Search Results (391)

Background/Objectives: Pediatric acquired demyelinating syndromes (ADSs) encompass a heterogeneous group of disorders, including multiple sclerosis (MS), MOG antibody-associated disease (MOGAD), and neuromyelitis optica spectrum disorder (NMOSD), with distinct clinical trajectories and prognoses. While analyzed collectively at baseline to reflect real-world diagnostic uncertainty, outcome predictors were also examined according to final diagnosis. Identifying early predictors is crucial for optimizing long-term outcomes. Methods: We retrospectively analyzed 30 pediatric patients (mean onset age: 11.3 years) with ADSs. Clinical, radiological, CSF, antibody, and neurophysiological data were collected and analyzed alongside treatment strategies. Outcomes—EDSS scores, neuroradiological changes, and clinical status—were evaluated over a 3-year period. Results: Final diagnoses included MOGAD (36.6%), MS (33.3%), NMOSD (6.6%), ADEM (10%), and other ADSs (13.3%). At onset, ≥3 brain lesions were present in 76.7% of patients. Disease-modifying therapies (DMTs) were used in 37% and acute immunotherapy in 90%. EDSS progression was significantly associated with DMT use at multiple timepoints, with additional predictors including MRI lesion type, CSF findings, antibody status, and evoked potentials. At 3 years, neurocognitive function predicted clinical outcome. Conclusions: Early immunotherapy and baseline instrumental findings are key predictors of outcome in pediatric ADSs. MOGAD showed a more favorable course, while MS and NMOSD were associated with greater long-term disability. A comprehensive, early diagnostic approach is essential for improving prognosis. Full article

Background/Objectives: Cognitive dysfunction is frequently observed in chronic migraine (CM) patients, but the contributing medical and psychological factors remain unclear. This study investigated associations between the cognitive reserve and medical, psychological, and lifestyle factors in individuals with CM. Methods: A retrospective review was conducted at a tertiary referral center in Taiwan. Cognitive function was evaluated via the mini-mental state examination (MMSE), while anxiety and depression were evaluated via the Beck Anxiety and Depression Inventories. Clinical variables included monthly headache days, headache intensity (numerical rating scale), migraine-related disability, and use of preventive medications. Multivariable linear regression analyses were performed to identify independent predictors of the cognitive reserve after adjusting for relevant covariates. Results: Among 50 participants (86.0% women; mean age 42.48 ± 13.47 years), six (12.0%) exhibited objective cognitive impairment (MMSE < cutoff). After a covariate adjustment, higher headache intensity was significantly associated with a lower cognitive reserve in anxiety and depression models. Patients with objective cognitive impairment reported significantly higher levels of pain, anxiety, and depression. Conclusions: The headache intensity, anxiety, and depression were significantly linked to a lower cognitive reserve in CM patients. These findings highlight the importance of incorporating routine psychological and cognitive assessments in CM care and suggest potential targets for integrative treatment strategies. Full article

(1) Background: Multiple sclerosis (MS) is a biologically highly heterogeneous disease and has poor predictability at diagnosis. Moreover, robust data indicate that early disease activity strongly correlates with future disability. Therefore, there is a need for strong and reliable biomarkers from diagnosis to characterize and identify patients who require highly effective disease-modifying treatments (DMTs). Several biomarkers are promising, particularly neurofilament light chains (NFLs), but the relevance of others is less consolidated. (2) Methods: We evaluated a panel of axonal damage and inflammatory biomarkers in cerebrospinal fluid (CSF) and matched serum obtained from a cohort of 60 newly diagnosed MS patients. Disability at diagnosis, negative prognostic factors, and the initial DMT prescribed were carefully recorded. (3) Results: We observed correlations between different axonal biomarkers: CSF and serum NFL versus CSF total tau; and between the inflammatory marker osteopontin (OPN) and axonal biomarkers CSF p-Tau, CSF total tau, and serum NFL. CSF and serum NFL and total tau, as well as CSF OPN, positively correlated with EDSS at diagnosis. Moreover, CSF and serum NFL levels were increased in patients with gadolinium-enhancing lesions (p = 0.01 and p = 0.04, respectively) and in those treated with highly effective DMT (p = 0.049). Furthermore, CSF OPN and both CSF and serum NFL levels significantly differentiated patients based on EDSS, with a combined ROC AUC of 0.88. We calculated and internally validated biomarker (in particular serum NFL) thresholds that significantly identified patients with higher disability. Finally, CSF OPN levels and dissemination in the spinal cord were significant predictors of EDSS at diagnosis. (4) Conclusions: These preliminary exploratory data confirm the pathological interconnection between inflammation and axonal damage from early disease stages, contributing to early disability. Follow-up data, such as longitudinal disability scores, repeated serum measurements, a healthy control group, and external validation of our results, are needed. We suggest that combining several fluid biomarkers may improve the clinical characterization of patients. Full article

Background/Objectives: Congenital cytomegalovirus (cCMV) infection is the most common non-genetic cause of sensorineural hearing loss (SNHL) in children. In cases of severe-to-profound SNHL, cochlear implantation (CI) is a widely used intervention, but outcomes remain variable due to possible neurodevelopmental comorbidities. This study aimed to evaluate the long-term auditory and language outcomes in children with cCMV after CI and to explore clinical and radiological predictors of post-CI performance. Methods: Fifty-three children with cCMV and bilateral severe-to-profound SNHL who underwent CI at five tertiary referral centers in Italy were included in the study. Auditory and language outcomes were assessed pre- and post-implantation using the Categories of Auditory Performance II (CAP-II) scale, the Nottingham 3-Level Classification, and the Bates Language Development Scale. Brain MRI abnormalities were classified according to the Alarcón classification. Correlations were explored between outcome scores and symptomatic status at birth, MRI findings, and neurodevelopmental comorbidities. Results: At birth, 40 children (75.5%) were symptomatic and 13 (24.5%) asymptomatic. Neurodevelopmental comorbidities were present in 19 children (35.8%). MRI was normal in 15 (28.3%), mildly abnormal in 26 (49%), and moderately to severely abnormal in 12 (22.6%). Auditory and language outcomes improved significantly post-CI (p < 0.001), though the outcomes varied widely. Twenty-five children (47%) reached CAP level ≥ 6, and thirteen (23%) reached Bates Level 6. Symptomatic status at birth correlated weakly with worse CAP (ρ = −0.291, p = 0.038) and Bates (ρ = −0.310, p = 0.028) scores. Higher Alarcón scores were significantly associated with neurodevelopmental comorbidities, though not directly with post-CI auditory and language outcomes. Finally, the presence of neurodevelopmental disabilities was generally associated with lower results, even if without statistical significance. Conclusions: CI provides substantial auditory and language benefit in children with cCMV, even in cases of severe neurodevelopmental comorbidities. MRI and developmental assessments, as well as perinatal history for clinical signs and symptoms, are helpful in guiding expectations and personalizing post-implantation support. Full article

Despite robust evidence linking career adaptability (CA) to positive vocational and psychosocial outcomes in general populations, research on the CA among individuals with special educational needs (SEN) remains limited. Prior reviews have largely overlooked the distinct challenges faced by SEN populations. To address this gap, we conducted a systematic review across five major databases, yielding an initial pool of 81 studies. Following rigorous screening, only eight quantitative studies met the inclusion criteria, reflecting the early stage of the research in this area. The included studies span diverse SEN groups, including individuals with visual impairments, intellectual disabilities, and mental health conditions. CA was consistently found to be associated with adaptive outcomes such as self-esteem, self-efficacy, hope, and career satisfaction. However, the literature is characterized by methodological limitations, notably the predominance of cross-sectional designs, the underrepresentation of neurodevelopmental conditions (e.g., ASD, ADHD), and a lack of cross-cultural perspectives and standardized instruments specifically adapted to SEN learners. Future studies should focus on the need for longitudinal and mixed-method designs, contextually cross-cultural research, and inclusive measurement tools. Furthermore, exploring the ecological and emotional predictors of CA; expanding to underrepresented SEN subgroups; and evaluating diverse interventions beyond mentoring are essential to informing tailored educational and vocational support for individuals with SEN. Full article

Background/Objectives: The objective of this study was to validate the Spanish version of the European Evaluation of Vertigo (EEV) and analyse its test–retest reliability, standard error of measurement (SEM), minimum detectable change (MDC), concurrent validity, and discriminant validity. Methods: A cross-sectional validation study was designed. Subjects were recruited from the Otolaryngology Service of the University Hospital of Jaen. Psychometric properties of the EEV were analysed, including the concurrent validity, the SEM, and the MDC. Discriminant validity was calculated using the receiver operating characteristic (ROC) curve. Results: The EEV test–retest reliability was nearly perfect (Kappa index = 0.97). The SEM and the MDC were set at 0.56 and 1.10, respectively. Regarding the discriminant validity, the area under the curve (AUC) was 0.831 (95% CI; 0.743–0.899) for the BPPV prediction, the AUC = 0.731 (95% CI; 0.633–0.815) for the disability prediction from the ABC-16 score, and the AUC = 0.846 (95% CI; 0.760–0.911) for the disability prediction from the ABC-6 score. Furthermore, a cut-off point greater than 12 was a good predictor of disability and the fall risk measured with the ABC scale, whereas a value of 11 points was a good predictor for discriminating BPPV patients. Conclusions: The Spanish version of the EEV is a valid and reliable instrument for evaluating the clinical symptoms of vestibular syndrome. This instrument demonstrated a nearly perfect test-retest reliability, a low measurement error, and good accuracy in discriminating between patients with vestibular disorders and those with BPPV. Full article

Background/Objectives: Cerebral palsy (CP) is the most common cause of neurological disability in children and is frequently associated with low bone mineral density (BMD) and increased risk of fractures. This study aimed to assess BMD in children with CP, compare it with normative standards, and explore potential associations with anthropometric parameters and the clinical characteristics of children with CP. Methods: Thirty-six children with CP aging 6–15 years from both sexes with varying levels of Gross Motor Functional Classification System (GMFCS) and spasticity were evaluated. Areal BMD and Z-scores (total and subtotal) were measured using dual-energy X-ray absorptiometry (DXA). Regression analysis identified predictors of BMD. Results: Children with GMFCS levels III–V had significantly lower total and subtotal Z-scores compared to those with levels I–II (p = 0.001 and p = 0.02, respectively). Total Z-score was significantly predicted by weight (β = 1.02, p = 0.002), height (β = −0.72, p = 0.02), and sedentary time (β = −0.47, p = 0.005). “No walking” was the only significant predictor for subtotal Z-score (β = −0.50, p = 0.004). Conclusions: Children with moderate to severe CP exhibited significantly lower BMD, particularly those with limited ambulation and higher spasticity levels. These findings underscore the importance of early screening and targeted interventions to optimize bone health in this population. Full article

Background/Objectives: Systemic sclerosis (SSc) is a multisystemic chronic autoimmune disease, which leads to disability and possibly early retirement. The objective of our study was to explore the associations between employment status (ES) and demographic, clinical and functional features in a single-center EUSTAR cohort. Methods: Consecutive patients with SSc examined between November 2011 and June 2023, who were under the age of retirement in our country (62 years for women, 65 for men at the time), were included. All patients underwent a comprehensive clinical assessment and filled in a work assessment questionnaire as well as two validated health-related questionnaires: the Scleroderma Health Assessment Questionnaire (SHAQ) and the Duruoz Hand Index (DHI). Associations between ES and potential predictors (education level, disease characteristics, work conditions, SHAQ and DHI) were tested using logistic regression adjusted for age and gender. Results: Ninety-one patients (mean ± SD age 53.7 ± 11.8 years, twenty-two with diffuse skin involvement, fifty-six with a history of digital of digital ulcers (DUs)), were included. Only 22 patients were still employed, while 69 were retired, of which 38 retired because of SSc. Among the employed, nine performed manual labor, nine spent many hours standing and three had to work in a cold environment. When potential predictors were tested separately, adjusted for age and sex, patients with higher education (OR (95% CI) 11.36 (2.03–63.36), p = 0.006) and no history of digital ulcers had higher odds of being employed. The presence of joint contractures and weightlifting as a work demand were associated with unemployment. In a multivariable model, higher education (OR 5.91, 95% CI 0.97–36.09, p = 0.054 and younger age (OR 0.90, 95% CI 0.85–0.96, p = 0.001) were independently associated with continued employment. High school education did not show a significant effect (OR 0.089, 95% CI 0.015–0.530, p = 0.008). Patients with a history of digital ulcers had the lowest employment rates compared to those with no digital ulcer history. No significant associations were found between employment status and SHAQ or DHI scores. Conclusions: SSc is associated with significant work disability and early retirement. Higher education, the lack of Dus and younger age were highly associated with staying employed. Given the rarity of SSc, we consider that our good sample size (n = 91) reflects disease prevalence, but results should be tested in other studies and the single center should be considered when interpreting generalizability. Full article

Objectives: The present study aimed to evaluate the long-term survival of patients with rheumatoid arthritis (RA) receiving biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in a real-world setting, and to identify key prognostic factors influencing mortality within this cohort. Methods: This retrospective, observational cohort study analyzed 165 patients with confirmed RA who were on b/tsDMARD treatment for at least six months as of June 2017. Patient data, including demographics, disease duration, prior therapeutic regimens, and global functional status were extracted from medical records to collect data covering a seven-year follow-up period, extending from June 2017 to December 2024. Corticosteroid use was defined as continuous systemic intake during the RA activity analysis period. Survival outcomes were analyzed using Kaplan-Meier methods and multivariate Cox proportional hazards models to identify independent predictors of mortality. Results: Over a mean follow-up of 9.4 years, the mortality rate was 13.5 deaths per 1000 treatment-years, with an overall survival rate of 87.3%. Advanced functional disability and prolonged corticosteroid use were independently associated with higher mortality risk. In subgroup analyses, chronic kidney disease significantly increased mortality among patients on TNF inhibitors. In contrast, patients who remained on their initial anti-IL6 therapy had lower mortality, though this may reflect survivor bias. Conclusions: This study highlights the importance of long-term b/tsDMARD intervention in RA patients, with observed low mortality and high survival rates. Subgroup findings suggest the importance of comorbidity management in TNFi users and therapeutic stability in anti-IL6 users. Full article

Background/Objectives: Degenerative lumbar spinal stenosis (LSS) is a prevalent cause of disability in elderly populations, often treated with decompressive surgery. However, postoperative functional outcomes are variable and influenced by factors beyond neural compression alone. This study aimed to investigate the prognostic significance of the Goutallier Classification System (GS), a radiological index of paravertebral muscle fatty degeneration, in predicting long-term postoperative disability and pain in elderly patients undergoing decompression for LSS. Methods: A retrospective cohort study was conducted on 100 elderly patients who underwent primary lumbar decompression surgery for LSS between January 2020 and July 2022, with a minimum two-year follow-up. Patients were stratified according to their preoperative GS grades assessed via MRI. The Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain were collected preoperatively and at follow-up. Changes in the ODI and VAS (ΔODI and ΔVAS) were analyzed to evaluate associations between GS grades and functional outcomes. Results: Significant improvements in the ODI (from 41.0 ± 17.5 to 16.9 ± 8.2) and VAS (from 6.23 ± 2.52 to 3.75 ± 2.38) were observed postoperatively (p < 0.01). However, higher GS grades were associated with greater residual disability and pain at follow-up, as well as with smaller postoperative improvements in these scores (p < 0.01 for ODI; p = 0.01 for VAS). Gender differences were noted, with females predominating in higher GS grades. No significant differences in comorbidities or complication rates were identified across GS subgroups. Conclusions: Preoperative paravertebral muscle degeneration, as measured by the GS, emerged as a significant predictor of postoperative disability and pain in elderly LSS patients. Incorporating GS assessment into preoperative planning may refine surgical risk stratification and inform shared decision-making to optimize long-term functional recovery. Full article

Background/Objectives: Patients with inflammatory bowel disease (IBD), whether affected by Crohn’s disease (CD) or ulcerative colitis (UC), are burdened by disability and a reduced quality of life. The individual’s regular participation in daily working life is a key factor among its determinants. This work aims to quantify work absenteeism in patients with IBD, profiling it concerning specific demographic variables, the degree of disease activity, and the level of self-reported anxious symptoms. Methods: A cross-sectional observational study targeted patients with a known diagnosis of IBD with disease activity no greater than moderate who were either employed or engaged in regular student activities. Participants were administered the Beck Anxiety Inventory (BAI) for the assessment of anxious symptoms, the Patient-Reported Outcome 2 (PRO-2) for evaluating IBD disease activity, and the Health and Work Performance Questionnaire (HPQ) short form for the analysis of work absenteeism, measured both as absolute and relative over two time frames (the last 7 days and the last 4 weeks). Within the HPQ, Likert scale (0–10) questions were administered to assess self-perceived work productivity. Results: A total of 300 patients were included [median age 43.5 years, IBD (UC 55.7%, CD 44.3%, sex (males 54%, females 46%)], recording absolute absenteeism of 56 (36–76) and 2 (−8–20) hours lost over 4 weeks and 7 days, respectively. The factors associated with worse absolute and relative absenteeism (both at 7-days and 4-weeks) were having CD (p < 0.001), having previous surgery (p < 0.05), and, exclusively in the 4-week assessment, being female (p < 0.05) and a smoker (p < 0.05). The BAI demonstrated a moderate correlation with 4-week absolute absenteeism (ρ = 0.374, p < 0.001), progressively increasing with anxiety severity. Additionally, the BAI was an independent predictor of a 25% work productivity loss over 4 weeks (aOR: 1.1, 95% CI 1.06–1.142, β = 0.096, p < 0.001). Disease activity measured based on PRO-2 strongly correlated with 4-week (ρ = 0.53, p < 0.001) and 7-day (ρ = 0.47, p < 0.001) absolute absenteeism. Conclusions: In conclusion, work absenteeism in IBD patients may be driven by the IBD phenotype, sex, anxiety, and disease activity. Improving these parameters could enhance productivity. Full article

Background: Chronic pain is an unpleasant sensory and emotional experience that greatly affects functioning and well-being. Studies link chronic pain and violence against women, with an odds ratio of 2.08 and a 26% prevalence rate. The bio-psycho-social consequences reduce quality of life and cause disability. Despite extensive research, the etiology remains unclear. This study investigates the bio-psycho-social risk factors of chronic pain in women, both victims and non-victims of violence. Methods: A case–control study (December 2023–June 2024) used odds ratios and Fisher’s exact test to explore risk factors associated with chronic pain. Univariate logistic regressions identified significant predictors. Results: The study included 170 women (68 victims), half with chronic pain. Nine risk factors were specific to victims (three biological, six psycho-social), four to non-victims (two biological, two psycho-social), and twenty-three to all women (five biological, eighteen psycho-social). A four-factor model best explained risk in victims and all women, while a two-factor model fit non-victims. Conclusions: The bio-psycho-social model of chronic pain is supported, identifying specific risk factors. These findings can aid anti-violence and healthcare professionals in screening and early intervention. Full article

Background/Objectives: Retained epidural catheter fragments are an infrequent but clinically relevant complication of neuraxial anesthesia. Optimal management remains undefined, with limited evidence guiding treatment selection or risk stratification. This systematic review synthesized individual patient data to compare treatment strategies, examine surgical outcomes, and determine predictors of intervention. Methods: A systematic review was conducted across six databases in accordance with PRISMA guidelines (PROSPERO: CRD420025638305). Adult cases of retained epidural catheter fragments were included. Functional outcomes were standardized using modified MacNab, McCormick, and Therapy–Disability–Neurology (TDN) scores. Predictors of surgery and detectability were assessed using univariate and multivariate logistic regression models with Firth correction. Results: Forty studies comprising 51 patients were included. Conservative management was chosen in 23 cases (45%); 39.1% (n = 9) ultimately required delayed surgery due to symptom onset during follow-up. Surgical removal (n = 28, 55%) was safe and yielded excellent outcomes in 95.8% of cases. Fragment length was significantly associated with increased odds of surgery (OR = 1.05, 95% CI: 1.01–1.10, p = 0.04), while catheter material was associated with surgery in univariate analysis (OR = 2.49, 95% CI: 1.08–9.00, p = 0.03). An MRI demonstrated the highest diagnostic accuracy (AUC = 0.859, cutoff = 70 mm catheter length), outperforming CT (AUC = 0.611) and X-ray (AUC = 0.533). Across all patients, 84.3% achieved “Excellent” recovery per MacNab, with no neurological deterioration in any surgical case. Conclusions: Surgical removal of retained epidural catheter fragments is safe and effective in symptomatic patients. Conservative management is viable for asymptomatic cases under structured surveillance. Catheter material and fragment length may dictate imaging selection and treatment decisions. Full article

Purpose: This study explored the potential long-term effects of academic-related variables, including academic satisfaction, college degree attainment, unmet academic accommodation needs, and demographic characteristics on the job and career satisfaction of adults with disabilities using modern machine learning techniques. Method: Participants (n = 409) completed an online survey assessing these constructs. All had a disability or chronic health condition, had attended school in the U.S. throughout their K-12 education, and were between 19 and 86 years of age. Results: The random forest models had 68.6% accuracy in correctly identifying job satisfaction and 72.5% accuracy in correctly identifying career satisfaction. When using mean decrease in impurity (MDI) and permutation importance to identify statistical predictors, academic satisfaction was the most important predictor of job satisfaction in both MDI and permutation importance, while unmet academic accommodations was the fourth highest predictor for MDI behind academic satisfaction, disability level, and age, but ahead of other demographic variables and college degree status, and the second highest predictor of job satisfaction in permutation importance. For career satisfaction, academic satisfaction accounted for the highest MDI, while unmet academic accommodations ranked fourth. For permutation importance, academic satisfaction ranked first, and unmet academic accommodations ranked fifth behind academic satisfaction, age, college degree status, and disability level. Discussion: Meeting the academic accommodation needs of disabled students is linked with lasting vocational success. This study underscores the associations between unmet academic accommodation needs and future job and career satisfaction, illuminated using novel machine learning techniques. To our knowledge, this is the first investigation of the potential long-term associations between unfulfilled accommodation needs and future job and career satisfaction. Full article

Background/Objectives: Research suggests that attitudes toward aging significantly impact health and well-being outcomes in older adults and are influenced by various factors. Our study aims to identify gender differences in attitudes toward aging among aging individuals with disabilities while also examining the influence of demographic and psychological factors on these attitudes. Methods: For this cross-sectional study, we collected data from 393 middle-aged and older adults with disabilities via an online Qualtrics survey administered through the Prolific platform in the United States. Participants completed the Attitudes Towards Aging Questionnaire Short Form, Purpose in Life Test Short Form, Mindfulness Attention Awareness Scale, Acceptance of Chronic Health Conditions Scale, and Three-Item Loneliness Scale. Descriptive and correlation analyses, t-tests, and multiple regression analyses were performed. Results: The independent t-test findings reveal significant differences in physical change and psychological growth between men and women, with men scoring higher in physical change and women in psychological growth. In multiple regression analyses, purpose in life significantly predicted all three domains of attitudes toward aging in men, while both purpose in life and acceptance were predictors across all domains in women. Additionally, age, employment, and financial stability contributed to aging attitudes only among women. Conclusions: Attitudes toward aging, specifically physical change and psychological growth, were found to vary by gender, with purpose in life, acceptance, and loneliness influencing these attitudes among both groups, while certain demographic factors influenced aging attitudes only among women. These findings underscore the need for gender-specific interventions addressing these substantial factors. Full article