Fetal size in mid- and late pregnancy is related to infant alertness: the generation R study

The vulnerability for behavioral problems is partly shaped in fetal life. Numerous studies have related indicators of intrauterine growth, for example, birth weight and body size, to behavioral development. We investigated whether fetal size in mid- and late pregnancy is related to infant irritability and alertness. In a population-based birth cohort of 4,255 singleton full-term infants ultrasound measurements of fetal head and abdominal circumference in mid- and late pregnancy were performed. Infant irritability and alertness scores were obtained by the Mother and Baby Scales at 3 months and z-standardized. Multiple linear regression analyses revealed curvilinear associations (inverted J-shape) of measures of fetal size in both mid- and late pregnancy with infant alertness. Fetal size characteristics were not associated with infant irritability. These results suggest that alterations of intrauterine growth affecting infant alertness are already detectable from mid-pregnancy onwards.     

Life Stressors as Mediators of the Relation Between Socioeconomic Position and Mental Health Problems in Early Adolescence: The TRAILS Study

ObjectiveLife stressors and family socioeconomic position have often been associated with mental health status. The aim of the present study is to contribute to the understanding of the pathways from low socioeconomic position and life stressors to mental problems.MethodIn a cross-sectional analysis using data from a longitudinal study of early adolescents (N = 2,149, 51% girls; mean age 13.6 years, SD 0.53, range 12–15), we assessed the extent of mediation of the association between family socioeconomic position and mental health problems by different types of life stressors in multiple regression models. Stressors were rated as environment related or person related. Information on socioeconomic position was obtained directly from parents, and internalizing and externalizing problem behaviors were assessed by reports from multiple informants (parents, self, and teachers).ResultsLow socioeconomic position was associated with more mental health problems and more life stressors. Both environment-related and person-related stressors predicted mental health problems independently of socioeconomic position. The associations between socioeconomic position and all mental health outcomes were partly mediated by environment-related life stressors. Mediation by environment-related and person-related stressors as assessed by linear regression amounted to 56% (95% confidence interval [CI] 35%–78%) and 7% (95% CI ?25% to 38%) for internalizing problems and 13% (95% CI 7%–19%) and 5% (95% CI ?2% to 13%) for externalizing problems, respectively.ConclusionsEnvironment-related, but not person-related, stressors partly mediated the association between socio economic position and adolescent mental problems. The extent of mediation was larger for internalizing than for externalizing problems. Because the effect sizes of the associations were relatively small, targeted interventions to prevent impaired mental health may have only modest benefits to adolescents from low socioeconomic background.     

Intrauterine Cannabis Exposure Affects Fetal Growth Trajectories: The Generation R Study

ObjectiveCannabis is the most commonly consumed illicit drug among pregnant women. Intrauterine exposure to cannabis may result in risks for the developing fetus. The importance of intrauterine growth on subsequent psychological and behavioral child development has been demonstrated. This study examined the relation between maternal cannabis use and fetal growth until birth in a population-based sample.MethodApproximately 7,452 mothers enrolled during pregnancy and provided information on substance use and fetal growth. Fetal growth was determined using ultrasound measures in early, mid-, and late pregnancy. Additionally, birth weight was assessed.ResultsMaternal cannabis use during pregnancy was associated with growth restriction in mid-and late pregnancy and with lower birth weight. This growth reduction was most pronounced for fetuses exposed to continued maternal cannabis use during pregnancy. Fetal weight in cannabis-exposed fetuses showed a growth reduction of ?14.44 g/week (95% confidence interval ?22.94 to ?5.94, p = .001) and head circumference (?0.21 mm/week, 95% confidence interval ?0.42 to 0.02, p = .07), compared with nonexposed fetuses. Maternal cannabis use during pregnancy resulted in more pronounced growth restriction than maternal tobacco use. Paternal cannabis use was not associated with fetal growth restriction.ConclusionsMaternal cannabis use, even for a short period, may be associated with several adverse fetal growth trajectories.     

Baseline cortisol measures and developmental pathways of anxiety in early adolescence

Objective: This study investigated whether baseline cortisol measures predicted future anxiety, and compared cortisol values of groups with different developmental pathways of anxiety. Method: Cortisol levels were assessed in 1768 individuals (10–12 years). Anxiety levels were assessed at the same age and 2 years later. Results: Cortisol measures did not predict future anxiety levels. Individuals with persistent anxiety problems did not show higher morning cortisol levels than those with persistently low, decreasing, or increasing anxiety levels. Instead, individuals with persistently high anxiety levels showed significantly lower evening cortisol levels than all other individuals. Further, participants with increasing anxiety levels showed higher morning cortisol levels (area under the curve; AUC) than individuals with persistently low anxiety levels. Conclusion: The extent to which the HPA‐axis – by itself – plays a role in the aetiology of anxiety is questionable. Interactions of the HPA‐axis with other biological or environmental factors may be more important.     

Ten-year increase in service use in the Dutch population

Since earlier research has indicated an increase in mental health problems among Dutch children, we investigated whether service use for mental health problems has also increased. Subsequently, we investigated whether a possible increase could be explained by child, family and socio-demographic characteristics that increase the likelihood of service use. We compared two population samples of 6- to 18-year-olds, one assessed in 1993 and one in 2003. Chi-square tests were conducted to examine differences between the proportions of service-users. We performed a logistic regression to test whether care-promoting factors accounted for the effect of year. Results showed that service use increased from 1993 to 2003, but not among children with high CBCL scores. Having serious problems, living in a family other than two biological parents, and having educational problems all increased the likelihood of service use and became more present in the Dutch population. These variables accounted for 49% reduction in the Odds Ratio of the effect of year. Although the proportion of children who used services increased from 1993 to 2003, still a large number of children experience an unmet need. The increase in the number of children from a family structure other than two biological parents or who have educational problems is a worrisome development in itself.     

A flexible research platform for multi-channel auditory steady-state response measurements

The possibilities of currently commercially available auditory steady-state response (ASSR) devices are mostly limited to avoid unintentional misuse and to guarantuee patient safety as such. Some setups, e.g. do not allow the application of high intensities or the use of own stimuli. Moreover, most devices generally only allow data collection using maximal two EEG channels. The freedom to modify and extend the accompagnying software and hardware is very restricted or inexistent. As a result, these devices are not suited for research and several clinically diagnostic purposes. In this paper, a research platform for multi-channel ASSR measurements is presented, referred to as SOMA (setup ORL for multi-channel ASSR). The setup allows multi-channel measurements and the use of own stimuli. It can be easily extended to facilitate new measurement protocols and real-time signal processing. The mobile setup is based on an inexpensive multi-channel RME soundcard and software is written in C++. Both hardware and software of the setup are described. An evaluation study with nine normal-hearing subjects shows no significant performance differences between a reference and the proposed platform. SOMA presents a flexible and modularly extensible mobile high-end multi-channel ASSR test platform.     

Blood stream infections of abdominal origin in the intensive care unit: characteristics and determinants of death

BACKGROUND: Blood stream infections (BSI) of abdominal origin are associated with a high mortality rate. We hypothesized that both patient and microbiological factors determine death in critically ill patients who develop such infections. METHODS: Ninety-six consecutive patients who developed BSI of abdominal origin in an 11-year period (1992-2002) in the intensive care unit (ICU) of the Ghent University Hospital were studied. Patient data were retrieved from a prospective registry of BSI. Demographics, disease severity, source of the BSI, incidence of organ failure, and outcome were recorded. Microbiological data were retrieved from the patient file and the hospital laboratory. RESULTS: Secondary peritonitis and intra-abdominal abscesses were the source of the BSI in the majority of patients. The majority of the organisms involved were gram-negative, with Escherichia coli isolated most frequently. Twenty-one patients (22%) had polymicrobial BSI, and in 39 patients, at least one of the micro-organisms was antibiotic resistant (41%). The mortality rate in the whole patient group was 62.5% (60/96), which was significantly higher than the Acute Physiology and Chronic Health Evaluation (APACHE) II-based expected mortality rate (p < 0.001). Patients who died were older, had a tendency to have a higher APACHE II score on admission, and were more likely to suffer from acute renal failure and cardiovascular failure during their ICU stay. Logistic regression analysis revealed that the following factors were independently associated with death: Age (odds ratio [OR] 1.09; 95% confidence interval [CI] 1.04, 1.14; p < 0.001) (per year increase) and the occurrence of acute renal failure (OR 4.18; 95% CI 1.22, 14.31; p = 0.023). CONCLUSIONS: The mortality rate of ICU patients who develop BSI of intra-abdominal origin is high. Gram-negative micro-organisms were isolated most frequently, and 41% of all organisms were antibiotic-resistant. Two patient-related factors (greater age and the development of acute renal failure) were associated independently with a higher mortality rate.     

Intrauterine growth and infant temperamental difficulties: the Generation R Study

OBJECTIVE: To determine whether intrauterine growth trajectories are associated with temperamental difficulties in infancy. METHOD: The Generation R Study is a population-based cohort study from fetal life onward. Size at different time points during gestation and growth trajectories, calculated on the basis of repeatedly measured fetal growth characteristics, were related to temperamental dimensions, assessed with the Infant Behavior Questionnaire-Revised, in 3,792 infants age 6 months. RESULTS: Birth weight, adjusted for gestational age, was negatively associated with activity level and duration of orienting. These associations disappeared after additional adjustment for maternal height, age, educational level, and national origin. Similarly, the negative associations between intrauterine total body weight gain and falling reactivity and activity level diminished after correction for maternal and child characteristics. After full adjustment, reduced fetal weight gain was only related to prolonged duration of orienting. Children scored 0.38 (95% confidence interval 0.09-0.68) points higher on duration of orienting per SD decrease in total body weight gain from mid-pregnancy to birth. CONCLUSIONS: After controlling for several genetic and socioeconomic status related factors, we found little indication of an association between intrauterine growth trajectories and temperamental difficulties in infants.     

Continuity and change of psychopathology from childhood into adulthood: a 14-year follow-up study

OBJECTIVE: To test the 14-year continuity and change of behavioral and emotional problems from childhood into adulthood. METHOD: For 1,615 children and adolescents aged 4 to 16 years from the general population, parents completed the Child Behavior Checklist (CBCL) at initial assessment. At follow-up 14 years later, subjects completed the Young Adult Self-Report (YASR), and their parents completed the Young Adult Behavior Checklist (YABCL). RESULTS: Of the subjects who were initially classified as deviant, 14 years later 41% were classified as deviant according to their YABCL Total Problem score, and 29% according to their YASR Total Problem score. Intrainformant (CBCL/YABCL) Withdrawn, Social Problems, Delinquent Behavior, and Aggressive Behavior scores, and cross-informant (CBCL/YASR) Anxious/Depressed, Thought Problems, and Delinquent Behavior scores were independent predictors of general levels of problem behavior. CONCLUSIONS: Childhood and adolescent problems persisted to a considerable degree into adulthood, although the majority of children who were deviant at initial assessment could not be regarded as deviant 14 years later. Children who were adolescents at initial assessment (12-16 years) showed higher stability of problem behaviors than subjects who were children at initial assessment (4-11 years).