Intergenerational transmission of adverse childhood experiences via maternal depression and anxiety and moderation by child sex.

Adverse childhood experiences (ACEs) of parents are associated with a variety of negative health outcomes in offspring. Little is known about the mechanisms by which ACEs are transmitted to the next generation. Given that maternal depression and anxiety are related to ACEs and negatively affect children's behaviour, these exposures may be pathways between maternal ACEs and child psychopathology. Child sex may modify these associations. Our objectives were to determine: (1) the association between ACEs and children's behaviour, (2) whether maternal symptoms of prenatal and postnatal depression and anxiety mediate the relationship between maternal ACEs and children's behaviour, and (3) whether these relationships are moderated by child sex. Pearson correlations and latent path analyses were undertaken using data from 907 children and their mothers enrolled the Alberta Pregnancy Outcomes and Nutrition study. Overall, maternal ACEs were associated with symptoms of anxiety and depression during the perinatal period, and externalizing problems in children. Furthermore, we observed indirect associations between maternal ACEs and children's internalizing and externalizing problems via maternal anxiety and depression. Sex differences were observed, with boys demonstrating greater vulnerability to the indirect effects of maternal ACEs via both anxiety and depression. Findings suggest that maternal mental health may be a mechanism by which maternal early life adversity is transmitted to children, especially boys. Further research is needed to determine if targeted interventions with women who have both high ACEs and mental health problems can prevent or ameliorate the effects of ACEs on children's behavioural psychopathology.

An unusual case of bowel perforation due to fish fin ingestion.

We reported the case of an 85-year-old woman who presented with an acutely tender abdomen and underwent abdominal computed tomography (CT) scanning initially reported as showing diverticulitis. After failed conservative management, this patient was taken to theatre, and laparotomy revealed a punctate perforation of the ileum due to a 4 x 3 cm fish fin, which was removed through enterotomy. Retrospective analysis of the initial CT scans showed a foreign body consistent with that removed. This is the first case documented in the literature of perforation of bowel due to fish fin ingestion, as opposed to fish bone. It highlights firstly how common presentations may have an uncommon cause and secondly, how easily a small foreign body can be missed on CT scan. It also highlights and the importance of (i) eliciting a full history of eating habits in those presenting with abdominal pain and (ii) basing intervention on clinical findings. In this case report, we review the wider medical literature on perforation due to foreign body ingestion.