[Parental experiences of distance schooling during the COVID-19 pandemic: Effects on children with and without mental health problems]. / Ouders over afstandsonderwijs door COVID-19: effecten op kinderen met en zonder psychische problemen.

BACKGROUND: In some lockdowns during the COVID-19 pandemic in 2020 and 2021, schools were closed and children attended distance learning. AIM: To investigate parental experiences of the effects of distance learning on the wellbeing of child and parent(s), and whether this differed between children with and without mental health problems and their parents. METHOD: Parents of children with (n = 192) and without (n = 271) mental health problems reported their experiences with distance learning. We investigated whether experiences differed between groups of parents, and whether experiences were influenced by characteristics of parents. RESULTS: Parents of children with mental health problems reported the quality of distance learning and the ability of their child to participate as lower relative to other parents. These differences increased when parents themselves were in higher need of support. General experiences and the levels of stress reported by parents did not differ between groups. Parents reported an increase in their child’s digital media use, particularly for children with mental health problems. CONCLUSION: Children with mental health problems seem more negatively affected by distance learning, especially when parents have problems themselves. These findings are in line with multiple recent studies and argue for minimizing distance learning.

Neuropsychological deficits in adults age 60 and above with attention deficit hyperactivity disorder.

OBJECTIVE: Neuropsychological deficits are of major importance in ADHD, yet no previous studies have assessed clinically referred samples of older adults. The authors compared older adults with ADHD (60-75years) with both younger adults with ADHD (18-45years) and older healthy controls with regard to various neuropsychological deficits. METHODS: Well-established tests were used to investigate working memory, inhibition, switching, planning, fluency, and speed of processing. Self-ratings of executive functioning and delay-related behaviors were also included. Both variable-oriented and person-oriented analyses were conducted. RESULTS: Older adults with ADHD differed from controls with regard to working memory, inhibition, switching, and delay-related behaviors. In comparison to younger adults with ADHD, they performed at a similar level with regard to working memory and planning, but significantly better with regard to inhibition, switching, fluency, speed of processing, and delay aversion. Despite several significant group differences relative to controls, person-oriented analyses demonstrated that a majority of older adults with ADHD performed within the average range on each test and 20% showed no clear deficit within any neuropsychological domain. CONCLUSIONS: The results are in line with models of heterogeneity that have identified different neuropsychological subtypes in ADHD as well as a subgroup of patients without any clear neuropsychological deficits. For older adults with ADHD, it will be important to assess their functioning across time as normal aging is related to memory decline and these patients could therefore end up with severe deficits as they grow older, which in turn could have serious negative effects on daily life functioning.

Stress responses to repeated exposure to a combined physical and social evaluative laboratory stressor in young healthy males.

Repeated exposure to homotypic laboratory psychosocial stressors typically instigates rapid habituation in hypothalamic-pituitary-adrenal (HPA) axis-mediated stress responses in humans. However, emerging evidence suggests the combination of physical stress and social evaluative threat may be sufficient to attenuate this response habituation. Neuroendocrine, cardiovascular and subjective stress responses following repeated exposure to a combined physical and social evaluative stress protocol were assessed to examine the habituation response dynamic in this context. The speech task of the Trier social stress test (TSST; Kirschbaum et al., 1993) and the socially evaluated cold pressor task (SECPT; Schwabe et al., 2008) were administered in a combined stressor protocol. Salivary cortisol, cardiovascular and subjective stress responses to a non-stress control and repeat stressor exposure separated by six weeks were examined in males (N=24) in a crossover manner. Stressor exposure resulted in significant elevations in all stress parameters. In contrast to the commonly reported habituation in cortisol response, a comparable post-stress response was demonstrated. Cortisol, heart rate and subjective stress responses were also characterised by a heightened response in anticipation to repeated stress exposure. Blood pressure responses were comparatively uniform across repeated exposures. Findings suggest a combined physical and social evaluative stressor is a potentially useful method for study designs that require repeated presentation of a homotypic stressor.

Deficient habituation to repeated rectal distensions in irritable bowel syndrome patients with visceral hypersensitivity.

BACKGROUND: Irritable bowel syndrome (IBS) patients show evidence of altered central processing of visceral signals. One of the proposed alterations in sensory processing is an altered engagement of endogenous pain modulation mechanisms. The aim was to test the hypothesis that IBS patients with (IBS-S) and without visceral hypersensitivity (IBS-N) differ in their ability to engage endogenous pain modulation mechanism during habituation to repeated visceral stimuli. METHODS: Brain blood oxygen level dependent (BOLD) response was measured during repeated rectal distension and its anticipation in 33 IBS patients with and without visceral hypersensitivity and 18 healthy controls (HCs). BOLD response to early and late phase of the distension series was compared within and between groups. KEY RESULTS: While BOLD response was similar during the early phase of the experiment, IBS-S showed greater BOLD response than IBS-N and HCs during the late phase of the distension series. IBS-S showed increasing BOLD response both to the anticipation and delivery of low intensity rectal distensions in brain regions including insula, anterior and mid cingulate cortex. IBS-N showed decreasing BOLD response to repeated rectal distensions in brain regions including insula, prefrontal cortex and amygdala. CONCLUSIONS & INFERENCES: These findings are consistent with compromised ability of IBS-S to respond to repeated delivery of rectal stimuli, both in terms of sensitization of sensory pathways and habituation of emotional arousal. The fact that both IBS subgroups met Rome criteria, and did not differ in terms of reported symptom severity demonstrates that similar symptom patterns can result from different underlying neurobiological mechanisms.

Variability of total and free IgE levels and IgE receptor expression in allergic subjects in and out of pollen season.

The inter- and intra-individual variability and seasonal variation of IgE, and high (FcεRI)- and low-affinity (CD23) IgE receptor expression in blood of seasonal allergic rhinitis (SAR) subjects, is not well studied. Thirty-two otherwise healthy subjects with a history of SAR to birch pollen and a positive skin prick test to birch pollen were sampled three times out of the pollen season and three times during the pollen season. FcεRI and CD23 expressions were analysed using flow cytometry. Total IgE was analysed using ImmunoCAP(®) and free IgE was analysed with a novel customised research assay using an IgG-FcεRI-chimera protein coupled to ImmunoCAP as capture reagent, ImmunoCAP-specific IgE conjugate and ImmunoCAP IgE calibrators. The performance of the free IgE assay was compared well with the reference ImmunoCAP total IgE assay. The working range of the assay was 0.35-200 kU/l IgE. FcεRI expression on basophils and CD23 expression on B cells showed low intrasubject variability both in and out of the pollen season (<10% CV). There was a small seasonal difference with lower total IgE levels (120 versus 128 kU/l; P = 0.004) and FcεRI expression (283 versus 325 mean fluorescence intensity (MFI); P < 0.001) during the pollen season. IgE, FcεRI expression and CD23 expression fulfilled biomarker and assay requirements of variability, and allergen exposure affected the biomarkers only to a minor degree. The free IgE assay may be used for measurement of free IgE levels in patients after anti-IgE antibody treatment.

Electrodermal hyporeactivity as a trait marker for suicidal propensity in uni- and bipolar depression.

BACKGROUND: A meta-analysis of studies investigating electrodermal activity in depressed patients, suggested that electrodermal hyporeactivity is sensitive and specific for suicide. AIMS: To confirm this finding and to study electrodermal hyporeactivity relative to type and severity of depression, trait anxiety, its stability and independence of depressive state. METHOD: Depressed inpatients (n = 783) were tested for habituation of electrodermal responses and clinically assessed using the Beck Depression Inventory (BDI) and the STAI-Trait scale for trait anxiety. RESULTS: The high sensitivity and raw specificity of electrodermal hyporeactivity for suicide were confirmed. Its prevalence was highest in bipolar disorders and was independent of severity of depression, trait anxiety, gender and age. Hyporeactivity was stable, while reactivity changed into hyporeactivity in a later depressive episode. CONCLUSIONS: The findings support the hypothesis that electrodermal hyporeactivity is a trait marker for suicidal propensity in depression.

Valid electrodermal hyporeactivity for depressive suicidal propensity offers links to cognitive theory.

OBJECTIVE: Studies from three independent laboratories report varying relationships between electrodermal hyporeactivity and suicidal behavior in depressed patients. The aims of this study were to explain that variation, to assess the discriminative validity of electrodermal hyporeactivity for suicide and suicide attempts and to suggest a tentative explanation model. METHOD: A meta-analysis was performed of 279 depressed patients and 59 healthy subjects. RESULTS: The sensitivity was 96.6% and specificity 92.9% of electrodermal hyporeactivity for suicide and 83.3% and 92.7%, respectively, for suicide and/or violent attempts. The shares of hyporeactives were strongly significantly and greatly larger in high than in low suicidal propensity groups, P-value ranging from 4.7 x 10(-8) to 1.1 x 10(-14). CONCLUSION: The high discriminative validity and the emerging links over a proposed interest-limiting precognitive set to cognitive theory of suicide encourage clinical application of tests of electrodermal reactivity. The study offers a series of testable hypotheses constituting a new platform for suicidological research in depression.

Graphometric variables of one's signature: II. Correlations with measures of perception, cognitive function, and personality.

This study focused on interrelations between graphometric variables of the signature and measures of perception, cognitive function, and personality. Signatures from a sample of psychiatric and somatic outpatients (N = 205) were analyzed into 23 graphometric variables and correlated with tests of IQ, cognitive and perceptual function, and personality. The results of a factor analysis of the graphometric, perceptual, and cognitive variables were very much like results from previous studies. Relationships with the graphometric variables can be described in five categories of intelligence, psychomotility, flexibility and speed of closure, and personality. Graphometric signs of Extraversion and Neuroticism were identified, and the two capitals in the signature indicated different psychological meanings. Measurements of the signature offered important personality information.

Behaviour problems and social competence deficits associated with symptoms of attention-deficit/hyperactivity disorder: effects of age and gender.

BACKGROUND: Previous research has shown that children with high levels of attention-deficit/hyperactivity disorder (ADHD) symptoms often have a wide variety of associated behaviour problems. However, relatively little is known regarding to what extent these associated behaviour problems are present to the same degree in younger as well as older children and in girls as well as in boys. METHODS: This study used parent ratings to examine effects of age and gender on behaviour problems, social competence, negative impact on everyday life, and family burden among pre-school and school-aged children high in ADHD symptoms (n=60) and comparison children (n=499). RESULTS: With regard to age, the pre-school children did not differ from the school-aged children on any of the different types of problem behaviour or with regard to social competence. The interactions between age and group were not significant. The behaviour problems of older children did, however, have more negative impact on the child's daily life and induced higher levels of family burden compared with problems of younger children, especially among children with high levels of ADHD symptoms. Boys were more severely affected than girls with regard to ADHD symptom severity, most associated problem behaviours, as well as negative impact and family burden. Significant interactions of ADHD symptoms and gender were also found, which indicated that gender differences were primarily found among children with high levels of ADHD symptoms. CONCLUSIONS: Children with high levels of ADHD symptoms have many associated behaviour problems, even in pre-school years, and boys with high levels of ADHD symptoms are more severely affected compared with girls.

Sympathetic (electrodermal) activity during repeated maximal rectal distensions in patients with irritable bowel syndrome and constipation.

Irritable bowel syndrome (IBS) is associated with visceral hypersensitivity, stress and autonomic dysfunction. Sympathetic activity during repeated events indicates excitatory or inhibitory mechanisms such as sensitization or habituation. We investigated skin conductance (SC) during repetitive rectal distensions at maximal tolerable pressure in patients with IBS and chronic constipation. Twenty-seven IBS patients, 13 constipation patients and 18 controls underwent two sets of isobaric rectal distensions. First, maximal tolerable distension was determined and then it was repeated five times. Skin conductance was measured continuously. Subjective symptom assessment remained steady in all groups. The baseline values of SC were higher in IBS patients than in patients with constipation and significantly lower in constipation patients than in controls. The maximal SC response to repetitive maximal distensions was higher in IBS patients compared with constipation patients. The amplitude of the initial SC response decreased successively with increased number of distensions in patients with IBS and constipation but not in controls. Irritable bowel syndrome and constipation patients habituated to maximal repetitive rectal distensions with decreasing sympathetic activity. Irritable bowel syndrome patients had higher sympathetic reactivity and baseline activity than constipation patients. A lower basal SC in constipation patients compared with controls suggests an inhibition of the sympathetic drive in constipation patients.

Graphometric variables of one's signature: I. Basic measures.

This study focused on statistical properties and interrelationships of graphometric variables of the signatures of outpatients, 100 men and 119 women, remitted from somatic and psychiatric clinics for possible psychotherapy or for tests of IQ, personality, or brain lesions. The patients' signature on test forms were used. The type of handwriting was classified into Common, Print and Block letters, quantified in breadth, length, and area and grades of slant of minuscules ("lower-case letters") and majuscules ("upper-case"). Analysis indicated sex and age played roles in style of handwriting and size of letters; writing styles differed on most graphometric variables; and meaningful patterns of interrelationships among graphometric variables were specified by factor analysis.

Pre-experimental stress in patients with irritable bowel syndrome: high cortisol values already before symptom provocation with rectal distensions.

Stress is known to affect symptoms of irritable bowel syndrome (IBS) probably by an alteration of visceral sensitivity. We studied the impact of maximal tolerable rectal distensions on cortisol levels in patients with IBS, chronic constipation and controls, and evaluated the effect of the experimental situation per se. In twenty-four IBS patients, eight patients with chronic constipation and 15 controls salivary cortisol was measured before and after repetitive maximal tolerable rectal balloon distensions and at similar times in their usual environment. Rectal sensitivity thresholds were determined. IBS patients but not controls and constipation patients had higher cortisol levels both before and after the experiment compared with similar times on an ordinary day in their usual environment (P = 0.0034 and 0.0002). There was no difference in salivary cortisol level before compared with after rectal distensions. The IBS patients had significantly lower thresholds for first sensation, urge and maximal tolerable distension than controls (P = 0.0247, 0.0001 and <0.0001) and for urge and maximal tolerable distension than patients with constipation (P = 0.006 and 0.013). IBS patients may be more sensitive to expectancy stress than controls and patients with constipation according to salivary cortisol. Rectal distensions were not associated with a further significant increase in cortisol levels.

Inner images and delineations of parental figures reported by psychotherapeutic outpatients.

Psychotherapeutic outpatients (10 men, 20 women) were tested with the Inner Images of Parental Figures. Each subject imagined first his mother and then his father. Questions were asked about size, look, and spatial and emotional distance of the imagined parent. The patient was then asked to describe the personality of each parent by underlining at least 20 of 85 adjectives in a list called Family Climate Scale. This originally consisted of four factors, Closeness, Spontaneity, Distance, and Chaos, but the two administered were Factor I (positive traits) and Factor II (negative traits). Emotional distance correlated positively with Factor I and negatively with Factor II. For the maternal figure there was a correlation with distance in metres and Factor I scores. The Inner Images of Parental Figures may be a valuable complement in psychotherapy, mapping out emotional relations between patients and their parents.

Hepatic encephalopathy verified by psychometric testing and EEG in cirrhotic patients: effects of mesocaval interposition shunt or sclerotherapy.

BACKGROUND: The aim of this randomised prospective study was to evaluate hepatic encephalopathy after mesocaval interposition shunt operation and after repeated endoscopic sclerotherapy. METHODS: Forty-five patients with bleeding oesophageal varices due to liver cirrhosis were randomised to the two treatment groups, 24 to the shunt group and 21 to the sclerotherapy group. The patients were evaluated preoperatively regarding blood tests, hepatic encephalopathy as measured by electroencephalogram with spectral analysis and by a battery of psychometric tests. The direction of portal flow in the shunt group was investigated by shunt phlebography and ultrasonography with Doppler. During follow-up the same investigations were performed twice at median 6.7 and 14.7 months after operation. RESULTS: No statistically significant difference was found during follow-up regarding blood tests and electroencephalography with spectral analysis. Although the preoperative psychometric tests showed that the shunt group performed significantly better than the sclerotherapy group, the first follow-up showed that the shunt group performed statistically worse than the sclerotherapy group in seven of the tests: Synonyms (measuring verbal ability), Block Design Test (measuring visuo-spatial ability), Memory for Design Test, Error Score (measuring memory function), Revised Visual Retention Test, correct answers and the same test error answers (measuring visuo-spatial memory, ability and immediate memory), Digit Symbol Test (measuring perceptual ability) and Trial Making Test B (measuring cognitive motor abilities). CONCLUSIONS: Patients treated by mesocaval interposition shunt showed a progressive general reduction in psychometric performance compared with patients treated with repeated sclerotherapy, in whom a general intellectual improvement was observed. This finding corresponds to the reverse direction of the preoperative portal flow to a hepatofugal pattern at first follow-up and at 12 months among two-thirds of the patients.

The safe threshold for gluten contamination in gluten-free products. Can trace amounts be accepted in the treatment of coeliac disease?

BACKGROUND: Gluten contamination in gluten-free products cannot totally be avoided. The safe threshold for gluten remains obscure. AIM: The purpose was to estimate a reasonable limit for residual gluten, based on current literature and measurement of gluten in gluten-free products on the market. METHODS: The gluten content of 59 naturally gluten-free and 24 wheat starch-based gluten-free products were analysed by enzyme-linked immunosorbent assay. The daily intake of flours was calculated in 76 adults on gluten-free diet, and the intake compared with mucosal histology. RESULTS: A number of both naturally gluten-free (13 of 59) and wheat starch-based gluten-free (11 of 24) products contained gluten from 20 to 200 ppm (=mg/kg). The median daily flour consumption was 80 g (range: 10-300). Within these limits, the long-term mucosal recovery was good. CONCLUSIONS: The threshold for gluten-contamination can safely be set at 100 ppm. Provided that the daily flour intake is even 300 g, a level of 100 ppm results in 30 mg of gluten intake. This has been shown to be safe, when correlated to histology, in clinical and challenge studies. The level can be achieved by the industry, and does not make the diet too cumbersome.

Salivary cortisol, posttraumatic stress symptoms, and general health in the acute phase and during 9-month follow-up.

BACKGROUND: Because traumatic events are unpredictable, there are few studies of psychobiological states immediately following such events. Our study aimed to determine the relation of salivary cortisol to psychologic distress immediately after a traumatic event and then during follow-up. METHODS: Measurement of morning and evening salivary cortisol and ratings of psychologic distress (using the Impact of Events Scale [IES], the Post Traumatic Symptom Scale, and the General Health Questionnaire) were performed with 31 United Nations soldiers at three time points--5 days and 2 and 9 months--following a mine accident in Lebanon. RESULTS: Five days after the accident, 15 subjects reported substantial posttraumatic distress according to the IES, as well as significantly lower morning and higher evening cortisol levels compared with the low-impact group. Within 9 months, the posttraumatic distress of the high-impact group was reduced, accompanied by an increase in morning and a decrease in evening cortisol levels. There were significant relationships between evening cortisol and all rating scales at the first and third time points. CONCLUSIONS: Subclinical posttraumatic stress following an adverse event can be measured biologically via salivary cortisol levels soon after the event.

Momentary increase in plasma calcitonin gene-related peptide is involved in hot flashes in men treated with castration for carcinoma of the prostate.

PURPOSE: In women the vasodilatory neuropeptides calcitonin gene-related peptide and neuropeptide Y seem to be involved in menopausal hot flashes. We assessed whether plasma calcitonin gene-related peptide and neuropeptide Y change during hot flashes in men after castration. MATERIALS AND METHODS: We evaluated 10 men 61 to 81 years old who underwent castration due to cancer of the prostate and had frequent hot flashes for changes in plasma calcitonin gene-related peptide and neuropeptide Y during 1 day at the outpatient clinic. At least 5 blood samples were obtained between flashes and 4 were obtained during each flash. The samples were analyzed for calcitonin gene-related peptide and neuropeptide Y using radioimmunoassay technique. Hot flashes were objectively recorded by measuring peripheral skin temperature and skin conductance. RESULTS: Plasma calcitonin gene-related peptide increased 46% (95% confidence interval 21 to 71) during flashes in the 6 men in whom it was measurable. This change was statistically significant (p = 0.028). The concentration of neuropeptide Y was below the detection limit. Skin conductance and temperature increased significantly during flashes. CONCLUSIONS: Calcitonin gene-related peptide is involved in the mechanisms of hot flashes in men who underwent castration due to prostate carcinoma. Thus, there may be a similar mechanism of hot flashes in women and in men deprived of sex steroids.

Light treatment of seasonal affective disorder in combination with citalopram or placebo with 1-year follow-up.

This placebo-controlled, double-blind, 1-year pilot study aimed at investigating possible clinical advantages of combining initial light therapy with the selective serotonin reuptake inhibitor (SSRI) citalopram as well as the effects of continuous long-term administration of this drug in patients with seasonal affective disorder (SAD). Eight physically healthy women who met the DSM-III-R criteria for SAD were included in the study. Four women were randomized to the citalopram group receiving 40 mg citalopram daily from the first of 10 light treatment days and throughout the 1-year study. The remaining four women were allocated to the placebo group using the same double-blind repeated measures design. The clinical outcome was measured by using three versions of the Comprehensive Psychopathological Rating Scale (CPRS) and Visual Analog Scales (VAS), respectively. Taking the initial rating scores into account in covariance analyses, no statistically significant group difference was found during the light treatment period. However, during the follow-up period the full version of the CPRS and the self-rating version of CPRS and the VAS-scales for global condition and depressed mood were statistically significantly lower in the citalopram group compared with the placebo group. Thus, in this small but carefully observed sample of SAD-patients combining initial light therapy and long-term citalopram treatment was clinically more effective over time than the placebo combination. Our findings support the notion that light therapy with concomitant and continued SSRI (citalopram) treatment is a useful strategy to achieve beneficial long-term effects in patients with the SAD syndrome.