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Childhood adversities (CAs) predict heightened risks of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among people exposed to adult traumatic events. Identifying which CAs put individuals at greatest risk for these adverse posttraumatic neuropsychiatric sequelae (APNS) is important for targeting prevention interventions.
Methods
Data came from n = 999 patients ages 18–75 presenting to 29 U.S. emergency departments after a motor vehicle collision (MVC) and followed for 3 months, the amount of time traditionally used to define chronic PTSD, in the Advancing Understanding of Recovery After Trauma (AURORA) study. Six CA types were self-reported at baseline: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect and bullying. Both dichotomous measures of ever experiencing each CA type and numeric measures of exposure frequency were included in the analysis. Risk ratios (RRs) of these CA measures as well as complex interactions among these measures were examined as predictors of APNS 3 months post-MVC. APNS was defined as meeting self-reported criteria for either PTSD based on the PTSD Checklist for DSM-5 and/or MDE based on the PROMIS Depression Short-Form 8b. We controlled for pre-MVC lifetime histories of PTSD and MDE. We also examined mediating effects through peritraumatic symptoms assessed in the emergency department and PTSD and MDE assessed in 2-week and 8-week follow-up surveys. Analyses were carried out with robust Poisson regression models.
Results
Most participants (90.9%) reported at least rarely having experienced some CA. Ever experiencing each CA other than emotional neglect was univariably associated with 3-month APNS (RRs = 1.31–1.60). Each CA frequency was also univariably associated with 3-month APNS (RRs = 1.65–2.45). In multivariable models, joint associations of CAs with 3-month APNS were additive, with frequency of emotional abuse (RR = 2.03; 95% CI = 1.43–2.87) and bullying (RR = 1.44; 95% CI = 0.99–2.10) being the strongest predictors. Control variable analyses found that these associations were largely explained by pre-MVC histories of PTSD and MDE.
Conclusions
Although individuals who experience frequent emotional abuse and bullying in childhood have a heightened risk of experiencing APNS after an adult MVC, these associations are largely mediated by prior histories of PTSD and MDE.
Racial and ethnic groups in the USA differ in the prevalence of posttraumatic stress disorder (PTSD). Recent research however has not observed consistent racial/ethnic differences in posttraumatic stress in the early aftermath of trauma, suggesting that such differences in chronic PTSD rates may be related to differences in recovery over time.
Methods
As part of the multisite, longitudinal AURORA study, we investigated racial/ethnic differences in PTSD and related outcomes within 3 months after trauma. Participants (n = 930) were recruited from emergency departments across the USA and provided periodic (2 weeks, 8 weeks, and 3 months after trauma) self-report assessments of PTSD, depression, dissociation, anxiety, and resilience. Linear models were completed to investigate racial/ethnic differences in posttraumatic dysfunction with subsequent follow-up models assessing potential effects of prior life stressors.
Results
Racial/ethnic groups did not differ in symptoms over time; however, Black participants showed reduced posttraumatic depression and anxiety symptoms overall compared to Hispanic participants and White participants. Racial/ethnic differences were not attenuated after accounting for differences in sociodemographic factors. However, racial/ethnic differences in depression and anxiety were no longer significant after accounting for greater prior trauma exposure and childhood emotional abuse in White participants.
Conclusions
The present findings suggest prior differences in previous trauma exposure partially mediate the observed racial/ethnic differences in posttraumatic depression and anxiety symptoms following a recent trauma. Our findings further demonstrate that racial/ethnic groups show similar rates of symptom recovery over time. Future work utilizing longer time-scale data is needed to elucidate potential racial/ethnic differences in long-term symptom trajectories.
There is a limited literature available showing mental health burden among adolescents following cyberbullying.
Objectives
Aim is to evaluate the association of low mood and suicidality amongst cyberbullied adolescents.
Methods
A study on CDC National Youth Risk Behavior Surveillance (YRBS) (1991-2017). Responses from adolescence related to cyberbullying and suicidality were evaluated. Chi-square and mix-effect multivariable logistic regression analysis was performed to find out the association of cyberbullying with sadness/hopelessness, suicide consideration, plan, and attempts.
Results
A total of 10,463 adolescents, 14.8% of adolescents faced cyberbullying a past year. There was a higher prevalence of cyberbullying in youths aged 15-17 years (25 vs 26 vs 23%), which included more females to males (68 vs 32%).(p<0.0001) Caucasians (53%) had the highest number of responses to being cyberbullied compared to Hispanics (24%), African Americans (11%).(p<0.0001) There was an increased prevalence of cyberbullied youths with feelings of sadness/hopelessness (59.6 vs 25.8%), higher numbers considering suicide (40.4 vs 13.2%), suicide plan (33.2 vs 10.8%), and multiple suicidal attempts in comparison to non-cyberbullied.(p<0.0001) On regression analysis, cyberbullied adolescence had a 155% higher chance of feeling sad and hopeless [aOR=2.55; 95%CI=2.39-2.72], considered suicide [1.52 (1.39-1.66)], and suicide plan [1.24 (1.13-1.36)].
Conclusions
In our study, cyberbullying was associated with negative mental health outcomes. Further research is warranted to examine the impact and outcomes of cyberbullying amongst adolescents and guiding the policies to mitigate the consequences.
There is a paucity of knowledge and understanding of medical error in opioid substitution treatment programmes.
Objectives
To characterise patient safety incidents involving opioid-substitution treatment with methadone or buprenorphine in community-based care to identify the sources and nature of harm, describe and interpret themes and use this qualitative analysis to identify priorities to focus future improvement work.
Methods
We undertook a mixed-methods study examining incidents involving opioid substitution treatment with methadone or buprenorphine in community-based care submitted between 2005 and 2015 from the National Reporting and Learning System, a repository of incident reports from England and Wales. We analysed each report using four frameworks to identify incident type, contributory factors, incident outcome and severity of harm. Analysis involved detailed data coding and iterative generation of data summaries using descriptive statistical and thematic analysis.
Results
2,284 reports were identified. We found that most risks of harm came from failure in one of four processes of care delivery: prescribing opiate-substitution (n=151); supervised dispensing errors (n=248); non-supervised dispensing errors (n=318); and monitoring and communication activities (n=1544). Most incidents resulting in harm involved supervised or non-supervised dispensing (n=91/127, 72%). Staff- (e.g. mistakes, not following protocols) and organisation-related (e.g. poor working conditions or poor continuity of care between services) contributory factors were present for over half of incidents.
Conclusions
We have identified four processes of care delivery and associated contributory factors, which represent potential target areas for healthcare systems worldwide to develop interventions to improve the safe delivery of opioid substitution treatment.
The association between fish consumption and decreased risk of CVD is well documented. However, studies on health effects of fish consumption suggest that other components than n-3 PUFA have beneficial cardiometabolic effects, including effects on glucose metabolism. The aim of the present study was to investigate effects of salmon fish protein on cardiometabolic risk markers in a double-blind, randomised controlled parallel trial. We hypothesised that daily intake of a salmon fish protein supplement for 8 weeks would improve glucose tolerance in persons with increased risk of type 2 diabetes mellitus (T2DM). Our primary outcome measure was serum glucose (s-glucose) 2 h after a standardised oral glucose tolerance test. In total, eighty-eight adults with elevated s-glucose levels were randomised to 7·5 g of salmon fish protein/d or placebo, and seventy-four participants were included in the analysis. We found no significant effect of salmon fish protein supplementation on our primary outcome or other markers related to glucose tolerance, serum lipids, weight or blood pressure compared with placebo. The present study does not support the hypothesis that daily intake of a salmon fish protein supplement for 8 weeks improves glucose tolerance in persons with increased risk of T2DM.
Illicit drug use in India is quite serious and Kashmir is also one of the hardest hit places and the scenario is worsened by the prevailing turmoil. The present study was conducted to find the epidemiological profile of substance abusers visiting De-addiction Centres in Srinagar Kashmir India.
Objective
To study the socio-demographic profile of substance use disorder patients seeking treatment and to identify the reasons for starting the use of substance.
Materials and methods
The present cross sectional study, was conducted at two Drug De-addiction and treatment Centers in Srinagar. Total of 125 Substance Use Disorder Patients were interviewed by using pretested semi-structured proforma, emphasizing on socio-demographic profile and reasons for starting use of substance.
Results
Majority (50.4%) of patients belonged to young and productive age group. Most of the patients started taking substances in the age group of 10-19 years and more so in case of nicotine (76.8%), volatile substances (76.9%) and cannabis (70.5%). Besides nicotine (89.6%), the most common substances used were cannabis (48.8%), codeine (48%), propoxyphene (37.6%), alcohol (36.8%) and benzodiazepines (36%). Peer pressure was the most common (72.8%) reason for starting the use of substance.
Conclusion
Whether the society views substance misuse primarily as a moral or legal problem; when it creates difficulties for the user, it becomes concern of all people including parents, teachers, doctors, sociologists and psychologists. An integrated approach of early detection, treatment and rehabilitation is essential for preventing and minimizing the long term negative consequences of substance abuse.
In the present study, an effective secondary selection of transgressive variants from a homozygous population of Pusa Sugandh 3 (PS3) has led to the development of basmati variant SKUA 494. SKUA 494 exhibited a grain yield (7.9 t/ha) with superiority of 21.5% over its progenitor (6.5 t/ha). Besides, the genotype revealed an earliness of about 13 and 15 days for flowering and maturity, respectively. Hulling, milling and head rice recovery traits of SKUA 494 were comparatively better over the controls PS3 and Pusa Basmati 1509. No significant differences in the cooking quality were observed in SKUA 494 over its parental line. Quality traits of SKUA 494 revealed an intermediate score for alkali spreading value, besides similar values for gel consistency and amylose content in comparison to PS3. On the basis of stability variables, stability index and overall mean for most of the traits, SKUA 494 depicted stable performance across the locations and over the years. Molecular analysis based on simple sequence repeat markers revealed polymorphism at locus flanking the quantitative trait loci for days to heading (Hd6) between SKUA 494 and its parent (PS3). Based on overall superiority in the performance and adaptability of SKUA 494, the variety has been recommended to farmers for general cultivation under temperate ecology.
The error-related negativity (ERN) is a negative deflection in the event-related potential occurring when individuals make mistakes, and is increased in children with internalizing psychopathology. We recently found that harsh parenting predicts a larger ERN in children, and recent work has suggested that variation in the brain-derived neurotrophic factor (BDNF) gene may moderate the impact of early life adversity. Parents and children completed measures of parenting when children were 3 years old (N = 201); 3 years later, the ERN was measured and diagnostic interviews as well as dimensional symptom measures were completed. We found that harsh parenting predicted an increased ERN only among children with a methionine allele of the BDNF genotype, and evidence of moderated mediation: the ERN mediated the relationship between parenting and internalizing diagnoses and dimensional symptoms only if children had a methionine allele. We tested this model with externalizing disorders, and found that harsh parenting predicted externalizing outcomes, but the ERN did not mediate this association. These findings suggest that harsh parenting predicts both externalizing and internalizing outcomes in children; however, this occurs through different pathways that uniquely implicate error-related brain activity in the development of internalizing disorders.
Immigrants and their children who return to their country of origin to visit friends and relatives (VFR) are at increased risk of acquiring infectious diseases compared to other travellers. VFR travel is an important disease control issue, as one quarter of Australia's population are foreign-born and one quarter of departing Australian international travellers are visiting friends and relatives. We conducted a 1-year prospective enhanced surveillance study in New South Wales and Victoria, Australia to determine the contribution of VFR travel to notifiable diseases associated with travel, including typhoid, paratyphoid, measles, hepatitis A, hepatitis E, malaria and chikungunya. Additional data on characteristics of international travel were collected. Recent international travel was reported by 180/222 (81%) enhanced surveillance cases, including all malaria, chikungunya and paratyphoid cases. The majority of cases who acquired infections during travel were immigrant Australians (96, 53%) or their Australian-born children (43, 24%). VFR travel was reported by 117 (65%) travel-associated cases, highest for typhoid (31/32, 97%). Cases of children (aged <18 years) (86%) were more frequently VFR travellers compared to adult travellers (57%, P < 0·001). VFR travel is an important contributor to imported disease in Australia. Communicable disease control strategies targeting these travellers, such as targeted health promotion, are likely to impact importation of these travel-related infections.
This paper, a report by the Clinical Governance and Audit Committee of the Scottish Otolaryngological Society, presents a consensus view of the minimal requirements for ENT clinics in National Health Service hospitals.
Results and conclusion:
The provision of adequate equipment and staff has gained increasing importance as the vast majority of ENT procedures can be safely performed in the out-patient or office setting.
Preliminary work indicates that cognitive vulnerability to depression may be associated with variants of the serotonin transporter promoter polymorphism (5-HTTLPR) and the valine to methionine at position 66 (val66met) polymorphism of the brain-derived neurotrophic factor (BDNF) gene; however, existing reports come from small samples. The present study sought to replicate and extend this research in a sample of 375 community-dwelling children and their parents. Following a negative mood induction, children completed a self-referent encoding task tapping memory for positive and negative self-descriptive traits. Consistent with previous work, we found that children with at least one short variant of the 5-HTTLPR had enhanced memory for negative self-descriptive traits. The BDNF val66met polymorphism had no main effect but was moderated by maternal depression, such that children with a BDNF methionine allele had a heightened memory for negative self-descriptive traits when mothers had experienced depression during children's lifetimes; in contrast, children with a methionine allele had low recall of negative traits when mothers had no depression history. The findings provide further support for the notion that the 5-HTTLPR is associated with cognitive markers of depression vulnerability and that the BDNF methionine allele moderates children's sensitivity to contextual factors.
The dopamine active transporter 1 (DAT1) gene is implicated in psychopathology risk. Although the processes by which this gene exerts its effects on risk are poorly understood, a small body of research suggests that the DAT1 gene influences early emerging negative emotionality, a marker of children's psychopathology risk. As child negative emotionality evokes negative parenting practices, the DAT1 gene may also play a role in gene–environment correlations. To test this model, children (N = 365) were genotyped for the DAT1 gene and participated in standardized parent–child interaction tasks with their primary caregiver. The DAT1 gene 9-repeat variant was associated with child negative affect expressed toward the parent during parent–child interactions, and parents of children with a 9-repeat allele exhibited more hostility and lower guidance/engagement than parents of children without a 9-repeat allele. These gene–environment associations were partially mediated by child negative affect toward the parent. The findings implicate a specific polymorphism in eliciting negative parenting, suggesting that evocative associations play a role in elevating children's risk for emotional trajectories toward psychopathology risk.
We study convective motion in vertically vibrated three-dimensional granular beds by comparing the predictions of a model based on a hydrodynamic description to Navier–Stokes order with experimental results obtained using positron emission particle tracking (PEPT). The three-dimensional conservation equations relating mass, momentum and energy are solved using the finite element (FE) method for a viscous vibrofluidized bed by using only observable system parameters such as particle number, size, mass and coefficients of restitution. The mean velocity profiles from the viscous model show reasonable agreement with the experimental results at relatively low altitudes for the range of experimental values studied, though the velocity fields at higher altitudes were systematically underestimated by the model. We confirm that the convection rolls are influenced by the sidewall coefficient of restitution and demonstrate the scaling relationships that operate, where increasing amplitude of vibration leads to a reduction in the angular velocity of the rolls.
The chamber could be made of metal, e.g. aluminium, or of glass or ceramic
It is filled with ionized gas
There is a thin lead foil shielding the inner side of the chamber to prevent light from reaching the tube
The anode is made of aluminium
In fluoroscopy, γ is higher than in film-screen radiography
Regarding the input screen in fluoroscopy:
Each absorbed X-ray photon gives rise to nearly 3000 light photons in the blue part of the spectrum
The input phosphor is antimony caesium (SbCs3)
The input window is usually made of aluminium or titanium
The phosphor thickness is 1–4 mm
Only 60% of the incoming X-rays will be detected by the input phosphor
Regarding the output screen in the fluoroscopy:
The output phosphor is silver-activated zinc cadmium sulphide (ZnCdS:Ag)
The output phosphor emits green light
The size of the output screen depends on the application
The output phosphor is thicker than the input phosphor
To reduce scatter in the output window, very thick glass can be used
Regarding image intensifiers in fluoroscopy:
The diameter of the input screen is usually twice the diameter of the output screen
The intensity of light produced in the input phosphor and the number of electrons produced by the photocathode are directly proportional to the intensity of the X-ray
In late 2002, health professionals from the ministries of health and academia of Jordan, the Palestinian Authority and Israel formed the Middle East Consortium on Infectious Disease Surveillance (MECIDS) to facilitate trans-border cooperation in response to infectious disease outbreaks. The first mission of MECIDS was to establish a regional, laboratory-based surveillance network on foodborne diseases. The development of harmonized methodologies and laboratory capacities, the establishment of a common platform of communication, data sharing and analysis and coordination of intervention steps when needed were agreed upon. Each of the three parties selected the microbiological laboratories that would form the network of sentinel laboratories and cover the different districts of each country and also designated one laboratory as the National Reference Laboratory (NRL). Data analysis units have been established to manage the data and serve as a central point of contact in each country. The MECIDS also selected a regional data analysis unit, the Cooperative Monitoring Centre (CMC) located in Amman, Jordan, and established a mechanism for sharing data from the national systems. Joint training courses were held on interventional epidemiology and laboratory technologies. Data collection started in July 2005 with surveillance of salmonellosis as the first target. This network of collaboration and communication established in an area of continuous dispute represents an important step towards assessing the burden of foodborne diseases in the region and is expected to be fundamental for coordination of public health interventions and prevention strategies.
Inbreeding coefficients were calculated from data on spouse relationships in a sample of 4833 marriages comprising 345 from three Nilotic tribes, 302 from two indigenous Negroid tribes, and 4186 from several Arab and other tribes. The average inbreeding coefficients were 0·0081 to 0·0145 in Nilotic tribes, 0·0251 to 0·0269 in indigenous Negroids, and 0·0286 to 0·0430 in Arab tribes. First cousin unions constituted about half of all the consanguineous marriages and the pattern of first cousin marriages was similar in all three groups. The inbreeding coefficient for the entire sample was 0·0317.
To highlight the difficulty in making a correct diagnosis of benign schwannoma in the paranasal region, to raise awareness of this rare condition, and to suggest the most appropriate treatment.
Method:
Retrieval of cases retrospectively from archives of the histopathology department of a major UK cancer centre with central review of all cases.
Results:
Five cases were identified since 1990 and clinical and pathological features are summarised. Median follow up of patients was 8.1 years. Radiological appearances of local bone invasion and histological features of tumour unencapsulation and hypercellularity could give the mistaken impression of malignant disease and lead to unnecessary over-treatment.
Conclusion:
Central pathological review and clinical awareness is required. Although local recurrence can occur, the prognosis is excellent. The treatment of choice is local excision. Radiotherapy can be considered, but in most cases it would incur unnecessary morbidity.
We present a rare case of unilateral anterior jugular venous phlebectasia in an 82-year-old female patient presenting as a soft cystic lump in the anterior aspect of the neck increasing in size during straining and valsalva manoeuvre. Although cases of internal and external jugular phlebectasia have been reported, as far as we are aware no case of anterior jugular phlebectasia has been reported in the literature previously.