童年期心理虐待和忽视、述情障碍对大学生无聊倾向的影响

目的探讨童年期心理虐待和忽视、述情障碍对大学生无聊倾向的影响及其关系。方法采用大学生无聊倾向问卷(boredom proneness scale for college students,BPS)、儿童心理虐待和忽视量表(child psychological abuse and neglect scale,CPANS)、多伦多述情障碍量表(the Toronto alexithymia scale,TAS-20)对1557名大学生进行调查,采用SPSS 22.0进行描述性统计、相关分析和回归分析。结果童年心理虐待[(26.540±8.985)分]、忽视[(32.665±10.651)分]、述情障碍的识别情感维度[(19.359±4.835)分]、描述情感维度[(14.173±3.001)分],外向思维维度[(20.383±3.429)分]与无聊倾向总分[(101.109±19.735)分]、外部刺激维度[(66.022±21.079)分]存在正相关(r=0.160~0.559,均P<0.01),而与内部刺激维度[(35.132±8.207)分]存在负相关(r=-0.302~-0.104,均P<0.01)。分层回归分析显示,在控制性别和年龄的影响后,心理虐待与忽视是无聊倾向、内部刺激和外部刺激的影响因素,分别可解释总变异的14.3%,5.1%和18.2%(△F=130.561、41.968、172.711,均P<0.01)。述情障碍的识别情绪、描述情绪和外向思维是无聊倾向、内部刺激和外部刺激的影响因素,分别可解释总变异的17.5%,9.9%和25.5%(△F=134.274、60.696、234.383,P<0.01)。结论童年心理虐待和忽视、述情障碍对大学生无聊倾向存在显著影响,主要体现在对无聊倾向的外部刺激的影响上,其中述情障碍影响最大、解释力最高。     

Understanding associations of early-life adversities with mid-life inflammatory profiles: Evidence from the UK and USA

ObjectivesIn two cohorts, we aimed to establish associations between early-life adversities and adult inflammation, and whether adult (a) adiposity or (b) socioeconomic disadvantage are key intermediaries.MethodsIn both cohorts (N = 7661, 1958 British birth cohort; N = 1255, MIDUS), information was used on adult inflammatory markers (C-reactive protein (CRP), fibrinogen and (MIDUS only) interleukin-6 (IL-6)), adiposity and socioeconomic disadvantage, and early-life adversities (neglect, emotional neglect, physical, psychological, sexual abuse and childhood disadvantage).ResultsEarly-life adversities varied from 1.6% (sexual abuse, 1958 cohort) to 14.3% (socioeconomic disadvantage, MIDUS). Across the two cohorts, associations were consistent for physical abuse, e.g. 16.3%(3.01,29.7) and 17.0%(−16.4,50.3) higher CRP in the 1958 cohort and MIDUS respectively. Associations attenuated after accounting for adult adiposity, e.g. physical abuse (1958 cohort) and sexual abuse (MIDUS, non-white participants) associations were abolished. Some associations attenuated after adjustment for adult socioeconomic disadvantage; e.g. 1958 cohort neglect–CRP associations reduced from 23.2%(13.7,32.6) to 17.7%(8.18,27.2). Across the cohorts, no associations were found for psychological abuse or emotional neglect; associations for childhood socioeconomic disadvantage were inconsistent.ConclusionsSpecific early-life adversities are associated with adult inflammation; adiposity is a likely intermediary factor. Weight reduction and obesity prevention may offset pro-inflammatory related adult disease among those who experienced early-life adversities.     

European map of prevalence rates of elder abuse and its impact for future research

This article aims to map existing prevalence research on abuse and neglect of older people and to provide a critical overview of existing methodologies, which have been adopted to survey the prevalence rates of abuse against elders. This article is part of the prevalence study of Abuse and Violence against Older Women (AVOW) study, which was conducted in five European countries (Austria, Belgium, Finland, Lithuania, and Portugal). The article provides an overview of the state of the art of prevalence data, survey designs and methods, instruments and results in Europe. Therefore, this draws on an extensive literature search and qualitative content analysis, which was conducted as an early part of the AVOW study. Results indicate that some EU countries have a rich history of prevalence research, whereas other countries have just begun to tackle this aspect of research on of elder abuse. One of the lacunae concerns reliable numbers on the prevalence rates of elder abuse. Research about where, when and how often elder abuse occurs, is inadequate and inconsistent. Data in some cases are based on professionals’ reports rather than on information from older people themselves. Surveying elders about such a sensitive topic, however, implies the need for an adequate research instrument (questionnaire) and research design, and an adapted data collection method. In conclusion, substantial attention is paid to outlining possible guidelines for future research.     

Effects of lateral head inclination on multimodal spatial orientation judgments in neglect: Evidence for impaired spatial orientation constancy

Recent research revealed that patients with spatial hemineglect show deficits in the judgment of the subjective vertical and horizontal. Systematic deviations in the subjective axes have been demonstrated in the visual and tactile modality, indicating a supramodal spatial orientation deficit. Further, the magnitude of the bias was shown to be modulated by head- and body-position. The present study investigated the effect of passive lateral head inclination on the subjective visual and tactile vertical and horizontal in neglect patients, control patients with left- or right-sided brain damage without neglect and healthy controls. Subjects performed visual- and tactile-spatial judgments of axis orientations in an upright head orientation and with lateral head inclination 25° in clockwise (CW) or counterclockwise (CCW) direction. Neglect patients displayed a marked variability as well as a systematic tilt in their spatial judgments. In line with a multisensory spatial orientation deficit their subjective vertical and horizontal was tilted CCW in the visual and in the tactile modality, while such a tilt was not evident in any other subject group. Furthermore, lateral head inclination had a differential effect in neglect patients, but not in control subjects. Neglect patients’ judgments were modulated in the direction of the head tilt (‘A-effect’). That is, a CCW inclination further increased the CCW spatial bias whereas a CW inclination decreased the spatial bias and thus led to approximately normal performance. The increased A-effect might be caused by a pathologically strong attraction of the subjective vertical by an idiotropic vector relying on the actual head orientation, as a consequence of impaired processing of gravitational information in neglect patients.     

中国城市中学生忽视状况调查分析

目的了解我国城市中学生忽视的特点、分布及程度,分析其影响因素,为制定科学干预措施提供依据。方法采用多阶段分层整群抽样方法 ,从全国13省中抽取24个具有代表性的城市,共调查3539例,分为12～14岁(初中组)1964例和15～17岁(高中组)1575例;男性占50.1%,少数民族占9.5%。应用我国自行开发研制的中国城市中学生忽视评价常模,所得资料采用SPSS13.0软件进行统计分析,包括对不同年龄、性别组忽视层面(身体、情感、教育、安全、医疗及社会)的忽视率与忽视度等进行统计描述、χ2检验及方差分析(ANOVA)等,以判断其差别。结果①12～14岁(初中组)学生的平均忽视度和忽视率分别为46.4和22.4%;15～17岁(高中组)学生平均忽视度和忽视率分别为49.7和32.8%;初中及高中组学生之间平均忽视率与忽视度差异有统计学意义(P<0.01)。②12～14岁组男、女生忽视度分别为46.9和45.9(P<0.05),忽视率分别为24.9%和19.9%(P<0.05);15～17岁组男、女生忽视度分别为51.1和48.2(P<0.01),忽视率分别为39.2%和26.1%(P<0.01)。③在儿童忽视的6个层面上,12～14岁学生的忽视度为39.2～50.7,忽视率为2.1%～10.6%;15～17岁学生的忽视度为42.4～56.0,忽视率为4.5%～14.7%。④无论以年龄或性别分组,中学生均以受到单项忽视为主,其平均发生率为15.9%,构成比为53.7%。⑤12～14岁组与15～17岁组分别以再婚家庭与单亲家庭中受忽视率最高(分别为44.1%与38.4%),均以核心家庭学生受忽视率最低(分别为20.7%与32.3%)。结论中国城市中学生受忽视的频度和强度均较高,且高中学生受到的忽视度和忽视率相对更高。初中和高中两个年龄组男生受到的忽视强度和频度均高于女生。中学生在身体、情感、教育和社会忽视方面受到的忽视较多,均以单项受忽视为主;初中和高中组学生均以单亲家庭和再婚家庭中受到的忽视频度最高。     

Les adolescents violents. Réflexions cliniques,psychopathologiques et thérapeutiques

Purpose

Based on observations done in consultations by a psycho-analytic oriented child psychiatrist, in two Educative Reinforced Centers in France, the aim of this article is to understand some of the psychic and identity forming processes taking place within violent and delinquent adolescents.

Machine learning models improve prediction of large vessel occlusion and mechanical thrombectomy candidacy in acute ischemic stroke

Background and PurposeEarly identification of large vessel occlusions (LVO) and timely recanalization are paramount to improved clinical outcomes in acute ischemic stroke. A stroke assessment that maximizes sensitivity and specificity for LVOs is needed to identify these cases and not overburden the health system with unnecessary transfers. Machine learning techniques are being used for predictive modeling in many aspects of stroke care and may have potential in predicting LVO presence and mechanical thrombectomy (MT) candidacy.MethodsIschemic stroke patients treated at Loyola University Medical Center from July 2018 to June 2019 (N = 286) were included. Thirty-five clinical and demographic variables were analyzed using machine learning algorithms, including logistic regression, extreme gradient boosting, random forest (RF), and decision trees to build models predictive of LVO presence and MT candidacy by area of the curve (AUC) analysis. The best performing model was compared with prior stroke scales.ResultsWhen using all 35 variables, RF best predicted LVO presence (AUC = 0.907 ± 0.856–0.957) while logistic regression best predicted MT candidacy (AUC = 0.930 ± 0.886–0.974). When compact models were evaluated, a 10-feature RF model best predicted LVO (AUC = 0.841 ± 0.778–0.904) and an 8-feature RF model best predicted MT candidacy (AUC = 0.862 ± 0.782–0.942). The compact RF models had sensitivity, specificity, negative predictive value and positive predictive value of 0.81, 0.87, 0.92, 0.72 for LVO and 0.87, 0.97, 0.97, 0.86 for MT, respectively. The 10-feature RF model was superior at predicting LVO to all previous stroke scales (AUC 0.944 vs 0.759–0.878) and the 8-feature RF model was superior at predicting MT (AUC 0.970 vs 0.746–0.834).ConclusionRandom forest machine learning models utilizing clinical and demographic variables predicts LVO presence and MT candidacy with a high degree of accuracy in an ischemic stroke cohort. Further validation of this strategy for triage of stroke patients requires prospective and external validation.     

Use of prism adaptation in children with unilateral brain lesion: Is it feasible?

IntroductionUnilateral visuospatial deficits have been observed in children with brain damage. While the effectiveness of prism adaptation for treating unilateral neglect in adult stroke patients has been demonstrated previously, the usefulness of prism adaptation in a pediatric population is still unknown. The present study aims at evaluating the feasibility of prism adaptation in children with unilateral brain lesion and comparing the validity of a game procedure designed for child-friendly paediatric intervention, with the ecological task used for prism adaptation in adult patients.MethodsTwenty-one children with unilateral brain lesion randomly were assigned to a prism group wearing prismatic glasses, or a control group wearing neutral glasses during a bimanual task intervention. All children performed two different bimanual tasks on randomly assigned consecutive days: ecological tasks or game tasks. The efficacy of prism adaptation was measured by assessing its after-effects with visual open loop pointing (visuoproprioceptive test) and subjective straight-ahead pointing (proprioceptive test).ResultsGame tasks and ecological tasks produced similar after-effects. Prismatic glasses elicited a significant shift of visuospatial coordinates which was not observed in the control group.ConclusionPrism adaptation performed with game tasks seems an effective procedure to obtain after-effects in children with unilateral brain lesion. The usefulness of repetitive prism adaptation sessions as a therapeutic intervention in children with visuospatial deficits and/or neglect, should be investigated in future studies.     

Perception of horizontal distances in patients with spatial neglect

Two different models have argued that neglect of contralateral stimuli following brain damage might be associated with either a compressed or an anisometric neural representation of space along the earth-horizontal axis. We tested these models by determining neglect patients’ perception of spatial distances in the horizontal plane. We found no evidence for any compression or expansion or for anisometry along the earth-horizontal axis. The findings argue against a distortion of subjective space along the horizontal axis in patients with neglect, which could account for their failure to orient towards and to explore the contralesional parts of space.     

Diverse patterns of performance in copying and severity of unilateral spatial neglect

We analysed the performances of 69 patients with left unilateral spatial neglect in copying a multi-object figure, as well as their performance of the line cancellation and line bisection tests. Three patterns of copying were mainly observed. The first pattern was almost satisfactory performance in copying the central figure with occasional omission of the elements located more laterally to the left. The second pattern was omission of the left half of the whole figure, which was the pattern expected of patients with typical left unilateral spatial neglect. The third pattern was left unilateral spatial neglect when copying the central figure, with favourable copying of left lateral objects; this may be regarded as object-centred neglect. Performance of the line cancellation test, which requires exploratory ability, was significantly better for the patients with the third pattern than for those with the second pattern. A significant difference was also observed between the two groups of patients in performance of the line bisection test, in which exploratory ability plays a more minor role. No significant difference was found in performance of the line cancellation and line bisection tests between the patients with the third and first patterns, in spite of remarkable differences in their copying performances. No distinctive characteristics were found for any group of patients as regards lesion, age, duration after onset, education, and WAJS scores. Therefore we concluded that in most of our patients with neglect, these diverse patterns of copying deficits resulted from different levels of neglect severity but not from different types of unilateral spatial neglect.