Interpretation biases in childhood spider fear: Content-specificity, priming, and avoidance

BACKGROUND AND OBJECTIVES

The relation between fear and interpretation bias has been widely studied in children. However, much less is known about its content-specificity and how interpretation biases predict variance in avoidance. The current study examined different interpretation bias tasks, the role of priming and the ability of the interpretation bias tasks to predict spider fear-related avoidance behaviour.

METHODS

169 children with varying levels of spider fear performed a behavioural avoidance task, two versions of the Ambiguous Scenarios Task (AST; with and without priming), and a size and distance estimation task.

RESULTS

Both versions of the AST and the size-estimation were significantly related to self-reported spider fear and avoidance. These relations were content-specific: children with higher levels of spider fear had a more negative interpretation bias related to spider-related materials than to other materials, and a more negative bias than children with lower levels of spider fear. Furthermore, self-reported spider fear, the AST with priming, and the size-estimation predicted unique variance in avoidance behaviour.

LIMITATIONS

Children varied in their level of spider fear, but clinical diagnoses of spider phobia were not assessed. The participants of this study were not randomly selected, they were children of parents with panic disorder or social anxiety disorder or no anxiety disorder and could therefore partly be seen as children at risk.

CONCLUSIONS

The results support cognitive models of childhood anxiety and indicate that both controlled and automatic processes play an important role in fear-related behaviour.

Efficacy of intensive, hospital-based rehabilitation in cases of thoracic outlet syndrome that failed to respond to private-practice physiotherapy

BACKGROUND

Rehabilitation is currently the preferred first-line treatment for thoracic outlet syndrome (TOS). When physiotherapy fails, the next treatment option is usually surgery - a complex procedure with potential complications.

OBJECTIVE

We sought to establish whether an intensive, multidisciplinary, day-hospital-based rehabilitation programme could reduce the symptoms of TOS after the failure of private-practice physiotherapy and before surgery was considered.

METHODS

We performed a retrospective, single-centre study of 63 TOS patients admitted to our day hospital for 3 weeks (15 therapy sessions) between 2003 and 2014. The data were extracted from hospital records or gathered in a phone interview.

RESULTS

Immediately after discharge, the observed improvements in hand function were related to lifting a load, reaching a high shelf, sweeping the floor, cleaning windows, and combing hair. Three months after the end of the intensive rehabilitation program, 80% of the patients reported a reduction in their symptoms. Forty-one of the 63 patients were subsequently contacted by phone. The mean time interval between the end of the rehabilitation programme and the phone interview was 4.5 years (median: 3.5 years; range: 1-12 years). Twenty-seven patients (66%) reported a worsening in hand function, and 25% had undergone surgery. Twenty-three patients had kept the same job, 7 had changed jobs after retraining, 4 had stopped working before the programme but were able to return to work afterwards (including one patient in a part-time job), 4 had not returned to work, and 3 received disability benefits.

CONCLUSION

An intensive, multidisciplinary, hospital-based rehabilitation programme was associated with improvements in the great majority of patients with TOS - even after private-practice physiotherapy had failed.

Concurrent validity of the ZeroWire® footswitch system for the measurement of temporal gait parameters

BACKGROUND

In contrast to wearable tools (like in-shoe) sensors, lab-based gait assessment (using pressure-sensitive mats or cameras) only acquire data over short distances in non-ecological environments.

RESEARCH QUESTION

To examine the concurrent validity of a wearable ZeroWire® footswitch system (Aurion Srl, Milan, Italy) vs. the GAITRite® walkway (CIR systems Inc., NJ, USA) for recording temporal gait parameters.

METHODS

We included 40 healthy participants in a prospective, single-center study. Temporal gait parameters were recorded simultaneously with the ZeroWire® and GAITRite® systems while each participant walked at three different speeds (slow (60steps/min), comfortable and maximum). To measure the validity, we calculated the interclass correlation coefficient (ICC) and the coefficient of variation (CV) for each parameter (gait cadence, stride time, step time, stance time, and single-support and double-support times). We also performed a graphical analysis using the Bland and Altman method.

RESULTS

The footswitch system showed moderate-to-excellent concurrent validity vs. the GAITRite mat. The degree of agreement between the two assessments was greatest at the maximum gait velocity showed, with very good validity (ICC > 0.91) seen for most parameters, whereas agreement ranged from moderate to very good for the other speeds. Independently of the gait speed, the highest levels of agreement were recorded for gait velocity, cadence, stride time, step time, and stance time. According to the CVs, both systems showed the same accuracy and double-support time was the more variable parameter.

SIGNIFICANCE

The ZeroWire® footswitch system appears to be valid for assessing temporal gait parameters (and particularly gait cadence and stride, step and stance times in healthy participants). It is likely to be well suited to the assessment of gait parameters under ecological conditions and in dual-task gait paradigms.

Evaluation of muscle oxygenation by near infrared spectroscopy in patients with facioscapulohumeral muscular dystrophy

The purpose of the study was to determine muscle metabolism adaptation to exercise in facioscapulohumeral muscular dystrophy patients (FSHD) and to study the correlation with clinical functional status (6-min walk test). 8 FSHD patients and 15 age-matched healthy controls (Controls) performed two isokinetic constant-load knee extension exercises: (1) at 20% of their maximal extensors' peak torque (i.e., the same relative workload) and (2) at (20N⋅m) (the same absolute workload) for up to 4 min. All exercises consisted of rhythmic, voluntary, isokinetic, concentric contractions of the quadriceps femoris at 90°/s, whereas the flexion was performed passively at the same speed. Muscle oxygenation in the vastus lateralis was evaluated using near-infrared spectroscopy (NIRS). The FSHD patients displayed a lower maximal peak torque than controls (-41%, p < 0.05). During the two-exercise modalities, deoxygenated haemoglobin (HHb) and total haemoglobin volume (tHb) were lower in the FSHD patients (p < 0.05). The initial muscle deoxygenation time delay was shorter in the control group (FSHD: 15.1 ± 4.1 s vs.

CONTROLS

10.4 ± 2.1 s, p < 0.05). Mean response time and maximal peak torque were both correlated with functional impairment (walking endurance). The results suggest that FSHD patients present an impairment in their capacity to deliver or to use oxygen.

Fate of abstracts presented at the 2008 European Congress of Physical and Rehabilitation Medicine

The subsequent full-text publication of abstracts presented at a scientific congress reflects the latter's scientific quality. The aim of this paper was to evaluate the publication rate for abstracts presented at the 2008 European Congress of Physical and Rehabilitation Medicine (ECPRM), characterize the publications and identify factors that were predictive of publication. It is a bibliography search. We used the PubMed database to search for subsequent publication of abstracts. We screened the abstracts' characteristics for features that were predictive of publication among abstracts features, such the status of the authors, the topic and the type of work. We performed univariate analyses and a logistic regression analysis. Of 779 abstracts presented at ECPRM 2008, 169 (21.2%) were subsequently published. The mean time to publication was 12±15.7 months and the mean impact factor of the publishing journals was 2.05±2.1. In a univariate analysis, university status (P<10-6), geographic origin (P=10-3), oral presentation (P<10-6), and original research (P<10-6) (and particularly multicentre trials [P<0.01] and randomized controlled trials [P=10-3]) were predictive of publication. In a logistic regression analysis, oral presentation (odds ratio [OR]=0.37) and university status (OR=0.36) were significant, independent predictors of publication. ECPRM 2008 publication rate and impact factor were relatively low, when compared with most other national and international conferences in this field. University status, the type of abstract and oral presentation were predictive of subsequent publication.

Botulinum toxin treatment of pes cavovarus in a child suffering from autosomal recessive axonal Charcot-Marie-Tooth neuropathy (AR-CMT2)

In a 12-year old girl suffering from autosomal recessive axonal Charcot-Marie-Tooth (CMT) neuropathy, pes cavovarus was treated with botulinum toxin injection in the tibialis posterior. The patient underwent a clinical evaluation, video analysis of spatiotemporal gait parameters and dynamic foot plantar pressure assessment before treatment and then two weeks, three months and six months thereafter. The video gait analysis revealed a decrease in varus during the swing phase of gait. The dynamic foot plantar pressure decreased by 50% in the excessive pressure at the side of the foot six months after the injection (maximal pressure=42.6N/cm2 before treatment and 18.9 N/cm2 after 6 month). Botulinum toxin injection appears to be an efficacious means of correcting pes cavovarus in CMT disease. A larger-scale clinical trial is now required to evaluate the putative longer-term preventive effect of this treatment on the pes cavus deformity.

Collection of normative data for spatial and temporal gait parameters in a sample of French children aged between 6 and 12

OBJECTIVE

Normative data on gait is essential for clinical practice - especially in children whose gait pattern changes over time. Sets of normative gait data in healthy children vary significantly from one country to another. We decided to generate a specific reference database of gait parameters for French children.

METHOD

Three hundred and eighty-two children (228 boys and 154 girls, aged between 6 and 12) were asked to walk as naturally as possible and at a self-selected speed on a GAITRite track. Velocity, step count, cadence, step time, step length, cycle time, stride length, base width, swing time, stance time, single support time and double support time were recorded. Parameters were analyzed by age group, height group and BMI.

RESULTS

Velocity, step and stride length increased regularly with advancing age and height. Cadence decreased with height. All temporal parameters (except for double support) differed significantly (P<0.05) when comparing the 6-year-old group or the 7-year-old group with the 9-year-old group and older groups. A small number of temporal parameters (cadence, step time, cycle time and stance time) differed significantly when comparing 7-year-olds and 8-year-olds. Temporal parameters appeared rise in proportion height from 110 cm to 130 cm and then reached a plateau. Overweight was associated with a longer stance time and more double support.

CONCLUSION

The gait pattern in French children aged between 6 and 12 differs from those recorded elsewhere in the world; although gait parameters appear to change in much the same way with age worldwide, our values (even when normalized) are different. Our local database should be of value in French studies of childhood gait disorders. Given that gait patterns do not appear to mature by the age of 12, it would be valuable to study gait patterns in a population of teenagers.

Treatment of dystonia in extensor hallucis longus and digitorum muscles with neurotomy of the branches of the deep fibular nerve: Preliminary results

INTRODUCTION

Dystonia in extensor hallucis and/or digitorum muscles can be observed in pyramidal and extrapyramidal lesions and results in pain in these toes, spontaneous or when walking, problems and discomfort when putting on shoes and socks, and cutaneous lesions on the toes. The objective of this study was to assess the efficacy and safety of deep fibular nerve neurotomy for the extensor hallucis longus (EHL) and/or the extensor digitorum longus (EDL) branches in the treatment of extension dystonia of the hallux and/or other toes.

PATIENTS AND METHODS

A deep fibular nerve neurotomy was performed in 20 patients (n=19 for the EHL, n=6 for the EDL). We retrospectively analyzed the treatment's efficacy and safety and assessed the patients' self-reported improvement and overall treatment satisfaction.

RESULTS

Dystonia totally disappeared in 15 cases (75%); it persisted at a minimal level in the other patients. The patients reported a decrease in pain (P<0.01) and fewer difficulties putting on shoes and socks (P<0.001) and had a high median level of satisfaction (8.5/10). Adverse effects were rare and transient. The identification of the nerve branches was sometimes difficult.

DISCUSSION

Deep fibular nerve neurotomy for the EHL and/or EDL branches seems to be an effective treatment for extension dystonia of the hallux and/or other toes and its consequences for the adult neurological patient. However, these encouraging preliminary results should be confirmed by prospective, longer-term studies.

Fate of abstracts presented at the 2008 congress of the French Physical and Rehabilitation Medicine Society

Publication of abstracts presented at a scientific meeting is a measure of the latter's scientific quality.

OBJECTIVES

To evaluate the publication rate for abstracts presented at the 2008 congress of the French Physical and Rehabilitation Medicine Society (SOFMER) and to identify (i) factors that were predictive of publication and (ii) the main reasons for non-publication.

METHODS

We searched the PubMed database for publications related to SOFMER 2008 abstracts. We then screened the abstracts' characteristics for features that were predictive of publication. Authors of abstracts that had not been published were contacted (by e-mail) in order to establish the reason(s) for non-publication.

RESULTS

Of the 231 abstracts presented at SOFMER 2008, 49 (21.2%) had been published. Original studies submitted by French university teams were more likely to be published. Most of the unpublished abstracts had never been submitted to scientific journals. A heavy workload (limiting the time available for drafting a publication) and unwillingness to submit incomplete or preliminary studies were the main barriers to submission for publication.

CONCLUSION

SOFMER 2008s abstract publication rate was lower than those of other national or international medical congresses. University status and the performance of original research were predictive of publication.

Subjective fear, interference by threat, and fear associations independently predict fear-related behavior in children

BACKGROUND AND OBJECTIVES

Several information-processing models highlight the independent roles of controlled and automatic processes in explaining fearful behavior. Therefore, we investigated whether direct measures of controlled processes and indirect measures of automatic processes predict unique variance components of children's spider fear-related behavior.

METHOD

Seventy-seven children between 8 and 13 years performed an Affective Priming Task (APT) measuring associative bias, a pictorial version of the Emotional Stroop Task (EST) measuring attentional bias, filled out the Spider Anxiety and Disgust Screening for Children (SADS-C) in order to assess self-perceived fear, and took part in a Behavioral Assessment Test (BAT) to measure avoidance of spiders.

RESULTS

The SADS-C, EST, and APT did not correlate with each other. Spider fear-related behavior was best explained by SADS-C, APT, and EST together; they explained 51% of the variance in BAT behavior.

LIMITATIONS

No children with clinical levels of spider phobia were tested. The direct and the different indirect measures did no correlate with each other.

CONCLUSIONS

These results indicate that both direct and indirect measures are useful for predicting unique variance components of fear-related behavior in children. The lack of relations between direct and indirect measures may explain why some earlier studies did not find stronger color-naming interference or stronger fear associations in children with high levels of self-reported fear. It also suggests that children with high levels of spider-fearful behavior have different fear-related associations and display higher interference by spider stimuli than children with non-fearful behavior.

Evaluation of muscle oxygenation by near-infrared spectroscopy in patients with Becker muscular dystrophy

Several authors have reported alterations in vasodilation during effort in patients with dystrophinopathies, in which a lack of neuronal NO synthase is thought to lead to functional muscle ischemia. In order to determine changes in muscle oxygenation during effort in patients with Becker muscular dystrophy (BMD) and assess the parameters' links with disease severity and functional status, 10 BMD patients and 10 age-matched controls performed isokinetic, constant-load knee extension exercises at (i) 20% of their extensors' peak torque (i.e. the same relative load) and (ii) the same absolute load (20 Nm). Muscle oxygenation was evaluated noninvasively using near-infrared spectroscopy (NIRS), with the time course of deoxygenation as the main criterion. As expected, BMD patients displayed a lower peak torque than controls (-62%). During both types of exercise, initial muscle deoxygenation was faster (by 27-41%) in BMD patients than in controls. Greater disease severity (according to the Motor Function Measure) and functional impairment (walking endurance) were associated with a faster second deoxygenation phase (τ). The validity and relevance of muscle deoxygenation parameters and the alteration of vasodilatation by nNOS deficiency in dystrophinopathies should be assessed by further studies.

Intensive in-patient and community intervention versus routine care after attempted suicide. A randomised controlled intervention study

BACKGROUND

A randomised clinical trial was carried out in suicide attempters to assess clinical efficacy of an intensive psychosocial intervention compared with treatment as usual.

METHOD

Two hundred and seventy-four suicide attempters presenting for medical treatment were randomly assigned to either intensive psychosocial treatment or 'care as usual'. Intensive psychosocial treatment consisted of brief admission to a special crisis-intervention unit and problem-solving aftercare. 'Care as usual' included any form of treatment the assessing clinicians thought appropriate. Psychological well-being was evaluated by the SCL-90 and the Hopelessness Scale at 3, 6 and 12 months following entry in the study.

RESULTS

No differences in outcome were found. The probability of repeat suicide attempts in the 12-month follow-up was 0.17 for patients in the experimental group and 0.15 for the control group. There were no differences in ratings on the SCL-90 and the Hopelessness Scale. Patients in the experimental group attended significantly more out-patient treatment sessions.

CONCLUSIONS

General implementation of an intensive in-patient and community intervention programme for suicide attempters does not seem justified.

Psychosocial intervention following suicide attempt: a systematic review of treatment interventions

Repeated suicide attempts are a common problem. However, few randomized controlled studies on the treatment of suicide attempters have been described. Although some of these studies showed beneficial effects on measures of well-being, none of them demonstrated lasting positive effects on repeated suicidal behaviour. In an attempt to analyse the results obtained, a systematic review of randomized controlled trials of interventions for suicide attempters is presented. The literature was gathered by means of a CD-ROM literature reference search (MEDLINE/PSYCLIT). Subsequently, information on study design and treatment efficacy was abstracted. Studies that were homogeneous with regard to therapeutic principles were reviewed accordingly, and pooled analyses were performed. Meta-analyses accounted for inter-study variance (random-effects model) to estimate a common-effect measure (relative risk). Systematic review of the data showed considerable differences in both study design and therapeutic protocols. In view of these differences, a single pooled analysis of all studies appeared to be unfeasible. A pooled analysis of studies that focus on psychiatric management of poor compliance showed no significant effect on the repetition of suicide attempts. Similarly, studies of psychosocial crisis intervention, as well as studies of guaranteed in-patient shelter in cases of emergency, did not show a significant reduction in repeated suicide attempts. However, the pooled results of four studies on cognitive-behavioural therapies showed a significant preventive effect on repeated suicide attempts. At present, only the cognitive-behavioural approach appears to have a beneficial effect on repeated suicide attempts. However, because of methodological variability, the results obtained may be too optimistic. Additional research is required to establish the merits of this type of intervention.