Monoamine oxidase A (MAOA) interaction with parenting practices on callous-unemotional traits in preschoolers

Background and Objectives: From a gene-by-environment perspective, parenting in interaction with the polymorphism in the Monoamine oxidase A (MAOA) gene (MAOA-uVNTR) might also be associated with increased callous-unemotional traits (CU) in preschoolers. MAOA-uVNTR results in differential enzyme activity, so that high-activity alleles (MAOA-H) are linked to reduced dopamine, serotonin, and norepinephrine availability in comparison to low-activity allele (MAOA-L). As MAOA-uVNTR has been previously described to moderate the relationship between childhood parental maltreatment and aggressive and antisocial behavior, it may also play a role in CU traits etiology.MethodsData was collected through questionnaires answered by parents and teachers. MAOA-uVNTR was genotyped in 368 Caucasian children from a community sample (51.9% male). Multiple linear regression analyses were conducted to analyze the interaction effect of MAOA genotypes and both positive parenting and punitive parenting practices on CU traits at two different periods (3 and 5 years old) and separately by sex.ResultsNo significant interactions were found for boys. Among girls, a significant interaction effect was found for MAOA-LL carriers, who showed higher CU traits at age 5 when exposed to higher punitive or positive parenting at age 3.ConclusionsOur study provides the first evidence for significant MAOA × early parenting effects on CU traits in preschoolers, specifically among female MAOA-LL carriers. This suggests that the MAOA-LL genotype for girls is associated with higher sensitivity to both positive and punitive parenting in girls, so that MAOA-LL emerges as a genotype that confers higher vulnerability to parental influences. (AU)

Manejo endodóncico y restaurador de un primer molar superior con cuatro raíces independientes / Endodontic and restorative management of an upper first molar with four independent roots

INTRODUCCIÓN: El primer molar superior se caracteriza por tener 3 raíces y cuatro conductos radiculares. La presencia de cuatro raíces es un hallazgo inusual, pocas veces reportado en la literatura. CASO CLÍNICO: Acude a la consulta un paciente caucásico con pulpititis irreversible del 2.6. Se decide iniciar el trata-miento de conductos, pero dada la diferente morfología radicular visible radiográficamente, se realiza una CBCT previa. En el corte axial, se aprecian 4 raíces, con ápices totalmente independientes. Además, la raíz mesiovestibular presenta un único conducto y forma redondeada. Con la ayuda del microscopio se realiza una apertura inusual y se localizan los cuatro conductos. Finalizadas la instrumentación, irrigación y obturación, se recubre el acceso cameral con composite, para la posterior realización de una incrustación, capaz de sellar la caries cervical y restaurar los puntos de contacto. En el control 2 años posterior, el paciente está totalmente asintomático y la restauración demuestra su funcionalidad y estética. CONCLUSIÓN: Las anomalías anatómicas pueden presentar-se en cualquier diente. Encontrar un primer molar superior con más de tres raíces es un hallazgo muy extraño, pero gracias a la ayuda de la radiología tridimensional, se pudo visualizar y tratar de forma adecuada. Ante cualquier imagen radiográfica donde no se pueda apreciar con claridad la anatomía dental a tratar, debemos realizar varias proyecciones radiográficas o una CBCT para poder conocer la morfología real a la que nos enfrentamos

INTRODUCTION: The upper first molar is characterized by having three roots and four root canals. The presence of four roots is an unusual finding, rarely reported in the literature. CLINICA CASE: A caucasian patient with irreversible pulpititis of 2.6 comes to the dental clinic. It was decided to start the root canal treatment, but due to the different root morphology visible radiographically, a previous CBCT was performed. In the axial section, 4 roots are seen, with completely independent apexes. Furthermore, the mesiovestibular root has a single canal and a rounded shape. With the help of the microscope, an unusual opening is made and the four canals are located. After the instrumentation, irrigation and obturation are completed, the cameral access is covered with composite, for the subsequent inlay, capable of sealing cervical caries and restoring the contact points. In the control 2 years later, the patient is completely asymptomatic and the restoration demonstrates its functionality and aesthetics. CONCLUSIONS: Anatomic anomalies occur in any tooth. Finding an upper first molar with more than three roots is a very strange finding, but thanks to the help of three-dimensional radiology, it was able to be properly visualized and treated. Before any radiographic image where the dental anatomy to be treated cannot be clearly seen, we must carry out several radiographic projections or a CBCT to be able to know the real morphology that we are facing

Manejo endoperiodontal de una reabsorción cervical externa tipo II bajo aislamiento absoluto y técnicas adhesivas / Endoperiodontal management of an external cervical resorption type II under absolute isolation and adhesive techniques

INTRODUCCIÓN: Las reabsorciones cervicales externas suelen ser asintomáticas y se detectan casualmente durante revisiones rutinarias. Puede aparecer una mancha rosácea conocida como "pink spot". Existe sintomatología cuando se afecta el tejido pul-par. La etiología es incierta pero existen factores de riesgo asociados. Caso Clínico: Tratamiento de un 4.2 afectado por una reabsorción cervical externa tipo II supraósea distal según la clasificación de Heithersay. Se realizó un colgajo y bajo aislamiento absoluto se trató la reabsorción y el sistema de conductos. Finalmente, se restauró con poste de fibra de vidrio, se selló la reabsorción con resina nanohíbrida y se suturó el colgajo. CONCLUSIÓN: Es necesario un CBCT para conocer la localización, extensión y determinar el plan de tratamiento exacto. Las reabsorciones cervicales externas supraóseas pueden tratarse mediante aislamiento absoluto para realizar el tratamiento de conductos y la restauración en la misma cita

INTRODUCTION: External cervical reabsorption is usually asympto-matic and is detected casually during routine check-ups. A pink spot may appear at cervical level. Symptoms exist when the pulp tissue is affected. The etiology is uncertain but there are associa-ted risk factors. Clinical Case: Treatment of a 4.2 affected by a distal supra-os-seous type II external cervical reabsorption according to the Hei-thersay classification. A flap was performed and under absolute isolation, the resorption and the duct system were treated. Finally, it was restored with a glass fiber post, the resorption was sealed with composite resin and the flap was sutured. CONCLUSIONS: A CBCT is necessary to know the location, extension and determine the exact treatment plan. Supra-osseous external cervical resorptions can be treated by absolute isolation to perform root canal treatment and restoration at the same appointment

Tratamiento endodóncico y blanqueamiento interno de un 2.1. con metamorfosis cálcica / Endodontic treatment and internal bleaching of a 2.1. with calcium metamorphosis

Introducción: La metamorfosis cálcica se presenta comúnmente tras lesiones traumáticas y se caracteriza por presentar depósitos de tejido duro dentro del espacio pulpar, obliterando parcial o totalmente la cámara pulpar y/o el conducto radicular. Este proceso suele provocar un cambio de coloración de la corona clínica haciéndola más oscura y opaca. Caso clínico: Paciente mujer de 40 años acude a la consulta motivada por una preocupación estética debido al oscurecimiento del diente 21. Se proponen varias opciones de tratamiento, hasta que finalmente se opta por el tratamiento de conductos de forma ortógrada, así como blanqueamiento interno del diente. Conclusión: El plan de tratamiento en dientes con metamorfosis cálcica sin patología periapical y con compromiso estético partirá siempre desde el más conservador. Es esencial en el tratamiento de estos dientes la experiencia del operador, así como el buen manejo del microscopio y los ultrasonidos, herramientas fundamentales para su abordaje

Introduction: Calcium metamorphosis commonly occurs after traumatic injuries and is characterized by hard tissue deposits within the pulp space, partially or totally obliterating the pulp chamber and/or the root canal. This process usually causes a change in the color of the clinical crown, making it darker and more opaque. Clinical case: A 40-year-old female patient came to the clinic motivated by an aesthetic concern due to the darkening of the tooth 21. Various treatment options are proposed, until finally the endodontic treatment is chosen, as well as internal bleaching of the tooth. Conclusion: The treatment in teeth with calcium metamorphosis, without periapical pathology and with aesthetic compromise, should always be the most conservative. It is essential in the treatment of these teeth the experience of the operator, as well as the correct use of the microscope and ultrasounds, which are fundamental tools for its approach

Development of a screening tool enabling identification of infants and toddlers at risk of family abuse and neglect: a feasibility study from three South European countries.

BACKGROUND: Child abuse is a health and social problem, and few screening instruments are available for the detection of risk in primary health care. The aim was to develop a screening instrument to be used by professionals in the public health care sector, thus enabling the detection of infants and toddlers at risk of emotional and physical abuse and neglect, and to provide evidence for the feasibility of the instrument in Cyprus, Greece and Spain. METHOD: A total of 50 health professionals from paediatric public health-care centres in the three countries were involved in a three-step process for guiding the development of the screening tool and its application. RESULTS: A nine-item screening tool, consisting of items assessing relational emotional abuse, physical abuse and other risk factors, was developed. The screening tool was applied on a total of 219 families with 0 to 3-year-old children attending public health centres in the three countries. Clinicians reported that they agreed on the inclusion of the questions (86.4-100%) and that they found the questions to be useful for the clinical evaluation of the family (63.2-100%). CONCLUSION: The screening tool shows considerable face validity and was reported feasible by an international set of clinicians.

Epidemiology of psychiatric disability in childhood and adolescence.

The goal of the study was to ascertain the factor structure and prevalence of psychiatric disability in children and adolescents in relation to demographic variables and diagnosis. A representative sample of 1,420 children (9-13 years) from 11 countries in North Carolina was followed for up to 6 years. Children and caretakers were interviewed with the Child and Adolescent Psychiatric Assessment, which generates DSM-IV diagnoses and includes a measure of disability secondary to psychological symptoms. Three broad areas of disability were identified (relating to family, school, and peers). School disabilities were more common in boys than girls. while the reverse was true of family disability. Effects of age were complex, and partially gender-differentiated. Children from minority ethnic groups had a higher overall prevalence of school disabilities, and were more prone than Whites to the disabling effects of disruptive behavior disorders. Anxiety disorders were as likely to result in disability as depressive disorders, and oppositional defiant disorders were more strongly associated with disability in some areas than was conduct disorder. The areas where disability is manifested are different depending on race, gender, age, and the type of disorder suffered. The implications of these findings for nosology and prevention are discussed.

Predictors of functional impairment in children and adolescents.

The goal of this study was to investigate the variables that best predict functional impairment in children and adolescents. Two hundred and eight psychiatric and 129 pediatric children aged 7 to 17 years were assessed with measures of psychopathology, functional impairment, temperament, marital discord, educational style, coping, developmental milestones, stressful life events, medical history, school information, and family history of psychopathology. Multiple regression models adjusted by psychopathology were estimated. The global model, which included all the significant variables in partial models, revealed the following predictors of impairment: receiving review lessons, chronic disease or handicap, the presence of problems the child interpreted as stressful, late onset and long duration of psychopathological problems. These indicators could be useful for the proper identification of children with severe difficulties, in order to provide them with adequate psychological services.

Diagnostic agreement between clinicians and the Diagnostic Interview for Children and Adolescents--DICA-R--in an outpatient sample.

The paper examines the diagnostic agreement between clinicians and the Diagnostic Interview for Children and Adolescents. One hundred and thirty-seven outpatients-children and adolescents, and their parents-were diagnosed independently following DSM-III-R criteria by clinicians and by the DICA-R. The diagnostic concordance between clinicians and DICA-R ranged from low to moderate in the majority of the categories. The only exception was Conduct Disorder. Differences depending on the informant and the quality of the information (cognitive vs. observable) were observed. Combining the information from the child/adolescent and their parents ameliorates the concordance. The reasons for the scanty agreement found could be due to the fact that clinicians and structured interviews differ in what they evaluate (conditions on which they focus), how they evaluate (strictness in the criteria application, use of different informants and different information etc.), and when they evaluate (present condition vs. lifespan). After analysing the pros and cons of both, the use of structured interviews is advisable for research purposes. There is a clear need for a variety of informants, and the combination of information from different sources is recommended, depending on the age of the children and the type of disorder.

Psychiatric disorders in children and adolescents: the contribution of the child's temperament and the parents' psychopathology and attitudes.

Correlates of child psychopathology were studied in a community sample of 210 children and adolescents (with equal numbers of boys and girls). Children suffering from a psychiatric disorder had more temperamental difficulties and their parents showed a higher level of psychopathology than those without a disorder. Furthermore, a regression analysis revealed that difficult temperamental traits in the child and the parents' attitudes toward the child were primary predictors of psychiatric disorders in the child. The relationship between the parent and child as well as the environment-temperament impact on child psychopathology are discussed.

Peer Nomination Inventory of Depression: characteristics in a Spanish sample.

The Peer Nomination Inventory of Depression (PNID) was answered by 1,121 children from Barcelona in the fourth year of grammar school and by their teachers (n = 36) to analyze this questionnaire in a Spanish sample. The results indicated (1) high internal consistency; (2) discriminative power between depressed and nondepressed; (3) low concurrent validity; (4) convergent and discriminant validity; (5) a two-factor structure; and (6) that two discriminant functions could differentiate between depressed, dysthymic, and nondepressed subjects. The teacher's responses showed (1) moderate internal consistency; (2) discriminative power between depressed and nondepressed groups; (3) moderate concurrent validity; (4) and that two discriminant functions could differentiate between the diagnostic groups. The importance of the information given by the teacher to help detect severe depressive problems was pointed out.