Frequent Difficulties Research Articles

Assessment of quality of life among dental practitioners using magnification devices during nonsurgical root canal treatment in the Kingdom of Saudi Arabia

Introduction: This study was conducted to assess the effect of magnification devices (MDs) during nonsurgical root canal treatment (RCT) on quality of life ( QOL) among dental professionals of the Kingdom of Saudi Arabia. The dental practitioners performing endodontic treatment were evaluated for ergonomic, postural, psychological, and financial issues associated with and without the use of MDs. Materials and Methodology: A total of 1650 dental professionals (general dentists and endodontists) were recruited from public and private sectors of Saudi Arabia from October 2021 to December 2021. The World Health Organization's QOL assessment questionnaire (WHOQOL-BREF) was administered to conduct the study. The questionnaire addressed four domains of QOL which included physical, psychological, procedural, and financial. Statistical analysis was done by SPSS software® version 23.0. Descriptive analysis, ANOVA test, and unpaired t-test were used. Results: All dental professionals completed the survey. 41.5% reported the use of MDs out of which dental loupe was most commonly used. Work-related musculoskeletal disorders were the most frequent physical difficulty which was faced by 61.5% of dental practitioners while performing RCT. 80% of DPs revealed that MDs improve manual abilities while performing RCT. MDs also relieved psychological, physical, and postural stress by 49.2%, 64.6%, and 63%, respectively. Further 72% of the dental professionals reported improved quality of work after the usage of MD. Conclusion: MDs are commonly used by dental professionals during RCT in Saudi Arabia. It is believed that its use can lead to a better ergonomic, postural, and psychological state of these dental professionals.

STUDENTS’ DIFFICULTIES IN WRITING THESIS OF ENGLISH EDUCATION STUDY PROGRAM IN MUHAMMADIYAH UNIVERSITY OF SUMATERA BARAT

This research is about difficulties faced by the students in writing thesis at eight semester of English Education Study Program of Muhammadiyah University of Sumatera Barat. The purpose of the research is to describe the students’ difficulties in writing the thesis. The participants of this research were eight semester students of English Education Study Program of Muhammadiyah University of Sumatera Barat that consist of 15 students. This research is a descriptive research. It is aimed at describing things as the way and also analyzing the interrelationship of the data. The instrument used in this research was questioner and interview. The questioner is used to find out the students’ difficulties in writing thesis while the interview is used to support the data gotten from questioner. The result of this research shows that there are 13 difficulties faced by students in writing thesis. And the most frequent difficulties is “pouring ideas into scientific writing”. All of the students (15) faced this difficulty.

Insights into social communication following traumatic brain injury sustained in older adulthood.

There is a lack of evidence relating to cognitive-communication difficulties following traumatic brain injury (TBI) sustained in older adulthood. A prominent area in which post-TBI cognitive-communication difficulties manifest is at the level of social communication. An investigation of social communication focusing on comparison of those injured in older and younger adulthood is a practical starting point for age-related cognitive-communication outcome comparison. The overall objective of this study was to explore the social communication of individuals who sustained severe TBI in an early period of older adulthood (50-70 years) compared to younger adulthood (18-40 years), as informed by self and close other reports. This exploratory controlled group comparison study involved analysis of self-reported and close other reported La Trobe Communication Questionnaire data for 22 adults with severe TBI (11 older at injury; 11 younger at injury) and 22 control participants (11 older; 11 younger). TBI participants were matched for injury variables and participant groups were matched for sex, age and education. The close others of the older and younger adults with TBI reported them to have significantly more frequent difficulty with social communication than the close others of age-matched control groups. Older adults with TBI reported significantly more frequent difficulty with social communication than uninjured older adults. In contrast, younger adults with TBI and uninjured younger adults reported a similar frequency of difficulty with social communication. No age-based difference in the frequency of social communication difficulty was evident when comparing the self or close other reports of older and younger adults with TBI. Awareness of social communication difficulty, as indexed by comparing self and close other perceptions, showed a different pattern across the TBI groups. The older TBI group rated themselves as having significantly less frequent social communication difficulty than was perceived by their close others. In contrast, no statistically significant difference was evident between the self and close other social communication ratings of the younger TBI group. Where possible clinicians need to work with close communication partners to understand the nature and degree of social communication difficulty following severe TBI. This may be especially important when working with people who sustain TBI in older adulthood if future research shows that this population have greater difficulty with self-awareness of social communication difficulty. What is already known on the subject Cognitive-communication difficulties are a common consequence of traumatic brain injury (TBI) that can have long-term impact on everyday functioning. These challenges have primarily been investigated in individuals who sustained TBI in younger adulthood. What this paper adds to existing knowledge Individuals who sustain severe TBI in early older adulthood have a higher frequency of reported social communication difficulty to non-injured adults of a similar age, albeit they may underreport such difficulties potentially in the context of reduced self-awareness. What are the potential or actual clinical implications of this work? Social communication difficulty is an issue for people who sustain severe TBI in early older adulthood. However, a poorer overall social communication outcome in comparison to those injured in younger adulthood should not be assumed. Clinical service delivery for these challenges is most optimally delivered in a collaborative manner with the individual and their close others. Future research is required to investigate the identified trends from this study.

The Influence of Technology in Educating English Language Learners at-risk or with Disabilities: A Systematic Review

With the development of technology, the quantity and quality of electronic devices for students learning English as a second or foreign language (ESL/EFL) are on the rise, especially since the outbreak of the Covid-19 pandemic. To facilitate practices in English language education for students with special needs, the researchers conducted a systematic review of the empirical studies of technology tools for ESL/EFL students with learning difficulties published in the previous two decades. This paper presents the study selection process and findings of the review based on 16 peer-reviewed journal articles and one book chapter. The paper reveals the frequent mental and physical difficulties of English language learning and the typical technology tools employed in and out of class. More importantly, this paper discusses the roles of these technology tools in students’ English language acquisition, specifically their effects on student learning outcomes and the students’ perceptions toward them. With limited primary sources, this paper calls for more attention to the use of technology in English language learning of ESL/EFL students identified as at-risk and with learning disabilities and raises some implications for future research and instructional practices.

CASE REPORT OF ICU ADMISSION DUE TO LEGIONELLA PNEUMOPHILA SEVERE PNEUMONIA IN VIET NAM

Legionnaires’ disease is a serious type of atypical pneumonia caused by Legionella bacteria. In this case study, the first case of ICU admission due to Legionella pneumophila severe infection in Vietnam is reported. A 40-year-old Japanese male patient with a history of hypertension for over 4 years was hospitalized with fever and frequent breathing difficulties. Diagnosis upon hospitalization was sepsis shock and ARDS pulmonary consolidation. The sputum specimen was then tested with multiplex PCR using Film array panel and the result was positive with Legionella pneumophila detection. The patient was medicated according to the results ofbacterial identification which gave good response and was discharged after 22 days of treatment.

Knowledge, attitudes and practices of mental health professionals regarding the management of major cognitive disorders in the Republic of Moldova

Major cognitive impairment is a significant public health problem despite advances in patient management. The purpose of the research was to analyze the knowledge, attitudes, and practices of mental health specialists regarding the management of major cognitive disorders in the Republic of Moldova. Material and method: The research were descriptive online survey type. A structured questionnaire with self-completion questions was used. The questionnaires were pre-tested and validated prior to conducting the research. Results: Barriers identified: 50.0% lack of social support services, 34.4% lack of a national guide/program, 46.9% lack of interdisciplinary collaboration, 43.8% problems in communicating with the patient, 25, 0% difficulties in establishing the diagnosis and developing the treatment plan, 31.3% in communication with relatives/caregiver, and 40.6% in the diagnosis and treatment of concomitant diseases. During consultations, 75.0% of those interviewed quantify the degree of impairment of cognitive function, 71.9% know national and international guidelines/protocols, 90.6% consider training in social and cultural activities useful, 75.0% – performing exercises physical therapy, 65.6% physical therapy, 56.3% cognitive-behavioral therapy, 53.1% speech therapy sessions, 46.9% psychotherapy, and 28.1% state that all options are useful. Positive attitudes 96.9% believe that the patient with cognitive disorders must benefit from access to medical services according to individual needs and that the patient has the right to live with dignity, without suffering, 81.3% are of the opinion that patients must be included in social and cultural activities, 62.5% support that people with cognitive disorders should benefit from institutionalization for palliative care. Negative attitudes 50.0% believe that patients consume time, emotions, and resources, and 25.0% mention that they are a burden on the healthcare system. Conclusion: The most frequent difficulties in the approach and management of patients with cognitive disorders are cited as the lack of social support services for patients or families, interdisciplinary collaboration/difficulty referring to other specialists and a national guide/program for cognitive disorders.

Piano with a twist: A pilot study exploring the preliminary effects of a piano therapy program for children with autism spectrum disorder

Children with autism spectrum disorder (ASD) show frequent maladaptive behaviors and difficulties in social communication and motricity. Various studies suggest that music-based interventions might help overcome these challenges. Yet, their findings are not conclusive, particularly regarding piano music. The current pilot study aims to present a new music-based intervention – the Piano Therapy program – and to explore its effects on social communication, motricity, self-care, and adaptive behavior skills in children with ASD. The program uses techniques derived from Applied Behavioral Analysis and active and receptive musical methods structured around a single instrument (i.e., piano). Sixty children with ASD were quasi-randomly assigned either to the Piano Therapy group or the control group. In the experimental group, the 4-month program was administered individually, twice a week. Using the Psychoeducational Profile - Third Edition (PEP-3) reports, the examiner and the caregivers assessed participants’ skills pre- and post-intervention. The findings indicate that the children enrolled in the Piano Therapy program show significant improvements in all the developmental areas assessed with PEP-3, compared to the control group. Although further research is required, these preliminary results have clinical implications for practitioners and bring new evidence about the beneficial effects of a piano-based intervention in individuals with ASD.

Terapi Komplementer Menggunakan Aromaterapi Minyak Esensial Berpengaruh Terhadap Insomnia Pada Ibu Menopause di ATMA Home Care Poncokusumo

Women will experience menopause physiologically at the age of 45 and show different signs symptoms. Menopause can cause psychological disturbances like frequent drowsiness, difficulty concentrating, insomnia, and fatigue. This study aimed to determine the effect of essential oil aromatherapy on insomnia. The pre-experimental design was used, with the One Group Pretest-Posttest approach to 30 menopausal women with insomnia in the ATMA Home Care Poncokusumo area, Malang Regency. The sampling technique chosen was accidental sampling. The data on insomnia was examined by modifying the KSPBJ-IRS-10 questions. The differences between groups were analyzed using the Wilcoxon Signed Rank Test. The respondents' age ranged between 46-53 years old (average 48 years), the average length of menopause was two years, and most graduated from high school, with mild insomnia. After the treatment, the respondents experienced a decrease in insomnia with a smaller mean score (19.5 to 11.5), p-value = 0.000 0.05, which means that there was a significant difference between the score of insomnia. It can be concluded that aromatherapy of essential oils can reduce the degree of insomnia in menopausal women. It is recommended to properly monitor the evaluation of the use of aromatherapy online and through home visits, as well as measure the characteristics of respondents.

Mental and physical health pathways linking insomnia symptoms to cognitive performance 14 years later.

Insomnia may be a modifiable risk factor for later-life cognitive impairment. We investigated: (1) which insomnia symptoms are associated with subsequent cognitive functioning across domains; (2) whether insomnia-cognition associations are mediated by mental and physical health; and (3) whether these associations are modified by gender. Participants included 2595 adults ages 51-88 at baseline (Mage=64.00 ± 6.66, 64.5% women) in the Health and Retirement Study. The frequency of insomnia symptoms (difficulty initiating sleep, night time awakenings, early awakenings, and feeling unrested upon awakening) at baseline (2002) were quantified using a modified Jenkins Sleep Questionnaire. Cognition was assessed in 2016 via the Harmonized Cognitive Assessment Protocol and operationalized with factor scores corresponding to five domains. Depressive symptoms and vascular conditions in 2014 were assessed via self-report. Structural equation models estimated total, indirect, and direct effects of insomnia symptoms on subsequent cognition through depressive symptoms and vascular diseases, controlling for baseline sociodemographic and global cognition. Frequent difficulty initiating sleep was associated with poorer episodic memory, executive function, language, visuoconstruction, and processing speed 14 years later (-0.06 ≤ β ≤ -0.04; equivalent to 2.2-3.4 years of aging). Depressive symptoms explained 12.3%-19.5% of these associations and vascular disease explained 6.3%-14.6% of non-memory associations. No other insomnia symptoms were associated with cognition, and no associations were modified by gender. Difficulty initiating sleep in later life may predict future cognitive impairment through multiple pathways. Future research with longitudinal assessments of insomnia, insomnia treatments, and cognition is needed to evaluate insomnia as a potential intervention target to optimize cognitive aging.

Public awareness of evidence-based medicine, the Cochrane collaboration and drug selection ­approaches in pharmacies

Background. The importance of the appropriate use of medicines by the population (consumers of health services) based on the principles and achievements of evidence-based medicine is widely recognized. However, little attention is paid to this issue all over the world, and the knowledge of the population about evidence-based medicine and sources of reliable information in Russia is practically not studied.
 Aim. To study public awareness of evidence-based medicine and the practice of choosing medicines.
 Material and methods. A descriptive study among the inhabitants of Russia was carried out. Information was collected using a questionnaire that respondents filled out on their own. A total of 238 people (representing the general population) participated in the study, and the responses of 134 people (individuals working in health care, patients and caregivers) to questions about information were additionally used.
 Results. The study showed that the majority of the population has no knowledge about evidence-based medicine (58%) and the Cochrane Collaboration (84%). Compared with the general population, a higher proportion of people working in health care were aware of both evidence-based medicine in general (41% vs. 26%; p=0.04) and the Cochrane Collaboration (37% vs. 5%; p=0.000002). 137/372 (37%) respondents experienced difficulties in choosing drugs in pharmacies, without significant differences between men and women. The most frequent difficulties in choosing medicines were ignorance of the comparative efficacy and safety of medicines, lack of understanding of the reasons for the variation in prices for the same medicine, the offer of predominantly expensive medicines by pharmacy workers, and the choice of the right medicine in a particular situation. When choosing medicines, the respondents most often relied on the recommendations of a doctor and a pharmacy worker. At the same time, half of the respondents also used other sources of information, the most popular of which was the Internet. The vast majority of respondents are interested in obtaining independent, evidence-based information about medicines.
 Conclusion. A low level of public awareness of evidence-based medicine and difficulties in choosing medicines in a pharmacy were revealed.

Rotating night shift work, sleep and thyroid cancer risk in the Nurses’ Health Study 2

Background and aim Thyroid cancer is the most common endocrine malignancy with rising incidence worldwide. We prospectively evaluated whether rotating night shift work and sleep disturbances are associated with incident thyroid cancer risk in the Nurses’ Health Study 2 (NHS2). Methods We assessed rotating night shift work (≥3 nights/month) history (cumulative number of years) at baseline and throughout follow-up (1989-2015) and sleep duration and sleep difficulty in 2001. Cox proportional hazard models, adjusted for potential confounders were used to calculate thyroid cancer hazard ratios (HR) and 95% confidence intervals (CI) for shift work history (0.1-4.9yrs, 5-9.9yrs, 10+yrs), sleep duration (≤5, 6, 7, 8, ≥9hours) and difficulty falling or staying asleep (little or none of the time, sometimes, most or all of the time). We further stratified the analyses of night shift work by sleep characteristics. Results We identified 588 incident cases among 114,534 women. We observed no association between night shift work history and thyroid cáncer risk (1-4.9 years: HR 1.19, 95% CI 0.98, 1.44; 5-9.9 years: HR 1.13 95% CI 0.86, 1.48; ≥10 years: HR 1.10, 95% CI 0.78, 1.54; Ptrend=0.55). Sleep difficulty was suggestively associated with higher incidence of thyroid cancer when reported sometimes (HR 1.26, 95% CI 0.95, 1.67) and most or all the time (HR 1.35, 95% CI 1.00, 1.81; Ptrend=0.03), compared to little or none of the time. Participants with >10 years of night shift work and ≤6 hours of sleep had a 2-fold increase in thyroid cancer risk (HR 2.23; 95%CI, 1.08-4.06). Shift workers with <5 years of shift work and frequent sleep difficulty had an increased risk of thyroid cancer (HR 1.95; 95% CI 1.03, 3.67). Conclusion We found evidence that rotating night workers with frequent sleep difficulty or short sleep had an increased risk of thyroid cáncer. Keywords night work, thyroid cancer

Post-Adoption Help-Seeking in Portugal: A Comprehensive Study on Parental Difficulties and Help-Seeking Behaviors and Perceptions.

Effective psychological parenting interventions delivered to adoptive parents may prevent serious adjustment difficulties and promote a healthy functioning; however, less is known about adoptive parents’ specific parental difficulties and help-seeking behaviors and perceptions, the understanding of which is deemed necessary to design well-informed interventions. This study aimed to describe parental difficulties, help-seeking behaviors, satisfaction with, and perceived barriers to seek, professional help, and acceptability of psychological parenting interventions among Portuguese adoptive parents. Comparisons with biological parents (Study 1) and between adoptive parents that requested adoption-specialized and non-specialized support (i.e., adoption-specialized vs. non-specialized help-seekers) (Study 2) were explored. A cross-sectional online survey was conducted. Participants were 471 adoptive and 552 biological parents of children aged under 18 years who were recruited through schools, adoption agencies, and social networks. They completed measures assessing parental difficulties, help-seeking behaviors, satisfaction with, and perceived barriers to seek, professional help, and acceptability of psychological parenting interventions. Comparison tests between the study groups, Pearson’s correlations, analyses of covariance (ANCOVA) and multivariate logistic regressions (MLR) were performed. Parents’ well-being and normative parenting challenges were the most frequent difficulties in both groups, but only associated with adoptive parents’ help-seeking. Although difficulties related to a child’s problems/parent–child relationship were more frequent among adoptive parents, adoption-related difficulties were rarely reported. Adoptive parents sought professional help more frequently, regardless of parental difficulties. Knowledge-related barriers to seeking help were the most frequent among adoptive parents. Adoption non-specialized help was less satisfactory. Acceptability of psychological parenting interventions was high, but dependent on parental difficulties. Implications for post-adoption services’ development are discussed.

Difficulties experienced by caregivers of patients with Alzheimer's Disease in relation to dietary care: integrative review

Objective: To analyze the problems experienced by caregivers of patients with Alzheimer's Disease (AD) in dietary care. Methods: An integrative review was carried out, whose guiding question was "What are the experiences and difficulties reported by caregivers of people with Alzheimer's disease concerning dietary care?". The search occurred in April/2021 in the following databases: MEDLINE, Science Direct, SCOPUS, Web of Science, SciELO, and Lilacs. Publications fromthe last 10 years in English, Portuguese or Spanish were included. Results: Of the 2,418 articles initially found, the titles of 39 seemed to fit the research objectives. Of these, 11 articles were selected for full reading, and 8 were evaluated to answer the research question. A gap in the approach to the problems experienced by caregivers of patients with AD concerning dietary care was observed. Difficulties dealing with reduced appetite, dysphagia, inability to remember eating, mealtime refusal, and food repulsion were reported. Allied to this, caregiver stress was reported. Conclusion: The main problems experienced by caregivers of patients with AD involve reduced appetite, dysphagia, difficulty remembering what they have already eaten, refusal at mealtimes, and food repulsion. Thus, the theme deserves the attention and involvement of health professionals to focus on the most frequent difficulties and teach caregivers to overcome them.

Electroacupuncture treatment of benign prostatic hyperplasia: A case report

Benign prostatic hyperplasia (BPH) is characterized by symptoms such as frequent urination and difficulty in urination. Currently, treatment is mainly carried out using medications and surgery, but all of these methods can lead to certain adverse effects. In this case, a ninety-year-old male elderly patient came to our acupuncture clinic for treatment of urinary tract occlusion due to BPH. According to the patient's condition, we adopted the eletroacupuncture treatment protocol of Prof. Zhanglian Wang, a famous experienced Chinese medicine doctor. After six weeks of acupuncture treatment, the patient's urinary status improved significantly. This case suggests that acupuncture may be an effective complementary alternative therapy for BPH.

Peningkatan Pengetahuan Penanganan Kadar Gula Darah Tinggi pada Penyandang Diabetes Melitus di Prolanis

People who suffers Diabetes Melitus has high blood sugar levels which is commonly referred to as hyperglycemia. Symptoms that usually appear include frequent urination, thirst, hunger, fatigue, blurred vision, difficulty concentrating, weight loss, and wounds that are difficult to heal. However, a common sign and symptom that patients commonly experience is an increase in blood sugar levels. The purpose of this health education is to increase the knowledge of diabetes melitus patients in handling high blood sugar levels at Prolanis Public Health Center Ngrampal, Sragen Regency, Central Java Province. This health education is carried out directly at the Ngrampal Public Health Center, Sragen Regency. This health education was held on February 19, 2022 at 08.00 WIB to 10.00 WIB, which was attended by 25 participants from diabetes melitus patients. The result of this health education is an increase in the knowledge of diabetic patients regarding the management of high blood sugar levels. During the health education the participants were very enthusiastic so that there were several questions asked by the health education participants. Suggestions from this seminar are that Diabetes Melitus patients are expected to be able to manage and handle independently or with the help of health workers to increase high blood sugar levels (hyperglycemia

Land Cover Changing Pattern in Pre- and Post-Earthquake Affected Area from Remote Sensing Data: A Case of Lushan County, Sichuan Province

Extremely hard-hit areas face frequent secondary geological hazards and difficulties in vegetation recovery, and subsequent effects have a significant impact on land cover changes. At present, there is a lack of research on the dynamic restoration of, and changes in, the ecological environment before and after an earthquake, and especially a lack of quantitative assessment of the impact of earthquakes on land cover at the microscopic scale of spatial distribution of landscape indices. Taking the Lushan earthquake in Sichuan Province as an example, this paper obtained land cover data from the study area between 2012 and 2020, and analyzes the spatial distribution characteristics and influencing factors of land cover change frequency by using a comprehensive land cover degree index, land cover transfer matrix and landscape ecology index. The results show that the types of cropland, forest, built-up and bare land have changed significantly in the study area. During the earthquake recovery period, the comprehensive land cover index of the study area showed an increasing trend, and land cover has been continuously improved under the effect of artificial measures and natural restoration. After 2013, patch density (PD) and landscape shape index (LSI) values decreased and aggregation index (AI) values increased for the vast majority of landscape land classes, indicating a benign ecological development across the region in the post-earthquake period. The research results are not only helpful to establish scientific ecological environmental management in the earthquake-stricken areas, but also helpful to formulate medium- and long-term ecological environmental monitoring and ecological restoration plans based on land cover change patterns.

An Analysis of Students’ Difficulties in Writing Descriptive Texts in the Tenth Grade of SMA Kristen Palangka Raya

Most students had problems writing a descriptive text when they were assigned their text. Many students were not able to describe themselves or they had difficulties in writing descriptive text. Some students think that writing is the most difficult skill in English. Some students also could not finish their writing at the end of the time set due to limited ideas and vocabulary. This research aimed to describe the students’ difficulties in writing descriptive texts and find out the causes underlining those frequent difficulties. This research uses the qualitative descriptive method. The research subjects were X MIPA students of SMA Kristen Palangka Raya who had difficulties when writing descriptive text. This research involved 17 students as the research subjects. The data of this research were the results of students’ worksheets and the student's answers to the given questionnaires. The researcher employed a writing test and questionnaires to gain descriptive data. As a result, the factors that cause the students’ difficulties in writing descriptive text were students’ lack of vocabulary, difficulties to translate, and lack of competence in understanding English tenses.

Sleep and behavioral problems in preschool-age children with Down syndrome

Sleep is a major concern, especially in people with Down Syndrome (DS). Beyond Obstructive Sleep Apnea, a number of other sleep difficulties have been reported in children with DS, such as delayed sleep onset, night-time awakenings, and early morning awakenings. The detrimental effect of sleep difficulties seems to contribute to and exacerbate the cognitive and behavioral outcomes of DS. Although the screening for sleep disorders is recommended early in age in DS, only a few studies have evaluated the sleep profile in preschool-age children with DS. The aim of the current study was to assess the association between sleep disturbances and behavioral problems in a group of preschool-age children with DS, by means of a feasible and easy-to-administer parent-report questionnaires. Seventy-one preschool-age children with DS, ranging in age from 3 to 5.11 years, were included in this retrospective study. Sleep disturbances were evaluated by means of the Sleep Disturbance Scale for Children, while emotional and behavioral problems by means of the Child Behavior Checklist. Sleep breathing disorders were the most frequent sleep difficulties reported by parents. Moreover, children with clinical scores in total sleep problems exhibited elevation of psychopathological symptoms, namely Total problems, Affective problems, Anxiety problems, Pervasive Developmental Problems, and Attention Deficit/Hyperactivity Problems. The identification of the broader connection between sleep difficulties and emotional and behavioral problems in preschool-age children with DS leads to important considerations for intervention.

Percutaneous Femoral Derotational Osteotomy in the Skeletally Immature Patient.

This is a percutaneous procedure that involves creation of femoral drill holes at the osteotomy site prior to reaming the canal4. External fixator pins are placed proximal and distal to the osteotomy site prior to completing the osteotomy. These pins are derotational markers for the surgeon and act to hold the correction with use of an external fixator while the interlocking screws are being placed. The pins are placed at a degree of divergence that is equal to the degree of intended derotation so that the pins will become parallel in the axial plane following derotation of the femur. The percutaneous osteotomy is then completed with use of an osteotome, and the trochanteric entry nail is passed across the osteotomy site while correcting rotation. Once rotation is fully corrected and the pins are parallel, the external fixator is placed to hold the rotation and interlocking screws are placed. Nonoperative alternatives to this procedure include physical therapy for gait training and strengthening as well as modalities to address hip and knee pain that may be associated with version abnormalities. Although physical therapy is often prescribed, it must be noted that excess version is a fixed osseous structural pathology that therapy cannot address. Additionally, compensatory mechanisms that may be taught to improve gait and walk with a neutral foot progression angle may exacerbate hip or knee pathology as a result of the underlying version abnormality. Surgical alternatives include derotational osteotomies of the proximal or distal aspects of the femur with use of an open technique with plate fixation, as opposed to an intramedullary nail following percutaneous diaphyseal osteotomy as presented here1. Additionally, an open technique with intramedullary nail fixation may be performed5. Excessive anteversion can cause both hip and knee symptoms, including hip pain, instability, labral and psoas pathology, and patellofemoral instability6. Excessive retroversion can cause impingement between the femoral neck and acetabulum, which results in pathology of the labrum and articular cartilage7. Additionally, abnormalities of version often lead to gait disturbances with frequent tripping and difficulty running8. Children with femoral version abnormalities have limited remodeling potential after age 83. A derotational osteotomy may be performed to correct symptomatic excess femoral version in an older child or adolescent. The patient may be weight-bearing as tolerated with upper-extremity assistance immediately following the procedure. The osteotomy typically heals between 6 and 12 weeks, and the patient may return to activities as tolerated once the osteotomy is healed. Gordon et al. described the outcomes of a similar technique for femoral derotational osteotomy in skeletally immature patients with excessive femoral anteversion3. The study retrospectively reviewed the results of the technique in 13 patients and 21 limbs at a minimum follow-up of 1 year. All patients complained of tripping and gait abnormalities preoperatively. All patients noted gait improvement, and no intraoperative or postoperative complications were reported. Healing of the osteotomy occurred at a mean of 6 weeks postoperatively. No patient developed osteonecrosis. We routinely remove hardware in skeletally immature patients approximately 1 year postoperatively. Complications are rare and include hardware irritation, infection, nonunion, and neurovascular injury. Preoperative planning is critical for this procedure, and the surgeon should know the intended degree of derotation, the location of the osteotomy relative to the greater trochanter, the length of the nail, and the approximate diameter of the nail prior to entering the operating room.Percutaneous bicortical femoral drill holes are created at the site of the osteotomy prior to reaming to allow for egress of reamings and bone marrow elements at the osteotomy site, which serve as autograft and stimulate bone healing. Additionally, the drill holes provide ventilation to prevent excessive intramedullary pressure during reaming9-11.External fixator pins are placed proximal and distal to the osteotomy prior to completion of the osteotomy to allow for rotational assessment after completion of the osteotomy. Placing these pins bicortically so that they are secure in the bone and ensuring that the divergence is correct for the intended amount of derotation is critical in this procedure because once the osteotomy is complete, the pins are the only markers of rotation the surgeon has to guide the correction.An external fixator is helpful in holding the femur at the intended degree of derotation during placement of the interlocking screws. ROM = range of motionCT = computed tomographyMRI = magnetic resonance imagingAP = anteroposteriorGT = greater trochanterAV = anteversionER = external rotationIR = internal rotationA = anteriorP = posteriorM = medialL = lateralXR = X-rayProx = proximalEx fix = external fixatorWBAT = weight-bearing as toleratedBLE = bilateral lower extremitiesDVT = deep venous thrombosisPT = physical therapyppx = prophylaxisAVN = avascular necrosis (osteonecrosis).

Cognitive Difficulties and Health-Related Quality of Life in Sarcoidosis: An Analysis of the GRADS Cohort.

Rationale: Subjective cognitive difficulties are common among sarcoidosis patients; however, previous studies have not modeled the link between cognitive difficulties and health-related quality of life (HRQOL). Objectives: To determine whether cognitive difficulties are associated with HRQOL in sarcoidosis patients after adjusting for demographics, fatigue, and physical disease severity measures. Methods: We performed a secondary analysis of the Genomic Research in Alpha-1 antitrypsin Deficiency and Sarcoidosis (GRADS) study data. We examined the association between self-reported cognitive difficulties (Cognitive Failures Questionnaire (CFQ)) and HRQOL (SF12v2 mental and physical component scores) while adjusting for the demographics, fatigue, and physical disease severity measures (i.e., organ involvement, forced vital capacity). Results: Approximately one-fourth of the patients with sarcoidosis endorsed cognitive difficulties. More frequent cognitive difficulties and more severe fatigue were significantly associated with worse mental HRQOL in the fully adjusted model, while older age was associated with better mental HRQOL. The association between cognitive difficulties and physical HRQOL was not significant in the final model. More severe fatigue, joint involvement, and reduced forced vital capacity (FVC) were associated with worse physical HRQOL, while higher income and higher education were associated with better physical HRQOL. Conclusions: Perceived cognitive difficulties are associated with diminished HRQOL after adjusting for demographics, organ involvement, pulmonary function, and fatigue. The association between cognitive difficulties and reduced HRQOL primarily occurs through the impact on mental components of HRQOL.