Intimate relationships among returning soldiers: The mediating and moderating roles of negative emotionality,PTSD symptoms,and alcohol problems

Research examining relationship quality among combat veterans largely focuses on the role of posttraumatic stress disorder (PTSD), with less attention devoted to other correlates of PTSD and relationship quality, such as personality and problematic drinking. In a sample of combat‐exposed National Guard soldiers recently returned from Iraq (N = 308), we examined (a) a meditational pathway from negative emotionality, to elevated postdeployment PTSD symptoms, to poorer relationship quality; and (b) the moderating role of problematic drinking. Moderated mediation regression strategies supported the mediating role of postdeployment PTSD symptoms, but not the moderating role of problematic drinking on soldiers' relationship quality. Findings suggest negative emotionality creates a vulnerability to more severe early postdeployment PTSD symptoms and poorer early postdeployment relationship quality.     

妇科肿瘤患者医学应对及负性情绪在家庭关怀度与心理弹性间的中介作用

目的 评估妇科肿瘤患者心理弹性水平，并探讨与家庭关怀度、应对方式、负性情绪之间的关系。方法 采用家庭关怀度指数量表、医学应对量表、抑郁-焦虑-压力量表、心理弹性量表对224例妇科肿瘤患者进行调查。结果 妇科肿瘤患者心理弹性总分（50.88±15.17）分。家庭关怀度、医学应对的面对、回避维度与心理弹性呈正相关，负性情绪与心理弹性呈负相关（均P＜0.05）。结构方程模型显示，家庭关怀度对妇科肿瘤患者心理弹性的直接预测作用不显著；应对方式、负性情绪在患者家庭关怀度与心理弹性间起完全中介作用，并存在链式中介作用。家庭关怀度、屈服、回避、面对、负性情绪对心理弹性的总效应值分别为0.413、-0.356、0.200、0.186、-0.564。结论 家庭关怀度可以通过应对方式和负性情绪预测妇科肿瘤患者的心理弹性。医护人员可通过实施家庭干预为患者构筑家庭支持网络，指导患者采取合适的应对方式，科学管理负性情绪，以提高其心理弹性水平。     

Dialysis shunt-associated steal syndrome (DASS) following brachial accesses: the value of fistula banding under blood flow control

Background  Dialysis shunt-associated steal syndrome (DASS) is a rare complication of hemodialysis access (HA) which preferably occurs in brachial fistulas. Treatment options are discussed controversially. Aim of this study was to evaluate flow-controlled fistula banding. Materials and methods  Patients treated between 2002 and 2006 were included in this prospective survey. According to a classification we established, patients were typed DASS I–III (I: short history, no dermal lesions; II: long history, skin lesions; III: long history, gangrene). Surgical therapy was HA banding including controlled reduction (about 50% of initial flow) of HA blood flow (patients type I and II). Patients with type III underwent closure of the HA. Results  In 15 patients with relevant DASS, blood-flow-controlled banding was performed. In ten patients (all type I), banding led to restitution of the hand function while preserving the HA. In five patients (all type II), banding was not successful; in two patients, closure of the HA was performed eventually. In five patients (type III), primary closure of the HA was performed. Four patients with DASS type II but only two with DASS type I had diabetes mellitus (p = 0.006). Conclusions  Banding under blood flow control resulting in an approximately 50% reduction in the initial blood flow is an adequate therapeutic option in patients with brachial HA and type I-DASS. In type II-DASS, banding does not lead to satisfying results, more complex surgical options might be more successful. Diabetes is associated with poor HA outcome in case of DASS.     

Stressful life events and adolescent well‐being: The role of parent and peer relationships

It is well established that stressful life events (e.g., family bereavements or moving to a new country) are damaging to psychological health and well‐being. Indeed, social relationships are often noted as an important factor that can influence well‐being and buffer the negative effects of stress. However, the quality and source of these relationships, particularly for adolescents, are often overlooked. Using the Growing Up in Ireland Survey, a population‐based study of 13‐year‐old Irish adolescents (N = 7,525; 51.1% female), the current study examines the quality of both parent and peer relationships as potential mechanisms explaining the association between stressful life events and psychological well‐being indices in adolescents. As expected, results showed that stressful life events negatively impacted the psychological well‐being of adolescents. Parallel mediation analyses indicated that both parent and peer relationship quality mediated this association. Further exploratory analyses found that for girls, greater numbers of stressful life events were associated with poorer quality relationships with both their parents and peers, and in turn, these were linked to lower levels of psychological well‐being. For boys, this effect was only evident for parental relationship quality, but not peers. The implication of these findings for adolescent's psychological well‐being, particularly for girls, is discussed.     

The Children's Revised Impact of Event Scale: Dimensionality and Measurement Invariance in a Sample of Children and Adolescents Exposed to Wildfires

Natural disasters are potentially traumatic events due to their disruptive nature and high impact on social and physical environments, particularly for children and adolescents. The present study aimed to examine the psychometric properties of the Children's Revised Impact of Event Scale (CRIES‐13) in a sample of Portuguese children and adolescents exposed to a specific type of natural disaster (i.e., wildfire). The sample was recruited at six school units of the Central region of Portugal following wildfires in the summer of 2017 and included children and adolescents without a clinical diagnosis of a psychopathological condition associated with exposure to the traumatic event (i.e., nonclinical sample, n = 486) and those with a clinical diagnosis of a trauma‐ and/or stress‐related disorder (i.e., posttraumatic stress disorder [PTSD], adjustment disorder, separation anxiety disorder, or grief; clinical sample, n = 54). Confirmatory factor analyses indicated that a two‐factor model (i.e., Intrusion/Arousal and Avoidance) provided a better fit than a three‐factor model (i.e., Intrusion, Arousal, and Avoidance) and was found to be invariant across gender and age groups. The CRIES‐13 showed good reliability for all subscales, with Cronbach's αs > .79. Higher CRIES‐13 scores were associated with poorer health and well‐being and more internalizing and externalizing problems. The clinical sample presented with significantly higher CRIES‐13 scores than the nonclinical sample, η_p² = .13. These results contribute to the cross‐cultural validation of the CRIES‐13 and support its use as a reliable and valid measure for assessing posttraumatic symptoms in children and adolescents.     

A Brief School‐Based Cognitive‐Behavioral Intervention for Japanese Adolescents With Severe Posttraumatic Stress

This pilot study investigated the efficacy of a brief school‐based cognitive–behavioral intervention program for Japanese adolescents exposed to the Great East Japan Earthquake in 2011. The participants were 22 adolescents with severe posttraumatic stress symptoms at the time of the study in March 2014. They completed a single‐session 4‐step intervention program based on Ehlers and Clark's (2000) model at their school. Symptom status was assessed at 3 time points (preintervention, postintervention, and 4‐month follow‐up) using the Impact of Event Scale‐Revised (Weiss, 2004) and Center for Epidemiologic Studies Depression Scale (Radloff, 1977). The results showed significant improvements in all posttraumatic stress symptoms at postintervention (d = 0.81), and the effects were maintained throughout the 4‐month follow‐up period (d = 1.10). However, no improvement in depressive symptoms was shown. Results from this pilot study suggest that school‐based cognitive–behavioral intervention programs are feasible and show promise for Japanese adolescents with posttraumatic stress symptoms regardless of cross‐cultural differences, but that additional research examining effectiveness is needed. Despite the preliminary nature of the findings of this pilot study, the strengths of our intervention were that it was driven by a well‐tested theoretical model and required only a single session to administer.     

Consequences of the Diagnostic Criteria Proposed for the ICD‐11 on the Prevalence of PTSD in Children and Adolescents

In 2013, a working group of the World Health Organization (WHO) proposed a reformulation of the posttraumatic stress disorder (PTSD) diagnostic criteria for the upcoming 11^th edition of the International Classification of Diseases (ICD‐11; Maercker, Brewin, Bryant, Cloitre, van Ommeren, et al., 2013). This study investigated the consequences of the proposed ICD‐11 PTSD symptom reduction on the prevalence of PTSD in children and adolescents. Prevalence rates of PTSD in a clinical sample of 159 traumatized children and adolescents were compared applying criteria according to the 4^th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV; American Psychiatric Association, 1994), the ICD‐10 (WHO, 1992), and the ICD‐11. The prevalence rate was 76.1% using DSM‐IV, 88.1% using ICD‐10, and 61.0% using ICD‐11. The use of the criteria proposed for ICD‐11 resulted in 27.1% less positive cases compared with ICD‐10 and 15.1% less positive cases compared with DSM‐IV. Our results showed that in a clinical sample of children and adolescents the prevalence of PTSD was significantly affected by the use of different diagnostic systems. This will constitute a major challenge for research and practice because, depending on the algorithm used, different groups of patients will be included in studies and different groups of individuals will be able to access medical care and therapy.     

Internalizing and externalizing classes in posttraumatic stress disorder: A latent class analysis

Using latent class analysis (LCA) the typology of personality profiles of veterans with posttraumatic stress disorder (PTSD) was examined based on internalizing/externalizing dimensions of psychopathology. Latent class analysis on Minnesota Multiphasic Personality Inventory‐2 (MMPI‐2) Personality Psychopathology‐5 (PSY‐5) scale data from 299 Australian combat veterans with PTSD supported the model, identifying an optimal 4‐class solution, with PTSD externalizing class defined by aggressiveness and disconstraint, high and moderate internalizing classes differentiated on the extent of elevations in introversion and negative emotionality and elevation of psychoticism in the high internalizing class and a simple PTSD class with normal range scores. The model was validated using external self‐report and psychiatric‐interview‐derived diagnoses. A second exploratory LCA using broader comorbidity indicators (MMPI‐2 Restructured Clinical scales) demonstrated some support for, although limitations in, using nonpersonality measures to identify these classes directly.     

Associations Between Motor Vehicle Crashes and Mental Health Problems: Data From the National Survey of Adolescents‐Replication

Motor vehicle crashes (MVCs) are a leading cause of physical injuries and mortality among children and adolescents in the United States. The purpose of this study was to examine associations between having an MVC and mental health outcomes, including posttraumatic stress disorder (PTSD), depression, and drug and alcohol misuse in a nationally representative sample of adolescents. A sample of 3,604 adolescents, aged 12–17 years, was assessed as part of the 2005 National Survey of Adolescents‐Replication (NSA‐R) study. Data were weighted according to the 2005 U.S. Census estimates. Within this sample, 10.2% of adolescents reported having at least 1 serious MVC. The prevalence of current PTSD and depression among adolescents having an MVC was 7.4% and 11.2%, respectively. Analyses revealed that an MVC among adolescents aged 15 years and younger was independently associated with depression (OR = 2.17) and alcohol abuse (OR = 2.36) after adjusting for other risk factors, including a history of interpersonal violence. Among adolescents aged 16 years and older, an MVC was associated only with alcohol abuse (OR = 2.08). This study was the first attempt to explore adverse mental health outcomes associated with MVCs beyond traumatic stress symptoms among adolescents in a nationally representative sample.     

A Meta‐Analysis of the Association Between Appraisals of Trauma and Posttraumatic Stress in Children and Adolescents

Cognitive models of posttraumatic stress disorder (PTSD) place an emphasis on the role of negative appraisals of traumatic events. It is suggested that the way in which the event is appraised determines the extent to which posttraumatic stress symptoms will be experienced. Therefore, a strong relationship between trauma appraisals and symptoms of PTSD might be expected. However, this relationship is not as firmly established in the child and adolescent literature. A systematic literature review of this relationship returned 467 publications, of which 11 met full eligibility criteria. A random effects meta‐analysis revealed a large effect size for the relationship between appraisals and PTSD symptoms in children and adolescents, r = .63, 95% CI [.58, .68], Z = 17.32, p < .001, with significant heterogeneity present. A sensitivity analysis suggested that this relationship was not contingent on 1 specific measure of appraisals. Results were consistent with the cognitive behavioral theory of PTSD, demonstrating that appraisals of trauma are strongly related to posttraumatic stress in children and adolescents. However, this relationship was not observed in a sample of 4‐ to 6‐year‐olds, indicating that further research is required to explicate cognitive processing of trauma in very young children.     

HIV,violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV

Introduction : Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non‐adherence to anti‐retroviral treatment, loss‐to‐follow‐up and morbidity. This study tested a theoretical model of multi‐level risk pathways to internalized HIV stigma among South African ALHIV. Methods : From 2013 to 2015, a survey using t otal population sampling of ALHIV who had ever initiated anti‐retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community‐tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow‐up. 90.1% of eligible ALHIV were interviewed (n = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV‐related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well‐validated self‐report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV‐related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address. Results : Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV‐related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070). Conclusions : These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi‐level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities and schools may interrupt risk pathways from HIV‐related health problems to psychological distress and internalized HIV stigma. This highlights the potential for interventions that do not explicitly target adolescents living with HIV but are sensitive to their needs.     

A holistic understanding of the effect of stress on adolescent well‐being: A conditional process analysis

Although traditional assumptions tend to conceptualize stress as inherently dysfunctional, psychological theory suggests that it is not intrinsically maladaptive. Contemporary models emphasize that the stress response can be differentiated into both negative and positive aspects, known as distress and eustress. Research examining the differential effect of positive and negative stress on adolescent well‐being is limited and has been hindered by a lack of appropriate measurement tools. The aim of the present study was to utilize the recently developed Adolescent Distress‐Eustress Scale to provide a balanced understanding of the impact of stress on positive mental health, holistically considering the effect of both distress and eustress on adolescent well‐being. One thousand eighty‐one Australian adolescents (M_age = 15.14, 54.03% female) completed an online survey composed of the Adolescent Distress‐Eustress Scale alongside measures of well‐being, self‐efficacy, psychological ill‐being, physical activity, and daytime sleepiness. Conditional process analysis suggested that distress exerted no direct influence on well‐being, with the observed negative relationship fully mediated by psychological and behavioural variables. Contrastingly, eustress was both directly related to increased well‐being and exerted an indirect effect through relationships with mediating variables. These results demonstrate that stress can have profoundly positive consequences. Theoretical contributions, implications for practice, and perspectives for future research are discussed.     

Stress and dietary quality in black adolescents in a metropolitan area

Adolescents from families with low socio‐economic status (SES) experience more stress and have poorer diets than adolescents from families with high SES. This study investigated whether change in dietary quality among urban, black adolescents related to changes in the Perceived Stress Scale (PSS) and the Daily Hassles Microsystem Scale (DHMS) while controlling for household income. At two times 1 month apart, 25 adolescents completed a modified Adolescent Food Habits Checklist (AFHC), the PSS and the DHMS. Change scores from time 1 to time 2 for each measure were computed. AFHC change and PSS change had a significant, negative correlation (r = ?0.458, p < 0.05), even when controlling for income (r = ?0.585, p < 0.05). For girls, AFHC change and PSS change had a significant, negative correlation (r = ?0.599, p < 0.05), even when controlling for income (r = ?0.697, p < 0.05). No significant correlation was observed for boys (r = 0.003, p = 0.993), and when controlling for income (r = ?0.346, p = 0.448). The correlation between AFHC change and DHMS change was not significant. Black adolescent girls, but not boys, tended to make more unhealthy dietary choices when under increased stress. Copyright © 2008 John Wiley & Sons, Ltd.     

Support for the Multidimensional Adolescent Stress Questionnaire in a Sample of Adolescents in the United Kingdom

Adolescence is a time of physical, social and emotional development, and this development can be accompanied by feelings of stress. The Adolescent Stress Questionnaire is a 56‐item scale measuring stress in 10 domains. Developed in Australia, the scale has been translated, and its reliability and validity have been tested in a number of countries across Europe, where the 10‐factor, 56‐item version of the scale has received little support. The present study tested the factor structure, construct validity and reliability in a sample (n = 610) of adolescents in the United Kingdom. Support was found for the 10‐factor, 56‐item version of the scale, and correlations with self‐concept measures, sex scores on stress factors and Cronbach's α‐values, suggesting that the scale may be a viable assessment tool for adolescent stress. Results for alcohol‐specific analyses support the domain‐specific nature of the scale. Future work may seek to investigate the stability of age‐specific stress domains (e.g. the stress of Emerging Adult Responsibility) in samples that include younger adolescents. Copyright © 2014 John Wiley & Sons, Ltd.     

Involvement of nitric oxide in the wound bed microcirculatory change during negative pressure wound therapy

This study investigated the role of nitric oxide (NO) in the mechanism of blood flow increase in the wound bed during negative pressure wound therapy (NPWT). We developed an improved experimental model that allowed visualisation of the wound bed microcirculation under NPWT. Wounds were created on the mouse ear, taking care to preserve the subdermal vascular plexus, because the wound bed microcirculation was visualised using an intravital microscope system. We investigated whether application of a NO synthase inhibitor (N^G‐nitro‐l ‐arginine methyl ester: L‐NAME) might diminish the effect of the NPWT in increasing the wound blood flow. The experimental animals were divided into a negative pressure group (negative pressure of ?125 mmHg applied to the wound for 5 minutes; n = 8), and a negative pressure plus L‐NAME group (administration of L‐NAME prior to application of the negative pressure; n = 8). In the negative pressure group, significant increase of blood flow was observed at 1 minute after the negative pressure application, which was sustained until 5 minutes. On the contrary, in the negative pressure plus L‐NAME group, no significant changes were observed throughout the period of observation. These findings suggest that NO synthesis is involved in the wound bed microcirculatory change induced by NPWT.     

Cost‐effectiveness analysis of single‐use negative pressure wound therapy dressings (sNPWT) to reduce surgical site complications (SSC) in routine primary hip and knee replacements

We sought to evaluate the cost‐effectiveness of single‐use negative pressure wound therapy in patients undergoing primary hip and knee replacements using effectiveness data from a recently completed non‐blinded randomized controlled trial. A decision analytic model was developed from UK National Health Service perspective using data from a single‐centre trial. 220 patients were randomized to treatment with either single‐use negative pressure wound therapy or standard care i.e., film dressings of clinician choice and followed for 6 weeks. Outcomes included dressing changes, length of stay, surgical site complications, cost and quality adjusted life years. The randomized controlled trial reported a reduction in dressing changes (p = 0.002), SSC (p = 0.06) and LOS (p = 0.07) in favor of single‐use negative pressure wound therapy compared with standard care. The model estimated 0.116 and 0.115 QALY gained, 0.98 and 0.92 complications avoided for single‐use negative pressure wound therapy and standard care, respectively. The cost/patient was £5,602 ($7,954) and £6,713 ($9,559) for single‐use negative pressure wound therapy and standard care respectively resulting in cost‐saving of £1,132 ($1,607) in favor of single‐use negative pressure wound therapy. Greater savings were observed in subgroups of higher risk patients with BMI ≥ 35 and ASA ≥ 3 i.e., £7,955 ($11,296) and £7,248 ($10,293), respectively. The findings were robust to a range of sensitivity analyses. In conclusion, single‐use negative pressure wound therapy can be considered a cost saving intervention to reduce surgical site complications following primary hip and knee replacements compared with standard care. Providers should consider targeting therapy to those patients at elevated risk of surgical site complications to maximize efficiency.     

Alternative Models of DSM‐5 Posttraumatic Stress Disorder in Portuguese Adolescents Exposed to Trauma and Childhood Adversity

The factor structure of DSM‐5 posttraumatic stress disorder (PTSD) has been extensively debated, with evidence supporting the recently proposed seven‐factor hybrid model. However, few studies examining PTSD symptom structure have assessed the implications of these proposed models on diagnostic criteria and PTSD prevalence. In the present study, we examined seven alternative DSM‐5 PTSD models within a confirmatory factor analysis (CFA), using the Child PTSD Symptom Scale–Self‐Report for DSM‐5 (CPSS‐5). Additionally, we generated prevalence rates for each of the seven models by using a symptom‐based diagnostic algorithm and assessed whether substance abuse, depression, anxiety symptoms, and daily functioning were differentially associated with PTSD depending on the model used to derive the diagnosis. Participants were 317 adolescents aged 13–17 years (M = 15.93, SD = 1.23) who had experienced a DSM‐5 Criterion A trauma and/or childhood adversity. The CFA results showed good fit indices for all models, with the seven‐factor hybrid model presenting the best fit. The rates of PTSD diagnosis varied according to each model. The four‐factor DSM‐5 model presented the highest rate (30.6%), and the seven‐factor hybrid model presented the lowest rate (17.4%). Similar to the CFA analysis, the inclusion criteria for the diagnosis based on the hybrid model also presented the strongest associations with daily functional impairment, odds ratio (OR) = 1.48, 95% CI [1.25, 1.75]; and adverse childhood experiences, OR = 1.46, 95% CI [1.16, 1.82]. Research and clinical implications of these results are discussed, and suggestions for future investigation are presented.     

Association of psychosocial factors with leukocyte telomere length among African Americans in the Jackson Heart Study

Leukocyte telomere length (LTL) is a biomarker of cellular aging. African Americans report more stress than other groups; however, the association of psychosocial stressors with biological aging among African Americans remains unclear. The current study evaluated the association of psychosocial factors (negative affect and stressors) with LTL in a large sample of African American men and women (n = 2,516) from the Jackson Heart Study. Using multivariable linear regression, we examined the sex‐specific associations of psychosocial factors (cynical distrust, anger in and out, depressive symptoms, negative affect summary scores, global stress, weekly stress, major life events, and stress summary scores) with LTL. Model 1 adjusted for demographics and education. Model 2 adjusted for model 1, smoking, alcohol intake, physical activity, diabetes, hypertension, and high‐sensitivity C‐reactive protein. Among women, high (vs. low) cynical distrust was associated with shorter mean LTL in model 1 (b = ?0.12; p = 0.039). Additionally, high (vs. low) anger out and expressed negative affect summary scores were associated with shorter LTL among women after full adjustment (b = ?0.13; p = 0.011; b = ?0.12, p = 0.031, respectively). High levels of cynical distrust, anger out, and negative affect summary scores may be risk factors for shorter LTL, particularly among African‐American women.     

Fetal Growth Velocity,Size in Early Life and Adolescence,and Prediction of Bone Mass: Association to the GH–IGF Axis

Poor growth in early life is associated with numerous adverse outcomes later in life. In 123 adolescents 16–18 yr of age, the previous findings of a positive relation between size in early life and later bone mass was confirmed. These associations were mediated by the current height and weight, but it was not confirmed that alterations of the GH–IGF axis cause this. Introduction: Numerous studies have found associations between low birth weight and disease later in life, including decreased bone mass. Materials and Methods: A longitudinal cohort of 16‐ to 19‐year‐old adolescents (n = 123) with data on third trimester fetal growth velocity (FGV) was assessed by serial ultrasound measurements, birth weight (BW), and weight at 1 yr. A follow‐up study included DXA scan, anthropometric measurements, and measurements of the growth hormone (GH) –IGF‐I axis in a representative subpopulation (n = 30). Results: BW and weight at 1 yr were positively associated with whole body BMC (p = 0.02 and p < 0.0001, respectively), lumbar spine BMC (p = 0.001 and p = 0.03, respectively), and lumbar spine BMD (p = 0.04). After correction for adolescent height and weight, no association remained significant. There was no relation between IGF‐I and IGF binding protein 3 (IGFBP‐3) levels in adolescence and size in early life or bone mass. In the subpopulation, GH secretion (median, 2.58 versus 4.05), GH pulse mass (median, 10.7 versus 19.4 mU/liter), and total GH (median, 74.9 versus 108.8 mU/liter/12 h) were decreased in the small for gestational age (SGA) group compared with the appropriate for gestational age (AGA) group; this did not reach statistical significance. Likewise, there were no differences in IGF‐I, IGF‐II, and IGFBP‐1, ?2, and ?3 levels between the SGA and AGA groups. A statistically significant positive association between FGV and adolescent IGF‐II was found (B = 199.9, p = 0.006). Significant negative associations between GH measurement and BMC, as well as BMD, were found (B = ?0.008, p = 0.005 and B = ?0.008, p = 0.006, respectively). Conclusions: This study confirms the previous findings of a positive relation between size in early life and later BMC, an association apparently independent of the distal part of the GH/IGF‐I axis. However, this association may be mediated mainly by postnatal growth determining size of the skeletal envelope rather than an effect of fetal programming on bone mass per se.     

Psychological assessment of ICU survivors: a comparison between the Hospital Anxiety and Depression scale and the Depression, Anxiety and Stress scale

Recovery from a critical illness can be delayed by persistent anxiety and depression. To identify such patients, a new self-report questionnaire (the Depression, Anxiety and Stress scale, DASS) was used alongside an established instrument (the Hospital Anxiety and Depression scale, HADS) in those who had spent a minimum of 3 days (median 9 days) in a general intensive care unit. Fifty-one patients were studied 3 months later, and 45 survivors were reviewed at 9 months. High Cronbach alpha values (0.92-0.95) for each subscale of DASS confirmed its internal consistency, and likewise for HADS (0.82-0.86). HADS and DASS correlated strongly at each time point both for anxiety (r = 0.88) and depression (r = 0.93), with few discrepant values on a Bland and Altman plot. DASS performs as consistently as HADS in screening for anxiety and depression, and its psychometric properties support its use in an intensive care setting.