Rhinoconjunctivitis in 5-year-old children: a population-based birth cohort study

BACKGROUND: There is a paucity of data on the prevalence, risk factors and natural history of rhinitis in early childhood. OBJECTIVE: Within the context of a whole-population birth cohort we investigated the prevalence of and risk factors for current rhinoconjunctivitis (CRC) at age 5 years. METHODS: Children were followed prospectively to age 5 years [questionnaires (n = 815), skin testing (n = 717), specific immunoglobulin E (n = 478), lung function (n = 711), dry air challenge (n = 556)]. Endotoxin and allergen exposures were measured in dust samples. RESULTS: The prevalence of rhinitis ever, current rhinitis and rhinoconjunctivitis was 28.2%, 26.1%, and 12.1%, respectively. Asthma, wheeze and eczema coexisted with CRC (P < or = 0.01). In a multivariate model, maternal asthma (OR 2.38, 95% CI: 1.30-4.38, P = 0.005), paternal hay fever (1.96, 1.11-3.46, P = 0.02) and sensitization to grass (3.46, 1.86-6.42, P < 0.001) and cat (2.42, 1.14-5.18, P = 0.02) remained significant and independent associates of CRC. Whilst almost half of children with CRC were nonatopic, there was little difference in risk factors between atopic and nonatopic CRC. Amongst children with current wheeze, the presence of concurrent CRC had no effect on either severity or frequency of wheezy episodes. There was no difference in specific airway resistance, forced expiratory volume in 1 second (FEV(1)) or airway reactivity between children with and without CRC after adjustment for the presence of wheeze. CONCLUSION: Family history of allergic disease and sensitization to inhalant allergens are risk factors for rhinoconjunctivitis in preschool children. In this age group, there is no association between the presence of rhinoconjunctivitis and severity of wheeze, increased airway reactivity and reduced lung function.     

An epidemiological study of disability in 4-year-old children from a birth cohort in Frederiksborg County, Denmark

In an epidemiological study of a county cohort of 4,138 liveborn children, surveyed at age four, 45 had disability (1.1%). The following period prevalences from birth to age four in per mille were found: motor handicap 5.1, to include cerebral palsy 4.1, myelomeningocele and hydrocephalus 0.5, and metabolic disorders 0.5; severe mental retardation 2.9, mild 1.4, subnormality 2.7; epilepsy 4.6; severe visual defect 1.4; severe auditory defect 0.7. Perinatal damage alone was likely in only three children out of 45. Two thirds had a prenatal cause or a combination of prenatal and perinatal causes. Birth asphyxia seemed to be a rare cause of motor disability and mental retardation. Prematurity per se gave a risk of spastic diplegia, but not of mental retardation. Among the mentally retarded, half were light for gestational age, and in more than half, the damage occurred prenatally.     

Heritability of borderline personality disorder features is similar across three countries

Summary BACKGROUND: Most of our knowledge about borderline personality disorder features has been obtained through the study of clinical samples. Although these studies are important in their own right, they are limited in their ability to address certain important epidemiological and aetiological questions such as the degree to which there is a genetic influence on the manifestation of borderline personality disorder features. Though family history studies of borderline personality disorder indicate genetic influences, there have been very few twin studies and the degree of genetic influence on borderline personality disorder remains unclear.MethodData were drawn from twin samples from The Netherlands (n=3918), Belgium (n=904) and Australia (n=674). In total, data were available on 5496 twins between the ages of 18 and 86 years from 3644 families who participated in the study by completion of a mailed self-report questionnaire on borderline personality disorder features. RESULTS: In all countries, females scored higher than males and there was a general tendency for younger adults to endorse more borderline personality disorder features than older adults. Model-fitting results showed that additive genetic influences explain 42% of the variation in borderline personality disorder features in both men and women and that this heritability estimate is similar across The Netherlands, Belgium and Australia. Unique environmental influences explain the remaining 58% of the variance.ConclusionGenetic factors play a role in individual differences in borderline personality disorder features in Western society.     

边缘性人格障碍临床表现与治疗现状综述

<正>边缘性人格障碍(BPD)是一种患者个体以情绪反应失调、自我意识和人际关系不稳定,常有行为冲动为临床特征的严重精神疾病。国外研究显示,BPD患者占普通人群的2%,精神科门诊患者的10%,住院患者的20%,人格障碍患者的30%～60%[1]。由于BPD缺乏特征性的临床症状并常与其他一种或一种     

Childhood cancer mortality and birth characteristics in Korea: a national population-based birth cohort study

To examine the relationship between birth characteristics and childhood cancer mortality, a retrospective cohort study of Korean children was conducted using data collected by the national birth register between 1995 and 2006, which were then individually linked to death data. A cohort of 6,479,406 children was followed from birth until their death or until December 31, 2006. Poisson regression analyses were used to calculate rate ratios of childhood cancer deaths according to birth characteristics. A total of 1,469 cancer deaths were noted and the childhood cancer mortality rate was found to be 3.43 per 100,000 person-years in Korea during the period of 1995-2006. The birth characteristics examined in this study (i.e. , birth weight, gestational age, multiple births, parental ages, and number of siblings) were generally found to be not significantly associated with childhood cancer mortality, and the associations did not vary meaningfully with gender nor with cancer sites. However, among children aged 5-11 yr, higher birth weight was associated with elevated childhood cancer mortality (rate ratio = 1.28, 95% confidence interval 1.04-1.58). Our results offer no overall associations between childhood cancer mortality and birth characteristics, but suggest that the association may be specific to age group.     

Early maladaptive schemas and borderline personality disorder features in a nonclinical sample: A network analysis

Borderline personality disorder (BPD) is a challenging problem. Early maladaptive schemas (EMSs) are considered as important vulnerability factors for the development and maintenance of BPD. Literature suggests a complex relationship between BPD and EMSs. The current study employed network analysis to model the complex associations between central BPD features (i.e., affective instability, identity problems, negative relations, and self‐harm) and EMSs in 706 undergraduate students. The severity of BPD symptoms was assessed using the Personality Assessment Inventory—Borderline subscale; the Young Schema Questionnaire—Short Form was used to assess EMSs. Results suggest that specific EMSs show unique associations with different BPD features. Interestingly, affective instability showed no unique associations with EMSs. Identity problems were uniquely associated with abandonment, insufficient self‐control, dependence/incompetence, and vulnerability to harm/illness schemas. Negative relations in BPD showed unique connections with mistrust/abuse and abandonment. Finally, BPD self‐harm was connected to emotional deprivation and failure. These findings indicate potential pathways between EMSs and specific BPD features that could improve our understanding of BPD theoretically and clinically.     

Trauma‐related dissociation: Psychological features and psychophysiological responses to script‐driven imagery in borderline personality disorder

Defense reactions to threatening situations are vital adaptations to stress that protect organisms from injury and ensure survival. We retrospectively investigated the role of peritraumatic dissociation (PD) in the occurrence of severe psychopathology and dissociative patterns of reactions in borderline personality disorder (BPD). We recruited 28 patients with a clinical diagnosis of BPD and 15 healthy controls. The BPD group was divided according to the level of PD (low vs. high): BPD and PD (n = 15) and BPD only (n = 13). We conducted an extensive investigation of history of trauma, clinical status, and measurements of emotional and physiologic responses to recall of personalized aversive experiences. Participants with BPD and high PD displayed highest degrees of trauma exposure and clinical symptoms. Their significant heart rate decline during the imagery of personal traumatic events was opposed to the heart rate increases exhibited by the other two groups and may indicate a dissociative reaction pattern. Skin conductance responses did not differentiate between groups. Several emotional responses to imagery also reinforced the idea that PD may play a role in memory processing of traumatic events and thus in the aggravation and maintenance of symptoms in particularly severe forms of BPD. Within a stepwise linear regression analysis, the best model for trauma‐evoked heart rate responses included PD and borderline symptoms, but no measures of state or trait dissociation. Our findings may provide initial evidence of an evolutionary model of peritraumatic reaction stages evolving from arousal to dissociation.     

Psychotherapist personality characteristics and the perception of self and patients in the treatment of borderline personality disorder.

The influence of certain personality characteristics (tendency to depressive experiences, personal boundary preferences) on psychotherapist reaction to patients with borderline personality disorder was assessed by semantic differential ratings in an analogue study. Vignettes presented one of two patients enacting the Rewarding and Withdrawing object relations unit in two separate therapy sessions. Therapists higher on anaclitic depressive and fusion tendencies evaluated themselves less positively than other therapists (p less than .01) in the Withdrawing condition. They evaluated the patient less positively regardless of condition (p less than .05). High boundary therapists evaluated patients more positively (p less than .05) in the Withdrawing condition. They evaluated themselves more positively regardless of condition (p less than .05) and showed less tendency to devalue self and patient with the lower functioning borderline patient.     

Structure of borderline personality disorder symptoms in a nonclinical sample

Relations among symptoms of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) borderline personality disorder (BPD) assessed using semistructured clinical interviews were examined using exploratory principal components analysis in a sample of 82 college men and women who were symptomatic for BPD (30.4% of whom met criteria for a BPD diagnosis at threshold or subthreshold certainty level). A three-component solution was found and, as expected, the first component was characterized by interpersonal instability and included unstable relationships, identity disturbance, and chronic emptiness. The second component reflected affective instability and low impulsivity. The third component reflected stress-related paranoia and low anger. Results highlight similarities in the structure of BPD criteria in clinical and nonclinical samples, and could inform future research on dimensional models of BPD.     

The role of attachment characteristics in dialectical behavior therapy for patients with borderline personality disorder

Attachment characteristics play a key role in understanding borderline‐specific problems with respect to childhood maltreatment. The aim of this study was to investigate how attachment representations may influence the trajectory of change in a 1‐year outpatient dialectical behavior therapy (DBT) for patients with borderline personality disorder (BPD). Attachment representations were assessed in 26 BPD patients and 26 healthy controls (HC) using the Adult Attachment Projective Picture System (AAP) before treatment. Borderline and global symptom severity and interpersonal problems were examined before, during, and after completing the intervention. Analysis of variance and stepwise hierarchical regression analyses were used to explore the course of symptomatology. As expected, BPD patients displayed a predominance of unresolved attachment in the AAP compared with HC, by showing a lack of ability to integrate attachment related trauma. Whereas both resolved and unresolved attachment groups revealed significant improvement in symptom severity during treatment, dimensional AAP scores showed differences. Patients with higher scores in “synchrony” demonstrated more indicators of mutual care in their narratives to dyadic pictures and displayed a significantly stronger decrease of interpersonal problems than patients with lower synchrony scores. Assessing attachment representations prior to DBT might provide a helpful insight into individual attachment related resources or lack of these capacities. Responsiveness and synchrony in dyadic interactions with significant others are crucial for healthy interpersonal relations. A stronger therapeutic focus on the patient's capacity to show synchrony in dyadic attachment situations might improve the patient's interpersonal problems towards sensitive and mutual interaction.     

Effects of borderline personality disorder features and a family history of alcohol or drug dependence on P300 in adolescents.

Decrements in P300 amplitude have been associated with familial risk for alcoholism as well as several other psychiatric disorders characterized by disinhibited behavior. The present study examined the P300 in relation to Borderline Personality Disorder (BPD) features in adolescents with a paternal history of alcohol or drug dependence. One hundred and seventy-five males and females, aged 14-20, were assigned to groups based on BPD features (BPD+ vs. BPD-), family history of substance dependence (negative FH-, alcohol FHA, drug FHD) and gender. BPD features were assessed using the Structured Clinical Interview for the DSM-III-R questionnaire. P300 ERPs were recorded while each subject performed the Stroop color-word compatibility test. Repeated measures analyses, which included Conduct Disorder and Depression symptoms as covariates, indicated a significant reduction in P300 amplitude in the BPD+ group. There were no significant effects of FH or gender on P300 amplitude. These results document the presence of neurophysiological abnormalities associated with BPD features in an adolescent sample. This effect appeared to be independent of a family history of alcohol or substance dependence. These findings suggest that BPD symptoms during adolescence are relevant to the examination of the physiological antecedents of those forms of adult psychopathology characterized by behavioral disinhibition, including alcohol and drug dependence.     

Neurocognitive impairment as a moderator in the development of borderline personality disorder

Borderline personality disorder (BPD) is characterized by a pervasive instability of interpersonal relationships, affects, self-image, marked impulsivity, dissociation, and paranoia. The cognitive dimension of the disorder has received relatively little attention and is poorly understood. This paper proposes that neurocognitive impairment is a key moderator in the development of BPD and elaborates a possible pathway for the expression of the cognitive domain. Neurocognitive impairment is hypothesized to moderate the relationship between caretaking and insecure disorganized attachment and pathological dissociation in the formation of the disorder contributing to impaired metacognition and a range of cognitive difficulties. The empirical evidence from studies of cognitive processes, brain function, attachment, and dissociation that support this theory are reviewed and discussed. Areas for future research that might verify or refute this theory are suggested.     

Multimodal longitudinal respiratory function assessment in very low birth weight 7-year-old children

PurposePreterm birth is associated with adverse pulmonary outcomes. We aimed to evaluate respiratory morbidities and lung function of very low birth weight (VLBW) Polish children followed up at the age of 7 years old, and to compare with electrical impedance segmentography (EIS) results recorded at 4 years of age.Materials and methodsVLBW children were compared with term controls using impulse oscillometry and spirometry. Perinatal data and current respiratory morbidities were analyzed and pulmonary function test results were compared with previous EIS results.ResultsWe included 40 VLBW children and 30 controls in the analysis. Elevated total airway resistance and forced expiratory volume in the first second below the lower limit of normal were more prevalent in VLBW children compared with term controls (15 vs 0%; 18 vs 0%). A positive bronchodilator response was more common in VLBW children (R_{5 Hz}: 46 vs 13.3%; R_{5–20 ​Hz}: 65 vs 36.7%). Children with bronchopulmonary dysplasia (BPD) had higher total airway resistance (R_{5 Hz}/R_{5 Hz pred}: 1.35 vs 0.95; p ​< ​0.001), large airway resistance (R_{20 Hz}/R_{20 Hz pred}: 0.89 vs 0.66; p ​= ​0.001), small airway resistance (R_{5–20 ​Hz}: 0.57 vs 0.34 ​kPa ​L⁻¹ ​s⁻¹; p ​= ​0.009), than controls. Strong correlation between BDR in EIS and R_{5 Hz}/R_{5 Hz pred} was observed in children with BPD (r ​= ​0.7).ConclusionVLBW school-aged children with BPD presented with substantial respiratory morbidity and persistent reduction of lung function, affecting small and large airways and lung parenchyma. EIS may be an alternative tool for lung function assessment in children with BPD.     

Parental mental illness and fatal birth defects in a national birth cohort

BACKGROUND: Few large studies describe links between maternal mental illness and risk of major birth defect in offspring. Evidence is sparser still for how effects vary between maternal diagnoses and no previous study has assessed risk with paternal illnesses.MethodA population-based birth cohort was created by linking Danish national registers. We identified all singleton live births during 1973m), all parental psychiatric admissions from 1969 onwards, and all fatal birth defects until 1 January 1999. Linkage and case ascertainment were almost complete. Relative risks were estimated using Poisson regression. RESULTS: Risk of fatal birth defect was elevated in relation to history of any maternal admission and also with affective disorders specifically, although the strongest effect found was with maternal schizophrenia. The rate was more than doubled in this group compared to the general population [relative risk (RR) 2.34, 95% confidence interval (CI) 1.45environment interactions. Further research is needed to elucidate the causal mechanisms.