Nonresidential fatherhood and father-child relationships among Curaçaoan and Dutch adolescents and young adults

Growing up with a nonresident biological father has been portrayed as problematic for different aspects of father-child relationships, but it is unclear whether experiencing nonresidential fatherhood is less problematic in countries where this family structure is more common and thus probably less stigmatized. Cross-country research into nonresidential fatherhood is scarce, especially including Caribbean countries where many children grow up without their biological father in the home. This study examined associations between nonresidential fatherhood and father-child relationship quality and fathers' parenting behaviors among Curaçaoan and Dutch adolescents and young adults. Curaçaoan (n = 450) and Dutch (n = 585) participants completed a digital questionnaire in class, using the same procedures on Curaçao and in the Netherlands. We estimated structural equation models of perceived avoidant and anxious father-child attachment and paternal emotional warmth, rejection, and monitoring for both groups separately because of measurement variance across countries. Nonresidential fatherhood was unrelated to perceptions of most aspects of father-child relationships among both Curaçaoan and Dutch participants. This study adds an important cross-country perspective to the current literature on nonresidential fatherhood and tentatively suggests that correlates of nonresidential fatherhood for father-child relationships might be less evident than previous studies suggest. Instead, young people's socioeconomic status (SES) and the frequency of contact between fathers and children seem to be more important for father-child attachment and paternal rearing behaviors. Further research across demographic characteristics and child outcomes is required to understand whether, when, and how nonresidence of the biological father might affect child well-being and development in different countries. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Gene-Environment Interplay in the Development of Overweight

PURPOSE

Overweight in youth is influenced by genes and environment. Gene-environment interaction (G×E) has been demonstrated in twin studies and recent developments in genetics allow for studying G×E using individual genetic predispositions for overweight. We examine genetic influence on trajectories of overweight during adolescence and early adulthood and determine whether genetic predisposition is attenuated by higher socioeconomic status and having physically active parents.

METHODS

Latent class growth models of overweight were fitted using data from the TRacking Adolescents' Individual Lives Survey (n = 2720). A polygenic score for body mass index (BMI) was derived using summary statistics from a genome-wide association study of adult BMI (N = ∼700,000) and tested as predictor of developmental pathways of overweight. Multinomial logistic regression models were used to examine effects of interactions of genetic predisposition with socioeconomic status and parental physical activity (n = 1675).

RESULTS

A three-class model of developmental pathways of overweight fitted the data best ("non-overweight", "adolescent-onset overweight", and "persistent overweight"). The polygenic score for BMI and socioeconomic status distinguished the persistent overweight and adolescent-onset overweight trajectories from the non-overweight trajectory. Only genetic predisposition differentiated the adolescent-onset from the persistent overweight trajectory. There was no evidence for G×E.

DISCUSSION

Higher genetic predisposition increased the risk of developing overweight during adolescence and young adulthood and was associated with an earlier age at onset. We did not find that genetic predisposition was offset by higher socioeconomic status or having physically active parents. Instead, lower socioeconomic status and higher genetic predisposition acted as additive risk factors for developing overweight.

Genetic confounding in bullying research: Causal claims revisited

Bullying research has shown repeatedly that victims of bullying have an increased risk for later internalizing problems and bullies have an increased risk for later externalizing problems. Bullying involvement is often, either explicitly or implicitly, presented as part of a causal mechanism for maladjustment. However, genetic vulnerability may confound the reported associations. This study examined to what extent genetic vulnerability can account for the reported associations between bullying involvement (age 11-14) and later internalizing and externalizing problems (age 16), using data from the TRacking Adolescents' Individual Lives Survey (n = 1604). Because polygenic scores capture only a fraction of the total genetic effect, they were extrapolated to the size of single-nucleotide polymorphism and twin heritability estimates to examine genetic confounding while controlling for (hypothetical) polygenic scores that fully capture the genetic effect. Genetic vulnerability for internalizing and externalizing problems confounded, respectively, the association between bullying victimization and later internalizing problems, and the association between bullying perpetration and later externalizing problems. As such, this study showcases a method that can be broadly used to assess the magnitude of genetic confounding. Caution is, however, warranted in interpreting particularly the less straightforward extrapolations of polygenic scores to the size of twin heritability estimates.

Bullying perpetration and social status in the peer group: A meta-analysis

INTRODUCTION

Associations between bullying perpetration and social status vary, not only between different facets of social status but also between bullying in primary versus secondary school. The main aim of the present study was to meta-analyse existing evidence regarding the prospective associations between bullying perpetration and various facets of social status, that is, popularity, peer acceptance, peer rejection, and social preference.

METHODS

Electronic databases were searched to identify studies on bullying perpetration and later social status published up to January 17, 2022. Multilevel random effects models were performed using Metafor and differences in effect sizes as a function of substantive and methodological moderators were tested.

RESULTS

In total, 116 effects were included from 18 publications, reporting on 17 different samples and more than 15,000 participants (mean age bullying assessment = 11.57 years, on average 51% female participants). Most samples were from the United States (7) or Europe (7). Overall, bullies were more popular, but also more rejected and scored lower on social preference compared with non-bullies. These associations remained when effects were adjusted for previous social status and other confounders. No link between bullying perpetration and acceptance was found. There was little evidence that effect sizes differed as a function of moderators.

CONCLUSIONS

Bullies become more popular over time, but also have a higher risk of being rejected and being less socially preferred. Bullying perpetrators are more popular but also more rejected by their peers. There is no evidence that these links differ depending on sex or age at which perpetrators bully, reporter or type of bullying.

Internalizing and externalizing correlates of parental overprotection as measured by the EMBU: A systematic review and meta-analysis

Aspects of parenting including overprotection explain individual differences in child adjustment. This review and meta-analysis summarizes studies on parental overprotection and internalizing and externalizing problems. To ensure that findings could be compared as systematically as possible, the focus was on studies that used the overprotection scale of the Egna Minnen Beträffande Uppfostran ("Memories of my Parents' Upbringing") (EMBU) questionnaire, a popular instrument to measure parental overprotection. In total, we extracted 176 effects from 29 studies. A modified version of the Newcastle-Ottawa Scale was used to perform quality assessments for the included studies. Parental overprotection was associated positively with offspring internalizing and externalizing problems, with overall estimates ranging from r = .14 to .18. Moderator analyses suggested that effects of maternal were larger than effects of paternal overprotection. Other factors that moderated the strength of the association between overprotection and maladjustment included whether outcomes were self-reported or parent-reported, the design was cross-sectional or longitudinal, and publication year. Cultural context, age at exposure, and child sex did not explain differences between effect sizes. Most findings were based on cross-sectional studies and therefore do not constitute proof of causal relations. Many studies were of less-than-satisfactory quality regarding representativeness of the sample, descriptions of the data collection, and statistical analyses. There is a clear need for well-powered longitudinal studies to strengthen inferences about associations between parental overprotection and internalizing and externalizing problems.

Gene-environment interplay in externalizing behavior from childhood through adulthood

BACKGROUND

Genetic and environmental influences on externalizing problems are often studied separately. Here, we extended prior work by investigating the implications of gene-environment interplay in childhood for early adult externalizing behavior. Genetic nurture would be indicated if parents' genetic predisposition for externalizing behavior operates through the family environment in predicting offspring early adult externalizing behavior. Evocative gene-environment correlation would be indicated if offspring genetic predisposition for externalizing behavior operates through child externalizing behavior in affecting the family environment and later early adult externalizing behavior.

METHOD

Longitudinal data from seven waves of the TRacking Adolescents' Individual Lives Survey, a prospective cohort study of Dutch adolescents followed from age 11 to age 29 (n at baseline = 2,734) were used. Child externalizing behavior was assessed using self and parent reports. Family dysfunction was assessed by parents. Early adult externalizing behavior was assessed using self-reports. Genome-wide polygenic scores for externalizing problems were constructed for mothers, fathers, and offspring.

RESULTS

Offspring polygenic score and child behavior each predicted early adult externalizing problems, as did family dysfunction to a small extent. Parents' polygenic scores were not associated with offspring's early adult externalizing behavior. Indirect effect tests indicated that offspring polygenic score was associated with greater family dysfunction via child externalizing behavior (evocative gene-environment correlation) but the effect was just significant and the effect size was very small. Parents' polygenic scores did not predict family dysfunction, thus the data do not provide support for genetic nurture.

CONCLUSIONS

A very small evocative gene-environment correlation was detected but effect sizes were much more pronounced for stability in externalizing behavior from childhood through early adulthood, which highlights the necessity to intervene early to prevent later problems.

Benefits of Bullying? A Test of the Evolutionary Hypothesis in Three Cohorts

Recent work on bullying perpetration includes the hypothesis that bullying carries an evolutionary advantage for perpetrators in terms of health and reproductive success. We tested this hypothesis in the National Child Development Study (n = 4998 male, n = 4831 female), British Cohort Study 1970 (n = 4261 male, n = 4432 female), and TRacking Adolescents' Individual Lives Survey (n = 486 male, n = 521 female), where bullying was assessed in adolescence (NCDS, BCS70: age 16, TRAILS: age 14) and outcomes in adulthood. Partial support for the evolutionary hypothesis was found as bullies had more children in NCDS and engaged in sexual intercourse earlier in TRAILS. In contrast, bullies reported worse health in NCDS and BCS70.

Women in Neurosurgery: Historical Path to Self-Segregation and Proposal for an Integrated Future

Despite the rising percentage of women accessing the medical profession over the last few decades, surgical specialties are still largely male-dominated; in particular, a remarkable gender disparity is evident in neurosurgery, where only 19% of practitioners are females. Although women may be reluctant to choose a challenging specialty like neurosurgery due to concerns around how to balance family and career, it must be admitted that prejudices against female neurosurgeons have been deeply rooted for long, prompting many to give up and switch track to less demanding subspecialties. Among those who have persisted, many, if not most, have experienced difficulties in career progression and received unequal treatment in comparison with their male counterparts. In 1989, a group of 8 female neurosurgeons founded Women in Neurosurgery (WINS), an organization that aimed to guarantee inclusivity in neurosurgery, encouraging a better and more egalitarian working environment. Thereafter, WINS sessions were regularly promoted at international conferences, offering female neurosurgeons a platform to report issues related to gender discrimination. Over recent years, the mission of WINS sessions in national and international conferences has taken an unexpected deviation; they have progressively become supplementary scientific sessions with only women neurosurgeons as speakers, thus paving the road to a form of self-segregation. This tendency has also resulted in the establishment of sections of only female neurosurgeons within some national societies. Although there remains a faction that fiercely supports the WINS mindset of reserved spaces for women, such segregation is an upsetting prospect for those who believe that science and professionalism have no gender; a growing part of the global neurosurgical community believes that the conception of a “female neurosurgery” and a “male neurosurgery” is misguided and counterproductive and consider the existence of the WINS as anachronistic and no longer necessary.

Intergenerational Transmission of Peer Aggression

It is plausible that peer aggression—like general forms of aggression—is transmitted from one generation to the next. As such, parental behavior in childhood and adolescence may be associated with offspring aggressive behavior against peers. This study used 1970 British Cohort Study data to test intergenerational transmission of peer aggression. The baseline sample consisted of 13,135 participants. At the first assessment that was used in this study, participants were on average 4.95 years old (SD = 0.79; 48.20% female). At the last assessment, participants were on average 33.88 years old (SD = 0.36; 52.1% female). Models were computed for early and middle childhood, and adolescence. Significant associations between parents’ and offspring peer aggression were found in most models – especially when correlating aggression in similar developmental periods for parents and children. Other transmission mechanisms such as genetic transmission may be relevant and should be taken into account in future studies.

Prevalence of overweight among Dutch primary school children living in JOGG and non-JOGG areas

Background

One of the most influential integrated approaches towards reducing childhood obesity is EPODE, a program that has been translated to over 20 different countries worldwide.

Aim

The goal of this study was to explore how JOGG–the Dutch EPODE adaptation–might reduce overweight prevalence among children.

Methods

To compare whether overweight prevalence was different in JOGG areas vs. non-JOGG areas, in long-term JOGG areas vs. short-term JOGG areas, and in low SES JOGG areas vs. middle/high SES JOGG areas, secondary anthropometric and personal data of 209,565 Dutch children were mapped onto publicly available JOGG data.

Results

Findings showed that overweight prevalence decreased from 25.17% to 16.08% in JOGG-areas, and from 32.31% to 18.43% in long-term JOGG areas. However, when taking into account SES, the decrease in prevalence was mainly visible in low SES long-term JOGG areas.

Conclusion

JOGG appeared to be successful in targeting areas where overweight was most prevalent. Low SES areas that had implemented JOGG for a longer period of time, i.e., six years, appeared to be successful in decreasing overweight prevalence.

“We Say ‘Mothers’ But Mean ‘Parents’”: Qualitative Perceptions and Experiences With Father Absence Among Curaçaoan, Curaçaoan-Dutch, and Dutch Young People

Perceptions and experiences with biological father absence might vary depending on the extent to which father absence constitutes a common family form, like it does in many Caribbean countries. The goal of this qualitative study was to better understand what it means to grow up without a father for Curaçaoan ( n = 19; 15–24 years), Curaçaoan-Dutch ( n = 15; 14–29 years), and Dutch ( n = 16; 16–26 years) young men and women. Findings from thematic analyses of ethically approved in-depth interviews revealed that most interviewees from all three cultural groups perceived no bond with and upbringing from their absent father. The interviewees noted emotional pain, but also mentioned that (m)others compensated for their father’s absence. Dutch interviewees were more negative about their absent father, and both Dutch and Curaçaoan-Dutch interviewees experienced more difficulties with respect to their father’s absence compared with Curaçaoan interviewees. Studying the similarities and differences between perceptions and experiences with father absence enriches our knowledge of what it means to grow up without a father. Doing so from young people’s point of view and across cultures has important practical value by providing a fuller understanding of the meaning of father absence for young people across cultures.

Family Belongingness Attenuates Entrapment and Buffers Its Association with Suicidal Ideation in a Sample of Dutch Sexual Minority Emerging Adults

Sexual minority emerging adults are more likely to engage in suicidal ideation than their heterosexual counterparts. Experiences of homophobic violence are associated with suicidal ideation. Yet, the specific mechanisms linking homophobic violence to suicidal ideation remain unclear. Entrapment and social belongingness were tested to determine their relevance for understanding the link between homophobic violence and suicidal ideation. A sample of sexual minority Dutch emerging adults (N = 675; ages 18-29, M = 21.93 years, SD = 3.20) were recruited through online platforms and flyers. Homophobic violence was expected to be positively associated with suicidal ideation and entrapment. The association between homophobic violence and suicidal ideation was expected to be indirectly linked through entrapment. We explored whether various sources of social belongingness moderated the path between entrapment and suicidal ideation and whether those sources of social belongingness moderated the indirect effect of homophobic violence on suicidal ideation through entrapment. Results showed that homophobic violence and entrapment were positively associated with suicidal ideation and that family belongingness was negatively associated with suicidal ideation. Homophobic violence and suicidal ideation were not indirectly linked through entrapment. The interaction effect between entrapment and family belongingness was significant, suggesting that, on average, the effect of entrapment on suicidal ideation decreased when family belongingness was high. These results suggest that family belongingness may reduce the association between entrapment and suicidal ideation while adjusting for homophonic violence. Reducing entrapment and improving family belongingness may be useful targets for programs aimed at preventing suicidal ideation among sexual minority emerging adults.

The Value of Multiple-Generation Cohorts for Studying Parenting and Child Development

Participants in longitudinal studies that followed children into adulthood now have children of their own, which has enabled researchers to establish multiple‐generation cohorts. In this article, I illustrate the benefits of multiple‐generation cohort studies for developmental researchers, including: (a) the impact of child and adolescent characteristics (i.e., preconception factors) on parenthood can be studied from a developmental perspective and without having to rely on retrospective reports, (b) intergenerational continuity and transmission can be examined for psychological, behavioral, and social development, and by comparing parent and offspring generations for the same developmental period, and (c) the interplay of genetic and environmental influences on parenting and child development can be disentangled. Even though multiple‐generation studies pose unique logistical and methodological challenges, such cohorts are indispensable for rigorous research into parenting and the origins of child development.

Childhood and Adolescent Bullying Perpetration and Later Substance Use: A Meta-analysis

CONTEXT

Previous meta-analyses substantially contributed to our understanding of increased drug use risk in bullies but only included research up to 2014 and did not report on other types of substances.

OBJECTIVE

To review and meta-analyze existing evidence regarding the prospective association between peer bullying perpetration in childhood and adolescence and later substance use.

DATA SOURCES

Electronic databases were searched on March 14, 2019.

STUDY SELECTION

We selected peer-reviewed articles and dissertations in English reporting original empirical studies on associations between bullying perpetration in childhood or adolescence and later use of drugs, alcohol, or tobacco. Records were assessed for eligibility independently by 2 authors.

DATA EXTRACTION

Data extraction and quality assessment was performed by one author and checked by another author.

RESULTS

In total, 215 effects were included from 28 publications, reporting on 22 samples, comprising 28 477 participants. Bullying perpetration was associated positively with all types of substance use (drugs, alcohol, tobacco, and general). The results for combined bullying-victimization were more mixed, with generally weaker effects.

LIMITATIONS

Effects were based on a large variability in operationalizations and measures of bullying and substance use, impeding the interpretation of the pooled effect sizes. Although bullying appears to be a risk factor for substance use, no inferences can be made about so-called causal risk factors that can provide the basis for preventive interventions.

CONCLUSIONS

There is evidence that adolescents and particularly children who bully their peers have a higher risk of substance use later in life than their nonbullying peers.

Reward Responsiveness, Optimism, and Social and Mental Functioning in Children Aged 6-7: Protocol of a Cross-Sectional Pilot Study

Background

There is evidence that reward responsiveness and optimism are associated with mental and social functioning in adolescence and adulthood, but it is unknown if this is also the case for young children. Part of the reason for this gap in the literature is that the instruments that are used to assess reward responsiveness and optimism in adolescents and adults are usually not suitable for young children.

Objective

Two behavioral tasks to assess reward learning, a questionnaire on reward responsiveness, and a questionnaire on optimism/pessimism will be tested on their feasibility and reliability in children aged 6-7. Depending on their feasibility and reliability, these instruments will also be used to investigate if reward responsiveness and optimism are associated with mental and social functioning in young children.

Methods

For this cross-sectional pilot study, we adapted a number of tasks and questionnaires to the needs of 6-7-year-old children, by simplification of items, oral rather than written assessment, and reducing the number of conditions and items. We will approach teachers and, with their help, aim to include 70 children aged 6-7 to assess the feasibility and reliability of the tasks and questionnaires. Feasibility measures that will be reported are the proportion of children completing the task/questionnaire, the proportion of children that were able to explain the instructions in their own words to the researcher, and the proportion of children that correctly answered the control questions. The reliability of the scales will be assessed by computing Cronbach α and item-total score correlations and the reliability of the tasks by correlations between different consecutive blocks of trials. Ethics approval was obtained from the Ethics Committee of the Department of Pedagogy and Educational Sciences.

Results

Data collection was originally planned in March and April 2020, but has been postponed due to Corona virus regulations. We expect to collect the data in the first half of 2021. The findings will be disseminated in preprints and peer-reviewed publications.

Conclusions

The development of feasible and reliable instruments for assessing reward responsiveness and optimism in young children is expected to benefit future research on underlying mechanisms of mental and social functioning in young children. If the instruments assessed in this study are usable with young children, it would be particularly interesting to include them in cohort studies because this would enable investigating not only concurrent associations, but also prospective associations between reward responsiveness and optimism early in life and mental and social functioning later in life. If, as we hypothesize, reward responsiveness and optimism are not only associated with (prospective) mental and social functioning in adults and adolescents but also in young children, this could provide a way of identifying vulnerable children already at an early stage.

International Registered Report Identifier (IRRID)

PRR1-10.2196/18902

Why Does a Universal Anti-Bullying Program Not Help All Children? Explaining Persistent Victimization During an Intervention

Although anti-bullying interventions are often effective, some children continue to be victimized. To increase knowledge of potential factors that might impede children's benefiting from an anti-bullying intervention, we examined potential reasons for individual differences in victimization trajectories during a group-based anti-bullying intervention. Data stem from a five-wave survey among 9122 children (7-12 years old; grades 2-5) who participated in the KiVa anti-bullying intervention (n = 6142) or were in control schools (n = 2980 children). Three trajectories were found in the intervention sample, representing children who experienced stable high, decreasing, or stable low/no victimization. A two-trajectory model of high and low trajectories represented the control sample best. Multinomial regressions on the intervention sample showed that children who experienced particularly high levels of peer rejection, internalizing problems, and lower quality parent-child relationships decreased less in victimization; thus these characteristics appeared to contribute to persistent victimization. The results call for tailored strategies in interventions aiming to reduce victimization for more children.

Interventions aimed at preventing and reducing overweight/obesity among children and adolescents: a meta-synthesis

The prevalence of child and adolescent obesity has been a major worldwide problem for decades. To stop the number of youth with overweight/obesity from increasing, numerous interventions focusing on improving children's weight status have been implemented. The growing body of research on weight-related interventions for youth has been summarized by several meta-analyses aiming to provide an overview of the effectiveness of interventions. Yet, the number of meta-analyses is expanding so quickly and overall results differ, making a comprehensive synopsis of the literature difficult. To tackle this problem, a meta-synthesis was conducted to draw informed conclusions about the state of the effectiveness of interventions targeting child and adolescent overweight. The results of the quantitative synthesis of 26 meta-analyses resulted in a standardized mean difference (SMD) of -0.12 (95%CI: -0.16, -0.08). Several moderator analyses showed that participant and intervention characteristics had little impact on the overall effect size. However, a moderator analysis distinguishing between obesity treatment and obesity prevention studies showed that obesity treatment interventions (SMD: -0.048, 95%CI: -0.60, -0.36) were significantly more effective in reducing body mass index than obesity prevention interventions (SMD: -0.08, 95%CI: -0.11, -0.06). Overall, the results of this meta-synthesis suggest that interventions result in statistically significant effects albeit of relatively little clinical relevance.

Configurations of Adolescents' Peer Experiences: Associations With Parent-Child Relationship Quality and Parental Problem Behavior

Adolescents' peer experiences embrace behavior, relationship quality, status, and victimization, but studies that account for multiple dimensions are rare. Using latent profile modeling and measures of peer behavior, relationship quality, peer status, and victimization assessed from 1,677 adolescents, four profiles were identified: High Quality, Low Quality, Low Quality Victimized, and Deviant Peers. Multinomial logistic regressions showed that negative parent-child relationships in preadolescence reduced the likelihood of High Quality peer relations in mid-adolescence but only partly differentiated between the other three profiles. Moderation by gender was partly found with girls showing greater sensitivity to parent-child relationship quality with respect to peer experiences. Results underline the multifaceted nature of peer experiences, and practical and theoretical implications are discussed.

Parent–child positivity and romantic relationships in emerging adulthood

Romantic relationship quality in adolescence and early adulthood has often been linked to earlier parent–child relationship quality but it is possible that these links are nonlinear. Moreover, the role of social skills as mediator of associations between parent–child and romantic relations has been discussed but not rigorously tested. Using data from 2,230 participants of the longitudinal TRAILS (TRacking Adolescents’ Individual Lives Survey) sample, this study examined whether parent–child positivity assessed at age 11 predicted romantic involvement, commitment and satisfaction in emerging adulthood. Moreover, indirect effects via cooperation, assertion and self-control were tested. Parent–child positivity did not predict romantic involvement as such. However, in those who were romantically involved, linear and, by trend, nonlinear associations between parent–child positivity and commitment were found, suggesting higher levels of commitment in those who had reported positive parent–child relationships but also in individuals with particularly low levels of parent–child positivity. Satisfaction was linearly linked to parent–child positivity. Little support was found for the assumption that the association between parent–child positivity and romantic relationship quality in emerging adulthood are partly explained by social skills. These results show that neither congruence nor compensation alone are sufficient to explain the associations between parent–child and romantic relationship quality.

Conduct Problem Trajectories Between Age 4 and 17 and Their Association with Behavioral Adjustment in Emerging Adulthood

Individual heterogeneity exists in the onset and development of conduct problems, but theoretical claims about predictors and prognosis are often not consistent with the empirical findings. This study examined shape and outcomes of conduct problem trajectories in a Belgian population-based sample (N = 682; 49.5 % boys). Mothers reported on children's conduct problems across six waves (age 4-17) and emerging adults reported on their behavioral adjustment (age 17-20). Applying mixture modeling, we found four gender-invariant trajectories (labeled life-course-persistent, adolescence-onset, childhood-limited, and low). The life-course-persistent group was least favorably adjusted, but the adolescence-onset group was similarly maladjusted in externalizing problems and may be less normative (15 % of the sample) than previously believed. The childhood-limited group was at heightened risk for specifically internalizing problems, being more worrisome than its label suggests. Interventions should not only be aimed at early detection of conduct problems, but also at adolescents to avoid future maladjustment.

Disparities in Depressive Symptoms Between Heterosexual and Lesbian, Gay, and Bisexual Youth in a Dutch Cohort: The TRAILS Study

Lesbian, gay, and bisexual (LGB) youth experience elevated levels of depressive symptoms compared to heterosexual youth. This study examined how differences in depressive symptoms between heterosexual and LGB youth developed from late childhood to early adulthood. The association between sexual orientation and depressive symptoms was estimated from age 11 to 22 using data from the TRacking Adolescents' Individual Lives Survey, a longitudinal Dutch cohort study. Of the 1738 respondents (54.8 % girls) that provided information on sexual orientation, 151 self-identified as LGB. In line with the Minority Stress Framework, it was tested whether self-reported peer victimization and parental rejection mediated the association between sexual orientation and depressive symptoms. Results indicated that LB girls and bisexuals were at increased risk of depressive symptoms already at age 11. The difference increased over time and was related to pubertal development in girls and bisexual individuals. Furthermore, self-reported peer victimization (for both boys and girls), as well as parental rejection (for girls/bisexuals), mediated the association between sexual orientation and depressive symptoms. The authors conclude that already in late childhood, associations between sexual orientation and depressive symptoms are found, partly due to minority stress mechanisms.

The Structured Assessment of Violence Risk in Youth in a large community sample of young adult males and females: The TRAILS study

This study examined associations between the Structured Assessment of Violence Risk in Youth (SAVRY; Borum, Bartel, & Forth, 2002) risk and protective items, identified clusters of SAVRY items, and used these clusters to predict police contact and violence. SAVRY items were assessed in a community sample of adolescent boys and girls (N = 963, 46.5% boys) via self-, parent, and teacher reports at ages 11 and 13.5 as part of a longitudinal cohort study. Police contact and violence were assessed at age 19. Correlations between risk and protective items and police contact and violence were largely similar in boys and girls, though there were some differences with regard to outcome measure. Principal factor analysis on the SAVRY items yielded a 2-factor model, distinguishing between History of Violence/Dysregulation and Social Support factors. Follow-up analyses showed incremental validity of the Social Support factor over and beyond the History of Violence/Dysregulation factor and sex in the prediction of violence. The findings provide new insights into the SAVRY factor structure and show that the SAVRY was able to predict violence in a community sample of adolescents over a period of 4 to 7 years.

Configurations of early risk and their association with academic, cognitive, emotional and behavioural outcomes in middle childhood

PURPOSE

Risk factors for children's development are multifarious and co-occur, having cumulative as well as individual impacts. Yet common configurations of early childhood risks remain little understood. The current study aimed to identify patterns of early risk exposure and to examine their relationship with diverse outcomes in middle childhood.

METHODS

Using latent class analysis in a large, community-based, UK sample (N = 13,699), we examined 13 putative risk factors to identify patterns of exposure.

RESULTS

Four risk configurations were identified: low (65 %), socio-demographic (14 %), family dysfunction (12 %), and multiple (9 %) risk classes. As expected, children in the low risk group fared best on all outcome measures, and those with multiple risk, worst. Importantly, specificity in associations with outcomes emerged, such that cognitive outcomes were predominantly linked with socio-demographic adversities, emotional difficulties with family dysfunction, and conduct problems increased across risk classes.

CONCLUSIONS

Better understanding of configurations of childhood risk exposures may help to target resources for children in need.

The Association Between Peer and own Aggression is Moderated by the BDNF Val-met Polymorphism

Peer antisocial behavior robustly predicts adolescents' own behavior but not all adolescents are equally vulnerable to their peers' influence and genetic factors may confer vulnerability. This study used data of n = 3081 adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine whether BDNF, a polymorphism that affects psychological functioning, moderates the association between affiliation with aggressive peers at age 10 and own aggression at age 15. A significant gene-environment interaction was found, where those who affiliated with aggressive peers in childhood showed increased risk for being aggressive in adolescence if they carried the BDNF met-met variant compared to val-val carriers. Our findings underline the importance of both biological and social factors for adolescent development.

Outcomes of childhood conduct problem trajectories in early adulthood: findings from the ALSPAC study

Although conduct problems in childhood are stably associated with problem outcomes, not every child who presents with conduct problems is at risk. This study extends previous studies by testing whether childhood conduct problem trajectories are predictive of a wide range of other health and behavior problems in early adulthood using a general population sample. Based on 7,218 individuals from the Avon longitudinal study of parents and children, a three-step approach was used to model childhood conduct problem development and identify differences in early adult health and behavior problems. Childhood conduct problems were assessed on six occasions between age 4 and 13 and health and behavior outcomes were measured at age 18. Individuals who displayed early-onset persistent conduct problems throughout childhood were at greater risk for almost all forms of later problems. Individuals on the adolescent-onset conduct problem path consumed more tobacco and illegal drugs and engaged more often in risky sexual behavior than individuals without childhood conduct problems. Levels of health and behavior problems for individuals on the childhood-limited path were in between those for stable low and stable high trajectories. Childhood conduct problems are pervasive and substantially affect adjustment in early adulthood both in at-risk samples as shown in previous studies, but also in a general population sample. Knowing a child's developmental course can help to evaluate the risk for later maladjustment and be indicative of the need for early intervention.

Pubertal development, spare time activities, and adolescent delinquency: testing the contextual amplification hypothesis

Extensive evidence supports associations between early pubertal timing and adolescent externalizing behavior, but how and under which conditions they are linked is not fully understood. In addition, pubertal development is also characterized by variations in the relative speed at which individuals mature, but studies linking pubertal 'tempo' and outcomes are scarce. This study examined the mediating and moderating roles of spare time activities in associations between pubertal development and later delinquency, using data from a large (4,327 girls, 4,250 boys) longitudinal UK cohort (Avon Longitudinal Study of Parents and Children). Self-reports of Tanner stage were available from ages 9 to 14, spare time activities at age 12 and delinquency at age 15. Pubertal development was examined using latent growth models. Spare time activities were categorized using factor analyses, yielding four types (hanging out at home, hanging out outside, consumerist behavior, and sports/games), which were examined as mediators and moderators. Earlier and faster maturation predicted delinquency in boys and girls. Spare time activities partially mediated these links such that early maturing girls more often engaged in hanging out outside, which placed them at greater risk for delinquency. In addition, compared to their later and slower maturing counterparts, boys who matured earlier and faster were less likely to engage in sports/games, a spare time activity type that is linked to lower delinquency risk. No moderation effects were found. The findings extend previous research on outcomes of early maturation and show how spare time activities act as proxies between pubertal development and delinquency.

Thoracic outlet syndrome in 3T MR neurography-fibrous bands causing discernible lesions of the lower brachial plexus

OBJECTIVES

To investigate whether targeted magnetic resonance neurography (MRN) of the brachial plexus can visualise fibrous bands compressing the brachial plexus and directly detect injury in plexus nerve fascicles.

METHODS

High-resolution MRN was employed in 30 patients with clinical suspicion of either true neurogenic thoracic outlet syndrome (TOS) or non-specific TOS. The protocol for the brachial plexus included a SPACE (3D turbo spin echo with variable flip angle) STIR (short tau inversion recovery), a sagittal-oblique T2-weighted (T2W) SPAIR (spectral adiabatic inversion recovery) and a 3D PDW (proton density weighted) SPACE. Images were evaluated for anatomical anomalies compressing the brachial plexus and for abnormal T2W signal within plexus elements. Patients with abnormal MR imaging findings underwent surgical exploration.

RESULTS

Seven out of 30 patients were identified with unambiguous morphological correlates of TOS. These were verified by surgical exploration. Correlates included fibrous bands (n = 5) and pseudarthrosis or synostosis of ribs (n = 2). Increased T2W signal was detected within compressed plexus portion (C8 spinal nerve, inferior trunk, or medial cord) and confirmed the diagnosis.

CONCLUSIONS

The clinical suspicion of TOS can be diagnostically confirmed by MRN. Entrapment of plexus structures by subtle anatomical anomalies such as fibrous bands can be visualised and relevant compression can be confirmed by increased T2W signal of compromised plexus elements.

KEY POINTS

• MR neurography (MRN) can aid the diagnosis of thoracic outlet syndrome (TOS). • Identifiable causes of TOS in MRN include fibrous bands and bony anomalies. • Increased T2W signal within brachial plexus elements indicate relevant nerve compression. • High positive predictive value allows confident and targeted indication for surgery.

Surgical treatment of thoracic disc herniations via tailored posterior approaches

We present clinical findings, radiological characteristics and surgical modalities of various posterior approaches to thoracic disc herniations and report the clinical results in 27 consecutive patients. Within an 8-year period 27 consecutive patients (17 female, 10 male) aged 30-83 years (mean 53 years.) were surgically treated for 28 symptomatic herniated thoracic discs in our department. Six of these lesions (21%) were calcified. In all cases surgery was performed via individually tailored posterior approaches. We evaluated the pre- and postoperative clinical status and the complication rate in a retrospective study. Nearly one half of the lesions (46.4%) were located at the three lowest thoracic segments. Clinical symptoms included back pain or radicular pain (77.8%), altered sensitivity (77.8%), weakness (40.7%), impaired gait (51.9%) or bladder dysfunction (22%). Costotransversectomy was performed in 8 patients, 1 lateral extracavitary approach, 2 foraminotomies, 15 transfacet and/or transpedicular approaches and 2 interlaminar approaches were used for removing the pathologies. After a mean follow-up of 38.6 months (3-100 months), complete normalization or reduction of local pain was recorded in 87% of the patients and of radicular pain in 70% of the cases, increased motor strength could be achieved in 55%, sensitivity improved in 76.2% and improvement of myelopathy was noted in 71.4%. Two patients suffered from postoperative impairment of sensory deficits, which in one case was discrete. The overall recovery rate within the modified JOA score was 39.5%. In 1 patient, two revisions were required because of instability and a persisting osteophyte, respectively. The rate of major complications was 7.1% (2/28). Surgical treatment of thoracic disc herniations via posterior approaches tailored to the individual patient produces satisfying results referring to clinical outcome. Posterior approaches remain a viable alternative for a large proportion of patients with symptomatic thoracic disc herniations.

Associations between adolescent siblings' relationship quality and similarity and differences in values

Theoretically framed by a self-determination perspective on value acquisition and taking into account research into sibling similarity and differences, the current study examined links between sibling relationship quality and adolescents' intrinsic values (benevolence and universalism) and extrinsic values (power, achievement, and materialism). Positive sibling experiences were expected to be positively linked to intrinsic values and negatively linked to extrinsic values, and negative experiences were hypothesized to fuel extrinsic values and thwart intrinsic values. Using a sample of 205 adolescent sibling pairs (older children M = 17.61 years, younger children M = 14.63 years) and multilevel modeling, we assessed within- and between-dyads differences to identify whether the sibling relationship functions as a correlate of values in a similar or different way for 2 siblings. Although siblings were not very similar in their values, sibling competition predicted sibling similarity in higher levels of extrinsic values and lower levels of intrinsic values. Implications for value acquisition research that so far has focused almost solely on parents and failed to acknowledge other processes within families are discussed.

Links between nonshared friendship experiences and adolescent siblings' differences in aspirations

Using a sibling design, this study examined the association between adolescents' friendship experiences and their aspirations for self-acceptance, affiliation, and financial success. We hypothesized that adolescent siblings would differ in their aspirations and that unique experiences in friendships would be associated with these differences. Within our sample of 102 same-sex sibling pairs (mean age older sibling 16 years, younger sibling 14 years), only a small degree of sibling similarity was found for aspirations as well as friendship experiences. Self-acceptance and affiliation were positively linked to general friendship positivity as well as to positive features of the adolescents' closest friend. Bivariate model-fitting techniques revealed that nonshared processes (i.e., unique to each child in the family) explained these links between friendship experiences and aspirations. The results indicate that growing up in one home and being socialized by the same parents does not make adolescent siblings similar in their aspirations but rather that nonshared experiences like those with close friends are related to aspiration dissimilarity of siblings.

Young children's sibling relationship quality: distal and proximal correlates

BACKGROUND

Relationships within families are interdependent and related to distal environmental factors. Low socioeconomic status (SES) and high household chaos (distal factors) have been linked to less positive marital and parent-child relationships, but have not yet been examined with regard to young children's sibling relationships. The present study tested direct associations between these distal factors and sibling relationship quality, as well as examining parenting as a potential mediator and/or moderator.

METHOD

One hundred and eighteen families with children aged 4 to 8 years were interviewed and completed questionnaires during home visits. Children provided reports about the quality of their sibling relationships via a puppet interview, and mothers and fathers reported on household chaos and their exertion of harsh discipline. Researchers rated parental warmth towards the children. Finally, parental education and household density were assessed as indicators of SES.

RESULTS

Using structural equation modelling (SEM), we found that lower levels of household chaos were related to better quality sibling relationships, and that this link was mediated by maternal warmth and paternal harsh discipline, as well as moderated by maternal harsh discipline.

CONCLUSION

Household chaos was more strongly linked to relationship quality between family members than SES, warranting further research and practical application. The study of children's sibling relationships should take into account inter-relations between proximal and distal environmental factors to fully reveal the complexity of family life.

Neurosurgical Management of Previously Coiled Recurrent Intracranial Aneurysms

OBJECTIVE

Endovascular treatment of cerebral aneurysms with detachable coils has proven to be a save and effective treatment. But long-term recurrence due to aneurysm regrowth or coil compaction has been reported in up to thirty percent of cases. Therefore a growing number of previously coiled aneurysms have to be retreated by coiling or, in some circumstances, by clipping. We present a consecutive series of ten patients who underwent surgical clipping for recurrent aneurysms after primary coil embolization.

METHODS

During a 4-year period ten patients with intracranial aneurysms previously treated by coil embolization underwent surgery for clipping of recanalized aneurysms. All aneurysms were located in the anterior circulation (internal carotid artery [ICA], 2; middle cerebral artery [MCA], 3; anterior communicating artery [AcomA], 5). Clinical data and imaging studies of the patients were analyzed retrospectively.

RESULTS

All recurrences were detected by routine control angiograms within a median period of 14 months after primary treatment. In three aneurysms treated for SAH dense arachnoid scarring around the aneurysm sac was noted. In four cases, coils were found intraoperatively to be extruding through the aneurysm sac into the subarachnoid space. Each aneurysm could be clipped without affecting the perfusion of the parent vessel. In one patient the aneurysm sac including the coil package was resected. In one patient one of the central anteromedial arteries was injured during dissection due to dense arachnoid scarring because of prior SAH. As a consequence infarction of the head of the caudate nucleus without neurological compromise was observed on follow-up CT scans. Another patient developed transient aphasia due to vasospasm in the early postoperative period with complete restitution. In the end all patients had an uneventful recovery. Removal of the coil package was not necessary in most cases. Clipping of the aneurysm neck was possible even in cases with coil dislocation into the parent vessel.

CONCLUSION

Clipping of previously coiled aneurysms is a unique problem for vascular neurosurgeons. In most cases clipping is feasible. Clipping should still be considered as a definite treatment option in previously coiled recurrent aneurysms. Results in this small series were good.

Brain tumour surgery in the vicinity of short-term memory representation--results of neuronavigation using fMRI images

OBJECTIVE

Functional information concerning the surrounding brain is mandatory for a good clinical outcome in brain tumour surgery. The value of fMRI to detect the motorcortex and Broca's area is widely accepted today. If an appropriate paradigm is used, short-term memory areas can be visualized as well. Obviously this information must be integrated into cranial neuronavigation for an appropriate intra-operative use. We report our first experiences with the direct integration of short-term memory fMRI into cranial neuronavigation.

METHOD

From January 2001 to March 2002 14 patients were operated on for intracranial tumours with short-term memory fMRI imaging, using the "two-back-paradigm". Both pre- and postoperatively, the short-term memory of all patients was tested additionally by a standardized test battery including 16 different verbal and visuo-spatial items.

RESULTS

In all 14 patients the general level of working memory capacity was preserved after surgery. The visuo-spatial performance was kept unchanged or deteriorated slightly, the alertness slightly worsened as well, but we found an improvement in verbal test items.

CONCLUSION

The two-back paradigm is able to visualize verbal memory tasks in fMRI. For visuo-spatial items, a new paradigm has to be designed. In contrast to deep seated brain lesions, focal cortical impairments do not lead to obvious and serious memory deficits. Therefore, the aim of gross total tumour removal has to be balanced against the aim of preservation of short-term memory fields. Nevertheless, the knowledge of the localization of cortical short-term memory fields may combine both aims during navigated brain tumour surgery, thus preserving the patient with a better quality of life.

Neurogenes Thoracic-outlet-Syndrom

OBJECTIVES

Neurogenic thoracic outlet syndrome (TOS) is one of the most controversial entrapment syndromes of the upper extremity. There are two different surgical approaches for its primary surgical treatment: supraclavicular decompression and transaxillary first rib resection. The aim of this study was to evaluate long-term results and surgical risks of the former.

METHODS

This retrospective long-term study examines a series of 50 supraclavicular decompressions in 45 patients. Follow-up was for at least 24 months. All patients were reexamined regularly in nonstandardized fashion. Finally, each patient underwent a telephone interview with a standardized questionnaire.

RESULTS

There was a significant deterioration of primary results during follow-up. About 30.0% of cases worsened within 24 months after operation. In the long run, about 80.0% of cases showed improvement of symptoms (26.0% excellent, 36.0% good, 18.0% moderate). The complication rate was 4.0%.

CONCLUSION

Due to secondary deterioration of treatment during follow-up, only long-term studies are suited for the examination of neurogenic TOS. Results after supraclavicular decompression are satisfactory, and the complication rate is low.

[Iatrogenic nerve injuries. Part 1: Frequency distribution, new aspects, and timing of microsurgical treatment]

OBJECTIVE

The aim of this study was to analyze the number and types of iatrogenic nerve injuries operated on during a 13-year period at a relatively busy nerve center.

METHOD

Retrospective analysis was done of 191 cases surgically treated because of iatrogenic nerve injuries.

RESULTS

Most iatrogenic nerve injuries occurred after surgical procedures. As a rule, symptoms and signs appeared immediately after the procedure. Single nerves most often involved were the spinal accessory nerve at the neck ( n=27), most frequently after lymph node biopsy, and the median nerve in the carpal tunnel ( n=25), usually after carpal tunnel release and most frequently after endoscopic technique. Following in frequency are the common peroneal nerve ( n=16), superficial sensory radial nerve ( n=13), genitofemoral ( n=12), and superficial peroneal and tibial nerves ( n=9 each). Clinical improvement after neurosurgical intervention appeared in 70% of cases. Frequently iatrogenic nerve lesions are referred with significant delay, that is, not during a time interval deemed appropriate for surgical intervention.

CONCLUSION

Iatrogenic nerve lesions must be recognized in a timely manner and should be operated upon as early as other traumatic nerve injuries to ensure best chances for successful recovery.

Iatrogene Nervenverletzungen

BACKGROUND

The objective of this study was to evaluate the causes of failed endoscopic carpal tunnel release (CTR) in order to detect potentially hazardous operative steps. The intraoperative findings of 10 microsurgically revised cases were retrospectively analyzed.

RESULTS

From January 1999 to October 2001, ten patients underwent open revision surgery after being referred because of failed endoscopic carpal tunnel release (CTR). The median nerve had been injured in five cases, necessitating autologous sural nerve grafting in four. Two other patients underwent extensive (external and internal) neurolysis. The lesions were located twice in the main nerve trunk, three times in the recurrent motor branch, three times in a digital nerve, and once in the sensory palmar branch. The transverse carpal ligament (TCL) had not been sectioned in four cases and was incomplete in two. In another two cases, previously sectioned TCLs were closed again by firm fibrous tissue. In three cases, postoperative hematomas after the initial release were described and possibly contributed to symptoms.

CONCLUSION

Endoscopic CTR in the hand of the inexperienced bears major risks for iatrogenic neurovascular injury.

Lipomas of the internal auditory canal--report of two cases and review of the literature

OBJECTIVE

Lipomas of the internal auditory canal are extremely rare. So far, only 21 cases have been described in the literature. We present here two of our own cases and review the literature to date with special emphasis on the diagnostic and therapeutic options.

METHOD

During the last seven years two lipomas of the internal auditory canal were surgically treated in our department. Despite native and gadolinium-enhanced MRI and a thin-sliced temporal bone CT scan they were misdiagnosed as intracanalicular acoustic neurinomas.

RESULTS

Total tumour removal could be achieved, the facial nerve function was conserved, but both patients were rendered functionally deaf after surgery.

CONCLUSION

Lipomas' radiological behaviour may mimic acoustic neurinomas; without fat-suppressed T(1)-weighted images they are often preoperatively misdiagnosed as acoustic neurinomas. Although the postoperative morbidity with respect to cochlear and facial nerve function is much higher than in small acoustic schwannomas, early surgery may be justified, because complete removal is only possible in this stage. No reliable data are available concerning the natural history of this kind of lesion.

[Management of obstetrical brachial plexus palsy--own experience with the primary operative technique]

Obstetrical brachial plexus palsy occurs at a frequency of 0.6 to 2.5 per 1000 births. 80 to 95% of these lesions recover spontaneously. If spontaneous recovery does not occur within the first six months of life, investigations like electrophysiology, and CT-myelography and surgical exploration of the brachial plexus are recommended. During the last ten years 73 children with obstetrical brachial plexus lesions were examined in our department. 29 newborns underwent surgery on the brachial plexus. In 20 out of 29 children nerve root avulsions were diagnosed preoperatively. We performed in 16 cases nerve grafting after neuroma excision, in four cases nerve grafting combined with neurotization, in seven cases external or internal neurolysis, and in the remaining two cases neurotization and plexo-plexal transfer, respectively. The children were followed up between 18 and 50 months (range 27 months) in 18 cases. Elbow function according to Gilbert scale achieved one half of the patients four to five points and the other half two to three points. We found shoulder function with abduction between 45 degrees to 128 degrees and external rotation in 61% (Grade II to V, according to Gilbert scale). In 31% hand function showed Grade III and IV (Gilbert and Raimondi scale). We recommend decision for surgery at the age of six months. Operation should be planned between six to nine months of life. In addition, physical therapy and options including muscle transfers and orthopaedic procedures must be available to ensure the optimal outcome for these children.

Accumulation of PN1 and PN3 sodium channels in painful human neuroma-evidence from immunocytochemistry

BACKGROUND

The axolemmal distribution and density of voltage-gated sodium channels largely determines the electrical excitability of sprouting neurites. Recent evidence suggests that accumulation of sodium channels at injured axonal tips may be responsible for ectopic axonal hyperexcitability and the resulting abnormal sensory phenomena of pain and paresthesias. For future improvement in pain management it is necessary to identify structurally significant generators of autorhythmicity. A first step in this regard will be to determine the predominant types of sodium channels in injured axons. The opportunity to test human specimens from painful and non-painful neuroma is of great value.

METHODS

We employed immunocytochemical methods to investigate if two types of highly specific voltage-gated sodium channel subtypes could be detected in sections of human neuroma.

FINDINGS

Both subtypes of sodium channels PN1 and PN3 accumulated abnormally in human neuromas. The immunoreactive pattern was more pronounced in painful neuromas. This is in contrast to previous reports that focused either on PN1 or PN3 as main generators of hyperexcitability induced pain.

INTERPRETATION

Both, PN1 and PN3 seem to be involved in hyperexcitability induced pain. It can be expected that a variety of other highly specific voltage gated sodium channel subtypes will be detected in regenerating peripheral nerve in the near future, which contribute to the development of neuropathic pain states. Thus, in order to therapeutically control hyperexcitability induced neuropathic pain, it might be worthwhile to develop pharmaceuticals that can selectively block different sodium channel subtypes and subunits.A review of the role of sodium channels in neuropathic pain is implemented in the discussion.

Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma

OBJECT

The purpose of this study was to discover the number and types of iatrogenic nerve injuries that were surgically treated during a 9-year period at a relatively busy nerve center. The specific nerves involved, their sites of injury, and the mechanisms of injury were also documented.

METHODS

The authors retrospectively evaluated the surgically treated iatrogenic lesions by reviewing case histories, operative reports, and follow-up notes in 722 cases of trauma. These cases were treated between January 1990 and December 1998 because of pain, dysesthesias, and sensory and/or motor deficits. latrogenic injury was a much larger category of trauma than predicted. One hundred twenty-six (17.4%) of the 722 surgically treated cases were iatrogenic in origin. Most of these injuries occurred during a previous operation. To a major extent, nerves of the extremities were affected, and a relatively large number of injuries occurred in the neck and groin. Incidence was highest in the spinal accessory nerve (14 cases), the common peroneal nerve (11 cases), the superficial radial nerve (10 cases), the genitofemoral nerve branches (10 cases), and the median nerve (nine cases). At least two thirds of the patients did not undergo surgery for the iatrogenic injury within an optimal time interval due to delayed referral. Follow-up data were available in 97 of the 126 patients. Surgical outcomes demonstrated improvement in 70% of patients. Operative results were especially favorable in patients suffering from iatrogenic injuries to the accessory and superficial sensory radial nerves.

CONCLUSIONS

latrogenic injuries should be corrected in a timely fashion just like any other traumatic injury to nerve.