Greater maltreatment severity is associated with smaller brain volume with implication for intellectual ability in young children.

Background: Childhood maltreatment profoundly alters trajectories of brain development, promoting markedly increased long-term health risks and impaired intellectual development. However, the immediate impact of maltreatment on brain development in children and the extent to which altered global brain volume contributes to intellectual development in children with maltreatment experience is currently unknown. We here utilized MRI data obtained from children within 6 months after the exposure to maltreatment to assess the association of maltreatment severity with global brain volume changes. We further assessed the association between maltreatment severity and intellectual development and tested for the mediating effect of brain volume on this association. Method: We used structural MRI (3T) in a sample of 49 children aged 3-5 years with maltreatment exposure, i.e. emotional and physical abuse and/or neglect within 6 months, to characterize intracranial and tissue-specific volumes. Maltreatment severity was coded using the Maternal Interview for the Classification of Maltreatment. IQ was tested at study entry and after one year using the Snijders Oomen Nonverbal Test. Results: Higher maltreatment severity was significantly correlated with smaller intracranial volume (r = -.393, p = .008), which was mainly driven by lower total brain volume (r = -.393, p = .008), which in turn was primarily due to smaller gray matter volume (r = -.454, p = .002). Furthermore, smaller gray matter volume was associated with lower IQ at study entry (r = -.548, p < .001) and predicted IQ one year later (r = -.493, p = .004.). The observed associations were independent of potential confounding variables, including height, socioeconomic status, age and sex. Importance: We provide evidence that greater maltreatment severity in early childhood is related to smaller brain size at a very young age with significant consequences for intellectual ability, likely setting a path for far-reaching long-term disadvantages. Insights into the molecular and neural processes that underlie the impact of maltreatment on brain structure and function are urgently needed to derive mechanism-driven targets for early intervention.

Immediate impact of child maltreatment on mental, developmental, and physical health trajectories.

OBJECTIVE: The immediate impact of child maltreatment on health and developmental trajectories over time is unknown. Longitudinal studies starting in the direct aftermath of exposure with repeated follow-up are needed. METHOD: We assessed health and developmental outcomes in 6-month intervals over 2 years in 173 children, aged 3-5 years at study entry, including 86 children with exposure to emotional and physical abuse or neglect within 6 months and 87 nonmaltreated children. Assessments included clinician-administered, self- and parent-report measures of psychiatric and behavioral symptoms, development, and physical health. Linear mixed models and latent growth curve analyses were used to contrast trajectories between groups and to investigate the impact of maltreatment features on trajectories. RESULTS: Maltreated children exhibited greater numbers of psychiatric diagnoses (b = 1.998, p < .001), externalizing (b = 13.29, p < .001) and internalizing (b = 11.70, p < .001) symptoms, impairments in cognitive (b = -11.586, p < .001), verbal (b = -10.687, p < .001), and motor development (b = -7.904, p = .006), and greater numbers of medical symptoms (b = 1.021, p < .001) compared to nonmaltreated children across all time-points. Lifetime maltreatment severity and/or age at earliest maltreatment exposure predicted adverse outcomes over time. CONCLUSION: The profound, immediate, and stable impact of maltreatment on health and developmental trajectories supports a biological embedding model and provides foundation to scrutinize the precise underlying mechanisms. Such knowledge will enable the development of early risk markers and mechanism-driven interventions that mitigate adverse trajectories in maltreated children.

Sensory-Tactile Functional Mapping and Use-Associated Structural Variation of the Human Female Genital Representation Field.

The precise location of the human female genital representation field in the primary somatosensory cortex (S1) is controversial and its capacity for use-associated structural variation as a function of sexual behavior remains unknown. We used a functional magnetic resonance imaging (fMRI)-compatible sensory-tactile stimulation paradigm to functionally map the location of the female genital representation field in 20 adult women. Neural response to tactile stimulation of the clitoral region (vs right hand) identified individually-diverse focal bilateral activations in dorsolateral areas of S1 (BA1-BA3) in alignment with anatomic location. We next used cortical surface analyses to assess structural thickness across the 10 individually most activated vertices per hemisphere for each woman. We show that frequency of sexual intercourse within 12 months is correlated with structural thickness of the individually-mapped left genital field. Our results provide a precise functional localization of the female genital field and provide support for use-associated structural variation of the human genital cortex.SIGNIFICANCE STATEMENT We provide a precise location of the human female genital field in the somatosensory cortex and, for the first time, provide evidence in support of structural variation of the human genital field in association with frequency of genital contact. Our study represents a significant methodological advance by individually mapping genital fields for structural analyses. On a secondary level, our results suggest that any study investigating changes in the human genital field must map the field individually to achieve sufficient precision. Our results pave the way for future research into the plasticity of the human genital cortex as a function of normal or adverse experience as well as changes in pathologic conditions, i.e., sexual dysfunction, sexual deviation, or sexual risk-taking behavior.

Childhood adversity correlates with stable changes in DNA methylation trajectories in children and converges with epigenetic signatures of prenatal stress.

Childhood maltreatment (CM) is an established major risk factor for a number of negative health outcomes later in life. While epigenetic mechanisms, such as DNA methylation (DNAm), have been proposed as a means of embedding this environmental risk factor, little is known about its timing and trajectory, especially in very young children. It is also not clear whether additional environmental adversities, often experienced by these children, converge on similar DNAm changes. Here, we calculated a cumulative adversity score, which additionally to CM includes socioeconomic status (SES), other life events, parental psychopathology and epigenetic biomarkers of prenatal smoking and alcohol consumption. We investigated the effects of CM alone as well as the adversity score on longitudinal DNAm trajectories in the Berlin Longitudinal Child Study. This is a cohort of 173 children aged 3-5 years at baseline of whom 86 were exposed to CM. These children were followed-up for 2 years with extensive psychometric and biological assessments as well as saliva collection at 5 time points providing genome-wide DNAm levels. Overall, only a few DNAm patterns were stable over this timeframe, but less than 10 DNAm regions showed significant changes. At baseline, neither CM nor the adversity score associated with DNAm changes. However, in 6 differentially methylated regions (DMRs), CM and the adversity score significantly moderated DNAm trajectories over time. A number of these DMRs have previously been associated with adverse prenatal exposures. In our study, children exposed to CM also presented with epigenetic signatures indicative of increased prenatal exposure to tobacco and alcohol, as compared to non-CM exposed children. These epigenetic signatures of prenatal exposure strongly correlate with DNAm regions associated with CM and the adversity score. Finally, weighted correlation network analysis revealed a module of CpGs exclusively associated with CM. While our study identifies DNAm loci specifically associated with CM, especially within long non-coding RNAs, the majority of associations were found with the adversity score with convergent association with indicators of adverse prenatal exposures. This study highlights the importance of mapping not only of the epigenome but also the exposome and extending the observational timeframe to well before birth.

Acadêmicos de enfermagem e o desenvolvimento da liderança: desafios enfrentados no estágio curricular / Estudiantes de enfermería y desarrollo de liderazgo: desafíos que enfrentan el currículo de la escena / Nursing students and leadership development: challenges facing the stage curriculum

Objetivo: compreender a percepção do acadêmico de enfermagem sobre o exercício da liderança nas atividades do estágio curricular. Método: utilizou-se abordagem qualitativa do tipo descritiva através de entrevistas com 12 acadêmicos de uma Faculdade de Enfermagem no Município de Juiz de Fora Minas Gerais. A análise dos dados amparou-se na análise temática. Resultados: emergiram três categorias: a liderança em enfermagem; o cotidiano do desenvolvimento da liderança; reflexo da liderança no processo de trabalho da equipe de enfermagem. A formação do enfermeiro permanece pautada no aprimoramento das técnicas/procedimentos e o desenvolvimento de habilidades e competências que o auxiliem a liderar acabam sendo afastadas do processo de aprendizagem. Os desafios que implicam no desenvolvimento da liderança durante o estágio relacionam-se à aceitação por parte da equipe e questões de relacionamento interpessoal na equipe. Sobre os reflexos da sua liderança apontam a confiança, a autonomia, o intercâmbio de saberes e a inserção de trabalho da equipe. Conclusão: verificou-se que a liderança de enfermagem é entendida como uma competência essencial para o trabalho do enfermeiro. A abordagem do tema liderança na graduação é imprescindível e um grande desafio, o qual deve ser constituído não somente na parte teórica, mas sua aplicabilidade na prática.

Objective: to know the understanding of nursing student on the exercise of leadership in the activities of the curriculum internship.Method: we used a qualitative approach, descriptive, semi-structured interviews were conducted with 12 students of a nursingcollege in the city of Juiz de Fora-Minas Gerais. Data analysis was based on thematic analysis. Results: three categories emerged:leadership in nursing; the daily development of leadership; reflecting the leadership in the work process of the nursing team. Theinternship of nurses remains based on the improvement of the techniques/procedures and the development of skills andcompetences that help them to lead are away from the learning process. The challenges involved in developing leadership during theinternship are related to team acceptance and interpersonal relationship issues. The reflexes of his leadership point to confidence,autonomy, exchange of knowledge and the insertion into the team work. Conclusion: It was verified that the nursing leadership isunderstood as an essential competency for the work of the nurse. The approach to the subject of leadership in graduation is essential anda great challenge, which should be constituted not only in the theoretical part, but its applicability in practice.

Objetivo: comprender la percepción de los estudiantes de enfermería en el ejercicio del liderazgo en las actividades del periodo deprácticas. Método: se utilizó el enfoque cualitativo, descriptivo, a través de entrevistas con 12 estudiantes de una escuela deenfermería en la ciudad de Juiz de Fora-Minas Gerais. Análisis de los datos se estabilizó en el análisis temático. Resultados: surgieron tres categorías: el liderazgo en la enfermería; el desarrollo de liderazgo todos los días; reflejo del liderazgo en el procesode trabajo del equipo de enfermería. La educación de enfermería sigue siendo guiado en la mejora de las técnicas / procedimientosy el desarrollo de habilidades y competencias que ayuden a llevar a terminar siendo lejos del proceso de aprendizaje. Los retosimplicados en el desarrollo de liderazgo durante la etapa conexo a la aceptación por el equipo y los problemas interpersonales en elequipo. Sobre las consecuencias de su punto de liderazgo a la confianza, la autonomía, el intercambio de conocimientos y lainserción equipo de trabajo. Conclusión: se encontró que la dirección de la enfermería es visto como un factor clave para el trabajode enfermería. El enfoque de la dirección en el tema de grado es esencial y un gran desafío, que debe hacerse no sólo en la parteteórica, pero su aplicabilidad en la práctica.

A utilização do lúdico na prevenção de acidentes na infância / Playful approaches in preventing childhood accidents

Dentre as muitas morbidades que acometem as crianças, os acidentes domésticos representam uma importante causa de morbimortalidade e de invalidez, constituindo-se assim em um grave problema de saúde pública. Portanto, além da identificação dos fatores envolvidos na ocorrência\ dos acidentes e do encaminhamento de suas consequências, faz-se necessário criar estratégias para sua prevenção. Neste contexto, este artigo relata uma experiência vivenciada por acadêmicos do curso de Enfermagem da Universidade Federal de Juiz de Fora, participantes do projeto "Brincando e Aprendendo Saúde", no qual utilizou-se o lúdico para abordagem do tema "prevenção de acidentes na infância". Tendo como público-alvo crianças de quatro a seis anos assistidas por uma Escola Municipal situada no município de Juiz de Fora ­ MG, o tema foi abordado ao longo de três oficinas nas quais estabeleceu-se um processo de ensino e aprendizagem por meio da utilização do lúdico. Foram utilizadas metodologias dinâmicas, participativas e com uma linguagem acessível, sempre valorizando o conhecimento prévio dos participantes e o seu contexto social, o que gerou grande interesse das crianças em aprender e dividir experiências.