Search

Maternal substance use (SUD) and mental health disorders commonly co-occur and require complex treatment. Information on women's use of appropriate services in the perinatal period is limited. Data from the New Zealand Infant Development, Environment and Lifestyle Study were used to examine the characteristics of women with high probability of substance use and/or psychiatric disorder and rates of service use at 1 and 12 months following birth (n = 221). The Substance Abuse Subtle Screening Inventory-3 and the Brief Symptom Inventory were used to identify risk of disorder. Despite a high proportion of mothers with disorder risk, rates of specialist treatment remained low across SUD and psychiatric groups at 1 (27–39%) and 12 months postnatal (25–42%). Very low rates of women with comorbid disorder received both mental health and substance use treatments (1 month, 4.5%; 12 months, 7.3%). There was no association between service use and risk for psychiatric disorder at 12 months after birth. The findings suggest that even when services are publicly funded, they may be under-utilised or under-resourced to provide effective treatment, despite the high and complex needs of this population. [ABSTRACT FROM AUTHOR]

Alcohol and illicit psychoactive drug use during pregnancy have increased worldwide, putting women and their children's health and development at risk. Multiple drug use, comorbid psychiatric disorders, sexual and physical abuse are common in women who use alcohol and drugs during pregnancy. The effects on the mother include poor reproductive and life-long health, legal, family, and social problems. Additionally, the exposed child is at increased risk of long-term physical health, mental health, and developmental problems. The stigma associated with substance use during pregnancy and some clinicians' reticence to inquire about substance use means many women are not receiving adequate prenatal, substance abuse, and mental health care. Evidence for mHealth apps to provide health care for pregnant and post-partum women reveal the usability and effectiveness of these apps to reduce gestational weight gain, improve nutrition, promote smoking cessation and manage gestational diabetes mellitus, and treat depression and anxiety. Emerging evidence suggests mHealth technology using a public health approach of electronic screening, brief intervention, or referral to treatment (e-SBIRT) for substance use or abuse can overcome the typical barriers preventing women from receiving treatment for alcohol and drug use during pregnancy. This brief intervention delivered through a mobile device may be equally effective as SBIRT delivered by a health care professional in preventing maternal drug use, minimizing the effects to the exposed child, and providing a pathway to therapeutic options for a substance use disorder. However, larger studies in more diverse settings with women who have co-morbid mental illness and a constellation of social risk factors that are frequently associated with substance use disorders are needed. [ABSTRACT FROM AUTHOR]

Rationale: Understand the impact of insurance coverage on sleep apnea outcomes for patients awaiting upper airway stimulation.Objectives: Examine the natural history of impact of upper airway stimulation treatment versus insurance denial (comparators) on sleep apnea outcomes.Methods: A parallel-arm experimental study design was used to compare objective sleep apnea measures and patient-reported outcomes in those who received upper airway stimulation approval versus denial in a multinational prospective study (NCT02907398). Wilcoxon rank-sum test and logistic regression models were used to assess for differences of objective and subjective outcome changes in those who underwent upper airway stimulation versus no treatment comparators.Results: A greater reduction in apnea-hypopnea index was observed in those who underwent upper airway stimulation (n = 230, follow-up: 360 ± 171 d) versus no treatment (n = 100, follow-up: 272 ± 278 d), that is, -19.1 ± 15.8 versus -8.1 ± 20.9, respectively, P < 0.001, with consistent findings observed with nocturnal hypoxia measures. Concordantly, a greater improvement noted with subjective measures of dozing propensity was observed in patients undergoing upper airway stimulation versus comparators (Epworth Score, -5.1 ± 5.5 vs. 1.8 ± 3.7, respectively, P < 0.001) and overall sleep-related patient-reported outcomes. Women and those with previous oral appliance use had a lower odds of insurance approval (odds ratio [OR], 0.40; 95% confidence interval [95% CI], 0.22-0.71 and OR, 0.35; 95% CI, 0.18-0.69, respectively).Conclusions: Objective and subjective sleep apnea burden was more improved in those receiving upper airway stimulation versus not. Results underscore the need to optimize clinical care pathways focused on effective treatment of patients with obstructive sleep apnea who are not upper airway stimulation-insurance eligible and prioritize public health policy initiatives to address insurance-based sex-specific disparities. [ABSTRACT FROM AUTHOR]

Copyright of Infant Mental Health Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective/hypothesis: The ADHERE Registry is a multicenter prospective observational study following outcomes of upper airway stimulation (UAS) therapy in patients who have failed continuous positive airway pressure therapy for obstructive sleep apnea (OSA). The aim of this registry and purpose of this article were to examine the outcomes of patients receiving UAS for treatment of OSA.Study Design: Cohort Study.Methods: Demographic and sleep study data collection occurred at baseline, implantation visit, post-titration (6 months), and final visit (12 months). Patient and physician reported outcomes were also collected. Post hoc univariate and multivariate analysis was used to identify predictors of therapy response, defined as ≥50% decrease in Apnea-Hypopnea Index (AHI) and AHI ≤20 at the 12-month visit.Results: The registry has enrolled 1,017 patients from October 2016 through February 2019. Thus far, 640 patients have completed their 6-month follow-up and 382 have completed the 12-month follow-up. After 12 months, median AHI was reduced from 32.8 (interquartile range [IQR], 23.6-45.0) to 9.5 (IQR, 4.0-18.5); mean, 35.8 ± 15.4 to 14.2 ± 15.0, P < .0001. Epworth Sleepiness Scale was similarly improved from 11.0 (IQR, 7-16) to 7.0 (IQR, 4-11); mean, 11.4 ± 5.6 to 7.2 ± 4.8, P < .0001. Therapy usage was 5.6 ± 2.1 hours per night after 12 months. In a multivariate model, only female sex and lower baseline body mass index remained as significant predictors of therapy response.Conclusions: Across a multi-institutional study, UAS therapy continues to show significant improvement in subjective and objective OSA outcomes. This analysis shows that the therapy effect is durable and adherence is high.Level Of Evidence: 2 Laryngoscope, 130:1333-1338, 2020. [ABSTRACT FROM AUTHOR]

Background: Although the toxic effects of prenatal alcohol exposure (PAE) on children are well established, there is emerging evidence about the dynamics and associated demographics of drinking patterns across pregnancy, with risky drinking more likely to take place in the period before pregnancy awareness. This study investigated the use of complementary measurement tools in the understanding of alcohol use across pregnancy and reports on the rates and patterns of alcohol use in a community antenatal setting. Methods: Data on alcohol consumption before and after awareness of pregnancy were collected via multiple measurement tools: anonymous lifestyle questionnaire, TWEAK (Tolerance, Worried, Eye‐opener, Amnesia, K/Cut down) screener questionnaire, and Substance Use Inventory interviews across multiple pregnancy timepoints. Additionally, phosphatidylethanol (PEth), a direct biomarker of alcohol metabolism, collected from newborns' dried blood spot cards, was analyzed. Results: The TWEAK screener was more likely to identify risky drinking behavior than the lifestyle questionnaire. When pregnancy was unplanned, women were more likely to find out they are pregnant significantly later (p < 0.001) and consume alcohol at moderate–heavy levels (p = 0.03), prolonging the risk to the fetus. There was an association between maternal self‐reported alcohol use on the lifestyle questionnaire and Substance Use Inventory interviews, but no association between maternal reports of alcohol use and PEth results (p = 0.72). Women self‐reported moderate–heavy alcohol use in early pregnancy only and a positive PEth screen indicated PAE in late pregnancy, suggesting that these methods may identify different groups of women. Conclusions: Multiple measurement tools and methods are needed to identify PAE at different points across pregnancy. Prospective sensitive interviewing is better suited to detecting PAE in early pregnancy, but not later when social desirability bias is stronger, and the use of an objective biomarker, such a PEth, may be useful for identifying the risk of PAE in late pregnancy. [ABSTRACT FROM AUTHOR]

Aims: To specify the regions of the brain stem that are characterized by changes in substance P (SP)-like immmunoreactivity following activation of capsaicin-sensitive afferents innervating temporomandibular joint (TMJ) tissues in New Zealand rabbits. Methods: Capsaicin, an activator of small-diameter unmyelinated and thinly myelinated nociceptive afferent fibers, was administered unilaterally to the right TMJ of experimental animals. Another group received vehicle solution and served as controls. The animals were sacrificed 6 hours post-treatment through transcardial perfusion. Their brain stems were removed and sectioned, and SP-like immunoreactivity was assessed in serial horizontal sections. Results: A decrease in brain stem SP-like immunoreactivity occurred ipsilateral to capsaicin application. This reduction was primarily localized in brain stem regions that correspond to the trigeminal main sensory nucleus, as well as subnucleus oralis, interpolaris, and caudalis of the trigeminal spinal tract nucleus. Conclusion: The present study revealed central nervous system changes following TMJ capsaicin treatment in rabbits. [ABSTRACT FROM AUTHOR]

Copyright of Infant Mental Health Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Mothers with severe mental illness are vulnerable and engage with services cautiously due to fears of stigma and custody loss. To develop best practice standards and patient-centred services, the subjective experience of those who use it must inform service improvement and policy. Method: This study utilised exploratory concurrent mixed methods design with primarily qualitative data. Women admitted between April 2015 and December 2016 to a newly developed psychiatric Mother Baby Unit (MBU) in New Zealand were invited to participate in this study. Qualitative data were collected in three ways: (i) semi-structured interviews incorporating Māori concepts of health and wellness by research assistants near discharge; (ii) invitation to provide anonymous feedback in writing using an open format; (iii) unsolicited verbal feedback provided during a home visit three months after discharge. Thematic analysis was undertaken. Demographic and clinical information was collected prospectively for mother-infant pairs during the course of admission and three months post-discharge. Results: Forty-five people participated in the study. High rates of satisfaction were described. Strengths of the service–as perceived by mothers–included co-admission of mother and infant, staff warmth and availability, transparent practice, inclusion of families, and having a comfortable environment. Mothers described intense distress and confusion, as well as negative self-perceptions when acutely unwell. Infant co-admission and the inclusion of partners and other family members alleviated mothers’ distress. Personal attributes of staff, practical support with caregiving, a range of therapeutic approaches and holistic care were all valued. Feedback collected three months after discharge was the most reflective. Significant inter-ethnic differences were not apparent. Conclusions: The experience of inpatient care can have lasting influence on recovery and wellbeing. Employing a Māori model of health broadened the holistic nature of enquiry. The approach and timing taken in seeking the views of participants’ yielded different information, all of which is of value to service evaluation and refinement. The findings suggest that keeping mothers and infants together during health service utilisation such as MBUs should be a priority for policy makers and service designers. This approach is consistent with Māori values, combining the importance of whānau relationships (kinship), wairua (spiritual connectivity), hinengaro (the mind) and tinana (physical health). These findings suggest that ‘holistic care’–in this case following a Māori holistic health model–is important in mental health settings. [ABSTRACT FROM AUTHOR]

Sleep disturbances occur in one third of the US population, and the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control has deemed insufficient sleep to be a public health problem. Knowledge about sleep and skills to screen sleep disorders and to promote sleep health have been recommended for physical therapists. Furthermore, in survey studies, physical therapists overwhelmingly agree that sleep is important for health and poor sleep impairs function. Sleep is critical for the proper functioning of the body, including immune function, tissue healing, pain modulation, cardiovascular health, cognitive function, and learning and memory. Sleep disruptions occur across the life span and in individuals with various conditions that are typically treated by physical therapists. Therefore, the purpose of this perspective paper is to (1) discuss the relevance of sleep to physical therapist practice, (2) recommend tools to screen for the 3 most common sleep disorders, and (3) provide suggestions for how therapists can integrate sleep health in prevention, health promotion, and wellness interventions. [ABSTRACT FROM AUTHOR]

Individuals with the short variant of the serotonin transporter linked polymorphic region gene are more susceptible than individuals homozygous for the long allele to the effects of stressful life events on risk for internalizing and externalizing problems. We tested whether individual differences in coping style explained this increased risk for problem behavior among youth who were at both genetic and environmental risk. Participants included 279 children, ages 8-11. from the Children's Experiences and Development Study. Caregivers and teachers reported on children's internalizing and externalizing symptoms, and caregivers and children on children's exposure to harsh parenting and parental warmth in middle childhood, and traumatic events. Children reported how frequently they used various coping strategies. Results revealed that short/short homozygotes had higher levels of internalizing problems compared with long allele carriers and that short allele carriers had higher levels of externalizing problems compared with long/long homozygotes under conditions of high cumulative risk. Moreover, among children who were homozygous for the short allele, those who had more cumulative risk indicators less frequently used distraction coping strategies, which partly explained why they had higher levels of internalizing problems. Coping strategies did not significantly mediate Gene x Environment effects on externalizing symptoms. [ABSTRACT FROM AUTHOR]

Background: Mounting evidence demonstrates that individuals with stroke benefit from sleep to enhance learning of a motor task. While stage NREM2 sleep and REM sleep have been associated with offline motor skill learning in neurologically intact individuals, it remains unknown which sleep parameters or specific sleep stages are associated with offline motor skill learning in individuals with stroke. Methods: Twenty individuals with chronic stroke (>6 months following stroke) and 10 control participants slept for three consecutive nights in a sleep laboratory with polysomnography. Participants practiced a tracking task the morning before the third night and underwent a retention test the morning following the third night. Offline learning on the tracking task was assessed. Pearson's correlations assessed for associations between the magnitude of offline learning and sleep variables, age, upper-extremity motor function, stroke severity, depression, and time since stroke occurrence. Results: Individuals with stroke performed with significantly less error on the tracking task following a night of sleep (p=0.006) while the control participants did not (p=0.816). Increased sleep efficiency (r =??0.285), less time spent in stage NREM3 sleep (r =0.260), and more time spent in stage REM sleep (r =??0.266) were weakly-to-moderately associated with increased magnitude of offline motor learning. Furthermore, higher upper-extremity motor function (r =??0.400), lower stroke severity (r =0.360), and less time since stroke occurrence (r =0.311) were moderately associated with increased magnitude of offline motor learning. Conclusion: This study is the first study to provide insight into which sleep stages and individual characteristics may be associated with offline learning in people with stroke. Further research is needed to delineate which factors or combination of factors promote offline motor learning in people with neurologic injury to best promote motor recovery in these individuals. [ABSTRACT FROM AUTHOR]

Upper airway stimulation of the tongue using an implantable neurostimulator has recently been approved for select patients with moderate to severe obstructive sleep apnoea (osa) and intolerance to continuous positive airway pressure therapy. effective implantation depends on the integrity of the hypoglossal nerve as well as the tongue musculature, notably the genioglossus. prior trauma to either of these structures may be viewed as a relative contraindication to implantation. We describe a case of successful right hypoglossal nerve implantation in a patient with a history of left cardiac pacemaker placement and severe left penetrating tongue trauma with decreased mobility from contracture and deviation mimicking a hypoglossal nerve palsy. preoperative and postoperative apnoea--hypopnoea index values were 52/hour and 5/hour, respectively. prior soft tissue trauma to the tongue may not necessarily preclude surgical candidacy for upper airway stimulation in patients with osa. [ABSTRACT FROM AUTHOR]

Background Given mixed findings as to whether stressful experiences and relationships are associated with increases or decreases in children's cortisol reactivity, we tested whether a child's developmental history of risk exposure explained variation in cortisol reactivity to an experimentally induced task. We also tested whether the relationship between cortisol reactivity and children's internalizing and externalizing problems varied as a function of their developmental history of stressful experiences and relationships. Method Participants included 400 children ( M = 9.99 years, SD = 0.74 years) from the Children's Experiences and Development Study. Early risk exposure was measured by children's experiences of harsh, nonresponsive parenting at 3 years. Recent risk exposure was measured by children's exposure to traumatic events in the past year. Children's cortisol reactivity was measured in response to a social provocation task and parents and teachers described children's internalizing and externalizing problems. Results The effect of recent exposure to traumatic events was partially dependent upon a child's early experiences of harsh, nonresponsive parenting: the more traumatic events children had recently experienced, the greater their cortisol reactivity if they had experienced lower (but not higher) levels of harsh, nonresponsive parenting at age 3. The lowest levels of cortisol reactivity were observed among children who had experienced the most traumatic events in the past year and higher (vs. lower) levels of harsh, nonresponsive parenting in early childhood. Among youth who experienced harsh, nonresponsive parent-child relationships in early childhood and later traumatic events, lower levels of cortisol reactivity were associated with higher levels of internalizing and externalizing problems. Conclusions Hypothalamic-pituitary-adrenal ( HPA) axis reactivity to psychological stressors and the relationship between HPA axis reactivity and children's internalizing and externalizing problems vary as a function of a child's developmental history of exposure to stressful relationships and experiences. [ABSTRACT FROM AUTHOR]

Aging in female rats is associated With cessation of reproductive cycles, development of mammary cancer, and increased incidence of autoimmune diseases. Previously, we demonstrated an age-related decline in sympathetic noradrenergic (NA) innervation in the spleen and lymph nodes of female F344 rats accompanied by significantly reduced natural killer cell activity, interleukin (IL)-2 and interferon (IFN)-γ production, and T- and B-cell proliferation, suggesting possible links between sympathetic activity and immunosenescence. Objectives: The aim of this study is to investigate the effects of L-(-)-deprenyl, a monoamine oxidase-B inhibitor, on the sympathetic nervous system and cell-mediated immune responses in old female rats. Methods: Low doses of L-deprenyl (0.25 or 1.0 mg/kg body weight, BW) were administered intraperitoneally to 19- to 21-month-old female F344 rats for 8 weeks. To assess the stereoselectivity of the effects of deprenyl on splenic sympathetic activity and immune responses, the D-enantiomer (D-(+)-deprenyl, 1.0 mg/kg BW) was also included in the studies. Norepinephrine (NE) concentration and content, and mitogen-induced T-cell proliferation and cytokine production were assessed in the splenocytes after deprenyl treatment. Results: Treatment with L-deprenyl reversed the age-related decrease in NE concentration and content and IFN-γ production, and increased IL-2 production in the spleen while D-deprenyl did not affect the age-associated reduction in splenic NE levels or cytokine production. Conclusions: These findings demonstrate that L-deprenyl exerts neurorestorative and immunostimulatory effects on the sympathetic nervous system and cell-mediated immune responses during aging and provides evidence for a causal relationship between some aspects of immunosenescence and the age-related decline in sympathetic nerves in the spleens of female F344 rats. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To evaluate the hearing changes and quality-of-life outcomes of 393 cases of streptomycin/dexamethasone inner ear perfusion performed by the primary author on 312 ears of 299 patients with Meniere's disease between July 2002 and May 2010. Study Design: Retrospective chart review. Methods: Objective arm: A database was used to compile pretreatment and post-treatment audiograms as well as basic demographic information, dates of treatment, number of treatments, and which ear was treated. All patients met the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium Guidelines for the diagnosis and evaluation of therapy in Meniere's disease. All patients underwent one or more 3-day treatments consisting of daily intratympanic injections of a low-dose streptomycin/high-dose dexamethasone mixture plus intravenous dexamethasone. The end point for treatment was adequate control of vertigo. Subjective arm: The Meniere's Disease Outcomes Questionnaire survey was used to assess patients' quality of life after receiving streptomycin/dexamethasone inner ear perfusion. All procedures were performed by the primary author at the Shea Ear Clinic, a tertiary-referral otology clinic and outpatient surgery center. Results: After a single 3-day treatment, the average change in pure tone average was 0.89 dB (±11). The average change in word recognition score was 0.49% (±17). The average number of days from treatment to follow-up audiogram was 94 with a range of 8 to 1,603. Clinically significant hearing loss occurred after 62 of 393 (15.7%) treatments. Severe hearing loss occurred after 20 of 393 treatments (5.0%). The percentage of ears with clinically significant hearing loss after all treatments was 56 of 312 (17.9%). A total of 215 surveys were returned from 383 patients (56.1%) to whom they were mailed. There were 90% of patients who indicated improvement in quality of life after treatment and 88% who indicated improvement in their 'vertigo subscore,' a domain within the survey that focuses on vertigo control. Conclusions: Streptomycin/dexamethasone inner ear perfusion is as safe to the hearing of patients with Meniere's disease as other aminoglycoside regimens and provides a significant improvement in quality of life.Laryngoscope, 122:204-211, 2012 [ABSTRACT FROM AUTHOR]

Background: A common polymorphism in the serotonin transporter gene ( SLC6A4, 5HTT) has been repeatedly shown to moderate the influence of childhood adversity and stressful life events on the development of psychopathology. Using data from the English and Romanian Adoptee Study, a prospective-longitudinal study of individuals ( n = 125) exposed to severe early institutional deprivation (ID), we tested whether the effect of ID on adolescent emotional problems is moderated by 5HTT genotype and stressful life events in adolescence. Methods: Emotional problems were assessed using questionnaire data (age 11), and on the basis of the CAPA diagnostic interview (age 15). Additionally, the number of stressful life events was measured. Results: There was a significant effect for genotype ( p = .003) and a gene × environment interaction ( p = .008) that was independent of age at testing. Carriers of the s/l and s/s genotype who experienced severe ID showed the highest emotional problem scores, while l/l homozygotes in the severe ID group showed the lowest overall levels. Furthermore, s/s carriers in the severe ID group who experienced a high number of stressful life events between 11 and 15 years had the largest increases in emotional problem scores, while a low number of stressful life events was associated with the largest decrease (4-way interaction: p = .05). Conclusions: The effects of severe early ID on emotional problems in adolescence are moderated by 5HTT genotype, and influenced by stressful life events in adolescence. [ABSTRACT FROM AUTHOR]

The article focuses the deprivation-specific psychological patterns (DSPs) in children with institutional deprivation, as investigated during the English and Romanian Adoptees (ERA) study. It discusses four patterns that are associated with institutional deprivation including quasi-autism (Q-A), disinhibited attachment (DA), cognitive impairment (CI) and inattention/overactivity (I/O). It describes the external validity of the patterns and states that it is not concerned with Q-A and DA due to their low incidence in the general population. It explains the associations among four DSPs, and concludes that there is an indication of the validity of all four DSPs and a coherence to the association of the four to develop an overall DSP syndrome.

The article focuses on the development of deprivation-specific psychological patterns (DSPs) in children, as investigated during the English and Romanian Adoptees (ERA) study done on the development of children adopted into Great Britain from Romania. It discusses the manifestations of DSPs in children at the time of leaving institutional care and their persistence after adoption up to the age of 15. It explains the development of four features of DSPs including quasi-autism (Q-A), disinhibited attachment (DA), cognitive impairment (CI) and inattention/overactivity (I/O). It mentions that improved social relationships such as friendship were observed in children being studied. It further discusses the continuance of DSP up to 15 years of age.

The article focuses on the findings of the English and Romanian Adoptee (ERA) studies which were relevant for issues such as the risk, inference of causation, testing of mediating variables, and the possible moderating influences. It analyzes the different meanings of risk, cause, mediation and moderation in children. It further discusses the possibility of genetic moderation of institutional deprivation effects. It mentions the role of two genes, the glucocorticoid receptor gene and the dopamine transporter (DATI) gene which could be involved in moderating deprivation-related effects. It concludes that deprivation-specific psychological patterns (DSPs) are caused due to institutional deprivation.

This article by Celia Beckett, Amanda Hawkins, Michael Rutter, Jenny Castle, Emma Colvert, Christine Groothues, Jana Kreppner, Suzanne Stevens and Edmund Sonuga-Barke examines attitudes regarding cultural and national identity in a group of 165 young people adopted from Romania. The attitudes of their adoptive parents are also explored. The adoptive parents were interviewed over three or four time periods, when their children were 4/6, 11 and 15 years, and the adopted young people at the age of 11 and 15. The majority of the adopted young people had an interest in Romania and expressed a wish to visit their country of origin. However, there was no association between this interest in Romanian identity and levels of self-esteem. The majority of the adoptees saw themselves as English or Anglo-Romanian. A small minority saw themselves as Romanian; these adoptees had both lower self-esteem and a higher level of deprivation-specific problems. The degree of sustained interest shown by adoptive parents in the importance of Romanian identity was associated with the adopted young people's interest in Romania. However, parental interest in this issue had significantly declined by the time the children were 11 years old, by which time fewer adoptive parents than young people had plans to visit Romania in the future. [ABSTRACT FROM AUTHOR]

Theory of Mind (ToM) and Executive Function (EF) have been associated with autism and with attention-deficit hyperactivity disorder (ADHD), and hence might play a role in similar syndromes found following profound early institutional deprivation. In order to examine this possibility the current study included a group of 165 Romanian adoptees, of whom 144 were adopted into the UK from deprived institutional settings before 43months of age, and a group of 52 within-UK adoptees, all adopted before 6months of age. Both groups were assessed at 6 and 11years. The Strange Stories task was used to assess ToM and the Stroop task was used to assess EF, both at age 11. The Romanian adoptees displayed deficits in both ToM and EF compared with the within-UK adoptee group. The degree of deficit was greater for children who had experienced more than 6months of institutional deprivation. Deficits in both domains (ToM and EF) were associated with each of the three apparently deprivation-specific problems, namely quasi-autism, disinhibited attachment and inattention/overactivity. Statistical analyses indicated a mediating role for both ToM and EF with respect to quasi-autism; possibly a partial mediating role for EF with respect to inattention/overactivity; and probably no mediating role for either ToM or EF in the case of disinhibited attachment. In conclusion, there is evidence for a possible mediating role for ToM and EF in the development of some apparently deprivation-specific difficulties in institution-reared Romanian adoptees, but neither accounts for the overall pattern of deprivation-related difficulties. [ABSTRACT FROM AUTHOR]

Institutional deprivation is multifaceted and includes adverse psychosocial and nutrition-related components. In this study we partitioned these risks in relation to cognitive impairment and mental ill health, and explored the mediating role of reduced head/brain size. There were 138 participants (61 males, 77 females) in the study. Participants were Romanian adoptees who had experienced at least 2 weeks of early institutional deprivation. The sample was stratified on the basis of duration of deprivation (high risk >6mo in institutions) and sub-nutrition (i.e. 1.5 SD below UK age-related norms for weight at UK entry). UK children adopted before 6 months of age and a group of non-institutionally deprived Romanian children constituted the comparison groups. Duration of deprivation was associated with smaller head circumference, lowered IQ, and increased mental heath problems, independently of effects found for sub-nutrition on head circumference and IQ. The mediating role of head circumference was limited to either sub-nourished (IQ) or non-sub-nourished (inattention/overactivity and disinhibited attachment) subgroups. Many negative effects of early deprivation, including stunted brain growth, occur without sub-nutrition: psychosocial deprivation plays a major role in neurodevelopmental effects of deprivation. Further studies of functional and structural neuroanatomy following institutional deprivation are required to delineate the role of brain development in its effects. [ABSTRACT FROM AUTHOR]

Adult height is a model polygenic trait, but there has been limited success in identifying the genes underlying its normal variation. To identify genetic variants influencing adult human height, we used genome-wide association data from 13,665 individuals and genotyped 39 variants in an additional 16,482 samples. We identified 20 variants associated with adult height (P < 5 × 10−7, with 10 reaching P < 1 × 10−10). Combined, the 20 SNPs explain ∼3% of height variation, with a ∼5 cm difference between the 6.2% of people with 17 or fewer 'tall' alleles compared to the 5.5% with 27 or more 'tall' alleles. The loci we identified implicate genes in Hedgehog signaling (IHH, HHIP, PTCH1), extracellular matrix (EFEMP1, ADAMTSL3, ACAN) and cancer (CDK6, HMGA2, DLEU7) pathways, and provide new insights into human growth and developmental processes. Finally, our results provide insights into the genetic architecture of a classic quantitative trait. [ABSTRACT FROM AUTHOR]

The current study examined the persistence and phenotypic presentation of inattention/overactivity (I/O) into early adolescence, in a sample of institution reared (IR) children adopted from Romania before the age of 43 months. Total sample comprised 144 IR and 21 non-IR Romanian adoptees, and a comparison group of 52 within-UK adoptees, assessed at ages 6 and 11 years. I/O was rated using Rutter Scales completed by parents and teachers. I/O continued to be strongly associated with institutional deprivation, with continuities between ages 6 and 11 outcomes. There were higher rates of deprivation-related I/O in boys than girls, and I/O was strongly associated with conduct problems, disinhibited attachment and executive function but not IQ more generally, independently of gender. Deprivation-related I/O shares many common features with ADHD, despite its different etiology and putative developmental mechanisms. I/O is a persistent domain of impairment following early institutional deprivation of 6 months or more, suggesting there may be a possible pathway to impairment through some form of neuro-developmental programming during critical periods of early development. [ABSTRACT FROM AUTHOR]

The study assessed conduct and emotional difficulties in a group of Romanian adoptees at age 11, and serves as a follow-up to assessments made when the children were 6 years old. It was found that there was a significant increase in emotional difficulties, but not conduct problems, for the Romanian sample since age 6. It was also found that emotional difficulty was significantly more prevalent at age 11 in the Romanian group than in a within-UK adoptee group. Emotional difficulties in the Romanian adoptee group were found to be significantly and strongly related to previous deprivation-specific problems (disinhibited attachment, cognitive impairment, inattention/overactivity and quasi-autism); however, the presence of such early problems did not account fully for the onset of later emotional problems. Five contrasting hypotheses concerning possible mediators for later onset of emotional difficulties for the Romanian group were examined. No links were found to duration of deprivation or other deprivation-related indices, stresses/difficulties in the postadoption family environment, or educational attainment and self-esteem. There was some evidence that emotion recognition might play a role in the emergence of these problems, but other measures of social competence and theory of mind showed no associations with the onset of emotional problems. [ABSTRACT FROM PUBLISHER]

A study of the views of two groups of 11-year-old adopted children (one adopted as babies within the UK, n = 47, the other adopted from Romania, aged between two and 43 months, n = 133) indicates that parents underestimate the difficulty that their children have in talking about adoption. Children who found this harder experienced lower self-esteem at age 11 and were also more likely to feel different from their adoptive families, and both these factors were related to the individual child's level of behavioural or cognitive difficulties. Children in the Romanian sample who had another adopted sibling found it easier to talk about their adoption. In summary, the ease with which children can talk about adoption does appear to be associated with higher self-esteem and the individual child's difficulties, as well as family composition. This article by Celia Beckett, Jenny Castle, Christine Groothues, Amanda Hawkins, Edmund Sonuga-Barke, Emma Colvert, Jana Kreppner, Suzanne Stevens and Michael Rutter follows 'The experience of adoption (1)' (Hawkins et al, 2007), which explored intercountry and domestic adoption from the child's point of view. [ABSTRACT FROM AUTHOR]

Aims: Endothelial progenitor cells (EPCs) are found in the peripheral circulation and are capable of endothelial repair and neovascularization. EPC number and function are reduced in subjects with cardiovascular risk factors or proven coronary artery disease (CAD). We hypothesized that EPC number and/or function may be genetically regulated and may vary in healthy adult offspring depending on parental history of CAD. [ABSTRACT FROM PUBLISHER]

The notion that coronary atherosclerosis and its most severe phenotype, myocardial infarction (MI), are chronic inflammatory diseases is supported by several lines of evidence. Interleukins (ILs) are important mediators and modulators of inflammation. Specific polymorphisms in the genes encoding subunits of IL-23 ( IL-12B) and its receptor ( IL-23R) have recently been consistently found to be associated with chronic immune-mediated diseases. In this study, we explored the hypothesis that these variants also affect the risk of MI. We conducted a case–control association study on a cohort of 738 British Caucasian MI patients and 716 population controls. We tested four variants (rs11209026, rs7517847, rs1343151, rs10889677) of IL-23R and the A1188C polymorphism (rs3212227) of IL-12B. There was no association of any IL-23R (rs11209026, p = 0.82; rs7517847, p = 0.87; rs1343151, p = 0.85; rs10889677, p = 0.48) or IL-12B (rs3212227, p = 0.32) polymorphisms with MI. Stratification for age, gender and other cardiovascular risk factors did not affect the findings. These results indicate that unlike other chronic inflammatory diseases, the examined variants are unlikely to be major contributors to the pathogenesis of MI. [ABSTRACT FROM AUTHOR]

The relationship between severe early institutional deprivation and scholastic attainment at age 11 in 127 children (68 girls and 59 boys) adopted from institutions in Romania was compared to the attainment of 49 children (17 girls and 32 boys) adopted within the UK from a non-institutional background. Overall, children adopted from Romania had significantly lower attainment scores than those adopted within the UK; the children within the Romanian sample who had spent 6 months or more in an institution had significantly lower attainment scores than those who had spent less than 6 months in an institution, but there was no additional risk of low attainment associated with longer institutional care after 6 months. The lower scholastic attainment in the children adopted from Romanian institutions, as compared with domestic adoptees, was mediated by IQ, and to a lesser degree, inattention/overactivity. When these factors were taken into account, only small between-group differences in attainment remained. [ABSTRACT FROM AUTHOR]

A randomly selected sample of 165 children from Romania (of whom 144 had been reared in institutions) who were adopted by UK families, with placement before the age of 42 months, was studied at 4, 6, and 11 years of age. Comparisons were made with a sample of 52 non-institutionalized UK children adopted before the age of 6 months, who were studied in the same way. The paper briefly summarizes circumstances at the time of adoption and then reports findings at age 11, focusing on changes between 6 and 11. Marked catch-up in psychological functioning was evident following adoption, but significant problems continued in a substantial minority of the children placed after the age of 6 months. The theoretical implications of the findings are considered, and the policy implications are noted. [ABSTRACT FROM AUTHOR]

Adolescent intercountry (n = 122) and domestic (n = 40) adoptees and their adoptive parents were asked about their views on communicative openness. The adoptees were also asked for their thoughts on birth parents and contact. A modest association between communicative openness and feelings about adoptive status and self-esteem was found. Girls were more interested in many aspects of their adoptions than boys. Compared with the situation at 11 years of age, there was greater parent child agreement on whether the child had difficulties talking about adoption. Nevertheless, at age 15, children were still nearly twice as likely to report difficulties talking about adoption issues than their adoptive parents realized. At the age of 15, the majority of the adoptees expressed a desire for contact with birth relatives, but this was a reduction from the numbers at age 11. They also reported finding it easier to talk about adoption issues than they did at the age of 11. The implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Background: Disinhibited attachment is an important sequel of an institutional rearing, but questions remain regarding its measurement, its persistence, the specificity of the association with institutional rearing and on whether or not it constitutes a meaningful disorder. Method: Children initially reared in profoundly depriving institutions in Romania and subsequently adopted into UK families were compared with respect to findings at 11 years with children who had not experienced institutional deprivation and who had been adopted within the UK before the age of 6 months. Measures included parental reports, a Strange Situation procedure modified for use in the home and systematic standardised investigator ratings of the children's behaviour. Results: Disinhibited attachment, as reported by parents, showed a high degree of persistence from 6 to 11, but also a reduction over time in its frequency. Investigator ratings validated the parental reports but suggested that much of the fall in rate of disinhibited attachment was a function of the parental measure being less developmentally appropriate at 11 than it had been at 6. Disinhibited attachment was strongly associated with institutional rearing but there was not a significant increase in relation to duration of institutional deprivation beyond the age of 6 months. Mild, but not marked, disinhibited attachment was quite frequent in non-institutionalised adopted children but both the course and correlates indicated that its meaning was probably quite different. In the institution-reared children, disinhibited attachment was associated with a marked increase in service usage and associations with other forms of psychopathology. Conclusions: Disinhibited attachment constitutes a valid, and handicapping, clinical pattern that is strongly associated with an institutional rearing. [ABSTRACT FROM AUTHOR]

Background: There is uncertainty about the extent to which language skills are part of general intelligence and even more uncertainty on whether deprivation has differential effects on language and non-language skills. Methods: Language and cognitive outcomes at 6 and 11 years of age were compared between a sample of 132 institution-reared Romanian children adopted into UK families under the age of 42 months, and a sample of 49 children adopted within the UK under the age of 6 months who had not experienced either institutional rearing or profound deprivation. Results: The effects of institutional deprivation were basically similar for language and cognitive outcomes at age 6; in both there were few negative effects of deprivation if it ended before the age of 6 months and there was no linear association with duration of deprivation within the 6 to 42 month range. For the children over 18 months on arrival (range 18–42 months), the presence of even very minimal language skills (imitation of speech sounds) at the time of arrival was a strong beneficial prognostic factor for language and cognitive outcomes, but not for social/emotional/behavioural outcomes. Individual variations in adoptive parent characteristics were unrelated to differences in language or cognitive outcomes, possibly as a consequence of the limited variability in the adoptive family group. Conclusions: Minimal language probably indexes some form of cognitive reserve that, in turn, indexes the degree of institutional deprivation. [ABSTRACT FROM AUTHOR]

Cognitive outcomes at age 11 of 131 Romanian adoptees from institutions were compared with 50 U.K. adopted children. Key findings were of both continuity and change: (1) marked adverse effects persisted at age 11 for many of the children who were over 6 months on arrival; (2) there was some catch-up between ages 6 and 11 for the bottom 15%; (3) there was a decrease of 15 points for those over 6 months on arrival, but no differentiation within the 6-42-month range; (4) there was marked heterogeneity of outcome but this was not associated with the educational background of the adoptive families. The findings draw attention to the psychological as well as physical risks of institutional deprivation. [ABSTRACT FROM AUTHOR]

Service use between six and 11 years of age is reported for children adopted from Romania into UK families, and compared with that for children adopted within the UK before six months of age. Between six and 11, there had been only one adoption breakdown, and about one in ten couples experienced a marital breakdown. Apart from continuing concerns over hepatitis B carrier status in a small number of children, physical health problems were not a prominent feature. By contrast, nearly one-third of the children from Romania placed in UK families after the age of six months received mental health services provision--a rate far higher than the 11 to 15% in the groups adopted before the age of six months. Such provision was strongly related to research assessments of mental health problems and largely concerned syndromes that were relatively specific to institutional deprivation (quasi-autism, disinhibited attachment and inattention/overactivity). There were similar differences between the UK adoptees and the adoptees from Romania entering the UK after six months of age in major special educational provision and, again, the findings showed that the provision was in accord with research assessments of scholastic achievement. The between group differences for lesser special educational provision were much smaller and there was some tendency for the early adopted groups to receive such provision for lesser degrees of scholastic problems than the children adopted from Romania who entered the UK after six months of age. The policy and practice implications of the findings are briefly discussed. [ABSTRACT FROM AUTHOR]

Cardiac sympathetic transmitter stores are reduced in the failing heart. In this study, we proposed to investigate whether the reduction of cardiac sympathetic neurotransmitters was associated with increased interstitial norepinephrine (NE) and reactive oxygen species in congestive heart failure (CHF), using a microdialysis technique and salicylate to detect .OH generation. Rabbits with and without rapid ventricular pacing (340 beats/min) were randomized to receive desipramine (10 mg/day) or placebo for 8 wk. Rapid pacing produced left ventricular dilation and systolic dysfunction. The failing myocardium also showed reduced tissue contents of NE and tyrosine hydroxylase protein and activity. In contrast, myocardial interstitial NE was increased in CHF (0.89 ± 0.11 ng/ml) compared with the sham-operated animals (0.26 ± 0.03 ng/ml). In addition, cardiac oxidative stress was increased in CHF animals as measured by myocardial interstitial .OH radical, tissue oxidized glutathione, and oxidized mitochondrial DNA. Desipramine treatment produced significant NE uptake inhibition as evidence by an exaggerated pressor response and a greater increase of myocardial interstitial NE in response to intravenous NE infusion but no significant effects on cardiac function or hemodynamics in sham-operated or CHF animals. However, desipramine treatment attenuated the reductions of tissue NE and tyrosine hydroxylase protein and activity in CHF. Desipramine also prevented the reduction of tyrosine hydroxylase produced by NE in PC12 cells. Thus the reduction of cardiac sympathetic neurotransmitters is related to the increased interstitial NE and tissue oxidative stress in CHF. Also, normal neuronal uptake of NE is required for NE or its oxidized metabolites to exert their neurotoxic effects. [ABSTRACT FROM AUTHOR]

In this paper, we develop a physiological oscillator model of which the output mimics the shape of the R-R interval Poincaré plot. To validate the model, simulations of various nervous conditions are compared with heart rate variability (HRV) data obtained from subjects under each prescribed condition. For a variety of sympathovagal balances, our model generates Poincaré plots that undergo alterations strongly resembling those of actual R-R intervals. By exploiting the oscillator basis of our model, we detail the way that low- and high-frequency modulation of the sinus node translates into R-R interval Poincaré plot shape by way of simulations and analytic results. With the use of our model, we establish that the length and width of a Poincaré plot are a weighted combination of low- and high-frequency power. This provides a theoretical link between frequency-domain spectral analysis techniques and time-domain Poincaré plot analysis. We ascertain the degree to which these principles apply to real R-R intervals by testing the mathematical relationships on a set of data and establish that the principles are clearly evident in actual HRV records. [ABSTRACT FROM AUTHOR]

Focuses on a study which determined whether changes in cardiac sympathetic nerve terminal function produced by norepinephrine infusion, associated with reduced nerve growth factor. Methodology of the study; Results and discussion.

Presents a study which determined the effect of renin-angiotensin system inhibition on noradrenergic nerve terminal function in pacing-induced heart failure. Methods; Results; Discussion.

An abstract of the research "Further development of the adolescent self management and independence scale: AMIS II" is presented.