Distinct electrocortical and behavioral evidence for increased attention to threat in generalized anxiety disorder

Background: Neural activity is increasingly used in addition to behavioral measures to study anxiety and attentional biases toward threatening stimuli. Event‐related potentials (ERPs) might be particularly useful because of their excellent temporal resolution. In particular, the late positive potential (LPP) reflects increased attention to emotional stimuli—and was recently found to be larger with increasing state anxiety. This study sought to examine the LPP among individuals with generalized anxiety disorder (GAD). Methods: Fifteen individuals with GAD and 15 healthy controls (HCs) viewed briefly presented pairs of aversive and neutral pictures that were presented to the left and right of, as well as above and below, fixation on each trial; ERP and behavioral measures were recorded as participants indicated whether the horizontal or vertical image pairs were the same or different. Results: Aversive pictures presented in unattended locations were associated with more errors overall, and this effect was larger in GAD than HC participants. Moreover, aversive targets elicited larger LPPs across all participants; this difference was larger in GAD than HC participants when distracters were neutral. Conclusions: Threatening stimuli presented in both target and distracting spatial locations have a greater impact on GAD than HC participants. Behavioral and ERP measures provide complimentary indices of attention toward threat in GAD. In terms of attentional control theory, behavioral interference indexes impaired processing effectiveness, whereas the LPP might index reduced processing efficiency in GAD. Both measures may provide unique windows onto how increased stimulus‐driven attention to threat impacts and characterizes GAD. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Out-of-hours GPs and palliative care-a qualitative study exploring information exchange and communication issues

Background  

Out-of-hours general practitioners (GPs) cover the community over a significant proportion of a given week, and palliative care patients are seen as a priority. Little is known about how well these GPs feel supported in their line of work and whether communication exchanges work well for the proportion of their patients who have palliative care needs. For this study, GPs who provide out-of-hours care were interviewed in order to explore factors that they identified as detrimental or beneficial for good communication between themselves, patients, relatives and other professionals, specifically to palliative care encounters.     

Encouraging early clinical experience with deliberately delayed temporary fetoscopic tracheal occlusion for the prenatal treatment of life-threatening right and left congenital diaphragmatic hernias

OBJECTIVE: In order to assess the effect of deliberately delayed percutaneous fetoscopic tracheal occlusion on survival of fetuses with life-threatening congenital diaphragmatic hernia. METHODS: Eight fetuses with life-threatening congenital diaphragmatic hernia underwent fetoscopic tracheal balloon occlusion between 29 + 0 and 32 + 4 weeks of gestation. Delayed occlusion was chosen in order to minimize potentially negative pulmonary effects from premature delivery as a result of fetal surgery. In addition, we wanted to become able to provide all available postnatal intensive care treatment means in these patients. RESULTS: Six of the 8 fetuses survived to discharge from hospital. CONCLUSION: Delayed fetoscopic tracheal balloon occlusion may be rewarded with lung growth sufficient to allow survival of fetuses with life-threatening congenital diaphragmatic hernia.     

Treatment of lymphangiomas with picibanil in the first year of life

BACKGROUND: The therapeutic gold standard of cystic hygroma is its complete resection. Because of its growth pattern and its main location in the head and neck region complete resection is not always possible. An alternative is the local injection of Picibanil, but only few cases have been published about its use in infants. PATIENTS/METHOD: We retrospectively analyzed the data of 8 infants (age: 2 weeks-12 months) who got Picibanil therapy because of cystic hygroma in the time period 2002 until 2006. Follow up ranged from 3 months up to 3 years. RESULTS: During the postoperative period all patients had local swelling, in 4 cases accompanied with local inflammation and fever. Tumor reduction of >50% was obtained in 7 of 8 patients. CONCLUSIONS: Local injection of Picibanil in infants with cystic hygroma seems to be a safe alternative to surgical therapy, especially when complete tumor resection means damage of important neighbouring structures. Prospective trials are necessary to confirm the better outcome after therapy with Picibanil compare to primary surgery.     

Age, anger regulation and well-being

Emotion regulation has been argued to be an important factor in well-being. The current study investigated the effects of adult aging on emotional expression, emotional control and rumination about emotional events, focusing on an emotion which is particularly important in social interaction: anger. Measures of anger regulation and well-being were obtained in a sample of 286 adults aged between 18 and 88. Older adults expressed anger outwardly less often, and reported more inner control of anger using calming strategies compared to their younger counterparts. These age differences were not explained by variance in social desirability of responding. Age improvements in negative affect and anxiety were partly explained by age differences in anger regulation suggesting an important role for anger management in good mental health amongst older adults. Further, age improvements in quality of life were explained by variance in anger regulation indicating that improved management of emotions with age is an important factor in maintaining well-being in old age.     

Modifiable Family Factors Among Treatment-Seeking Families of Children With High Body Mass Index: Report of a Pilot Study

PurposeThe purpose of this pilot study was to explore parenting style and other potential family and social indicators of an obesogenic or weight-promoting family environment. Modifiable factors were sought on which to base a nursing behavioral intervention that could be combined with diet and exercise to reduce youth weight.MethodsTwenty-eight parents and their 9- to 18-year-old children who were seeking care for overweight responded to in-home surveys to characterize parenting style (warmth/responsiveness and control). We also examined the extent to which parent modeling of health behavior, child feeding practices, parent knowledge of nutrition, and family social characteristics differed by the control aspect of parenting style.ResultsNearly all youth and parents reported substantial parental love (responsiveness), suggesting little variability in the warmth aspect of parenting style. In contrast, considerable variability was found in the control (moderate versus high) aspect of parenting style. Large effect sizes indicated that mothers with moderate control perceived their lifetime weight to be higher, had more concern about their youth’s weight (p = .03), had better knowledge of nutrition, and had a lower body mass index (p = .02) than did mothers with high (firm or restrictive) control. Moderate effect sizes indicated that mothers with moderate control demonstrated better modeling behavior, higher perception of youth weight, practiced less pressure to eat, and had youth with lower body mass index and percent body fat than did mothers with high (firm or restrictive) control. Families who volunteered for the study kept their data gathering appointments, but we recommend a recruitment period of more than 4 months and the inclusion of several referral sites.DiscussionFurther study of how parent control is related to youth overweight and how appropriate control can be achieved among families with teens who are overweight is recommended.     

A pilot study of adjuvant intraperitoneal 5-fluorouracil using 4% icodextrin as a novel carrier solution.

AIM: This pilot study utilised the sustained intraperitoneal (i.p.) dwell properties of an iso-osmotic solution of 4% icodextrin to investigate the tolerability, toxicity and feasibility of home-based i.p. 5FU adjuvant chemotherapy following resective surgery for colorectal cancer. METHODS: Twenty eligible patients (Dukes' stage B and C with potentially curative resection) underwent perioperative Tenckhoff catheter placement. Ten (6 male, 4 female, aged 46-85; mean 67.5 years) received 5FU chemotherapy. After initial flushing and gradual increase in volumes of 4% icodextrin alone, patients received home-based i.p. 5FU (150-300 mg/m(2)/day given as equal doses at 12-hourly intervals) for 14 days, with a 14-day recovery period, for a maximum of 6 courses. Two incurable patients, treated on compassionate grounds, provided further safety data. RESULTS: Nine of the 10 patients became proficient in self-treatment with 5FU and two completed 6 courses. Frequent abdominal pain was the main dose-limiting toxicity of 5FU, causing withdrawal of three patients after a high (300 mg/m(2)/day) first course and one following a third course at lower doses. I.p. 5FU concentrations (mean>30000 ngml(-1)) were 1000 fold higher than systemic venous levels. Bacterial peritonitis led to two withdrawals but was not a frequent event (microbiologically confirmed incidence of 1 per 27 catheter-months). CONCLUSIONS: Home-based i.p. adjuvant chemotherapy is a feasible treatment option in patients with surgically resected colorectal carcinoma.