Biological and Contextual Predictors of the Stability of Behavioural Inhibition in Early Childhood

Persistently elevated behavioural inhibition (BI) in children confers increased risk for anxiety disorders. However, little research has jointly examined exogenous and endogenous factors that may moderate BI stability in early childhood. To explore whether parent (i.e., parental overinvolvement, parent anxiety) and child (i.e., 5-HTTLPR and BDNF val66met genotype, positive emotionality) factors influenced the stability of early BI, a community sample of 371 preschoolers and their caregivers completed observational measures of child temperament, observational and questionnaire measures of parenting, and parent interviews for anxiety disorder history. Child BI at age 3 interacted with children’s 5-HTTLPR variants to predict age 5 BI; children with at least one copy of the short allele exhibited less stability of BI, indexed via associations between age 3 and age 5 BI. Findings are consistent with previous work indicating the 5-HTTLPR short variant increases plasticity to contextual influences, thereby serving to decrease BI stability in early childhood

Baby steps: investigating the development of perceptual-motor couplings in infancy

There are cells in our motor cortex that fire both when we perform and when we observe similar actions. It has been suggested that these perceptual-motor couplings in the brain develop through associative learning during correlated sensorimotor experience. Although studies with adult participants have provided support for this hypothesis, there is no direct evidence that associative learning also underlies the initial formation of perceptual–motor couplings in the developing brain. With the present study we addressed this question by manipulating infants’ opportunities to associate the visual and motor representation of a novel action, and by investigating how this influenced their sensorimotor cortex activation when they observed this action performed by others. Pre-walking 7–9-month-old infants performed stepping movements on an infant treadmill while they either observed their own real-time leg movements (Contingent group) or the previously recorded leg movements of another infant (Non-contingent control group). Infants in a second control group did not perform any steps and only received visual experience with the stepping actions. Before and after the training period we measured infants’ sensorimotor alpha suppression, as an index of sensorimotor cortex activation, while they watched videos of other infants’ stepping actions. While we did not find greater sensorimotor alpha suppression following training in the Contingent group as a whole, we nevertheless found that the strength of the visuomotor contingency experienced during training predicted the amount of sensorimotor alpha suppression at post-test in this group. We did not find any effects of motor experience alone. These results suggest that the development of perceptual–motor couplings in the infant brain is likely to be supported by associative learning during correlated visuomotor experience

Symptom Recognition in Elders with Heart Failure

Purpose: Aging is associated with losses in hearing and vision. The objective of this study was to assess whether aging also is associated with less ability to detect and interpret afferent physiological information. Design: A cross‐sectional mixed methods study was conducted with 29 persons with a confirmed diagnosis of chronic heart failure of at least 6 months duration. The sample was divided at the median to compare younger (\u3c73 years) versus older (≥73 years) patients in the ability to detect and interpret their heart failure symptoms. Methods: Shortness of breath was stimulated using a 6‐minute walk test (6MWT) and used to assess the ability of heart failure patients to detect shortness of breath using the Borg measure of perceived exertion compared with gold standard ratings of each person\u27s shortness of breath by trained registered nurse research assistants (inter‐rater congruence 0.91). Accuracy of ratings by older patients was compared with those of younger patients. In‐depth interviews were used to assess symptom interpretation ability. Findings: Integrated quantitative and qualitative data confirmed that older patients had more difficulty in detecting and interpreting shortness of breath than younger patients. Older patients were twice as likely as younger to report a different level of shortness of breath than that noted by the registered nurse research assistants immediately after the 6MWT. Conclusions: These results support our theory of an age‐related decline in the ability to attend to internal physical symptoms. This decline may be a cause of poor early symptom detection. Clinical Relevance: The results of this study suggest that there is a need to develop interventions that focus on the symptom experience to help patients—particularly older ones—in somatic awareness and symptom interpretation. It may be useful to explore patients’ statements about how they feel: “Compared to what? How do you feel today compared to yesterday?

Let the sun shine in: effects of ultraviolet radiation on invasive pneumococcal disease risk in Philadelphia, Pennsylvania

BACKGROUND: Streptococcus pneumoniae is a common cause of community acquired pneumonia and bacteremia. Excess wintertime mortality related to pneumonia has been noted for over a century, but the seasonality of invasive pneumococcal disease (IPD) has been described relatively recently and is poorly understood. Improved understanding of environmental influence on disease seasonality has taken on new urgency due to global climate change. METHODS: We evaluated 602 cases of IPD reported in Philadelphia County, Pennsylvania, from 2002 to 2007. Poisson regression models incorporating seasonal smoothers were used to identify associations between weekly weather patterns and case counts. Associations between acute (dayto- day) environmental fluctuations and IPD occurrence were evaluated using a case-crossover approach. Effect modification across age and sex strata was explored, and meta-regression models were created using stratum-specific estimates for effect. RESULTS: IPD incidence was greatest in the wintertime, and spectral decomposition revealed a peak at 51.0 weeks, consistent with annual periodicity. After adjustment for seasonality, yearly increases in reporting, and temperature, weekly incidence was found to be associated with clear-sky UV index (IRR per unit increase in index: 0.70 [95% CI 0.54-0.91]). The effect of UV index was highest among young strata and decreased with age. At shorter time scales, only an association with increases in ambient sulphur oxides was linked to disease risk (OR for highest tertile of exposure 0.75, 95% CI 0.60 to 0.93). CONCLUSION: We confirmed the wintertime predominance of IPD in a major urban center. The major predictor of IPD in Philadelphia is extended periods of low UV radiation, which may explain observed wintertime seasonality. The mechanism of action of diminished light exposure on disease occurrence may be due to direct effects on pathogen survival or host immune function via altered 1,25-(OH)2-vitamin-D metabolism. These findings may suggest less diminution in future IPD risk with climate change than would be expected if wintertime seasonality was driven by temperature

The complex relationship between household income of family caregivers, access to palliative care services and place of death : A national household population survey

BACKGROUND: Previous work shows that more affluent patients with cancer are more likely to die at home, whereas those dying from non-cancer conditions are more likely to die in hospital. Family caregivers are an important factor in determining place of death. AIM: To investigate associations between family caregivers' household income, patients' access to specialist palliative care and place of patients' death, by level of personal end-of-life care. DESIGN: A cross-sectional community household population survey. SETTING AND PARTICIPANTS: Respondents to the Household Survey for England. RESULTS: One-third of 1265 bereaved respondents had provided personal end-of-life care (caregivers) (30%). Just over half (55%) of decedents accessed palliative care services and 15% died in a hospice. Place of death and access to palliative care were strongly related ( p < 0.001). Palliative care services reduced the proportion of deaths in hospital ( p < 0.001), and decedents accessing palliative care were more likely to die at home than those who did not ( p < 0.001). Respondents' income was not associated with palliative care access ( p = 0.233). Overall, respondents' income and home death were not related ( p = 0.106), but decedents with caregivers in the highest income group were least likely to die at home ( p = 0.069). CONCLUSION: For people who had someone close to them die, decedents' access to palliative care services was associated with fewer deaths in hospital and more home deaths. Respondents' income was unrelated to care recipients' place of death when adjusted for palliative care access. When only caregivers were considered, decedents with caregivers from higher income quartiles were the least likely to die at home. Family caregivers from higher income brackets are likely to be powerful patient advocates. Caregiver information needs must be addressed especially with regard to stage of disease, aim of care and appropriate interventions at the end of life

Mathematics difficulties in extremely preterm children : evidence of a specific deficit in basic mathematics processing

Background: Extremely preterm (EP, <26 wk gestation) children have been observed to have poor academic achievement in comparison to their term-born peers, especially in mathematics. This study investigated potential underlying causes of this difficulty. Methods: A total of 219 EP participants were compared with 153 term-born control children at 11 y of age. All children were assessed by a psychologist on a battery of standardized cognitive tests and a number estimation test assessing children’s numerical representations. Results: EP children underperformed in all tests in comparison with the term controls (the majority of Ps < 0.001). Different underlying relationships between performance on the number estimation test and mathematical achievement were found in EP as compared with control children. That is, even after controlling for cognitive ability, a relationship between number representations and mathematical performance persisted for EP children only (EP: r = 0.346, n = 186, P < 0.001; control: r = 0.095, n = 146, P = 0.256). Conclusion: Interventions for EP children may target improving children’s numerical representations in order to subsequently remediate their mathematical skills

The serotonin transporter promoter polymorphism moderates the continuity of behavioral inhibition in early childhood.

Persistently elevated behavioral inhibition (BI) in children is a marker of vulnerability to psychopathology. However, little research has considered the joint influences of caregiver and child factors that may moderate the continuity of BI in early childhood, particularly genetic variants that may serve as markers of biological plasticity, such as the serotonin transporter linked polymorphic region (5-HTTLPR). We explored this issue in 371 preschoolers and their caregivers, examining whether parent characteristics (i.e., overinvolvement or anxiety disorder) and child 5-HTTLPR influenced the continuity of BI between ages 3 and 5. Measures were observational ratings of child BI, observational and questionnaire measures of parenting, and parent interviews for anxiety disorder history, and children were genotyped for the 5-HTTLPR. Parent factors did not moderate the association between age 3 and age 5 BI; however, child BI at age 3 interacted with children\u27s 5-HTTLPR variants to predict age 5 BI, such that children with at least one copy of the short allele exhibited less continuity of BI over time relative to children without this putative plasticity variant. Findings are consistent with previous work indicating the 5-HTTLPR short variant increases plasticity to contextual influences, thereby serving to decrease the continuity of BI in early childhood

Mental wellbeing in bereaved carers: A Health Survey for England population study

Objectives: The experience of caregiving may affect carers' well-being into bereavement. We explored associations between mental well-being and previous experience of bereavement of, and caring for, someone close at the end-of-life. Methods: An end-of-life set of questions was included in population-based household survey administered to adults (age 16 years and above). We used univariable regression to explore the cross-sectional relationship between our primary outcome (Warwick-Edinburgh Mental Well-being Scale (WEMWBS)) and possible explanatory variables: sociodemographic; death and bereavement including ability to continue with their life; disease and carer characteristics; service use and caregiving experience. Results: The analysis dataset included 7606 of whom 5849 (77%) were not bereaved, 1174 (15%) were bereaved but provided no care and 583 (8%) were bereaved carers. WEMWBS was lower in the oldest age class (85 years and above) in both bereaved groups compared with not bereaved (

The cost of providing care by family and friends (informal care) in the last year of life: A population observational study

Introduction: Little is known about replacement costs of care provided by informal carers during the last year of life for people dying of cancer and non-cancer diseases. Aim: To estimate informal caregiving costs and explore the relationship with carer and decedent characteristics. Design: National observational study of bereaved carers. Questions included informal end-of-life caregiving into the 2017 Health Survey for England including estimated recalled frequency, duration and intensity of care provision. We estimated replacement costs for a decedent’s last year of life valuing time at the price of a substitutable activity. Spearman rank correlations and multivariable linear regression were used to explore relationships with last year of life costs. Setting/participants: Adult national survey respondents – England. Results: A total of 7997 adults were interviewed from 5767/9612 (60%) of invited households. Estimated replacement costs of personal care and other help were £27,072 and £13,697 per carer and a national cost of £13.2 billion and £15.5 billion respectively. Longer care duration and intensity, older age, death at home (lived together), non-cancer cause of death and greater deprivation were associated with increased costs. Female sex, and not accessing ‘other care services’ were related to higher costs for other help only. Conclusion: We provide a first adult general population estimate for replacement informal care costs in the last year of life of £41,000 per carer per decedent and highlight characteristics associated with greater costs. This presents a major challenge for future universal care coverage as the pool of people providing informal care diminish with an ageing population

Reconciling complex stratigraphic frameworks reveals temporally and geographically variable depositional patterns of the Campanian Ignimbrite

The 39.8-ka Campanian Ignimbrite was emplaced during a large caldera-forming eruption of Campi Flegrei near Naples, Italy. The ignimbrite is found up to 80 km from the caldera, and co-ignimbrite ash-fall deposits occur 3200 km away. The proximal and distal stratigraphy of the Campanian Ignimbrite has not been definitively correlated due to the dissimilar appearance of the proximal and distal deposits, a lack of medial exposures, and the inconsistency and heterogeneity of the proximal stratigraphy. Here, we document the major-element glass-shard chemistry, matrix componentry, and lithic componentry of the proximal and distal stratigraphic sequences of the ignimbrite to attempt to correlate the units. The results of these disparate observations taken together suggest that the established stratigraphic units cannot be directly and uniquely correlated between the proximal and distal regions and that neither the proximal nor distal stratigraphy provides a record of the entire eruptive sequence. However, the characteristics studied can be used to demarcate eruptive phases that are connected to some of the defined units in the proximal and distal stratigraphy