Functional Difficulties Research Articles

Does early adversity predict executive functioning difficulties among undergraduates? Dissociations among self-report, performance, and EEG measures.

The present research aimed to determine whether self-reports of early adversity predicted individual differences in self-reported and laboratory-measured executive functioning in college-aged samples. Two studies with young adult samples (n = 231 and n = 61) measured endorsement of adverse childhood experiences (ACEs), self-reported executive functioning difficulties on the Behavior Rating Inventory of Executive Function (BRIEF), and self-report measures of depression and emotion regulation. The second sample also completed laboratory performance tasks of working memory, inhibitory control, and selective attention while electroencephalogram (EEG) was recorded. In both samples, greater self-reported ACEs predicted greater reports of executive functioning difficulties on the BRIEF (rs = 0.378 and 0.322), relationships of medium effect size that remained significant when controlling for depression and emotion regulation variables. In the second sample, despite robust EEG/event-related potential (ERP) task findings in the group as a whole, neither lab task performance nor EEG/ERP measures were reliably correlated with individual differences in ACEs. We consider multiple alternative explanations for why early adversity predicted self-reported executive functioning difficulties but not lab task performance or neural measures in the same sample. These findings may reflect a propensity for negative self-evaluation among those with early adverse experiences, leading to inflated estimates of their own executive function problems. Alternatively, the findings may indicate that the lab tasks are insufficient in tapping aspects of executive functions that are relevant outside the lab context. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Capacidade funcional e práticas de autocuidado de idosos usuários da atenção primária à saúde e sua associação com indicadores de vulnerabilidade social

Abstract Introduction Public policies for older people encourage interventions aimed at preserving or improving their functional capacity and autonomy. Some of these policies emphasize self-care practices and the strengthening of daily activities, especially in primary healthcare. Objective The objective of this study was to assess the functional capacity and self-care practices of older users of primary healthcare in Brazil and their association with indicators of social vulnerability. Method This is a quantitative, cross-sectional, descriptive, and analytical study conducted with 128 older individuals. Results The results showed that being male, frail, and having diabetes and depression increases the likelihood of having difficulties in basic activities. They also showed that being female, aged over 80 years, frail, having poor self-perception of health, chronic conditions, anemia, osteoarthritis, and depression influence functional outcomes in instrumental activities. Conclusion The characterization of older people regarding sociodemographic data, self-perception of health, chronic conditions, level of frailty, and their relation to functional capacity and self-care is novel and relevant, given the scarcity of scientific studies assessing these aspects as compensatory practices for functional difficulties, as well as the associated factors, especially in older individuals residing in areas with indicators of vulnerability.

Disability and labour market participation among smallholder farmers in Western Kenya.

Despite the importance of labour market participation and the high number of people with disabilities in rural Africa who rely on subsistence agriculture to survive, very few studies have documented labour market outcomes among farmers with and without disabilities in Africa. We examined how labour market participation differed by disability and other factors among smallholder farmers in Western Kenya. We use cross-sectional data collected between January and April 2022 from sorghum farmers enrolled in a trial evaluating the impact of a programme designed to improve labour market participation among sorghum farmers in rural Western Kenya. Disability and Labour market outcomes were assessed using questions from the Washington Group /ILO Labor Force Survey Disability Module the ILO Labour Force Survey module respectively. Univariate and multiple regression analyses were conducted to identify socio-demographic characteristics and other related factors associated with labour market participation. Among 4459 participants, disability was reported by 20.3% of women and 12.3% of men. Labour market participation was reported by 77.1% and 81.3% of women and men, respectively. Adjusting for demographic confounders, having a disability was associated with a lower likelihood of labour market participation (odds ratio 0.59, 95% confidence interval, 0.42-0.83, P = 0.001). These findings were similar in a modified model that looked at functional difficulties separately from anxiety and depression. Women, older participants, and those who were dependent on others were also more likely not to report participation in the labour market. Increased recognition and understanding of functional limitations among smallholder farmers is vital for the success of economic empowerment programmes aimed at increasing labour market participation among the most vulnerable populations.

Cognitive Profile of Children with Autistic Traits

Background Three neuropsychological theories have been extensively studied in both autism spectrum disorders and the broader autism phenotype ndash Theory of Mind Executive Function and Central Coherence. The exact profile is still under debate.Objective The objective of this study was to compare the neuropsychological profile of children with high and low levels of autistic traits. Methodology Around 771 children between the ages of 5 and 11 years from mainstream schools were assessed using the Social Responsiveness Scale SRS. Two hundred children among the 771 assessed children were administered a battery of neuropsychological tests. Further the SRS scores were subjected to factor analysis FA and the 28 items from the SRS which were common across factor analyses were taken and scores were recalculated based on these items. The neuropsychological profiles on this were further compared.Results Executive Function difficulties were apparent among the high scorers across all comparisons. Children with higher levels of autistic traits post FA had weaker central coherence. The difference in central coherence was apparent even when the comparison was made without the lower socio-economic group. While there was no significant difference in the performance on the Theory of Mind there was a trend towards significance in the group without the lower socio-economic group.Conclusion Executive function deficits are strongly associated with higher levels of autistic traits. The influence of Central Coherence is apparent only when the autistic traits are more closely woven. Theory of Mind appears to be a more downstream effect of Executive Function and Central Coherencenbsp

Determinants of Functional Difficulty among Women in Nepal: A Cross-sectional Study

This study explores the situation of women with functional difficulties in Nepal and identifies key determinants contributing to their challenges. Utilizing data from the 2019 Multiple Indicator Cluster Survey, the research examines the association of various factors with functional difficulties among a sample of 13,255 married women aged 18 to 49. The results reveal significant associations between province, age, education, and media exposure with functional difficulties. Wealthier women and those with higher education exhibit lower odds of experiencing functional difficulties, while women aged 35 and above and those with medium or high media exposure demonstrate higher odds. The study highlights the limited access to healthcare and rehabilitation services, social stigma and discrimination, and high levels of poverty and unemployment faced by women with functional difficulties in Nepal. By shedding light on these issues, this research aims to provide valuable insights for policymakers, healthcare providers, and disability rights advocates, fostering improvements in the lives of women with functional difficulties in Nepal.

영아기 의도적 통제가 아동기 학교적응에 미치는 종단적 영향: 집행기능 곤란의 매개효과

This study aimed to longitudinally explore the mediating effect of executive function difficulties in the relationship between an infant’s effortful control and a child’s school adjustment. For the analyses, data from 205 pairs of mothers and their children (106 boys, 99 girls) who participated in the 1st, 8th and 9th Panel Study of Korean Children (PSKC) were used. The survey data were analyzed using the structural equation model (SEM) with SPSS 21.0 and AMOS 18.0 programs. The major findings were as follows. First, the infant’s effortful control had negative effects on executive function difficulties, but effortful control did not have a significant effect on the child’s school adjustment. Second, executive function difficulties positively affected school adjustment. Third, the child’s executive function difficulties completely mediated the relationship between effortful control and school adjustment. This study explored the meaningful longitudinal path from the infant’s effortful control to school adjustment through executive function difficulties in early childhood. The results of this study may provide basic information for the childhood school adjustment interventions.

Adaptive behavior of school-aged children with Autism Spectrum Disorder

Children with Autism Spectrum Disorder (ASD) face challenges related to their functioning, also known as adaptive behavior. Studies in recent literature explore the association between adaptive behavior and cognitive ability in children with ASD. Aim: The present study investigates adaptive behavior and adaptive skills in children with ASD in relation to their cognitive ability. Methods: In the present study, the sample consisted of 54 children with ASD, with a minimum Intelligence Quotient-IQ of “70”, who were admitted to a Child Psychiatric Hospital Clinic. Screening of functional and cognitive difficulties was performed by administering the Vineland Adaptive Behavior Scales (VABS) and Wechsler's Intelligence Scale for children-III (WISC-III), respectively. Results: Children with ASD exhibited deviations in adaptive behavior, with a pattern of deficits in adaptive skills (p<0.001). The group with high general cognitive score showed higher performance in the areas of Communication and Socialization, compared to the group with low general cognitive score. Both groups showed significant deficits in Daily Living Skills. The relationship between adaptive behavior/adaptive skills was investigated in relation to general, verbal and performance IQ (VIQ-PIQ). The general cognitive score was found to predict the performance of adaptive behavior. In the high cognitive ability group, the verbal and performance cognitive score predicted performance in Communication and Activities of Daily Living, respectively. Conclusions: The functioning of children with ASD is reflected in adaptive behavior, where a pattern of deficits is presented in relation to the cognitive ability.

Do patients in neurosurgical wards benefit from psychotherapy? A brief discussion on the application of cognitive-behavioural therapy in patients treated for spinal conditions

The present article reviews the existing literature on the application and effectiveness of cognitive-behavioural therapy in a group of patients with spine problems. It encompasses publications describing the use of cognitive-behavioural therapy in the treatment of patients with back pain and spinal cord injuries of various aetiologies, as well as those experiencing disabilities and difficulties in social and emotional functioning. The findings confirm that cognitive-behavioural interventions are effective in reducing the intensity of pain, improving mobility, reducing the duration of professional inactivity, facilitating adaptation to disability, and enhancing overall life satisfaction. They also support the effectiveness of therapeutic interventions in addressing depressive and anxiety disorders among these patients. It appears that both the traditional and newer approaches of cognitive-behavioural therapy offer potential in patients with spine issues and their families and caregivers. However, due to the insufficient number of randomised and controlled studies, high heterogeneity among study groups, and diversity of research protocols, it is not possible to definitive formulate final conclusions or recommendations at this stage. Nevertheless, the literature findings herein support further exploration of cognitive-behavioural therapy among patients experiencing spine problems.

Funkcjonowanie świetlic socjoterapeutycznych w czasie pandemii COVID-19 w Gdańsku, Poznaniu i Katowicach

Socio-therapeutic day-care facilities are specifically dedicated to the conduct of socio-therapeutic activities for children and adolescents from high-risk groups and those displaying difficulties in psycho-social functioning. During the pandemic, socio-therapeutic day facilities continued to aid their clients. The aim of this analysis is to describe the operation of socio-therapeutic day care facilities in Gdańsk, Katowice and Poznań. The data collection method for this project is a semi-structured telephone interview, while data is examined via a template analysis. The analyses concerned 30 socio-therapeutic day care facilities in Gdańsk, Katowice and Poznań. The data collected shows that socio-therapeutic day facilities could be an important source of support for the participants and their families. Elements of socio-therapeutic work were retained in contact with the clients to the highest possible degree via online communication. Online meetings enabled discussion of current difficulties, emotional respite and support. Topics discussed included those supporting health-promoting behavior in an epidemiological emergency. Many of the activities went beyond group work and were mainly supportive or crisis intervention. Staff members contacted parents, helped with children’s homework and even donated food parcels.

Integrating Irish health care: How can we use the United Nations Convention on the Rights of Persons with Disabilities and Nine Pillars of Integrated Care?

Introduction: Over 1 billion (15%) of the world’s population are estimated to experience some form of disability, of whom up to 190 million people live with significant difficulties in functioning, often requiring health care services.
 Despite a myriad of policies and research, disabled people globally continue to be denied their human rights and face enduring barriers to full participation in society.
 The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) is an International Treaty setting out legal obligations on States to promote and protect the rights of persons with disabilities. It provides a unique opportunity to improve the quality of life of all disabled people. The convention identifies that disability arises as a result of barriers in society, including negative attitudes, inappropriate or inaccessible services that result in discrimination against persons with disabilities. The convention includes persons who are or will require Integrated Care. A number of the fifty Articles of the Convention are relevant as a framework to guide the implementation of Integrated Care for and with persons with disabilities. The aim of this workshop was to seek to understand how UNCRPD articles and the IFIC 9 pillars might inform priorities for integrated care.
 Methods: Led and co-designed by people with disabilities, a workshop was held to seek to understand from a broad audience how to use the UNCRPD to frame integrated health care in Ireland in parallel with the IFIC 9 pillars of integrated care.
 The workshop used a World Café methodology, a participatory multi-stakeholder action research process that takes place in a cafe style setting and supports the development of collective knowledge among individuals and communities to address shared problems.
 Participants were allocated into four groups to discuss the following four questions under the guidance of facilitators -
 1.In the context of the UNCRPD and the IFIC 9 pillars of integrated care what are the top 3 priorities to be addressed for people with disabilities across Ireland?
 2.What is currently happening in advancing integrated care for people with disabilities in Ireland?
 3.What would a successful, innovative integrated care system for people with disabilities in Ireland look like?
 4.What are the top 3 solutions you would like to see and work to see implemented immediately?
 Feedback and perspectives were captured on post-it notes and flipcharts and subsequently collated by facilitators. Data were reviewed, and a thematic analysis was conducted.
 Results: There were 20 participants from diverse backgrounds, including experts by experience, disabled persons organisations, academia and health services. Four key themes were generated through inductive thematic analysis: 1) the importance of co-production, 2) the need for equity as opposed to equality, 3) the need for data collection, sharing and knowledge mobilisation and 4) the need for a socioecological integrated care system for people with disabilities.
 Conclusions: Having policies and conventions, and models for the rights of persons with disabilities is not sufficient to ensure implementation. Successful implementation of integrated care needs enablers, including co-production of initiatives with persons with disabilities.

Women's Sexual Dysfunctions Following Stem Cell Transplant and the Impact on Couple Relationship.

Stem cell transplant proved its efficacy in increasing the survival rate among young patients diagnosed with hematological malignancies. A transplant conditioning regimen is particularly destructive on the genital system, often determining premature ovarian failure, accompanied by vulvovaginal atrophy and sexual dysfunctions. The aims of the present study were, first, to evaluate sexual dysfunctions among transplanted women, using clinical examination and the female sexual function index (FSFI), and second, to determine their impact on a couple's relationship. A prospective observational comparative study was performed and included 38 patients who underwent allogenic stem cell transplant (SCT) procedures for different hematological malignancies and 38 healthy patients (control group). This study included baseline evaluation, one-year, and three-year follow-up visits. In addition to anamnesis and medically obtained information, FSFI was evaluated to determine the impact of gynecological damage in a subjective manner. In the study group, vulvovaginal atrophy was diagnosed in 76.32%, with subsequent sexual dysfunctions in 92.10% of patients, based on FSFI scoring. Even though the results improved throughout the study, at the last visit, mild vulvovaginal atrophy was diagnosed in 81.58% of patients, and the FSFI score was abnormal for 21.05%. When compared to the control group, both sexual dysfunctions and FSFI results were considerably impaired, with statistical significance. There is a confirmed negative impact of sexual dysfunctions and self-declared FSFI on couple/marital status and couple relationships, with statistical significance, at the last visit. In conclusion, anatomical, functional, and psychological difficulties are a reality of long-term survivors after a stem cell transplant. They should be addressed and assessed equally to other medical conditions, as they may determine serious consequences and impact the sexual quality of life and the couple's relationship.

HOME MODIFICATION ON FAVORITE ACTIVITY AND SELF-EFFICACY AMONG OLDER ADULTS WITH DEMENTIA

Abstract Globally, most older people with dementia live at home and want to remain at home as long as possible with a sense of agency, and engagement in preferred everyday activities. To remain at home, a safe and supportive home environment is crucial as dementia progresses. Yet research on environmental modification among people with dementia is focused on neighborhood or urban built environment, and less on home modification. Guided by the ecological model of aging, this study aimed to explore the impact of home modification on both affective (e.g., self-efficacy) and adaptive behavioral (e.g., favorite activities) responses as a result of person-environmental fit among people living with dementia. Using two waves (2018-2019) data from the National Health and Aging Trends Study (NHATS), we examined the extent to which home modification is associated with self-efficacy and engagement in favorite activities. Multi-group structural equation modeling was conducted on 273 older adults living with dementia in the communities, comparing 145 with functional limitations and 129 without. Although home modification did not affect one’s self-efficacy in any group, a positive impact of home modification on engaging favorite activities, especially those that require more physical effort (e.g., active leisure), was significant among older people with dementia with functional difficulties (p< 0.01). Our finding points to the importance of home modification for the most vulnerable subgroup of older adults with dementia, not only ensuring physical safety at home but their continued engagement in the activities meaningful for them, thereby helping them age in place.

AGEING WELL WITH AUTISM

Abstract Autism is characterized by patterns of neurological development that can cause differences in social interactions and sensory processing; restricted and repetitive patterns of behavior; and difficulties in identifying and describing feelings. The highly sociable and unpredictable environments typical of most societies are poorly suited to autistic people*, leading to disadvantage and exclusion. Despite increasing numbers of people aging with autism, little is known about the needs and experiences of middle-aged and older autistic adults. This is important given that autistic people experience higher rates of health and functional difficulties, and express a need for appropriate, accessible forms of support as they age. In this study, we interviewed seventeen autistic adults, aged from 46-72 years, about their views and experiences of aging, and how services could better support them to age well. The transcribed interviews were analyzed using inductive thematic analysis. The findings revealed several potential ways that autism affected people’s ability to age well. This included difficulties in accessing formal and informal supports; interactions between autism and health conditions; and negative attitudes and low understanding about autism encountered within services and society. Recommendations for supporting autistic adults to age well included involving autistic people in the design of services, and introducing specialized advocate/coordinator roles or ‘one-stop-shop’ hubs that could help autistic people navigate services more easily. * Our use of the terms ‘autistic people/adults’ is in-line with evidence-based guidance for writing about autism research, and is preferred by autistic people to ‘person-first’ terms like ‘person with autism’ (https://journals.sagepub.com/pb-assets/cmscontent/AUT/Autism-terminology-guidance-2021-1626860796.pdf)

SOCIAL ISOLATION, UNMET NEEDS, AND LONG-TERM SERVICES AND SUPPORTS IN COMMUNITY-DWELLING OLDER ADULTS

Abstract Social isolation is associated with adverse health outcomes among older adults but can be attenuated through increased social contact and support. Long-term services and supports (LTSS) are a potential mechanism to increase social contact and provide socially isolated older adults with the help needed to perform routine activities. Using a nationally representative sample of 6,705 community-dwelling older adults from the 2015 National Health and Aging Trends Study (NHATS), we examined associations between social isolation, functional difficulty, adverse consequences due to unmet needs, and indicators of the LTSS environment (e.g., Meals on Wheels). About 22% of older adults were socially isolated. Socially isolated older adults had greater functional difficulty compared to those who were not socially isolated (45.3% vs 38.3%; p<0.0001). Socially isolated older adults were more likely to be Medicaid enrollees (17.5% vs 8.4%; p<0.0001) and use LTSS including SNAP benefits (12.7% vs 5.5%; p<0.0001), Meals on Wheels (4.1% vs 1.6%; p<0.0001), energy/gas financial assistance (7.5% vs 4.2%; p<0.0001), and transportation services for older adults or people with disabilities (4.6% vs 2.7%; p=0.001). Despite greater LTSS use, socially isolated older adults more often experienced adverse consequences due to unmet needs compared to those who were not socially isolated (12.5% vs 7.7%; p<0.0001). Findings suggest that LTSS in the form of social and senior services are critical in supporting those lacking social connection, but they may not be adequate to support aging in place in the absence of informal support.

LIFESTYLE TRAJECTORIES PREDICT LATER COGNITIVE FUNCTION AMONG OLDER PEOPLE IN TAIWAN

Abstract Purpose The purpose of this study was to identify the group-based trajectories of lifestyles and to predict the later cognitive function among older people in Taiwan. Methods The data were from five waves of the “Taiwan Survey on Aging “ (1999-2015). Only those who completed the last wave of cognitive function were used for analysis (n=1314). The cognitive function was measured by 8 items of SPMSQ, reverse numbers and recall 10 words, with score ranged 0-19. Nineteen lifestyle behaviors (healthy behaviors, leisure activities, lifelong learning and social participation) across waves were analysed by group-based trajectory analysis first, and then the effects of lifestyle trajectories on cognitive function were analysed by linear regression. Results Each lifestyle variable was identified as 2 to 6 trajectory groups. Significant lifestyle trajectories on later cognitive function included gardening (high), drinking (increasing), providing instrumental support (increasing), playing chess (high), reading (middle & high), outdoor activities (high), group activities (yes), political participation (no), volunteering (yes), and stress (high vs. lowest). After controlling for covariates, cognitive function was related to gardening (high) (B=0.642), playing chess (high) (B=0.855), reading (high) (B=1.699), group activities (B=0.640), and lower stress (high stress B=−0.806). Other significant variables for better cognitive function included younger age, living with less family members, having less physical function difficulties, having lower depressive symptoms, and being more religious. Conclusion Long-term lifestyle trajectories may affect later cognitive function. Having more social participation, more cognitive-related leisure, having less stress and being physically healthier are protective for cognitive function.

Impact of Hair Transplantation on Quality of Life.

Alopecia is defined as partial or complete hair loss. The most common form is androgenetic alopecia, which occurs in both men and women. Despite the nonsurgical options available for treatment, the only permanent solution is hair transplantation. Hair loss has been shown to have significant psychological consequences associated with loss of self-confidence, poor self-image and difficulties in social functioning. We aim to examine the effect of hair transplantation on quality of life and psychosocial functioning. Forty-eight patients with androgenetic alopecia were enrolled in this two-center prospective study and underwent hair transplantation by the Follicular Unit Extraction method. Different questionnaires were used to assess their quality of life and other psychosocial parameters before and after hair transplantation. According to SF-36 Physical and Mental Health Score patients showed significant improvement in life quality after hair transplantation. Diener's Life Satisfaction Scale (DASS-21) revealed increased life satisfaction after the procedure. Stress and anxiety DASS-21 subscales showed significantly reduced results; while, the DASS-21 depression scale and MSPSS were not significantly changed. Taken together, quality of life and psychosocial functioning increased after hair transplantation. Structured abstract is required. Please provide.I insert name of paragraphs within abstract as follows: background, methods, results, conclusion Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Specific emotion regulation difficulties and executive function explain the link between worry and subsequent stress: A prospective moderated mediation study

BackgroundWorry is a transdiagnostic risk factor for stress-related mental health complaints such as anxiety, depression, and insomnia. Although worry may function as a form of avoidance of unwanted emotions and accordingly interfere with adaptive emotion regulation, the specific domains of emotion regulation that are perturbed by excessive worry to confer risk for stress-related symptoms are unclear. Further, it is unknown if cognitive control mechanisms that underlie successful emotion regulation influence the effect of worry on stress. The present study addressed these gaps in the literature by examining specific emotion regulation difficulties as mediators of the relationship between worry and subsequent stress, as well as executive function as a moderator of the mediated effects. Method656 community adults were assessed for trait worry, emotion dysregulation, stress, and executive dysfunction once per month for three months (time 1 – time 3). ResultsThe effect of worry (time 1) on subsequent stress (time 3) was partially mediated by difficulties with emotional clarity and difficulty engaging in goal-directed behavior when upset (time 2) after controlling for age, gender, and baseline stress. Moderated mediation models revealed that the indirect effect of worry on stress via difficulty with goal-directed behavior was significantly moderated by executive dysfunction, such that fewer executive function difficulties acted as a buffer against the harmful effects of worry. LimitationsLimitations include reliance on self-report measures, lack of experimental manipulation, and a nonclinical sample. ConclusionsFindings point to specific domains of emotion regulation as treatment targets for individuals with high worry proneness.

SNAP-25 Polymorphisms in Autism Spectrum Disorder: A Pilot Study towards a Possible Endophenotype.

While there is substantial agreement on the diagnostic criteria for autism spectrum disorder, it is also acknowledged that it has a broad range of clinical presentations. This can complicate the diagnostic process and aggravate the choice of the most suitable rehabilitative strategy for each child. Attentional difficulties are among the most frequently reported comorbidities in autism spectrum disorder. We investigated the role of SNAP-25 polymorphisms. Synaptosome-associated protein 25 (SNAP25) is a presynaptic membrane-binding protein; it plays a crucial role in neurotransmission and has already been studied in numerous psychiatric disorders. It was also seen to be associated with hyperactivity in children with autism spectrum disorder. We collected clinical, behavioral and neuropsychological data on 41 children with a diagnosis of autism spectrum disorder, and then genotyped them for five single-nucleotide polymorphisms of SNAP-25. Participants were divided into two groups according to the Autism Diagnostic Observation Schedule (ADOS-2) Severity Score. In the group with the highest severity score, we found significant associations of clinical data with polymorphism rs363050 (A/G): children with the GG genotype had lower total IQ, more severe autistic functioning and more attentional difficulties. Our research could be the starting point for outlining a possible endophenotype among patients with autism spectrum disorder who are clinically characterized by severe autistic functioning and significant attentional difficulties.

Trastorno por déficit de atención e hiperactividad: perfil neuropsicológico y estudio de su impacto en las funciones ejecutivas y académicas

IntroductionThe aim of the study was to describe the neuropsychological profile of patients with attention deficit hyperactivity disorder (ADHD) and the impact of the disorder on executive functioning and academic performance. Patients and methodsWe conducted a retrospective observational and analytical study. The sample consisted of 24 children with a diagnosis of ADHD (aged 6-15 years) without pharmacological treatment and 24 controls without ADHD (aged 7-15 years). A comprehensive neuropsychological evaluation was carried out, encompassing major cognitive domains, in addition to assessment of executive functioning and psychopathological symptoms through the administration of questionnaires to parents and teachers. ResultsThe cognitive profile of the ADHD group was characterized by overall scores (including executive functions and academic abilities) in the normal range (z scores between −1 and 1), although significantly lower compared to the control group. Over half of the patients with ADHD (58%) had associated specific learning disorders. Furthermore, teachers tended to report executive function difficulties more frequently in male students. ConclusionsIn the study sample, the group of patients with ADHD exhibited cognitive performance within the normal range, although with lower scores compared to controls. Behavioural rating scales provide valuable information about functioning outside the clinic, but may yield biased results on account of the focus on externalising symptoms. The neuropsychological evaluation is a useful tool that can facilitate the diagnosis of ADHD and an effective response to the needs and characteristics of patients and families.

Health Related Quality of Life in Patients with Bladder Cancer Receiving a Radical Cystectomy.

Radical Cystectomy (RC) and Urinary Diversion (UD) is a complex surgery associated with a significant impact on health-related quality of life (HRQoL). However, HRQoL assessment is too often overlooked, with survival and complications being the most commonly investigated outcomes. This study aimed to identify the most impaired HRQoL features in patients receiving RC, compared to a healthy population (HP) control, as well as patients' recovery after surgery, differentiating between patients receiving ORC and RARC. Patients with Bca, who were candidates for RC with curative intent, were enrolled in the "BCa cohort". HRQoL outcomes were collected with an EORTC QLQ-C30 questionnaire. These were collected at baseline, and then at 6-, 12- and 24 mo after surgery in the BCa cohorts, and at baseline in the HP cohort. A 1:1 propensity score matched (PSM)-analysis, adjusted for age, Charlson Comorbidity Index (CCI) and smoking history, was performed. Between January 2018 and February 2023, a total of 418 patients were enrolled in the study, 116 and 302 in the BCa and HP cohorts, respectively. After applying the 1:1 propensity scored match (PSM) analysis, two homogeneous cohorts were selected, including 85 patients in each group. Baseline HRQoL assessment showed a significant impairment in terms of emotional and cognitive functioning, appetite loss and financial difficulties for the BCa cohort. Among secondary outcomes, we investigated patients' recovery after RC and UD, comparing HRQoL outcome questionnaires between the HP and BCa cohorts at 6-, 12- and 24 mo after surgery, and a subgroup analysis was performed differentiating between patients receiving ORC and RARC with totally intracorporeal UD. Interestingly, ORC compared to RARC provided a major impact on HRQoL recovery across the early, mid and long term. In particular, the ORC cohort experienced a major impairment in terms of symptoms scales items such as fatigue, nausea and vomiting, pain and appetite loss. Consequently, comparing ORC and RARC vs. HP reported a major HRQoL impairment in the ORC cohort, possibly defining a benefit of RARC in early, mid- and long-term recovery. To conclude, this study confirmed the undeniable impact of RC on HRQoL. Interestingly, we highlighted the benefit of RARC in early, mid- and long-term recovery, expressed as less impairment of symptoms scales.