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We examined parent- and adolescent-reported executive functioning (EF) behaviors following pediatric traumatic brain injury (TBI) in the context of Online Family Problem-Solving Therapy (OFPST) and moderators of change in EF behaviors.
In total, 274 families were randomized to OFPST or an internet resource comparison group. Parents and adolescents completed the Behavior Rating Inventory of Executive Function at four time points. Mixed models were used to examine EF behaviors, assessing the effects of visit, treatment group, rater, TBI severity, age, socioeconomic status, and family functioning.
Parents rated their adolescents’ EF as poorer (F(3,1156) = 220.15, p < .001; M = 58.11, SE = 0.73) than adolescents rated themselves (M = 51.81, SE = 0.73). Across raters, EF behaviors were poorer for adolescents whose parents had less education (F(3,1156) = 8.60, p = .003; M = 56.76, SE = 0.98) than for those with more education (M = 53.16, SE = 0.88). Age at baseline interacted with visit (F(3,1156) = 5.05, p = .002), such that families of older adolescents reported improvement in EF behaviors over time. Family functioning also interacted with visit (F(3, 1156) = 2.61, p = .049), indicating more improvement in EF behaviors over time in higher functioning families. There were no effects of treatment or TBI severity.
We identified a discrepancy between parent- and adolescent-reported EF, suggesting reduced awareness of deficits in adolescents with TBI. We also found that poorer family functioning and younger age were associated with poorer recovery after TBI, whereas adolescents of parents with less education were reported as having greater EF deficits across time points.
Optimal maternal long-chain PUFA (LCPUFA) status is essential for the developing fetus. The fatty acid desaturase (FADS) genes are involved in the endogenous synthesis of LCPUFA. The minor allele of various FADS SNP have been associated with increased maternal concentrations of the precursors linoleic acid (LA) and α-linolenic acid (ALA), and lower concentrations of arachidonic acid (AA) and DHA. There is limited research on the influence of FADS genotype on cord PUFA status. The current study investigated the influence of maternal and child genetic variation in FADS genotype on cord blood PUFA status in a high fish-eating cohort. Cord blood samples (n 1088) collected from the Seychelles Child Development Study (SCDS) Nutrition Cohort 2 (NC2) were analysed for total serum PUFA. Of those with cord PUFA data available, maternal (n 1062) and child (n 916), FADS1 (rs174537 and rs174561), FADS2 (rs174575), and FADS1-FADS2 (rs3834458) were determined. Regression analysis determined that maternal minor allele homozygosity was associated with lower cord blood concentrations of DHA and the sum of EPA + DHA. Lower cord blood AA concentrations were observed in children who were minor allele homozygous for rs3834458 (β = 0·075; P = 0·037). Children who were minor allele carriers for rs174537, rs174561, rs174575 and rs3834458 had a lower cord blood AA:LA ratio (P < 0·05 for all). Both maternal and child FADS genotype were associated with cord LCPUFA concentrations, and therefore, the influence of FADS genotype was observed despite the high intake of preformed dietary LCPUFA from fish in this population.
Given a passive tracer distribution $f(x,y)$, what is the simplest unstirred pattern that may be reached under incompressible advection? This question is partially motivated by recent studies of three-dimensional (3-D) magnetic reconnection, in which the patterns of a topological invariant called the field line helicity greatly simplify until reaching a relaxed state. We test two approaches: a variational method with minimal constraints, and a magnetic relaxation scheme where the velocity is determined explicitly by the pattern of $f$. Both methods achieve similar convergence for simple test cases. However, the magnetic relaxation method guarantees a monotonic decrease in the Dirichlet seminorm of $f$, and is numerically more robust. We therefore apply the latter method to two complex mixed patterns modelled on the field line helicity of 3-D magnetic braids. The unstirring separates $f$ into a small number of large-scale regions determined by the initial topology, which is well preserved during the computation. Interestingly, the velocity field is found to have the same large-scale topology as $f$. Similarity to the simplification found empirically in 3-D magnetic reconnection simulations supports the idea that advection is an important principle for field line helicity evolution.
This study aimed to examine the predictors of cognitive performance in patients with pediatric mild traumatic brain injury (pmTBI) and to determine whether group differences in cognitive performance on a computerized test battery could be observed between pmTBI patients and healthy controls (HC) in the sub-acute (SA) and the early chronic (EC) phases of injury.
203 pmTBI patients recruited from emergency settings and 159 age- and sex-matched HC aged 8–18 rated their ongoing post-concussive symptoms (PCS) on the Post-Concussion Symptom Inventory and completed the Cogstate brief battery in the SA (1–11 days) phase of injury. A subset (156 pmTBI patients; 144 HC) completed testing in the EC (∼4 months) phase.
Within the SA phase, a group difference was only observed for the visual learning task (One-Card Learning), with pmTBI patients being less accurate relative to HC. Follow-up analyses indicated higher ongoing PCS and higher 5P clinical risk scores were significant predictors of lower One-Card Learning accuracy within SA phase, while premorbid variables (estimates of intellectual functioning, parental education, and presence of learning disabilities or attention-deficit/hyperactivity disorder) were not.
The absence of group differences at EC phase is supportive of cognitive recovery by 4 months post-injury. While the severity of ongoing PCS and the 5P score were better overall predictors of cognitive performance on the Cogstate at SA relative to premorbid variables, the full regression model explained only 4.1% of the variance, highlighting the need for future work on predictors of cognitive outcomes.
OBJECTIVES/GOALS: Geographic and linguistic isolation is associated with negative mental health outcomes, including increased risk for suicide, among ethnic/racial minorities. This study explores the feasibility of using smartphone technology with active and passive sensing to assess mental health symptoms and social behavior among at risk Spanish-speakers. METHODS/STUDY POPULATION: Participants were 13 Spanish-speaking adult outpatients who reported hopelessness/suicide ideation in the last month. Participants completed a baseline interview, 2-weeks of remote ecological momentary assessments (EMA; 4xday) using a smartphone with optional passive sensing (GPS, ambient sound recording), and a final interview. All participants identified as Hispanic (84.6% female, M age = 42.24 years). 53.8% identified as White, with 46.2% reporting race as Other (e.g., Indio, Trigueña). On average, participants had lived in the USA for 6.56 years (SD = 12.63 years). A majority (69.2%) met for Major Depressive Episode Current. At baseline, 53.8% reported passive and 23.1% reported active suicide ideation in the last month. 46.2% of participants reported a previous suicide attempt. RESULTS/ANTICIPATED RESULTS: A majority (84.6%) of participants consented to all passive data collection (GPS tracking and ambient sound recording). One participant dropped out after baseline and did not complete the EMA study portion. Participants completed on average 76.93% EMA survey instances (SD = 18.01%). Baseline depression/anxiety severity were significantly positively associated with symptom severity at 2-week follow-up (p < .01); however, baseline suicide ideation was not associated with ideation at follow-up. Participants did not report significant changes in mood or ideation from baseline to 2-week follow-up. Symptom severity at baseline was not associated with EMA instances completed. Percent of EMA instances completed were also not associated with symptom severity at follow-up, controlling for baseline severity. DISCUSSION/SIGNIFICANCE OF IMPACT: Results support the feasibility of smartphones to assess mental health symptoms and behaviors in real time, real world settings with Spanish-speakers. A majority of patients consented to active and passive remote assessments. Adherence to remote EMA was good and study attrition was minimal. Implications and future directions will be discussed.
The long-term effects of pediatric concussion on white matter microstructure are poorly understood. This study investigated long-term changes in white matter diffusion properties of the corpus callosum in youth several years after concussion.
Participants were 8–19 years old with a history of concussion (n = 36) or orthopedic injury (OI) (n = 21). Mean time since injury for the sample was 2.6 years (SD = 1.6). Participants underwent diffusion magnetic resonance imaging, completed cognitive testing, and rated their post-concussion symptoms. Measures of diffusivity (fractional anisotropy, mean, axial, and radial diffusivity) were extracted from white matter tracts in the genu, body, and splenium regions of the corpus callosum. The genu and splenium tracts were further subdivided into 21 equally spaced regions along the tract and diffusion values were extracted from each of these smaller regions.
White matter tracts in the genu, body, and splenium did not differ in diffusivity properties between youth with a history of concussion and those with a history of OI. No significant group differences were found in subdivisions of the genu and splenium after correcting for multiple comparisons. Diffusion metrics did not significantly correlate with symptom reports or cognitive performance.
These findings suggest that at approximately 2.5 years post-injury, youth with prior concussion do not have differences in their corpus callosum microstructure compared to youth with OI. Although these results are promising from the perspective of long-term recovery, further research utilizing longitudinal study designs is needed to confirm the long-term effects of pediatric concussion on white matter microstructure.
The association of MeHg exposure through fish consumption on human autoimmunity remains unclear. Fish also contain n-3 long chain polyunsaturated fatty acids (LCPUFA) that are known to regulate inflammation and mitigate autoimmune disease symptoms. We studied the association of low-level exposure to methylmercury (MeHg) through fish consumption in the SCDS. We examined this association at age 19 years in the SCDS Main Cohort (n = 497). We measured MeHg exposure at 3 time points [prenatal, weighted average (6 months to 19 years) and concurrent (19 years) and LCPUFA status and a panel of 13 autoimmune markers at age 19 years. The autoimmune markers included antinuclear antibodies (ANA), anti-dsDNA and anti-RNP, and total (non-specific) immunoglobulins (Ig) IgG, IgA, and IgM. A combined ANA variable was also calculated based on being within or above reference range for any of the ANA markers; 56% of the subjects met this criterion. Multivariable regression models adjusted for prenatal MeHg, sex and waist circumference, with and without adjustment for LCPUFA, were fit for the three MeHg exposure metrics and each immune marker. Mean (SD) prenatal, weighted average and concurrent MeHg was 6.84 (4.55), 7.46 (2.82), and 10.23 (6.02) ppm, respectively. Combined ANA was positively associated with concurrent MeHg following adjustment for the n6:n3 LCPUFA ratio (β = 0.036, 95%; CI: 0.001, 0.073). Prenatal and average MeHg exposures were not significantly associated with any individual ANA. IgM was negatively associated with concurrent (β = -0.016, 95%CI: -0.016, -0.002), and average (β = -0.042, 95%CI: -0.042, -0.009) MeHg exposure in the models adjusted for n-3, n-6 LCPUFA and when separately adjusted for the n6:n3 LCPUFA ratio. Total (19-year) n-3 PUFA status was negatively associated with anti-RNP (β = -20.355, 95%CI: -36.89, -4.34) and IgG (β = -1.384, 95%CI: -2.682, -0.087). Total n-3 LCPUFA was associated with lower markers of autoimmunity. MeHg exposure at 19 years was associated with higher ANA and lower IgM but only following adjustment for LCPUFA. The clinical significance of these findings is unclear and further research is warranted to determine if these associations precede autoimmune disease development.
Red meat is an important dietary source of protein and many other essential nutrients including omega(n)-3 polyunsaturated fatty acids (PUFA) which provide numerous benefits to human health. It is well known that grass-fed meat contains a more favourable fatty acid profile, compared to other feeding regimes, but the feasibility of grass finishing is in decline for many farmers/producers. Therefore, alternative methods to enhance the fatty acid profile of red meats, such as beef, are needed to meet increasing consumer demands for ‘healthier’ products. This study compared plasma PUFA concentrations across cattle finished on three different feeding regimes. Three farms supplied livestock to the current study, where cattle were fed three different feeding regimes for a minimum of 15-weeks prior to slaughter. Feeding regimes were ad lib concentrate (negative control), n3-enriched ad lib concentrate (treatment) or grass-fed only (positive control). Blood was collected at slaughter into EDTA tubes and plasma aliquots were stored at -80°C until analysis. A validated gas chromatography–mass spectrometry (GC-MS) method was used to quantify individual PUFA concentrations in mg/ml [linoleic acid (LA); arachidonic acid (AA); alpha-linolenic acid (ALA); eicosapentaenoic acid (EPA); docosapentaenoic acid (DPA); docosahexaenoic acid (DHA)]. Samples from 23, 49 and 40 animals (in control, treatment & grass groups, respectively) were available for the current analysis. One-way ANOVA tests revealed significant differences between groups in all PUFA concentrations quantified (all P < 0.026). Post-hoc (LSD) tests showed mean ± SD n3 PUFA concentrations were significantly different within all three groups (all P < 0.04), increasing from negative control (0.049 ± 0.013 mg/ml), to treatment (0.095 ± 0.034 mg/ml) and grass-fed groups (0.461 ± 0.132 mg/ml). The opposite was observed for mean ± SD n6 PUFA concentrations (1.060 ± 0.297 vs. 0.918 ± 0.267 vs. 0.355 ± 0.085 mg/ml, respectively; all P < 0.02). Cattle finished on either treatment or grass regimes had a more favourable n6:n3 PUFA ratio, compared to negative control (11.98 and 0.79 vs. 22.65, respectively). This study demonstrates that the finishing diet can impact plasma PUFA concentrations of beef cattle. Animals finished on the n3-enriched concentrate had, on average, double the total n3 PUFA concentrations, as well as an improved n6:n3 ratio, compared to control cattle. These results provide preliminary data on an alternative n3-enriched feeding regime for beef cattle to improve PUFA concentrations. Further research, however, is required to confirm if such beneficial changes are also observed in bovine muscle, which would have direct benefits for consumers.
Optimal maternal polyunsaturated fatty acid (PUFA) status is essential for foetal development. The desaturase enzymes, encoded by the fatty acid desaturase (FADS) genes, are involved in the endogenous synthesis of long chain (LC)PUFA and influence maternal LCPUFA concentrations. The minor allele of various FADS SNPs has been associated with increased maternal concentrations of the precursors linoleic acid (LA) and α-linolenic acid (ALA), and lower concentrations of the LCPUFA arachidonic acid (AA) and docosahexaenoic acid (DHA); however, there is limited research to date on the influence of FADS genotype on cord PUFA status. The aim of the current study was to investigate the influence of maternal and child genetic variation on cord blood PUFA status in a high fish-eating cohort.
Cord blood samples collected from mother-child pairs (n = 1088) taking part in the Seychelles Child Development Study (SCDS) Nutrition Cohort 2 (NC2) were analysed for total serum PUFA. Maternal (n = 1088) and child genotype (n = 592) were determined for the FADS SNPs rs174537, rs174561, rs174575, and rs3834458. Regression analysis determined associations between maternal and child FADS genotype and cord PUFA status. In all regression models, the major allele homozygote genotype for each SNP was used as the reference group.
Directions of significant associations were as predicted. In mothers, the minor allele homozygote genotype for SNPs rs174537, rs174561 and rs3834458 was associated with lower cord DHA and lower total n-3 PUFA when compared to the major allele homozygous genotype (p < 0.05 for all). The heterozygous genotype was associated with increased concentrations of LA compared to the reference genotype for rs174561 (p = 0.021) and rs383448 (p = 0.023). In children, the heterozygous genotype was associated with lower AA concentrations and lower cord n-6:n-3 ratio for all SNPs (p < 0.05 for all) compared to those with the major allele homozygous genotype. A lower cord AA:LA ratio was also observed for children heterozygous for rs174547, rs174561 and rs174575 (p < 0.05 for all). Contrary to expected, there were no associations between cord PUFA concentrations and child minor allele homozygous genotype.
The current study indicates that variation in maternal and child FADS genotype influences cord PUFA concentrations, despite the high intake of preformed dietary LCPUFA from fish in this population. The sample size for minor allele homozygous children was likely too small to observe any statistically significant associations in the current analysis. Further research is needed to determine whether increased dietary intake can compensate for lower PUFA status as a result of FADS genotype.
Acquired brain injury (ABI) in adulthood is a sudden insult to the brain that does not worsen over time. Examples of ABIs include traumatic brain injury, stroke (ischaemic and haemorrhagic), infections (e.g. encephalitis, meningitis), hypoxia or oxygen starvation (often occurring following cardiac arrest) and enduring difficulties following the resection of brain tumours. Difficulties that emerge from these brain lesions are complex, multi-faceted and enduring. Psychological needs are central, including anxiety, depression, anger and irritability, post-traumatic stress and struggles to adjust to the condition (Williams and Evans 2003). These often occur alongside physical restrictions (reduced, mobility, balance, sensation), cognitive impairments (problems in information processing, attention, memory, planning and organising, visuospatial perception and social communication) and strain in interpersonal relationships, with progressive social isolation developing over time (Elsass and Kinsella 1987).
Depression often coexists with other chronic conditions in older people. The COACH study is an ongoing random controlled trial (RCT) to test the effectiveness of a primary-care-based collaborative care approach to treat co-morbid hypertension and depression in Chinese rural elders. In the COACH model, a team—village doctor (VD), aging worker (AW), and psychiatrist consultant—provides collaborative care to enrolled subjects in each intervention village for 12 months. This study examines how COACH was implemented and identifies facilitators and barriers for its more widespread implementation.
Five focus groups were conducted, two with VDs, two with AWs, and one with psychiatrists, for a total of 38 participants. Transcripts were analyzed using qualitative content analysis.
COACH care-team members showed shared understanding and appreciation of the team approach and integrated management of hypertension and depression. Team collaboration was smooth. All members regarded COACH to be effective in reducing depressive symptoms and improving patient health. Facilitators to implementation include training, leaders’ support, geographic proximity between VD and AW pairs, preexisting relationships among care-team members, comparability of COACH activities and existing practices of VDs and AWs, and care team members’ caring about older members of their villages. Barriers to sustainability include frustration of some VDs related to their low wages and feelings of overload of some AWs.
COACH was positively perceived and successfully implemented. The findings offer guidance for planning primary-care-based collaborative depression care in low- and middle-income countries.
Objectives: We conducted joint analyses from five randomized clinical trials (RCTs) of online family problem-solving therapy (OFPST) for children with traumatic brain injury (TBI) to identify child and parent outcomes most sensitive to OFPST and trajectories of recovery over time. Methods: We examined data from 359 children with complicated mild to severe TBI, aged 5–18, randomized to OFPST or a control condition. Using profile analyses, we examined group differences on parent-reported child (internalizing and externalizing behavior problems, executive function behaviors, social competence) and family outcomes (parental depression, psychological distress, family functioning, parent–child conflict). Results: We found a main effect for measure for both child and family outcomes [F(3, 731) = 7.35, p < .001; F(3, 532) = 4.79, p = .003, respectively], reflecting differing degrees of improvement across measures for both groups. Significant group-by-time interactions indicated that children and families in the OFPST group had fewer problems than controls at both 6 and 18 months post baseline [t(731) = −5.15, p < .001, and t(731) = −3.90, p = .002, respectively, for child outcomes; t(532) = −4.81, p < .001, and t(532) = −3.80, p < .001, respectively, for family outcomes]. Conclusions: The results suggest limited differences in the measures’ responsiveness to treatment while highlighting OFPST’s utility in improving both child behavior problems and parent/family functioning. Group differences were greatest at treatment completion and after extended time post treatment.
Objective: Traumatic brain injury (TBI) sustained in childhood is associated with poor social outcomes. This study investigated the role of theory of mind (ToM) as a mediator of the relation between TBI and peer rejection/victimization and reciprocated friendships, as well as the moderating effect of parental nurturance on those relationships. Method: Participants were children of 8–13 years old (M = 10.45, SD = 1.47), including 13 with severe TBI, 39 with complicated mild/moderate TBI, and 32 children with orthopedic injuries. Data on peer rejection/victimization and friendship were collected in school classrooms using the Extended Class Play and friendship nominations. Parents rated parental nurturance using the Child-Rearing Practices Report. Finally, ToM was measured based on children’s average performance across three tasks measuring different aspects of ToM. Results: Severe TBI was associated with poorer ToM, greater peer rejection/victimization, and fewer reciprocated friendships. ToM mediated the relation between severe TBI and peer rejection/victimization (i.e., severe TBI predicted poorer ToM, which in turn predicted greater rejection/victimization). Parental nurturance significantly moderated this relation, such that the mediating effect of ToM was significant only at low and average levels of parental nurturance, for both severe and complicated mild/moderate TBI groups. Neither the mediating effect of ToM nor the moderating effect of parental nurturance was significant for reciprocated friendships. Conclusion: High parental nurturance may mitigate the negative effects of ToM deficits on risk of peer rejection/victimization among children with TBI. Interventions designed to increase parental nurturance or ToM may promote better social outcomes among children with TBI.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Transnational families occupy centre-stage in literatures on transformations in the social organisation and relations of care and welfare because they express how social bonds are sustained despite geographical separation. This paper examines some key themes arising from a research study into remittance-sending practices of UK-based Ghanaians and Nigerians in the light of research literatures on transnational family care and development finance. The data comprises qualitative interviews with 20 UK-based Ghanaian and Nigerian people who regularly send remittances to their families ‘back home’. This paper discusses a social issue that arises from the transnationalisation of family structures and relations, when migrant family members are positioned within family networks as ‘absent providers’, and familial relations eventually become financialised. The findings show the complexities of transnational living, the hardships endured by remittance-senders and the particular strains of remittance-mediated family relationships. The financialisation of family relations affects the social subjectivity and positioning of remittance-senders within the family. Strain and privation are integral to participants’ experiences of transnational family life, while themes of deception, betrayal, and expatriation also feature. The suppression of emotion is a feature of the significant labour inputs participants make in sustaining relationships within transnational families. The paper considers UK social policy implications of the findings.
Background: The Montreal Cognitive Assessment (MoCA) is a cognitive screening tool known to accurately measure mild cognitive impairment (MCI) in many different neurological populations. Objective: We aimed to determine whether a sport-related concussion (SRC) history and other concussion modifiers influence global cognitive function in high-performance athletes. Methods: A cross-sectional study of 326 varsity and national team athletes aged 18–36 years was completed at the University of Calgary Sports Medicine Clinic, Calgary, Alberta, Canada. Logistic regression analysis was used to examine the association between the total MoCA score, MoCA subscales, and number of previous SRC, adjusting for age, sex, sport participation (SP), and concussion modifiers. Results: Athletes with a history of three or more SRC were 5.36 times more likely to score less than 26/30 on the MoCA (the cutoff for MCI) compared to athletes with two or less SRC (p = 0.02). Males were 2.23 times more likely to have MCI than females (p = 0.0004). There was a significant relationship between the number of previous concussions and the MoCA subscales of attention (p = 0.05) and abstraction (p = 0.003). Age, SP, and concussion modifiers (migraine, depression, anxiety, and attention deficit and hyperactivity disorder) did not influence the relationship between MoCA and previous concussion history. Conclusion: In the appropriate clinical context, cognitive screening with the MoCA may benefit clinical care in athletes with multiple previous SRC, but should not replace a full neuropsychological assessment. Thus, further research is needed to compare the MoCA to full neuropsychological assessments in this population.