Pre-event attachment anxiety and avoidance predict posttraumatic stress symptom severity - Results from a longitudinal population-based study

Attachment-related anxiety and avoidance have been identified as risk factors for psychopathology following traumatic events. However, the predictive value of pre-event attachment orientations for PTSD symptoms in the general population remains unclear. Attachment anxiety and avoidance, as well as symptoms of anxiety and depression, were assessed in autumn 2010 (T0) in 270 adult members of a Dutch research panel. PTSD symptoms were assessed in April (T1), August (T2), and December (T3) 2012 for events occurring within one year before T1. The predictive value of attachment orientations for severity and remission of PTSD cluster and total scores was estimated by latent growth curve analyses controlling for gender, age, and pre-event psychopathology. Attachment anxiety predicted higher posttraumatic stress severity at T1, while attachment avoidance predicted lower initial posttraumatic stress levels, together adding 7.4 % independently explained variance. Higher attachment anxiety was related to more remission of PTSD total scores (6.0 % independently explained variance) which might be understood as an effect of regression to the mean. In conclusion, insecure attachment orientation predicts PTSD symptoms in the general population. Our results advocate the significance of pre-traumatic factors for the prediction of posttraumatic stress and the consideration of attachment orientations in clinical work with trauma survivors.

Which dimensions of emotion dysregulation predict the onset and persistence of eating disorder behaviours? A prospective study

BACKGROUND

Theoretical models highlight the importance of emotion dysregulation as a key risk and maintaining factor for eating disorders. However, most studies testing these theories are cross-sectional. It remains unclear which dimensions of emotion dysregulation account for the onset and persistence of eating disorder behaviours over time.

METHODS

To address these gaps, data were analyzed from 1321 adult women who completed study measures at baseline and eight-month follow-up. The dimensions of emotion dysregulation assessed were five subscales from the abbreviated 16-item Difficulties in Emotion Regulation Scale. Outcomes included the onset (versus asymptomatic) and persistence (versus remission) of binge eating and compensatory behaviours.

RESULTS

Univariate logistic regressions showed that, among initially asymptomatic women, higher baseline levels of each emotion dysregulation dimension (except the "goals" subscale) predicted the onset of binge eating and compensatory behaviours at follow-up. Each dimension also predicted the persistence of compensatory behaviours at follow-up among women endorsing these behaviours at baseline, while the "impulse", "strategies", and "non-acceptance" dimensions predicted the persistence of binge eating. In multivariate analyses, only the "strategies" dimension predicted the onset and persistence of binge eating, while the "non-acceptance" dimension predicted the onset and persistence of compensatory behaviours.

LIMITATIONS

Only a limited number of emotion dysregulation dimensions were tested.

CONCLUSION

Findings demonstrate the importance of emotion dysregulation dimensions in accounting for the onset and maintenance of eating disorder behaviours. The delivery of specific intervention strategies designed to address emotion dysregulation may depend on the risk and symptom profile of an individual.

Perfluorooctanoate and perfluorooctane sulfonate in umbilical cord blood and child cognitive development: Hamamatsu Birth Cohort for Mothers and Children (HBC Study)

BACKGROUND

Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) has been shown to affect offspring behaviors in laboratory animals. Several epidemiological studies investigated associations between prenatal PFAS exposure and child neurodevelopment, but results were inconclusive. We examined associations between cord blood concentrations of perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) and cognitive development in children from 4 to 40 months of age.

METHODS

This study included 598 mother-child pairs who participated in the Hamamatsu Birth Cohort Study for Mothers and Children (HBC Study), a prospective birth cohort study in Japan. PFOA and PFOS were quantified in cord blood. The Mullen Scales of Early Learning (MSEL) was used to assess child cognitive function at 4, 6, 10, 14, 18, 24, 32, and 40 months of age. For each of log 2-transformed PFOA and PFOS concentrations, we examined: 1) associations with the scores of MSEL Early Learning Composite (Composite) and four subscales (Fine Motor, Visual Reception, Receptive Language, Expressive Language) at each assessment time point; and 2) associations with longitudinal changes in the Composite and subscale scores.

RESULTS

MSEL Composite scores were inversely associated with PFOA at 18 months of age (per 2-fold increase in concentration: β = -2.23, 95% CI: -3.91, -0.56), but not at other ages. When accounting for changes in scores from 4 to 40 months of age, PFOA and PFOS were positively associated with Composite as well as Receptive and Expressive Language scores. Child's sex modified associations between PFOA and Composite scores at 14, 18, and 40 months and those between PFOS and Composite scores at 14 months, showing negative associations among females.

CONCLUSIONS

In this study, cord blood PFOA and PFOS concentrations showed mixed associations with child cognitive functions at specific age but had positive associations with longitudinal changes in cognitive development from 4 to 40 months of age.

Does social defeat cause negative symptoms? A prospective study in a multi-national community sample

Psychological models of the consequences of ostracism (i.e. being socially excluded and ignored) and negative symptoms in schizophrenia suggest that repeatedly experiencing ostracism can lead to elevated levels of amotivation, anhedonia, and asociality (i.e. negative symptoms). We tested this assumption in a prospective study, following up a large multi-national community sample from Germany, Indonesia, and the United States (N = 962) every four months over one year. At each of the four assessment points (T0 - T3), participants rated their recent ostracism experiences and negative symptoms. Using cross-lagged panel analyses we found a) that negative symptoms and experiences of ostracism were significantly associated in each of the four assessment points, b) that ostracism predicted negative symptoms over time (T2 to T3), and c) that negative symptoms increased ostracism (T0 to T1). The results are in line with the social defeat model of negative symptoms and suggest a bi-directional longitudinal relationship between ostracism and negative symptoms. Moving forward, it will therefore be important to gain an understanding of potential moderators involved in the mechanism.

Mental distress of parents with chronic diseases during the COVID-19 pandemic in Australia: A prospective cohort study

OBJECTIVE

To-date there has been limited examination of the experience of the COVID-19 pandemic in parents who suffer from chronic physical conditions. We aimed to 1) examine whether presence of a chronic disease predicts differential latent distress profile memberships, and 2) assess factors that could predict different distress profiles in the sub-group of parents with a chronic disease.

METHODS

We used a sample of 1618 parents, from the longitudinal COVID-19 Pandemic Adjustment Study, who completed a measure of mental distress (Depression, Anxiety and Stress Scale) at 13 data collection points. Distress profiles were assessed with the latent profile analysis.

RESULTS

We identified four distinct mental distress profile memberships, with the most common membership characterised by very low (48.1%), followed by low (31.9%), moderate (15.7%), and high (4.3%) distress scores. A higher proportion of parents with chronic diseases belonged to profiles experiencing low (34.7% vs. 30.4%), moderate (18.7% vs. 14.1%), and high (5.5% vs. 3.7%) compared to very low (41.2% vs. 51.8%) distress levels than other parents. Residing in Victoria, younger age, lower levels of social support and appraisal of COVID as risk were associated with membership to higher compared to very low distress profiles.

CONCLUSION

Our findings highlight the importance of considering chronic disease co-morbidity as an additive risk factor in addressing mental health outcomes of parents during pandemic-like events, since parents with chronic conditions are more vulnerable to experiencing worse mental distress. Future interventions should focus on ways to strengthen social support and provide guidance for managing threat appraisal.

Bacteroides vulgatus and Bacteroides dorei predict immune-related adverse events in immune checkpoint blockade treatment of metastatic melanoma

BACKGROUND

Immune checkpoint blockade (ICB) shows lasting benefits in advanced melanoma; however, not all patients respond to this treatment and many develop potentially life-threatening immune-related adverse events (irAEs). Identifying individuals who will develop irAEs is critical in order to improve the quality of care. Here, we prospectively demonstrate that the gut microbiome predicts irAEs in melanoma patients undergoing ICB.

METHODS

Pre-, during, and post-treatment stool samples were collected from 27 patients with advanced stage melanoma treated with IPI (anti-CTLA-4) and NIVO (anti-PD1) ICB inhibitors at NYU Langone Health. We completed 16S rRNA gene amplicon sequencing, DNA deep shotgun metagenomic, and RNA-seq metatranscriptomic sequencing. The divisive amplicon denoising algorithm (DADA2) was used to process 16S data. Taxonomy for shotgun sequencing data was assigned using MetaPhlAn2, and gene pathways were assigned using HUMAnN 2.0. Compositionally aware differential expression analysis was performed using ANCOM. The Cox-proportional hazard model was used to assess the prospective role of the gut microbiome (GMB) in irAES, with adjustment for age, sex, BMI, immune ICB treatment type, and sequencing batch.

RESULTS

Two natural GMB clusters with distinct community compositions were identified from the analysis of 16S rRNA data (R2 = 0.16, p < 0.001). In Cox-proportional hazard modeling, these two clusters showed a near 7-fold differential risk for developing irAEs within 1 year of initiating treatment (HR = 6.89 [95% CI: 1.33-35.58]). Using shotgun metagenomics, we further identified 37 bacterial strains differentially expressed between the risk groups, with specific dominance of Bacteroides dorei within the high-risk GMB cluster and Bacteroides vulgatus in the low-risk cluster. The high-risk cluster also appeared to have elevated expression of several functional pathways, including those associated with adenosine metabolism (all FDR < 0.05). A sub-analysis of samples (n = 10 participants) at baseline and 6 and 12 weeks after the start of treatment revealed that the microbiome remained stable over the course of treatment (R2 = 0.88, p < 0.001).

CONCLUSIONS

We identified two distinct fecal bacterial community clusters which are associated differentially with irAEs in ICB-treated advanced melanoma patients.

Prospective study on resting state functional connectivity in adolescents with major depressive disorder after antidepressant treatment

Recent advances in functional magnetic resonance imaging (fMRI) have resulted in many studies on resting-state functional connectivity (rsFC) in depressed patients. Previous studies have shown alterations between multiple brain areas, such as the prefrontal cortex, anterior cingulate cortex, and basal ganglia, but there are very few prospective studies with a longitudinal design on adolescent depression patients. We therefore investigated the change in positive rsFC in a homogeneous drug-naïve adolescent group after 12 weeks of antidepressant treatment. Functional neuroimaging data were collected and analyzed from 32 patients and 27 healthy controls. Based on previous literature, the amygdala, anterior cingulate cortex (ACC), insula, hippocampus, and dorsolateral prefrontal cortex (DLPFC) were selected as seed regions. Seed-to-voxel analyses were performed between pre- and post-treatment states as well as between the patients and controls at baseline. The positive rsFC between the right DLPFC and the left putamen/right frontal operculum were shown to be higher in patients than in the controls. The positive rsFC between the left DLPFC and left putamen/left lingual gyrus was also higher in the patients than in the controls. The positive rsFC between the right dorsal ACC and the left precentral gyrus had reduced after the 12-week antidepressant treatment. Regions involved in the frontolimbic circuit showed changes in the positive rsFC in the depressed adolescents as compared to in the healthy controls. There were also significant changes in the positive rsFC after 12-weeks of antidepressant treatment. The involved regions were associated with emotional regulation, cognitive functioning, impulse control, and visual processing.

The role of familial confounding in the associations of physical activity, smoking and alcohol consumption with early exit from the labour market

We investigated the associations between health behaviors and sustainable working life outcomes including all-cause disability pension, disability pensions due to musculoskeletal and mental diagnoses and unemployment. The role of familial factors behind these associations was studied by analysing discordant twin pairs. Our data included Swedish twins born in 1925-1986 (51891 twin individuals). Baseline data based on two independent surveys in 1998-2003 and 2005-2006 for health behaviors were linked to national registers on disability pension and unemployment until 2016. Cox proportional hazards models for hazard ratios (HR) with 95% confidence intervals (CI) were estimated for the whole sample adjusting for covariates. Analyses of health behavior discordant twin pairs (n = 5903 pairs) were conducted using conditional Cox models. In the whole cohort, the combination of healthy behaviors was associated with lower risk for all-cause disability pension, disability pension due to musculoskeletal diagnoses or mental diagnoses, and for unemployment (HRs 0.56-0.86, 95% CIs 0.51-0.92) as did being physically active (HRs 0.69-0.87, 95% CI 0.65-0.92). The discordant pair analyses confirmed the lower risk among those having healthy behaviors (HR 0.70-0.86) or being physically active (HR 0.86-0.87) for all-cause disability pension, disability pension due to musculoskeletal diagnoses, and for unemployment. To conclude, controlling the effects of covariates or familial confounding (i.e. discordant twin pair analyses) shows that being physically active or having several healthy behaviors predict better working life outcomes. This points towards independent association between healthy behavior and longer working life.

Changes in Health Literacy during the first year following a kidney transplantation: Using the Health Literacy Questionnaire

OBJECTIVES

The study aimed to identify changes in health literacy (HL) and associated variables during the first year following a kidney transplantation.

METHODS

A total of 196 transplant recipients were included in a prospective follow-up study. The patients answered the Health Literacy Questionnaire (HLQ) at 5 days, 8 weeks, 6 and 12 months following the kidney transplantation. Mixed linear models were used to analyze changes in HL and backward elimination was used to identify variables associated with HL.

RESULTS

Two main patterns of change were identified: a) HL increased during the first 8 weeks of close follow-up and b) in several domains, the positive increase from 5 days to 8 weeks flattened out from 5 days to 6 and 12 months. Self-efficacy, transplant-related knowledge, and general health were core variables associated with HL.

CONCLUSIONS

Overall, HL increased during the 8 weeks of close follow-up following the kidney transplantation, while 6 months seem to be a more vulnerable phase. Furthermore, low self-efficacy, less knowledge, and low self-perceived health may represent vulnerable characteristics in patients.

PRACTICAL IMPLICATIONS

Future kidney transplant care should take into account patients' access to and appraisal of health information and social support, and draw attention to potentially vulnerable groups.

Prospective Association between Childhood Behavioral Inhibition and Anxiety: a Meta-Analysis

Behavioral inhibition (BI) is a risk factor for anxiety. However, the estimates of the strength of this association vary widely. In addition, while BI is a strong predictor of social anxiety disorder (SAD), its association with other anxiety disorders is unclear. The current study sought to establish the relationship between BI and anxiety and to quantify this association for a range of anxiety disorders. We searched PsycInfo, PubMed and Embase for articles published before May 18th, 2019 using search terms for BI, anxiety and prospective study design. We selected articles which assessed the prospective relationship between BI in childhood and anxiety. Using random-effects meta-analysis with robust variance estimation, which allowed for the inclusion of multiple follow-ups of the same sample, we established the association between BI and any anxiety. We also explored the association between BI and individual anxiety disorders. Data from 27 studies consisting of 35 follow-ups of 20 unique samples indicated that BI prospectively increases the odds of anxiety (OR = 2.80, 95% CI 2.03 to 3.86, p < 0.001). There was also a positive association between BI and all individual anxiety disorders, with effect sizes ranging from small in the case of specific phobia (OR = 1.49, 95% CI 1.03 to 2.14, p = 0.03) to large in the case of SAD (OR = 5.84, 95% CI 3.38 to 10.09, p < 0.001). BI in early childhood is a strong risk factor for anxiety. Targeting BI may help reduce the number of children who will develop anxiety disorders.

Genetic pre-screening for glaucoma in population-based epidemiology: protocol for a double-blind prospective screening study within Lifelines (EyeLife)

Background

Early detection of glaucoma is paramount to maintain patients’ eyesight, however glaucomatous vision loss tends to begin in the periphery with up to 50% of patients unaware they are affected. Because glaucomatous vision loss is permanent, screening appears attractive, but currently is not cost-effective. Therefore we aim to investigate the utility of genetic pre-screening for glaucoma in a population-based setting, called EyeLife.

Methods

EyeLife adopts a double blind prospective design with contrasting groups. Selected participants (n = 1600) from the Lifelines cohort are 55 years of age or older, and of either the highest or lowest 20% of the genetic risk distribution for glaucoma. We obtained a highly curated list of genetic variants from the literature to obtain each participants’ genetic risk for glaucoma. Participants will undergo comprehensive ophthalmic screening. The primary outcome is the relative risk of glaucoma given a high genetic risk compared to a low genetic risk.

Discussion

If genetic pre-screening is successful, it will increase the yield of a glaucoma screening program by focusing on high-risk individuals. This, in turn, may improve long-term visual health of middle-aged and elderly people.

Trial registration

Ethics approval was obtained on January 31, 2019, and the study was retrospectively registered with the Netherlands Trial Register (NL8718) on the 17th of June, 2020.

Associations of objectively measured total duration and maximum bout length of standing at work with lower-extremity pain intensity: a 2-year follow-up of construction and healthcare workers

Background

Musculoskeletal disorders are among the major reasons for years lived with disability. Approximately one third of the European working population report lower-extremity discomfort and many attribute these discomforts to work-related factors. Employees in the healthcare and construction sectors reports high levels of lower-extremity pain and commonly relate the pain to their profession. These workers spend a large part of their workday standing. Periods of prolonged standing is suggested to increase lower-extremity symptoms, but this cannot be concluded on, since limited evidence is available from longitudinal studies using objective measures. This study aimed to determine possible associations between objectively measured total duration and maximum bout length of static- and dynamic standing at work and lower-extremity pain intensity (LEPi) among Norwegian construction- and healthcare workers.

Methods

One-hundred and twenty-three construction and healthcare workers wore two accelerometers for up to four consecutive days, to establish standing behavior at baseline. The participants reported LEPi (Likert scale 0–9) for the preceding 4 weeks at baseline and after 6, 12, 18, and 24 months. We investigated associations between standing at work and average and change in LEPi using linear mixed models with significance level p ≤ 0.05.

Results

Total duration of static- and dynamic standing showed weak associations with average LEPi, for the total sample and for construction workers. Maximum bout of static- and dynamic standing was associated with average LEPi in construction workers, but not in healthcare workers. Furthermore, we found no associations between standing and change in LEPi over the 2-year follow-up in any of our analyses.

Conclusions

This study indicate that objectively measured standing is associated with average LEPi over 2-years follow-up in construction workers, and that maximal bout of standing have a stronger association to LEPi than total duration. For every 10 min added to the maximal length of continuous standing during an average workday, we found approximately one unit increase in pain on a 0–9 scale. The lack of significant findings in analyses on healthcare workers suggest that the association between standing and LEPi depend on work-tasks, gender and/or other sector-specific factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-020-03868-0.

Post-stroke depression and functional impairments - A 3-year prospective study

BACKGROUND

Post-Stroke Depression (PSD) is a severe condition, affecting about 30% of stroke survivors within a five-year period after stroke. Post-stroke functional impairments (FI) and social support are associated with PSD. It is inconclusive, whether one of the factors, post-stroke FI and PSD, shows a stronger predictive value on the respective other over time. The aims of the present study were to 1) investigate the relationship between PSD, FI, and social support of stroke patients in a 3-year prospective design, and 2) address methodological shortcomings of previous studies.

METHODS

We investigated 174 stroke survivors and assessed PSD with a structured clinical interview and a dimensional symptom rating scale. We conducted regression analyses and applied the approach of multiple imputations (MI) for missing data due to dropout during follow-up.

RESULTS

PSD prevalence was 32.2% in the acute phase after stroke. Individuals with a PSD in this phase revealed a fivefold higher risk for PSD 3 years later. FI in the acute phase did not additionally contribute to the prediction of PSD at follow-up. Compared to individuals without PSD in the acute phase, individuals with PSD had an increased risk for FI at follow-up. Limitations regarding sample characteristics, design, and dropout are discussed.

CONCLUSIONS

Results indicate that PSD rather than FI represents a crucial risk factor for negative long-term consequences regarding physical and psychological health after stroke. Post-stroke treatment might be optimized by a routine assessment of PSD and FI after stroke and considering the results for personalized treatment options.

Prospective prediction of suicide attempts in community adolescents and young adults, using regression methods and machine learning

BACKGROUND

The use of machine learning (ML) algorithms to study suicidality has recently been recommended. Our aim was to explore whether ML approaches have the potential to improve the prediction of suicide attempt (SA) risk. Using the epidemiological multiwave prospective-longitudinal Early Developmental Stages of Psychopathology (EDSP) data set, we compared four algorithms-logistic regression, lasso, ridge, and random forest-in predicting a future SA in a community sample of adolescents and young adults.

METHODS

The EDSP Study prospectively assessed, over the course of 10 years, adolescents and young adults aged 14-24 years at baseline. Of 3021 subjects, 2797 were eligible for prospective analyses because they participated in at least one of the three follow-up assessments. Sixteen baseline predictors, all selected a priori from the literature, were used to predict follow-up SAs. Model performance was assessed using repeated nested 10-fold cross-validation. As the main measure of predictive performance we used the area under the curve (AUC).

RESULTS

The mean AUCs of the four predictive models, logistic regression, lasso, ridge, and random forest, were 0.828, 0.826, 0.829, and 0.824, respectively.

CONCLUSIONS

Based on our comparison, each algorithm performed equally well in distinguishing between a future SA case and a non-SA case in community adolescents and young adults. When choosing an algorithm, different considerations, however, such as ease of implementation, might in some instances lead to one algorithm being prioritized over another. Further research and replication studies are required in this regard.

Specific traumatic events elevate the risk of a suicide attempt in a 10-year longitudinal community study on adolescents and young adults

Traumatic events (TEs) have been associated with suicide attempts (SAs). However, the empirical status of some TEs is inconclusive. This also concerns community adolescents and young adults, known to be a high-risk group for SAs. We examined associations between (a) a range of prior TEs (physical attack, rape/sexual abuse, serious accident, and witnessing somebody else experiencing a TE) and a subsequent SA, and (b) the number of prior TEs and an SA, and (c) we estimated attributable proportions of SAs, in relation to each TE. Over a 10-year period, the Early Developmental Stages of Psychopathology (EDSP) study prospectively assessed community members, aged 14-24 years at baseline. Starting with 3021 subjects, each individual was assessed up to four times. Assessment was based on the Munich-Composite International Diagnostic Interview. Temporal associations were estimated using the Cox model with time-dependent covariates. Attributable proportions were based on the results of the Cox models. All four TEs elevated the risk for a subsequent SA, adjusting for confounders. Highest risk was found for the combined TE rape/sexual abuse. Results showed that 56-90% of SAs could be attributed to TEs in the exposed group; on the population level, attributable proportions ranged between 6.9% and 23.5%. Different TEs have been shown to elevate the risk of an SA in a young community sample. Our results suggest that both health professionals and health policy decision-makers consider specific TEs and the number of prior TEs as risk factors for SAs.

Risk factors for hospital readmission among Swedish older adults

Introduction

Hospital readmissions of older persons are common and often associated with complex health problems. The objectives were to analyze risk factors for readmission within 30 days from hospital discharge.

Methods

A prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA) was conducted. During 9 years of follow-up, information on hospitalizations, readmissions and associated diagnoses were obtained from national registers. Logistic regression models controlling for age and sex were conducted to analyze risk factors for readmissions.

Results

Of the 772 participants, [mean age 69.7 (± 11.1), 84 (63%)] were hospitalized and among these 208 (43%) had one or several readmissions within 30 days during the follow-up period. Most of the readmissions (57%) occurred within the first week; mean days from hospital discharge to readmission was 7.9 (± 6.2). The most common causes of admission and readmission were cardiovascular diseases and tumors. Only 8% of the readmissions were regarded as avoidable admissions. In a multivariate logistic regression, falling within the last 12 months (OR 0.57, p = 0.039) and being a male (OR 1.84, p = 0.006) increased the risk of readmission.

Conclusions

Most older persons that are readmitted return to hospital within the first week after discharge. Experiencing a fall was a particular risk factor of readmission. Preventive actions should preferably take place already at the hospital to reduce the numbers of readmission. Still, it should be remembered that most readmissions were considered to be necessary.

Mental disorders and the risk for the subsequent first suicide attempt: results of a community study on adolescents and young adults

Adolescents and young adults represent the high-risk group for first onset of both DSM-IV mental disorders and lifetime suicide attempt (SA). Yet few studies have evaluated the temporal association of prior mental disorders and subsequent first SA in a young community sample. We examined (a) such associations using a broad range of specific DSM-IV mental disorders, (b) the risk of experiencing the outcome due to prior comorbidity, and (c) the proportion of SAs that could be attributed to prior disorders. During a 10-year prospective study, data were gathered from 3021 community subjects, 14-24 years of age at baseline. DSM-IV disorders and SA were assessed with the Munich-Composite International Diagnostic Interview. Cox models with time-dependent covariates were used to estimate the temporal associations of prior mental disorders with subsequent first SA. Most prior mental disorders showed elevated risk for subsequent first SA. Highest risks were associated with posttraumatic stress disorder (PTSD), dysthymia, and nicotine dependence. Comorbidity elevated the risk for subsequent first SA, and the more disorders a subject had, the higher the risk for first SA. More than 90% of SAs in the exposed group could be attributed to PTSD, and over 30% of SAs in the total sample could be attributed to specific phobia. Several DSM-IV disorders increase the risk for first SA in adolescents and young adults. Several promising early intervention targets were observed, e.g., specific phobia, nicotine dependence, dysthymia, and whether a young person is burdened with comorbid mental disorders.

Rates of meaningful change in the mental health of children in long-term out-of-home care: A seven- to nine-year prospective study

Children residing in long-term out-of-home care have high rates of clinical-level mental health difficulties. However, the stability of these children's difficulties throughout their time in care is uncertain. This paper reports estimates of the seven- to nine-year stability of carer-reported scores on the Child Behavior Checklist (CBCL) and Assessment Checklists for Children (ACC) and Adolescents (ACA) for 85 children in long-term foster or kinship care. Prospective score changes on the CBCL total problems and ACC-ACA shared-item scales were assigned to one of four change groups: 'sustained mental health'; 'meaningful improvement'; 'no meaningful change'; and 'meaningful deterioration'. On each of the two measures, more than 60% of children manifested either sustained mental health or meaningful improvement in their mental health, while less than a quarter showed meaningful deterioration. Mean mental health scores for the aggregate sample did not change over the 7-9year period. Findings discount the presence of a uniform, population-wide effect-suggesting instead, that children's mental health follows several distinct trajectories. Rather than asking whether long-term care is generally therapeutic or harmful for the development of previously maltreated children, future investigations should focus on the questions "…what are the systemic and interpersonal characteristics of care that promote and sustain children's psychological development throughout childhood, and what characteristics are developmentally harmful?" and "…for which children is care therapeutic, and for which children is it not?"

Severe fatigue in type 1 diabetes: Exploring its course, predictors and relationship with HbA1c in a prospective study

AIMS

To prospectively identify the course of severe fatigue, its predictors and the relationship with HbA_1c in patients with type 1 diabetes.

METHODS

214 adult patients completed questionnaires on fatigue severity and fatigue-related factors at baseline. HbA_1c was retrieved from medical records. After 43months, fatigue severity and HbA_1c were reassessed in 194 patients. A logistic regression analysis was used to determine predictors of severe fatigue at follow-up with various cognitive-behavioral and clinical factors as potential predictors. The relationship between fatigue and HbA_1c was investigated in a sub-analysis by differentiating between patients with suboptimal glucose control [HbA_1c>7% (53mmol/mol)] and optimal glucose control [HbA_1c⩽7% (53mmol/mol)].

RESULTS

The prevalence of severe fatigue was 40% at baseline and 42% at follow-up. In three out of four severely fatigued patients at baseline (76%), severe fatigue persisted over time. More depressive symptoms, more pain, sleep disturbances, lower self-efficacy concerning fatigue, less confidence in diabetes self-care, more fatigue severity at baseline and more diabetes complications predicted severe fatigue at follow-up. Over time, HbA_1c at baseline was positively associated with fatigue severity at follow-up in both groups (suboptimal glucose control: r=.18, p<.05; optimal glucose control: r=.09, p<.05).

CONCLUSIONS

About three quarters of fatigued[corrected] patients with type 1 diabetes suffer from persistent fatigue. Aside from the number of diabetes complications, no clinical factors explained the persistence of fatigue. HbA_1c and fatigue were weakly associated in a sub-analysis. Since the strongest predictors of severe fatigue were cognitive-behavioral factors, behavioral interventions might be effective in decreasing fatigue.

Factors associated with hospitalization risk among community living middle aged and older persons: Results from the Swedish Adoption/Twin Study of Aging (SATSA)

The aims of the present study were to: (1) describe and compare individual characteristics of hospitalized and not hospitalized community living persons, and (2) to determine factors that are associated with hospitalization risk over time. We conducted a prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA). A total of 772 Swedes (mean age at baseline 69.7 years, range 46-103, 59.8% females) answered a postal questionnaire about physical and psychological health, personality and socioeconomic factors. During nine years of follow-up, information on hospitalizations and associated diagnoses were obtained from national registers. Results show that 484 persons (63%) had at least one hospital admission during the follow-up period. The most common causes of admission were cardiovascular diseases (25%) and tumors (22%). Cox proportional hazard regression models controlling for age, sex and dependency within twin pairs, showed that higher age (HR=1.02, p<0.001) and more support from relatives (HR=1.09, p=0.028) were associated with increased risk of hospitalization, while marital status (unmarried (HR=0.75, p=0.033) and widow/widower (HR=0.69, p<0.001)) and support from friends (HR=0.93, p=0.029) were associated with lower risk of hospitalization. Social factors were important for hospitalization risk even when medical factors were controlled for in the analyses. Number of diseases was not a risk in the final regression model. Hospitalization risk was also different for women and men and within different age groups. We believe that these results might be used in future interventions targeting health care utilization.

Memory control ability modulates intrusive memories after analogue trauma

BACKGROUND

Most people suffer from intrusive memories in the aftermath of trauma. For survivors' well-being, it is key that these intrusions are controlled. Memory control can be exerted through retrieval suppression. Poor retrieval suppression, however, should be associated with persistent distressing intrusions and posttraumatic stress disorder (PTSD). This study tested the hypothesis that individual differences in retrieval suppression predict intrusive memories after trauma. Retrieval suppression was examined with the think/no-think task (TNT) using behavioral and event related potential (ERP) measures.

METHODS

Twenty-four healthy participants watched a "traumatic" film after performing the TNT task. The frequency and distress of intrusions from the "traumatic" film was measured with an electronic diary. Additionally the Impact of Event Scale (IES) was assessed.

RESULTS

In line with our hypothesis, behavioral measures of retrieval suppression ability predicted reduced distress ratings for intrusions (r=-.53, p<.01). Further ERP markers of retrieval suppression (a fronto-centrally distributed N2) predicted reduced distress ratings for intrusions (r=-.45, p<.05) and reduced IES Intrusion scores (r=-.56, p<.01).

LIMITATIONS

The presented film is a relatively mild stressor as compared to a real-life trauma. Further studies are needed to explore the role of memory control processes for real-life trauma.

CONCLUSIONS

Participants with lower retrieval suppression ability exhibited less distressing intrusive memories after analogue trauma. The ERP correlate of retrieval suppression was associated with less distressing intrusive memories and reduced IES Intrusion scores, suggesting that deficient memory control is a potential risk factor for developing PTSD.

Changes in urinary metabolic profiles of colorectal cancer patients enrolled in a prospective cohort study (ColoCare)

INTRODUCTION

Metabolomics is a valuable tool for biomarker screening of colorectal cancer (CRC). In this study, we profiled the urinary metabolomes of patients enrolled in a prospective patient cohort (ColoCare). We aimed to describe changes in the metabolome in the longer clinical follow-up and describe initial predictors as candidate markers with possibly prognostic significance.

METHODS

In total, 199 urine samples from CRC patients pre-surgery (n=97), 1-8 days post-surgery (n=12) and then after 6 and 12 months (n=52 and 38, respectively) were analyzed using both GC-MS and ¹H-NMR. Both datasets were analyzed separately with built in uni- and multivariate analyses of Metaboanalyst 2.0. Furthermore, adjusted linear mixed effects regression models were constructed.

RESULTS

Many concentrations of the metabolites derived from the gut microbiome were affected by CRC surgery, presumably indicating a tumor-induced shift in bacterial species. Associations of the microbial metabolites with disease stage indicate an important role of the gut microbiome in CRC.We were able to differentiate the metabolite profiles of CRC patients prior to surgery from those at any post-surgery timepoint using a multivariate model containing 20 marker metabolites (AUCROC=0.89; 95% CI:0.84-0.95).

CONCLUSION

To the best of our knowledge, this is one of the first metabolomic studies to follow CRC patients in a prospective setting with repeated urine sampling over time. We were able to confirm markers initially identified in case-control studies and pin point metabolites which may serve as candidates for prognostic biomarkers of CRC.

Associations with legal representation in a compensation setting 12 months after injury

CONTEXT

Many people with Whiplash Associated Disorder (WAD) seek treatment though a compensation system where factors such as legal involvement have been reported as having a negative impact on recovery outcomes.

OBJECTIVE

To compare those with and without legal involvement in their compensation claim, and identify associations with legal involvement at 12 months post injury; and longer term disability.

STUDY DESIGN

Inception cohort study.

PARTICIPANTS

246 people with WAD compensation claim.

OUTCOME MEASURES

Legal involvement and Functional Rating Index at 12 months post injury.

METHODS

Participants were recruited from an insurance database. Baseline health (Functional Rating Index, Pain Catastrophising Scale and SF-36), socio-economic, work capacity, and claims data were collected within three months of injury and 12 months. Logistic regression models were used to identify associations with legal involvement at 12 months; and disability (FRI) at 12 months.

RESULTS

At baseline 246 participants were enrolled into the study in a median 72 days post injury. At 12 months post injury 52 (25%) had engaged a lawyer. The significant independent associations with legal involvement at 12 months were higher levels of initial disability, work disability, speaking a language other than English at home and lower levels of mental health. Specifically, the odds of lawyer involvement at 12 months post injury was 4.9 times greater for those with work disability; 2.3 times greater for those who spoke a language other than English at home. In terms of health, they had poorer mental health and for every 10 unit increase in the baseline FRI score the odds of having lawyer involvement increased by 38%. DISABILITY: at 12 months (FRI) was significantly independently associated with, PCS-helplessness (p<0.001), age (p<0.001) and prior claim (p=0.001).

CONCLUSION

This study suggests the people with lawyer involvement in their claim 12 months after injury have socio-economic disadvantage, have had a prior claim and a worse baseline health profile compared to those without a lawyer. Understanding this profile could allow for improved claims processes and targeted interventions to assist this group through any perceived complexities in the system and address the underlying reasons for lawyer participation within compensation schemes.

Do race, neglect, and childhood poverty predict physical health in adulthood? A multilevel prospective analysis

Childhood neglect and poverty often co-occur and both have been linked to poor physical health outcomes. In addition, Blacks have higher rates of childhood poverty and tend to have worse health than Whites. This paper examines the unique and interacting effects of childhood neglect, race, and family and neighborhood poverty on adult physical health outcomes. This prospective cohort design study uses a sample (N=675) of court-substantiated cases of childhood neglect and matched controls followed into adulthood (M(age)=41). Health indicators (C-Reactive Protein [CRP], hypertension, and pulmonary functioning) were assessed through blood collection and measurements by a registered nurse. Data were analyzed using hierarchical linear models to control for clustering of participants in childhood neighborhoods. Main effects showed that growing up Black predicted CRP and hypertension elevations, despite controlling for neglect and childhood family and neighborhood poverty and their interactions. Multivariate results showed that race and childhood adversities interacted to predict adult health outcomes. Childhood family poverty predicted increased risk for hypertension for Blacks, not Whites. In contrast, among Whites, childhood neglect predicted elevated CRP. Childhood neighborhood poverty interacted with childhood family poverty to predict pulmonary functioning in adulthood. Gender differences in health indicators were also observed. The effects of childhood neglect, childhood poverty, and growing up Black in the United States are manifest in physical health outcomes assessed 30 years later. Implications are discussed.

Persistent smoking as a predictor of disability pension due to musculoskeletal diagnoses: a 23 year prospective study of Finnish twins

OBJECTIVE

To investigate whether stability or changes in smoking predict disability pension (DP) due to low back diagnoses (LBD) and musculoskeletal diagnoses (MSD) after taking familial confounding into account using a co-twin design.

METHOD

Longitudinal smoking patterns and multiple covariates in a population-based cohort of 17,451 Finnish twins (6959 complete pairs) born before 1958 were surveyed through questionnaires in 1975 and 1981. The outcome data were collected from the national pension registers until the end of 2004. Cox proportional hazards regression models were used for statistical analyses.

RESULTS

Disability pension due to low back diagnoses was granted to 408 individuals and disability pension due to musculoskeletal diagnoses to 1177 individuals during the follow-up of 23 years. Being a persistent smoker (current smoker both 1975 and 1981) predicted a significantly increased risk for disability pension (hazard ratio 1.69, 95% confidence interval 1.46, 1.97) compared to those individuals who had never smoked. The association remained when several confounding factors, including familial factors, were taken into account.

CONCLUSION

Persistent smoking predicts early disability pension due to musculoskeletal diagnoses and low back diagnoses independently from numerous confounding factors, including familial effects shared by the co-twins.