Prenatal determinants of anxiety symptoms in middle childhood. Evidence from Growing Up in New Zealand.

BACKGROUND: Early life environments can have long-lasting impacts on future health and wellbeing. Maternal health during pregnancy, including experiencing stress or mood disorders, has been associated with psychopathology in later life. Anxiety disorders are one of the most prevalent mental health conditions, affecting approximately 7 % of children and adolescents globally, with a lifetime prevalence of 15-20 %. Identifying prenatal risk factors can support future and current public health interventions and maternity care. METHODS: Data were obtained from the Growing Up in New Zealand longitudinal study of child development. Prenatally, mothers provided sociodemographic information as well as data on their mental health, potential teratogens, and lifestyle factors such as supplement intake and exercise levels. At 8-years old, 4922 children self-completed the PROMIS-SF anxiety measure. Bivariate analyses and backward stepwise regression were used to determine the best multivariable model. RESULTS: Significant prenatal predictors of anxiety symptoms at 8-years old included elevated maternal depression symptoms, body mass index in the overweight/obese range, exercise patterns, and paracetamol, anti-inflammatory and alcohol intake. LIMITATIONS: Sample attrition from baseline to 8-year may have affected statistical power. To further untangle the effect of timing and duration of the exposures reported in this study, larger sample sizes would be required. CONCLUSIONS: Prenatal mental health and wellbeing was significantly associated with child anxiety symptoms at 8-years of age. This study highlights the importance of supporting expectant mothers' health and wellbeing during pregnancy to ensure children have the best opportunity to have good mental health.

Defining the relationship between arm and leg blood pressure readings: a systematic review and meta-analysis.

OBJECTIVES: To define the relationship between arm and leg blood pressure (BP) to inform the interpretation of leg BP readings in routine clinical practice where arm readings are not available. METHODS: Systematic review of all existing studies comparing arm and leg BP measurements. A search strategy was designed in MEDLINE and adapted to be run across six further databases. Articles were deemed eligible for inclusion if they measured and reported arm and leg BP taken in the supine position and/or the difference between the two. Mean values for arm-leg BP difference and measures of precision [95% confidence intervals (CIs) or SD] were extracted and entered into a random-effects meta-analysis. RESULTS: A total of 887 articles were screened and 44 were included in the descriptive analyses, including 9771 patients. In the general population, ankle SBP was 17.0 mmHg (95% CI 15.4-21.3 mmHg) higher than arm BP in the supine position. For DBP, there was no difference between arm and ankle BP (-0.3 mmHg, 95% CI -1.5-1.0 mmHg). In patients with vascular disease, SBP was -33.3 mmHg (95% CI -59.1 to -7.6 mmHg) lower in the ankle compared with the arm. CONCLUSION: This is the first review to provide empirical data defining the difference between BP in the arm and leg in the general population. Findings suggest a diagnostic threshold of 155/90 mmHg could be used for diagnosing hypertension when only ankle measurements are available in routine practice.

Predictors of the Home-Clinic Blood Pressure Difference: A Systematic Review and Meta-Analysis.

BACKGROUND: Patients may have lower (white coat hypertension) or higher (masked hypertension) blood pressure (BP) at home compared to the clinic, resulting in misdiagnosis and suboptimal management of hypertension. This study aimed to systematically review the literature and establish the most important predictors of the home-clinic BP difference. METHODS: A systematic review was conducted using a MEDLINE search strategy, adapted for use in 6 literature databases. Studies examining factors that predict the home-clinic BP difference were included in the review. Odds ratios (ORs) describing the association between patient characteristics and white coat or masked hypertension were extracted and entered into a random-effects meta-analysis. RESULTS: The search strategy identified 3,743 articles of which 70 were eligible for this review. Studies examined a total of 86,167 patients (47% female) and reported a total of 60 significant predictors of the home-clinic BP difference. Masked hypertension was associated with male sex (OR 1.47, 95% confidence interval (CI) 1.18-1.75), body mass index (BMI, per kg/m(2) increase, OR 1.07, 95% CI 1.01-1.14), current smoking status (OR 1.32, 95% CI 1.13-1.50), and systolic clinic BP (per mm Hg increase, OR 1.10, 95% CI 1.01-1.19). Female sex was the only significant predictor of white coat hypertension (OR 3.38, 95% CI 1.64-6.96). CONCLUSIONS: There are a number of common patient characteristics that predict the home-clinic BP difference, in particular for people with masked hypertension. There is scope to incorporate such predictors into a clinical prediction tool which could be used to identify those patients displaying a significant masked or white coat effect in routine clinical practice.

Season-long increases in perceived muscle soreness in professional rugby league players: role of player position, match characteristics and playing surface.

Rugby League (RL) is a high-impact collision sport characterised by repeated sprints and numerous high-speed impacts and consequently players often report immediate and prolonged muscle soreness in the days after a match. We examined muscle soreness after matches during a full season to understand the extent to which match characteristics influence soreness. Thirty-one elite Super League players provided daily measures of muscle soreness after each of the 26 competitive fixtures of the 2012 season. Playing position, phase of the season, playing surface and match characteristics were recorded from each match. Muscle soreness peaked at day 1 and was still apparent at day 4 post-game with no attenuation in the magnitude of muscle soreness over the course of the season. Neither playing position, phase of season or playing surface had any effects on the extent of muscle soreness. Playing time and total number of collisions were significantly correlated with higher ratings of muscle soreness, especially in the forwards. These data indicate the absence "contact adaptations" in elite rugby players with soreness present throughout the entire season. Strategies must now be implemented to deal with the physical and psychological consequences of prolonged feeling of pain.

A longitudinal investigation of the relationship between maternal mind-mindedness and theory of mind.

Data are presented from a longitudinal investigation examining the relationship between maternal mind-mindedness (MM) in infancy and socio-cognitive development in childhood. We revisited children (n = 18) who had taken part in a longitudinal study as infants. MM had been assessed at 10, 12, 16, and 20 months of age. We followed up these children at 5-6 years of age to test their higher order theory of mind (ToM) (using the strange stories task). The convergent validity, temporal stability, and predictive validity of the construct of MM were examined in a longitudinal data set. The five measures of MM were not significantly correlated. Mother's production of appropriate mind-related comments (but no other measures) showed evidence of temporal stability throughout infancy. Thus, MM (as measured by appropriate mind-related comments) was confirmed as a stable construct. Children's ToM at 5-6 years of age was significantly predicted by their mother's MM up to 4 years earlier, with MM accounting for 40% of the variance of the strange stories task scores. These findings identify a relationship between MM across a protracted period of infancy and socio-cognitive development at 5-6 years of age.

Self-help for weight loss in overweight and obese adults: systematic review and meta-analysis.

We conducted a systematic review and meta-analysis investigating the components and effectiveness of self-help weight-loss interventions and their applicability to less-advantaged populations. We searched (November 2013) for randomized controlled trials comparing self-help interventions with each other or with minimal controls in overweight and obese adults, with 6 months or longer follow-up. We calculated mean difference between intervention and control for 6- and 12-month weight change. Twenty-three studies met the inclusion criteria (9632 participants; 39 intervention arms). Intervention participants lost significantly more weight than controls at 6 months (mean difference -1.85 kg; 95% confidence interval [CI]=-2.86, -0.83; 7 studies). No significant effect was detected at 12 months but results were sensitive to the inclusion of 1 study at high risk of bias. Interactive programs appeared more effective than standard ones at 6 months (mean difference -0.94 kg; 95% CI=-1.50, -0.38). Evidence is insufficient to reach conclusions on effectiveness in socioeconomically disadvantaged people, but suggests self-help interventions may be less effective in this group.

A complex multimodal activity intervention to reduce the risk of dementia in mild cognitive impairment--ThinkingFit: pilot and feasibility study for a randomized controlled trial.

BACKGROUND: Dementia affects 35 million people worldwide and is currently incurable. Many cases may be preventable because regular participation in physical, mental and social leisure activities during middle age is associated with up to 47% dementia risk reduction. However, the majority of middle-aged adults are not active enough. MCI is therefore a clear target for activity interventions aimed at reducing dementia risk. An active lifestyle during middle age reduces dementia risk but it remains to be determined if increased activity reduces dementia risk when MCI is already evident. Before this can be investigated conclusively, complex multimodal activity programmes are required that (1) combine multiple health promoting activities, (2) engage people with MCI, and (3) result in sufficient adherence rates. METHODS: We designed the ThinkingFit programme to engage people with MCI in a complex intervention comprised of three activity components: physical activity, group-based cognitive stimulation (GCST) and individual cognitive stimulation (ICST). Engagement and adherence was promoted by applying specific psychological techniques to enhance behavioural flexibility in an early pre-phase and during the course of the intervention. To pilot the intervention, participants served as their own controls during a 6- to 12-week run-in period, which was followed by 12 weeks of activity intervention. RESULTS: Out of 212 MCI patients screened, 163 were eligible, 70 consented and 67 completed the intervention (mean age 74 years). Activity adherence rates were high: physical activity = 71%; GCST = 83%; ICST = 67%. Significant treatment effects (p < .05) were evident on physical health outcomes (decreased BMI and systolic blood pressure, [pre/post values of 26.3/25.9 kg/m2 and 145/136 mmHg respectively]), fitness (decreased resting and recovery heart rate [68/65 bpm and 75/69 bpm]), and cognition (improved working memory [5.3/6.3 items]). CONCLUSIONS: We found satisfactory recruitment, retention and engagement rates, coupled with significant treatment effects in elderly MCI patients. It appears feasible to conduct randomized controlled trials of the dementia prevention potential of complex multimodal activity programmes like ThinkingFit. TRIAL REGISTRATION: ClinicalTrials.gov registration nr: NCT01603862; date: 17/5/2012.

Exploring the views of patients not on the transplant waiting list: a qualitative study.

BACKGROUND: Not all patients are suitable for kidney transplantation; however, little is known about the views and attitudes of patients who are not on the waiting list for transplantation. OBJECTIVE: This study aimed to determine the views and attitudes of patients who are not on the waiting list regarding the process of transplant allocation. METHODS: A grounded theory approach was used to develop theories from patient views, opinions and attitudes. Patients receiving dialysis, and not on the waiting list at a United Kingdom renal unit were identified by the renal counsellor and invited to take part. Five patients formed a focus group to enable construction of an interview schedule. Patients (n=10, different from those in the focus group) were interviewed until themes became saturated. Interview transcripts generated conceptual categories. RESULTS: Seven conceptual categories emerged regarding access to transplantation. Patients experience emotions of loss relating to transplantation exacerbated by restrictions imposed by dialysis. Patients find coping mechanisms, accept their situation and trust that clinical decisions were equitable. CONCLUSIONS: Patients trust their carers and support an efficacy argument when considering scarce resources. Communication should be improved to ensure clarity and understanding of clinical decisions.

Giving cognition a helping hand: the effect of congruent gestures on object name retrieval.

The gestures that accompany speech are more than just arbitrary hand movements or communicative devices. They are simulated actions that can both prime and facilitate speech and cognition. This study measured participants' reaction times for naming degraded images of objects when simultaneously adopting a gesture that was either congruent with the target object, incongruent with it, and when not making any hand gesture. A within-subjects design was used, with participants (N= 122) naming 10 objects under each condition. Participants named the objects significantly faster when adopting a congruent gesture than when not gesturing at all. Adopting an incongruent gesture resulted in significantly slower naming times. The findings are discussed in the context of the intrapersonal cognitive and facilitatory effects of gestures and underline the relatedness between language, action, and cognition.

To sign or not to sign? The impact of encouraging infants to gesture on infant language and maternal mind-mindedness.

Findings are presented from the first randomized control trial of the effects of encouraging symbolic gesture (or "baby sign") on infant language, following 40 infants from age 8 months to 20 months. Half of the mothers were trained to model a target set of gestures to their infants. Frequent measures were taken of infant language development and dyadic interactions were scrutinized to assess mind-mindedness. Infants exposed to gesture did not differ from control conditions on language outcomes; thus, no support was found for previous claims that encouraging gesturing with infants accelerates linguistic development. Microgenetic analysis revealed mothers in the gesture training conditions were more responsive to their infants' nonverbal cues and encouraged more independent action by their infant.

Improving the recruitment activity of clinicians in randomised controlled trials: a systematic review.

Background Poor recruitment to randomised controlled trials (RCTs) is a widespread problem. Provision of interventions aimed at supporting or incentivising clinicians may improve recruitment to RCTs. Objectives To quantify the effects of strategies aimed at improving the recruitment activity of clinicians in RCTs, complemented with a synthesis of qualitative evidence related to clinicians' attitudes towards recruiting to RCTs. Data sources A systematic review of English and non-English articles identified from: The Cochrane Library, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ebsco CINAHL, Index to Theses and Open SIGLE from 2001 to March 2011. Additional reports were identified through citation searches of included articles. Study eligibility criteria Quantitative studies were included if they evaluated interventions aimed at improving the recruitment activity of clinicians or compared recruitment by different groups of clinicians. Information about host trial, study design, participants, interventions, outcomes and host RCT was extracted by one researcher and checked by another. Studies that met the inclusion criteria were assessed for quality using a standardised tool, the Effective Public Health Practice Project tool. Qualitative studies were included if they investigated clinicians' attitudes to recruiting patients to RCTs. All results/findings were extracted, and content analysis was carried out. Overarching themes were abstracted, followed by a metasummary analysis. Studies that met the inclusion criteria were assessed for quality using the Critical Appraisal Skills Programme qualitative checklist. Data extraction Data extraction was carried out by one researcher using predefined data fields, including study quality indicators, and verified by another. Results Eight quantitative studies were included describing four interventions and a comparison of recruiting clinicians. One study was rated as strong, one as moderate and the remaining six as weak when assessed for quality using the Effective Public Health Practice Project tool. Effective interventions included the use of qualitative research to identify and overcome barriers to recruitment, reduction of the clinical workload associated with participation in RCTs and the provision of extra training and protected research time. Eleven qualitative studies were identified, and eight themes were abstracted from the data: understanding of research, communication, perceived patient barriers, patient-clinician relationship, effect on patients, effect on clinical practice, individual benefits for clinicians and methods associated with successful recruitment. Metasummary analysis identified the most frequently reported subthemes to be: difficulty communicating trial methods, poor understanding of research and priority given to patient well-being. Overall, the qualitative studies were found to be of good quality when assessed using the Critical Appraisal Skills Programme checklist. Conclusions There were few high-quality trials that tested interventions to improve clinicians' recruitment activity in RCTs. The most promising intervention was the use of qualitative methods to identify and overcome barriers to clinician recruitment activity. More good quality studies of interventions are needed to add to the evidence base. The metasummary of qualitative findings identified understanding and communicating RCT methods as a key target for future interventions to improve recruitment. Reinforcement of the potential benefits, both for clinicians and for their patients, could also be a successful factor in improving recruitment. A bias was found towards investigating barriers to recruitment, so future work should also encompass a focus on successfully recruiting trials.

Dynamic assessment of learning ability improves outcome prediction following acquired brain injury.

PRIMARY PURPOSE: There is a need to improve the prediction of outcome following acquired brain injury. The previous focus has been on specifying the relative contribution of such variables as pre-morbid intellectual ability, socioeconomic status, severity of injury and performance on neuropsychological assessments. To date, findings remain discrepant and often inconclusive. The present study examined whether dynamic assessment testing scores predict outcome. RESEARCH DESIGN: Both standard and dynamic assessment of 77 individuals with acquired brain injury was performed. Dynamic assessment identifies the learning potential of the individual, rather than measuring their statically assessed cognitive ability. The individual's potential to learn the Wisconsin Card Sorting Task (WCST), with guided instruction and feedback, was assessed and compared with standardized static measures. RESULTS: Using Rasch analysis, individual learning potential was determined and, unlike the standard WCST scores, was predictive of integration into the community following brain injury. CONCLUSION: It is concluded that dynamic testing potentially may offer advantages over the traditional standard cognitive tests in predicting the outcome for people with brain injuries.

The genetic versus pharmacological invalidation of the cannabinoid CB(1) receptor results in differential effects on 'non-associative' memory and forebrain monoamine concentrations in mice.

The endocannabinoid CB(1) receptor has been implicated in the inhibitory control of learning and memory. In the present experiment, we compared the behavioral response of CB(1) receptor knockout mice (CB(1)R(-/-)) with animals administered CB(1) receptor antagonist/inverse agonist SR141716A (rimonabant; 3 mg/kg IP, 30 min pre-trial) in terms of acquisition and retention of a habituation task and changes in cerebral monoamines. The results can be summarized as follows: (i) the acute and chronic invalidation of the CB(1) receptor resulted in an increase of behavioral habituation during the first exposure to an open field, indicative of enhanced acquisition of the task; (ii) CB(1)R(-/-) mice, but not rimonabant-treated animals, showed enhanced retention of the habituation task when re-tested 48 h and 1 week subsequent to the first exposure to the open field, respectively; (iii) the facilitation of retention of the habituation task in CB(1)R(-/-) mice was accompanied by a selective and site-specific increase in serotonin activity in hippocampus; and (iv) rimonabant-treated animals displayed 'antidepressant-like' neurochemical alterations of cerebral monoamines, that is, most parameters of monoaminergic activity were increased especially in dorsal striatum and hippocampus. Taken together, the present findings demonstrate that the genetic disruption of the CB(1) receptor gene can cause an improvement of behavioral habituation, which is considered to represent a form of 'non-associative' learning. Furthermore, our data support the assumption of a rimonabant-sensitive cannabinoid receptive site that is different from the 'classical' CB(1) receptor and which, under physiological conditions, might be involved in the inhibitory control of the acquisition but not retention of non-associative learning tasks.

How visual images of chocolate affect the craving and guilt of female dieters.

This study asks whether exposure to images of chocolate induces cravings and guilty feelings in females. A further aim was to examine whether these effects are heightened in the case of dieters. The participants, 85 females, saw a series of enticing media images, either of chocolate or of non-food products. Two thirds of the sample were dieting or had dieted in the past; 15% had been on seven or more diets. After viewing the images all participants completed the Attitudes to Chocolate Questionnaire (ACQ) [Benton, Greenfield, & Morgan (1998). The development of the attitudes to chocolate questionnaire. Personality and Individual Differences, 24(4), 513-520]. The different conditions affected only those who dieted. Dieters had significantly higher ACQ scores after viewing the chocolate images than the non-dieters. It is suggested that dietary restriction increases desire for forbidden foods, in the form of craving, and may induce negative affect such as guilt, anxiety and depression.