Palliative Stenting of the Venous Duct in a Premature Neonate with Obstructed Infradiaphragmatic Total Anomalous Pulmonary Venous Connection

In infracardiac, infradiaphragmatic total anomalous pulmonary venous connection, all four pulmonary veins connect to a descending vertical vein that usually drains to the portal vein or one of its tributaries. Obstruction is common, and definitive treatment is surgical repair. We present a case of late-diagnosed infradiaphragmatic total anomalous pulmonary venous connection in a premature neonate who was too high risk for surgery and underwent palliative stenting of the venous duct. We demonstrate the feasibility of a transhepatic approach when umbilical access is no longer available

Tattoos and antisocial personality disorder

Objective  The relationship of tattoos to the diagnosis of antisocial personality disorder (ASPD) was explored in a forensic psychiatric inpatient hospital setting. It was hypothesized that a greater proportion of forensic inpatients that possessed tattoos had ASPD than patients who did not possess tattoos. Method  Forensic male psychiatric inpatients (N = 36) were administered a semi-structured interview to determine the presence of a tattoo. ASPD was determined by criteria on a Diagnostic and Statistical Manual of Mental Disorders-IV ASPD checklist. Demographic and background characteristics of the patients were collected, and details about each tattoo were obtained including a calculation of the surface area of each tattoo. Results  Significantly more forensic psychiatric inpatients with tattoos had a diagnosis of ASPD compared to patients without tattoos. Patients with ASPD also had a significantly greater number of tattoos, a trend toward having a greater percentage of their total body surface area tattooed, and were more likely to have a history of substance abuse than patients without ASPD. Tattooed subjects, with or without ASPD, were significantly more likely to have histories of substance abuse, sexual abuse and suicide attempts than non-tattooed patients. Conclusions  Forensic psychiatric inpatients with tattoos should be assessed carefully for the presence of ASPD as well as for substance abuse, sexual abuse and suicide attempts, factors having potentially significant influence on the assessment and treatment of such patients. Copyright © 2008 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60449/1/43_ftp.pd

Como podemos criar jogos que incluem alunos com e sem autismo dentro de uma classe regular?

Em um contexto de educação inclusiva, este presente trabalho monográfico propõe a trazer alguns conceitos e características do autismo e a refletir sobre as diversas possibilidades a serem trabalhadas com alunos com esta síndrome dentro das classes regulares. O tema foi escolhido por ser de vivência da autora deste trabalho durante o curso de Pedagogia. Nesta pesquisa buscou-se trabalhar o conceito de inclusão como uma luta histórica para que se diminua a exclusão no Brasil. A discussão sobre autismo nesta monografia possui características de uma visão psicológica. Os referenciais teóricos estudados sobre alunos com autismo incluídos em classes regulares vão ao encontro do que a autora desta monografia vivenciou

Community- delivered infant- parent psychotherapy improves maternal sensitive caregiving: Evaluation of the Michigan model of infant mental health home visiting

The current study evaluated the effectiveness of a home- based psychotherapeutic Infant Mental Health Home Visiting (IMH- HV) intervention for enhancing parenting sensitivity; a secondary aim was to evaluate whether the use of video feedback was associated with greater treatment response. Participants were N = 78 mothers and their children (age at entry ranged from prebirth to 24- month old (M = 9.8, SD = 8.4), who were initiating IMH- HV services with community mental health- based therapists (N = 51). Dyads were assessed during extended home visits via standardized interviews and observational and questionnaire methods within the first month of treatment (baseline), and again 6 and 12 months thereafter. Following each of these extended home visits, study evaluators completed a standard Q- sort to capture observations of maternal sensitivity during the visit. Therapists completed fidelity checklists used to derive the total number of IMH- HV sessions received (i.e., dosage) and frequency with which therapists provided video feedback. Results indicated a dose- response relationship between number of sessions and maternal sensitivity, and that video review with parents independently contributed to improved maternal sensitivity. Discussion focuses on the effectiveness of this community- based psychotherapeutic home visiting model for enhancing parenting, as well as the value of video feedback as a specific therapeutic strategy.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154891/1/imhj21840_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154891/2/imhj21840.pd

Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale

The aim of this study was to examine preliminary evidence of the validity of the Trauma Reflective Functioning Scale and to investigate reflective functioning (RF) and attachment in pregnant women with histories of trauma, with a particular focus on the capacity to mentalize regarding trauma and its implications for adaptation to pregnancy and couple functioning. The Adult Attachment Interview was used to assess attachment, unresolved trauma and mentalization (measured as RF) regarding relationships with attachment figures (RF-G) and trauma (RF-T) in 100 pregnant women with histories of abuse and neglect. The majority (63%) of women had insecure attachment states of mind and approximately half were unresolved regarding trauma. Furthermore, the majority of women manifested deficits specific to RF-T. Their RF-T was significantly lower than their RF-G; the findings indicate that women with histories of childhood abuse and neglect do not manifest a generic inhibition of reflectiveness, but a collapse of mentalization specific to trauma. Low RF-T, indicative of difficulty in considering traumatic experiences in mental state terms, was associated with difficulty in investment in the pregnancy and lack of positive feelings about the baby and motherhood. In addition, low RF-T was also associated with difficulties in intimate relationships. Results of a regression analysis with RF indicated that RF-T was the best predictor of investment in pregnancy and couple functioning. In sum, the study provides preliminary evidence that RF-T can be reliably measured and is a valid construct that has potential usefulness for research and clinical practice. It highlights the importance of mentalization specifically about trauma and suggests that it is not the experience of trauma per se, but the absence of mentalization regarding trauma that is associated with difficulties in close relationships and in making the transition to parenthood

Transcatheter valve implantation for right atrium‐to‐right ventricle conduit obstruction or regurgitation after modified Björk–fontan procedure

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136276/1/ccd26648_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136276/2/ccd26648.pd

Access and utilisation of maternity care for disabled women who experience domestic abuse:a systematic review

BACKGROUND: Although disabled women are significantly more likely to experience domestic abuse during pregnancy than non-disabled women, very little is known about how maternity care access and utilisation is affected by the co-existence of disability and domestic abuse. This systematic review of the literature explored how domestic abuse impacts upon disabled women’s access to maternity services. METHODS: Eleven articles were identified through a search of six electronic databases and data were analysed to identify: the factors that facilitate or compromise access to care; the consequences of inadequate care for pregnant women’s health and wellbeing; and the effectiveness of existing strategies for improvement. RESULTS: Findings indicate that a mental health diagnosis, poor relationships with health professionals and environmental barriers can compromise women’s utilisation of maternity services. Domestic abuse can both compromise, and catalyse, access to services and social support is a positive factor when accessing care. Delayed and inadequate care has adverse effects on women’s physical and psychological health, however further research is required to fully explore the nature and extent of these consequences. Only one study identified strategies currently being used to improve access to services for disabled women experiencing abuse. CONCLUSIONS: Based upon the barriers and facilitators identified within the review, we suggest that future strategies for improvement should focus on: understanding women’s reasons for accessing care; fostering positive relationships; being women-centred; promoting environmental accessibility; and improving the strength of the evidence base

Adolescent Suicide Risk Screening in the Emergency Department

Many adolescents who die by suicide have never obtained mental health services. In response to this, the National Strategy for Suicide Prevention recommends screening for elevated suicide risk in emergency departments (EDs). This cross-sectional study was designed to examine 1) the concurrent validity and utility of an adolescent suicide risk screen for use in general medical EDs and 2) the prevalence of positive screens for adolescent males and females using two different sets of screening criteria.Participants were 298 adolescents seeking pediatric or psychiatric emergency services (50% male; 83% white, 16% black or African American, 5.4% Hispanic). The inclusion criterion was age 13 to 17 years. Exclusion criteria were severe cognitive impairment, no parent or legal guardian present to provide consent, or abnormal vital signs. Parent or guardian consent and adolescent assent were obtained for 61% of consecutively eligible adolescents. Elevated risk was defined as 1) Suicidal Ideation Questionnaire-Junior [SIQ-JR] score of ≥31 or suicide attempt in the past 3 months or 2) alcohol abuse plus depression (Alcohol Use Disorders Identification Test-3 [AUDIT-3] score of ≥3, Reynolds Adolescent Depression Scale-2 [RADS-2] score of ≥76). The Beck Hopelessness Scale (BHS) and Problem Oriented Screening Instrument for Teenagers (POSIT) were used to ascertain concurrent validity.Sixteen percent ( n =  48) of adolescents screened positive for elevated suicide risk. Within this group, 98% reported severe suicide ideation or a recent suicide attempt (46% attempt and ideation, 10% attempt only, 42% ideation only) and 27% reported alcohol abuse and depression. Nineteen percent of adolescents who screened positive presented for nonpsychiatric reasons. One-third of adolescents with positive screens were not receiving any mental health or substance use treatment. Demonstrating concurrent validity, the BHS scores of adolescents with positive screens and the POSIT scores of those with positive screens due to alcohol abuse and depression indicated substantial impairment. The addition of alcohol abuse with co-occurring depression as a positive screen criterion did not result in improved case identification. Among the subgroup screening positive due to depression plus alcohol abuse, all but one (>90%) also reported severe suicide ideation and/or a recent suicide attempt. This subgroup (approximately 17% of adolescents who screened positive) also reported significantly more impulsivity than other adolescents who screened positive.The suicide risk screen showed evidence of concurrent validity. It also demonstrated utility in identifying 1) adolescents at elevated risk for suicide who presented to the ED with unrelated medical concerns and 2) a subgroup of adolescents who may be at highly elevated risk for suicide due to the combination of depression, alcohol abuse, suicidality, and impulsivity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78701/1/j.1553-2712.2009.00500.x.pd