[Morphological changes in the epithelium of the auditory tube with prolonged respiratory support in children of the first year of life]. / Morfologicheskie izmeneniya epiteliya slukhovoi truby pri dlitel'noi respiratornoi podderzhke u detei pervogo goda zhizni.

OBJECTIVE: To analyze the condition of the epithelium of the cartilaginous part of the auditory tube in premature and full-term infants with prolonged respiratory support using noninvasive assisted ventilation (continuous positive airway pressure - CPAP) and artificial lung ventilation (ventilator). MATERIAL AND METHODS: All the obtained material is distributed relative to the gestation period into the main and control groups. The main group (25 children) is represented by premature and full-term live-born children who were on respiratory support for a period of several hours to 2 months, the average gestation period of which was 30 weeks and 40 weeks, respectively. The control group (8 children) is represented by stillborn newborns with an average gestation period of 28 weeks. The study was conducted posthumously. RESULTS: Prolonged use of respiratory support in premature and full-term children, regardless of the type (CPAP or ventilator), leads to a violation of the row of cilia of the ciliated epithelium, various inflammatory processes, as well as to the expansion of the ducts of the mucous glands of the epithelium of the auditory tube, which affects its drainage system. CONCLUSION: Prolonged respiratory support causes destructive changes in the epithelium of the auditory tube, which make it difficult to evacuate the mucous discharge from the tympanic cavity. This negatively affects the ventilation function of the auditory tube and in the future may lead to the development of chronic exudative otitis media.

Associations of independent living and labor force participation with impairment indicators in schizophrenia and bipolar disorder at 20-year follow-up.

BACKGROUND: Since the Iowa 500 study, residential and occupational status have been frequently used as indicators of everyday achievements in research on schizophrenia and bipolar disorder. The relationships of residential and occupational status with impairment in multiple domains including physical health indicators across these two diagnoses, however, have rarely been studied. We examined these relationships at the 20-year follow-up assessment of a first-admission sample. METHODS: We included 146 participants with schizophrenia and 87 with bipolar disorder with psychosis who participated in the 20-year follow-up of the Suffolk County Mental Health Project. In addition to interviewer-based ratings of employment and residential independence, we examined self-reported impairment derived from the WHODAS, standard measures of current psychopathology, indicators of obesity, as well as performance-based measures of physical and cognitive functioning. RESULTS: Participants with bipolar disorder were more likely to live independently and be gainfully employed; they also performed significantly better on each indicator of impairment apart from balance ability. In both groups, unemployment, but not residential independence, was associated with greater self-reported disability on the WHODAS. Residential independence, gainful employment, and subjective disability were also associated with better physical functioning. Across the two groups, psychiatric symptoms and physical functioning were the major determinants of subjective disability. DISCUSSION: People with psychotic bipolar disorder were more likely to be gainfully employed and living independently than participants with schizophrenia but as a group, much less frequently than population standards. Interventions aimed at physical fitness may have the potential to improve both objective functioning and perceived disability.

Health status and mobility limitations are associated with residential and employment status in schizophrenia and bipolar disorder.

INTRODUCTION: Schizophrenia (SCZ) and bipolar disorder (BP) are linked to multiple impairments in everyday functioning which share cognitive and symptom risk factors. Other risk factors for critical aspects of every day functioning (e.g., gainful employment; residential independence) such as physical health have not been evaluated, despite poor health in SCZ and BP. METHODS: We analyzed 20-year follow-up data from the Suffolk County Mental Health Project cohort of consecutive first admissions with a psychotic disorder to 12 psychiatric facilities in Suffolk County, NY, between September 1989 and December 1995. Both 20-year symptom, health, and cognition data, and the 20-year course of weight gain were included as predictors of employment and residence status. RESULTS: The analysis sample consisted of 122 participants with SCZ ad BP, with SCZ participants less likely to work or live independently. Correlational analyses showed symptoms and cognition predicted vocational outcomes in both samples. The effect of diagnosis was significant for both gainful employment and independence in residence. After consideration of diagnosis, mobility and negative symptoms predicted gainful employment in both samples, but there were no additional predictors of residential independence. Prospective analysis of BMI found that baseline BMI, but not changes during the 20-year follow up, predicted labor force participation. DISCUSSION: Health status limitations were associated with residential and, particularly, employment status independent from other, previously established predictors of everyday outcomes, including cognition and symptoms. The importance of health status limitations for predicting outcome was confirmed in both SCZ and BP, with schizophrenia representing the more impaired group.

An epigenome-wide DNA methylation study of PTSD and depression in World Trade Center responders.

Previous epigenome-wide association studies (EWAS) of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) have been inconsistent. This may be due to small sample sizes, and measurement and tissue differences. The current two EWA analyses of 473 World Trade Center responders are the largest to date for both PTSD and MDD. These analyses investigated DNA methylation patterns and biological pathways influenced by differentially methylated genes associated with each disorder. Methylation was profiled on blood samples using Illumina 450 K Beadchip. Two EWA analyses compared current versus never PTSD, and current versus never MDD, adjusting for cell types and demographic confounders. Pathway and gene set enrichment analyses were performed to understand the complex biological systems of PTSD and MDD. No significant epigenome-wide associations were found for PTSD or MDD at an FDR P<0.05. The majority of genes with differential methylation at a suggestive threshold did not overlap between the two disorders. Pathways significant in PTSD included a regulator of synaptic plasticity, oxytocin signaling, cholinergic synapse and inflammatory disease pathways, while only phosphatidylinositol signaling and cell cycle pathways emerged in MDD. The failure of the current EWA analyses to detect significant epigenome-wide associations is in contrast with disparate findings from previous, smaller EWA and candidate gene studies of PTSD and MDD. Enriched gene sets involved in several biological pathways, including stress response, inflammation and physical health, were identified in PTSD, supporting the view that multiple genes play a role in this complex disorder.

Social support buffers the effect of interpersonal life stress on suicidal ideation and self-injury during adolescence.

BACKGROUND: The effect of life stress on suicidal symptoms during adolescence is well documented. Stressful life events can trigger suicidality, but most adolescents are resilient and it is unclear which factors protect against the deleterious impact of stress. Social support is thought to be one such factor. Therefore, we investigated the buffering effect of specific sources of social support (parental and peer) on life stress (interpersonal and non-interpersonal) in predicting suicidal symptoms during adolescence. In order to test the specificity of this stress buffering, we also examined it with regard to dysphoric mood. METHOD: Data come from the Adolescent Development of Emotions and Personality Traits (ADEPT) Project, a cohort of 550 adolescent females aged 13.5-15.5 recruited from Long Island. Self-reported social support, suicidality, and dysphoria were assessed at baseline and suicidality and dysphoria were assessed again at 9-month follow-up. Life stress was assessed by interview at the follow-up. RESULTS: High levels of parental support protected adolescent girls from developing suicidal symptoms following a stressor. This effect was less pronounced for peer support. Also, social support did not buffer the pathogenic effects of non-interpersonal stress. Finally, social support did not buffer the effect of life stress on dysphoric symptoms. CONCLUSIONS: Altogether, our results highlight a distinct developmental pathway for the development of suicidal symptoms involving parental support that differs from the development of dysphoria, and signifies the importance and specificity of social support in protecting against suicidality in adolescent girls.

Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants.

BACKGROUND: This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including anxiety, depression, and substance abuse) as well as thought disorders (psychosis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory. METHOD: This meta-analysis included 59 longitudinal/prospective studies with 443 313 participants. RESULTS: The results showed large unadjusted prospective associations between neuroticism and symptoms/diagnosis of anxiety, depression, and non-specific mental distress (d = 0.50-0.70). Adjustment for baseline symptoms and psychiatric history reduced the associations by half (d = 0.10-0.40). Unadjusted prospective associations for substance abuse and thought disorders/symptoms were considerably weaker (d = 0.03-0.20), but were not attenuated by adjustment for baseline problems. Unadjusted prospective associations were four times larger over short (<4 year) than long (⩾4 years) follow-up intervals, suggesting a substantial decay of the association with increasing time intervals. Adjusted effects, however, were only slightly larger over short v. long time intervals. This indicates that confounding by baseline symptoms and psychiatric history masks the long-term stability of the neuroticism vulnerability effect. CONCLUSION: High neuroticism indexes a risk constellation that exists prior to the development and onset of any CMD. The adjusted prospective neuroticism effect remains robust and hardly decays with time. Our results underscore the need to focus on the mechanisms underlying this prospective association.

DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11).

BACKGROUND: Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11-13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being. METHOD: Master's-level psychologists administered sections of the Structured Clinical Interview for DSM-IV and the Range of Impaired Functioning Tool to 3231 responders monitored at the Stony Brook University World Trade Center Health Program. The PTSD Checklist (PCL) and current medical symptoms were obtained at each visit. RESULTS: In all, 9.7% had current, 7.9% remitted, and 5.9% partial WTC-PTSD. Among those with active PTSD, avoidance and hyperarousal symptoms were most commonly, and flashbacks least commonly, reported. Trajectories of symptom severity across monitoring visits showed a modestly increasing slope for active and decelerating slope for remitted PTSD. WTC exposures, especially death and human remains, were strongly associated with PTSD. After adjusting for exposure and critical risk factors, including hazardous drinking and co-morbid depression, PTSD was strongly associated with health and well-being, especially dissatisfaction with life. CONCLUSIONS: This is the first study to demonstrate the extent and correlates of long-term DSM-IV PTSD among responders. Although most proved resilient, there remains a sizable subgroup in need of continued treatment in the second decade after 9/11.

Personality diatheses and Hurricane Sandy: effects on post-disaster depression.

BACKGROUND: According to diathesis-stress models, personality traits, such as negative emotionality (NE) and positive emotionality (PE), may moderate the effects of stressors on the development of depression. However, relatively little empirical research has directly examined whether NE and PE act as diatheses in the presence of stressful life events, and no research has examined whether they moderate the effect of disaster exposure on depressive symptoms. Hurricane Sandy, the second costliest hurricane in US history, offers a unique opportunity to address these gaps. METHOD: A total of 318 women completed measures of NE and PE 5 years prior to Hurricane Sandy. They were also assessed for lifetime depressive disorders on two occasions, the latter occurring an average of 1 year before the hurricane. Approximately 8 weeks after the disaster (mean = 8.40, s.d. = 1.48 weeks), participants completed a hurricane stress exposure questionnaire and a measure of current depressive symptoms. RESULTS: Adjusting for lifetime history of depressive disorders, higher levels of stress from Hurricane Sandy predicted elevated levels of depressive symptoms, but only in participants with high levels of NE or low levels of PE. CONCLUSIONS: These findings support the role of personality in the development of depression and suggest that personality traits can be useful in identifying those most vulnerable to major stressors, including natural disasters.

Familial risk for distress and fear disorders and emotional reactivity in adolescence: an event-related potential investigation.

BACKGROUND: The late positive potential (LPP) is an event-related potential component that is sensitive to the motivational salience of stimuli. Children with a parental history of depression, an indicator of risk, have been found to exhibit an attenuated LPP to emotional stimuli. Research on depressive and anxiety disorders has organized these conditions into two empirical classes: distress and fear disorders. The present study examined whether parental history of distress and fear disorders was associated with the LPP to emotional stimuli in a large sample of adolescent girls. METHOD: The sample of 550 girls (ages 13.5-15.5 years) with no lifetime history of depression completed an emotional picture-viewing task and the LPP was measured in response to neutral, pleasant and unpleasant pictures. Parental lifetime history of psychopathology was determined via a semi-structured diagnostic interview with a biological parent, and confirmatory factor analysis was used to model distress and fear dimensions. RESULTS: Parental distress risk was associated with an attenuated LPP to all stimuli. In contrast, parental fear risk was associated with an enhanced LPP to unpleasant pictures but was unrelated to the LPP to neutral and pleasant pictures. Furthermore, these results were independent of the adolescent girls' current depression and anxiety symptoms and pubertal status. CONCLUSIONS: The present study demonstrates that familial risk for distress and fear disorders may have unique profiles in terms of electrocortical measures of emotional information processing. This study is also one of the first to investigate emotional/motivational processes underlying the distress and fear disorder dimensions.

The structure and short-term stability of the emotional disorders: a dimensional approach.

BACKGROUND: Factor-analytic studies have found that depressive, bipolar, post-traumatic, obsessive-compulsive, and anxiety disorders - jointly referred to as the emotional disorders - form an internalizing spectrum that includes distress and fear subfactors. However, placement of some disorders is uncertain. Also, prior research analysed dichotomous interview-based diagnoses or dimensional self-report measures. We investigated this structure using a third-generation measure - the Interview for Mood and Anxiety Symptoms (IMAS) - that combines strengths of a clinical interview with dimensional assessment. METHOD: The interview was administered to 385 students and 288 psychiatric out-patients. Participants were reinterviewed 2 months later. RESULTS: Exploratory and confirmatory factor analyses identified three factors: distress (depression, generalized anxiety, post-traumatic stress, irritability, and panic syndrome); fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and bipolar (mania and obsessive-compulsive). The structure was consistent over time and across samples, except that panic and agoraphobia had higher factor loadings in patients. Longitudinal analyses revealed high temporal stability of the factors (test-retest r = 0.72 to 0.87), but also substantial disorder-specific stability. CONCLUSIONS: This investigation - which bridges diagnostic and self-report studies - found three subfactors of internalizing psychopathology. It provided support for a new subfactor, clarified the placement of obsessive-compulsive and bipolar disorders, and demonstrated that this model generalizes across populations. The accumulating research suggests the need to recognize formally the close links among the emotional disorders, as well as empirical clusters within this spectrum. The IMAS demonstrated strong psychometric properties and can be useful for various research and clinical applications by providing dimensional, interview-based assessment of the emotional disorders.

Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers.

BACKGROUND: Thousands of rescue and recovery workers descended on the World Trade Center (WTC) in the wake of the terrorist attack of September 11, 2001 (9/11). Recent studies show that respiratory illness and post-traumatic stress disorder (PTSD) are the hallmark health problems, but relationships between them are poorly understood. The current study examined this link and evaluated contributions of WTC exposures. METHOD: Participants were 8508 police and 12 333 non-traditional responders examined at the WTC Medical Monitoring and Treatment Program (WTC-MMTP), a clinic network in the New York area established by the National Institute for Occupational Safety and Health (NIOSH). We used structural equation modeling (SEM) to explore patterns of association among exposures, other risk factors, probable WTC-related PTSD [based on the PTSD Checklist (PCL)], physician-assessed respiratory symptoms arising after 9/11 and present at examination, and abnormal pulmonary functioning defined by low forced vital capacity (FVC). RESULTS: Fewer police than non-traditional responders had probable PTSD (5.9% v. 23.0%) and respiratory symptoms (22.5% v. 28.4%), whereas pulmonary function was similar. PTSD and respiratory symptoms were moderately correlated (r=0.28 for police and 0.27 for non-traditional responders). Exposure was more strongly associated with respiratory symptoms than with PTSD or lung function. The SEM model that best fit the data in both groups suggested that PTSD statistically mediated the association of exposure with respiratory symptoms. CONCLUSIONS: Although longitudinal data are needed to confirm the mediation hypothesis, the link between PTSD and respiratory symptoms is noteworthy and calls for further investigation. The findings also support the value of integrated medical and psychiatric treatment for disaster responders.

[The functional state of the auditory analyzer in prematurely born infants (after 29 weeks of gestation) at 6 months of life].

The objective of the present study was to evaluate the functional state of the auditory analyzer in infants born prematurely (after 29 weeks of gestation) and examined at 6 months of life. The evoked otoacoustic emission (EOAE) techniques were used for the purpose. Testing with the help of two different modes of EOAE yielded virtually identical results which confirms the possibility to apply both delayed EOAE (dEOAE) and distortion-product frequency OAE (dpOAE) for the assessment of the auditory function. It is concluded that the degree of cochlear development in prematurely born infants (after 29 weeks of gestation) examined by the dpOAE technique at 6 months of life is significantly different from that in children born between the gestation age of 33 and 37 weeks.

[The functional state of the cochlea in premature infants born before 28 weeks gestation on the 6th month of life].

The objective of the present study was to assess the state of the peripheral portion of the auditory analyzer based on induced otoacoustic emissions (IOAEs), distortion product otoacoustic emissions (DPOAEs), and delayed IOAEs (DIOAEs). The study included 31 premature infants born before 28 weeks gestation and examined later on the 6th month of postnatal life. All of them were shown to have the underdeveloped cochlea. It was shown that the DPOAEs technique makes it possible to record induced otoacoustic emissions more frequently than the DIOAEs method. It is concluded that the hearing function in premature infants born before 28 weeks gestation should be evaluated on the 6th month of postnatal life based on two classes of emission.

Effects of amikacin on maturation of the auditory analyzer in rabbits.

We studied the dynamics of maturation of the hearing function by records of short-term latent brainstem evoked potentials and the effect of amikacin on maturation of the hearing function. The peripheral compartment of the auditory analyzer matures sooner than the central structures. Amikacin in therapeutic doses exhibited an ototoxic effect on the peripheral compartment of the auditory analyzer without impairing its central structures.

[The importance of studying ENT organs in premature infants].

Otorhinolaryngological examination makes it possible to objectively evaluate the state of ENT organs in prematurely born babies, take adequate measures to ensure their survival, undertake early prevention of ENT pathologies, carry out rehabilitation in case of post-resuscitation or congenital complications, and form groups of children selected for the follow-up and further treatment by an otorhinolaryngologist.

The Chornobyl accident and cognitive functioning: a follow-up study of infant evacuees at age 19 years.

BACKGROUND: The cognitive and academic outcomes of infants exposed to radiation after the meltdown at Chornobyl have been intensely debated. Western-based investigations indicate that no adverse effects occurred, but local studies reported increased cognitive impairments in exposed compared with non-exposed children. Our initial study found that at age 11 years, school grades and neuropsychological performance were similar in 300 children evacuated to Kiev as infants or in utero compared with 300 classmate controls, yet more evacuee mothers believed that their children had memory problems. This study re-examined the children's performance and academic achievement at age 19 years. METHOD: In 2005-2006, we conducted an 8-year follow-up of the evacuees (n=265) and classmate controls (n=261) assessed in Kiev in 1997. Outcomes included university attendance, tests of intelligence, attention, and memory, and subjective appraisals of memory problems. Scores were standardized using a local population-based control group (n=327). Analyses were stratified by parental education. RESULTS: Evacuees and classmates performed similarly and in the normal range on all tests, and no differential temporal changes were found. The results were comparable for the in utero subsample. The rates of university attendance and self-reported memory problems were also similar. Nevertheless, the evacuee mothers were almost three times as likely to report that their children had memory problems compared with controls. CONCLUSIONS: Chornobyl did not influence the cognitive functioning of exposed infants although more evacuee mothers still believed that their offspring had memory problems. These lingering worries reflect a wider picture of persistent health concerns as a consequence of the accident.

The mental health of clean-up workers 18 years after the Chernobyl accident.

BACKGROUND: The psychological aftermath of the Chernobyl accident is regarded as the largest public health problem unleashed by the accident to date. Yet the mental health of the clean-up workers, who faced the greatest radiation exposure and threat to life, has not been systematically evaluated. This study describes the long-term psychological effects of Chernobyl in a sample of clean-up workers in Ukraine. METHOD: The cohorts were 295 male clean-up workers sent to Chernobyl between 1986 and 1990 interviewed 18 years after the accident (71% participation rate) and 397 geographically matched controls interviewed as part of the Ukraine World Mental Health (WMS) Survey 16 years after the accident. The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was administered. We examined group differences in common psychiatric disorders, suicide ideation and severe headaches, differential effects of disorder on days lost from work, and in the clean-up workers, the relationship of exposure severity to disorder and current trauma and somatic symptoms. Analyses were adjusted for age in 1986 and mental health prior to the accident. RESULTS: Relatively more clean-up workers than controls experienced depression (18.0% v. 13.1%) and suicide ideation (9.2% v. 4.1%) after the accident. In the year preceding interview, the rates of depression (14.9% v. 7.1%), post-traumatic stress disorder (PTSD) (4.1% v. 1.0%) and headaches (69.2% v. 12.4%) were elevated. Affected workers lost more work days than affected controls. Exposure level was associated with current somatic and PTSD symptom severity. CONCLUSIONS: Long-term mental health consequences of Chernobyl were observed in clean-up workers.

[Endoscopic laser surgery in combined nasopharyngeal and middle ear pathology in children with conductive hypoacusis].

Endoscopic laser surgery on lymphoid structures of the nasopharynx near the pharyngeal opening of the auditory tube was made with Lazon-10P laser in 67 children aged 3 to 14 years with documented exudative otitis media (EOM). All the children had conductive hypoacusis. Children who had tympanogram of type B and in whom otoscopy detected exudate behind the tympanic membrane were subjected to one-stage laser tympanostomy in the anteroinferior quadrant of the tympanic membrane followed by transtympanic drug introduction into the tympanic cavity. Tympanostoma closed spontaneously 3 weeks later. Normal hearing recovered in all the children. Diagnostic endoscopy of the nasopharynx can reveal causes underlying dysfunction of the auditory tube. The results demonstrate high efficacy of the methods allowing elimination of mechanical occlusion of the auditory tube in the region of its pharyngeal opening with one-stage intervention on the middle ear.