Perceived team roles of medical students: a five year cross-sectional study.

INTRODUCTION: Despite the increasing importance of teamwork in healthcare, medical education still puts great emphasis on individual achievements. The purpose of this study is to examine medical students' team role preferences, including the association with gender and specialty; and to provide implications for policy makers and medical educators. METHODS: We used an exploratory methodology, following a cross-sectional design. Data was collected from first year master students in medicine (n = 2293) during five consecutive years (2016-2020). The Belbin Team Role Self Perception Inventory (BTRSPI) was used to measure medical students' self-perceptions of their team role. RESULTS: The Team Worker was the most preferred team role among medical students (35.8%), regardless of gender or specialty. Female and male students had similar team role patterns, although female students scored higher on Team Worker (40.4% vs. 29.1%, P < .001) and Completer-Finisher (14.0% vs. 8.0%, P < .001). With regard to specialties, the Team Worker role was more often chosen by general practitioners than by person-centered and technique-oriented specialties (47.1% vs. 41.8% vs. 29.1%, P < .001). CONCLUSIONS: Our findings contribute to an increased scientific understanding of how medical students perceive their own team role, and how this is related to gender and specialty. This is valuable due to the increased importance of interdisciplinary teamwork in healthcare. Medical schools should prioritize stimulating teamwork skills through the implementation of different interventions at all stages (i.e. from the admission process to curricula to residency) and all levels (i.e. explicit and implicit curricula).

Attachment and Non-Suicidal Self-Injury among Young Adolescents: The Indirect Role of Behavioral Problems.

Non-suicidal self-injury (NSSI) often occurs before age 15, yet the majority of research on risk factors for this dangerous behavior has focused on samples of older participants. Insecure attachment has been previously identified as a risk factor for both NSSI and behavioral problems, and behavioral problems appear to be particularly associated with NSSI among young populations. Redressing the lack of young adolescent NSSI research, the present study uses longitudinal data from a sample of young adolescents to test a model in which insecure attachment acts as a prospective risk factor for NSSI via emotional and behavioral problems. Data on NSSI, child-mother attachment, and emotional and behavioral problems were collected from 559 (41.1% male) Flemish adolescents when they were 13 years old (M = 12.71, SD =0.32), and again 1 year later. Insecure attachment was measured using maternal items on the Experiences in Close Relationships-Revised Child scale. Psychological adjustment was assessed with the Strengths and Difficulties Questionnaire. We found that anxious and avoidant attachment were indirectly associated with NSSI through behavioral problems but not through emotional problems. Findings highlight the role of behavioral problems as a risk factor for NSSI in early adolescence, a rarely studied developmental period during which NSSI often first starts. Findings suggest that one possible pathway for the attachment-NSSI association among young adolescents is through behavioral problems. Therapies that improve child-parent attachment may reduce NSSI among young adolescents both directly, and indirectly by improving behavioral problems.

Attitudes, believes, determinants and organisational barriers behind the low seasonal influenza vaccination uptake in healthcare workers - A cross-sectional survey.

BACKGROUND: Seasonal influenza threatens hospitalised patients and residents of nursing homes annually. Due to age and chronic disease their protection following immunisation is diminished. Additional immunisation of direct contacts and in particular healthcare workers (HCWs) has proven added value. As vaccination coverage in HCWs remains low, we aimed to gain insight in the factors behind the demotivation for influenza vaccination. METHODS: Attitudes and believes towards influenza vaccination and socio-demographic and professional determinants were surveyed in 5141 Belgian HCWs from 13 hospitals and 14 nursing homes. Additionally, influenza campaign coordinators of the participating healthcare institutions were interviewed about the factors of success/failure in their campaigns. RESULTS: The mean vaccination coverage registered by the participating healthcare institutions was 40.4% in the hospitals and 45.3% in the nursing homes. Overall, up to 90% of HCWs found it important not to infect their patients. However, only 20% of non-vaccinated HCWs considered influenza vaccination a duty to not harm their patients. Up to 40% of unvaccinated staff believed they could get influenza after vaccination and that vaccination weakens their immune system. Also, only about 20% of unvaccinated staff thought to have a high chance of getting influenza. Reasons for unvaccinated staff to get vaccinated in the future are self-protection and protection of family members. Factors that positively influenced vaccination coverage are encouragement by supervisors (OR, hospitals: 7.1, p < 0.001; nursing homes: 7.5, p < 0.001) and well-organized vaccination campaigns with on-site vaccination. Factors that negatively affected vaccination coverage are misconceptions about influenza and its vaccine (OR, range 0.1-0.7, p < 0.001 for most misconceptions) and underestimation of the risk of contracting influenza by patients or HCWs (OR of perceived susceptibility, range 2.1-5.1, p < 0.001 for most factors). CONCLUSION: There is a need for guidance for the organization of seasonal influenza campaigns, in which education, communication and easy accessible vaccination are promoted.

Coverage of recommended vaccines during pregnancy in Flanders, Belgium. Fairly good but can we do better?

BACKGROUND: In Flanders, Belgium, pertussis vaccination is recommended since 2013 and available free-of-charge in every pregnancy between 24 and 32 weeks of gestation. Influenza vaccination is recommended for more than 10 years with a co-payment system in the second or third trimester of pregnancy, when pregnancy coincides with the influenza season. This study aims to estimate the coverage of pertussis and influenza vaccination during pregnancy in 2016 and to determine predictors for missing vaccination. METHODS: Postpartum women were visited at home for a vaccination coverage survey using an Expanded Program on Immunization (EPI)-based two-stage cluster sampling design. Predictors for missed vaccination were identified using a multiple logistic regression model. RESULTS: Among 481 participating women, 69.3% were vaccinated against pertussis and 47.2% were vaccinated against influenza. Moreover, 65.3% of pertussis vaccine recipients and 96.9% of influenza vaccine recipients were vaccinated within the recommended gestational window. Surprisingly, among women who were completely informed (i.e. on disease-associated risks, maternal vaccination costs and recommendations), still 12.4% were unvaccinated against pertussis and 23.9% against influenza. In the final models, the only common predictor of missing maternal pertussis and influenza vaccination was multiparity. Significant predictors of maternal pertussis vaccination were family income (less likely if unknown or low (< €3000) than if moderate (€3001-€4000)) and hospital of delivery (less likely if >800 annual deliveries than <800). Significant predictors of maternal influenza vaccination, though with less straight-forward associations, were maternal ethnicity and educational level, involvement of a gynaecologist in pregnancy follow-up, and characteristics of the hospital of delivery. CONCLUSION: In Flanders, more than two-third of pregnant women receives pertussis vaccination but less than half of them receives the influenza vaccine. Further improvement for both maternal vaccination programs can be achieved by targeting the underserved populations and diminishing vaccination hurdles.

School-Age Hearing Screening Based on Speech-in-Noise Perception Using the Digit Triplet Test.

OBJECTIVES: This study aims to investigate the large-scale applicability of the Digit Triplet test (DTT) for school-age hearing screening in fifth grade elementary (5E) (9 to 12 years old) and third grade secondary (3S) (13 to 16 years old) school children. The reliability of the test is investigated as well as whether pass/fail criteria need to be corrected for training and/or age, and whether these criteria have to be refined with respect to referral rates and pure-tone audiometry results. DESIGN: Eleven school health service centers participated in the region of Flanders (the Northern part of Belgium). Pure-tone screening tests, which are commonly used for hearing screening in school children, were replaced by the DTT. Initial pass/fail criteria were determined. Children with speech reception thresholds (SRT) of -7.2 dB signal to noise ratio (SNR) (5E) and -8.3 dB SNR (3S) or worse were referred for an audiogram and follow-up. In total, n = 3412 (5E) and n = 3617 (3S) children participated. RESULTS: Population SRTs (±2 SD) were -9.8 (±1.8) dB SNR (5E) and -10.5 (±1.6) dB SNR (3S), and do not need correction for training and/or age. Whereas grade-specific pass/fail criteria are more appropriate, a linear regression analysis showed an improvement of 0.2 dB per year of the SRT until late adolescence. SRTs could be estimated with a within-measurement reliability of 0.6 dB. Test duration was also grade-dependent, and was 6 min 50 sec (SD = 61 sec) (5E) and 5 min 45 sec (SD = 49 sec) (3S) on average for both ears. The SRT, test reliability, and test duration were comparable across centers. With initial cut-off values, 2.9% (5E) and 3.5% (3S) of children were referred. Based on audiograms of n = 39 (5E) and n = 59 (3S) children, the diagnostic accuracy of the DTT was assessed. A peripheral hearing loss was detected in 31% (5E) and 53% (3S) of the referred children. Hearing losses found were mild. Less strict pass/fail criteria increased the diagnostic accuracy. Optimal pass/fail criteria were determined at -6.5 dB SNR (5E) and -8.1 dB SNR (3S). With these criteria, referral rates dropped to 1.3% (5E) and 2.4% (3S). CONCLUSIONS: The DTT has been implemented as the new hearing screening methodology in the Flemish school-age hearing screening program. Based on the results of this study, pass/fail criteria were determined and optimized to be used for systematic hearing screening of 5E and 3S school children. Furthermore, this study provides reference values for the DTT in children 9 to 16 years of age. Reliable SRTs can be obtained with the test, allowing accurate monitoring of hearing over time. This is important in the context of a screening guideline, which aims to identify children with noise-induced hearing loss. Validation of the screening result should go beyond taking an audiogram, as a peripheral hearing impairment cannot always be found in children with a failed test.

Exploring parental behavior and child interactive engagement: A study on children with a significant cognitive and motor developmental delay.

BACKGROUND AND AIMS: Parenting factors are one of the most striking gaps in the current scientific literature on the development of young children with significant cognitive and motor disabilities. We aim to explore the characteristics of, and the association between, parental behavior and children's interactive engagement within this target group. METHODS AND PROCEDURES: Twenty-five parent-child dyads (with children aged 6-59 months) were video-taped during a 15-min unstructured play situation. Parents were also asked to complete the Parental Behavior Scale for toddlers. The video-taped observations were scored using the Child and Maternal Behavior Rating Scales. OUTCOMES AND RESULTS: Low levels of parental discipline and child initiation were found. Parental responsivity was positively related to child attention and initiation. CONCLUSIONS AND IMPLICATIONS: Compared to children with no or other levels of disabilities, this target group exhibits large differences in frequency levels and, to a lesser extent, the concrete operationalization of parenting domains. Further, this study confirms the importance of sensitive responsivity as the primary variable in parenting research.

To make a molehill out of a mountain: An ERP-study on cognitive reappraisal of negative pictures in children with and without ADHD.

OBJECTIVE: We investigated cognitive reappraisal in children with ADHD by means of the late positive potential (LPP) and self-report ratings. We expected diminished LPP modulation following reappraisal and lower self-report scores in children with ADHD. METHODS: Eighteen children with ADHD and 24 typically developing (TD) children (8-12years) performed a cognitive reappraisal task, while EEG was recorded, and filled out a questionnaire on cognitive reappraisal. RESULTS: Despite the lack of main reappraisal effects on LPP, the LPP was less positively modulated during reappraisal in ADHD compared to TD children. CONCLUSIONS: Children with ADHD reported less use of reappraisal and could be distinguished from TD children based on LPP modulation. However the lack of main effects of reappraisal on LPP in both groups hinders clear interpretation of this finding and questions the suitability of LPP modulation within the current paradigm as a neural index of reappraisal in children 8-12years old, and warrants further research on the inter-individual variability and sensitivity of LPP modulation as a neural index of emotion regulation in children. SIGNIFICANCE: This is the first study investigating the LPP during cognitive reappraisal in children with ADHD.

Regulation of emotion in ADHD: can children with ADHD override the natural tendency to approach positive and avoid negative pictures?

Studies have demonstrated inefficient use of antecedent-focused emotion regulation strategies in children with ADHD attention-deficit/hyperactivity disorder (ADHD). In the current study we tested for the first time if ADHD is also associated with difficulties in response-focused strategies by measuring the ability to override action tendencies induced by emotional information. Performance data on a computer-based approach-avoidance paradigm of 28 children with ADHD and 38 typically developing children between 8 and 15 years of age were analyzed, by comparing a congruent condition in which they were instructed to approach positive and avoid negative pictures and an incongruent condition where they had to override these automatic reactions and approach negative and avoid positive pictures. Children also rated the valence and salience of the pictures. Children with ADHD and typically developing children rated the emotional valence of the pictures appropriately and similarly, while positive pictures were rated as more arousing by children with ADHD. Solid congruency effects were found indicating that the task measured response-focused emotion regulation; however groups did not differ in this respect. Our findings do not support a deficit in emotion regulation in ADHD in terms of the ability to override natural tendencies to approach positive and avoid negative pictures.

Developmental changes in neural correlates of cognitive reappraisal: An ERP study using the late positive potential.

OBJECTIVE: The reduction of the amplitude of the late positive potential (LPP) following cognitive reappraisal has been used as a neural marker of emotion regulation. However, studies employing this neural marker in children are scarce and findings are not conclusive, with most studies showing a lack of LPP modulation after reappraisal in children in the age range of 5-12 years. The aim of the current study was therefore to investigate developmental changes in sensitivity of LPP modulation to cognitive reappraisal. To do so, LPP modulation due to cognitive reappraisal of negative pictures was compared between two age groups (8- to 11- versus 12- to 15-year-olds) and regression analyses were applied within the total sample to test whether sensitivity of LPP modulation shows a linear increase with age. METHOD: In 63 children the LPP was measured after negative pictures that were either combined with a negative story or with a neutral, reappraising story. RESULTS: Although groups did not differ for self-reports on reappraisal, a significant reduction of LPP following cognitive reappraisal was only found in the older children, whereas such an effect was absent in the younger children. Findings were similar for boys and girls. Additional analyses showed a linear increase in sensitivity of LPP modulation with age. CONCLUSIONS: The results indicate that LPP modulation as measured in the current paradigm can be used as a valid index of emotion regulation in boys and girls but that caution is recommended using it in younger children.

Antibody Persistence and Booster Responses to Split-Virion H5N1 Avian Influenza Vaccine in Young and Elderly Adults.

Avian influenza continues to circulate and remains a global health threat not least because of the associated high mortality. In this study antibody persistence, booster vaccine response and cross-clade immune response between two influenza A(H5N1) vaccines were compared. Participants aged over 18-years who had previously been immunized with a clade 1, A/Vietnam vaccine were re-immunized at 6-months with 7.5 µg of the homologous strain or at 22-months with a clade 2, alum-adjuvanted, A/Indonesia vaccine. Blood sampled at 6, 15 and 22-months after the primary course was used to assess antibody persistence. Antibody concentrations 6-months after primary immunisation with either A/Vietnam vaccine 30 µg alum-adjuvanted vaccine or 7.5 µg dose vaccine were lower than 21-days after the primary course and waned further with time. Re-immunization with the clade 2, 30 µg alum-adjuvanted vaccine confirmed cross-clade reactogenicity. Antibody cross-reactivity between A(H5N1) clades suggests that in principle a prime-boost vaccination strategy may provide both early protection at the start of a pandemic and improved antibody responses to specific vaccination once available. TRIAL REGISTRATION: ClinicalTrials.gov NCT00415129.

Dutch-Flemish translation of nine pediatric item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS)®.

PURPOSE: The Patient-Reported Outcomes Measurement Information System (PROMIS(®)) is a new, state-of-the-art assessment system for measuring patient-reported health and well-being of adults and children. It has the potential to be more valid, reliable, and responsive than existing PROMs. The items banks are designed to be self-reported and completed by children aged 8-18 years. The PROMIS items can be administered in short forms or through computerized adaptive testing. This paper describes the translation and cultural adaption of nine PROMIS item banks (151 items) for children in Dutch-Flemish. METHODS: The translation was performed by FACITtrans using standardized PROMIS methodology and approved by the PROMIS Statistical Center. The translation included four forward translations, two back-translations, three independent reviews (at least two Dutch, one Flemish), and pretesting in 24 children from the Netherlands and Flanders. RESULTS: For some items, it was necessary to have separate translations for Dutch and Flemish: physical function-mobility (three items), anger (one item), pain interference (two items), and asthma impact (one item). Challenges faced in the translation process included scarcity or overabundance of possible translations, unclear item descriptions, constructs broader/smaller in the target language, difficulties in rank ordering items, differences in unit of measurement, irrelevant items, or differences in performance of activities. By addressing these challenges, acceptable translations were obtained for all items. CONCLUSION: The Dutch-Flemish PROMIS items are linguistically equivalent to the original USA version. Short forms are now available for use, and entire item banks are ready for cross-cultural validation in the Netherlands and Flanders.

Characteristics of the menstrual cycle in 13-year-old Flemish girls and the impact of menstrual symptoms on social life.

UNLABELLED: This study aimed to investigate the characteristics of symptoms related to the menstrual cycle and their impact on social activities in young teenage girls. Between March and June 2009, all girls born in 1996 who were residents of eight regions in Flanders (Belgium) received a semi-structured questionnaire, including questions about the age of menarche, characteristics of the menstrual cycle, and its impact on social activities. Participants were 792 13-year-old girls (15.7 % of the target population). Out of 363 (47.2 % of participants) postmenarcheal girls, 41.6 % (95 % confidence interval (CI) 36.4-47.0 %) reported painful menstruations. The proportion of girls with painful menstrual periods decreased approximately 16 % with each year the age at menarche increased (relative risk (RR) = 0.84; 0.73-0.98; p < 0.05) and was positively correlated with the amount of blood loss (RR = 0.33; 0.16-0.67; p < 0.05 when little and 1.85; 1.49-2.31; p < 0.001 when abundant, compared to average). One in four (25.4 %) postmenarcheal girls indicated a negative impact of menstruation on social activities, but this proportion was significantly higher in girls who experienced menstruation as painful (41.3 %) compared to those who did not (14.2 %). CONCLUSION: Early menstrual complaints are common in young adolescent girls and the likelihood of pain increased significantly with lower menarcheal age. What is Known? • Menstrual cycle-related symptoms may negatively interfere with school absence and social activities. • Early menarche and severe dysmenorrhea are correlated with endometriosis. What is New? • In this large population-based study on the characteristics of the menstrual cycle in young teenage girls at or shortly after menarche, painful menstruation was highly prevalent (41.7 %), but related school absenteeism was low (3.2 %). The likelihood of pain increased significantly with lower menarcheal age. • The findings support the need for a systematic evaluation of the characteristics of the menstrual cycle shortly after menarche.

"Turning down the heat": Is poor performance of children with ADHD on tasks tapping "hot" emotional regulation caused by deficits in "cool" executive functions?

Emotional dysregulation in daily life is very common in children with attention deficit hyperactivity disorder (ADHD). It is however not clear whether this reflects a specific deficit or that it may be the result of generic executive function (EF) deficits. The current study addresses this question by means of an emotional working memory (WM) task with 2 memory load conditions and four possible backgrounds (blank screen, neutral, positive or negative picture), which was administered to 38 typically developing children and 29 children with ADHD. Children responded slower on trials when negative pictures were presented at the background versus when neutral pictures were presented, indicating an emotional interference effect; however crucially, groups did not differ in this respect. Reaction times were also slower on trials with a neutral picture as background versus trials without a picture, with children with ADHD showing an enhanced interference effect. There was a main effect of WM load on performance, but it did not interact with interference or group effects. To summarize, the findings indicate a generic interference control deficit in the children with ADHD in the current sample, while they could not provide support for an emotional interference deficit.

Should children with overweight or obesity be excluded from height references?

BACKGROUND AND OBJECTIVES: Growth reference charts are usually based on measurements of children free from a medical condition that affects growth. However, samples collected during the past decades often contain a large proportion of overweight or obese children. Because obesity increases linear growth, the question arises to what extent the percentiles curves for length/height are affected by the presence of children with overweight or obesity. METHODS: Data from two cross-sectional samples of 2-year-old to 18-year-old children were analysed: 12,252 Belgian children, measured in 2002-2004, and 6159 Norwegian children, measured in 2003-2006. The LMS method was used to estimate height-for-age curves with and without children considered overweight or obese according to the International Obesity Task Force thresholds. RESULTS: The prevalence of overweight (including obesity) and obesity was 13.0% and 2.8% in the Belgian and 13.8% and 2.3% in the Norwegian sample. Children were taller when overweight (+0.49 and 0.43 SD, in the Belgian and Norwegian sample, respectively) or obese (+0.73 and 0.72 SD in the Belgian and Norwegian sample, respectively). Effect sizes were smaller in younger and older children, which points to an advanced age of maturation as a possible cause. Excluding overweight and obese children had only a minor impact on the growth curves with largest difference in mean height SD scores -0.09 in the Belgian and -0.12 in the Norwegian sample with a corresponding increase of up to 0.5% and 1.2% in number of children >+2 SD. CONCLUSIONS: Current Belgian and Norwegian growth references for length/height were found to be largely unaffected by the current proportion of overweight and obese children. There is, therefore, no need for revised height charts that exclude overweight or obese children.

Decennial administration in young adults of a reduced-antigen content diphtheria, tetanus, acellular pertussis vaccine containing two different concentrations of aluminium.

BACKGROUND: Regular booster vaccination might be necessary throughout life to protect against pertussis infection. Nevertheless the duration of protection after booster vaccination remains unclear. In this study, antibody persistence up to 10 years after previous vaccination of adolescents (N=478) with combined reduced-antigen-content diphtheria-tetanus-acellular pertussis vaccine (dTpa, Boostrix™, GlaxoSmithKline Belgium) containing 0.5mg, 0.3mg or 0.133mg of aluminium was assessed. The immunogenicity, reactogenicity and safety of a decennial booster dTpa dose were also investigated. METHODS: Young adults vaccinated as adolescents in the initial booster study were invited to participate in an assessment of antibody persistence at years 8.5 and 10, and to receive a dTpa booster dose at year 10 with immunogenicity assessment one month later. Those who originally received the 0.5mg or 0.3mg formulations received the same vaccine at year 10. Those in the 0.133mg group received the 0.5mg formulation. Reactogenicity and safety endpoints were captured until 30 days after booster vaccination. RESULTS: Prior to the decennial booster at year 8.5 and year 10, all participants had seroprotective antibodies for diphtheria (ELISA or neutralisation assay) and tetanus. At least 77.8% were seropositive for anti-pertussis toxin (PT) antibodies at year 8.5 and 82.8% at year 10. All participants were seropositive for antibodies for filamentous haemagglutinin and pertactin at both time points. The decennial booster dose induced robust increases in antibody GMCs to all antigens. The post-booster anti-PT geometric mean concentration was 82.5EL.U/ml (95%CI 67.0-101.6) and 124.0 (103.5-148.5) in the 0.3mg and 0.5mg groups, respectively. The reactogenicity and safety profile of the decennial booster dose was consistent with the known safety profile of dTpa. No serious adverse events were reported. CONCLUSIONS: Decennial booster vaccination with either of the two licensed formulations of dTpa was highly immunogenic and well tolerated in young adults. Either formulation could be confidently used as a decennial booster. This study is registered at www.clinicaltrials.govNCT01147900.

The relation between parenting stress and adolescents' somatisation trajectories: a growth mixture analysis.

OBJECTIVE: The impact of somatisation in adolescence is substantial. Knowledge on (predictors of) individual-level development of somatisation is necessary to develop tailored treatment. The current study assessed individual-level development of somatisation by means of latent mixed modelling. Parenting stress was included as a predictor of somatisation trajectory membership and within-trajectory variation. METHODS: A total of 1499 adolescents and one of their parents (mostly the mother) agreed to participate. Questionnaires were administered when the adolescents were respectively 12-13 (T1), 13-14 (T2), and 14-15 (T3) years old. Adolescents reported on their somatisation, parents on their parenting stress. RESULTS: Four individual somatisation trajectories were found: increased, long-term low, long-term high, and decreased. Higher early parenting stress (T1) significantly predicted less favourable trajectory membership (increased and long-term high). The relation between later parenting stress (T2 and T3) and somatisation depended on trajectory membership. For adolescents in the long-term high and decreased somatisation trajectories, lower T2 and T3 parenting stress was related to higher somatisation, while for adolescents in the long-term low and increased trajectories, higher T2 and T3 parenting stress was related to higher somatisation. CONCLUSIONS: The results support a general recommendation to prevent the onset of high levels of parenting stress. In addition, for families in which high levels of parenting stress already exist, clinicians should be aware of natural fluctuations in parenting stress, its associated features (e.g., aspects of overall care, like looking for professional help) and of the consequences this might have for the adolescent.

The association between parenting behavior and somatization in adolescents explained by physiological responses in adolescents.

INTRODUCTION: This study adds to the knowledge on somatization in adolescents by exploring its relation with parenting behavior and the mediating/moderating role of physiological responses in adolescents to parenting behavior. METHOD: Eighteen adolescents with high and 18 adolescents with low somatization scores and their mothers completed a discussion task, from which observed parenting behavior scores were derived. Skin conductance in adolescents was measured before and during the discussion. RESULTS: For adolescents with high levels of physiological responses, unadaptive parenting was related to a higher chance of high somatization scores. For low physiologically responsive adolescents, the relation between parenting behavior and somatization was not significant. CONCLUSION: Parenting behavior is not univocally related to somatization in adolescents, but the association depends on physiological responses in adolescents.

The distinction of 'psychosomatogenic family types' based on parents' self reported questionnaire information: a cluster analysis.

The theory of 'psychosomatogenic family types' is often used in treatment of somatizing adolescents. This study investigated the validity of distinguishing 'psychosomatogenic family types' based on parents' self-reported family features. The study included a Flemish general population sample of 12-year olds (n = 1428). We performed cluster analysis on 3 variables concerning parents' self-reported problems in family functioning. The distinguished clusters were examined for differences in marital problems, parental emotional problems, professional help for family members, demographics, and adolescents' somatization. Results showed the existence of 5 family types: 'chaotic family functioning,' 'average amount of family functioning problems,' 'few family functioning problems,' 'high amount of support and communication problems,' and 'high amount of sense of security problems' clusters. Membership of the 'chaotic family functioning' and 'average amount of family functioning problems' cluster was significantly associated with higher levels of somatization, compared with 'few family functioning problems' cluster membership. Among additional variables, only marital and parental emotional problems distinguished somatization relevant from non relevant clusters: parents in 'average amount of family functioning problems' and 'chaotic family functioning' clusters reported higher problems. The data showed that 'apparently perfect' or 'enmeshed' patterns of family functioning may not be assessed by means of parent report as adopted in this study. In addition, not only adolescents from 'extreme' types of family functioning may suffer from somatization. Further, professionals should be careful assuming that families in which parents report average to high amounts of family functioning problems also show different demographic characteristics.

Anaphylaxis after vaccination of children: review of literature and recommendations for vaccination in child and school health services in Belgium.

BACKGROUND: Concerns about the very small, but real risk of anaphylaxis after vaccination, has given rise to specific questions about the safe administration of vaccines to children and adolescents in the context of preventive settings (i.e. well baby clinics and school health services). As a support to preventive health professionals a guideline based on scientific evidence and supported by professional consensus was developed in Belgium. METHODS: First, a draft of guideline was written based on a review of international literature. Second, through several rounds of consultation professional consensus about the document was obtained across the Belgian communities and professional groups, and in a final version endorsed by the Belgian Superior Health Council in July 2012. RESULTS: In a literature overview information is given about the definition of anaphylaxis, allergens in vaccines potentially causing anaphylaxis, published incidence rates of anaphylaxis after vaccination, and strategies for first-aid management of anaphylaxis. The Belgian guideline on the prevention of anaphylaxis after vaccination includes recommendations on prevaccination risk assessment, the content of the emergency kit, measures to be taken after vaccination, differential diagnosis and first-aid management of anaphylaxis. CONCLUSION: The guideline, summarized as a flowchart for the prevention and first-aid management of anaphylaxis, is considered as the actual state of the art in Belgium for vaccination of children and youngsters in preventive health services, and may inspire governmental bodies and/or professional groups in other countries to adopt similar recommendations.

Effects of varying antigens and adjuvant systems on the immunogenicity and safety of investigational tetravalent human oncogenic papillomavirus vaccines: results from two randomized trials.

BACKGROUND: A prophylactic human papillomavirus (HPV) vaccine targeting oncogenic HPV types in addition to HPV-16 and -18 may broaden protection against cervical cancer. Two Phase I/II, randomized, controlled studies were conducted to compare the immunogenicity and safety of investigational tetravalent HPV L1 virus-like particle (VLP) vaccines, containing VLPs from two additional oncogenic genotypes, with the licensed HPV-16/18 AS04-adjuvanted vaccine (control) in healthy 18-25 year-old women. METHODS: In one trial (NCT00231413), subjects received control or one of 6 tetravalent HPV-16/18/31/45 AS04 vaccine formulations at months (M) 0,1,6. In a second trial (NCT00478621), subjects received control or one of 5 tetravalent HPV-16/18/33/58 vaccines formulated with different adjuvant systems (AS04, AS01 or AS02), administered on different schedules (M0,1,6 or M0,3 or M0,6). RESULTS: One month after the third injection (Month 7), there was a consistent trend for lower anti-HPV-16 and -18 geometric mean antibody titers (GMTs) for tetravalent AS04-adjuvanted vaccines compared with control. GMTs were statistically significantly lower for an HPV-16/18/31/45 AS04 vaccine containing 20/20/10/10 µg VLPs for both anti-HPV-16 and anti-HPV-18 antibodies, and for an HPV-16/18/33/58 AS04 vaccine containing 20/20/20/20 µg VLPs for anti-HPV-16 antibodies. There was also a trend for lower HPV-16 and -18-specific memory B-cell responses for tetravalent AS04 vaccines versus control. No such trends were observed for CD4(+) T-cell responses. Immune interference could not always be overcome by increasing the dose of HPV-16/18 L1 VLPs or by using a different adjuvant system. All formulations had acceptable reactogenicity and safety profiles. Reactogenicity in the 7-day post-vaccination period tended to increase with the introduction of additional VLPs, especially for formulations containing AS01. CONCLUSIONS: HPV-16 and -18 antibody responses were lower when additional HPV L1 VLPs were added to the HPV-16/18 AS04-adjuvanted vaccine. Immune interference is a complex phenomenon that cannot always be overcome by changing the antigen dose or adjuvant system.