Functional Difficulties Research Articles

Links across disabilities: unveiling associations between functional domains

BackgroundPersons with disabilities experience higher risks of mortality as well as poorer health as compared to the general population. The aim of this study is to estimate the correlations between functional difficulties across several domains in six countries.MethodsNational census data with questions on disability from six countries (Mauritius, Morocco, Senegal, Myanmar, Vietnam, and Uruguay) was used in this study. We performed logistic regressions to assess the extent to which having a functional difficulty in one domain is correlated with having a functional difficulty in each of the other domains and report weighted odds ratios (ORs) overall and within age-groups (‘18–44’ years and ‘45+’ years). Models adjust for age, sex, and location (rural or urban). Sensitivity analyses around different choices of predictors and response variables were conducted.FindingsFor all countries, reporting a functional difficulty in one domain was consistently and significantly positively correlated with reporting a functional difficulty in other domains (overall) and for each of the two age-groups considered - ‘18–44’ years and ‘45+’ years. All ORs were greater than one. Cognition, mobility, and hearing were the domains that were the most correlated ones with other domains. The highest pairwise correlations were for i/ hearing and cognition; ii/ mobility and cognition. Results were robust to changing the severity thresholds for functional difficulties. Across countries, Uruguay, the only high-income country among the six countries under study, had the lowest correlations between functional domains.ConclusionsThere are consistent positive associations in the experience of functional difficulties in various domains in the six countries under study. Such correlations may reflect barriers to social services including healthcare services and resources (e.g. assistive devices) that may lead to an avoidable deterioration of functioning across domains. Further research is needed on the trajectories of functional difficulties and on structural barriers that people with functional difficulties may experience in their communities and in healthcare settings in particular. This is important as some functional difficulties may be preventable.

Type 2 Diabetes Moderates the Association Between Amyloid and 1-Year Change in Everyday Functioning in Older Veterans.

Type 2 diabetes mellitus (T2DM) affects ∼25% of Veterans, a prevalence rate double that of the general population. T2DM is associated with greater dementia risk and has been shown to exacerbate the impact of Alzheimer's disease (AD) risk factors on declines in daily functioning; however, there are few studies that investigate these patterns in older Veterans. This study sought to determine whether T2DM moderates the association between amyloid-β (Aβ) positron emission tomography (PET) and 1-year change in everyday functioning in older Veterans. One-hundred-ninety-eight predominately male Vietnam-Era Veterans without dementia from the Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) with (n = 74) and without (n = 124) T2DM completed Aβ PET imaging and everyday functioning measures, including the Clinical Dementia Rating-Sum of Boxes (CDR-SB) and Everyday Cognition (ECog). Linear mixed effects models tested the moderating role of T2DM on the association between Aβ PET and 1-year change in everyday functioning. The 3-way T2DM×Aβ PET×time interaction was significant for CDR-SB (p < 0.001) as well as the Memory (p = 0.007) and Language (p = 0.011) subscales from the ECog. Greater amyloid burden was associated with greater increases in functional difficulties, but only in Veterans with T2DM. Higher Aβ was only associated with declines in everyday functioning over 1 year in Veterans with T2DM. Given that people with T2DM are more likely to have co-occurring cerebrovascular disease, the combination of multiple neuropathologies may result in faster declines. Future studies should examine how diabetes duration, severity, and medications impact these associations.

The association between post-traumatic stress disorder (PTSD) and executive functioning

ABSTRACT Introduction: Post-Traumatic Stress Disorder (PTSD) is a condition characterised by several disturbances in an individual's executive functioning. We were interested in the link between executive functions and the presence of anxiety and depression in a clinical population with post-traumatic stress disorder. Methods: Our sample comprised 180 participants divided into three groups: 60 with PTSD, 60 trauma-exposed without PTSD, and 60 controls. All participants were assessed on the following dimensions: PTSD, dissociation, executive functions, anxiety, and depression. Results: Consistent with the literature, the results of our study suggest that individuals with PTSD have difficulties in executive functioning. These disturbances are related to levels of anxiety and depression. Conclusion: The severity of PTSD is positively correlated with executive function disturbances, but the observed disturbances, especially in working memory updating, can be explained mainly by the high level of depression, rather than by PTSD alone.

Investigating Trajectories of Negative Emotionality in Early Childhood and First-Grade Outcomes

This study investigated Korean children’s negative emotionality trajectories from infancy to age 4 and their learning (i.e., executive functioning), behavioral, and self-esteem outcomes in first grade. Using nationally representative data from the Panel Study on Korean Children, negative emotionality trajectories were explored to determine whether patterns emerged over time (N = 2,149, boys = 50.7%) and whether different negative emotionality patterns were associated with specific first-grade outcomes (i.e., teacher-reported executive function difficulties, parent-reported behavioral problems, and child-reported self-esteem). According to latent class growth analysis, Korean children developed one of three negative emotionality patterns from infancy to age 4: Low stable (28.0%), moderate (57.9%), and intense and increasing (14.1%). First-grade outcomes, including executive functioning and behavior problems, were associated with negative emotionality trajectories. No association was found between the negative emotionality trajectories and child-reported self-esteem. First graders who developed and maintained intense negative emotionality until age 4 were regarded as the most vulnerable group in executive functioning difficulties and risk of behavioral problems. Impact Statement Negative emotionality in early childhood is an important predictor of future difficulties, and more research is needed in terms of patterns of emotionality, stability over time, and associated outcomes for different patterns. In this study, children developed one of three negative emotionality patterns from infancy to age 4: Low stable (28.0%), moderate (57/9%), and intense and increasing (14.1%). First graders who developed intense negative emotionality until age 4 were the most vulnerable group for executive function difficulties and risk of behavioral problems.

Parent-Report Sleep Disturbances and Everyday Executive Functioning Difficulties in Children with Tourette Syndrome

ABSTRACT There is an increasing need to identify and treat sleep disturbances in Tourette syndrome (TS), a neurodevelopmental condition characterized by tics. This study explored sleep, tics, and executive functioning in children with TS (n=136) and neurotypical controls (n=101) through parent-report scales and open-ended questions. 85% of children with TS scored in the clinical range for a sleep disorder. Higher tic severity predicted increased sleep disturbances and executive difficulties. Qualitative insights indicated a bidirectional link between sleep and tics, which warrants consideration in clinical settings. Further research is needed to explore causal links.

Functional difficulties in children and youth with autism spectrum disorder: analysis of the 2019 Canadian Health Survey on Children and Youth.

This study examined the prevalence of functional difficulties and associated factors in Canadian children/youth aged 5 to 17 years diagnosed with autism spectrum disorder (ASD). We analyzed data from the 2019 Canadian Health Survey on Children and Youth (CHSCY), a nationally representative survey of Canadian children/youth that used the Washington Group Short Set on Functioning (WG-SS) to evaluate functioning in six daily tasks. For each functional domain, binary outcomes were derived (no/some difficulty, a lot of difficulty/no ability). We used logistic regression to identify associations between demographic characteristics, educational experiences, and perceived mental and general health and the most common functional difficulties, namely those related to remembering/concentrating, communication and self-care. All estimates were weighted to be representative of the target population. The bootstrap method was used to calculate variance estimates. Analysis of the records of 660 children/youth with ASD revealed that the most common functional difficulties were remembering/concentrating (22%; 95% CI: 18-27), communicating (19%; 95% CI: 15-23) and self-care (13%; 95% CI: 10-17). Lower perceived mental health was associated with increased functional difficulties with remembering/concentrating. ASD diagnosis at a lower age and lower perceived general health were associated with increased functional difficulty with communication. Parental expectations for postsecondary education were associated with decreased functional difficulty for self-care. One or more functional difficulties from the WG-SS was present in 39% of Canadian children/youth aged 5 to 17 years with ASD. Functional difficulties with remembering/concentrating, communication and self-care were most common.

Effect of non-invasive brain stimulation in children with acquired brain injury-a scoping review.

Children and young people (CYP) with acquired brain injury (ABI) require early and effective neurorehabilitation to improve long-term functional outcomes. Non-invasive brain stimulation (NIBS), including transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), have been used to improve motor and sensory skills for children with cerebral palsy. However, there is limited evidence supporting its use in CYP with ABI. To systematically review the TMS and tDCS intervention effects on motor, sensory and other functional issues in CYP with ABI as reported in the literature. A comprehensive online bibliographic databases search was performed in various databases using keywords related to NIBS and CYP with ABI. Studies that examine the effect of NIBS intervention on motor function and other functional difficulties either as a primary or secondary objective were included in this review. Fourteen studies (10 single case reports, one retrospective analysis, one case series, one randomised and one quasi-randomised controlled trial) published between 2006 and 2023 were identified. These studies examined the use of NIBS to manage motor disorders, hearing, vision, headaches, speech and language and memory issues. Seventy-six children with mild to severe ABI had received NIBS. The session frequency (3-20), duration (10-45 min) was variable, and NIBS delivered between 3 and 28 days. The literature describing NIBS interventions in CYP with ABI is scarce. An insufficient number of studies, inadequate information reported in them, and small sample sizes limit the ability to conclude how effective NIBS is in improving motor function and other functional issues in this cohort. Further studies are therefore necessary to examine the therapeutic effects of NIBS to manage various functional problems in the CYP with ABI.

Natural vs. Surgical Postmenopause and Psychological Symptoms Confound the Effect of Menopause on Executive Functioning Domains of Cognitive Experience.

The menopause transition is associated with difficulties in executive function. However, it is unclear whether these difficulties persist past perimenopause. This study investigated whether potential confounders, including natural vs. surgical postmenopause and menopause-related psychological symptoms, influence whether executive dysfunction persists into postmenopause. A cross-sectional sample of women aged 35-65 years (N = 1971) in one of four groups, premenopause, perimenopause, natural postmenopause, and surgical postmenopause, were surveyed. Participants self-reported executive functioning with the Brown Attention Deficit Disorder Scale (BADDS), anxiety symptom severity with the Generalized Anxiety Disorder Questionnaire (GAD-7), and depression symptom severity with the Center for Epidemiologic Studies Depression Scale (CES-D). We analyzed the association between group and BADDS scores using linear regression models - first, by controlling for age, education, and self-reported attention deficit hyperactivity disorder (ADHD) diagnosis (Model #1) and, second, by further controlling for current difficulty sleeping, anxiety, and depression (Model #2). In both models, BADDS scores were significantly elevated (indicating more difficulties in executive function) among women in the perimenopausal and surgical postmenopausal groups compared with those in the premenopausal group. Likewise, the perimenopausal and surgical postmenopausal groups had the highest proportions of participants who reported difficulty sleeping and clinical levels of anxiety and depression. BADDS scores were significantly higher in natural postmenopausal vs. premenopausal women without controlling for difficulty sleeping, anxiety, and depression (Model #1), but not when adjusting for these variables (Model #2). The type of menopause and psychological symptoms are important confounders of the relationship between the menopause transition and executive dysfunction, and help explain whether executive dysfunction persists or recovers in postmenopause.Reprinted from Maturitas 2023; 170:64-73, with permission from Elsevier. Copyright © 2023.

Non-cationic hyper-crosslinked ionic polymers with hierarchically ordered porous structures: facile synthesis and applications for highly efficient CO2 capture and conversion.

Hyper-crosslinked porous ionic polymers (HCPIPs) have garnered significant attention due to their unique ionic properties and high specific surface areas. However, the limited variety of monomers, low ionic density, and difficulty in functionalization restrict their development. Herein, a series of functionalized non-cationic HCPIPs with high ionic density are designed and directly synthesized via an innovative and straightforward approach - anion (and cation) hyper-crosslinking of tetraphenylborate-based ionic liquids (ILs). These HCPIPs offer controllable hydroxyl group content (0-2.40 mmol g-1), high IL content (1.20-1.78 mmol g-1), and large specific surface area (636-729 m2 g-1) with hierarchically ordered porous structures. These HCPIPs demonstrate exceptional CO2 adsorption capacities and CO2/N2 adsorption selectivities, reaching up to 2.68-3.01 mmol g-1 and 166-237, respectively, at 273 K and 1 bar. Furthermore, these ionic porous materials serve as highly efficient heterogeneous catalysts for CO2 cycloaddition to epoxides under mild conditions (1 bar CO2, 60-80 °C, 12-24 h). Notably, the CO2 adsorption performances and catalytic activities of these HCPIPs are regulated by the hydroxyl groups within their structures, with enhancements observed as the number of hydroxyl groups increases. This work presents a facile and widely applicable method for constructing high-performance and task-specific HCPIPs.

Identifying Facilitators of and Barriers to Referrals to Occupational Therapy Services by Israeli Cancer Health Care Professionals: A Qualitative Study.

Persons living with and beyond cancer (PLWBC) are rarely referred to occupational therapy services despite their functional difficulties. An understanding of the barriers to and facilitators of occupational therapy referrals from the perspective of cancer health care professionals could help minimize referral gaps. To explore cancer health care professionals' perspectives on and knowledge of occupational therapy's role in cancer care, identify the barriers, and explore solutions to optimize referrals. Multiexplanatory qualitative case study. Community and hospital cancer clinics in Israel. Six in-person focus groups of cancer care Israeli nurses and social workers, totaling 28 participants. Two main themes were identified: (1) barriers to occupational therapy referrals and (2) partial facilitators of occupational therapy referrals. The four barriers subthemes were (1) gaps in knowledge about symptoms' effects on daily functioning, (2) gaps in knowledge regarding occupational therapy's role in cancer care, (3) bureaucratic and organizational barriers, and (4) unavailability of occupational therapy services. The two facilitators subthemes were (1) collaborations and communication with occupational therapists and (2) awareness of occupational therapy services. Participants suggested practical solutions for improving occupational therapy referrals, interdisciplinary collaboration and communication, and integrating occupational therapy into cancer care. Barriers to referrals included gaps in participants' knowledge that link side effects to functional difficulties indicating a need for referral to occupational therapy. Participants' suggestions to bolster referrals can be implemented by occupational therapists to reduce patients' unmet needs and bridge existing gaps in cancer care. Plain-Language Summary: This research helped to identify barriers and facilitators regarding insufficient knowledge about occupational therapy's role in cancer care and adds a better understanding of gaps in referrals to occupational therapy. In addition, cancer health care professionals who participated in the study suggested practical solutions for reducing barriers and maximizing support for referral. With these nuances, occupational therapy practitioners can work with medical cancer care units (i.e., acute care hospitals, medical cancer centers, and community health care clinics) to target the use of strategies that work for their units to ensure that persons living with and beyond cancer receive needed occupational therapy services.

Subjective Functional Difficulties Were Associated With Subjective Cognitive Decline Among U.S. Older Adults: Mentally Unhealthy Days Mediation and Income Level Moderation Effects.

Subjective cognitive decline (SCD) is a self-perceived decline in cognition that may progress to mild cognitive impairment or Alzheimer's disease. SCD may be associated with difficulties in daily functioning and psychological distress. Previous research has shown the association between functional difficulties and SCD via mentally unhealthy days (MUDs). However, whether income levels influence the mediation effect of MUDs is less understood. This study examined the association between subjective functional difficulties and the odds of SCD through MUDs, and whether the mediation effect was moderated by income levels. Cross-sectional data were obtained from the 2019 Behavioral Risk Factor Surveillance System (N = 13,160 older adults aged 65+; 7,370 women). SCD was assessed by more frequent or worse memory loss and confusion in the past 12 months. Subjective functional difficulties represented difficulties with daily activities. MUDs denoted the days that a person felt mentally unwell within the past 30 days. We used path analysis with 5,000 bootstrapped confidence intervals and logistic regression to classify the risks of SCD based on subjective functional difficulties and MUDs. Subjective functional difficulties were positively associated with SCD through mediation by MUDs (b = 0.119, 95% CI 0.102, 0.137). After accounting for covariates, we found that greater subjective functional difficulties were associated with 2.50 times the odds of SCD (AOR = 2.50; 95% CI: 2.14, 2.91); MUDs were related to 1.06 times the odds of SCD reporting (AOR = 1.06; 95% CI: 1.05, 1.07). Income levels moderated the indirect effect of MUDs in the subjective functional difficulties-SCD relationship, with an income of <$15,000 showing the most prominent effect. Those earning ≥$50,000 self-reported a lower SCD than those earning <$15,000. Our study extends previous findings by demonstrating that greater subjective functional difficulties are associated with higher odds of SCD through more frequent MUDs, with higher income levels being associated with more SCD reporting.

Prevalence and associated risk factors of carpal tunnel syndrome among orthopedic surgeons working in Riyadh, KSA

Objective: This study aimed to investigate the prevalence of carpal tunnel syndrome (CTS) and its associated risk factors among orthopedic surgeons working in Riyadh, Saudi Arabia. Methods: This cross-sectional study was conducted among orthopedic surgeons working in multiple hospitals in Riyadh, Saudi Arabia. The data were collected from the participants through Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Results: This study enrolled 151 orthopedic surgeons. Around 39.1% were aged between 25 and 29 years old, with males being dominant (88.1%). And 39.7% were overweight (25 – 29.9 kg/m2). Most of them were right-handed (93.4%). The prevalence of surgeons who were diagnosed with CTS was 3.3%. Around 20.5% were consultant surgeons with 57.6% had 1 to 5 years of experience and 55.6% had 5 or less performed surgeries per week. The overall mean score of the Symptom Severity Scale (SSS) domain was 13 (SD 4.12), with 62.3% considered as having no symptoms. Regarding the Functional Status Scale (FSS) domain, the total mean score was 8.38 (SD 1.49), with nearly all categorized as no difficulty (83.4%). It was observed that increasing SSS score was associated with increasing BMI level (Z=2.164; p=0.030) and performing arthroscopic procedures (Z=2.653; p=0.008), while a higher FSS score was more associated with conducting arthroscopic procedures (Z=1.438; p=0.021) Conclusion: The prevalence of mild to severe CTS symptoms among orthopedic surgeons was 37.7%. Increased severity was more prevalent among surgeons with elevated body mass index, while those regularly dealing with arthroscopic procedures had increased symptom severity and functional difficulties.

The disability gap in employment in developing economies: Evidence from the Nigerian labour market

A viable and functional labour market is a sin qua non for economic development. This study thus examines the evidence of disability-related employment discrimination in Nigeria. Utilising the Fairlie decomposition technique in analysing households? data elicited from wave 4 of the General Household Survey, the study found that the disability gap in employment was plausibly existent in Nigeria. The study therefore suggested, among other viable options, that policies aimed at promoting the elimination of physical obstacles in workplaces while also ensuring equitable training opportunities for individuals with disabilities should be rigorously pursued. There is a need to enact more stringent anti- discriminatory policies in Nigeria, with individuals having functional difficulties being the focal target.

How word meaning structure relates to executive functioning and theory of mind in children with developmental language disorder: A multiple case study.

Many children with developmental language disorder (DLD) have difficulties in executive functioning (EF) and theory of mind (ToM). These difficulties might be explained by the theory that children's conceptual understanding changes over five stages of word meaning structure, from concrete and context-dependent to abstract and precise. We present a multiple case study examining how word meaning structure relates to EF and ToM in children with DLD. Participants were five children with DLD aged 9-12 and five typically developing children matched for age, gender, and nonverbal intelligence. Word meaning structure was assessed using new dynamic test. EF was assessed using the Zoo Map Task and Behavioral Rating Inventory for EF. ToM was assessed using the ToM test, Frith-Happé Animations, and Bermond-Vorst Alexithymia Questionnaire. Behavioral problems were measured using the Child Behavior Checklist. Anamnestic interviews with the parents were conducted to describe the case histories. For the children with DLD, lower scores in the word meaning structure task were observed compared to those observed for their matched peers, with no statistical test applied. Word meaning structure related positively to EF and ToM, but not to behavioral problems. Instances in which word meaning structure dissociates from EF and ToM are discussed in individual case descriptions. By linking language to conceptual development, variations in word meaning structure may explain some EF and ToM difficulties in children with DLD. The present study offers a basis for future research on the relationships among word meaning structure, EF, and ToM.

Subtle microstructural alterations in white matter tracts involved in socio-emotional processing after very preterm birth

Children born very preterm (VPT, < 32 weeks of gestation) have an increased risk of developing socio-emotional difficulties. Possible neural substrates for these socio-emotional difficulties are alterations in the structural connectivity of the social brain due to premature birth. The objective of the current study was to study microstructural white matter integrity in VPT versus full-term (FT) born school-aged children along twelve white matter tracts involved in socio-emotional processing. Diffusion MRI scans were obtained from a sample of 35 VPT and 38 FT 8-to-12-year-old children. Tractography was performed using TractSeg, a state-of-the-art neural network-based approach, which offers investigation of detailed tract profiles of fractional anisotropy (FA). Group differences in FA along the tracts were investigated using both a traditional and complementary functional data analysis approach. Exploratory correlations were performed between the Social Responsiveness Scale (SRS-2), a parent-report questionnaire assessing difficulties in social functioning, and FA along the tract. Both analyses showed significant reductions in FA for the VPT group along the middle portion of the right SLF I and an anterior portion of the left SLF II. These group differences possibly indicate altered white matter maturation due to premature birth and may contribute to altered functional connectivity in the Theory of Mind network which has been documented in earlier work with VPT samples. Apart from reduced social motivation in the VPT group, there were no significant group differences in reported social functioning, as assessed by SRS-2. We found that in the VPT group higher FA values in segments of the left SLF I and right SLF II were associated with better social functioning. Surprisingly, the opposite was found for segments in the right IFO, where higher FA values were associated with worse reported social functioning. Since no significant correlations were found for the FT group, this relationship may be specific for VPT children. The current study overcomes methodological limitations of previous studies by more accurately segmenting white matter tracts using constrained spherical deconvolution based tractography, by applying complementary tractometry analysis approaches to estimate changes in FA more accurately, and by investigating the FA profile along the three components of the SLF.

Состояние здоровья и качество жизни детей с хронической диареей

The purpose — to comprehensively assess the health status of children and adolescents with chronic diarrhea and the impact of chronic diarrhea on quality of life indicators. Material and methods. 466 children were examined. The main group consisted of 240 children with chronic diarrhea aged from 1 month to 18 years (average age 7.3 ± 5.3 years). The comparison group consisted of 226 children of health groups 1-2 without chronic diarrhea (average age 6.9 ± 4.6 years). The exclusion criteria were newborn period, children with chronic pathology during decompensation period, severe somatic pathology. Clinical and anamnestic research methods were used: parents’ questionnaires, anthropometric measurements, system analysis of the child’s medical documentation, general clinical research methods. The quality of life was assessed in children over 2 years of age using the PedsQL4.0™ general questionnaire. Results. Children with chronic diarrhea are 3 times more likely to have allergic pathology, significantly more likely to develop deficient conditions — rickets and latent iron deficiency. When analyzing the degree of resistance in the study groups, it was revealed that children with chronic diarrhea are significantly more likely to have lower body resistance indicators. When assessing the state of the colon microflora, it was found that an excessive growth of opportunistic flora is much more common among the children of the main group. It was also found that children with chronic diarrhea at an early age are most susceptible to a decrease in body mass index. Children of the main group have low indicators of quality of life in terms of physical functioning and experience difficulties in the social sphere in the form of low communication with peers and a decrease in school performance. Conclusion. Children suffering from chronic diarrhea under dispensary supervision need additional correction of trace elements, nutritional support and prevention of acute respiratory diseases. It is important to assess the physical development of children suffering from chronic diarrhea more often for timely diagnosis of abnormalities.

Class III malocclusion: Insights and current perspectives

Class III malocclusion is a complex orthodontic challenge characterized by the lower front teeth being positioned ahead of the upper front teeth, often resulting in functional and social difficulties. This review explores the etiology, classification, diagnosis, and treatment options for Class III malocclusion, emphasizing the genetic inheritance and skeletal growth patterns that influence its manifestation. Orthopedic appliances and orthognathic surgery are key treatment approaches, with early intervention favored to optimize outcomes. This article also discusses the role of temporary anchorage devices in treatment, retention protocols, and the importance of long-term follow-up to ensure stability and patient satisfaction. Advances in orthodontic technology and ongoing research into the genetic basis of Class III malocclusion promise continued improvements in treatment strategies, offering more predictable and patient-centered care.

The unmet need for mental health support among persons with disabilities in Somalia: Principal correlates and barriers to access.

Disability and mental ill-health may be especially prevalent in Somalia, largely due to a protracted armed conflict and its consequent humanitarian crises. Little, if any, research to date, however, has simultaneously explored disability- and mental health-related factors in the Somali context. Using both descriptive and regression analytical techniques, we aimed to determine how increasing levels of functional impairment reported across different disability domains (i.e., visual, hearing and cognition), number of concomitant disabilities, and other empirically supported variables (such as employment and sex) are associated with the likelihood of self-identifying the need for mental health support among a sample (N=1,355) of Somalis with disabilities, as well as identify the common barriers to such support. Despite most participants self-identifying a need for mental health support, only 15% were able to access it, with the most common barriers being the cost of services and the unavailability of local services. Being female, married, and having increasing levels of functional difficulty in the cognitive, mobility and self-care domains of disability were each significantly associated with an increased likelihood of the self-identified need for mental health support. This study's findings highlight potential points of prioritisation for mental health policy and programming in Somalia. A Somali version of this abstract can be found in the SupplementaryMaterial.

Unmet Needs and Barriers to Assistive Technology in the Coastal Districts of Karnataka, India.

Assistive Technologies (AT), such as hearing aids, walking aids, prostheses, spectacles, can improve the quality of life and enable many to lead dignified lives. The rapid Assistive Technology Assessment (rATA) tool developed by World Health Organization (WHO) can measure the needs of AT and the barriers to accessing them. This study aimed to measure the unmet needs and the usage of AT via the rATA tool in the coastal state of Karnataka in India. A population-based survey was conducted among a total of 500 households - 250 from Mangalore and 250 from Udupi of Coastal Karnataka. The need for AT was assessed under six domains of activities, including mobility, seeing, hearing, communication, remembering, and self-care. The mean age of study participants was 34.3 years with standard deviation of 21.2 years. 30.6% of the study participants reported the use of assistive products out of which 27.3% used one product and 2% used two products. 89.5% of assistive products were procured from private sector and only 4.1% was obtained from public sector. The level of difficulty in doing any activity increased with age. 301 participants reported out of pocket expenditure for assistive products with mean expenditure of Rs 2226.05 (S. D. 2204) per year. Spectacles, orthoses (spinal) and therapeutic footwear were most common assistive products with unmet need. Our findings highlight the urgent need to mainstream geriatric care policies which address functional difficulties among older people, resolve out-of-pocket spending through public private partnership for assistive technologies.

Examining the influence of child nutritional disorders on early childhood development in Bangladesh: insights from the multiple indicator cluster survey.

The objective of this study was to explore the relationship between various forms of child nutritional disorders and early childhood development in Bangladesh. We analysed data from the nationally representative cross-sectional 2019 Multiple Indicator Cluster Survey. Early childhood development was evaluated using the Early Childhood Development Index (ECDI), which comprised 10 yes-or-no questions across four domains: literacy-numeracy, physical well-being, socio-emotional development, and learning abilities. Nutritional disorders (e.g. stunting, wasting, and underweight) were measured based on the World Health Organization's height and weight guidelines. To investigate the relationships between child development and nutritional disorders, we used multilevel logistic regression models. Bangladesh. Data of 9,455 children aged 3 and 4 years. Approximately 38 % of the children analysed experienced a nutritional disorder, with stunting being the most prevalent at 28·15 %. Overall, 25·27 % did not meet expected developmental progress measured by the ECDI. Stunted children were more likely to be off track developmentally, while those without any nutritional disorder were more likely to be on track. Socio-demographic factors, including age, sex, attendance in early childhood education programme, maternal education, maternal functional difficulties, region, and income, were identified as determinants of ECDI. Childhood nutrition and socio-demographic factors significantly affect multiple developmental domains and overall ECDI among children aged 3-4 years. Prioritising policies and programmes that improve nutrition and address these determinants are crucial for fostering optimal development in children.