Adolescent Research Papers - Academia.edu (original) (raw)

Objective: To examine the significance of neonatal risk factors from the individual, family, social, and parenting behavior domains of the ecological model of child maltreatment in predicting maltreatment reports in the first 4 years of... more

Objective: To examine the significance of neonatal risk factors from the individual, family, social, and parenting behavior domains of the ecological model of child maltreatment in predicting maltreatment reports in the first 4 years of life, and to examine the extent to which the interactions of life event stress and social support modify those risk factors. Method: Mothers of 708 predominantly at-risk infants were interviewed in their homes soon after their infants' discharge from the hospital. State child abuse and neglect central registry data were tracked every 6 months until the infants reached their fourth birthdays. Results: The incidence of maltreatment reports was higher in households where the mothers were depressed, complained of psychosomatic symptoms, had not graduated from high school, consumed alcohol, participated in public income support programs, cared for more than one dependent child, or were separated from their own mothers at age 14 years (p Ͻ .1). In interaction models including these seven predisposing variables, there were significant interactions (p Ͻ .01) between social support, as measured by the social well-being index after the birth of the index child, and depression, and between social well-being and stress, as measured by an increase in total life events. Conclusion: Some predisposing risk factors measured soon after birth continue to be significant predictors of child maltreatment reports through the fourth year of life. In general, families with low levels of social support had a higher risk of a maltreatment report. For families with lower levels of maternal depression and/or life event stress, low social support significantly increased the risk of a maltreatment report by as much as a factor of four.

This study investigated the relationship between the perception of family functioning and depressive symptomatology in individuals with eating disorders (EDs). Subjects were evaluated by diagnostic clinical interview using DSM-III-R... more

This study investigated the relationship between the perception of family functioning and depressive symptomatology in individuals with eating disorders (EDs). Subjects were evaluated by diagnostic clinical interview using DSM-III-R criteria for EDs, the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L), and two self-report measures, the Beck Depression Inventory (BDI) and the Family Assessment Device (FAD). A significant association was found between self-reported depressive symptomatology and perceived poor family functioning. Subjects with bulimia nervosa (BN) reported a significantly more dysfunctional family background than subjects with anorexia nervosa (AN). In our sample, the presence of self-reported depressive symptomatology was a more powerful predictive variable for perceived family dysfunction than the diagnosis of affective disorder. Also, the diagnosis of BN was a more consistent predictor of dysfunctional family interaction than the diagnosis of affective disorder. Depressive symptoms and EDs seem to play different roles in the way in which they contribute to dysfunctional family patterns.

Gender differences have been shown across many domains, and motor skills are no exception. One of the most robust findings is a significant sex difference in throwing accuracy, which reflects the advantage of men in targeting abilities.... more

Gender differences have been shown across many domains, and motor skills are no exception. One of the most robust findings is a significant sex difference in throwing accuracy, which reflects the advantage of men in targeting abilities. However, little is known about the basis of this difference. To try to dissect possible mechanisms involved in this difference, here we tested for gender variations in a prism adaptation throwing task. We tested 154 subjects in a visuomotor prism adaptation task that discriminates between motor performance, visuomotor adaptation and negative aftereffects. Our results corroborate men's significant better throwing accuracy, although there were no adaptation differences between genders. In contrast, women showed significant larger negative aftereffects, which could be explained by a larger contribution of spatial alignment. These results suggest that different learning mechanisms, like strategic calibration and spatial alignment, may have different contributions in men and women.

Although male partner cooperation is often essential for successful use of the female condom, only a few studies have directly assessed men's experiences of using the device. We examined barriers to and facilitators of female condom... more

Although male partner cooperation is often essential for successful use of the female condom, only a few studies have directly assessed men's experiences of using the device. We examined barriers to and facilitators of female condom use via qualitative in-depth interviews with 38 young men (18 to 28 years) in South Africa whose partners, all university students, were enrolled in a female condom intervention trial. In all, 21 men used the female condom; the remaining 17 did not attempt use. The main facilitators to female condom use were convenience of use for men, curiosity to see how female condoms compared to male condoms, enhanced sexual sensation, and perceptions of better safety and comfort of the device compared to male condoms. The main barriers were men's limited familiarity with the device, insertion difficulties, and men's concerns about loss of control over sexual encounters. We recommend that human immunodeficiency virus (HIV) prevention and condom promotion ...

There are frequent applications for endoscopy in neurosurgery. However, endoscopic surgery in children has peculiar characteristics and is associated with different rates of success. In this study, the authors report on their experience... more

There are frequent applications for endoscopy in neurosurgery. However, endoscopic surgery in children has peculiar characteristics and is associated with different rates of success. In this study, the authors report on their experience with 134 consecutive endoscopy procedures performed in 126 patients<18 years of age. Between April 1993 and October 2007, 134 endoscopic procedures were performed in 126 children. Indications for surgery included brain tumors in 48 children, cystic lesions in 24, aqueductal stenosis in 23, various malformations in 20, hemorrhage and infarction in 6, and isolated ventricles in 5 children. In this long-term followup study, data were analyzed with respect to clinical and radiological success rates, as well as shunt dependence both in relation to lesion origin, and to the type of endoscopic procedure performed (endoscopic third ventriculostomy [ETV], septostomy, aqueductoplasty, or cystocisternostomy). Finally, the influence of patient age on the succ...

Neurodevelopmental disorders affect a substantial minority of the general population. Their origins are still largely unknown, but a complex interplay of genetic and environmental factors causing disturbances of the central nervous... more

Neurodevelopmental disorders affect a substantial minority of the general population. Their origins are still largely unknown, but a complex interplay of genetic and environmental factors causing disturbances of the central nervous system's maturation and a variety of higher cognitive skills is presumed. Only limited research of rather small sample size and narrow scope has been conducted in neurodevelopmental disorders using a twin-differences design. The Roots of Autism and ADHD Twin Study in Sweden (RATSS) is an ongoing project targeting monozygotic twins discordant for categorical or dimensional autistic and inattentive/hyperactive-impulsive phenotypes as well as other neurodevelopmental disorders, and typically developing twin controls. Included pairs are 9 years of age or older, and comprehensively assessed for psychopathology, medical history, neuropsychology, and dysmorphology, as well as structural, functional, and molecular brain imaging. Specimens are collected for induced pluripotent (iPS) and neuroepithelial stem cells, genetic, gut bacteria, protein-/monoamine, and electron microscopy analyses. RATSS's objective is to generate a launch pad for novel surveys to understand the complexity of genotype-environmentphenotype interactions in autism spectrum disorder and attention-deficit hyperactivity disorder (ADHD). By October 2013, RATSS had collected data from 55 twin pairs, among them 10 monozygotic pairs discordant for autism spectrum disorder, seven for ADHD, and four for other neurodevelopmental disorders.

Purpose Religious delusions are common and are considered to be particularly difficult to treat. In this study we investigated what psychological processes may underlie the reported treatment resistance. In particular, we focused on the... more

Purpose Religious delusions are common and are considered to be particularly difficult to treat. In this study we investigated what psychological processes may underlie the reported treatment resistance. In particular, we focused on the perceptual, cognitive, affective and behavioural mechanisms held to maintain delusions in cognitive models of psychosis, as these form the key treatment targets in cognitive behavioural therapy. We compared religious delusions to delusions with other content. Methods Comprehensive measures of symptoms and psychological processes were completed by 383 adult participants with delusions and a schizophrenia spectrum diagnosis, drawn from two large studies of cognitive behavioural therapy for psychosis. Results Binary logistic regression showed that religious delusions were associated with higher levels of grandiosity (OR 7.5; 95 % CI 3.9-14.1), passivity experiences, having internal evidence for their delusion (anomalous experiences or mood states), and being willing to consider alternatives to their delusion (95 % CI for ORs 1.1-8.6). Levels of negative symptoms were lower. No differences were found in delusional conviction, insight or attitudes towards treatment. Conclusions Levels of positive symptoms, particularly anomalous experiences and grandiosity, were high, and may contribute to symptom persistence. However, contrary to previous reports, we found no evidence that people with religious delusions would be less likely to engage in any form of help. Higher levels of flexibility may make them particularly amenable to cognitive behavioural approaches, but particular care should be taken to preserve self-esteem and valued aspects of beliefs and experiences.

Methods Three hundred and twenty-eight IUGR fetuses (abdominal circumference < 5th percentile, elevated umbilical artery (UA) pulsatility index (PI)) had concurrent surveillance with UA, middle cerebral artery (MCA) and ductus venosus... more

Methods Three hundred and twenty-eight IUGR fetuses (abdominal circumference < 5th percentile, elevated umbilical artery (UA) pulsatility index (PI)) had concurrent surveillance with UA, middle cerebral artery (MCA) and ductus venosus (DV) Doppler ultrasonography and BPS (fetal tone, movement, breathing, maximal amniotic fluid pocket and fetal heart rate). Patients were stratified into three groups according to their Doppler examination: (1) abnormal UA alone; (2) brain sparing (MCA-PI > 2 SD below mean for gestational age); and (3) abnormal DV (PI > 2 SD above the mean for gestational age) and BPS groups: (1) normal (> 6/10);

Background: This analysis was designed to assess the efficacy and safety of aripiprazole compared with placebo in subpopulations of patients with acute manic or mixed episodes of bipolar I disorder. Methods: Acutely manic patients... more

Background: This analysis was designed to assess the efficacy and safety of aripiprazole compared with placebo in subpopulations of patients with acute manic or mixed episodes of bipolar I disorder. Methods: Acutely manic patients experiencing DSM-IV manic/mixed episodes of bipolar I disorder were pooled from two randomized, three-week, flexible-dose, double-blind, placebo-controlled trials (N = 516) and stratified by disease severity (Young Mania Rating Scale, YMRS), episode type, presence or absence of psychotic features, episode frequency, age, gender, and baseline severity of depressive symptoms. Safety and treatment-emergent adverse-event analyses were also performed. Results: Aripiprazole significantly reduced mean YMRS total scores at end point compared with placebo in patients with more severe or less severe illness, with mixed or manic episodes, with or without psychotic features, or with a history of rapid or nonrapid cycling (p b 0.01 for each subpopulation); in men and women (p = 0.001 for both); in patients in the 18-40 and 41-55 year age groups (p ≤ 0.001 for both); and in three subgroups stratified by baseline severity of depressive symptoms using the Montgomery-Åsberg Depression Rating Scale (p b 0.05). The treatment-emergent adverse events reported in ≥ 5% of patients aged 18-40 years receiving aripiprazole were similar to those reported for the overall population. Limitations: This post hoc analysis utilized pooled data from two short-term studies. Conclusion: Efficacy of the second-generation antipsychotic aripiprazole was noted across a broad range of subpopulations often associated with treatment resistance in patients experiencing manic or mixed episodes of bipolar I disorder.

People migrate to improve their well-being, whether through an expansion of economic and social opportunities or a reduction in persecution. Yet a large literature suggests that migration can be a very stressful process, with potentially... more

People migrate to improve their well-being, whether through an expansion of economic and social opportunities or a reduction in persecution. Yet a large literature suggests that migration can be a very stressful process, with potentially negative impacts on mental health reducing the net benefits of migration. However, to truly understand the effect of migration on mental health one must compare the mental health of migrants to what their mental health would have been had they stayed in their home country. The existing literature is not able to do this and typically settles for comparing the mental health of migrants to that of natives in the destination country,which takes no account of any pre-existing differences between these groups. This paper overcomes the selection problems affecting previous studies of the effect of migration on mental health by examining a migrant lottery program. New Zealand allows a quota of Tongans to immigrate each year with a lottery used to choose amo...

Objective To assess the prevalence of domestic violence in pregnancy when midwives are trained to enquire about it routinely. Design A cross sectional study during a period after midwives had been trained to routinely enquire about it and... more

Objective To assess the prevalence of domestic violence in pregnancy when midwives are trained to enquire about it routinely. Design A cross sectional study during a period after midwives had been trained to routinely enquire about it and a retrospective case note survey at an earlier period. Setting The maternity services of Guy's and St Thomas' NHS Hospital Trust in South London.

Interpreting the significance of anal findings in child sexual abuse can be difficult. The aim of this study is to compare the frequency of anal features between children with and without anal penetration. This is a retrospective blinded... more

Interpreting the significance of anal findings in child sexual abuse can be difficult. The aim of this study is to compare the frequency of anal features between children with and without anal penetration. This is a retrospective blinded review of consecutive charts of children seen for suspected sexual abuse at a regional referral center from January 1. 2005 to December 31. 2009 Based on predetermined criteria, children were classified into two groups: low or high probability of anal penetration. The charts of 1115 children were included, 84% girls and 16% boys with an age range from 0.17 to 18.83 years (mean 9.20 year). 198 children (17.8%) were classified as belonging to the anal penetration group. Bivariate analysis showed a significant positive association between the following features and anal penetration: Anal soiling (p = 0.046), fissure (p = 0.000), laceration (p = 0.000) and total anal dilatation (p = 0.000). Logistic regression analysis and stratification analysis confirmed a positive association of soiling, anal lacerations and anal fissures with anal penetration. Total anal dilation was significantly correlated with a history of anal penetration in girls, in children examined in the prone knee chest position and in children without anal symptoms. Several variables were found to be significantly associated with anal penetration, including the controversial finding of total anal dilatation. Due to limitations in the study design, this finding should still be interpreted with caution in the absence of a clear disclosure from the child.

The aim of this study was to systematically review the psychometric properties, interpretability and feasibility of self-report pain intensity measures for children and adolescents for use in clinical trials evaluating pain treatments.... more

The aim of this study was to systematically review the psychometric properties, interpretability and feasibility of self-report pain intensity measures for children and adolescents for use in clinical trials evaluating pain treatments. Databases were searched for selfreport measures of single-item ratings of pain intensity for children aged 3-18 years. A total of 34 single-item self-report measures were found. The measures' psychometric properties, interpretability and feasibility, were evaluated independently by two investigators according to a set of psychometric criteria. Six single-item measures met the a priori criteria and were included in the final analysis. While these six scales were determined as psychometrically sound and show evidence of responsivity, they had varying degrees of interpretability and feasibility. No single scale was found to be optimal for use with all types of pain or across the developmental age span. Specific recommendations regarding the most psychometrically sound and feasible measures based on age/developmental level and type of pain are discussed. Future research is needed to strengthen the measurement of pain in clinical trials with children. Ó

Background-From an affective neuroscience perspective, our understanding of psychiatric illness may be advanced by neuropsychological test paradigms probing emotional processes. Reversal learning is one such process, whereby subjects must... more

Background-From an affective neuroscience perspective, our understanding of psychiatric illness may be advanced by neuropsychological test paradigms probing emotional processes. Reversal learning is one such process, whereby subjects must first acquire stimulus/reward and stimulus/punishment associations through trial and error and then reverse them. We sought to determine the specificity of previously demonstrated reversal learning impairments in youths with bipolar disorder (BD) by now comparing BD youths to those with severe mood dysregulation (SMD), major depressive disorder (MDD), anxiety (ANX), and healthy controls.

Traditionally, the American child welfare system intervenes in cases of evident and severe maltreatment. Families in need of help, but who have not reached a crisis, are excluded from typical services. Some suggest that if these families... more

Traditionally, the American child welfare system intervenes in cases of evident and severe maltreatment. Families in need of help, but who have not reached a crisis, are excluded from typical services. Some suggest that if these families were served, few would be rereferred to the child welfare system. California’s Differential Response (DR) has three tracks, of which ‘‘Track 1’’ targets families screened out of child protective services (CPS) and refers them to agencies that provide voluntary, home-based services and referrals. This study examined child-welfare trajectories for families receiving Track 1 DR services in one California county. Using survival analysis, treatment group children (N = 134) were compared to children eligible for services but denied due to program capacity (comparison group N = 511). Findings suggest no statistically significant differences between groups on the likelihood of a re-report following program participation, timing of maltreatment reports, or r...

Background: Pancreatic pseudocyst endoscopic drainage has been described as a good treatment option, with morbidity and mortality rates that are lower than surgery. The aim of our study is to describe the efficacy of different forms of... more

Background: Pancreatic pseudocyst endoscopic drainage has been described as a good treatment option, with morbidity and mortality rates that are lower than surgery. The aim of our study is to describe the efficacy of different forms of endoscopic drainage and estimate pseudocyst recurrence rate after short follow up period.

Seventy-six percent of 65 psychotherapy cases seen in a child guidance clinic either did not change or improved following a mandated report of suspected child abuse. In a significant minority of cases, the therapy relationship... more

Seventy-six percent of 65 psychotherapy cases seen in a child guidance clinic either did not change or improved following a mandated report of suspected child abuse. In a significant minority of cases, the therapy relationship deteriorated when the report was made about a client in treatment, and improved when the report was made about a third party not in treatment.

Decline in episodic memory is one of the most prominent cognitive deficits seen in late adulthood. It is therefore surprising that few studies have examined how the related capacity for episodic foresight might also be affected in this... more

Decline in episodic memory is one of the most prominent cognitive deficits seen in late adulthood. It is therefore surprising that few studies have examined how the related capacity for episodic foresight might also be affected in this age group. Preliminary evidence suggests that older adults show deficits in generating phenomenological characteristics of future events, but the critical question of whether such deficits extend to generating and executing appropriate future intentions remains to be addressed. Here, we present 2 studies. In Study 1, we report the results of our pilot testing, which was used to develop and validate stimuli for the first measure of this construct that is appropriate for use in adult populations. In Study 2, we administer this measure to 40 older and 40 younger adults. The results indicate that, relative to their younger counterparts, older adults are less likely to spontaneously acquire items that would later allow a problem to be solved, and are also ...

The purpose of this study was to examine patterns of comorbidity of DSM-III-R anxiety disorders and personality disorders (PD). Two-hundred subjects were independently interviewed with the Structured Clinical Interview for DSM-III-R... more

The purpose of this study was to examine patterns of comorbidity of DSM-III-R anxiety disorders and personality disorders (PD). Two-hundred subjects were independently interviewed with the Structured Clinical Interview for DSM-III-R (SCID) and the Personality Disorder Examination (PDE) face-to-face by two experienced clinicians. One-hundred and forty-six also completed the Personality Diagnostic Questionnaire Revised (PDQ-R). Rates of personality disorder among patients with and without anxiety disorders were determined by each of the three instruments. Comorbidity between panic disorder, social phobia, obsessive-compulsive disorder, and simple phobia and a conservative estimate of individual Axis I1 disorders was examined. Results indicate that panic disorder, either current or lifetime, is associated with borderline, avoidant, and dependent personality disorders; social phobia is associated with avoidant personality disorder; and obsessivecompulsive disorder is associated with obsessive-compulsive and avoidant personality disorders. Anxiety disorders with personality disorders are characterized by chronicity and lower levels of functioning compared with anxiety disorders without personality disorders.

Gambling is an important public health concern. To better understand gambling behavior, we conducted a classroom-based survey that assessed the role of the theory of planned behavior (TPB; i.e., intentions, subjective norms, perceived... more

Gambling is an important public health concern. To better understand gambling behavior, we conducted a classroom-based survey that assessed the role of the theory of planned behavior (TPB; i.e., intentions, subjective norms, perceived behavioral control, and attitudes) in past year gambling and gambling frequency among college students. Results from this research support the utility of the TPB to explain gambling behavior in this population. Specifically, in TPB models to predict gambling behavior, friend and family subjective norms and perceived behavioral control predicted past year gambling and friend and family subjective norms, attitudes and perceived behavioral control predicted gambling frequency. Intention to gamble mediated these relationships. These findings suggest that college responsible gambling efforts should consider targeting misperceptions of approval regarding gambling behavior (i.e., subjective norms), personal approval of gambling behavior (i.e., attitudes), and perceived behavioral control to better manage gambling behavior in various situations.

The authors aimed to evaluate age-related differences in inflammation biomarkers during the first 72 h of hospitalization for sepsis. This was a secondary analysis of a prospective observational cohort of adult patients (n = 855) from 10... more

The authors aimed to evaluate age-related differences in inflammation biomarkers during the first 72 h of hospitalization for sepsis. This was a secondary analysis of a prospective observational cohort of adult patients (n = 855) from 10 urban academic emergency departments with confirmed infection and two or more systemic inflammatory response syndrome criteria. Six inflammation-related biomarkers were analyzedVchemokine (CC-motif) ligand-23, C-reactive protein, interleukin-1 receptor antagonist, neutrophil gelatinaseYassociated lipocalin (NGAL), peptidoglycan recognition protein, and tumor necrosis factor receptor-1a (TNFR-1a)Vmeasured at presentation and 3, 6, 12, 24, 48, or 72 h later. The median age was 56 (interquartile range, 43 Y 72) years, and sepsis severity was 38% sepsis, 16% severe sepsis without shock, and 46% septic shock; the overall 30-day mortality was 12%. Older age was associated with higher sepsis severity: 41% of subjects aged 18 to 34 years had severe sepsis or septic shock compared with 71% for those aged 65 years or older (P G 0.001). In longitudinal models adjusting for demographics, comorbidities, and infection source, older age was associated with higher baseline values for chemokine (CC-motif) ligand-23, interleukin-1 receptor antagonist, NGAL, and TNFR-1a (all P G 0.05). However, older adults had higher mean values during the entire 72-h period only for NGAL and TNFR-1a and higher final 72-h values only for TNFR-1a. Adjustment or stratification by sepsis severity did not change the ageinflammation associations. Although older adults had higher levels of inflammation at presentation and an increased incidence of severe sepsis and septic shock, these age-related differences in inflammation largely resolved during the first 72 h of hospitalization.

• Drooling is a common problem in disabled individuals and has significant physical, psychosocial and aesthetic repercussions. Scopolamine has been used to treat drooling in a number of medical specialities, including otorhinolaryngology,... more

• Drooling is a common problem in disabled individuals and has significant physical, psychosocial and aesthetic repercussions. Scopolamine has been used to treat drooling in a number of medical specialities, including otorhinolaryngology, neurology and palliative care. This study evaluates the efficacy of this treatment in severely disabled patients.

We evaluated the bioavailability of Cd in 86 components of 57 jewelry items found to contain high levels of Cd (> 10,000 ppm) by X-ray fluorescence (XRF), using extractions that simulate mouthing or swallowing of jewelry items. Methods:... more

We evaluated the bioavailability of Cd in 86 components of 57 jewelry items found to contain high levels of Cd (> 10,000 ppm) by X-ray fluorescence (XRF), using extractions that simulate mouthing or swallowing of jewelry items. Methods: We screened jewelry for Cd content by XRF. Bioavailability was measured in two ways. Items were placed in saline solution at 37°C for 6 hr to simulate exposures from mouthing of jewelry items. Items were placed in dilute hydrochloric acid (HCl) at 37°C for 6-96 hr, simulating the worst-case scenario of a child swallowing a jewelry item. Damaged pieces of selected samples were also extracted by both methods to determine the effect of breaching the outer plating on bioavailability. Total Cd content of all items was determined by atomic absorption. results: The 6-hr saline extraction yielded as much as 2,200 μg Cd, and 24-hr dilute HCl extraction yielded a maximum of > 20,000 μg Cd. Leaching of Cd in dilute HCl increased linearly over 6-96 hr, indicating potential for increasing harm the longer an item remains in the stomach. Damage to jewelry by breaching the outer plating generally, but not always, increased Cd release. Bioavailability did not correlate directly with Cd content. conclusions: These results indicate the potential for dangerous Cd exposures to children who wear, mouth, or accidentally swallow high-Cd jewelry items. key words: cadmium, children's health, import safety, jewelry, potential cadmium exposures.

In this fMRI study we investigated functional connectivity between components of the mentalising system during a social emotion task, using psychophysiological interaction (PPI) analysis. Ten adults (22–32 years) and 18 adolescents (11–18... more

In this fMRI study we investigated functional connectivity between components of the mentalising system during a social emotion task, using psychophysiological interaction (PPI) analysis. Ten adults (22–32 years) and 18 adolescents (11–18 years) were scanned while thinking about scenarios in which a social or a basic emotion would be experienced. Unlike basic emotions (such as disgust and fear), social emotions (such as embarrassment and guilt) require the representation of another’s mental states. In both adults and adolescents, an anterior rostral region of medial prefrontal cortex (arMPFC) involved in mentalising showed greater connectivity with the posterior superior temporal sulcus (pSTS) bordering on the temporo-parietal junction (TPJ) and with anterior temporal cortex (ATC) during social than during basic emotion. This result provides novel evidence that components of the mentalising system interact functionally during a social emotion task. Furthermore, functional connectivity differed between adolescence and adulthood. The adolescent group showed stronger connectivity between arMPFC and pSTS/TPJ during social relative to basic emotion than did the adult group, suggestive of developmental changes in functional integration within the mentalising system.

Adolescent substance abuse is a major public health concern. It is associated with an increased incidence of various psychiatric disorders like depressive disorders, anxiety disorders, attention deficit hyperactivity disorder, and conduct... more

Adolescent substance abuse is a major public health concern. It is associated with an increased incidence of various psychiatric disorders like depressive disorders, anxiety disorders, attention deficit hyperactivity disorder, and conduct disorders and the relationship between mental and behavioral disorders and the substance use problems seems to be bi-directional. Adolescent suicide and substance abuse have a number of risk factors in common. Prevention of suicide requires an individualized comprehensive assessment and management plan aimed at substance use and psychiatric disorders. This would involve a multidisciplinary collaboration and use of pharmacological, psychological and social interventions.

Opinion is divided on the role of routine repeat head computed tomography (RHCT) for guiding clinical management in pediatric patients with blunt head trauma. We hypothesize that routine RHCT does not lead to change in management in mild... more

Opinion is divided on the role of routine repeat head computed tomography (RHCT) for guiding clinical management in pediatric patients with blunt head trauma. We hypothesize that routine RHCT does not lead to change in management in mild and moderate traumatic brain injury (TBI).

Delays in follow-up after cancer screening contribute to racial/ethnic disparities in cancer outcomes. We evaluated a patient navigator intervention among innercity women with breast abnormalities. A full-time patient navigator supported... more

Delays in follow-up after cancer screening contribute to racial/ethnic disparities in cancer outcomes. We evaluated a patient navigator intervention among innercity women with breast abnormalities. A full-time patient navigator supported patients using the care management model. Female patients 18 years and above, referred to an urban, hospital-based, diagnostic breast health practice from January to June 2000 (preintervention) and November 2001 to February 2003 (intervention), were studied. Timely follow-up was defined as arrival to diagnostic evaluation within 120 days from the date the original appointment was scheduled. Data were collected via computerized registration, medical records, and patient interview. Bivariate and multivariate logistic regression analyses were conducted, comparing preintervention and intervention groups, with propensity score analysis and time trend analysis to address the limitations of the pre-post design. 314 patients were scheduled preintervention; 1018, during the intervention. Overall, mean age was 44 years; 40% black, 36% non-Hispanic white, 14%

Background: Tendinopathies represent a serious challenge for orthopaedic surgeons involved in treatment of athletes.

Background: Kenya has a maternal mortality ratio of 488 per 100,000 live births. Preventing maternal deaths depends significantly on the presence of a skilled birth attendant at delivery. Kenyan national statistics estimate that the... more

Background: Kenya has a maternal mortality ratio of 488 per 100,000 live births. Preventing maternal deaths depends significantly on the presence of a skilled birth attendant at delivery. Kenyan national statistics estimate that the proportion of births attended by a skilled health professional have remained below 50% for over a decade; currently at 44%, according to Kenya's demographic health survey 2008/09 against the national target of 65%. This study examines the association of mother's characteristics, access to reproductive health services, and the use of skilled birth attendants in Makueni County, Kenya. Methods: We carried out secondary data analysis of a cross sectional cluster survey that was conducted in August 2012. Interviews were conducted with 1,205 eligible female respondents (15-49 years), who had children less than five years (0-59 months) at the time of the study. Data was analysed using SPSS version 17. Multicollinearity of the independent variables was assessed. Chi-square tests were used and results that were statistically significant with p-values, p < 0.25 were further included into the multivariable logistic regression model. Adjusted odds ratio (AOR) and their 95% confidence intervals were (95%) calculated. P value less than 0.05 were considered significant.

There are several pathologies related to the patellofemoral joint, in which the patellofemoral syndrome is one af the most common and challenging to treat. The patellofemoral syndrome results from a malalignment of the knee extenso r... more

There are several pathologies related to the patellofemoral joint, in which the patellofemoral syndrome is one af the most common and challenging to treat. The patellofemoral syndrome results from a malalignment of the knee extenso r mechanism. The purpose af our study was to describe and compare EMG responses of the vastus medialis and vastus lateralis muscles while walking up and down stairs and other clinical and functional responses in PFS subjects before and afier a physical therapy intervention. Eleven subjects were studied and divided in two groups: six subjects with clinically diagnosed patellofemoral syndrome and five healthy control subjects. Subjects were evaluated by a functional and biomechanical evaluation protocol: postural evaluation, pain and knee function evaluation, and electromyographic activity of vastus medialis and lateralis muscles while walking up and down a staircase. Results showed higher efficiency of the vastus medialis muscle in carrying out eccentric exercises and increased musc1e activity in both the vastus medialis and vastus lateralis muscles while c1imbing stairs after physical therapy treatment. We were able to identify an improvement in postural alignment of lower Ihl1b muscles and knee functionality among patellofemoral syndrome group subjects afier treatment.

Objective: This randomized trial of a family-focused preventive intervention for Mexican American middle schoolers examined internalizing, externalizing, and substance use outcomes in late adolescence, five years after completing the... more

Objective: This randomized trial of a family-focused preventive intervention for Mexican American middle schoolers examined internalizing, externalizing, and substance use outcomes in late adolescence, five years after completing the intervention. Parent-adolescent conflict was tested as a mediator of these effects. The role of parent and adolescent acculturation in these pathways was also examined. Method: 498 7 th grade adolescents and their primary female caregivers were randomized to receive either a 9-week, multi-component intervention or a brief workshop control group. Assessments were conducted at pre-test, two year follow-up (9 th grade), and five year follow-up (when most participants were in the 12 th grade). Results: The Bridges program significantly reduced mother-adolescent conflict measured in the 9 th grade, with conflict mediating program effects on internalizing and externalizing symptoms, adolescent substance use, and diagnosed internalizing disorder in late adolescence. Mother and child acculturation were both significantly predictive of late adolescence outcomes. Contrary to hypotheses, neither mother nor child acculturation emerged as a significant predictor of mother-adolescent conflict, and the interaction of mother and adolescent acculturation was similarly not related to motheradolescent conflict. Intervention effects were largely consistent across different levels of acculturation. Conclusions: These findings provide support for the efficacy of family-focused intervention during early adolescence, both in reducing mental health problems and substance use in the long term, as well as in impacting parent-adolescent conflict processes that appear to play an important role in the development of later adjustment problems.

The longitudinal growth in stature for 509 males and 311 females was characterized from early childhood to adulthood. A triphasic generalized logistic (BTT) model (Bock et al. [1994] Chicago: SSI) was used through the AUXAL software... more

The longitudinal growth in stature for 509 males and 311 females was characterized from early childhood to adulthood. A triphasic generalized logistic (BTT) model (Bock et al. [1994] Chicago: SSI) was used through the AUXAL software program. Growth parameters were derived from the estimated distance and velocity curves for each individual. A set of estimated growth parameters, including adult stature, was selected to develop equations, through the forward stepwise regression method, for the prediction of adult stature for Japanese boys and girls. Am.

International standards highlight the steps required by risk assessment and involving first hazard identification, then risk evaluation and finally, if necessary, risk assessment. To check approach appropriateness to "risk... more

International standards highlight the steps required by risk assessment and involving first hazard identification, then risk evaluation and finally, if necessary, risk assessment. To check approach appropriateness to "risk evaluation" from manual patient handling through MAPO, a cross study was carried out in view of checking relationship between this new risk assessment model and occurrence of acute low back pain. After proper training the MAPO screening method was assessed in 31 wards, 411 exposed subjects of geriatric hospitals. At the same time health data were collected on occurrence of low back pain episodes during the last year both in the exposed subjects' group and the external reference group (n�237). Risk and clinical assessment data were tutored and checked by EPM research unit. The logistic analysis was used as a method to evaluate the relationship between risk index and acute low back pain. Investigating relationship between acute low back pain episodes a...

Objective: Interoceptive awareness is known to be impaired in eating disorders. To date, it has remained unclear whether this variable is related to the construct of interoceptive sensitivity. Interoceptive sensitivity is considered to be... more

Objective: Interoceptive awareness is known to be impaired in eating disorders. To date, it has remained unclear whether this variable is related to the construct of interoceptive sensitivity. Interoceptive sensitivity is considered to be an essential variable in emotional processes. The objective of the study was to elucidate this potential relationship and to clarify whether general interoceptive sensitivity is reduced in anorexia nervosa. Methods: Using a heartbeat perception task, interoceptive sensitivity was assessed in 28 female patients with anorexia nervosa and 28 matched healthy controls. Questionnaires assessing interoceptive awareness (EDI) and several other variables were also administered. Results: Patients with anorexia nervosa displayed significantly decreased interoceptive sensitivity. They also had more difficulties in interoceptive awareness. Conclusions: In addition to a decreased ability to recognize certain visceral sensations related to hunger, there is a generally reduced capacity to accurately perceive bodily signals in anorexia nervosa. This highlights the potential importance of interoceptive sensitivity in the pathogenesis of eating disorders.

Parents of 28 children and a young adult with CHARGE syndrome participated in a survey on factors related to communication development. Information was obtained using a questionnaire and a follow-up interview. Parents were asked to (1)... more

Parents of 28 children and a young adult with CHARGE syndrome participated in a survey on factors related to communication development. Information was obtained using a questionnaire and a follow-up interview. Parents were asked to (1) specify their child's primary mode of communication, (2) judge the significance of the effects of physical disorders, sensory deficits, and behavior on development and communication, (3) provide lists of their child's conditions and disorders, and (4) provide information about intervention related to communication and education. Thirtynine percent of the participants (11/28) did not use symbolic language to communicate. The results suggest that factors affecting the majority of participants-physical disorders, vision loss, and hearing loss-may adversely affect communication ability. However, these factors did not preclude the development of symbolic language. Factors that were related to the development of symbolic language were success in the treatment of hearing loss with amplification, the ability to walk independently, and communication training initiated by 3 years of age. Other factors that may be related to the development of symbolic language are also discussed. ß 2005 Wiley-Liss, Inc.

Background: Most new cases of active tuberculosis in Norway are presently caused by imported strains and not transmission within the country. Screening for tuberculosis with a Mantoux test of everybody and a chest X-ray of those above 15... more

Background: Most new cases of active tuberculosis in Norway are presently caused by imported strains and not transmission within the country. Screening for tuberculosis with a Mantoux test of everybody and a chest X-ray of those above 15 years of age is compulsory on arrival for asylum seekers. We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis. Methods: All asylum seekers who arrived at the National Reception Centre between January 2005-June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008. Cases reported within two months after arrival were defined as being detected by screening. Results: Of 4643 eligible asylum seekers, 2237 were included in the study. Altogether 2077 persons had a Mantoux ≥ 6 mm and 314 had an abnormal chest X-ray. Of 28 cases with tuberculosis, 15 were detected by screening, and 13 at 4-27 months after arrival. Abnormal X-rays on arrival were more prevalent among those detected by screening. Female gender and Somalian origin increased the risk for active TB. Conclusion: In spite of an imperfect follow-up of screening results, a reasonable number of TB cases was identified by the programme, with a predominance of pulmonary TB.

Objective: Posttraumatic stress disorder (PTSD) has been linked to reduced heart rate variability (HRV), which is in turn a risk factor for cardiovascular disease and death. Although hyperarousal and anxiety are thought to underlie this... more

Objective: Posttraumatic stress disorder (PTSD) has been linked to reduced heart rate variability (HRV), which is in turn a risk factor for cardiovascular disease and death. Although hyperarousal and anxiety are thought to underlie this association, behavioral health risks, including smoking, alcohol dependence, obesity, and sleep disturbance, represent potential mechanisms linking PTSD and HRV. Methods: To test this hypothesis, short-term laboratory-based and 24-hour ambulatory measures of HRV were collected from 227 young adults (18Y39 years), 107 of whom were diagnosed as having PTSD. Latent variable modeling was used to assess the relationship of PTSD symptoms with HRV along with potential behavioral health mediators. Results: PTSD symptoms were associated with reduced HRV (A = j0.21, p = .002). However, this association was reduced in models that adjusted for cigarette consumption and history of alcohol dependence and was rendered nonsignificant in a model adjusting for sleep disturbance. Independent mediation effects were deemed significant via bootstrapping analysis. Together, the three behavioral health factors (cigarette consumption, history of alcohol dependence, and sleep disturbance) accounted for 94% of the shared variance between PTSD symptoms and HRV. Abdominal obesity was not a significant mediator. Conclusions: These results indicate that behavioral factorsVspecifically smoking, alcohol overuse, and sleep disturbanceVmediate the association between PTSD and HRV-based indices of autonomic nervous system dysregulation. Benefits from psychiatric and psychological interventions in PTSD may therefore be enhanced by including modification of health behaviors. Key words: posttraumatic stress disorder, heart rate variability, cigarette smoking, alcohol dependence, sleep disturbance. PTSD = posttraumatic stress disorder; HRV = heart rate variability; SNS = sympathetic nervous system; PNS = parasympathetic nervous system; CAPS = Clinician Administered PTSD Scale; DTS = Davidson Trauma Scale; MDD = major depressive disorder; SDNN = standard deviation of all normal R-R intervals; TR index = triangular index; LF power = low-frequency power; HF power = highfrequency power; RRSD = standard deviation of normal-to-normal R-R intervals; RMSEA= root mean square error of approximation; CFI = comparative fit index; SRMR = standardized root mean square residual; CI = confidence interval.

Therapeutic horse riding is often employed for disabled children. The aim of the present paper was to determine the influence of exercise in a mechanical saddle, imitating horse's walk, on the skin temperature responses in lower limbs... more

Therapeutic horse riding is often employed for disabled children. The aim of the present paper was to determine the influence of exercise in a mechanical saddle, imitating horse's walk, on the skin temperature responses in lower limbs in children with cerebral palsy. Sixteen children, aged 14-16, were enrolled into the study. Skin surface temperature was assessed with thermography, using an infrared thermovision camera, AGEMA 550, before and directly after 20 +/-5 min of exercise. The findings demonstrate that mechanical hippotherapy provides an exercise stimulus that is capable of inducing a visible change in skin temperature of paralyzed limbs. The change, however, is one of a decrease in skin temperature, which points to acute vasoconstrictive effects of exercise and to decreased skin blood flow. The results, therefore, do not support the use of mechanical hippotherapy in children suffering from cerebral palsy, with a hope to stimulate blood circulation to spastically altered...

We evaluated the role of placental protein 13 (PP13; galectin 13) in the process of trophoblast invasion and decidual necrosis. Immunohistochemical analysis for PP13, immune cells, human placental lactogen, cytokeratin, and apoptosis... more

We evaluated the role of placental protein 13 (PP13; galectin 13) in the process of trophoblast invasion and decidual necrosis. Immunohistochemical analysis for PP13, immune cells, human placental lactogen, cytokeratin, and apoptosis markers was performed on 20 elective pregnancy termination specimens between 6 and 15 weeks of gestation. Placental protein 13 was localized to syncytiotrophoblasts in the chorionic villi and to occasional multinucleated luminal trophoblasts within converted decidual spiral arterioles. Cytotrophoblasts, anchoring trophoblasts, and invasive trophoblasts did not stain for PP13. Extracellular PP13 aggregates were found around decidual veins associated with T-cell-, neutrophil-and macrophage-containing decidual zones of necrosis (ZONEs). We hypothesize that PP13 is secreted into the intervillus space, drains through the decidua basalis veins, and forms perivenous PP13 aggregates which attract and activate maternal immune cells. Thus, syncytiotrophoblast-derived PP13 may create a ZONE that facilitates trophoblast invasion and conversion of the maternal spiral arterioles.

Patients with chronic renal failure (CRF) often have signs and symptoms related to fluid and electrolyte disturbances, anemia, malnutrition, bone disease, and gastrointestinal problems. Vascular and neurologic impairment in particular... more

Patients with chronic renal failure (CRF) often have signs and symptoms related to fluid and electrolyte disturbances, anemia, malnutrition, bone disease, and gastrointestinal problems. Vascular and neurologic impairment in particular remain an important source of morbidity and mortality in this vulnerable patient population. Sagliker syndrome is a novel syndrome that was recently described in 2004 in patients with CRF and severe and late secondary hyperparathyroidism who suffered from severe skull and facial bone changes, particularly from uglifying human face appearances and neuropsychiatric disorders. The goal of this study was to assess neuropsychiatric manifestations occurring in CRF patients with Sagliker syndrome. Four female and 8 male patients with CRF on regular dialysis at the hemodialysis units of the Internal Medicine Departments around southern Turkey participated in the study. All patients underwent a clinical neurologic examination performed by the same neurologist. Neuropsychiatric signs and symptoms were found in all cases. The results showed that the most frequent neurologic manifestations in CRF patients with Sagliker syndrome were headache, polyneuropathy, cranial neuropathy, fatigue, and psychiatric disorders.