Attention Problems Research Articles

Atypical procedural learning in children with developmental coordination disorder: A combined behavioral and neuroimaging study

While procedural learning (PL) has been implicated in delayed motor skill observed in developmental coordination disorder (DCD), few studies have considered the impact of co-occurring attentional problems. Furthermore, the neurostructural basis of PL in children remains unclear. We investigated PL in children with DCD while controlling for inattention symptoms, and examined the role of fronto-basal ganglia-cerebellar morphology in PL. Fifty-nine children (6–14 years; nDCD = 19, ncontrol = 40) completed the serial reaction time (SRT) task to measure PL. The Attention-Deficit Hyperactivity Disorder Rating Scale-IV was administered to measure inattention symptoms. Structural T1 images were acquired for a subset of participants (nDCD = 10, ncontrol = 28), and processed using FreeSurfer. Volume was extracted for the cerebellum, basal ganglia, and frontal regions. After controlling for inattention symptoms, the reaction time profile of controls was consistent with learning on the SRT task. This was not the case for those with DCD. SRT task performance was positively correlated with cerebellar cortical volume, and children with DCD trended towards lower cerebellar volume compared to controls. Children with DCD may not engage in PL during the SRT task in the same manner as controls, with this differential performance being associated with atypical cerebellar morphology.

Behavior problems 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de L'Enfant study.

To investigate the occurrence of behavioral problems 7 years after severe pediatric traumatic brain injury (TBI), and their evolution from 3 months to 7 years postinjury. Thirty-four participants, 38% girls, M (SD) age at injury 7.6 (4.7) years, age at assessment 15 (4.6) years, underwent comprehensive assessments 7 years after severe TBI from March 2014 to March 2016 and were matched to a control group by age, gender, and parental education. A subgroup of 20 participants had available behavioral assessments at 3, 12, and 24 months postinjury. Internalizing, externalizing, and total behavioral problems were assessed with self- and parent reports of the Achenbach's Behavioral Checklist. Additional data included sociodemographic background, initial injury severity, and specific outcomes assessed concurrently 7 years postinjury. Compared to controls: (a) a significant proportion of participants with severe TBI fell above the clinical cutoff for self- (42%) and parent-reported (36%) externalizing problems, but not for self- (33%) or parent-reported (45%) internalizing problems; (b) withdrawn/depressed, intrusive behavior, and somatic complaints were significantly higher in self-reports; and (c) rule-breaking behavior, attention, and social problems were significantly higher in parent reports. Parent-reported internalizing problems were associated with older age at injury, whereas externalizing problems correlated with greater injury severity and concurrent levels of greater overall disability, lower intellectual ability, and poorer family functioning. In multiple hierarchical regression analyses, overall disability and worse family functioning significantly predicted externalizing problems. Parent-reported internalizing and externalizing problems persisted over time. These results highlight the importance of long-term follow-up and individualized behavioral interventions for children who sustained severe TBI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

High-risk neighbourhoods and behaviour outcomes in children born extremely preterm.

Study the association between neighbourhood risk and behaviour in extreme preterm (EPT) children. We hypothesised that EPT children living in high-risk neighbourhoods have increased risk of clinical range behaviour problems at age 30-36 months. Retrospective analyses of Child Behavior Checklist (CBCL)scores for 739 EPTs born 2005-2016. Addresses were geocoded to identify census block groups and create high versus low-risk groups. Regression analyses assessed the impact of neighbourhood risk on behaviour. Children from high-risk (N = 272, 39%) and low-risk (N = 417, 61%) neighbourhoods were compared. In adjusted analyses, odds of clinical range scores remained greater in high-risk neighbourhoods for Emotionally Reactive (OR: 4.32, CI: 1.13, 16.51), Somatic Complaints (2.30, CI 1.11,4.79), Withdrawn (OR: 2.56, CI: 1.21, 5,42), Aggressive Behaviour (OR: 4.12, CI: 1.45, 11.68), Internalising (OR: 1.96, CI: 1.17, 3.28), and Total score (OR: 1.86, OR: CI: 1.13, 3.07). Cognitive delay was higher in high-risk neighbourhoods and a risk factor for Attention Problems (2.10,1.08, 4.09). Breast milk was protective for Emotionally Reactive (OR: 0.22, CI: 0.06, 0.85) and Sleep Problems (OR: 0.47, CI:0.24, 0.94). Neighbourhood risk provided an independent contribution to preterm adverse behaviour outcomes with cognitive delay an additional independent risk factor. Breast milk at discharge was protective.

Behaviour-correlated profiles of cerebellar-cerebral functional connectivity observed in independent neurodevelopmental disorder cohorts

The cerebellum, through its connectivity with the cerebral cortex, plays an integral role in regulating cognitive and affective processes, and its dysregulation can result in neurodevelopmental disorder (NDD)-related behavioural deficits. Identifying cerebellar-cerebral functional connectivity (FC) profiles in children with NDDs can provide insight into common connectivity profiles and their correlation to NDD-related behaviours. 479 participants from the Province of Ontario Neurodevelopmental Disorders (POND) network (typically developing = 93, Autism Spectrum Disorder = 172, Attention Deficit/Hyperactivity Disorder = 161, Obsessive-Compulsive Disorder = 53, mean age = 12.2) underwent resting-state functional magnetic resonance imaging and behaviour testing (Social Communication Questionnaire, Toronto Obsessive-Compulsive Scale, and Child Behaviour Checklist – Attentional Problems Subscale). FC components maximally correlated to behaviour were identified using canonical correlation analysis. Results were then validated by repeating the investigation in 556 participants from an independent NDD cohort provided from a separate consortium (Healthy Brain Network (HBN)). Replication of canonical components was quantified by correlating the feature vectors between the two cohorts. The two cerebellar-cerebral FC components that replicated to the greatest extent were correlated to, respectively, obsessive-compulsive behaviour (behaviour feature vectors, rPOND-HBN = −0.97; FC feature vectors, rPOND-HBN = −0.68) and social communication deficit contrasted against attention deficit behaviour (behaviour feature vectors, rPOND-HBN = −0.99; FC feature vectors, rPOND-HBN = −0.78). The statistically stable (|z| > 1.96) features of the FC feature vectors, measured via bootstrap re-sampling, predominantly comprised of correlations between cerebellar attentional and control network regions and cerebral attentional, default mode, and control network regions. In both cohorts, spectral clustering on FC loading values resulted in subject clusters mixed across diagnostic categories, but no cluster was significantly enriched for any given diagnosis as measured via chi-squared test (p > 0.05). Overall, two behaviour-correlated components of cerebellar-cerebral functional connectivity were observed in two independent cohorts. This suggests the existence of generalizable cerebellar network differences that span across NDD diagnostic boundaries.

Analyzing Co-Occurrence of Non-Suicidal Self-Injury With Suicidal Ideation and Related Factors Among Adolescents in Jeju Island.

Non-suicidal self-injury (NSSI) and suicidal behavior, including suicidal ideation (SI) and suicide attempts, are important predictors of suicide in adolescents. This study aimed to investigate the associations between NSSI, SI, NSSI+SI, mental health problems, and family factors in Korean adolescents in Jeju Island, with an emphasis on key findings. A total of 561 adolescents completed self-report questionnaires regarding demographics, NSSI, SI, suicidal behavior, perceived family functioning, and mental health problems, which were assessed using Center for Epidemiological Studies Depression Scale for Children, Screen for Children Anxiety-Related Disorders (SCARED), and Youth Self-Report (YSR). Data were analyzed using descriptive statistics, one-way analysis of variance, chi-square test, post-hoc analyses, and multivariate logistic regression. In this study, 22.3% of adolescents reported either NSSI or SI, with 5.5% reporting NSSI and 20.7% reporting SI. Combined (NSSI+SI) group showed a significantly higher SCARED score, anxiety/depression, thought problems, attention problem, and rule breaking on YSR than did the SI only group. Higher level of depression and anxiety were significantly associated with NSSI and SI. Female sex and perceived family dissatisfaction were significantly associated factors for SI, but not for NSSI in multivariate logistic regression. This study provides insights into the clinical characteristics and associated factors among adolescents with NSSI, SI, and NSSI+SI in Jeju Island. Identifying these results can inform the development of targeted prevention and intervention strategies to mitigate the negative consequences of these behaviors and contribute to a better understanding of the role of family in this context.

Validation of the Ukrainian caregiver-report version of the Child and Adolescent Trauma Screen (CATS) in children and adolescents in Ukraine.

Emerging research indicates that the ongoing conflict in Ukraine has led to an increased prevalence of war-related posttraumatic stress disorder (PTSD) in children and adolescents. The current study sought to test the psychometric properties of a Ukrainian-translated measure of PTSD for children and adolescents; the Child and Adolescent Trauma Screen (CATS; Sachser et al., 2017). Participants were an opportunistic sample of N = 2,004 parents living in Ukraine who provided data on themselves and one target child in their household as part of The Mental Health of Parents and Children in Ukraine Study. The latent structure of the parent-reported CATS was tested using confirmatory factor analysis, composite reliability estimates were estimated, and criterion validity was assessed. The latent structure of the parent-reported CATS was best reflected by a three-factor model and a four-factor model in the preschool and child and adolescent samples, respectively. Estimates of internal reliability were high for both samples. Criterion validity was supported through associations with external measures of internalizing, externalizing, and attention problems. Parent-report child milestone development delays and prior psychological or pharmacological support were associated with higher average scores on the CATS symptom scales. The prevalence of probable PTSD for the preschool sample was 15.4% (n = 77) and the prevalence of probable PTSD for the child and adolescent sample was 14.4% (n = 217). This study supports the psychometric properties of the Ukrainian parent-reported CATS which can be used routinely in clinical practice for the caregiver-rated assessment of PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Prevalence and comorbidities of disruptive mood dysregulation disorder

IntroductionFollowing the release of DSM-5 in 2013, a newly introduced diagnostic category emerged in psychiatric classification—the disruptive mood dysregulation disorder (DMDD). DMDD is a depressive disorder that begins in childhood and is marked by a consistently irritable or angry mood, frequently accompanied by temper outbursts that are notably severe.ObjectivesIt is to study the prevalence and comorbidities of DMDD in Morocco, specifically at Arrazi University Psychiatric HospitalMethodsData were collected from youths aged 6 to 18 years who underwent a systematic assessment of symptoms. This assessment was extended to all patients consulting at Arrazi Hospital in Salé within the pediatric department over a period of four months (sample accrued from July 2023 to October 2023). The diagnosis of DMDD was established utilizing the diagnostic criteria outlined in DSM-5ResultsAbout 31% of the young participants met the operational criteria for DMDD. Those with DMDD exhibited increased comorbidity rates with attention-deficit/hyperactivity disorder (ADHD), another Depressive disorder and conduct disorder compared to those without DMDD. Additionally, they displayed elevated symptoms of aggressive behavior, rule-breaking, social issues, anxiety/depression, attention problems, and thought problems in comparison to all other participants without DMDD. It’s noteworthy that youth with DMDD presented with at least one psychiatric comorbidity.ConclusionsGiven that DMDD is accompanied by other comorbid psychiatric disorders, particularly depression and anxiety, and appears to impact familial and occupational status in adulthood, the early detection and subsequent effective treatment of DMDD symptoms are of utmost importance.Disclosure of InterestNone Declared

Negative factors of personality hardiness that effect on ability to control situation and cope with the stress

IntroductionPersonality hardiness expresses the characteristics that help to overcome stress and achieve well-being.ObjectivesThis study focused on the Hardiness as the important personality trait, which allow coping with stress and the relationship of empathy, emotional sensitivity and the personality hardiness.Methods88 healthy volunteers, students aged 17 to 26 years (mean age = 19, SD = 1,69), participated in this study. We used Cloninger’s Temperament and Character Inventory (TCI), the Maddi Hardiness Survey (adapted by Leontyev), Buss Perry Aggression Questionnaire (BPAQ), the Barratt impulsiveness scale (BIS-11), Maslach Burnout Inventory (MBI), the Questionnaire Measure of Emotional Empathy (QMEE).Results The cluster analysis was used to identify groups of hardy personalities. We demonstrated a negative relationship between hardiness and depression and burnout. It revealed significant differences between these groups by the following traits: Attention (BIS-11), Self-Control (BIS-11), Cognitive Complexity (BIS-11), Hostility (BPAQ), Exploratory activity (NS1 TCI), Shyness of strangers (HA3 TCI), Resourcefulness (S3 TCI). Regression analysis was used to identify Hardiness factors and to build the following regression models. For the first group the models describe 100% of dispersion (R-square=1,000, Durbin-Watson statistic = 1,419) and are:Control = -16,998 - 2,922*С2 + 3,549*С5 + 3,264*CI + 0,723*ST2 + 0,747*S4 - 0,306*SC + 0,166*RD3 - 0,020*C — 0,003*NS2, where C2 – scale Empathy (TCI), C5 – scale Principles (TCI), CI – cognitive instability, ST2 – Transpersonal identification scale (TCI), S4 – Self-acceptance (TCI), SC – Self-Control (BIS-11), RD3 – Social attachment (TCI), C – Cooperativeness (TCI), NS2 – Impulsive decision making (TCI). The Hardiness model described 50% (R-square=0,456) of dispersion:Hardiness = 63,527 – 4,080*C2, where C2 –Empathy scale (TCI) (p=0,003).The regression models of the second group explain 50% of group dispersion (R-square=0,512) and are Independent variables significance p<0,05:Challenge = 12,484 + 0,389*SC + 0,197*EE — 0,702*RD1 — 0,206*A,where SC- Self-Control scale (BIS-11), EE – Emotional Empathy (Personality test of Emotional Empathy), RD1 – Sentimentality scale (TCI), A – Anger (BPAQ).The Hardiness model describes 35% of dispersion (R-square=0,364, Durbin-Watson statistic = 2,066): Hardiness = 100,352 + 0,941*SC — 0,527*H, where SC – Self-Control scale (BIS-11) (p=0,009), H – Hostility scale (BPAQ) (p=0,021).ConclusionsThus, the attention and self-control problems, hostility, cognitive complexity and shyness have a negative impact on hardiness.Our results suggest that the excessive use of empathy leads to decrease of ability to control situation and cope with the stress.Disclosure of InterestNone Declared

The Effect of Ear Acupressure on Behavioral Problems in Children with Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial.

Due to the limits on treatment for people with attention-deficit/hyperactivity disorder (ADHD), ear acupressure treatment has been considered. This study examined the effect of ear acupressure on behavioral problems of children with ADHD. This randomized controlled trial was conducted in 70 children with ADHD who were randomized into 2 groups. The intervention group received ear acupressure in treatment points and the control group received massage at neutral points. Behavioral problems were measured 3 times: (1) baseline; week 4; and week 8. The last timepoint was a follow-up, using the Child Behavior Checklist. The intervention group had fewer behavioral problems at all 3 timepoints than the control group (Cohen's ∂ = 1.49; 95% confidence interval at week 4: 20.97, 47.43).The ear acupressure group had a large effect size with respect to reduction of attention problems at week 4 (∂ = 1.88) and week 8 (∂ = 1.48) than the control group. Ear acupressure induced significant reduction of the behavioral problems of children with ADHD. Further research can evaluate the use and continuity of the effectiveness of this treatment as a complementary treatment in addition to the usual treatments for these children.

Social skill and social withdrawal outcomes in children following pediatric stroke

ABSTRACT Pediatric stroke can result in long-term impairments across attention, functional communication and motor domains. The current paper utilized parent reports of the Behavioral Assessment System for Children 2nd Edition and the Pediatric Stroke Outcome Measure to examine children’s social skills and withdrawal behavior within a pediatric stroke population. Using the Canadian Pediatric Stroke Registry at The Hospital for Sick Children, data were analyzed for 312 children with ischemic stroke. Children with ischemic stroke demonstrated elevated parent-reported social skills problems (observed = 20.51%, expected = 14.00%) and clinically elevated social withdrawal (observed = 11.21%, expected = 2.00%). Attentional problems significantly contributed to reduced social skills, F (3,164) = 30.68, p < 0.01, while attentional problems and neurological impairments accounted for increased withdrawal behavior, F (2, 164) = 7.47, p < 0.01. The presence of a motor impairment was associated with higher social withdrawal compared to individuals with no motor impairment diagnosis, t(307.73) = 2.25, p < .025, d = 0.25, 95% CI [0.42, 6.21]. The current study demonstrates that children with stroke who experience motor impairments, attentional problems, reduced functional communication skills, and neurological impairments can experience deficits in their social skills and withdrawal behavior.

Pharmacists' Knowledge, Attitudes And Beliefs About Attention Deficit And Hyperactivity Disorder And Medical Treatment

Attention deficit hyperactivity disorder (ADHD) is a common and devastating disorder that poses a significant burden on families and society.ADHD treatment is multifaceted and requires long-term care and support. As pharmacists are directly involved in the distribution of medication, they are well positioned to collaborate with patients, support their treatment, highlight the importance of adherence to medication, and explain the medicine. This survey study aimed to identify pharmacists' knowledge gaps, attitudes and beliefs about ADHD and its medical treatment, and their experience in ADHD management. In our study, a questionnaire was prepared for pharmacists in Sivas Center, covering descriptive questions such as the pharmacist's age and professional year, what pharmacists do when they encounter children and adolescents with attention problems and/or mobility, and their thoughts on the diagnosis and treatment of ADHD, and applied face-to-face. The study involved 113 pharmacists. Respondents were asked to assess their level of knowledge regarding ADHD. It was observed that 29.2% of the participants had limited knowledge about ADHD and 14.2% had good knowledge. Nearly half (48.7%) of the respondents acknowledged their lack of knowledge on psychostimulants. It was revealed that 41.6% of the pharmacists consider ADHD treatment medication to be potentially addictive. When comparing survey responses on ADHD among participants based on their professional experience, it was discovered that there is a statistically significant relationship (p

Transitional Neonatal Hypoglycemia and Adverse Neurodevelopment in Midchildhood

The circumstances under which neonatal hypoglycemia leads to brain damage remain unclear due to a lack of long-term data on the neurodevelopment of affected children. As a result, diagnostic strategies and treatment recommendations are inconsistent. To evaluate whether the occurrence of severe transitional neonatal hypoglycemia (defined as having at least 1 blood glucose measurement of 30 mg/dL or below) is associated with adverse neurodevelopment in midchildhood. This cohort study using neurodevelopmental testing of a retrospectively recruited cohort was conducted at a single-center tertiary hospital in Germany between March 2022 and February 2023. Children with neonatal blood glucose screening data were randomly selected from all births between 2010 and 2015. Frequency matching for sex, birth weight, gestational age, socioeconomic status, and primary risk factors for neonatal hypoglycemia was performed. Children with persistent hypoglycemia diseases or any risk factor for adverse neurodevelopment except hypoglycemia were excluded. Data were analyzed between February 2023 and March 2023. At least 1 neonatal hypoglycemia measurement with blood glucose measuring 30 mg/dL or below vs all measured blood glucose levels above 30 mg/dL during postnatal blood glucose screening starting on the first day of life. Cognitive function measured by full-scale IQ test. Secondary outcomes included standardized scales of motor, visual, and executive functions, and child behavior, each measured at ages 7 to 11 years. A total of 140 children (mean [SD] age 9.1 [1.3] years; 77 male [55.0%]) participated in the study. Children with severe neonatal hypoglycemia had a 4.8 points lower mean full-scale IQ than controls (107.0 [95% CI, 104.0-109.9] vs 111.8 [95% CI, 108.8-114.8]). They showed a 4.9-fold (95% CI, 1.5-15.5) increased odds of abnormal fine motor function and a 5.3-fold (95% CI, 2.1-13.3) increased odds of abnormal visual-motor integration. Significantly higher T scores for attention problems (58.2 [95% CI, 56.1-60.2] vs 54.6 [95% CI, 52.6-56.6]) and attention-deficit/hyperactivity disorder symptoms (58.2 [95% CI, 56.2-60.2] vs 54.7 [95% CI, 52.8-56.7]) were reported by parents. Neonatal hypoglycemia with blood glucose levels of 30 mg/dL or below was associated with an increased risk for suboptimal neurodevelopmental outcomes in midchildhood. These findings imply that treatment strategies should aim to prevent episodes of hypoglycemia at these severely low levels.

ACQ: Improving generative data-free quantization via attention correction

Data-free quantization aims to achieve model quantization without accessing any authentic sample. It is significant in an application-oriented context involving data privacy. Converting noise vectors into synthetic samples through a generator is a popular data-free quantization method, which is called generative data-free quantization. However, there is a difference in attention map between synthetic samples and authentic samples. This is always ignored and restricts the quantization performance. First, since synthetic samples of the same class are prone to have homogenous attention, the quantized network can only learn limited intra-class visual features. Second, synthetic samples in eval mode and training mode exhibit different attention. Hence, the statistical distribution matching tends to be inaccurate. ACQ is proposed in this paper to fix the attention of synthetic samples. Regarding intra-class attention homogeneity, we introduce an attention center matching loss aimed at achieving coarse-grained matching of attention of synthetic samples. Additionally, we have devised an adversarial loss based on pairs of samples with identical conditions. On one hand, this mechanism prevents the generator from mode collapse due to excessive attention on conditional information. On the other hand, it augments the separation between intra-class samples, thus further enhancing intra-class attention diversity. To improve the attention similarity of synthetic samples in different network modes, we introduce a consistency penalty to guarantee accurate statistical distribution matching. The experimental results demonstrate that ACQ effectively improves the attention problems of synthetic samples. Under various training settings, ACQ achieves the best quantization performance. For the 4-bit quantization of Resnet18 and Resnet50, ACQ reaches 67.55 % and 72.23 % accuracy, respectively.

Comparing the effectiveness of game literacy education and game coding education in improving problematic internet gaming.

Problematic internet gaming by adolescents has been thought to be associated with low self-esteem, depression, anxiety, and attention problems. We hypothesized that both game literacy and coding education would effectively improve problematic internet use. However, game coding education would be more effective in enhancing self-esteem and social anxiety in adolescents than game literacy education. A total of 733 adolescent volunteers were included and randomly assigned to either the game coding education or game literacy education programs. Both programs consisted of eight sessions, each lasting 45 minutes, over four weeks. The coding education sessions included game planning and development lessons and allowed students to create the game's characters, stages, and tutorials directly using Scratch, a free coding program. Game literacy education sessions included lessons on enjoying gaming with a healthy rationale and etiquette. Data on demographics, gaming patterns, and psychological status, including positive/negative perceptions of online games, depression, social anxiety, and self-esteem, were collected. Both game coding and game literacy education significantly improved YIAS scores compared to baseline, and there was no significant difference in the YIAS scores between the two groups after the interventions. In the hierarchical logistic regression analysis of all participants, higher YIAS scores, stronger negative perceptions of gaming, and lower attention problem scores at baseline predicted lower levels of internet gaming addiction after interventions. In the hierarchical logistic regression analysis among individuals with game coding education, higher YIAS scores, stronger negative perceptions of gaming, lower attention problem scores, and higher self-esteem scores at baseline predicted lower levels of internet gaming addiction after intervention. In addition, game coding education greatly improved negative perceptions of games, self-esteem, and social anxiety compared to game literacy education. Both game literacy and game coding education effectively mitigate internet game addiction. However, game coding education effectively mitigated problematic internet gaming by improving negative perceptions of games, self-esteem, and social anxiety in adolescents. We found that the application of knowledge by students in creating their own games was more effective than simply developing a conceptual understanding of the games.

Sex-specific association between maternal mild anemia and children's behavioral development: a birth cohort study.

There has been limited research on maternal anemia affecting children's behavioral development, with a lack of studies focusing on sex differences in this association. Based on the Ma'anshan Birth Cohort, 2132 mother-child pairs were included. Maternal anemia was evaluated based on the hemoglobin concentration and children's behavioral development was assessed by Achenbach Child Behavior Checklist 1.5-5. Binary logistic regression models indicated that compared with children born of mothers without anemia throughout pregnancy, maternal mild anemia during pregnancy or only anemia in the 3rd trimester was associated with increased risks of aggressive behaviors in boys. Maternal mild anemia only in the 2nd trimester was associated with increased risks of attention problems in boys. In girls, maternal mild anemia during pregnancy was associated with increased risks of withdrawn, internalizing problems and total problems. Girls born of mothers with mild anemia only in the 2nd trimester had higher risks of total problems. Maternal mild anemia in both 2nd and 3rd trimesters was associated with increased risks of internalizing problems in girls. Our study identified sex-specific effects of maternal mild anemia during pregnancy on children's behavioral development problems.

Comparison of Oxygen Saturation Dynamics Between Types of Acute Stroke in Early Hospitalization Period

Introduction. Stroke is the number one cause of death and disability in Indonesia. It was found that the incidents of stroke were higher at ages over 45 years. The use of pulse oximeter is an efficient step in monitoring oxygenation in stroke patients. Decreased oxygen levels can cause neurological deficits such as cognitive impairment, causing patients to have problems in attention and executive functions. This study aims to determine the relationship between the type of acute stroke and oxygen saturation in early hospitalization period. Methods. This research was carried out from November to December 2023 at the National Brain Center Hospital, Jakarta, using a cross sectional approach. Information on diagnosis and oxygen saturation values were obtained through medical records, with a total of 70 patients as subjects. Subjects selected through simple random sampling with patients age over 45 years. Statistical analysis used the Mann Whitney test with a significantly different p value &lt;0.05. Results. A total of 68.6% of the subjects were male with ages of 45-59 dominated the subjects at 51.4%. Statistical tests on the type of acute stroke with oxygen saturation values produced a value of p = 0.044 (p &lt; 0.05) on the 3rd day of hospitalization. These results indicate a significant relationship between the type of acute stroke and the oxygen saturation value on the 3rd day of hospitalization. Conclusion. There is a significant correlation between the type of acute stroke and oxygen saturation in the 3rd day of hospitalization.

Efficacy of a virtual reality-based cognitive interactive training program for children with traumatic brain injuries: study protocol for a parallel-group randomized controlled trial

BackgroundTraumatic brain injury (TBI) is a leading cause of disability in children. Cognitive rehabilitation for this population is critical for their long-term health outcomes. This trial aims to evaluate the efficacy of a virtual reality-based program (VICT) for training executive functions in children with TBI.MethodsA parallel group randomized controlled trial will be conducted among up to 32 children with TBI. Children in the intervention group will receive the VICT training while children in the control group will play a comparable VR game without executive function training. Each participant will be assessed at baseline, post-intervention, and 1-month follow-up. Outcomes will include core executive functions, attention, and health-related quality of life measured by computerized tasks or standardized questionnaires.DiscussionCognitive rehabilitation is among the top healthcare needs for pediatric TBI patients. Virtual reality-based training is promising due to its versatile content, flexibility, and potential cost savings for both patients and providers. Findings of this trial will provide data on the efficacy of the VICT program on core executive functions, attention problems, and health-related quality of life and serve as the empirical foundation for future larger multi-site effectiveness trials.Trial registrationClinicalTrials.gov NCT04526639. Registered on August 18, 2020.

Explanatory and modifying factors of the association between sex and depression onset during adolescence: An exploratory study

BackgroundThe prevalence of Major Depressive Disorder (MDD) is twice as high in women as in men and this difference already emerges during adolescence. Because the mechanisms underlying this sex-difference remain poorly understood, we took a bottom-up approach to identify factors explaining the sex-MDD relationship. MethodsData came from the TRacking Adolescents' Individual Lives Survey (TRAILS), a population study investigating youths' development from age 11 into adulthood. We assessed multiple baseline covariates (e.g., demographic, social and psychological) at ages 11–13 years and MDD onset at ages 19 and 25 years. In regression analyses, each covariate's role in the sex-MDD association as an effect modifier or confounder/explanatory variable was investigated. Replicability was evaluated in an independent sample. ResultsThe analyses identified no effect-modifiers. Baseline internalizing problems, behavioral inhibition, dizziness, comfort in classroom, physical complaints, attention problems, cooperation, self/effortful control, interpersonal life events and computer use partially explained the association between sex and MDD at age 19. The association between sex and MDD at age 25 was explained by largely the same variables, but also by shyness, acne, antisocial behavior, aggression, affection from peers and time spent shopping. The explanatory roles of internalizing problems, behavioral inhibition, negative events involving gossip/rumors and leisure-time spending (computer-use/shopping) were replicated. LimitationsPotentially important baseline variables were not included or had low response rates. Gender roles or identification were not considered. Baseline MDD was not adjusted for. ConclusionThe sex-MDD association is partially explained by sex differences in symptoms and vulnerability factors already present in early adolescence.

Neurobehavioral and developmental profiles: genotype–phenotype correlations in individuals with Cornelia de Lange syndrome

BackgroundCornelia de Lange (CdLS) is a rare genetic disorder that affects most body systems. Variants in multiple genes including NIPBL and SMC1A, can cause the syndrome. To date, literature on genotype–phenotype associations in individuals with CdLS is extremely limited, although studies suggest some differences in clinical phenotype severity across variants. This study aimed to examine and compare neurobehavioral differences and developmental variability across CdLS genes, specifically NIPBL and SMC1A, and identify genotype–phenotype correlations.Participants and methodsThis patient-reported outcomes study included accessing data from the Coordination of Rare Diseases registry at Sanford. Parents of a total of 26 children/adults with CdLS and a known variant in NIPBL (Mean age = 20.46 years, SD = 11.21) and 12 with a known variant in SMC1A (Mean age = 11.08 years, SD = 9.04) completed a series of questionnaires regarding their child’s developmental history. This included attainment of common language and motor milestones, intervention history, and behavior functioning. Developmental history and reported behavior regulation difficulties were compared across variant groups.ResultsOverall, individuals with a pathogenic variant in NIPBL or SMC1A were similarly delayed across motor and language milestones with about 70% not using phrase speech and 30–50% not walking by 5 years of age. However, those with NIPBL variants showed more severity in behavioral phenotype, namely with more repetitive behaviors, tantrums, and withdrawn behaviors. In addition, these individuals were more likely than those with SMC1A variants to demonstrate self-injurious behaviors, and anxiety. Both groups yielded a similar proportion of participants who participated in speech and occupational therapy, however those with SMC1A variants were more likely to engage in physical therapy. Both clinical groups report low rate of communicative or assistive device use despite a large proportion of participants never mastering single word or sentence use.ConclusionsStudy results are consistent with recent investigations highlighting more severe behavioral phenotype, particularly autistic features, anxiety, and behavior regulation challenges, among those with NIPBL variants albeit comparable developmental milestones. Both groups endorsed very elevated attention problems. Findings highlight importance of early interventions, including behavioral health services.

A study on the stratification of long-tail customers in civil aviation based on a cluster ensemble

Stratifying long-tail customers and identifying high-quality customers with high growth potential are crucial for civil aviation companies to explore new profit growth points. This paper proposes a long-tail customer stratification model based on clustering ensemble to address the problems of insufficient attention to long-tail customers in previous studies and the low accuracy and lack of accuracy testing of single clustering algorithms. First, the Bayesian information criterion is used to determine the optimal number of clusters. Then, an ensemble framework integrating the Gaussian mixture model, spectral clustering, Two step clustering and K-means algorithm is constructed, and the stacking and bagging ensemble methods are used for the cluster ensemble. Finally, three different indicators are used to evaluate the algorithm performance. Experimental results indicate that compared with single clustering algorithms, the Stacking algorithm increases the silhouette coefficient by 14.77% to 27.11%, the Calinski-Harabasz index by 38.83% to 122.18%, and the Davies-Bouldin Index by 19.38% to 98.04%. This indicates that each clustering has high cohesion and separation, with samples within a category being more closely related and those between categories having clear boundaries. It shows that the Stacking algorithm more accurately stratifies long-tail customers with similar consumption behaviors into different categories, achieving customer stratification.