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We use childhood exposure to disasters as a natural experiment inducing variations in adulthood outcomes. Following the fetal origin hypothesis, we hypothesize that children from households with greater famine exposure will have poorer health outcomes. Employing a unique dataset from Bangladesh, we test this hypothesis for the 1974–75 famine that was largely caused by increased differences between the price of coarse rice and agricultural wages, together with the lack of entitlement to foodgrains for daily wage earners. People from northern regions of Bangladesh were unequally affected by this famine that spanned several months in 1974 and 1975. We find that children surviving the 1974–75 famine have lower health outcomes during their adulthood. Due to the long-lasting effects of such adverse events and their apparent human capital and growth implications, it is important to enact and enforce public policies aimed at ameliorating the immediate harms of such events through helping the poor.
Disaster experiences have long-term effects on disaster preparedness. This study examined the long-term (10-y) effect of disaster severity of the 2008 Wenchuan earthquake on survivors’ disaster preparedness and the moderating effects of household vulnerability.
Methods:
The data were collected in January 2018 covering 30 counties in Wenchuan earthquake-stricken areas. The dependent variable was survivors’ disaster preparedness (including overall, material, knowledge and awareness, and action preparedness) in 2018. Disaster severity included survivors’ housing damage and county death rate caused by the earthquake in 2008. Household vulnerability is a set of conditions that negatively affects the ability of people to prepare for and withstand disaster, proxied by households’ per-capita income and the highest years of schooling of household members. We performed multivariable linear regression models to answer the research questions.
Results:
A higher county death rate was associated with better overall preparedness (β = 0.043; P < 0.05) and knowledge and awareness preparedness (β = 0.018; P < 0.05), but housing damage was not significantly associated with disaster preparedness. The positive association of county death rate with overall preparedness (β = −0.065; P < 0.05) becomes weaker when a household has a higher per-capita income. Also, with the household per-capita income increasing, the associations of county death rate with material preparedness (β = −0.037; P < 0.05) and action preparedness (β = −0.034; P < 0.01) become weaker.
Conclusions:
Disaster severity has positive and long-term effects on survivors’ disaster preparedness. Also, the positive and long-term effects are affected by household vulnerability. Specifically, the positive and long-term effects of disaster severity on disaster preparedness are more substantial when a household is more vulnerable.
To what degree and why are traditional institutions persistent? Following up the literature on the long-term effects of precolonial institutions in Africa, we investigate whether and where today's traditional institutions mirror their precolonial predecessors. We do so by linking data on contemporary traditional institutions of African ethnic groups with Murdock's historical Ethnographic Atlas. We find a robust association between past and present levels of institutional complexity, differentiating between institutions’ political centralization and functional differentiation. However, this persistence originates almost exclusively from former British colonies governed with more reliance on precolonial institutions than other colonies, in particular French ones. These findings contribute to research on the development and effects of traditional institutions, highlighting the need to account for varying persistence of traditional institutions.
Twice weekly sessions of cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD) lead to less drop-out and quicker and better response compared to once weekly sessions at posttreatment, but it is unclear whether these effects hold over the long run.
Aims
Compare the effects of twice weekly v. weekly sessions of CBT and IPT for depression up to 24 months since the start of treatment.
Methods
Using a 2 × 2 factorial design, this multicentre study randomized 200 adults with MDD to once or twice weekly sessions of CBT or IPT over 16–24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II and the Longitudinal Interval Follow-up Evaluation. Intention-to-treat analyses were conducted.
Results
Compared with patients who received once weekly sessions, patients who received twice weekly sessions showed a significant decrease in depressive symptoms up through month 9, but this effect was no longer apparent at month 24. Patients who received CBT showed a significantly larger decrease in depressive symptoms up to month 24 compared to patients who received IPT, but the between-group effect size at month 24 was small. No differential effects between session frequencies or treatment modalities were found in response or relapse rates.
Conclusions
Although a higher session frequency leads to better outcomes in the acute phase of treatment, the difference in depression severity dissipated over time and there was no significant difference in relapse.
Folate and vitamin B12 are essential for growth. Our objective was to estimate their long-term effects on linear growth in North Indian children. This is a follow-up study of a factorial designed, double-blind, randomised, placebo-controlled trial in 1000 young children. Starting at 6–30 months of age, we gave folic acid (approximately 2 RDA), vitamin B12 (approximately 2 RDA), both vitamins or a placebo daily for 6 months. Six years after the end of supplementation, we measured height in 791 children. We used the plasma concentrations of cobalamin, folate and total homocysteine to estimate vitamin status. The effect of the interventions, the association between height-for-age z-scores (HAZ) and baseline vitamin status, and the interactions between supplementation and baseline status were estimated in multiple regression models. Mean (sd) age at follow-up was 7·4 (0·7) years (range 6 to 9 years). There was a small, non-significant effect of vitamin B12 on linear growth and no effect of folic acid. We observed a subgroup effect of vitamin B12 supplementation in those with plasma cobalamin concentration < 200 pmol/l (Pfor interaction = 0·01). The effect of vitamin B12 supplementation in this group was 0·34 HAZ (95 % CI 0·11, 0·58). We found an association between cobalamin status and HAZ in children not given vitamin B12 (Pfor interaction = 0·001). In this group, each doubling of the cobalamin concentration was associated with 0·26 (95 % CI 0·15, 0·38) higher HAZ. Suboptimal vitamin B12 status in early childhood seemingly limits linear growth in North Indian children.
This article examines how violence against citizens affects their political attitudes and behavior in the long run, and how those effects vary over time. We construct and analyze a novel dataset on the victims of Taiwan's February 28 Incident, in 1947, with survey data spanning 1990 to 2017. Our empirical analysis shows that cohorts having directly or indirectly experienced the Incident are less likely to support the Kuomintang Party (KMT), the former authoritarian ruling party responsible for the Incident. They tend to disagree with the key conventional policy stand of the KMT (unification with mainland China), are more likely to self-identify as Taiwanese, and are less likely to vote for KMT presidential candidates. Taiwan's residents who were born in towns with larger number of casualties during the Incident are more likely to reject unification. Finally, the effects are found to vary over the period following democratization.
We investigated whether different rearing conditions affected the physical development, ease of integration into the dairy herd and performance of primiparous dairy cows and the results are reported in this Research Communication. The three rearing conditions investigated were whole-day cow-calf contact for 9 weeks (WDC), half-day contact for nine weeks (HDC) and no mother-contact (NC) with nipple-bucket-feeding (max. 2 × 3 l/d) and group-housing from the 8th day onward. After permanent separation from the dams (WDC and HDC), all calves had been nipple-bucket-fed and gradually weaned from week 10 to 13 of life and kept together as calves and heifers. Measures of physical development were trunk girth, height at withers and body weight. Lying behavior during the first 48 h after introduction to the dairy herd after first calving was used as an indicator of ease of integration. Performance measures were age at calving, lactation duration, milk yield and culling rates during the first lactation. No differences between WDC and HDC could be detected. Moreover, no treatment-effects on physical development or performance could be found. All treatments showed reduced lying for the first 24 h after introduction to the dairy herd. Afterward NC-heifers lay less than WDC, with HDC-heifers ranging in between. We conclude that under the conditions investigated higher weights two weeks after weaning in WDC- and HDC-calves did not carry through to the first lactation and did not lead to earlier maturity and higher performance, but that integration into the herd may be alleviated when calves have early experience of the herd and associated conditions.
Chapter 3 is devoted to the demographic impact of the famine in terms of mortality, fertility, and its long-term biological effects. It shows that in the entire crisis period of September 1944-July 1945, the estimated war-related excess deaths among civilians was 35,000 in the three famine-exposed western provinces. Deaths in the large conurbations began to rise sharply after December 1944 and reached a peak in March 1945. It took until the summer of that year before mortality reached normal patterns again. Fertility followed similar patterns, with birth rates in the urban west two to three times lower in the famine’s wake. The long-term effects of the famine are present even today, in adults who were conceived or born during the famine.
To evaluate the short-term and long-term clinical effectiveness and safety of subthalamic nucleus deep brain stimulation (STN-DBS) for medically intractable pediatric isolated dystonia.
Methods:
Using a longitudinal retrospective design, we assessed the clinical outcomes of nine patients who underwent STN-DBS for treatment-refractory pediatric isolated dystonia one decade ago (mean age at surgery: 15.9 ± 4.5 years). The primary clinical outcome used was assessed by retrospective video analyses of patients’ dystonia symptoms using the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Clinical assessments were performed at baseline, 1-year follow-up (1-yr FU), and 10-year follow-up (10-yr FU). Adverse side effects, including surgery-related, device-related, and stimulation-related effects, were also documented.
Results:
After STN-DBS surgery, the mean improvement in the BFMDRS motor score was 77.1 ± 26.6% at 1-yr FU and 90.4 ± 10.4% at 10-yr FU. Similarly, the mean BFMDRS disability score was improved by 69.5 ± 13.6% at 1-yr FU and by 86.5 ± 13.9% at 10-yr FU. The clinical improvements gained at 10-yr FU were significantly larger than those observed at 1-yr FU. Negative correlations were found between the duration of disease to age at surgery ratio (DD/AS) and the improvements in the BFMDRS motor score and total score at 1-yr FU and 10-yr FU.
Conclusion:
To our knowledge, this study provides the first clinical evidence for the short- and long-term effectiveness and safety of STN-DBS for pediatric isolated dystonia. Additionally, putative evidence is provided that earlier STN-DBS intervention in patients with refractory pediatric isolated dystonia may improve short- and long-term clinical outcomes.
Antidepressant medications (ADMs) are widely used and long-term use is increasing. Given this extensive use and recommendation of ADMs in guidelines, one would expect ADMs to be universally considered effective. Surprisingly, that is not the case; fierce debate on their benefits and harms continues. This editorial seeks to understand why the controversy continues and how consensus can be achieved.
Methods
‘Position’ paper. Critical analysis and synthesis of relevant literature.
Results
Advocates point at ADMs impressive effect size (number needed to treat, NNT = 6–8) in acute phase treatment and continuation/maintenance ADM treatment prevention relapse/recurrence in acute phase ADM responders (NNT = 3–4). Critics point at the limited clinically significant surplus value of ADMs relative to placebo and argue that effectiveness is overstated. We identified multiple factors that fuel the controversy: certainty of evidence is low to moderate; modest efficacy on top of strong placebo effects allows critics to focus on small net efficacy and advocates on large gross efficacy; ADM withdrawal symptoms masquerade as relapse/recurrence; lack of association between ADM treatment and long-term outcome in observational databases. Similar problems affect psychological treatments as well, but less so. We recommend four approaches to resolve the controversy: (1) placebo-controlled trials with relevant long-term outcome assessments, (2) inventive analyses of observational databases, (3) patient cohort studies including effect moderators to improve personalized treatment, and (4) psychological treatments as universal first-line treatment step.
Conclusions
Given the public health significance of depression and increased long-term ADM usage, new approaches are needed to resolve the controversy.
Objectives: Concussions affect the processing of emotional stimuli. This study aimed to investigate how sex interacts with concussion effects on early event-related brain potentials (ERP) measures (P1, N1) of emotional facial expressions (EFE) processing in asymptomatic, multi-concussion athletes during an EFE identification task. Methods: Forty control athletes (20 females and 20 males) and 43 multi-concussed athletes (22 females and 21 males), recruited more than 3 months after their last concussion, were tested. Participants completed the Beck Depression Inventory II, the Beck Anxiety Inventory, the Post-Concussion Symptom Scale, and an Emotional Facial Expression Identification Task. Pictures of male and female faces expressing neutral, angry, and happy emotions were randomly presented and the emotion depicted had to be identified as fast as possible during EEG acquisition. Results: Relative to controls, concussed athletes of both sex exhibited a significant suppression of P1 amplitude recorded from the dominant right hemisphere while performing the emotional face expression identification task. The present study also highlighted a sex-specific suppression of the N1 component amplitude after concussion which affected male athletes. Conclusions: These findings suggest that repeated concussions alter the typical pattern of right-hemisphere response dominance to EFE in early stages of EFE processing and that the neurophysiological mechanisms underlying the processing of emotional stimuli are distinctively affected across sex. (JINS, 2018, 24, 1–11)
Comparative models suggest that effects of dietary tryptophan (Trp) on brain serotonin (5-hydroxytryptamine; 5-HT) neurochemistry and stress responsiveness are present throughout the vertebrate lineage. Moreover, hypothalamic 5-HT seems to play a central role in control of the neuroendocrine stress axis in all vertebrates. Still, recent fish studies suggest long-term effects of dietary Trp on stress responsiveness, which are independent of hypothalamic 5-HT. Here, we investigated if dietary Trp treatment may result in long-lasting effects on stress responsiveness, including changes in plasma cortisol levels and 5-HT neurochemistry in the telencephalon and hypothalamus of Atlantic salmon. Fish were fed diets containing one, two or three times the Trp content in normal feed for 1 week. Subsequently, fish were reintroduced to control feed and were exposed to acute crowding stress for 1 h, 8 and 21 d post Trp treatment. Generally, acute crowding resulted in lower plasma cortisol levels in fish treated with 3×Trp compared with 1×Trp- and 2×Trp-treated fish. The same general pattern was reflected in telencephalic 5-HTergic turnover, for which 3×Trp-treated fish showed decreased values compared with 2×Trp-treated fish. These long-term effects on post-stress plasma cortisol levels and concomitant 5-HT turnover in the telencephalon lends further support to the fact that the extrahypothalamic control of the neuroendocrine stress response is conserved within the vertebrate lineage. Moreover, they indicate that trophic/structural effects in the brain underlie the effects of dietary Trp treatment on stress reactivity.
Population ageing is a global trend that affects individual life plans, family arrangements, market structures, care provisions and pension schemes. We combine insights from demography and lifecourse research to understand better the causes of population ageing. Demography explains population ageing by describing changes in fertility, mortality and migration rates. Lifecourse research argues that these rates are interconnected because they are embedded in the lifecourses of individuals. An individual's experiences at an early age can influence behaviours at a later age, thereby creating continuity throughout the lifecourse. Additionally, lifecourse research underlines that social networks – such as families – and countries influence lifecourse. Thus, historical events and past experiences have already set the course for today's demographic changes. Moreover, the effects of policies that strive to influence population ageing will not be evident for years or even decades to come. This paper introduces a conceptual framework that explains how the lifecourse perspective can be applied to the phenomenon of population ageing and illustrates the framework through a case study of Germany. The case study highlights that insights from the micro-, meso- and macro-levels need to be combined to achieve a deeper understanding of population ageing. Scholars can use the framework presented in this paper as a guideline for merging arguments from demography and lifecourse research in future studies.
Depression in mothers during pregnancy and in the postnatal period has been recognized to have wide-ranging adverse impacts on offspring. Our study examines some of the outcomes and long-term economic implications experienced by offspring who have been exposed to perinatal depression.
Method
We analysed the effects of perinatal depression on child development outcomes of children at ages 11 and 16 years from the community-based South London Child Development Study. Economic consequences were attached to those outcomes through simple decision-analytic techniques, building on evidence from studies of epidemiology, health-related quality of life, public sector costs and employment. The economic analysis takes a life-course perspective from the viewpoints of the public sector, individual and society.
Results
Additional risks that children exposed to perinatal depression develop emotional, behavioural or cognitive problems ranged from 5% to 21%. In addition, there was a high risk (24%) that children would have special educational needs. We present results in the form of cost consequences attached to adverse child outcomes. For each child exposed to perinatal depression, public sector costs exceeded £3030, costs due to reduced earnings were £1400 and health-related quality of life loss was valued at £3760.
Conclusions
Action to prevent or treat mothers' depression during pregnancy and after birth is likely to reduce public sector costs, increase earnings and improve quality of life for children who were exposed to the condition.
To evaluate the long-term effects of the Schoolgruiten Project, a Dutch primary school-based intervention providing free fruit and vegetables (F&V). In addition, we assessed whether children’s appreciation of the project mediated these intervention effects.
Design and methods
Participating schoolchildren (mean age 9·9 years at baseline) and their parents completed parallel questionnaires at baseline, at 1-year and at 2-year follow-up, including questions on usual F&V intake of the child, potential behavioural determinants, their appreciation of the project and general demographics. Primary outcomes were usual F&V intakes as assessed by parent and child self-reported food frequency measures. Secondary outcome measures were taste preference, knowledge of daily recommendations, availability and accessibility for fruit intake. Multilevel linear regression analyses were used to assess differences at second follow-up adjusted for baseline values between control and intervention groups.
Subjects
Reports were available for 346 intervention children (148 parents) and 425 control children (287 parents).
Results
Both child and parent reports indicated that the intervention group had a significantly higher fruit intake at 2-year follow-up (difference, servings/d: 0·15; 95 % CI 0·004, 0·286 for child reports; 0·19; 95 % CI 0·030, 0·340 for parent reports). No significant effects on vegetable intake were observed. Significant positive intervention effects were also found for knowledge of fruit recommendations among boys. Some evidence was found for partial mediation analyses of the effects on fruit intake.
Conclusion
The present study indicates that the Schoolgruiten scheme was effective in increasing children’s fruit intake and that appreciation of the project partially mediated this effect.
In the long term after traumatic brain injury, the most disabling problems are generally related to neuropsychiatric sequelae, including personality change and cognitive impairment, rather than neurophysical sequelae. Cognitive impairment after severe injury is likely to include impaired speed of information processing, poor memory and executive problems. Personality change may include poor motivation, and a tendency to be self-centred and less aware of the needs of others. Patients may be described as lazy and thoughtless. Some become disinhibited and rude. Agitation and aggression can be very difficult to manage. Anxiety and depression symptoms are quite frequent and play a role in the development of persistent post-concussion syndrome after milder injury. Depression may be associated with a deterioration in disability over time after injury. Psychosis is not unusual though it has been difficult to confirm that traumatic brain injury is a cause of schizophrenia. Head injury may, many years later, increase the risk of Alzheimer’s disease. Good rehabilitation probably minimizes the risk of psychiatric sequelae, but specific psychological and pharmacological treatments may be needed.
Neurobehavioural sequelae of traumatic brain injuries require an appropriate/effective pharmacological response in that they represent an important cause of disability. In this field, there is no evidence that reaches the level of a standard: there are guidelines on the use of methylphenidate, donepezil and bromocriptine for the treatment of cognitive disturbances, for the non-use of phenytoin and for the use of β-blockers for controlling aggressiveness. Resolving a single symptom is not relevant in a rehabilitation project if it is not in the context of a more complex picture of neurobehavioural recovery, in which the positive and negative effects of every therapeutic choice are considered. For example, phenytoin could be used for the positive control of epileptic crises but is not advised since it impedes the recovery of cognitive functions in general. Analogous effects not yet identified may concern benzodiazepine, neuroleptics and other sedatives usually prescribed in cases of cranial trauma. Psychotropic drugs are considered to be able to influence the neuronal plasticity processes. Studies on animals have shown that the administration of D-amphetamine combined with sensorial-motor exercise produces the steady acceleration of motor recovery, which acts as a catalyst to the neurological recovery process. On the other hand, α1-NA receptor antagonist drugs produce negative effects; these include clonidine (antihypertension) and haloperidol (neuroleptic). Studies need to be carried out to evaluate the effectiveness of particular drugs. These studies need to focus not only on the disappearance of symptoms but also on the positive and negative effects on overall rehabilitation and on the neurobiological recovery of the patient.
Twenty participants with self-reported long-term benzodiazepine use
(mean 108 months) who had previously withdrawn from medication (mean 42
months) were administered a battery of neuropsychological tests. Each
long-term user was case matched for age, sex, and education to two control
participants who reported never taking benzodiazepines (those with and
those without anxiety). The results indicated that long-term
benzodiazepine use may lead to impairments in the areas of verbal memory,
motor control/performance, and nonverbal memory but not visuospatial
skills and attention/concentration. The length of abstinence (> 6
months) indicates that these impairments persist well beyond cessation of
benzodiazepine use. However, observed impairments in the area of nonverbal
memory were not solely attributable to benzodiazepine use and may be
influenced by the elevated anxiety levels present in both the case and the
anxious control group. (JINS, 2005, 11,
281–289.)
Temperature as one of the most important single physical factors determining or influencing embryo development and hatchability is reviewed and possible temperature manipulations are discussed as a management tool.
Pre-incubation egg holding temperature is reviewed as a factor acting on variability in developmental stage at oviposition. A mathematical approach for determining the temperature threshold or physiological zero for embryonic development is outlined. Temperature requirements during incubation are discussed, taking into account the ultimate aims and objectives of the incubation process, i.e. hatchability and chick quality for survival, growth and reproduction, challenging at the same time the idea that the best hatchability is synonymous with the highest chick quality.
Factors affecting limits of variation in incubation temperature, with particular reference to strain or line differences, are discussed.
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