Analyzing the Quality of Life in Individuals with Fragile X Syndrome in Relation to Sleep and Mental Health

The purpose of this paper was to examine the physical, emotional, social and school functioning domains of quality of life of individuals with Fragile X Syndrome, in relation to mental health and sleep patterns to gain a better understanding of how these aspects are affected by the disorder. This study included 119 individuals with Fragile X Syndrome who were given different cognitive examinations by a neuropsychologist or by parent-proxy questionnaires. This study focused on the Pediatric Quality of Life Inventory (PedsQoL), the Anxiety, Depression and Mood Scale (ADAMS), the Children's Sleep Habits Questionnaire (CSHQ), but did include other cognitive tests (Vineland Adaptive Behaviour Scales, Nonverbal IQ, Autism Diagnostic Observation Schedule). We identified significant associations between decreases in emotional, social and school domains of PedsQoL and the ADAMS subtests of Generalized Anxiety, Manic/Hyperactivity and Obsessive/Compulsivity, with the subtest of Depressed Mood having associations with lower physical and emotional domains. We also identified a significant impact between CSHQ subtests of Sleep Anxiety, Night Wakings, Daytime Sleepiness, and Parasomnia with the emotional and school domains of PedsQoL. There were associations connecting school functioning with Bedtime Resistance, and additional associations connecting emotional functioning with Sleep Duration and Sleep Onset Delay. Physical functioning was also associated with Sleep Anxiety. Our study shows how mental health and sleep defects impact improper sleep patterns and mental health which leads to decreases in the quality of life for individuals with FXS, and how it is important to screen for these symptoms in order to alleviate issues.

Measure what matters: considerations for outcome measurement of care coordination for children with neurodevelopmental disabilities and medical complexity

Introduction

Care Coordination (CC) is a significant intervention to enhance family's capacity in caring for children with neurodevelopmental disability and medical complexity (NDD-MC). CC assists with integration of medical and behavioral care and services, partnerships with medical and community-based supports, and access to medical, behavioral, and educational supports and services. Although there is some consensus on the principles that characterize optimal CC for children with NDD-MC, challenges remain in measuring and quantifying the impacts of CC related to these principles. Two key challenges include: (1) identification of measures that capture CC impacts from the medical system, care provider, and family perspectives; and (2) recognition of the important community context outside of a hospital or clinical setting.

Methods

This study used a multilevel model variant of the triangulation mixed methods design to assess the impact of a CC project implemented in Alberta, Canada, on family quality of life, resource use, and care integration at the broader environmental and household levels. At the broader environmental level, we used linked administrative data. At the household level we used quantitative pre-post survey datasets, and aggregate findings from qualitative interviews to measure group-level impacts and an embedded multiple-case design to draw comparisons, capture the nuances of children with NDD-MC and their families, and expand on factors driving the high variability in outcome measures. Three theoretical propositions formed the basis of the analytical strategy for our case study evidence to explore factors affecting the high variability in outcome measures.

Discussion

This study expanded on the factors used to measure the outcomes of CC and adds to our understanding of how CC as an intervention impacts resource use, quality of life, and care integration of children with NDD-MC and their families. Given the heterogeneous nature of this population, evaluation studies that account for the variable and multi-level impacts of CC interventions are critical to inform practice, implementation, and policy of CC for children with NDD-MC.

Children with Disabilities in Canada during the COVID-19 Pandemic: An Analysis of COVID-19 Policies through a Disability Rights Lens

Children with disabilities were especially vulnerable during the COVID-19 pandemic, and policies designed to mitigate its effects were limited in addressing their needs. We analyzed Canadian policies related to children with disabilities and their families during the COVID-19 pandemic to identify the extent to which these policies aligned with the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) and responded to their mental health needs by conducting a systematic collection of Canadian provincial/territorial policies produced during the pandemic, building a categorization dictionary based on the UN CRPD, using text mining, and thematic analysis to identify policies' alignment with the UN CRPD and mental health supports. Mental health was addressed as a factor of importance in many policy documents, but specific interventions to promote or treat mental health were scarce. Most public health policies and recommendations are related to educational settings, demonstrating how public health for children with disabilities relies on education and community that may be out of the healthcare system and unavailable during extended periods of the pandemic. Policies often acknowledged the challenges faced by children with disabilities and their families but offered few mitigation strategies with limited considerations for human rights protection.

Impacts of the COVID-19 Pandemic: Pan-Canadian Perspectives From Parents and Caregivers of Youth With Neurodevelopmental Disabilities

INTRODUCTION

The COVID-19 pandemic brought unprecedented challenges for youth with neurodevelopmental disabilities (NDD) and their families. Although health measures were implemented to contain the COVID-19 virus, they disrupted public service, profoundly impacting youth and their families' access to services. This study sought to better understand the perspectives and experiences of parents and caregivers of youth with NDD across Canada in accessing services and their mental health needs during the pandemic.

METHOD

The study used a qualitative research design in which we interviewed 40 parents and caregivers across Canada.

RESULTS

The results enabled us to understand the impact of service disruptions in significant areas of life, including health, education, employment, and risk mitigation.

DISCUSSION

Policymakers must consider a disability-inclusive lens during public health emergency planning and response to reduce the disproportionate impacts faced by youth with NDD and their families.

Pan-Canadian caregiver experiences in accessing government disability programs: A mixed methods study

BACKGROUND

At present, little is known about the factors that contribute to the relatively low uptake of government-funded disability programs in Canada.

AIM

Understand how parents/caregivers of Canadian youth with neurodevelopmental disability (NDD) experience the process of applying for and accessing disability programs.

METHODS AND PROCEDURES

This mixed methods sequential explanatory study utilized two phases: an online survey (quantitative), followed by semi-structured interviews (qualitative). The quantitative phase gathered sociodemographic information and preliminary information about participant experiences applying for and accessing programs. The qualitative phase provided greater depth by asking participants to describe barriers and facilitators to program access.

OUTCOMES AND RESULTS

499 participants completed the online survey and 81 participants completed an interview. Analysis of survey data revealed that many participants are not accessing disability programs and experience difficulty when applying. Regression analyses revealed that factors relating to the process of applying and applicant/family attributes are significantly associated with program access. Inductive thematic analysis of interview data revealed four barriers and three facilitators to access. Integration of findings provided an overview of the multi-faceted journey to program access.

CONCLUSIONS AND IMPLICATIONS

The results of this study highlight policy changes that are needed to ensure disability programs adequately support Canadian families.

Mental health challenges during COVID-19: perspectives from parents with children with neurodevelopmental disabilities

Background

The global pandemic and subsequent denials, delays, and disruptions in essential daily activities created significant challenges for children with neurodevelopmental disorders (NDDs) and their parents. Public health restrictions during the COVID-19 pandemic limited access to supports and services required by children with NDDs to maintain their health and well-being.

Objective

This study sought to understand the impacts of these public health measures and restrictions on mental health from the perspective of parents with children with NDDs to inform pathways for public health policies responsive to the needs of this population.

Method

Interpretive descriptive design was used to guide data collection and data analysis. Forty caregivers were interviewed about their experience with pandemic restrictions.

Findings

Generic policy measures contributed to many gaps in families’ social support systems and contributed to mental health challenges for children and their parents. Four themes emerged: 1) lack of social networks and activities, 2) lack of access to health and social supports, 3) tension in the family unit, and 4) impact on mental health for children and their parents.

Recommendations

Emergency preparedness planning requires a disability inclusive approach allocating resources for family supports in the home and community. Families identified supports to minimize further pandemic disruptions and enhance recovery.

Generic preference-based health-related quality of life in children with neurodevelopmental disorders: a scoping review

AIM

To describe how generic preference-based health-related quality of life (HRQoL) instruments have been used in research involving children with neurodevelopmental disorders (NDD).

METHOD

A systematic search of nine databases identified studies that used generic preference-based HRQoL instruments in children with NDD. Data extracted following the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Review guidelines included type of NDD, instrument used, respondent type, justification, and critical appraisal for these selections.

RESULTS

Thirty-six studies were identified: four cost-utility analyses; 15 HRQoL assessments; five economic burden studies; three intervention studies; and nine 'other'. The Health Utilities Index (Mark 2 and Mark 3) and EuroQoL 5D (EQ-5D; three-level EQ-5D, five-level EQ-5D, and the youth version of the EQ-5D) instruments were most frequently used (44% and 31% respectively). The relatively low use of these instruments overall may be due to a lack of psychometric evidence, inconsistency in justification for and lack of clarity on appropriate respondent type and age, and geographical challenges in applying preference weights.

INTERPRETATION

This study highlights the dearth of studies using generic preference-based HRQoL instruments in children with NDD. The use of cost-utility analysis in this field is limited and validation of these instruments for children with NDD is needed. The quality of data should be considered before guiding policy and care decisions.

WHAT THIS PAPER ADDS

Limited use of generic preference-based health-related quality of life (HRQoL) instruments in studies on children with neurodevelopmental disorders. Only 11% of studies were cost-utility analyses. Inconsistencies in justification for choosing generic preference-based HRQoL instruments and respondent types.

Nodular melanoma presenting as an exophytic subungual mass

Despite being recognised and reported in the literature for decades, subungual melanoma of the foot remains a diagnostic pitfall, with it commonly being mistaken for benign conditions. We present an interesting case of delayed diagnosis of subungual melanoma of the hallux that was misdiagnosed in the community for over one year. With melanoma being the fourth most commonly diagnosed cancer in Australia in 2013, this case serves as a reminder to all clinicians about the importance of maintaining a high index of suspicion for melanoma of the foot.

Intestinal microbiota balance modulates host susceptibility to infection with enteric pathogenss

Background: During our lifetimes we develop a very complex set of interactions with the multitude of microorganisms colonizing our bodies. In the gastrointestinal system, the microbiota is highly important for morphological development, nutrition, and protection against infectious diseases. The gastrointestinal pathogens, enterohemorrhagic and enteropathogenic Escherichia coli (EHEC and EPEC) and Salmonella enterica serovar Typhimurium (ST) are food-borne pathogens that cause much morbidity and mortality worldwide. Citrobacter rodentium (Cr) is a mouse pathogen that is used in small animal models to mimic EHEC and EPEC infections. Methods: We began to characterize the contribution of intestinal microbiota to the progression of these infections. Two main phyla comprise the majority of mouse intestinal microbiota: Bacteroidetes and Firmicutes. Bacteria from a number of additional phyla are also present in smaller numbers; among them γ-Proteobacteria class, belonging to Proteobacteria phylum, is note-worthy as this class harbours many intestinal pathogens, such as ST and Cr. The mouse intestinal microbiota was perturbed using tetracycline (Tet) and streptomycin (Sm) to increase the proportion of Bacteroidetes in the colonic microbiota, and using vancomycin (Vanc) to create a predominance of Firmicutes. The mice with this perturbed microbiota were infected with ST to investigate the resultant pathology and virulence characteristics, and any additional shifts in microbiota as a result of infection. Results: Treatment of mice with Sm and Vanc was found to decrease the resistance of mice to colonization with ST, while Tet-treated mice exhibited unchanged colonization resistance. Treatment of mice with gradually increasing doses of Sm, which gradually augmented the proportion of CFB bacteria in the microbiota, resulted in progressively increasing colonization of mice by ST, as well as a step-wise increase in the ST-induced typhlitis, associated with higher levels of inflammatory markers IL-6 and KC. The increasing levels of ST colonization following both Sm and Vanc treatment were associated with an increase in the proportion of γ-Proteobacteria in the cecal and colonic microbiota, as well as a decrease in the total bacterial numbers in both organs. Conclusions: It is evident that the intestinal microbiota plays a significant role in the host’s response to infection with enteric pathogens, and its composition and numbers are also affected by the offending bacteria. Elucidation of the details regarding the contribution of the microbiota to infectious disease progression will offer novel targets for the future design of superior prevention and treatment methods.

Controlling the maturation of pathogen-containing vacuoles: a matter of life and death

Once considered to be contained, infectious diseases of bacterial origin are now making a comeback. A lack of innovative therapies and the appearance of drug-resistant pathogens are becoming increasingly serious problems. A better understanding of pathogen-host interactions at the cellular and molecular levels is necessary to define new targets in our fight against microorganisms. In the past few years, the merging of cell biology and microbiology has started to yield critical and often surprising new information on the interactions that occur between various pathogens and their mammalian host cells. Here we focus on the intracellular routing of vacuoles containing microorganisms, as well as on the bacterial effectors and their host-cell targets that control vacuole maturation. We also describe new approaches for isolating microorganism-containing vacuoles and analysing their molecular composition, which will help researchers to define the molecules and mechanisms governing vacuole biogenesis.

Masculinity scores as an artifact of feminist attitude: evidence from a study of lesbians and college women

Data from a sample of lesbian women (n = 58) and college women (n = 129) are analyzed to examine the relationship between feminism (AWS), sexual orientation, and a PAQ-defined masculinity score. While lesbians have higher M scores, they also have very high AWS scores. When AWS is controlled in a multiple regression analysis, the difference on M scores between the two sexual orientation groups disappears. The results support the hypothesis that high masculinity scores for women represent strong self-confidence and independence, characteristics of those with positive feminist outlooks. We also argue that measures of traits such as independence and expressiveness need to be labeled as such, and not as "masculinity" or "femininity."

A biomechanical analysis of joint contact forces in the posterior cruciate deficient knee

The approach to the posterior cruciate deficient knee is controversial. The purpose of this study is to document the biomechanical changes in the static cadaveric knee model with simulated physiological loads. Nine fresh cadaveric knees from young donors (aged under 45 years) were mounted on a materials testing machine. Loading was carried out at 0 degrees, 30 degrees and 60 degrees to 1.5 kN with low-pressure sensitive Prescale film (Fuji; Tokyo, Japan) inserted through arthrotomies into the medial and lateral compartments. Computerized analysis of the imprints on the film was then carried out. Tests were then repeated after cutting the posterior cruciate ligament (PCL). Results demonstrate a statistically significant posterior subluxation of the tibia on the femur at 60 degrees flexion. This causes a significant increase in contact pressure and pressure concentration on the medial compartment of the knee after cutting the PCL. This may help explain the long-term degenerative changes observed in the medial femoral condyle after cutting the PCL.