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Objective: The present study examines sociopolitical stress, coping, and well-being among college students. Participants: Young adult college students (N = 588; ages 18-29; 72% cisgender women) from 10 universities in the USA participated in this study. Methods: Participants completed a 45-minute online survey with closed-ended and open-ended questions, administered via Qualtrics. Results: Election-related sociopolitical stress was high with notable differences across students' demographic backgrounds (e.g., Hispanic/Latinx students, women, and sexual minority students reported high sociopolitical stress). Among those who reported being stressed by the election (N = 448), closed-ended and open-ended data reveal coping strategies including self-care, drugs and alcohol, and further civic action/political participation. Higher sociopolitical stress predicted more depression and many coping strategies were related with flourishing. Conclusions: Young adult college students are experiencing election-related sociopolitical stress and are coping in different ways. More work is needed to understand what coping strategies support well-being. Implications for colleges are discussed.

Objective: The COVID-19 pandemic has elicited wide-scale general psychological distress; however, longitudinal investigations are required to identify the critical resources that support individuals' adaptation to this type of unique situation over time. Hardiness, a cognitive trait that facilitates adaptation in the context of adversity and possible posttraumatic growth, may be particularly influential on mental health recovery during health disasters when other resources are not available or effective., Method: We tested the hypothesis that greater psychological hardiness prior to the pandemic would predict lower traumatic stress symptoms (TSSs) and loneliness early into the pandemic and decreases in TSSs and loneliness between early 2020 and late 2021. Predominantly ethnic minority (77% Latina/o/x or Asian American) female young adults ( N = 80; M age = 25 years; 88% female) attending a minority-serving public university completed a measure of hardiness in January 2020 as well as measures of pandemic-related TSSs and loneliness in April 2020, October 2020, and December 2021., Results: Latent growth curve analyses indicated that hardiness was associated with lower initial loneliness as well as decreases in TSSs and loneliness over time., Conclusions: Consistent with previous research on adaptation to other potentially traumatic stressors, the current findings suggest that psychological hardiness may play a critical protective role during a global health disaster, both in terms of initial distress and changes in distress over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Theories of suicidality typically center intrapersonal processes, with limited attention to social determinants of mental health disparities. Using a legal vulnerability framework, we examined the association between self/parental immigration status and suicidal and self-harm ideation (SI) disparities in three groups of immigrant-origin Latinx young adults attending college in the USA: undocumented students (n = 564), US citizens with undocumented parents (n = 605), and US citizens with lawfully present parents (n = 596). We also evaluated whether self/parental immigration status differences in SI could be accounted for by six dimensions of legal vulnerability and, based on prominent theories of suicidality, explored the role of campus belongingness as a protective factor. Participants completed self-report measures, and SI was assessed using one item from the Patient Health Questionnaire-9, a screening tool that assesses the severity of depression symptomatology. Rates of SI were significantly higher among undocumented students (23.1%) and US citizens with undocumented parents (24.3%) compared to US citizens with lawfully present parents (17.8%). Immigration policy-related social exclusion and discrimination-mediated self/parental immigration status differences in SI. Although food insecurity did not differ by self/parental immigration status, greater food insecurity was associated with higher likelihood of SI. Greater campus belongingness was associated with a lower likelihood of endorsing SI for all students regardless of immigration status or legal vulnerability factors. Findings underscore the importance of examining self and parental immigration status as a social determinant of SI and the value of investigating aspects of legal vulnerability as explanatory factors., (© 2023. W. Montague Cobb-NMA Health Institute.)

Objectives: Informed by a social-ecological framework, this study nested undocumented students' individual mental health needs within micro-level campus factors and the macro-level immigration policy context to examine how these are associated with undocumented Latina/o/x college students' use of on-campus mental health services., Method: A large-scale survey was administered to 1,277 undocumented college students attending 4-year public universities in California. Only Latina/o/x respondents were included in this study ( N = 1,181). Fifty percent of students attended a UC system ( n = 589). On average, students were 21.84 years old ( SE = .15), and most were women (75.3%, n = 890)., Results: Greater level of mental health symptoms and perceived mental health need, and greater use of campus-wide resources and undocumented student services predicted greater likelihood of using on-campus mental health services. Greater perceptions of social exclusion due to the immigration policy context predicted lower use of mental health services., Conclusions: Results indicate that a greater use of resources and an inclusive campus environment, as well as efforts to minimize policy-related feelings of social exclusion, may facilitate undocumented students' professional mental health help-seeking. These findings emphasize the need to take multiple and multi-level ecological factors into account when considering mental health service use, particularly in the case of undocumented immigrants and likely other structurally marginalized groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Childhood maltreatment strongly predicts suicidality in young adulthood, which is increasingly common among Latina/o and Asian Americans. However, greater attention to modifiable explanatory factors is needed, particularly in ethnically minoritized populations. Aims: The current study evaluated whether the association between childhood maltreatment and suicidality may be accounted for by emotion regulation difficulties among a sample of young adults attending a large, minority-serving state university. Methods: Young adults ( n = 853 participants; M age = 22.43 years; 76.2% female) completed validated measures of suicidality, childhood maltreatment, depression, and emotion regulation difficulties. A multiple indirect effect analysis was conducted in a structural equation modeling framework. Results: Greater childhood maltreatment was associated with significantly greater emotion regulation difficulties across all six types and greater endorsement of overall suicidality. An indirect effect was found for limited access to regulation strategies only. Unexpectedly, lack of emotional awareness was associated with lower levels of ideation/attempts or threats of engaging in suicidal behavior. Limitations: The study was cross-sectional, precluding conclusions regarding causality. Conclusions: The findings suggest that, for individuals who have experienced childhood maltreatment, it is particularly important to address deficits in access to emotion regulation strategies to reduce the risk of suicidal ideation and behavior.

Sociopolitical stress arises in reaction to awareness of, exposure to, and/or involvement in political events. Among a longitudinal cohort of 628 college students from 10 universities across the U.S., we explored trajectories of sociopolitical stress during the 2020 United States presidential election season and examined relationships to psychological well-being. Growth mixture modeling classified our sample into four subgroups each with distinct trajectories of sociopolitical stress: High and Decreasing , Moderate and Increasing , Consistently Low , and High-to-Low . Participants with lower levels of sociopolitical stress expressed higher psychological well-being (high flourishing, high optimism, low anxiety symptoms, low depressive symptoms). The High and Decreasing subgroup was associated with the highest levels of civic action. Participants in the High and Decreasing trajectory were 20 times more likely to identify as LGBQ+, and 4 times more likely to be a woman or a transgender/gender diverse student, compared to participants in the Consistently Low subgroup., Competing Interests: We have no conflicts of interest to disclose., (© 2023 The Authors.)

It can be said that the specialty of neurosurgery in Iceland had its beginnings on November 30, 1971, with the arrival of a huge American C-130 Hercules aircraft. It was carrying a small package containing Scoville aneurysm clips. They were sent to the late Bjarni Hannesson (1938-2013), who had received his neurosurgical training in 1967-1971 at the Dartmouth-Hitchcock Medical Center (then known as Mary Hitchcock Memorial Hospital and located in Hanover, New Hampshire). He used one to clip the right posterior communicating artery aneurysm of a 34-year-old fisherman, who recovered well. The apparent reason for the use of such a huge aircraft for such a small payload is to be found in the sociocultural politics of the Cold War. It involved the continued presence of the American base at Keflavík, where the C-130 landed. The base was under pressure to be closed by Iceland's left-leaning, nominally communist government. The C-130's arrival generated welcome publicity for the continued operation of the American base, which is still there.

Background: Due to its ultraminimally invasive nature, endoscopic spinal surgery is an attractive tool in spinal oncologic care. To date, there has been no comprehensive review of this topic. The authors therefore present a thorough search of the medical literature on endoscopic techniques for spinal oncology., Methods: A systematic review using PubMed was conducted using the following keywords: endoscopic spine surgery, spinal oncology, and spinal tumors., Results: Collectively, 19 cases described endoscopic spine surgery for spinal oncologic care. Endoscopic spine surgery has been employed for the care of patients with spinal tumors under the following 4 circumstances: (1) to obtain a reliable tissue diagnosis; (2) to serve as an adjunct during traditional open surgery; (3) to achieve targeted debulking; or (4) to perform definitive resection. These cases employing endoscopic techniques highlight the versatility of this approach and its utility when applied to the right patient and with an experienced surgeon., Conclusions: Our systematic review suggests that, given the right patient and an experienced surgeon, endoscopic spine surgery should be considered in the armamentarium for spinal oncologic care for both staging and definitive resection., Clinical Relevance: This systematic literature review showed that endoscopic techniques have been successfully applied across the spectrum of care in spinal oncology, from diagnosis to definitive treatment., Competing Interests: Declaration of Conflicting Interests : The authors report no conflicts of interest in this work., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2023 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)

Background: The COVID-19 pandemic has negatively impacted parental and child mental health; however, it is critical to examine this impact in the context of parental histories of adversity. We hypothesized that maternal adverse childhood experiences (ACEs) and pandemic-related negative life events would predict child traumatic stress symptoms (TSS) and tested potential mediating pathways through maternal pandemic-related TSS and/or poorer maternal sensitivity during the pandemic., Methods: Data were collected from a longitudinal sample of low-income, racially/ethnically diverse mothers and their children. Between May and November 2020, mothers (n = 111) of young children (M age = 7.42 years, SD = 0.45) completed questionnaires to assess their own and their child's pandemic-related TSS, exposure to pandemic-related negative events, and parent-child relationship quality. Maternal ACEs, maternal depression, parent-child relationship quality, and child internalizing symptoms had been assessed approximately 1-3 years prior., Results: Structural equation analyses revealed that pandemic negative life events were indirectly associated with child TSS via greater maternal TSS. For mothers, recent pandemic-related negative events were associated with their own TSS, whereas maternal ACEs were not. Maternal ACEs directly predicted greater child TSS, with no evidence of mediation by either maternal TSS or maternal sensitivity., Limitations: All measures were parent report, and pandemic-related measures were collected at the same time point., Conclusions: Findings underscore the long reach of mothers' own adverse childhood experiences, highlighting the negative consequences of these prior traumatic exposures alongside current pandemic-related maternal trauma symptoms for children's adjustment during the pandemic., Competing Interests: Declaration of competing interest All authors declare that they have no conflicts of interest., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: In the context of increased attention afforded to hospital efficiency and improved but safe patient throughput, decreasing unnecessary hospital length of stay (LOS) is imperative. Given that lumbar spine procedures may be among a hospital's most profitable services, identifying patients at risk of increased healthcare resource utilization prior to surgery is a valuable opportunity to develop targeted pre- and peri-operative intervention and quality improvement initiatives. The purpose of the present investigation was to examine patient factors that predict prolonged LOS as well as discharge disposition following elective, posterior, lumbar spine surgery., Methods: We employed a retrospective cohort analysis on 779 consecutive patients treated with lumbar surgery without fusion. Our primary outcome measures were extended LOS (three or more midnights) and discharge disposition. Patient sociodemographic, procedural, and discharge characteristics were adjusted for in our analysis. Sociodemographic variables included Area of Deprivation Index (ADI), a comprehensive metric of socioeconomic status, utilizing income, education, employment, and housing quality based on patient zip code. Multivariable logistic regression and ordinal logistic regression analyses were performed to assess whether covariates were independently predictive of extended LOS and discharge disposition, respectively., Results: 779 patients were studied, with a median age of 66 years (±15) and a median LOS of 1 midnight (range, 1-10 midnights). Patients in the most disadvantaged ADI quintile (adjusted odds ratio, aOR 2.48 95% CI 1.15-5.47), those who underwent a minimally-invasive or tubular retractor surgery (aOR 3.03 95% CI 1.02-8.56), those who had an intra-operative drain placed (aOR 4.46 95% CI 2.53-7.26), who had a cerebrospinal fluid leak (aOR 3.46 95% CI 1.55-7.58), who were discharged anywhere but home (aOR 17.11 95% CI 9.24-33.00), and those who were evaluated by physical therapy (aOR 7.23 95% CI 2.13-45.30) or OT (aOR 2.20 95% CI 1.13-4.22) had a significantly increased chance of an extended LOS. Preoperative opioid use was not associated with an increased LOS following surgery (aOR 1.12 95% CI 0.56-1.46). Extended LOS was not associated with post-discharge emergency department representation or unplanned readmission within 90 days following discharge (p=0.148). Patients who were older (aOR 1.99 95% CI 1.62-2.48), in higher quintiles on ADI (3rd quintile; aOR 1.90 95% CI 1.12-3.23, 4th quintile; aOR 1.79, 95% CI 1.05-3.05, 5th quintile; aOR 2.16 95% CI 1.26-3.75), who had a CSF leak (aOR 2.18 95% CI 1.22-3.86), or who had a longer procedure duration (aOR 1.38 95% CI 1.17-1.62) were more likely to require additional services or be sent to a subacute facility upon discharge., Conclusions: Patient sociodemographics, along with procedural factors, and discharge disposition were all associated with an increased likelihood of prolonged LOS and resource intensive discharges following elective lumbar spine surgery. Several of these factors could be reliably identified pre-operatively and may be amenable to targeted preoperative intervention. Improving discharge disposition planning in the peri-operative period may allow for more efficient use of hospitalization and inpatient and post-acute resources., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Published by Elsevier Ltd on behalf of North American Spine Society.)

Background: Discharge to acute rehabilitation is strongly correlated with functional recovery after traumatic injury, including spinal cord injury (SCI). However, services such as acute care rehabilitation and Skilled Nursing Facilities (SNF) are expensive. Our objective was to understand if high-cost, resource-intensive post-discharge rehabilitation or alternative care facilities are utilized at disparate rates across socioeconomic groups after SCI., Methods: We performed a cohort analysis using the National Trauma Data Bank® tabulated from 2012-2016. Eligible patients had a diagnosis of cervical or thoracic spine fracture with spinal cord injury (SCI) and were treated surgically. We evaluated associations of sociodemographic and psychosocial variables with non-home discharge (e.g., discharge to SNF, other healthcare facility, or intermediate care facility) via multivariable logistic regression while correcting for injury severity and hospital characteristics., Results: We identified 3933 eligible patients. Patients who were older, male (OR=1.29 95% Confidence Interval [1.07-1.56], p=.007), insured by Medicare (OR=1.45 [1.08-1.96], p=.015), diagnosed with a major psychiatric disorder (OR=1.40 [1.03-1.90], p=.034), had a higher Injury Severity Score (OR=5.21 [2.96-9.18], p<.001) or a lower Glasgow Coma Score (3-8 points, OR=2.78 [1.81-4.27], p<.001) had a higher chance of a non-home discharge. The only sociodemographic variable associated with lower likelihood of utilizing additional healthcare facilities following discharge was uninsured status (OR=0.47 [0.37-0.60], p<.001)., Conclusions: Uninsured patients are less likely to be discharged to acute rehabilitation or alternative healthcare facilities following surgical management of SCI. High out-of-pocket costs for uninsured patients in the United States may deter utilization of these services., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Objective: Identifying patients at risk of increased health care resource utilization is a valuable opportunity to develop targeted preoperative and perioperative interventions. In the present investigation, we sought to examine patient sociodemographic factors that predict prolonged length of stay (LOS) after traumatic spine fracture., Methods: We performed a cohort analysis using the National Trauma Data Bank tabulated during 2012-2016. Eligible patients were those who were diagnosed with cervical or thoracic spine fracture with spinal cord injury and who were treated surgically. We evaluated the effects of sociodemographic as well as psychosocial variables on LOS by negative binomial regression and adjusted for injury severity, injury mechanism, and hospital characteristics., Results: We identified 3856 eligible patients with a median LOS of 9 days (interquartile range, 6-15 days). Patients in older age categories, who were male (incidence rate ratio (IRR), 1.05; 95% confidence interval [CI], 1.01-1.09), black (IRR, 1.12; CI, 1.05-1.19) or Hispanic (IRR, 1.09; CI, 1.03-1.16), insured by Medicaid (IRR, 1.24; CI, 1.17-1.31), or had a diagnosis of alcohol use disorder (IRR, 1.12; CI, 1.06-1.18) were significantly more likely to have a longer LOS. In addition, patients with severe injury on Injury Severity Score (IRR, 1.32; CI, 1.14-1.53) and lower Glasgow Coma Scale (GCS) scores (GCS score 3-8, IRR, 1.44; CI, 1.35-1.55; GCS score 9-11, IRR, 1.40; CI, 1.25-1.58) on admission had a significantly lengthier LOS. Patients admitted to a hospital in the Southern United States (IRR, 1.09; CI, 1.05-1.14) had longer LOS., Conclusions: Socioeconomic factors such as race, insurance status, and alcohol use disorder were associated with a prolonged LOS after surgical management of traumatic spine fracture with spinal cord injury., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Transradial access has been described for mechanical thrombectomy in acute stroke, and proximal balloon occlusion has been shown to improve recanalization and outcomes. However, sheathed access requires a larger total catheter diameter at the access site. We aimed to characterize the safety of sheathless transradial balloon guide catheter use in acute stroke intervention., Methods: Consecutive patients who underwent sheathless right-sided transradial access for thrombectomy with a balloon guide catheter were identified in a prospectively collected dataset from 2019 to 2021. Demographics, procedure details, and short-term outcomes were collected and reported with descriptive statistics., Results: A total of 48 patients (20 women) with a mean age of 72.3 years were identified. Of patients, 56.3% had occlusions in the left-sided circulation; 35 (72.9%) had M1 occlusions, 7 (14.6%) had M2 occlusions, and 6 (12.5%) had internal carotid artery occlusions. Tissue plasminogen activator was administered to 16 (33.3%) patients. Five (10.4%) patients underwent intraprocedural carotid stenting. The cohort had successful reperfusion after a median of 1 (interquartile range: 1, 2) pass. Median time from access to recanalization was 31 (interquartile range: 25, 53) minutes. A postprocedural Thrombolysis In Cerebral Infarction score of ≥2b was achieved in 46 (95.8%) patients. Five patients had wrist access site hematomas. All hematomas resolved with warm compresses, and no further intervention was required., Conclusions: Sheathless radial access using a balloon guide catheter may be safely performed for acute ischemic stroke with excellent radiographic outcomes. Further investigation is warranted to evaluate the comparative effectiveness of sheathless compared with sheathed transradial balloon guide access., (Copyright © 2022. Published by Elsevier Inc.)

Endoscopic spine surgery (ESS) advances the principles of minimally invasive surgery, including minor collateral tissue damage, reduced blood loss, and faster recovery times. ESS allows for direct access to the spine through small incisions and direct visualization of spinal pathology via an endoscope. While this technique has many applications, there is a steep learning curve when adopting ESS into a surgeon's practice. Two types of navigation, optical and electromagnetic, may allow for widespread utilization of ESS by engendering improved orientation to surgical anatomy and reduced complication rates. The present review discusses these two available navigation technologies and their application in endoscopic procedures by providing case examples. Furthermore, we report on the future directions of navigation within the discipline of ESS., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this article., (Copyright © 2022 Matthew J. Hagan et al.)

Objective: The aim of this study was to describe a minimally invasive transforaminal surgical technique for treating awake patients presenting with lumbar radiculopathy and compressive facet cysts., Methods: Awake transforaminal endoscopic decompression surgery was performed in 645 patients over a 6-year period from 2014 to 2020. Transforaminal endoscopic decompression surgery utilizing a high-speed endoscopic drill was performed in 25 patients who had lumbar facet cysts. All surgeries were performed as outpatient procedures in awake patients. Nine of the 25 patients had previously undergone laminectomies at the treated level. A retrospective chart review of patient-reported outcome measures is presented., Results: At the 2-year follow-up, the mean (± standard deviation) preoperative visual analog scale leg score and Oswestry Disability Index improved from 7.6 ± 1.3 to 2.3 ± 1.4 and 39.7% ± 8.1% to 13.0% ± 7.4%, respectively. There were no complications, readmissions, or recurrence of symptoms during the 2-year follow-up period., Conclusions: A minimally invasive awake procedure is presented for the treatment of lumbar facet cysts in patients with lumbar radiculopathy. Approximately one-third of the treated patients (9 of 25) had postlaminectomy facet cysts.

Background: A significant portion of health care spending is driven by a small percentage of the overall population. Understanding risk factors predisposing patients to disproportionate use of health care resources is critical. Our objective was to identify risk factors leading to a prolonged length of stay (LOS) after cervical spine surgery., Methods: A single-center cohort analysis was performed on patients who underwent elective anterior spine surgery from 2015 to 2021. Multivariate logistic regression evaluated the effects of sociodemographic factors including Area of Deprivation Index (quantifies income, education, employment, and housing quality), procedural, and discharge characteristics on postoperative LOS. Extended LOS was defined as greater than the 90th percentile in midnights for the study population (≥3 midnights)., Results: A total of 686 patients were included in the study, with a mean age of 57 years (range, 26-92 years), median of 1 level (1-4) fused, and median LOS of 1 midnight (interquartile range, 1-2). After adjusting for confounders, patients had increased odds of extended LOS if they were highly disadvantaged on the Area of Deprivation Index (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.04-4.82; P = 0.039); had surgery on Thursday or Friday (OR, 1.94; 95% CI, 1.01-3.72; P = 0.046); had a corpectomy performed (OR, 2.81; 95% CI, 1.26-6.28; P = 0.012); or discharged not to home (OR, 8.24; 95% CI, 2.88-23.56; P < 0.001). Patients with extended LOS were more likely to present to the emergency department or be readmitted within 30 days after discharge (P = 0.024)., Conclusions: After adjusting for potential cofounders, patients most disadvantaged on Area of Deprivation Index were more likely to have an extended LOS., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Metabolic syndrome (MetS) is a disorder characterized by a constellation of cardiometabolic risk factors including abdominal obesity, dyslipidemia, hypertension, and glucose intolerance that has been associated with adverse perioperative outcomes. We evaluated outcomes for patients with MetS after carotid endarterectomy (CEA) in the largest population to date., Methods: We performed a matched cohort analysis using clinical data from 2012 to 2018 in the American College of Surgeons National Surgical Quality Improvement Program. We used propensity scores to match patients to attain covariate balance and used logistic regression to assess odds of unfavorable outcomes, including a predefined primary outcome of composite cardiovascular incident., Results: We identified 50,423 eligible adult patients, of whom 14.2% qualified for MetS (n = 7156). Patients with MetS tended to have CEA at an earlier age, more functional dependence, and longer operative durations. After matching, MetS remained associated with the primary outcome of combined cardiovascular incident (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.18-1.72; P < 0.001), stroke (OR, 1.44; 95% CI, 1.12-1.85; P = 0.004), prolonged length of stay (OR, 1.31; 95% CI, 1.18-1.44; P < 0.001), and discharge to facility (OR, 1.32; 95% CI, 1.08-1.61; P = 0.007). We also found that obesity alone is protective against combined cardiovascular incident, whereas hypertension with diabetes and MetS increase odds of a cardiovascular complication., Conclusions: Metabolic syndrome is associated with adverse outcomes for adult patients undergoing elective CEA., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Encouraging early time of discharge (TOD) for medical inpatients is commonplace and may potentially improve patient throughput. It is unclear, however, whether early TOD after elective spine surgery achieves this goal without a consequent increase in re-presentations to the hospital., Objective: To evaluate whether early TOD results in increased rates of hospital readmission or return to the emergency department after elective anterior cervical spine surgery., Methods: We analyzed 686 patients who underwent elective uncomplicated anterior cervical spine surgery at a single institution. Logistic regression was used to evaluate the relationship between sociodemographic, procedural, and discharge characteristics, and the outcomes of readmission or return to the emergency department and TOD., Results: In multiple logistic regression, TOD was not associated with increased risk of readmission or return to the emergency department within 30 days of surgery. Weekend discharge (odds ratio [OR] 0.33, 95% CI 0.21-0.53), physical therapy evaluation (OR 0.44, 95% CI 0.28-0.71), and occupational therapy evaluation (OR 0.32, 95% CI 0.17-0.63) were all significantly associated with decreased odds of discharge before noon. Disadvantaged status, as measured by area of deprivation index, was associated with increased odds of readmission or re-presentation (OR 1.86, 95% CI 0.95-3.66), although this result did not achieve statistical significance., Conclusion: There does not appear to be an association between readmission or return to the emergency department and early TOD after elective spine surgery. Overuse of inpatient physical and occupational therapy consultations may contribute to decreased patient throughput in surgical admissions., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

Objective: Socioeconomic factors are known to influence outcomes after spinal trauma, but it is unclear how these factors affect health care utilization in acute care settings. We aimed to elucidate if sociodemographic and psychosocial factors are associated with obtaining magnetic resonance imaging (MRI), a costly imaging modality, after cervical or thoracic spine fracture., Methods: Data from the 2012-2016 American College of Surgeons National Trauma Data Bank were used. We assessed the relationship between receipt of MRI and patient-level sociodemographic and psychosocial factors as well as hospital characteristics while correcting for injury-specific characteristics. Multiple logistic regression was performed to assess for associations between these variables and MRI after spine trauma., Results: A total of 213,071 patients met the inclusion criteria, of whom 13.0% had an MRI (n = 27,757). After adjusting for confounders in multivariate regression, patients had increased odds of MRI if they were Hispanic (odds ratio [OR], 1.09; P = 0.001) or black (OR, 1.14; P < 0.001) or were diagnosed with major psychiatric disorder (OR, 1.06; P = 0.009), alcohol use disorder (OR, 1.05; P < 0.001), or substance use disorder (OR, 1.10; P < 0.001). Patients with Medicare (OR, 0.88; P < 0.001) or Medicaid (OR, 0.94; P < 0.011) were less likely to have an MRI than were those with private insurance, whereas patients treated in the Northeast (OR, 1.48; P < 0.001) or at for-profit hospitals (OR, 1.12; P < 0.001) were more likely., Conclusions: After adjusting for injury severity and spinal cord injury diagnosis, psychosocial comorbidities and for-profit hospital status were associated with higher odds of MRI, whereas public insurance was associated with lower odds. Results highlight potential biases in the provision of MRI as a costly imaging modality., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Cerebral cavernous malformations (CCMs) are hemorrhagic neurovascular lesions that affect more than 1 million people in the United States. Rapamycin inhibits CCM development and bleeding in murine models. The appropriate dosage to modify disease phenotype remains unknown. Current approved indications by the U.S. Food and Drug Administration and clinicaltrials.gov were queried for rapamycin human dosing for various indications. A systematic literature search was conducted on PubMed to investigate mouse dosimetry of rapamycin. In humans, low daily doses of <2 mg/day or trough level targets <15 ng/mL were typically used for benign indications akin to CCM disease, with relatively low complication rates. Higher oral doses in humans, used for organ rejection, result in higher complication rates. Oral dosing in mice, between 2 and 4 mg/kg/day, achieved blood trough levels in the 5-15 ng/mL range, a concentration likely to be targeted in human studies to treat CCM. Preclinical studies are needed utilizing dosing strategies which achieve blood levels corresponding to likely human dosimetry., Competing Interests: The authors declare no competing financial interest., (© 2022 American Chemical Society.)

Objective: Intraoperative computed tomography and navigation (iCT-Nav) is increasingly used to aid spinal instrumentation. We aimed to document the accuracy and revision rate of pedicle screw placement across many screws placed using iCT-Nav. We also assess patient-level factors predictive of high-grade pedicle breach., Methods: Medical records of patients who underwent iCT-Nav pedicle screw placement between 2015 and 2017 at a single center were retrospectively reviewed. Screw placement accuracy was individually assessed for each screw using the 2-mm incremental grading system for pedicle breach. Predictors of high-grade (>2 mm) breach were identified using multiple logistic regression., Results: In total, 1400 pedicle screws were placed in 208 patients undergoing cervicothoracic (29; 13.9%), thoracic (30; 14.4), thoracolumbar (19; 9.1%) and lumbar (130; 62.5%) surgeries. iCT-Nav afforded high-accuracy screw placement, with 1356 of 1400 screws (96.9%) being placed accurately. In total, 37 pedicle screws (2.64%) were revised intraoperatively during the index surgery across 31 patients, with no subsequent returns to the operating room because of screw malpositioning. After correcting for potential confounders, males were less likely to have a high-grade breach (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.10-0.59, P = 0.003) whereas lateral (OR 6.21; 95% CI 2.47-15.52, P < 0.001) or anterior (OR 5.79; 95% CI2.11-15.88, P = 0.001) breach location were predictive of a high-grade breach., Conclusions: iCT-Nav with postinstrumentation intraoperative imaging is associated with a reduced need for costly postoperative return to the operating room for screw revision. In comparison with studies of navigation without iCT where 1.5%-1.7% of patients returned for a second surgery, we report 0 revision surgeries due to screw malpositioning., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Endoscopic techniques in spine surgery are rapidly evolving, with operations becoming progressively safer and less invasive. Lumbar interbody fusion (LIF) procedures comprise many spine procedures that have benefited from endoscopic assistance and minimally invasive approaches. Though considerable variation exists within endoscopic LIF, similar principles and techniques are common to all types. Nonetheless, innovations continually emerge, requiring trainees and experienced surgeons to maintain familiarity with the domain and its possibilities. We present two illustrative cases of endoscopic transforaminal lumbar interbody fusion with a comprehensive literature review of the different approaches to endoscopic LIF procedures., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Bryan Zheng et al.)

Background: Mucormycosis can lead to fatal rhinocerebral infection., Case: A 53-year-old male with diabetes presented with altered mental status. He had been recently discharged from an admission for COVID-19 pneumonia treated with remdesivir and methylprednisolone. Imaging demonstrated a large left frontal mass with midline shift suspicious for a primary brain neoplasm. His neurologic exam rapidly declined and the patient was taken to the operating room for decompressive hemicraniectomy. Post-operatively, the patient remained comatose and failed to improve. Autopsy revealed a cerebral mucormycosis infection., Discussion: Despite concern for a primary brain neoplasm the patient was diagnosed postmortem with a mucormycosis infection. Other features supporting this diagnosis included nasal sinusitis on initial scans, his fulminant clinical decline, rapidly progressive imaging findings, and persistent hyperglycemia throughout his clinical course., Conclusion: In an era of high steroid usage to treat COVID-19, mucormycosis infection must be considered in high-risk patients demonstrating disproportionate clinical decline.

Background: Socioeconomic factors can bias clinician decision-making in many areas of medicine. Psychosocial characteristics such as diagnosis of alcoholism, substance abuse, and major psychiatric disorder are emerging as potential sources of conscious and unconscious bias. We hypothesized that these psychosocial factors, in addition to socioeconomic factors, may impact the decision to operate on patients with a traumatic cervicothoracic fracture and associated spinal cord injury (SCI)., Methods: We performed a cohort analysis using clinical data from 2012-2016 in the American College of Surgeons (ACS) National Trauma Data Bank at academic level I and II trauma centers. Patients were eligible if they had a diagnosis of cervicothoracic fracture with SCI. Using ICD codes, we evaluated baseline characteristics including race; insurance status; diagnosis of alcoholism, substance abuse, or major psychiatric disorder; admission drug screen and blood alcohol level; injury characteristics and severity; and hospital characteristics including geographic region, non-profit status, university affiliation, and trauma level. Factors significantly associated with surgical intervention in univariate analysis were eligible for inclusion in multivariate logistic regression., Results: We identified 6,655 eligible patients, of whom 62% underwent surgical treatment (n=4,137). Patients treated non-operatively were more likely to be older; be female; be Black or Hispanic; have Medicare, Medicaid, or no insurance; have been assaulted; have been injured by a firearm; have thoracic fracture; have less severe injuries; have severe TBI; be treated at non-profit hospitals; and be in the Northeast or Western U.S. (all P<0.01). After adjusting for confounders in multivariate analysis, only insurance status remained associated with operative treatment. Medicaid patients (OR=0.81; P=0.021) and uninsured patients (OR=0.63; P<0.001) had lower odds of surgery relative to patients with private insurance. Injury severity and facility characteristics also remained significantly associated with surgical management following multivariate regression., Conclusions: Psychosocial characteristics such as diagnosis of alcoholism, substance abuse, or psychiatric illness do not appear to bias the decision to operate after traumatic cervicothoracic fracture with SCI. Baseline sociodemographic imbalances were explained largely by insurance status, injury, and facility characteristics in multivariate analysis., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jss-21-37). The authors have no conflicts of interest to declare., (2021 Journal of Spine Surgery. All rights reserved.)

Introduction: Arachnoid cysts are a common incidental finding on head imaging. While the natural history of these cysts in poorly described, hemorrhage with subdural hygroma formation is rare. We review the clinical course of a patient who developed a subdural hygroma following trauma., Case: The patient was a previously healthy 14-month-old male who presented to the Emergency Department with vomiting after a fall and was found to have esotropia without other focal neurological deficits and a CT scan consistent with a subdural cerebrospinal fluid collection with midline shift. The patient was treated conservatively and his symptoms resolved., Discussion: Arachnoid cyst rupture is a rare complication which can lead to increased intracranial pressure with devastating consequences. Clinical manifestation can be similar to that of other intracranial pathologies. Prompt diagnosis is required to avoid life-threatening symptoms., Conclusion: Arachnoid cyst rupture should be considered when evaluating patients with non-specific neurological symptoms following trauma.

There is emerging evidence that the development of problematic aggression in childhood may be associated with specific physiological stress response patterns, with both biological overactivation and underactivation implicated. This study tested associations between sex-specific patterns of stress responses across the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis and peer nominations of aggression among 271 kindergarten children (Mean age = 5.32 years; 52% Female; 44% White). Upon entry to kindergarten, children participated in a multidomain standardized stress paradigm. Changes in pre-ejection period (PEP) and salivary cortisol were assessed. On a separate day, children provided peer ratings of physical and relational aggression in a standardized interview. As expected, there was a significant three-way interaction between PEP, cortisol reactivity, and sex, but only for physical aggression. Among boys, cortisol reactivity was positively associated with physical aggression only for those with higher SNS reactivity. Findings suggest that for boys, asymmetrical and symmetrical HPA/SNS reactivity may be associated with lower and higher risk for peer-directed physical aggression, respectively. Understanding the complex associations between multisystem physiology, child sex and peer-directed aggression in early childhood may offer insight into individual differences underlying the emergence of behavioral dysregulation in early peer contexts.

Classrooms are key social settings that impact children's mental health, though individual differences in physiological reactivity may render children more or less susceptible to classroom environments. In a diverse sample of children from 19 kindergarten classrooms (N = 338, 48% female, M age = 5.32 years), we examined whether children's parasympathetic reactivity moderated the association between classroom climate and externalizing symptoms. Independent observers coded teachers' use of child-centered and teacher-directed instructional practices across classroom social and management domains. Children's respiratory sinus arrhythmia reactivity to challenge tasks was assessed in fall and a multi-informant measure of externalizing was collected in fall and spring. Both the social and the management domains of classroom climate significantly interacted with children's respiratory sinus arrhythmia reactivity to predict spring externalizing symptoms, controlling for fall symptoms. For more reactive children, as classrooms shifted toward greater proportional use of child-centered methods, externalizing symptoms declined, whereas greater use of teacher-dominated practices was associated with increased symptoms. Conversely, among less reactive children, exposure to more teacher-dominated classroom management practices was associated with lower externalizing. Consistent with the theory of biological sensitivity to context, considering variability in children's physiological reactivity aids understanding of the salience of the classroom environment for children's mental health.

Evidence indicates that patterns of biological reactivity underlie different forms of aggression, but greater precision is needed in research targeting biopsychosocial processes that underlie such differences. This study investigated how sympathetic and parasympathetic nervous system (SNS and PNS) responses to social stress were associated with multiple forms of aggression in an ethnically-diverse sample of young adult females; it further examined whether early life exposure to family conflict moderated these relationships. In the context of high levels of family conflict history, greater SNS activation during a social conflict task was associated with more direct proactive aggression and increasing RSA was associated with more direct reactive aggression. Greater SNS activation during the task was associated with more direct reactive aggression regardless of family conflict history. Our findings affirm the need to capture the contributions of multiple physiological systems simultaneously and the importance of considering family history in the study of aggression., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to report., (Copyright © 2020. Published by Elsevier B.V.)

The early neuropathological features of amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) are protein aggregates in motor neurons and microglial activation. Similar pathology characterizes Guamanian ALS/Parkinsonism dementia complex, which may be triggered by the cyanotoxin β-N-methylamino-l-alanine (BMAA). We report here the occurrence of ALS/MND-type pathological changes in vervets (Chlorocebus sabaeus; n = 8) fed oral doses of a dry powder of BMAA HCl salt (210 mg/kg/day) for 140 days. Spinal cords and brains from toxin-exposed vervets were compared to controls fed rice flour (210 mg/kg/day) and to vervets coadministered equal amounts of BMAA and l-serine (210 mg/kg/day). Immunohistochemistry and quantitative image analysis were used to examine markers of ALS/MND and glial activation. UHPLC-MS/MS was used to confirm BMAA exposures in dosed vervets. Motor neuron degeneration was demonstrated in BMAA-dosed vervets by TDP-43+ proteinopathy in anterior horn cells, by reactive astrogliosis, by activated microglia, and by damage to myelinated axons in the lateral corticospinal tracts. Vervets dosed with BMAA + l-serine displayed reduced neuropathological changes. This study demonstrates that chronic dietary exposure to BMAA causes ALS/MND-type pathological changes in the vervet and coadministration of l-serine reduces the amount of reactive gliosis and the number of protein inclusions in motor neurons., (© 2020 American Association of Neuropathologists, Inc.)

Low-income communities of color experience significant political, economic, and health inequities and, not unrelatedly, are disproportionately exposed to violent crime than are residents of higher income communities. In an effort to mitigate concentrations of poverty and crime, governmental agencies have partnered with affordable housing developers to redevelop public housing "projects" into mixed-income communities and to do so within a "trauma-informed" framework. The current study analyzes how residents have historically and contemporaneously negotiated, endured, and resisted structural and interpersonal violence in 2 long-standing, predominately African American, public housing communities undergoing a public-private housing redevelopment initiative. Interviews with 44 adult public housing residents (age range = 18-75 years; 82% African American/Black) were conducted during a 2-year period while residents' homes were being demolished and rebuilt into mixed-income communities. Analysis of in-depth interviews used constructivist grounded theory principles to reveal a common theme and basic social process of the ongoing formation of homeplace, with subthemes focusing on the ways homeplace emerges through shared lineage, knowing and caring practices; how homeplace is maintained through networks of protection in unsafe contexts; how homeplace is disrupted as a result of redevelopment activities; and the reclamation of homeplace during redevelopment in the service of hope and healing. These findings offer a nuanced view of resident's lived experiences of place-based trauma and collective resistance and resilience, while also highlighting the place-specific ways in which redevelopment unsettles deeply rooted sociocultural configurations of home and community. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objectives: College students have cited the 2016 U.S. presidential election as a significant source of stress. The current study examined the prevalence and demographic correlates of clinically significant election-related avoidance and intrusion symptoms among college students 2-3 months after the election. Participants: College students attending a large public university ( N  = 769; M age  = 19.19; 48.2% female; 58.4% White) were surveyed in January and February 2017. Methods: Participants completed a validated measure of clinically significant event-related distress symptoms (eg, intrusive thoughts, avoidance) and demographic questions. Results: One out of four students met criteria for clinically significant symptoms related to the election. Regression analyses suggested that sex, political party, religion, and perceived impact of the election on relationships were more useful predictors of stress symptoms than race or social class. Conclusions: The high level of event-related distress is concerning because elevated symptoms of event-related stress are predictive of future distress and subsequent PTSD diagnoses.

Adolescence is a sensitive developmental period in which substance use can exert long-term effects on important biological systems. Emerging cross-sectional research indicates that problematic alcohol consumption may be associated with dysregulated neuroendocrine system functioning. The current study evaluated the prospective effects of binge drinking in adolescence on cortisol stress reactivity in young adulthood among individuals who had experienced parental divorce in childhood (N = 160; Mean age = 25.55, SD = 1.22; 46.9% Female; 88.8% White Non-Hispanic). Youth completed validated measures of problematic drinking during adolescence (aged 15-19) and participated in a standardized social stress task nine years later in young adulthood. Latent growth modeling was conducted within a structural equation modeling framework. Greater binge drinking during adolescence was associated with a significantly lower cortisol stress response in young adulthood, controlling for young adult drinking, sex, childhood externalizing problems, and socioeconomic status. Findings suggest problematic alcohol consumption during mid-to-late adolescence may have important effects on the neuroendocrine stress response system at subsequent developmental stages., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The objective of this study was to investigate associations between household food insecurity, maternal clinical depression, and child behavior problems in low-income Latino households. Data were collected from a cohort of 168 children and their Latina mothers recruited prenatally at two San Francisco hospitals from 2006 to 2007. Food insecurity at year four was associated with increased odds of maternal clinical depression at years four to five (adjusted OR 1.22, 95% confidence interval 1.03 to 1.43). Food insecurity at year four was associated with child pervasive developmental problems at year five (B=0.21, p=0.041) in adjusted models. The association between food insecurity at year four and oppositional defiant problems at year five was partially mediated (28.7% mediation, p=0.046) by maternal clinical depression in years four and five. Our results suggest that household food insecurity is associated with greater maternal depression, and both food insecurity and maternal depression uniquely predict certain types of child behavior problems. Assessing for and addressing household food insecurity may be beneficial additions to psychosocial interventions targeting maternal and child mental health., Competing Interests: Conflict of interest: None of the authors have a conflict of interest.

Intimate partner violence (IPV) victimization during pregnancy is a major public health concern, yet little is known about how risk factors for IPV during pregnancy may depend on whether women have histories of victimization dating back to early childhood (ages 0-5 years). This study examined whether risk factors for physical IPV victimization during pregnancy (a pregnancy that was not planned and prenatal substance use) differed for women with versus without early childhood victimization. Participants were 236 ethnically diverse, low-income biological mothers ( M = 30.94 years; 50.0% Latina, 16.9% Caucasian, 13.1% African American, and 16.9% multiracial) of children aged 0 to 6 years. Mothers were classified into four groups based on whether they had experienced early childhood victimization and physical IPV victimization during pregnancy with the target child. Multinomial logistic regressions, controlling for demographic characteristics, examined whether a pregnancy not planned and prenatal substance use predicted group membership. Compared to mothers with early victimization only, mothers with both early childhood victimization and physical IPV during pregnancy were more than 3 times as likely to report that their pregnancy with the target child was not planned. In follow-up analyses, mothers with early victimization and physical IPV during pregnancy also reported higher lifetime parity than mothers with physical IPV during pregnancy but no early victimization. Early childhood victimization may place women on a risk pathway to physical IPV during pregnancy, particularly if the pregnancy is not planned. Prevention and policy efforts should screen women for early childhood victimization to understand risks for physical IPV during pregnancy.

Objective: Children from families with lower socioeconomic status (SES) evidence greater physiological dysregulation and poorer health. Despite recognition of environmental contributors, little is known about the influence of neighborhood characteristics. The present study examined the moderating role of community-level risks and resources on the relation of family SES to children's daily cortisol output and physical health during the kindergarten year., Methods: In fall and spring of kindergarten, children's (N = 338) daily total cortisol was measured and parents and teachers rated children's global physical health. Parents reported family SES. Neighborhood characteristics were assessed using the Child Opportunity Index, a population-level tool that evaluates the quality of multiple domains of neighborhood attributes., Results: In fall, children reared in lower SES family environments had higher cortisol when residing in lower quality (lower opportunity) neighborhoods (b = -.097, p < .001), but there was no relation between family SES and children's cortisol in more advantaged (higher opportunity) neighborhoods (b = -.023, p = .36). Lower family SES was prospectively associated with poorer physical health in spring (controlling for fall health) only among children living in lower opportunity neighborhoods (b = -.250, p = .018) and was unrelated to physical health among children residing in higher opportunity neighborhoods (b = .042, p = .70)., Conclusions: Higher opportunity neighborhoods may protect against the negative consequences of low family SES on children's stress physiology and physical health. Public health interventions that bolster neighborhood opportunities may benefit young children reared in socioeconomically disadvantaged family environments.

Purpose: This study aims to examine the longitudinal association between puberty and sleep in a diverse sample of girls and explore racial/ethnic differences in this association., Methods: Using latent growth curve modeling, the present study measured pubertal development (timing and rate) and sleep (wake time and bedtime) in 1,239 socioeconomically and ethnically diverse girls starting when they were 6-8 years old and followed longitudinally for up to 8 years. Pubertal assessment was conducted annually in clinic by physical examination, classified by sexual maturation stage for breast and pubic hair development by trained raters., Results: In line with previous research, black girls had the earliest pubertal development, followed by Hispanic, white, and Asian girls. Black girls, on average, reported significantly shorter sleep duration than Hispanic (β = -.20, p < .001), Asian (β = -.29, p = .002), and white (β = -.35, p < .001) girls. In a series of dual-process models, we found that early pubertal timing predicted shorter sleep duration for early-maturing black girls (breast development: β = .13, p = .005; pubic hair development: β = .14, p = .012). There was no evidence of any association between pubertal rate and sleep. All models controlled for family socioeconomic status and body mass index., Conclusion: Sleep is essential for many aspects of youth development, including emotional, cognitive, and physical functioning. Developmental changes associated with puberty may put some early maturing girls at risk of shorter sleep duration in adolescence and exacerbate racial/ethnic disparities in health and well-being., (Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: A Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) was added to the DSM-5, but little is known about this symptom pattern in young children exposed to trauma. Tailoring treatment to traumatized young children requires understanding the different patterns of trauma-related symptomatology and important correlates. The current study tested the hypothesis that type and number of child traumatic events, caregiver trauma exposure, and caregiver symptomatology would predict whether traumatized young children presented with PTSD, PTSD with clinical dissociation, or non-clinical trauma symptoms., Methods: A multinomial regression was conducted using data collected from an ethnically and economically diverse sample of 297 trauma-exposed children between the ages of 3 and 6 and their caregivers. Based on parent-report on a well-validated measure of trauma symptoms, children were categorized into three groups: non-clinical (n = 128), PTSD only (n = 104), or PTSD with dissociation (PTSD-DISS; n = 65). Predictors included trauma exposure, parent trauma symptoms, and child sex., Results: Girls were twice more likely than boys to be in the PTSD-DISS group; sexually abused children were almost three times as likely to be in the PTSD-DISS group; and, for every unit increase in parent avoidance symptoms or number of traumatic events, the odds of being in the PTSD-DISS group increased significantly., Limitations: Given the cross-sectional study design, conclusions cannot be drawn regarding causality. Measures were completed by a single reporter., Conclusions: Findings suggest that subgroups of children may be especially vulnerable to comorbid PTSD and dissociation. Implications for treatment are discussed., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Five randomized controlled trials have shown that child-parent psychotherapy (CPP) improves trauma symptoms in children. Less is known about parent symptoms or moderators of symptom change. In a sample of 199 parent (81% biological mother; 54% Latina/o) and child (aged 2 to 6 years; 52% male; 49% Latina/o) dyads who participated in an open treatment study of CPP, this study investigated whether parent and child symptoms similarly decreased during treatment and whether improvement was moderated by parent, child, and treatment characteristics. Parents completed baseline and posttreatment interviews regarding exposure to traumatic events, posttraumatic stress symptomatology (PTSS), and other mental health indices. Latent difference score analysis showed that PTSS significantly decreased by more than 0.5 SD for parents and children. The PTSS improvement in parents was associated with reductions in child avoidance, r = .19, p = .040, and hyperarousal, r = .33, p < .001. Girls showed a greater reduction than boys in reexperiencing, β = -.13, p = .018, and hyperarousal, β = -.20, p = .001. Contrary to expectations, parent and child improvement in PTSS was greater for those with fewer parental lifetime stressors, β range = .15 to .33, and for those who participated in fewer treatment sessions, β range = .15 to .21. The extent of improvement in parent PTSS varied based on clinician expertise, β = -.20, p = .009. Significant reductions in parent and child PTSS were observed during community-based treatment, with CPP and symptom improvement varying according to child, parent, and treatment characteristics., (Copyright © 2017 International Society for Traumatic Stress Studies.)

Entry into kindergarten is a developmental milestone that children may differentially experience as stressful, with implications for variability in neurobiological functioning. Guided by the goodness-of-fit framework, this study tested the hypothesis that kindergarten children's (N = 338) daily cortisol would be affected by the "match" or "mismatch" between children's temperament and qualities of the classroom relational context. The robustness of these associations was also explored among a separate sample of children in third grade (N = 165). Results among kindergarten children showed negative affectivity and overcontrolled temperament were positively related to cortisol expression within classrooms characterized by lower levels of teacher motivational support, but there was no relation between temperament and cortisol when motivational support was higher. Among third-grade children, negative affectivity was marginally positively related to cortisol at lower levels of teacher-child closeness and unrelated at higher levels of teacher-child closeness. Findings suggest children's cortisol expression depends on the extent to which specific temperamental characteristics "fit" within the relational and contextual qualities of the classroom environment, particularly as children navigate the new roles and relationships that emerge during the transition to formal schooling. Developmentally informed neurobiological research in classrooms may contribute to tailored programmatic efforts to support children's school adjustment.

Background and Objectives: Although it has been postulated that psychological responses to stress in adulthood are grounded in childhood experiences in the family environment, evidence has been inconsistent. This study tested whether two putative measures of neurobiological sensitivity (vagal flexibility and attentional capacity) moderated the relation between women's reported exposure to a risky childhood environment and current engagement in suppressive or avoidant coping in response to daily stress., Design and Methods: Adult women (N = 158) recruited for a study of stress, coping, and aging reported on early adversity (EA) in their childhood family environment and completed a week-long daily diary in which they described their most stressful event of the day and indicated the degree to which they used suppression or avoidance in response to that event. In addition, women completed a visual tracking task during which heart rate variability and attentional capacity were assessed., Results: Multilevel mixed modeling analyses revealed that greater EA predicted greater suppression and avoidance only among women with higher attentional capacity. Similarly, greater EA predicted greater use of suppression, but only among women with greater vagal flexibility., Conclusion: Childhood adversity may predispose individuals with high neurobiological sensitivity to a lifetime of maladaptive coping.

Objective: We tested the hypothesis that socioeconomic status (SES) would predict children's physical health problems at the end of kindergarten among children whose parent reported greater parent-child relationship (PCR) negativity and/or who exhibited greater parasympathetic (RSA) reactivity. We also tested whether RSA and PCR negativity mediated the SES-health association., Methods: Data were collected from 338 children (mean [SD] age, 5.32 [.32] years) and their primary caregivers (87% biological mothers) during the fall and subsequent spring of kindergarten. In the fall, parents reported income and education level (SES) and PCR negativity, and RSA reactivity was assessed via a standardized challenge protocol for young children. In the fall and then spring, parents reported children's chronic medical conditions and physical health impairments. Multivariate regression was conducted within a structural equation-modeling framework to test hypotheses., Results: Significant interactions were found between SES and PCR negativity (b = -0.074, p = .035) and between SES and RSA reactivity (b = 0.169, p = .019) as predicts children's spring health impairment, adjusting for health in the preceding fall. Lower SES was associated with greater health impairment among children whose parents reported more PCR negativity (b = -0.110, p = .024) and children who showed greater RSA reactivity (b = -0.106, p = .011). Socioeconomic status was unrelated to physical health at low PCR negativity or RSA reactivity. Mediation models were not supported., Conclusion: Parent-child relationship quality and individual differences in stress reactivity may modulate the influence of SES on physical health in childhood., Competing Interests: The authors have no conflicts of interest to report.

The temperamental trait of negative emotionality (NE) plays an important role in maladaptation among adults experiencing significant life stress. However, the prospective relation between childhood NE and subsequent interrelated behavioral, emotional, and biological dysregulation in later life has not yet been established among children who experience early adversity. Using a longitudinal sample of youth who experienced parental divorce during childhood (N = 160; 53% male; 83% White), we tested the hypothesis that childhood NE would predict physiological, emotional, and behavioral dysregulation 15 years later. NE was assessed by maternal report when youth were between 9 and 12 years old. Fifteen years later, young adults (mean age = 25.55 years) participated in a psychosocial stress task to assess cortisol reactivity and reported on internalizing symptoms and problematic alcohol use. Structural equation modeling revealed that higher childhood NE predicted significantly greater alcohol use, internalizing symptoms, and total cortisol output during a stress task 15 years later. Importantly, these findings held after adjusting for childhood internalizing symptoms. In addition, problematic alcohol use was associated with greater cortisol reactivity and internalizing symptoms. Findings suggest that childhood NE is a critical risk marker for interrelated forms of dysregulation in young adulthood among at-risk youth. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Studies of the association between traumatic experiences and psychopathology in early childhood have primarily focused on specific types of events (e.g., sexual abuse) or aggregated different types of events without differentiating among them. We extend this body of work by investigating patterns of traumatic event exposure in a high-risk, ethnically diverse sample of children ages 3-6 (N = 211; 51 % female) and relating these different patterns to parents' reports of child externalizing, internalizing, and post-traumatic stress symptomatology. Using latent class analysis, which divides a heterogeneous population into homogenous subpopulations, we identified three patterns of traumatic events based on parents' responses to an interview-based assessment of trauma exposure in young children: (1) severe exposure, characterized by a combination of family violence and victimization; (2) witnessing family violence without victimization; and (3) moderate exposure, characterized by an absence of family violence but a moderate probability of other events. The severe exposure class exhibited elevated internalizing and post-traumatic stress symptoms relative to the witness to violence and moderate exposure classes, controlling for average number of traumatic events. Results highlight the need for differentiation between profiles of traumatic life event exposure and the potential for person-centered methods to complement the cumulative risk perspective.

Objectives: The experience of parental divorce during childhood is associated with an increased risk of behavioral and physical health problems. Alterations in adrenocortical activity may be a mechanism in this relation. Parent-child relationships have been linked to cortisol regulation in children exposed to adversity, but prospective research is lacking. We examined maternal warmth in adolescence as a predictor of young adults' cortisol stress response 15 years after parental divorce., Methods: Participants included 240 youth from recently divorced families. Mother and child reports of maternal warmth were assessed at 6 time points across childhood, adolescence, and young adulthood. Offspring salivary cortisol was measured in young adulthood before and after a social stress task. Structural equation modeling was used to predict cortisol response from maternal warmth across early and late adolescence., Results: Higher child-reported maternal warmth in early adolescence predicted higher child-reported maternal warmth in late adolescence (standardized regression = 0.45, standard error = 0.065, p < .01), which predicted lower cortisol response to a challenging interpersonal task in young adulthood (standardized regression = -0.20, standard error = 0.094, p = .031). Neither mother-reported warmth in early adolescence nor late adolescence was significantly related to offspring cortisol response in young adulthood., Conclusions: Results suggest that for children from divorced families, a warm mother-child relationship after divorce and across development, as perceived by the child, may promote efficient biological regulation later in life., Trial Registration: ClinicalTrials.gov Identifier: NCT01407120.

The current study investigated maternal sensitivity in a treatment-seeking sample of predominately Latina, low-income pregnant women with histories of interpersonal trauma exposure. Pregnant women (N = 52; M = 27.08 years, SD = 5.66) who enrolled in a study of a perinatal adaptation of child-parent psychotherapy reported on their posttraumatic stress symptoms and child-rearing attitudes at baseline and again at 6-months postpartum. Maternal sensitivity was measured via observational coding of a free-play episode at 6-months postpartum. Two thirds of mothers exhibited healthy levels of maternal sensitivity, M > 4.0 (range = 2.5-7.0). The results of multiple linear regression predicting maternal sensitivity, R(2) = .26, indicated that greater improvements in child-rearing attitudes over the course of treatment predicted higher levels of maternal sensitivity, β = .33, whereas improvements in posttraumatic stress symptoms over the course of treatment did not, β = -.10. Mothers' attitudes regarding parenting during the perinatal period may be a mechanism by which intervention fosters healthy mother-infant relationship dynamics. Thus, parenting attitudes are a worthy target of intervention in vulnerable families., (Copyright © 2015 International Society for Traumatic Stress Studies.)

Children who have experienced interpersonal trauma are at an increased risk of developing dissociation; however, little is known about the prevalence or correlates of dissociation in young children. The current study examined symptoms of dissociation in 140 children (mean age = 51.17 months, range = 36-72 months, SD = 10.31 months; 50.0% male; 45.7% Hispanic) who experienced trauma (e.g., witnessing domestic violence, experiencing abuse). Child dissociation and exposure to traumatic events were assessed using a clinician-administered interview with the biological mother (mean age = 32.02 years, SD = 6.13; 49.3% Hispanic; 25.5% married or cohabitating). Mothers completed measures of maternal dissociation, depression/anxiety, and child behavior problems. At least subclinical dissociation was present for 24.3% of children. Robust regression with least trimmed squares estimation showed that greater maternal dissociation was related to greater child dissociation, adjusting for child internalizing symptoms, number of traumas, and maternal depression/anxiety, B = 0.09, χ(2) = 10.47, p < .001, R(2) Δ = .04. Children who experienced direct victimization did not exhibit a significantly higher level of dissociation compared to children who experienced other traumas, F(1, 138) = 3.76, p = .054, η(2) = .03. These findings highlight the need to assess dissociation in traumatized young children., (Copyright © 2015 International Society for Traumatic Stress Studies.)

Background: The relationship between behavioral problems and obesity in early childhood in Latinos is largely unknown., Methods: Cross-sectional anthropometric and behavioral data of children at three years of age were gathered from a cohort of 174 children of Latina mothers at two San Francisco hospitals. Child behaviors were assessed using the preschool Child Behavior Checklist (CBCL/1½-5). Logistic regression was used to analyze the association between behavior and obesity., Results: At three years, 27.7% were obese. There were no associations between affective (OR = 1.89; 95% confidence interval [CI] 0.42-8.59), anxiety (OR = 1.86; 95% CI 0.53-6.47), pervasive developmental (OR = 0.42; 95% CI 0.13-1.36), attention deficit hyperactivity (OR = 0.58; 95% CI 0.12-2.76), or oppositional defiant (OR = 6.49; 95% CI 0.65-64.49) problems and obesity., Conclusions: Though psychological problems and obesity are associated among older children and adolescents, there was no association in Latino three-year olds in a low-income sample.