Harsh discipline relates to internalizing problems and cognitive functioning: findings from a cross-sectional study with school children in Tanzania

BACKGROUND

Child maltreatment poses a risk to children and adolescents' mental health and may also affect cognitive functioning. Also harsh discipline has been frequently associated with mental health problems. However, within societies in which harsh disciplinary methods are culturally normed and highly prevalent less is known about the association between harsh punishment, mental health problems, and cognitive functioning.

METHODS

In a cross-sectional study, we conducted structured clinical interviews with a sample of Tanzanian primary school students assessing exposure to harsh discipline (Maltreatment and Abuse Chronology of Exposure), internalizing problems (Strength and Difficulties Questionnaire, Children's Depression Inventory), and working memory (Corsi Blocktapping Task). School performance was measured by using the exam grades in 4 core subjects. The 409 children (52% boys) had a mean age of 10.5 years (range: 6 - 15).

RESULTS

Using structural equation modeling, a strong relationship was found between harsh discipline and internalizing problems (β = .47), which were related to lower working memory capacity (β = -.17) and school performance (β = -.17).

CONCLUSIONS

The present study suggests that harsh discipline is closely linked to children's internalizing mental health problems, which are in turn associated with lower cognitive functioning and school performance. Given the high rates of harsh discipline experienced by children in East African homes and elsewhere, the findings of the present study emphasize the need to inform the population at large about the potentially adverse consequences associated with harsh discipline.

The use of referenced-EEG (rEEG) in assisting medication selection for the treatment of depression

OBJECTIVE

To evaluate the efficacy of rEEG(®)-guided pharmacotherapy for the treatment of depression in those circumstances where rEEG and STAR*D provided different recommendations.

MATERIALS AND METHODS

This was a randomized, single-blind, parallel group, 12 center, US study of rEEG-guided pharmacotherapy vs. the most effective treatment regimens reported in the NIH sponsored STAR*D study. Relatively treatment-resistant subjects ≥18 years who failed one or more antidepressants were required to have a QIDS-16-SR score ≥13 and a MADRS score ≥26 at baseline. All subjects underwent a washout of all current medications (with some protocol-specified exceptions) for at least five half-lives before receiving a QEEG and rEEG report. Subjects randomized to rEEG were assigned a regimen based on the rEEG report. Control subjects who had failed only SSRI's in their current episode were randomized to receive venlafaxine XR. Control subjects who had failed antidepressants from ≥2 classes of antidepressants were randomized to receive a regimen from Steps 2-4 of the STAR*D study. Treatment lasted 12 weeks. The primary outcome measures were change from baseline for self-rated QIDS-SR16 and Q-LES-Q-SF.

RESULTS

A total of 114 subjects were randomized and 89 subjects were evaluable. rEEG-guided pharmacotherapy exhibited significantly greater improvement for both primary endpoints, QIDS-SR16 (-6.8 vs. -4.5, p<0.0002) and Q-LES-Q-SF (18.0 vs. 8.9, p<0.0002) compared to control, respectively, as well as statistical superiority in 9 out of 12 secondary endpoints.

CONCLUSIONS

These results warrant additional studies to determine the role of rEEG-guided psychopharmacology in the treatment of depression. If these results were confirmed, rEEG-guided pharmacotherapy would represent an easy, relatively inexpensive, predictive, objective office procedure that builds upon clinical judgment to guide antidepressant medication choice.

Time-frequency characterization of electrocorticographic recordings of epileptic patients using frequency-entropy similarity: a comparison to other bi-variate measures

Expert evaluation of electrocorticographic (ECoG) recordings forms the linchpin of seizure onset zone localization in the evaluation of epileptic patients for surgical resection. Numerous methods have been developed to analyze these complex recordings, including uni-variate (characterizing single channels), bi-variate (comparing channel pairs) and multivariate measures. Developing reliable algorithms may be helpful in clinical tasks such as localization of epileptogenic zones and seizure anticipation, as well as enabling better understanding of neuronal function and dynamics. Recently we have developed the frequency-entropy (F-E) similarity measure, and have tested its capability in mapping the epileptogenic zones. The F-E similarity measure compares time-frequency characterizations of two recordings. In this study, we examine the method's principles and utility and compare it to previously described bi-variate correspondence measures such as correlation, coherence, mean phase coherence and spectral comparison methods. Specially designed synthetic signals were used for illuminating theoretical differences between the measures. Intracranial recordings of four epileptic patients were then used for the measures' comparative analysis by creating a mean inter-electrode matrix for each of the correspondence measures and comparing the structure of these matrices during the inter-ictal and ictal periods. We found that the F-E similarity measure is able to discover spectral and temporal features in data which are hidden for the other measures and are important for foci localization.

Lateral visual field stimulation reveals extrastriate cortical activation in the contralateral hemisphere: an fMRI study

We examined whether lateral visual field stimulation (LSTM) could activate contralateral extrastriate cortical areas as predicted by a large experimental literature. We asked seven unscreened, control subjects to wear glasses designed to allow vision out of either the left (LVF) or right lateral visual field (RVF) depending upon which side the subject looked toward. Each subject participated in a block design functional magnetic resonance imaging (fMRI) study with alternating 30-s epochs in which he was asked to look to one side and then the other for a total of five epochs. On each side of the bore of the scanner, we taped a photograph for the subject to view in the LVF and RVF. The data were analyzed with SPM99 using a fixed effect, box-car design with contrasts for the LVF and the RVF conditions. Both LVF and RVF conditions produced the strongest fMRI activation in the contralateral occipitotemporal and posterior parietal areas as well as the contralateral dorsolateral prefrontal cortex. LSTM appears to increase contralateral fMRI activation in striate and extrastriate cortical areas as predicted by earlier studies reporting differential cognitive and/or emotional effects from unilateral sensory or motor stimulation.

Activation of attention networks using frequency analysis of a simple auditory-motor paradigm

The purpose of this study was to devise a paradigm that stimulates attention using a frequency-based analysis of the data acquired during a motor task. Six adults (30-40 years of age) and one child (10 years) were studied. Each subject was requested to attend to "start" and "stop" commands every 20 s alternatively and had to respond with the motor task every second time. Attention was stimulated during a block-designed, motor paradigm in which a start-stop commands cycle produced activation at the fourth harmonic of the motor frequency. We disentangled the motor and attention functions using statistical analysis with subspaces spanned by vectors generated by a truncated trigonometric series of motor and attention frequency. During our auditory-motor paradigm, all subjects showed activation in areas that belong to an extensive attention network. Attention and motor functions were coactivated but with different frequencies. While the motor-task-related areas were activated with slower frequency than attention, the activation in the attention-related areas was enhanced every time the subject had to start or end the motor task. We suggest that although a simple block-designed, auditory-motor paradigm stimulates the attention network, motor preparation, and motor inhibition concurrently, a frequency-based analysis can distinguish attention from motor functions. Due to its simplicity the paradigm can be valuable in studying children with attention deficit disorders.

Diltiazem, nifedipine, and their combination in patients with stable angina pectoris: effects on angina, exercise tolerance, and the ambulatory electrocardiographic ST segment

The efficacy and safety of oral nifedipine and diltiazem were compared in 20 patients with stable angina pectoris with use of a placebo run-in, randomized, double-blind titration to maximal effect crossover protocol. The effects of treatment withdrawal were also analyzed. All patients received placebo for 2 weeks and were then randomly assigned to receive either diltiazem or nifedipine. A 2 week drug titration phase in which patients received either diltiazem (180 to 360 mg/day) or nifedipine (30 to 120 mg/day) in three divided doses was followed by a 1 week maintenance phase. Patients then received placebo for 1 to 2 weeks, followed by crossover to the other treatment regimen and a second placebo washout period of 1 week. Patients (n = 13) who remained symptomatic on both diltiazem and nifedipine during the monotherapy periods entered a 3 week combination treatment phase, followed by a final 1 week placebo washout period. Frequency of angina, nitroglycerin consumption, exercise tolerance (Naughton protocol), and frequency of daily episodes of ST segment deviations on the electrocardiogram (1 mm of ST segment depression persisting for at least 1 min with and without chest pain) on an ambulatory electrocardiographic monitor were assessed during the baseline placebo, active monotherapy, placebo withdrawal, and combination treatment phases. Plasma drug levels were also measured. Compared with initial placebo values, the frequency of angina and the amount of nitroglycerin treatment were reduced by both diltiazem (p less than .001) and nifedipine (p less than .02). Diltiazem was more effective than nifedipine in reducing angina (p less than .02). Exercise duration increased with both drugs (p less than .0001). Diltiazem was significantly better than nifedipine in reducing the episodes of ST segment depression on the ambulatory monitor (p less than .01). Diltiazem reduced the resting heart rate (p less than .01); both drugs reduced the resting blood pressure and rate-pressure product. Overall, combination therapy was more effective in patients who did not maximally respond to diltiazem or nifedipine alone with respect to anginal and exercise variables and in reducing blood pressure at rest and during exercise. Plasma drug levels could not predict an individual patient's treatment response. Diltiazem may increase nifedipine drug levels when the drugs are combined. Fewer side effects were observed with diltiazem than nifedipine; the most side effects were seen with combination treatment. There were no apparent withdrawal effects observed with either treatment regimen.(ABSTRACT TRUNCATED AT 400 WORDS)

Antianginal drug therapy for silent myocardial ischemia

Many of the available nitrate preparations, beta-adrenergic blockers, and calcium antagonists appear to be useful in patients with painful and silent ischemic episodes detected on the ECG (Table 1). More controlled studies need to be done using standardized methodologies for assessing silent myocardial ischemia, to evaluate and compare the different antianginal medications. It is fortunate, however, that the nitrates, beta-blockers, and calcium antagonists, used alone and in combination, appear to have favorable effects not only on painful ischemic episodes but also on those ischemic episodes not associated with pain.

Existence of simply connected algebraic surfaces of general type with positive and zero indices

In the classification problem of algebraic surfaces of general type, an important conjecture states that for simply connected such surfaces Chern numbers satisfy the inequality c(1) (2) </= 2c(2) (or equivalently, the index tau </= 0). We disprove this conjecture by computing fundamental groups of Galois coverings corresponding to generic CP(2) projections of projective embeddings of CP(1) x CP(1) related to linear systems [unk]al(1) + bl(2)[unk], a >/= 3, b >/= 2. Also, we proved the existence of simply connected minimal surfaces of general type with zero index (e.g., c(1) (2) = 2c(2)). Previously, it was conjectured that these are exactly the surfaces uniformizable in the polydisk. So this conjecture is also disproved.

Beta-adrenergic blockade. An update

beta-Adrenergic blockade represents a major pharmacologic advance. These drugs bind to membrane adrenergic receptors interfering with the effects of endogenous catecholamines. Eight beta-blockers are available in the United States, and others are being studied. The drugs have varying pharmacodynamic properties that may modify certain side effects: beta 1-selectivity, partial agonism, alpha-adrenergic blocking activity, membrane stabilization, and varying pharmacokinetic characteristics. The drugs have been shown to be relatively safe and useful for a wide variety of cardiovascular and noncardiovascular disease states, and their wide spectrum of therapeutic activity illustrates the importance of the sympathetic nervous system in the pathophysiology of medical illness.