Frequent Bullying Involvement and Brain Morphology in Children.

Background: Over the past few decades, bullying has been recognized as a considerable public health concern. Involvement in bullying is associated with poor long-term social and psychiatric outcomes for both perpetrators and targets of bullying. Despite this concerning prognosis, few studies have investigated possible neurobiological correlates of bullying involvement that may explain the long-term impact of bullying. Cortical thickness is ideally suited for examining deviations in typical brain development, as it has been shown to detect subtle differences in children with psychopathology. We tested associations between bullying involvement and cortical thickness using a large, population-based cohort. Methods: The study sample consisted of 2,602 participants from the Generation R Study. When children were 8 years old, parents and teachers reported on common forms of child bullying involvement (physical, verbal, and relational). Questions ascertained whether a child was involved as a perpetrator (n = 82), a target of bullying (n = 92), as a combined perpetrator and target of bullying (n = 47), or uninvolved in frequent bullying (n = 2,381). High-resolution structural MRI was conducted when children were 10 years of age. Cortical thickness estimates across the cortical mantle were compared among groups. Results: Children classified as frequent targets of bullying showed thicker cortex in the fusiform gyrus compared to those uninvolved in bullying (B = 0.108, p corrected < 0.001). Results remained consistent when adjusted for socioeconomic factors, general intelligence, and psychiatric symptoms. Children classified as frequent perpetrators showed thinner cortex in the cuneus region; however, this association did not survive stringent correction for multiple testing. Lastly, no differences in cortical thickness were observed in perpetrator-targets. Discussion: Bullying involvement in young children was associated with differential cortical morphology. Specifically, the fusiform gyrus, often involved in facial processing, showed thicker cortex in targets of frequent bullying. Longitudinal data are necessary to demonstrate the temporality of the underlying neurobiology associated with bullying involvement.

Establishing Goals of Care for Patients With Stroke and Feeding Problems: An Interdisciplinary Trigger-Based Continuous Quality Improvement Project.

BACKGROUND: Few patients with dysphagia because of stroke receive early palliative care (PC) to align treatment goals with their values, as called for by practice guidelines, particularly before enteral access procedures for artificial nutrition. MEASURES: To increase documented goals of care (GOC) discussions among acute stroke patients before feeding gastrostomy tube placement. INTERVENTION: We undertook a rapid-cycle continuous quality improvement process with interdisciplinary planning, implementation, and performance review to operationalize an upstream trigger for PC referral prompted by the speech and language pathology evaluation. OUTCOMES: During a six-month period, 21 patients underwent gastrostomy tube placement; 52% had preprocedure GOC discussions postintervention, with the rate of compliance increasing steadily from 13% (11/87, preintervention) to 100% (2/2) in the final two months. CONCLUSIONS/LESSONS LEARNED: We effectively increased documented GOC discussions before feeding gastrostomy tube placement among stroke patients. Systems-based tools and education will enhance this upstream trigger model to ensure early PC for stroke patients.

Salud intercultural: impacto en la identidad social de mujeres aimaras / Intercultural health: the impact in the aimara women social identity

Este artículo busca determinar el impacto sociocultural de las políticas públicas y la modernización en salud y educación en los pueblos aimaras en Chile, desde un enfoque cultural. Su intención es aproximarse al significado atribuido por las mujeres aimaras de Colchane a las políticas públicas en salud reproductiva y cómo impacta en su cosmovisión. Nuestra hipótesis es que las mujeres aimaras no se apropian de las políticas culturales en salud reproductiva porque no responden al sentido cultural que involucra el proceso reproductivo. Este trabajo quiso indagar sobre el sentido social y la construcción valórica tras estos procesos sociales y determinar cómo afecta a la incorporación de las políticas públicas.

This paper is part of a research project which tries to determine the socio cultural impact of public policies and the modernization process in the health care of the aimara ethnic group in Chile, from a cultural perspective. Its purpose is to approach to the meaning attributed by the aimara women from Colchane to the public policies related to reproductive health and how it impacts their cosmic vision. Our hypothesis is that the aimara women do not appropriate these public policies on reproductive health as proper because they do not respond to their cultural meaning about the reproductive process.

Este artigo procura determinar o impacto socio-cultural das políticas públicas, a modernização em saúde e a educação nos povos Aimaras no Chile, desde um enfoque cultural. Seu objetivo é se aproximar do significado atribuido pelas mulheres Aimaras de Colchane às políticas públicas em saúde reprodutiva e como impacta em sua cosmovisão. Nossa hipótese é que as mulheres Aimaras não se apropriam das políticas culturais em saúde reprodutiva porque não respondem ao sentido cultural que envolve o processo reprodutivo. Este trabalho quis indagar sobre o sentido social e a construção de valores através destes processos sociais e determinar como isto afeta a incorporação das políticas públicas.