Pesticide exposure in New Zealand school-aged children: Urinary concentrations of biomarkers and assessment of determinants.

This study aimed to assess pesticide exposure and its determinants in children aged 5-14 years. Urine samples (n = 953) were collected from 501 participating children living in urban areas (participant n = 300), rural areas but not on a farm (n = 76), and living on a farm (n = 125). The majority provided two samples, one in the high and one in the low spraying season. Information on diet, lifestyle, and demographic factors was collected by questionnaire. Urine was analysed for 20 pesticide biomarkers by GC-MS/MS and LC-MS/MS. Nine analytes were detected in > 80% of samples, including six organophosphate insecticide metabolites (DMP, DMTP, DEP, DETP, TCPy, PNP), two pyrethroid insecticide metabolites (3-PBA, trans-DCCA), and one herbicide (2,4-D). The highest concentration was measured for TCPy (median 13 µg/g creatinine), a metabolite of chlorpyrifos and triclopyr, followed by DMP (11 µg/g) and DMTP (3.7 µg/g). Urine metabolite levels were generally similar or low compared to those reported for other countries, while relatively high for TCPy and pyrethroid metabolites. Living on a farm was associated with higher TCPy levels during the high spray season. Living in rural areas, dog ownership and in-home pest control were associated with higher levels of pyrethroid metabolites. Urinary concentrations of several pesticide metabolites were higher during the low spraying season, possibly due to consumption of imported fruits and vegetables. Organic fruit consumption was not associated with lower urine concentrations, but consumption of organic food other than fruit or vegetables was associated with lower concentrations of TCPy in the high spray season. In conclusion, compared to other countries such as the U.S., New Zealand children had relatively high exposures to chlorpyrifos/triclopyr and pyrethroids. Factors associated with exposure included age, season, area of residence, diet, in-home pest control, and pets.

The effects of docosahexaenoic acid supplementation on cognition and well-being in mild cognitive impairment: A 12-month randomised controlled trial.

OBJECTIVES: Several recent clinical trials have shown that docosahexaenoic acid (DHA) supplements have a significant effect on cognition in cognitively impaired older adults. This randomised controlled trial aimed to investigate the cognitive effects of a DHA fish oil supplement in older adults with mild cognitive impairment, and to examine the moderating effect of the apolipoprotein E (APOE) ɛ4 allele on cognition and well-being. METHODS/DESIGN: Seventy-two older adults between the ages of 60 and 90 from New Zealand were given a DHA supplement equivalent to 1491 mg DHA + 351 mg eicosapentaenoic acid per day or a placebo for a period of 12 months. Outcome measures included cognition, wellbeing and self-rated quality of life as well as height, weight, blood pressure and APOE genotyping. RESULTS: The final analysis (n = 60) found no evidence of a treatment effect on cognitive measures, although did find a treatment effect on systolic blood pressure (p = 0.03, ƞ2  = 0.08), and a treatment interaction for APOE ɛ4 carriers on depression (p = 0.04, ƞ2  = 0.07) and anxiety (p = 0.02, ƞ2  = 0.09) scores in favour of the DHA supplement. CONCLUSIONS: Despite no effect on cognition, the positive result in APOE ɛ4 carriers on depression and anxiety scores and on systolic blood pressure justifies further DHA trials. It may be a prudent step going forward for more studies to replicate the design elements (dose, duration and cognitive measures) of previous DHA trials to help understand why not all older adults appear to benefit from taking a fish oil supplement.

Developmental and epileptic encephalopathy: Personal utility of a genetic diagnosis for families.

Objectives: Identifying genetic pathogenic variants improves clinical outcomes for children with developmental and epileptic encephalopathy (DEE) by directing therapy and enabling accurate reproductive and prognostic information for families. We aimed to explore the additional personal utility of receiving a genetic diagnosis for families. Methods: Semi-structured interviews were conducted with fifteen families of children with a DEE who had received a genetic diagnosis. The interviews stimulated discussion focusing on the impact of receiving a genetic diagnosis for the family. Interview transcripts were analyzed using the six-step systematic process of interpretative phenomenological analysis (IPA). Results: Three key themes were identified: "Importance of the label," "Relief to end the diagnostic journey," and "Factors that influence personal utility." Families reported that receiving a genetic label improved their knowledge about the likely trajectory of the DEE, increased their hope for the future, and helped them communicate with others. The relief of finally having an answer for the cause of their child's DEE alleviated parental guilt and self-blame as well as helped families to process their grief and move forward. Delay in receipt of a genetic diagnosis diluted its psychological impact. Significance: To date, the factors associated with the personal utility of a genetic diagnosis for DEEs have been under appreciated. This study demonstrates that identifying a genetic diagnosis for a child's DEE can be a psychological turning point for families. A genetic result has the potential to set these families on an adaptive path toward better quality of life through increased understanding, social connection, and support. Early access to genetic testing is important as it not only increases clinical utility, but also increases personal utility with early mitigation of family stress, trauma, and negative experiences.

The efficacy of problem solving therapy to reduce post stroke emotional distress in younger (18-65) stroke survivors.

PURPOSE: To investigate the efficacy of problem solving therapy for reducing the emotional distress experienced by younger stroke survivors. METHOD: A non-randomized waitlist controlled design was used to compare outcome measures for the treatment group and a waitlist control group at baseline and post-waitlist/post-therapy. After the waitlist group received problem solving therapy an analysis was completed on the pooled outcome measures at baseline, post-treatment, and three-month follow-up. RESULTS: Changes on outcome measures between baseline and post-treatment (n = 13) were not significantly different between the two groups, treatment (n = 13), and the waitlist control group (n = 16) (between-subject design). The pooled data (n = 28) indicated that receiving problem solving therapy significantly reduced participants levels of depression and anxiety and increased quality of life levels from baseline to follow up (within-subject design), however, methodological limitations, such as the lack of a control group reduce the validity of this finding. CONCLUSION: The between-subject results suggest that there was no significant difference between those that received problem solving therapy and a waitlist control group between baseline and post-waitlist/post-therapy. The within-subject design suggests that problem solving therapy may be beneficial for younger stroke survivors when they are given some time to learn and implement the skills into their day to day life. However, additional research with a control group is required to investigate this further. This study provides limited evidence for the provision of support groups for younger stroke survivors post stroke, however, it remains unclear about what type of support this should be. Implications for Rehabilitation Problem solving therapy is no more effective for reducing post stroke distress than a wait-list control group. Problem solving therapy may be perceived as helpful and enjoyable by younger stroke survivors. Younger stroke survivors may use the skills learnt from problem solving therapy to solve problems in their day to day lives. Younger stroke survivors may benefit from age appropriate psychological support; however, future research is needed to determine what type of support this should be.

Neuropsychological performance in solvent-exposed vehicle collision repair workers in New Zealand.

OBJECTIVES: To assess whether contemporary solvent exposures in the vehicle collision repair industry are associated with objectively measured neuropsychological performance in collision repair workers. METHODS: The RBANS battery and additional tests were administered to 47 vehicle collision repair and 51 comparison workers randomly selected from a previous questionnaire study. RESULTS: Collision repair workers performed lower on tests of attention (digit span backwards: -1.5, 95% CI -2.4, -0.5; digit span total: -1.7, CI -3.3, -0.0; coding: -6.1, CI -9.9, -2.8; total attention scale: -9.3, CI -15.9, -2.8) and the RBANS total scale (-5.1, CI -9.1, -1.2). Additional tests also showed deficits in visual attention and reaction time (Trails B: -11.5, CI -22.4, -0.5) and motor speed/dexterity (coin rotation dominant hand & non-dominant: -2.9, CI -5.3, -0.4 and -3.1, CI -5.6, -0.7 respectively). The strongest associations were observed in panel beaters. Applying dichotomised RBANS outcomes based on the lowest percentile scores of a normative comparison group showed strongly increased risks for attention (5th percentile: OR 20.1, 95% CI 1.5, 263.3; 10th percentile: 8.8, CI 1.7, 46.2; and 20th percentile: 5.1, CI 1.5, 17.6, respectively). Those employed in the industry for ≤ 17 years (the median work duration) generally had lower scores in the attention domain scale and RBANS total scale compared to those employed >17 years suggesting a healthy worker survivor bias, but trends were inconsistent for other domains. CONCLUSIONS: This study has found significant deficits in cognitive performance in collision repair workers despite low current airborne exposures in New Zealand.

Efficacy of memory aids after traumatic brain injury: A single case series.

BACKGROUND: Individuals living with traumatic brain injury commonly have difficulties with prospective memory-the ability to remember a planned action at the intended time. Traditionally a memory notebook has been recommended as a compensatory memory aid. Electronic devices have the advantage of providing a cue at the appropriate time to remind participants to refer to the memory aid and complete tasks. Research suggests these have potential benefit in neurorehabilitation. OBJECTIVE: This study aimed to investigate the efficacy of a memory notebook and specifically a smartphone as a compensatory memory aid. METHODS: A single case series design was used to assess seven participants. A no-intervention baseline was followed by training and intervention with either the smartphone alone, or a memory notebook and later the smartphone. Memory was assessed with weekly assigned memory tasks. RESULTS: Participants using a smartphone showed improvements in their ability to complete assigned memory tasks accurately and within the assigned time periods. Use of a smartphone provided additional benefits over and above those already seen for those who received a memory notebook first. CONCLUSIONS: Smartphones have the potential to be a useful and cost effective tool in neurorehabilitation practice.

Systematic behavioural observation of executive performance after brain injury.

OBJECTIVE: To develop an ecologically valid measure of executive functioning (i.e. Planning and Organization, Executive Memory, Initiation, Cognitive Shifting, Impulsivity, Sustained and Directed Attention, Error Detection, Error Correction and Time Management) during a functional chocolate brownie cooking task. METHODS: In Study 1, the inter-rater reliability of a novel behavioural observation assessment method was assessed with 10 people with traumatic brain injury (TBI). In Study 2, 27 people with TBI and 16 healthy controls completed the functional task along with other measures of executive functioning to assess validity. RESULTS: Intraclass correlation coefficients for six of the nine aspects of executive functioning ranged from .54 to 1.00. Percentage agreements for the remaining aspects ranged from 70% to 90%. Significant and non-significant, moderate, correlations were found between the functional cooking task and standard neuropsychological measures. The healthy control group performed better than the TBI group in six areas (d = 0.56 to 1.23). CONCLUSIONS: In this initial trial of a novel assessment method, adequate inter-rater reliability was found. The measure was associated with standard neuropsychological measures, and our healthy control group performed better than the TBI group. The measure appears to be an ecologically valid measure of executive functioning.

Neuropsychological assessment of refugees: Methodological and cross-cultural barriers.

Cross-cultural research in neuropsychological assessment has primarily focused on Hispanic and African American populations. Less is known about the impact of language, culture, education, socioeconomic factors, and life experiences on assessment for other cultural groups. We highlight the methodological and cross-cultural barriers encountered at each stage of the neuropsychological assessment of Arabic- and Burmese-speaking refugees, who were culturally and linguistically diverse (CALD). A total of 18 refugees (13 men/five women; in their 20-50s) who were victims of torture in their countries of origin, some with post-traumatic stress disorder (PTSD) and now residents in New Zealand, were seen for neuropsychological assessment. Measures were officially translated, back translated, and administered with the assistance of professional interpreters. Multiple challenges arose in terms of administration (e.g., use of interpreters, interactions with the tester, assessment environment, assessment experience, and motivation), scoring, and interpretation (e.g., age appropriate scoring, estimation of prior function, estimation of brain injury severity, obtaining collateral information), the tests themselves, and ecological validity. There are more challenges in the neuropsychological assessment of people who are CALD than can be managed by adhering to current guidelines. The best approach is to find a balance between maintaining assessment integrity and working creatively and sensitively with this group.

Subjective Cognitive Complaints and Objective Cognitive Function in Aging: A Systematic Review and Meta-Analysis of Recent Cross-Sectional Findings.

Research investigating how subjective cognitive complaints (SCCs) might reliably indicate impairments in objective cognitive functioning has produced highly varied findings, and despite attempts to synthesise this literature (e.g., Jonker et al. International Journal of Geriatric Psychiatry, 15, 983-991, 2000; Reid and MacLullich Dementia and Geriatric Cognitive Disorders, 22(5-6), 471-485, 2006; Crumley et al. Psychology and Aging, 29(2), 250-263, 2014), recent work continues to offer little resolution. This review provides both quantitative and qualitative synthesis of research conducted since the last comprehensive review in 2006, with the aim of identifying reasons for these discrepancies that might provide fruitful avenues for future exploration. Meta-analysis found a small but significant association between SCCs and objective cognitive function, although it was limited by large heterogeneity between studies and evidence of potential publication bias. Often, assessments of SCCs and objective cognitive function were brief or not formally validated. However, studies that employed more comprehensive SCC measures tended to find that SCCs were associated independently with both objective cognitive function and depressive symptoms. Further explicit investigation of how assessment measures relate to reports of SCCs, and the validity of the proposed 'compensation theory' of SCC aetiology, is recommended.

Brain injury and discrimination: Two competing models-perceptions of responsibility and dangerousness.

OBJECTIVES: (1) To examine whether the willingness of people to socialize with adolescents with brain injury is influenced by gender, visibility of injury and/or knowing how to interact with people with brain injury; and (2) To consider two models: the responsibility model (attributions about the cause of a condition) and the danger appraisal model (perceptions of dangerousness due to anger/aggression) for their effect on willingness to socialize and to understand how these perceptions lead to avoidant behaviour. METHOD AND PROCEDURES: Participants were recruited either by personal approach or via Facebook advertising and completed a survey after reading a brief vignette and seeing a photo of an adolescent male or female, with or without a head scar. Vignettes for some participants were varied to represent perceptions of responsibility and dangerousness Main outcomes and results: ANOVAs and structural equation modelling revealed that participants were more willing to socialize with the adolescents with a scar than with no scar. Knowledge about how to interact with survivors impacted willingness to socialize, but familiarity did not. The full danger appraisal model was supported, but only some aspects of the responsibility model were supported. CONCLUSION: The results provide useful information for rehabilitation health professionals working with survivors of brain injury. The implications of these findings are discussed with regards to assisting adolescents' re-entry into society post-injury.

Assessing subjective memory complaints: a comparison of spontaneous reports and structured questionnaire methods.

BACKGROUND: Subjective memory complaints (SMCs) are a common occurrence for adults, which increase with age, and cause considerable distress. Traditionally SMCs have been assessed by either questionnaires, which ask whether a person has experienced given examples of SMCs, or open-ended questions which elicit spontaneous reports of SMCs. However, little is known about how these methods of assessment might influence reporting of SMCs. METHODS: Four hundred and twenty one adults aged 40 years and above were surveyed about SMCs using spontaneous report and questionnaire methods. RESULTS: As expected, spontaneously reported SMCs were fewer in number and rated more distressing overall than SMCs endorsed on a questionnaire. However, comparison of individual SMCs revealed that distress ratings tended to be higher when assessed in a questionnaire than spontaneously reported, which may be due to the context of a questionnaire causing inflated ratings. Participants also reported SMCs which were not well assessed by the questionnaire, including some which were among the most distressing SMCs overall. Conversely, other SMCs were over-sampled by the questionnaire and did not feature in spontaneous reports. CONCLUSIONS: Implications for clinical assessment of SMCs are that open-ended questioning might be preferable to initial use of prescriptive questionnaires, in order to elicit SMCs that are most distressing. While use of questionnaires may reveal endorsement of a wider range of SMCs than are spontaneously reported, they can take focus away from, or even fail to assess, those SMCs which cause most subjective distress (and therefore should be the target of interventions).

Peritraumatic distress: its relationship to posttraumatic stress and complicated grief symptoms in sudden death survivors.

Although sudden death has been linked to posttraumatic stress disorder (PTSD), its role in complicated grief (CG) and sudden death survivors is unknown. This questionnaire study investigated the role of peritraumatic distress in PTSD and CG symptoms in adults (n = 125) an average of 28.37 months (SD = 3.12) after a loved one's sudden death. The Peritraumatic Distress Inventory, Impact of Event Scale-Revised, and Inventory of Complicated Grief were administered to assess symptoms of peritraumatic distress, PTSD, and CG, respectively. Peritraumatic distress was the strongest correlate of both PTSD (ß = .42, p < .001) and CG (ß = .39, p < .001) symptoms, in a model containing current distress (Hopkins Symptom Checklist-21). Peritraumatic distress may be a key mechanism in the development of both PTSD and CG, therefore suddenly bereaved individuals reporting higher peritraumatic distress may be at risk of both adverse trauma and grief reactions.

Memory control beliefs and everyday forgetfulness in adulthood: the effects of selection, optimization, and compensation strategies.

Controlling for age, gender, education, and self-rated health, the present study used regression analyses to examine the relationships between memory control beliefs and self-reported forgetfulness in the context of the meta-theory of Selective Optimization with Compensation (SOC). Findings from this online survey (N = 409) indicate that, among adult New Zealanders, a higher sense of memory control accounts for a 22.7% reduction in self-reported forgetfulness. Similarly, optimization was found to account for a 5% reduction in forgetfulness while the strategies of selection and compensation were not related to self-reports of forgetfulness. Optimization partially mediated the beneficial effects that some memory beliefs (e.g., believing that memory decline is inevitable and believing in the potential for memory improvement) have on forgetfulness. It was concluded that memory control beliefs are important predictors of self-reported forgetfulness while the support for the SOC model in the context of memory controllability and everyday forgetfulness is limited.

An initial study to establish symptom base rates of traumatic brain injury in children.

Traumatic brain injury (TBI) is associated with complaints including headaches, restlessness, memory problems, or irritability, which are assumed to be a consequence of the TBI. The current study is a first attempt to establish the prevalence of common TBI complaints reported by non-brain-injured children aged 11-13. In a 38-item self-report questionnaire, 124 children reported high base rates for symptoms over the past year, especially "grumpy/cross" (79.4%), "frustration" (74.0%), and "fatigue (mental or physical)" (72.2%). This was comparable with base rate information reported by Lees-Haley and Brown (1993) for non-brain-injured adults for a longer period (24-month period). Approximately 20% of children reported five or more symptoms on a daily or weekly basis. They were most likely to be in behavioral and emotional rather than somatic or cognitive domains. Therefore, further research is needed to establish base rate information in order to clarify the true significance of symptom reporting and caution is recommended in interpretation of these symptoms in neuropsychological assessment of TBI in children.

Assessing executive performance during cognitive rehabilitation.

Executive functioning influences a host of other cognitive processes and people who attend neuropsychological services are more likely to display executive dysfunction than any other cognitive deficit (Stuss & Levine, 2002). Impairment in executive functioning disrupts a person's ability to effectively employ their intact areas of functioning, and undermines effective self-management of other areas of dysfunction, hampering attempts to employ compensatory strategies. Therefore, assessment of a person's executive functioning is a high priority as part of a comprehensive neurorehabilitation plan. Guided by the International Classification of Functioning, Disability, and Health model (ICF model; Peterson, 2005), we suggest that an important development in the field is moving to formal assessment of executive performance in functional contexts, in addition to more traditional assessment of executive impairment. We outline a number of existing studies in this area, review current measures that can provide clinicians with useful information on these issues, and discuss how this research could be further advanced.

Mild traumatic brain injury and fatigue: a prospective longitudinal study.

PRIMARY OBJECTIVE: To examine fatigue prevalence, severity, predictors and co-variates over 6 months post-mild traumatic brain injury (MTBI). RESEARCH DESIGN: Longitudinal prospective study including 263 adults with MTBI. PROCEDURES: Participants completed the Fatigue Severity Scale (FSS), Rivermead Post-concussion Symptoms Questionnaire (RPSQ), Hospital Anxiety and Depression Scale (HADS) and the Short Form 36 Health Survey-Version 2 (SF-36v2). Complete data were available for 159 participants. Key measures; prevalence--RPSQ Item 6: severity--FSS. The effect of time on fatigue prevalence and severity was examined using ANOVA. Multiple regression analysis identified statistically significant covariates. MAIN OUTCOMES AND RESULTS: Post-MTBI fatigue prevalence was 68%, 38% and 34% at 1 week, 3 and 6 months, respectively. There was a strong effect for time over the first 3 months and moderate-to-high correlations between fatigue prevalence and severity. Early fatigue strongly predicted later fatigue; depression, but not anxiety was a predictor. Fatigue was seen as laziness by family or friends in 30% of cases. CONCLUSIONS: Post-MTBI fatigue is a persistent post-concussion symptom, exacerbated by depression but not anxiety. It diminishes in the first 3 months and then becomes relatively stable, suggesting the optimum intervention placement is at 3 months or more post-MTBI.

A study investigating the effects of Tai Chi Chuan: individuals with traumatic brain injury compared to controls.

OBJECTIVE: To explore the effects of a 6-week course in Tai Chi associated with traumatic brain injury (TBI) symptoms. METHOD: Eighteen participants, with TBI assigned to a control (waiting list) group (n = 9) or Tai Chi group (n = 9) completed the Medical Outcome Scale Short Form 36 (SF-36) and Rosenberg Self-Esteem Scale (RSES) before, during, immediately after and 3 weeks after completion of the Tai Chi course. The Tai Chi group completed the Visual Analogue Mood Scales (VAMS) before and after each class. RESULTS: Tai Chi was associated with significant improvement on all VAMS scores (except fatigue) with decreases in sadness, confusion, anger, tension, fear and increases in energy and happiness. There were no significant between-group differences on the SF-36 or RSES. CONCLUSIONS: Tai Chi provides short-term benefits after TBI, with rigorous outcome measurement needed to examine long-term benefits.

Information provision after mild traumatic brain injury (MTBI): a survey of general practitioners and hospitals in New Zealand.

AIMS: To determine the nature, extent, and quality of information provided by general practitioners (GPs) and hospital emergency departments to people after mild traumatic brain injury (MTBI). METHOD: A survey was distributed throughout New Zealand to a representative sample of GPs and emergency departments (EDs). RESULTS: 244 valid surveys were returned, (229 from GPs and 15 from EDs), giving a return rate of 50.1%. Included with the returned surveys were 145 samples of information that these agencies typically provide after MTBI. Overall, 45.9% of respondents (93.4% of EDs and 42.8% of GPs) provided an information sheet to patients with a confirmed or suspected MTBI. These generally covered signs and symptoms; when to seek medical attention; and advice about pain relief, driving, alcohol, and rest. Of the information sheets provided by EDs, 92.9% had a FRE score of over 61 (the level recommended to be able to be read by 70% of the population), compared to 56% of those provided by GPs. Information sheets ranged in length from half a page to 10 pages, with those provided by EDs generally longer than those provided by GPs (mean 33.6 compared to 12.9 sentences). CONCLUSIONS: Less than half of the GPs who returned questionnaires routinely provided information sheets about head injury and what to expect. Of the sample information sheets that were returned, just under half did not meet the criteria for being able to be read by 70% of the population.

The effects of test anxiety, age, intelligence level, and arithmetic ability on Paced Auditory Serial Addition Test performance.

This study investigated the effects of test anxiety, intelligence, arithmetic ability, and age on the Paced Auditory Serial Addition Test (PASAT) performance of 45 participants ages 16 to 54. Level of anxiety as measured by a short form measure of state anxiety and retrospective report during the PASAT appeared to have no significant effect on performance. Intelligence and arithmetic ability, however, together accounted for 46% of the variance on PASAT scores. Although no significant correlation was found between PASAT performance and age, those over 26 years of age performed significantly better on the 2.0 second paced presentation.

Neuropsychological assessment of individuals with expressive disabilities in addition to traumatic brain injuries.

Little empirical research has examined guidelines for neuropsychological assessment of people with severe physical and sensory disabilities. This study focused on people with expressive disabilities--people unable to speak, write, draw, or manipulate test materials. Measures were selected and adapted to be suitable for the assessment of cognitive functioning for such people. Responses were selected from multiple choice answers or were spelled out on an alphabet board. Individuals with expressive disabilities in addition to traumatic brain injuiry (TBI) were compared to individuals with TBI alone and a normative group. The measures were generally found to be reliable and valid assessment instruments. Individuals with expressive disabilities were able to manage the task requirements of the adapted tests. The results provided support for the adaptations trialed.