Parenting, family functioning and anxiety-disordered children: Comparisons to controls, changes after family versus child CBT

We examined (1) whether families of clinic-referred anxiety-disordered children are characterized by anxiety-enhancing parenting and family functioning, compared to control families; (2) whether family cognitive-behavioral therapy (FCBT) for anxiety-disordered children decreases anxiety-enhancing parenting and family functioning more so than child-focused cognitive-behavioral therapy (CCBT); (3) whether anxiety-disordered children benefit more from therapy in the long-term when parents display less anxiety enhancing parenting and family functioning. The referred sample consisted of 104 anxiety-disordered children (8-18 year-olds) and their families, randomized to FCBT or CCBT. The control sample consisted of 44 families from the general population. At pretreatment (referred and control sample), posttreatment, 3-months and 1-year follow up (referred sample), children’s anxiety disorders were assessed by the ADIS-C/P. Child and parents’ anxiety symptoms, parenting behaviors (autonomy granting, overprotection, rejection) and family functioning (relational functioning, family control) were assessed with questionnaires. Parent-reported autonomy granting and family relational functioning were lower in the referred versus control families. Child-reported autonomy granting was higher in the referred families. Anxiety-enhancing parenting/family functioning decreased after FCBT and CCBT, with no differences between treatments. Good family relational functioning at posttreatment predicted more improvement on anxiety measurements at the long term for adolescents, but not for school-aged children. The generally hold idea that certain parenting styles and family functioning cause child anxiety, and need to be specifically targeted in the treatment of anxious children, is not supported. Good relational functioning within adolescent’s families however is associated with better long-term outcome on anxiety, suggesting that families can support the maintenance of treatment gains

Experimental validation of the recovery effect in batteries for wearable sensors and healthcare devices discovering the existence of hidden time constants

Wearable sensors and healthcare devices use small lightweight batteries to power their typical operations of monitoring and tracking. It becomes absolutely vital to effectively utilise all the available battery charge for device longevity between charges. The electrochemical recovery effect enables the extraction of more power from the battery when implementing idle times in between use cycles, and has been used to develop various power management techniques. However, there is no evidence concerning the actual increase in available power that can be attained using the recovery effect. Also, this property cannot be generalised on all the battery chemistries since it is an innate phenomenon, relying on the anode/cathode material. Indeed recent developments suggest that recovery effect does not exist at all. This paper presents experimental results to verify the presence and level of the recovery effect in commonly used battery chemistries in wearable sensors and healthcare devices. The results have revealed that the recovery effect significantly does exist in certain batteries, and importantly we show that it is also comprised of two different time constants. This novel finding has important implications for the development of power management techniques that utilise the recovery effect with application in a large range of battery devices

The Population Genetics of Pseudomonas aeruginosa Isolates from Different Patient Populations Exhibits High-Level Host Specificity

Objective To determine whether highly prevalent P. aeruginosa sequence types (ST) in Dutch cystic fibrosis (CF) patients are specifically linked to CF patients we investigated the population structure of P. aeruginosa from different clinical backgrounds. We first selected the optimal genotyping method by comparing pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and multilocus variable number tandem-repeat analysis (MLVA). Methods Selected P. aeruginosa isolates (n = 60) were genotyped with PFGE, MLST and MLVA to determine the diversity index (DI) and congruence (adjusted Rand and Wallace coefficients). Subsequently, isolates from patients admitted to two different ICUs (n = 205), from CF patients (n = 100) and from non-ICU, non-CF patients (n = 58, of which 19 were community acquired) were genotyped with MLVA to determine distribution of genotypes and genetic diversity. Results Congruence between the typing methods was >79% and DIs were similar and all >0.963. Based on costs, ease, speed and possibilities to compare results between labs an adapted MLVA scheme called MLVA9-Utrecht was selected as the preferred typing method. In 363 clinical isolates 252 different MLVA types (MTs) were identified, indicating a highly diverse population (DI = 0.995; CI = 0.993–0.997). DI levels were similarly high in the diverse clinical sources (all >0.981) and only eight genotypes were shared. MTs were highly specific (>80%) for the different patient populations, even for similar patient groups (ICU patients) in two distinct geographic regions, with only three of 142 ICU genotypes detected in both ICUs. The two major CF clones were unique to CF patients. Conclusion The population structure of P. aeruginosa isolates is highly diverse and population specific without evidence for a core lineage in which major CF, hospital or community clones co-cluster. The two genotypes highly prevalent among Dutch CF patients appeared unique to CF patients, suggesting specific adaptation of these clones to the CF lung

Child anxiety in mental health care: Closing the gaps between research and clinical practice

In this dissertation about child anxiety in mental health care, three gaps between research and everyday clinical practice were addressed. Despite the high prevalence of anxiety disorders in children, only a minority is referred to mental health care. It was found that more severe impairment in the daily functioning of the child as a result of their anxiety disorders is associated with referral to mental health care. Family variables were no predictors. Focussing on anxiety-enhancing parenting and family functioning is believed to increase child anxiety treatment effectiveness and to facilitate treatment generalization. It was found that only a minority of the parenting and family variables differed between referred clinically anxious families versus control families. Anxiety-enhancing parenting and family functioning did improve after both family-focused cognitive behavioural therapy (CBT) and child-focused CBT, with no differences between treatments. Good family relational functioning at post-treatment was the only family variable that was consistently associated with more improvement on anxiety measurements for adolescents. CBT for child anxiety is considered effective. However, circumstances in research trials might be different to real clinical practice. It was found that CBT was not only effective within the context of a research trial, but also in daily clinical practice. Improvements on anxiety symptoms were similar. More general experience in mental health care and with prior anxiety cases of the therapist were associated with better treatment outcomes. No association were found between anxiety improvement and therapist’s pre-treatment training, supervision and treatment adherence. Results and their implications are discussed

Factors associated with the referral of anxious children to mental health care: The influence of family functioning, parenting, parental anxiety and child impairment

Contains fulltext : 140333-free.pdf (publisher's version ) (Open Access)This study aims to identify factors that predict the mental health care referral of anxious children. In total, 249 children and families, aged 8-13 years, participated: 73 children were referred with anxiety disorders to mental health care [mean (M) age =10.28, standard deviation (SD) =1.35], 176 non-referred anxious children recruited in primary schools (M age =9.94, SD =1.22). Child anxiety and other disorders were assessed with semi-structured interviews. Child anxiety symptoms, behavioural problems, parental anxiety, the parenting styles overprotection, autonomy encouragement, rejection, and the family functioning dimensions control and relational functioning, were assessed with child, father and mother report on questionnaires. The summed interference rating of children's anxiety disorders was a predictor of referral, consistent over child and parent reports, but not comorbidity. Most family and parenting variables did not predict referral, nor differed between the referred and non-referred sample. Contrary to our hypothesis, maternal self-reported anxiety decreased the odds of referral and child reported parental autonomy granting increased, while child reported overprotection decreased the odds of referral. The impairment for the child due to the number and severity of their anxiety disorder(s) is, based on child, mother and father report associated with referral. This indicates that those who need it most, receive clinical treatment.12 p