Mapping area variability in social and behavioural difficulties among Glasgow pre-schoolers: linkage of a survey of pre-school staff with routine monitoring data

BACKGROUND

Social, emotional and behavioural development in early to middle childhood impact upon many outcomes in future life and are influenced by home, neighbourhood and school environments. We used linked data to investigate differences between areas in Glasgow City in level of difficulties in pre-school age children, after consideration of demographics, including area-level deprivation.

METHODS

Pre-school education staff completed Strengths and Difficulties Questionnaires (SDQ) on all children progressing to school from a local authority or partnership (local authority-funded private) pre-school in Glasgow City between 2010 and 2012. These data were linked to individual (age, gender) and area-level (deprivation) demographics from the City Council Education Services Department. Statistical models were fitted to the SDQ scores, adjusting for age, gender, area deprivation, year of school entry, pre-school establishment attended and electoral ward of residence. Correlation between neighbouring wards was incorporated to allow for clustering of scores.

RESULTS

Boys and those living in more deprived areas had higher levels of difficulties. Children aged 5.0-5.5 years had fewest difficulties, while the oldest and youngest children had similar levels of difficulties. There were no significant secular trends by year of school entry. There remained differences among areas after adjusting for these variables, with children living in some areas having fewer difficulties than would be expected based on their socio-demographic characteristics.

CONCLUSIONS

There remained differences in children's levels of difficulties between areas after adjusting for age, gender, area deprivation and year of school entry. Children in some very deprived areas had fewer difficulties than might be expected, while those in relatively affluent areas had more difficulties than expected based on their deprivation level. There may be other, unmeasured, individual- and area-level reasons for children's level of difficulties, and these require further exploration.

The Incorporation of an Advanced Donation Program Into Kidney Paired Exchange: Initial Experience of the National Kidney Registry

The continued growth of kidney paired donation (KPD) to facilitate transplantation for otherwise incompatible or suboptimal living kidney donors and recipients has depended on a balance between the logistics required for patients and the collaborating transplant centers. The formation of chains for KPD and the shipping of kidneys have permitted networks such as the National Kidney Registry (NKR) to offer KPD to patients over a transcontinental area. However, over the last 3 years, we have encountered patient requests for a more flexible experience in KPD to meet their individual needs often due to rigid time constraints. To accommodate these requests, we have developed an Advanced Donation Program (ADP) in which the donor desires to donate by a specific date, but their paired recipient has not yet been matched to a specific donor or scheduled for surgery. After obtaining careful informed consent from both the donor and paired recipient, 10 KPD chains were constructed using an ADP donor. These 10 ADP donors have facilitated 47 transplants, and thus far eight of their paired recipients have received a kidney within a mean of 178 (range 10-562) days. The ADP is a viable method to support time limited donors in a KPD network.

Expansions of salivary gland CD4+ T cells from Sjögren’s syndrome patients: single-cell repertoire analysis and correlation with clinical measures of disease (HUM3P.255)

Sjögren’s syndrome is a systemic rheumatic disorder characterized by dry eyes, dry mouth and T cell infiltration of exocrine gland tissue. To determine the extent of salivary gland (SG) CD4+ memory T cell clonal expansion and whether these expansions are as frequent in peripheral blood (PB), a multiplex PCR method was used to amplify both the α and β T cell receptor (TCR) sequences from memory CD4+ T cells sorted from SG lip biopsy tissue and PB of 10 primary Sjögren’s syndrome patients. Over 3,000 TCR sequences were obtained from 50-115 (median 91) individual SG and 75-121 (median 104) individual PB T cells per patient. The percentage of cells that were part of clonal expansions was significantly higher in SG (median 11%, range 0-28%) compared to PB (median 0.9%, range 0-7%, p=0.003). Sequence analysis revealed: 1) highly homologous CDR3s among different expanded SG T cell clones within single patients, suggesting antigen-driven expansion and 2) unique cases of convergent recombination among unrelated patients, where different V segments/additions/deletions were utilized to make identical CDR3 amino acid sequences. The percentages of clonally expanded SG T cells correlated significantly with degree of SG fibrosis and reduced saliva production but not with systemic features of disease. SG clonal expansions detected in this study likely identify T cells involved in recognition of common antigen(s) and glandular dysfunction.

Altered innate, adaptive, and TNF-superfamily soluble inflammatory mediators mark impending systemic lupus erythematosus disease flare, while regulatory mediators distinguish lack of impending disease flare in African-American lupus patients (CCR5P.201)

SLE is a multifaceted disease characterized by immune dysregulation and varied disease activity. We evaluated changes in plasma soluble mediators (n=52) preceding clinically-defined disease flare, in 13 African American (AA) SLE patients who developed disease flare 6 or 12 weeks after baseline assessment compared to matched SLE patients without impending flare and healthy controls. In addition, mediators within samples preceding SLE disease flare and during a clinically stable period from the same individual were compared in 18 AA SLE patients. Patients with impending flare had significant (q<0.01) alterations in 32 soluble mediators at baseline with significantly higher levels of pro-inflammatory mediators, including innate and adaptive cytokines. Baseline levels of regulatory cytokines, including IL-10 and TGF-β, were higher in non-flare SLE patients, while baseline levels of soluble TNFRI, TNFRII, TRAIL, FasL, and CD40L were significantly greater in pre-flare patients (p<0.05). A normalized and weighted combined soluble mediator score was significantly higher in pre-flare SLE patients versus those with stable disease (p<0.0001). Pro-inflammatory soluble mediators are elevated prior to disease flare, while regulatory mediators are elevated during periods of stable disease. Alterations in the balance between inflammatory and regulatory mediators may help identify AA patients at risk of disease flare and help decipher SLE pathogenic mechanisms.

Comparison of referrals for lumbar spine magnetic resonance imaging from physiotherapists, primary care and secondary care: how should referral pathways be optimised?

OBJECTIVE

To compare sensitivity of pathology on imaging between referrals from primary care, physiotherapists, spinal surgeons and other secondary care providers.

DESIGN AND SETTING

A retrospective review of 200 consecutive magnetic resonance imaging (MRI) scans of patients' first presentations to radiology for MR lumbar scanning at a tertiary orthopaedic centre. A scan report was defined as positive if there was any evidence of neural compromise. Fisher's exact 2×2 contingency analyses were performed.

RESULTS

Eighty-seven (44%) scans were positive and 113 (57%) were negative. Forty-four percent of scans requested by general practitioners (GPs) were reported as positive compared with 57% of scans requested by physiotherapists. Only 40% and 20% of scans requested by specialist spinal surgeons and non-spinal team secondary care providers were positive, respectively. Physiotherapist referrals for MRI lumbar spine scans were significantly more likely to be positive compared with GPs (P=0.05), spinal surgeons (P=0.03) and others (P=0.004).

CONCLUSION

When appropriate, referrals via the extended physiotherapy service should be encouraged, rather than referrals directly from GPs. With appropriate training and in the appropriate clinical context, extended physiotherapy services could include inpatients and could accept outpatient referrals from other secondary care providers and not just from GPs; this would improve efficiency and reduce the workload of the radiology department and the spinal surgical unit.

Early parental physical punishment and emotional and behavioural outcomes in preschool children

OBJECTIVE

To determine whether there is an association between being smacked by your main caregiver in the first two years and emotional and behavioural problems at age four.

DESIGN

Secondary analysis of data from the Growing Up in Scotland Prospective Study (GUS).

SETTING

Scotland, UK.

PARTICIPANTS

GUS birth cohort children, whose main caregiver had no concerns about their behaviour at 22 months.

EXPOSURE

Ever smacked by main caregiver in first 22 months, as measured by caregiver self-report at 22 months.

MAIN OUTCOME

Emotional and behavioural problems as measured by parental assessment and the Strengths and Difficulties Questionnaire (SDQ) at 46 months.

RESULTS

Preschool children exposed to main caregiver smacking in the first two years were twice as likely to have emotional and behavioural problems as measured by parental assessment [odds ratio (OR) 2.5, 95% confidence interval (CI) 1.9-3.2; absolute risk reduction (ARR) 17.8%, 95% CI 12.1-23.5] and SDQ (OR 2.5, 95% CI 1.7-3.7; ARR 7.5%, 95% CI 3.7-11.5), as children never smacked by their main caregiver. The association remained significant after adjusting for child age and sex, caregiver age, sex, ethnicity, educational attainment and mental health status, sibling number, structural family transitions and socioeconomic status (adj. OR 2.4, 95% CI 1.8-3.2 for parental assessment and adj. OR 2.2, 95% CI 1.4-3.5 for SDQ).

CONCLUSIONS

Parental use of physical punishment in the first two years may be a modifiable risk factor for emotional and behavioural difficulties in preschool children.

TCR repertoire analysis of La/SS-B autoantigen-responsive peripheral blood CD4+ T cells using single-cell RT-PCR: a proof of principle case study (P3249)

TCR repertoire analysis in a variety of biological settings has largely consisted of TCR spectratyping of V-beta expression or V-specific antibody staining. Here, we combine in vitro stimulation of CFSE-labeled antigen specific T cells with a single cell nested multiplex RT-PCR to efficiently capture the unique T cell repertoire of autoantigen La/SS-B specific CD4+ T cells in a systemic lupus erythematosus and Sjögren’s syndrome patient with precipitating levels of anti-La and Ro antibodies. CFSE-labeled peripheral blood cells were cultured with either purified La protein or a mixture of human La peptides, and CD4+CFSElow cells were single sorted into PCR plates. TCR alpha and beta chain cDNAs were amplified and sequenced. The efficiency of paired TCR chain recovery was 60-65%, and was similar between the populations analyzed. While the magnitude of proliferative responses to the two types of La antigen-specific stimuli were similar, the responding T-cells displayed little overlap in TCR sequence. The sequences derived from the peptide pool-stimulated CD4+ cells were pauci-clonal, with 2 clones dominating more than half the response (58/93 cells). Conversely, the purified protein-responsive CD4+ TCRs were distributed among multiple clonotypes. Our approach maps the T cell repertoire of human antigen responsive cells and may have great utility for elucidating the properties of a variety of antigen-specific T cells in diverse clinical settings.

Altered adaptive and TNF-superfamily soluble inflammatory mediators mark impending Systemic Lupus Erythematosus disease flare in European-American lupus patients after influenza vaccination (P6282)

SLE is a waxing and waning disease characterized by major organ involvement, disease flares and immune dysregulation. Understanding mechanisms and identifying biomarkers of flare would help prevent damage and improve management. Plasma samples were obtained from SLE patients on the day of influenza vaccination (BL) and at 6 and 12 weeks post (FU) in 28 European American SLE patients who exhibited SELENA-SLEDAI defined disease flare at 6 (n=13) or 12 (n=15) weeks post-vaccination. Each SLE patient was matched to a unique SLE patient who did not flare (NF), and to a healthy control (HC). Samples from 13 SLE patients with flare were compared to samples from a non-flare year (self nonflare, SNF). Plasma samples were tested for 52 soluble inflammatory mediators using xMAP technology. SLE patients who exhibited disease flare had significantly (p < 0.01) higher levels of BL pro-inflammatory mediators, including Th1, Th2, and Th17-type cytokines compared to NF/SNF SLE patients and HC. Regulatory cytokines, including IL-10 and TGF-β were increased (p < 0.01) at BL in SLE patients not exhibiting disease flare (NF/SNF) compared to SLE flare and HC. TNFR family members, TNFRI, TNFRII, Fas, FasL, CD40L, were increased at BL in SLE flare patients. Select serum cytokines and chemokines are elevated in patients before SLE disease flare, providing important pathways to dissect for mechanism of flare, therapeutic selection or development.

Insula and orbitofrontal cortical morphology in substance dependence is modulated by sex

BACKGROUND AND PURPOSE

Frontolimbic circuits are involved in learning and decision-making processes thought to be affected in substance-dependent individuals. We investigated frontolimbic cortical morphometry in substance-dependent men and women and determined whether morphometric measurements correlated with decision-making performance.

MATERIALS AND METHODS

Twenty-eight abstinent SDI (17 men/11 women) were compared with 28 controls (13 men/15 women). Cortical thicknesses and volumes were computed by using FreeSurfer. After controlling for age and intracranial volume, group and sex effects were analyzed in 3 a priori regions of interest: the insula, orbitofrontal cortex, and anterior cingulate cortex by using analysis of covariance. A secondary whole-brain analysis was conducted to verify region-of-interest results and to explore potential differences in other brain regions.

RESULTS

Region-of-interest analyses revealed a main effect of group on the left insula cortex, which was thinner in SDI compared with controls (P = .02). There was a group by sex interaction on bilateral insula volume (left, P = .02; right, P = .001) and right insula cortical thickness (P = .007). Compared with same-sex controls, female SDI had smaller insulae, whereas male SDI had larger insulae. Neither ACC nor OFC significantly differed across group. Performance on a decision-making task was better in controls than SDI and correlated with OFC measurements in the controls.

CONCLUSIONS

SDI and controls differed in insula morphology, and those differences were modulated by sex. No group differences in OFC were observed, but OFC measurements correlated with negative-reinforcement learning in controls. These preliminary results are consistent with a hypothesis that frontolimbic pathways may be involved in behaviors related to substance dependence.