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Dunne TF, Chandna J, Majo F, Tavengwa N, Mutasa B, Chasekwa B, Ntozini R, Prendergast AJ, Humphrey JH, Gladstone MJ. Performance of the UNICEF/UN Washington Group tool for identifying functional difficulty in rural Zimbabwean children. PLoS One 2022; 17:e0274664. [PMID: 36112574 PMCID: PMC9480986 DOI: 10.1371/journal.pone.0274664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Over one billion people live with disability worldwide, of whom 80% are in developing countries. Robust childhood disability data are limited, particularly as tools for identifying disability function poorly at young ages. METHODS A subgroup of children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (a cluster-randomised, community-based, 2x2 factorial trial in two rural districts in Zimbabwe) had neurodevelopmental assessments at 2 years of age. We evaluated functional difficulty prevalence in HIV-exposed and HIV-unexposed children using the Washington Group Child Functioning Module (WGCFM), comparing absolute difference using chi-squared or Fisher's exact tests. Concurrent validity with the Malawi Developmental Assessment Tool (MDAT) was assessed using logistic regression with cohort MDAT score quartiles, linear regression for unit-increase in raw scores and a Generalised Estimating Equation approach (to adjust for clusters) to compare MDAT scores of those with and without functional difficulty. A 3-step, cluster-adjusted multivariable regression model was then carried out to examine risk factors for functional difficulty. FINDINGS Functional Difficulty prevalence was 4.2% (95%CI: 3.2%, 5.2%) in HIV-unexposed children (n = 1606) versus 6.1% (95%CI: 3.5%, 8.9%) in HIV-exposed children (n = 314) (absolute difference 1.9%, 95%CI: -0.93%, 4.69%; p = 0.14). Functional difficulty score correlated negatively with MDAT: for each unit increase in WGCFM score, children completed 2.6 (95%CI: 2.2, 3.1) fewer MDAT items (p = 0.001). Children from families with food insecurity and poorer housing were more at risk of functional difficulty. INTERPRETATION Functional difficulty was identified in approximately 1-in-20 children in rural Zimbabwe, which is comparable to prevalence in previous studies. WGCFM showed concurrent validity with the MDAT, supporting its use in early childhood.
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Affiliation(s)
- Thomas Frederick Dunne
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Jaya Chandna
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Melissa J. Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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Abstract
Glycogen storage disease type 1 (GSD-1) is a group of inherited metabolic disorders characterised by the inability to use intracellular glucose stores. It is associated with a high risk of hypoglycaemia, as well as long-term complications including growth retardation, hepatocellular adenomas, renal disease, hypertriglyceridaemia and hyperuricaemia. Treatment involves slow absorption carbohydrates, for example, cornstarch. We present a case of acute psychosis in a patient with GSD-1a. This was initially attributed to his opiate use. Later in his management an MRI scan of his head was performed which revealed regions of brain atrophy following significant hypoglycaemic insult, thus identifying an organic cause of his psychosis. This case presents a rare complication of glycogen storage disease: organic psychosis attributable to cortical atrophy from profound hypoglycaemic insult. It emphasises the importance of investigating organic causes of psychiatric symptoms.
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Affiliation(s)
| | - Tarekegn Geberhiwot
- Institute of Metabolism and Systems Research, University of BIrmingham, Birmingham, UK
| | - Rowena Jones
- Department of Psychiatry, Queen Elizabeth Hospital, Birmingham, UK
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Mallikarjun PK, Lalousis PA, Dunne TF, Heinze K, Reniers RLEP, Broome MR, Farmah B, Oyebode F, Wood SJ, Upthegrove R. Aberrant salience network functional connectivity in auditory verbal hallucinations: a first episode psychosis sample. Transl Psychiatry 2018; 8:69. [PMID: 29581420 PMCID: PMC5913255 DOI: 10.1038/s41398-018-0118-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/20/2017] [Accepted: 01/15/2018] [Indexed: 01/15/2023] Open
Abstract
Auditory verbal hallucinations (AVH) often lead to distress and functional disability, and are frequently associated with psychotic illness. Previously both state and trait magnetic resonance imaging (MRI) studies of AVH have identified activity in brain regions involving auditory processing, language, memory and areas of default mode network (DMN) and salience network (SN). Current evidence is clouded by research mainly in participants on long-term medication, with chronic illness and by choice of seed regions made 'a priori'. Thus, the aim of this study was to elucidate the intrinsic functional connectivity in patients presenting with first episode psychosis (FEP). Resting state functional MRI data were available from 18 FEP patients, 9 of whom also experienced AVH of sufficient duration in the scanner and had symptom capture functional MRI (sc fMRI), together with 18 healthy controls. Symptom capture results were used to accurately identify specific brain regions active during AVH; including the superior temporal cortex, insula, precuneus, posterior cingulate and parahippocampal complex. Using these as seed regions, patients with FEP and AVH showed increased resting sb-FC between parts of the SN and the DMN and between the SN and the cerebellum, but reduced sb-FC between the claustrum and the insula, compared to healthy controls.It is possible that aberrant activity within the DMN and SN complex may be directly linked to impaired salience appraisal of internal activity and AVH generation. Furthermore, decreased intrinsic functional connectivity between the claustrum and the insula may lead to compensatory over activity in parts of the auditory network including areas involved in DMN, auditory processing, language and memory, potentially related to the complex and individual content of AVH when they occur.
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Affiliation(s)
- Pavan Kumar Mallikarjun
- 0000 0004 1936 7486grid.6572.6Institute for Mental Health, University of Birmingham, Birmingham, UK ,0000 0004 1936 7486grid.6572.6College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK ,Forward Thinking Birmingham, Birmingham, UK
| | | | - Thomas Frederick Dunne
- 0000 0004 1936 7486grid.6572.6College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kareen Heinze
- 0000 0004 1936 7486grid.6572.6Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Renate LEP Reniers
- 0000 0004 1936 7486grid.6572.6Institute for Mental Health, University of Birmingham, Birmingham, UK ,0000 0004 1936 7486grid.6572.6College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Matthew R. Broome
- 0000 0004 1936 7486grid.6572.6Institute for Mental Health, University of Birmingham, Birmingham, UK ,Forward Thinking Birmingham, Birmingham, UK ,0000 0004 1936 8948grid.4991.5University of Oxford, Oxford, UK
| | | | - Femi Oyebode
- 0000 0004 1936 7486grid.6572.6College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK ,Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Stephen J Wood
- 0000 0004 1936 7486grid.6572.6Institute for Mental Health, University of Birmingham, Birmingham, UK ,grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK. .,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,Forward Thinking Birmingham, Birmingham, UK.
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