Foram estudados 125 pacientes em idade escolar que procuraram o Posto de Atendimento Médico Especializado (PAME) da cidade de São Leopoldo, Rio Grande do Sul, Brasil, nos anos de 2003 e 2004, encaminhados pela escola, pelo pediatra ou Conselho Tutelar, por estarem apresentando dificuldades na escolarização. Realizaram-se entrevistas com os pais ou responsáveis, exame neurológico tradicional, exame neurológico evolutivo, eletroencefalograma em sono e vigília em todas as crianças e tomografia cerebral e ressonância magnética, quando necessário. Foram estudados aspectos neuropsicossociais dos indivíduos e de suas respectivas famílias. Encontraram-se famílias comprometidas em sua história prévia e atual: 29,30% com dificuldades escolares, 27,20% com doenças psiquiátricas, 26,10% com epilepsia, 21,70% com alcoolismo e 10,90% com deficiência mental. As comorbidades tiveram um papel relevante no desempenho escolar: 50,50% com hiperatividade, 17,20% com distúrbio de conduta e 17,20% com problemas emocionais (listados como queixa principal por ocasião do encaminhamento para a triagem). / A hundred and twenty five patients at school age referred to the Ambulatory of Specialized Diseases in the town of São Leopoldo, Rio Grande do Sul, Brazil, by the school, by the pediatricians or by Tutor Counsellor, due to learning disability, were followed during the years 2003 and 2004. Parents were interviewed; neurological examination was performed as well as electroencephalographic exams. In some cases, brain computadorized tomography and brain magnetic resonance was also done, when necessary. Neurological, psychological and social aspects of the patient and his family were investigated. Both past and current conditions were found in these families: 29.30% with learning disabilities, 27.20% with mental illness, 26.10% with epilepsy, 21.70% with alcoholism, 10.90% with mental handicap. Comorbidities also played an important role in school performance: 50.50% hyperactivity, 17.20% conduct problems, 17. 20% emotional problems all listed as complaints by the school, pediatricians, parents or Tutor Counsellor.

Abstract The aim of this dissertation was to investigate the association between family history of mental disorders, especially psychosis, and long-term social, occupational and clinical outcome in schizophrenia. In addition, the association of pregnancy, birth and early development related factors with occupational and clinical outcome in schizophrenia were analysed. Two meta-analyses and the Northern Finland Birth Cohorts 1966 and 1986 (NFBC1966 and NFBC1986) were used to gather the data. In the meta-analyses family history of psychosis was associated with poorer long-term clinical, occupational and global (i.e. combined occupational, social and clinical) outcome in schizophrenia. NFBC1966 is an unselected, population-based sample of 12,058 live-born children and includes 161 individuals with schizophrenia spectrum disorder. NFBC1986 is also an unselected, population-based cohort and consists of 9,432 live-born children and includes 189 individuals with psychosis. In the NFBC1966 study family history of any mental disorder was associated with more severe positive and emotional symptoms, but was not associated with other clinical symptoms or social, occupational or global outcome in schizophrenia. The family history of psychosis was not associated with outcomes. Regarding pregnancy, birth and early development related factors, it was found that young maternal age was associated with higher probability of being hospitalised with schizophrenia. In the NFBC1986 study a family history of any mental disorder was associated with higher number of days spent at hospital and higher number of hospitalisations, but it was not associated with occupational outcome or disability pension in psychotic disorders. A family history of psychosis was not associated with outcomes. This study suggests that family history of psychosis has a small association with clinical, occupational and global outcome in schizophrenia. There is less research regarding the association between family history of any mental disorder and outcome in schizophrenia, but based on the cohort studies family history of any mental disorder could be even stronger outcome predictor than family history of psychosis. Family history of mental disorders and especially psychosis is a strong risk factor for schizophrenia, and based on this study it seems to also associate with poorer outcome. / Tiivistelmä Tämän väitöstutkimuksen tavoitteena oli tutkia, miten mielenterveyshäiriöiden, erityisesti psykoosin, esiintyminen suvussa on yhteydessä pitkän ajan sosiaaliseen, kliiniseen ja työkykyyn liittyvään ennusteeseen skitsofreniassa. Lisäksi tutkittiin sitä, kuinka raskauteen, syntymään ja varhaiseen kehitykseen liittyvä tekijät ovat yhteydessä työntekoon ja kliiniseen ennusteeseen skitsofreniassa. Asiaa tutkittiin kahdessa meta-analyysissä ja Pohjois-Suomen vuoden 1966 ja 1986 syntymäkohorteissa. Meta-analyysien mukaan psykoosin sukurasitus oli yhteydessä huonompaan pitkän ajan kliiniseen, työkykyyn liittyvään ja kokonaisennusteeseen (yhdistetty sosiaalinen, kliininen ja työnteon ennuste) skitsofreniassa. Pohjois-Suomen vuoden 1966 syntymäkohortti on valikoitumaton, yleisväestöpohjainen kohortti, johon kuuluu 12 058 elävänä syntynyttä lasta. Kohortti sisältää 161 skitsofreniaa sairastavaa henkilöä. Pohjois-Suomen vuoden 1986 syntymäkohortti on myös valikoitumaton, yleisväestöpohjainen kohortti. Siihen kuuluu 9 432 elävänä syntynyttä lasta, joista 189:llä on psykoosi. Pohjois-Suomen vuoden 1966 syntymäkohortin mukaan mielenterveyshäiriön esiintyminen suvussa liittyi vakavampiin positiivisiin ja emotionaalisiin oireisiin, mutta ei liittynyt muihin kliinisiin oireisiin, työkykyyn, sosiaaliseen tai kokonaisennusteeseen. Psykoosin sukurasitus ei liittynyt ennusteeseen. Raskauteen, syntymään ja varhaiseen kehitykseen liittyvien tekijöiden osalta tutkimuksessa todettiin, että äidin nuori ikä oli yhteydessä suurempaan sairaalahoidon todennäköisyyteen skitsofreniassa. Pohjois-Suomen vuoden 1986 syntymäkohortin mukaan mielenterveyshäiriön esiintyminen suvussa liittyi suurempaan sairaalahoitopäivien ja sairaalahoitokertojen lukumäärään, mutta ei liittynyt työssäkäyntiin tai työkyvyttömyyseläkkeeseen psykoottisissa häiriöissä. Psykoosin sukurasitus ei liittynyt ennusteeseen. Näiden tulosten mukaan psykoosin sukurasituksella on pieni yhteys kliiniseen, työkykyyn liittyvään ja kokonaisennusteeseen skitsofreniassa. Minkä tahansa suvussa esiintyvän mielenterveyshäiriön yhteydestä ennusteeseen on vähemmän tutkimuksia, mutta kohorttitutkimusten perusteella millä tahansa suvussa esiintyvällä mielenterveyshäiriöllä voi olla jopa suurempi yhteys ennusteeseen kuin psykoosin sukurasituksella. Mielenterveyshäiriöiden ja etenkin psykoosin esiintyminen suvussa on voimakas skitsofrenian riskitekijä, ja tämän tutkimuksen mukaan se on myös yhteydessä huonompaan ennusteeseen.

Abstract Specific prevention of sudden cardiac death (SCD) caused by an acute coronary event in the general population has remained a challenge for clinicians since the recognizable risk factors for this fatal outcome of an underlying coronary artery disease (CAD) may be partly the same as those of a non-fatal coronary event. This case-control study was designed to compare genetic and several other factors between consecutive series of survivors (n = 644) and victims of SCD (n = 425) from an acute coronary event. Only subjects with an acute coronary event verified at medico-legal autopsy were included in the SCD group. As controls, 809 subjects without any history of CAD, acute myocardial infarction or aborted cardiac arrest were examined. Subjects to the sub-studies were drawn from these study populations. The increased risk for SCD in the general population was associated with family history of SCD, male gender, smoking, cardiac hypertrophy and the severity of CAD. In the present study, 100% mortality was observed when all these risk factors were present at the time of an acute coronary event. In the subjects with a family history of SCD, the increased risk of SCD was correlated with the severity of CAD without any clustering of coronary risk factors, suggesting that genetic factors affecting the accelerated progression of CAD may have an important role in familial SCD. However, polymorphisms of genes affecting thrombosis, which are believed to have effects on plaque progression and the consequences of plaque complications, were not associated with an increased risk for SCD. The present results show that the risk of SCD at the time of an acute coronary event can be assessed by generally available methods. If a subject is a male smoker and has a family history of SCD, the risk of SCD is substantially increased. In our study sample the currently known polymorphisms affecting thrombosis did not have a major impact in risk stratification of genetic susceptibility for SCD. Simple association studies have clear shortcomings when they attempt to reveal genetic associations with complex outcomes and thus new research strategies are needed to elucidate the genetic background of SCD.

First degree relatives (FDRs) of subjects with early onset of coronary heart disease (CHD) have higher risk of developing cardiovascular disease. We verified early CHD by angiography in the index patients and extensively phenotyped their FDRs to investigate the relationship of traditional and non-traditional cardiovascular risk factors to carotid ultrasound and coronary calcium scoring findings. B-mode carotid ultrasound was used to assess the combined intima-media thickness and plaque burden in 111 FDRs. The biochemical and anthropometrical characteristics of the FDRs were compared with those of healthy controls matched for sex, age, ethnicity and BMI. Odds ratios indicate that FDRs are more likely to have positive carotid ultrasound findings compared to controls; 2.23 (95% CI 1.14 – 4.37) for intima-media thickness and 2.3 (95% CI 1.22 - 4.35) for average total thickness. In multivariate analysis positive carotid ultrasound findings were higher in FDRs independent of age, gender, total cholesterol over HDL-c ratio, systolic blood pressure and smoking but not homocysteine which had higher values in FDRs compared to controls. In conclusion FDRs of patients with angiographically confirmed CHD have higher burden of subclinical atherosclerosis even when considered in the context of traditional risk factors. Coronary artery calcium scoring (CAC), assessed by 64-slice multi-detector computed tomography (MDCT), was used to assess burden of subclinical atherosclerosis in 57 FDRs compared to controls. FDRs have a two-fold increase in risk of having CAC positive findings; odds ratios for the 75th percentile was 1.96 (95%CI 1.04 – 3.67, p<0.05) while for the 90th percentile odds ratio was 2.59 (95% 1.232 – 5.473, p<0.05). In summary, the risk of significant CAC findings, measured by 64-slice MDCT, is two-fold higher in FDRs than controls. These findings correlate highly with carotid ultrasound findings in the same cohort. Different thresholds for CAC may be appropriate when assessing male versus female FDRs. Together increased carotid ultrasound findings and CAC scoring results in FDRs of patients with validated early onset of CHD suggest these imaging techniques as potentially useful tools in cardiovascular risk assessment that will go above and beyond the current diagnostic algorithms. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate

Family history (FH) is a risk factor for many diseases. Disease guidelines often include family history as important in assessing chronic disease risks, but the empirical evidence base to inform the routine use of family history in primary care in practice appears largely lacking. An environmental scan of how family history is represented in prevention guidelines for five conditions showed that, while family history is often included in guidelines, there is variation in the definition used, recommendation given and evidence cited. A dataset on cardiovascular health in women was analyzed to examine whether family history offers useful discrimination value above standard risk factors. Regression results showed that family history is an independent risk predictor for coronary heart disease which improves discrimination beyond classical clinical factors. However, the absolute amount of discriminatory ability alone or with other factors is moderate at best, raising issues regarding clinical utility.

Abstract: Family history (FH) is a risk factor for many conditions that can affect pediatric patients. While there is no evidence of the clinical utility of FH taking in pediatrics and there is no standard of care as to FH taking, many suggestions were made as to what conditions should be covered in a pediatric FH assessment. There is also no evidence of the current practice. In this study the Theoretical Domains Framework was applied to FH taking and used to conduct semi-structured interviews with pediatricians to explore their FH taking practice. The pediatricians reported similar FH taking habits. Their FH taking was reported to include a wide range of conditions and determinants of health, and they used this information for a broad range of clinical tasks. FH taking in pediatric practice was reported to be complex and embedded with other aspects of practice. Résumé: Les antécédents familiaux (AF) sont des facteurs de risque pour plusieurs maladies affectant les patients pédiatriques. Alors qu'il n'y a ni données probantes concernant l'utilité des AF en pédiatrie ni normes pour la prise d'AF, plusieurs ont fait des suggestions quant à ce qui devrait être couvert par la prise d'AF. Il n'y a pas de données probantes décrivant la pratique actuelle de prise d'AF en pédiatrie. Dans cette étude, le Theoretical Domains Framework a été appliqué à la prise d'AF et utilisé afin de diriger des entrevues semi-structurées avec des pédiatres, dans le but de décrire leur pratique actuelle. Les pédiatres ont dit avoir des habitudes semblables quant à la prise d'AF. Cette dernière inclut plusieurs maladies et déterminants de la santé, et ils utilisent cette information pour plusieurs tâches. La prise d'AF en pédiatrie a été décrite comme étant complexe et très intégrée à leur pratique entière.

Research shows that the pupils in school need anchoring in reality and motivation to become interested and understand history. Local history is the history about the community and makes it possible for the ordinary person to become part of historic events. The aim with this study is to clarify in which magnitude local history is taught in middle school, how and what is taught and if teaching local history contributes to the development of the pupils´ identity and knowledge. Interviews with teachers in middle school reveals that the teachers mainly teach local history by visiting different locations, for example museums. Teachers use local history when ordinary history lessons need clarification. The study contains a survey that shows that the larger part of the pupils who answered the survey knows what local history means. The pupils are also mainly interested in his or her family history compared to history in general and history about his or her hometown. / Forskning visar att eleverna i skolan behöver verklighetsförankring och motivation för att intressera sig och förstå historia. Lokalhistorien är historia om närsamhället och möjliggör för den vanliga människan att vara delaktig i det historiska skeendet. Syftet med denna studie är att förtydliga i vilken omfattning lokalhistoria undervisas på mellanstadiet, hur och vad som undervisas, samt om undervisning av lokalhistoria bidrar till elevers identitets- och kunskapsutveckling. Genom lärarintervjuer framkommer det att lärarna främst undervisar om lokalhistoria genom olika studiebesök, men också för att förtydliga undervisningen av historia. Studien innefattar en enkätundersökning med syfte att undersöka om elever som går i årskurs sex har intresse av historia och om deras reflektioner kring lokalhistoria. Enkätundersökningen visade att större delen av de elever som svarade på enkäten vet vad lokalhistoria betyder. Eleverna är också främst intresserade av sin familjs historia jämfört med historia allmänt och om sin hemstad.

The study examined the overlap between cognitive and affective measures of alcohol expectancies as they related to risk for developing alcohol use disorders. It was hypothesized that cognitive-based, paper-and-pencil measures and appetitive psychophysiological reactivity to alcohol cues would correlate and independently correlate to drinking behavior in a sample of college drinkers. It was also hypothesized that genetic risk would impact the relationship between upstream and downstream expectancy measures, given that children of alcoholics displayed blunted reactivity to appetitive cues. A sample of 137 college drinkers (67 males; mean age = 20.23 ± 1.61) reporting a range of drinking behavior (mean quantity/occasion = 4.03 ± 2.34; mean frequency/month = 6.24 ± 4.31) and genetic risk for alcohol use disorders (47 children of alcoholics) participated in this study. The cue reactivity paradigm included the measurement of skin conductance, cardiac response, and acoustic startle eyeblink response to a randomized sequence of alcohol and neutral pictures. Questionnaires and interviews assessed alcohol expectancies, family history, drinking behavior, and risk. Findings revealed that cognitive and affective measures shared modest overlap in the overall sample, such that sedating and negative alcohol expectancies were positively correlated with less appetitive early acoustic startle response. However, alcohol expectancies were not significantly correlated with any of the remaining psychophysiological measures. Further, affective measures were not related to drinking behavior, indicating failure to detect drinking variance in a sample of college drinkers. Findings also indicated that genetic risk impacted the relationship between cognitive and affective measures of expectancy. Specifically, children of alcoholics (COAs) displayed stronger relationships between both positive and negative expectancies and early startle response than their peers. Further, COA Status moderated the relationship between early startle response and Social/Physical Pleasure and Positive/Arousing alcohol expectancies. This dissertation provided evidence that cognitive and affective measures of alcohol expectancies shared modest overlap, indicating that expectancy subscales and early acoustic startle response tapped into the same expectancy construct. Further, genetic risk moderated the strength of relationships between upstream and downstream expectancy measures, which were stronger in children of alcoholics. Overall, affective measures of expectancy were more sensitive to expectancy variation in high-risk college drinkers.

Indiana University-Purdue University Indianapolis (IUPUI) / It is well documented that adolescent substance use is associated with deficits in brain function and behavior. However, possible deficits that predate substance use initiation remain poorly characterized in preadolescents at-risk for developing substance use disorder (SUD). To characterize potential brain and behavioral differences that predate substance use, substance naïve preadolescents, ages 11–12, were recruited into three groups to complete functional magnetic resonance imaging delay discounting: (1) High-risk youth (n=35) with a family history of SUD and externalizing psychiatric disorders, (2) psychiatric controls (n=35) with no family history of SUD, but equivalent externalizing psychiatric disorders as high-risk youth, and (3) healthy controls (n=29) with no family history of SUD and minimal psychopathology. While no behavioral differences between groups were identified, there were group differences in posterior cingulate cortex (PCC) function during decision making. Specifically, the high-risk group showed stronger deactivation of the PCC than healthy controls. These results suggest that high-risk preadolescents may need to suppress activity of key nodes of the default mode network (a task negative network) to a greater extent to properly allocate attention to the task.

During World War II, Japanese across North America were forced into internment camps out of suspicion and wartime hysteria. The historiography has chosen to focus specifically on Japanese Americans and their experiences. Academic and popular history is overwhelmingly focused on Japanese Americans, with minimal discussion ever given to Japanese Canadians or Mexicans who were interned. Tens of thousands of Japanese Canadians were interned during this tumultuous time. By ignoring their testimonies and hardships, history has forgotten these oppressed people. This thesis seeks to examine the current historiography of Japanese Canadians and compare it to that of Japanese Americans while also exploring the importance of including Japanese Canadians in the historiography. By tying together family history and academic research, this work seeks to bring greater attention to this subject so that the plights of these innocent people are no longer forgotten.