Fear conditioning, persistence of disruptive behavior and psychopathic traits: an fMRI study.

Children diagnosed with Disruptive Behavior Disorders (DBD), especially those with psychopathic traits, are at risk of developing persistent and severe antisocial behavior. Deficient fear conditioning may be a key mechanism underlying persistence, and has been associated with altered regional brain function in adult antisocial populations. In this study, we investigated the associations between the neural correlates of fear conditioning, persistence of childhood-onset DBD during adolescence and psychopathic traits. From a cohort of children arrested before the age of 12 years, participants who were diagnosed with Oppositional Defiant Disorder or Conduct Disorder in previous waves (mean age of onset 6.5 years, s.d. 3.2) were reassessed at mean age 17.6 years (s.d. 1.4) and categorized as persistent (n=25) or desistent (n=25) DBD. Using the Youth Psychopathic Traits Inventory and functional magnetic resonance imaging during a fear conditioning task, these subgroups were compared with 26 matched healthy controls from the same cohort. Both persistent and desistent DBD subgroups were found to show higher activation in fear processing-related brain areas during fear conditioning compared with healthy controls. In addition, regression analyses revealed that impulsive-irresponsible and grandiose-manipulative psychopathic traits were associated with higher activation, whereas callous-unemotional psychopathic traits were related to lower activation in fear-related areas. Finally, the association between neural activation and DBD subgroup membership was mediated by impulsive-irresponsible psychopathic traits. These results provide evidence for heterogeneity in the neurobiological mechanisms underlying psychopathic traits and antisocial behavior and, as such, underscore the need to develop personalized interventions.

Nursing home aides' work and family connections.

In order to maintain a productive workforce, organizations must acknowledge that many employees, particularly nurse aides, perform full-time care giving, both on and off the job. Competing demands between work and family can affect job performance, quality of care and bring on burnout.

Strategies for improving nursing home care: a research roundtable.

The findings reported here are from a group of researchers identified by the authors for their leadership in the advancement of knowledge about nursing homes as organizations. Three themes were identified from the current research presented at the Roundtable. The first was a recognition of the pervasive which society's conflicting expectations about nursing homes create for those who staff them. The second related to the central, at times unsupervisable, role of non-professional staff. The third theme called attention to the reinforcement power of supervision and leadership in bringing about positive change in care giving staff. These issues and the research described had implications for both policy and practice. While far from a comprehensive treatment of organizational and managerial issues, the observations reported here represent new research interest in nursing homes be considered simple organizations with stable and predictable inputs. The processes of care and the way those processes are implemented vary from one facility to another and, indeed, among nursing units within the same facility. Broadbased practitioner-researcher collaborations are needed to promote usable research on the internal processes of nursing homes. Future collaborations will probably focus on how and why some procedures and structures produce better results for residents and others. Policy makers and administrators will benefit as the tools and methods of organizational research are used to identify the best structures and practices in the nursing home industry. Similarly, the knowledge base of long-term care administration will be enriched by contemporary reconsideration of the structure and processes of nursing homes as organizations.

Assessing nursing assistants' knowledge of behavioral approaches to mental health problems.

Nurse's aides are the primary caregivers in nursing homes, a major receiving site for elders with behavioral and psychiatric problems. We describe the development, psychometric properties, and utility of a brief instrument designed to assess aides' knowledge of three specific mental health problems (depression, agitation, and disorientation) and behavioral approaches to them. The instrument was administered to 191 nurse's aides and 21 clinicians with training in behavioral management and experience with older residents. The nurse's aides averaged 11 of 17 correct answers, and the clinicians averaged 15 of 17 correct answers. Implications for staff training and consultation activities in nursing homes are discussed.

Behavior management training for nurse aides: is it effective?

Nursing assistants are responsible for 80% to 90% of all direct resident care in nursing homes, but are the least well trained personnel. Even with currently mandated training, specific skills to meet mental health needs are not taught. Training in behavior management skills prepares aides to observe and respond to problem behaviors more effectively. Aides view their own use of skills as increased by this training. To be practically useful, mental health training programs for nurse aides should be provided by professional personnel in brief, concrete, self-contained units that model the skills they present.

Traumatismo abdominal cerrado / Blunt abdominal trauma

Se analizó retrospectivamente 50 pacientes operados por contusión abdominal complicada entre enero de 1983 y septiembre de 1987. La mortalidad de los pacientes mayores de 45 años fue de 35,7% en relación a 19,4% para los menores de esta edad. Los pacientes intervenidos entre las 3 y 6 horas de ingreso fueron los de menor mortalidad (13%). Los órganos abdominales más frecuentes lesionados fueron: bazo con 36%, e hígado con 24%. En 58% hubo lesión extraabdominal asociada, en ellos la mortalidad fue de 37,9% y de 4,75% en los sin asociación. La mortalidad global alcanzó 24%

Stress and later-life childbearing: important implications for nursing.

Scientific literature which links advanced maternal age to pregnancy outcome was critically appraised. Little evidence was found to support the pessimistic advice offered to older expectant mothers. Evidence is accumulating which suggests that emotional stress has a deleterious effect on obstetrical outcome, although the manner in which the deleterious effects are produced remains unclear.