An Ecological Risk Model for Early Childhood Anxiety: The Importance of Early Child Symptoms and Temperament

Childhood anxiety is impairing and associated with later emotional disorders. Studying risk factors for child anxiety may allow earlier identification of at-risk children for prevention efforts. This study applied an ecological risk model to address how early childhood anxiety symptoms, child temperament, maternal anxiety and depression symptoms, violence exposure, and sociodemographic risk factors predict school-aged anxiety symptoms. This longitudinal, prospective study was conducted in a representative birth cohort (n=1109). Structural equation modeling was used to examine hypothesized associations between risk factors measured in toddlerhood/preschool (age=3.0 years) and anxiety symptoms measured in kindergarten (age=6.0 years) and second grade (age= 8.0 years). Early child risk factors (anxiety symptoms and temperament) emerged as the most robust predictor for both parent-and child-reported anxiety outcomes and mediated the effects of maternal and family risk factors. Implications for early intervention and prevention studies are discussed

The problem of underpowered rivers

This study has hypothesized that for many rivers the trade‐off between flow accumulation and the decrease in slope along channel length means that stream power increases downstream and, moreover, that given the low slope angles in headwater and low‐order streams, they would have insufficient stream power to erode let alone transport sediment. The study considered the stream power profile, the particle travel distances and the application of the Hjulström curve based on the velocity profile of nine, large UK catchments. The study showed that: Some rivers never showed a maximum in their longitudinal stream power profile, implying that some rivers never develop a deposition zone before they discharge at the tidal limit. Particle travel distances during a bankfull discharge event showed that for some rivers 91% of the upper main channel would not be cleared of sediment. Furthermore, while some rivers could transport a 2 mm particle their entire length in one bankfull event, for another river it would take 89 such events. The Hjulström curve shows that for three of the study rivers the upper 20 km of the river was not capable of eroding a 2 μm particle. The study has shown that for all rivers studied, erosion is focused downstream and deposition upstream. Many UK rivers have a dead zone where, on time scales of the order of centuries, no erosion or transport occurs and erosion only occurs in the lower courses of the channel where discharge rather than slope dominates – we propose these as underpowered rivers

A strong sense of coherence associated with reduced risk of anxiety disorder among women in disadvantaged circumstances: British population study.

OBJECTIVE: Many patients receiving medical treatment for anxiety relapse or do not improve. Research has therefore been turning to coping mechanisms as a way to decrease anxiety rates. Previously, we showed that living in a deprived area significantly increases the risk of anxiety in women, but not in men. The objective of this study is to assess whether sense of coherence (coping mechanism) buffers the influence of area deprivation on women's risk of generalised anxiety disorder using data from the European Prospective Investigation of Cancer-Norfolk. DESIGN: Large, population study. SETTING: UK population-based cohort. PARTICIPANTS: 30 445 people over the age of 40 years were recruited through general practice registers in England. Of these, 20 919 completed a structured health and lifestyle questionnaire used to assess generalised anxiety disorder and sense of coherence. Area deprivation was measured using 1991 Census data, and sense of coherence and anxiety were examined in 1996-2000. 10 183 women had data on all variables. MAIN OUTCOME MEASURE: Past-year generalised anxiety disorder defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. RESULTS: In this study, 2.6% (260/10 183) of women had generalised anxiety disorder. In those with a strong sense of coherence, area deprivation was not significantly associated with anxiety (OR 1.29, 95% CI 0.77 to 2.17). However, among women with a weak sense of coherence, those living in deprived areas were almost twice as likely to have generalised anxiety disorder compared with those living in more affluent areas (OR 1.99, 95% CI 1.37 to 2.91). CONCLUSION: The number of women living in deprived conditions is large worldwide, and significant numbers are affected by generalised anxiety disorder. Sense of coherence moderates the association between area deprivation and anxiety in women; therefore, interventions targeting coping mechanisms may need to be considered for people with anxiety

The impact of air-sea coupling and ocean biases on the seasonal cycle of southern West African precipitation

The biannual seasonal rainfall regime over the southern part of West Africa is characterised by two wet seasons, separated by the `Little Dry Season' in July-August. Lower rainfall totals during this intervening dry season may be detrimental for crop yields over a region with a dense population that depends on agricultural output. Coupled Model Intercomparison Project Phase 5 (CMIP5) models do not correctly capture this seasonal regime, and instead generate a single wet season, peaking at the observed timing of the Little Dry Season. Hence, the realism of future climate projections over this region is questionable. Here, the representation of the Little Dry Season in coupled model simulations is investigated, to elucidate factors leading to this misrepresentation. The Global Ocean Mixed Layer configuration of the Met Office Unified Model is particularly useful for exploring this misrepresentation, as it enables separating the effects of coupled model ocean biases in different ocean basins while maintaining air-sea coupling. Atlantic Ocean SST biases cause the incorrect seasonal regime over southern West Africa.Upper level descent in August reduces ascent along the coastline, which is associated with the observed reduction in rainfall during the Little Dry Season. When coupled model Atlantic Ocean biases are introduced, ascent over the coastline is deeper and rainfall totals are higher during July-August. Hence, this study indicates detrimental impacts introduced by Atlantic Ocean biases, and highlights an area of model development required for production of meaningful climate change projections over the West Africa region

Crustal rejuvenation stabilised Earth’s first cratons

This work was funded by Australian Research Council grant FL160100168 and Australian Research Council grant DP180100580.The formation of stable, evolved (silica-rich) crust was essential in constructing Earth’s first cratons, the ancient nuclei of continents. Eoarchaean (4000–3600 million years ago, Ma) evolved crust occurs on most continents, yet evidence for older, Hadean evolved crust is mostly limited to rare Hadean zircons recycled into younger rocks. Resolving why the preserved volume of evolved crust increased in the Eoarchaean is key to understanding how the first cratons stabilised. Here we report new zircon uranium-lead and hafnium isotope data from the Yilgarn Craton, Australia, which provides an extensive record of Hadean–Eoarchaean evolved magmatism. These data reveal that the first stable, evolved rocks in the Yilgarn Craton formed during an influx of juvenile (recently extracted from the mantle) magmatic source material into the craton. The concurrent shift to juvenile sources and onset of crustal preservation links craton stabilisation to the accumulation of enduring rafts of buoyant, melt-depleted mantle.Publisher PDFPeer reviewe

Common data elements for pediatric traumatic brain injury: Recommendations from the working group on demographics and clinical assessment

The Common Data Elements (CDEs) initiative is a National Institutes of Health (NIH) interagency effort to standardize naming, definitions, and data structure for clinical research variables. Comparisons of the results of clinical studies of neurological disorders have been hampered by variability in data coding, definitions, and procedures for sample collection. The CDE project objective is to enable comparison of future clinical trials results in major neurological disorders, including traumatic brain injury (TBI), stroke, multiple sclerosis, and epilepsy. As part of this effort, recommendations for CDEs for research on TBI were developed through a 2009 multi-agency initiative. Following the initial recommendations of the Working Group on Demographics and Clinical Assessment, a separate workgroup developed recommendations on the coding of clinical and demographic variables specific to pediatric TBI studies for subjects younger than 18 years. This article summarizes the selection of measures by the Pediatric TBI Demographics and Clinical Assessment Working Group. The variables are grouped into modules which are grouped into categories. For consistency with other CDE working groups, each variable was classified by priority (core, supplemental, and emerging). Templates were produced to summarize coding formats, guide selection of data points, and provide procedural recommendations. This proposed standardization, together with the products of the other pediatric TBI working groups in imaging, biomarkers, and outcome assessment, will facilitate multi-center studies, comparison of results across studies, and high-quality meta-analyses of individual patient data

Generalised anxiety disorder and hospital admissions: findings from a large, population cohort study.

OBJECTIVE: Generalised anxiety disorder (GAD) is the most common anxiety disorder in the general population and has been associated with high economic and human burden. However, it has been neglected in the health services literature. The objective of this study is to assess whether GAD leads to hospital admissions using data from the European Prospective Investigation of Cancer-Norfolk. Other aims include determining whether early-onset or late-onset forms of the disorder, episode chronicity and frequency, and comorbidity with major depressive disorder (MDD) contribute to hospital admissions. DESIGN: Large, population study. SETTING: UK population-based cohort. PARTICIPANTS: 30 445 British participants were recruited through general practice registers in England. Of these, 20 919 completed a structured psychosocial questionnaire used to identify presence of GAD. Anxiety was assessed in 1996-2000, and health service use was captured between 1999/2000 and 2009 through record linkage with large, administrative health databases. 17 939 participants had complete data on covariates. MAIN OUTCOME MEASURE: Past-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. RESULTS: In this study, there were 2.2% (393/17 939) of respondents with GAD. Anxiety was not independently associated with hospital admissions (incidence rate ratio (IRR)=1.04, 95% CI 0.90 to 1.20) over 9 years. However, those whose anxiety was comorbid with depression showed a statistically significantly increased risk for hospital admissions (IRR=1.23, 95% CI 1.02 to 1.49). CONCLUSION: People with GAD and MDD comorbidity were at an increased risk for hospital admissions. Clinicians should consider that meeting criteria for a pure or individual disorder at one point in time, such as past-year GAD, does not necessarily predict deleterious health outcomes; rather different forms of the disorder, such as comorbid cases, might be of greater importance

The organisation and delivery of health improvement in general practice and primary care: a scoping study

Background This project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities. Aims The aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice. Methods We undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff. Findings Many of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely. Future Research Future research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc