Personality and marital satisfaction: a behavioural genetic analysis

Previous research has found that genetic and nonshared environmental factors influence marital quality (Spotts et al., 2004). The current study explored personality as a source for these genetic and environmental individual differences. A sample of 752 Swedish twin women and their spouses were used. Genetic and environmental influences were found for self‐report measures of marital quality, but only environmental factors contributed to the variance of observational measures of marital quality. Wives' personality characteristics accounted for genetic and nonshared environmental variance in the wives' own marital satisfaction, their husbands' marital satisfaction, and the agreement between the spouses on the quality of their marriage. Genetic influences on the correlation between wives' genetically influenced personality characteristics and their husbands' marital satisfaction indicate a gene–environment correlation. Contrary to expectations, husbands' personality did not explain large portions of wives' marital satisfaction beyond that explained by wives' personality. This study emphasizes the importance of spousal personality to the well‐being of marriages, and results are discussed within the context of three different theories regarding associations between personality and marital quality. Copyright © 2005 John Wiley & Sons, Ltd.

Detection of early osteoarthritis in the centrodistal joints of Icelandic horses: Evaluation of radiography and low-field magnetic resonance imaging

REASONS FOR PERFORMING STUDY

Validated noninvasive detection methods for early osteoarthritis (OA) are required for OA prevention and early intervention treatment strategies.

OBJECTIVES

To evaluate radiography and low-field magnetic resonance imaging (MRI) for the detection of early stage OA osteochondral lesions in equine centrodistal joints using microscopy as the reference standard.

STUDY DESIGN

Prospective imaging of live horses and imaging and microscopy of cadaver tarsal joints.

METHODS

Centrodistal (distal intertarsal) joints of 38 Icelandic research horses aged 27-29 months were radiographed. Horses were subjected to euthanasia approximately 2 months later and cadaver joints examined with low-field MRI. Osteochondral joint specimens were classified as negative or positive for OA using light microscopy histology or scanning electron microscopy. Radiographs and MRIs were evaluated for osteochondral lesions and results compared with microscopy.

RESULTS

Forty-two joints were classified OA positive with microscopy. Associations were detected between microscopic OA and the radiography lesion categories; mineralisation front defect (P<0.0001), joint margin lesion (P<0.0001), central osteophyte (P = 0.03) and the low-field MRI lesion categories; mineralisation front defect (P = 0.01), joint margin lesion (P = 0.02) and articular cartilage lesion (P = 0.0003). The most frequent lesion category detected in microscopic OA positive joints was the mineralisation front defect in radiographs (28/42 OA positive joints, specificity 97%, sensitivity 67%). No significant differences were detected between the sensitivity and specificity of radiography and low-field MRI pooled lesion categories, but radiography was often superior when individual lesion categories were compared.

CONCLUSIONS

Early stage centrodistal joint OA changes may be detected with radiography and low-field MRI. Detection of mineralisation front defects in radiographs may be a useful screening method for detection of early OA in centrodistal joints of young Icelandic horses.

Osteochondral lesions in distal tarsal joints of Icelandic horses reveal strong associations between hyaline and calcified cartilage abnormalities

Osteochondral lesions in the joints of the distal tarsal region of young Icelandic horses provide a natural model for the early stages of osteoarthritis (OA) in low-motion joints. We describe and characterise mineralised and non-mineralised osteochondral lesions in left distal tarsal region joint specimens from twenty-two 30 ±1 month-old Icelandic horses. Combinations of confocal scanning light microscopy, backscattered electron scanning electron microscopy (including, importantly, iodine staining) and three-dimensional microcomputed tomography were used on specimens obtained with guidance from clinical imaging. Lesion-types were described and classified into groups according to morphological features. Their locations in the hyaline articular cartilage (HAC), articular calcified cartilage (ACC), subchondral bone (SCB) and the joint margin tissues were identified and their frequency in the joints recorded. Associations and correlations between lesion-types were investigated for centrodistal joints only. In centrodistal joints the lesion-types HAC chondrocyte loss, HAC fibrillation, HAC central chondrocyte clusters, ACC arrest and ACC advance had significant associations and strong correlations. These lesion-types had moderate to high frequency in centrodistal joints but low frequencies in tarsometatarsal and talocalcaneal-centroquartal joints. Joint margin lesion-types had no significant associations with other lesion-types in the centrodistal joints but high frequency in both the centrodistal and tarsometatarsal joints. The frequency of SCB lesion-types in all joints was low. Hypermineralised infill phase lesion-types were detected. Our results emphasise close associations between HAC and ACC lesions in equine centrodistal joints and the importance of ACC lesions in the development of OA in low-motion compression-loaded equine joints.

Short-term hemodynamic and neuroendocrine effects of pimobendan and benazapril in dogs with myxomatous mitral valve disease and congestive heart failure

BACKGROUND

Pimobendan and benazepril are frequently used with diuretics to treat dogs in congestive heart failure (CHF) caused by myxomatous mitral valve disease (MMVD).

AIM

To compare the short-term effects of pimobendan versus benazepril on pump function, heart size, and neuroendocrine profile in dogs with CHF caused by MMVD.

ANIMALS

Sixteen client-owned dogs.

MATERIAL AND METHODS

Seven-day prospective single-blinded study of dogs stabilized on furosemide monotherapy, randomized to pimobendan (0.4-0.6 mg/kg/day) or benazepril (0.25-1.0 mg/kg/day). Dogs had first-pass radionuclide angiocardiography, and heart size was measured by radiography and echocardiography. Circulating neuroendocrine hormones were measured.

RESULTS

Baseline variables did not differ between treatment groups. Greater decreases in the pimobendan than in the benazepril group were found for heart rate (P = .001), heart rate-normalized pulmonary transit time (P = .02), left atrial size (P = .03), and systolic and diastolic left ventricular diameters (P < .001 and P = .03, respectively) and volumes (P < .001 and P = .02, respectively), whereas ejection fraction increased more (P = .02) in the pimobendan group. Of the neuroendocrine hormones, only N-terminal proatrial natriuretic peptide (NT-ProANP) differed (P = .04) between groups. Within groups, plasma aldosterone increased (P = .01), and NT-proANP (P = .01) and NT-proB-type (P = .02) natriuretic peptide decreased in the pimobendan group, and NT-proANP (P = .02) and plasma vasopressin (P = .01) decreased in the benazepril group.

CONCLUSIONS AND CLINICAL IMPORTANCE

Pimobendan improves short-term cardiac function more than benazepril in dogs with CHF caused by MMVD. Pimobendan treatment enables the heart to work at smaller end-systolic and diastolic dimensions while maintaining adequate forward stroke volume. Some of the treatment responses found in neuroendocrine profile might have therapeutic relevance.

International epidemiology of child and adolescent psychopathology ii: integration and applications of dimensional findings from 44 societies

OBJECTIVE

To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society, gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications.

METHOD

Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies.

RESULTS

CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation [RMSEA]), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms.

CONCLUSIONS

Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children.

Radiographic heart size and its rate of increase as tests for onset of congestive heart failure in Cavalier King Charles Spaniels with mitral valve regurgitation

BACKGROUND

In canine mitral regurgitation (MR) the rate of heart enlargement increases in the last year before congestive heart failure (CHF). Measurement of heart size and its rate of increase may be useful tests for CHF in MR.

OBJECTIVES

To determine the value of vertebral heart scale (VHS) and its rate of increase (∆VHS units/month) for diagnosing the presence and predicting the onset of CHF.

ANIMALS

Longitudinal study of 94 Cavalier King Charles Spaniels (CKCS).

METHODS

VHS was measured at intervals before CHF. ∆VHS/month was calculated from sequential pairs of VHS measurements and the interval between them. Diagnostic accuracy and utility were determined by the areas under receiver operating characteristic plots (AUROC), and likelihood ratios (LR).

RESULTS

AUROC for VHS at the onset of CHF was 0.93 (95% CI, 0.96-0.90), to predict CHF 1-12 months before CHF was 0.74 (95% CI, 0.81-0.66), and for ∆VHS/month at CHF was 0.98 (95% CI, 0.99-0.96). Interval LRs and their cutoff values for CHF were for VHS: 13 (95% CI, 20-7.3) at ≥12.7; 1.2 (95% CI, 2.0-0.68) between 12.7 and 12.0; 0.04 (95% CI, 0.18-0.01) at ≤12.0, and for ∆VHS/month: 15 (95% CI, 30-7.7) at ≥0.08; 0.72 (95% CI, 2.0-0.25) between 0.08 and 0.06; and 0.05 (95% CI, 0.13-0.02) at ≤0.06.

CONCLUSIONS AND CLINICAL IMPORTANCE

Under the conditions of this study, VHS and particularly ∆VHS/month are useful measurements for detecting onset of CHF in CKCS with MR.

Prothrombin complex concentrate and recombinant prothrombin alone or in combination with recombinant factor X and FVIIa in dilutional coagulopathy: a porcine model

BACKGROUND

This study was conducted to assess whether newly developed recombinant clotting factor concentrates enable the reversal of dilutional coagulopathy.

METHODS

In 50 anesthetized pigs, ~60% of the blood volume was withdrawn and replaced with hydroxyethyl starch. Pigs were randomized to receive either 200 mg kg(-1) fibrinogen (n = 10), fibrinogen and 35 IU kg(-1) prothrombin complex concentrate (PCC) (n = 10), fibrinogen and 4 mg kg(-1) recombinant human factor II (rhFII) concentrate (n = 10), fibrinogen and a three-factor combination (3F) of 4 mg kg(-1) rhFII, 0.006 mg kg(-1) recombinant human FVIIa and 0.32 mg kg(-1) recombinant human FX (n = 10), or saline (n = 10). Thereafter, a standardized liver laceration was performed to induce uncontrolled hemorrhage. Survival time and blood loss were determined, and standard coagulation tests and thrombelastometry were performed.

RESULTS

Fibrinogen combined with rhFII or PCC improved survival. Blood loss was significantly decreased in all groups as compared with the animals receiving saline. Clotting time was significantly shortened in the animals treated with fibrinogen and PCC, as well as in those treated with fibrinogen and 3F. One animal died after administration of fibrinogen and PCC.

CONCLUSION

Following hemodilution, a combination of fibrinogen and PCC, rhFII or 3F enhances coagulation and final clot strength. Mortality was reduced statistically significantly only in the animals treated with fibrinogen and rhFII or PCC, whereas administration of the combination of fibrinogen and PCC caused a fatal thromboembolic complication. The combination of fibrinogen and rhFII might be effective in reversing dilutional coagulopathy and may reduce blood loss in cases of dilutional coagulopathy.

Sexual abuse and associations with psychosocial aspects of health. A population-based study with Swedish adolescents

BACKGROUND

Few population-based Nordic studies with adolescents investigate the associations between sexual abuse (SA) and psychosocial health.

AIM

Associations between adolescents' self-reported experiences of SA different severity and aspects of psychosocial health such as emotional and behavioral problems, sense of coherence and self-esteem were investigated.

METHODS

A school-based study with 1107 Swedish high school seniors was conducted. The students completed the Strengths and Difficulties Questionnaire (SDQ), the Sense of Coherence Scale (SOC), I think I am and a self-report survey that included questions about SA, socio-demographic variables and family variables.

RESULTS

SA was related to more emotional and behavioral problems, weaker SOC and lower self-esteem when compared with non-abuse. There was also a dose-response effect insofar as more severe abuse was related to poorer psychosocial health. When adjusted for socio-demographic and family-related variables, the associations between penetrating SA and most of the health variables weakened or disappeared. SOC was associated with penetrating SA even after adjustment.

CONCLUSIONS

This population-based study suggests that SA should not be regarded as an isolated factor in relation to psychosocial health as the associations at a group level may be smaller than expected. Among a number of covariates, family variables such as parental bonding showed to be especially important. Sense of Coherence may be of special interest in further research and clinical treatment.

Temperament and character associated with depressive symptoms in women: analysis of two genetically informative samples

Although previous research has explored associations between personality and depressive symptoms, a limited number of studies have assessed the extent to which genetic and environmental influences explain the association. This study investigated how temperament and character were associated with depressive symptoms in 131 pairs of twin and sibling women in early adulthood, as well as 326 pairs of twin women in middle adulthood. Results indicated that genetic influences accounted for a moderate to substantial percentage of the association between these personality features and depressive symptoms, emphasizing the role of genetic influences. Nonshared environmental influences made important contributions to the association between character and depressive symptoms, particularly in the sample of middle-aged twin women. These findings suggest that unique social experiences and relationships with a partner in adulthood may play an important role in these associations between character and depressive symptoms.

Reader performance in radiographic diagnosis of signs of mitral regurgitation in cavalier King Charles spaniels

OBJECTIVES

To measure accuracy and variability of diagnosis by radiography of heart enlargement (HE) and heart failure (HF) in mitral regurgitation (MR).

METHODS

Sixteen readers representing four levels of experience evaluated 50 sets of radiographs with varying severity of MR for presence or absence of HE, left atrial enlargement (LAE) and HF. The performance of the readers was compared with a reference standard, using area under the curve (AUC) of receiver operating characteristic (ROC) curves. The interreader agreement value kappa (K) was calculated. A subset of difficult cases of HF was analysed before and after removing an outlying reader from each group.

RESULTS

AUC for HE was 0.89, for LAE it was 0.93 and for HF it was 0.92. Experience increased certainty of diagnosis but not accuracy. K ranges were HE, 0.53 to 0.67; LAE, 0.61 to 0.69 and HF, 0.49 to 0.58. When only difficult cases of HF were read, accuracy decreased and experienced readers performed better than inexperienced. When outlying readers were excluded, the differences between experienced and inexperienced readers increased.

CLINICAL SIGNIFICANCE

LAE, not HE, should be used to evaluate the heart size and indirectly the severity of MR on radiographs. For HF, agreement among individual readers was only moderate. Studies of reader accuracy should consider the effects of interreader variability.

A long-term follow-up study of adolescents with conduct disorder: Can outcome be predicted from self-concept and intelligence?

BACKGROUND

This study examines Swedish young adults (age 21) with a history of conduct disorder (CD) in adolescence. Research has established CD as a condition for a range of adverse outcomes. Intelligence, aggression, parent-child conflict, parent-child relation and peer-rejection are known factors influencing the outcome.

AIM

The aim of this longitudinal study is to find how self-confidence and intelligence in an inpatient group diagnosed with CD are related to health in young adulthood.

METHODS

The subjects were diagnosed with CD in their adolescence at the inpatient child and adolescent psychiatric unit. Using structured questionnaires as independent variables, this study uses multiple regression analysis to predict health outcomes.

RESULTS

The results showed that self-concept and verbal intelligence could significantly predict health outcomes. However, in the multivariate analysis, only self-concept variables significantly predicted the outcome. The predicted outcome was small, but substantial in most models (R(2)=0.12-0.25).

CONCLUSION

This means that clinicians need to be humble in forecasting individual adult health among adolescents with severe CD. According to this study, it is difficult to separate positive and negative outcomes. We suggest that this structural data has better prediction potential than medical casebook data. If this is the general case, this psychometric data paves the way for more structural ways of assessing child and adolescence psychiatric problems.

Understanding the role of personality in explaining associations between marital quality and parenting

Analyses assessed the degrees to which personality accounts for associations between marital quality and parenting and mediates genetic contributions to these relationships. Participants included 318 male and 544 female same-sex twin pairs from the Twin and Offspring Study in Sweden. All twins completed self-report measures of marital quality and personality (anxiousness, aggression, sociability). Composite measures of parent negativity and warmth were derived from the twins' and their adolescent children's ratings of the twins' disciplinary styles and the emotional tone of the parent-child relationship. Observational ratings of marital quality and parenting were also obtained for a subset of twins. Personality characteristics explained 33% to 42% of the covariance between reported marital quality and parenting and 26% to 28% of the covariance between observed marital quality and parenting. For both sets of analyses, personality accounted for more than half of the genetic contributions to covariance between marital quality and parenting. Results indicate that personality significantly contributes to associations between marital quality and parenting and that personality is an important path through which genetic factors contribute to family relationships.

Minimizing contrast medium doses to diagnose pulmonary embolism with 80-kVp multidetector computed tomography in azotemic patients

BACKGROUND

In diagnosing acute pulmonary embolism (PE) in azotemic patients, scintigraphy and magnetic resonance imaging are frequently inconclusive or not available in many hospitals. Computed tomography is readily available, but relatively high doses (30-50 g I) of potentially nephrotoxic iodine contrast media (CM) are used.

PURPOSE

To report on the diagnostic quality and possible contrast-induced nephropathy (CIN) after substantially reduced CM doses to diagnose PE in azotemic patients using 80-peak kilovoltage (kVp) 16-row multidetector computed tomography (MDCT) combined with CM doses tailored to body weight, fixed injection duration adapted to scan time, automatic bolus tracking, and saline chaser.

MATERIAL AND METHODS

Patients with estimated glomerular filtration rate (eGFR) <50 ml/min were scheduled to undergo 80-kVp MDCT using 200 mg I/kg, and those with eGFR >or=50 ml/min, 120-kVp MDCT with 320 mg I/kg. Both protocols used an 80-kg maximum dose weight and a fixed 15-s injection time. Pulmonary artery density and contrast-to-noise ratio were measured assuming 70 Hounsfield units (HU) for a fresh clot. CIN was defined as a plasma creatinine rise >44.2 micromol/l from baseline.

RESULTS

89/148 patients (63/68 females) underwent 80-/120-kVp protocols, respectively, with 95% of the examinations being subjectively excellent or adequate. Mean values in the 80-/120-kVp cohorts regarding age were 82/65 years, body weight 66/78 kg, effective mAs 277/117, CM dose 13/23 g I, pulmonary artery density 359/345 HU, image noise (1 standard deviation) 24/21 HU, contrast-to-noise ratio 13/13, and dose-length product 173/258 mGy x cm. Only 1/65 and 2/119 patients in the 80- and 120-kVp cohorts, respectively, with negative CT and no anticoagulation suffered non-fatal thromboembolism during 3-month follow-up. No patient developed CIN.

CONCLUSION

80-kVp 16-row MDCT with optimization of injection parameters may be performed with preserved diagnostic quality, using markedly reduced CM doses compared with common routine practice, which should be to the benefit of patients at risk of CIN.

Individual resiliency factors from a genetic perspective: results from a twin study

This article is part of the Twin Mother's Study, a study that examines influences on maternal adjustment. A number of studies have investigated the importance of genetic factors for mental health, but few of these examine how genes and the environment influence resiliency/salutogenic factors. This article investigates the relative importance of genetic and environmental influences on resiliency/salutogenic factors. This study includes 326 twin pairs (150 monozygotic and 176 dizygotic) who are mothers, who are living with their spouse, and who are part of the Swedish twin register. Using self-report structured questionnaires, we assessed salutogenic factors, depression, and quality of life; however, we analyzed the questionnaires completed by the mothers. Statistical analyses were conducted using structural equation modeling. We conclude that nonshared environmental components were of principal importance in individual resiliency/salutogenic factors in a genetically informative design, but we also noted that genetic influences were important. The shared environment had mainly no effect.

The transportability of multisystemic therapy to Sweden: short-term results from a randomized trial of conduct-disordered youths

This randomized clinical trial assessed the effectiveness of multisystemic therapy (MST) for 156 youths who met the diagnostic criteria for conduct disorder. Sweden's 3 largest cities and 1 small town served as the recruiting area for the study. A mixed factorial design was used, with random allocation between MST and treatment as usual groups. Assessments were conducted at intake and 7 months after referral. With an intention-to-treat approach, results from multiagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were no significant differences in treatment effects between the 2 groups. The lack of treatment effect did not appear to be caused by site differences or variations in program maturity. MST treatment fidelity was lower than that of other studies, although not clearly related to treatment outcomes in this study. The results are discussed in terms of differences between Sweden and the United States. One difference is the way in which young offenders are processed (a child welfare approach vs. a juvenile justice system approach). Sociodemographic differences (e.g., rates of poverty, crime, and substance abuse) between the 2 countries may also have moderating effects on the rates of rehabilitation among young offenders. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

Treatment of ADHD with amphetamine: short-term effects on family interaction

OBJECTIVE

This research seeks to study the impact on family function after 3 months of treatment with amphetamine.

METHOD

A total of 43 children, 6 to 11 years of age, with ADHD were treated with amphetamine for 3 months. Family function was studied before and after treatment by parent self-rating and independent observer ratings of videotaped parent-child interactions.

RESULTS

The families with a child with ADHD were found to be more dysfunctional than control families. Families with children with severe ADHD behavior showed evidence of more family dysfunction compared to families with children with less severe ADHD behavior. After 3 months of treatment with amphetamine, the children's behavior and the mother's well-being and some aspects of parent-reported and observer-rated family functioning improved.

CONCLUSION

This study gives support to the notion that some aspects of family dysfunction may be related to the child's ADHD behavior.

The role of temperament and social support in depressive symptoms: a twin study of mid-aged women

BACKGROUND

Although research has found that temperament and social support are associated with depression, these relationships have not been explored in conjunction with one another as they relate to depression using a genetically informative design. This study investigated how the association among the three constructs is mediated.

METHODS

The sample in this study consisted of 326 pairs of adult monozygotic and dizygotic twins drawn from the Swedish Twin Registry. Twins were mothers of adolescent from married or partnered relationships. The genetic and environmental contributions to the association were evaluated by self-reported measures of temperament, social support, and depressive symptoms.

RESULTS

Multivariate genetic model fitting revealed that a moderate portion of genetic influences were common among the three central constructs of harm avoidance, perceived social support, and depressive symptoms.

LIMITATIONS

The results may not be generalizable to depressive disorders in clinical settings. The measures were self-reported from a cross-sectional study.

CONCLUSIONS

The findings suggest that the heritable component may contribute to genetic influences on an individual's ability to secure social support and thus to genetic risk for depressive symptomatology in women.

A framework for evaluation of flood management strategies

The resulting impact of disasters on society depends on the affected country's economic strength prior to the disaster. The larger the disaster and the smaller the economy, the more significant is the impact. This is clearest seen in developing countries, where weak economies become even weaker afterwards. Deliberate strategies for the sharing of losses from hazardous events may aid a country or a community in efficiently using scarce prevention and mitigation resources, thus being better prepared for the effects of a disaster. Nevertheless, many governments lack an adequate institutional system for applying cost effective and reliable technologies for disaster prevention, early warnings, and mitigation. Modelling by event analyses and strategy models is one way of planning ahead, but these models have so far not been linked together. An approach to this problem was taken during a large study in Hungary, the Tisza case study, where a number of policy strategies for spreading of flood loss were formulated. In these strategies, a set of parameters of particular interest were extracted from interviews with stakeholders in the region. However, the study was focused on emerging economies, and, in particular, on insurance strategies. The scope is now extended to become a functional framework also for developing countries. In general, they have a higher degree of vulnerability. The paper takes northern Vietnam as an example of a developing region. We identify important parameters and discuss their importance for flood strategy formulations. Based on the policy strategies in the Tisza case, we extract data from the strategies and propose a framework for loss spread in developing and emerging economies. The parameter set can straightforwardly be included in a simulation and decision model for policy formulation and evaluation, taking multiple stakeholders into account.

A follow-up study of adolescents with conduct disorder: can long-term outcome be predicted from psychiatric assessment data?

This study examines Swedish young adults (mean age 21) with a history of conduct disorder (CD) as adolescents. Using medical records, this study explores the relationship between adolescent inpatients and their outcomes in adulthood. Two outcome variables were used: an indication of non-successful outcome variable (seven undesirable outcomes) and sense of coherence. Using multiple regression analyses, this study showed that extracted data from the medical case record could significantly explain small variance depending on output variable. The small variance could be related to the homogeneous clinical sample, the follow-up time, the outcome variables and the absence of a biological perspective. This study suggest, clinicians should be very careful when predicting outcome in young adulthood, if they should predict outcome at all. The positive conclusion in this matter is that as far as we know any teenager with CD could have a positive outcome in young adulthood.

Evaluation of the Incredible Years Series - an open study of its effects when first introduced in Sweden

Behaviour management problems (BMP) are common among children (4-12%) and the prevalence seems to be rising. Persistent antisocial behaviour often leads to poor long-term psychosocial adjustment. Structured parent-training programmes have proven to be the most effective way of treating BMP in young children. The Incredible Years Series (IYS), which is a manual-based programme, was introduced in Sweden in 2001. The aim of the present study was to evaluate the effectiveness of IYS in diverse clinical settings in Sweden. Parents of 113 children (3-9 years), recruited through the IYS-trained group leaders' ordinary services, participated in the study. The parents answered various questionnaires regarding their children's symptoms and their own psychological well-being before and after participating in the parent-training groups. The results are very encouraging; significant reduction of BMP in the children was found on all relevant measures. A significant increase in the self-rated well-being of the mothers was also found. The IYS seems to work in Sweden, even when used by group leaders who are in training. The importance of using a well-documented manualized method when implementing new models is accentuated.

Blueprints in Sweden. Symptom load in Swedish adolescents in studies of Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC)

The purpose of the present study was to compare symptom load in youth groups treated with three Swedish Blueprint programmes - Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC) - to see if symptom load matches the intensity of the treatment model as expected. These youth groups were also compared with in- and outpatients from child and adolescent psychiatry, and a normal comparison group. In addition, we compared the symptom load of their mothers. Symptom load was measured by the Achenbach System of Empirically Based Assessment (ASEBA) in the adolescents, and by the Symptom Checklist 90 in their mothers. The results showed that youth in the MST and MTFC studies had a higher symptom load than in the FFT study, and the same pattern of results was found in their mothers. It is concluded that there seems to be a reasonable correspondence between the offered resources and the symptom load among youth and parents; treatment methods with higher intensity have been offered to youth with higher symptom load. The correlation between internalized and externalized symptoms was high in all study groups. The MST and MTFC groups had an equally high total symptom load as the psychiatric inpatient sample.

Group therapy for women sexually abused as children: mental health before and after group therapy

Forty-five female outpatients sexually abused in childhood were offered a 2-year phase-divided group therapy. Before and after treatment and at 12 months follow-up, they answered questionnaires designed to elicit responses concerning psychological symptoms (Symptom Checklist; SCL-90) and sense of coherence (SOC). Symptoms for posttraumatic stress disorder (PTSD) were assessed before and after treatment. Inpatient days and sick listing days were assessed during 2 years before and 2 years after treatment. The psychological and PTSD symptoms were significantly reduced after treatment, and the SOC was increased as well. Inpatient days were decreased, and sick listing days increased but not significantly. Compared to a similar short-term focused therapy group and a waiting-list group there were no significant differences between the groups. Trauma-focused group therapy for women who were sexually abused in childhood seems to have promising effects on mental health, both concerning long-term and short-term approaches.

Fractures of the shaft of the humerus

We studied the epidemiology of 401 fractures of the shaft of the humerus in 397 patients aged 16 years or older. The incidence was 14.5 per 100 000 per year with a gradually increasing age-specific incidence from the fifth decade, reaching almost 60 per 100 000 per year in the ninth decade. Most were closed fractures in elderly patients which had been sustained as the result of a simple fall. The age distribution in women was characterised by a peak in the eighth decade while that in men was more even. Simple fractures were by far the most common and most were located in the middle or proximal shaft. The incidence of palsy of the radial nerve was 8% and fractures in the middle and distal shaft were most likely to be responsible. Only 2% of the fractures were open and 8% were pathological. These figures are representative of a population with a low incidence of high-energy and penetrating trauma, which probably reflects the situation in most European countries.

The development of a systemic school-based intervention: Marte Meo and coordination meetings

Antisocial behavior is often persistent, and in addition to causing suffering to children and their families, it also poses considerable costs for society. Children who display externalizing behavior in their early years run a high risk of having severe problems later in life. There is a need for treatment methods that may be used in various settings because these children constitute a group that is hard to reach with conventional treatment methods. In addition, the dropout rate from ordinary treatment is often high. In the present study, a systemic school-based model for early detection and intervention among 4-12-year-old children who displayed externalizing behavior problems was developed and examined in a nonrandomized study in the county of Skaraborg in Sweden. The intervention was collaborative and included a combination of the Marte Meo model and coordination meetings based on systemic theory and practice. Treatment effects in the group who had received the intervention were compared with a group who had received treatment as usual in their ordinary school setting. Assessments were carried out before, and 2 years after, the intervention. For the intervention group (N = 33), there was a significant decrease in the children's reported symptoms in school and in the home. No decrease in externalizing behavior was found in the comparison group (N = 16). There were no dropouts in the intervention group after the intervention had begun. The results are promising; the study demonstrates that it is possible to work effectively with many children who display externalizing behavior problems in a nonclinical setting.

A long-term follow-up of conduct disorder adolescents into adulthood

This study focuses on young male and female adults (n=290) who were diagnosed with conduct disorder (CD) during adolescence at the inpatient child and adolescent psychiatric unit in Lund, Sweden. Their adulthood is described using seven outcome variables: in custody, crime, illicit drug use, mental health, teenage parenthood, transference income and educational attainment. Together, the seven outcome variables represent a wide perspective of individual life and known risks for both genders. The variables are compared, scaled and described in an outcome that identifies successful outcome. Although this was a severe clinical inpatient group of adolescents, a relatively large number-about a third of the males and close to half of the females-exhibit a successful outcome by their early twenties. This study highlighted the merits use gender-sensitive outcome variables. The take-home message from a societal perspective is that many improvements are needed, a message that has been voiced in several Swedish commissions.

Genetic effects on women's positive mental health: do marital relationships and social support matter?

Interpersonal relationships are important factors in mental health. A genetically sensitive design was used to examine associations among marital quality, adequacy of social support, and 2 aspects of positive mental health in a sample of 652 Swedish twin women and their families. There were 3 main findings. First, the covariance between relationships and positive mental health was partially accounted for by common genetic variance. Second, nonshared environmental influences played a substantial role in the covariance among the 3 constructs, with evidence for husbands being a source of this influence. Finally, different patterns of associations were found between relationships and 2 aspects of mental health, well-being and global self-worth, which shows how seemingly similar constructs can be differentially associated with relationships. Together, these findings emphasize the importance of genetically informed studies in family research and the role of the environment and interpersonal relationships in promoting and improving mental health.

Array-CGH detection of micro rearrangements in mentally retarded individuals: clinical significance of imbalances present both in affected children and normal parents

BACKGROUND

The underlying causes of mental retardation remain unknown in about half the cases. Recent array-CGH studies demonstrated cryptic imbalances in about 25% of patients previously thought to be chromosomally normal.

OBJECTIVE AND METHODS

Array-CGH with approximately 3500 large insert clones spaced at approximately 1 Mb intervals was used to investigate DNA copy number changes in 81 mentally impaired individuals.

RESULTS

Imbalances never observed in control chromosomes were detected in 20 patients (25%): seven were de novo, nine were inherited, and four could not have their origin determined. Six other alterations detected by array were disregarded because they were shown by FISH either to hybridise to both homologues similarly in a presumptive deletion (one case) or to involve clones that hybridised to multiple sites (five cases). All de novo imbalances were assumed to be causally related to the abnormal phenotypes. Among the others, a causal relation between the rearrangements and an aberrant phenotype could be inferred in six cases, including two imbalances of the X chromosome, where the associated clinical features segregated as X linked recessive traits.

CONCLUSIONS

In all, 13 of 81 patients (16%) were found to have chromosomal imbalances probably related to their clinical features. The clinical significance of the seven remaining imbalances remains unclear. The limited ability to differentiate between inherited copy number variations which cause abnormal phenotypes and rare variants unrelated to clinical alterations currently constitutes a limitation in the use of CGH-microarray for guiding genetic counselling.

Outcomes in couple therapy: reduced psychiatric symptoms and improved sense of coherence

In Sweden, only a few empirical studies of couple therapy have been performed. This is the hitherto most comprehensive assessment of clinical treatment. Effectiveness of treatment is reported and compared with non-clinical ratings. Initially the couples displayed marital distress, many psychiatric symptoms, dyadic interactions characterized by high criticism and a low sense of coherence. In Sweden, couple therapy is primarily aimed to reduce marital distress and does not focus on individual disorders. It should be seen as innovative that overall psychic symptoms (Global Symptom Index, GSI) as well as depressive symptoms were reduced (more than one standard deviation) for both women and men to the extent of 50-55%. Normal values were attained by 73-78%. Of those who initially identified a low sense of coherence, 22% of the women and 37% of the men improved (more than one standard deviation). Normal values were attained by 68-70%. The treatment was relatively short, which meant that, with relatively limited treatment, it was also possible to attain relatively significant improvements in all dimensions of psychiatric symptoms.

Genetic and environmental influences on mothering of adolescents: a comparison of two samples

This study examined 2 samples of adolescents and mothers using a child-based design (Nonshared Environment in Adolescent Development [NEAD] project, N = 395 families) and a parent-based design (Twin Moms [TM] project, N = 236 twin family pairs) to compare genetic and environmental influences on mothering. For both samples, the same measures of positivity, negativity, control, and monitoring were used. The use of matched child-based and parent-based samples enabled passive and nonpassive genotype-environment (GE) correlations to be approximated, providing information about process. Passive GE correlations were suggested for mother's positivity and monitoring. For mother's negativity and control, primarily nonpassive GE correlations were suggested. In several cases, both types of GE correlation were indicated. Finally, observer ratings of negativity and monitoring were influenced only by environmental factors.

Working memory and novel word learning in children with hearing impairment and children with specific language impairment

BACKGROUND

Working memory is considered to influence a range of linguistic skills, i.e. vocabulary acquisition, sentence comprehension and reading. Several studies have pointed to limitations of working memory in children with specific language impairment. Few studies, however, have explored the role of working memory for language deficits in children with hearing impairment.

AIMS

The first aim was to compare children with mild-to-moderate bilateral sensorineural hearing impairment, children with a preschool diagnosis of specific language impairment and children with normal language development, aged 9-12 years, for language and working memory. The special focus was on the role of working memory in learning new words for primary school age children.

METHODS & PROCEDURES

The assessment of working memory included tests of phonological short-term memory and complex working memory. Novel word learning was assessed according to the methods of. In addition, a range of language tests was used to assess language comprehension, output phonology and reading.

OUTCOMES & RESULTS

Children with hearing impairment performed significantly better than children with a preschool diagnosis of specific language impairment on tasks assessing novel word learning, complex working memory, sentence comprehension and reading accuracy. No significant correlation was found between phonological short-term memory and novel word learning in any group. The best predictor of novel word learning in children with specific language impairment and in children with hearing impairment was complex working memory. Furthermore, there was a close relationship between complex working memory and language in children with a preschool diagnosis of specific language impairment but not in children with hearing impairment.

CONCLUSIONS

Complex working memory seems to play a significant role in vocabulary acquisition in primary school age children. The interpretation is that the results support theories suggesting a weakened influence of phonological short-term memory on novel word learning in school age children.

Genetic and environmental influences on marital relationships

As most adults will marry at least once during their lifetime, studying marital quality and its predictors is of great importance. The current study addresses (a) the extent of agreement between husbands and wives on their marital quality, (b) genetic and environmental sources of individual differences on spouse reports of marital quality, and (c) the extent to which genetic and environmental influences account for overlap of spouse reports on marital quality. Adult Swedish twin women and their partners participated in this study. Genotype-environment (GE) correlations were found for marital quality, suggesting that wives' genetically influenced characteristics set a tone for the marriage. Wives' genetically influenced characteristics also accounted for overlap of spouse reports of marital quality. Finally, nonshared environmental influences were the primary contributor to both individual reports and the overlap of spouse reports, an interesting deviation from findings of behavior genetic studies of other types of relationships.