Functional Difficulties Research Articles

IMPACT OF LESION COMPLEXITY ON PCI SUCCESS IN LAD DISEASE: A RETROSPECTIVE STUDY

Coronary artery disease (CAD) involving the left anterior descending (LAD) artery is a major cause of morbidity and mortality globally. The prognosis of patients with coronary artery disease depends on the extent of at-risk myocardium. LAD comparatively supplies a large percentage of the left ventricle compared to RCA or LCX. The principal indication of percutaneous coronary intervention is to improve the quality of life in patients with angina refractory to medications. There are many advancements in PCI techniques for better management of challenging lesions due to physiological, anatomical, or functional difficulties. Some of the complex lesions include ostial lesions, bifurcating lesions, calcified lesions, and chronic total occlusions. However, as lesion complexity plays a significant role in procedural success and long-term outcomes, complex lesions are often associated with increased rates of restenosis, adverse events, and procedural challenges Objective: This study aims to evaluate the impact of lesion complexity on PCI success in patients with LAD disease. Methods: This retrospective cohort study was conducted from January 1, 2021, to December 31, 2023, at a tertiary cardiovascular center. A total of 216 participants who had PCI to LAD lesions done were included. Lesion complexity was assessed using the SYNTAX score and categorised into low, intermediate, and high complexity groups. The primary outcome was restenosis at 12 months, defined as ≥50% luminal narrowing in patients requiring repeat angiography due to any indication. Secondary outcomes included procedural success, major adverse cardiac events (MACE), and rates of stent thrombosis. Data were analysed using SPSS version 24.0, with statistical significance set at p < 0.05. Results: Among the 216 participants, 72% were male, and the mean age was 61.4 ± 9.8 years. Restenosis occurred in 13.9% of participants, with higher rates observed in patients with high-complexity lesions (24.5%) compared to low-complexity lesions (7.7%) (p = 0.02). Procedural success was achieved in 92.6% of cases, though it decreased with increasing lesion complexity (97.8% for low, 93.4% for intermediate, and 85.7% for high-complexity groups). MACE occurred in 4.6% of participants, with stent thrombosis noted in 2.7%. Conclusion: Lesion complexity significantly influences PCI success and restenosis rates in LAD disease. Patients with higher complexity lesions experience worse outcomes, necessitating individualised treatment strategies to optimise procedural success.

The healthy habits questionnaire (HHQ): Validation of a measure designed to assess problematic influential behaviours amongst families of children living with obesity or a risk of developing obesity.

The 48-item Healthy Habits Questionnaire (HHQ-48) was developed to (1) monitor positive changes in family lifestyles following engagement in the Parents Plus Healthy Families (PP-HF) parent training programme and (2) be utilised as a standalone measure in clinical settings to identify and track problematic influential behaviours amongst families of children in weight-management services. This study aimed to develop and validate a brief version of the HHQ-48. The scale was administered to a cross-sectional community sample (n = 480), and on two occasions to a control sample (n = 50) and an experimental sample (n = 40) from a randomised controlled trial (RCT) of the PP-HF programme to assess test-retest reliability and sensitivity to change respectively. Exploratory and confirmatory factor analysis showed that a 23-item, 4-factor version of the HHQ (i.e., the HHQ-23) best fit the data. The scale and factor subscales had good internal consistency and test-retest reliability. They also had good concurrent and construct validity shown by significant correlations with another scale that assessed lifestyle issues, and scales that assessed parenting satisfaction, family functioning, and children's strengths and difficulties. The HHQ-23 was sensitive to change following parents completing the PP-HF programme. The HHQ-23 may, therefore, be used to monitor positive changes in family lifestyles following engagement in the PP-HF parent training programme. The HHQ-23 also shows promising potential as a standalone screening measure or as part of a larger battery of screening assessments in paediatric weight-management services.

학령기 아동의 부모애착 및 부모의 민주적 양육행동과 초기 청소년기 학교적응 간의 관계에서 집행기능곤란의 매개효과

Objective: This study was conducted to verify the mediating effect of executive function difficulties in the relationship between school adaption in early adolescence and children’s parental attachment and democratic parenting behavior in school-age. Methods: Data of 9-year-olds from the 11th (2018) to 12-year-olds from the 14th (2021) Panel Study on Korean Children were used to extract variable data that fit the purpose of this study. Descriptive statistics were performed using SPSS 21.0, and AMOS 21.0 was used to analyze correlation, structural equation modeling, and mediating effects through bootstrapping to verify the research hypothesis model. Results: First, school-age children’s attachment to their parents had a direct positive effect on school adaptation in early adolescence, but parents’ democratic parenting behavior did not. Second, executive function fully mediated the relationship between democratic parenting behavior and school adaptation, and partially mediated the effect of parental attachment on school adaption. Conclusion: Executive function, secure parental attachment, and democratic parenting behavior in school-age children tended to reduce executive function difficulties in early adolescence. These results are discussed in terms of need to develop parent education programs to increase attachment to parents and teach desirable parenting behaviors. Also discussed to provide continuous and systematic guidance and education on the importance of executive function to parents.

Use of biomarkers in the diagnosis of Alzheimer's disease in adults with intellectual disability.

People with intellectual disability are a vulnerable cohort who face challenges accessing health care. Compared with the general population, people with intellectual disability have an elevated risk of developing dementia, which often presents at a younger age and with atypical symptoms. The lifelong cognitive and functional difficulties faced by people with intellectual disability further complicate the diagnostic process. Specialised intellectual disability memory services and evaluation using reliable biomarkers of neurodegeneration are needed to improve diagnostic and prognostic certainty in this group. Inadequate specialist services and paucity of research on biomarkers in this population hinders progress and impedes the delivery of adequate health care. Although cerebrospinal fluid-based biomarkers and radiological biomarkers are used routinely in the evaluation of Alzheimer's disease in the general population, biological variation within the clinically heterogenous group of people with intellectual disability could affect the clinical utility of existing biomarkers. As disease-modifying therapies become available for the treatment of early Alzheimer's disease, and hopefully other neurodegenerative conditions in the future, biomarkers will serve as gatekeepers to establish the eligibility for such therapies. Inadequate representation of adults with intellectual disability in biomarker research will result in their exclusion from treatment with disease-modifying therapies, thus perpetuating the inequity in health care that is already faced by this group. The aim of this Series paper is to summarise current evidence on the application of biomarkers for Alzheimer's disease in a population with intellectual disability (that is not attributable to Down syndrome) and suspected cognitive decline.

A cluster-randomised controlled feasibility trial evaluating the Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS).

There is a high prevalence of cognitive difficulties in MS, but despite this, there are few programmes targeting cognition that focus on the ability to function well in everyday life. The Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS), an occupation-focused cognitive intervention, was developed to address this. It addresses both the functional difficulties and the wide-ranging symptoms that present in MS. Here we report on the results of a cluster-randomised controlled feasibility trial (ISRCTN11462710; registered 4th September 2019) evaluating the COB-MS in terms of feasibility and initial efficacy as a cognitive intervention for people with MS. The eight-session COB-MS intervention was delivered remotely by occupational therapists to participants with MS in the intervention group. Following the end of the trial the COB-MS was delivered to the wait-list control group. Data was collected from people with MS experiencing cognitive difficulties at baseline, post-intervention, 12-weeks, and 6-month follow-up. The primary outcome measure was the Goal Attainment Scaling at 12weeks. Data was also collected in the domains ofcognition, quality of life, and mood. One hundred and eighteen people with MS and cognitive difficulties were randomised to either usual care (n = 60) or COB-MS intervention (n = 58). Ninety-four participants were retained at 6-month follow-up. The COB-MS was found to be feasible, including trial procedures and protocol. Data indicates that the COB-MS is accepted by participants and had positive impacts on daily life. Those allocated to the COB-MS group had a significant improvement in the primary outcome compared to the control condition. Progression criteria set for the feasibility trial have been met therefore further testing of the COB-MS at a definitive trial is supported by the results. The results provide a strong basis for a pathway to a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy. ISRCTN11462710 Date of registration: 4th September 2019.

Prevalence of Functional Difficulty Among School-Aged Children and Effect on School Enrolment in Rural Southern India: A Cross-Sectional Analysis.

Despite the large number of children in India, there is little information on the impact of children's disability on school enrolment, and how this differs by population. We estimated the prevalence of childhood disability in two sites in Tamil Nadu, southern India, and the effect of functional difficulty on school enrolment. We used a parent-reported survey containing the UNICEF-Washington Group questions to identify children aged 5 to 17 years with functional difficulty during a census conducted for an ongoing trial. We estimated pooled- and gender-specific prevalence of functional difficulty among 29,044 children. We fitted regression models to identify subgroups with higher rates of functional difficulty and the effect of functional difficulty on reported school enrolment. We estimated the modification of the effect of functional difficulty by age, gender, socioeconomic status, household education, and sub-site, on additive and multiplicative scales. We found of 29,044 children, 299 (1.0%) had any functional difficulty, equal among boys and girls. Being understood (0.5%) and walking (0.4%) were the most common difficulties. Functional difficulty was strongly associated with non-enrolment in school (Prevalence ratio [PR] 4.59, 95% CI: 3.87, 5.43) after adjusting for age, gender, and site. We show scale-dependent differences between age and socioeconomic groups in the effect of functional difficulty on enrolment. This study shows that at least one in a hundred children in this region have severe functional difficulties and nearly half of these children are not enrolled in school, highlighting the need for further efforts and evidence-based interventions to increase school enrolment among these groups.

COVID-19 vaccine uptake in individuals with functional difficulty, disability, and comorbid conditions: insights from a national survey in Bangladesh

BackgroundCOVID-19 vaccine uptake among individuals with disabilities is crucial for safeguarding their health and well-being. However, the extent of vaccine uptake among this group remains largely unknown in low- and middle-income countries. This study aims to assess the COVID-19 vaccine uptake among persons with functional difficulty, disability and/or comorbidity in Bangladesh and their associated factors.MethodsData from 9,370 respondents extracted from the 2021 National Household Survey on Persons with Disability were analysed. The outcome variable was the uptake of at least one dose of the COVID-19 vaccine (yes, no). Key explanatory variables included the presence of disability (yes, no), comorbidity (yes, no), and both comorbidity and disability (yes, no) among persons with functional difficulty. The relationship between the outcome and explanatory variables was determined using mixed-effects multilevel logistic regressions adjusted for covariates.ResultsThe overall uptake of at least one dose of the COVID-19 vaccine among persons with functional difficulty was 57.37%, among persons with functional difficulty and disability was 48.63% and among persons with functional difficulty and single (57.85%) or multi-comorbidity (60.37%). Compared to the respondents with functional difficulty only, the adjusted odds ratio (aOR) of not receiving any dose of the COVID-19 vaccine for individuals with both functional difficulty and disability was 1.37 (95% CI, 1.22–1.53), and for individuals with functional difficulty, disability and one or more comorbid conditions was 1.30 (95% CI, 1.15–1.47). The aOR of receiving at least one dose of the COVID-19 vaccine among individuals with functional difficulty and one or more comorbid conditions was significantly higher than among those with functional difficulty only.ConclusionIn Bangladesh, COVID-19 vaccine uptake was relatively low among individuals with disabilities. The existing COVID-19 vaccine rollout programs and similar future programs should prioritise individuals with disabilities and include targeted strategies to reach them.

Multidisciplinary treatment of a patient with TMJ ankylosis and a severe dentofacial discrepancy: A case report.

Temporomandibular joint (TMJ) ankylosis is a debilitating condition characterised by the fusion of bony or fibrous tissues in the TMJ, resulting in restricted mouth opening, functional challenges and facial deformities. This report highlights the complexity and multifaceted nature of TMJ ankylosis and emphasises the significance of early intervention and a multidisciplinary approach. Distraction osteogenesis has emerged as a successful method for managing TMJ ankylosis and associated facial asymmetry. Post-distraction orthodontic management is essential to address occlusal changes, including posterior open bite and crossbite. A 17-year-old boy with unilateral right-sided TMJ ankylosis presented with restricted mouth opening, facial asymmetry and functional difficulties. Multidisciplinary treatment planning involved distraction osteogenesis, condylectomy, coronoidectomy and orthodontic correction to achieve proper occlusion and facial aesthetics. The treatment significantly improved facial aesthetics, mouth opening, occlusion and the patient's confidence and self-esteem. This case report underscores the complexity of TMJ ankylosis and the need for a comprehensive approach, including surgical and orthodontic interventions. Collaboration among healthcare professionals and ongoing research is vital to refine treatment approaches and improve the quality of life for patients with TMJ ankylosis.

B - 96 Relationships between Self-Reported Cognitive Dysfunction, Functional Activities, and Intraindividual Cognitive Variability in Persons with Multiple Sclerosis (Pwms)

Abstract Objective To examine the relationships between intraindividual cognitive variability (IIV) and self-reported cognitive and functional difficulties in persons with multiple sclerosis (pwMS). We hypothesized higher perceived cognitive and functional difficulties would be associated with higher IIV. Method Participants (n = 35) were pwMS from a prospective memory intervention study. During the baseline evaluation, participants completed an objective neuropsychological test battery and a self-report measure of cognitive functioning (Perceived Deficits Questionnaire; PDQ Total). Participants were asked if they had problems in eight different functional areas due to their memory, with the number of endorsed problems summed. Two measures of IIV, an intraindividual standard deviation (ISD) score and maximum discrepancy score (MDS), were created from 11 indices. The relationship between the IIV and PDQ were assessed with individual linear regressions, controlling for demographics and disease-related characteristics, while Spearman correlations examined the associations with the number of reported functional memory problems. Results The PDQ was not significantly associated with either the ISD (b = −0.03, 95% CI: −0.15, 0.10, p = 0.672) or MDS (b = −0.01, 95% CI: −0.51, 0.32, p = 0.645). The overall number of functional memory problems was correlated with both the PDQ (ρ = 0.40, p = 0.018) and ISD (ρ = −0.35, p = 0.039), but not MSD (ρ = −0.22, p = 0.201). Conclusion(s) Perceived cognitive dysfunction was not associated with IIV. However, self-reported functional problems with memory were associated with perceived cognition, as well as one metric of IIV. ISD may better reflect moment to moment fluctuations that lead to difficulties with daily functioning, as opposed to MDS which may reflect underlying variation (e.g., base rates of impairment) in cognitive performance.

B - 6 The BRIEF-2A Pattern of Self and Informant Executive Functioning Difficulties in Adults with Epilepsy

Abstract Objective People with epilepsy (PWE) commonly have executive functioning (EF) difficulties on objective testing. However, less is known about subjective EF difficulties in everyday life. We examined self- and informant-rated EF in PWE using the Behavior Rating Inventory of Executive Function for Adults-2 (BRIEF-2A). We hypothesized that PWE and their informants would endorse greater EF difficulties relative to healthy participants. Method Participants included 43 PWE who completed comprehensive clinical neuropsychological evaluation at a large Northeastern academic medical center, which included BRIEF-2A Informant and Self Report Forms (Age M = 40.4 ± 17.2 years, 53% female, Education M = 13.0 ± 1.8 years). Twenty-four participants completed self-reports, while 19 had both self and informant reports. The comparison sample included 43 age- and gender-matched healthy controls (HC). We analyzed BRIEF-2A subscales using MANOVAs, where elevated T scores indicated worse EF. Repeated measures ANOVAs compared self and informant ratings. Multi-rater comparisons (90% CIs) and chi-squares analyzed patterns of discrepant ratings. Results Self-reported EF difficulties in PWE were elevated across all scales, compared to HC (p’s0.25), with greatest difference observed for working memory (PWE = 69.7 ± 12.7, HC = 44.5 ± 16.7, ηp2 = 0.61). Similar elevations across all scales were observed for PWE informant reports (p’s0.14). PWE rated greater self-monitoring (p = 0.03, ηp2 > 0.23) and emotional control (p = 0.08, ηp2 > 0.16) difficulties than informants. There was 42.1–68.4% concordance between self and informant reports for PWE, compared to 84–95% in HC. Patterns of self and informant ratings were similar between PWE and HC for initiation, planning/organization, and task-monitoring (p’s > 0.20). Conclusions PWE and their informants report high, yet relatively similar, levels of EF difficulties in daily life.

A 'Problematic' Pattern of Power-system Functioning and its Association with psychopathological Symptoms.

Following the well-researched two-dimensional model of attachment-system functioning, based on the concepts of hyperactivation and deactivation, a two-dimensional model of the power behavioral system has recently been proposed. The power system is aimed at activating, organizing, and implementing action patterns that protect or restore a sense of power or dominance. Here, we tested predictions derived from the two-dimensional model of power-system functioning regarding the contribution of a 'problematic' high-high pattern, characterized by the coexistence of both hyperactivating and deactivating strategies, to psychopathological symptoms. A non-clinical sample of Italian adults (N = 385) completed the Power Behavioral System Scale together with self-report measures of anxiety and depression symptoms and difficulties in executive control. Multiple regression analyses showed that higher deactivation and hyperactivation scores, characteristic of the 'problematic' pattern, significantly predicted anxiety and depression symptoms as well as executive function difficulties. These results provide initial support for the pathogenic implications of the 'problematic' high-high pattern of power-system functioning.

A - 100 Who Is at the Door? Clinical Presentations and Predictors of Dementia Diagnosis in a Specialist Dementia Service

Abstract Objective This service audit aimed to identify predictors associated with a dementia diagnosis and the diagnostic base rate in a UK-based, specialist Younger People with Dementia (YPWD) Service. Method All patients referred between July 2022 and 2023 to the YPWD service were included in the study. All 191 patients were under 65 years at the time of referral. 69 patients were excluded from analysis (e.g., if the patient withdrew from the service prior to assessment or if the referral was deemed inappropriate based on service guidelines). A quasi-experimental design was used, investigating the relative predictive value of factors such as demographics, presenting cognitive symptoms, comorbidities, or mental health to receiving a dementia diagnosis. Following definition, raters reviewed client case notes to establish the presence or absence of each criterion. Results Significant predictors of a dementia diagnosis in YPWD were functional change (p < 0.001), behavior change (p < 0.001), being accompanied to assessment (p < 0.001), diminished insight (p < 0.001), executive functioning difficulties (p < 0.05), cognitive screening test score below cut-off (p < 0.05) and previous radiological investigation prior to referral (p < 0.001). The diagnostic rate for YPWD was 15%. Conclusions Memory problems alone are an insufficient predictor for a dementia diagnosis in YPWD, unless accompanied by additional factors. Overreliance on the presence of subjective memory complaints in primary care as a percipient to referral for specialist assessment contributes to a low diagnostic rate for the service The presence of insight and attending appointments alone contraindicate the presence of an organic disorder. Results indicate that factors beyond diagnostic criteria may be clinically significant.

Differences in need for and access to eye health services between older people with and without disability: A cross-sectional survey in four districts of northern Uganda.

Eye health and disability are both common among older people, and it is important to understand how disability relates to visual health status and access to services. While people with disabilities face barriers to accessing health services, few studies have measured participants' functional status in domains other than vision and little evidence exists on how disability impacts eye health services access. This paper describes how visual impairment and access to eye health services differ between people aged 50 years and above with and without disability in Karamoja, Uganda, and explores the factors driving that difference. This was a cross-sectional survey among individuals aged 50 years and above. A standardised eye health survey was conducted, with additional questions on personal and health characteristics. Ophthalmologists conducted a vision examination, and recorded participants' self-reported functional difficulties using the Washington Group Short Set Enhanced. Descriptive analyses were conducted using Stata, and multivariate models constructed to explore relationships. 21.7% of respondents self-reported some sort of functional difficulty. Twenty-five percent of individuals with a non-visual functional difficulty are also blind, and a further 29% experience a lower level of VI. In a multivariate model, blindness was associated with self-reported difficulties seeing, but not any other type of difficulty. Blindness was also associated with age, not being married, and living in a smaller household. Access to cataract surgery was associated with non-visual functional difficulties, male gender, and having a regular household income. This study confirms that in the study area, disability and visual impairment are common among people aged 50 years and above, access to eye health services is low, and self-reported functional difficulties are not associated with lower access to services.

Executive deficits after SARS-CoV-2 infection: A cross-sectional population study

ImportanceDespite the major implications of executive deficits in day-to-day functioning, few studies have investigated this in post-acute sequelae of SARS-CoV-2 infection using standardized measures that differentiate between aspects of executive function. ObjectiveExamine whether SARS-CoV-2 infection is associated with deficits in executive functions and if so, investigate the duration of this association. Design, Setting, and ParticipantsThe present research has a cross-sectional design and uses data from the Norwegian Covid-19 Cohort study. The current cohort (n = 8102) completed the Behavior Rating Inventory of Executive Function- Adult Version (BRIEF-A) electronically between April 2021 and September 2021. During the assessment, 4183 of the included participants had a prior positive polymerase chain reaction test (PCR) for SARS-CoV-2 and 3919 were untested or had a confirmed negative PCR test. ExposureLaboratory-confirmed SARS-CoV-2 infection. Main outcomes and measuresExecutive functions were measured using the BRIEF-A, a self-report questionnaire comprising 75 items within nine theoretically and empirically distinct clinical scales. All participants self-reported on demographical variables and comorbidity. Information on sex and age was derived from the personal identification number, and vaccination status was obtained from the Norwegian Immunization Registry (SYSVAK). ResultsParticipants with a positive SARS-CoV-2 status reported executive deficits in everyday life above the clinical threshold (T-score ≥65) more often than non-infected controls (383 vs. 225). Specifically, the SARS-CoV-2 positive status group indicated significantly more deficits related to metacognition, with the greatest difference demonstrated for working memory. This difference remained when adjusting for various demographic factors and comorbidities, with significantly greater odds of reporting above the clinical threshold following SARS-CoV-2 infection, as observed on the global executive composite score 6–12 months after infection (OR 1.97; 95% CI 1.51 to 2.55). ConclusionsOur study confirms more perceived executive deficits following SARS-CoV-2 infection compared to non-infected controls, with metacognitive aspects being the most affected. These findings shed light on the potential functional difficulties that individuals may encounter during the post-acute phase of SARS-CoV-2 infection and may guide further development of targeted interventions addressing metacognitive domains of executive functioning.

Childhood Trauma and Parental Burnout: The Mediating Role of Difficulties in Emotion Regulation and Reflective Functioning.

This study investigated the mediating role of difficulties in emotion regulation and reflective functioning in the association between childhood trauma and parental burnout. The participants included 402 mothers with children ranging in age from 1 to 6years. Mothers completed the Parental Burnout Assessment (PBA) the parental reflective functioning questionnaire (PRFQ), the Difficulties in Emotion Regulation Scale (DERS), and the Childhood Trauma Questionnaire (CTQ). Data analysis was performed using SPSS 26, and Hayes Macro in SPSS was also used to analyze the effects of mediating variables. The results show that although childhood trauma and parental burnout do not have a direct and significant relationship, there is a significant indirect relationship through difficulties in emotional regulation and the two factors of parental reflective functioning, i.e., pre-mentalization, interest and curiosity about mental states. These findings contribute to the understanding of the importance of variables such as difficulties in emotion regulation and reflective functioning, which play a mediating role in the relationship between childhood trauma and parental burnout. This suggests that designing interventions and prevention to reduce parental burnout based on emotion regulation and reflective functioning may be beneficial.

The Impact of Estrogen-Suppressing Contraceptives on Behavioral and Functional Difficulties in Borderline Personality Disorder.

Borderline Personality Disorder (BPD) is characterized by rapidly shifting emotional, interpersonal, and behavioral symptoms, and is often co-morbid with mood and anxiety disorders. Females are more likely to be diagnosed with BPD than males and exhibit greater functional impairment. Hormonal fluctuations, particularly in estrogen levels, may influence the manifestation of BPD symptoms. Here we investigated the influence of estrogen-suppressing contraceptives on behavioral and functional difficulties in BPD. The analytical sample included 348 females ages 18-50 undergoing residential treatment for psychiatric disorders, with 131 having a BPD diagnosis. Patients were categorized based on their contraceptive method: 1) Estrogen-suppressing contraceptives (N=145) and 2) Naturally cycling (N=203). Interaction models tested the impact of estrogen-suppressing contraceptives on the relationship between BPD diagnosis and behavioral and functional difficulties at admission and discharge, assessed by the four Behavior and Symptom Identification Scale (BASIS-32) domains: difficulties in relationships, daily living, depression/anxiety, and impulsivity. Females with a BPD diagnosis were more likely to use estrogen-suppressing contraceptives compared to those without BPD (p=0.04). However, estrogen-suppressing contraceptive use was not associated with behavioral and functional difficulties at admission, discharge, or over time. Estrogen-suppressing contraceptives moderated the association between BPD diagnosis and difficulties in relationships (p=0.004), difficulties in daily living (p=0.01), and depression/anxiety symptoms (p=0.004). Patients with BPD expressed increased behavioral and functional difficulties at admission, discharge, and over time only if naturally cycling (p<0.003). Our findings suggest that estrogen-suppressing contraceptives may help to regulate the rapidly shifting emotional, interpersonal, and behavioral symptoms in females with BPD by stabilizing estrogen levels.

Executive function performance in persons with non-syndromic cleft lip and palate

Background: Executive functions (EFs) are crucial cognitive functions that mature from birth to adolescence. They are vital for daily task execution and overall success and also influence language and communication development. Children with EFs deficits often experience delays in language and speech abilities. These impairments are particularly prevalent among individuals with cleft lip and palate. Consequently, speech and language pathologists must address these impairments through assessments and interventions. Despite this urgent need for action, there is a scarcity of research on executive function performance in this population in Thailand, prompting an investigation to address this issue. This study explores executive function performance in this population to enhance the quality of life for individuals with cleft lip and palate. Materials and methods: Using a survey-based approach, executive function performance was assessed in 5- to 15-year-old volunteer with non-syndromic cleft lip and palate attending the speech therapy camp provided by the Princess Sirindhorn IT Foundation Craniofacial Center at Chiang Mai University in April 2024. Parents completed the Behavior Rating Inventory of Executive Function (Parent form), with scores ≥65 indicating executive function difficulties. Results: The study involved 29 participants, 14 males (48.28%) and 15 females (51.72%), with a mean age of 8 years and 9 months. Average scores for executive function abilities in BRI, MI, and GEC were 52.21, 56.48, and 58.90, respectively. There are several participants with abnormal executive function in each age group, along with their average T-scores across different domains. Children aged 5, 6-8, and 9-11 have T-scores for executive function performances falling into problematic levels for 1, 2, and 5 individuals, respectively. Conclusion: Most of the sample group demonstrated executive function skills within the normal range. However, a certain number of individuals experienced issues with executive function. These findings offer guidance for speech and language pathologists and emphasize the importance of executive function in individuals with cleft palates.

A narrative review of mitochondrial dysfunction and male infertility.

Recent investigations have highlighted mitochondrial dysfunction as a major component in reduced sperm function and male infertility. The creation of energy, control of reactive oxygen species (ROS), apoptosis, and sperm motility are all critically dependent on mitochondria. The health of the male reproductive system may be significantly impacted by any alteration of mitochondrial structure, function, or integrity. This review intends to open the door to better diagnostic methods, novel therapy strategies, and improved reproductive outcomes for infertile couples by clarifying the crucial function of mitochondria. We searched PubMed, Google Scholar, and others for articles related to male infertility and mitochondrial dysfunction from 2014 to 2023. The articles related to the theme were preliminarily screened by abstract, and then the selected literature was read and summarized. In this essay, we examine the research on male infertility and mitochondrial malfunction. We investigate the intricate connection between sperm quality, deoxyribonucleic acid damage, oxidative stress (OS), and mitochondrial bioenergetics. We discuss about how spermatogenesis and sperm function are affected by mitochondrial mutations, deletions, and single nucleotide polymorphisms. We also explore the impact of age-related changes, lifestyle choices, and environmental factors on mitochondrial function and male fertility. This review also clarifies the mechanisms by which mitochondrial dysfunction impacts the viability, morphology, and capacitation of sperm, among other aspects of male reproductive health. Furthermore, we go over the recently developed field of mitochondrial treatments and possible therapeutic approaches that target mitochondrial malfunction to enhance male fertility. Mitochondria are important for sperm: The control of sperm motility, capacitation, and general quality is largely dependent on mitochondria. Deterioration of sperm motility and male infertility may result from disruption of the structure, function, or integrity of the mitochondria. Future studies should focus on figuring out the processes underlying mitochondrial dysfunction as fertility and reproductive health are significantly impacted by it. We discuss the evaluation of infertile men mitochondrial function defects and difficulties, and make recommendations for further study in this area. This article provides a thorough resource for clinicians, researchers, and reproductive biologists to understand the underlying mechanisms of male infertility and explore potential therapeutic interventions.

Impact on the nervous system of long COVID-19 infection in children.

The coronavirus disease 2019 (COVID-19) pandemic has had a profound global impact, raising concerns about its long-term effects, particularly neurological complications. While studies have highlighted such complications in adults, there is a paucity of research focusing on children. To examine the medium- to long-term neurological and cognitive symptoms in 18 year old children and below with positive versus negative COVID-19 antigens and to identify the probable risk factors to promote specific health actions. An observational study was carried out to determine neurological symptoms in the medium and long terms after COVID 19. A random sample of 124 children, both symptomatic or asymptomatic, tested positive or negative for COVID-19 through swab tests. Neurological symptoms were assessed between 6 to 12 months and 2 years after the infection. Acute symptoms, including headache, anosmia, ageusia, and myalgia, were observed in more than 20% of the children, but they generally resolved within 6 to 12 months. Persistent functional difficulties, such as in studying, paying attention, and socializing, were reported in 3% of the cases. Behavioral symptoms at baseline were noted in 7.8% of children, but they were remitted in most cases, except for those with prior involvement. These findings underscore the need for continued monitoring of children following COVID-19 infection and the importance of tailored health interventions.

Association between self-reported difficulty in chewing or swallowing and frailty in older adults: A retrospective cohort study.

Oral frailty can contribute to physical and mental health disorders. Previous research has shown an association between frailty and self-reported difficulty in chewing or swallowing. However, their combined assessment has obscured their specific impact on frailty-related outcomes. To investigate the independent associations between difficulty in chewing or swallowing and 1-year frailty outcomes, while also examining their interactions. This retrospective cohort study utilized the DeSC database to identify older adults aged ≥ 75years who underwent health checkups between April 2014 and November 2022. Multivariate Cox regression analyses were conducted to assess the association between self-reported difficulty in chewing or swallowing and outcomes, including hospitalization due to aspiration pneumonia, all-cause hospitalization, and all-cause mortality within 1year. Interactions between chewing and swallowing difficulties were also evaluated. Among 359,111 older adults, 39.0% reported oral function difficulties. Swallowing difficulty alone lacked significant outcome association. However, chewing difficulty alone was significantly associated with higher risks of hospitalization due to aspiration pneumonia (hazard ratio (HR), 1.35; 95% confidence interval (CI), 1.15-1.58; P < 0.001), all-cause hospitalization (HR, 1.08; 95% CI, 1.05-1.11; P < 0.001), and all-cause mortality (HR, 1.28; 95% CI, 1.14-1.44; P < 0.001) compared with no self-reported difficulty. A significant positive interaction between self-reported difficulty in chewing and swallowing was observed for all-cause mortality (P = 0.009). Self-reported difficulty in chewing was significantly associated with higher risks of hospitalization due to aspiration pneumonia, all-cause hospitalization, and all-cause mortality among older adults. Chewing and swallowing difficulties showed a synergistic effect, significantly increasing all-cause mortality risk.