The role of parent and offspring sex on risk for externalizing psychopathology in offspring with parental alcohol use disorder: a national Swedish study

Purpose

The substantial literature showing that offspring of parents with alcohol use disorder (AUD) is at increased risk for externalizing psychopathology rarely examines the differential effects of parental and offspring sex. This literature also has other important limitations, such as modest sample sizes and use of unrepresentative samples. Using a large, nationwide Swedish sample, we aim to investigate the roles of parental and offspring sex in externalizing psychopathology among offspring with parental AUD.

Methods

AUD diagnosis and externalizing measures were obtained from national registries. Associations between outcomes and parental AUD were examined using logistic regressions. Parental and offspring sex effects were examined with interaction terms.

Results

Risks for externalizing disorders were increased in sons and daughters with parental AUD, with significant differences between sons and daughters for criminal behavior; maternal AUD had a greater impact than paternal AUD (regardless of offspring sex), but having two parents with AUD increased risk for all outcomes substantially more than having one parent; and maternal AUD increased risk of drug abuse for daughters more than sons, while paternal AUD increased risk of AUD and criminal behavior for sons more than daughters.

Conclusions

Offspring of parents with AUD are at increased risk for externalizing psychopathology. Maternal and paternal AUD differentially affected sons’ vs. daughters’ risks for AUD, drug abuse, and criminal behavior. The transmission of psychopathology within the externalizing spectrum appears to have sex-specific elements.

     

Can access to psychiatric health care explain regional differences in disability pension with psychiatric disorders?

Background

Psychiatric disorders are a serious public health problem, especially as many psychiatric disorders begin early in life. Disability pension (DP) with psychiatric diagnoses has, since the mid 1990s, increased in several European countries and regional differences within countries have emerged. It is not clear whether these regional differences are associated with differences in access to psychiatric health care.

Aim

The aim of this study was to investigate whether regional differences in DP with psychiatric diagnoses in Norway were associated with differences in psychiatric service provision (the number of staff employed and psychiatric beds available).

Method

The study population consisted of individuals aged 16–67 years living in Norway (n = 4,348,410) and six southern regions. Included cases were individuals who were granted a DP with a psychiatric diagnosis between 1 January and 31 December 1990, 1995 or 2000. Mental retardation was excluded. Data on cases were collected from the National Insurance Administration and data on psychiatric health care staff and beds was collected from Specialist Health Service, Statistics Norway. Regression models were used to calculate incidence rate ratios (IRR) with 95% confidence intervals (CI) using Norway as reference.

Results

Staffing levels (per 10,000 inhabitants) did not differ substantially between the regions, with the exception of Oslo that had about 70% higher numbers of staff employed. In regression analyses controlling for numbers of psychiatric staff and beds, regional differences in DP remained. Both men and women in the semi rural regions Aust-Agder and Vest-Agder were significantly more likely to receive a DP with a psychiatric diagnosis, while the IRR for DP was reduced in Östfold. Different psychiatric staff groups were associated with increased or decreased rates of DP. The adjusted IRR between number of psychiatric staff (man-years of staff per 10,000 inhabitants) and DP with psychiatric diagnoses were: 1.23 (1.18–1.29) for psychologists, 1.13 (1.04–1.23) for physicians, 1.03 (1.00–1.07) for nurses and 0.84 (0.80–0.88) for auxiliary nurses. Furthermore, increased numbers of beds were associated with DP with a psychiatric diagnosis (IRR 2.86 (2.03–4.05) for 100 beds/10,000 population).

Conclusion

Psychiatric provision (in terms of both staff and beds) was associated with the incidence of DP with psychiatric diagnoses but regional differences in provision did not explain the regional differences in DP with a psychiatric diagnosis. Future work needs to examine whether differences in case detection and case management are associated with regional differences in DP with psychiatric diagnoses.

     

Direct and Indirect Associations Between the Built Environment and Leisure and Utilitarian Walking in Older Women

Background

The built environment predicts walking in older adults, but the degree to which associations between the objective built environment and walking for different purposes are mediated by environmental perceptions is unknown.

Purpose

We examined associations between the neighborhood built environment and leisure and utilitarian walking and mediation by the perceived environment among older women.

Methods

Women (N = 2732, M _age = 72.8 ± 6.8 years) from Massachusetts, Pennsylvania, and California completed a neighborhood built environment and walking survey. Objective population and intersection density and density of stores and services variables were created within residential buffers. Perceived built environment variables included measures of land use mix, street connectivity, infrastructure for walking, esthetics, traffic safety, and personal safety. Regression and bootstrapping were used to test associations and indirect effects.

Results

Objective population, stores/services, and intersection density indirectly predicted leisure and utilitarian walking via perceived land use mix (odds ratios (ORs) = 1.01–1.08, 95 % bias corrected and accelerated confidence intervals do not include 1). Objective density of stores/services directly predicted ≥150 min utilitarian walking (OR = 1.11; 95% CI = 1.02, 1.22). Perceived land use mix (ORs = 1.16–1.44) and esthetics (ORs = 1.24–1.61) significantly predicted leisure and utilitarian walking,

Conclusions

Perceived built environment mediated associations between objective built environment variables and walking for leisure and utilitarian purposes. Interventions for older adults should take into account how objective built environment characteristics may influence environmental perceptions and walking.

     

Rates and Predictors of Renewed Quitting After Relapse During a One-Year Follow-Up Among Primary Care Patients

Background

Most people who quit smoking relapse within a year of quitting. Little is known about what prompts renewed quitting after relapse or how often this results in abstinence.

Purpose

This study seeks to identify rates, efficacy, and predictors of renewed quit attempts after relapse during a 1-year follow-up.

Methods

Primary care patients in a comparative effectiveness trial of smoking cessation pharmacotherapies reported daily smoking every 6–12 weeks for 12 months to determine relapse, renewed quitting, and 12-month abstinence rates.

Results

Of 894 known relapsers, 291 (33 %) renewed quitting for at least 24 h, and 99 (34 %) of these were abstinent at follow-up. The average latency to renewed quitting was 106 days and longer latencies predicted greater success. Renewed quitting was more likely for older, male, less dependent smokers, and later abstinence was predicted by fewer depressive symptoms and longer past abstinence.

Conclusions

Renewed quitting is common and produces meaningful levels of cessation.

     

Influence of Glycemic Control on Endogenous Circulating Ketone Concentrations in Adults Following Traumatic Brain Injury

Background

The objective was to investigate the impact of targeting tight glycemic control (4.4–6.1 mM) on endogenous ketogenesis in severely head-injured adults.

Methods

The data were prospectively collected during a randomized, within-patient crossover study comparing tight to loose glycemic control, defined as 6.7–8.3 mM. Blood was collected periodically during both tight and loose glycemic control epochs. Post hoc analysis of insulin dose and total nutritional provision was performed.

Results

Fifteen patients completed the crossover study. Total ketones were increased 81 μM ([38 135], p < 0.001) when blood glucose was targeted to tight (4.4–6.1 mM) compared with loose glycemic control (6.7–8.3 mM), corresponding to a 60 % increase. There was a significant decrease in total nutritional provisions (p = 0.006) and a significant increase in insulin dose (p = 0.008).

Conclusions

Permissive underfeeding was tolerated when targeting tight glycemic control, but total nutritional support is an important factor when treating hyperglycemia.

     

Onset of bladder and motor symptoms in multiple system atrophy: differences according to phenotype

Purpose

To compare the order of presentation of bladder and motor symptoms between multiple system atrophy phenotypes.

Methods

Medical records were retrospectively reviewed in 144 patients.

Results

Bladder symptoms occurred either before or within 12 months after onset of motor symptoms in significantly more patients with the cerebellar phenotype than the parkinsonian phenotype (80 vs. 53%, p = 0.003); similar results were observed for urinary incontinence (79 vs. 45%, p = 0.001).

Conclusions

Urinary dysfunction is more likely to appear either before or shortly after motor symptoms in the cerebellar phenotype than in the parkinsonian phenotype.

     

Carotid artery reactivity during sympathetic activation following acute resistance exercise

Objective

Acute resistance exercise has been shown to reduce brachial endothelial function. Whether there are concomitant reductions in carotid endothelial function remains unexplored.

Methods

Cold pressor test–mediated vasodilation of the carotid artery was used to assess carotid endothelial function in 15 young and healthy participants (age 26 ± 1 years, body mass index 24 ± 1 kg/m²) after acute resistance exercise or an inactive time control condition.

Results

Acute resistance exercise had no effect on the cold pressor test–mediated vasodilation compared to time control (5.8 ± 0.8 vs 6.2 ± 0.9% dilation, p > 0.05).

Interpretation

Carotid endothelial function may not be compromised following acute resistance exercise in young healthy adults.

     

Resilience Resources Moderate the Association of Adverse Childhood Experiences with Adulthood Inflammation

Background

Exposure to adverse childhood experiences (ACE) has been associated with elevated circulating inflammatory markers in adulthood. Despite the robust effect of ACE on later health outcomes, not all individuals exposed to ACE suffer from poor health.

Purpose

The goal of this study was to evaluate whether current resilience resources may attenuate the impact of ACE on inflammatory markers among individuals with elevated C-reactive protein (CRP) levels.

Methods

Participants (N = 174) completed one-time self-report questionnaires assessing ACE exposure within the first 18 years of life and current resilience resources, and provided blood samples for interleukin-6 (IL-6) and CRP.

Results

Individuals who were exposed to multiple ACE had greater IL-6 than participants with lesser ACE exposure. However, current resilience resources significantly moderated this effect. Among individuals who reported multiple ACE, higher resilience resources were associated with lower IL-6 levels.

Conclusion

These data suggest that resilience resources might attenuate the association between ACE and later health outcomes.

     

Attachment Orientations,Respiratory Sinus Arrhythmia,and Stress Are Important for Understanding the Link Between Childhood Socioeconomic Status and Adult Self-Reported Health

Background

Low childhood socioeconomic status (SES) is reliably associated with poor adult health. Social environments early in life and physiological stress responses are theorized to underlie this link; however, the role of attachment orientations is relatively unknown.

Purpose

In this study, we examined whether attachment orientations (i.e., attachment anxiety and attachment avoidance) and self-reported stress were mediators of the association between childhood SES and self-reported health in adulthood. Furthermore, we examined whether parasympathetic nervous system functioning was a moderator of associations between attachment orientations and self-reported stress.

Methods

Participants (N = 213) provided self-reports of childhood SES, attachment orientations, general stress, and self-rated health. Respiratory sinus arrhythmia (RSA) was measured at rest, as well as during an acute social stressor.

Results

Low childhood SES was associated with poor self-reported health via the serial pathway from attachment anxiety to general stress. Moreover, attachment avoidance was associated with self-reported health via general stress, but only among those with high stress-induced RSA. Findings were independent of participant age, sex, race, body mass index, baseline RSA, and adult SES.

Conclusions

Attachment theory is useful for understanding why those from low SES backgrounds are at greater risk of negative health outcomes in adulthood. Findings extend our knowledge of how interpersonal relationships in childhood can shape emotional and physical health outcomes in adulthood.

     

Education as a social pathway from parental socioeconomic position to depression in late adolescence and early adulthood: a Finnish population-based register study

Purpose

There is inconsistent evidence for social differentials in the risk of depression in youth, and little is known about how education at this age influences the risk. We assess how parental socioeconomic position (SEP) and education predict depression from late adolescence to early adulthood, a time of major educational transitions.

Methods

We followed a nationally representative 20 % sample of Finnish adolescents born in 1986–1990 (n = 60,829) over two educational transitory stages at the age of 17–19 and 20–23 covering the years 2003–2011. We identified incident depression using health care register data. We estimated the risk of depression by parental SEP and personal education using Cox regression, adjusting for family structure, parental depression and the individual’s own psychiatric history.

Results

Lower parental income was associated with up to a twofold risk of depression. This effect was almost fully attributable to other parental characteristics or mediated by the individual’s own education. Educational differences in risk were attenuated following adjustment for prior psychiatric history. Adjusted for all covariates, not being in education increased the risk up to 2.5-fold compared to being enrolled in general upper secondary school at the age of 17–19 and in tertiary education at the age of 20–23. Vocationally oriented women experienced a 20 % higher risk than their academically oriented counterparts in both age groups.

Conclusions

Education constitutes a social pathway from parental SEP to the risk of depression in youth, whereby educational differences previously shown in adults are observed already before the establishment of adulthood SEP.

     

Autonomic symptoms following Zika virus infection

Purpose

To determine if autonomic symptoms are associated with previous Zika virus infection.

Methods

Case–control study including 35 patients with Zika virus infection without evidence of neurological disease and 105 controls. Symptoms of autonomic dysfunction were assessed with the composite autonomic symptom scale 31 (COMPASS-31).

Results

Patients with previous Zika virus infection had significantly higher COMPASS-31 score than controls regardless of age and sex (p = 0.007). The main drivers for the higher scores where orthostatic intolerance (p = 0.003), secretomotor (p = 0.04) and bladder symptoms (p < 0.001).

Conclusion

Zika virus infection is associated with autonomic dysfunction. The mechanisms remain to be elucidated.

     

The epidemiology of current depression in Macau,China: towards a plan for mental health action

Purpose

Macau is a Special Administrative Region in China that has experienced tremendous development in its gambling industry during its post-colonial years. To inform mental health planning, this study presents the first population estimates and correlates of the current depression in Macau.

Methods

A population-representative sample of 1068 Macau Chinese citizens aged 18 or above responded to a household telephone survey in January, 2015. The Patient Health Questionnaire-9 measured the current depression. Logistic regression models assessed the association between depression and potential correlates.

Results

Overall, 8.0% (95% CI 6.3–9.7) of persons reported the current depression. A higher but non-significant proportion of women reported depression than men (9.3 vs. 6.6%) and older women reported higher prevalence (13.4%) than other demographic groups. Persons who were unemployed (OR = 4.9, 2.3–10.5), separated or divorced (OR = 3.1, 1.1–8.9), and reported poor self-rated health (OR = 5.0, 2.8–9.0), low quality of life (OR = 6.2, 3.1–12.7), lower social standing (OR = 2.4, 1.4–4.0), lower community trust (OR = 1.9, 1.2–3.1), lower perceived fairness (OR = 2.3, 1.4–3.8), lower social cohesion (OR = 3.8, 2.3–6.2), and lower social integration (OR = 3.0, 1.9–5.0) had greater odds of depression than their comparison group.

Conclusions

The current study demonstrated the burden of depression among Macau adults disproportionately affects women during emerging adolescence and old age, and men during middle adulthood. Key strategies to improve mental health services in Macau are discussed.

     

Sleep Apnea Is a Risk Factor for Stroke and Vascular Dementia

Purpose of Review

In this article, we review the cerebrovascular complications of sleep apnea (SA). SA is the major sleep disorder associated with stroke and vascular dementia.

Recent Findings

Sleep apnea syndrome of moderate to severe intensity affects 17% of 50–70-year-old men and 9% of 50–70-year-old women, making SA a notorious and prevalent disorder. SA increases the risk of hypertension, stroke, myocardial infarction, and atrial fibrillation (AF) and is closely linked to vascular dementia. In addition, SA may worsen the neurologic outcome in acute stroke patients and interferes with rehabilitation after stroke.

Summary

Proper management of SA may decrease the clinical impact of stroke risk factors, improve neurologic outcome after stroke, and lessen the progression of subcortical ischemic vascular disease. In this article, we will cover the most salient pathologies that associate SA and cerebrovascular pathology.

     

A Self-Regulatory Intervention for Patients with Head and Neck Cancer: Pilot Randomized Trial

Background

Research is yet to investigate whether psychological interventions delivered early after diagnosis can benefit patients with head and neck cancer (HNC).

Purpose

The aim of this study was to investigate the effectiveness of a brief self-regulatory intervention (targeting illness perceptions and coping) at improving HNC patient health-related quality of life (HRQL).

Methods

A pilot randomized controlled trial was conducted, in which 64 patients were assigned to receive three sessions with a health psychologist in addition to standard care or standard care alone. Participants completed questionnaires assessing HRQL, general distress, and illness perceptions at baseline and again 3 and 6 months later.

Results

Compared to the control group, patients who received the intervention had increased treatment control perceptions at 3 months (p = .01), and increased social quality of life at 6 months (p = .01). The intervention was particularly helpful for patients exhibiting distress at baseline.

Conclusion

A brief psychological intervention following HNC diagnosis can improve patient perceptions of treatment and social quality of life over time. Such interventions could be targeted to patients who are distressed in order to confer the greatest benefit.

Trial Registration Number

12614000813684.

     

Suicidal deaths in elementary school students in Korea

Background

The purpose of this study was to determine the characteristics of childhood suicidal deaths among elementary school students that occurred from 2011 to 2015 in Korea.

Methods

The report form of each suicide case by the teacher in charge to the Education Ministry was reviewed retrospectively.

Results

There were 19 suicidal deaths (12 boys, 7 girls) in elementary school students. The youngest case was a third grader (n = 1). Jumping from heights (n = 12) was the most frequently used method. Most suicides (n = 12) were committed in their homes.

Conclusion

These results highlight the alarming trend of early suicidal deaths and the importance of early suicide prevention strategies, especially in schools.

     

The Influence of Age on Brain Processing of Odors in Adolescent Girls

Introduction

Brain processing of odorants in different stages during adolescence is not well understood. This study aimed to investigate differences in brain processing of pleasant and unpleasant odors between adolescent girls at different ages.

Methods

Eleven girls aged 9–10 years and 20 girls aged 15–16 years participated in an fMRI study (1.5 T, repetition time 2.5 s) where two odorants (peach and n-butanol) were delivered passively to the participants’ nostrils. Psychophysical measurements for odor intensity, pleasantness, and familiarity were recorded.

Results

Compared to older ones, younger girls were less familiar with peach odor. Stronger brain activation of piriform cortex, amygdala, bilateral insular cortex, anterior cingulate cortex, and dorsal striatum (caudate and putamen) was observed in younger vs. older girls, whereas in older girls there was no superior activation in olfactory regions as compared to younger participants.

Conclusion and Implication

The findings demonstrating differences of brain activation patterns between girls of two age groups may reflect olfactory perception development during adolescence.

     

Therapeutic Hypothermia After Resuscitation From a Non-Shockable Rhythm Improves Outcomes in a Regionalized System of Cardiac Arrest Care

Objective

Therapeutic hypothermia (TH) improves neurologic outcome in patients resuscitated from ventricular fibrillation. The purpose of this study was to evaluate TH effects on neurologic outcome in patients resuscitated from a non-shockable out-of-hospital cardiac arrest rhythm.

Design and Setting

This is a retrospective cohort study of data reported to a registry in an emergency medical system in a large metropolitan region. Patients achieving field return of spontaneous circulation are transported to designated hospitals with TH protocols.

Patients

Patients with an initial non-shockable rhythm were identified. Patients were excluded if awake in the Emergency Department or if TH was withheld due to preexisting coma or death prior to initiation. The decision to initiate TH was determined by the treating physician.

Measurements

The primary outcome was survival with good neurologic outcome defined by a cerebral performance category of 1 or 2.

Main Results

Of the 2772 patients treated for cardiac arrest during the study period, there were 1713 patients resuscitated from cardiac arrest with an initial non-shockable rhythm and 1432 patients met inclusion criteria. The median age was 69 years [IQR 59–82]; 802 (56 %) male. TH was induced in 596 (42 %) patients. Survival with good neurologic outcome was 14 % in the group receiving TH, compared with 5 % in those not treated with TH (risk difference = 8 %, 95 % CI 5–12 %). The adjusted OR for a CPC 1 or 2 with TH was 2.9 (95 % CI 1.9–4.4).

Conclusion

Analyzing the data collected from the registry of the standard practice in a large metropolitan region, TH is associated with improved neurologic outcome in patients resuscitated from initial non-shockable rhythms in a regionalized system for post-resuscitation care.

     

Physical Education and Student Activity: Evaluating Implementation of a New Policy in Los Angeles Public Schools

Background

California law has standards for physical education (PE) instruction in K-12 public schools; audits found that the Los Angeles Unified School District did not enforce the standards. In 2009, the district adopted a PE policy to comply with these standards.

Purpose

This study aimed to evaluate the outcomes of the PE policy in district schools.

Methods

PE class observations were conducted using the System for Observing Fitness Instruction Time in the 2010–2011 and 2011–2012 school years in an income-stratified random sample of 34 elementary, middle, and high schools to assess changes in PE class size, class duration, and time students spent in moderate to vigorous physical activity.

Results

PE class duration increased in high-income elementary schools. Mean class size decreased in low-income middle schools.

Conclusions

There was limited implementation of the PE policy 2 years after passage. Opportunities exist to continue monitoring and improving PE quantity and quality.

     

Perceived Life Expectancy Is Associated with Colorectal Cancer Screening in England

Background

Cancer screening is a behavior that represents investment in future health. Such investment may depend on how much ‘future’ a person expects.

Purpose

The purpose of this study was to investigate the prospective association between perceived personal life expectancy and participation in fecal occult blood test screening for colorectal cancer (CRC) in a national program.

Methods

Data were from interviews with 3975 men and women in the English Longitudinal Study of Ageing (ELSA) within the eligible age range for the national screening program (60 to 74 years). Perceived life expectancy was indexed as the individual’s estimate of their chance of living another 10–15 years (exact time varied by age), assessed in 2008/2009. Participation in CRC screening from 2010 to 2012/2013 was assessed in 2012/2013. Logistic regression was used to estimate the association between perceived life expectancy and screening participation, adjusted for numeracy and known mortality risk factors.

Results

Overall, 71% of respondents (2817/3975) reported completing at least one fecal occult blood test (FOBt) during the follow-up. Screening uptake was 76% (1272/1683) among those who estimated their 10–15-year life expectancy as 75–100%, compared with 52% (126/243) among those who estimated theirs as 0–25% (adjusted OR 1.74, 95% CI 1.29–2.34).

Conclusions

A longer perceived life expectancy is associated with greater likelihood of participating in CRC screening in England. However, half of people with a low perceived life expectancy still participated in screening. Given that CRC screening is recommended for adults with a remaining life expectancy of ≥10 years, future research should investigate how to communicate the aims of screening more effectively.

     

Family socioeconomic position in early life and onset of depressive symptoms and depression: a prospective cohort study

Purpose

To investigate whether low parental socioeconomic position (SEP) at birth is associated only with early-onset depressive symptoms in offspring.

Methods

This prospective cohort study used data on 9193 individuals (4768 females, 4425 males) from the Avon Longitudinal Study of Parents and Children. Depressive symptoms during three age periods (10–12, 12–16, 16–20 years) were assessed using the Short Mood and Feelings Questionnaire, and ICD-10 depression at age 18 was assessed using the Clinical Interview Schedule-Revised.

Results

Low SEP was associated with increased incidence rates of depressive symptoms in all age periods, with indicators of low standard of living showing the strongest associations. For instance, incidence rate ratios for material hardship were 1.75 (95% CI [1.42–2.15]) at 10–12 years, 1.36 (1.16–1.61) at 12–16 years and 1.39 (1.21–1.59) at 16–20 years. Low SEP was also associated with increased odds of ICD-10 depression at 18 years, ranging from OR = 1.20 (95% CI [0.94–1.52]) for manual social class to 1.74 (1.35–2.24) for material hardship.

Conclusions

There was no evidence that depressive symptoms can be “subtyped” by the age of onset, because the association with low SEP was evident for early- and later-onset symptoms. If socioeconomic inequalities in early life have long-term adverse impacts on mental health, policies addressing these inequalities could benefit the mental health of the population.