Sequential Down Syndrome Screening: The Importance of First and Second Trimester Test Correlations when Calculating Risk

Down syndrome screening can be particularly effective when both first and second trimester tests are performed. However, the counseling of women who have received sequential first and second trimester screening can be problematic. We evaluated an approximation where the post-test risk from the first trimester screening is used as the new a priori risk for the second trimester screening. The approximation disregards between-trimester test correlations. The Down syndrome detection rate based on the approximation (90.2%) would be close to that obtained when all correlations were considered (90.8%) but the false positive rate would be 26% higher (3.9% versus 3.1%, respectively). For any particular woman, the use of the approximation could result in highly inaccurate risks. We conclude that the correlations that exist between first and second trimester screening tests preclude the use of second trimester risks derived from the direct product of separate first and second trimester screening. Counseling issues in the delivery of sequential screening are discussed.     

Prospective Relations Between Dysfunctional Metacognitive Beliefs,Metacognitive Strategies,and Anxiety: Results From a Four-Wave Longitudinal Mediation Model

The metacognitive model of psychological disorders suggests that emotional disorders are related to maladaptive metacognitive strategies corresponding to underlying dysfunctional metacognitive beliefs. There is substantial empirical evidence supporting a role of metacognition in psychopathology, but fewer studies have evaluated the metacognitive model using longitudinal data and taken into consideration its differentiation between components and how they are hypothesized to be related to each other. Thus, more specific model evaluation is important as it relates to identifying mechanisms of disorder with a potential to provide clinical advances. In the present study, 868 participants took part in a 4-wave survey and reported on metacognitive beliefs and strategies and anxiety symptoms. Two longitudinal mediation models (forward and reversed causation) were run to test temporal precedence and bidirectional relations. The results indicated that metacognitive beliefs significantly predicted metacognitive strategies, which further predicted anxiety symptoms and mediated the indirect effect in the relationship between metacognitive beliefs and anxiety over time. The relationship between metacognitive beliefs and anxiety symptoms over time were bidirectional, but this relationship was not accounted for by metacognitive strategies. These findings largely support central predictions set forward by the metacognitive model and indicate that metacognitions play a preceding and maintaining role in anxiety.     

The effect of manual movements on stuttering in individuals with down syndrome

PurposeStuttering may disrupt the speech of individuals with Down syndrome (DS), but standard stuttering therapies may be less adapted to these clients’ needs. This study examined if their strength in gesture use can lead to the development of a new stuttering therapy.MethodEighteen individuals with DS who stutter participated in an experimental task. During this task, they produced sentences in three different conditions: once without the ability to use gestures, once while moving the mouth of a hand puppet synchronous with their speech, and once while making beat gestures along their speech. Stuttering frequency was measured and compared between conditions while controlling for the effect of articulation rate.ResultsThe experimental hand puppet and beat condition did not affect the stuttering frequency, but the covariate articulation rate did. An exploratory posthoc analysis showed that the articulation rate decreased during the experimental hand puppet and beat condition. Manual movements in the present task might only induce fluency through articulation rate reduction. However, analyses at individual level show significant interindividual variability.ConclusionIndividual analyses show that effect on stuttering frequency cannot be attributed entirely to articulation rate reduction and that beat gestures might still play a role. However, at this point, there is not enough direct evidence to implement beat gestures in current stuttering therapy.     

Depression After Mild Traumatic Brain Injury: A Review of Current Research

Research pertaining to the occurrence of depression and/or depression symptomatology after a Mild Traumatic Brain Injury (MTBI) was reviewed. We found that methodological differences such as the criteria used to assess MTBI and depression, time that elapsed since brain injury, and control group variations confounded comparisons across studies. Nevertheless, the studies are consistent with at least a 35% prevalence of, and left frontal damage with depression after MTBI, an overlap of symptoms of depression and Postconcussion Syndrome (PCS), and indicate that depression can continue for many years following the injury. Our conclusion is that MTBI is the triggering event for a set of pathophysiological changes and a concomitant depressive episode in a vulnerable subset of the population. Due to a paucity of research, it cannot be definitively concluded that the underlying substrates of depression seen after MTBI and clinical depression are the same. Implications for future investigations are discussed.     

The development of responses to people and a toy in infants with down syndrome

The behavior of eight infants with Down syndrome was observed biweekly from 8 to 24 weeks and monthly up to 48 weeks. At each visit the infants were presented with their mother, a female stranger, and a rattle puppet that were alternately active and passive. Each condition lasted 60 s. The results showed that by 4 months of age the infants began to differentiate, in the proportion of time they looked, smiled, and vocalized, between people and the toy. They did not discriminate, however, between mother and female stranger and between the active and passive adults until the second half of the first year. In particular, whereas normal infants usually show distress toward passive or “still-face” adults, the infants in this study continued to vocalize, at times even with smiling faces. The implications of these atypical aspects of the social development of infants with Down syndrome for their subsequent nonverbal communicative development are discussed.     

突发公共卫生事件下心境障碍的特点与应对

突发公共卫生事件会给较大范围的人群造成相当的心理压力和情绪问题。突发事件发生时,社会心理因素对突发事件控制效果和进程的影响越来越显著,因疫情、疾病、生活、工作以及社会和人际关系等因素而致的情绪问题非常突出。突发事件时情绪问题的表现有疑病、恐慌、焦虑、抑郁和强迫心理等,对此应采取相应的对策,而不同群体如罹患人群、隔离人群、家属、普通就医者及一般公众的情绪问题有其独特的表现和应对措施。突发事件为情绪问题的研究提供了广阔的前景。     

青少年“无聊症候群”问题探讨

为了探讨我国学校青少年“无聊症候群”问题的有关现状及成因,选取浙江省4个地区7所中学的613名中学生为研究对象,采用自编量表进行调查。研究发现：(1)“无聊症候群”问题在青少年群体中具有较高比例;(2)男生总体平均得分显著地高于女生;(3)城区中学学生总体平均得分显著地高于乡镇中学学生;(4)独生子女与非独生子女总体上无显著性差异;(5)六个年级间总体上无显著性差异。     

Comparing the effects of differential reinforcement of other behavior and response-cost contingencies on tics in youth with tourette syndrome

Tics are rapid, repetitive, stereotyped movements or vocalizations that arise from neurobiological dysfunction and are influenced by environmental factors. Although persons with tic disorders often experience aversive social reactions in response to tics, little is known about the behavioral effects of such consequences. Along several dimensions, the present study compared the effects of two treatments on tics: response cost (RC) and differential reinforcement of other behavior (DRO). Four children with Tourette syndrome were exposed to free-to-tic baseline, DRO, RC, and quasibaseline rebound evaluation conditions using an alternating treatments design. Both DRO and RC produced substantial decreases in tics from baseline levels. No differential effects of DRO and RC contingencies were seen on self-reported stress or in the strength of the reflexive motivating operation (i.e., premonitory urge) believed to trigger tics, and neither condition produced tic-rebound effects. Implications of these findings and directions for future research are discussed.     

Generalized Worry in Patients With Chronic Fatigue Syndrome Following Cognitive Behavioral Therapy: A Prospective Cohort Study in Secondary Care

Research has shown that generalized anxiety disorder is commonly associated with Chronic Fatigue Syndrome (CFS). This prospective cohort study aimed to investigate the prevalence of generalized worry in CFS patients and its relationship with fatigue, anxiety and social functioning, before and after Cognitive Behavioral Therapy (CBT). Our cohort consisted of 470 patients diagnosed with CFS who received CBT at a secondary care, specialist clinic. Patients completed self-report measures investigating levels of generalized worry, fatigue, work and social adjustment, anxiety and depression at baseline (pretreatment), discharge from treatment, 3-month and 6-month follow up (posttreatment). Analysis indicated a high prevalence of generalized worry (72.4%) at assessment. A significant reduction in worry following CBT (M = −3.42, p < .001, 95% CIs: 2.26, 4.57) was observed at discharge, which remained stable at follow-up. Severe baseline worriers had greater overall fatigue score (M = 3.74, p = .026, 95% CIs: .33, 7.15) and worse overall work and social adjustment than mild worriers across time-points (M = 5.42, p = .035 95% CIs: .27, 10.58). Avoidance behavior mediated the association between generalized worry and work and social adjustment (95% bootstrap CIs: 013, .080). The majority of patients with CFS had comorbid generalized worry and severe worriers reported greater fatigue, anxiety, and worse work and social adjustment. This suggests that CFS patients may benefit from targeting generalized worry during CBT.     

甲亢合并急性冠脉综合征的临床及冠脉特点研究

探讨甲亢合并急性冠脉综合征（ACS）患者的临床及冠状动脉病变特点.选取2010年1月至2013年6月于我院住院诊断的甲亢合并ACS患者（甲亢组）64例及甲状腺功能正常的ACS患者（对照组）56例,分析其临床及冠脉病变特点.甲亢组静息性心绞痛、高血压、糖尿病的发生率,纤维蛋白原（FIB）、氨基末端B型利钠肽前体（NT-proBNP）水平、零病变及冠状动脉痉挛比例明显高于对照组（P＜0.05）,低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）水平明显低于对照组（P＜0.05）.甲亢合并ACS患者常发生静息性心绞痛,冠心病危险因素与甲状腺功能正常患者有所不同,零病变及冠脉痉挛比例高,冠状动脉痉挛可能是其发生急性心肌缺血的重要机制.