Vision is adapted to the natural level of blur present in the retinal image

Background

The image formed by the eye''s optics is inherently blurred by aberrations specific to an individual''s eyes. We examined how visual coding is adapted to the optical quality of the eye.

Methods and Findings

We assessed the relationship between perceived blur and the retinal image blur resulting from high order aberrations in an individual''s optics. Observers judged perceptual blur in a psychophysical two-alternative forced choice paradigm, on stimuli viewed through perfectly corrected optics (using a deformable mirror to compensate for the individual''s aberrations). Realistic blur of different amounts and forms was computer simulated using real aberrations from a population. The blur levels perceived as best focused were close to the levels predicted by an individual''s high order aberrations over a wide range of blur magnitudes, and were systematically biased when observers were instead adapted to the blur reproduced from a different observer''s eye.

Conclusions

Our results provide strong evidence that spatial vision is calibrated for the specific blur levels present in each individual''s retinal image and that this adaptation at least partly reflects how spatial sensitivity is normalized in the neural coding of blur.     

Addressing Women's Non-Maternal Healthcare Financing in Developing Countries: What Can We Learn from the Experiences of Rural Indian Women?

Background and Objectives

This paper focuses on the inadequate attention on women''s non-maternal healthcare in low- and middle-income countries. The study assessed the purchase of and financial access to non-maternal healthcare. It also scoped for mainstreaming household financial resources in this regard to suggest for alternatives.

Methods

A household survey through multi-stage stratified sampling in the state of Orissa interviewed rural women above 15 years who were neither pregnant nor had any pregnancy-related outcome six weeks preceding the survey. The questions explored on the processes, determinants and outcomes of health seeking for non-maternal ailments. The outcome measures were healthcare access, cost of care and financial access. The independent variables for bivariate and multivariate analyses were contextual factors, health seeking and financing pattern.

Results

The survey obtained a response rate of 98.64% and among 800 women, 43.8% had no schooling and 51% were above 60 years. Each woman reported at least one episode of non-maternal ailment; financial constraints prevented 68% from receiving timely and complete care. Distress coping measures (e.g. borrowings) dominated the financing source (67.9%) followed by community–based measures (32.1%). Only 6% had financial risk-protection; financial risk of not obtaining care doubled for women aged over 60 years (OR 2.00, 95% CI 0.84–4.80), seeking outpatient consultation (OR 2.01, 95% CI 0.89–4.81), facing unfavourable household response (OR 2.04, 95% CI 1.09–3.83), and lacking other financial alternatives (OR 2.13, 95% CI 1.11–4.07). When it comes to timely mobilization of funds and healthcare seeking, 90% (714) of the households preferred maternal care to non-maternal healthcare.

Conclusion

The existing financing options enable sub-optimal purchase of women''s non-maternal healthcare. Though dominant, household economy extends inadequate attention in this regard owing to its unfavourable approach towards non-maternal healthcare and limited financial capacity and support from other financial resources.     

Heart rate during conflicts predicts post-conflict stress-related behavior in greylag geese

Background

Social stressors are known to be among the most potent stressors in group-living animals. This is not only manifested in individual physiology (heart rate, glucocorticoids), but also in how individuals behave directly after a conflict. Certain ‘stress-related behaviors’ such as autopreening, body shaking, scratching and vigilance have been suggested to indicate an individual''s emotional state. Such behaviors may also alleviate stress, but the behavioral context and physiological basis of those behaviors is still poorly understood.

Methodology/Principal Findings

We recorded beat-to-beat heart rates (HR) of 22 greylag geese in response to agonistic encounters using fully implanted sensor-transmitter packages. Additionally, for 143 major events we analyzed the behavior shown by our focal animals in the first two minutes after an interaction. Our results show that the HR during encounters and characteristics of the interaction predicted the frequency and duration of behaviors shown after a conflict.

Conclusions/Significance

To our knowledge this is the first study to quantify the physiological and behavioral responses to single agonistic encounters and to link this to post conflict behavior. Our results demonstrate that ‘stress-related behaviors’ are flexibly modulated by the characteristics of the preceding aggressive interaction and reflect the individual''s emotional strain, which is linked to autonomic arousal. We found no support for the stress-alleviating hypothesis, but we propose that stress-related behaviors may play a role in communication with other group members, particularly with pair-partners.     

Regrets associated with providing healthcare: qualitative study of experiences of hospital-based physicians and nurses

Background

Regret is an unavoidable corollary of clinical practice. Physicians and nurses perform countless clinical decisions and actions, in a context characterised by time pressure, information overload, complexity and uncertainty.

Objective

To explore feelings associated with regretted clinical decisions or interventions of hospital-based physicians and nurses and to examine how these regrets are coped with.

Method

Qualitative study of a volunteer sample of 12 physicians and 13 nurses from Swiss University Hospitals using semi-structured interviews and thematic analysis

Results

All interviewees reported at least one intense regret, which sometimes led to sleep problems, or taking sickness leave. Respondents also reported an accumulation effect of small and large regrets, which sometimes led to quitting one''s unit or choosing another specialty. Respondents used diverse ways of coping with regrets, including changing their practices and seeking support from peers and family but also suppression of thoughts related to the situation and ruminations on the situation. Another coping strategy was acceptance of one''s limits and of medicine''s limits. Physicians reported that they avoided sharing with close colleagues because they felt they could lose their credibility.

Conclusions

Since regret seems related to both positive and negative consequences, it is important to learn more about regret coping among healthcare providers and to determine whether training in coping strategies could help reduce negative consequences such as sleep problems, absenteeism, or turnover.     

A Method for the Automated,Reliable Retrieval of Publication-Citation Records

Background

Publication records and citation indices often are used to evaluate academic performance. For this reason, obtaining or computing them accurately is important. This can be difficult, largely due to a lack of complete knowledge of an individual''s publication list and/or lack of time available to manually obtain or construct the publication-citation record. While online publication search engines have somewhat addressed these problems, using raw search results can yield inaccurate estimates of publication-citation records and citation indices.

Methodology

In this paper, we present a new, automated method that produces estimates of an individual''s publication-citation record from an individual''s name and a set of domain-specific vocabulary that may occur in the individual''s publication titles. Because this vocabulary can be harvested directly from a research web page or online (partial) publication list, our method delivers an easy way to obtain estimates of a publication-citation record and the relevant citation indices. Our method works by applying a series of stringent name and content filters to the raw publication search results returned by an online publication search engine. In this paper, our method is run using Google Scholar, but the underlying filters can be easily applied to any existing publication search engine. When compared against a manually constructed data set of individuals and their publication-citation records, our method provides significant improvements over raw search results. The estimated publication-citation records returned by our method have an average sensitivity of and specificity of (in contrast to raw search result specificity of less than 10%). When citation indices are computed using these records, the estimated indices are within of the true value, compared to raw search results which have overestimates of, on average, .

Conclusions

These results confirm that our method provides significantly improved estimates over raw search results, and these can either be used directly for large-scale (departmental or university) analysis or further refined manually to quickly give accurate publication-citation records.     

The role of vaccine coverage within social networks in cholera vaccine efficacy

Background

Traditional vaccine trial methods have an underlying assumption that the effect of a vaccine is the same throughout the trial area. There are, however, many spatial and behavioral factors that alter the rates of contact among infectious and susceptible individuals and result in different efficacies across a population. We reanalyzed data from a field trial in Bangladesh to ascertain whether there is evidence of indirect protection from cholera vaccines when vaccination rates are high in an individual''s social network.

Methods

We analyzed the first year of surveillance data from a placebo-controlled trial of B subunit-killed whole-cell and killed whole-cell-only oral cholera vaccines in children and adult women in Bangladesh. We calculated whether there was an inverse trend for the relation between the level of vaccine coverage in an individual''s social network and the incidence of cholera in individual vaccine recipients or placebo recipients after controlling for potential confounding variables.

Results

Using bari-level social network ties, we found incidence rates of cholera among placebo recipients were inversely related to levels of vaccine coverage (5.28 cases per 1000 in the lowest quintile vs 3.27 cases per 1000 in the highest quintile; p = 0.037 for trend). Receipt of vaccine by an individual and the level of vaccine coverage of the individual''s social network were independently related to a reduced risk of cholera.

Conclusions

Findings indicate that progressively higher levels of vaccine coverage in bari-level social networks can lead to increasing levels of indirect protection of non-vaccinated individuals and could also lead to progressively higher levels of total protection of vaccine recipients.     

Individual preferences and social interactions determine the aggregation of woodlice

Background

The aggregation of woodlice in dark and moist places is considered an adaptation to land life and most studies are focused on its functionality or on the behavioural mechanisms related to the individual''s response to abiotic factors. Until now, no clear experimental demonstration was available about aggregation resulting from inter-attraction between conspecifics.

Methodology/Main Findings

We present the dynamics of aggregation, not previously described in detail in literature, as being independent of the experimental conditions: homogeneous and heterogeneous environments with identical or different shelters. Indeed whatever these conditions, the aggregation is very quick. In less than 10 minutes more than 50% of woodlice were aggregated in several small groups in the homogeneous environment or under shelters in the heterogeneous environment. After this fast aggregation, woodlice progressively moved into a single aggregate or under one shelter.

Conclusions/Significance

Here we show for the first time that aggregation in woodlice implies a strong social component and results from a trade-off between individual preferences and inter-attraction between individuals. Moreover, our results reveal that the response to the heterogeneities affects only the location of the aggregates and not the level of aggregation, and demonstrate the strong inter-attraction between conspecifics which can outweigh individual preferences. This inter-attraction can lead to situations that could seem sub-optimal.     

Metabolic State Alters Economic Decision Making under Risk in Humans

Background

Animals'' attitudes to risk are profoundly influenced by metabolic state (hunger and baseline energy stores). Specifically, animals often express a preference for risky (more variable) food sources when below a metabolic reference point (hungry), and safe (less variable) food sources when sated. Circulating hormones report the status of energy reserves and acute nutrient intake to widespread targets in the central nervous system that regulate feeding behaviour, including brain regions strongly implicated in risk and reward based decision-making in humans. Despite this, physiological influences per se have not been considered previously to influence economic decisions in humans. We hypothesised that baseline metabolic reserves and alterations in metabolic state would systematically modulate decision-making and financial risk-taking in humans.

Methodology/Principal Findings

We used a controlled feeding manipulation and assayed decision-making preferences across different metabolic states following a meal. To elicit risk-preference, we presented a sequence of 200 paired lotteries, subjects'' task being to select their preferred option from each pair. We also measured prandial suppression of circulating acyl-ghrelin (a centrally-acting orexigenic hormone signalling acute nutrient intake), and circulating leptin levels (providing an assay of energy reserves). We show both immediate and delayed effects on risky decision-making following a meal, and that these changes correlate with an individual''s baseline leptin and changes in acyl-ghrelin levels respectively.

Conclusions/Significance

We show that human risk preferences are exquisitely sensitive to current metabolic state, in a direction consistent with ecological models of feeding behaviour but not predicted by normative economic theory. These substantive effects of state changes on economic decisions perhaps reflect shared evolutionarily conserved neurobiological mechanisms. We suggest that this sensitivity in human risk-preference to current metabolic state has significant implications for both real-world economic transactions and for aberrant decision-making in eating disorders and obesity.     

Acute Stress Increases Sex Differences in Risk Seeking in the Balloon Analogue Risk Task

Background

Decisions involving risk often must be made under stressful circumstances. Research on behavioral and brain differences in stress responses suggest that stress might have different effects on risk taking in males and females.

Methodology/Principal Findings

In this study, participants played a computer game designed to measure risk taking (the Balloon Analogue Risk Task) fifteen minutes after completing a stress challenge or control task. Stress increased risk taking among men but decreased it among women.

Conclusions/Significance

Acute stress amplifies sex differences in risk seeking; making women more risk avoidant and men more risk seeking. Evolutionary principles may explain these stress-induced sex differences in risk taking behavior.     

Health-Related Financial Catastrophe,Inequality and Chronic Illness in Bangladesh

Background

Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk.

Objective

This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe.

Methods

A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively.

Results

On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults.

Conclusion

Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by reducing the health system''s dependency on OOP payments and providing more financial risk protection.     

Maternal Complications and Women's Behavior in Seeking Care from Skilled Providers in North Gondar,Ethiopia

Background

Maternal complications are morbidities suffered during pregnancy through the postpartum period of 42 days. In Ethiopia, little is known about women''s experience of complications and their care-seeking behavior. This study attempted to assess experiences related to obstetric complication and seeking assistance from a skilled provider among women who gave birth in the last 12 months preceding the study.

Methods

This study was a cross-sectional survey of women who gave birth within one year preceding the study regardless of their delivery place. The study was carried out in six selected districts in North Gondar Zone, Amhara Region. Data was collected house-to-house in 12 selected clusters (kebeles) using a pretested Amharic questionnaire. During the survey, 1,668 women were interviewed. Data entry was done using Epi Info version 3.5.3 and was exported to SPSS for analysis. Logistic regression was applied to control confounders.

Results

Out of the total sample, 476 women (28.5%, 95% CI: 26.4%, 30.7%) reported some kind of complication. The most common complications reported were; excessive bleeding and prolonged labor that occurred mostly at the time of delivery and postpartum period. Out of the total women who faced complications, 248 (52.1%, 95% CI: 47.6%, 56.6%) sought assistance from a skilled provider. Inability to judge the severity of morbidities, distance/transport problems, lack of money/cost considerations and use of traditional options at home were the major reasons for not seeking care from skilled providers. Belonging to a wealthier quintile, getting antenatal care from a skilled provider and agreement of a woman in planning for possible complications were significantly associated with seeking assistance from a skilled provider.

Conclusion

Nearly half of the women who faced complications did not use skilled providers at the time of obstetric complications. Cognitive, geographic, economic and cultural barriers were involved in not using skilled maternal care.     

Injury Related Risk Behaviour: A Health Belief Model-Based Study of Primary School Students in a Safe Community in Shanghai

Aim

To explore the relationship between Health belief model (HBM) and children and adolescents'' unintentional injury risk behavior, to add some useful information for injury prevention.

Methodology

We investigated injury related health risk behavior and health belief status of students at primary schools grade 3 to 4, in a Safe Community, in Shanghai. Self-administered injury questionnaires were used to investigate risk behavior of students and HBM factors.

Principal Findings

The prevalence of risk behavior among students reported in this community was high. HBM scores showed differences between two groups of students classified by whether they had risk behavior or not. Self-efficacy was highly related with the status of socio-psychological behavior.

Significance

HBM has been widely used in explaining the disease-related behavior; however, it has been seldom used in injury-related behavior. The study demonstrated important relation of HBM to students'' injury issues, and HBM could explain injury related behavior as well, especially for traffic injury-related behavior. When developing injury prevention strategies, we can take it into account.     

Political Regimes,Political Ideology,and Self-Rated Health in Europe: A Multilevel Analysis

Background

Studies on political ideology and health have found associations between individual ideology and health as well as between ecological measures of political ideology and health. Individual ideology and aggregate measures such as political regimes, however, were never examined simultaneously.

Methodology/Principal Findings

Using adjusted logistic multilevel models to analyze data on individuals from 29 European countries and Israel, we found that individual ideology and political regime are independently associated with self-rated health. Individuals with rightwing ideologies report better health than leftwing individuals. Respondents from Eastern Europe and former Soviet republics report poorer health than individuals from social democratic, liberal, Christian conservative, and former Mediterranean dictatorship countries. In contrast to individual ideology and political regimes, country level aggregations of individual ideology are not related to reporting poor health.

Conclusions/Significance

This study shows that although both individual political ideology and contextual political regime are independently associated with individuals'' self-rated health, individual political ideology appears to be more strongly associated with self-rated health than political regime.     

Incubation patterns in a central-place forager affect lifetime reproductive success: scaling of patterns from a foraging bout to a lifetime

Background

Long-lived seabirds face a conflict between current and lifelong reproductive success. During incubation shifts, egg neglect is sometimes necessary to avoid starvation, but may compromise the current reproductive attempt. However, factors underlying this decision process are poorly understood. We focus on the ancient murrelet, Synthliboramphus antiquus, an alcid with exceptionally long incubation shift lengths, and test the impact of environmental factors on incubation shift length in relation to reproductive success.

Methodology/Principal Findings

Using an information theoretic approach, we show that incubation shift length was a strong predictor of reproductive success for ancient murrelets at Reef Island, Haida Gwaii, British Columbia, Canada during the 2007 and 2008 breeding seasons. The most important factors explaining an individual''s shift length were egg size, wind speed and the length of the mate''s previous shift. Wind speed and tide height were the two most important factors for determining foraging behavior, as measured by dive frequency and depth.

Conclusions/Significance

Our study demonstrates that (i) species-specific reproductive strategies interact with environmental conditions such as wind speed to form multiple incubation patterns and (ii) maintaining regular incubation shifts is an essential component of reproductive success.     

Consistency of financial interest disclosures in the biomedical literature: the case of coronary stents

Background

Disclosure of authors'' financial interests has been proposed as a strategy for protecting the integrity of the biomedical literature. We examined whether authors'' financial interests were disclosed consistently in articles on coronary stents published in 2006.

Methodology/Principal Findings

We searched PubMed for English-language articles published in 2006 that provided evidence or guidance regarding the use of coronary artery stents. We recorded article characteristics, including information about authors'' financial disclosures. The main outcome measures were the prevalence, nature, and consistency of financial disclosures. There were 746 articles, 2985 authors, and 135 journals in the database. Eighty-three percent of the articles did not contain disclosure statements for any author (including declarations of no interests). Only 6% of authors had an article with a disclosure statement. In comparisons between articles by the same author, the types of disagreement were as follows: no disclosure statements vs declarations of no interests (64%); specific disclosures vs no disclosure statements (34%); and specific disclosures vs declarations of no interests (2%). Among the 75 authors who disclosed at least 1 relationship with an organization, there were 2 cases (3%) in which the organization was disclosed in every article the author wrote.

Conclusions/Significance

In the rare instances when financial interests were disclosed, they were not disclosed consistently, suggesting that there are problems with transparency in an area of the literature that has important implications for patient care. Our findings suggest that the inconsistencies we observed are due to both the policies of journals and the behavior of some authors.     

Effect of Cafeteria Diet History on Cue-, Pellet-Priming-, and Stress-Induced Reinstatement of Food Seeking in Female Rats

Background

Relapse to unhealthy eating habits is a major problem in human dietary treatment. The individuals most commonly seeking dietary treatment are overweight or obese women, yet the commonly used rat reinstatement model to study relapse to palatable food seeking during dieting primarily uses normal-weight male rats. To increase the clinical relevance of the relapse to palatable food seeking model, here we pre-expose female rats to a calorically-dense cafeteria diet in the home-cage to make them overweight prior to examining the effect of this diet history on cue-, pellet-priming- and footshock-induced reinstatement of food seeking.

Methods

Post-natal day 32 female Long-Evans rats had seven weeks of home-cage access to either chow only or daily or intermittent cafeteria diet alongside chow. Next, they were trained to self-administer normally preferred 45 mg food pellets accompanied by a tone-light cue. After extinction, all rats were tested for reinstatement induced by discrete cue, pellet-priming, and intermittent footshock under extinction conditions.

Results

Access to daily cafeteria diet and to a lesser degree access to intermittent cafeteria diet decreased food pellet self-administration compared to chow-only. Prior history of these cafeteria diets also reduced extinction responding, cue- and pellet-priming-induced reinstatement. In contrast, modest stress-induced reinstatement was only observed in rats with a history of daily cafeteria diet.

Conclusion

A history of cafeteria diet does not increase the propensity for cue- and pellet-priming-induced relapse in the rat reinstatement model but does appear to make rats more susceptible to footshock stress-induced reinstatement.     

Cardiovascular Disease Risk Models and Longitudinal Changes in Cognition: A Systematic Review

Background

Cardiovascular disease and its risk factors have consistently been associated with poor cognitive function and incident dementia. Whether cardiovascular disease prediction models, developed to predict an individual''s risk of future cardiovascular disease or stroke, are also informative for predicting risk of cognitive decline and dementia is not known.

Objective

The objective of this systematic review was to compare cohort studies examining the association between cardiovascular disease risk models and longitudinal changes in cognitive function or risk of incident cognitive impairment or dementia.

Materials and Methods

Medline, PsychINFO, and Embase were searched from inception to March 28, 2014. From 3,413 records initially screened, 21 were included.

Results

The association between numerous different cardiovascular disease risk models and cognitive outcomes has been tested, including Framingham and non-Framingham risk models. Five studies examined dementia as an outcome; fourteen studies examined cognitive decline or incident cognitive impairment as an outcome; and two studies examined both dementia and cognitive changes as outcomes. In all studies, higher cardiovascular disease risk scores were associated with cognitive changes or risk of dementia. Only four studies reported model prognostic performance indices, such as Area Under the Curve (AUC), for predicting incident dementia or cognitive impairment and these studies all examined non-Framingham Risk models (AUC range: 0.74 to 0.78).

Conclusions

Cardiovascular risk prediction models are associated with cognitive changes over time and risk of dementia. Such models are easily obtainable in clinical and research settings and may be useful for identifying individuals at high risk of future cognitive decline and dementia.     

Validation of an Instrument to Measure Older Adults' Expectations Regarding Movement (ERM)

Background

Many individuals with Parkinson''s disease are not diagnosed and treated. Attitudes about aging and related help-seeking may affect the timely diagnosis of Parkinson''s disease. Our objectives were to develop measures of older adults'' expectations regarding movement with aging, specifically related to parkinsonism, and their beliefs about seeking healthcare for the diagnosis and treatment of parkinsonism.

Methods

We established content and face validity from interviews with experts, review of the literature, and pre-testing with key informants. Two 9-item instruments resulted: Expectations Regarding Movement (ERM) and Healthcare Seeking Beliefs for parkinsonism (HSB). These instruments were administered to 210 older adults at senior centers to investigate internal consistency and construct validity.

Results

192 (91%) of the older adults completed more than 90% of the survey. The mean age was 76; 17 (9%) reported parkinsonism. Both scales demonstrated good internal consistency (α = 0.90). Factor analysis supported construct validity of the ERM and HSB scores. Older age, lower education, worse self-reported health and African American race each were associated with lower ERM scores, but not HSB scores.

Conclusion

The ERM, a brief measure of expectations regarding movement with aging, shows reliability and validity. This scale may be useful in identifying older adults at increased risk for under-identification of Parkinson''s disease. Further work is needed to measure healthcare seeking for parkinsonism.     

Combining qualitative and quantitative evidence to determine factors leading to late presentation for antiretroviral therapy in Malawi

Background

Treatment seeking delays among people living with HIV have adverse consequences for outcome. Gender differences in treatment outcomes have been observed in sub-Saharan Africa.

Objective

To better understand antiretroviral treatment (ART) seeking behaviour in HIV-infected adults in rural Malawi.

Methods

Qualitative interviews with male and female participants in an ART cohort study at a treatment site in rural northern Malawi triangulated with analysis of baseline clinical and demographic data for 365 individuals attending sequentially for ART screening between January 2008 and September 2009.

Results

43% of the cohort presented with late stage HIV disease classified as WHO stage 3/4. Respondents reported that women''s frequency of testing, health awareness and commitment to children led to earlier ART uptake and that men''s commitment to wider social networks of influence, masculine ideals of strength, and success with sexual and marital partners led them to refuse treatment until they were sick. Quantitative analysis of the screening cohort provided supporting evidence for these expressed views. Overall, male gender (adjusted OR 2.3, 95% CI1.3–3.9) and never being married (adjusted OR 4.1, 95% CI1.5–11.5) were risk factors for late presentation, whereas having ≥3 dependent children was associated with earlier presentation (adjusted OR 0.31, 95% CI0.15–0.63),compared to those with no dependent children.

Conclusion

Gender-specific barriers and facilitators operate throughout the whole process of seeking care. Further efforts to enrol men into care earlier should focus on the masculine characteristics that they value, and the risks to these of severe health decline. Our results emphasise the value of exploring as well as identifying behavioural correlates of late presentation.     

Facial Mimicry in 6–7 Year Old Children with Disruptive Behavior Disorder and ADHD

Background

Impairments in facial mimicry are considered a proxy for deficits in affective empathy and have been demonstrated in 10 year old children and in adolescents with disruptive behavior disorder (DBD). However, it is not known whether these impairments are already present at an earlier age. Emotional deficits have also been shown in children with attention-deficit/hyperactivity disorder (ADHD).

Aims

To examine facial mimicry in younger, 6–7 year old children with DBD and with ADHD.

Methods

Electromyographic (EMG) activity in response to emotional facial expressions was recorded in 47 children with DBD, 18 children with ADHD and 35 healthy developing children.

Results

All groups displayed significant facial mimicry to the emotional expressions of other children. No group differences between children with DBD, children with ADHD and healthy developing children were found. In addition, no differences in facial mimicry were found between the clinical group (i.e., all children with a diagnosis) and the typically developing group in an analysis with ADHD symptoms as a covariate, and no differences were found between the clinical children and the typically developing children with DBD symptoms as a covariate.

Conclusion

Facial mimicry in children with DBD and ADHD throughout the first primary school years was unimpaired, in line with studies on empathy using other paradigms.