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1.  Paternal and maternal alcohol abuse and offspring mental distress in the general population: the Nord-Trøndelag health study 
BMC Public Health  2012;12:448.
The degree to which parental alcohol abuse is a risk factor for offspring mental distress is unclear, due to conflicting results of previous research. The inconsistencies in previous findings may be related to sample characteristics and lack of control of confounding or moderating factors. One such factor may be the gender of the abusing parent. Also, other factors, such as parental mental health, divorce, adolescent social network, school functioning or self-esteem, may impact the outcome. This study examines the impact of maternal and paternal alcohol abuse on adolescent mental distress, including potentially confounding, mediating or moderating effects of various variables.
Data from the Nord-Trøndelag Health Study (HUNT), a Norwegian population based health survey, from 4012 offspring and their parents were analyzed. Parental alcohol abuse was measured by numerical consumption indicators and CAGE, whereas offspring mental distress was measured by SCL-5, an abbreviated instrument tapping symptoms of anxiety and depression. Statistical method was analysis of variance.
Maternal alcohol abuse was related to offspring mental distress, whereas no effect could be shown of paternal alcohol abuse. Effects of maternal alcohol abuse was partly mediated by parental mental distress, offspring social network and school functioning. However, all effects were relatively small.
The results indicate graver consequences for offspring of alcohol abusing mothers compared to offspring of alcohol abusing fathers. However, small effect sizes suggest that adolescent offspring of alcohol abusing parents in general manage quite well.
PMCID: PMC3484056  PMID: 22708789
Maternal/paternal alcohol abuse; Mental distress; Families; Anxiety/depression; Population study
2.  Do True and False Intentions Differ in Level of Abstraction? A Test of Construal Level Theory in Deception Contexts 
Frontiers in Psychology  2017;8:2037.
The aim was to examine how people mentally represent alleged future actions—their true and false intentions. In two experiments, participants were asked to either tell the truth (i.e., express true intentions) or lie (i.e., express false intentions) about performing future tasks. Drawing on Construal Level Theory, which proposes that psychologically distant events are more abstractly construed than proximal ones, it was predicted that liars would have more abstract mental representations of the future tasks than truth tellers, due to differences in hypotheticality (i.e., the likelihood of the future tasks occurring). Construal level was measured by a video segmentation task (Experiment 1, N = 125) and preference for abstract or concrete descriptions of tasks (Experiment 2, N = 59). Veracity had no effect on construal level. Speaking against our initial predictions, the data indicate that true and false intentions are construed at similar levels of abstraction. The results are discussed in the light of Construal Level Theory and the emerging psycho-legal research on true and false intentions.
PMCID: PMC5702305
true and false intentions; mental representations; deception; Construal Level Theory; psychological distance
3.  Overexpression of OSM and IL-6 impacts the polarization of pro-fibrotic macrophages and the development of bleomycin-induced lung fibrosis 
Scientific Reports  2017;7:13281.
Although recent evidence indicates that gp130 cytokines, Oncostatin M (OSM) and IL-6 are involved in alternative programming of macrophages, their role in lung fibrogenesis is poorly understood. Here, we investigated the effect of transient adenoviral overexpression of OSM or IL-6 in mice during bleomycin-induced lung fibrosis. Lung fibrosis and M2-like macrophage accumulation were assessed by immunohistochemistry, western blotting, gene expression and flow cytometry. Ex-vivo isolated alveolar and bone marrow-derived macrophages were examined for M2-like programming and signalling. Airway physiology measurements at day 21 demonstrated that overexpression of OSM or IL-6 exacerbated bleomycin-induced lung elastance, consistent with histopathological assessment of extracellular matrix and myofibroblast accumulation. Flow cytometry analysis at day 7 showed increased numbers of M2-like macrophages in lungs of mice exposed to bleomycin and OSM or IL-6. These macrophages expressed the IL-6Rα, but were deficient for OSMRβ, suggesting that IL-6, but not OSM, may directly induce alternative macrophage activation. In conclusion, the gp130 cytokines IL-6 and OSM contribute to the accumulation of profibrotic macrophages and enhancement of bleomycin-induced lung fibrosis. This study suggests that therapeutic strategies targeting these cytokines or their receptors may be beneficial to prevent the accumulation of M2-like macrophages and the progression of fibrotic lung disease.
PMCID: PMC5643520  PMID: 29038604
4.  Quality by Design–Applied Liquid Chromatography-Tandem Mass Spectrometry Determination of Enzalutamide Anti-Prostate Cancer Therapy Drug in Spiked Plasma Samples 
Analytical Chemistry Insights  2017;12:1177390117726776.
This research article presents the Quality by Design (QbD)–finalised conditions for a method that uses liquid chromatography-tandem mass spectrometry for the determination of concentration of enzalutamide (ENZ), an atypical anticancer drug, in a drug formulation and in spiked plasma samples. Critical process attributes (CPA) considered to be the influential parameters in separation, identification, and quantification processes by ultrahigh-performance liquid chromatography-electrospray ionisation-tandem mass spectrometry (UHPLC-ESI-MS/MS) were organic content, buffer strength, pH modifier, flow rate, spray voltage, sheath gas, and auxiliary gas that alter critical analytical attributes, such as retention time (R1) and area (R2). These factors were evaluated first in a factorial design (Taguchi orthogonal array design) and then extensively in a central composite design (CCD) to zero-in on the mobile phase for the quantification of ENZ standard drug and along with its internal standard (ENZIS) in spiked plasma samples and in formulation. Pareto chart from initial factorial design (Taguchi orthogonal array design) model suggested which of the CPA factors should be given the weightage, that is, to be exhaustively analysed in the CCD and response surface analysis. The elaborated parameters proposed by World Health Organization were studied by method validation, ie, selectivity, linearity, accuracy, precision repeatability system-suitability tests, method robustness/ruggedness, sensitivity, and stability. The strategy followed gives an insight on the development of a robust QbD-compliant quantitative UHPLC-ESI-MS/MS method for ENZ drug containing plasma samples (spiked).
PMCID: PMC5576540
Enzalutamide; anti-prostate cancer; Quality by Design; response surface analysis; spiked plasma samples; UHPLC-ESI-MS/MS
5.  Intraosseous access can be taught to medical students using the four-step approach 
BMC Medical Education  2017;17:50.
The intraosseous (IO) access is an alternative route for vascular access when peripheral intravascular catheterization cannot be obtained. In Denmark the IO access is reported as infrequently trained and used. The aim of this pilot study was to investigate if medical students can obtain competencies in IO access when taught by a modified Walker and Peyton’s four-step approach.
Nineteen students attended a human cadaver course in emergency procedures. A lecture was followed by a workshop. Fifteen students were presented with a case where IO access was indicated and their performance was evaluated by an objective structured clinical examination (OSCE) and rated using a weighted checklist. To evaluate the validity of the checklist, three raters rated performance and Cohen’s kappa was performed to assess inter-rater reliability (IRR). To examine the strength of the overall IRR, Randolph’s free-marginal multi rater kappa was used.
A maximum score of 15 points was obtained by nine (60%) of the participants and two participants (13%) scored 13 points with all three raters. Only one participant failed more than one item on the checklist. The expert rater rated lower with a mean score of 14.2 versus the non-expert raters with mean 14.6 and 14.3. The overall IRR calculated with Randolph’s free-marginal multi rater kappa was 0.71.
The essentials of the IO access procedure can be taught to medical students using a modified version of the Walker and Peyton’s four-step approach and the checklist used was found reliable.
PMCID: PMC5335802  PMID: 28253870
Intraosseous access; Vascular access; Medical students; Medical education; Anaesthesiology; Traumatology; Emergency medicine; Resuscitation; OSCE and checklist validity
6.  Endoplasmic reticulum stress inhibition attenuates hypertensive chronic kidney disease through reduction in proteinuria 
Scientific Reports  2017;7:41572.
Endoplasmic reticulum (ER) stress is implicated in chronic kidney disease (CKD) development in patients and in animal models. Here we show that ER stress inhibition through 4-phenylbutyric acid (4-PBA) administration decreases blood pressure, albuminuria, and tubular casts in an angiotensin II/deoxycorticosterone acetate/salt murine model of CKD. Lower albuminuria in 4-PBA-treated mice was associated with higher levels of cubilin protein in renal tissue membrane fractions. 4-PBA decreased renal interstitial fibrosis, renal CD3+ T-cell and macrophage infiltration, mRNA expression of TGFβ1, Wnt signaling molecules, and ER stress-induced pro-inflammatory genes. CHOP deficient mice that underwent this model of CKD developed hypertension comparable to wild type mice, but had less albuminuria and tubular casts. CHOP deficiency resulted in higher nephrin levels and decreased glomerulosclerosis compared to wild type mice; this effect was accompanied by lower macrophage infiltration and fibrosis. Our findings portray ER stress inhibition as a means to alleviate hypertensive CKD by preserving glomerular barrier integrity and tubular function. These results demonstrate ER stress modulation as a novel target for preserving renal function in hypertensive CKD.
PMCID: PMC5288651  PMID: 28148966
7.  Progress in Cherenkov femtosecond fiber lasers 
We review the recent developments in the field of ultrafast Cherenkov fiber lasers. Two essential properties of such laser systems – broad wavelength tunability and high efficiency of Cherenkov radiation wavelength conversion are discussed. The exceptional performance of the Cherenkov fiber laser systems are highlighted - dependent on the realization scheme, the Cherenkov lasers can generate the femtosecond output tunable across the entire visible and even the UV range, and for certain designs more than 40 % conversion efficiency from the pump to Cherenkov signal can be achieved. The femtosecond Cherenkov laser with all-fiber architecture is presented and discussed. Operating in the visible range, it delivers 100–200 fs wavelength-tunable pulses with multimilliwatt output power and exceptionally low noise figure an order of magnitude lower than the traditional wavelength tunable supercontinuum-based femtosecond sources. The applications for Cherenkov laser systems in practical biophotonics and biomedical applications, such as bio-imaging and microscopy, are discussed.
PMCID: PMC4839584  PMID: 27110037
ultrafast lasers; photonic crystal fibers; ultrafast nonlinear optics
8.  Longitudinal associations between social anxiety disorder and avoidant personality disorder: A twin study 
Journal of abnormal psychology  2015;125(1):114-124.
Social anxiety disorder (SAD) and avoidant personality disorder (AvPD) are frequently co-occurring psychiatric disorders with symptomatology related to fear of social situations. It is uncertain to what degree the two disorders reflect the same genetic and environmental risk factors. The current study addresses the stability and co-occurrence of SAD and AvPD, the factor structure of the diagnostic criteria, and genetic and environmental factors underlying the disorders at two time points. SAD and AvPD were assessed in 1,761 young adult female twins at baseline and 1,471 of these approximately 10 years later. Biometric models were fitted to dimensional representations of SAD and AvPD. SAD and AvPD were moderately and approximately equally stable from young to middle adulthood, with increasing co-occurrence driven by environmental factors. At the first wave, approximately one in three individuals with AvPD had SAD, increasing to one in two at follow-up. The diagnostic criteria for SAD and AvPD had a two-factor structure with low cross-loadings. The relationship between SAD and AvPD was best accounted for by a model with separate, although highly correlated (r = .76), and highly heritable (.66 and .71) risk factors for each disorder. Their genetic and environmental components correlated .84 and .59, respectively. The finding of partially distinct risk factors indicates qualitative differences in the etiology of SAD and AvPD. Genetic factors represented the strongest time-invariant influences, whereas environmental factors were most important at the specific points in time.
PMCID: PMC4701609  PMID: 26569037
Social anxiety disorder; social phobia; avoidant personality disorder; twin study
9.  Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study 
BMC Psychiatry  2016;16:383.
The prevalence of trauma-related psychiatric disorders is high among refugees. Despite this, little is known about the effect of pharmacological treatment for this patient group. The objective of the present study was therefore to examine differences in the effects of venlafaxine and sertraline on Post-Traumatic Stress Disorder (PTSD), depression and functional impairment in trauma-affected refugees.
The study was a randomised pragmatic trial comparing venlafaxine and sertraline in combination with psychotherapy and social counselling. PTSD symptoms were measured on the Harvard Trauma Questionnaire – part IV, which was the primary outcome measure. Other outcome measures included: Hopkins Symptom Check List-25 (depression and anxiety), Social Adjustment Scale – short version (social functioning), WHO-5 Well-being Index (quality of life), Crisis Support Scale (support from social network), Sheehan Disability Scale (disability in three areas of functioning), Hamilton Depression and Anxiety scale, the somatisation items of the Symptoms Checklist-90, Global Assessment of Functioning scales and the summarised score of pain in four body areas rated on visual analogue scales.
Two hundred seven adult refugee patients were included in the trial (98 in the venlafaxine and 109 in the sertraline group). Of these, 195 patients were eligible for intention-to-treat analyses. Small but significant pre-treatment to post-treatment differences were found on the Harvard Trauma Questionnaire and a number of other ratings in both groups. On the primary outcome measure, no difference was found in treatment effect between the sertraline and venlafaxine group. A significant group difference was found in favour of sertraline on the Sheehan Disability Scale.
Sertraline had a slightly better outcome than venlafaxine on some of the secondary outcome measures, but not on the primary outcome measure. Furthermore, a higher percentage of dropouts was found in the venlafaxine group compared to the sertraline group. Although this could indicate that sertraline was better tolerated, which is supported by other studies, a final conclusion on tolerability cannot be drawn from the current study due to lack of systematic reporting of side effects.
Trial Registration NCT01569685. Registration date: 28/2/12
Electronic supplementary material
The online version of this article (doi:10.1186/s12888-016-1081-5) contains supplementary material, which is available to authorized users.
PMCID: PMC5101827  PMID: 27825327
Refugee; Trauma; Venlafaxine; Sertraline; Stress disorders, Post-traumatic stress disorders; Depression
10.  Testing the validity of the proposed ICD-11 PTSD and complex PTSD criteria using a sample from Northern Uganda 
European Journal of Psychotraumatology  2016;7:10.3402/ejpt.v7.32678.
The International Classification of Diseases (ICD-11) is currently under development with proposed changes recommended for the posttraumatic stress disorder (PTSD) diagnosis and the inclusion of a separate complex PTSD (CPTSD) disorder. Empirical studies support the distinction between PTSD and CPTSD; however, less research has focused on non-western populations.
The aim of this study was to investigate whether distinct PTSD and CPTSD symptom classes emerged and to identify potential risk factors and the severity of impairment associated with resultant classes.
A latent class analysis (LCA) and related analyses were conducted on 314 young adults from Northern Uganda. Fifty-one percent were female and participants were aged between 18 and 25 years. Forty percent of the participants were former child soldiers (n=124) while the remaining participants were civilians (n=190).
The LCA revealed three classes: a CPTSD class (40.2%), a PTSD class (43.8%), and a low symptom class (16%). Child soldier status was a significant predictor of both CPTSD and PTSD classes (OR=5.96 and 2.82, respectively). Classes differed significantly on measures of anxiety/depression, conduct problems, somatic complaints, and war experiences.
To conclude, this study provides preliminary support for the proposed distinction between PTSD and CPTSD in a young adult sample from Northern Uganda. However, future studies are needed using larger samples to test alternative models before firm conclusions can be made.
Highlights of the article
Examine the validity of CPTSD in a non-western sample
Separate PTSD and CPTSD classes emerged
Former child soldiers were more strongly associated with the CPTSD class
CPTSD class reported significantly higher levels of anxiety, depression, somatic complaints and conduct problems
PMCID: PMC5018065  PMID: 27613369
ICD-11; PTSD; complex PTSD; latent class analysis; Northern Uganda
11.  The latent structure of post-traumatic stress disorder among Arabic-speaking refugees receiving psychiatric treatment in Denmark 
BMC Psychiatry  2016;16(1):309.
Refugees are known to have high rates of post-traumatic stress disorder (PTSD). Although recent years have seen an increase in the number of refugees from Arabic speaking countries in the Middle East, no study so far has validated the construct of PTSD in an Arabic speaking sample of refugees.
Responses to the Harvard Trauma Questionnaire (HTQ) were obtained from 409 Arabic-speaking refugees diagnosed with PTSD and undergoing treatment in Denmark. Confirmatory factor analysis was used to test and compare five alternative models.
All four- and five-factor models provided sufficient fit indices. However, a combination of excessively small clusters, and a case of mistranslation in the official Arabic translation of the HTQ, rendered results two of the models inadmissible. A post hoc analysis revealed that a simpler factor structure is supported, once local dependence is addressed.
Overall, the construct of PTSD is supported in this sample of Arabic-speaking refugees. Apart from pursuing maximum fit, future studies may wish to test simpler, potentially more stable models, which allow a more informative analysis of individual items.
PMCID: PMC5011808  PMID: 27596249
Cross-cultural; Refugees; Posttraumatic stress disorder; Factor analysis
12.  Sixteen-year follow-up of childhood avalanche survivors 
European Journal of Psychotraumatology  2016;7:10.3402/ejpt.v7.30995.
Every year a substantial number of children are affected by natural disasters worldwide. However, data are scarce on long-term psychological impact of natural disasters on children's health. Identifying risk factors and outcomes associated with the long-term sequelae of posttraumatic stress disorder (PTSD) can provide a gateway to recovery as well as enhancement of preventive measures.
Among childhood avalanche survivors, we aimed to investigate risk factors for PTSD symptoms and the relationship between socioeconomic status (SES) and PTSD symptoms in adulthood.
Childhood survivors (aged 2–19 at the time of exposure) of two avalanches were identified through nationwide registers 16 years later. The Posttraumatic Diagnostic Scale was used to assess current PTSD symptoms. One-way ANOVA was used to explore PTSD symptoms by background and trauma-specific factors, as well as associations with current SES. Predictors of PTSD symptoms were examined by multivariable regression analysis.
Response rate was 66% (108/163). Results from univariate ANOVA analysis revealed that female sex was associated with PTSD symptoms (F=5.96, p<0.05). When adjusted for age and sex, PTSD symptoms were associated with lower education (F=7.62, p<0.001), poor financial status (F=12.21, p<0.001), and unemployment and/or disability (F=3.04, p<0.05). In a multivariable regression model, when adjusting for age and sex, lack of social support (t=4.22, p<0.001) and traumatic reactions of caregivers (t=2.49, p<0.05) in the aftermath of the disaster independently predicted PTSD 16 years post-trauma.
Lingering PTSD symptoms after childhood exposure to a disaster may negatively influence socioeconomic development in adulthood. Strengthening children's support systems post-disaster may prevent the long-term sequelae of symptoms.
Highlights of the article
PTSD symptoms following avalanche exposure during childhood were associated with poorer socioeconomic status in adulthood.
Lack of social support and traumatic reactions of caregivers in the aftermath of avalanches predicted PTSD symptoms among childhood survivors 16 years later.
Findings underscore the importance of strengthening children's support systems in the aftermath of disasters.
PMCID: PMC4989177  PMID: 27534741
Children; disaster; avalanche; posttraumatic stress disorder; long-term follow-up
13.  Mood, anxiety, and alcohol use disorders and later cause-specific sick leave in young adult employees 
BMC Public Health  2016;16:702.
Mental disorders strongly influence work capability in young adults, but it is not clear which disorders that are most strongly associated with sick leave, and which diagnoses that are stated on the sick leave certificates. Better knowledge of the impairments associated with different mental disorders is needed for optimal planning of interventions and prioritization of health services. In the current study, we investigate the prospective associations between eight mood, anxiety, and alcohol use disorders, and later sick leave granted for mental, somatic, or any disorder.
Lifetime mental disorders were assessed by structured diagnostic interviews in 2,178 young adults followed for eight years with registry data on sick leave. Relative risk ratios were estimated for the associations between each mental disorder and the different forms of sick leave.
All included diagnoses were associated with later sick leave. In adjusted analyses, major depressive disorder and generalized anxiety disorder were the strongest predictors of sick leave granted for mental disorders, whereas social anxiety disorder and specific phobia were the strongest predictors of sick leave granted for somatic disorders. Specific phobia and major depressive disorder had the highest attributable fractions for all-cause sick leave.
Mood and anxiety disorders constituted independent risk factors for all cause sick leave, whereas alcohol use disorders seemed to be of less importance in young adulthood. Disorders characterised by distress were most strongly associated with sick leave granted for mental disorders, whereas disorders characterised by fear primarily predicted sick leave granted for somatic conditions. A large part of all sick leave is related to specific phobia, due to the high prevalence of this disorder. The impairment associated with this common disorder may be under-acknowledged, and it could decrease work capacity among individuals with somatic disorders. This disorder has good treatment response and may be overlooked as a target for interventions aimed at prevention of sick leave.
PMCID: PMC4972995  PMID: 27488425
Anxiety; Depression; Specific phobia; Sick leave; Sickness absence; Functional impairment; Occupational health
14.  Characterization of Proliferating Lesion‐Resident Cells During All Stages of Atherosclerotic Growth 
Monocyte recruitment leads to accumulation of macrophage foam cells and contributes to atherosclerotic lesion growth. Recent studies have reported that lesion‐resident macrophages can proliferate and represent a major cellular component during lesion development. This study was designed to assess whether the rate of macrophage proliferation changes during well‐established stages of lesion growth and to characterize other populations of proliferating cells within these lesions.
Methods and Results
Using murine models of atherosclerosis (Apoe −/− and LDLr −/− mice) and human coronary artery lesions, in situ proliferation of lesion‐resident cells at different stages of growth was assessed by staining for Ki67 and bromodeoxyuridine (BrdU). In early lesions, close to half of all actively growing macrophages were proliferating in situ. BrdU pulse labeling allowed for accurate identification of in situ proliferating macrophages compared to those derived from monocyte recruitment. Local macrophage proliferation declined as lesions advanced. Interestingly, intimal inflammatory cell infiltrates containing proliferating T lymphocytes were identified during the active phase of lesion growth and correlated with apoptotic cell death. Inflammatory cell infiltrates were completely resolved in advanced lesions and replaced with the necrotic core.
Our findings indicate that atherosclerotic lesions contain locally proliferating macrophages primarily during early and intermediate stages of lesion growth. Furthermore, T‐lymphocyte‐enriched inflammatory cell infiltrates represent a novel subset of proliferating cells within the atherosclerotic lesion that correlate with apoptosis and precede the necrotic core. These findings have novel implications in understanding the pathogenesis of atherosclerosis and may implicate proliferating T lymphocytes as a contributing factor to lesion progression and stability.
PMCID: PMC5015311  PMID: 27528409
apoptosis; atherosclerosis; cardiovascular disease; lesion; leukocyte; macrophage; proliferation; Atherosclerosis; Vascular Biology; Inflammation; Thrombosis; Animal Models of Human Disease
15.  Child maltreatment and ADHD symptoms in a sample of young adults 
European Journal of Psychotraumatology  2016;7:10.3402/ejpt.v7.32061.
The present study investigated the relationship between different types of childhood maltreatment (emotional, sexual, overall abuse, and no abuse) and the symptoms of attention deficit hyperactivity disorder (ADHD) in young adulthood.
Data were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4,718 young adults (24 years of age) were randomly selected using the total birth cohort of children born in 1984. Structured interviews were conducted with a response rate of 63%, equating to a total sample size of 2,980 participants.
Chi-square analyses revealed significant relationships between child maltreatment groups and a probable diagnosis of ADHD using the Adult ADHD Self-Report Scale (ASRS). Binary logistic regression analysis showed that the overall abuse class was more strongly associated with probable ADHD (OR=5.08), followed by emotional abuse (OR=3.09) and sexual abuse (OR=2.07).
The results showed that childhood maltreatment was associated with increased risk of ADHD symptoms in young adulthood. The findings of this study are discussed within the existing literature and suggestions for future research are outlined in order to replicate these findings in other adult populations.
Highlights of the article
Child maltreatment is associated with higher levels of ADHD symptoms in a nationally representative sample of young Danish adults.
Co-occurring (multiple) types of maltreatment display stronger associations with ADHD symptoms with attenuated effects for sexual abuse.
Males confer stronger associations with ADHD symptoms than females.
Findings underscore the importance of exploring the role of childhood trauma in young adults with ADHD symptoms.
PMCID: PMC4910305  PMID: 27306866
Abuse typologies; child maltreatment; attention deficit hyperactivity disorder
16.  Psychosocial predictors of treatment outcome for trauma-affected refugees 
European Journal of Psychotraumatology  2016;7:10.3402/ejpt.v7.30907.
The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment outcome.
The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees.
The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients’ past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed.
Overall, the total score of the CTP Predictor Index was significantly correlated to pre- to post treatment score changes on the majority of the ratings mentioned above. While employment status was the only single item significantly correlated to HTQ-score changes, a number of single items from the CTP Predictor Index correlated significantly with changes in depression and anxiety symptoms, but the size of the correlation coefficients were modest.
The total score of the CTP Predictor Index correlated significantly with outcomes on most of the rating scales, but correlations were modest in size, possibly due to the number of different factors influencing treatment outcome.
Highlights of the article
The study investigated the relation between the CTP Predictor Index including 15 different possible predictors and outcome on a range of different rating scales.
The total score of the index correlated significantly to score changes on the majority of the ratings.
Employment status was the only single item from the index that was significantly correlated to changes in posttraumatic stress disorder symptoms.
A number of single items correlated significantly with changes in depression and anxiety symptoms.
PMCID: PMC4889772  PMID: 27251179
Refugee; trauma; treatment; stress disorders; posttraumatic; depression
17.  Critical Role of CD2 Co-stimulation in Adaptive Natural Killer Cell Responses Revealed in NKG2C-Deficient Humans 
Cell Reports  2016;15(5):1088-1099.
Infection by human cytomegalovirus (HCMV) leads to NKG2C-driven expansion of adaptive natural killer (NK) cells, contributing to host defense. However, approximately 4% of all humans carry a homozygous deletion of the gene that encodes NKG2C (NKG2C−/−). Assessment of NK cell repertoires in 60 NKG2C−/− donors revealed a broad range of NK cell populations displaying characteristic footprints of adaptive NK cells, including a terminally differentiated phenotype, functional reprogramming, and epigenetic remodeling of the interferon (IFN)-γ promoter. We found that both NKG2C− and NKG2C+ adaptive NK cells expressed high levels of CD2, which synergistically enhanced ERK and S6RP phosphorylation following CD16 ligation. Notably, CD2 co-stimulation was critical for the ability of adaptive NK cells to respond to antibody-coated target cells. These results reveal an unexpected redundancy in the human NK cell response to HCMV and suggest that CD2 provides “signal 2” in antibody-driven adaptive NK cell responses.
Graphical Abstract
•NKG2C−/− donors have normal T cell immunity to cytomegalovirus•NKG2C−/− donors have normal frequencies of adaptive NK cells•CD2 is critical for antibody-triggered responses by adaptive NK cells•CD2 synergizes with NKG2C in classical adaptive NK cells
Liu et al. demonstrate the emergence of redundant adaptive NK cell subsets in NKG2C−/− donors. Functional studies unraveled a critical role for CD2 in antibody-dependent responses by adaptive NK cells, paving the way for new strategies to harness their cytotoxic potential in cell therapy.
PMCID: PMC4858565  PMID: 27117418
18.  Importance of coastal primary production in the northern Baltic Sea 
Ambio  2016;45(6):635-648.
In this study, we measured depth-dependent benthic microalgal primary production in a Bothnian Bay estuary to estimate the benthic contribution to total primary production. In addition, we compiled data on benthic microalgal primary production in the entire Baltic Sea. In the estuary, the benthic habitat contributed 17 % to the total annual primary production, and when upscaling our data to the entire Bothnian Bay, the corresponding value was 31 %. This estimated benthic share (31 %) is three times higher compared to past estimates of 10 %. The main reason for this discrepancy is the lack of data regarding benthic primary production in the northern Baltic Sea, but also that past studies overestimated the importance of pelagic primary production by not correcting for system-specific bathymetric variation. Our study thus highlights the importance of benthic communities for the northern Baltic Sea ecosystem in general and for future management strategies and ecosystem studies in particular.
Electronic supplementary material
The online version of this article (doi:10.1007/s13280-016-0778-5) contains supplementary material, which is available to authorized users.
PMCID: PMC5012998  PMID: 27075572
Benthic primary production; Pelagic primary production; Benthic contribution; Coastal ecosystems; Bothnian Bay; Northern Baltic Sea
19.  Measurement of the centrality dependence of the charged-particle pseudorapidity distribution in proton–lead collisions at \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sqrt{s_{_\text {NN}}} = 5.02$$\end{document}sNN=5.02 TeV with the ATLAS detector 
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The centrality dependence of the mean charged-particle multiplicity as a function of pseudorapidity is measured in approximately 1 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\upmu $$\end{document}μb\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^{-1}$$\end{document}-1 of proton–lead collisions at a nucleon–nucleon centre-of-mass energy of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sqrt{s_{_\text {NN}}} = 5.02$$\end{document}sNN=5.02 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\text {TeV}$$\end{document}TeV using the ATLAS detector at the Large Hadron Collider. Charged particles with absolute pseudorapidity less than 2.7 are reconstructed using the ATLAS pixel detector. The collision centrality is characterised by the total transverse energy measured in the Pb-going direction of the forward calorimeter. The charged-particle pseudorapidity distributions are found to vary strongly with centrality, with an increasing asymmetry between the proton-going and Pb-going directions as the collisions become more central. Three different estimations of the number of nucleons participating in the collision have been carried out using the Glauber model as well as two Glauber–Gribov inspired extensions to the Glauber model. Charged-particle multiplicities per participant pair are found to vary differently for these three models, highlighting the importance of including colour fluctuations in nucleon–nucleon collisions in the modelling of the initial state of collisions.
PMCID: PMC5312138
20.  Prevalence and predictors of Axis I disorders in a large sample of treatment-seeking victims of sexual abuse and incest 
European Journal of Psychotraumatology  2016;7:10.3402/ejpt.v7.30686.
Childhood sexual abuse (CSA) is a common occurrence and a robust, yet non-specific, predictor of adult psychopathology. While many demographic and abuse factors have been shown to impact this relationship, their common and specific effects remain poorly understood.
This study sought to assess the prevalence of Axis I disorders in a large sample of help-seeking victims of sexual trauma, and to examine the common and specific effects of demographic and abuse characteristics across these different diagnoses.
The participants were attendees at four treatment centres in Denmark that provide psychological therapy for victims of CSA (N=434). Axis I disorders were assessed using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Multivariate logistic regression analysis was used to examine the associations between CSA characteristics (age of onset, duration, number of abusers, number of abusive acts) and 10 adult clinical syndromes.
There was significant variation in the prevalence of disorders and the abuse characteristics were differentially associated with the outcome variables. Having experienced sexual abuse from more than one perpetrator was the strongest predictor of psychopathology.
The relationship between CSA and adult psychopathology is complex. Abuse characteristics have both unique and shared effects across different diagnoses.
Highlights of the article
The prevalence of Axis I disorders were assessed in a large sample of sexual abuse and incest survivors.
The impact of demographic and abuse characteristics were also examined.
There was significant variation in the prevalence of disorders.
Abuse characteristics were differentially associated with the disorders.
Abuse from multiple perpetrators was the strongest overall predictor of psychopathology.
PMCID: PMC4827144  PMID: 27064976
Childhood sexual abuse; Axis I disorders; help-seeking sample; sexual trauma; incest; multivariate analysis; multiple perpetrators; adult psychopathology
21.  Treatment of Danish Survivors of Child Sexual Abuse—A Cohort Study 
Behavioral Sciences  2015;5(4):589-601.
Objective: To investigate the changes in psychological and social domains associated with treatment in survivors of child sexual abuse. Method: Participants from four centers were assessed at baseline and were followed up after six and 12 months. The battery covered posttraumatic and general distress symptoms, attachment, coping styles, self-worth, and social support. Results: The estimated prevalence of Posttraumatic Stress Disorder (PTSD) was 78% at baseline; this rate declined to 40% after one year. There were no differences in outcome measures across the different centers or between the individual and group treatments. Half of the PTSD variation at 12 months was explained by four factors: education, avoidance attachment, emotional coping, and social support. Conclusion: The findings in this study indicated a substantial reduction in mental health problems in survivors following 12 months of treatment and identified personality and social factors important for recovery.
PMCID: PMC4695781  PMID: 26690484
Treatment; adults; child sexual abuse; posttraumatic stress disorder; attachment; coping
22.  Less is more? Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples 
European Journal of Psychotraumatology  2015;6:10.3402/ejpt.v6.28766.
In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the symptom profile of posttraumatic stress disorder (PTSD) was expanded to include 20 symptoms. An alternative model of PTSD is outlined in the proposed 11th edition of the International Classification of Diseases (ICD-11) that includes just six symptoms.
Objectives and method
The objectives of the current study are: 1) to independently investigate the fit of the ICD-11 model of PTSD, and three DSM-5-based models of PTSD, across seven different trauma samples (N=3,746) using confirmatory factor analysis; 2) to assess the concurrent validity of the ICD-11 model of PTSD; and 3) to determine if there are significant differences in diagnostic rates between the ICD-11 guidelines and the DSM-5 criteria.
The ICD-11 model of PTSD was found to provide excellent model fit in six of the seven trauma samples, and tests of factorial invariance showed that the model performs equally well for males and females. DSM-5 models provided poor fit of the data. Concurrent validity was established as the ICD-11 PTSD factors were all moderately to strongly correlated with scores of depression, anxiety, dissociation, and aggression. Levels of association were similar for ICD-11 and DSM-5 suggesting that explanatory power is not affected due to the limited number of items included in the ICD-11 model. Diagnostic rates were significantly lower according to ICD-11 guidelines compared to the DSM-5 criteria.
The proposed factor structure of the ICD-11 model of PTSD appears valid across multiple trauma types, possesses good concurrent validity, and is more stringent in terms of diagnosis compared to the DSM-5 criteria.
PMCID: PMC4598338  PMID: 26450830
CFA; PTSD; DSM-5; ICD-11; latent structure
23.  Supervisors' Strategies to Facilitate Work Functioning among Employees with Musculoskeletal Complaints: A Focus Group Study 
The Scientific World Journal  2015;2015:865628.
Aim. To explore what strategies the supervisors found beneficial to prevent or reduce sickness absence among employees with musculoskeletal complaints. Methods. Five focus groups were conducted and 26 supervisors from health and social sector participated. Commonly used strategies to prevent sickness absence and interdisciplinary cooperation in this work were discussed in the focus groups. Systematic text condensation was used to analyse the data. Results. The supervisors described five strategies for sick leave management: (1) promoting well-being and a healthy working environment, (2) providing early support and adjustments, (3) making employees more responsible, (4) using confrontational strategies in relation to employees on long-term sick leave, and (5) cooperation with general practitioners (GPs). Conclusions. Strategies of promoting a healthy working environment and facilitating early return to work were utilised in the follow-up of employees with musculoskeletal complaints. Supportive strategies were found most useful especially in the early phases, while finding a balance between being supportive, on one side, and confronting the employee, on the other, was endeavoured in cases of recurrent or long-term sick leave. Further, the supervisors requested a closer cooperation with the GPs, which they believed would facilitate return to work.
PMCID: PMC4562179  PMID: 26380370
25.  Alcohol consumption and risk of dementia up to 27 years later in a large, population-based sample: the HUNT study, Norway 
European Journal of Epidemiology  2015;30(9):1049-1056.
The relationship between alcohol consumption and dementia risk is unclear. This investigation estimates the association between alcohol consumption reported in a population-based study in the mid-1980s and the risk for dementia up to 27 years later. The entire adult population in one Norwegian county was invited to the Nord-Trøndelag Health Study during 1984–1986 (HUNT1): 88 % participated. The sample used in this study includes HUNT1 participants born between 1905 and 1946 who completed the questionnaire assessing alcohol consumption. A total of 40,435 individuals, of whom 1084 have developed dementia, are included in the analysis adjusted for age, sex, years of education, hypertension, obesity, smoking, and symptoms of depression. When adjusting for age and sex, and compared to reporting consumption of alcohol 1–4 times during the last 14 days (drinking infrequently), both abstaining from alcohol and reporting consumption of alcohol five or more times (drinking frequently) were statistically significantly associated with increased dementia risk with hazard ratios of 1.30 (95 % CI 1.05–1.61) and 1.45 (1.11–1.90), respectively. In the fully adjusted analysis, drinking alcohol frequently was still significantly associated with increased dementia risk with a hazard ratio of 1.40 (1.07–1.84). However, the association between dementia and abstaining from alcohol was no longer significant (1.15, 0.92–1.43). Equivalent results for Alzheimer’s disease and vascular dementia indicated the same patterns of associations. When adjusting for other factors associated with dementia, frequent alcohol drinking, but not abstaining from alcohol, is associated with increased dementia risk compared to drinking alcohol infrequently.
PMCID: PMC4584101  PMID: 25968174
Dementia; Risk factor; Alcohol consumption; Epidemiology; Longitudinal study

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