Exploring School Professionals' Definitions of Childhood Trauma

PURPOSE

Little is known about school professionals' definitions of trauma outside of the context of trauma-informed school trainings.

METHODS

The present study used thematic analysis to explore school professionals' open-ended definitions of childhood trauma (N = 1271). Follow-up chi-square tests of independence were used to investigate differences in professionals' definitions based on their professional role and education.

RESULTS

Five themes were identified: effects of trauma, events of trauma, solutions to trauma, emotional responses, and no knowledge. Effects of trauma and events of trauma contained ten and five subthemes, respectively. School professionals who identified long-term effects of trauma on students most commonly listed general negative effects (e.g., "An experience or event that can negatively impact that child") instead of effects on specific domains such as behavior or emotions (e.g., "An experience that negatively impacted a child emotionally"). School professionals who identified an event of trauma most commonly provided examples of trauma (e.g., child maltreatment) or a general definition of trauma. School professionals' roles and education were somewhat related to their definitions of childhood trauma. Findings suggest that childcare providers and professionals without a bachelor's degree have gaps in their knowledge of child trauma.

CONCLUSIONS

These results suggest school professionals have some foundational knowledge about trauma, but it is not universal. To best serve school professionals working with this vulnerable population of students, researchers and practitioners should design future trauma-informed professional development opportunities around school professionals' prior knowledge and understanding of trauma as well as their potential misunderstandings of trauma.

Early child maltreatment and reading processes, abilities, and achievement: A systematic review

BACKGROUND

Children with maltreatment histories demonstrate weaker reading abilities compared to their peers. However, the differential processes driving this effect remain unclear. Prior studies focused on social and behavioral factors explaining this effect, yet reading research has shown that one's ability to comprehend written text is driven by a set of underlying dynamic and interactive cognitive abilities.

OBJECTIVE

This systematic review sought to understand what theoretical or conceptual frameworks researchers cited as guiding their studies, what reading processes and abilities were studied as outcomes, how reading processes or abilities were measured, and what constructs were included to help understand the relationship between maltreatment and reading.

METHOD

Three databases were searched for empirical peer-reviewed journal articles. Articles retained using inclusion and exclusion criteria were coded based on their sample characteristics, reference to theoretical or conceptual frameworks, reading processes and abilities measured, and included predictors of reading. Procedures were documented using the reporting items for systematic reviews and meta-analyses (PRISMA) statement (Moher et al., 2009).

RESULTS

Twenty-seven studies were included in the final systematic review. Those that discussed theoretical or conceptual frameworks focused on the social and behavioral predictors of reading. Many studies (51.9 %) examined effects of maltreatment on reading achievement, rather than specific reading processes or abilities. Most studies (92.6 %) used at least one standardized reading measure. However, only four studies included cognitive abilities as potential predictor variables.

CONCLUSIONS

Future research could benefit from investigating specific cognitive and reading-related processes, using measures to examine specific reading processes leading to breakdowns in reading achievement, and incorporation of reading theories to drive research questions and methods.

Exploratory Structural Equation Modeling Analysis and Validity of the Family Needs Screener

Assessment that accurately categorizes families' risk for family violence (i.e., intimate partner violence and child maltreatment) and identifies areas of family need is essential for prevention program planning, practice, and resource allocation. The Family Needs Screener (FNS) assesses risk for intimate partner violence and child maltreatment. It is used as a tool to prioritize those who are in the greatest need of services as well as plan prevention efforts in selected prevention services offered to military families. To date, no peer-reviewed studies examine the factor structure of the FNS. In this study, we examined measurement aspects of the FNS as an assessment tool in identifying risk of family violence. Data were drawn from Army families (N = 18,159) who were screened between 2009 and 2013 and matched to substantiated cases of family violence. Exploratory structural equation modeling (ESEM) was used to examine the factor structure, measurement invariance, and predictive validity of the FNS. Results supported a shortened measure with a five-factor structure and full gender invariance. In particular, relationship issues were predictive of both intimate partner violence and child maltreatment. In addition, family of origin/history of family violence was predictive of substantiated cases of child maltreatment. Findings support the use of the FNS to assess risk, allocate, and plan for services in an Army population. Implications for scale modifications and use, as well as prevention efforts, are discussed.

A multicenter experience on the prevalence of ARMC5 mutations in patients with primary bilateral macronodular adrenal hyperplasia: from genetic characterization to clinical phenotype

ARMC5 mutations have recently been identified as a common genetic cause of primary bilateral macronodular adrenal hyperplasia (PBMAH). We aimed to assess the prevalence of ARMC5 germline mutations and correlate genotype with phenotype in a large cohort of PBMAH patients. A multicenter study was performed, collecting patients from different endocrinology units in Italy. Seventy-one PBMAH patients were screened for small mutations and large rearrangements in the ARMC5 gene: 53 were cortisol-secreting (two with a family history of adrenal hyperplasia) and 18 were non-secreting cases of PBMAH. Non-mutated and mutated patients' clinical phenotypes were compared and related to the type of mutation. A likely causative germline ARMC5 mutation was only identified in cortisol-secreting PBMAH patients (one with a family history of adrenal hyperplasia and ten apparently sporadic cases). Screening in eight first-degree relatives of three index cases revealed four carriers of an ARMC5 mutation. Evidence of a second hit at somatic level was identified in five nodules. Mutated patients had higher cortisol levels (p = 0.062), and more severe hypertension and diabetes (p < 0.05). Adrenal glands were significantly larger, with a multinodular phenotype, in the mutant group (p < 0.01). No correlation emerged between type of mutation and clinical parameters. ARMC5 mutations are frequent in cortisol-secreting PBMAH and seem to be associated with a particular pattern of the adrenal masses. Their identification may have implications for the clinical care of PBMAH cases and their relatives.

Screening for mutations in the ISL1 gene in patients with thyroid dysgenesis

CONTEXT

Congenital hypothyroidism (CH) is a common endocrine disorder with an incidence of 1:3000- 4000 newborns. In 80-85% of cases, CH is caused by defects in thyroid organogenesis, resulting in absent, ectopically located, and/or severely reduced gland, all conditions indicated as "thyroid dysgenesis" (TD). A higher prevalence of congenital heart diseases has been documented in children with CH compared to the general population. This association suggests a possible pathogenic role of genes involved in both heart and thyroid development. Among these, it can be included Isl1, a transcription factor containing a LIM homeodomain that is expressed in both thyroid and heart during morphogenesis.

OBJECTIVE

In the present study, we investigate the role of ISL1 in the pathogenesis of TD.

SETTINGS AND PATIENTS

By single stranded conformational polymorphism, we screened for mutations the entire ISL1 coding sequence in 96 patients with TD and in 96 normal controls.

RESULTS

No mutations have been found in patients and controls.

CONCLUSION

Our data indicate that, despite the relevant role of ISL1 in thyroid and heart morphogenesis, mutations in its coding region are not associated with TD in our group of patients.

Mutations in TAZ/WWTR1, a co-activator of NKX2.1 and PAX8 are not a frequent cause of thyroid dysgenesis

AIM

In 80-85% of cases, congenital hypothyroidism is associated with thyroid dysgenesis (TD), but only in a small percentage of cases mutations in thyroid transcription factors (NKX2.1, PAX8, FOXE1, and NKX2.5) have been associated with the disease. Several studies demonstrated that the activity of the transcription factors can be modulated by the interaction with other proteins, such as coactivators and co-repressors, and TAZ (transcriptional co-activator with PDZ-binding motif or WWTR1) is a co-activator interacting with both NKX2.1 and PAX8. In the present study we investigate the role of TAZ in the pathogenesis of TD.

MATERIAL AND METHODS

By Single Stranded Conformational Polymorphism, we screened the entire TAZ coding sequence for mutations in 96 patients with TD and in 96 normal controls.

RESULTS

No mutations were found in patients and controls, but we found several polymorphisms in both groups. No significant differences could be demonstrated in the prevalence of the mutations between patients and controls.

CONCLUSIONS

Our data indicate that TAZ mutations are not a cause of TD in the series of patients studied.

New fluoroquinolones in lower respiratory tract infections and emerging patterns of pneumococcal resistance

The increasing resistance of Streptococcus pneumoniae, the most important community respiratory pathogen, to beta-lactams and other first-line antimicrobial agents usually employed for the empirical treatment of lower respiratory tract infections has led to the inclusion, in several current guidelines, of a fluoroquinolone with improved activity against pneumococci as the first choice agent for the management of such infections. The excellent microbiological, pharmacokinetic, and pharmacodynamic characteristics of the new fluoroquinolones (levofloxacin, moxifloxacin, gemifloxacin, and gatifloxacin) have encouraged their growing use, probably contributing to the emergence of fluoroquinolone-resistant pneumococci; although pneumococcal resistance to new fluoroquinolones is currently low, there is still concern about the potential for widespread emergence of resistance to these agents if they become indiscriminately used. Levofloxacin clinical failures have already been reported in the management of patients with pneumococcal community-acquired pneumonia; development of resistance in clinical isolates of S. pneumoniae has prompted a critical reexamination of the newer fluoroquinolones to assess their potency and to preserve their activity. An understanding of the pharmacokinetic and pharmacodynamic properties, allowing selection of the most potent fluoroquinolone, will reduce the opportunity for resistance to develop. Finally, a targeted use of these agents will maintain class efficacy.

[The epidemiology of adverse reactions to nonsteroidal anti-inflammatory drugs. Nimesulide is tolerated by patients with adverse reactions to NSAIDs and modulates in man the skin response to histamine and codeine]

We evaluated the tolerance to NIM in patients with adverse reactions to NSAIDs, expressed by urticaria-angioedema, bronchial asthma or erythema polymorphous on 92 patients among which 32 atopics affected by asthma, rhinitis or contact dermatitis. Challenge test has been performed with increasing amounts of NIM per os every 2 hrs to a maximum of 100 mg/dose. The last dosage was repeated every 12 hrs for 4 times more. No reactions were observed in 86 patients (93.4%). Moreover we evaluated the efficacy of NIM in modulating pomphoid cutaneous reaction to histamine (HIS) and codeine (COD). Three subjects were prick tested with HIS and COD solutions at different concentrations (0.1 to 10 mg/ml), before and after a 5 days therapy with NIM at different dosages/kg/die. At NIM dosages of 3.7 and 2.7 mg/kg/die we observed a strong reduction of pomphoid activity of both HIS and COD. No clear effects were detected at 2.2 mg/kg/die dosage. We assume a dose-related in vivo inhibitory effect of NIM on cutaneous mast cells releasability or a direct anti-histaminic effect. We point out the possible therapeutic role of NIM in the treatment of allergic flogosis at steroid and cromon's side.

The clinical nurse specialist role in product research and development

Think about the variety of products used each day in the critical care environment. They include everything from the most sophisticated monitors to the many disposable products. Most products function very well, but when they do not, do you wish you could talk to the person who designed that product? How can your input make medical products work better? The authors describe a career opportunity open to critical care nurses, that of a clinical nurse specialist for a medical products corporation, whose job it is to influence the design and quality of medical products.