Immediate impact of child maltreatment on mental, developmental, and physical health trajectories.

OBJECTIVE: The immediate impact of child maltreatment on health and developmental trajectories over time is unknown. Longitudinal studies starting in the direct aftermath of exposure with repeated follow-up are needed. METHOD: We assessed health and developmental outcomes in 6-month intervals over 2 years in 173 children, aged 3-5 years at study entry, including 86 children with exposure to emotional and physical abuse or neglect within 6 months and 87 nonmaltreated children. Assessments included clinician-administered, self- and parent-report measures of psychiatric and behavioral symptoms, development, and physical health. Linear mixed models and latent growth curve analyses were used to contrast trajectories between groups and to investigate the impact of maltreatment features on trajectories. RESULTS: Maltreated children exhibited greater numbers of psychiatric diagnoses (b = 1.998, p < .001), externalizing (b = 13.29, p < .001) and internalizing (b = 11.70, p < .001) symptoms, impairments in cognitive (b = -11.586, p < .001), verbal (b = -10.687, p < .001), and motor development (b = -7.904, p = .006), and greater numbers of medical symptoms (b = 1.021, p < .001) compared to nonmaltreated children across all time-points. Lifetime maltreatment severity and/or age at earliest maltreatment exposure predicted adverse outcomes over time. CONCLUSION: The profound, immediate, and stable impact of maltreatment on health and developmental trajectories supports a biological embedding model and provides foundation to scrutinize the precise underlying mechanisms. Such knowledge will enable the development of early risk markers and mechanism-driven interventions that mitigate adverse trajectories in maltreated children.

Childhood adversity correlates with stable changes in DNA methylation trajectories in children and converges with epigenetic signatures of prenatal stress.

Childhood maltreatment (CM) is an established major risk factor for a number of negative health outcomes later in life. While epigenetic mechanisms, such as DNA methylation (DNAm), have been proposed as a means of embedding this environmental risk factor, little is known about its timing and trajectory, especially in very young children. It is also not clear whether additional environmental adversities, often experienced by these children, converge on similar DNAm changes. Here, we calculated a cumulative adversity score, which additionally to CM includes socioeconomic status (SES), other life events, parental psychopathology and epigenetic biomarkers of prenatal smoking and alcohol consumption. We investigated the effects of CM alone as well as the adversity score on longitudinal DNAm trajectories in the Berlin Longitudinal Child Study. This is a cohort of 173 children aged 3-5 years at baseline of whom 86 were exposed to CM. These children were followed-up for 2 years with extensive psychometric and biological assessments as well as saliva collection at 5 time points providing genome-wide DNAm levels. Overall, only a few DNAm patterns were stable over this timeframe, but less than 10 DNAm regions showed significant changes. At baseline, neither CM nor the adversity score associated with DNAm changes. However, in 6 differentially methylated regions (DMRs), CM and the adversity score significantly moderated DNAm trajectories over time. A number of these DMRs have previously been associated with adverse prenatal exposures. In our study, children exposed to CM also presented with epigenetic signatures indicative of increased prenatal exposure to tobacco and alcohol, as compared to non-CM exposed children. These epigenetic signatures of prenatal exposure strongly correlate with DNAm regions associated with CM and the adversity score. Finally, weighted correlation network analysis revealed a module of CpGs exclusively associated with CM. While our study identifies DNAm loci specifically associated with CM, especially within long non-coding RNAs, the majority of associations were found with the adversity score with convergent association with indicators of adverse prenatal exposures. This study highlights the importance of mapping not only of the epigenome but also the exposome and extending the observational timeframe to well before birth.

Building Maryland's health care leadership capacity: The Nurse Leadership Institute at the University of Maryland School of Nursing.

Nurse leadership was identified as essential to the advancement of health care in the State of Maryland. The State's Health Services Cost Review Commission's (HSCRC) committed to building the next generation of nurse leaders as part of its vision for advancing healthcare in Maryland. In 2015, HSCRC approved a $2.5 million, multiyear grant that supported development of the Nurse Leadership Institute (NLI) at the University of Maryland School of Nursing. The NLI designed a leadership development program that prepared nurse faculty and clinicians with critical competencies needed for assuming leadership positions unique to complex adaptive systems, facilitating collaborative partnerships between academia and practice, and ultimately improving health outcomes for Maryland's residents. This article is the first in a series reporting on outcomes of this initiative, which describes the design and implementation of the Nurse Leadership Institute, its Leadership Development Program, and preliminary findings for the first 4 years.

[Support for families with a parent diagnosed with cancer and children under the age of five--delineation of a counselling concept]. / Unterstützung von Familien mit einem an Krebs erkrankten Elternteil und Kindern unter fünf Jahren--Darstellung eines Beratungskonzeptes.

Parents of infants and young children, who have been diagnosed with cancer wish to protect their child from the emotional strains of their illness. They wonder, what the child can understand about the illness and how it is able to process or assimilate the experience of the illness. In fact, infants and young children are particularly sensitive to the degree of emotional burden and the mental state of their parents and will experience varying degrees of insecurity due to even small changes in their relationship with their parents. On the basis of psychological development parameters specific to this age group as well as scientific findings on risk and protection factors an integrated interaction based counseling approach was developed. Within this approach, support for the communication between parent and child in view of the specific strains of their illness, both non-verbal and in the child's early stages of verbal communication, is central. In the present article the counselling concept is described and illustrated by case studies. Application and limits are discussed.

Multiple contributions to priming effects for familiar faces: analyses with backward masking and event-related potentials.

The model of face recognition by Bruce and Young postulates a pool of structural representations for familiar faces in long-term memory, so-called face recognition units (FRUs). Event-related brain potentials show early repetition priming effects for familiar faces around 250-300 ms [N250r or early repetition effect (ERE)], which are thought to reflect the activation of these FRUs. However, small N250r effects are also seen for unfamiliar faces suggesting that priming of perceptual codes (i.e., pictorial and structural codes) also contributes to early repetition effects. Using a face-familiarity task in Experiment 1, we aimed to eliminate these perceptual contributions to face priming by backward masking the prime face with a different, unfamiliar face. As expected, a repetition priming effect appeared only for familiar faces. Experiment 2 used a semantic-decision task and compared the effects of different kinds of masks that interfered with either pictorial codes or with pictorial and structural codes. Our findings indicate that both structural codes and memory representations contribute to the N250r and that unfamiliar-face masks interfere only with structural codes. Face-masks may therefore provide a useful tool to extract the pure contributions of memory representations (i.e., FRUs) to repetition priming.

A prospective study on the course of anxiety after vestibular neuronitis.

OBJECTIVE: Critical life events trigger intense emotions. Anxiety is one of the most frequent of these emotions. It is unclear which factors determine the intensity and course of anxiety after a critical life event. METHOD: Anxiety levels of 92 patients in the 6 weeks after experiencing an acute vestibular disorder were examined. The influence of cognitive, personality and illness variables on the course of their anxiety was analyzed. RESULTS: Acute vestibular disorder is accompanied by intensive anxiety. In most patients, anxiety decreased as vertigo regressed. Catastrophizing and dysfunctional cognitions and different personality styles predicted 17.6% of the anxiety 6 weeks after the functional loss of vestibular equilibrium. CONCLUSIONS: Acute vestibular disorder is a critical life event. Most individuals cope successfully with acute vestibular disorder. However, dysfunctional cognitions are risk factors for the persistence of anxiety.