Language forms the foundation of social interactions, allowing us to connect with family and peers. Through speech, we express our thoughts and emotions to others. Experiencing challenges in speech and language functions during development can therefore significantly affect social relationships, cognitive and affective development. In child and adolescence psychiatry, clinicians have observed that speech and language abilities may be altered in various mental (behavioral/developmental) disorders (psychiatric disorders). This review provides an overview of systematic and original investigations exploring how speech and language are affected in child and adolescent psychiatric conditions, including autism spectrum, schizophrenia, attention deficit/hyperactivity disorder, and depression. We emphasize research that utilized neuroimaging techniques (i.e., EEG, MRI, fNIRS) to investigate the neurobiological basis for alterations in speech or language in child and adolescence psychiatry. The findings indicate that each reviewed syndrome shows evidence of altered speech or language functions, along with corresponding neurobiological changes. Most available studies focus on autism spectrum, while research concerning schizophrenia and depression generally involved adults rather than children or adolescents. This highlights a considerable research gap in understanding (the neurobiological cause of) speech and language alterations in developing populations with psychiatric conditions.
Adolescence is a period in which appearance and relationships matter more than most. For those with visible differences, they can experience psychosocial challenges in their interactions with others. For young people with limb difference, it is unclear in the literature if they experience similar social challenges to their peers with other visible differences. The study aimed to understand the lived experience of young people with limb difference and explore the impact on their relationships and interactions with others. A qualitative design was used in which data was collected via semi-structured interviews with six young people with limb difference (aged 14-17 years) and analysed using interpretative phenomenological analysis (IPA). Three themes were developed [1]: 'functioning under the threat of others' intrigue' [2], 'being with others like me' [3], 'disability being seen over capability'. Findings demonstrate limb-different young people's perception of their appearance and ability is impacted by other people. Interacting with peers with limb difference can have a positive impact, whereas comments and assumptions from others can have a negative impact. Young people with visible difference can be at risk of psychosocial difficulties due to challenges with interactions with others.The findings demonstrated how the actions of others within social interactions can impact how a young person with limb difference perceives themselves, in terms of their appearance and ability.Rehabilitation professionals should facilitate peer support spaces for socialising with limb-different others as this is not universally available through paediatric healthcare at present.
Suicidal crisis in adolescence often emerges within a context of relational tension. Following a suicide attempt, the assessment of suicidal intent is critical yet complex, particularly when discrepancies arise between the adolescent's self-assessment and their parent's perception. These parent-adolescent discordances are understudied, despite their potential clinical significance. This prospective, monocentric, convergent mixed-methods study included 150 adolescent-parent dyads assessed after an SA. Suicidal intent was evaluated at baseline (T0) and 3 months later (T3) using parallel visual analogue scales completed independently by the adolescent and one parent. Discordance was defined as the difference between both scores. Linear regression models were used to explore associations with changes in suicidal distress. A subsample of 10 dyads underwent semi-structured interviews, analyzed through Interpretative Phenomenological Analysis (IPA). Adolescents rated their suicidal intent higher than their parents did (mean difference = + 2.53, p < 0.001). Three discordance profiles emerged: Parent-High Group, Concordant Group, and Parent-Low Group. Discordance was significantly associated with clinical outcomes at 3 months (p = 0.003). Adolescents in the Parent-Low Group showed the strongest improvements, while those in the Parent-High Group showed higher levels of persistent distress (p = 0.041). This association was attenuated after accounting for baseline adolescent-reported VAS severity. Qualitative analysis revealed the role of discordance as a marker of impaired communication, divergent interpretations, and challenges in parental adjustment. Parent-adolescent discordance in suicidal intent ratings provides clinical insight into the relational configuration of the post-attempt crisis. Its early assessment, alongside dedicated parental support, may improve crisis management. These findings support NICE recommendations for integrative and relational approaches to suicidal crises in adolescents.
Chronic musculoskeletal pain (CMSKP) in adolescence is associated with physical, psychological, social, and academic impairment and increased risk for chronic pain in adulthood. Although physical activity interventions are an evidence-based approach for managing pediatric chronic pain, many adolescents with CMSKP avoid physical activity due to fear of increased pain, low confidence in physical functioning, and other pain-avoidance behaviors. Resilience-focused interventions targeting self-efficacy, motivation, and mental flexibility may improve engagement in valued activities despite pain. This study describes the design and protocol of the Pain REsilience Promotion for Youth (PREP-Y) intervention, a resilience-focused physical activity intervention for adolescents with CMSKP. This single-site, pilot phase 2, single-group, non-randomized clinical trial will enroll 40 adolescents aged 12-17 years with CMSKP from Nationwide Children's Hospital in Columbus, Ohio, USA. Participants complete questionnaires, objective physical functioning assessments, and physical activity monitoring using activPAL devices as baseline measures. Participants then complete 4 virtual resilience-focused intervention sessions targeting pain resilience, self-efficacy, motivation, and adaptive coping related to physical activity. Garmin watches are used to track activity during the intervention period. Follow-up assessments occur post-intervention and at 3 months post-intervention. Primary outcomes include feasibility and acceptability, assessed through recruitment, retention, attendance, intervention fidelity, and completion of study measures. Exploratory outcomes include physical activity, sedentary behavior, pain-related functioning, pain catastrophizing, kinesiophobia, self-efficacy, and resilience-related constructs. The study was approved by the Nationwide Children's Hospital Institutional Review Board. Findings will inform a future randomized clinical trial. This manuscript reflects protocol version 5.0 dated 23 March 2026. ClinicalTrials.gov NCT06923891.
Uncorrected Refractive Errors (URE) constitute a significant public health concern in Kenya, where limited availability of qualified eye care professionals continues to impede equitable access to refractive services. This shortage is particularly acute in rural and underserved regions, resulting in significant unmet visual health needs. The implementation of telemedicine; specifically, a tele-refraction model utilizing low-cost, portable devices, has emerged as a viable and cost-effective approach to decentralize service delivery, enhance accessibility, and mitigate the burden of URE at the primary healthcare level. This non-inferiority diagnostic accuracy study was conducted in Machakos. County, Kenya, to evaluate the performance of the OneSight EssilorLuxottica Foundation's ClickCheck™ tele-refraction model in comparison with conventional face-to-face retinoscopy, which served as the reference (gold) standard. A total of 92 patients (184 eyes) were examined. The tele-refraction procedure entailed a trained technician performing objective refraction using the ClickCheck™ device, followed by subjective refinement under the real-time supervision of a remote optometrist via telecommunication. Statistical analyses assessed the agreement between the final subjective prescriptions obtained from both methods, focusing on the clinical conformity rate for spherical equivalent (SE), cylindrical power, and power vector components within a strict clinical tolerance limit of ±0.50 diopters (D). The study demonstrated a high level of clinical concordance between the telerefraction model and the conventional gold-standard refraction method. The mean difference in spherical equivalent (SE) for objective refraction was minimal (+0.08 D), indicating negligible bias between the two techniques. Importantly, the final subjective prescriptions exhibited excellent clinical interchangeability, with 93.01% of cases falling within the ± 0.50D tolerance for SE and 94.41% within the same tolerance for cylindrical power magnitude. Furthermore, for clinically significant astigmatism, axis alignment showed complete conformity within the 10 degrees tolerance range across all cases. The tele-refraction model using the ClickCheck™ device, combined with remotely guided subjective refraction, demonstrated accuracy, reliability, and non-inferiority when compared with conventional in-person refraction. These findings substantiate the clinical validity of tele-refraction, which holds the potential to mitigate the acute shortage of eye care professionals and to enhance equitable access to refractive error correction services among underserved populations in Kenya.
In 2023 and 2024, Espírito Santo state, Brazil, experienced its largest dengue epidemic in 30 years, with record numbers of cases and deaths. This study aimed to characterize confirmed dengue cases and the dengue virus (DENV) during the epidemic and pre-epidemic periods. A population-based descriptive study integrated with cross-sectional genomic sampling was conducted using data from the eSUS Health Surveillance System (2020-2024) and molecular analysis of serum samples (2023-2024). Whole 26 DENV genomes were obtained and combined with public data for phylogenetic reconstruction. In 2023, 127 070 dengue cases were reported; 2.8% showed warning signs or severe dengue, 2.6% required hospitalization, and 99 cases resulted in death. In 2024, 131 170 cases were reported, with 2.0% showing warning signs or severe dengue, 2.3% requiring hospitalization, and 42 fatalities. Four lineages were detected: DENV-1 genotype V lineages 1V_A and 1V_E.1, DENV-2 genotype II lineage 2II_F.1.1.2, and genotype III lineage 2III_C.1.1. These lineages were closely related to viruses from other regions in Brazil and South America. Our findings highlight the complex dynamics of DENV in Espírito Santo state and hypothesize that the multiple introduced DENV lineages and genetic diversity may have contributed to the magnitude and sustained transmission observed over consecutive years.
The reciprocal pathways between fixed emotion mindsets (FEMs) and responses to negative emotions were examined across three timepoints in a prospective, school-based intervention study of 284 adolescents (119 girls; Mage = 15.38; 48.9% boys; 67.49% non-White) across the 2022-2023 school year. Total-effect models revealed FEMs predicted significantly more disengagement and involuntary dysregulation; indirect-effect models revealed that FEMs predicted significantly lower proactive engagement and higher cognitive avoidance via lower cognitive flexibility. Results also revealed that cognitive flexibility predicted significantly lower FEMs, and involuntary dysregulation predicted marginally higher FEMs. These results highlight the importance of mindsets in the development of effective emotion regulation and identify one potential mechanism that may underlie this link. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Acoziborole (Acoziborole Winthrop), a single-dose, oral antiprotozoal agent, has been developed by Drugs for Neglected Diseases initiative (DNDi), Sanofi and partners for the treatment of human African trypanosomiasis due to Trypanosoma brucei gambiense (g-HAT). In February 2026, the European Medicines Agency (EMA) Committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion for acoziborole for the treatment of first- and second-stage (including severe second-stage) g-HAT in adolescents aged ≥ 12 years and weighing ≥ 40 kg and in adults. Acoziborole was assessed via the EU-M4all procedure for medicines intended for use outside of the EU, and the positive opinion will facilitate the registration of acoziborole in sub-Saharan African countries where g-HAT is endemic. This article summarizes the milestones in the development of acoziborole leading to this positive opinion for the treatment of first- and second-stage g-HAT.
BackgroundDepression undermines adherence to antiretroviral therapy (ART) and is often under-recognized among adolescents living with HIV (ALHIV) in Ghana. We examined the prevalence, associated factors, and lived experiences of depressive symptoms among ALHIV in Accra.MethodsWe conducted a cross-sectional study with an embedded qualitative component at a tertiary hospital. Depressive symptoms were assessed using PHQ-A (score ≥5). Logistic regression identified associations with sociodemographic and clinical factors. In-depth interviews with adolescents screening positive and key informant interviews with healthcare providers were analyzed thematically.ResultsAmong 215 adolescents (mean age 14.1 years; 52.6% male), 9.3% reported depressive symptoms. ART duration <1-year increased odds of depression (AOR 7.2; 95% CI 1.5-36.0). Participants described challenges with guardian-led disclosure, stigma and treatment burden. Counselling and peer support mitigated distress.ConclusionThe study found a low prevalence of depressive symptoms likely attributable to post-counselling exposure. Strengthening structured HIV disclosure could further reduce depression and improve outcomes among ALHIV.
To study the features and co-relation of optic nerve hypoplasia (ONH) with severity of visual impairment and associated neuro-radiologic features. Of 297 ONH medical records screened, 57 patients with photographic documentation of the optic nerves and magnetic resonance imaging (MRI) of the brain and orbits were included in the study. Patient demographics, vision, ocular examination findings, and optic disc photographs for disc diameter: macula distance (DD: DM), size of the disc, and double ring size along with MRI were analyzed by a single observer. The disc to macula ratio was used to grade ONH as <3 as partial/mild ONH, 3.12-4 as complete ONH, and >4.12 severe ONH. The mean age at presentation was 11.38 (±8.87) years. The best corrected visual acuity in the better eye ranged from 20/20 (n = 2; 3.5%) to severe to profound vision loss (<20/200 - no light perception) (n = 25; 43.85%). Optic disc findings suggestive of mild ONH in n= 31eyes (39.2%); and severe in n =17eyes (21.5%). Bilateral ONH was noted in 22 patients (38.6%), and unilateral was noted in 35 patients (59.65%). Neuroimaging findings were reported normal (n = 10, 17.54%), absent septum pellucidum and corpus callosal thinning (n = 19, 33.33%), and chiasmal atrophy (n = 9, 15.8%). Correlation analysis confirmed that as the DD: DM distance increases, poorer vision and abnormal neuro-imaging findings were noted. Severity of ONH as indicated by DD: DM ratio is a surrogate indicator of neuro-radiological abnormalities and poor vision. Neuro-imaging and a multidisciplinary approach are warranted.
Adults formerly placed out-of-home (care leavers) often accumulate multiple psychosocial adversities that can lead to poor quality of life (QoL) and place them at high risk for developing mental disorders persisting into adulthood. This study examines the development of mental disorders among care leavers and their QoL, differentiating by disorder groups. The sample consisted of 119 young adults formerly placed out-of-home (Mage at baseline = 15.0 years; Mage at follow-up = 25.4 years). Mental disorders were assessed at baseline using the Kiddie Schedule for Affective Disorder and Schizophrenia-Present and Lifetime Version and at a 10-year follow-up with the Structured Clinical Interview for DSM-5 Disorders-Clinician Version. Personality disorders were evaluated at both time points using the Structured Clinical Interview for DSM-IV-TR Axis II. QoL was measured at follow-up using the World Health Organization QoL-BREF questionnaire. Four groups based on the presence or absence of mental disorders at baseline and follow-up were identified: resilient (n = 24, 20.2%), persistent (n = 56, 47.0%), remitted (n = 25, 21.0%), and newly occurring (n = 14, 11.8%). Regarding the mental disorder groups, internalizing disorders at baseline (β = -0.44, p < .05, 95% CI [-0.85, -0.04]) and internalizing (β = -0.78, p < .001, 95% CI [-1.14, -0.43]) and externalizing disorders (β = -0.50, p < .01, 95% CI [-0.86, -0.13]) at follow-up were negatively associated with QoL in young adulthood. Mental disorder trajectories from childhood to young adulthood can negatively impact care leavers' QoL. Prevention and early intervention, as well as addressing mental health during out-of-home placement and transition into young adulthood, are important to reduce the risk of persistent psychopathology and lower QoL.
A 13-year-old boy presented with a painful limp for 2 weeks without trauma and guarded (L) hip movements with spasm. Radiographs revealed a valgus slipped capital femoral epiphysis (SCFE) of the left hip with generalized osteosclerosis. Elevated serum calcium, phosphate, and parathyroid hormone levels were noted. Whole-exome sequencing identified a homozygous FGF23 variant, confirming hyperphosphatemic tumoral calcinosis. He was managed with phosphate binders, dietary restriction, and in situ fixation of both hips. At the 2-year follow-up, alignment and function were normal. Association of valgus SCFE with metabolic or sclerosing bone dysplasia requires careful assessment to achieve favorable outcomes.
Postural control (PC) is the capacity to integrate sensory information (visual, somatosensory, and vestibular) to generate muscular responses that maintain an upright posture. PC reflects overall musculoskeletal and neurological health. Establishing normative PC values in healthy middle school students (MSS), ages 11 to 14 years, is important for facilitating the early detection of balance-related anomalies. However, this process is complicated by variations in pubertal development, and existing research on sex differences in PC among MSS has produced inconclusive findings. Therefore, PC was measured using a portable force platform (stabilometry) under 12 testing conditions: three stances [two-feet, tandem, one-foot] with two vision states (eyes open/closed) on two surfaces (firm/foam). Two 30-sec trials in all 12 stances were performed by 164 (68 females, 12.1 ± 0.9 yrs; 96 males, 12.3 ± 1.0 yrs) MSS, with the best effort (i.e., lowest score) used for statistical analysis. Postural summary statistics of path length (mm), median velocity (MD, mm/sec), mean velocity (MN, mm/sec), and sway area (mm2) were calculated and compared. Results demonstrated that females consistently achieved better PC in all four summary statistics across stances. This study suggests that separate normative values for PC should be established for male and female MSS.
Congenital central hypoventilation syndrome (CCHS) is characterized by a markedly impaired ventilatory response to CO2 due to central chemoreceptor dysfunction. Although inadequate ventilation and hypercapnia during exercise have been reported, ventilatory response during exercise has not been quantitatively evaluated in CCHS. This study aimed to quantify ventilatory response during exercise and compare it with that at rest. Ten patients with genetically confirmed CCHS underwent cardiopulmonary exercise test (CPET) using a stepwise incremental treadmill protocol with breath-by-breath respiratory gas analysis. CPET was terminated when end-tidal CO2 (EtCO2) increased by at least 2% (15.2 mmHg) from baseline. Ventilatory response to CO2 (VRCO2) was calculated as Δminute volume (MV)/ΔEtCO2/body weight (mL/min/mmHg/kg). VRCO2 at rest was measured using the CO2 rebreathing method. Data are presented as median (interquartile range [IQR]). Age was 13.5 (12.3-15.5) years, and exercise duration was 5 min 53 s (4 min 47 s-6 min 56 s). Although MV increased during exercise, SpO2 decreased and EtCO2 increased, indicating hypoventilation. VRCO2 during exercise was 2.27 (1.61-3.16), not significantly different from VRCO2 at rest, 1.56 (1.07-2.83) (p = 0.85). VRCO2 was markedly lower than values in healthy children (34.6 (29.3-42.8)). No patients reported dyspnea, and no serious adverse events occurred. VRCO2 during exercise remains profoundly low in CCHS. No significant difference from VRCO2 at rest was detected, suggesting persistent impairment of CO2-driven ventilatory control despite increased metabolic demand. These findings provide insight into exercise-related hypoventilation in CCHS and underscore the importance of objective physiological assessment to support cautious and individualized clinical judgment rather than subjective symptoms.
Healthy life years are estimated from national population surveys that assess limitations in daily activities. However, the infrequent timing and limited sample sizes hinder the timely and detailed assessment of regional health conditions. We aimed to develop a novel method to estimate municipal-level healthy life years without activity limitations by using medical claims data. We analysed medical claims data in Kyoto Prefecture, Japan. Outpatient data from May to July in 2016 and 2019 (n = 1 489 920) were used for development and data from the same period in 2022 (n = 739 236) were used for evaluation. A total of 5743 diagnostic codes were aggregated into 40 disease categories. A machine-learning model was employed to produce the probability of activity limitation, which was calibrated by using data from the Comprehensive Survey of Living Conditions and applied to derive age-specific prevalence rates. Healthy life years at the municipal level as of June 2022 were then estimated by incorporating a life table. We observed variation in healthy life years among municipalities: 72.1 years across all regions for males, ranging from 67.3 to 75.2 years, and 75.8 years for females, ranging from 71.3 to 77.6 years. Regional disparities were also noted in the prevalence of diseases associated with activity limitations. This study provides the first robust, scalable method to estimate healthy life years without activity limitations at the municipal level by using real-world administrative data. Timely monitoring of regional healthy life years will support targeted health-promotion policies and contribute to reducing health disparities.
Dravet syndrome (DS) is a severe, drug‐resistant developmental and epileptic encephalopathy (DEE) that requires polytherapy for adequate seizure control. The need to combine multiple antiseizure medications (ASMs), together with variability in seizure types, safety considerations, and evolving patient needs, makes treatment optimization particularly complex for clinicians. As the United States (US) has one of the largest populations of DS patients and pediatric neurologists/epileptologists worldwide, this study aimed to develop US‐focused consensus guidance to guide clinicians in managing treatment combinations in DS. A modified Delphi consensus methodology was applied. 35 statements tailored to the US clinical context were developed, covering six key themes: general treatment principles; strategies to support and empower caregivers; stiripentol (STP) as an add‐on to DS‐specific and nonspecific ASMs; use of fenfluramine (FFA) in STP‐containing regimens; use of cannabidiol (CBD) in STP‐containing regimens; and patient follow‐up during treatment initiation. Statements were submitted for online voting to 52 US clinicians with expertise in DS and experience with all approved DS‐specific ASMs. Agreement was rated using a 9‐point Likert scale, with predefined criteria used to determine strong, good, or absent consensus. 26 experts participated in the voting process. Of the 35 statements evaluated, 23 (66%) reached strong consensus, 6 (17%) reached good consensus, and 6 (17%) did not reach consensus. Strong agreement was observed for general principles of DS management, caregiver involvement, structured follow‐up, and several practical aspects of initiating and managing STP‐ and FFA‐containing regimens. Areas without consensus primarily concerned CBD efficacy expectations, dosing strategies, and pharmacokinetic interactions in complex polytherapy regimens. This US‐focused consensus provides structured guidance to support clinical decision‐making in the management of polytherapy for DS. Dravet syndrome is a rare and severe form of epilepsy that begins in early childhood and causes seizures that are difficult to control and often persist throughout life. Because most patients require treatment with multiple medications, managing Dravet syndrome is complex and must adapt as patients grow and their needs change. This US‐focused consensus brings together published evidence and expert clinical experience to provide practical guidance on the management of polytherapy in Dravet syndrome, supporting clinicians in optimizing patient care.
Using archival Behavior Rating Inventory of Executive Functioning-Adult (BRIEF-A), Personality Assessment Inventory (PAI), and executive functioning (EF) test data from 826 assessment-seeking postsecondary students, this study sought to assess the impact that response bias, symptom validity, and psychological factors have on self-reported executive dysfunction and the relationship between self-reported EF and objective performance. Study 1 examined whether the BRIEF-A adequately samples negative response bias (NRB) and what the effect was of undetected NRB on obtained BRIEF-A scores. Study 2 explored the relationship between PAI scales and the BRIEF-A Metacognitive Index. When controlling for NRB, Study 3 examined whether objective EF test scores or psychological complaints best predict self-reported EF problems on the BRIEF-A. Findings demonstrate that NRB, as measured by the PAI, resulted in significantly elevated scores on all of the BRIEF-A scales and indices compared with valid reporters. The BRIEF-A Metacognitive Index was most strongly correlated with and best predicted by an overall measure of general psychological distress on the PAI. When controlling for NRB, all BRIEF-A indices were unrelated to objective EF performance but significantly related to general psychological distress along with psychological symptoms reported on the PAI. Overall, in a postsecondary population, responses on the BRIEF-A appear most reflective of psychological symptoms and NRB, not performance on objective EF tests. Clinical implications are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Relative to younger adults, older adults describe autobiographical event memories using less episodic detail. This outcome, although robust and highly replicated, is based on studies conducted in laboratory contexts that use unfamiliar, impersonal structured interviews-a context that may place older adults at an episodic specificity disadvantage. The present preregistered study compared how young adults (N = 24) and cognitively normal older adults (N = 50) narrate autobiographical event memories in a laboratory context, and as they went about their daily lives, using a smartphone application that unobtrusively captured their natural conversations. Findings revealed a significant Context × Age Group interaction for autobiographical memory episodic specificity. Consistent with prior research, older adults recalled less episodic detail than young adults in the laboratory context. However, older adults' episodic detail was significantly higher in event memory narratives captured in their natural conversations relative to the memories they described in the laboratory-based structured interview. In fact, young and older adults did not significantly differ in how specifically they shared event memories in their natural conversations. We found a similar outcome when we zoomed out and examined overall autobiographical thought specificity in natural daily conversations. These findings, along with additional analyses examining how well laboratory measures of autobiographical and neuropsychological functioning predict everyday autobiographical thinking, suggest that even though laboratory tasks may provide some insight into how autobiographical event memories and thoughts are shared in daily conversation, they nonetheless underestimate older adults' natural episodic specificity. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Dysfunctional breathing is an important cause of breathlessness, characterised by alterations in breathing patterns. Breathing retraining (BRtr) is believed to aid patients re-establish a normal diaphragmatic breathing pattern. Structured light plethysmography was used to assess the breathing pattern of 23 children and adolescents before and after attending a specialist BRtr clinic. It showed that a 3-month physiotherapist-led BRtr programme was associated with a significant reduction in the contribution of rib cage movement to the total change in thoracic volume and respiratory rate, which was maintained when reassessed 3 months later, despite having persisted for the 3 months prior to intervention. This study provides the first objective evidence that BRtr may result in sustained improvements in breathing patterns in children and adolescents with dysfunctional breathing. ClinicalTrials.gov, TRN: NCT04215341. Date of registration: 23 April 2015. • Dysfunctional breathing has significant effects on children and adolescents, affecting academic and sport performance, social interactions and activities of daily living. • Breathing retraining-based physiotherapy interventions are known to improve symptoms and quality of life in children and adolescents with dysfunctional breathing. • Breathing retraining may result in positive objective changes in the biomechanics of breathing. • Objective improvements in breathing pattern are maintained for at least 3 months after intervention.
To determine the prevalence of visual field (VF) defect among Indian driving licence (DL) holders and to evaluate their eligibility according to UK Driver and Vehicle Licensing Agency (DVLA) visual fitness standards. Design: This hospital-based cross-sectional observational study included individuals holding a valid Indian DL who were actively engaged in driving and visiting a tertiary care center in Western India. Participants underwent detailed demographic and driving history assessment, visual acuity (VA) evaluation, comprehensive anterior and posterior segment examination, and binocular Esterman visual field testing using the Humphrey Field Analyzer. VF results were interpreted according to UK-DVLA criteria due to the absence of defined national standards. Data were analyzed using descriptive statistics. A total of 1900 participants were included in the analysis. The mean age was 47.6 years (range, 18-82 years), and 93% were male. The best corrected visual acuity in the better eye was ≥6/18 in 99% of participants. Binocular VF defects were detected in 86 individuals (4.5%). All 86 participants with VF defects failed to meet the more stringent DVLA Group 2 criteria. Of these, 31 participants (1.6% of the total sample) also failed to meet the Group 1 criteria. VF defects were most frequent in 61-70 years (29%). Glaucoma (46.8%) was the leading cause, followed by retinal diseases (25.5%) and cataract (10.6%). Night-driving glare was reported by approximately one-third of participants. A measurable proportion of active drivers were found to have VF defects that would disqualify them under international standards, despite having normal VA. Incorporating standardized VF testing into driver licensing and periodic renewal, with stricter reassessment beyond 40 years of age, could substantially improve road-traffic safety.