Executive Functions in Non-WEIRD Populations: Reflections from Ecuador and Thailand

Neuropsychiatric symptoms (NPSs) after moderate-to-severe traumatic brain injury (TBI) have been well documented in WEIRD (Western, educated, industrialized, rich, and democratic) populations. In non-WEIRD populations, such as Vietnam, however, patients with TBI clinically remain uninvestigated with potential neuropsychiatric disorders, limiting on-time critical interventions. This study aims to (1) adapt the Vietnamese Neuropsychiatric Inventory (V-NPI), (2) examine NPSs after moderate-to-severe TBI and (3) evaluate their impact on caregiver burden and well-being in Vietnam. Caregivers of seventy-five patients with TBI completed the V-NPI, and other behavior, mood, and caregiver burden scales. Our findings demonstrated good internal consistency, convergent validity, and structural validity of the V-NPI. Caregivers reported that 78.7% of patients with TBI had at least three symptoms and 16.0% had more than seven. Behavioral and mood symptoms were more prevalent (ranging from 44.00% to 82.67% and from 46.67% to 66.67%, respectively) and severe in the TBI group. Importantly, NPSs in patients with TBI uniquely predicted 55.95% and 33.98% of caregiver burden and psychological well-being, respectively. This study reveals the first evidence for the presence and severity of NPSs after TBI in Vietnam, highlighting an urgent need for greater awareness and clinical assessment of these symptoms in clinical practice. The adapted V-NPI can serve as a useful tool to facilitate such assessments and interventions. In addition, given the significant impact of NPS on caregiver burden and well-being, psychosocial support for caregivers should be established.

Executive functions and play

Measuring executive function (EF) among adults is important, as the cognitive processes involved in EF are critical to academic achievement, job success and mental health. Current evidence on measurement and structure of EF largely come from Western, Educated, Industrialized, Rich and Democratic (WEIRD) countries. However, measuring EF in low-and-middle-income countries (LMICs) is challenging, because of the dearth of EF measures validated across LMICs, particularly measures that do not require extensive training, expensive equipment, or professional administration. This paper uses data from three LMIC cohorts to test the feasibility, validity and reliability of EF assessment in adults using three sub-tests (representing key components of EF) of the NIH Toolbox Cognitive battery. For each cohort, all three EF measures (inhibition, flexibility and working memory) loaded well onto a unidimensional latent factor of EF. Factor scores related well to measures of fluid intelligence, processing speed and schooling. All measures showed good test-retest reliability across countries. This study provides evidence for a set of sound measures of EF that could be used across different cultural, language and socio-economic backgrounds in future LMIC research. Furthermore, our findings extend conclusions on the structure of EF beyond those drawn from WEIRD countries.

Measuring executive function (EF) among adults is important, as the cognitive processes involved in EF are critical to academic achievement, job success and mental health. Current evidence on measurement and structure of EF largely come from Western, Educated, Industrialized, Rich and Democratic (WEIRD) countries. However, measuring EF in low-and-middle-income countries (LMICs) is challenging, because of the dearth of EF measures validated across LMICs, particularly measures that do not require extensive training, expensive equipment, or professional administration. This paper uses data from three LMIC cohorts to test the feasibility, validity and reliability of EF assessment in adults using three sub-tests (representing key components of EF) of the NIH Toolbox Cognitive battery. For each cohort, all three EF measures (inhibition, flexibility and working memory) loaded well onto a unidimensional latent factor of EF. Factor scores related well to measures of fluid intelligence, processing speed and schooling. All measures showed good test-retest reliability across countries. This study provides evidence for a set of sound measures of EF that could be used across different cultural, language and socio-economic backgrounds in future LMIC research. Furthermore, our findings extend conclusions on the structure of EF beyond those drawn from WEIRD countries.

The present study sought to clarify the impact of executive and social functioning on challenging behavior and the downstream influence of challenging behavior on quality of life and functioning in a large transdiagnostic sample. Understanding these relationships is crucial for developing and designing tailored intervention strategies. In a cross-sectional study, parent informants of 2,004 children completed measures of executive and social functioning, challenging behavior, child and family quality of life, and reported on functional impacts of challenging behavior. Using structural (path) modeling, analyses evaluated the associations between executive and social functioning, including emotion regulation and risk avoidance, with overall and specific types of challenging behavior. Structural models also examined the influence of challenging behavior on child and family quality of life, including measures of the immediate and extended environment, and functional impacts on the parent/child as well as interactions with the medical/legal systems. Finally, mediational models explored the direct and indirect effects of executive and social functioning on quality of life and impact measures via challenging behavior. Results indicated that executive functioning accounts for substantial variance (R2 = 0.47) in challenging behavior. In turn, challenging behavior accounts for substantial variance in child and family quality of life (R2 = 0.36) and parent/child impacts (R2 = 0.31). Exploratory mediational models identified direct effects from executive and social functioning measures on quality of life and functional impacts and indirect effects for executive functioning via challenging behavior. These findings support the development of new intervention strategies and suggest the need to measure executive functioning when assessing and tailoring the treatment of challenging behavior in clinical practice.

You have accessThe ASHA LeaderFrom My Perspective1 Jul 2017Tackling the Toll of Hearing Loss on Executive FunctionWe need to think beyond the speech chain—and hearing aids—to fully address effects of hearing loss on older adults’ cognitive health. M. Kathleen Pichora-Fuller, andPhD Natalie PhillipsPhD M. Kathleen Pichora-Fuller Google Scholar More articles by this author , PhD and Natalie Phillips Google Scholar More articles by this author , PhD https://doi.org/10.1044/leader.FMP.22072017.6 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Remember those graduate school lessons about the speech chain—in which a message travels between sender and receiver in stages, from one person’s intention to another person’s understanding? For decades, we communication sciences and disorders professionals have used this model to consider how communication breakdowns relate to disorders of speech production or hearing. But it’s important that we also think beyond this model when considering one person’s difficulty understanding what another is saying. Hearing can be challenging even when a talker’s speech and a listener’s audiogram are technically “normal.” These challenges may come from poor room acoustics, incomprehensible messages, background noise or distorting technologies such as poor PA systems that thwart transmission of the speech signal. These factors interfere with hearing more as we get older, making us work harder to understand a message. The speech-chain model is certainly useful, but most versions of it don’t factor in whether message senders and receivers will expend extra effort trying to make it work—and if they must deliberately allocate mental resources to overcome communication obstacles (see sources). The reality is that most people will need to expend that extra effort as they get older; as hearing deteriorates (see “Lost in the Midst”), they’ll need to concentrate harder when adverse conditions threaten to break the speech chain. The inevitable result is a greater burden on people’s cognitive resources and executive functioning. So, to effectively intervene with older patients, we need to look beyond hearing aids alone and train them on strategies to reduce the demands of listening on the brain. To effectively intervene with older patients, we need to look beyond hearing aids alone and train them on strategies to reduce the demands of listening on the brain. Passive hearing versus active listening The brain controls the speech chain largely by cognitive executive functions: a collection of processes people use to guide behavior toward a goal (see sources). These processes promote self-initiated actions. They involve cognitive flexibility, planning, working memory, updating and shifting tasks or mental sets, goal maintenance, monitoring and regulation of performance, and inhibition or suppression of overlearned responses. In brief, executive functions, often governed by brain networks including the prefrontal cortex, reflect how or whether a person goes about doing something. In the book “The Human Frontal Lobes: Functions and Disorders,” Adam Gazzaley and Mark D’Esposito argue that executive control influences sensory input (including audition and vision), internal states (including emotion and cognition), and motor and behavioral output (including speech and language production). In effect, executive control is what differentiates passive hearing from active listening. Executive control functions may help to explain how and whether people listen effectively in a given situation, regardless of whether they have normal or impaired hearing. Age-related declines Active listening requires “executive attention”—the ability to shut out distractions and focus on a main task or goal. Psychologists have found that executive attention rests on strong relationships between working memory and executive functioning. To a lesser extent, it also rests on processing speed, a general processing resource related to many aspects of higher-level cognition and known to decline with age (see sources). Some of these executive-attention subcomponents decline more rapidly than others over the adult lifespan. For example, in adults older than 60, the ability to suppress habitual or dominant responses and the ability to divide attention efficiently appear to decline more quickly than abilities such as verbal fluency and reasoning. Now consider some older listeners’ increasing difficulties with understanding speech: Their difficulties may stem from an interaction of age-related declines in peripheral and central auditory processing, working memory, and divided attention. Certainly, age appears to be related to declines in performance on simple listening tasks—such as word recognition in quiet or noise—according to evidence we reviewed in a recent chapter (see sources). Giving older listeners more context can help improve performance. But age-related differences often persist when listening tasks are more cognitively demanding and involve memory or attention. Thus, older adults draw heavily on auditory processing and executive functions when trying to understand what others are saying in many everyday situations. And the risk of developing clinically significant cognitive impairment appears to be greater for older adults with hearing loss than for peers with better hearing. Active listening requires “executive attention”—the ability to shut out distractions and focus on a main task or goal. Dementia and hearing The everyday consequences of hearing impairment become significantly more serious when a person has one of the major neurodegenerative dementias. Auditory symptoms of these dementias include deficits in perception, auditory apperception, the semantic processing of sounds and emotions, and nonverbal auditory working memory and attention (see sources). Within the last decade, researchers have linked dementia with central and peripheral hearing loss. For example, in the journal Cognitive Behavioral Neurology, George A. Gates and colleagues report evidence of an association between central presbycusis and executive dysfunction. They suggest both may result from similar neurodegenerative processes. The real call to action here for geriatric health (in addition to screening hearing) is to identify older adults in the pre-clinical or asymptomatic phase of dementia—typically called mild cognitive impairment (MCI). It is at this stage that people could benefit the most from interventions. Consider that people with MCI are about five times more likely to develop dementia than their cognitively healthy peers (5 to 10 percent versus 1 to 2 percent). The drive to identify people at-risk for and in the early stages of dementia has sparked clinical interest in subjective cognitive impairment (SCI), in which people who perform normally on cognitive tests experience a subjective decline in cognition. Studies indicate that people with SCI are at higher risk for transitioning to MCI and dementia; one study found almost a quarter of people with SCI developed MCI over four years (see sources). What’s more, hearing impairment emerged as one of the strongest predictors of SCI, along with depressive symptoms and poor psychological well-being, in a study of a population-based sample by Julian Benito-Leon and colleagues (published in the Journal of Alzheimer’s Disease). Our hope is that future studies further probe relationships among hearing loss, executive functions and cognitive impairment in older adults. The speech chain and the brain Growing awareness of the connection between auditory and cognitive aging has inspired new research and raised questions about the implications of cognitive decline for audiology practice. Optimistically, many older adults can enjoy better audibility due to advances in hearing technologies. We can hope that better hearing will result in better cognitive health and quality of life. However, many older adults delay seeking help for hearing problems for decades. And those who do purchase hearing aids may struggle to adjust to them without professional support. This, in turn, can affect cognitive functioning: For example, epidemiological research led by Paul Mick (published in the journal Ear and Hearing) found that older adults with unacknowledged or unaddressed hearing loss performed more poorly on cognitive tests and showed a greater risk of social isolation compared with peers with normal hearing. Can hearing aids counteract cognitive decline and dementia? Although the evidence is still sparse, it’s unlikely that amplification alone will be sufficient. But this doesn’t mean older adults with hearing loss are doomed to social isolation and dementia. Viewed through the lens of the speech-chain model, hearing aids would seem a viable solution to the problem of compromised auditory input. If an older adult wears an appropriately fit hearing aid or assistive technology and receives appropriate support services, then the speech chain should be improved. However, if the person experiences a decline in cognitive executive-control functions, the speech chain may malfunction when demanding listening tasks drain diminished cognitive resources. In such everyday situations, it is very likely that listeners will quit listening, especially when the effort of listening exceeds the perceived value of achieving their listening goals. As quitting becomes a more frequent coping strategy, the person may increasingly withdraw from social interactions—which may exacerbate declines in cognition or other aspects of health. This downward spiral in health has implications for how we address hearing loss in older adults: We advise going beyond the traditional focus on hearing aids to include a focus on executive attention and active listening. A useful guideline here is the Framework for Understanding Effortful Listening (FUEL), the consensus paper of the Eriksholm Workshop on “Hearing Impairment and Cognitive Energy.” For example, FUEL proposes that we train patients on strategies to improve the allocation of cognitive resources. For example, patients can select quieter spaces or learn to use context to reduce listening demands. Other areas of training could include breaking complex tasks into smaller ones and using conversational strategies and multimodal cues to increase focus of attention, improve self-efficacy, and optimize support from conversational partners. Many of these behavioral interventions are already familiar to rehabilitative audiologists, but they take on a new meaning when we rethink the speech chain to link to the brain—and shift the emphasis from passive hearing to active listening. Sources Albers M. W., Gilmore G. C., Kaye J., Murphy C., Wingfield A., Bennett D. A., … Zhang L. I. (2015). At the interface of sensory and motor dysfunctions and Alzheimer’s disease.Alzheimer’s and Dementia, 11(1), 70–98. https://doi.org/10.1016/j.jalz.2014.04.514 CrossrefGoogle Scholar Albert M. S., DeKosky S. T., Dickson D., Dubois B., Feldman H. H., Fox N. C., … Phelps C. H. (2011). The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging–Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease.Alzheimer’s and Dementia, 7, 270–279. https://doi.org/10.1016/j.jalz.2011.03.008 CrossrefGoogle Scholar Amieva H., Ouvrard C., Giulioli C., Meillon C., Rullier L., & Dartigues J. F. (2015). Self-reported hearing loss, hearing aids & cognitive decline in the elderly: A 25 -year study.Journal of the American Geriatrrics Society, 63(10), 2099–104. https://doi.org/10.1111/jgs.13649 CrossrefGoogle Scholar Banich M. T. (2009). Executive function: The search for an integrated account.Current Directions in Psychological Science, 18, 89–94. https://doi.org/10.1111/j.1467-8721.2009.01615.x CrossrefGoogle Scholar Benito-Leon J., Mitchell A. J., Vega S., & Bermejo-Pareja F. (2010). A population-based study of cognitive function in older people with subjective memory complaints.Journal of Alzheimer’s Disease, 22, 159–170. https://doi.org/10.3233/JAD-2010-100972 CrossrefGoogle Scholar Gates G. A., Gibbons L. E., McCurry S. M., Crane P. K., Feeney M. P., & Larson E. B. (2010). Executive dysfunction and presbycusis in older persons with and without memory loss and dementia.Cognitive and Behavioral Neurology: Official Journal of the Society for Behavioral and Cognitive Neurology, 23(4), 218–223. https://doi.org/10.1097/WNN.0b013e3181d748d7 CrossrefGoogle Scholar Gazzaley A., & D’Esposito M. (2007). Unifying prefrontal cortex function: Executive control, neural networks, and top-down modulation. In Miller B. L. & Cummings J. L. (Eds.), The Human Frontal Lobes: Functions and Disorders (2nd ed. 187–206). New York: Guilford Press. Google Scholar Gorno-Tempini M. L., Hillis A. E., Weintraub S., Kertesz A., Mendez M., Cappa S. F., … Grossman M. (2011). Classification of primary progressive aphasia and its variants.Neurology, 76, 1006–1014. https://doi.org/10.1212/WNL.0b013e31821103e6 CrossrefGoogle Scholar Hardy C. J., Marshall C. R., Golden H. L., Clark C. N., Mummery C. J., Griffiths T. D., … Warren J. D. (2016). Hearing and dementia.Journal of Neurology, 263, 2339–2354. https://doi.org/10.1007/s00415-016-8208-y CrossrefGoogle Scholar Lezak M. D., Howieson D. B., & Loring D. W. (2004). Neuropsychological Assessment. (4th ed.) Oxford: Oxford University Press. Google Scholar McCabe D. P., Roediger H. L., McDaniel M. A., Balota D. A., & Hambrick D. Z. (2010). The relationship between working memory capacity and executive functioning: Evidence for a common executive attention construct.Neuropsychology, 24, 222–243. https://doi.org/10.1037/a0017619 CrossrefGoogle Scholar McKhann G. M., Knopman D. S., Chertkow H., Hyman B. T., Jack C. R., Kawas C. H., … Phelps C. H., … (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease.Alzheimer’s & Dementia, 7, 263–269. https://doi.org/10.1016/j.jalz.2011.03.005 CrossrefGoogle Scholar Mick P. T., & Pichora-Fuller M. K. (2016). Is hearing loss associated with poorer health in older adults who might benefit from hearing screening?.Ear and Hearing, 37(3), e194–e201. https://doi.org/10.1097/AUD.0000000000000267 CrossrefGoogle Scholar Mitchell A. J., Beaumont H., Ferguson D., Yadegarfar M., & Stubbs B. (2014). Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: Meta-analysis.Acta Psychiatrica Scandinavica, 130, 439–451. https://doi.org/10.1111/acps.12336 CrossrefGoogle Scholar Petersen R. C. (2011). Clinical practice: Mild cognitive impairment.New England Journal of Medicine, 364, 2227–2234. https://doi.org/10.1056/NEJMcp0910237 CrossrefGoogle Scholar Petersen R. C., Caracciolo B., Brayne C., Gauthier S., Jelic V., & Fratiglioni L. (2014). Mild cognitive impairment: A concept in evolution.Journal of Internal Medicine, 275, 214–228. https://doi.org/10.1111/joim.12190 CrossrefGoogle Scholar Pichora-Fuller M. K., Alain C., & Schneider B. (2017). Older adults at the cocktail party (pp.). In Middlebrooks J., Simon J., Popper A., & Fay R. R. (Eds.), The Auditory System at the Cocktail Party (227–259), Springer Handbook of Auditory Research. Springer: Berlin. https://doi.org/10.1007/978-3-319-51662-2_9 CrossrefGoogle Scholar Pichora-Fuller M. K., Kramer S. E., Eckert M., Edwards B., Hornsby B., Humes L., … Wingfield A. (2016). Hearing impairment and cognitive energy: The framework for understanding effortful listening (FUEL).Ear and Hearing, 37 Supp. 5S–S27. https://doi.org/10.1097/aud.0000000000000312 CrossrefGoogle Scholar Royall D. R., Lauterbach E. C., Cummings J. L., Reeve A., Rummans T. A., Kaufer D., … Coffey C. E. (2002). Executive control function: A review of its promise and challenges for clinical research.Journal of Neuropsychiatry and Clinical Neurosciences( 14(4), 377–405. https://doi.org/10.1176/jnp.14.4.377 CrossrefGoogle Scholar Weintraub S., Wicklund A. H., & Salmon D. P. (2012). The neuropsychological profile of Alzheimer disease.Cold Spring Harbor Perspectives in Medicine, 2, a006171. https://doi.org/10.1101/cshperspect.a006171 CrossrefGoogle Scholar Author Notes M. Kathleen Pichora-Fuller, PhD, is a professor in the Department of Psychology at the University of Toronto in Mississauga, Ontario, Canada. [email protected] Natalie Phillips, PhD, is a professor in the Department of Psychology and Centre for Research in Human Development at Concordia University in Montreal, Quebec, Canada. [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetailsCited byPerspectives of the ASHA Special Interest Groups3:6 (43-50)1 Jan 2018Cognition and Hearing Aids: What Should Clinicians Know?Pamela E. Souza Volume 22Issue 7July 2017 Get Permissions Add to your Mendeley library History Published in print: Jul 1, 2017 Metrics Current downloads: 1,273 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2017 American Speech-Language-Hearing AssociationLoading ...

Background/Objectives: Executive functions-including inhibitory control, working memory, and cognitive flexibility-are fundamental for children's learning and development. Physical activity is recognized as a key factor that enhances these functions through neurobiological and structural brain adaptations. This narrative review aims to synthesize current evidence on the relationship between physical activity, executive functions, and brain outcomes in children. Methods: A narrative review was conducted using systematic evidence search across PubMed, Scopus, and Web of Science until August 2025. Search terms encompassed physical activity, executive functions, and brain mechanisms. Eligible studies included randomized controlled trials, longitudinal and cross-sectional studies, systematic reviews, and meta-analyses that examined executive function domains and brain-related outcomes in children, with or without neurodevelopmental disorders. Results: The evidence reviewed highlights that acute physical activity improves inhibitory control, working memory, and cognitive flexibility, primarily through enhanced neurotransmission and cerebral oxygenation. Chronic interventions promote structural and functional brain adaptations, including improved white matter integrity and increased network efficiency. Benefits are observed in both neurotypical children and those with ADHD, with inhibitory control emerging as the most responsive domain. However, findings are moderated by intervention type, intensity, and duration, with heterogeneity across protocols. Conclusions: Physical activity is a promising strategy to support the development of executive and brain functions in childhood, with implications for education and clinical practice. Despite consistent short- and long-term benefits, further research is required to establish optimal prescriptions and evaluate sustained real-world impacts, particularly in children with neurodevelopmental disorders.

The Multidimensional Subjective Financial Well-Being Scale (MSFWBS) has demonstrated strong validity in assessing subjective financial well-being among emerging adults in WEIRD (Western, Educated, Industrialized, Rich, and Democratic) contexts. However, evidence from developing countries remains limited and mixed. This study aimed to validate the Persian version of the MSFWBS among emerging adults in Iran. Adopting a contemporary view to validity, the scale was first translated and culturally adapted to ensure face and content validity. Subsequently, a series of Structural Equation Models were conducted to collect evidence of score structure, reliability, generalizability, and both convergent and criterion-related validity. Data were collected from 356 participants aged 18–29 in Sanandaj, Iran. Confirmatory factor analysis supported the original five-factor structure, with good fit indices and high internal consistency. Measurement invariance was confirmed across gender, age, living arrangement, and occupational status. Additionally, significant associations with personal income and life satisfaction provided further evidence for convergent and criterion-related validity, respectively. Overall, the findings suggest that the Persian version of the MSFWBS is a reliable and valid instrument for assessing subjective financial well-being among Iranian emerging adults. The study contributes to expanding research in non-WEIRD populations and supports the broader cross-cultural applicability of the MSFWBS in developing economies.

Despite the widespread use of verbal fluency (VF) tasks in child neuropsychological research and clinical practice, the contribution of executive and linguistic processes to variability in children’s fluency performance is still unclear. This is particularly important when considering the development of orthographic knowledge and semantic network during childhood. The present study investigated the contributions of executive functions and linguistic skills to performance in VF tasks in children. We examined the contributions of basic executive functions (i.e.,inhibitory control, working memory, and flexibility) and high-order executive functions (i.e., planning), vocabulary, lexical access speed, and phonological awareness to VF performance in 111 typically developing children (8–10 years old). Multiple regression analyses showed that phonological awareness was a predictor of performance in phonemic verbal fluency (PVF), and lexical access speed was the best predictor of performance in semantic verbal fluency (SVF). Among the executive function components, working memory was a predictor of performance in PVF and most categories of SVF (except animal fluency). In addition to working memory resources (i.e., a basic executive function), planning (i.e., a high-level executive function) was also recruited in the clothing category of SVF. These results highlight the importance of phonological processing skills in children’s performance on VF tasks and show similarities and differences in the contributions of various linguistic and executive skills to PVF and SVF. These findings have implications for interpreting the results of these measures in research and clinical practice.

Executive and social functioning difficulty is well established in pediatric brain tumor survivors. Few studies have compared posterior fossa (PF) tumor survivors in comparison to their peers. The relationship between attention, processing speed, working memory, fatigue, and executive and social functioning was investigated to better understand the factors that impact executive and social functioning in PF tumor populations. Sixteen medulloblastomas, 9 low-grade astrocytomas (LGAs), and 17 healthy controls recruited from 4 sites completed measures of working memory and processing speed, and self-reported fatigue. One parent completed questionnaires on executive and social functioning. There were no significant differences among all 3 groups on parent-reported executive and social functioning; of note, parents of LGA survivors expressed greater concerns regarding behavioral and cognitive regulation than did parents of medulloblastoma survivors and healthy controls. Parent-reported attention was related to parent-reported emotion, behavior, and cognitive regulation. Worse self-reported fatigue was associated with greater emotional dysregulation for the 2 PF tumor groups. Parents of PF tumor survivors described their children as performing similarly to their peers in most facets of executive and social functioning. While LGA survivors are traditionally thought to have more favorable outcomes, our finding of parent-reported executive functioning concerns to be worse for this group highlights the importance of long-term follow-up for all PF tumor survivors. Additionally, significant effects of attention on aspects of executive functioning in PF tumor survivors may inform current clinical practice and the future development of more effective interventions.

Aim:To assess ethical issues in everyday clinical practice among physicians and nurses of the University Hospital Rijeka, Rijeka, Croatia.Subjects and methods:We surveyed the entire population of internal medicine, oncology and...

The purpose of the research presented in this chapter is to investigate if virtual reality (VR) neurocognitive, executive, and motor function assessment tools are susceptible to practice and fatigue effects similar to those currently used in a clinical practice. Fifteen athletically active and neurologically normal Penn State students participated in a VR “practice effect” study. Another 15 Penn State football players participated in an “effect of fatigue” study on neurocognitive, balance, and executive functions. Subjects performed VR tests on several occasions. The statistical analysis was conducted to examine the VR measures as a function of testing session (practice effect) and physical fatigue (prior to and after full contact practices). The number and type of the full contacts during the practices were assessed via a specially developed observational chart. There are several major findings of interest. First, all subjects reported the “sense of presence” and “significant mental effort” while performing the VR tests. Second, neither effect of testing day (p > 0.05) nor effect of VR testing modality (p > 0.05) was revealed by ANOVA. Third, physical fatigue did not influence the VR measures in the majority of football players under study (p > 0.05). However, there was a reduction in several VR performance measures in football players who sustained prior concussive injuries. The findings show that VR testing modalities implemented in this study and aimed to evaluate neurocognitive (spatial memory, attention), motor (balance), and executive functions may be used as a complementary tool in a clinical practice. VR testing modalities under laboratory conditions are easily transferable into field conditions, and can potentially be used as the side-line evaluation of subjects at risk for concussion.

Background: It is known that cognitive impairment is associated with low bone mineral density (BMD) and that low BMD is also observed in elderly people with neurodegenerative diseases, in which executive functions (EF) could be decreased. A limited number of studies investigated the association between EF with BMD and fracture risk in elderly women. Aims: The aim of this study was to explore the association between cognitive impulsivity, BMD and fall risk in a sample of postmenopausal women evaluated for osteoporosis. Methods: We consecutively recruited women who obtained a score ≥ 24 at the Mini Mental State Examination (MMSE). Cognitive impulsivity was evaluated by the Stroop Colour and Word Test (SCWT). BMD was detected by dual-energy X-ray absorptiometry at lumbar spine and femoral neck. Results: Cognitive impulsivity, as evidenced by the greater number of errors at the SCWT, was significantly related with BMD values at lumbar spine and femoral neck (r= -0.39, p= 0.01 and r= -0.43, p= 0.008; respectively), suggesting a neuropsychological impairment in patients assessed for osteoporosis. Moreover, interference effect on response time was significantly associated with higher prevalence of falls (r= 0.342; p= 0.031). Discussion and Conclusions: Our findings suggested a potential involvement of cognitive impulsivity on BMD and risk of fall. This is a relevant issue in clinical practice for both clinical psychologists and physicians who evaluate postmenopausal women, to eventually predict risk of fracture.

Earlier research and clinical practice show that specific language impairment (SLI) is often associated with nonverbal cognitive deficits and weakened skills in executive functions (EFs). Executive deficits may have a remarkable influence on a child's everyday activities in the home and school environments. However, research information is still limited on EFs in school-aged children with SLI, mostly conducted among English- and Dutch-speaking children. To study whether there are differences in EFs between Finnish-speaking children with SLI and typically developing (TD) peers at school age. EFs are compared between the groups with and without controlling for nonverbal intelligence. Parents and teachers of children with SLI (n = 22) and age- and gender-matched TD peers (n = 22) completed The Behavior Rating Inventory of Executive Functions (BRIEF). The mean age of the children was 8,2 years. BRIEF ratings of parents and teachers were compared between the children with SLI and with TD peers by paired analysis using conditional logistic regression models with and without controlling for nonverbal IQ. Intellectual functioning was assessed with the Wechsler Intelligence Scale for Children. Children with SLI had weaker scores in all parent and teacher BRIEF scales compared with TD peers. Statistically significant differences between the groups were found in BRIEF scales Shift, Emotional Control, Initiate, Working Memory, Plan/Organize and Monitor. Differences between the groups were statistically significant also in intellectual functioning. On BRIEF scales some group differences remained statistically significant after controlling for nonverbal IQ. This study provides additional evidence that also Finnish-speaking school-aged children with SLI are at risk of having deficits in EFs in daily life. EFs have been proposed to have an impact on developmental outcomes later in life. In clinical practice it is important to pay attention to EFs in school-aged children with SLI when making diagnostic evaluations and planning interventions for them.

Penjangkitan wabah Avian influenza menjadi persoalan kesehatan yang menimbulkan dampak serius di bidang yang lain, seperti ekonomi, sosial-budaya, politik, pertahanan, dan keamanan, baik di tingkat nasional maupun internasional, termasuk di Indonesia. Berbagai upaya telah dilakukan untuk mengantisipasi penyebaran wabah ini, salah satunya dengan tindakan karantina untuk menghambat penyakit tersebut dengan tetap mempertimbangkan kelancaran perjalanan, yang dilakukan di area pintu masuk, antara lain di bandar udara, pelabuhan laut, stasiun angkutan darat, sebagai tempat perbatasan antara suatu wilayah dan wilayah luar. Karena itu, tujuan penelitian ini adalah untuk mengetahui peran karantina sebagai alat pencegah untuk menghalangi penjangkitan Avian influenza dan efektivitas implementasinya di Bandara Internasional Soekarho-Hatta. Penelitian ini menggunakan metode deskriptif kualitatif. Lokasi penelitian ini adalah Kantor Kesehatan Pelabuhan (KKP) Kelas I Jakarta Bandara Soekarno Hatta. Data yang digunakan adalah data primer yang diperoleh melalui observasi dan wawancara dan data sekunder yang diperoleh lewat studi dokumenter. Data yang terkumpul dianalisis dengan teknik deskriptif kualitatif. Hasil penelitian ini menunjukkan bahwa di Indonesia, kegiatan karantina diterapkan terutama di Kantor Kesehatan Pelabuhan Kelas I Jakarta dengan tugas dan fungsi pokok mencegah masuknya penyakit karantina dan penyakit menular berpotensi wabah. Sementara itu, di Kantor Kesehatan Pelabuhan Kelas I Bandara Soekarno-Hatta, tugas dan fungsi pokoknya adalah melaksanakan karantina pada pintu masuk wilayah negara Republik Indonesia. Pelaksanaan tugas dan fungsi itu dipengaruhi oleh beberapa faktor antara lain: dasar legalitas (landasan hukum dan operasional) organisasi, sarana dan prasarana, sumber daya manusia, Standar Operasional Prosedur, Kerjasama Lintas-Sektor dalam penerapan teknologi informasi serta dukungan dana untuk pembiayaan operasional kegiatan. Efektivitas berbagai upaya tersebut sangat diperlukan untuk mendukung kokohnya ketahanan nasional dalam upaya penyempurnaan kegiatan karantina yang dilaksanakan KKP Kelas I Bandara Soekarno-Hatta. Pertama, revisi UU No. 2/1962 tentang Karantina perlu dilakukan agar lebih disesuaikan dengan Peraturan Kesehatan Internasional 2005. Kedua, pembenahan sarana dan prasarana perlu dilakukan untuk mendukung pelaksanaan pengawasan higienitas dan sanitasi pesawat sebagai alat angkut, pelayanan kesehatan berupa perbaikan sarana observasi penderita, laboratorium maupun kegiatan rujukan penderita. Ketiga, pengembangan sumber daya manusia, rekrutmen tenaga operasional sesuai dengan tugas melalui pendidikan dan pelatihan. Keempat, penyempurnaan Standar Operasional Prosedur, yang sesuai dengan karakteristik penyakit, dengan tetap mempertimbangkan kelancaran pelaku perjalanan. Kelima, mempermantap kerjasama lintas-sektor antar- dan inter-lembaga serta jaringan informasi pihak banda dan di luar negeri. Dan keenam, mengoptimalkan ketersediaan dana dalam upaya mendukung kegiatan karantina dengan menggali sumber dana dari pihak yang terkait. The outbreak of Avian influenza epidemics is a health problem resulting in serious impact in economic, socio-cultural, political, defence and security sectors at the national and international levels, including in Indonesia. Various efforts are done to anticipate the epidemic, one of which is to do the quarantine efforts of impeding its dissemination while considering smooth traveling in gateways, such as in airport, seaport and land transport station as main borders between territory and the outside. Therefore, purpose of this study is to find out the role of quarantine as the preventive instrument of inhibiting the outbreak of Avian influenza and its effectiveness of implementation in Soekarno-Hatta International Airport. The study used a descriptive qualitative method. The location of the study was the Airport Health Office of Class I Jakarta. Data used were both primary data obtained from interview and secondary data obtained through documentary study. Data collected were then analyzed by a descriptive qualitative technique. Result of the study indicates that the quarantine efforts in Indonesia were particularly done in Airport Health Officer of Class I (AHO-I) Jakarta with main task and function of inhibiting the dissemination of quarantined diseases and potential infectious disease epidemics. In AHO-I of Soekarno-Hatta International Airport, the main task and function was to do quarantine activity in gateways of the Republic of Indonesia. The performance of main tasks and functions were influenced by several factors, such as regulation, infrastructure, human resource, Standard Operating Procedures, cross-sector cooperation in the application of information technology, and fund to support operational finance. The effectiveness of various efforts is highly required to support the national security of completing the quarantine programs in AHO-I of Soekarno-Hatta International Airport. First, revision of Act No. 2/1962 on Quarantine should be done in order to be adapted to International Health Regulation of 2005. Second, the improvement of infrastructures is necessary to do for supporting the performance of hygienist and sanitation monitoring of plane as transport facility, health services by improving patient observation facility, laboratory, and patient reference guides. Third, human resource development and operational personnel recruitment appropriate with main tasks by education and training. Four, completing the Standard Operating Procedures adapted to the characteristics of disease while considering smooth traveling. Five, the establishment of intra- and inter-institutional cross-sector cooperation and the information networks of domestic and foreign airports. And six, optimizing fund sufficiency in the efforts of supporting the quarantine activity by exploring the source of fund from related parties.