Loneliness and posttraumatic stress in U.S. adolescents: A longitudinal study.

BACKGROUND: Loneliness and posttraumatic stress (PTS) are common in adolescence. However, there has been little longitudinal research on their association. To address this deficit, this study examined the longitudinal association between these phenomena in a sample of U.S. school students while also exploring if gender was important in this context. METHODS: Data were analysed from 2807 adolescents (52.1 % female; age at baseline 11-16 years (M = 12.79)) who were followed over a one-year period. Information was obtained on loneliness in year 1 using a single-item question, while PTS was assessed with the self-report Child Post-Traumatic Stress - Reaction Index (CPTS-RI). A full path analysis was performed to assess the across time associations. RESULTS: Almost one-third of the students reported some degree of loneliness while most students had 'mild' PTS. In the path analysis, when controlling for baseline PTS and other covariates, loneliness in year 1 was significantly associated with PTS in year 2 (ß = 0.06, 95%CI: 0.02, 0.09). Similarly, PTS in year 1 was significantly associated with loneliness in year 2 (ß = 0.19, 95%CI: 0.15, 0.23). An interaction analysis further showed that loneliness was higher in girls with PTS than in their male counterparts. LIMITATIONS: The use of a single-item measure to assess loneliness that used the word 'lonely' may have resulted in underreporting. CONCLUSION: Loneliness and PTS are bidirectionally associated in adolescence. Efforts to reduce loneliness in adolescence may help in combatting PTS, while clinicians should intervene to address loneliness if detected in adolescents with PTS.

Longitudinal associations between community violence exposure, posttraumatic stress symptoms, and eating disorder symptoms.

BACKGROUND: Eating disorder (ED) symptoms have been associated with different types of traumatic events, such as exposure to sexual and physical violence, and emotional abuse. However, the relation between ED symptoms and community violence exposure (CVE) is underexplored, despite the latter's adverse effects on many aspects of adolescent functioning. The primary aim of this study was to evaluate the relation between CVE and ED symptoms in adolescents, while also investigating the potential mediating and moderating roles of posttraumatic stress (PTS) symptoms, gender, and ethnicity. METHODS: Data were collected longitudinally over two consecutive years in the city of New Haven, CT, in the United States. Participants were 2612 adolescent students from the public school system (1397 girls and 1215 boys) with an average age of 12.8 years (SD = 1.29). The students were comprised of several different ethnic groups, including Caucasians, African Americans and Hispanic Americans. Associations between CVE (no exposure, witnessing, and victimization) and PTS symptoms at year one, and ED symptoms (thoughts and compensatory behaviors) at year two, were assessed with self-rating instruments. Moderation and mediation analyses were conducted using a variant of linear regression (Hayes PROCESS macro). RESULTS: ED symptoms at year two were significantly associated with both witnessing and being a victim of community violence at year one, with most or all of the relations being explained by PTS symptoms. Overall, neither gender nor ethnicity had a meaningful moderating effect in the observed relations. CONCLUSIONS: The findings support the notion that assessing and addressing PTS symptoms might be beneficial when treating individuals with ED symptoms who have experienced community violence, irrespective of gender or ethnicity.

In this study we wanted to see if there was a relation between adolescents experiencing violence in their community and showing signs of eating disorders. We also looked at the role of gender, ethnicity, and post-traumatic stress symptoms in this relation. We collected data from 2612 students in New Haven, in the United States, over 2 years. The participants were from various ethnic backgrounds. We used surveys to measure their exposure to community violence and their post-traumatic stress symptoms in the first year, and in the second year, we measured their eating disorder symptoms. We found that adolescents who witnessed or were victims of community violence in the first year were more likely to have eating disorder symptoms in the second year. Post-traumatic stress symptoms seemed to explain most of this relation. Gender and ethnicity did not appear to change these findings in any meaningful way. Thus, It is likely important to assess and address post-traumatic stress symptoms when helping adolescents with eating disorders who have experienced community violence, regardless of their gender or ethnicity.

Community Violence Exposure and Eating Disorder Symptoms among Belgian, Russian and US Adolescents: Cross-Country and Gender Perspectives.

Community violence exposure (CVE) is one of the most common adverse childhood experiences worldwide. Despite this, its potential effect on disordered eating in adolescents from different cultures is underexplored. In the present cross-sectional study, self-reported data were collected from 9751 students (Mean age = 14.27) from Belgium, Russia and the US on CVE (witnessing violence and violence victimization), eating disorder (ED) symptoms (ED thoughts with associated compensatory behaviors), and comorbid symptoms of posttraumatic stress, depression and anxiety. Increased CVE (from no exposure to witnessing to victimization) was associated with more ED symptoms, and the associations remained significant after adjusting for comorbid conditions. The associations were similar for adolescents across the three countries. No gender differences were observed in the association between CVE and ED symptoms, even though girls in general reported more ED symptoms than boys. We conclude that CVE appears to be associated with ED symptoms in three culturally different samples of adolescents.

Longitudinal Associations Between Community Violence Exposure and Mental Health Problems in Inner-City Youth: Ethnicity and Gender Perspectives.

There is a lack of agreement on whether children and adolescents with different cultural/ethnic backgrounds react to trauma in a similar fashion. This study adds to the existing literature by providing ethnicity and gender perspectives on the longitudinal associations between the degree of community violence exposure (CVE) and mental health problems in U.S. inner-city youth. The study was conducted on a representative sample of predominantly ethnic minority youth (N = 2,794; 54.1% female; age 11-16 years old (M [SD] = 12.77 [1.29]); 60.0% African-American, 26.1% Hispanic American, 13.9% White). Self-reported information was obtained on CVE in year 1 and on mental health problems (depressive symptoms, posttraumatic stress, alcohol use, and conduct problems) in year 1 and year 2. Multivariate analyses of covariance (MANCOVA) were used to compare mental health problems in youth from the three ethnic groups in relation to the different degrees of CVE experienced one year prior, while controlling for their baseline mental health problem levels, age, and socio-economic status. Mental health problems in year 2 increased in a similar fashion in relation to the degree of severity of CVE in year 1 in all three ethnic groups. The interaction effects suggested a gender-specific response to CVE, where girls in the three ethnic groups reported higher levels of depression and posttraumatic stress in relation to the same degree of CVE, as compared to boys. Adolescents from different ethnic backgrounds respond similarly to differing degrees of CVE with an increase in mental health problems over time. In response to a similar degree of exposure, girls tend to experience greater levels of internalizing problems than boys. Timely recognition of traumatic exposure and associated mental health problems is important for early prevention and intervention strategies.

Cutaneous Metastasis of Alveolar Rhabdomyosarcoma in a Child.

ABSTRACT: Rhabdomyosarcoma (RMS) is one of the most common soft tissue sarcomas in children. This lesion is classically included in the generic group of "small round blue cell tumors" along with other entities that share similar microscopic features. Although the head and neck region is a frequent site for primary tumors, cutaneous metastases of RMS involving this anatomical location are rare in the pediatric population. We report a case of a 12-year old girl previously diagnosed with a primary alveolar RMS involving the left maxillary sinus, presenting with a metastatic lesion on the skin of the left temple area. Along with a brief review of the previous case reports on the topic, we highlight the initial immunohistochemistry panel useful for diagnosing this tumor.

Rapid cytologic diagnosis of subcutaneous fat necrosis of the newborn.

Subcutaneous fat necrosis of the newborn is a rare self-limited panniculitis that classically presents within the first few weeks of life. The diagnosis is typically clinical, but some cases require skin biopsy with hematoxylin and eosin stain for confirmation. We report a previously undocumented rapid diagnostic protocol that involves collecting a small amount of exudate from a suppurative lesion, placement onto a slide without fixation, and simply viewing the material under a microscope. This novel and practical method of diagnosis reveals doubly refractile crystals diagnostic of subcutaneous fat necrosis without a biopsy, which may be helpful for rapid diagnosis or use in low resource settings.

Complex sweat gland hamartoma: A case report.

Syringocystadenoma papilliferum (SCAP), tubular apocrine adenoma (TAA), and eccrine nevus are rare benign sweat gland tumors with varied clinical presentations but generally distinctive histomorphologic profiles. TAA and SCAP have been associated with other cutaneous hamartomas, most commonly with nevus sebaceus. Additionally, TAA and SCAP have uncommonly co-occurred in the same lesion. In contrast to nevus sebaceus, eccrine nevus is considerably less common and is rarely associated with other benign adnexal lesions. Here we present an unusual case of a complex sweat gland hamartoma containing features of syringocystadenoma papilliferum, tubular apocrine adenoma, and eccrine nevus in a 7-year-old female.

Cutaneous melanocytic tumor with CRTC1::TRIM11 fusion and prominent epidermal involvement: A case report.

Cutaneous melanocytic tumor with CRTC1::TRIM11 fusion (CMCT) is a recently described entity with only 13 cases reported in the literature. Histopathologically, the neoplasm consists of atypical epithelioid to spindled cells that form a well-circumscribed nodule usually confined to the dermis and subcutis with cytological features including large vesicular nuclei with prominent nucleoli and abundant eosinophilic cytoplasm. Immunohistochemistry shows variable expressivity of melanocytic markers. Currently, there are limited data regarding long-term outcomes of this newly described entity. Most cases have done well, but there is one case reported with an adverse event. Hence, further studies are needed to accurately classify this tumor. Definitive diagnosis is made by laboratory evidence of CMCT. Herein, we report the first case of CMCT with epidermal involvement in the youngest patient known to be affected to date.

Attenuation of actinic prurigo eruptions with Polypodium leucotomos supplementation.

Actinic prurigo is a rare pruritic photodermatosis. We report the use of Polypodium leucotomos extract in an 11-year-old female patient with actinic prurigo, resulting in a significant attenuation of her disease without development of adverse effects to date. Polypodium leucotomos exerts a pleiotropic immunomodulatory and antioxidant effect by shifting the balance from pro- to an antiinflammatory cytokine environment. This counteracts the effects of UV-induced cellular damage characteristic of photodermatoses.

Prevalence and early risk factors for bulimia nervosa symptoms in inner-city youth: gender and ethnicity perspectives.

BACKGROUND: Research on risk factors associated with bulimia nervosa symptoms (BN) in ethnic minorities has been limited. This study adds to the existing literature by providing the ethnicity- and gender-specific prevalence of BN in US inner-city youth and by exploring the longitudinal associations between a clinical level of BN and early risk factors assessed one year previously. METHODS: The study was conducted on a representative sample of predominantly ethnic minority youth (N = 2794; 54.1% female; age 11-16 years old (M(SD) = 12.77(1.29)); 60.0% African-American, 26.1% Hispanic American, 13.9% White). Self-reported information was obtained on BN and early risk factors (e.g., depressive and anxiety symptoms, posttraumatic stress, somatic complaints). Multivariate analysis of covariance was used to examine the longitudinal associations. RESULTS: The 3-month BN prevalence was higher in girls (5.1%) than in boys (2.3%) (ratio 2.22:1). Significant differences in BN rates were found between White and African American students (higher in Whites), whereas Hispanic-Americans did not differ significantly from either group. Individuals with BN had significantly higher levels of early risk factors one year prior. CONCLUSIONS: Timely recognition of BN and associated early risk factors is important for early prevention and intervention strategies.

Community Violence Exposure and School Functioning in Youth: Cross-Country and Gender Perspectives.

Background: Many children and adolescents experience violent events which can be associated with negative consequences for their development, mental health, school, and social functioning. However, findings between settings and on the role of gender have been inconsistent. This study aimed to investigate cross-country and gender differences in the relationship between community violence exposure (CVE) and school functioning in a sample of youths from three countries. Methods: A self-report survey was conducted among school students (12-17 years old) in Belgium (Antwerp, N = 4,743), Russia (Arkhangelsk, N = 2,823), and the US (New Haven, N = 4,101). Students were recruited from within classes that were randomly selected from within schools that had themselves been randomly selected (excepting New Haven, where all students were included). CVE was assessed with the Screening Survey of Exposure to Community Violence. School functioning was assessed with four measures: the Perceived Teacher Support scale, Negative Classroom Environment scale, and Academic Motivation and Perception of Safety at School scales. Multivariate Analyses of Covariance were performed to assess differences in the levels of school-related problem behaviors in boys and girls, who reported different degrees of CVE. Results: Participants in all three countries reported a relatively high prevalence of violence exposure (36.2% in Belgium, 39.3% in Russia and 45.2% in the US who witnessed violence), with a higher proportion of girls than boys witnessing violent events (varied from 37.4 to 51.6% between the countries), whereas boys reported more episodes of victimization by violence than girls (varied from 32.3 to 49.9% between the countries). Youths who experienced increased CVE (from no exposure to witnessing to victimization) reported an increase in all school functioning problems in all of the countries and this association was not gender-specific. Conclusions: Our findings suggest that regardless of differences in the level of CVE by country and gender, violence exposure is negatively associated with school functioning across countries. Nonetheless, even though reactions to community violence among adolescents may be expressed in a similar fashion, cross-country differences in social support systems should also be taken into account in order to provide culturally sensitive treatment modalities.

A case of idiopathic acquired leukonychia totalis in a 17-year-old boy.

Whitening of the nail, or leukonychia, can have a wide range of etiologies including genetic disorders, trauma, poisoning, autoimmune disorders, and infections. Here we detail a case of idiopathic acquired leukonychia totalis in a 17-year-old boy. This condition has been reported 13 times in the literature previously, with only young boys being affected. Proper diagnosis may help minimize unnecessary investigations and prevent additional psychological stress over whether an underlying disease is present.

Effectiveness of Categorical Clustering as an Encoding Versus a Retrieval Strategy Among Preschoolers.

The relative effectiveness of categorical clustering as an encoding and retrieval strategy was examined among 92 three- and four-year-olds on a spatial memory task used to examine utilization deficiencies. Specifically, participants were asked to remember the locations of one of two categories of toys (i.e., four animals and four chairs) within in a multicolored square box. Most children spontaneously used a categorical clustering strategy when removing toys from the box (reflecting encoding) and/or replacing them (reflecting retrieval). However, the production of a categorical clustering strategy did not facilitate recall for all participants. Children who engaged in categorical clustering exclusively during encoding were more likely to present with a utilization deficiency by recalling fewer toy locations than those exclusively clustering during retrieval. Recall performance was not enhanced among children who used categorical clustering during both phases.

Risk and Protective Factors for Problematic Drinking in Early Adolescence: A Systematic Approach.

Alcohol use during early adolescence is associated with other risk behaviors as well as future health problems. Within the design of a larger prospective research program, a cohort of U.S. inner-city sixth-grade students (N = 1573, mean age = 12.10) were assessed and reassessed in the seventh-grade. Self-reported information was obtained on problems related to alcohol, fixed markers of risk (e.g. sex, age, SES), individual and interpersonal factors (e.g. internalizing and externalizing symptoms) and contextual factors (e.g. substance availability). Alcohol-related problems in seventh grade were foremost predicted by individual and interpersonal factors in the sixth grade including depressive symptoms, conduct problems, a decreased perception of wrongdoing, and affiliation with delinquent peers. In addition, alcohol use in the sixth grade and being of Hispanic or White ethnicity was also associated with subsequent alcohol-related problems. Interventions should be directed towards assessing and treating individual risk factors such as depression and externalizing symptoms.