Mothers' and fathers' depressive symptoms across four years postpartum: An examination of between- and bidirectional within-person relations.

BACKGROUND: Both mothers and fathers are at risk for experiencing postpartum depressive symptoms shortly after the birth of a child. Previous studies suggest mothers' and fathers' depressive symptoms to be interrelated. This study examined bidirectional relations between mothers' and fathers' depressive symptoms across four years postpartum. METHODS: Longitudinal data for this study were collected across five waves from 485 mothers and 359 fathers of infants when infants were on average 6 months-old until children were 54 months-old (1-year lags). Mothers and fathers reported on their depressive symptoms using the Center for the Epidemiological Studies Short Depression Scale (CES-D 10). A random intercept cross-lagged panel model (RICLPM) was specified to examine the bidirectional relations between mothers' and fathers' depressive symptoms over time. RESULTS: At the between-person level, mothers' and fathers' depressive symptoms were positively associated. At the within-person level, unique carry-over effects were found for mothers and fathers in that when reporting higher depressive symptoms than their trait levels, they were more likely to report higher depressive symptoms one year later. Moreover, intermittent cross-lagged effects were observed from mothers' depressive symptoms to fathers' depressive symptoms during toddlerhood. LIMITATIONS: The sample was not racially or structurally diverse thereby limiting the generalizations of the findings. CONCLUSIONS: After the birth of a child, mothers and fathers are at risk for experiencing chronic depressive symptoms which can have implications for individual, couple and child health. Mothers' depressive symptoms are related to fathers' depressive symptoms over time.

Cardiogenic Rhinorrhea: Evidence for an Unrecognized Heart Failure Symptom.

There have been anecdotal observations of rhinorrhea as an isolated symptom indicating volume overload and impending congestive heart failure (CHF). We present a case of apparent cardiogenic rhinorrhea presaging acute systolic CHF, with hemodynamics supported by thoracic impedance data (Medtronic OptiVol 2.0).

Atrial Fibrillation Caused by Intractable Hiccups: A Unique Cause and Cure.

We present the case of a 61-year-old male who developed persistent hiccups concurrently with the onset of atrial fibrillation (AF). The hiccups were refractory to traditional treatment but resolved immediately upon electrical cardioversion (ECV) to normal sinus rhythm (NSR). The patient has remained in NSR and free of hiccups. The potential etiologies for hiccups are numerous and varied, and the management of persistent hiccups can be difficult. Cardiac associations including myocardial infarction and pericarditis have been described, while few cases of first-time onset of atrial fibrillation leading to hiccups have been documented. This case discusses a unique instance demonstrating a connection between hiccups and cardiac pathology and an overview of its management.

Speaking of State of Mind: Maternal Mental Health Predicts Children's Home Language Environment and Expressive Language.

Maternal depression and anxiety are potential risk factors to children's language environments and development. Though existing work has examined relations between these constructs, further work is needed accounting for both depression and anxiety and using more direct measures of the home language environment and children's language development. We examined 265 mother-infant dyads (49.6% female, Mage = 17.03 months) from a large city in the Western United States to explore the relations between self-reports of maternal depression and anxiety and observational indices of the home language environment and expressive language as captured by Language Environment Analysis (LENA) and parent-reported language comprehension and production. Results revealed maternal depressive symptoms to be negatively associated with home language environment and expressive language indices. Maternal anxiety symptoms were found to be negatively associated with children's parent-reported language production. These findings provide further evidence that maternal mental health modulates children's home language environments and expressive language.

Withdrawn and Acting out?: Early Adolescents' Social Avoidance and Externalizing Problems.

Relative to other motivations of social withdrawal (i.e., shyness, unsociability), social avoidance is understudied. Furthermore, the relation between social avoidance and externalizing problems seldom has been investigated despite reasons to expect an association. We examined the association between social avoidance and externalizing problems using a sample of early adolescents in the United States using parents' reports (N = 294; 54.1% boys; M age = 12.43 years). Supporting our hypotheses, structural equation models indicated that social avoidance positively predicted concurrent externalizing problems, controlling for shyness, unsociability, and internalizing problems (including depression and anxiety). Findings highlight that socially avoidant adolescents' behaviors may include avoiding others as well as acting out. Longitudinal work is needed to examine the potential bidirectional relations between social avoidance and externalizing problems.

Carotid endarterectomy for asymptomatic carotid stenosis is safe in octogenarians.

OBJECTIVE: Carotid endarterectomy (CEA) is the gold standard to prevent a recurrent stroke in symptomatic patients with carotid stenosis. However, in the modern era, the benefit of CEA in asymptomatic octogenarian patients has come into question. This study investigates real-world outcomes of CEA in asymptomatic octogenarians. METHODS: Patients who underwent CEA for asymptomatic carotid stenosis were identified in the American College of Surgeons National Surgical Quality Improvement Program CEA-targeted database from 2012 to 2017. They were stratified into two groups: octogenarians (≥80 years old) and younger patients (<80 years old). The 30-day outcomes evaluated included mortality and major morbidities such as stroke, cardiac events, pulmonary, and renal dysfunction. Multivariable logistic regression was used for data analysis. RESULTS: We identified 13,846 patients with asymptomatic carotid stenosis who underwent an elective CEA including 2509 octogenarians and 11,337 younger patients. Octogenarians were more likely to be female and less likely to be diabetic or smokers compared with younger patients. There was no difference in preoperative use of statins or antiplatelet therapy. Examination of 30-day outcomes revealed that octogenarians had slightly higher mortality (1.2% vs 0.5%; odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P < .01), and a higher risk of return to the operating room (3.3% vs 2.3%; odds ratio, 1.4; 95% confidence interval, 1.1-1.9; P = .01). However, there was no difference between octogenarians and younger patients in adverse cardiac events or pulmonary, renal, or wound complications. Twenty-five octogenarian and 138 younger patients suffered from periprocedural stroke at a similar rate (1.0% vs 1.2%; P = .54). Stroke/death occurred for 51 of 2509 patients (2.0%) in the older group and 184 of 11,337 patients (1.6%) in the younger group, a difference that was not significant (P = .15). CONCLUSIONS: The 30-day outcomes of CEA in octogenarians are comparable with those in younger patients. Although the octogenarians had slightly higher mortality than younger patients, the absolute risk of mortality was still low at 1.2%. Therefore, CEA is safe in asymptomatic carotid stenosis in octogenarians. Overall life expectancy and preoperative functional status, rather than age, should be the major determinants in the decision to operate.

Preservation of renal perfusion by hepatorenal and splenorenal bypasses before explantation of an infected abdominal aortic endograft.

We report the case of an 82-year-old patient with an infected abdominal aortic endograft who presented with a right psoas abscess and lumbar osteomyelitis. The psoas abscess was drained percutaneously. Fluid obtained grew Fusobacterium nucleatum. The patient, an active and highly functional individual, wished to pursue definitive management. The infected endograft was surgically removed, and the aorta was ligated above the renal arteries after staged axillary-bifemoral, hepatorenal, and splenorenal bypasses.