Adult Life Outcomes Research Articles

Obstáculos para o diagnóstico e tratamento do transtorno do espectro autista

Objective: To understand the obstacles that reduce accessibility to the diagnosis and treatment of autism spectrum disorder (ASD). Literature review: ASD is a disorder characterized by difficulties in social interaction, impairments in communication and restricted patterns of behavior. Its diagnosis is clinical, based on behavioral observations and the patient's history and on criteria defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM – 5). Treatment includes pharmacological and behavioral approaches. However, the difficulties and challenges found in the literature include the symptomatological heterogeneity of ASD, the need for training health professionals and a more accurate assessment through a multidisciplinary team. Late diagnosis or its absence can lead to unfavorable outcomes in adult life, such as: anxiety, depression, and difficulty in interpersonal relationships. Recent studies include the use of specific biomarkers and innovative therapies that are not yet accessible. Final considerations: Early diagnosis and appropriate treatment are ideal for improving the quality of life of individuals with ASD. The importance of the doctor and new studies to improve therapeutic choice in ASD is also highlighted.

Palliative rehabilitation and quality of life: systematic review and meta-analysis

ImportanceInternational guidelines recommend the integration of multidisciplinary rehabilitation into palliative care services but its impact on quality of life across disease types is not well understood.ObjectiveTo determine the effect of...

Maternal use of electronic cigarettes and impact on offspring: a double-hit model.

Endothelial dysfunction is a predictor for cardiovascular disease. Preclinical data suggest longstanding cardiovascular and cerebrovascular dysfunction occurs in offspring with perinatal electronic cigarette (Ecig) exposure. Furthermore, direct use of Ecigs increases reactive oxygen species and impairs cerebrovascular function, but the combined effect of direct use in offspring with a history of perinatal exposure (i.e. double-hit condition) is not known. We tested the hypothesis that offspring with double-hit Ecig exposure will lead to greater cerebrovascular and neurocognitive dysfunction compared with in utero exposure only. Male and female offspring were obtained from time-mated Sprague Dawley female rats exposed to air (n = 5 dams) or Ecig exposed (n = 5 dams) and studied at either 3 or 6 mo after birth. Ecig exposure for double-hit offspring began at 1-mo before the timepoints and lasted 4 wk (5 days/wk with 90-min exposure/day). We found double-hit offspring (Ecig:Ecig = exposure dam:offspring) sustained further blunted middle cerebral artery (MCA) reactivity, increased severity of neuronal damage, and increased interactions of astrocytes and endothelial cells compared with offspring with maternal (Ecig:Air) or direct (Air:Ecig) exposure only. Circulating extracellular vesicles (EVs) were increased, whereas sirtuin 1 (SIRT1) was decreased, in all Ecig-exposed groups compared with controls (Air:Air), with Ecig:Ecig group showing the greatest respective change for each. Electron paramagnetic resonance (EPR) spectroscopy revealed oxidative stress was the highest in the plasma of Ecig:Ecig group (P < 0.05) than the other groups. These data show that a double-hit exposure in adolescent or adult offspring results in a greater decline in cerebrovascular function, biomarkers of neuronal dysfunction, and increased circulation of EVs compared with a single-hit exposure.NEW & NOTEWORTHY These data add to the growing body of literature demonstrating that electronic cigarette (Ecig) use during pregnancy (even without nicotine) is not safe, and primes offspring to have worse cardiovascular health outcomes in early and adult life. A key finding from this work is that a second insult from direct vaping in offspring with prior in utero exposure induces greater vascular dysfunction, increased oxidative stress, and shows evidence of neuronal dysfunction compared with either direct- or maternal-only exposure.

Life outcomes in adults living with FASD in a rural South African community: A follow-up study.

Even though adults with foetal alcohol spectrum disorder (FASD) are at risk of negative life outcomes, there is no published evidence of this in South Africa, which has the highest estimated FASD prevalence rate globally. The purpose of the study was to describe and compare the life outcomes of adults with FASD and adults without FASD in a South African rural community, 16 years after diagnosis. Participants were examined and interviewed regarding their biographical information, knowledge of FASD, information on their family, relationships, home circumstances, education, work and medical history. Adults with FASD were less likely to be in a relationship and more likely to have poor educational outcomes and to be exposed to violence as victim or perpetrator than their peers who did not have FASD. None of the participants with FASD completed secondary school successfully. No differences were found for independent living, employment, health, substance use and legal outcomes, between the foetal alcohol syndrome (FAS) or partial foetal alcohol syndrome (PFAS) and control group. While significant differences existed in certain aspects, differences are not as stark as one would expect between individuals with FASD and controls. This study highlights the importance of considering the social context in which a FASD diagnosis is made. The comparative negative impact of an FASD diagnosis and the associated challenges on life outcomes may be less pronounced in rural communities where everyone has fewer opportunities and resources. This can also make the unique needs of persons with disabilities less visible.

Supporting children and young people affected by domestic abuse in Wales: a multiagency perspective on existing responses in the school system

ABSTRACT Children and young people (CYP) who experience domestic abuse are at greater risk of negative outcomes in adult life. In Wales, an emphasis is placed on a multiagency response to domestic abuse, and there is growing interest in the role of schools in prevention and intervention. A mixed-methods design was adopted to explore the views of professionals on the current response to domestic abuse. Questionnaires were completed by 36 schools in Wales, and a series of focus groups was held with CYP workers from specialist domestic abuse settings and from school and social work staff. Data were analysed using descriptive statistics and reflexive thematic analysis. Four overarching themes were developed. Findings illustrate that, whilst there are a variety of interventions and support available for CYP who have experienced domestic abuse, an effective response is impacted by the systems in place to respond to it. It is argued that current practice needs to be more radical if meaningful change is to take place for CYP and their families. Implications for practice are discussed, including the role of the educational psychologist (EP).

Long-term outcomes and adaptive behavior in adult patients with Lennox-Gastaut syndrome.

Lennox-Gastaut syndrome (LGS) is a severe form of epilepsy characterized by difficult-to-control seizures and cognitive dysfunction. Previous studies mainly focused on pediatric populations, and little is known about the long-term cognitive outcome in adult patients with LGS. The objective of this study was to investigate the long-term functional and adaptive behavior in adult patients with LGS. This cross-sectional study enrolled adult patients diagnosed with LGS according to the recently published International League Against Epilepsy (ILAE) diagnostic criteria. The adaptive behavior of participants was assessed using the Vineland Adaptive Behavior Scales, Survey Interview, Second Edition (VABS-II). Demographic, clinical, electroencephalography (EEG), and antiseizure medication (ASM) data were also collected at different timepoints, to investigate their association with VABS-II scores. The study included 38 adult patients with LGS. A low score on the Adaptive Behavior Composite Scale was found in all patients. When considering single VABS-II domains, particularly low scores were found in daily living skills and socialization, whereas slightly higher performances were observed in communication. An earlier age at LGS diagnosis was identified as the most significant predictor of worse adaptive outcomes in adult life. At the time of study evaluation, high seizure frequency, higher EEG background slowing, and multifocal EEG epileptiform abnormalities were significantly associated with lower VABS-II raw scores. Furthermore, in an exploratory correlation analysis with ASM regimen at the study visit, treatment with cannabidiol was associated with higher adaptive behavior scores, whereas benzodiazepine intake correlated with lower scores. This study provides relevant insights into the long-term challenges faced by adults with Lennox-Gastaut syndrome (LGS), highlighting significant impairments in adaptive behavior as well as the associated clinical and electroencephalography features. Additionally, this study provides a more specific neuropsychological profile in adults with LGS and underscores the importance of comprehensive care approaches that go beyond seizure control in this population. This study examined adults with Lennox-Gastaut syndrome (LGS), a severe type of epilepsy, to understand their long-term abilities to perform daily tasks and adapt socially. We found that these adults have significant difficulties with daily living and social skills, although not all areas were equally affected. They performed somewhat better in communication, particularly in understanding others (receptive communication). Importantly, the younger the age at which LGS was diagnosed, the worse their outcomes were as adults. This study highlights the need for research and treatment approaches that focus not only on controlling seizures but also on improving daily life skills.

Effectiveness of an interdisciplinary home care approach for older adults with chronic conditions: A systematic review and meta-analysis.

The effectiveness of interdisciplinary home healthcare service consisting of at least two or more healthcare providers, such as a nurse, physician and physiotherapist, for community-dwelling older adults remains unclear. This systematic review assesses the effects of interdisciplinary home care on quality of life (QOL) and health outcomes in older adults with chronic conditions using validated tools. Databases were searched using CINAHL Plus with Full Text, PubMed, EMBASE, CENTRAL, PsycINFO, and OpenGrey from inception to January 25, 2021. Eligibility criteria included (i) an interdisciplinary home care approach, (ii) participants aged 65 years and older with chronic conditions, (iii) randomized controlled trials (RCTs), and (iv) original literature in English. The study reviewer's dyad independently screened the literature and assessed the study quality using the Cochrane's Risk of Bias 2 tool. The analysis employed qualitative and quantitative integration and Grading of Recommendations Assessment, Development, and Evaluation. This study included 13 RCTs with 4709 participants. Four RCTs indicated that interdisciplinary home healthcare services reduced hospital admissions during the initial 6 months after the start of home care interventions (risk ratio [RR] = 0.73; 95% confidence interval [CI] = 0.61-0.88; p < 0.001; I2 = 0%). However, evidence certainty was moderate; QOL and mortality showed low certainty; and institutionalization and adherence showed moderate certainty of evidence. This study suggests that the interdisciplinary home care approach reduces hospital admissions but lacks effects on other outcomes. More robust studies are required to evaluate this evidence. Geriatr Gerontol Int 2024; ••: ••-••.

Exposure to metal mixtures and telomere length in Bangladeshi children.

Telomere length is associated with chronic diseases and in younger populations, may represent a biomarker of disease susceptibility. As growing evidence suggests that environmental factors, including metals, may impact telomere length, we investigated the association between 17 metals measured in toenail samples and leukocyte relative telomere length (RTL), among 472 five- to seven-year-old children enrolled in the Bangladesh Environmental Research in Children's Health (BiRCH) cohort. In single exposure linear regression models, a doubling of arsenic (As) and mercury (Hg) (μg/g) were associated with a -0.21 (95%CI: -0.032, -0.010; p=0.0005) and -0.017 (95%CI: -0.029, -0.004; p=0.006) difference in RTL, respectively. In Bayesian Kernel Machine Regression (BKMR) mixture models, the overall metal mixture was inversely associated with RTL (P-for-trend <0.001). Negative associations with RTL were observed with both log2-As and log2-Hg, while an inverted U-shaped association was observed for log2-zinc (Zn) with RTL. We found little evidence of interaction among metals. Sex-stratification identified stronger associations of the overall mixture and log2-As with RTL among females, compared to males. Our study suggests that As and Hg may independently influence RTL in mid-childhood. Further studies are needed to investigate potential long-term impacts of metal-associated telomere shortening in childhood on health outcomes in adult life.

The Role of L1PA in Patient-reported Outcomes in Patients Undergoing Single-level Lumbar Fusion for Degenerative Spondylolisthesis.

Retrospective cohort study. To determine whether the L1 pelvic angle (L1PA) can be used to predict quality of life outcomes for adults one year after L4-L5 fusion to treat degenerative spondylolisthesis. L1PA is beneficial in the evaluation of preoperative and postoperative quality of life outcomes in patients undergoing surgery for spinal deformity. No studies have examined its utility in surgical patients with degenerative spinal disease. Patients undergoing L4-L5 posterolateral decompression and fusion or transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis were grouped by preoperative and postoperative L1PA, and further stratified by cut offs of >7.2° and <7.2° based on previous literature. We also stratified patients by presence of an ideal calculated L1PA, defined as (0.5×Pelvic incidence) -21 +/-5°, as proposed by prior literature. Preoperative, one-year postoperative and Δ (postoperative minus preoperative) patient-reported outcome measures (PROMs) and radiographic measurements were collected. Twenty-four patients were identified with preoperative L1PAs <7.2° and 132 with L1PAs >7.2°. Eighteen patients were identified with postoperative L1PAs <7.2° and 138 with L1PAs>7.2°. Sixty-five and fifty-seven patients were identified as having ideal calculated preoperative and postoperative L1PAs, respectively. When using absolute cutoffs, L1PA correlated with pelvic tilt, pelvic incidence, and pelvic incidence-lumbar lordosis mismatch (PI-LL). When using calculated L1PAs, L1PA correlated with lumbar lordosis, PI-LL, pelvic tilt and sacral slope. With respect to PROMs, no statistically significant differences existed between cohorts both preoperatively and at one-year postoperatively on either univariate and multivariate analyses. L1PA may be a helpful radiographic consideration that translates to clinically relevant outcomes in spinal deformity. However, it does not appear as predictive of patient outcomes after single-level fusion for patients with L4-L5 degenerative spondylolisthesis. Further studies are warranted to investigate the role of L1PA in degenerative spine patients.

Investigating positive reading trajectories among children who experienced out-of-home care

BackgroundChildren who experience out-of-home care (OOHC) often have low academic achievement which subsequently negatively affects their adult life outcomes, yet a smaller proportion succeed in spite of adversity. Scant research has examined the trajectories of children who achieve well in school and factors associated with positive educational outcomes. Objectives(1) Describe the reading trajectories from Year 3 to Year 7 of school of children who experienced OOHC, with a focus on higher achievement and improving trajectories. (2) Identify child, carer and placement characteristics plus supports and services associated with positive reading trajectories among children who have experienced OOHC. Participants and settingThe study included 325 children from the Pathways of Care Longitudinal Study (POCLS) in New South Wales, Australia. MethodsThe POCLS is a prospective cohort study including linked survey data and administrative child protection and education data. Group based trajectory modeling (GBTM) was used to identify and describe common trajectories of reading achievement. Multinomial logistic regression was used to identify factors associated with different reading trajectories. ResultsGBTM revealed three reading trajectories among non-Aboriginal children, and two among Aboriginal children. A high achieving group (12% of non-Aboriginal children) were the only trajectory group to maintain their level of achievement across the study. Improving achievement was rare, while falling behind over time was common across achievement levels. ConclusionsResults point to the need for early intervention supporting school readiness and catch-up growth, with ongoing interventions for children who experience OOHC to prevent declining student outcomes across achievement levels and extend talented students.

The influence of sarcopenia and myosteatosis on severe laboratory toxicity and overall mortality in older adults with cancer receiving chemotherapy.

12131 Background: Older adults with cancer often present with suboptimal muscle quantity and quality prior to treatment due to disease-related catabolic effects combined with the aging process. Muscle catabolism is further exacerbated by cancer treatments leading to worse metabolic health, patient quality of life, and clinical outcomes. Our objective was to examine the impact of sarcopenia and myosteatosis on severe laboratory toxicity and overall mortality in older adults with cancer receiving chemotherapy. Methods: This was a retrospective cohort study of older adults who had undergone chemotherapy at the Princess Margaret Cancer Centre, Toronto, Canada from June 2015 to June 2022. A computed tomography scan after diagnosis but prior to treatment was used to assess skeletal muscle index (SMI) and skeletal muscle density (SMD) for each participant. Sarcopenia was defined as the presence of low muscle strength (grip strength &lt;35.5kg for males and &lt;20kg for females), low SMI, and low physical performance (walking speed &lt;0.8m/s or a total Short Physical Performance Battery score of ≤8) prior to chemotherapy initiation. Myosteatosis was assessed through SMD in Hounsfield Units using previously published cut-offs. Severe laboratory toxicity was defined as occurrence of a grade ≥3 adverse event per the Common Terminology Criteria for Adverse Events (version 4.0). Severe laboratory toxicity and overall mortality were assessed from treatment initiation until treatment termination or loss to follow up. Multivariable logistic regression was used to determine the role of sarcopenia and myosteatosis in predicting occurrence of severe laboratory toxicity. Multivariable Cox regression was used to assess the risk of overall mortality. Results: A total of 115 older adults (mean age: 77.1 y) were included, of whom 63.5% had metastatic disease. Sarcopenia was identified in 27% of the cohort, whereas 80% had myosteatosis. A total of 132 severe laboratory toxicities occurred during the study period in 41 participants (35.7%). Sarcopenia was a significant predictor of severe laboratory toxicity (adjusted odds ratio (aOR)=3.19, 95%CI= 1.19 to 8.52, p= 0.012) after adjusting for sex, body mass index, and hemoglobin. Myosteatosis was significantly associated with overall mortality (adjusted hazard ratio (aHR)= 2.51, 95%CI= 1.12-5.61, p=0.025) after adjusting for albumin, alkaline phosphatase, and treatment intent. Conclusions: Sarcopenia may be used to inform the risk of severe laboratory toxicity in older adults prior to chemotherapy. Pre-treatment myosteatosis defined by low SMD predicts overall mortality in the same cohort. Optimization of skeletal muscle health through targeted exercise and nutritional interventions may improve patient quality of life and clinical outcomes in older adults with cancer receiving chemotherapy.

Guest editorial: Generating evidence to improve quality of life and other outcomes for children and adults with intellectual and other developmental disabilities

Guest editorial: Generating evidence to improve quality of life and other outcomes for children and adults with intellectual and other developmental disabilities

ENGAGE: COMMUNITY – A STUDENT LED, TELEHEALTH EXERCISE PHYSIOLOGY SERVICE DELIVERY MODEL TO COMBAT SOCIAL ISOLATION IN OLDER ADULTS

BACKGROUND AND AIMS EngAGE: Community is a student-led Exercise Physiology service delivery model that provides accessible, enjoyable and socially engaged exercise programs for older adults to combat loneliness. We aimed to assess the impact of EngAGE: Community on social, psychological, and quality of life outcomes in community-dwelling older adults, and student development. METHODS EngAGE: Community was a 15-week telehealth group-exercise program that recruited community-dwelling older adults and student Exercise Physiology practitioners. Classes were supervised by an Accredited Exercise Physiologist. Each EngAGE session consisted of exercise, educational and community-developing activities. Participant survey outcomes for social and psychological health, and quality of life were collected online before and following the program. Student development outcomes were also collected online before and following the program. RESULTS Across four programs, 73 community participants and 15 student participants were recruited, providing 1042 community engagement hours and 900 student development hours. Of these, 45 community participants completed sufficient attendance for data inclusion, and 14 student datasets were included. Community participants reported significant improvements in social [UCLA Loneliness Scale (p=0.001), Social Anxiety and Phobias Scale (p=0.007)] and psychological health [Kessler-10 (p=0.03)], as well as quality of life [SF-12 (p=0.02) and Satisfaction with Life Scale (p=0.05)]. A subset of the population demonstrated significant improvements in lower (p&amp;lt;0.001) and upper body strength (p=0.003). Student practitioners reported significant improvements in Work Self-Efficacy (p=0.002), Confidence in Skills (p=0.02) and Work Readiness (p=0.03). Community participants (n=48) provided an 81-98% agree/strongly agree response to qualifying statements suggesting the program was enjoyable, educational, social, and beneficial for their wellbeing. The cost per practitioner contact minute for all EngAGE: Community rotations was calculated as $1.92 compared to $4.21 for usual care (45% saving). CONCLUSION EngAGE: Community is a viable and cost-effective telehealth strategy to improve older Australians social and psychological health while developing Exercise Physiology student practitioners.

Marked by a Criminal Record? Socioeconomic Differences in the Relationship Between Early Criminal Justice Contacts and Adult Life Outcomes

AbstractThis paper combines life course theory and empirical research on the collateral consequences of punishment as a backdrop to exploring the relationship between both the presence of and seriousness of a criminal record measured in early adulthood (age 25) and later life outcomes (ages 41-49), both in total and by socioeconomic status. The analysis relies on a combination of longitudinal survey data and administrative register data for 2,022 individuals who were between 12 and 20 years old when the data collection started. Results show that the criminal record is linked to both labor market and social exclusion later in life, but most systematically to (worse) labor market outcomes. Somewhat surprisingly, low SES seems to “buffer” against some of the unwanted outcomes linked to having a more serious criminal record, while high SES seems to “boost” others. Implications for future research on both deviance and stratification are discussed.

Developing a Measure of Key Adult Outcomes in Adults with Developmental Disabilities: Conceptual Model and Item Generation of the REALS (Relationships, Employment, Autonomy, and Life Satisfaction).

Employment, social relationships, and autonomy are priorities topeople with intellectual and developmental disabilities (IDDs). However, few validated measures exist to systematically assess these key adult outcomes in this population. This research includes first steps to develop self- and proxy report measures of life outcomes for adults with IDDs-the Relationships, Employment, Autonomy, and Life Satisfaction (REALS). A literature search identified existing adult outcome measures, and comparison of their domains informed initial conceptual model development. External consultants revised the model, and items were generated. Autistic adults (n = 15), adults with other IDDs (n = 7), caregivers of autistic adults (n = 13), and caregivers of adults with other IDDs (n = 10) completed in-depth cognitive interviews to assess comprehension of items and response categories, factors influencing how participants respond to items, and the inclusiveness of the item pool. A final conceptual model was generated with three subdomains (social relationships, employment, and autonomy), including assessment of life satisfaction within each domain. Cognitive interviews revealed that response set restructuring and item-level revisions were needed to capture the complexity of adult life and make the measure more accessible across a range of abilities. This study developed a conceptual model of relationships, work, and autonomy specific to adults with IDDs. Future work will involve collecting data from 800 + self-reporters with IDDs and 800 + caregivers of adults with IDDs to conduct psychometric analyses. Improving measurement in this area is critical to better understanding the needs of adults with IDDs and improving services available to them.

Compressive buttress compared with off-axial screw fixation for vertical femoral neck fractures in young adults: a prospective, randomized controlled trial

BackgroundTo compare the clinical outcomes of compressive buttress screw (CBS) fixation, a novel screw fixation strategy, to off-axial screw fixation (off-axial partial threaded cannulated screw, OPTCS) for vertical femoral neck fractures (FNFs) in young adults.MethodsA total of 146 adults younger than 55 years old with high-energy Pauwels type III FNFs were randomized to receive CBS fixation or OPTCS fixation. Primary outcomes were complication rates, including fixation failure, fracture nonunion, and avascular necrosis of the femoral head (ANFH) at 24 months after treatment. Fixation loosening, femoral neck shortening and varus collapse, patient function and quality of life using the Harris hip score (HHS), and EuroQol-5 dimensional-5 levels (EQ-5D-5L) questionnaire (including EQ-5D-5L and EQ-VAS) were assessed as secondary outcomes at 24 months.ResultsCBS and OPTCS fixation groups were similar with regard to demographics at baseline. At 24 months, patients in the CBS fixation cohort had a significantly lower rate of fixation failure (10.5% vs. 25.0%, p = 0.041) and fracture nonunion (1.8% vs. 18.3%, p = 0.003) compared with patients who received OPTCS fixation. There was no difference in rate of ANFH (7.0% vs. 11.7%, p = 0.389) between groups. Additionally, patients managed with CBS fixation showed significantly less fixation loosening (19.3% vs. 58.3%, p < 0.001), less severe femoral neck shortening and varus collapse (10.5% vs. 25.0%, p = 0.007), higher HHS (93 vs. 83, p = 0.001) and more excellent grade (68.4% vs. 36.7%, p = 0.008), higher EQ-5D-5L (0.814 vs, 0.581, p < 0.001) and EQ-VAS (85 vs. 80, p = 0.002).ConclusionCBS screw fixation confers significantly lower complication rate in addition to higher functional and quality of life outcomes for young adults with high-energy FNF compared with OPTCS fixation.Trial registrationThis prospective, randomized controlled trial was approved by the institutional review board of our center, Ethics Committee of Shanghai sixth people's Hospital, and registered at www.chictr.org.cn (Approval Number: ChiCTR1900026283; Registered 29 September 2019—Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=43164).

Evaluation of high dose N- Acetylcysteine on airway inflammation and quality of life outcomes in adults with bronchiectasis: A randomised placebo-controlled pilot study

BackgroundHigh dose N acetylcysteine (NAC), a mucolytic, anti-inflammatory and antioxidant agent has been shown to significantly reduce exacerbations, and improve quality of life in placebo controlled, double blind randomised (RCT) studies in patients with COPD, and in an open, randomised study in bronchiectasis. In this pilot, randomised, double-blind, placebo-controlled study, we wished to investigate the feasibility of a larger clinical trial, and the anti-inflammatory and clinical benefits of high dose NAC in bronchiectasis. AimsPrimary outcome: to assess the efficacy of NAC 2400 mg/day at 6 weeks on sputum neutrophil elastase (NE), a surrogate marker for exacerbations. Secondary aims included assessing the efficacy of NAC on sputum MUC5B, IL-8, lung function, quality of life, and adverse effects. MethodsParticipants were randomised to receive 2400 mg or placebo for 6 weeks. They underwent 3 visits: at baseline, week 3 and week 6 where clinical and sputum measurements were assessed. ResultsThe study was stopped early due to the COVID pandemic. In total 24/30 patients were recruited, of which 17 completed all aspects of the study. Given this, a per protocol analysis was undertaken: NAC (n = 9) vs placebo (n = 8): mean age 72 vs 62 years; male gender: 44% vs 50%; baseline median FEV11.56 L (mean 71.5 % predicted) vs 2.29L (mean 82.2% predicted). At 6 weeks, sputum NE fell by 47% in the NAC group relative to placebo (mean fold difference (95%CI: 0.53 (0.12,2.42); MUC5B increased by 48% with NAC compared with placebo. Lung function, FVC improved significantly with NAC compared with placebo at 6 weeks (mean fold difference (95%CI): 1.10 (1.00, 1.20), p = 0.045. Bronchiectasis Quality of life measures within the respiratory and social functioning domains demonstrated clinically meaningful improvements, with social functioning reaching statistical significance. Adverse effects were similar in both groups. ConclusionHigh dose NAC exhibits anti-inflammatory benefits, and improvements in aspects of quality of life and lung function measures. It is safe and well tolerated. Further larger placebo controlled RCT's are now warranted examining its role in reducing exacerbations.

EXPLORING MULTIDIMENSIONAL RELATIONSHIPS OF OLDER ADULTS LIVING WITH CHRONIC PAIN

Abstract Older adults who experience chronic pain (CP) face many challenges from their illness, which can affect their personal and healthcare relationships. Research indicates the importance of relationships on health and quality of life outcomes in older adults with CP. However, minimal research has explored their perspectives on the relationships they have with their healthcare providers, healthcare system, their CP, and family/friends/community. Objective: To understand how older adults’ CP impacts their relationship with the healthcare system; and how older adults’ CP impacts their personal relationships (i.e. self, family, community). Methods: Adults &amp;gt;50 years of age with pain were eligible to enroll in virtual focus groups and/or interviews. Audio recordings were transcribed, coded, and analyzed via a mixed inductive-deductive framework approach using ATLAS.ti. Microsoft. Descriptive statistics were performed using Stata 16. Results: Sixteen participants participated in a focus group (n=3) or an interview (n=13). Participants identified as White (n=12,75%), female (n=12,75%), and were between the ages of 55-64 years old (n=8,50%). Most participants held an associate’s degree or higher (n=15,93%) and reported private medical insurance coverage (n=11,70%). Sessions lasted between 30-90 minutes. Participants described complex relationships that could have positive or negative impacts on their ability to manage their CP and their overall quality of life. Relationships explored included the healthcare system, clinician(s), family, other patients, and CP. Discussion: The relationships of older adults living with CP are multidimensional and can support or adversely affect pain management, mental health, and quality of life.

The psychological, social, and quality of life outcomes of people with a cardiac implantable electronic device: an umbrella review.

To synthesize the psychological, social, and quality of life outcomes of people with a cardiac implantable electronic device. An umbrella review of systematic reviews that reported the psychological, social, or quality of life outcomes of adults with a cardiac implantable electronic device was conducted. This umbrella review was pre-registered with PROSPERO (CRD42023437078) and adhered to JBI and PRISMA guidelines. Seven databases (CINAHL, Cochrane Library, Embase, EmCare, PsycINFO, PubMed, and the Web of Science) were searched alongside citation and bibliographic searches. Methodological quality was assessed using the JBI Checklist of Systematic Reviews and Research Syntheses. Due to the heterogeneity of the included reviews, the findings were reported narratively. A total of 14 systematic reviews met the inclusion criteria; 11 considered quality of life outcomes, and 3 considered psychological outcomes. Little difference in quality of life was found between people with an implantable cardioverter-defibrillator and controls; however, a high prevalence of psychological disorders was present. Cardiac resynchronization therapy devices demonstrated improvements in quality of life compared with control groups, alongside possible cognitive benefits. Quality of life did not differ between subcutaneous and transvenous implantable cardioverter-defibrillators. Pacemakers were associated with improved post-implantation quality of life. Research on the psychosocial and quality of life outcomes of people with a cardiac implantable electronic device is limited and inconsistent. Given the heterogeneity of the current research, conclusions are uncertain. Nevertheless, some recipients may experience adverse psychosocial complications. Further research employing rigorous methodologies is needed, and healthcare practitioners should provide care that acknowledges the potential for adverse psychosocial experiences. PROSPERO: CRD42023437078.

Treatment Outcomes of Interdisciplinary Care on Speech and Health-Related Quality of Life Outcomes in Adults With Cleft Palate.

Individuals born with a cleft palate with or without a cleft lip (CP ± L) often experience functional, aesthetic, and psychosocial consequences well into adulthood. This study aimed to investigate outcomes of speech and health-related quality of life (HRQoL) in adults with a CP ± L who received interdisciplinary cleft care at the Ghent University Hospital using valid, reliable, and condition-specific instruments. Thirteen Belgian Dutch-speaking participants with a CP ± L with a mean age of 25.4 years (SD = 5.1, range: 20-33 years) and an age- and gender-matched control group of 13 participants without a CP ± L with a mean age of 25.2 years (SD = 4.8, range: 20-32 years) were included in this study. Speech characteristics were evaluated perceptually and instrumentally. HRQoL was assessed through standardized patient-reported outcome measures. Outcomes were compared with those of the control group and to normative data where available. Participants with a CP ± L in this sample demonstrated significantly lower speech acceptability (p < .001) and higher rates of hypernasality (p = .015) and nasal turbulence (p = .005) than the control group. They showed significantly higher satisfaction with appearance of the cleft scar compared with norms of adults with a CP ± L (p = .047). No other differences in speech characteristics, sociodemographics, or HRQoL were found between participants with and without a CP ± L. The reduced speech acceptability and the presence of resonance and nasal airflow disorders may indicate the need for standardized long-term outcome measurement and interdisciplinary follow-up for speech characteristics and velopharyngeal insufficiency in young and middle adulthood in future clinical practice. Additional research is necessary to further substantiate these findings and to determine predictors for these continuing complications in adults with a CP ± L. https://doi.org/10.23641/asha.24243901.