Lower Impairment Research Articles

Subjective Health Impairment And Associated Factors In The Heatwave Of Summer 2022: An Online Survey

Heatwaves might diminish the sense of well-being and are associated with increased mortality. Individual measures to protect against heat are often insufficient, with the perception of one's own risk playing a crucial role. Due to varying levels of vulnerability, it is expected that the perception differs among populations. Presumably, symptom awareness is higher when people are concerned with and inform themselves about the topic of heat. Our study examined subjective health impairment during the heatwave in 2022, its association with socio-demographic and economic factors, as well as perceived heat stress and individual engagement with the issue. An online survey of a population-based sample from five federal states of Germany was carried out. Multivariable regression analyses were conducted to explore the relationship between subjective health impairment due to heat and potential risk indicators. Out of 3,111 people contacted, 1,522 responded, with 649 (20.9%) included in the analysis as they were affected by heat in their region of residence during the summer of 2022. The average subjective health impairment was 9.29 (SD: 5.25) out of 29 possible points. Higher age was associated with lower impairment; -1.36 points (95%-CI: -4.10; 1.38) in the group of those aged 80 and compared with the reference group of 60 to 69-year-old people. Furthermore, higher impairment was reported more by women and individuals with lower educational levels. Low impairment was associated with a high perceived level of information. Interventions aimed at reducing heat-related health problems should target a broader audience, particularly young people, women, individuals with lower education, and working people.

Genetic polymorphisms and post-stroke upper limb motor improvement - A systematic review and meta-analysis.

Post-stroke upper limb (UL) motor improvement is associated with adaptive neuroplasticity and motor learning. Both intervention-related (including provision of intensive, variable, and task-specific practice) and individual-specific factors (including the presence of genetic polymorphisms) influence improvement. In individuals with stroke, most commonly, polymorphisms are found in Brain Derived Neurotrophic Factor (BDNF), Apolipoprotein (APOE) and Catechol-O-Methyltransferase (COMT). These involve a replacement of cystine by arginine (APOEε4) or valines by 1 or 2 methionines (BDNF:val66met, met66met; COMT:val158met; met158met). However, the implications of these polymorphisms on post-stroke UL motor improvement specifically have not yet been elucidated. Examine the influence of genetic polymorphism on post-stroke UL motor improvement. Systematic Review and Meta-Analysis. We conducted a systematic search of the literature published in English language. The modified Downs and Black checklist helped assess study quality. We compared change in UL motor impairment and activity scores between individuals with and without the polymorphisms. Meta-analyses helped assess change in motor impairment (Fugl Meyer Assessment) scores based upon a minimum of 2 studies/time point. Effect sizes (ES) were quantified based upon the Rehabilitation Treatment Specification System as follows: small (0.08-0.18), medium (0.19 -0.40) and large (≥0.41). We retrieved 10 (4 good and 6 fair quality) studies. Compared to those with BDNF val66met and met66met polymorphism, meta-analyses revealed lower motor impairment (large ES) in those without the polymorphism at intervention completion (0.5, 95% CI: 0.11-0.88) and at retention (0.58, 95% CI:0.06-1.11). The presence of CoMT val158met or met158met polymorphism had similar results, with lower impairment (large ES ≥1.5) and higher activity scores (large ES ranging from 0.5-0.76) in those without the polymorphism. Presence of APOEε4 form did not influence UL motor improvement. Polymorphisms with the presence of 1 or 2 met alleles in BDNF and COMT negatively influence UL motor improvement. https://osf.io/wk9cf/.

Association of intrinsic capacity with functional decline and mortality in older adults: a systematic review and meta-analysis of longitudinal studies

Together with environmental factors, intrinsic capacity (the composite of all the physical and mental capacities of an individual) has been proposed as a marker of healthy ageing. However, whether intrinsic capacity predicts major clinical outcomes is unclear. We aimed to explore the association of intrinsic capacity with functional decline and mortality in older adults. In this systematic review and meta-analysis, we conducted a systematic search in MEDLINE (via PubMed), Scopus, and Web of Science from database inception to Feb 14, 2024, of observational longitudinal studies conducted in older adults (age ≥60 years) assessing the association of intrinsic capacity with impairment in basic activities of daily living (BADL) or instrumental activities of daily living (IADL) or risk of mortality. Estimates were extracted by two reviewers (JLS-S and W-HL) and were pooled using three-level meta-analytic models. The quality of each study was independently assessed by two authors (JLS-S and PLV) using the Newcastle-Ottawa Scale for longitudinal studies. Heterogeneity was evaluated using the I2 indicator at two levels: within-study (level 2) and between-study (level 3) variation. For associations between intrinsic capacity and IADL and BADL, we transformed data (standardised β coefficients and odds ratios [ORs]) into Pearson product moment correlation coefficients (r) using Pearson and Digby formulas to allow comparability across studies. For associations between intrinsic capacity and risk of mortality, hazard ratios (HRs) with 95% CIs were extracted from survival analyses. This study is registered with PROSPERO, CRD42023460482. We included 37 studies (206 693 participants; average age range 65·3-85·9 years) in the systematic review, of which 31 were included in the meta-analysis on the association between intrinsic capacity and outcomes; three studies (2935 participants) were included in the meta-analysis on the association between intrinsic capacity trajectories and longitudinal changes in BADL or IADL. Intrinsic capacity was inversely associated with longitudinal impairments in BADL (Pearson's r -0·12 [95% CI -0·19 to -0·04]) and IADL (-0·24 [-0·35 to -0·13]), as well as with mortality risk (hazard ratio 0·57 [95% CI 0·51 to 0·63]). An association was also found between intrinsic capacity trajectories and impairment in IADL (but not in BADL), with maintained or improved intrinsic capacity over time associated with a lower impairment in IADL (odds ratio 0·37 [95% CI 0·19 to 0·71]). There was no evidence of publication bias (Egger's test p>0·05) and there was low between-study heterogeneity (I2=18·4%), though within-study (I2=63·2%) heterogeneity was substantial. Intrinsic capacity is inversely associated with functional decline and mortality risk in older adults. These findings could support the use of intrinsic capacity as a marker of healthy ageing, although further research is needed to refine the structure and operationalisation of this construct across settings and populations. None. For the Spanish and French translations of the abstract see Supplementary Materials section.

Social Networks and Communication Impairment: Racial Differences Among Stroke Survivors

Purpose: Recent evidence highlights the importance of social networks—the composition of social relationships—and their characteristics in stroke recovery. This study explores the relationship between social networks and poststroke communication outcomes. Method: A cohort of 30 non-Hispanic Black ( n = 12) and non-Hispanic White ( n = 18) adult stroke survivors completed the Stroke Impact Scale (SIS) Communication subtest and the Stroke Social Network Scale (SSNS). The SSNS captures elements of social networks including satisfaction and contact with friends, relatives, children, and groups. The relationship between the SIS Communication subtest scores and SSNS scores was explored using ordinal Bayesian regression estimation models adjusting for sex, age, time postonset, marital status, and stroke type. Results: Average SIS Communication scores differed ( t = 2.07, p = .335) between White ( M = 81.75, SD = 22.90) and Black ( M = 95.71, SD = 4.95) participants, but SSNS Comprehensive scores were similar between the two groups ( t = −0.89, p = 1.00). SSNS children subtest scores were higher among the Black than the White ( t = −1.73, p = .0473) participants. Similarly, satisfaction subtest scores were comparatively higher among Black than White participants ( t = 1.85, p = .451). SSNS Satisfaction, Friends, and Groups subtest scores were positively associated with SIS Communication, indicating strong associations with lower impairment. SSNS Children subtest scores were negatively related to SIS, indicating higher impairment. Although most subtest associations were similar for both groups, the associations with SSNS Children and Friends subtests differed between racial groups. Conclusions: Levels of communication impairment were correlated with child, friendship, and group attachments among participants. However, strong social ties to children and friends had different associations among racial groups.

Residual effects of medications for sleep disorders on driving performance: A systematic review and network meta-analysis of randomized controlled trials: NMA driving and hypnotics

Sleep medications often carry residual effects potentially affecting driving safety, warranting network meta-analysis (NMA). PubMed/EMBASE/TRID/Clinicaltrials.gov/WHO-ICTRP/WebOfScience were inquired for randomized controlled trials of hypnotic driving studies in persons with insomnia and healthy subjects up to 05/28/2023, considering the vehicle's standard deviation of lateral position - SDLP (Standardized Mean Difference/SMD) and driving impairment rates on the first morning (co-primary outcomes) and endpoint. Risk-of-bias, global/local inconsistencies were measured, and CINeMA was used to assess the confidence in the evidence. Of 4,805 identified records, 26 cross-over RCTs were included in the systematic review, of which 22 entered the NMA, focusing on healthy subjects only. After a single administration, most molecules paralleled the placebo, outperforming zopiclone regarding SDLP. In contrast, ramelteon 8 mg, daridorexant 100 mg, zolpidem 10 mg bedtime, zolpidem middle-of-the-night 10 mg and 20 mg, mirtazapine 15–30 mg, and triazolam 0.5 mg performed significantly worse than placebo. Lemborexant 2.5–5 mg, suvorexant 15–20 mg, and zolpidem 3.5 mg middle-of-the-night associated with lower impairment than zopiclone. Repeated administration (maximum follow-up time of ten days) caused fewer residual effects than acute ones, except for flurazepam. Heterogeneity and inconsistency were negligible. Confidence in the evidence was low/very low. Sensitivity analyses confirmed the main analyses. Most FDA-approved hypnotics overlapped placebo at in-label doses, outperforming zopiclone. Repeated administration for 15 days or less reduced residual effects, warranting further research on the matter.

Abstract TMP33: Do Social Networks Matter in Post-Stroke Communication Recovery?

Purpose: Current evidence highlights the value of social networks in stroke recovery. Social networks can be small or broad and are commonly associated with positive psychological, emotional, and physical stroke recovery outcomes. However, less is known about the relationship between social networks and post-stroke impairments such as communication disorders. This pilot study was designed to elucidate the relationship between types of social connections and post-stroke communication outcomes. Hypothesis: Social networks are positively associated with improvement in post-stroke communication outcomes, but the importance of social network subtypes differs among sociodemographic cohorts. Methods: Data was collected from 30 adults stroke survivors who completed the Stroke Impact Scale (SIS) Communication subtest and the Stroke Social Network Scale (SSNS). Regression analysis evaluated the relationship between the SIS Communication subtest score and SSNS network subtypes. Outcomes were evaluated across racial-ethnic groups to explore differential impacts. Results: The average SIS Communication scores differed significantly between Whites (81.75, SD=22.90) and Blacks (95.71, SD=4.95) (t=2.07, p=0.05) while SSNS Comprehensive scores were generally similar between the two groups (t=1.73, p=0.09). Both social ties (t=-1.73, p=.09) and satisfaction was higher among Black than White stroke survivors (t=1.85, p=0.08). SSNS Friend (β Friends =0.414, SE=0.414) and Group (β Groups =0.479; SE=0.266) subtest scores were positively associated with SIS Communication Impairment among both Black and White stroke survivors suggesting strong associations with lower impairment. However, the association between communication impairment and SSNS Children subtest scores differed between racial groups as noted by significant interaction effect (β SSNS Childre n*Black=0.821, SE=0.294). Conclusions: Lower levels of communication impairment were correlated with friendship and group attachments among Blacks and Whites. Social ties to children were observed among White stroke survivors with high levels of communication impairment, compared to Black stroke survivors who reported strong social ties to children at all impairment levels.

Using "functional hand" protocol to improve hand function following a spinal cord injury: an explorative study.

A cervical spinal cord injury often affects hand control, causing ineffective grasping and handling functions, with a negative impact on patient's independence and quality of life. Literature recognises scientific evidence only for surgical or instrumental re-education approaches. The purpose of this study is to present the "functional hand" protocol, a physiotherapy tool that, to date, represents a good clinical practice but has no supporting literature. a longitudinal-single cohort study was conducted at Spinal Unit- Azienda Usl Piacenza. Patients with spinal cord injury at C5-C7 neurologic level, older than 18 years, with correct comprehension of Italian language were recruited. All patients were evaluated with Action Research Arm Test (ARAT) scale to state hand functionality; positive/negative history of Functional Hand protocol was deducted by physiotherapy discharge letters on first spinal unit hospitalisation. six patients were involved in the study; three of them had a positive history of protocol application. ARAT scores differences showed that patients who underwent functional hand protocol had a lower impairment, a better ability to produce cylindrical and cuboid sockets. Functional hand protocol reached a preliminary evidence as effective tool to improve hand recovery in tetraplegic patients; future studies should confirm these conclusions on larger samples, and verify protocol effectiveness in addition to other treatment strategies (functional electric stimulation/ transcranial direct current stimulation/robotic assisted therapy).

Electrophysiological evidence of mal-adaptation to error in remitted depression

Identifying risk markers for major depressive disorder (MDD) that persist into remission is key to address MDD’s high rate of recurrence. Central to MDD recurrence are the disorder’s negative information processing biases, such as heightened responses to errors, which may subsequently impair abilities to monitor performance and adjust behaviors based on environmental demands. However, little is known regarding the neurophysiological correlates of post-error adaptation in depression. The current study investigated event-related potentials (ERPs) and behavioral performance following errors from a flanker task in 58 participants with remitted MDD (rMDD) and 118 healthy controls (HC). Specifically, using trial-level data, we tested: (a) the impact of errors on response-locked ERPs of the current and post-error trials (error-related negativity [ERN] and correct response negativity [CRN]) and (b) longer-term adaptation to errors (ERN/CRN) over the course of the task. Compared to HC, rMDD participants showed a larger ERN to the current trial and smaller habituation in ERN over time. On trials immediately following errors, rMDD participants showed slower reaction times that were predicted by the previous-trial ERN amplitude but comparable accuracy to HC, suggesting a deficient ability to disengage from errors and/or a compensatory effort to mitigate accuracy decrements. Critically, this pattern of responding: (a) was concurrently associated with greater levels of anhedonia symptoms, more severe MDD history, and interpersonal impairment (but lower impairment in life activities) and (b) predicted more anhedonia symptoms at one-year follow-up. Collectively, a hyperactive performance monitoring system may be a useful risk marker for future MDD recurrence.

Effect of Granulocyte Colony-Stimulating Factor (G-CSF) on Improving Impairment Scale After Acute Spinal Cord Injury: An Individual Participant Data Meta-Analysis

Background and Aim: The present study was conducted to investigate the effects of granulocyte colony-stimulating factor (G-CSF) after acute spinal cord injury on increasing a grade of improvement entitled American spinal cord injury association impairment scale (AIS) as an individual participant data (IPD) meta-regression analysis of clinical trials. Methods and Materials/Patients: According to our search strategy, four studies were selected. Multilevel ordered logistic regression modeling was used to predict AIS grade with G-CSF administration and time variable (first day and a 3-month follow-up). The IDs of the studies as well as the time series variable were imported to the random part of the model. Odds ratio (OR) and 95% confidence interval (CI) were reported. Results: A total of 277 samples were studied. A fixed effect model was performed at first. Accordingly, using G-CSF was associated with increased AIS grade (lower impairment) (OR=1.503, 95% CI=1.110-2.035) adjusted with time series (OR=1.868, 95% CI=1.378-2.532). In the mixed effect model, G-CSF was again associated with increased AIS grade (OR=1.780, 95% CI=1.301- 2.436) adjusted with time series (OR=2.152, 95% CI=1.406-3.294). Conclusion: The present meta-analysis showed the protective effect of GCS-F observed as an improvement in AIS grade. This protecting effect was further after adjusting the random effects of time series and individual studies. Although multilevel modeling could reduce our limitations, it should be regarded that the number of trials was not enough to establish strong conclusions.

Quality of life, functional impairment and continuous performance task event-related potentials (ERPs) in young adults with ADHD and autism: A twin study.

Young adulthood is a key developmental period for understanding outcomes of childhood onset attention-deficit/hyperactivity disorder (ADHD) and autism. Measurement of functional impairment and quality of life (QoL) can provide important information on the real-life challenges associated with these conditions. Event-related potential (ERP) measures from the continuous performance task (CPT) have long been identified as altered in ADHD and autism but the role of these functions in the aetiological pathway to the disorders and associated impact on quality of life in young adulthood is unknown. We investigated the relationships between ADHD and autism, functional impairment, quality of life, and ERP measures from the cued CPT (CPT-OX) in a young adult twin sample (566 participants aged 22.43±0.96years old). We observed significant phenotypic correlations between ADHD/autism and lower quality of life with specific genetic overlap between ADHD and physical health, psychological, and environmental aspects. We found significant phenotypic and genetic correlations between ADHD and functional impairment in all domains, as well as between autism and impairment in social functioning and lower impairment in risk-taking. Both ADHD and autism were associated with attenuated amplitude of inhibitory and proactive control ERPs, with large genetic contributions to the overlap. We also found significant phenotypic correlations between these ERP measures and Weiss Functional Impairment Rating Scale (WFIRS) and QoL. This is the first study to investigate the phenotypic and genetic relationships between ADHD and autism, functional impairment, quality of life and ERP measures in young adulthood. Our findings could represent a step towards identifying ERP measures that are related to behaviour in the absence of overt symptoms.

Accidental hypothermia: direct evidence for consciousness as a marker of cardiac arrest risk in the acute assessment of cold patients

BackgroundRapid stratification of the risk of cardiac arrest is essential in the assessment of patients with isolated accidental hypothermia. Traditional methods based on measurement of core temperature are unreliable in the field. Behavioural observations have been used as predictors of core temperature and thus indirect predictors of cardiac arrest. This study aims to quantify the direct relationship between observed conscious level and cardiac arrest.MethodsRetrospective case report analysis identified 114 cases of isolated accidental hypothermia meeting inclusion criteria. Level of consciousness in the acute assessment and management phase was classified using the AVPU system with an additional category of “Alert with confusion”; statistical analysis then related level of consciousness to incidence of cardiac arrest.ResultsAll patients who subsequently suffered cardiac arrest showed some impairment of consciousness (p < < .0001), and the risk of arrest increased directly with the level of impairment; none of the 33 fully alert patients arrested. In the lowest impairment category, Alert confused, a quarter of the 12 patients went on to arrest, while in the highest Unresponsive category, two thirds of the 43 patients arrested. Where core temperature was available (62 cases), prediction of arrest by consciousness level was at least as good as prediction from core temperature.ConclusionsThis study provides retrospective analytical evidence that consciousness level is a valid predictor of cardiac arrest risk in isolated accidental hypothermia; the importance of including confusion as a criterion is a new finding. This study suggests the use of consciousness alone may be at least as good as core temperature in cardiac arrest risk prediction. These results are likely to be of particular relevance to the management of accidental hypothermia in the pre-hospital and mass casualty environment, allowing for rapid and accurate triage of hypothermic patients.

MP15-14 RETZIUS-SPARING (rsRARP) vs. CONVENTIONAL ROBOTIC ASSISTED RADICAL PROSTATECTOMY (cRARP)—A PROSPECTIVE, RANDOMISED, SINGLE BLINDED TRIAL—RESULTS OF EARLY CONTINENCE

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-14 RETZIUS-SPARING (rsRARP) vs. CONVENTIONAL ROBOTIC ASSISTED RADICAL PROSTATECTOMY (cRARP)—A PROSPECTIVE, RANDOMISED, SINGLE BLINDED TRIAL—RESULTS OF EARLY CONTINENCE Joanne Nyarangi-Dix, Viktoria Schuetz, Maximilian Guettlein, David Wuerkner, Luisa Hofer, Magdalena Goertz, Philipp Reimold, Katrin Kaltenecker, Svenja Dieffenbacher, Georgi Tosev, and Markus Hohenfellner Joanne Nyarangi-DixJoanne Nyarangi-Dix More articles by this author , Viktoria SchuetzViktoria Schuetz More articles by this author , Maximilian GuettleinMaximilian Guettlein More articles by this author , David WuerknerDavid Wuerkner More articles by this author , Luisa HoferLuisa Hofer More articles by this author , Magdalena GoertzMagdalena Goertz More articles by this author , Philipp ReimoldPhilipp Reimold More articles by this author , Katrin KalteneckerKatrin Kaltenecker More articles by this author , Svenja DieffenbacherSvenja Dieffenbacher More articles by this author , Georgi TosevGeorgi Tosev More articles by this author , and Markus HohenfellnerMarkus Hohenfellner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since the introduction of rsRARP in 2010 three prospective RCTs comparing rsRARP and cRARP have been published. To further evaluate the results published until now we conducted a prospective, randomised, single blinded trial. METHODS: A total of 202 men (age 64.2±6.9 yrs.) with localised prostate cancer (PCa) were included and randomised 1:1. Pre-operative as well as one, four and twelve weeks after foley catheter removal functional parameters (continence, sexual function) were registered via validated questionnaires (ICIQ-UI SF, IPSS, IIEF-5, QoL). RESULTS: Three months postoperative complete data sets were available for 186 patients (cRARP n=92, rsRARP n=94). Pre-operative characteristics were well balanced between the two groups. Hospital stay (4.1±0.9 vs. 5.4±5.8 d; p=0.037) and console time for prostate dissection (36.8±8.8 vs. 46.8±12.8Min; p=0.017) were significantly shorter in the rsRARP-Group. Also did patients after rsRARP have a faster recovery of continence (after 1 week p=0.003, 3 months p=0.022), lower number of incontinence pads used per day (p=0.001, 0.011, 0.019 after 1, 4 and 12 weeks respectively) and a lower impairment in quality of life caused by involuntary loss of urine (p=0.001, 0.002, 0.005, 1, 4 and 12 weeks respectively). Oncological follow-up data is not yet available for this cohort. From our experience the rate of BCR after rsRARP is 5.9% (4.1% for R1-resection). CONCLUSIONS: Despite being technically more challenging rsRARP results in a significantly faster recovery of continence and lower number of incontinence pads used. Also, quality of life after a period of three months is significantly higher. Furthermore, rsRARP is associated with a good oncological outcome and a low BCR-rate. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e269-e269 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joanne Nyarangi-Dix More articles by this author Viktoria Schuetz More articles by this author Maximilian Guettlein More articles by this author David Wuerkner More articles by this author Luisa Hofer More articles by this author Magdalena Goertz More articles by this author Philipp Reimold More articles by this author Katrin Kaltenecker More articles by this author Svenja Dieffenbacher More articles by this author Georgi Tosev More articles by this author Markus Hohenfellner More articles by this author Expand All Advertisement Loading ...

Longitudinal trajectory and predictors of change in family accommodation during exposure therapy for pediatric OCD

Family accommodation (FA) is key in the maintenance of OCD. However, most studies are cross-sectional, and have not identified long-term trajectories and correlates of FA changes over treatment. This study investigated changes in clinician-rated FA over 10 sessions of cognitive behavioral therapy (CBT) for 142 children with OCD, as well as several key predictors/correlates: (a) clinician-rated OCD symptom severity, (b) child- and parent-rated functional impairment, (c) parent-rated treatment expectancies, and (d) child- and parent-rated therapeutic alliance. Multi-level models indicated that FA changed significantly during treatment, with gains maintained over 6-months. Baseline clinician-rated OCD severity did not predict changes in FA. Significant interactions indicated that children with higher child- and parent-rated impairment exhibited greater FA improvements over treatment (versus children with lower impairment). Child- and parent-rated therapeutic alliance and parent-rated expectancies did not predict FA changes. Finally, FA mediated the relationship between OCD severity and parent- (but not child-) rated impairment. Reverse mediation models were also significant. Findings indicate that CBT can successfully reduce FA (a) even if children experience high OCD severity and interference in school, relationships, and family life, and (b) regardless of non-specific factors like treatment expectancies and alliance. FA reductions are an important mechanism mediating treatment response.

Promoting Classroom Social and Academic Functioning among Children at Risk for ADHD: The MOSAIC Program

ABSTRACT Objective: Social and academic functioning are linked in elementary school, and both are frequently impaired in children with elevated symptoms of attention-deficit/hyperactivity disorder (ADHD). This study evaluated the Making Socially Accepting Inclusive Classrooms (MOSAIC) program, a classroom intervention to support children’s social and academic functioning, especially for children at risk for ADHD. Teachers delivered MOSAIC practices to the whole class and applied some strategies more frequently to target children selected for elevated ADHD symptoms and peer impairment. Method: Participants were 34 general education teachers (grades K-5) and 558 children in their classrooms, randomized to MOSAIC or to a typical practice control group for one academic year. In the fall and spring, we assessed (a) peers’ sociometric judgments of children, (b) children’s self-report of supportive relationships with teachers and peers, and (c) teachers’ report of children’s social and academic competencies and impairments. Results: Regarding whole class effects, relative to control group children, children in MOSAIC classrooms (target and non-target children) were rated by teachers in spring as having better competencies and lower impairment, after controlling for fall functioning. There were no main effects of MOSAIC on peer sociometrics or child perceptions of supportive relationships. Target status moderated some effects such that, in spring, target children in MOSAIC perceived greater support from their teachers but received poorer sociometrics than did target children in control classrooms. Conclusions: We discuss the difficulty in changing peers’ perceptions of children with ADHD symptoms, even in the presence of improvements in other aspects of social and academic functioning.

Effects of metabolic syndrome on cognitive outcomes in long-term survivors of childhood cancer.

12013 Background: Childhood cancer therapy increases risk for cognitive impairment and other chronic conditions, which also may impact cognition. We assessed the unique impact of metabolic syndrome (MetS) on cognition in survivors participating in the St. Jude Lifetime Cohort Study. Methods: Participants included 4058 survivors of childhood cancer (53.9% female; mean [SD] age 30.1 [10.5] years at evaluation; 22.6 [10.1] years from diagnosis) who completed clinical evaluation and cognitive testing. MetS criteria followed Adult Treatment Panel III guidelines (at least 3 of: hypertension, high triglycerides, abdominal obesity, low high-density lipoprotein [HDL], high fasting glucose). Multivariable log-binomial regression models assessed risk of cognitive impairment associated with MetS stratified by survivors who did (n = 2301) or did not (n = 1757) receive central nervous system (CNS)-directed therapy. Mediation analysis assessed effects of MetS and physical activity in cranial radiotherapy (CRT)-associated cognitive impairment. Models were adjusted for age, sex, follow-up time and treatment exposures. Results: MetS was associated with increased risk of impaired attention (relative risk [RR] 1.34 95% confidence interval [CI] 1.07-1.66), processing speed (RR 1.25 CI 1.11-1.41) and executive function (RR 1.18 CI 1.01-1.37) in survivors with CNS-directed therapy and academic achievement (RR 1.84 CI 1.18-2.89), attention (RR 1.43 CI 1.10-1.87), and processing speed (RR 1.46 CI 1.21-1.75) in those without CNS-directed therapy. MetS components associated with cognitive impairment included abdominal obesity (memory RR 1.34 CI 1.13-1.59; processing speed RR 1.41 CI 1.24-1.59; executive function RR 1.21 CI 1.05-1.39) and low HDL (intelligence RR 1.26 CI 1.06-1.49; attention RR 1.27 CI 1.03-1.57; processing speed RR 1.17 CI 1.01-1.35; executive function RR 1.20 CI 1.05-1.37) in survivors with CNS-directed therapy. In survivors treated without CNS-directed therapy hypertension (academic achievement RR 1.49 CI 1.18-1.88; intelligence RR 1.34 CI 1.02-1.76; attention RR 1.42 CI 1.12-1.79; memory RR 1.45 CI 1.14-1.84; processing speed RR 1.30 CI 1.08-1.55; executive function RR 1.32 CI 1.08-1.62) and abdominal obesity (academic achievement RR 1.71 CI 1.07-2.72; processing speed RR 1.23 CI 1.02-1.49; executive function RR 1.38 CI 1.09-1.75) were associated with impairment. In mediation analyses, direct effects of CRT were identified, as were indirect effects through physical activity (processing speed β = 0.035 p &lt; 0.01; attention β = 0.03 p &lt; 0.01; executive function β = 0.172 p &lt; 0.01). Conclusions: MetS increases risk of cognitive impairment in survivors, particularly abdominal obesity, hypertension and low HDL. Physical activity appears to partially mediate impact of CRT on cognitive outcomes and is an important target for interventions to lower impairment risk.

Types of leisure time physical activities (LTPA) of community-dwelling persons who have been screened positive for dementia

BackgroundTo (a) describe the pattern of leisure time physical activities (LTPA) in community-dwelling persons who have been screened positive for dementia and (b) determine the health-related and sociodemographic factors associated with LTPA.MethodsData of the general practitioner-based, randomized, controlled intervention trial, DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) were used. Patients aged 70 years or older, who lived at home and had a DemTect< 9 were informed about the study by their General practitioners and invited to participate. Data from 436 participants with complete baseline data were used. Standardized, computer-assisted assessments were made during face-to-face interviews at the participants’ homes.ResultsTwo hundred thirty-eight patients (54.6%) carried out LTPA (men 58.4%, women 51.8%). Physically active patients mentioned one to two different activities; diversity of LTPA was higher for men than for women. The most-frequently mentioned types of activity were gardening (35.3%), cycling (24.1%) and mobility training (12.4%); there was only a statistically significant difference between men and women in cycling, χ2(1) = 21.47, p < .001. The odds of LTPA increased with increasing quality of life (OR = 2.41), lower impairments in activities of daily living (OR = 0.85), and living in a rural environment (OR = 2.02).ConclusionsOur findings suggest that people who have been screened positive for dementia living in a rural area are more likely to be active than people living in an urban area. Following studies should investigate whether this difference has an effect on the progression of dementia.Trial registrationClinicalTrial.gov Identifier NCT01401582.

Potential source of ecofriendly insecticides: Essential oil induces avoidance and cause lower impairment on the activity of a stingless bee than organosynthetic insecticides, in laboratory

The negative effect of insecticides on bees has been reported as one of the factors associated with the decline in population of these pollinators. Thus, the aim of this study was to evaluate the response of the stingless bee Nannotrigona aff. testaceicornis (Lepeletier, 1836) to a promising source of new insecticide molecules obtained from Lippia sidoides (rosemary pepper) essential oil (EO) and its major compounds (thymol, ρ-cymene, and (E)-caryophyllene), comparing them to commercial insecticides (organosynthetic: imidacloprid, deltamethrin and semisynthetic: spinetoram). For this, stingless bees were exposed by contact with these compounds to evaluate the lethal and sublethal (locomotion and flight orientation) toxicity. The L. sidoides EO and its major compounds have low lethal toxicity to forager worker bees (N. aff. testaceicornis). The organosynthetics imidacloprid (LD50 =0.00146 µgbee−1) and deltamethrin (LD50 =0.0096 µg bee−1) were about 209,589 and 31,875 times more toxic, respectively, than the least toxic natural compound, (E)-caryophyllene (LD50 =306 µgbee−1). Locomotion ability and flight orientation were little affected by spinetoram and by L. sidoides EO and its major compounds, however, were greatly reduced by the imidacloprid and deltamethrin insecticides. Besides shows low lethal and sublethal toxicity, the bioinsecticides were also avoided by the forager bees. Individuals treated with the L. sidoides EO and thymol were avoided by the untreated bees. Therefore, the natural products studied here were promising due to their recognized effectiveness against pest insects and greater safety to bees N. aff. testaceicornis.

Interest and credit risk management in German banks

Abstract Using unique data of a survey among small and medium-sized German banks, we analyze various aspects of risk management. We especially analyze the effect of a 200-bp increase in the interest level. We find that banks seem to reduce the volatility of their net interest margin by exposing themselves to interest rate risk, that they act as if they have a risk budget which they allocate either to interest rate risk or credit risk and that banks’ exposures to interest rate risk and to credit risk are remunerated. In addition, we find that, in the first year, the impairments of banks’ bond portfolios are much larger than the reductions in their net interest income, that banks attenuate the resulting write-downs by liquidating hidden reserves and that banks which use interest derivatives have lower impairments in their bond portfolios.

The physician's gender influences the results of the diagnostic workup for erectile dysfunction.

Despite the well-known influence of psychological and situational factors on erectile dysfunction, the influence of the physician's gender on the andrological workup has never been investigated so far. To investigate physician's gender influence on the erectile dysfunction diagnostic workup. Cross-sectional study with retrospective data collection. We evaluate a consecutive series of erectile dysfunction patients: 95 at the University of Modena and Reggio Emilia (UNIMORE) and 1808 at the University of Florence (UNIFI). In the UNIMORE cohort (Cohort 1), intracavernousal injection test was performed in case of suspected vascular pathogenic component. In the UNIFI cohort (Cohort 2), patients were evaluated by structured interview on erectile dysfunction and ANDROTEST. Both cohorts were divided into two groups according to the gender of the physician who performed the intracavernousal injection test or the structured interview. In Cohort 1, patients who had the intracavernousal injection test performed by a female physician had a significantly higher probability of obtaining a better intracavernousal injection test response. In Cohort 2, patients interviewed by female physician more frequently reported to have a conflictual couple relationship and a reduced frequency of climax in their partners. However, they reported less difficulties in achieving and maintaining erection, higher frequency of autoeroticism, lower occurrence of erectile dysfunction during masturbation and lower impairment in morning erections. Physician's gender affects the results obtained during the erectile dysfunction diagnostic workup. Men interviewed by a female physician describe a less severe erectile dysfunction probably as attempt to defend their own virility. On the other hand, the presence of a male physician during intracavernousal injection test is associated to a worse response suggesting a possible unconscious competition.

Interest and Credit Risk Management in German Banks: Evidence From a Quantitative Survey

Using unique data of a survey among small and medium-sized German banks, we analyze various aspects of risk management over a short-term and medium-term horizon. We especially analyze the effect of a 200-bp increase in the interest level. We find that, in the first year, the impairments of banks' bond portfolios are much larger than the reductions in their net interest income, that banks attenuate the resulting write-downs by liquidating hidden reserves and that banks which use interest derivatives have lower impairments in their bond portfolios. In addition, we find that banks' exposures to interest rate risk and to credit risk are remunerated, that banks' try to stabilize the mid-term net interest margin with exposure to interest rate risk and that they act as if they have a risk budget which they allocate either to interest rate risk or credit risk.