Increased cardiac vagal tone in childhood-only, adolescent-only, and persistently antisocial teenagers: the mediating role of low heart rate.

BACKGROUND: Cardiac vagal tone is an indicator of parasympathetic nervous system functioning, and there is increasing interest in its relation to antisocial behavior. It is unclear however whether antisocial individuals are characterized by increased or decreased vagal tone, and whether increased vagal tone is the source of the low heart rate frequently reported in antisocial populations. METHODS: Participants consisted of four groups of community-dwelling adolescent boys aged 15.7 years: (1) controls, (2) childhood-only antisocial, (3) adolescent-only antisocial, and (4) persistently antisocial. Heart rate and vagal tone were assessed in three different conditions: rest, cognitive stressor, and social stressor. RESULTS: All three antisocial groups had both lower resting heart rates and increased vagal tone compared to the low antisocial controls across all three conditions. Low heart rate partially mediated the relationship between vagal tone and antisocial behavior. CONCLUSIONS: Results indicate that increased vagal tone and reduced heart rate are relatively broad risk factors for different developmental forms of antisocial behavior. Findings are the first to implicate vagal tone as an explanatory factor in understanding heart rate - antisocial behavior relationships. Future experimental work using non-invasive vagus nerve stimulation or heart rate variability biofeedback is needed to more systematically evaluate this conclusion.

Publication guidelines for human heart rate and heart rate variability studies in psychophysiology-Part 1: Physiological underpinnings and foundations of measurement.

This Committee Report provides methodological, interpretive, and reporting guidance for researchers who use measures of heart rate (HR) and heart rate variability (HRV) in psychophysiological research. We provide brief summaries of best practices in measuring HR and HRV via electrocardiographic and photoplethysmographic signals in laboratory, field (ambulatory), and brain-imaging contexts to address research questions incorporating measures of HR and HRV. The Report emphasizes evidence for the strengths and weaknesses of different recording and derivation methods for measures of HR and HRV. Along with this guidance, the Report reviews what is known about the origin of the heartbeat and its neural control, including factors that produce and influence HRV metrics. The Report concludes with checklists to guide authors in study design and analysis considerations, as well as guidance on the reporting of key methodological details and characteristics of the samples under study. It is expected that rigorous and transparent recording and reporting of HR and HRV measures will strengthen inferences across the many applications of these metrics in psychophysiology. The prior Committee Reports on HR and HRV are several decades old. Since their appearance, technologies for human cardiac and vascular monitoring in laboratory and daily life (i.e., ambulatory) contexts have greatly expanded. This Committee Report was prepared for the Society for Psychophysiological Research to provide updated methodological and interpretive guidance, as well as to summarize best practices for reporting HR and HRV studies in humans.

Maternal invalidation and child RSA reactivity to frustration interact to predict teacher-reported aggression among at-risk preschoolers.

BACKGROUND: Aggression is a transdiagnostic indicator of risk and represents one of the most common reasons children are referred for mental health treatment. Theory and research highlight the impact of maternal invalidation on child aggression and suggest that its influence may vary based on differences in child physiological reactivity. Moreover, the interaction between these risk factors may be particularly pronounced among children of mothers with emotion regulation (ER) difficulties. The current study examined the independent and interactive effects of maternal invalidation and child physiological reactivity to frustration on teacher-reported aggression in an at-risk sample of preschool children. METHOD: Participants included 77 mothers (Mage = 33.17 years, s.d. = 4.83; 35% racial/ethnic minority) and their children (Mage = 42.48 months; s.d. = 3.78; 56% female; 47% racial/ethnic minority). Groups of mothers with and without clinician-rated ER difficulties reported on maternal invalidation, and child respiratory sinus arrhythmia (RSA) was assessed continuously during a frustration task as an indicator of physiological reactivity. Teachers or daycare providers reported on child aggression. RESULTS: Results demonstrated positive associations between maternal ER difficulties and both maternal invalidation and child RSA reactivity to frustration. As expected, the interaction between maternal invalidation and child RSA reactivity was significant, such that higher maternal invalidation and greater child RSA reactivity to frustration predicted more aggression in a daycare or preschool setting. Importantly, this effect was demonstrated while controlling for demographic covariates and baseline RSA. CONCLUSIONS: Findings are in line with diathesis-stress and biosocial models of risk and point to multiple targets for prevention and early intervention.

Cardiac timing and threatening stimuli influence response inhibition and ex-Gaussian parameters of reaction time in a Go/No-go task.

Sensorimotor responses vary as a function of the cardiac cycle phase. These effects, known as cardiac cycle time effects, have been explained by the inhibition of cardiac afferent signals on information processing. However, the validity of cardiac cycle time effects is challenged by mixed findings. Factors such as current information processing and affective context may modulate cardiac cycle time effects and account for inconsistencies in the literature. The current study examines the influence of cardiac cycle time and threatening stimuli on two aspects of sensorimotor processing, response speed and inhibition. Thirty-four participants (Mage  = 19.35 years; 29 female) completed an auditory Go/No-go task in no face, neutral face, and fearful face conditions. Faces were presented at either cardiac diastole or systole. Participants' reaction times (RTs) during Go trials and failures in response inhibition during No-go trials were recorded. The ex-Gaussian model was fit to RT data in each condition deriving the parameters, mu (µ) and tau (τ), that indicate response speed and attentional lapses, respectively. Repeated measures ANOVA were used to analyze behavioral data. Results showed that cardiac systole prolonged µ but decreased τ, and that cardiac diastole reduced inhibition errors in the fearful face condition but not in other conditions. These findings indicate that cardiac timing differentially modulates sensory-perceptual and top-down attentional processes and cardiac timing interacts with threatening contexts to influence response inhibition. These results highlight the specificity of cardiac cycle time effects on sensorimotor processing.

The role of youths' cardiac autonomic balance and parental responses to youth emotion in vulnerability to borderline personality disorder development.

Developmental models of borderline personality disorder (BPD) emphasize the effects of youths' biological vulnerabilities and their experiences of parental responses to emotion, as well as the interaction between these two elements. The current study evaluated the independent and interactive effects of two indices of autonomic nervous system response and parental responses to youth negative emotions on severity and exacerbation of youths' BPD features during the transition to adolescence. The sample consisted of 162 psychiatric youth (10-14 years; 47.2% female) and their parents. At baseline, youth and their parents completed a lab-based conflict discussion during which parasympathetic and sympathetic nervous system response were measured and indices of sympathetic-parasympathetic balance and coactivation/coinhibition were calculated. Youth also reported on supportive and non-supportive parental responses. At baseline and after 9 months, youth self-reported on their BPD features. Results demonstrated that shifting toward sympathetic dominance independently predicted exacerbation of BPD across 9 months. Additionally, fewer experiences of supportive parental responses and more non-supportive parental responses were associated with greater severity of BPD features in youth. This study highlights the role of autonomic response to parent-child conflict as well as the significance of parental responses to youth emotion for the development of BPD during this developmental window.

Isotemporal Associations of Device-Measured Sedentary Time and Physical Activity with Cardiac-Autonomic Regulation in Previously Pregnant Women.

BACKGROUND: High sedentary time (ST) and low physical activity may increase cardiovascular risk, potentially though cardiac-autonomic dysregulation. This study investigated associations of statistically exchanging device-measured ST and physical activity with measures of cardiac-autonomic regulation in previously pregnant women. METHOD: This cross-sectional, secondary analysis included 286 women (age = 32.6 ± 5.7 years; 68% white) measured 7-15 years after delivery. ST and light (LPA), moderate (MPA), vigorous (VPA), and moderate-to-vigorous (MVPA) intensity physical activity were measured by ActiGraph GT3X. ST was further partitioned into long (≥ 30 min) and short (< 30 min) bouts. MVPA was also partitioned into long (≥ 10 min) and short (< 10 min) bouts. Cardiac-autonomic regulation was assessed by heart rate variability (HRV) (resting heart rate, natural log transformed standard deviation of normal R-R intervals [lnSDNN], natural log-transformed root mean square of successive differences [lnRMSSD]) from a 5-min seated ECG. Progressive isotemporal substitution models adjusted for confounders. Sensitivity analyses removed women with related underlying medical conditions and who did not meet respiration rate criteria. RESULTS: Initial analyses found no significant associations with HRV when exchanging 30 min of ST and physical activity (p > 0.05). Yet, replacing long- and short-bout ST with 30 min of long-bout MVPA yielded significantly higher (healthier) lnRMSSD (B = 0.063 ± 0.030 and B = 0.056 ± 0.027, respectively; both p < 0.05). Sensitivity analyses strengthened these associations and yielded further associations of higher lnSDNN and lnRMSSD when replacing 30 min of short-bout MVPA with equivalent amounts of long-bout MVPA (B = 0.074 ± 0.037 and B = 0.091 ± 0.046, respectively). CONCLUSION: Replacing ST with long-bout MVPA is a potential strategy to improve cardiac-autonomic function in previously pregnant women.

An exploration of barriers to access to trial of labor and vaginal birth after cesarean in the United States: a scoping review.

INTRODUCTION: Increasing the number of vaginal birth after cesarean (VBAC) deliveries is one strategy to reduce the cesarean rate in the United States. Despite evidence of its safety, access to trial of labor after cesarean (TOLAC) and VBAC are limited by many clinical and non-clinical factors. We used a scoping review methodology to identify barriers to access of TOLAC and VBAC in the United States and extract potential leverage points from the literature. CONTENT: We searched PubMed, Embase, Cochrane, and CINAHL for peer-reviewed, English-language studies published after 1990, focusing on access to TOLAC and/or VBAC in the United States. Themes and potential leverage points were mapped onto the Minority Health and Health Disparities Research Framework. The search yielded 21 peer-reviewed papers. SUMMARY: Barriers varied across levels of influence and included factors related to restrictive clinical guidelines, provider reluctance, geographic disparities, and midwifery scopes of practice. While barriers varied in levels of influence, the majority were related to systemic and interpersonal factors. OUTLOOK: Barriers to TOLAC and VBAC exist at many levels and are both clinical and non-clinical in nature. The existing body of literature can benefit from more research examining the impact of recent revisions to clinical guidelines related to VBAC as well as additional qualitative studies to more deeply understand the complexity of provider reluctance.

Provision of chaplaincy services in U.S. hospitals: A strategic conformity perspective.

BACKGROUND: Increasingly, hospitals are expected to provide patient-centered care that attends to patients' health needs, including spiritual care needs. Chaplaincy services help to meet patients' spiritual care needs, which have been shown to have a positive impact on health outcomes. Variation in the provision of chaplaincy services suggests hospitals do not uniformly conform to the expectation of making chaplaincy services available. PURPOSE: The aim of this study was to examine the availability and factors that influence hospitals' provision of chaplaincy services. METHODOLOGY: Data were combined from the American Hospital Association annual surveys with the Area Health Resource File at the county level from 2010 to 2019. Observations on general, acute-care community hospitals were analyzed (45,384 hospital-year observations) using logistic regression that clustered standard errors at the hospital level. RESULTS: Hospitals with Joint Commission accreditation, more staffed beds, nonprofit and government ownership, teaching status, one or more intensive care units, a higher percentage of Medicare inpatient days, church affiliation, and system membership were more likely to provide chaplaincy services than their counterparts. Certification as a trauma hospital and market competition showed no influence on the provision of chaplaincy services. CONCLUSION: The lack of chaplaincy services in many hospitals may be due to limited resources, workforce shortage, or a lack of consensus on scope and nature of chaplaincy services. PRACTICE IMPLICATIONS: Chaplaincy services are an underutilized resource that influences patient experience, clinician burnout and turnover, and the goal of ensuring care is patient-centered. Administrators should consider stronger partnerships where services are provided; researchers and policymakers should consider how the lack of these services in some hospitals may reinforce existing health disparities.

Links between oral health-related quality of life in US adults and type 2 diabetes: structural equation modeling analysis.

OBJECTIVES: To analyze the effects of type 2 diabetes mellitus (T2DM), need for dental care, personal health practices and use of services on oral health-related quality of life (OHRQoL) in US adults. BASIC RESEARCH DESIGN: The sample included 2,945 participants (aged ≥ 20) selected from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 stratified probability sample that represented 124,525,899 individuals in the weighted sample. Two-stage structural equation modelling (SEM) assessed interrelationships between T2DM regressions on factors associated with OHRQoL in a simplified three-factor Andersen Behavioral Model (ABM). RESULTS: SEM supported the hypotheses that T2DM directly predicted need (perceived need, evaluated need, general health condition) with a significant path coefficient of 0.49 (ß=0.49, p⟨0.05). Need had direct (77%) and indirect (23%) effects on OHRQoL (ßdirect=0.30, ßindirect=0.09, p⟨ 0.001). Need predicted personal health practices including use of services (reason for dental visit, frequency of dental visits, smoking status) (ß=0.46, p⟨0.001). Need, in turn, predicted OHRQoL (ß=0.19, p⟨0.001). In the model, 23.8%, 59.7%, and 18.1% of the variance was explained by need, personal health practices including use of services, and OHRQoL, respectively. CONCLUSIONS: The results confirmed T2DM predicted need, which in sequence had direct and indirect effects on OHRQoL.

Examining Factors Associated with Utilization of Chaplains in the Acute Care Setting.

Hospitalized persons want their spiritual needs addressed and discussed by the healthcare team, but medical providers and nurses lack the necessary training. Patients want chaplaincy care, but very few receive it, and little is known about utilization factors. To identify the population characteristics associated with the utilization of chaplaincy services, hospitalization data from March 2012 to July 2017 were analyzed (N = 15,242 patients). Religiously affiliated individuals and those with the most acute health needs were more likely to receive chaplaincy care and received more total care. Patient-centered healthcare models may need to evaluate strategic integration of spiritual care beyond reactive spiritual care provision.

Attention and sensory integration for postural control in young adults with autism spectrum disorders.

Postural control impairments have been reported in adults with autism spectrum disorders (ASD). Balance relies on the integration of multisensory cues, a process that requires attention. The purpose of this study was to determine if the influence of attention demands on sensory integration abilities relevant for balance partially contributes to postural control impairments in ASD. Young adults with ASD (N = 24) and neurotypical participants (N = 24) were exposed to sensory perturbations during standing. An established dual-task paradigm was used, requiring participants to maintain balance in these sensory challenging environments and to perform auditory information processing tasks (simple reaction time task and choice reaction time task). Balance was assessed using sway magnitude and sway speed, and attention demands were evaluated based on the response time in the auditory tasks. While young adults with ASD were able to maintain balance in destabilizing sensory conditions, they were more challenged (greater sway speed) than their neurotypical counterparts. Additionally, when exposed for an extended amount of time (3 min) to the most challenging sensory condition included in this study, adults with ASD exhibited a reduced ability to adapt their postural control strategies (sway speed was minimally reduced), demonstrating a postural inflexibility pattern in ASD compared to neurotypical counterparts. Finally, the impact of performing an auditory information processing task on balance and the dual-task cost on information processing (response time) was similar in both groups. ASD may disrupt temporal adaptive postural control processes associated with sensory reweighting that occurs in neurotypicals.

Safety of bone marrow aspiration and biopsy in severely thrombocytopenic patients.

PURPOSE: To assess the safety of fluoroscopically guided drill-assisted bone marrow aspirate and biopsy in severely thrombocytopenic patients. MATERIALS AND METHODS: The study was approved by the IRB with waiver of informed consent. Retrospective review of 111 bone marrow aspirate and biopsies (BMAB) performed in 94 patients who received a CT scan which included the pelvis and biopsy site within the 7 days following the BMAB. The 94 patients were subdivided based on their platelet count: severe thrombocytopenia (< 20 platelets × 109/L), thrombocytopenia (20-50 platelets × 109/L), and control (> 50 platelets × 109/L). The procedure report was reviewed for sedation time, aspirate volume, and aggregate size of core biopsy specimens. The electronic medical record was reviewed for specimen adequacy; pathologic diagnosis; body mass index; pre- and post-procedure labs including platelet count, hemoglobin (HGB), hematocrit (HCT), prothrombin time (PT), and international normalized ratio (INR) levels; post-procedural transfusion; and complications including mortality at 30 and 90 days. CT scans were independently reviewed by 2 fellowship-trained radiologists for the presence of post-procedural hemorrhage. RESULTS: There was no significant difference in CT-identified post-procedural hematoma, or change in the hemoglobin and hematocrit levels pre- and post-procedure between the three groups. There was no significant difference in complication rate or all-cause mortality. There was a significant difference in transfusion at 30 days with thrombocytopenic and severely thrombocytopenic patients more likely to receive transfusion within the 30 days post-procedure. CONCLUSION: Fluoroscopically guided BMAB can be safely performed in patients with severe thrombocytopenia.

RSA reactivity to parent-child conflict as a predictor of dysregulated emotion and behavior in daily life.

BACKGROUND: Individual variability in tonic (resting) and phasic (reactivity) respiratory sinus arrhythmia (RSA) may underlie risk for dysregulated emotion and behavior, two transdiagnostic indicators that permeate most psychological disorders in youth. The interaction between tonic and phasic RSA may specify unique physiological profiles during the transition to adolescence. The current study utilized clinically referred youth (Mage = 12.03; s.d. = 0.92) to examine baseline RSA, RSA reactivity, and their interaction as predictors of dysregulated emotion and behavior in daily life. METHOD: Participants were 162 youth (47% female; 60% minority) in psychiatric treatment for any mood or behavior problem. RSA was assessed during three, 2-minute baselines and an 8-minute parent-child conflict discussion task. Dysregulated emotion and behavior were assessed during a 4-day ecological momentary assessment protocol that included 10 time-based prompts over a long weekend. RESULTS: Greater RSA withdrawal to the conflict was associated with dysregulated basic emotion (sadness, anger, nervousness, stress) in daily life. Two distinct interactions also emerged, such that baseline RSA was related to dysregulated complex emotion (shame, guilt, loneliness, emptiness) and dysregulated behavior as a function of RSA reactivity to conflict. Lower baseline RSA and greater RSA withdrawal were associated with dysregulated complex emotion, while higher baseline RSA and greater RSA withdrawal were associated with dysregulated behavior. CONCLUSIONS: Findings point to physiological profiles that increase the risk of dysregulated emotion and behavior during the transition to adolescence. Excessive RSA withdrawal uniquely, and in combination with baseline RSA, increased risk for dysregulation in daily life, underscoring the role of autonomic stress responding as a risk factor for psychopathology.

Osteoid osteoma in older adults: clinical success rate of percutaneous image-guided thermal ablation.

AIM: To assess the clinical success rate of percutaneous radiofrequency and laser ablation of osteoid osteomas in older adults. MATERIALS AND METHODS: Percutaneous radiofrequency or laser ablation was performed in 43 patients (35 years and older) with osteoid osteoma to achieve definitive cure in this retrospective study. The clinical success rate was defined as complete pain relief determined by numeric rating scale (NRS) scores (pre-procedural and post-procedural at 1-week, 6-week, and 2-year intervals). Tumour characteristics, technical success, procedural details, biopsy results, and complications were documented. RESULTS: Forty-four osteoid osteomas were ablated in 43 patients, and all procedures were technically successful. The clinical success rates were 95.2% (41/43), 93% (40/43), and 93.2% (41/44) at 1-week, 6-week, and 2-year post-procedural intervals. The acute complication rate was 2.3% (1/44; meningeal perforation following epidural anaesthesia). No delayed complication was documented. CONCLUSION: Osteoid osteomas are not unique to the paediatric and young population, and safe and effective definitive treatment of these benign tumours in older adults can be achieved by percutaneous radiofrequency and laser ablation with excellent patient outcomes.

The relationship between resting heart rate and aggression in males is racially variant.

Although resting heart rate is thought to be a generalizable risk factor for aggression, very little research has examined whether this relationship varies by race. We addressed this limitation using longitudinal data from the Pittsburgh Youth Study. Current data are from 197 men who participated in a teenage biosocial study (mean age = 15.7 years) and adult follow-up study (mean age = 32.1 years). Teenage resting heart rate interacted with race to predict teenage and adult aggression. The relationship between heart rate and aggression was significant in White, but not in Black males. To our knowledge, this is the first study to find that the relationship between resting heart rate and aggression is racially variant, suggesting that resting heart rate may not be a generalizable biomarker for conduct problems. At an intervention-level, findings could contribute to the development of more accurate risk assessment tools that take into account racial variance in risk factors.

Prospective Associations of Adolescent Conscientiousness With Psychological Resources and Metabolic Syndrome in Black and White Men.

OBJECTIVE: Conscientiousness predicts better psychological resources as well as lower cardiovascular mortality and lower metabolic syndrome (MetS) risk. However, the benefits of conscientiousness might be amplified, disabled, or reversed in disadvantaged groups. This study is the first to test these competing hypotheses for prospective associations between adolescent conscientiousness and adult psychological resources and MetS. METHOD: Participants were 220 men (54.6% black) from the Pittsburgh Youth Study. Adolescent conscientiousness (M [SD] age = 16 [1]) was rated by participants and their parents. Adult (M [SD] age = 32 [1]) socioeconomic status (SES; occupation and education), psychological resources (composite of positive affect, purpose in life, optimism, self-mastery, and self-esteem), and MetS scores (glucose, lipids, waist circumference, and blood pressure) were measured. Hierarchical regressions were used to evaluate the association of conscientiousness with adult psychological resources and MetS scores, with testing of moderation by race and SES. RESULTS: Self- and parent-reported conscientiousness were associated with better psychological resources (ßs = 0.23-0.29, ps ≤ .015), with no moderation by race or socioeconomic status. In the full sample, a three-way interaction of self-reported conscientiousness, race, and SES was obtained for MetS (ß = 0.12, p = .093). Subgroup analysis indicated that self-reported conscientiousness was related to higher MetS scores in low SES black men (ßint = -0.22, p = .022), but there was no comparable linear (ßs ≤ 0.08, ps ≥ .50) or interaction (ßs ≤ -0.13 ps ≥ .25) pattern in white men. CONCLUSIONS: Adolescent conscientiousness was beneficial for adult psychological resources, regardless of race or SES. However, there may be physiological costs of conscientiousness for black men from disadvantaged backgrounds.

Depressive Symptoms During Childhood and Cardiovascular Risk Factors in Black and White Men.

OBJECTIVE: Depressive symptoms and major depression predict cardiovascular disease (CVD) and CVD risk factors in adulthood. Evidence regarding the role of depression in the development of CVD risk in youth is minimal. The study evaluated the prospective relationship of depressive symptoms in childhood and adolescence with adult CVD risk factors in black and white men. METHODS: Health behaviors and medical history were measured in 165 black and 146 white men (mean age = 32); a subset in the Pittsburgh area had a fasting blood draw to measure metabolic syndrome and inflammation. Adult CVD risk factors were related to depressive symptoms and childhood socioeconomic status (SES) prospectively measured annually from ages 7 to 16 years, followed by adjustments for adult SES and depressive symptoms. RESULTS: Men with higher depressive symptoms ages 7 to 16 smoked more cigarettes, B = 0.28 (standard error = 0.12), p = .015, and ate fewer servings of fruits and vegetables, B = -0.08 (0.04), p = .040, as adults. The association for smoking was independent of adult depressive symptoms (concurrent) and childhood and adult SES as well as race. Depressive symptoms during childhood were unrelated to the metabolic syndrome or biomarkers of inflammation in adulthood. CONCLUSIONS: Depressive symptoms in childhood may predict later adverse health behaviors in black and white men. No evidence was found for an association between childhood depressive symptoms with metabolic syndrome or inflammation markers at ages approximately 32 years. The nature of the sample and lack of measurement of depressive disorder diagnosis tempers the conclusions, and future research is needed to determine associations with biological measures at later life span phases.

Depressive symptoms and cerebral microvascular disease in adults with Type 1 diabetes mellitus.

AIM: To assess the prevalence of, and risk factors for, depressive symptoms, comparing a sample of middle-aged adults with and without juvenile-onset Type 1 diabetes mellitus, and to determine if depressive symptoms were associated with white matter hyperintensity volume among those with Type 1 diabetes. METHODS: Depressive symptoms and white matter hyperintensities were compared between adults (age range 30-65 years) with juvenile-onset Type 1 diabetes (n=130) and adults without Type 1 diabetes (n=133). The association of Type 1 diabetes with depression was computed before and after adjustment for white matter hyperintensities. Among the Type 1 diabetes group, the primary associations of interest were between depressive symptoms (Beck Depression Inventory score ≥10) and white matter hyperintensities (n=71), hyperglycaemia and physical activity. Associations between depressive symptoms and diabetes-related complications, cognitive impairment, smoking and self-reported disability were examined. Analyses were controlled for education, sex, age and antidepressant use. RESULTS: Depressive symptoms were more prevalent among those with vs those without Type 1 diabetes (28% vs 3%; P<0.001). White matter hyperintensities explained 40% of the association of Type 1 diabetes with depressive symptoms, while Type 1 diabetes had a direct effect of 68% on depressive symptoms. Among those with Type 1 diabetes, depressive symptoms were related to white matter hyperintensity volume, a 16-year average HbA1c ≥58 mmol/mol (7.5%), and lower physical activity levels. Associations with other characteristics were not significant. CONCLUSION: These findings suggest a cerebrovascular origin for depressive symptoms in adults with Type 1 diabetes, perhaps triggered by hyperglycaemia. Future longitudinal studies should investigate whether targeting hyperglycaemia and physical inactivity alleviates depressive symptoms, possibly by slowing the development of cerebral microvascular disease, in people with Type 1 diabetes.

Inhibition and decision-processing speed are associated with performance on dynamic posturography in older adults.

Changes in cognition due to age have been associated with falls and reduced standing postural control. Sensory integration is one component of postural control that may be influenced by certain aspects of cognitive functioning. This study investigated associations between measures of cognitive function and sensory integration capabilities for healthy young and older adults. Dynamic posturography was performed using the Equitest Sensory Organization Test (SOT) protocol to evaluate sensory integration during standing using sway-referencing of the platform and/or visual scene to alter somatosensory and visual inputs. The Equilibrium Score was used as a measure of sway. Cognitive testing examined aspects of cognitive function that have been associated with falls in older adults. A correlational analysis investigated associations between the cognitive measures and postural sway during the altered sensory conditions of the SOT. For older subjects only, slower decision-processing speed was associated with increased sway during SOT conditions whenever somatosensation was altered. Reduced perceptual inhibition was associated with increased sway whenever somatosensation was intact, and particularly when vision was altered in the presence of somatosensation. Visuospatial construct ability was associated with sway only when the eyes were closed during altered somatosensation. Task-switching was associated with sway only when vision and somatosensation were intact. With increased age, deficits in decision speed and inhibition appear associated with the sensory integration crucial for balance maintenance. Associations are modulated by the availability of somatosensation and vision. These associations define situations and individual differences in aspects of cognition that may relate to situational loss of balance in older adults.

Heart rate and hurtful behavior from teens to adults: Paths to adult health.

A low resting heart rate across development from infancy to young adulthood relates to greater aggression/hostility. Adult aggression and a high heart rate relate to health risk. Do some aggressive individuals retain low heart rate and less health risk across development while others show high heart rate and more risk? A longitudinal sample of 203 men assessed as teens (age 16.1) and adults (mean age 32.0) permitted us to assess (a) stability of heart rate levels and reactivity, (b) stability of aggression/hostility, and (c) whether change or stability related to health risk. Adults were assessed with Buss-Perry measures of aggression/hostility; teens with the Zuckerman aggression/hostility measure. Mean resting heart rate, heart rate reactivity to speech preparation, and aggression/hostility were moderately stable across development. Within age periods, mean heart rate level, but not reactivity, was negatively related to hostility/aggression. Maintaining low heart rate into adulthood was related to better health among aggressive individuals relative to those with increasing heart rate into adulthood. Analyses controlled for weight gain, socioeconomic status, race, health habits, and medication. Low heart rate as a characteristic of hostile/aggressive individuals may continue to relate to better health indices in adulthood, despite possible reversal of this relationship with aging.