An integrated parenting intervention for maternal depression and child development in a low-resource setting: Cluster randomized controlled trial.

BACKGROUND: Rates of depression among Pakistani mothers are high, leading to poor developmental outcomes in their children. This study tested the effectiveness of a manualized integrated parenting program; Learning through Play Plus (LTP+) for maternal depression in Karachi, Pakistan. METHODS: A cluster randomized control trial conducted from January 2014 to December 2015 across 120 villages in Karachi. A total of 774 depressed mothers aged 18-44 years with children aged 0-30 months old, were included. Villages were randomized to receive LTP+ added to treatment as usual (TAU) or TAU alone. Primary outcomes were severity of maternal depression at 3 and 6 months measured by the Edinburgh Postnatal Depression Scale and child socio-emotional development at 6 months measured by the Ages and Stages Questionnaire (ASQ). Secondary outcomes included maternal anxiety, quality of life, social support, parenting competence, and knowledge about child development. RESULTS: Mothers in the LTP+ group reported significantly lower depression scores compared to those in the TAU group (6.6 vs. 13.8, effect size [ES]: -7.2; 95% confidence interval [CI]: -8.2, -6.1) at 3 and 6 months (7.2 vs. 12.00; ES: -4.6; 95% CI: -5.9, -3.4). Child socio-emotional development at 6 months was significantly better in the LTP+ group on all domains of the ASQ. There were also statistically significant improvements on all secondary outcomes at 3- and 6-month follow-up. CONCLUSION: In low-resource settings like Pakistan, low-cost integrated parenting interventions delivered by lay health workers can provide effective treatment for depressed mothers, leading to improvements in child development.

Perceived environmental supports for fruit and vegetable consumption among older adults in the US.

BACKGROUND: The physical and social environments surrounding food, whether perceived or observed, can influence consumers' food choices by changing food access, and affordability, or by changing settings where food-related behaviors occur. AIM: To describe older adults' perceived food environment, identify the most important sites and factors that enable healthy eating, and explore older adults' recommendations for communities to facilitate fruit and vegetable consumption. METHODS: Participants aged 60 and older from metropolitan areas in Massachusetts, Iowa, and Illinois completed a researcher-administered survey to rate the perceived environment including accessibility, availability, and affordability of fruits and vegetables, and perceived importance of factors and establishments related to fruit and vegetable consumption. Participants also suggested changes for establishments to facilitate fruit and vegetable consumption. RESULTS: The majority of the 142 participants perceived their food environment for fruits and vegetables as not difficult to access (85.2%) with good or excellent availability (90.1%). Education, marital status, and race were associated with some aspects of the perceived food environment. Perceived accessibility and supermarkets were rated as the most important factor and establishment, respectively, to facilitate fruit and vegetable consumption across all study sites. Participants proposed recommendations to address the availability, quality, accessibility and affordability of fruits and vegetables. CONCLUSION: Interventions promoting accessible, affordable, quality fruits and vegetables may improve older adult consumers' perceptions of their food environment. Communities may also use undervalued resources such as mobile markets more strategically to provide additional support for healthy eating in older adults.

Functional MRI of facial emotion processing in left temporal lobe epilepsy.

Temporal lobe epilepsy (TLE) may negatively affect the ability to recognize emotions. This study aimed to determine the cortical correlates of facial emotion processing (happy, sad, fearful, and neutral) in patients with well-characterized left TLE (LTLE) and to examine the effect of seizure control on emotion processing. We enrolled 34 consecutive patients with LTLE and 30 matched healthy control (HC) subjects. Participants underwent functional MRI (fMRI) with an event-related facial emotion recognition task. The seizures of seventeen patients were controlled (no seizure in at least 3months; LTLE-sz), and 17 continued to experience frequent seizures (LTLE+sz). Mood was assessed with the Beck Depression Inventory (BDI) and the Profile of Mood States (POMS). There were no differences in demographic characteristics and measures of mood between HC subjects and patients with LTLE. In patients with LTLE, fMRI showed decreased blood oxygenation level dependent (BOLD) signal in the hippocampus/parahippocampus and cerebellum in processing of happy faces and increased BOLD signal in occipital regions in response to fearful faces. Comparison of groups with LTLE+sz and LTLE-sz showed worse BDI and POMS scores in LTLE+sz (all p<0.05) except for POMS tension/anxiety (p=0.067). Functional MRI revealed increased BOLD signal in patients with LTLE+sz in the left precuneus and left parahippocampus for "fearful" faces and in the left periarcheocortex for "neutral" faces. There was a correlation between the fMRI and Total Mood Disturbance in the left precuneus in LTLE-sz (p=0.019) and in LTLE+sz (p=0.018). Overall, LTLE appears to have a relatively minor effect on the cortical underpinnings of facial emotion processing, while the effect of seizure state (controlled vs. not controlled) is more pronounced, indicating a significant relationship between seizure control and emotion processing.

Higher order language competence and adolescent mental health.

BACKGROUND: Clinic and community-based epidemiological studies have shown an association between child psychopathology and language impairment. The demands on language for social and academic adjustment shift dramatically during adolescence and the ability to understand the nonliteral meaning in language represented by higher order language becomes essential. OBJECTIVES:  : This article reports on the association between difficulties in higher order language skills, reading, cognition, and social-emotional adjustment in adolescents. METHOD:  : 144 clinic-referred and 186 comparison youth aged 12-18 years were administered a battery of standardized tests of intelligence, working memory, structural and higher order language, and reading achievement. Parent ratings on the Child Behavior Checklist were used as a measure of severity of social-emotional problems. RESULTS:  : Clinic-referred youth scored significantly lower than comparison youth on measures of structural and higher order language, working memory, and reading. Of the clinic-referred youth, 45% had some type of higher order language impairment, whereas this was the case for 15% of youth in the comparison group. Lower levels of nonverbal ability and working memory as well as lower level of mothers' education were associated with greater risk of having higher order language impairment. CONCLUSIONS:  : Findings have implications for practitioners' seeking to understand and treat adolescents since therapeutic techniques rely on skills where higher order language is at play including the ability to discuss opinions flexibly and to weigh interpretations. Therapists must be aware that there are areas that have potential for miscommunication with some adolescents and where inaccurate inferences may be made about their behavior. Furthermore, educators must consider resources for youth who may increasingly struggle in high school because of such difficulties.

I thought we were good: social cognition, figurative language, and adolescent psychopathology.

BACKGROUND: Language has been shown to play a critical role in social cognitive reasoning in preschool and school-aged children, but little research has been conducted with adolescents. During adolescence, the ability to understand figurative language becomes increasingly important for social relationships and may affect social adjustment. This study investigated the contribution of structural and figurative language to social cognitive skills in adolescents who present for mental health services and those who do not. METHOD: One hundred and thirty-eight adolescents referred to mental health centers (clinic group) and 186 nonreferred adolescents (nonclinic group) aged 12-17 were administered measures of structural and figurative language, working memory, and social cognitive problem solving. RESULTS: We found that adolescents in the clinic group demonstrated less mature social problem solving overall, but particularly with respect to anticipating and overcoming potential obstacles and conflict resolution compared with the nonclinic group. In addition, results demonstrated that age, working memory, and structural and figurative language predicted social cognitive maturity in the clinic group, but only structural language was a predictor in the nonclinic group. CONCLUSIONS: Social problem solving may be particularly difficult for adolescents referred for mental health services and places higher demands on their cognitive and language skills compared with adolescents who have never been referred for mental health services.

Efficacy of learning through play plus intervention to reduce maternal depression in women with malnourished children: A randomized controlled trial from Pakistan✰.

BACKGROUND: The risk factors and adverse outcomes related to maternal depression and child malnutrition are a leading cause of morbidity and mortality in low and middle-income countries (LMIC) including Pakistan. Above 25% of women suffer from maternal depression. Up to 50% children are under-nourished which contributes to 35% of all under-5 deaths in the country. AIM: To determine the efficacy of Learning through Play Plus Thinking Healthy Program (LTP Plus) intervention to reduce maternal depression in mothers with undernourished children. METHODS: In this randomised controlled trial, all eligible mothers presenting to the paediatric departments were invited to participate in the study. Out of the total 256 mothers screened, 107 were included, 54 of those were randomly allocated to LTP Plus group and 53 to treatment as usual (TAU). Edinburgh Postnatal Depression Scale (EPDS) was used to screen for depression. Hamilton Depression Rating Scale (HDRS), Maternal Attachment Inventory (MAI), Social Support Scale (OSLO-3) and the Euro-QoL (EQ-5D) were used to measure the severity of depression, mother-child attachment, level of support and health related quality of life dimensions. Assessments were completed at baseline, end of intervention (3 months from baseline) and at 6 months from baseline. RESULTS: Mothers in the LTP Plus group significantly showed improvements in depression (p<0.001), social support (p = 0.02) and quality of life (p<0.001) at the end of the intervention (LTP Plus), as compared to the TAU group, which were sustained up to 6 months after baseline. CONCLUSION: The outcomes of LTP Plus intervention for mothers of malnourished children show promising results in reducing maternal depression and improving child outcomes. A full trial with longer-term outcomes and cost-effectiveness needs to be conducted.

Caenorhabditis elegans ABCRNAi transporters interact genetically with rde-2 and mut-7.

RNA interference (RNAi) mechanisms are conserved and consist of an interrelated network of activities that not only respond to exogenous dsRNA, but also perform endogenous functions required in the fine tuning of gene expression and in maintaining genome integrity. Not surprisingly, RNAi functions have widespread influences on cellular function and organismal development. Previously, we observed a reduced capacity to mount an RNAi response in nine Caenorhabditis elegans mutants that are defective in ABC transporter genes (ABC(RNAi) mutants). Here, we report an exhaustive study of mutants, collectively defective in 49 different ABC transporter genes, that allowed for the categorization of one additional transporter into the ABC(RNAi) gene class. Genetic complementation tests reveal functions for ABC(RNAi) transporters in the mut-7/rde-2 branch of the RNAi pathway. These second-site noncomplementation interactions suggest that ABC(RNAi) proteins and MUT-7/RDE-2 function together in parallel pathways and/or as multiprotein complexes. Like mut-7 and rde-2, some ABC(RNAi) mutants display transposon silencing defects. Finally, our analyses reveal a genetic interaction network of ABC(RNAi) gene function with respect to this part of the RNAi pathway. From our results, we speculate that the coordinated activities of ABC(RNAi) transporters, through their effects on endogenous RNAi-related mechanisms, ultimately affect chromosome function and integrity.

Determination of physicochemical characteristics in different products of tomato varieties.

The objective of this work was to study the newly developed and existing tomato (Lycopersicon esculentum Mill.) varieties for physicochemical changes in the fruits in the ripe period. Varieties 'CXD179' and 'CX8401' in fresh and canned, and 'CXD203' and 'CXD276' in paste were found superior with respect to ascorbic acid and antioxidant capacity. The highest lycopene and beta-carotene contents were determined in 'CXD203', 'CXD276', and 'CX8401'. Color values showed a change from a greenness value of 'a' to redness values, whereas 'b' decreased. In general, parameter values were higher in canned samples. Studies showed that the lycopene content best correlated with 'a' values in the ripening. Inter-variety variation in physicochemical parameters at the ripe stage revealed that 'CXD179' and 'CXD203' in all products among red varieties were the best varieties. Among light color varieties 'CXD276' and 'CX8401' in view of red color, and 'CX8400' and 'CX8402' in view of green color were better.

Insight into Health Care Outcomes for Persons Living with Heart Failure Using Health Data Analytics.

The Integrated Funding Model (IFM) is designed to measure the impact of a bundled model of health care for patients with Congestive Heart Failure (CHF) for a period of 60 days post discharge. CHF is a primary reason for patient admissions. The goal of this study is to gain insight into the effectiveness of the IFM pathway intervention on health care outcomes for persons living with CHF, using Health data Analytics.

Children adopted from China: a prospective study of their growth and development.

BACKGROUND: China has become a lead country for international adoption because of the relatively young age of the children and reported positive conditions of the orphanages. This study examined the process and outcome of growth and development of children adopted from China over their first two years with their adoptive families. METHOD: Seventy infant girls adopted from China at 8 to 21 months of age (Mean age = 13 months) were examined on arrival in Canada and 6, 12, and 24 months later. Comparisons were made with non-adopted Canadian girls of similar age and from a similar family background as adoptive parents on indices of growth and standardized measures of mental, psychomotor, and language development. RESULTS: At arrival, children adopted from China were smaller physically and exhibited developmental delays compared to current peers. Children adopted from China were functioning in the average range on physical and developmental measures within the first 6 months following adoption. However, they were not performing as well as current peers until the end of their second year after adoption. Even then, there was developmental variation in relation to comparison children and continuation of relatively smaller size with respect to height, weight, and head circumference. Physical measurement was related to outcomes at various points on all developmental measures. CONCLUSIONS: Deprivation in experience in the first year of life has more long-lasting effects on physical growth than on mental development. The variable most consistently related to development was height-to-age ratio. As a measure of nutritional status, the findings reinforce the critical importance of early nutrition.

Language impairment and psychiatric comorbidities.

This article provides an overview of language impairment and its associated conditions and discusses the interactive relationship between language and other domains of development, using the framework of developmental psychopathology. This framework emphasizes the mutually influential transactions approach between developmental domains within individuals and their environment. How knowledge can be translated to practice is discussed.

Social cognition and externalizing psychopathology: an investigation of the mediating role of language.

The present study integrates findings from three lines of research on the association of social cognition and externalizing psychopathology, language and externalizing psychopathology, and social cognition and language functioning using Structural Equation Modeling (SEM). To date these associations have been examined in pairs. A sample of 354 clinic-referred children (aged 7 to 14 years) recruited from a children's mental health centre were tested on measures of language, social cognition, working memory, and child psychopathology. We compared a hypothesized model presenting language functioning as a mediator of the association between social cognition and externalizing psychopathology to a model presenting the independent contribution of language and social cognition to externalizing psychopathology. As hypothesized, we found that the mediation model fits the data better than the alternative model. Our findings have implications for developing and modifying intervention techniques for children with dual language and externalizing psychopathology.

Community Priorities for Healthy Eating in Older Adults.

Community planners such as policymakers and health care and nutrition service providers can create an "age-friendly" environment to support healthy eating in older residents by addressing the highest priorities that enable older adults to improve their dietary intake through different food-related community settings. To identify and prioritize these factors that facilitate behavioral change (enablers) and behavioral settings important for older adult nutrition based on the social ecological model, nutrition and aging professionals (n = 30) from two rural (West Virginia, Iowa) and two urban (Massachusetts, New York) city/county regions (communities) participated in an online or live focus group discussion and completed an analytic hierarchy process survey online. Overall, the most important perceived enablers were accessibility and cost, followed by transportation and social support, but their relative importance varied by community. Participants from all communities considered congregate meal sites and food banks among the most important behavioral settings. Participants from most communities considered food stores to be important and also highlighted other settings unique to the area, such as senior housing, neighborhood, and farmers' markets. By targeting interventions to address the most notable enablers and behavioral settings specific to their community, planning groups can enhance their older residents' ability to achieve optimal nutritional health.

From nutrition scientist to nutrition communicator: why you should take the leap.

Media reports about new nutrition research are abundant, but they may confuse the public when unqualified sources are quoted, findings are reported out of context, or results appear to contradict previous studies. The nutrition scientist who conducts the research is best qualified to communicate the findings accurately and within context. Yet, some nutrition scientists hesitate to speak out in the media because of barriers such as a lack of time, media skills, and support from administrators or fear that their results will be miscommunicated or sensationalized. Scientists who do grant media interviews enjoy benefits such as positively affecting the public's eating habits, influencing health and nutrition policy, and receiving heightened attention to their work, which can lead to future research funding. Scientists who want to improve their media skills can seek support from their institution's public relations professionals and can learn from continuing education opportunities at conferences and self-study through articles and other resources.

Compliance With Recommended Food Safety Practices in Television Cooking Shows.

OBJECTIVE: Examine compliance with recommended food safety practices in television cooking shows. METHODS: Using a tool based on the Massachusetts Food Establishment Inspection Report, raters examined 39 episodes from 10 television cooking shows. RESULTS: Chefs demonstrated conformance with good retail practices for proper use and storage of utensils in 78% of episodes; preventing contamination (62%), and fingernail care (82%). However, 50% to 88% of episodes were found to be out of compliance with other personal hygiene practices, proper use of gloves and barriers (85% to 100%), and maintaining proper time and temperature controls (93%). Over 90% failed to conform to recommendations regarding preventing contamination through wiping cloths and washing produce. In only 13% of episodes were food safety practices mentioned. CONCLUSIONS AND IMPLICATIONS: There appears to be little attention to food safety during most cooking shows. Celebrity and competing chefs have the opportunity to model and teach good food safety practices for millions of viewers.

Package Information Used by Older Adults to Identify Whole Grain Foods.

A structured interview protocol was used to investigate the ability of older adults (n = 89, age ≥ 65 years) to accurately determine whether three common food items were whole grain, and to assess the package information used in their decision process. Cereal and crackers, which were both whole grain products, were correctly identified by 63% and 66% of participants, respectively. Bread (a refined product), was correctly identified by only 19% of participants, while 46% of participants misidentified the bread as being whole grain. The ingredient list was the information most frequently cited in deciding if a food was whole grain, but participants varied in their ability to accurately interpret it. Package information considered nonpertinent (e.g., the Nutrition Facts label) in identifying a whole grain product was used almost as often as the ingredient list. Older adults would benefit from whole grain education programs that focus on accurately interpreting package information.

Polycystin-2 accelerates Ca2+ release from intracellular stores in Caenorhabditis elegans.

Polycystin-2, a member of the TRP family of calcium channels, is encoded by the human PKD2 gene. Mutations in that gene can lead to swelling of nephrons into the fluid-filled cysts of polycystic kidney disease. In addition to expression in tubular epithelial cells, human polycystin-2 is found in muscle and neuronal cells, but its cell biological function has been unclear. A homologue in Caenorhabditis elegans is necessary for male mating behavior. We compared the behavior, calcium signaling mechanisms, and electrophysiology of wild-type and pkd-2 knockout C. elegans. In addition to characterizing PKD-2-mediated aggregation and mating behaviors, we found that polycystin-2 is an intracellular Ca(2+) release channel that is required for the normal pattern of Ca(2+) responses involving IP(3) and ryanodine receptor-mediated Ca(2+) release from intracellular stores. Activity of polycystin-2 creates brief cytosolic Ca(2+) transients with increased amplitude and decreased duration. Polycystin-2, along with the IP(3) and ryanodine receptors, acts as a major calcium-release channel in the endoplasmic reticulum in cells where rapid calcium signaling is required, and polycystin-2 activity is essential in those excitable cells for rapid responses to stimuli.

Office versus operating room insertion of the bone-anchored hearing aid: a comparative analysis.

BACKGROUND: The Bone-anchored Hearing Aid is indicated for patients with unilateral deafness and/or an irreversible conductive hearing loss. The insertion of this device is usually performed in the operating room under intravenous sedation or general anesthesia. We suggest that the placement of the abutment can occur easily and safely in the clinic setting, reducing time and costs for both the patient and the physician. STUDY DESIGN: Retrospective study. METHODS: Ten patients requiring 11 devices (1 bilateral) were implanted with the Bone-anchored Hearing Aid device in the outpatient clinic and another 8 patients were implanted in the operating room. All office procedures were done under local anesthesia; operating room procedures used either general anesthesia or intravenous sedation. Follow-up occurred over 12 months. Time required, cost of the procedure, and other logistical concerns between operating room and office-based insertion were evaluated and compared. RESULTS: When performed in the office, patient fees were reduced by 31%, and patient time investment was reduced 73%. Physician time was reduced by 50%. After office-based insertion, patients were able to return to their normal routine immediately after the procedure, and no chaperone or designated driver was required. No infection or complications occurred in either group. CONCLUSION: Bone-anchored Hearing Aid insertion in the clinic setting is safe and cost-effective, saving the patient and physician significant time and resources.

Dietary patterns and their association with hypertension among Pakistani urban adults.

Hypertension is one of the most common chronic diseases affecting more than 25% of adults worldwide. In Pakistan, 33% of the adult population suffers from hypertension. Numerous epidemiological studies have demonstrated the critical role of dietary patterns in the causation, prevention and management of hypertension. There's a dearth of evidence from South Asia in this regard. The present study aimed to identify the association between dietary patterns and hypertension among 4304 low income urban adults who participated in the Control of Blood Pressure and Risk Attenuation (COBRA) study in Karachi, Pakistan. Dietary information was collected by a 33- item food frequency questionnaire and 3 unique dietary patterns namely; fat and sweet, fruit and vegetable, and seafood and yogurt patterns were derived using principal component factor analyses. We used univariate and multivariable logistic regression to examine the association between dietary patterns and hypertension. Men were more likely to have hypertension, while increase in age, and body mass index were also associated with hypertension (p<0.001). After adjusting for age, gender, education, marital status, body mass index, and tobacco use; the seafood and yogurt pattern was less likely (OR=0.78: 95% CI: 0.63, 0.98; p-value 0.03) to be associated with hypertension, whereas no significant associations were seen for other two dietary patterns. These findings suggest that certain dietary patterns may be associated with hypertension among Pakistani low income urban adults.