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19, p less then .0001. Trainees with frequent sleep difficulties were 2.7 times more likely to be discharged than those without sleep difficulties based on the odds ratio statistic. CONCLUSIONS Rates of self-reported frequent "difficulty sleeping…," before basic training started, were similar to civilian populations and were the second strongest predictor of one-year attrition. "Difficulty sleeping…" encompasses many sleep problems (e.g., insomnia, sleep deprivation, circadian misalignment). Future studies should determine what specific sleep difficulties pose the greatest risk for attrition and then determine if they can be remediated, thus decreasing attrition risk, or if they should be a focus of screening. PURPOSE Transgender adolescents are at risk for internalizing and externalizing problems, along with high suicidality rates, and poor peer relations. The present study compared transgender adolescents before and after gender-affirmative care with a sample of nonclinical age-equivalent cisgender adolescents from the general population on psychological well-being and aimed to investigate the possible effect of transgender care involving puberty suppression. METHODS In this cross-sectional study, emotional and behavioral problems were assessed by the Youth Self-Report in a sample of 272 adolescents referred to a specialized gender identity clinic who did not yet receive any affirmative medical treatment and compared with 178 transgender adolescents receiving affirmative care consisting of puberty suppression and compared with 651 Dutch high school cisgender adolescents from the general population. RESULTS Before medical treatment, clinic-referred adolescents showed more internalizing problems and reported increased self-harm/suicidality and poorer peer relations compared with their age-equivalent peers. Transgender adolescents receiving puberty suppression had fewer emotional and behavioral problems than the group that had just been referred to transgender care and had similar or fewer problems than their same-age cisgender peers on the Youth Self-Report domains. CONCLUSIONS Transgender adolescents show poorer psychological well-being before treatment but show similar or better psychological functioning compared with cisgender peers from the general population after the start of specialized transgender care involving puberty suppression. PURPOSE Previous reports have shown limbic dysregulation in patients with restrictive eating disorders (EDs). This study investigated functional responses in brain systems to visual food stimuli and their correlation with psychological and behavioral outcomes. METHODS A total of 18 females, aged 13-18 years, who were diagnosed with anorexia nervosa (n = 11) or atypical anorexia nervosa (n = 7), completed functional magnetic resonance imaging during a visual food paradigm. Stimuli included four food types and one nonfood. Anxiety and disordered eating cognitions were assessed using the State-Trait Anxiety Inventory and Eating Attitude Test (EAT-26). Analyses were performed to obtain contrasts among different food categories and test their correlations with cognitive and behavioral scores. RESULTS Contrasts of foods versus nonfood generally resulted in positive responses in occipital regions and negative responses in temporal and parietal gyri. Contrast of sweets versus nonfood, in particular, elicited additional activation in the hippocampus. Contrasting sweet to nonsweet food, the orbitofrontal cortex and anterior cingulate cortex (ACC) were activated. Contrast of all foods versus nonfood had a positive correlation with State-Trait Anxiety Inventory-state scores in the orbitofrontal cortex and ACC. Finally, the sweet versus nonsweet contrast correlated positively with EAT-26 in ACC and other frontal areas. CONCLUSIONS Visual food stimuli elicited brain responses in limbic centers, and sweet foods extended activation to other limbic domains. find more Sweet food contrast correlated to EAT-26 in regions comprising the default mode network tied to introspection. Thus, we conclude that visual food stimuli produce activation in limbic-regulating regions in patients with restrictive EDs that correlate with disordered-eating cognitions and behaviors. OBJECTIVES Unilateral vocal fold palsy (UVFP) is the commonest neurological laryngeal disorder. Much of the research have focused on its implication on voice, with limited data on its impact on swallowing. The aim of this paper is to examine the current evidence on the pathophysiology, impact and management of UVFP and swallowing. METHODS A literature search was conducted on the PubMed, MedLine, and Embase databases based on the keywords "unilateral vocal cord palsy" and "dysphagia" for this narrative review. RESULTS Dysphagia is common in UVFP. A safe and effective swallow is more than just glottic competence but coordination of complex events within the aerodigestive tract's sensory and motor systems. It is an important secondary outcome which has short- and long-term impact on our patient's quality of life. It should be managed in a multi-disciplinary manner to optimise patient's outcome. CONCLUSION It is important to consider the disease, patient and surgical factors when deciding on the type and timing of management options. There is increasing evidence of benefits with early surgical interventions, challenging the traditional conservative management to rule out spontaneous recovery and compensation. V.OBJECTIVE This study investigated the reliability of body plethysmography in comparison to spirometry in objectively measuring upper airway functions. METHODS The study population consisted of 53 participants, 23 patients with BVFI after endolaryngeal laser posterior cordectomy and 30 healthy volunteers. All of them had body plethysmography (airway resistance, Raw), spirometry (ratio of forced expiratory flow at 50% to forced inspiratory flow at 50%, FEF50/FIF50 and peak inspiratory flow, PIF), 6 min-walking-test (6MWT) and Medical Research Council (MRC) dyspnea scale measurements. The tests were repeated and reliability was evaluated using intraclass correlation (ICC) and Spearman correlation. RESULTS The reliability of Raw was high with ICC of 0.92, comparable to the spirometry measurements FEF50/FIF50(ICC = 0.72) and PIF (ICC = 0.97). The mean of Raw was significantly higher in patient group. A strong significant correlation between Raw and MRC dyspnea scale (r = 0.79; p less then 0.05) and a moderate negative correlation between Raw and 6MWT (r = 0.
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