consent, a case note review was conducted every year from baseline, or from 2002 if they were included in partial follow-up, to obtain an overview of the individual's clinical and functional recovery to December 2014. For participants who died, the same was conducted until December 2014 or until date of death. The review was conducted only if participant case notes were still available.The 20 year follow-up was conducted in the context of recovery and included, in addition to the previously used suite of interview tools, the original 22-item questionnaire about the process of recovery (QPR)  and a seThese tools allowed for the exploration of social and personal recovery. In the absence of data relating to forensic cohorts and the performance of the QPR, the decision was made to use the original 22-item tool, as this would also allow assessment of the revised 15-item measure  was applTo complement other data collection efforts, permission was obtained to extract data from National Services Scotland (NSS) data sets (Scottish Morbidity Records SMR 04 Psychiatric Inpatient and SMR00 Outpatient-Psychiatric Only) to accurately establish the journey of consented/deceased individuals through services and to establish the location of case notes for review. Data were also extracted for deceased/consented individuals in relation to general hospital inpatient and day patient (SMR 01) events to more robustly examine physical health , 19. CriAn overview of the main findings by recovery category is presented.The journey through services was explored to provide an overview of clinical recovery. Data from NSS SMR04  describing the full location journey from baseline (1992/93) to 31st December 2014 or the date of death, were available for 62.2% of cohort members. 2(6) = 22.7, p = 0.001, Cramer's V = 0.28]. Of those achieving the lowest security level, either high or medium secure care, 83.3% were subject to criminal procedures at baseline, where the lowest level attained was low/open secure services, 73.8% were criminally detained. Of those under civil detention at baseline, 42.4% were now residents in the community with occasional readmission. Similarly, 73.9% of those who had been under prison transfer for treatment orders resided in the community and experienced occasional admissions.It should be noted that the first Scottish medium secure service opened in 2002, with the other two centers opening in 2007 and 2014. A significant difference was observed between baseline legal status and lowest security level achieved , coherently expressed delusions , depression , and poverty of speech . No statistically significant differences were noted with regard to incoherence and irrelevance of speech, anxiety, hallucinations, and motor retardation.The change in symptom profile over time was assessed using the Manchester Rating Scale (MRS) , which pThe physical health of the cohort was primarily assessed through the examination of death certificate information and general hospital inpatient/day patient event  data centrally held by NSS for both deceased and consented individuals. Data have been comprehensively examined in a previous study . In summThe mean age at death was 55.6 years (range 30.5–84.7), with 77 (36.2%) of the men dying at a mean age of 56.6 years (range 30.5–84.7) and 12 (42.9%) women at a mean age of 48.9 years (36.2–66.1). Years of birth for the deceased cohort were applied to the expectation of life by gender and selected age, Scotland, 1861 to 2017 table . Deaths Premature death was primarily the result of respiratory disease/cancer (31.7%), while circulatory disease/event accounted for 19% of deaths. No significant differences by cause were noted between premature and post-expected-age deaths. Suicide accounted for 5.6% of overall deaths, accidental deaths for 3.4%, and drug- and alcohol-related deaths for 4.5%.p = 0.002) compared to living participants. Similarly, significant differences were apparent between prematurely deceased  and living participants when the means of injury, poisoning, and other external causes of injury were examined (1.31 diagnoses). It was not possible to distinguish incidents of self-harm from accidental events.Examining morbidity, we found that there were no significant differences in mean endocrine, nutritional and metabolic disease diagnoses, or diseases of the circulatory system between those who died prematurely and those who remained alive. However, those dying prematurely demonstrated significantly higher mean respiratory disease diagnoses  and those who attained the community as their lowest level , U = 640.0, z = −2.03, p = 0.042, r = −0.20 and in disturbed ward behavior; high or medium (Mdn = 5.00), community (Mdn = 3.50), U = 628.5, z = −2.05, p = 0.40, r = −0.20. However, when considering contact with the outside world, those who progressed to the community (Mdn = 0.67) exhibited significantly higher dysfunction at baseline than those remaining in high or medium security (Mdn = 0.33), U = 633.5, z = −2.05, p = 0.039, r = −0.20. There was no significant difference between groups at baseline in relation to the nurses's opinion of dysfunction or functioning within occupational services. No significant differences in baseline functioning were observed between individuals with high or medium security and those with low or open security as their lowest attained level of security.Analysis with Mann–Whitney U test, demonstrated a significant (two-tailed) difference in overall dysfunction at baseline between those with high or medium secure care as their lowest level of security  and contact with the outside world  for individuals within high- or medium-secure (n = 14) services, there was an increase in median scores over time, from Mdn 0.43 to 0.77 and Mdn 0.33 to 0.83, respectively. For those with the lowest security level or low/open (n = 17) security, a significant difference in disturbed ward behavior was observed , with a decrease over time observed (Mdn 4.00 to 1.00). There was no significant difference observed between the baseline and the 20 year follow-up in overall dysfunction for individuals progressing into the community as their lowest level of security.Functional change over time was examined between the baseline and the 20 year follow-up. The Wilcoxon signed-rank test indicated significant differences in dysfunction scores in terms of nurses' opinion of dysfunction  for 59 participants and 92 deceased individuals ; some convictions were removed in accordance with Police Scotland's Weeding and Retention policy for CHS , and 10.From 1993 to 31st December 2014, 66.1% of participants and 32.6% of deceased individuals had no convictions recorded. Over 15% of participants could not be traced, and these were mainly long-term inpatients. Over half of the deceased individuals (58.7%) were untraceable. The untraceable individuals were anticipated as confirmed deceased individuals were removed from police data sets. Convictions were returned for 21.1% of traceable deceased and 24.0% of traceable participants. An overall conviction rate of 22.7% was observed, with violent offenses committed by 7.9% of individuals with convictions. Together, these 20 individuals committed 54 crimes. The case note review supported the Police Scotland data and confirmed that no homicides, attempted homicides, or acts of rape were committed. The sexual assaults were also examined through case-note review, with all convictions relating to non-contact sexual offenses committed by three individuals.U analysis of the Questionnaire about the Process of Recovery (QPR) data captured through an interview at the 20 year follow-up indicates a statistically significant difference in self-reported ratings of recovery in terms of the 22-item intra-personal scale  and the revised 15-item measure  between the high or medium (median 43.4 and 38.4 respectively) and low/open secure environments . No other significant differences were observed in terms of security level at the 20 year follow-up interview. QPR data were explored using the Mann–Whitney U test and Kendall's tau in relation to a range of baseline measures examining demographic, diagnostic and symptomatic, forensic/legal, functional, and behavioral variables, with no significant differences observed. The correlation with Kendall's tau demonstrated that depression at baseline (1992/93) as rated within the Manchester Rating Scale, which was delivered at the interview, and 15-item QPR scores were significantly associated . To further explore this finding using Spearman's correlation coefficient (rho), 15-item QPR scores were assessed against depression as reported at baseline (n = 46) using the MADRS, which was also delivered at the interview. A significant (two-tailed) negative correlation was observed for reported sadness (subjective) . In examining MADRS scores at first follow-up (2000/01) among those with a schizophrenia diagnosis (n = 23) against 15 item QPR scores, significant negative correlations were observed for reported sadness (subjective) , pessimistic thoughts , and suicidal thoughts . Significant negative correlations were also observed between 20 years follow-up (n = 46) MADRS and 15 item-QPR scores; apparent sadness , reported sadness (subjective) , inner tension , concentration difficulties , inability to feel , pessimistic thoughts , and suicidal thoughts .The Mann–Whitney N = 10 qualitative interviews were conducted with individuals who were residents within the community at 20 year follow-up. At baseline, 80% of the group had received a primary diagnosis of schizophrenia. By the time of follow-up, half the cohort were living in supported accommodation or receiving a comprehensive support package within their own homes. Eighty of the interviewed cohort were men. Reflexive thematic analysis . The admission length we observed may be partly due to the relative lack of medium secure services in Scotland at the time the original cohort was gathered. The first medium secure unit opened in 2000, with another two units opening in 2007 and 2013. Where full journey data were available, 45.3% experienced at least one readmission to a higher level of security following progression to a lower level/community, with 42.7% moving downwards through security levels without any readmissions. In a comparison of English general and forensic patients based in the community, Hodgins et al.  noted thIn existing studies, functional recovery is generally associated with a return to premorbid levels of functioning in relation to the diversity of skills required for daily living, which can encompass those required for independent or supported living, employment and training, and developing and maintaining relationships . More reWithin our cohort and specifically in relation to social roles, the overwhelming majority of cohort members described themselves as single (85.5%) at baseline, with only around a quarter (23.2%) indicating that they had ever been employed, and these findings were similar to those of Völlm et al. . These rAt baseline, this cohort represented the general sociodemographic characteristics of other forensic cohorts in terms of raised childhood adversities  and histFurther functional recovery data at baseline and 20 year follow-up were obtained through ward/community keyworker interviews , while tRoosenschoon et al.  demonstrOffender recovery is considerably intertwined with personal recovery in terms of the renegotiation of identity , 49, 50.We acknowledge that, in line with other recidivism research among mentally disordered offenders (MDO) , 51, theThis cohort was diagnostically diverse, with only 5% experiencing a primary diagnosis of antisocial personality disorder (ASPD) and 29% comorbid ASPD at baseline , reflectThe QPR is a quantitative tool developed primarily to examine recovery from psychosis . The QPRWe examined QPR scores by security levels at the point of interview and, as expected, noted a significant difference in recovery between those who were detained within high-secure care and those who had progressed to low/open wards. The fact that there was no significant difference between individuals remaining in high or medium secure care and those currently living within the community was more unexpected and may be accounted for by the apparent lack of social recovery and self-protective measures adopted by those now residents within the community environment. Through exploration of clinical recovery, we noted that remaining within high or medium secure care throughout the 20 year follow-up was associated with sub-score for depression  exhibited at baseline (1992/93). Within this cohort, the dominant diagnostic group was schizophrenia, and it has been reported  that ratWithin the literature, affective symptoms at onset are associated with better outcomes in first-admission psychosis . It shouWhile exploring the potential relationship between depressive symptoms and recovery, we examined the more nuanced scores obtained through the MADRS . We wereFMHS have embraced person-centered recovery-based philosophies that are rooted in the subjective experience and conceptualized as an attitude or orientation . TherefoAnalysis of qualitative data from our cohort of individuals who are now residents in the community reflecting upon their journey from the high secure state hospital to their current community placement yielded a picture of progress and personal development. The findings have been interpreted in terms of the three primary themes of personal forensic recovery , highlighted through meta-syntheses by Clarke et al.  and ShepIt has been suggested that for recovery to develop within the individual, they must feel a sense of safety and security , 50. TheNegotiating changing identities is reported as another major theme , 49, 50,As mentioned, the development of hope is also considered essential to the establishment of the process of recovery . Again, Where individuals are obliged to undertake a programme of care, FMHS also have a duty of reciprocity, to provide safe and appropriate services to foster and support the development of rehabilitation and recovery. Recovery should provide the opportunity for individuals to become empowered, exert control, and create lives beyond the confines of their illness that reflect their life goals at both personal and social levels . One of Individuals' sense of connectedness , as demoAs reflected in this cohort , forensiIn contrast, individuals resident in low/open wards demonstrated an understanding and appreciation of the importance of family, staff/peer relationships, and the ward social community. This was associated with a deeper ability to generally engage with their recovery tasks, as evidenced by their progression beyond high secure care. Greater access to the community and vocational projects commensurate with location within low/open wards can ameliorate barriers to social recovery created by detention in high or medium secure services . HospitaThose who had transitioned to life in the community reverted to superficial and isolative behavior from a position of general social engagement and confidence, which was in contrast to that observed among those residing in low/open wards. This change in perspective appears to be internally driven, with community-dwelling individuals acknowledging engagement in casual social relations but expressing little desire to establish deeper interactions. This self-protectionist stance is also reflected in community residents' approaches to intimate relationships, general openness, and a sense of community. Although they have achieved long-sought independence and freedom that comes with moving out of the hospital environment, community residents demonstrated self-restricted social lives.This overview of the clinical, functional, offender, social, and personal recovery of a cohort of 241 individuals cared for in high secure forensic care during 1992/93 has highlighted a range of issues; 36.9% of the cohort died at an average age of 55.6 years, and FMHS must do more to support and encourage the physical wellbeing of patients to ensure that individuals live long, healthy lives and can enjoy the improvements in mental health that the majority develop. Over 40% progressed through secure care without any readmissions to higher levels, and only 12% could not move on from high secure care. Recidivism rates were very low. Although symptom management was very good, empirical measurement of recovery for schizophrenia provided a poor result. This, however, needs to be interpreted alongside personal recovery, which evidenced good insight, self-development, and an overall positive reflection upon their recovery journey. It was noted that subjective sadness/depressive experiences might impact not only personal recovery but more widely across the recovery process. Social and functional recovery, as interpreted through societal measures, was not great, with individuals failing to develop intimate relationships or secure open employment and fearing others finding out their past, leading to rejection or persecution. Although there is some evidence of self-stigma which can be more impactful upon recovery than societal stigma, mental health stigma within society remains pervasive. Until more is successfully done to address the issues, many forensic patients will restrict their social engagement.There are several limitations associated with this study. We were unable to secure cross-border communication with England and Northern Ireland to obtain gatekeeper information for cohort members residing within their regions. Similarly, we could not request information for those residents overseas. This restricted the cohort to those remaining resident within Scotland, with the exception of the mortality status and death certificate information relating to those resident within England/Wales. As a gatekeeper approach was adopted, the invitation to participate could only be made to those for whom a suitable gatekeeper could be located and where the gatekeeper advised that the cohort member held the capacity to consent and remained mentally and physically well enough to participate. Although permission had been sought for the health records of deceased members to be reviewed, the length of follow-up and the year of death meant that some volumes had been destroyed.Similarly, a small number of volumes were not available for all living participants. Health information could only be requested for deceased and consented participants. Not all deceased/consented participants could be traced by Police Scotland, and some offenses may have been weeded from the Criminal History System in accordance with their Weeding and Retention policy . CriminaThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The study involving human participants were reviewed and approved by South East Scotland Regional Ethical Committee 01, reference 15/SS/0015. The patients/participants provided their written informed consent to participate in this study.Conceptualization and writing—review and editing: LT. Design and methodology: LT and CR. Conduction of the study, statistical analysis, interpretation, and writing—original draft preparation: CR. All authors contributed to the article and approved the submitted version.


The aim of this national prospective surveillance study was to compare the clinical presentation, laboratory findings, treatment, and coronary artery outcome in patients with incomplete and complete Kawasaki disease (KD).Between March 2013 and February 2019, children with a diagnosis of complete and incomplete KD were reported by the Swiss Paediatric Surveillance Unit and prospectively enrolled. Clinical data, laboratory values, treatment, and echocardiographic features were collected at diagnosis and 1 year of follow-up. Data were compared between children with complete or incomplete KD.p = 0.01). At diagnosis, 39 (11.1%) patients had only coronary artery dilation and 57 (16.2%) had at least one coronary artery aneurysm. There were no differences in coronary artery involvement between the two groups. At follow-up, 273 of 294 (92.8%) patients had no coronary artery involvement, with no difference between the two groups (p = 0.609). The overall incidence of coronary artery aneurysms at diagnosis was 16.2%. At follow-up, most coronary artery aneurysms had regressed, and coronary artery aneurysms were present in only 5.8% of the patients. Coronary artery aneurysms were slightly more frequent in patients with incomplete KD at follow-up (p = 0.039) but not at diagnosis (p = 0.208).A total of 351 questionnaires were registered from children with a diagnosis of KD. Of them, 219 (62.4%) children had complete KD, and 132 (37.6%) children had incomplete KD. Children with incomplete KD were younger and had a longer-lasting fever; however, there were no differences in the level of C-reactive protein. All but four children received intravenous immunoglobulin treatment, whereas 14% of children were treated with corticosteroids. Children with incomplete KD were more often treated with corticosteroids than children with incomplete KD (Although the clinical presentation in children with incomplete and complete KD differs, the absence of coronary artery involvement does not. The use of corticosteroids appears to be preventive against the development of coronary artery aneurysms in these patients. However, the results of this study suggest a lower rate of coronary artery aneurysm regression in patients with incomplete KD. Further studies on a larger scale are needed to assess the risk of non-regression of coronary artery aneurysms in this particular group of patients. A diagnosis of Kawasaki disease (KD) is based on clinical and laboratory criteria, and no definitive diagnostic test exists. The diagnosis of incomplete KD remains challenging, and diagnostic delays often occur, especially in infants. A more severe coronary outcome in children with incomplete KD has been suggested but remains controversial , 2. A prA prompt diagnosis and rapid treatment with intravenous immunoglobulin (IVIG) remain the mainstays, as they have been shown to be effective in reducing coronary artery aneurysms (CAAs) .The aim of the present study was to compare the clinical presentation, laboratory findings, treatment, and mid-term coronary artery outcome in patients with complete or incomplete KD in Switzerland. We hypothesized a more severe coronary outcome for patients with incomplete KD.Children aged under 18 years with a diagnosis of complete or incomplete KD who were admitted between March 2013 and February 2019 in one of the 33 pediatric clinics in Switzerland and reported by the Swiss Paediatric Surveillance Unit (SPSU) were prospectively enrolled.www.spsu.ch), which is a surveillance system for rare pediatric diseases in hospitalized children in each of the 33 Swiss pediatric hospitals set up by the Swiss Pediatric Association and the Federal Office of Public Health. After receiving the initial anonymous announcement from the SPSU, a questionnaire was sent to the physician in charge of the patient during the hospital stay.As for our previous study on the epidemiology of KD in Switzerland , an annoDemographic and clinical data were collected, including diagnostic clinical features for KD  and the duration of the fever. The results from laboratory investigations were recorded, including the most abnormal values during hospitalization for C-reactive protein (CRP), albumin, hemoglobin (HBG), white blood cell count (WBC), and platelet count.Patients with a diagnosis of KD were matched either to the “incomplete KD” or the “complete KD” group according to the American Heart Association (AHA) guidelines , 6.A follow-up questionnaire was sent 1 year after diagnosis to the pediatric cardiologist listed on the initial questionnaire. Clinical symptoms were recorded during the follow-up. This included symptoms of heart failure, chest pain, and/or shortness of breath at rest or during exercise.The data from the echocardiography indicating a presence or absence of coronary artery dilation and/or aneurysms were recorded at the time of diagnosis and during the follow-up. In the case of coronary artery involvement and data availability, coronary artery dimensions for the right coronary and the left coronary artery (expressed in mm) were recorded and z-scores were calculated . CoronarInitial treatments with IVIG and doses of acetylsalicylic acid (ASA), together with any additional immunomodulatory therapy , were recorded. Medical treatments during the follow-up were collected.Demographic data, clinical symptoms and signs, laboratory values, treatments, and coronary artery outcomes at presentation were compared between the incomplete and complete KD groups.The coronary artery outcome between the two groups was compared during the follow-up.t-test for continuous variables and Pearson's chi-square test for categorical variables. A p-value <0.05 was considered significant.Data have been reported as the mean with SD or the median with interquartile range, as appropriate. The statistical significance of differences between patients with complete and incomplete KD was assessed using the Student's The research protocol was approved by the Institutional Ethics Board (CER-VD). Because of the anonymous data collection, the Ethics Committee waived informed consent. The study was performed in compliance with the 1964 Helsinki Declaration and its later amendments.Between March 2013 and February 2019, 351 questionnaires were collected from children with a diagnosis of KD. Of them, 219 (62.4%) children had complete KD, and 132 (37.6%) children had incomplete KD. In children aged under one year of age, the proportion of incomplete KD was even higher, at 54.5%. The demographic, clinical, and laboratory features of children with complete or incomplete KD at the time of diagnosis are illustrated in The mean age at diagnosis was 3.4 ± 1.2 years. Children with an incomplete KD were younger and had a longer-lasting fever. The typical clinical symptoms were significantly less frequent in children with incomplete KD, with rash being the most common symptom in both groups. There were no differences in inflammatory markers, such as CRP levels, but all other recorded laboratory parameters  did differ . For thep = 0.01).The medical therapies at the time of diagnosis and 1 year of follow-up are illustrated in Additional anticoagulation therapy with vitamin K antagonists or antiplatelet therapy with clopidogrel was added in 12 patients.The follow-up questionnaires of 294 patients were reviewed. The remaining 56 patients were either lost to follow-up or the questionnaire was not returned. One child died during the acute phase of KD.The mean time from diagnosis to follow-up was 10.1 ± 5.5 months. This is explained by the fact that, although the questionnaire was sent out 1 year after the acute illness, some cardiologists in charge of the patients did see them earlier for follow-up and discharged them earlier. At follow-up, aspirin was continued in 36 (12.2%) patients. Six patients received therapy with vitamin K antagonists. Two patients had additional therapy .At the time of follow-up, all patients were free of cardiovascular symptoms.p = 0.038).In total, 255 (72.6%) children had no coronary artery involvement at the time of diagnosis. Of the 96 (27.3%) children with coronary artery involvement, 39 (11.1%) patients had only coronary artery dilation, and 57 (16.2%) had at least one CAA on echocardiography. There were no differences in coronary artery involvement between both groups . For thoOf the 57 patients with at least one CAA, 30 (52.6%) patients had small CAAs, 18 (31.6%) patients had medium-sized CAAs, and 8 (14.0%) patients had giant CAAs. Of those patients with giant CAAs, five had incomplete KD, and three had complete KD. p = 0.609). Coronary artery dilation was seen in 5 (1.7%) patients and 16 (5.8%) patients had at least one coronary aneurysm. The presence of at least one CAA was slightly more prevalent in incomplete KD (p = 0.039). In total, five patients had small CAAs, eight had medium-sized CAAs, and two had giant CAAs at the time of follow-up. In one patient, the dimension of the CAA was not specified. At the follow-up, 273 of 294 (92.8%) patients had no coronary artery involvement, with no difference between the two groups (This is the first prospective study comparing cardiac outcomes in complete or incomplete KD during acute illness and mid-term follow-up in Switzerland.The proportion of patients with incomplete KD versus complete KD in this national prospective surveillance study is in line with recent studies , 8, 9, aIndeed, several epidemiological studies have shown a rise in the incidence of incomplete KD over the last several years, with some reports showing that more than 40% of KD patients have incomplete KD , 11–12. In the present study, the age of onset was lower in patients with incomplete KD than in those with complete KD, and in patients aged under one year of age, more than half fulfilled the criteria for incomplete KD. Indeed, the proportion of patients with incomplete KD has been shown to be particularly high in patients aged younger than one  and evenNot surprisingly, classic clinical symptoms were less prevalent in children with incomplete KD in our study. This is in line with the American Heart Association algorithm , which dOne clinical difference between the two groups is the duration of fever, which was longer in the group with incomplete KD. This can be due to the delay in diagnosis in the last group, which was not evaluated in our study, and because of the definition of incomplete KD in infants , but alsDespite the longer duration of fever in incomplete KD patients, there were no differences in inflammatory markers, such as CRP levels, between the two groups. This has also been observed in another study comparing children with complete and incomplete KD , 18. In Incomplete KD is characterized by some but not all of the diagnostic criteria for KD . As a reIn this study, patients with incomplete KD did not receive a second dose of IVIG more often; however, they were more often treated with corticosteroids. This might be due to the fact that patients with incomplete KD have a higher rate of IVIG resistance, needing, in addition to a second dose of IVIG, second-line treatments such as corticosteroids. Furthermore, patients in this group are younger, some aged under one year, making them a high-risk group for treatment with corticosteroids in addition to IVIG.In this national prospective surveillance study, the overall incidence of CAA at diagnosis was 16.2%. Tulloh et al.  reportedAt follow-up, most CAAs had regressed, and CAAs were present in only 5.8% of the patients.z-score at diagnosis and a lack of regression. This cannot explain a lower regression rate in incomplete KD in our study, as there were no differences in the size of CAAs at diagnosis between the two groups. However, because of the small number of patients, further studies are warranted to identify any potential association between the regression rate of CAAs in incomplete and complete KD.Overall, 72.6% and 92.8% of the patients had no coronary artery involvement at diagnosis and follow-up, respectively, with no differences between patients with incomplete and complete KD, despite a longer duration of fever in the first group. CAAs were slightly more frequent in patients with incomplete KD at follow-up but not at diagnosis. This suggests that the CAA regression rate is lower in incomplete KD than in complete KD. Friedman et al.  found anIn Asian countries, especially in Japan, numerous risk scores, including Kobayashi et al. , Egami ePrevious studies in non-Asian countries have been contradictory regarding the risk of coronary artery involvement in incomplete versus complete KD. A retrospective study by Manlhiot et al.  found noIn this study, the use of corticosteroids was higher in patients with incomplete KD. This could explain the lack of difference in inflammatory markers and coronary artery involvement between the two groups despite the longer duration of fever in children with incomplete KD. Indeed, steroids have been shown to reduce the risk of coronary artery development in addition to IVIG in KD, especially when given as an initial treatment . Some auA high index of suspicion and prompt treatment with IVIG and, when indicated, corticosteroids are crucial to reducing the risk of coronary artery involvement.z-scores for the left main coronary artery. This might underestimate some results in terms of the severity of the CAAs of the left coronary artery. Furthermore, a number of patients were lost to follow-up. Second, during the study period, the international guidelines for the diagnosis and management of KD changed in 2017. This might have led to changes in clinical practice in the different hospitals involved in the study.The present study has some limitations. First, several clinical and paraclinical data items were not completed in the questionnaire. The echocardiographic data from the left coronary artery were recorded, but the questionnaire did not specify the branches. If not specified by the treating cardiologist, we used the Although the clinical presentation in children with incomplete and complete KD is different, especially in the duration of fever, freedom from coronary artery involvement did not differ in this nationwide prospective surveillance study in Switzerland. The use of corticosteroids appears to be protective against the development of CAAs in this patient population. However, the results of this study suggest a lower rate of CAA regression in patients with incomplete KD. Further studies on a larger scale are needed to assess the risk of non-regression of CAA in this particular group of patients.


Background: Sarcopenia is a progressive and generalized skeletal muscle disorder. Early diagnosis is necessary to reduce the adverse effects and consequences of sarcopenia, which can help prevent and manage it in a timely manner. The aim of this study was to identify the important risk factors for sarcopenia diagnosis and compare the performance of machine learning (ML) algorithms in the early detection of potential sarcopenia. Methods: A cross-sectional design was employed for this study, involving 160 participants aged 65 years and over who resided in a community. ML algorithms were applied by selecting 11 features—sex, age, BMI, presence of hypertension, presence of diabetes mellitus, SARC-F score, MNA score, calf circumference (CC), gait speed, handgrip strength (HS), and mid-upper arm circumference (MUAC)—from a pool of 107 clinical variables. The results of the three best-performing algorithms were presented. Results: The highest accuracy values were achieved by the ALL  model using LightGBM (0.931), random forest , and XGBoost (0.922) algorithms. In the female model, the support vector machine , RF (0.923), and k-nearest neighbors  algorithms performed the best. Regarding variable importance in the ALL model, the last HS, sex, BMI, and MUAC variables had the highest values. In the female model, these variables were HS, age, MUAC, and BMI, respectively. Conclusions: Machine learning algorithms have the ability to extract valuable insights from data structures, enabling accurate predictions for the early detection of sarcopenia. These predictions can assist clinicians in the context of predictive, preventive, and personalized medicine (PPPM). Sarcopenia is a common condition that affects muscle mass, increases morbidity due to fractures, decreases cognitive functions and increases the risk of cardiovascular disease, hospitalization, and mortality in older adults. It is a major contributor to frailty and disability and can significantly impact an individual’s quality of life. Early diagnosis of sarcopenia is important for the successful management and treatment of this condition ,2,3,4.In addition, sarcopenia causes an increase in direct and indirect health expenditures. Since the globally increasing elderly population will lead to more patients with sarcopenia, the identification and treatment of sarcopenia should be focused on reducing the financial burden of sarcopenia on health expenditures . Thus, iTraditionally, sarcopenia has been diagnosed using physical exams and functional assessments, such as measuring muscle strength and evaluating an individual’s ability to perform activities of daily living. However, these methods can be subjective and may not always accurately reflect an individual’s muscle mass and function.Recently, machine learning models started to develop as a potential method of diagnosis of sarcopenia. Early diagnosis and treatment of sarcopenia can be achieved by using these developed and optimized models. Thus, while increasing the quality of life, it also reduces the burden on the health system.The prevalence of sarcopenia depends on the criteria and cut-off values used to define sarcopenia; in addition, study groups consisting of the elderly living in a community, nursing homes, or hospitals may explain the large differences in the prevalence of sarcopenia. Regarding the new criteria of EWGSOP (European Working Group on Sarcopenia in Older People—EWGSOP 2), it has been reported that the prevalence of sarcopenia is 4.6–23.3% among the elderly living in a community ,8,9,10.The EWGSOP2 recommends the use of the SARC-F questionnaire as a way to elicit self-reports from patients on the signs that are characteristic of sarcopenia. The SARC-F can be readily used in community healthcare and other clinical settings . In the It is recommended to use the SARC-F sarcopenia risk screening scale, which relies on self-reporting by elderly individuals and is a cost-effective and convenient tool to inquire about the characteristic signs of sarcopenia. The validity of the SARC-F in identifying individuals at risk of adverse outcomes associated with sarcopenia has been confirmed in various languages and communities, both within public health services and clinical practice ,16,17,18Anthropometric measurements such as calf circumference (CC) and mid-upper arm circumference (MUAC) are inexpensive and easy-to-apply methods in the evaluation of muscle mass. A modified version of the SARC-F produced by adding calf circumference (CC) to the SARC-F  has significantly improved sensitivity and accuracy ,19,20,21In 2019, EWGSOP updated its definition of sarcopenia by introducing threshold values (EWGSOP2) and incorporated physical performance in assessing the severity of sarcopenia. Within the EWGSOP 2 diagnostic criteria, low muscle strength has become the primary factor in identifying sarcopenia, as it represents the most reliable measure of muscle function. When low muscle strength is detected in older individuals, it is categorized as ‘possible sarcopenia’, and the diagnosis of sarcopenia is confirmed through the presence of low muscle quantity/quality. If all the criteria of low muscle strength, low muscle quantity/quality, and low physical performance are met in older individuals, this indicates ‘severe’ sarcopenia ..40].Variable (feature) importance refers to the measure of the contribution or relevance of each variable or feature in a statistical or machine learning model for predicting or explaining the outcome of interest. It provides insights into the relative significance of different variables in influencing the model’s performance and helps in understanding the factors driving the observed patterns or trends in the data .A total of 210 community-dwelling participants aged 65 years and over were included in this study. Of those, 12 patients did not complete the SARC-F questionnaire and 8 patients lacked the measurement data of HS and were thus excluded from this study. Finally, the data from 190 participants were included in the analysis. p = 0.005). The height average for females was lower than for males (p < 0.001). Conversely, BMI (p = 0.012) and the SARCF (p = 0.002) median was higher in females. The median MNA score was similar in males and females (p = 0.343). CC (p = 0.802) and walking speed (0.060) means had no statistical difference between males and females. The median HS score was found to be much higher in males (31.0 [18.0–43.0]) than in females (21.0 [6.0–41.0]) (p < 0.001). The mean MUAC was 29.5 ± 3.1 in males and 30.7 ± 3.7 in females, respectively (p = 0.029)  .p = 0.406). The distribution of the presence of hypertension showed a statistically significant difference according to sex (p = 0.019). The frequency in women (59.8%) was higher than in men (41.4%). Diabetes mellitus (p = 0.725) and malnutrition status (0.702) were also found to be similar according to sex. Prevalence of possible sarcopenia was 14.7%  using the EWGSOP-2 criteria (Smoking was found to be similar in men (10.3%) and women (6.8%)  or dual-energy X-ray absorptiometry (DXA), which are included in the EWGSOP criteria and which are accepted as the current gold standard for the diagnosis of sarcopenia.In the participants where the equipment such as the BIA and DXA are not available for the diagnosis of sarcopenia, there is a need for methods that are non-invasive, fast, economical, can be used in population screening, and can support the clinician. The widespread use of biological data processing technology and the cheaper and widespread use of technologies have changed the direction of medical research. With the ML/DL algorithms which detect meaningful information from data structures, successful predictions have begun to be obtained that support clinicians in diagnosing many diseases. In our study, we aimed to develop an early diagnosis algorithm that includes some basic measurements in the EWGSOP 2 diagnostic criteria, which are routinely used for the diagnosis of possible sarcopenia, patients’ demographic characteristics, and physical measurements. We presented the performance of the models in predicting sarcopenia for ALL and females. The ALL model included 11 variables and the female model included 9 variables. We obtained an accuracy of 0.931 with the LightGBM algorithm via the ALL model and 0.939 with the SVM in the female model. The innovative algorithms used in this study showed different and higher performance than those used by the researchers in the literature.Kang 2019 et al.  evaluateCiu 2020 et al.  made a rCastillo-Olea 2019 et al.  evaluateKo B. 2021 et al.  developeAgnes 2019 et al.  developeSeok and Kim explored the impact of daily-life physical activity (PA) and obesity on sarcopenia prediction in their study. To demonstrate the feasibility of predicting sarcopenia using PA, they trained various machine learning models  using the data samples from the Korea National Health and Nutrition Examination Survey. Among these models, the deep neural network (DNN) achieved the highest average accuracy of 81% when considering PA features across all data combinations. The accuracy increased to 90% with the inclusion of obesity-related information, such as total fat mass and fat percentage. Various metrics were used for precise model evaluation, and the algorithms exhibited significant predictive performance using only PA features, including waist circumference, with the AUC values being consistently around a value of 0.85 and often approaching or exceeding a value of 0.90. In our study, physical and anthropometric measurements were jointly evaluated, leading to high performances, which closely align with our models’ outcomes. Based on this studies’ results, it is evident that when appropriate anthropometric and physical measurements are collected from individuals, crucial information can be derived, significantly contributing to a definitive diagnosis within the models .Due to advancements in computer technologies, the frequency of misdiagnoses in diseases is decreasing steadily. The utilization of high-performance algorithms for extracting precise information from complex patterns, such as deep learning, is on the rise in the healthcare sector. In a study conducted by Asaf et al., a deep learning model achieved a classification accuracy of 99.35% for breast cancer detection and classification. It is well-established that convolutional neural network architectures in deep learning algorithms exhibit exceptional predictive capabilities, particularly when imaging data are available. . In anotAs observed in the literature, the development of models for sarcopenia diagnosis continues to progress. The individuals included in our study were patients who voluntarily sought care at a university hospital. Therefore, the prevalence rate aligns with the general population. We explored models that encompassed all participants and separately examined female individuals. Unfortunately, due to the limited number of male participants, separate models for men could not be evaluated. While the number of participants in our study is similar to some studies in the literature, the prevalence of the disease underscores the importance of conducting dedicated screening efforts, particularly in nursing homes and areas with denser elderly populations.The models we developed in our study demonstrated high performance, providing valuable support to clinicians in diagnosing sarcopenia. Innovative machine learning algorithms such as XGBoost and LightGBM have proven to be highly effective in identifying patterns within the disease data for the diagnosis of challenging conditions. According to our results, the development and implementation of models suitable for rapid, cost-effective population screenings, without the need for devices such as the BIA and DXA, which are costly and expose patients to radiation (even at low levels), are crucial for alleviating the burden on healthcare systems.These results highlight that ML algorithms can support clinicians in the early diagnosis of sarcopenia without using the BIA and/or DXA.Early diagnosis and therapeutic intervention for individuals prone to suffering sarcopenia decrease the risks of disability, hospitalization, and mortality.Early diagnosis of sarcopenia models will have a significant economical contribution to the healthcare system.The first limitation is that the muscle mass for sarcopenia diagnosis was measured using the BIA—which can be influenced by the hydration status. Secondly, only ALL participants and female results were presented in this study. The sample was taken from spontaneous admissions from a university hospital, and the prevalence of sarcopenia in this study reflects community-dwelling elderly persons. Therefore, the ML models could not be applied due to the low number of male participants. Even if we analyzed “ALL and only female” participants, as we can see from There is a need for studies in which participants are recruited from centers such as nursing homes where the frequency of sarcopenia is higher.