Search Results (125)

Background/Objectives: This study aims to explore both the psychosocial outcomes of hearing aid use and the factors that differentiate users from non-users among older adults with sensorineural hearing loss (SNHL) in Romania. Methods: We conducted a cross-sectional, comparative study with follow-up, including 201 patients aged between 49 and 92 years (mean age 70.76 ± 11.86 years), diagnosed with moderate to severe SNHL, evaluated between 1 November 2023, and 30 November 2024, at the Municipal Clinical Hospital Orăștie, Romania. Audiological assessment involved pure-tone audiometry and speech testing. Outcome measures included the Word Recognition Score (WRS), International Outcome Inventory for Hearing Aids (IOI-HA), Hearing Handicap Inventory for Adults (HHIA), Tinnitus Handicap Inventory (THI), and the Self-Esteem Scale (SES). Results: Of the 201 patients, 105 (52.2%) accepted hearing aid (HA) fitting and 96 (47.8%) declined. No significant differences were found in age (p = 0.565) or sex (p = 0.476) between groups. HA users reported significantly lower perceived handicap (HHIA: 46.48 ± 24.83 vs. 77.74 ± 28.02, p = 0.015) and higher self-esteem scores (SES: 35.68 ± 4.88 vs. 23.03 ± 4.90, p < 0.001), while tinnitus-related distress (THI) did not differ significantly (p = 0.785). Word recognition scores improved significantly post-fitting across all degrees of hearing loss: moderate (48.52% → 86.13%), moderately severe (47.47% → 85.31%), and severe (47.55% → 85.46%), all p < 0.001. Conclusions: Hearing aid use in older adults with SNHL was associated with significant improvements in speech perception and reduced perceived hearing handicap. These benefits were consistent across all severity levels and were independent of unilateral or bilateral device use. The difference in self-esteem observed between users and non-users may reflect pre-existing psychological factors influencing HA adoption, underlining the importance of personalized counseling in hearing rehabilitation. Full article

Background/Objectives: Multidisciplinary care is the gold-standard approach for delivering comprehensive pediatric healthcare. For children undergoing cochlear implant (CI) evaluation, multiple appointments are required to assess candidacy, set realistic expectations, and counsel families on rehabilitation and the psychosocial impact of hearing loss. Established pediatric CI users also need coordinated follow-up to address ongoing auditory, educational, and psychosocial needs. This study evaluated the satisfaction and family perspectives of the implementation of a virtual, team-based multidisciplinary model for both CI candidates and established CI users. Methods: Thirty-nine children and their families participated in discipline-specific telehealth consultations, including audiology, listening and spoken language (LSL) therapy, psychology, and educational services, followed by a 60 min multidisciplinary team meeting. Team meetings occurred during pre-implantation and at six months post-activation for CI candidates. Team meetings for established CI users were scheduled following completion of individual consultations. Providers summarized findings from their individual visits before transitioning to a caregiver-led discussion. Post-visit surveys assessed satisfaction and perceived benefit from the multidisciplinary model. Results: Thirty-nine dyads were enrolled (11 Pre-CI; 28 Established CI). Caregivers were predominantly mothers (89.7%), most identified as Hispanic (55.3%) and White (71.1%). Over half of children identified as Hispanic (59%) and White (71.8%); most were diagnosed with hearing loss at birth (55.9%). Satisfaction with the virtual model was uniformly high: 100% of caregivers were satisfied or very satisfied, and most rated care quality as “very good” or “excellent.” LSL therapy was most frequently rated as the most beneficial visit (70% Pre-CI; 45% Established CI). Caregivers strongly preferred ongoing team-based care, with 55–80% reporting that they would like it to occur every six months and 95–100% preferring remote meetings. Conclusions: A virtual multidisciplinary model offers a high-quality, family-centered approach for both CI evaluations and ongoing management of established CI users. By integrating simultaneous team-based sessions, this model not only supports the ‘whole child’ but also strengthens the family system by improving communication, streamlining care, and reducing the burden of multiple in-person appointments. Families consistently report high levels of satisfaction with the convenience, clarity, and collaboration provided through virtual team visits. Incorporating routine check-ins with families is essential to ensure their needs are addressed, reinforce progress, and guide timely, targeted interventions that maximize each child’s developmental outcomes. Full article

Malnutrition in patients with gastrointestinal (GI) cancers can be the result of functional and/or anatomical changes in the alimentary tract, secondary to malignancy or oncologic therapies. Understanding the underlying mechanisms of malnutrition in these patients is imperative in providing appropriate interventions that can not only improve quality of life for these individuals, but also improve their tolerance of oncologic treatment and progression towards remission or cure. In this narrative review, we address common nutritional deficiencies associated with GI malignancies, including pancreatic, biliary, and hepatic cancers. Furthermore, we address common issues related to these deficiencies and causes of nutrition barriers as they relate to organ malfunction or surgical alterations of anatomy. Recommendations for counseling, dietary modifications, nutritional supplements, and pharmacologic interventions are provided based on individual barriers and the vital role of multidisciplinary care is highlighted. Additionally, we highlight novel techniques, such as the role of psychosocial care, prehabilitation, digital health, and machine learning, which can improve nutritional outcomes, provide patient-directed care, and improve risk stratification for this complex and multifaceted issue that faces patients diagnosed with GI cancers. Full article

Background: Carpometacarpal (CMC-I) arthritis is a frequent and disabling condition. Standard surgical options include trapeziectomy and prosthetic arthroplasty. While quantitative outcomes have been widely studied, little is known about patient perspectives regarding function, aesthetics, and rehabilitation. Methods: We conducted semi-structured interviews with ten patients who had undergone trapeziectomy on one side and prosthesis implantation on the contralateral side. Interviews were performed ≥6 months postoperatively, audio-recorded, transcribed verbatim, and analyzed thematically following Braun and Clarke’s framework. Researcher triangulation and member checking were applied to enhance trustworthiness. Results: Four overarching themes were identified. (1) Strength: Most patients reported greater strength and endurance on the prosthetic side, though both hands were generally adequate for daily activities. (2) Rehabilitation: Recovery after prosthesis implantation was described as markedly faster and less burdensome, with reduced need for therapy compared to trapeziectomy. (3) Aesthetics: Trapeziectomy was often associated with dissatisfaction due to thumb shortening and collapse, while prostheses were perceived as restoring a more natural appearance. (4) Surgical preference: When asked which procedure they would hypothetically choose again, all participants favored prosthesis implantation, citing superior function, faster recovery, and more favorable aesthetics. Conclusions: Patients who experienced both procedures consistently preferred prosthesis implantation. Their narratives highlight dimensions beyond standard clinical scores, including rehabilitation burden, appearance, and psychosocial impact. Incorporating patient-reported outcomes into surgical counseling is essential to align treatment of CMC-I arthritis with patient priorities and to support shared decision-making. Full article

Limb-Girdle Muscular Dystrophies (LGMDs) are genetically heterogeneous disorders primarily affecting proximal limb muscles. The most common form, LGMDR1, results from biallelic CAPN3 mutations encoding calpain-3, a muscle-specific protease. Recently, growing evidence implicates heterozygous CAPN3 variants in autosomal dominant disease (LGMDD4), with pathogenic mechanisms still incompletely understood. In a retrospective multicenter Italian study of patients harboring monoallelic CAPN3 variants (ClinicalTrials.gov NCT05956132), the p.Asp753Asn substitution was the most frequent change, detected in eight unrelated individuals. These patients, aged 6–80 years, exhibited a spectrum of presentations ranging from asymptomatic hyperCKemia and exertional myalgia to mild proximal weakness. Muscle biopsies showed mild, nonspecific myopathic changes, while calpain-3 expression was variably reduced. Structural modeling suggested that Asp753 may stabilize the Ca²⁺-bound conformation, with substitution potentially disrupting inter-domain interactions. Literature review identified 31 additional reports worldwide, confirming recurrence while highlighting marked phenotypic heterogeneity and limited clinical annotation. The aggregated evidence supports a pathogenic role for p.Asp753Asn, though the precise mechanism, potentially involving a dominant-negative effect, remains to be validated. These findings emphasize diagnostic challenges posed by single CAPN3 variants and underscore the need for integrated clinical, segregation, and functional studies to clarify pathogenic mechanisms, refine counseling, and guide patient-specific rehabilitation and therapeutic strategies. Full article

Background/Objectives: Cochlear implantation (CI) has been shown to be effective in children with inner ear malformations (IEMs). However, outcomes vary with malformation type and anatomical complexity. Advances in radiological classification may improve the understanding of such variability to better guide patient counseling. We aimed to assess one-year post-implant auditory outcomes in children with IEMs using radiology-based classifications, and to explore genetic and perinatal predictors. We also propose a preliminary severity score derived from the INCAV system. Methods: Out of 303 pediatric CI recipients assessed at a tertiary center, we retrospectively analyzed 41 children (82 ears) diagnosed with IEMs. Malformations were categorized with the Sennaroğlu system and re-coded using INCAV, from which a severity score was derived. Postoperative outcomes were assessed in 56 implanted ears, including pure-tone average (PTA), word recognition score (WRS), and post-surgical complications. Statistical analyses included Spearman’s correlation, linear regression, and exploratory discriminant MANOVA. Results: The most frequent malformation was enlarged vestibular aqueduct (33%), followed by incomplete partition type II (22%). CI was performed in 56 malformed ears with a complication rate of 10.7%. PTA and WRS correlated with the INCAV-derived severity score, with higher severity linked to poorer thresholds and lower WRS. Linear regression showed severity explained ~20% of PTA variance, with outcomes more frequently impaired in ears with scores > 3. Exploratory analysis revealed inter-subject variability, with partial separation of mild versus moderate/severe groups mainly driven by PTA and WRS. Conclusions: CI in pediatric IEMs is safe and consistently improves hearing thresholds. PTA was the most robust predictor of performance, while the INCAV-derived severity score, though exploratory, may provide additional value for anatomical stratification, prognostic counseling, and rehabilitation planning. Full article

Chronic venous insufficiency (CVI) is a common peripheral vascular condition characterised by the retrograde blood flow in the lower extremities and its consequences such as oedema and other complications. Clinical severity of CVI is assessed according to the CEAP (Clinical, Etiological, Anatomic, and Physiopathologic) classification, which recognises seven grades of increasing clinical severity (C₀–C₆). Compression therapy aims to accelerate vein, lymph, and microcirculation flow and therefore reduce chronic nonbacterial inflammation and oedema of the extremities. In accordance with the elasticity and stiffness, compression bandages and garments are divided into short-stretch and long-stretch compression materials. Compression therapy is applicable in all stages of CVI. Moreover, compression therapy in conjunction with physical therapy and lifestyle modifications is more effective in reducing oedema, preventing venous distension, and reducing venous wall tension, all while improving calf muscle pump function. Physical therapy in CVI treatment combines everyday lifestyle modifications, physical activity, medical exercise, sports activity, hydrotherapy, and electrotherapy. Therefore, physical therapy is used either for prevention or either for therapeutic purposes in CVI. For grades CEAP C₀–C_2, preventive measures consist of education and counselling, medical exercise and general fitness, and sports and physical activities. However, for therapy in grades CEAP C₃–C₆, medical exercise and a specific rehabilitation programme, manual lymphatic drainage and massage, balneotherapy, and electrotherapy are recommended. Full article

Objectives: Facial paralysis is a devastating yet frequent complication of skull base surgery, significantly impacting quality of life through functional impairments and psychosocial consequences. Management is complex and requires an individualized approach based on duration of paralysis, etiology and extent of nerve injury, overall prognosis, and rehabilitative goals. This review provides a comprehensive overview of current strategies for managing post-skull base surgery facial paralysis. Methods: A narrative review of the literature was performed, analyzing surgical reanimation techniques (nerve grafting, nerve transfers, regional and free muscle transfers), static procedures for facial symmetry and ocular protection, and non-surgical interventions such as physical therapy, botulinum toxin injections, and psychological support. Key criteria guiding treatment selection, including muscle viability and timing since injury, were examined. Results: Dynamic surgical approaches remain central to restoring movement. Nerve grafting and transfers are effective when viable musculature is present, whereas regional or free muscle transfers are required in long-standing paralysis with irreversible atrophy. Static procedures provide adjunctive improvements in resting symmetry and eye protection. Non-surgical strategies, including rehabilitation therapy and botulinum toxin, enhance functional outcomes and reduce synkinesis. Psychological counseling addresses the profound emotional burden associated with facial disfigurement. Across modalities, individualized treatment planning is crucial. Conclusions: Management of facial paralysis after skull base surgery demands a multidisciplinary, patient-centered approach. Combining surgical and non-surgical interventions optimizes functional and aesthetic outcomes, helping restore both facial movement and psychosocial well-being. Full article

Background: The aim of this study was to separately assess return to work (RTW) and return to sports (RTS) rates and timelines following surgical and conservative treatment of tibial plateau fractures (TPF). A secondary objective was to identify factors associated with faster recovery. Methods: All patients with TPF treated at a single level I trauma center between 1 January 2008 and 31 December 2016 were retrospectively reviewed. Standardized questionnaires were used to evaluate pre- and postoperative work and sports activity. Subgroup and correlation analyses were performed to investigate the influence of demographic and treatment-related factors on RTW and RTS duration. Results: A total of 105 patients were included, of whom 85% (n = 89) received surgical treatment and 15% (n = 16) were treated conservatively. RTW was achieved by 100% of surgically treated and 93% of conservatively treated employed patients, with a mean duration of 11.3 ± 9.5 weeks and 6.5 ± 4.2 weeks, respectively. RTS was achieved by 85% of surgically treated and 86% of conservatively treated previously active patients, occurring after a mean of 22.1 ± 17.9 weeks and 12.2 ± 8.8 weeks, respectively. Male sex, lower fracture complexity, absence of external fixation, and shorter operative times were associated with faster recovery. A general shift toward low-impact and recreational sports and a reduction in sport types and weekly training sessions were observed. Conclusions: Independent of the treatment modality, high RTW and RTS rates are observed within six months following TPF. The identified factors may help guide patient counseling and improve individual rehabilitation planning. Full article

Background/Objectives: Vascular Malformation—Osteolytic Subtype (VMOS) is an exceptionally rare autosomal recessive disorder caused by homozygous pathogenic variants in the ELMO2 gene, with fewer than ten genetically confirmed pediatric cases reported worldwide. This report presents the longitudinal dental management and clinical course of a child with VMOS, emphasizing the challenges of preventive and restorative care in such cases. Methods: A four-year-old child with a confirmed diagnosis of VMOS and a history of urgent bilateral coil embolization and surgical excision of mandibular aneurysmal bone cysts presented for dental care. The patient was followed for three years (2022–2025). Management focused on staged oral rehabilitation, preventive strategies, and restorative interventions adapted to changes across dentition stages. Results: At initial presentation, the child exhibited mandibular swelling, gingival hypertrophy, and a history of spontaneous intraoral bleeding. The postoperative course had been complicated by cerebral abscesses requiring prolonged intravenous antibiotics. During the primary dentition stage, full oral rehabilitation and strict preventive protocols were implemented to minimize caries and infection risk. In the mixed dentition period, the permanent incisors and molars erupted with enamel hypoplasia and developmental defects, necessitating composite restorations. Ectopic eruption and suboptimal oral hygiene, partly related to parental fear of bleeding, were also managed with reinforced preventive counseling. Conclusions: This case highlights the long-term dental implications of VMOS, underscoring the crucial role of the pediatric dentist in early preventive planning and individualized restorative management. Effective multidisciplinary coordination remains essential to preserve oral health and minimize complications in rare vascular syndromes with craniofacial involvement. Full article

The formation of an emotional bond with young people’s parents is crucial for healthy development and serves as a model for future relationships. Disruptions to this bond can result in neurobiological consequences, manifesting as problematic behaviours and social deficits. Social-educational work in re-education facilities in Slovakia focuses on supporting and rehabilitating young people in conflict with the law, aiming for their reintegration into society. This study presents a qualitative analysis of social workers’ activities across 11 re-education facilities in Slovakia, utilizing semi-structured interviews, document analysis, and field observation. The findings reveal that social workers play an indispensable role in the re-education and resocialization process, providing emotional support, professional counselling, and coordination with multidisciplinary teams. Despite differences in client typology and methodologies among facilities, a shared emphasis exists on restoring social ties and personal development. The effectiveness of social work is influenced by adequate staffing, methodological support, and inter-ministerial cooperation. Implementing targeted recommendations could significantly enhance the effectiveness of the system and improve outcomes for children and young people in institutional care. This study contributes vital insights into how social workers must balance competing interests—such as individual therapeutic needs, institutional constraints, and family and community involvement—to successfully facilitate youth reintegration into society. Full article

Background: Communication difficulty restricts education, healthcare, and social participation, yet population-level data for Saudi Arabia have been scarce. This study analysed the 2017 Saudi National Disability Survey to estimate prevalence, describe severity and demographic patterns, and identify factors linked to these difficulties. Objectives: We aimed to estimate national and regional prevalence, assess severity, and gender differences, and identify socio-demographic and disability-related correlates. Methods: A cross-sectional, two-stage stratified cluster sample of 33,575 households (weighted N = 20,408,362 citizens) provided self-reported data on communication difficulty and socio-demographics. Weighted frequencies described prevalence and multivariable logistic regression identified independent correlates. Results: Among all Saudi citizens, 7.1% reported at least one functional difficulty, and of this group 15.7%—equivalent to 1.1% of the total population (n = 226,510)—had a communication difficulty; within that communication difficulty stratum, (n = 185,508) (0.9% of all citizens) experienced it alongside additional impairments, whereas (n = 41,002) (0.2% of all citizens) reported communication difficulty in isolation. The communication difficulties exhibit significant regional variation, ranging from 0.45% in Najran to 1.55% in Aseer. Most cases were classified as being associated with some difficulty (72%); females were over-represented in the extreme category despite a modest male excess overall (adjusted odds ratio [AOR] = 1.09). Higher education, married status, and bilateral first-cousin marriage (AOR = 1.22) were associated with greater risk. Chronic disease (44%) and perinatal causes (13%) predominated, and 84% of cases co-occurred with at least one other disability. Independent predictors included a long duration (AOR = 4.18), disease or delivery-related cause, and consanguinity. Conclusions: Findings highlight geographically clustered need, genetic risk factors, and substantial multimorbidity, indicating the importance of region-specific screening, premarital counselling, and integrated rehabilitation within chronic disease services. Full article

Introduction: Prostate cancer is one of the most common neoplasia in men, and its clinical evolution is highly influenced by psycho-emotional factors, especially in elderly patients. Comorbidities, the perception of one’s identity and its impact on life quality become relevant variables in the therapeutic decision. Sexual dysfunction after treatment along with decreased libido, erectile dysfunction and ejaculatory dysfunction are significant problems in patients with prostate cancer. Case presentation: The present study presents the oncological evolution of an elderly patient with a dual diagnosis, prostate adenocarcinoma and lung squamous cell carcinoma, who faced a significant amount of medical and psychological challenges. Reluctance to hormone therapy was closely linked to the fear of sexual dysfunction, a very common reaction in elderly men concerned with maintaining autonomy and intimacy. The peculiarity of the case consists in the interaction between the evolution of the disease, the therapeutic decisions and the psychological impact on the patient. Discussion: Androgen deprivation therapy negatively influences multiple aspects of sexual function, significantly impairing the life quality of patients diagnosed with prostate cancer. In this context, therapy through acceptance and commitment is the appropriate one, its main purpose being to change the patient’s relationship with suffering—from struggle and rejection to active acceptance and value of the present. The intervention of the psychologist or the psychotherapist is essential in decision-making counseling, using coping techniques, the clarification of personal values and the involvement of the family in the decision-making process. Oncological psychology helps the patient redefine their life goals and priorities, not just to choose a treatment. Conclusions: Sexuality and psychological health are deeply affected by prostate cancer. Psychological flexibility and emotional support can mitigate this negative impact. The integration of therapy through acceptance and commitment in the rehabilitation after treatment increases effectiveness and patient satisfaction. Full article

Heart transplantation represents a pivotal intervention for end-stage heart failure, extending survival. However, it imposes profound physical, psychological, and social challenges that often undermine recipients’ quality of life (QoL). These challenges are especially pronounced in collectivist cultural contexts like China, where familial obligations and stigma surrounding chronic illness intensify existential burdens. Grounded in theoretical frameworks including Coping Theory, Self-Determination Theory, Socioemotional Selectivity Theory, and Terror Management Theory, this cross-sectional study explored the interplay between social support and QoL among Chinese heart transplant recipients, elucidating the mediating roles of self-esteem and death anxiety, as well as their sequential chain-mediating pathway. Employing validated psychometric instruments, including the Social Support Rating Scale (SSRS), Rosenberg Self-Esteem Scale (RSES), Templer Death Anxiety Scale (T-DAS) and SF-36 Health Survey, along with chain-mediation modeling, the analysis revealed that social support exerts a direct positive influence on QoL, supplemented by indirect effects through enhanced self-esteem, reduced death anxiety, and a chained cognitive-existential mechanism linking these factors. These insights highlight the complex psychosocial dynamics of post-transplant adaptation, advocating for targeted and culturally attuned interventions. These interventions include family-based support programs, self-esteem enhancement strategies, and death anxiety counseling. The aim is to promote holistic rehabilitation and sustained well-being among heart transplant recipients in China’s context. Full article

Background/Objectives: Parent caregivers of children with medical complexity experience high levels of chronic stress and trauma symptoms. Despite ongoing and continuous involvement with the healthcare system, parents often do not seek support for their own mental health concerns. Parent mental wellness is a critical component of reducing family distress. This study aimed to explore how various factors such as resilience, coping, and support impacted well-being and trauma symptom severity. Methods: Parents/caregivers from a complex care clinic in a mid-Atlantic children’s hospital were recruited for this study. A total of 125 participants completed the study which included a battery of measures focused on trauma symptoms, well-being, coping, and resilience. Results: PTSD symptom severity was significantly negatively related to resilience and subjective well-being. Significant mediators included informational support, indicating that collaboration between healthcare providers and caregivers/parents is critical. Conclusions: This study highlights potential target intervention areas to promote well-being and reduce trauma symptom severity, such as resiliency promotion and enhancement and increasing informational support provided by healthcare professionals. Full article