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This study evaluated the efficacy of a family-centered preventive intervention, the Family Check-Up (FCU), delivered as an online, eHealth model to middle school families. To increase accessibility of family-centered prevention in schools, we adapted the evidence-based FCU to an online format, with the goal of providing a model of service delivery that is feasible, given limited staffing and resources in many schools. Building on prior research, we randomly assigned participants to waitlist control (n = 105), FCU Online as a web-based intervention (n = 109), and FCU Online with coaching support (n = 108). We tested the effects of the intervention on multiple outcomes, including parental self-efficacy, child self-regulation, and child behavior, in this registered clinical trial (NCT03060291). Families engaged in the intervention at a high rate (72% completed the FCU assessment) and completed 3-month posttest assessments with good retention (94% retained). Random assignment to the FCU Online with coaching support was associated with reduced emotional problems for children (p = .003, d = −0.32) and improved parental confidence and self-efficacy (p = .018, d = 0.25) when compared with waitlist controls. Risk moderated effects: at-risk youth showed stronger effects than did those with minimal risk. The results have implications for online delivery of family-centered interventions in schools.
The Wisconsin Twin Project comprises multiple longitudinal studies that span infancy to early adulthood. We summarize recent papers that show how twin designs with deep phenotyping, including biological measures, can inform questions about phenotypic structure, etiology, comorbidity, heterogeneity, and gene–environment interplay of temperamental constructs and mental and physical health conditions of children and adolescents. The general framework for investigations begins with rich characterization of early temperament and follows with study of experiences and exposures across childhood and adolescence. Many studies incorporate neuroimaging and hormone assays.
Palliative care and the hospice movement were founded as a response to people dying from cancer . However, there is now wide recognition that palliative care should be provided and made available for people with a range of progressive advanced chronic diseases including dementia, frailty and organ failure. This is particularly pertinent as the population ages and a growing number of people are dying with these conditions. This chapter defines palliative care and the role of the psychiatrist, and examines some current issues in palliative care including having difficult conversations, dealing with uncertainty, symptom control and supporting grieving family and friends both before and after death, with a focus on the needs of those with dementia.
Objectives: Studies of neurocognitively elite older adults, termed SuperAgers, have identified clinical predictors and neurobiological indicators of resilience against age-related neurocognitive decline. Despite rising rates of older persons living with HIV (PLWH), SuperAging (SA) in PLWH remains undefined. We aimed to establish neuropsychological criteria for SA in PLWH and examined clinically relevant correlates of SA. Methods: 734 PLWH and 123 HIV-uninfected participants between 50 and 64 years of age underwent neuropsychological and neuromedical evaluations. SA was defined as demographically corrected (i.e., sex, race/ethnicity, education) global neurocognitive performance within normal range for 25-year-olds. Remaining participants were labeled cognitively normal (CN) or impaired (CI) based on actual age. Chi-square and analysis of variance tests examined HIV group differences on neurocognitive status and demographics. Within PLWH, neurocognitive status differences were tested on HIV disease characteristics, medical comorbidities, and everyday functioning. Multinomial logistic regression explored independent predictors of neurocognitive status. Results: Neurocognitive status rates and demographic characteristics differed between PLWH (SA=17%; CN=38%; CI=45%) and HIV-uninfected participants (SA=35%; CN=55%; CI=11%). In PLWH, neurocognitive groups were comparable on demographic and HIV disease characteristics. Younger age, higher verbal IQ, absence of diabetes, fewer depressive symptoms, and lifetime cannabis use disorder increased likelihood of SA. SA reported increased independence in everyday functioning, employment, and health-related quality of life than non-SA. Conclusions: Despite combined neurological risk of aging and HIV, youthful neurocognitive performance is possible for older PLWH. SA relates to improved real-world functioning and may be better explained by cognitive reserve and maintenance of cardiometabolic and mental health than HIV disease severity. Future research investigating biomarker and lifestyle (e.g., physical activity) correlates of SA may help identify modifiable neuroprotective factors against HIV-related neurobiological aging. (JINS, 2019, 25, 507–519)
Objectives: Caregivers of youth with heavy prenatal alcohol exposure report impaired communication, which can significantly impact quality of life. Using data collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD), we examined whether cognitive variables predict communication ability of youth with histories of heavy prenatal alcohol exposure. Methods: Subjects (ages 10–16 years) comprised two groups: adolescents with heavy prenatal alcohol exposure (AE) and non-exposed controls (CON). Selected measures of executive function (NEPSY, Delis-Kaplan Executive Function System), working memory (CANTAB), and language were tested in the child, while parents completed communication ratings (Vineland Adaptive Behavior Scales – Second Edition). Separate multiple regression analyses determined which cognitive domains predicted communication ability. A final, global model of communication comprised the three cognitive models. Results: Spatial Working Memory and Inhibition significantly contributed to communication ability across groups. Twenty Questions performance related to communication ability in the CON group only while Word Generation performance related to communication ability in the AE group only. Effects remained significant in the global model, with the exception of Spatial Working Memory. Conclusions: Both groups displayed a relation between communication and Spatial Working Memory and Inhibition. Stronger communication ability related to stronger verbal fluency in the AE group and Twenty Questions performance in the CON group. These findings suggest that alcohol-exposed adolescents may rely more heavily on learned verbal storage or fluency for daily communication while non-exposed adolescents may rely more heavily on abstract thinking and verbal efficiency. Interventions aimed at aspects of executive function may be most effective at improving communication ability of these individuals. (JINS, 2018, 24, 1026–1037)
Elizabeth Howard Moore, Professor in the School of Oriental and African Studies, University of London and Visiting Researcher at the Nalanda-Sriwijaya Centre, ISEAS – Yusof Ishak Institute, Singapore,
Win Maung (tampawaddy), traditional architect and an independent scholar
The processes by which Buddhism was introduced and mediated in the culturally specific context of Kyaukse are exemplified by the Ta Mok Shwe-gu-gyi temple complex. While to some degree its development was stimulated through its relation to Bagan, Ta Mok's principal identity is local. In this context, it deepens our understanding of the complex interrelationships and definitions that constituted Bagan and questions normative concepts of centre and periphery. The archaeology of Ta Mok authenticates national traditions of the founding of the eleven khayaing of Kyaukse by King Anawrahta (1044–77 CE) (Than Swe 1994, p. 19). Pyu (2nd to 9th century CE) pottery, burnished wares, and bones possibly dating to 3000 bce from Ta Mok highlight earlier connections to other regions. Thus, in both its prehistoric and historic dimensions, the Ta Mok evidence demonstrates the nuanced manner in which global ideas and styles were used to address issues of active local concern.
Chronology of the Site
The Shwe-gu-gyi temple complex, 9.65 kilometres west of Kyaukse, is located inside the Ta Mok fort, the only one of the nine Pan Laung Shwe-gu (“golden cave”) located within the khayaing fort wall. Based on the plan, brickwork and iconography, five features of the complex are dated here to the reign of Anawrahta: the central temple, two gu or small caves on the southwest of the complex, the thein or ordination hall, the innermost of the encased images of the Buddha in the southwest gu, and a row of three images of the Buddha in the thein and the palin or thrones of these images.
Based again on stylistic grounds, we argue that Myit-taw Narapatisithu (1174–1211 CE) enlarged the central temple and added an upper storey. The interior and upper storey of the main temple and other buildings such as the ordination hall and images of the Buddha were repeatedly encased and redecorated from the 11th to 14th century ce. However, as described below, the many unique aspects of the temple set out new parameters for the art, patronage and chronology of wider Bagan.
The earliest structure that has been unearthed is located on the northeast of the two-storey temple: a square building provisionally dated to the 8th to 10th century ce late Pyu period, with burial urns at the foundation level.