Adverse life events, area socioeconomic disadvantage, and psychopathology and resilience in young children: the importance of risk factors’ accumulation and protective factors’ specificity

Few studies on resilience in young children model risk appropriately and test theory-led hypotheses about its moderation. This study addressed both issues. Our hypothesis was that for preschool children’s emotional/behavioral adjustment in the face of contextual risk protective factors should be located in the cognitive domain. Data were from the first two sweeps of the UK’s Millennium Cohort Study. The final study sample was 4,748 three-year-old children clustered in 1,549 Lower layer Super Output Areas in nine strata. Contextual risk was measured at both area (with the Index of Multiple Deprivation) and family (with proximal and distal adverse life events experienced) level. Moderator variables were parenting, verbal and non-verbal ability, developmental milestones, and temperament. Multivariate multilevel models—that allowed for correlated residuals at both individual and area level—and univariate multilevel models estimated risk effects on specific and broad psychopathology. At baseline, proximal family risk, distal family risk and area risk were all associated with broad psychopathology, although the most parsimonious was the proximal family risk model. The area risk/broad psychopathology association remained significant even after family risk was controlled but not after family level socioeconomic disadvantage was controlled. The cumulative family risk was more parsimonious than the specific family risks model. Non-verbal ability moderated the effect of proximal family risk on conduct and emotional problems, and developmental milestones moderated the effect of proximal family risk on conduct problems. The findings highlight the importance of modeling contextual risk appropriately and of locating in the cognitive domain factors that buffer its effect on young children’s adjustment.     

Modeling risks: effects of area deprivation, family socio-economic disadvantage and adverse life events on young children’s psychopathology

Background  

The effects of contextual risk on young children’s behavior are not appropriately modeled.     

Body mass index, calcium intake, and physical activity affect calcaneal ultrasound in healthy Greek males in an age-dependent and parameter-specific manner

Quantitative ultrasound (QUS) is a peripheral bone densitometry technique that is rapidly gaining in popularity for the assessment of skeletal status. This study was carried out to examine the effect of anthropometric, dietary, physical activity, and other lifestyle factors on QUS parameters in healthy Greek males of various ages, including children (n = 192), adults (n = 106), and elderly (n = 86) subjects. Calcaneal QUS measurements were performed with the Sahara device (Hologic), which measures broadband ultrasound attenuation (BUA) and speed of sound (SOS) through the os calcis. A composite parameter, the quantitative ultrasound index (QUI), and an estimate of heel bone mineral density (eBMD) were also derived. BUA correlated positively with height, weight, and body mass index, as well as waist and hip circumferences (P < 0.001), but this was not the case for SOS. QUI and eBMD were inconsistently related with anthropometric characteristics. Overweight and obese males had significantly higher BUA than normal-weight subjects (P < 0.05), but similar SOS, QUI, and eBMD; this held true for all age groups. Boys participating in organized physical activities had significantly higher SOS, QUI, and eBMD than those who did not (P < 0.05), although BUA was similar in the two groups; no differences according to organized physical activity were detected in adults and the elderly. On the other hand, adult men devoting at least some time to non-organized physical activities had significantly higher QUS values than their non-exercising peers (P < 0.05); no such effects, however, were seen in children and the elderly. Adult men with calcium intakes above 800mg/day had significantly higher SOS, QUI, and eBMD than those consuming less calcium (P < 0.05), and also tended towards higher BUA (P = 0.079); no such differences were observed among children and elderly men. The effects of physical activity and calcium intake on heel QUS persisted even after controlling for body size. Overall, body weight was the sole significant positive determinant of BUA ( = 0.373; t = 6.589; P < 0.001), explaining approximately 14% of the total variance, while age was the sole significant negative determinant of SOS ( = –0.198; t = –3.321; P = 0.001), albeit explaining only less than 4% of the total variance. In conclusion, body size, dietary calcium intake, and physical activity patterns seem to inconsistently and age-dependently influence heel QUS among healthy Greek males in a parameter-specific manner.     

Hypoparathyroidism in a patient presenting with severe myopathy and skin rash. Case report and review of the literature

A 47-year old man with idiopathic hypoparathyroidism (IHP), presented as severe myopathy and skin rash is described. The serum muscle enzymes were increased. After treatment with calcium and vitamin D, the clinical condition improved, the skin rash gradually disappeared, and the muscle enzymes decreased and remained within the normal range thereafter.     

Quantitative ultrasound calcaneus measurements: normative data for the Greek population

Quantitative ultrasound (QUS) is a peripheral bone densitometry technique that is rapidly gaining in popularity, and is widely used worldwide for the assessment of skeletal status. This, however, generally occurs in the absence of adequate clinical guidelines. As accurate interpretation of the results and correct classification in individual fracture risk assessment are of great value, the present study was carried out to establish a reference database for calcaneal QUS measurements across age group and gender in Greece. A total of 1205 subjects (821 females and 384 males) from three age groups (409 children, 341 adults and 455 elderly) were recruited. QUS measurements were performed at the heel with the Sahara device, which measures broadband ultrasound attenuation (BUA) and speed of sound (SOS), and then combines these variables into a single parameter, the quantitative ultrasound index (QUI). Overall, gender-related differences were more pronounced among the elderly, while age-related differences were more pronounced among females. Elderly men had higher QUS parameters than women of peer age, but no major gender differences were observed in children and adults. In males, only BUA showed a variation with age, being higher in adult and elderly men compared to boys. On the other hand, all QUS parameters varied significantly with age in females, the general trends being mildly positive from childhood to adulthood, when peak levels were observed, and negative thereafter. The results for the Greek population were in the range reported previously for other populations, but some discrepancies were evident, probably resulting from ethno-specific characteristics and different QUS instrumentation. Importantly, using the manufacturers or the local database as the reference population for computing T-scores led to significantly different classification of subjects into conventional categories of risk. These data could be useful as a guide for comparing the results of individual studies, as well as for the assessment of Greek men and women at risk of fracture.     

Detached endothelial cells and microparticles as sources of tissue factor activity

INTRODUCTION: Cytokine activation of endothelial cell monolayers is associated with cell detachment, microparticle shedding from plasma membranes, and phosphatidylserine appearance in the plasma membrane outer leaflets. While tissue factor expression on activated endothelial cells and microparticles is well documented, the contribution of detached endothelial cells to tissue factor activity is less clear. We studied tissue factor expression and the role of tissue factor pathway inhibitor on adherent and detached endothelial cells and on microparticles following endothelial cell activation with TNF-alpha. MATERIALS AND METHODS: Detached endothelial cells and microparticles were obtained from cultures of human umbilical vein endothelial cells by differential centrifugation of cell culture supernatant. For microparticle capture, an antibody directed against CD146 was used. Functional tissue factor activity was measured by chromogenic assay and tissue factor antigen by ELISA. Endothelial cell and microparticle morphology was examined by light and transmission electron microscopy. RESULTS: After cell activation for 22 h, functional tissue factor activity was distributed as follows: 60%, adherent endothelial cells; 35%, detached cells; and 5%, microparticles. Tissue factor protein followed a similar distribution. Cell detachment was 47%. Electron microscopy demonstrated shedding of microparticles with a diameter of 0.1-0.6 mum. Cy3-annexin V revealed increased phosphatidylserine on activated adherent endothelial cells and microparticles. Pre-incubation of adherent and detached endothelial cells and microparticles with anti-tissue factor antibody blocked factor Xa production. Pre-incubation with anti-tissue factor pathway inhibitor antibody increased tissue factor activity of adherent endothelial cells 2.8-fold, detached cells 1.4-fold, and microparticles 45-fold. CONCLUSIONS: Detached endothelial cells as well as microparticles from activated endothelial cell monolayers express tissue factor activity, and this activity on microparticles is markedly inhibited by microparticle-associated tissue factor pathway inhibitor.