Improved weight bearing during gait at 6 weeks post-surgery with an angle stable locking system after distal tibial fracture.

BACKGROUND: Functional recovery after intramedullary nailing of distal tibial fractures can be monitored using ipsilateral vertical ground reaction forces (vGRF), giving insight into recovery of patients' gait symmetry. Previous work compared patient cohorts to healthy controls, but it remains unclear if these metrics can identify treatment-based differences in return to function post-surgery. RESEARCH QUESTION: Is treatment of a distal tibial fracture with intramedullary nailing with an angle stable locking system (ASLS) associated with higher ipsilateral vGRF and improved symmetry compared to conventional intramedullary nailing at an early time point? METHODS: Thirty-nine patients treated with ASLS intramedullary nailing were retrospectively compared to thirty-nine patients with conventional locking. vGRFs were collected at 1, 6, 12, 26, and 52 weeks post-surgery during standing and gait. Discrete metrics of ipsilateral vGRF (maximal force, impulse) and asymmetry were compared between treatments at each time point. Time-scale comparisons of ipsilateral vGRF and lower limb asymmetry were additionally performed for gait trials. Mann-Whitney Test or a two-way analysis of variance tested discrete comparisons; statistical non-parametric mapping tested time-scale data between treatment groups. RESULTS: During gait, ASLS-treated patients applied more load on the operated limb (17-38% stance, p = 0.015) and consequently loaded limbs more symmetrically (8-37% stance, p = 0.008) during the loading response at 6 weeks post-surgery compared to conventional IM treatment. Discrete measures of symmetry at the same time point identified treatment-based differences in maximal force (p = 0.039) and impulse (p = 0.012), with ASLS-treated patients exhibiting more symmetry. No differences were identified in gait trials at later time points nor from all standing trials. SIGNIFICANCE: During the initial loading response of gait, increased ipsilateral vGRF and improved weightbearing symmetry were identified in ASLS patients at 6 weeks post-surgery compared to conventional IM nailing. Early and objective metrics of dynamic movement are suggested to identify treatment-based differences in functional recovery.

Perinatal mental health counselling programme: A scoping review.

OBJECTIVE: To map the evidence on a Perinatal Mental Health Counselling Programme, identifying its characteristics, participants, and outcomes. METHODS: This review followed the guidelines of the Joanna Briggs Institute and PRISMA-ScR. Published and unpublished studies, from 2011 to 2021, written in English, Portuguese or Spanish were included. RESULTS: Despite the high number of articles identified, only nine articles were included in the final analysis, mainly from Iran, Italy and one Portuguese study. All articles referred to community health care centres and hospitals. The sessions varied between 6 and 16 and lasted 30-90 min. The method used was either individual and/or group, with weekly or monthly sessions or whenever deemed necessary throughout the evaluation. Different techniques were found, but emotional management, problem-solving, relaxation and mindfulness techniques were highlighted. Participants are pregnant women, partners, or family members. All articles suggest a decrease in the levels of stress, anxiety, and depression after the counselling intervention. CONCLUSION: Perinatal counselling programme have varied characteristics and mental health nurses are potential facilitators.

Follow-up da turma piloto do Programa Promotor de Saúde Mental Positiva em adolescentes - O Brilho da Mente / Follow-up of the pilot class of the Positive Mental Health Promoter Program in adolescents - The Brightness of the Mind

Resumo Contexto: Tendo por base os estudos do Modelo Multifatorial Teresa Lluch (1999), foi criado e validado um Programa Promotor Saúde Mental Positiva (SM+) para adolescentes e aplicado numa turma piloto. Após 3 meses do final do programa, procedeu-se ao follow-up na mesma turma, dando origem a novos dados. O trabalho integra-se Projeto Saúde Mental Positiva: CINTESIS/NursID: Centro de Investigação em Tecnologias e Serviços de Saúde/ Escola Superior de Enfermagem do Porto. Objetivo(s): Avaliar o impacto do programa de SM+ em adolescentes após 3 meses do seu término, analisar a eficácia do programa SM+ na promoção da saúde mental dos adolescentes em ambiente escolar e avaliar a vulnerabilidade psicológica dos adolescentes. Métodos: Estudo quantitativo, observacional-descritivo e longitudinal. A amostra foi constituída por 23 alunos com idades entre os 14-16 anos, e como instrumento foi aplicado novamente Escala de Vulnerabilidade Psicológica (EVP) e o Questionário de Saúde Mental Positiva (QSM+). Resultados: Antes do programa o QSM+ da turma era de 94,35, após programa passou a 92,61. Após 3 meses, QSM+ passou para 91,17. Cotações baixas no QSM+ correspondem a níveis mais elevados de SMP, variando entre 39 e 156. Na EVP registou-se alterações, passando de 14,26 após o programa para 15,39 no follow-up. Conclusões: Apesar das diferenças observadas não terem significado estatístico, que nos permita afirmar que o Programa de SM+ teve eficácia na saúde mental dos adolescentes e na sua vulnerabilidade psicológica, foram observadas mudanças a nível comportamental, com maior interajuda entre eles, melhor comunicação e mais ativos nas atividades escolares.

Abstract Background: Based on studies of Teresa Lluch's Multifactorial Model (1999), a Positive Mental Health Promoting Program for adolescents was created and validated and applied to a pilot class. Three months after the end of the program, we followed up in the same class, giving rise to new data. The work is part of the Positive Mental Health Project of CINTESIS / NursID of the Research Center on Health Technologies and Services and the Porto School of Nursing. Aim: To assess the impact of the positive mental health (PMH) program on adolescents 3 months after its end; analyze the effectiveness of the PMP program in promoting adolescent mental health in the school environment and assess the psychological vulnerability of adolescents. Methods: The study was quantitative, observational, descriptive and longitudinal. The sample consisted of 23 students aged 14 to 16 years, and as instrument was applied again the psychological vulnerability scale and the Positive Mental Health Questionnaire (QSM +). Results: Before the program, the class's QSM + was 94.35, after the program it went to 92.61. After 3 months, the QSM + increased to 91.17. Low quotations on the QSM + correspond to higher levels of SMP, ranging from 39 to 156. In EVP, there were changes, going from 14.26 after the program to 15.39 in the follow-up. Conclusions: Although the observed differences have no statistical significance, which allows us to affirm that the PMP Program was effective in the mental health of adolescents and their psychological vulnerability, changes were observed at the behavioral level, with greater mutual help between them, better communication and more active in school activities.

The Recovery of Weight-Bearing Symmetry After Total Hip Arthroplasty Is Activity-Dependent.

This study aimed to characterize ipsilateral loading and return to weight-bearing symmetry (WBS) in patients undergoing total hip arthroplasty (THA) during activities of daily living (ADLs) using instrumented insoles. A prospective study in 25 THA patients was performed, which included controlled pre- and postoperative follow-ups in a single rehabilitation center of an orthopedic department. Ipsilateral loading and WBS of ADLs were measured with insoles in THA patients and in a healthy control group of 25 participants. Measurements in the THA group were performed at 4 different visits: a week pre-THA, within a week post-THA, 3-6 weeks post-THA, and 6-12 weeks post-THA, whereas the healthy control group was measured once. ADLs included standing comfortably, standing evenly, walking, and sit-to-stand-to-sit (StS) transitions. All ADLs were analyzed using discrete methods, and walking included a time-scale analysis to provide temporal insights in the ipsilateral loading and WBS waveforms. THA patients only improved beyond their pre-surgery levels while standing comfortably (ipsilateral loading and WBS, p < 0.05) and during StS transitions (WBS, p < 0.05). Nevertheless, patients improved upon their ipsilateral loading and WBS deficits observed within a week post-surgery across all investigated ADLs. Ipsilateral loading and WBS of THA patients were comparable to healthy participants at 6-12 weeks post-THA, except for ipsilateral loading during walking (p < 0.05) at the initial and terminal double-leg support period of the stance phase. Taken together, insole measurements allow for the quantification of ipsilateral loading and WBS deficits during ADLs, identifying differences between pre- and postoperative periods, and differentiating THA patients from healthy participants. However, post-THA measurements that lack pre-surgery assessments may not be sensitive to identifying patient-specific improvements in ipsilateral loading and WBS. Moreover, StS transitions and earlier follow-up time points should be considered an important clinical metric of biomechanical recovery after THA.

Ground reaction forces and external hip joint moments predict in vivo hip contact forces during gait.

Younger patients increasingly receive total hip arthroplasty (THA) as therapy for end-stage osteoarthritis. To maintain the long-term success of THA in such patients, avoiding extremely high hip loads, i.e., in vivo hip contact force (HCF), is considered essential. However, in vivo HCFs are difficult to determine and their direct measurement is limited to instrumented joint implants. It remains unclear whether external measurements of ground reaction forces (GRFs), a non-invasive, markerless and clinic-friendly measure can estimate in vivo HCFs. Using data from eight patients with instrumented hip implants, this study determined whether GRF time series data, alone or combined with other scalar variables such as hip joint moments (HJMs) and lean muscle volume (LMV), could predict the resultant HCF (rHCF) impulse using a functional linear modeling approach. Overall, single GRF time series data did not predict in vivo rHCF impulses. However, when GRF time series data were combined with LMV of the gluteus medius or sagittal HJM using a functional linear modeling approach, the in vivo rHCF impulse could be predicted from external measures only. Accordingly, this approach can predict in vivo rHCF impulses, and thus provide patients with useful insight regarding their gait behavior to avoid hip joint overloading.

Intramuscular and intratendinous placenta-derived mesenchymal stromal-like cell treatment of a chronic quadriceps tendon rupture.

BACKGROUND: Quadriceps tendon ruptures (QTRs) are rare but debilitating injuries, often associated with chronic metabolic conditions or long-term steroid treatment. While the surgical treatment for acute QTRs is described thoroughly, no common strategy exists for the often frustrating treatment of chronic, reoccurring QTRs. The pro-angiogenic and immunomodulatory properties of placenta-derived adherent mesenchymal stromal-like (PLX-PAD) cells have been described to protect musculoskeletal tissues from inflammation and catabolic cytokine migration, yet little is known about the regenerative potential of PLX-PAD cells in repetitively damaged tendon tissue. CASE: We report the case of an 80-year-old male patient with a chronic three-time QTR of his right knee. The quadriceps tendon was reconstructed applying a conventional suture anchor repair procedure combined with a synthetic mesh augmentation and additional intramuscular and intratendineous PLX-PAD cell injections as an individualized treatment approach. No adverse events were reported, and excellent radiological and functional outcomes with a passive range of motion of 0/0/120° knee extension-flexion were observed at the 12 month follow-up. Gait analysis confirmed restoration of joint motion, including gait speed, deficit in step length, and knee extensor muscle strength (pre-surgery: 0.98 m/s, 40 cm, 42.4 ± 12.4 N; 9 months post-surgery: 1.07 m/s, 0 cm, 10.4 ± 18.9 N) as well as hyperextension throughout stance and late swing phases (pre-surgery: -11.2 ± 0.9°; 9 months post-surgery: -2.7 ± 1.6°). Postoperative lymphocyte and cytokine analyses from the patient's peripheral blood serum suggested a systemic short-term immunoregulatory reaction with postoperatively increased interleukin (IL)-6 (pre-surgery: 0.79 pg/mL; day 1: 139.97 pg/mL; day 5: 5.58 pg/mL; 9 months: 1.76 pg/mL) and IL-10 (pre-surgery: 0.9 pg/mL; day 1: 1.21 pg/ mL; day 5: 0.3 pg/mL; 9 months: 0.34 pg/mL) levels that decreased again over time. CONCLUSIONS: Herein, we demonstrate a successfully treated chronic QTR with a synergistic surgical and biological reconstructive treatment approach. This local add-on treatment with PLX-PAD cells may be considered in specific cases of chronic QTRs, not susceptible to traditional suture anchor procedures and which exhibit a high risk of treatment failure. Further scientific engagement is warranted to explore underlying immunomodulatory mechanisms of action behind PLX-PAD cell treatment for tendon injuries.

Encapsulation with Natural Polymers to Improve the Properties of Biostimulants in Agriculture.

Encapsulation in agriculture today is practically focused on agrochemicals such as pesticides, herbicides, fungicides, or fertilizers to enhance the protective or nutritive aspects of the entrapped active ingredients. However, one of the most promising and environmentally friendly technologies, biostimulants, is hardly explored in this field. Encapsulation of biostimulants could indeed be an excellent means of counteracting the problems posed by their nature: they are easily biodegradable, and most of them run off through the soil, losing most of the compounds, thus becoming inaccessible to plants. In this respect, encapsulation seems to be a practical and profitable way to increase the stability and durability of biostimulants under field conditions. This review paper aims to provide researchers working on plant biostimulants with a quick overview of how to get started with encapsulation. Here we describe different techniques and offer protocols and suggestions for introduction to polymer science to improve the properties of biostimulants for future agricultural applications.

Patient Safety in Dental Practice: Lessons to Learn About the Risks and Limits of Professional Liability.

INTRODUCTION: Health professionals should work with the notion of risk involved in the health care process. Dental practice risk is of particular interest because it encompasses both aesthetic and functional components. Focusing on guidelines suggested by the World Health Organization and objectives on patient safety, this study has 2 objectives: to present Portuguese medicolegal data on corporal damage evaluation related to iatrogenic sequelae during dental practice and to present updated evidence on patient safety. MATERIALS AND METHODS: A retrospective study was performed by analysing data from the database of the Laboratory of Forensic Dentistry of the Faculty of Medicine, University of Coimbra, Portugal, from 2013 to 2018. RESULTS: One hundred seven medicolegal files were selected according to the inclusion and exclusion criteria. Iatrogenic sequelae (73.8%, 79 out of 107) were categorised as risks (60 out of 79) and malpractice (19 out of 79). The risk was associated mostly with mandibular dysfunction and orthodontic treatment (62.2%). Malpractice was mostly associated with neurological deficit and implant rehabilitation (47.4%). DISCUSSION AND CONCLUSION: Greater attention to these data by professionals was emphasised, especially when considering patient safety and health care quality. This article presents the Portuguese data on professional liability in the field of dental practice, categorising iatrogenic sequelae into risks and malpractice, as well as the oral rehabilitation procedure and timeline.

Seminal features and reproductive index of Thai tilapia (Oreochromis sp. )on different reproductive periods

Learning about the biology of the species is essential to the success of intensive farming. This study aimed to evaluate the semen of Thai tilapia during the four seasons of the year and thereby analyze their reproductive indices. Thus, 60 breeding males of Tilapia were used and were randomly divided into four water tanks and fed with isoproteic and isocaloric feed. The experiment lasted 12 months, starting from October 2014 and ending on September 2015. Thus, it was possible to collect sperm material of animals during the four seasons, twice a month, as well as to evaluate the water quality parameters in the tanks (temperature, pH and dissolved oxygen). The semen was evaluated from a light microscope in an increase of 100 x, then was activated with water. Motility was measured subjectively in the light microscope, as well as the percentage of sperm showing progressive motility. The duration was evaluated with the addition of a timer. For analysis of the morphology of the semen, the test consisted of morphopathology observation of 100 sperm focused in various fields throughout the slide in the light microscope. Once obtained, these data were analyzed through ANOVA and Tukey test as post-hoc analysis, with the help of the software R Statistics. Water quality factors (temperature, pH and2dissolved) were acceptable and during the 12 month period the sperm of tilapia (Oreochromis sp.) had a good ability for fertilization, seen that it performed below the averageof the percentage of critical abnormalities, and quality was perceived by the parameters that also influence fertilization (motility rate, duration of motility and vigor).

Quantifying Asymmetry in Gait: The Weighted Universal Symmetry Index to Evaluate 3D Ground Reaction Forces.

Though gait asymmetry is used as a metric of functional recovery in clinical rehabilitation, there is no consensus on an ideal method for its evaluation. Various methods have been proposed to analyze single bilateral signals but are limited in scope, as they can often use only positive signals or discrete values extracted from time-scale data as input. By defining five symmetry axioms, a framework for benchmarking existing methods was established and a new method was described here for the first time: the weighted universal symmetry index (wUSI), which overcomes limitations of other methods. Both existing methods and the wUSI were mathematically compared to each other and in respect to their ability to fulfill the proposed symmetry axioms. Eligible methods that fulfilled these axioms were then applied using both discrete and continuous approaches to ground reaction force (GRF) data collected from healthy gait, both with and without artificially induced asymmetry using a single instrumented elbow crutch. The wUSI with a continuous approach was the only symmetry method capable of identifying GRF asymmetry differences in different walking conditions in all three planes of motion. When used with a continuous approach, the wUSI method was able to detect asymmetries while avoiding artificial inflation, a common problem reported in other methods. In conclusion, the wUSI is proposed as a universal method to quantify three-dimensional GRF asymmetries, which may also be expanded to other biomechanical signals.

Criação e validação de um programa promotor de saúde mental positiva em adolescentes / Creation and validation of a program promoter of positive mental health in adolescents

Introduction: The WHO estimates that at least 20% of children and adolescents have at least one mental disorder before reaching the age of 18 years. (PNSE, 2015) Based on the studies of the Multifactorial Model of Teresa Lluch (1999), it was proposed for the present study the conception and validation of a positive mental health promotion program in the field of mental health nursing directed to adolescents who attend the 3rd cycle of studies. Objectives: Elaborate a positive mental health nursing program based on the Multifactorial Model of Teresa Lluch; Implement a positive mental health program within the framework of the primary health care services portfolio, in response to the guidelines of the national school health program (PNSE, 2015); to analyse the effectiveness of the positive mental health program in promoting adolescents' mental health in a school environment; to evaluate the positive mental health levels of adolescents in school settings. Methodology: Mixed, quasi-experimental (through a pilot study) and also observational-descriptive cross-sectional study focused on a Focus Group was chosen. Results: In the pilot group the mean positive mental health questionnaire pre-program, was 94.35, post-program had a decrease, and was at 92.61. Conclusions: Program implementation improved participants' positive mental health. Knowing that mental health is worked on the basis of continuity, it is believed that the time factor was limiting in this study. It would have been an added value to carry out a follow-up at the end of the academic year to analyse positive mental health questionnaire

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Healthcare Workers: Occupational Health Promotion and Patient Safety.

The purpose of the present study was to explore the relation of work-related risk factors and well-being among healthcare workers and the impact on patient safety, using the Health and Work Survey (INSAT) and Mental Health Continuum - Short Form (MHC-SF). A sample of 361 Portuguese healthcare workers participated in this study. The results indicate some significant work-related risk factors: for emotional well-being, Impossible to express myself (ß = -0.977), Not having recognition by superiors (ß = -1.028) and Have to simulate good mood and/or empathy (ß = -1.007); for social well-being, Exposed to the risk of sexual discrimination (ß = -2.088), Career progress is almost impossible (ß = -1.518), and Have to hide my emotions (ß = -2.307); finally for psychological well-being Exposed to the risk of sexual discrimination (ß = -2.153), Career progress is almost impossible (ß = -1.377), and Have to simulate good mood and/or empathy (ß = -3.201). The results showed high levels of well-being despite the exposure of several risk factors at workplace. Regarding the work-related risk factors, the study showed that most of the participants are exposed to several risk factors at workplace (ranging from environmental risk factors, biological to physical), although psychosocial risk factors (work relations with superiors and colleagues, employment relations, and emotional demands) are the ones that most impact on well-being.

Childhood abuse and reduced cortical thickness in brain regions involved in emotional processing.

BACKGROUND: Alterations in gray matter development represent a potential pathway through which childhood abuse is associated with psychopathology. Several prior studies find reduced volume and thickness of prefrontal (PFC) and temporal cortex regions in abused compared with nonabused adolescents, although most prior research is based on adults and volume-based measures. This study tests the hypothesis that child abuse, independent of parental education, predicts reduced cortical thickness in prefrontal and temporal cortices as well as reduced gray mater volume (GMV) in subcortical regions during adolescence. METHODS: Structural MRI scans were obtained from 21 adolescents exposed to physical and/or sexual abuse and 37 nonabused adolescents (ages 13-20). Abuse was operationalized using dichotomous and continuous measures. We examined associations between abuse and brain structure in several a priori-defined regions, controlling for parental education, age, sex, race, and total brain volume for subcortical GMV. Significance was evaluated at p < .05 with a false discovery rate correction. RESULTS: Child abuse exposure and severity were associated with reduced thickness in ventromedial prefrontal cortex (PFC), right lateral orbitofrontal cortex, right inferior frontal gyrus, bilateral parahippocampal gyrus (PHG), left temporal pole, and bilateral inferior, right middle, and right superior temporal gyri. Neither abuse measure predicted cortical surface area or subcortical GMV. Bilateral PHG thickness was inversely related to externalizing symptoms. CONCLUSIONS: Child abuse, an experience characterized by a high degree of threat, is associated with reduced cortical thickness in ventromedial and ventrolateral PFC and medial and lateral temporal cortex in adolescence. Reduced PHG thickness may be a mediator linking abuse with externalizing psychopathology, although prospective research is needed to evaluate this possibility.

A computed tomographic, mixed dentition, space analysis comparison.

INTRODUCTION: A considered space analysis aims to predict the combined mesiodistal widths of unerupted permanent canine and premolars. A miscalculation can lead to the application of inadequate and irreversible treatments. OBJECTIVE: To assess the level of agreement between predictions generated by three methods (Moyers' predictive tables at the 50th and 75th percentiles and Tanaka-Johnston's equations) on the sum of unerupted teeth compared with measurements derived from cone beam computed tomography, considered in the present study as a 'gold standard'. MATERIALS AND METHODS: The study sample was comprised of children (N = 26) aged 8-13 who visited the Department of Dentistry. Moyers' predictive tables and the Tanaka-Johnston equation were applied to ascertain the space requirements. Cone beam computed tomography was performed on each patient and the volumetric data analysed. A concordance correlation coefficient between each method's predictions was applied. RESULTS: The three methods tended to overestimate the cone beam computed tomography readings and were not able to entirely capture the variability of the sum of the unerupted teeth. Moyers' 50th percentile estimate revealed a more balanced distribution between over- and underestimation. CONCLUSION: The present study suggested that Moyers' 50th percentile is the predictive method with the lowest absolute error and is preferred for clinical use.

Child Maltreatment and Neural Systems Underlying Emotion Regulation.

OBJECTIVE: The strong associations between child maltreatment and psychopathology have generated interest in identifying neurodevelopmental processes that are disrupted following maltreatment. Previous research has focused largely on neural response to negative facial emotion. We determined whether child maltreatment was associated with neural responses during passive viewing of negative and positive emotional stimuli and effortful attempts to regulate emotional responses. METHOD: A total of 42 adolescents aged 13 to 19 years, half with exposure to physical and/or sexual abuse, participated. Blood oxygen level-dependent (BOLD) response was measured during passive viewing of negative and positive emotional stimuli and attempts to modulate emotional responses using cognitive reappraisal. RESULTS: Maltreated adolescents exhibited heightened response in multiple nodes of the salience network, including amygdala, putamen, and anterior insula, to negative relative to neutral stimuli. During attempts to decrease responses to negative stimuli relative to passive viewing, maltreatment was associated with greater recruitment of superior frontal gyrus, dorsal anterior cingulate cortex, and frontal pole; adolescents with and without maltreatment down-regulated amygdala response to a similar degree. No associations were observed between maltreatment and neural response to positive emotional stimuli during passive viewing or effortful regulation. CONCLUSION: Child maltreatment heightens the salience of negative emotional stimuli. Although maltreated adolescents modulate amygdala responses to negative cues to a degree similar to that of non-maltreated youths, they use regions involved in effortful control to a greater degree to do so, potentially because greater effort is required to modulate heightened amygdala responses. These findings are promising, given the centrality of cognitive restructuring in trauma-focused treatments for children.

Child maltreatment and autonomic nervous system reactivity: identifying dysregulated stress reactivity patterns by using the biopsychosocial model of challenge and threat.

OBJECTIVE: Disruptions in stress response system development have been posited as mechanisms linking child maltreatment (CM) to psychopathology. Existing theories predict elevated sympathetic nervous system reactivity after CM, but evidence for this is inconsistent. We present a novel framework for conceptualizing stress reactivity after CM that uses the biopsychosocial model of challenge and threat. We predicted that in the context of a social-evaluative stressor, maltreated adolescents would exhibit a threat pattern of reactivity, involving sympathetic nervous system activation paired with elevated vascular resistance and blunted cardiac output (CO) reactivity. METHODS: A sample of 168 adolescents (mean age =14.9 years) participated. Recruitment targeted maltreated adolescents; 38.2% were maltreated. Electrocardiogram, impedance cardiography, and blood pressure were acquired at rest and during an evaluated social stressor (Trier Social Stress Test). Pre-ejection period (PEP), CO, and total peripheral resistance reactivity were computed during task preparation, speech delivery, and verbal mental arithmetic. Internalizing and externalizing symptoms were assessed. RESULTS: Maltreatment was unrelated to PEP reactivity during preparation or speech, but maltreated adolescents had reduced PEP reactivity during math. Maltreatment exposure (F(1,145) = 3.8-9.4, p = .053-<.001) and severity (ß = -0.10-0.12, p = .030-.007) were associated with significantly reduced CO reactivity during all components of the stress task and marginally associated with elevated total peripheral resistance reactivity (F(1,145) = 3.8-9.4; p = .053-<.001 [ß = 0.07-0.11] and p = .11-.009, respectively). Threat reactivity was positively associated with externalizing symptoms. CONCLUSIONS: CM is associated with a dysregulated pattern of physiological reactivity consistent with theoretical conceptualizations of threat but not previously examined in relation to maltreatment, suggesting a more nuanced pattern of stress reactivity than predicted by current theoretical models.

Amygdala response to negative stimuli predicts PTSD symptom onset following a terrorist attack.

OBJECTIVE: Individuals with posttraumatic stress disorder (PTSD) exhibit heightened amygdala reactivity and atypical activation patterns in the medial prefrontal cortex (mPFC) in response to negative emotional information. It is unknown whether these aspects of neural function are risk factors for PTSD or consequences of either trauma exposure or onset of the disorder. We had a unique opportunity to investigate this issue following the terrorist attacks at the 2013 Boston Marathon and the ensuing manhunt and shelter in place order. We examined associations of neural function measured prior to the attack with PTSD symptom onset related to these events. METHODS: A sample of 15 adolescents (mean age = 16.5 years) who previously participated in a neuroimaging study completed a survey assessing posttraumatic symptoms related to the terrorist attack. We examined blood oxygen level dependent (BOLD) response to viewing and actively down-regulating emotional responses to negative stimuli in regions previously associated with PTSD, including the amygdala, hippocampus, and mPFC, as prospective predictors of posttraumatic symptom onset. RESULTS: Increased BOLD signal to negative emotional stimuli in the left amygdala was strongly associated with posttraumatic symptoms following the attack. Reduced bilateral hippocampal activation during effortful attempts to down-regulate emotional responses to negative stimuli was also associated with greater posttraumatic symptoms. Associations of amygdala reactivity with posttraumatic symptoms were robust to controls for pre-existing depression, anxiety, and PTSD symptoms and prior exposure to violence. CONCLUSIONS: Amygdala reactivity to negative emotional information might represent a neurobiological marker of vulnerability to traumatic stress and, potentially, a risk factor for PTSD.

Vagal regulation and internalizing psychopathology among adolescents exposed to childhood adversity.

Childhood adversity (CA) is strongly associated with youth psychopathology. Identifying factors that reduce vulnerability following CA is critical for developing preventive interventions. Vagal tone and vagal reactivity following psychosocial stressors might influence psychopathology among youths exposed to CA. We acquired heart period and impedance cardiography data to calculate respiratory sinus arrhythmia (RSA) and preejection period (PEP) from 157 adolescents aged 13-17 years at rest and during the Trier Social Stress Test (TSST). Internalizing and externalizing symptoms and multiple forms of CA were assessed. Resting RSA and RSA reactivity interacted with CA in predicting internalizing but not externalizing psychopathology; CA was unassociated with internalizing problems in adolescents with high resting RSA and RSA reactivity. No interactions were observed with PEP. High resting RSA predicted greater vagal rebound and accelerated heart rate recovery following the TSST, highlighting one potential mechanism underlying low internalizing symptoms following CA among youths with high vagal tone.