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Climate change is an indisputable threat to human health, especially for societies already confronted with rising social inequality, political and economic uncertainty, and a cascade of concurrent environmental challenges. Archaeological data about past climate and environment provide an important source of evidence about the potential challenges humans face and the long-term outcomes of alternative short-term adaptive strategies. Evidence from well-dated archaeological human skeletons and mummified remains speaks directly to patterns of human health over time through changing circumstances. Here, we describe variation in human epidemiological patterns in the context of past rapid climate change (RCC) events and other periods of past environmental change. Case studies confirm that human communities responded to environmental changes in diverse ways depending on historical, sociocultural, and biological contingencies. Certain factors, such as social inequality and disproportionate access to resources in large, complex societies may influence the probability of major sociopolitical disruptions and reorganizations-commonly known as "collapse." This survey of Holocene human-environmental relations demonstrates how flexibility, variation, and maintenance of Indigenous knowledge can be mitigating factors in the face of environmental challenges. Although contemporary climate change is more rapid and of greater magnitude than the RCC events and other environmental changes we discuss here, these lessons from the past provide clarity about potential priorities for equitable, sustainable development and the constraints of modernity we must address.
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Carcinoma de Células Renais , Neoplasias Renais , Humanos , Mudança Climática , Desenvolvimento Sustentável , ProbabilidadeRESUMO
OBJECTIVES: Poststroke delirium may be underdiagnosed due to the challenges of disentangling delirium symptoms from underlying neurologic deficits. We aimed to determine the prevalence of individual delirium features and the frequency with which they could not be assessed in patients with intracerebral hemorrhage. DESIGN: Prospective observational cohort study. SETTING: Neurocritical Care and Stroke Units at a university hospital. PATIENTS: Consecutive patients with intracerebral hemorrhage from February 2018 to May 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: An attending neurointensivist performed 257 total daily assessments for delirium on 60 patients (mean age 68.0 [SD 18.4], 62% male, median intracerebral hemorrhage score 1.5 [interquartile range 1-2], delirium prevalence 57% [n = 34]). Each assessment included the Confusion Assessment Method for the ICU, Intensive Care Delirium Screening Checklist, a focused bedside cognitive examination, chart review, and nurse interview. We characterized individual symptom prevalence and established delirium diagnoses using Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, then compared performance of the Confusion Assessment Method for the ICU and Intensive Care Delirium Screening Checklist against reference-standard expert diagnosis. Symptom fluctuation (61% of all assessments), psychomotor changes (46%), sleep-wake disturbances (46%), and impaired arousal (37%) had the highest prevalence and were never rated "unable to assess," while inattention (36%), disorientation (27%), and disorganized thinking (18%) were also common but were often rated 'unable to assess' (32%, 43%, and 44% of assessments, respectively), most frequently due to aphasia (32% of patients). Including nonverbal assessments of attention decreased the frequency of 'unable to assess' ratings to 11%. Since the Intensive Care Delirium Screening Checklist may be positive without the presence of symptoms that require verbal assessment, it was more accurate (sensitivity = 77%, specificity = 97%, area under the receiver operating characteristic curve, 0.87) than the Confusion Assessment Method for the ICU (sensitivity = 41%, specificity = 88%, area under the receiver operating characteristic curve, 0.64). CONCLUSIONS: Delirium is common after intracerebral hemorrhage, but severe neurologic deficits may confound its assessment and lead to underdiagnosis. The Intensive Care Delirium Screening Checklist's inclusion of nonverbal features may make it more accurate than the Confusion Assessment Method for the ICU in patients with neurologic deficits, but novel tools designed for such patients may be warranted.
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Hemorragia Cerebral/complicações , Delírio/etiologia , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Delírio/diagnóstico , Delírio/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos ProspectivosRESUMO
OBJECTIVES: Inflammatory periosteal reaction (IPR) on the visceral surfaces of the ribs has been used in bioarchaeology as an indicator of lower respiratory tract disease. This article presents a detailed method for recording IPR on the ribs, even those in severely fragmented states, with the objectives of increasing the consistency of recording and producing true prevalence rates for skeletons so as to improve data comparability between future bioarchaeological studies of lower respiratory tract disease. MATERIALS AND METHODS: The presence and prevalence of respiratory-related IPR were recorded from three different Sudanese cemetery sites using a detailed method for identifying and recording IPR. Sites with variable preservation were chosen to test the applicability of the method. A flowchart to aid in identification of bony changes is presented. The method requires the recording of IPR on three separate sections of the rib (neck, angle, and shaft) and the allocation of ribs into rib cage regions of upper, upper-middle, middle, lower-middle, and lower. RESULTS: Results demonstrate differences in the distribution of IPR between sites and verify the method's applicability to archeological sites with various levels of skeletal preservation. DISCUSSION: While crude prevalence rates can indicate the number of individuals experiencing lower respiratory tract disease within a site, this method can provide information about the distribution of IPR within the rib cage. This should lead to new ways of distinguishing respiratory diseases within archeological populations. This method also allows for comparability between well-preserved and lesser-preserved sites by accommodating for rib fragmentation.
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Doenças Pleurais , Costelas/patologia , Adolescente , Adulto , Arqueologia , Cemitérios , História Antiga , História Medieval , Humanos , Paleopatologia , Doenças Pleurais/epidemiologia , Doenças Pleurais/história , Doenças Pleurais/patologia , Sudão , Adulto JovemRESUMO
OBJECTIVE: To introduce a novel, naturalistic observational methodology (the Electronically Activated Recorder; EAR) as an opportunity to better understand the central role of the family environment in children's recovery from trauma. METHODS: Discussion of current research methods and a systematic literature review of EAR studies on health and well-being. RESULTS: Surveys, experience sampling, and the EAR method each provide different opportunities and challenges for studying family interactions. We identified 17 articles describing relevant EAR studies. These investigated questions of emotional well-being, communicative behaviors, and interpersonal relationships, predominantly in adults. 5 articles reported innovative research in children, triangulating EAR-observed behavioral data (e.g., on child conflict at home) with neuroendocrine assay, sociodemographic information, and parent report. Finally, we discussed psychometric, practical, and ethical considerations for conducting EAR research with children and families. CONCLUSIONS: Naturalistic observation methods such as the EAR have potential for pediatric psychology studies regarding trauma and the family environment.
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Adaptação Psicológica , Relações Familiares/psicologia , Estudos Observacionais como Assunto/métodos , Projetos de Pesquisa , Ferimentos e Lesões/psicologia , Adulto , Criança , Humanos , Psicologia da Criança , PsicometriaRESUMO
OBJECTIVE: In 2016, Indonesia introduced its Human Papillomavirus (HPV) vaccination demonstration program for girls in grades 5 and 6 of primary school, to reduce cervical cancer (CC) burden in selected provinces and test the viability of nationwide vaccination. This study explored schoolgirls' experience of school-based HPV vaccination, their knowledge of HPV and HPV vaccination, and their preferences for cervical cancer (CC) education. METHODS: An online survey was conducted with schoolgirls who experienced HPV vaccination between 2019 and 2021 through the demonstration program. Using purposive sampling, respondents were recruited through partnerships with primary public health centres and primary schools in Jakarta and Yogyakarta. Data analysis was conducted using Chi-square test, Independent-samples t-test, and one-way ANOVA. RESULTS: One hundred and forty primary schoolgirls with a mean age of 12.2 years (SD = 0.70) completed the survey. Schools and mothers were identified as key actors in socialising children about important health information and as girls' preferred sources of information. The average summed score for girls' knowledge of HPV, the HPV vaccine, and CC after being vaccinated was 5.07 out of 10 (SD 0.23). Significant differences in the mean knowledge scores among participants with different preferences regarding CC education in school were observed. CONCLUSION: While schoolgirls' experiences of HPV vaccination were largely positive, their knowledge of critical health information regarding HPV vaccination and CC prevention needs improving. Thus, it is necessary to provide parents, and school-based educators with culturally appropriate strategies and comprehensive evidence-based information about HPV vaccination and CC prevention more effectively to children.
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Conhecimentos, Atitudes e Prática em Saúde , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Vacinação , Humanos , Feminino , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/administração & dosagem , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia , Indonésia , Criança , Vacinação/psicologia , Instituições Acadêmicas , Inquéritos e Questionários , Educação em Saúde/métodos , Adolescente , Seguimentos , Serviços de Saúde Escolar , Prognóstico , Papillomaviridae/imunologiaRESUMO
Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised Controlled Trial (fRCT) of a whole-family intervention with Syrian, Iraqi and Jordanian families in Jordan. We aimed to determine the feasibility of intervention and study procedures to inform a fully-powered RCT. Eligible families were randomised to receive the Nurturing Families intervention or enhanced usual care (1:1). Masked assessors measured outcomes at baseline and endline; primary outcome measures were caregiver psychological distress, family functioning, and parenting practices. Families and implementing staff participated in qualitative interviews at endline. Of the 62 families screened, 60 (98%) were eligible, 97% completed the baseline and 90% completed the endline. Qualitative feedback indicated specific improvements in adolescent well-being, caregiver distress and parenting, and family relationships. Data highlighted high participant engagement and adequate facilitator fidelity and competence. Outcome measures had good psychometric properties (most α > 0.80) and sensitivity to change, with significant changes seen on most measures in the intervention but not control group. Findings indicate the acceptability and feasibility of intervention and study procedures. Subsequent full-scale evaluation is needed to determine effectiveness.
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OBJECTIVE: To test the hypothesis that a left-dominant brain immune network (LD-BIN) might affect the occurrence of infection during inpatient rehabilitation of stroke and traumatic brain injury (TBI). DESIGN: A retrospective analysis was performed on electronic medical records between January 2009 and December 2010. All patients with left- or right-sided stroke or TBI were included into the study. The LD-BIN hypothesis was tested by comparing HAI rates depending on whether patients had left- or right-sided brain lesions. SETTING: A large inpatient rehabilitation hospital. PARTICIPANTS: Among the patients (N=2236) with stroke or TBI who had either a left- or right-sided brain lesion, 163 patients were identified with HAIs. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Frequency of HAIs. RESULTS: In the 163 patients identified with HAIs with a diagnosis of stroke or TBI, chi-square analysis revealed a significantly higher proportion of HAIs among patients with left-sided (n=98; 60.1%) relative to right-sided (n=65; 39.9%) brain injuries (χ(2)=6.68, P<.01). These effects could not be attributed to either clinical or demographic factors. CONCLUSIONS: Our findings are consistent with the hypothesis that an LD-BIN may mediate vulnerability to infection during rehabilitation of patients with stroke or TBI. Further translational research investigating novel means of managing patients based on brain lesion location, and modulating the LD-BIN via behavioral and physiologic interventions, may result in neuroscience-based methods to improve infection resistance in brain-injured patients.
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Lesões Encefálicas/reabilitação , Infecção Hospitalar/epidemiologia , Dominância Cerebral , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Pacientes Internados , Masculino , New Jersey/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: Lack of identification and referral of children and adolescents with mental health problems contributes to the treatment gap in low- and middle-income countries, and especially in humanitarian settings. The Community Case Detection Tool (CCDT) is developed to improve community-based detection and increase help-seeking among children and adolescents in need of mental health care. The CCDT uses brief, easily understood pictorial vignettes that represent common symptoms of childhood internalizing and externalizing problems. The tool is developed for gatekeepers to support proactive detection of children in need of mental health care and to subsequently encourage help-seeking. This study evaluates the accuracy of the CCDT in detecting children and adolescents aged 6-18 years with significant mental health care needs in a conflict-affected setting: the occupied Palestinian territory. METHODS: Teachers and community workers were trained to use the CCDT. Children detected using the tool were invited for a structured clinical interview with a psychologist using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version, as well as the Strengths and Difficulties Questionnaire, to test the accuracy of CCDT-based detection. RESULTS: Our sample consists of 52 children positively detected as matching with one of the vignettes. Approximately three of four detected children were indicated for psychological treatment based on the clinical interview (positive predictive value = .769), and 64.6% returned 'borderline' or 'abnormal' total difficulty scores on the Strengths and Difficulties Questionnaire. CONCLUSIONS: The CCDT offers a promising low-cost solution to mitigate underdetection of mental health problems in challenging settings.
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Transtornos Mentais , Criança , Adolescente , Humanos , Escalas de Graduação Psiquiátrica , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Transtornos Mentais/psicologiaRESUMO
Metabolomics is a modern tool that aids in our understanding of the molecular changes in organisms. Archaeological science is a branch of archaeology that explores different archaeological materials using modern analytical tools. Human osteoarchaeological material are a frequent finding in archaeological contexts and have the potential to offer information about previous human populations, which can be illuminating about our current condition. Using a set of samples comprising different skeletal elements and bone structures, here we explore for the first time the possibility of extracting metabolites from osteoarchaeological material. Here, a protocol for extraction and measurement of extracted polar and less-polar/apolar metabolites by ultra-high performance liquid chromatography hyphenated to high resolution mass spectrometry is presented to measure the molecules separated after a reversed phase and hydrophilic interaction liquid chromatography column. Molecular information was obtained, showing that osteoarchaeological material is a viable source of molecular information for metabolomic studies.
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Metabolômica , Humanos , Cromatografia Líquida/métodos , Cromatografia Líquida de Alta Pressão/métodos , Metabolômica/métodos , Espectrometria de Massas/métodos , Interações Hidrofóbicas e HidrofílicasRESUMO
Metabolomics, the study of metabolites (small molecules of <1500 daltons), has been posited as a potential tool to explore the past in a comparable manner to other omics, e.g., genomics or proteomics. Archaeologists have used metabolomic approaches for a decade or so, mainly applied to organic residues adhering to archaeological materials. Because of advances in sensitivity, resolution, and the increased availability of different analytical platforms, combined with the low mass/volume required for analysis, metabolomics is now becoming a more feasible choice in the archaeological sector. Additional approaches, as presented by our group, show the versatility of metabolomics as a source of knowledge about the human past when using human osteoarchaeological remains. There is tremendous potential for metabolomics within archaeology, but further efforts are required to position it as a routine technique.
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Arqueologia , Metabolômica , Humanos , Metabolômica/métodos , Genômica , ProteômicaRESUMO
OBJECTIVE: To determine the psychometric properties of 2 neglect measures, the Behavioral Inattention Test (BIT)-conventional and the Catherine Bergego Scale (CBS), in acute spatial neglect. Spatial neglect is a failure or slowness to respond, orient, or initiate action toward contralesional stimuli, associated with functional disability that impedes stroke recovery. Early identification of specific neglect deficits may identify patients likely to experience chronic disability. However, psychometric evaluation of assessments has focused on subacute/chronic populations. DESIGN: Correlational/psychometric study. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: Screening identified 51 consecutive patients with a right-hemisphere stroke with left neglect (BIT score <129 or CBS score >11) tested an average of 22.3 days poststroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We obtained BIT, CBS, and Barthel Index assessments for each participant and clinical and laboratory measures of perceptual-attentional and motor-intentional deficits. RESULTS: The BIT showed good reliability and loaded onto a single factor. Consistent with our theoretical prediction, principal components analysis of the CBS identified 2 underlying factors: Where perceptual-attentional items (CBS-PA) and embodied, motor-exploratory items (CBS-ME). The CBS-ME uniquely predicted deficits in activities of daily living (ADLs) assessed by using the Barthel Index, but did not predict clinical and laboratory assessments of motor-intentional bias. More severe neglect on the CBS-PA correlated with greater Where perceptual-attentional bias on clinical and laboratory tests, but did not uniquely predict deficits in ADLs. CONCLUSIONS: Our results indicate that assessments of spatial neglect may be used to detect specific motor-exploratory deficits in spatial neglect. Obtaining CBS-ME scores routinely might improve the detection of acute-stage patients with spatial action deficits requiring increased assistance that may persist to the chronic stage.
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Hemiplegia/reabilitação , Transtornos da Percepção/diagnóstico , Transtornos da Percepção/reabilitação , Comportamento Espacial/fisiologia , Reabilitação do Acidente Vascular Cerebral , Atividades Cotidianas , Doença Aguda , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Avaliação da Deficiência , Pessoas com Deficiência/reabilitação , Feminino , Seguimentos , Lateralidade Funcional , Hemiplegia/etiologia , Hemiplegia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Transtornos da Percepção/etiologia , Valor Preditivo dos Testes , Psicometria , Centros de Reabilitação , Reprodutibilidade dos Testes , Medição de Risco , Fatores Sexuais , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Testes de Campo Visual/métodosRESUMO
Spatial neglect is a debilitating poststroke neurocognitive disorder associated with prolonged hospitalization and poor rehabilitation outcomes. The literature suggests a high prevalence of this disorder, but clinicians have difficulty reliably identifying affected survivors. This discrepancy may result from suboptimal use of validated neglect assessment procedures. In this article, we suggest use of a validated assessment tool that is sensitive to identification of neglect and its functional consequences - the Catherine Bergego Scale (CBS). We provide detailed item-by-item instructions for observation and scoring - the Kessler Foundation Neglect Assessment Process (KF-NAP). Rehabilitation researchers may be able to use the CBS via the KF-NAP to measure ecological outcomes and specific, separable perceptual-attentional and motor-exploratory spatial behaviors.
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Avaliação da Deficiência , Testes Neuropsicológicos/normas , Transtornos da Percepção/reabilitação , Índice de Gravidade de Doença , Reabilitação do Acidente Vascular Cerebral , Humanos , Transtornos da Percepção/fisiopatologia , Guias de Prática Clínica como Assunto , Acidente Vascular Cerebral/fisiopatologiaRESUMO
Hypoxaemia (low blood oxygen) is common among hospitalised patients, increasing the odds of death five-fold and requiring prompt detection and treatment. However, we know little about hypoxaemia prevalence in primary care and the role for pulse oximetry and oxygen therapy. This study assessed the prevalence and management of hypoxaemia at primary care facilities in Uganda. We conducted a cross sectional prevalence study and prospective cohort study of children with hypoxaemia in 30 primary care facilities in Uganda, Feb-Apr 2021. Clinical data collectors used handheld pulse oximeters to measure blood oxygen level (SpO2) of all acutely unwell children, adolescents, and adults. We followed up a cohort of children aged under 15 years with SpO2<93% by phone after 7 days to determine if the patient had attended another health facility, been admitted, or recovered. Primary outcome: proportion of children under 5 years of age with severe hypoxaemia (SpO2<90%). Secondary outcomes: severe (SpO2<90%) and moderate hypoxaemia (SpO2 90-93%) prevalence by age/sex/complaint; number of children with hypoxaemia referred, admitted and recovered. We included 1561 children U5, 935 children 5-14 years, and 3284 adolescents/adults 15+ years. Among children U5, the prevalence of severe hypoxaemia was 1.3% (95% CI 0.9 to 2.1); an additional 4.9% (3.9 to 6.1) had moderate hypoxaemia. Performing pulse oximetry according to World Health Organization guidelines exclusively on children with respiratory complaints would have missed 14% (3/21) of severe hypoxaemia and 11% (6/55) of moderate hypoxaemia. Hypoxaemia prevalence was low among children 5-14 years (0.3% severe, 1.1% moderate) and adolescents/adults 15+ years (0.1% severe, 0.5% moderate). A minority (12/27, 44%) of severely hypoxaemic patients were referred; 3 (12%) received oxygen. We followed 87 children aged under 15 years with SpO2<93%, with complete data for 61 (70%), finding low rates of referral (6/61, 10%), hospital attendance (10/61, 16%), and admission (6/61, 10%) with most (44/61, 72%) fully recovered at day 7. Barriers to referral included caregiver belief it was unnecessary (42/51, 82%), cost (8/51, 16%), and distance or lack of transport (3/51, 6%). Hypoxaemia is common among acutely unwell children under five years of age presenting to Ugandan primary care facilities. Routine pulse oximetry has potential to improve referral, management and clinical outcomes. Effectiveness, acceptability, and feasibility of pulse oximetry and oxygen therapy for primary care should be investigated in implementation trials, including economic analysis from health system and societal perspectives.
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BACKGROUND AND PURPOSE: Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke. METHODS: We performed a case-control analysis using 6 biennial interview waves (1998 to 2008) of the Health and Retirement Study. We compared 631 noninstitutionalized individuals who had a single stroke with 631 control subjects matched for age, gender, and interview wave. We studied sleep problems, urinary incontinence, motor impairment, falls, and memory deficits among the 2 groups. RESULTS: Stroke survivors frequently developed new or worsened motor impairment (33%), sleep problems (up to 33%), falls (30%), urinary incontinence (19%), and memory deficits (9%). As compared with control subjects, the risk of developing a secondary health problem was highest for memory deficits (OR, 2.45; 95% CI, 1.34 to 4.46) followed by urinary incontinence (OR, 1.86; 95% CI, 1.31 to 2.66), motor impairment (OR, 1.61; 95% CI, 1.16 to 2.24), falls (OR, 1.5; 95% CI, 1.12 to 2.0), and sleep disturbances (OR, 1.49; 95% CI, 1.09 to 2.03). In contrast, stroke survivors were not more likely to injure themselves during a fall (OR, 1.14; 95% CI, 0.72 to 1.79). After adjusting for cardiovascular risk factors, social status, psychiatric symptoms, and pain, the risks of falling or developing sleep problems were not different from the control subjects. CONCLUSIONS: The risk of developing a secondary health problem that can impact daily life is markedly increased after stroke. A better understanding of frequencies and risks for secondary health problems after stroke is necessary for designing better preventive and rehabilitation strategies.
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Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Atividades Cotidianas , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Feminino , Geriatria/métodos , Humanos , Masculino , Qualidade de Vida , Aposentadoria , Risco , Meio SocialRESUMO
Patterns of cerebral asymmetry related to visuospatial functions may change with age. The typical leftward bias on a line bisection task may reflect cerebral asymmetry. With age, such leftward bias decreases. This study demonstrated that the age-related decrease of leftward bias may actually be sex-specific. In addition, previous research suggests that young adults' deviation in line bisection may reflect asymmetric hemispheric activation of perceptual-attentional "where" spatial systems, rather than motor-intentional "aiming" spatial systems; thus, we specifically fractionated "where" and "aiming" bias of men and women ranging in age from 22 to 93 years old. We observed that older men produced greater rightward line bisection errors, of primarily "where" spatial character. However, women's errors remained leftward biased, and did not significantly change with age. "Where" spatial systems may be linked to cortico-cortical processing networks involving the posterior part of the dorsal visuospatial processing stream. Thus, the current results are consistent with the conclusion that reduced right dorsal spatial activity in aging may occur in the male, but not female, adult spatial system development.
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Envelhecimento , Viés , Lateralidade Funcional/fisiologia , Caracteres Sexuais , Percepção Espacial/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Luminosa , Adulto JovemRESUMO
Adolescence is a key period for the development of brain circuits underlying affective and behavioral regulation. It remains unclear, however, whether and how adolescent brain structure influences day-to-day affective behavior. Because of significant changes in the nature of family relations that also typically occur during adolescence, parent-child interactions provide a meaningful context where affective behavior and its regulation may be assessed. In a sample of 137 early adolescents, we investigated the relationship between aspects of the adolescents' brain structure and their affective behavior as assessed during observation of parent-child interactions. We found a significant positive association between volume of the amygdala and the duration of adolescent aggressive behavior during these interactions. We also found male-specific associations between the volume of prefrontal structures and affective behavior, with decreased leftward anterior paralimbic cortex volume asymmetry associated with increased duration of aggressive behavior, and decreased leftward orbitofrontal cortex volume asymmetry associated with increased reciprocity of dysphoric behavior. These findings suggest that adolescent brain structure is associated with affective behavior and its regulation in the context of family interactions, and that there may be gender differences in the neural mechanisms underlying affective and behavioral regulation during early adolescence. Particularly as adolescence marks a period of rapid brain maturation, our findings have implications for mental health outcomes that may be revealed later along the developmental trajectory.
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Comportamento do Adolescente/fisiologia , Tonsila do Cerebelo/fisiologia , Relações Pais-Filho , Córtex Pré-Frontal/fisiologia , Adolescente , Adulto , Agressão , Feminino , Humanos , Masculino , Fatores SexuaisRESUMO
Aphasia researchers and clinicians share some basic beliefs about language recovery post stroke. Most agree there is a spontaneous recovery period and language recovery may be enhanced by participation in a behavioral therapy program. The application of biological interventions in the form of pharmaceutical treatments or brain stimulation is less well understood in the community of people who work with individuals having aphasia. The purpose of this article is to review the literature on electrical brain stimulation as an intervention to improve aphasia recovery. The article will emphasize emerging research on the use of transcranial magnetic stimulation (TMS) to accelerate stroke recovery. We will profile the current US Food and Drug Administration (FDA)-approved application to depression to introduce its potential for future application to other syndromes such as aphasia.
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Afasia/terapia , Idioma , Estimulação Magnética Transcraniana/métodos , Afasia/etiologia , Humanos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicaçõesRESUMO
OBJECTIVE: To investigate evidence for maxillary sinusitis and pulmonary inflammation in archaeological skeletons dating to the Late Intermediate Period (AD 1000-1476) at the site of Pachacamac, Peru. MATERIALS: Thirty-nine individuals (male, female, and unknown sex; 16+ years age-at-death) were analyzed for inflammatory periosteal reaction (IPR) on the visceral (inner) surfaces of the ribs, and 16 individuals were analyzed for evidence of maxillary sinusitis. METHODS: All individuals were macroscopically examined for bony changes in the maxillary sinuses and new bone formation on the ribs according to pre-established criteria. RESULTS: Some 33.3% (13/39) of individuals had IPR on the ribs and 93.8% (15/16) had bony changes in the maxillary sinuses. CONCLUSIONS: Respiratory disease was likely prevalent in people buried at Pachacamac during the Late Intermediate Period. A number of factors may have increased the risk of developing respiratory disease, including exposure to poor air quality and increased crowding and social mixing, resulting from pilgrimage to this important ritual center. SIGNIFICANCE: This paper represents one of the first systematic analyses of evidence for respiratory disease in Peruvian and South American human skeletal remains, demonstrating the suitability of the region for further study. LIMITATIONS: A limited sample was available for analysis. Additionally, the site's skeletal preservation was excellent, meaning the sample available for assessment of maxillary sinusitis was smaller, being limited to individuals with post-mortem breakage. FURTHER RESEARCH: The results of this study should stimulate further much needed systematic investigation of evidence for respiratory disease in other Peruvian and South American populations.
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Arqueologia , Paleopatologia , Restos Mortais , Feminino , Humanos , Masculino , Peru , CostelasRESUMO
OBJECTIVE: To investigate the prevalence of maxillary sinusitis in people who lived in the Middle Nile Valley across different periods, cultures, and environmental conditions. MATERIALS: 481 skeletons from 13 sites, curated at the British Museum, London, were analysed. The sites ranged in date from the Neolithic to Medieval periods (c. 4900 BCE-CE 1500). METHODS: Bony changes within the maxillary sinuses, associated with sinusitis and oroantral fistulae were systematically recorded according to pre-established criteria. RESULTS: There were significant differences in the prevalence of maxillary sinusitis between time period/subsistence economy groups. The Neolithic hunter-gatherer/early agricultural group had the lowest prevalence, whilst the urban group demonstrated the highest frequency of the disease. CONCLUSIONS: Factors involved in the development of maxillary sinusitis are manifold and complex. However, the results indicate that increased aridity in Sudan in later periods and intensification of agricultural practices may have played a role in increasing prevalence of the disease. Urban environments, including crowding, poor sanitation, and industrial air pollution, could also have influenced susceptibility to maxillary sinusitis. SIGNIFICANCE: Prior to this paper, the impact of arid environments on respiratory health in the past had received little attention despite growing clinical research on the topic. Both arid and urban environments are predicted to expand in the future. This paper provides a deep-time perspective on an issue of increasing concern today. LIMITATIONS: Poor preservation of skeletons and a lack of archaeological settlement data for some sites. FUTURE RESEARCH: Investigation of a greater range of populations from different environments/climates.
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Sinusite Maxilar , Sinusite , Meio Ambiente , Humanos , Seio Maxilar , Sinusite Maxilar/epidemiologia , Prevalência , Sinusite/epidemiologiaRESUMO
Proposals that adaptation with left-shifting prisms induces neglect-like symptoms in normal individuals rely on a dissociation between the postadaptation performance of individuals trained with left- versus right-shifting prisms (e.g., Colent, Pisella, & Rossetti, 2000). A potential problem with this evidence is that normal young adults have an a priori leftward bias (e.g., Jewell & McCourt, 2000). In Experiment 1, we compared the line bisection performance of young adults to that of aged adults, who as a group may lack a leftward bias in line bisection. Participants trained with both left- and right-shifting prisms. Consistent with our hypothesis, while young adults demonstrated aftereffects for left, but not right prisms, aged adults demonstrated reliable aftereffects for both prisms. In Experiment 2, we recruited a larger sample of young adults, some of whom were right-biased at baseline. We observed an interaction between baseline bias and prism-shift, consistent with the results of Experiment 1: Left-biased individuals showed a reduced aftereffect when training with right-shifting prisms and right-biased individuals showed a reduced aftereffect when training with left-shifting prisms. These results suggest that previous failures to find generalizable aftereffects with right-shifting prisms may be driven by participants' baseline biases rather than specific effects of the prism itself.