Trauma Therapy for Very Young Children Living in Poverty: A Randomized Controlled Trial

This study used a randomized control design with immediate treatment and wait list control conditions to evaluate the efficacy of the New Hope program, a home-based, parent-and-child therapy program that has been developed for very young children living in poverty who experienced one or more potentially traumatizing events. Within a three-phase model of treatment, the New Hope program is designed to establish safety, build the caregiver child relationship, create a nurturing environment, teach coping skills, address trauma-related thoughts and feelings, and develop prosocial skills. Training in this program included discussions regarding the cultural implications of providing therapy services in the context of urban poverty. Sixty-four children under the age of six were referred to a community agency for behavior problems and emotional difficulties. All children had experienced at least one potentially traumatic event, and all families received some kind of government assistance indicating that the family’s income was below the federal definition for poverty. Participants were randomly assigned to immediate treatment or wait list control groups. Analyses of covariance (ANCOVAs) revealed significant between-group differences on all post-test measures with pre-test scores as covariates. After the waitlist group completed treatment, repeated measures analyses of variance (ANOVAs) showed significant improvement for both groups on all measures at 4-6 week follow-up. Outcomes included reductions in challenging behaviors and emotional symptoms of trauma, improved caregiver-child relationships, and increased caregiver use of treatment strategies. Participating caregivers also reported a high level of general satisfaction with the treatment program and provided qualitative feedback in response to a follow-up interview. This study offers support for early intervention using a home-based parent-and-child therapy program for very young children exposed to potentially traumatic events

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes