The role of social support in reducing the long-term burden of cumulative childhood adversity on adulthood internalising disorder.

PURPOSE: Previous research indicates that social support is protective for the mental health outcomes of exposure to childhood adversity. However, the impact of social support as a protective factor following exposure to cumulative childhood adversity is understudied with prospective longitudinal data. The aim of this present study was to examine how social support mediates the impact of cumulative exposure to childhood adversity on internalising disorder in adulthood. METHODS: The Christchurch Health and Development Study (CHDS) is a general population birth cohort, born in 1977 and representative of Christchurch, New Zealand at the time of the cohort members' birth. The present study used a generalised estimating equations (GEE) framework to analyse direct associations between a cumulative measure of childhood adversity (CA) and internalising disorders (major depression, and any anxiety disorder), and indirect associations through social support. RESULTS: Results indicated a dose-dependent relationship between increased exposure to CA and worsened odds of a diagnosis for major depression and any anxiety disorder, respectively. There was also a significant mediating effect of social support on the direct associations between CA and both major depression (OR (95%CI) =0 .98 (0.97, 0.99), p < 001) and any anxiety disorder (OR (95%CI) = .98 (0.97, 0.99), p < 001). CONCLUSION: The findings indicate that social support reduces the impact of childhood adversity on adult mental health, and is therefore a target for future work examining potential interventions following CA.

Arthrocentesis of suspected septic sternoclavicular arthritis: microbial yield and predictors of culture positivity.

OBJECTIVE: Evaluate the microbial yield and factors predicting culture positivity for image-guided arthrocentesis of suspected septic sternoclavicular (SC) arthritis. MATERIALS AND METHODS: An electronic health record search identified image-guided SC joint aspirations for suspected septic arthritis. Data was extracted by retrospective chart review including patient demographics, procedure characteristics, pre-procedure lab testing, joint culture results, final SC joint diagnoses and any effect of positive synovial cultures on subsequent antibiotic therapy. Factors associated with positive joint fluid cultures were assessed using a Chi-squared test for categorical predictors and logistic regression for continuous predictors. RESULTS: A total of 31 SC arthrocenteses met inclusion criteria with most (81%) performed using ultrasound guidance. Synovial fluid was successfully aspirated in 19/31 (61%) of cases, and in all other cases lavage fluid was successfully obtained. Synovial cultures were positive in 9/31 (29%) of cases. A final diagnosis of septic arthritis was assigned to 20/31 cases (65%) in which 9/20 (45%) had positive synovial cultures. There was no statistically significant association between synovial culture positivity and risk factors for septic arthritis, positive blood cultures, pre-aspiration antibiotics and whether synovial fluid or lavage fluid was cultured. Serum white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) demonstrated statistically significant positive correlation with positive synovial cultures. CONCLUSION: Arthrocentesis is effective for microbial speciation in SC septic arthritis, and diagnostic yield may be increased with lavage when encountering a dry tap. Normal serum WBC and ESR values indicate an extremely low likelihood of positive synovial cultures.

Protective factors for psychosocial outcomes following cumulative childhood adversity: systematic review.

BACKGROUND: The long-term cumulative impact of exposure to childhood adversity is well documented. There is an increasing body of literature examining protective factors following childhood adversity. However, no known reviews have summarised studies examining protective factors for broad psychosocial outcomes following childhood adversity. AIMS: To summarise the current evidence from longitudinal studies of protective factors for adult psychosocial outcomes following cumulative exposure to childhood adversity. METHOD: We conducted a formal systematic review of studies that were longitudinal; were published in a peer-reviewed journal; examined social, environmental or psychological factors that were measured following a cumulative measure of childhood adversity; and resulted in more positive adult psychosocial outcomes. RESULTS: A total of 28 studies from 23 cohorts were included. Because of significant heterogeneity and conceptual differences in the final sample of articles, a meta-analysis was not conducted. The narrative review identified that social support is a protective factor specifically for mental health outcomes following childhood adversity. Findings also suggest that aspects of education are protective factors to adult socioeconomic, mental health and social outcomes following childhood adversity. Personality factors were protective for a variety of outcomes, particularly mental health. The personality factors were too various to summarise into meaningful combined effects. Overall GRADE quality assessments were low and very low, although these scores mostly reflect that all observational studies are low quality by default. CONCLUSIONS: These findings support strategies that improve connection and access to education following childhood adversity exposure. Further research is needed for the roles of personality and dispositional factors, romantic relationship factors and the combined influences of multiple protective factors.

Life course development following childhood adversity: methods and findings from the Christchurch Health and Development Study.

Aim: To review research developments on childhood adversity in the Christchurch Health and Development Study (CHDS) since 2001. Method: Narrative overview of the published work of the CHDS since 2001 in the context of research methods. Results: The CHDS research has continued to evolve as the cohort has aged. A clear focus has remained on the measurement of outcomes associated with psychosocial risk factors over the life course. This focus has allowed the CHDS to examine the linkages between exposure to adversity in childhood and later mental health, psychosocial and occupational outcomes across the life span to middle adulthood. The CHDS has many strengths, including prospective measurement of a broad and deep set of constructs, the use of multiple informants for data, and a range of statistical approaches suited to repeated measures longitudinal data. The CHDS has pioneered new approaches to the study of human development over the lifespan, which has been instrumental in investigating childhood adversity. Conclusion: The CHDS continues to provide unique information from a population cohort that has been studied for more than four decades. Future research will include examination of factors that mitigate the effects of childhood adversity and enhance resilience.

Metastatic melanoma presenting as rapidly enlarging hepatic cysts.

Malignant melanoma is a highly aggressive disease with a propensity for metastatic spread. Although recent advances in targeted therapies have improved outcomes, effective screening for metastasis remains an important area of further research. We present a case of a man in his 70s who was recently diagnosed with recurrent, locally advanced melanoma. He presented with abdominal fullness, jaundice, and poor appetite. MR imaging of the abdomen revealed innumerable hepatic cysts with internal fluid-fluid levels which were markedly increased in size and number from recent imaging. These findings necessitated a broad differential that included parasitic or bacterial infection, metastases, or drug-induced polycystic liver disease. Subsequent biopsy revealed metastatic melanoma consistent with the patient's primary tumor. The patient was ultimately transitioned to comfort care measures due to the burden of the liver metastases and passed away shortly after presentation.

CT Evaluation of the Esophagus: The Role of CT Imaging and CT Imaging Findings in Diagnosing Esophageal Abnormalities.

Esophageal disorders are commonly encountered by radiologists on computed tomography. Characteristic computed tomography findings of various esophageal pathologies have been extensively described and are important for the radiologist to know to facilitate accurate and timely diagnosis. Esophageal disorders can be broadly classified as infectious and inflammatory, congenital/structural, or neoplastic. This paper reviews the most common presentations of various esophageal pathologies within each classification.

Cannabis use and patterns of psychotic symptomatology in a longitudinal birth cohort.

AIM: Research has established associations between regular cannabis use and psychotic symptomatology in young people. However, there has been little previous research on whether the experience of psychotic symptomatology differs between non-users and regular users of cannabis. METHOD: Data were from the Christchurch Health and Development Study (CHDS), a longitudinal cohort born in 1977. Data on frequency of cannabis use and (past month) psychotic symptomatology were obtained at the age 18, 21 and 25 waves of assessment. Symptoms were rank ordered by the number of affirmative responses over the three assessments, and the symptom profile of non-users and regular users were compared using a non-parametric Mann-Whitney U test. RESULTS: Among non-users and regular users, the commonly reported symptoms of psychosis were those that would be considered "mild". More severe symptoms were not commonly reported. A comparison of the symptom profile across the two groups showed no significant differences. CONCLUSION: There was no evidence of qualitative differences in the pattern of psychotic symptomatology reported by non-cannabis users and regular cannabis users. Although regular cannabis users tend to report a greater number of symptoms, these symptoms did not tend to be severe, and were unlikely to be indicative of psychotic illness.

The Utility of Point-of-Care Testing at Emergency Department Triage by Nurses in Simulated Scenarios.

We developed and tested simulated patient scenarios to assess how normal or abnormal point-of-care (POC) test results at triage change prioritization decisions. This was a cross-sectional study where our team developed simulated scenarios and presented them to triage nurses from 3 academic medical centers. Twenty-four scenarios were constructed on the basis of 12 clinical indications from a protocol previously developed by our team. In each scenario, nurses were presented with 2 patients with the same Emergency Severity Index Version 4 (ESI v.4; Agency for Healthcare Research and Quality, Rockville, MD) triage level (Level 2 or Level 3). One of the patients met the inclusion criteria for POC testing under the protocol (cases), whereas the other patient did not (controls). Nurses were asked which of the 2 patients to prioritize first in 3 separate rounds: first without any POC test results, once with abnormal POC test results for case patients, and once with normal POC test results for case patients. Prioritization decisions that changed on the basis of abnormal POC results were defined as "up-triage" and prioritization decisions that changed on the basis of normal results were defined as "down-triage." A total of 39 nurses completed 468 scenarios. In scenarios without any POC test results, 42.3% of case patients were prioritized first. When POC test results were abnormal, 71.6% of cases were prioritized first. When POC test results were normal, 32.7% of case patients were prioritized first. An abnormal POC test resulted in up-triage in 32.5% of the scenarios. When POC test results were normal, there was down-triage in 18.6% of the scenarios. Up- and down-triage rates varied considerably by scenario and clinical indication. Point-of-care testing at emergency department triage results in reasonably high rates of up- and down-triage in simulated scenarios; however, POC tests for specific indications appear to be more useful than others.

Multiprofessional education: improving care for acutely ill children.

A three-year programme was established for practitioners who work with acutely ill and injured children and young people. Courses were held in urban and rural areas of Scotland and more than 2,000 NHS staff, including nurses, paramedics, doctors and allied health professionals, took part. Three-day training comprised clinical skills updates, scenario-based teaching and observed structural clinical examinations. As a result, NHS Scotland says care delivery to children, young people and their families has improved in community and hospital environments.

Europa DONNA, the European Breast Cancer Coalition: lobbying at European and local levels.

Breast cancer is a serious medical and social problem, and the ultimate goal should be to promote accessible and financially sustainable high standard healthcare interventions and develop patient-oriented strategies for prevention, diagnosis, and treatment. EUROPA DONNA, a nonprofit organization, is a European women's movement against breast cancer. It provides a focus for the exchange of information and experience between members and serves as a moving force for combined actions. EUROPA DONNA represents the concerns and interests of European women to local and national authorities and governments, drawing attention to the need for improvement in or introduction of essential programs and services in the fight against breast cancer. It is a coalition of individual women and associations involved in the fight against breast cancer, active in 32 European countries, each organized as a national independent forum. Lobbying is one of the most important activities of EUROPA DONNA. In fact, only by involving institutions both on a local and a national level is it possible to achieve results that can benefit a large number of women.

Establishing a bereavement program: caring for bereaved families and staff in the emergency department.

The successful planning and implementation of a Bereavement Program in the Emergency Departments of two of Melbourne's major metropolitan teaching hospitals, Monash Medical Centre (MMC) and Dandenong Hospital (DH) was in response to staff dissatisfaction regarding their capacity to care for bereaved families and involved staff. Key influencing factors were identified and literature evidence was sought. A multidisciplinary team was brought together to form a Planning Group and guidelines were developed. The aim was to improve the care of all those involved with a death in the Emergency Department, both family and staff. Fundamental to facilitating these improvements was the need for staff education in the needs of families, self and staff and a grief education program was arranged, and provided through multiple sources, utilising the expertise of the Centre for Grief Education. The extremely positive feedback, which has been received from families and ED staff is testimony to the care delivered and the difference the Program is making at Southern Health, to those experiencing a death in the Emergency Department.