Atypical Interpersonal Problem-Solving and Resting-state Functional Connectivity in Adolescents with Maltreatment Experience

BACKGROUND

Childhood maltreatment is associated with altered neurocognitive functioning, which is thought to reflect, in part, adaptation to early adverse environmental experiences. However, we continue to lack a precise mechanistic understanding linking atypical neurocognitive processing with social functioning and psychiatric outcomes following early adversity.

OBJECTIVE

The present work investigated interpersonal problem-solving, resting-state functional connectivity (rsFC), and mental health symptoms in adolescents with documented maltreatment experience and explored whether altered neural function contributes in part to poorer social functioning.

METHODS

Forty adolescents (aged 12-17) with documented experiences of abuse or neglect and a carefully matched group of 42 non-maltreated peers participated in this study that measured task-based interpersonal problem-solving skills and rsFC.

RESULTS

Adolescents with maltreatment experience showed poorer interpersonal problem-solving performance, which partly accounted for their elevated mental health symptoms. Resting-state seed-based analyses revealed that adolescents with maltreatment experience showed a significant increase in rsFC between medial Default Mode Network (DMN) hubs, the medial prefrontal cortex (mPFC), with a posterior cluster, including the posterior cingulate cortex (PCC), precuneus (PCu), retrosplenial cortex (RSC), and lingual gyrus (LG). Moderation analyses revealed that maltreatment-related increased DMN rsFC partly accounted for poorer performance in interpersonal problem-solving.

CONCLUSION

Poorer interpersonal problem-solving, partly accounted for by atypical coupling between DMN medial hubs, was associated with maltreatment exposure. Interventions tailored to enhance interpersonal problem-solving represents a promising avenue to promote resilience and reduce the likelihood of mental health disorder following maltreatment experience.

Functional brain plasticity following childhood maltreatment: A longitudinal fMRI investigation of autobiographical memory processing

Altered autobiographical memory (ABM) processing characterizes some individuals with experiences of childhood maltreatment. This fMRI study of ABM processing evaluated potential developmental plasticity in neural functioning following maltreatment. Adolescents with (N = 19; MT group) and without (N = 18; Non-MT group) documented childhood maltreatment recalled specific ABMs in response to emotionally valenced cue words during fMRI at baseline (age 12.71 ± 1.48) and follow-up (14.88 ± 1.53 years). Psychological assessments were collected at both timepoints. Longitudinal analyses were carried out with BOLD signal changes during ABM recall and psychopathology to investigate change over time. In both groups there was relative stability of the ABM brain network, with some developmental maturational changes observed in cortical midline structures (ventromedial PFC (vmPFC), posterior cingulate cortex (pCC), and retrosplenial cortex (rSC). Significantly increased activation of the right rSC was observed only in the MT group, which was associated with improved psychological functioning. Baseline group differences in relation to hippocampal functioning, were not detected at follow-up. This study provides preliminary empirical evidence of functional developmental plasticity in children with documented maltreatment experience using fMRI. This suggests that altered patterns of brain function, associated with maltreatment experience, are not fixed and may reflect the potential to track a neural basis of resilience.

Trust and childhood maltreatment: evidence of bias in appraisal of unfamiliar faces

BACKGROUND

Child maltreatment is associated with poorer social functioning and increased risk of mental health problems in adolescence and adulthood, but the processes underlying these associations remain unclear. Although crucial for establishing and maintaining relationships, trust judgements have not been experimentally investigated in children who have experienced abuse and neglect.

METHODS

A community-based sample of 75 children aged 8-16 years with maltreatment documented on the basis of social services records, and a group of 70 peers matched on age, gender, cognitive ability, socioeconomic status, and ethnicity took part in the study. Children completed a trustworthiness face-judgement task in which they appraised the trustworthiness of unfamiliar facial stimuli varying along a computationally modelled trustworthiness dimension.

RESULTS

In line with clinical observations that childhood maltreatment is associated with an atypical pattern of trust processing, children with maltreatment experience were significantly less likely than their peers to rate unfamiliar faces as trustworthy. Moreover, they were more variable in their trust attributions than their peers.

CONCLUSIONS

The study provides compelling experimental evidence that children with documented maltreatment perceive others as less trustworthy than their peers and are less consistent in their estimates of trustworthiness in others. Over time, alterations in trust processing may disrupt the development of social bonds and contribute to 'social thinning' (a reduction in the extent and quality of social relationships), leaving children more vulnerable to environmental stressors, increasing risk of mental health difficulties.

Harms from a partner's drinking: an international study on adverse effects and reduced quality of life for women

BACKGROUND

Partners of heavy drinking individuals can be detrimentally affected as a result of their partner's drinking.

OBJECTIVES

The aim of this study was to identify the proportion of heterosexual intimate partner relationships with a heavy drinking male that resulted in reported alcohol-related harm and to investigate the impact of this on well-being in 9 countries.

METHODS

This study used survey data from the Gender and Alcohol's Harm to Others (GENAHTO) Project on Alcohol's Harm to Others in 9 countries (10,613 female respondents, 7,091 with intimate live-in partners). Respondents were asked if their partners drinking had negatively affected them as well as questions on depression, anxiety, and satisfaction with life.

RESULTS

The proportion of partnered respondents that reported having a harmful heavy drinking partner varied across countries, from 4% in Nigeria and the US to 33% in Vietnam. The most consistent correlate of experiencing harm was being oneself a heavy episodic drinker, most likely as a proxy measure for the acceptability of alcohol consumption in social circles. Women with a harmful heavy drinking partner reported significantly lower mean satisfaction with life than those with a partner that did not drink heavily.

CONCLUSIONS

Harms to women from heavy drinking intimate partners appear across a range of subgroups and impact on a wide range of women, at least demographically speaking. Women living with a heavy drinking spouse experience higher levels of anxiety and depression symptoms and lower satisfaction with life.

Evidence for Depressogenic Spontaneous Thoughts and Altered Resting-State Connectivity in Adolescents With a Maltreatment History

OBJECTIVE

Childhood maltreatment has been associated with major depressive disorder (MDD). Atypical self-generated thoughts (SGT), lacking in positive and privileging negative content-a feature of ruminative thinking-might represent one vulnerability factor for developing depression. Rumination in MDD has been linked to alterations in resting-state functional connectivity (RSFC) of the subgenual anterior cingulate cortex (sgACC) to the default mode network and the fronto-parietal network (FPN). This study aimed to investigate online SGT content and its variability, as well as sgACC RSFC, as potential risk markers for depression in adolescents who experienced maltreatment.

METHOD

Adolescents 12 to 16 years old (29 with maltreatment history [MT] and 39 with no maltreatment history [NMT]) performed an established mind-wandering task. Participants made nondemanding number discriminations during which intermittent questions probed their SGTs that were classified as off-task, positive, negative, self-related, other-related, past-oriented, or future-oriented. Resting-state data were acquired separately for 22 of 29 MT and 27 39 NMT adolescents, and seed-based functional connectivity analyses of the sgACC were performed.

RESULTS

MT, relative to the NMT adolescents, generated significantly fewer positively valenced thoughts, and exhibited more extreme ratings for positively valenced thoughts. MT adolescents also showed significantly reduced RSFC between the sgACC and the FPN. Group differences in depressive symptoms between the MT and NMT adolescents were partly accounted by differences in sgACC-FPN RSFC.

CONCLUSION

Adolescents who experienced maltreatment show a reduction in positively valenced spontaneous thoughts and reduced sgACC-FPN RSFC at the neural level. These may contribute to a ruminative thinking style, representing risk factors for developing depression later in life.

Hello Sunday Morning: Strategies used to support temporary alcohol abstinence through participation in an online health promotion program

ISSUE ADDRESSED

Hello Sunday Morning (HSM) is an online program that encourages people to commit to a period of non-drinking and blog about their experiences. Among a sample of Victorian HSM users, we aimed to explore the barriers faced and the strategies adopted to maximise potential for achieving temporary abstinence.

METHODS

A content analysis of blog data from 154 HSM users (a total of 2844 blog posts) was undertaken by three researchers. Participants were predominantly women aged 30-50 years.

RESULTS

The most common barriers to achieving temporary alcohol abstinence reported by participants were stress and tiredness, pervasiveness of drinking in social life, negative effects from not drinking and negative reactions from others. The strategies most commonly implemented included drawing on HSM and other non-drinking networks, self-talk, engaging in non-alcohol-related activities and substituting alcohol with other drinks.

CONCLUSIONS

Although significant individual and systemic barriers to abstaining from alcohol were identified by HSM users, multiple strategies were identified and effectively utilised to overcome these barriers. SO WHAT?: We suggest that the virtual support from an online community with a shared interest in reducing their alcohol use appears to be a useful health promotion strategy for temporarily reducing consumption, particularly for women.

A Multi-Country Study of Harms to Children Because of Others' Drinking

OBJECTIVE

This study aims to ascertain and compare the prevalence and correlates of alcohol-related harms to children cross-nationally.

METHOD

National and regional sample surveys of randomly selected households included 7,848 carers (4,223 women) from eight countries (Australia, Chile, Ireland, Lao People's Democratic Republic [PDR], Nigeria, Sri Lanka, Thailand, and Vietnam). Country response rates ranged from 35% to 99%. Face-to-face or telephone surveys asking about harm from others' drinking to children ages 0-17 years were conducted, including four specific harms: that because of others' drinking in the past year children had been (a) physically hurt, (b) verbally abused, (c) exposed to domestic violence, or (d) left unsupervised.

RESULTS

The prevalence of alcohol-related harms to children varied from a low of 4% in Lao PDR to 14% in Vietnam. Alcohol-related harms to children were reported by a substantial minority of families in most countries, with only Lao PDR and Nigeria reporting significantly lower levels of harm. Alcohol-related harms to children were dispersed sociodemographically and were concentrated in families with heavy drinkers.

CONCLUSIONS

Family-level drinking patterns were consistently identified as correlates of harm to children because of others' drinking, whereas sociodemographic factors showed few obvious correlations.

Size and shape of the posterior neck muscles measured by ultrasound imaging: normal values in males and females of different ages

Measurements of muscle strength or size are valuable indicators of muscle status in health and disease. When force cannot be measured directly, due to a particular muscle being one of a functional group or because of pain, size measurements may be the only option. For such data to be useful, normal values for age and gender are necessary. Procedures for scanning and measuring semispinalis capitis and the deep posterior neck muscles (semispinalis cervicis, multifidus and rotatores) using ultrasound imaging are described and normal data provided on size, shape and symmetry of these muscles from a sample of 99 healthy subjects (46 males aged 20-72 years and 53 females aged 18-70 years). Significant gender differences were found (P<0.001) but muscle size did not alter significantly with age. Between-side symmetry can be used to assess abnormality of the deep neck muscle group but not semispinalis capitis. A regression equation is provided for predicting the cross-sectional area (CSA) of the deep neck muscles from spinous process length in males. Clinically, linear measurements can be used to predict the neck muscle CSAs (r=0.66-0.84, P<0.001). The method described for assessing the neck muscles is a potentially valuable tool in clinical practice.

Ultrasound imaging of lumbar multifidus muscle: normal reference ranges for measurements and practical guidance on the technique

This cross-sectional, prospective study aimed to produce normal reference data for measurements of the lumbar multifidus muscle. A total of 120 subjects, 68 females (aged 20-64 years) and 52 males (20-69 years) were studied. Bilateral transverse ultrasound images were made of multifidus at the fourth and fifth lumbar vertebrae (L4 & L5). Cross-sectional area (CSA, cm(2)) and linear dimensions (AP, anteroposterior; Lat, lateral) were measured and the latter expressed as a ratio (AP/Lat) to reflect shape. Relationships between CSA and anthropometric measures were examined. Multifidus CSA was larger in males (P<0.001) and age had no effect. The CSA was larger at L5 than L4 (P<0.001) and highly correlated between the two levels (males r=0.82, females 0.80). Differences in muscle shape were observed for gender, age and vertebral level. Between-side symmetry was high for size but not shape (CSA <10% difference). Linear measurements multiplied (APxLat) correlated highly with CSA (all groups r0.94, P<0.0001). The AP dimension was also acceptably predictive of CSA at L4 (r0.79). There were no clinically useful correlations between CSA and anthropometric measures. These findings provide normal references ranges for objective assessment of lumbar multifidus. This paper also addresses specific practical issues when scanning multifidus.

Otoacoustic emission criteria for neonatal hearing screening

Transient evoked otoacoustic emission measures are gaining acceptance as a technique in new-born hearing screening. At present a wide variety of pass-fail screening criteria are used in otoacoustic emission screening programs. In a study of 100 special care neonates and 35 well, full term babies, a number of screening criteria were examined for sensitivity and specificity characteristics when compared to a standard auditory brainstem response protocol. Results indicate that, for normal and special care neonates with a gestational age at test of 38-41 weeks, high sensitivity ( > 80%) could be obtained when a pass-fail criterion involving analysis of emission reproducibility, or emission reproducibility and emission response level, was set. Sensitivity was reduced for special care neonates who fell outside this age range. Specificity was found to be relatively low overall (always < 65%) and may relate to clinical factors in special care neonates not investigated in this study.

Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses

OBJECTIVE

To provide a practical guide to appropriate statistical analysis of a reliability study using real-time ultrasound for measuring muscle size as an example.

DESIGN

Inter-rater and intra-rater (between-scans and between-days) reliability.

SUBJECTS

Ten normal subjects (five male) aged 22-58 years.

METHOD

The cross-sectional area (CSA) of the anterior tibial muscle group was measured using real-time ultrasonography.

MAIN OUTCOME MEASURES

Intraclass correlation coefficients (ICCs) and the 95% confidence interval (CI) for the ICCs, and Bland and Altman method for assessing agreement, which includes calculation of the mean difference between measures (d), the 95% CI for d, the standard deviation of the differences (SDdiff), the 95% limits of agreement and a reliability coefficient.

RESULTS

Inter-rater reliability was high, ICC (3,1) was 0.92 with a 95% CI of 0.72 --> 0.98. There was reasonable agreement between measures on the Bland and Altman test, as d was -0.63 cm2, the 95% CI for d was -1.4 --> 0.14 cm2, the SDdiff was 1.08 cm2, the 95% limits of agreement -2.73 --> 1.53 cm2 and the reliability coefficient was 2.4. Between-scans repeatability was high, ICCs (1,1) were 0.94 and 0.93 with 95% CIs of 0.8 --> 0.99 and 0.75 --> 0.98, for days 1 and 2 respectively. Measures showed good agreement on the Bland and Altman test: d for day 1 was 0.15 cm2 and for day 2 it was -0.32 cm2, the 95% CIs for d were -0.51 --> 0.81 cm2 for day 1 and -0.98 --> 0.34 cm2 for day 2; SDdiff was 0.93 cm2 for both days, the 95% imits of agreement were -1.71 --> 2.01 cm2 for day 1 and -2.18 --> 1.54 cm2 for day 2; the reliability coefficient was 1.80 for day 1 and 1.88 for day 2. The between-days ICC (1,2) was 0.92 and the 95% CI 0.69 --> 0.98. The d was -0.98 cm2, the SDdiff was 1.25 cm2 with 95% limits of agreement of -3.48 --> 1.52 cm2 and the reliability coefficient 2.8. The 95% CI for d (-1.88 --> -0.08 cm2) and the distribution graph showed a bias towards a larger measurement on day 2.

CONCLUSIONS

The ICC and Bland and Altman tests are appropriate for analysis of reliability studies of similar design to that described, but neither test alone provides sufficient information and it is recommended that both are used.

Blue Pr(3+)-doped ZBLAN fiber upconversion laser

We demonstrate blue laser emission from a direct semiconductor laser-diode-pumped Pr(3+)-doped upconversion fiber laser. This laser produced more than 1 mW of power at a wavelength of 492 nm from pump lasers operating at 830 and 1020 nm.

Wechsler adult intelligence scale-revised in the evaluation of anterior temporal lobectomy candidates

We wished to (a) determine the ability of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) to discriminate between patients with epilepsy of left or right temporal lobe (LTLE, RTLE) origin and (b) examine the ability of Kaufman's (1990) WAIS-R short forms to estimate actual Full-Scale IQ (FSIQ). We administered the WAIS-R to 215 nonretarded, left hemisphere dominant patients with invasively verified epilepsy of unilateral TL origin without lesions demonstrated by magnetic resonance imaging (MRI) (excluding mesial temporal sclerosis, MTS). LTLE (n = 106) and RTLE (n = 109) groups were compared on the WAIS-R subtests and summary IQ scores. Verbal-Performance IQ (VIQ-PIQ) discrepancies of various magnitudes, and Verbal Comprehension (VC) and Perceptual Organization (PO) scores derived by factor analysis. The LTLE group scored significantly lower on the Vocabulary subtest, and none of the other indexes reliably distinguished LTLE from RTLE patients. The Kaufman 2, 3, and 4 subtest short forms were significant predictors of FSIQ, with the 4 subtest short form having the highest correlation and lowest error of estimate.

Reduced sidelobe integrated acousto-optic filter with birefringence apodization

A two-section integrated acousto-optic tunable filter with significantly reduced sidelobes has been fabricated. The sidelobe reduction was achieved with birefringence apodization in the form of variable-width Ti-stripe waveguides. The design and fabrication of the device, which includes integrated proton-exchanged TE and TM-pass polarizers, are described. Experimental tuning curves for each filter section and the overall device are presented and compared with calculated results. The largest sidelobes were found to be 24 dB below the peak transmission, which represents a 5.3-dB improvement over an ideal filter without birefringence apodization. The FWHM of the filter is 1.36 nm, which is only 16% larger than predicted for its interaction length of 17 mm/section.

A biomechanical evaluation of a cannulated compressive screw for use in fractures of the scaphoid

The compressive force generated by a 3.5 mm ASIF cannulated cancellous screw with a 5 mm head was compared with that generated by a standard 3.5 mm ASIF screw (6 mm head), a 2.7 mm ASIF screw (5 mm head), and a Herbert screw. The screws were evaluated in the laboratory with the use of a custom-designed load washer (transducer) to the maximum compressive force generated by each screw until failure, either by thread stripping or by head migration into the specimen. Testing was done on paired cadaver scaphoids. To minimize the variability that occurs with human bone, and because of the cost and difficulty of obtaining human tissue specimens, a study was also done on polyurethane foam simulated bones. The 3.5 cannulated screw generated greater compressive forces than the Herbert screw but less compression than the 2.7 mm and 3.5 mm ASIF cortical screws. The 3.5 mm cannulated screw offers more rigid internal fixation for scaphoid fractures than the Herbert screw and gives the added advantage of placement over a guide wire.

Nodular fasciitis: a rapidly growing tumor of the hand

Nodular fasciitis is an uncommon benign neoplasm infrequently seen in the hand. There are often difficulties in diagnosis of this tumor. It is usually surgically excised while it is still small. The patient described here had a large and aggressive tumor that ruptured through the skin of the hand and extended to the periosteum of the ring metacarpal.

Double blind, placebo controlled trial of metronidazole in Crohn's disease

A double blind study compared the efficacy of metronidazole in two doses (20 mg/kg, 10 mg/kg) with placebo in patients with Crohn's disease. One hundred and five patients participated but only 56 completed the 16 week study -21 were withdrawn for deterioration of symptoms, 17 for adverse experiences, and 11 for protocol violation. Significant improvement in disease activity as measured by the Crohn's disease activity index (metronidazole 20 mg/kg, 97 units; metronidazole 10 mg/kg, 67 units; placebo -1 unit, p = 0.002) and serum orosomucoid (metronidazole 20 mg/kg/day, 49; 10 mg/kg/day, 38; placebo, -9, p = 0.001)) were detected. Changes in C reactive protein concentrations did not achieve significance when all three groups were considered but were significant when all metronidazole treated patients were grouped and compared with the placebo treated patients (0.8 v -0.9, p less than 0.05). Although patients receiving metronidazole 20 mg/kg/day had a greater improvement in disease activity than those receiving 10 mg/kg/day (difference 30 units (95% confidence intervals -27-87), the small sample size may have precluded the detection of statistical significance. Preliminary analysis suggests that metronidazole was more effective in patients with disease confined to the large intestine or affecting both small and large bowel than in those with small bowel disease only. There were no differences in remission rates between metronidazole and placebo treated patients. We conclude that metronidazole warrants further assessment in the treatment of patients with active Crohn's disease.

Palmar shelf arthroplasty in the rheumatoid wrist. Results of long-term follow-up

Sixty-three palmar-shelf arthroplasties (so-called pseudofusions of the wrist) that had been performed between 1970 and 1978 in forty-nine patients were evaluated. The length of follow-up averaged eighty-three months (minimum, twelve months for the wrists that fused and twenty-four months for those that did not). Preoperatively, all wrists were painful, with 96 per cent being moderately or severely so. Carpal subluxation was present in 79 per cent of the wrists. Postoperatively, pain recurred in 84 per cent of the wrists, but it was less severe (mild in 48 per cent, moderate in 35 per cent, and severe in 2 per cent). Sixty-eight per cent of the wrists fused spontaneously and were no longer painful. Of the twenty wrists (32 per cent) that did not fuse, 70 per cent were mildly or moderately painful. In patients who have rheumatoid arthritis, we found that palmar shelf arthroplasty was followed by a high rate of delayed spontaneous fusion and an unacceptably high rate of recurrent pain, although the pain was less severe.

The isolation of antibiotic resistant coliforms from meat and sewage

Beef and pig carcases, meat products, frozen chickens, and sewage were examined in 3 separate surveys for antibiotic resistant coliforms. Escherichia coli was isolated from 18 of 50 beef carcases; the numbers were low and resistance was found only to tetracycline. E. coli was isolated from 45 to 50 pig carcases; the numbers were high and showed a range of patterns of multiple antibiotic resistance. In meat products, the proportion of E. coli in contaminating organisms was low, and most resistance found was to tetracycline and streptomycin. E. coli was isolated from 66 of 75 chickens and these gave 23 patterns of antibiotic resistance, often multiple. Sewage from hospital or domestic origin and abattoir effluent yielded approximately 10(6) coliforms/ml, most of which were resistant to one or more antibiotics; few of those from hospital or domestic origin however, were classified as E. coli of faecal origin. Twenty-four patterns of resistance were found in coliforms from domestic sewage, 19 from hospital sewage and 11 from abattoir effluent. Transfer of resistance, often multiple, was achieved from 55% of 447 resistant strains to an E. coli K12 recipient. Much more information is required on the prevalence of R-factors in bacteria associated with food producing animals and their products.

Achondroplasia

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