The Impact of Social Disparity on Prefrontal Function in Childhood

The prefrontal cortex (PFC) develops from birth through late adolescence. This extended developmental trajectory provides many opportunities for experience to shape the structure and function of the PFC. To date, a few studies have reported links between parental socioeconomic status (SES) and prefrontal function in childhood, raising the possibility that aspects of environment associated with SES impact prefrontal function. Considering that behavioral measures of prefrontal function are associated with learning across multiple domains, this is an important area of investigation. In this study, we used fMRI to replicate previous findings, demonstrating an association between parental SES and PFC function during childhood. In addition, we present two hypothetical mechanisms by which SES could come to affect PFC function of this association: language environment and stress reactivity. We measured language use in the home environment and change in salivary cortisol before and after fMRI scanning. Complexity of family language, but not the child's own language use, was associated with both parental SES and PFC activation. Change in salivary cortisol was also associated with both SES and PFC activation. These observed associations emphasize the importance of both enrichment and adversity-reduction interventions in creating good developmental environments for all children

Social and emotional difficulties in children with ADHD and the impact on school attendance and healthcare utilization

Abstract Background The objective of this study was to examine the impact of co-occurring social and emotional difficulties on missed school days and healthcare utilization among children with attention deficit/hyperactivity disorder (ADHD). Methods Data were from the 2007 U.S. National Health Interview Survey (NHIS) and were based on parental proxy responses to questions in the Sample Child Core, which includes questions on demographics, health, healthcare treatment, and social and emotional status as measured by questions about depression, anxiety, and phobias, as well as items from the brief version of the Strength and Difficulties Questionnaire (SDQ). Logistic regression was used to assess the association between co-occurring social and emotional difficulties with missed school days and healthcare utilization, adjusting for demographics. Results Of the 5896 children aged 6–17 years in the 2007 NHIS, 432 (7.3%) had ADHD, based on parental report. Children with ADHD and comorbid depression, anxiety, or phobias had significantly greater odds of experiencing > 2 weeks of missed school days, ≥ 6 visits to a healthcare provider (HCP), and ≥ 2 visits to the ER, compared with ADHD children without those comorbidities (OR range: 2.1 to 10.4). Significantly greater odds of missed school days, HCP visits, and ER visits were also experienced by children with ADHD who were worried, unhappy/depressed, or having emotional difficulties as assessed by the SDQ, compared with ADHD children without those difficulties (OR range: 2.2 to 4.4). Conclusions In children with ADHD, the presence of social and emotional problems resulted in greater odds of missed school days and healthcare utilization. These findings should be viewed in light of the limited nature of the parent-report measures used to assess social and emotional problems.</p

Association of biological antirheumatic therapy with risk for type 2 diabetes: a retrospective cohort study in incident rheumatoid arthritis

Objective To explore possible associations of treatment with biological disease-modifying antirheumatic drugs (bDMARDs), including T-cell-based and interleukin-6 inhibition (IL-6i)-based therapies, and the risk for type 2 diabetes mellitus (T2DM) in patients with rheumatoid arthritis (RA).Study design, setting and participants Five treatment groups were selected from a United States Electronic Medical Records database of 283 756 patients with RA (mean follow-up, 5 years): never received bDMARD (No bDMARD, n=125 337), tumour necrosis factor inhibitors (TNFi, n=34 873), IL-6i (n=1884), T-cell inhibitors (n=5935) and IL-6i+T cell inhibitor abatacept (n=1213). Probability and risk for T2DM were estimated with adjustment for relevant confounders.Results In the cohort of 169 242 patients with a mean 4.5 years of follow-up and a mean 641 200 person years of follow-up, the adjusted probability of developing T2DM was significantly lower in the IL-6i (probability, 1%; 95% CI 0.6 to 2.0), T-cell inhibitor (probability, 3%; 95% CI 2.3 to 3.3) and IL-6i+T cell inhibitor (probability, 2%; 95% CI 0.1 to 2.9) groups than in the No bDMARD (probability, 5%; 95% CI 4.6 to 4.9) and TNFi (probability, 4%; 95% CI 3.7 to 4.7) groups. Compared with No bDMARD, the IL-6i and IL-6i+T cell inhibitor groups had 37% (95% CI of HR 0.42 to 0.96) and 34% (95% CI of HR 0.46 to 0.93) significantly lower risk for T2DM, respectively; there was no significant difference in risk in the TNFi (HR 0.99; 95% CI 0.93 to 1.06) and T-cell inhibitor (HR 0.96; 95% CI 0.82 to 1.12) groups.Conclusions Treatment with IL-6i, with or without T-cell inhibitors, was associated with reduced risk for T2DM compared with TNFi or No bDMARDs; a less pronounced association was observed for the T-cell inhibitor abatacept

The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer’s disease: A matched case–control study

Objectives: Behavioral and psychological symptoms of dementia in individuals with Alzheimer’s disease and caregiver characteristics may influence the decision to provide care at home or in a nursing home, though few studies examine this association near the actual time of nursing home placement. Using a matched case–control design, this study investigates the association between (1) total Neuropsychiatric Inventory score, (2) the Neuropsychiatric Inventory-4 (an agitation/aggression subscale), and (3) individual domains of the Neuropsychiatric Inventory and nursing home placement. Methods: Data from the South Carolina Alzheimer’s disease Registry provides an opportunity to expand the literature by looking at cases at the time of nursing home care eligibility/placement and allowing for propensity-score-matched controls. Cases (n = 352) entered a nursing home within 6 months of study initiation; controls (n = 289) remained in the community. Registry data were combined with caregiver survey data, including the Neuropsychiatric Inventory. Conditional logistic regression was applied. Results: A 10% increase in the Neuropsychiatric Inventory score implied a 30% increase in odds of nursing home admission (odds ratio: 1.30; 95% confidence interval: 1.14–1.50), having married or male caregivers predicted nursing home placement. Cases versus controls were significantly more likely to have behavioral and psychological symptoms of dementia related to agitation/aggression 1 month prior to nursing home admission. Conclusion: Interventions targeting behavioral and psychological symptoms of dementia without available effective interventions in individuals with Alzheimer’s disease and caregiver support services are necessary to prevent or delay nursing home admission

Incidence and Risk of Glucocorticoid-Associated Adverse Effects in Patients With Rheumatoid Arthritis

Using the UK Clinical Practice Research Datalink (CPRD), we examined the incidence of GC-related serious adverse events (SAEs) in RA and non-RA patients, and quantified their risk in RA patients.; We matched incident RA patients to an equal-sized, age- and sex-matched, non-RA comparison group. In a cohort analysis, we estimated incidence rates and incidence rate ratios (IRRs) for GC-related AEs (i.e. diabetes, osteoporosis, fractures, glaucoma, hypertension, GI perforation or bleeding, 'thrombotic stroke or MI', death), stratified by GC use. We conducted a series of nested case-control analyses among RA patients, evaluating the effects of increasing cumulative and average daily GC dose. Cases of each outcome were matched to controls on age, sex and general practice. We calculated adjusted odds ratios with 95% CIs for each outcome.; RA patients had a higher incidence for all investigated SAEs except glaucoma, compared to non-RA patients. IRRs were greater in those prescribed a GC than in those without. In RA patients, GCs were associated with an elevated risk of diabetes (adjusted OR, 95% CI) (1.33, 1.14-1.56), osteoporosis (1.41, 1.25-1.59), 'thrombotic stroke or MI' (1.28, 1.07-1.52), serious infection (1.28, 1.11-1.48) and death (1.33, 1.19-1.48). There was a trend of increasing risk with increasing cumulative and average daily GC dose (p &lt;0.05) for all outcomes other than glaucoma, hypertension and GI perforations or bleeding.; RA patients had an increased incidence of GC-related AEs. Increasing cumulative and average daily GC doses were found to be associated with increasing risk of developing an AE

Significantly active areas (p<.05, cluster level corrected) for the two sample t-test comparing children from low socioeconomic status families to children from high socioeconomic status families for the novel rule > familiar rule contrast.

<p>Activation in red represents areas that were more active for children from low socioeconomic status families during learning. Activation in blue represents areas more active for children from high socioeconomic status families during learning. Circled in red is the RMFG, which survived further correction at p<.001 cluster level correction.</p

Brain activity during early trials: Activity for learning with behavior equated.

<p>(<i>Top</i>) Significantly active areas for children from either LSES or HSES families for the early trials of the novel rule > familiar rule contrast (one sample t-test). (<i>Bottom</i>) Significantly active areas for the two sample t-test comparing children from LSES families to children from HSES families for the early trials of the novel rule > familiar rule contrast. Only areas that were above baseline for one group compared to the other are reported.</p

Learning curves for children from high and low SES families for accuracy performance on both Novel (blue) and Familiar (green) rules.

<p>Data at each time point is collapsed across instances of Familiar (A/B) and instances of Novel (A/B) rules, yielding 10 time points from an original 20 if instances of rules were viewed separately. HSES children performed significantly less accurately on Novel compared to Familiar rules during early blocks of the scanner task (asterisks) whereas LSES children performed more poorly on the Novel compared to Familiar rule throughout the scan. (*) indicates a significant difference for Familiar Rule Accuracy > Novel Rule Accuracy for HSES participants (solid lines); (x) indicates a significant Familiar Rule Accuracy > Novel Rule Accuracy for LSES participants (dotted lines).</p