Researchers have discovered a blood protein that could help detect which children will experience ongoing concussion symptoms more than two weeks after an injury.
The research, led by Murdoch Children’s Research Institute (MCRI) and published in the Journal of Neurotrauma, found the protein was a potential biomarker for delayed recovery from concussion in children.
For the study, blood samples were collected from children, aged five-18 years, who presented to the emergency department at The Royal Children’s Hospital less than 48 hours after a concussion.
Levels of the protein alpha-1-antichymotrypsin (alpha-1-ACT) were significantly lower in children with a delayed recovery.
MCRI researcher Ella Swaney said with concussion being a growing public health concern, there was an increasing need to develop a tool that could contribute to identifying those at risk of delays to recovery.
Of the four million children who experience a concussion each year, 25-30 per cent will have long-term symptoms and about half will never seek out medical care. Symptoms including headaches, difficulty remembering and sensitivity to light can last for months while mental health conditions can persist for several years.
“Delayed recovery from concussion spans emotional, behavioural, physical and cognitive symptoms, which can affect the well-being of the child, delaying their return to school and sport,” Ms Swaney said.
“Early detection of children at risk of delayed recovery is crucial to ensure effective treatment and targeted follow-up.”
MCRI Professor Vicki Anderson said this small study, involving 80 children, was the first in human trial to identify that alpha-1-ACT could contribute to the early detection of those who will experience a delayed recovery from concussion.
“If the finding holds up in larger studies, the discovery could contribute to acute clinical management by providing clinicians with an acute marker to guide more timely and targeted treatments to children most likely to experience long-term problems,” she said.
Mackenzie, 16, suffered a concussion during a netball match 15 months ago. She was hit in the face by an opposing player’s upper arm, knocking her out, and causing her to smack her head on the indoor court.
Out cold for a minute and suffering a nosebleed and swollen left eye, Mackenzie was taken to hospital where she was diagnosed with a concussion.
“I was knocked out while jumping mid-air, the force spinning me 180 degrees, and then I landed on my head for a second blow,” she said.
“When I woke up, I couldn’t see out of my eye and I was lying in a pool of my own blood. I felt dizzy, confused and everything became a blur.”
In the weeks that followed, as well as the dizziness and confusion, Mackenzie was nauseous, sensitive to bright lights, had memory loss, headaches and muscle soreness and poor mental health. She also missed weeks of school due to the ongoing concussion symptoms.
To help her recover, Mackenzie was enrolled in MCRI’s Concussion Essentials Plus program for children with chronic persisting concussion symptoms. It involved weekly physiotherapy and psychology treatments spanning months and education around return to exercise, school and sports.
“It was a slow recovery process, but the intervention helped me return to my normal self again,” she said. All I wanted was to be back on the netball court. I didn’t understand at the time how much of a long-term impact concussion can have.”
Mackenzie returned to netball five months after the injury.
“I’m more hesitant and cautious on the court now but I would never give up playing netball, I love the sport too much,” she said.
Mackenzie’s mum Karen Payne, who will never forget the image of her daughter lying unconscious on the court, said the latest MCRI research would come as a welcome to relief to families.
“If clinicians can easily find out which children will have long term concussion symptoms then they can receive targeted and early intervention,” she said. Recovery from concussion can be a long process, like our daughter’s, and anything that can help speed up the process would make a world of difference.”
In 2023, a vast body of international research, with major contributions from MCRI researchers, took a deep dive into all aspects of concussion management.
The updated consensus findings aimed to change how concussion was viewed across sporting codes, recreational sport and within medical clinics and emergency departments by overhauling exercise and rehabilitation methods and upgrading return-to school and return-to-sport protocols.
Another concussion management tool, the HeadCheck App, designed by child concussion experts at MCRI in collaboration with The Royal Children’s Hospital and the Australian Football League (AFL), also helps recognise concussion early and manage recovery.
Researchers from the University of Melbourne, Macquarie University’s Australian Proteome Analysis Facility, Austin and Cabrini Hospitals, Johns Hopkins All Children’s Institute for Clinical and Translational Research and Hopkins University also contributed to the study findings.
Publication: Ella EK Swaney, Franz E Babl, Vanessa C Rausa, Nicholas Anderson, Stephen JC Hearps, Georgia Parkin, Gene Hart-Smith, Thiri Zaw, Luke Carroll, Michael Takagi, Marc L Seal, Gavin A Davis, Vicki Anderson and Vera Ignjatovic. ‘Discovery of alpha-1-antichymotrypsin as a marker of delayed recovery from concussion in children,’ Journal of Neurotrauma. DOI: 10.1089/neu.2023.0503
*The content of this communication is the sole responsibility of the Murdoch Children’s and does not reflect the views of the NHMRC.
Available for interview:
Professor Vicki Anderson, MCRI Theme Director, Clinical Sciences
Ella Swaney, MCRI researcher
Karen Payne and her daughter Mackenzie, 16, who suffered a concussion
JOURNAL
Journal of Neurotrauma
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Discovery of alpha-1-antichymotrypsin as a marker of delayed recovery from concussion in children
ARTICLE PUBLICATION DATE
9-Apr-2024
More synchrony between parents and children not always better
UNIVERSITY OF ESSEX
More synchrony between parents and children may not always be better, new research has revealed.
For the first time a new University of Essex study looked at behavioural and brain-to-brain synchrony in 140 families with a special focus on attachment.
It looked at how they feel and think about emotional bonds whilst measuring brain activity as mums and dads solved puzzles with their kids.
The study – published in Developmental Science - discovered that mums with insecure attachment traits showed more brain-to-brain synchrony with their children.
Dr Pascal Vrticka, from the Department of Psychology, said: “For secure child attachment development, sensitive and mutually attuned interactions with parents are crucial.
“If the parent, here the mother, has more insecure attachment traits it may be more difficult for the dyad to achieve optimal behavioural synchrony.
“Increased brain-to-brain synchrony may reflect a neural compensation mechanism to overcome otherwise less attuned interaction elements.”
The study also discovered different behavioural and brain-to-brain synchrony patterns depending on whether the parent was a mum or a dad.
Fathers and children showed stronger brain-to-brain synchrony, whereas mums and their kids had stronger behavioural synchrony.
These findings suggest higher father-child brain-to-brain synchrony may reflect a neural compensation strategy to counteract a relative lack of behavioural synchrony.
It hopes this research will springboard studies into parent-child relationships and open new avenues for intervention and prevention.
It comes as Dr Vrticka prepares to work with the NHS to explore family relationships.
He added: “Together with the East Suffolk and North Essex NHS Foundation Trust, we will soon start looking at synchrony within families with neurodivergent children and children with experiences of care and adoption.
“Our aim is to find behavioural and neurobiological correlates of an optimal range of synchrony to help all families with their relationships and child attachment development.
In doing so, we must appreciate that not only low but also high synchrony can signal interaction and relationship difficulties.”
Attachment was assessed in parents with an interview and in children with a story completion task.
Brain-to-brain synchrony between parents and children was derived from functional near-infrared spectroscopy (fNIRS) hyperscanning.
Finally, the parent-child interaction was video-recorded and coded for behavioural synchrony.
The study was led by Dr Trinh Nguyen who now works at the Italian Institute of Technology in Rome, Italy, and Dr Melanie Kungl from the University of Erlangen-Nuremberg, Germany - along with colleagues from Vienna, Berlin, and Leipzig.
JOURNAL
Developmental Science
METHOD OF RESEARCH
Experimental study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Visualizing the invisible tie: Linking parent–child neural synchrony to parents’ and children's attachment representations
The SUNRISE European Study Group, led by experts in physical activity and children’s health, is urgently appealing to countries across Europe to take specific measures to promote healthy movement behaviours in children aged under five years. Under the leadership of Jesús del Pozo, an expert in the Epidemiology of Physical Activity and (children’s) health and leader of the EPAFit (Epidemiology of Physical Activity and Fitness Across Lifespan) Research Group at the University of Seville and the leader of the SUNRISE study in Spain, specific actions are being taken to tackle this public health crisis.
The World Health Organization (WHO) guidelines for “24-hour movement behaviours” (physical activity (PA), sedentary behaviour (SB), including screen time and sleep) in children aged under five were published in April 2019. The guidelines were developed as a response to the childhood obesity pandemic to help ensure that children under five engage in healthy levels of physical activity, screen time and sleep. The review and synthesis of the evidence showed that these behaviours influenced a wide range of other outcomes (cognitive, social and emotional development; language development; cardiometabolic health; bone and skeletal health; motor development; physical fitness, growth and well-being), and had substantial short- and long-term consequences.
Five years on, it is now time to review whether key steps have been taken in response to these guidelines across Europe and to explore ways to increase the impact of the WHO Guidelines across Europe over the next five years. The members of the SUNRISE group have published a paper in The Lancet Regional Health in which they set out their conclusions and recommendations.
The researchers acknowledge that development of physical activity policies for school-aged children and adolescents is reasonably good across Europe, and many countries in the SUNRISE Study Group already set physical activity guidelines for children aged under five years. However, it is stressed that policy development in this field is inadequate and should be extended to cover sedentary behaviour, including screen time and sleep. Moreover, emphasis is placed on the need for adequate policy implementation and assessment, which are often lacking.
According to experts, policy implementation must address “bottom-up” influences on movement behaviours, in recognition that they are strongly influenced by the wider environment, including the physical, built, socio-cultural and political environment. It is especially crucial to address early childhood education and care settings, since they are central to developing healthy movement behaviours in children aged under five years.
The researchers insist that effective policies targeting upstream environmental influences are required to equitably change movement behaviours among European populations. The SUNRISE Study Group urges European countries to take specific actions and work together to secure a healthier and more prosperous future for children across Europe.
JOURNAL
The Lancet Regional Health - Europe
ARTICLE TITLE
Practical steps needed to achieve impact of the WHO 2019 movement behaviour guidelines for children under the age of 5: the SUNRISE Study Europe Group evaluation
ARTICLE PUBLICATION DATE
9-Apr-2024
PULLMAN, Wash. – Just two emails, at the right time with the right message, can make a big difference for students who are the first in their families to go to college.
A recent Washington State University study highlighted the power of an instructors’ growth mindset -- the belief that abilities are not innate but can be improved. Researchers found that when first-generation students in an introductory science course received growth mindset emails after their initial exams, they did better in the whole course than a control group.
On average the students raised their final grade by about a third of a letter grade, such as moving from a C+ to a B-, making their overall performance on par with “continuing-generation” students, whose parents had graduated from college. The findings are reported in the journal CBE: Life Sciences Education.
“It's a pretty sizable effect,” said lead author Elizabeth Canning, a WSU psychology researcher. “Many studies have shown that continuing generation students outperform first-generation students, but in the condition where we sent emails from the instructor that had growth mindset language, we saw that difference in performance completely go away.”
Canning and graduate student Makita White conducted the study in a large, introductory biology class taught by WSU Professor Bill Davis online in 2021 during the pandemic. The course is considered challenging, and as a prerequisite to many majors, it can determine whether a student continues on to a medical or scientific career.
After the first two exams about 200 students were sent a standard email telling them that exam grades had been posted online and reminding them of the professor’s office hours. Another 200 students received longer emails after those exams which also contained the professor’s growth mindset views.
The messages were based on a theory called “wise interventions,” Canning said, meaning they are designed to come at critical times of uncertainty in a student’s development. The emails not only emphasized that improvement in the class was possible even after a low exam grade but also normalized struggling academically.
For example, the professor said he had worked with many students in the past who performed poorly on the first exam but turned things around on future tests, and they did so by figuring out better ways to learn in the course. Then, he gave specific actions they could take, such as forming a study group or accessing extra resources.
Since the course was taught completely online, the researchers could see if the students’ behavior changed following the exams. They found that the students who received the growth mindset messages went to the course website, accessed lecture materials and study notes more often. The first-generation students performed better on the third exam, and ultimately, achieved a better grade in the whole course than the control group.
First-generation college students tend to face a lot of challenges simply because they do not have parents who have university-experience to help them. Other research shows that they tend to ask fewer questions in class and do not access resources, such as attending instructor office hours, as often as continuing-generation students. They also represent about one-third of all college attendees.
“Just for equity reasons, it’s important to help first-generation students,” said Canning. “But especially in STEM fields, to keep up with medical advances and rapidly changing technology, we need apable students who have a foundation in science, so retaining them is especially important.”
This study received support from the National Science Foundation. Based on the promise of this work, Canning’s team has received another NSF grant for a larger, national study involving 10,000 students to look at the impact of this type of intervention on minority students.
JOURNAL
CBE—Life Sciences Education
A new study suggests that children who felt lonely for more than 6 months before the age of 12 are more likely to experience an episode of psychosis than children who did not, with women more affected than men.
Psychosis refers to a collection of symptoms that affect a person’s mind, where there has been some loss of contact with reality.[1] During an episode of psychosis, a person may have difficulty recognising what is real and what is not.[1] Symptoms of psychosis include hallucinations, delusions and confused thoughts.[2] In some instances, psychosis may be a symptom of other mental health conditions, such as schizophrenia, bipolar disorder, or severe depression.[1] Symptoms of schizophrenia are often categorised as positive (any change in behaviour or thoughts, such as hallucinations or delusions), negative (where people appear to withdraw from the world around them).[3]
Loneliness is defined as the subjective feeling of distress associated with a lack of meaningful relationships, regardless of the amount of social contact, whereas social isolation is defined as the objective lack of social contact or support.
In an observational, case-control study, researchers assessed loneliness in children with the question "Have you ever felt lonely for more than 6 months before the age of 12" and differentiated this from social isolation by using the ‘peer relationships’ item from the Premorbid Adjustment Scale. The study sample comprised 285 patients who had experienced their first episode of psychosis and 261 controls.
Key findings from the study include:
- Loneliness in childhood was associated with an increased likelihood of experiencing a psychotic episode (adjusted odds ratio; aOR: 2.17, 95% CI [1.40-3.51], p=.002) and this association remained significant after controlling for objective social isolation in childhood (aOR:2.70, IC 95% [1.58-4.62], p<.001).
- The association between loneliness and experiencing a psychotic episode was stronger in women (aOR:4.74, 95% CI [2.23-10.05], p<.001) than in men (aOR:1.17, IC 95% [0.63-2.19], p=.623).
- In women who had experienced a psychotic episode, loneliness in childhood was associated with a significantly reduced likelihood of being diagnosed with schizophrenia spectrum disorders (aOR:0.155, 95% CI [0.048-0.506], p=.002) relative to other forms of psychosis.
- In those who had experienced a psychotic episode, loneliness in childhood was associated with a greater severity of positive psychotic symptoms as well as affective symptoms (disturbance of mood) and worse functioning.
Dr Covadonga Díaz-Caneja of the Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain, said “There is increasing evidence of the negative health and social consequences of loneliness in adults, but much less is known about the long-term effects of loneliness in young people. Despite their preliminary nature, our results suggest that childhood loneliness may serve as an early risk factor for later psychotic disorders and support its role as a potential target for preventive mental health interventions from an early age. This may be especially relevant considering that childhood loneliness is a prevalent phenomenon that appears to be increasing in recent years”.
“This study offers valuable insight into the association between childhood loneliness and first-episode psychosis. With the rise of digitalisation and social isolation, loneliness has become a pervasive issue affecting young individuals. The compelling findings of this study, which establish a direct connection between childhood loneliness and the onset of psychosis, highlight a concerning trend and underscore the importance of addressing social connectedness and emotional well-being from an early age,” said Professor Andrea Fiorillo, President Elect of the European Psychiatric Association.
The European Congress of Psychiatry takes place from 6-9 April 2024 in Budapest, Hungary, and represents Europe’s largest congress dedicated to psychiatry, with over 4000 participants: epa-congress.org.
+++
Notes to editors
Association between loneliness in childhood and first-episode psychosis (O0102)
Introduction: Evidence from observational and genetic studies suggests a bidirectional relationship between loneliness and psychosis. To our knowledge, no previous study has assessed the association between loneliness in childhood and first-episode psychosis (FEP).
Objectives: We aimed to assess the association between loneliness in childhood and the odds of FEP and clinical variables of interest (i.e., diagnosis and clinical and functional severity) in FEP and to explore gender differences in this association.
Methods: This was an observational, case-control study, based on the AGES-CM cohort, a longitudinal prospective study including patients with FEP ages 7-40, their first-degree relatives, and an age- and sex-matched sample of controls in seven university hospitals in the region of Madrid. We assessed loneliness in childhood with the question "Have you ever felt lonely for more than 6 months before the age of 12" and objective social isolation with the peer relationships item from the childhood subscale of the Premorbid Adjustment Scale. We conducted logistic and linear regression analyses to assess the association between childhood loneliness and i) the odds of presenting a FEP and ii) clinical variables of interest (diagnosis and scores on positive, negative, general, depressive, and manic symptoms and functioning), while adjusting for demographic variables.
Results: The study sample comprised 285 patients with FEP (32.6% female, age 24.50 ± 6.2 years) and 261 controls (48.7% female, age 25.93 ± 5.5 years). Loneliness in childhood was associated with increased odds of FEP (adjusted odds ratio; aOR: 2.17, 95% CI [1.40-3.51], p=.002). This association remained significant after controlling for objective social isolation in childhood (aOR:2.70, IC 95% [1.58-4.62], p<.001). The effect of the association was stronger in females (aOR:4.74, 95% CI [2.23-10.05], p<.001) than in males (aOR:1.17, IC 95% [0.63-2.19], p=.623). In females with FEP, loneliness in childhood was significantly associated with increased odds of receiving a diagnosis of other psychosis (aOR:0.155, 95% CI [0.048-0.506], p=.002) relative to a schizophrenia spectrum disorders (SSD) diagnosis. In the FEP sample, loneliness in childhood was associated with greater severity of positive and affective symptoms and worse functioning.
Conclusions: Loneliness in childhood is associated with increased odds of FEP and clinical variables of interest. This suggests the potential role of this phenotype as an early risk marker for psychosis that could help guide targeted interventions.
Disclosure of interest: None declared.
About the European Psychiatric Association
With active individual members in as many as 88 countries and 44 National Psychiatric Association Members who represent more than 78,000 European psychiatrists, the European Psychiatric Association is the main association representing psychiatry in Europe. The EPA’s activities address the interests of psychiatrists in academia, research and practice throughout all stages of career development. The EPA deals with psychiatry and its related disciplines and focuses on the improvement of care for the mentally ill as well as on the development of professional excellence. More information: https://www.europsy.net/
References
[1] Understanding psychosis. National Institute of Mental Health. Available at: www.nimh.nih.gov/health/publications/understanding-psychosis (Accessed: February 2024).
[2] Psychosis symptoms. NHS choices. Available at: www.nhs.uk/mental-health/conditions/psychosis/symptoms/ (Accessed: February 2024).
[3] Schizophrenia symptoms. NHS choices. Available at: www.nhs.uk/mental-health/conditions/schizophrenia/symptoms/ (Accessed: February 2024).
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
Vaccination timeliness among US children ages 0-19 months
JAMA Network Open
About The Study: In this study of National Immunization Survey–Child data, improvements in vaccination timeliness were observed from the 2011 to the 2021 survey. However, widening disparities by socioeconomic indicators signal that increased efforts to facilitate timely vaccination among children in lower-income families are needed.
Authors: Sophia R. Newcomer, Ph.D., M.P.H., of the University of Montana, Missoula, is the corresponding author.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamanetworkopen.2024.6440)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.
