People in Glasgow are more likely than other UK citizens to die prematurely, even when socio-economic deprivation is taken into account. This excess mortality is largely due to problem substance use, suicide and violence: the 'Glasgow Effect'.
There are compelling reasons to believe that experiences in utero and early childhood largely explain the Glasgow Effect through programming of the hypothalamo-pituitary-adrenal axis, through learned patterns of attachment to caregivers and through other learned behaviours. Several early indicators of vulnerability can now be identified and doctors should pay attention to them in the same way as they pay attention to blood pressure readings.
Lecture given to the Glasgow Southern Medical Society on Thursday 8th November 2012 by Prof. Phil Wilson, Professor of Primary Care and Rural Health, University of Aberdeen.
http://www.gsms.org.uk
The Indian Equity market remained volatile in February weighed down by Indo-Pak tensions, US-China trade war concerns, rise in crude oil prices, concerns regarding lenders selling pledged shares, weak GDP data as well as mixed earnings from India Inc. The index was below its crucial psychological levels of 11000. The index fell down 0.36 percent in February. But in last week of
A Pilot study on KAP of the people in Araihazar UpazillaFZare
A Pilot study on the Knowledge, Attitude and Practice (KAP) of the people related to water, air and soil pollution in Araihazar Upazilla; by Dr. S K Roy
Prof G Luke Larkin and Dr Annette Beautrais discuss strengthening protective factors & instilling hope in a webinar to mark World Suicide Prevention Day 2012. More information and video: http://www.spinz.org.nz/page/239-events-archive+webinar-for-world-suicide-prevention-day-2012
The Indian Equity market remained volatile in February weighed down by Indo-Pak tensions, US-China trade war concerns, rise in crude oil prices, concerns regarding lenders selling pledged shares, weak GDP data as well as mixed earnings from India Inc. The index was below its crucial psychological levels of 11000. The index fell down 0.36 percent in February. But in last week of
A Pilot study on KAP of the people in Araihazar UpazillaFZare
A Pilot study on the Knowledge, Attitude and Practice (KAP) of the people related to water, air and soil pollution in Araihazar Upazilla; by Dr. S K Roy
Prof G Luke Larkin and Dr Annette Beautrais discuss strengthening protective factors & instilling hope in a webinar to mark World Suicide Prevention Day 2012. More information and video: http://www.spinz.org.nz/page/239-events-archive+webinar-for-world-suicide-prevention-day-2012
This project involved the design and implementation of an Automation tool that would search a database of sound models for a given audio input query. The sound model to which the algorithm points to is the one that can best model / can produce sounds very similar to the input sound query. It is a growing application in the Games, Music production industry where there is a growing need to have an easy access to sounds without having to develop / code them every single time there is a need. Searching is always easier than developing from scratch! This project was performed at Interactive Digital Media Institute, Singapore
The Complete Transformation from Offline to Online Magento Implementation of a B2B Platform – a Case Study. This case study shows how we managed to reach 100.000.000 EUR of online revenue, within only 3 quarters last year.
Why Your Content Is Failing You, and How to Fix it Mathew Sweezey
Content marketing is more about strategy, than the piece of content itself. In these 5 examples of amazing content marketing, Mathew explains why high performing contnet marketings prevail, and how you can too.
Gas is like a blood that makes car well-functioning. Without it, you can't be able to travel far as much as you loved to.
Remember these important tips that help in saving up gas!
You might have heard a lot of car maintenance myths, but hey, don't believe them easily for they are just MYTHS! To clear things up, here are the truth about these myths!
This is the output for Index valuation of sensex previously uploaded.
This shows the average market or what I think is 'Ideal' value of Sensex taking into account present earnings.
Quality healthcare is one of the most important factors in how individuals perceive their quality of life. In some countries, such as the UK with the National Health Service (NHS), the healthcare delivery organisation is a part of their national identity.
This project involved the design and implementation of an Automation tool that would search a database of sound models for a given audio input query. The sound model to which the algorithm points to is the one that can best model / can produce sounds very similar to the input sound query. It is a growing application in the Games, Music production industry where there is a growing need to have an easy access to sounds without having to develop / code them every single time there is a need. Searching is always easier than developing from scratch! This project was performed at Interactive Digital Media Institute, Singapore
The Complete Transformation from Offline to Online Magento Implementation of a B2B Platform – a Case Study. This case study shows how we managed to reach 100.000.000 EUR of online revenue, within only 3 quarters last year.
Why Your Content Is Failing You, and How to Fix it Mathew Sweezey
Content marketing is more about strategy, than the piece of content itself. In these 5 examples of amazing content marketing, Mathew explains why high performing contnet marketings prevail, and how you can too.
Gas is like a blood that makes car well-functioning. Without it, you can't be able to travel far as much as you loved to.
Remember these important tips that help in saving up gas!
You might have heard a lot of car maintenance myths, but hey, don't believe them easily for they are just MYTHS! To clear things up, here are the truth about these myths!
This is the output for Index valuation of sensex previously uploaded.
This shows the average market or what I think is 'Ideal' value of Sensex taking into account present earnings.
Quality healthcare is one of the most important factors in how individuals perceive their quality of life. In some countries, such as the UK with the National Health Service (NHS), the healthcare delivery organisation is a part of their national identity.
Prof. Eugene McCloskey's presentation from Osteoporosis 2016: Assessment and intervention thresholds for FRAX probabilities in the UK- Impact on the need for BMD in older women with prior fracture
Find out more at: https://nos.org.uk/conference
Presentation by Josep Mestres Domenech (OECD, Directorate for Employment, Labour and Social Affairs International Migration Division) on the occasion of the SOC section hearing on Migrant entrepreneurs’ contribution to the EU economy on 24.11.2011 in the framework of the Permanent Study Group on Immigration and Integration.
SWELOGS – a population study on Gambling and Health, Ulla Romild & Jessika Svensson, Swedish National Institute of Public Health,
Parallel 4, NFHK2011 Turku, Finland
Messy, not smelling of roses and a tilted view requiredepicyclops
Presidential Address given to the Glasgow Southern Medical Society on 24th October 2013. In her lecture, Dr Andrea Williamson discusses health inequalities and homelessness from the viewpoint of a general practitioner in Glasgow.
Two videos are discussed during the meeting:
The first is Isha and the Poverty Truth Commission:
http://www.youtube.com/watch?v=CKGMok5s2Rs&noredirect=1
The second is Brian and the Housing First pilot in Glasgow:
http://www.youtube.com/watch?v=iKyNhAaCsE0
Lecture given to the West of Scotland Pain Group on 27th February 2013 by Consultant Neurologist Dr Colin O'Leary on the clinical features of multiple sclerosis and management of MS pain and spasticity.
The Dismal Scientist: the price of everything, the value of nothingepicyclops
How do we evaluate the cost-effectiveness of new medicines? What value do we place on effective drugs? Prof. Ken Paterson explores the challenging area of health economics and how we judge whether we can afford new treatments in a cash-limited health service.
Lecture given to the West of Scotland Pain Group on Wednesday 28th November 2012 by Emma Mair, Specialist Physiotherapist in Pain Management about Complex Regional Pain Syndrome (CRPS) and its treatment with Graded Motor Imagery (GMI).
Greater Glasgow & Clyde Back Pain Service - Claire MacKelvieepicyclops
Lecture given by Clinical Physiotherapy Specialist, Claire MacKelvie to the West of Scotland Pain Group on Wednesday 30th November 2011. Claire describes the development and function of the back pain service.
Working with interpreters in healthcare settingsepicyclops
Lecture given to the West of Scotland Pain Group by Dr Sharon Doherty, Clinical Psychologist, on Wednesday 26th January, 2011.
Dr Doherty discusses the increasingly important role of professional interpreters and how to get the best out of an interpreted consultation.
www.wspg.org
Lecture given to the West of Scotland Pain Group on Wednesday 24th November 2010 in the Ebenezer Duncan Centre, Victoria Infirmary, Glasgow by Dr Paul Reading, Consultant Neurologist.
In this talk, Dr Reading describes the importance of good quality sleep and how pain and sleep interact.
www.wspg.org.uk
The role of illness perceptions and medicine beliefs in adherence to chronic ...epicyclops
Presentation given by Dr Leanne Ramsay & Dr Martin Dunbar to the West of Scotland Pain Group on 7th October 2008 at the Royal College of Physicians and Surgeons of Glasgow.
Assessment Of Complex Regional Pain Syndrome Dr Candy Mccabeepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Candy McCabe. In this talk, Dr McCabe discusses the mechanisms and assessment of patients with complex regional pain syndrome.
Pain And Dependence Screening For Addiction In A Pain Setting Dr Steve Gi...epicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Steve Gilbert and Dr Alex Baldaccino. In this talk, they discuss the assessment and screening of patients in the pain clinic for evidence of drug dependence.
www.nbpa.org.uk
Psychological Assessment For Implantable Therapies Dr Peter Murphyepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Peter Murphy. In this talk, Dr Murphy discusses the psychological assessment and preparation of patients for implantable therapies including spinal cord stimulation.
www.nbpa.org.uk
Nursing Assessment Of The New Chronic Pain Patient Sr Christine Wakefieldepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Sr Christine Wakefield. In this talk, Sr Wakefield discusses the role of the nurse specialist in the assessment of the newly-referred patient with chronic pain. www.nbpa.org.uk
Referral For Invasive Procedures For Cancer Pain Dr Alison Mitchellepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Alison Mitchell. In this talk, Dr Mitchell discusses the indications for referral of patients with cancer pain for invasive procedures. She describes the new interventional cancer pain service being set up in Glasgow. www.nbpa.org.uk
Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyenepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Johan Vlaeyen. In this talk, Dr Vlaeyen discusses the mechanisms, assessment and treatment of fear avoidance in patients with chronic pain. Edinburgh, UK. www.nbpa.org.uk
The Wine Diet (healthy eating and drinking) - Prof. Alan Crozierepicyclops
Prof Alan Crozier, Professor of Plant Biochemistry and Human Nutrition, University of Glasgow speaks to the Glasgow Southern Medical Society on the benefits of a diet rich in phytoantioxidants.
New directions in the psychology of chronic pain managementepicyclops
Lecture followed audience discussion on contextual cognitive behaviour therapy and acceptance and commitment therapy in the management of chronic pain from the West of Scotland Pain Group on Wednesday 5th December 2007. The speaker is Lance M. McCracken PhD, of the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases & University of Bath, Bath UK.
www.wspg.org.uk
Further reading:
DAHL, J., & LUNDGREN, T. (2006). Living beyond your pain using acceptance and commitment therapy to ease chronic pain. Oakland, CA, New Harbinger Publications.
http://www.worldcat.org/oclc/63472470
HAYES, S. C., STROSAHL, K., & WILSON, K. G. (1999). Acceptance and commitment therapy an experiential approach to behavior change. New York, Guilford Press.
http://www.worldcat.org/oclc/41712470
MCCRACKEN, L. M. (2005). Contextual cognitive-behavioral therapy for chronic pain. Progress in pain research and management, v. 33. Seattle, IASP Press.
http://www.worldcat.org/oclc/57564664
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
How early childhood experience determines our health
1. How early childhood experience
determines our health
Phil Wilson
Centre for Rural Health
University of Aberdeen
2. Overview
• Childhood deprivation and health
• Adverse childhood experiences
• The “Glasgow effect”
• Some possible mechanisms
• Critical/sensitive periods
• HPA axis
• Parenting, social learning and attachment
• Early identification of vulnerability
• Glasgow maps
• Future plans
3.
4.
5. • Low childhood SES associated with increased
cortisol production regardless of current SES
• Genome-wide transcription profiling:
• Up-regulation of pro-inflammatory mechanisms
• Down-regulation of glucocorticoid receptor-related mechanisms
PNAS 2009, 106: 14716-21
8. Comparing health outcomes in Glasgow with those of
almost identically deprived cities Liverpool and
Manchester:
premature deaths in Glasgow are over 30% higher,
excess mortality found across men and women,
all ages except the very young,
both deprived and non-deprived neighbourhoods.
9. Standardised mortality rates by cause,
all ages: Glasgow relative to Liverpool
& Manchester
All ages, both sexes: cause-specific standardised mortality ratios 2003-07, Glasgow relative
to Liverpool & Manchester, standardised by age, sex and deprivation decile
Calculated from various sources
350
300
248.5
229.5
250
Standardised mortality ratio
200 168.0
150 131.7
126.7
112.2 111.9
100
50
0
All cancers Circulatory system Lung cancer External causes Suicide (inc. Alcohol Drugs-related
(malignant undetermined intent) poisonings
neoplasms)
Source: Walsh D, Bendel N., Jones R, Hanlon P. It’s not ‘just deprivation’: why do equally deprived UK cities experience different health outcomes? Public Health, 2010
10. UNICEF domains of child
wellbeing
• Material Deprivation – Relative Income, Households
without jobs
• Health & Safety – Infant Mortality, Immunisations
• Educational Well-being – School Achievement, Post-
15 Education
• Relationships – Family Structure, Peer Relationships
• Behaviours & Risks – Health Behaviours, Experience
of Violence
• Subjective Well-being – Self-assessed indicators.
13. Adverse Childhood
Experiences study – 17,000
Kaiser Permanente patients
• Abuse
• emotional – recurrent threats, humiliation (11%)
• physical—beating, not spanking (28%)
• contact sexual abuse (28% women, 16% men; 22% overall)
• Household dysfunction
• mother treated violently (13%)
• household member was alcoholic or drug user (27%)
• household member was imprisoned (6%)
• household member was chronically depressed, suicidal, mentally ill, or
in psychiatric hospital (17%)
• not raised by both biological parents (23%)
• Neglect
• physical (10%)
• emotional (15%)
14. A C E S c o r e v s In t r a v e n o u s D r u g U s e
3 .5
3
% H a v e In je c te d D r u g s
2 .5
2
1 .5
1
0 .5
0
0 1 2 3 4 o r m o re
A C E S c o re
p < 0 .0 0 1
Felitti & Anda in: R. Lanius & E. Vermetten eds. 2010
16. ACE and physical morbidity
The ACE Score and the Prevalence of Liver
Disease (Hepatitis/Jaundice)
A C E S c o re v s . C O P D
20
18
16
Percent (%)
14
P e r c e n t W ith P r o b le m
12
10
8
6
4
2
0
ACE Score COPD
Felitti & Anda in: R. Lanius & E. Vermetten eds. 2010
17. ACE and cardiovascular disease
A C E s In c r e a s e L ik e lih o o d o f H e a r t D is e a s e *
¥ E m o tio n a l a b u s e 1 .7 x
¥ P h y s ica l a b u s e 1 .5 x
¥ S ex u al a bu se 1 .4 x
¥ D o m e s tic v io le n c e 1 .4 x
¥ M e n t a l il ln e s s 1 .4 x
¥ S u b s ta n c e a b u s e 1 .3 x
¥ H o u s e h o ld c r i m i n a l 1 .7 x
¥ E m o tio n a l n e g le c t 1 .3 x
¥ P h y s ica l n eg lect 1 .4 x
• After correction for smoking, lipids, diabetes
18. Harsh parenting and
conduct disorder
• Strong association between erratic, coercive
or punitive parenting and conduct disorder
or other forms of aggression
• The earlier the exposure, the greater the risk
of CD
• CD much more common in boys
• Great variability between individuals in
response to harsh parenting
19. Harsh parenting and
conduct disorder
• Dunedin cohort study:
• MAO A gene – lower MAO
A activity shown in animal
studies to be linked to
aggression
• MAO A gene lies on X
chromosome
• Caspi et al (2002) looked
at the link between MAO A
genotypes and conduct
disorder
• High MAO A activity
protects against the
tendency of abuse to lead
to violence
20. Child psychopathology
and later health
• Few robust longitudinal studies
• Selective attrition of children with problems
• Lack of funding
• But good evidence of, for example:
• Strong associations between ADHD or conduct disorder and
problem substance use
• Strong associations between conduct disorder and later
psychopathology
• Substantial excess premature mortality with conduct disorder
(RR>9)
21. What happens during
early brain development?
• Physical growth
• Neuron numbers
• Basic structure: cell migration ends by sixth
month of gestation
• Synaptogenesis and myelination
23. Critical and sensitive
periods
• The visual system
• Cataracts, hypermetropia and amblyopia
• Amblyopia represents the selective pruning of synapses in the visual
system as a result of lack of ‘through traffic’
• Partially preventable through patching
• Children under 4 need less patching than older children, and probably
pointless beyond age 7-8.
• Is emotional, social and cognitive
development like visual development?
24. Sensitive Periods in Early
Brain Development
High Pre-school years School years
Numbers
Peer social skills
Symbol Language
Habitual ways of responding
Emotional control
Vision
Hearing
Low
0 1 2 3 4 5 6 7
Years
Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.)
25. Early stress and
the HPA axis
Hunter, Minnis, Wilson. Altered stress responses in children exposed to early adversity: A systematic review of
salivary cortisol studies. Stress, 2011
27. Severe emotional deprivation
• Long term outcomes in
institutionalised
Romanian orphans:
• mild cognitive impairment
• Impulsivity
• Attention deficits
• Social deficits
• Abnormalities of HPA function
28. 00-046
The Founders’ Network
Evening Cortisol Levels Increase with
Months of Orphanage Rearing *
-0.2
-0.4
-0.6
-0.8
-1 *linear trendline
-1.2
0 10 20 30 40 50
Months of Orphanage Rearing
29. Severe emotional deprivation
• Chugani et al
(2001): ‘Glass
brain’
• 10 orphans
(mean age 9, in
orphanages from
5 weeks old for
mean 3 years)
and 24 controls
• PET scans
31. Early identification –
GUS*
• Looking for predictors of persisting conduct
problems at 3, 4 and 5 years
• Used Strengths & Difficulties Questionnaire
• 2070 children born in 2003 with SDQ data at all
time points
• Comparing:
• 90 children with conduct problems at all 3 times
• And 1557 who never had conduct problems
*Wilson, Bradshaw, Tipping, Henderson, Minnis, JECH 2012 in press
32. Early identification -
GUS
Adjusted odds, C.I. and P value
No. of natural parents in household
Two
One or none
2.10 (1.28, 3.44) <0.01
Child’s general health
Very good or good
Fair, bad or very bad
3.32 (1.35, 8.19) 0.01
Child had some difficulty being understood
No
Yes
1.93 (1.08, 3.44) 0.03
Maternal smoking during pregnancy
No
Yes
2.35 (1.32, 4.19) <0.01
Agree that smacking is sometimes the only thing that will work
No
Yes
2.07 (1.13, 3.79) 0.02
Frequency child taken to visit other people with children
Fortnightly or more often
Less often or never
2.16 (1.14, 4.09) 0.02
Frequency child is read to
Daily
Less often 1.86 (0.98, 3.52) 0.06
33. Early identification -
ALSPAC
• Avon Longitudinal Study of Parents and
Children – 14,000 pregnancies
• Videos (not very good!) of 10% sample of
children aged one year and their parents, in
1992/3
• Psychiatric assessment at age 7.5 years
(DAWBA)
34. Early identification -
ALSPAC
• 60 (6%) children had a psychiatric diagnosis:
• 27 Conduct/oppositional disorder (CD, ODD, DBD NOS)
• 6 Pervasive developmental disorder (autism)
• 16 ADHD
• 28 Emotional problems (anxiety, depression, phobias etc)
• 12 with more than one diagnosis
• Compared with 120 children with no diagnosis
35. ALSPAC findings so
far...
• (Specialist) clinicians failed to predict
psychopathology1
• Infant motor activity not associated with later
ADHD2
1
Allely et al , RIDD 2012 in press
2
Johnson et al, IJMPR 2012 in press
37. ALSPAC findings so far...
• Increased infant vocalisation associated with later diagnosis of
disruptive behaviour disorders (ADHD/CD)
• MATERNAL hypoactivity is associated with later ADHD,
CD/ODD and anxiety disorders*
• Low levels of MATERNAL vocalisation are associated with later
ADHD and CD/ODD*
• Positive parenting behaviours associated with reduced risk of
conduct disorder
• Reduced mutual gaze and shared attention in conduct disorder
...even when adjusted for maternal depression
*Marwick et al 2012, RIDD, in press
38. The Glasgow parenting support
framework evaluation
• Three year project – 2011 to 2013
• Led by team at Glasgow University, in collaboration
with NHSGGC – Public Health Resource Unit
• Funded by Scottish Government and Fairer Scotland
Fund
• Multiple strands of data collection:
• Triple P monitoring data
• Population level data - assessing social, emotional and
behavioural problems at various stages
• Looking for population and individual changes
• Qualitative interviews with parents and practitioners
39. The Strengths and Difficulties
Questionnaire
(www.sdqinfo.org)
• A brief behavioural screening questionnaire for 3-16
year olds.
• 2 versions – 3-4 years, 4-16 years
• Can be teacher, parent or self-complete
• Used extensively as before- and after- measure for
range of parenting and family intervention studies as
well as a population measure of children’s wellbeing
e.g. GUS
• NOT a diagnostic tool
40. The Strengths and Difficulties
Questionnaire
• 25 questions in 5 domains:
• Emotional problems
• Conduct problems
• Inattention/hyperactivity problems
• Peer-relationship problems
• Prosocial behaviour
• First four domains summed to give total difficulties
score.
42. 30 month results
80% eligible children received visit
• ~20% had some language or
SDQ problem identified
• More than half the children with
likely SDQ or language
difficulties had been considered
to be at low risk
• 2/3 children with language delay
also had ‘abnormal’ SDQ score
43. Pre-school results
• Data from 2010-12
• About 10,500 children
• Linear mixed effects modelling
• Scores higher among boys, in looked-after
children and in areas of higher deprivation
45. Where next?
• Analysis of local determinants of
social/emotional development problems
• Using data linkage to identify determinants of
‘good’ or ‘bad’ trajectories
• A new birth cohort?
46. Acknowledgements
• Carolyn Wilson and the SG Child and Maternal Health Division
• Lucy Thompson, Louise Marryat, Kim Jones, Kelly Chung, Elsa
Ekevall, Jane White
• Chris Gillberg, Christine Puckering, Helen Marwick, Clare Allely
• John Butcher, Amanda Kerr, Michele McClung, Morag Gunion
and City of Glasgow Education Services
• Margaret McGranachan and colleagues in PHRU
• Sarah Barry, Alex McConnachie, Paul Johnson
• Scottish Government produced the socio-economic data and
Scottish Neighbourhood Statistics provided the datazone
information.
Editor's Notes
Scotland’s health-where we are at at the moment. We aim to increase life expectancy and healthy life expectancy
Brain is just over ¼ adult size at birth but 90% of adult size by age 3, 95% of adult size at age 5
With permission from Prof Seeman
‘ Sensitive periods’ in early brain development – this slide is based on the following references: Doherty, G. (1997). Zero to Six: the Basis for School Readiness . Applied Research Branch R-97-3E Ottawa: Human Resources Development Canada. McCain & Mustard (1999). Early Years Study. Toronto, Ontario: Publications Ontario. Shonkoff, Jack (Ed) (2000). From Neurons to Neighborhoods: The Science of Early Childhood Development . Washington, D.C.: National Academy Press.
Sandman et al IJP 2011.
HPA abnormalities: low am cortisol, high pm cortisol
Harry T. Chugani, Michael E. Behen, Otto Muzik, Csaba Juhasz,Ferenc Nagy, and Diane C. Chugani. Local Brain Functional Activity Following Early Deprivation: A Study of Postinstitutionalized Romanian Orphans. NeuroImage 14, 1290–1301 (2001) Statistical parametric mapping Examination findings consistent with Romanian orphans. Showed significantly decreased metabolism bilaterally in the orbital frontal gyrus, the infralimbic prefrontal cortex, the medial temporal structures (amygdala and head of hippocampus), the lateral temporal cortex, and the brain stem. The brain areas with significantly decreased glucose metabolism in the Romanian orphans are strongly interconnected and are known to be damaged as a result of prolonged stress. Infralimbic cortex has been called the autonomic motor cortex as its ventral efferent pathway projects to autonomic cell groups in the brain stem and spinal cord. Feedback mechanism – these circuits contol HPA axis, but their synaptogenesis is also influenced by glucocorticoids
x – data collection point Solid lines indicate cohorts within the life of this project Dashed lines project to future data collection (beyond this project) 2009-10 : SDQ data at school entry only (cross-sectional time-specific only). 2010-11 : SDQ data at school entry PLUS at 2.5 years (as above PLUS cross-sectional time-series). 2012-13 : SDQ data at school entry PLUS at 2.5 years PLUS at 7 and 10 years (as above PLUS longitudinal cohort).