Search Results (446)

Paraneoplastic neurological syndromes (PNSs) are immune-mediated disorders caused by an antitumor response that cross-reacts with the nervous system, leading to severe and often irreversible neurological disability. Once considered exceedingly rare, PNSs are now increasingly recognized owing to the identification of novel neural autoantibodies, wider use of commercial testing, and the emergence of immune checkpoint inhibitor (ICI)-related neurotoxicity that phenotypically overlaps with classic PNS. In this narrative review, we performed a structured search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, without date restrictions, to summarize contemporary advances in the epidemiology, pathogenesis, diagnosis, and management of PNS. Population-based data show rising incidence, largely reflecting improved ascertainment and expanding indications for ICIs. Pathogenetically, we distinguish T-cell-mediated syndromes associated with intracellular antigens from antibody-mediated disorders targeting neuronal surface proteins, integrating emerging concepts of molecular mimicry, tumor genetics, and HLA-linked susceptibility. The 2021 PNS-Care criteria are also reviewed, which replace earlier “classical/non-classical” definitions with risk-stratified phenotypes and antibodies, and demonstrate superior diagnostic performance while underscoring that “probable” and “definite” PNS should be managed with equal urgency. Newly described antibodies and methodological innovations such as PhIP-Seq, neurofilament light chain, and liquid biopsy are highlighted, which refine tumor search strategies and longitudinal monitoring. Management principles emphasize early tumor control, prompt immunotherapy, and a growing repertoire of targeted agents, alongside specific considerations for ICI-associated neurological syndromes. Remaining challenges include diagnostic delays, limited high-level evidence, and the paucity of validated biomarkers of disease activity. Future work should prioritize prospective, biomarker-driven trials and multidisciplinary pathways to shorten time to diagnosis and improve long-term outcomes in patients with PNS. Full article

Background: Children with disabilities and special educational needs show heterogeneous developmental profiles that may be associated with executive functioning and family factors. This study examined functional developmental profiles in primary education and their associations with executive functions, behavioural indicators, and parental mental health. Methods: Participants were 106 children aged 6–12 years attending mainstream schools, including a subgroup with special educational needs. Parents completed the Developmental Profile-3 (DP-3) and a family mental-health record, while teachers completed the Screening of Emotional and Behavioural Problems in Children (SPECI) and Behaviour Rating Inventory of Executive Function-2 (BRIEF-2) based on structured ratings derived from daily interaction with the child. Correlational and regression analyses were conducted. Results: Executive functions—particularly working memory and planning/organisation—were consistently associated with global, adaptive, and social development. Parental overload showed negative associations with several developmental domains. Associations with behavioural indicators were modest. Conclusions: Developmental functioning in children with and without special educational needs is associated with executive functions and family factors as perceived by parents and teachers. Findings should be interpreted as relational and inform future assessment and inclusive educational planning. Full article

Background/Objectives: Finger amputation is frequently followed by complications, with reported revision rates of up to 20%. One of the most disabling sequelae is the formation of painful neuromas, occurring in approximately 3–9% of cases. Several biological and mechanical risk factors have been proposed, but the potential influence of psychological traits remains poorly understood. This study aimed to investigate whether a correlation exists between patients’ personality traits and the development of neuropathic pain or related symptoms. Methods: A retrospective study was conducted at a Level II Hand Trauma Center, including patients who underwent digital amputation between 2021 and 2023. Neuropathic pain and cold intolerance were assessed using the S-DN4 and CISS questionnaires, respectively. Personality traits were evaluated using the BFI-10 scale. Demographic data and other clinical risk factors, including work-related injuries, psychiatric history, infection, treatment delay, and surgical technique, were also analyzed. Results: A total of 54 patients were included. Neuropathic pain, defined by an S-DN4 score ≥ 4, was identified in 10 patients (18.5%). A significant correlation was found between the occurrence of neuropathic pain, cold intolerance, and the “neuroticism” personality trait. Patients with work-related injuries or psychiatric disorders also showed a higher risk of neuropathic pain and cold intolerance. Conversely, infection and delayed treatment were associated with an increased risk of revision procedures, whereas the type of surgical technique used for nerve stump management was not significantly correlated with pain outcomes. Conclusions: The study demonstrated a meaningful association between the neurotic personality trait and both neuropathic pain and cold intolerance after finger amputation. Additionally, work-related injuries and psychiatric comorbidities were identified as potential risk factors. Patients exhibiting these characteristics may benefit from early psychological assessment and multidisciplinary management to prevent further complications and improve postoperative outcomes. Full article

Pathogenic variants in the PAK1 gene are linked to neurodevelopmental and neurodegenerative disorders by disrupting neuronal signaling and function. Despite increasing recognition, the mechanisms underlying these conditions remain incompletely understood, limiting therapeutic options. Here, we report a novel de novo PAK1 variant, c.396C>A (p.Asn132Lys), in a 5-year-old girl with Intellectual Developmental Disorder with Macrocephaly, Seizures, and Speech Delay (IDDMSSD). The patient presented with mild intellectual disability, delayed speech, macrocephaly, hypotonia, gait ataxia, autism-like behaviors, and focal epileptiform activity. Trio exome sequencing confirmed the variant as likely pathogenic, absent in her parents and population databases. This finding expands the phenotypic spectrum of PAK1-related disorders and underscores the critical role of the autoinhibitory domain in neurodevelopment. In addition, we performed a comprehensive literature review of PAK1 variants affecting both the autoregulatory and kinase domains, summarizing associated clinical features and pathogenic mechanisms. Our study highlights the importance of identifying PAK1 pathogenic variants for accurate diagnosis, refined genotype-phenotype correlations, and the development of potential targeted therapeutic strategies. By integrating novel case data with existing literature, this work advances understanding of PAK1-related neurodevelopmental disorders and supports the application of genetic analysis in rare pediatric NDD cases. Full article

Background/Objectives: Return to work (RTW) after an industrial accident is crucial for an individual’s well-being and socioeconomic recovery. This study investigated factors influencing RTW among workers who sustained physical or brain lesion-related disabilities following industrial accidents. Methods: Using five-year panel data (2018–2022) from the Panel Study of Workers’ Compensation Insurance of South Korea, we analyzed 340 individuals with physical or brain lesion-related disabilities sustained from industrial accidents. We used logistic regression models to identify factors associated with RTW and return to employed (RTE) status. Results: The RTW and non-RTW groups comprised 160 and 180 participants, respectively. Factors associated with non-RTW included female sex (adjusted odds ratio [aOR], 0.33; 95% confidence interval [CI], 0.13–0.86; p = 0.023), injury caused by disease (aOR, 0.18; 95% CI, 0.05–0.66; p = 0.010), long recovery periods (aOR, 0.27; 95% CI, 0.10–0.72; p = 0.009), low self-confidence (aOR, 0.16; 95% CI, 0.07–0.35; p < 0.001), and older age (aOR, 0.08; 95% CI, 0.02–0.34; p = 0.001). Workers with no blood pressure problems (aOR, 2.21; 95% CI, 1.11–4.38; p = 0.024) and longer employment durations (aOR, 3.84; 95% CI, 1.15–12.81; p = 0.029) had a higher chance of RTW. Similar factors were associated with RTE, with more emphasis on older age, long recovery periods, low self-confidence, and injury caused by disease. Conclusions: Our findings contribute to developing targeted support services and informing policy decisions to improve RTW for workers with physical or brain lesion-related disabilities caused by industrial accidents. Full article

The oxoglutarate dehydrogenase-like (OGDHL) gene encodes a brain-enriched, rate-limiting enzyme in the tricarboxylic acid cycle, playing an essential role in mitochondrial energy metabolism. Mutations in OGDHL are linked to a broad spectrum of neurodevelopmental disorders, characterized by developmental delay, intellectual disability, epilepsy, corpus callosum dysgenesis, and sensory deficits. This mini-review systematically summarizes the discovery, structural features, and molecular functions of OGDHL, and provides a comprehensive catalog of all reported pathogenic mutations and their clinical phenotypes. By linking mitochondrial energy metabolism and neural pathogenesis, this work positions OGDHL as a potential key regulator in neural development and function. Ultimately, this review aims to advance further research on OGDHL in the nervous system, enhance the understanding of metabolic regulation in neurodevelopment, and lay the groundwork for elucidating the mechanisms underlying OGDHL-related neurological diseases. Full article

Background/Objectives: Musculoskeletal disorders (MSDs) contribute to work disability arising from personal and work-related physical, organizational and psychosocial factors that often differentially affect men and women. We aimed to identify determinants of the sex/gender difference in duration of MSD work absence through a mixed-studies systematic review. Methods: We synthesized evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach adapted to prognostic studies and meta-ethnography for qualitative studies, followed by a mixed synthesis. Results: Twenty-six quantitative and four qualitative studies contributed to the evidence synthesis. Only two of the twenty-six quantitative studies addressed the sex/gender gap directly, compared to three of the four qualitative studies. Most other quantitative studies provided evidence from sex/gender-stratified analyses of determinants of MSD disability. The synthesis of qualitative studies suggested that domestic strain, less access to modified work/retraining, and gender-biased attitudes of health and insurance system gatekeepers hindered women’s return to work. Prognostic factors in women supporting this conclusion from quantitative studies included the combination “working ≥ 40 h/week and having dependents” and low supervisor support. The mixed synthesis yielded a conceptual model of hypothesized determinants of the sex/gender difference in MSD work disability that integrates factors from personal, workplace, healthcare and insurance–disability management spheres, influenced by the larger sociopolitical, cultural and macroeconomic context. Conclusions: Studies directly addressing the sex/gender gap in MSD disability are needed. These can be informed by the proposed model. Practitioners and policymakers can build upon the model to develop and implement MSD prevention and rehabilitation interventions tailored to the needs of men and women to reduce sex/gender disparities. Full article

The intersections between disability, sex work, and the law are complex and intertwined. The paper aims to uncover how courts approach this entanglement and conceptualize disabled sexuality. Our account will illustrate how social norms, legal frameworks, international standards, and disability rights intersect in judicial outcomes and reasoning. The paper employs a case study methodology and disability theory. It offers a detailed analysis of two case studies that share a similar story, that of a disabled individual seeking funding for some sexuality-related services. Yet, they differ in many other perspectives; they were given 15 years apart by courts in different countries with distinct social and legal contexts. An Israeli case from 2006 highlights the challenges faced by a disabled individual in the absence of a formal disability rights framework, reflecting broader debates about the meaning of sexuality in the lives of disabled people, and an Australian case from 2020 centers on the inclusion of sexual services within disability support schemes, touching on issues of sexual rights, participation, and disabled individuals’ needs. This comparative approach highlights the evolving nature of judicial views on disabled sexuality, revealing both a gradual recognition of disabled individuals’ sexual rights and needs, alongside persistent stigmatizing and ableist misconceptions of disabled sexuality. Full article

Introduction: Chronic non-specific neck pain is a musculoskeletal disorder which may affect psychological well-being and work performance. Depression, anxiety, and limitations in daily and work activities may occur differently between genders in individuals with chronic non-specific pain. The main purpose of the present cross-sectional study was to investigate the differences between men and women with chronic non-specific neck pain in disability due to pain, quality of life, and sedentary behavior. Secondly, we investigated the intercorrelations between the three above measured variables in the total sample. Methods: Eighty patients (44 men and 36 women), aged 20–55 years (Μ = 33.55, SD = 11.16) with chronic non-specific neck pain in the last 3 years participated. They completed three validated questionnaires which measured neck disability pain, quality of life, and sedentary behavior with (a) the Neck Disability Index (NDI), (b) the quality-of-life EuroQol-5D (EQ-5D), and (c) the International Physical Activity Questionnaire (IPAQ), respectively. Gender comparisons with Kruskal–Wallis H tests and correlation analysis with Spearman r tests were performed between the above variables using SPSS 29.00. Results: Men reported (a) better quality of life (H = 16.14, p < 0.001), (b) lower pain-related disability (H = 13.96, p < 0.001), (c) more time spending in vigorous physical activity (H = 3.37, p < 0.05), (d) more time spending in moderate physical activity (H = 5.17, p < 0.05), and (e) more time spending in walking (H = 11.24, p < 0.001). A strong positive correlation was found between the NDI and the EQ-5D Index (r = 0.74, p = 0.002) and a negative correlation was found between NDI and the EQ-5D VAS (r = −0.65, p = 0.003). Discussion: The present findings reported that men have more time walking, and have lower disability due to neck pain than women, thus they have better quality of life than women with chronic non-specific neck pain. Full article

Over the 21st century, the confluence between engineering and universal accessibility has emerged as a key research domain, reflecting the growing awareness of the importance of inclusive layout in technological innovation. Despite the growing number of studies on sustainability and inclusion, there is still a lack of comprehensive analyses exploring how engineering contributes to universal accessibility within the framework of the United Nations Sustainable Development Goals. This study addresses this gap by providing the first large-scale mapping of research trends, collaborations, and thematic evolution in this field. The present bibliometric analysis examines the evolution of engineering research in relation to the United Nations Sustainable Development Goals, stressing its role in encouraging universal accessibility. Through a systematic review of scholarly works produced over the last twenty years, this study uncovers dominant issues, evolving research fronts, and the global relevance of engineering-based approaches to improve accessibility for persons with disabilities. Analyzing citation dynamics, publication trajectories, and institutional involvement, this study underlines the contribution of engineering to building inclusive societies and ensuring equitable access to technology and infrastructure. Discoveries underscore that cross-sector collaboration and technological innovation are essential to overcoming accessibility challenges among disfavored populations, directly advancing SDG 10 on reducing disparities and SDG 11 on sustainable urban development. Full article

This research explores how coalitions of leaders who score high in the Dark Triad traits—narcissism, Machiavellianism, and psychopathy—rebuild moral architectures in organizations to consolidate power, suppress dissent, and secure their rule. Contrary to work that has focused predominantly on individual toxic leaders, this research examines the collective processes that emerge when multiple high-DT-scoring leaders coalesce and unify their moral leadership front. Adopting a qualitative, article-based document analysis methodology, this study synthesizes and critiques evidence from 55 peer-reviewed articles published between 2015 and 2025. Thematic analysis identified three fundamental dynamics through which Dark Triad leaders collectively exercise dominance. The first, the Ethics Cartel, involves the construction of a shared moral façade that legitimates power and shields wrongdoing. The second, Mutual Cover, outlines forms of mutual protection in which leaders shield one another from accountability and scrutiny. The third, Cultural Capture, outlines processes through which organizational culture is increasingly reconfigured such that “ethics” are structured to favor leadership over employees or wider stakeholders. This study illustrates how these coalitions cross over into individual transgressions, creating systemic risk that warps the fabric of organizational culture. Employees are confronted with a work culture that positions ethics as a means of developing survival adaptive mechanisms, such as silence, withdrawal, or compliance. These processes not only harm psychological safety and break trust but also disable accountability mechanisms established to maintain integrity. This study contributes to the study of leadership and organizational ethics by framing ethics not as merely an individual moral stance but as a collective instrument of power. It calls for more attention to the risks that follow collaboration among toxic leaders and for governance arrangements that address the organizational and systemic consequences of these unions. By situating these findings within the broader debate on power, people, and performance, this paper aligns with the focus of the Special Issue “Power, People, and Performance: Rethinking Organizational Leadership and Management” by showing how collective Dark Triad leadership distorts organizational performance outcomes while reshaping power relations in ways that undermine people’s trust and well-being. These insights extend Alowais & Suliman’s findings, highlighting the systemic feedback loops sustaining ethical distortion. Full article

Background: The American Society of Clinical Oncology (ASCO) established recommendations for palliative care (PC), and they still remain the most trusted source overall. The standard published by C. Earle (defined in solid tumors) for referral to PC is > 55%. However, these rates remain unclear in general onco-hematology. Our referral rate reaches 60%; while it meets the standard, there are significant differences between ST and HM. Several authors have already pointed out these discrepancies. Arguing in some cases its possible relationship with the different behavior of professionals with different pathologies. Objective: The primary objective of this work is to understand the role that PC plays in onco-hematology and to determine the profile of patients referred to PC. Therefore, the article aims to establish some recommendations related to the results of prevalent characteristics. Methods: The Mortality Subcommittee (MS) includes and registers in a database all cancer patients who died in hospital undergoing systemic anticancer therapy (SACT) in their last 30 days of life (SACT ≤ 30 d). PC, in turn, works on relieving symptoms related to the disease and the patient. To understand the impact of PC in the MS database patients, we reviewed the literature for symptoms related to palliative care activity. Subsequently, we selected some signs and symptoms, by consensus with our PC specialists, in order to add them to the MS database and register them retrospectively. We measured the percentage of patients who registered these symptoms based on the data found in their electronic records. The results include the comparison by group: between patients referred or not to the PC program (PCP), and between the pathologies ST and HM. We used the programming language R (version 4.2) in our statistical analysis, including the “compareGroups” package (version 4.6), applying the pertinent tests based on the distribution of the data. Results: We completed the records on the 1681 patients from the period 2020–2023. 59.4% were men, the average age was 65.5 years, and 73.5% had ST and 26.5% had HM. Patients with lung cancer predominate (28.5%), with 71% of them being in the stage IV, followed by leukemia (9.76%). 60% are in progression of their disease, and 77% have advanced disease (AD). The average therapeutic aggressiveness indicators were SACT < 30 d: 38.9% (ST: 33.4%; HM: 70.97%); SACT < 14 d: 16.36% (ST: 13.76%; HM: 31.56%); the change in therapeutic regimen was 22% (ST: 20.8%; HM: 25.1%). The referral rate to PCP was 59.7% (ST: 68.2% and HM: 36.3%). Late referral (PCP ≤3 days before death) occurred in 29.2% of all patients, being 29% for ST cases and 30.4% for HM cases. Regarding the recording of signs and symptoms: psycho-emotional and analgesia regimens (including opioids) are better recorded in the PCP group (p < 0.001); the more physical symptoms (dyspnea, bleeding, infections, and severe symptoms) do not present statistically significant differences, although the severe symptoms in the PCP group are more disabling (cerebral involvement, spinal cord compression, vertebral crushing). The number of bags of blood products transfused is significantly lower in the PCP group (average 6.9 vs. 12.7). The total number of symptom variables with significant statistical differences was 13 for ST and 8 for HM. Conclusions: In this cohort, patients visited by PC had a better record of psycho-emotional symptoms. We consider that patients who are in any of the following situations should be referred to PC: initial diagnosis of stage IV lung cancer, leukemia; patients with advanced disease; presence of pain requiring opioids; psychoemotional symptoms; need for >7 to 15 transfusions of blood products and, if there are disabling symptoms. PC improves professional interest in the psycho-emotional and fragility situation of these patients. According to our data (in terms of the number of variables with significant differences by pathology group), we observed that hematologists tend to take on palliative tasks more frequently than their oncologist peers, who delegate them to PC in order to have more time dedicated to their specific field. Full article

Background and Objectives: Individuals with Down syndrome (DS) represent a specific and vulnerable population requiring improvements in public health and social policies to ensure equal opportunities, longer life expectancy, and better quality of life. Accurate epidemiological and demographic indicators are essential for planning and evaluating interventions. This study aims to assess the prevalence of DS in Croatia from 2014 to 2024, analyzing demographic characteristics and regional distribution. A comparative analysis with international data and a review of national policies related to persons with disabilities and DS are also included. Materials and Methods: Data on the prevalence of DS were collected from the National Registry of Persons with Disabilities, where reporting individuals with DS is mandatory for the realization of legal rights. This ensures high data quality and representativeness. Prevalence per 1000 live births was calculated based on data from the national birth database and the registry. Results: The overall prevalence of DS in Croatia increased from 3.7 to 5.3 per 10,000 population during the observed period, while prevalence among live-born infants ranged from 1.1 to 1.5 per 1000. Males were slightly more represented (52.5%). The most common comorbidities included congenital heart defects. The mean age of individuals with DS was 28 years, with 12 individuals recorded as being older than 65 years and one individual aged 85. Conclusions: The DS prevalence in Croatia is comparable to data from European Union countries. The observed increase in prevalence and in the total number of individuals with disabilities highlights the need for continuous development and adaptation of national policies. As a signatory of the Convention on the Rights of Persons with Disabilities, Croatia is actively working to improve its legislative framework and support systems to ensure equal rights and enhance quality of life for individuals with DS. Full article

Background: Swimming is a common goal for children with disability, and the most popular sport for children in Australia. This study explored swimming and rehabilitation professionals’ perceptions of swimming for Australian children with disability. Methods: Rehabilitation and swimming professionals with recent experience working with children with disability completed an online survey. Quantitative data from binary and Likert-scale questions were analysed descriptively. Qualitative data from open-ended questions was evaluated using reflexive thematic analysis and mapped to the family of Participation-Related Constructs (fPRC). Results: Ninety-one swimming and 55 rehabilitation professionals (n = 146) responded. Most were confident supporting children with disability with swimming goals (rehabilitation = 71.6%, swimming = 73.8%) but had neutral–very low knowledge of para-swimming eligibility and classification (rehabilitation = 75%, swimming = 77.7%). Ten themes (33 code groups) covering all core elements of the fPRC were identified. Barriers/facilitators included pool accessibility (physical and sensory); program availability; affordability; acceptability (of content and culture); and having accommodating professionals and programs. Professionals believed that swimming programs should develop children’s confidence, water-safety, swimming skills, and fitness. Conclusion: Rehabilitation and swimming professionals should review existing programs to ensure they meet the needs of children with disability. Further research is needed to create an action plan to improve swimming participation for Australian children with disability. Full article

Asthma is a chronic respiratory disease resulting from a complex interplay of genetic, environmental, and occupational factors. Key environmental risks include exposure to tobacco smoke and respiratory sensitizing agents, many of which are prevalent in workplace settings. In adults, asthma is associated with reduced employment, job instability, and work-related disability, resulting in significant social and economic consequences. This scoping review investigates the role of exposure to respiratory sensitizers in the onset and progression of asthma, considering data from the general population to occupational settings, with a focus on sex and gender as key modifiers of risk, disease severity, and occupational outcomes. Biological studies were also considered to clarify the mechanisms underlying observed sex/gender differences. Epidemiological data indicate that women are disproportionately affected by asthma, experiencing more severe symptoms, higher comorbidity rates, and increased exposure in certain professions such as healthcare, cleaning, and textile work. These disparities are attributed to both sex-related factors (e.g., hormonal influences) and gender-related factors (e.g., occupational roles, smoking habits). Although traditional job roles are changing, women continue to face greater occupational asthma risks. As roles evolve, physiological sex-based differences may become increasingly relevant in shaping asthma susceptibility. This review emphasizes the need for sex- and gender-sensitive strategies in asthma prevention, surveillance, and management, especially in occupational health contexts. Full article