The relationship between menopause-related hormonal changes and disease outcomes in women with multiple sclerosis (WwMS) is still debated. We investigated whether natural estrogen exposure during reproductive years and its decrease at menopause correlate with disease outcomes in WwMS. Thirty-two perimenopausal WwMS participated in a two-phase study. In the first cross-sectional phase, we calculated the cumulative lifetime estrogen exposure (CLEE) and examined its associations with physical and cognitive disability, as well as optical coherence tomography and magnetic resonance imaging metrics, comparing individuals with long versus short CLEE. In the second longitudinal phase, 21 WwMS returned for follow-up at 6, 12 and 18months. The cohort was divided into menopause-positive (M+) and menopause-negative (M-) groups, and group differences were analyzed. WwMS with longer CLEE had lower baseline Expanded Disability Status Scale scores (p=0.03), a thicker optic nerve head (p=0.04), and a thicker macular retinal nerve fiber layer (p=0.03). They also performed better on the 9-Hole Peg Test (p=0.018) and scored lower on the MS Impact Scale-29 (p=0.002). After 12months, longer CLEE correlated inversely with loss of the macular ganglion cell-inner plexiform layer (r=-0.532, p=0.04). Additionally, M+ WwMS experienced greater brain volume loss compared with M- WwMS (p=0.029). A longer duration of CLEE is associated with better outcomes in WwMS, while menopause appears to be linked to increased brain atrophy. Larger clinical studies are warranted to further explore these findings and clarify the relationships between CLEE, menopause and MS outcomes.

Proteomic profiling identifies systemic drivers of blood-brain barrier injury in sickle cell disease.

Dental implant therapy is increasingly offered to patients with physical, cognitive or multiple disabilities; however, their long-term survival and complication patterns remain poorly defined. To determine the 10-year cumulative survival rate of dental implants and characterize biological and mechanical complications in patients with disabilities treated at a single university oral care centre. We retrospectively reviewed clinical and radiographic records of patients who underwent implant surgery between 2013 and 2023. Implant outcomes were classified based on established clinical and radiographic criteria for survival and failure. Kaplan-Meier analysis estimated cumulative survival, and subgroup analyses compared outcomes by disability type. Prosthetic complications were evaluated only in implants with definitive restorations. A total of 137 patients (465 implants) were analysed; 35 patients (117 implants) did not receive definitive prostheses. The mean age of the patients at surgery was 46.3 years. The 10-year cumulative implant survival rate was 98.3%. Subgroup survival rates were 99.1% (mental impairment), 98.1% (physical impairment) and 95.7% (multiple disabilities). Seven implants failed (five early biologic failures before prosthesis delivery; two mechanical failures, including one traumatic fixture fracture and one abutment screw fracture). Biological complications occurred in 11 restored implants, whereas mechanical complications were more frequent, predominantly crown decementation (n = 32), followed by veneer chipping (n = 12), screw loosening (n = 12) and screw fracture (n = 3). Within the limitations of this retrospective single-centre cohort, careful surgical planning, simplified prosthetic design and structured caregiver-inclusive maintenance were associated with high long-term implant survival in patients with disabilities.

Legal capacity and supported decision-making rights for people with psychosocial disabilities: Insights from the WHO QualityRights training.

Community gathering places in Japan, supported by local governments, are expected to promote physical and cognitive health through physical activity and social interaction, in line with the World Health Organization's concept of age-friendly environments. However, evidence regarding their effects on dementia prevention remains inconsistent. This study aimed to assess whether habitual exercise modifies the association between participation in community gathering places and incident cognitive disability in older adults. This retrospective cohort study used data from the Public Survey of Long-Term Care Prevention in Habikino City, Japan, and included community-dwelling adults aged ≥ 65 years without certified care needs. Participation in community gathering places was investigated at baseline and incident cognitive disability was tracked from January 2020 to January 2024. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for demographics and health status. To test the effect modification by exercise habit, product terms between participation and exercise status were included in the model. We addressed missing baseline data using multiple imputation. A total of 2758 eligible older adults were included in the primary analysis. We observed a potential effect modification by exercise habit status (p for interaction = 0.092). Participation in community-gathering places was associated with a lower hazard of cognitive disability among individuals without exercise habits (adjusted HR [95% CI], 0.51 [0.27, 0.97]), whereas no such association was observed among those with exercise habits (1.09 [0.57, 2.09]). The association between participation in community gathering places and cognitive disability may differ according to habitual exercise status. These findings suggest that municipally supported community gathering places may represent an accessible form of participation associated with a lower risk of cognitive disability among older adults without established exercise habits.

Police officers' ability or inability to identify suspects' cognitive disabilities may directly influence how those suspects are treated and progress through the criminal justice process. Through qualitative interviews with police employees - including both frontline officers and investigators from six districts - this article explores the police's strategies for assessment and identification of cognitive disabilities. Findings show that police officers demonstrate varying levels of understanding of cognitive disabilities and that they base their assessments primarily on personal experience and instinct rather than on formal training and research-based practice. The article further explores legal protection implications by using two international human rights standards: the Convention on the Rights of Persons with Disabilities (CRPD) and the European Convention on Human Rights (ECHR). Findings underscore the importance of structural adaptations and training to ensure that individuals with cognitive disabilities receive fair treatment in the criminal justice system.

A Tale of Two Cerebral Palsies.

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system and the most commonneurodegenerative diseasein young adults, characterized by motor, sensory, visual, and cognitive impairments. Vitamin E (α-Tocopherol), a fat-soluble antioxidant, may influence cognitive function, disability, and mood in MS. One hundred eighty-four Italian Caucasian MS patients and ninety-four healthy controls were included. Clinical and demographic variables were recorded, and serum vitamin E levels were measured by HPLC. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), disability with the Expanded Disability Status Scale (EDSS), and depressive symptoms with the Hamilton Depression Rating Scale (HDRS). Logistic and linear regression analyses were performed, adjusting for demographic, MS-related, and metabolic confounders. Bonferroni correction was applied. Discriminative ability for clinical cut-offs (MMSE ≤ 24, EDSS ≥ 6, HDRS ≥ 8) was assessed using receiver operating characteristic (ROC) curves. MS patients had significantly lower serum vitamin E levels compared to controls. Lower vitamin E levels were associated with MS diagnosis. In MS patients, higher vitamin E levels were associated with better cognitive performance and lower disability. All associations remained significant after Bonferroni correction in fully adjusted models. No significant relationship was found between vitamin E levels and depressive symptoms. Vitamin E showed good discriminative ability. Serum vitamin E levels showed significant associations with MS diagnosis, cognitive function, and disability, with good discriminative ability. Longitudinal studies are needed to clarify whether low vitamin E levels influence the risk of developing MS, while randomized controlled trials are warranted to determine whether vitamin E supplementation may provide clinical benefits.

Axonal damage results in permanent cognitive and physical disability during the early as well as progressive stages of multiple sclerosis (MS). However, the mechanism of axonal damage may vary during different stages of MS. The extent and severity of the disease can be estimated by various clinical tests and imaging. However, these measures lack sensitivity and accuracy for understanding subclinical disease activity. Therefore, there is a need for a promising biomarker that can reflect on clinical and subclinical disease activities and have additional diagnostic applications, such as studying MS pathology, disease severity, and rate of relapse. Neurofilaments (NFs) are released into the extracellular fluid following axonal insult, and hence, measuring them can help understand the severity of neuro-axonal damage, particularly during early stages of the disease. It can, therefore, serve as a promising biomarker in MS. This review discusses NFs' biology and its correlation with disease activity, which may have clinical applicability in the diagnosis and prognosis of MS. Furthermore, their levels in response to treatment are also discussed, which can assist in the development of therapeutic strategies.

ABSTRACT Background Social determinants of health (SDOH) influence access to nutrition, healthcare, and living conditions and may contribute to pediatric anemia. Anemia in children is particularly concerning because delayed identification can lead to developmental and long-term health consequences. Despite their potential impact, SDOH are not explicitly recognized as risk factors in current AAP anemia screening guidelines. Identifying whether SDOH predict anemia risk may facilitate earlier detection and treatment. Objective To determine whether specific SDOH domains predict an increased risk of anemia in pediatric patients in primary care settings. Methods Pediatric patients (<18 years) presenting for routine or acute primary care visits and their caregivers were recruited. Caregivers completed a validated SDOH screener, and tcHgb measurements were obtained. A retrospective chart review provided demographic and clinical data. Associations between tcHgb and numeric variables were assessed using Spearman correlations; categorical variables were analyzed with Kruskal–Wallis or Wilcoxon rank sum tests. Regression analysis evaluated tcHgb as the outcome with SDOH risk as the predictor, adjusting for age, sex, race, and insurance type. Analyses were conducted using SAS v9.4. Results Among 248 families, 186 children (75%) had at least one identified social need. The most common were financial strain (31.85%), food insecurity (25.00%), cognitive disabilities (21.77%), language and literacy barriers (21.05%), and mental health concerns (18.11%). Mean (SD) tcHgb was 12.7 (1.2) g/dL, with a median of 2.0 [0.5, 3.0] positive SDOH domains when present. TcHgb was not associated with age, BMI, or sex but differed by insurance type. Each additional SDOH concern was associated with a 0.29 g/dL decrease in tcHgb (p < .0001). Conclusion SDOH risk factors are significantly associated with lower hemoglobin levels in pediatric patients, with cumulative social needs conferring increased anemia risk. Incorporating SDOH screening into pediatric primary care may improve early identification and outcomes for children at risk of anemia.

Brain magnetic resonance imaging (MRI) biomarkers for dementia exist, but little is known about their association with future frailty. We investigated whether baseline brain MRI findings associate with pre-frailty/frailty over 11 years. One hundred twenty participants, aged 60 to 77 years, in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) had baseline MRI data. Frailty status (Fried phenotype) was measured at baseline, and at 2, 7, and 11 years. Risk of future pre-frailty/frailty per one standard deviation or one class greater volume/thickness/Fazekas score in baseline MRI was evaluated. Pre-frailty/frailty was not associated with MRI biomarkers at baseline. Smaller left hippocampal volume was associated with pre-frailty/frailty at 2 (p=0.042) and 7 years (p=0.017), and higher load of periventricular white matter hyperintensities (WMHs) at 2 years (p=0.048), independently of baseline cognition. Smaller left hippocampal volume and higher periventricular WMH score in brain MRI may indicate future frailty risk. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is registered at ClinicalTrials.gov (no. NCT01041989).

The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was the first to show that multidomain lifestyle interventions can enhance brain health and reduce cognitive decline. However, the clinical effectiveness and delivery of the FINGER model within primary care settings remain unexplored. This paper presents the protocol for the STRONGER 60+trial, which aims to evaluate both the clinical effectiveness and real-world delivery of an adapted FINGER-based intervention in primary care. This 6-month randomised controlled clinical effectiveness trial will be conducted in primary care and will include adults aged 60 and older with vascular or lifestyle-related risk factors for dementia. A total of 80 participants will be randomised to either a structured, supervised multidomain lifestyle intervention or a self-guided version of the same programme. The intervention includes nutritional guidance, physical exercise, cognitive training, social engagement and management of vascular and metabolic risk factors. Data will be collected at baseline, 6 months (primary endpoint) and 12 months post-randomisation. The primary outcome is the change in a composite healthy lifestyle score at 6 months. In addition, the study will explore delivery processes and stakeholder (participant and healthcare professional) perspectives using both qualitative and quantitative methods. The study has been approved by the Swedish Ethical Review Authority (approval numbers: 2020-05785, 2021-06413-02, 2022-05454-02) and will follow the principles of the Declaration of Helsinki. Ethical procedures for informed consent, confidentiality and data management will be strictly observed. Results will be disseminated through scientific publications, conferences and targeted outreach to healthcare professionals and the general public. NCT07117916.

Reasons for cannabis use among adults with disabilities: Findings from the 2023-2024 National Survey on Health and Disabilities.

Despite the growing number of residents with disabilities, barriers to equitable access persist in medical training. Program access to accommodation has been linked to improved training and mental health outcomes, but little is known about possible resident and program characteristics associated with access to and requests for needed accommodations. To examine demographic, training, and disability-related factors associated with program access and accommodation requests among internal medicine (IM) residents with disabilities. This national cross-sectional study looked at accredited IM residency programs in mainland US and Puerto Rico. Participants were IM residents who took the 2023 Internal Medicine In-Training Examination and reported having at least 1 type of disability. The primary outcomes were program access, defined as receiving accommodations or not needing them, and requesting needed accommodations. Multivariable logistic regression models were conducted for each of the outcomes. Of 19 205 respondents, 1824 (9.5%) reported a disability; participants were predominantly men (979 men [53.7%]), US medical graduates (1398 participants [76.6%]), and enrolled in categorical IM programs (1532 participants [84.0%]). With regard to race, 340 participants (18.6%) were Asian, 415 (22.8%) were from groups underrepresented in medicine (including self-reported Black or African American or Afro-Caribbean; Latinx or Latino or Hispanic; Native American or American Indian or Indigenous or Alaskan Native; Native Hawaiian or Pacific Islander), and 823 (45.1%) were White. Among 1052 with complete accommodation information, 811 (77.1%) had program access and 241 (22.9%) did not. In multivariable regression models, having cognitive disabilities (adjusted odds ratio [aOR], 0.27; 95% CI, 0.15-0.49) and identifying as women (aOR, 0.55; 95% CI, 0.40-0.75), Asian (aOR, 0.53; 95% CI, 0.34-0.82) and underrepresented racial or ethnic groups (aOR, 0.58; 95% CI, 0.38-0.87) were associated with lower odds of program access. Among 699 residents coded as needing disability accommodations with classifiable responses, 200 (28.6%) did not request them. Fear of stigma (164 respondents [82.0%]) and unclear institutional processes (60 respondents [30.0%]) were the most cited reasons for nonrequest for needed accommodations. Requesting accommodations was less likely among residents with cognitive disabilities (aOR, 0.16; 95% CI, 0.08-0.31) and who identify as women (aOR, 0.37; 95% CI, 0.25-0.54), genderqueer or nonbinary (aOR, 0.11; 95% CI, 0.02-0.68), Asian (aOR, 0.50; 95% CI, 0.30-0.85), or underrepresented in medicine (aOR, 0.60; 95% CI, 0.37-0.97). These findings suggest that despite growing disability representation, substantial inequities in access to and requests for accommodations persisted for IM residents with disabilities, particularly those with cognitive disabilities and marginalized identities. Institutions should implement inclusive, transparent policies to foster psychological safety and disability inclusion.

Abstract Ensuring digital safety for individuals under legal guardianship due to cognitive disabilities is the responsibility of their legally appointed guardians. These guardians are charged with making personal and lifestyle decisions in the best interests of the wards, which include their online access. Traditional blacklists are often ineffective for this purpose, as wards may trust misleading or harmful content across the entire web. Whitelists are a more suitable solution, as they restrict access to a predefined set of trusted websites, thereby reducing exposure to misleading, manipulative, or harmful content. However, creating and maintaining large whitelists is challenging and requires frequent updates, particularly for hyperlocal websites that are most important for a ward’s social life and independence. We present SafeWeb, a supervised system designed to assist guardians in curating whitelists. Our method automatically curates relevant hyperlocal websites, which are essential for fostering ward independence but difficult to process with existing approaches. The processed websites are categorized into three groups: facility (e.g., schools and social centers), commerce (e.g., shops and service points), and prohibited (e.g., gambling venues and nightclubs). We provide the SafeWeb source code and curated websites for 20 countries (including USA, France, Japan, and Australia), along with validation results for selected countries. The results demonstrate SafeWeb’s effectiveness as a decision-support tool for guardians to act in the ward’s best interest.

People with intellectual and other cognitive disabilities often face barriers to participating in clinical research, particularly related to the informed consent process. Recent federal policy and legal efforts have advanced strategies to address these challenges, including using supported decision-making. This article discusses this recent progress and the risks and potential opportunities to continuing it in a shifting federal landscape.

Building on prior research that found more restrictive educational placements for secondary than elementary students, we explored grade-level placement variations of the population of 171,216 Utah public school students receiving special education services between kindergarten and 11th grade (2016-2022). Of these students, 9,037 (5%) were eligible for the state alternative assessment based on significant cognitive disability (SCD). Linear regression predicting mean placement level showed that students without SCD in later grades tend to have more restrictive placements due to a different distribution of disability categories—specifically, more students with Specific Learning Disability and Other Health Impairments and fewer students with Speech Language Impairment. Multilevel linear regression showed SCD had the strongest negative effect on placement, followed by disability categories often associated with complex support needs (multiple disabilities, intellectual disability, autism). Prior research and federal reports indicating increasing inclusion rates of students with disabilities across years only apply to students without SCD. Highly segregated placements for students with SCD remain largely unchanged across grades and years. Our findings highlight a substantial, longstanding gap in improving inclusive opportunities for students with SCD.

Supported decision-making is rapidly gaining attention as an alternative to guardianship and other forms of surrogate decision-making for people with cognitive disabilities. This article provides an overview of the legal status of supported decision-making in the United States, with particular attention to how states are recognizing supported decision-making in different legal contexts. It then explores how the law of supported decision-making applies to clinical research. It explains that although federal research regulations and guidance do not explicitly address formal supported decision-making, individuals may use supported decision-making to make decisions about participating in clinical research and researchers may be required to allow such use under federal laws that protect against disability discrimination. It then concludes by considering legal barriers to greater use of supported decision-making and how these barriers might be overcome.

Background: Patient-family centred approach with interprofessional and cross sectoral collaboration is highly recommended in paediatric rehabilitation, to improve children's participation in daily life activities. However, children with disabilities receive fragmented rehabilitation care, due to the diversity of professions and sectors (care, education, community) involved, and it's difficult to maintain the children and families’ engagement throughout this long care pathway. Digital health technologies (DHTs) such as mobile applications are a promising way to promote integrated care. The aim of this study was to explore stakeholders’ perspectives about DHTs to facilitate integrated paediatric rehabilitation pathways, to inform the development a mobile app. Approach: The methodology was design with patients, parents and clinicians as co-researchers, who participated to defining the research question, co-designing the interview guide, recruiting participants on social networks, analysing the verbatims and reviewing the articles. Qualitative descriptive interpretative study design. 74 participants took part in semi-structured interviews and focus groups (25 youth with motor and cognitive disabilities from 12 to 25, 16 parents, 33 professionals involved in paediatric rehabilitation pathway (health care rehabilitation professionals, educators, community professionals as leisure), recruited with purposeful sampling. Open questions were about perceived opportunities, needs and challenges of DHTs, and ideas for features to be integrated. A thematic analysis was carried out on Nvivo14, following Braun &amp; Clarke steps. Saturation was obtained for each group of participants. Results: Key opportunities to facilitate integrated care in paediatric rehabilitation were: 1) facilitating a continuum between clinic, school and community with a shared app, the possibility of sharing observations of the child in various environments and to codetermine rehabilitation goals 2) improving engagement of children and families through a more transparent access to health data, giving them control over who they share their data with, and 3) facilitating skill acquisition and transfer into everyday life, through self-rehabilitation exercises to do at home, and the sharing of videos, photos, documents, etc. Professionals expressed many concerns: confidentiality regarding the integration of education and community professionals in the app, children's screen time, parents' digital literacy and dehumanizing relationship with patients, interoperability with other information and communication technologies. Parents were concerned about professionals' involvement and their attitudes towards interprofessional and family collaboration. Youth wanted this app to be open to other people in their circle, universally accessible and that they could give access to trusted professionals, because they were more concerned about professionals' ableism and professionals/parents' adultism. Implications: These results provide new knowledge about the core components for integrated paediatric rehabilitation care, with stakeholders' concrete needs. This user-centred design is essential considering the limited adoption of e-health in clinical practice. Next steps will be to align stakeholders needs with focus group. Then a health app shared by children with disabilities, caregivers and professionals will be developed, to offer more holistic rehabilitation services to children and their families in France, enhancing the participation in all aspects of the child’s life. Involvement of stakeholders at all stages of the project will facilitate its implementation in clinical settings and the dissemination of knowledge.

Organizations increasingly recognize web accessibility as both necessary and beneficial for legal, ethical, and economic reasons. This article shows how instructors can easily integrate accessible web design into an introductory web design and development course for business students who have limited experience with design theory and user interface design. By applying testable criteria, following industry-standard guidelines, and using online tools, these business students can successfully build websites that individuals with visual, hearing, cognitive, or motor-control disabilities can use. The authors present their approach, describe specific assignments, and provide suggestions for incorporating accessibility into a traditional introductory web development course.