Early Family Research Articles

Genome-Wide Characterization of the Aux/IAA Gene Family in Orchardgrass and a Functional Analysis of DgIAA21 in Responding to Drought Stress.

Drought stress is an important factor that reduces plant biomass production and quality. As one of the most important economic forage grasses, orchardgrass (Dactylis glomerata) has high drought tolerance. Auxin/indole-3-acetic acid (Aux/IAA) is one of the early responsive gene families of auxin and plays a key role in the response to drought stress. However, the characteristics of the Aux/IAA gene family in orchardgrass and their potential function in responding to drought stress remain unclear. Here, 30 Aux/IAA members were identified in orchardgrass. Segmental duplication may be an important driving force in the evolution of the Aux/IAA gene family in orchardgrass. Some Aux/IAA genes were induced by IAA, drought, salt, and temperature stresses, implying that these genes may play important roles in responding to abiotic stresses. Heterologous expression in yeast revealed that DgIAA21 can reduce drought tolerance. Similarly, the overexpression of DgIAA21 also reduced drought tolerance in transgenic Arabidopsis, which was supported by lower total chlorophyll content and relative water content as well as higher relative electrolyte leakage and malondialdehyde content (MDA) than Col-0 plants under drought conditions. The results of this study provided valuable insight into the function of DgIAAs in response to drought stress, which can be further used to improve forage grass breeding programs.

A Review on Rett Syndrome: A Debilitating Neurodevelopmental Disorder

Rett syndrome is a neurodevelopmental disorder primarily affecting females, characterised by slowed growth, developmental regression, loss of fine motor skills, communication difficulties, and stereotypical hand movements. It is strongly associated with mutations in the MECP2 gene, while other variations have been linked to FOXG1 and CDKL5 mutations. This review provides an in-depth understanding of Rett syndrome, including its causes, symptoms, and available treatments. The epidemiology of Rett syndrome indicates a varying prevalence across different regions. Males with Rett syndrome, though rare, have been reported. The aetiology of Rett syndrome involves MECP2 mutations that lead to functional loss, affecting synapse development and maintenance. Mitochondrial dysfunction and oxidative stress have also been implicated in the disorder. Neuropathological findings reveal specific abnormalities in various brain regions. The symptoms of Rett syndrome include slowed head growth, abnormal gait, loss of intentional hand movements, breathing difficulties, and loss of speech. Complications such as metabolic issues, epilepsy, scoliosis, and gastrointestinal dysfunction are common. The diagnosis relies on clinical criteria and genetic testing for MECP2 mutations. Treatment for Rett syndrome is symptomatic and includes individualised rehabilitation therapies such as physical therapy, applied behaviour analysis, environmental enrichment, hydrotherapy, and music therapy. The review emphasises the importance of early intervention and family involvement in rehabilitation programmes.

Lamin A/C cardiomyopathy in children

Abstract Background Lamin A/C gene (LMNA) variants cause familial dilated cardiomyopathy (DCM) with a malignant cardiac phenotype characterized by atrioventricular (AV) block and supraventricular and ventricular arrhythmias, often preceding cardiac dilatation and dysfunction. Current guidelines recommend genetic and clinical screening of family members, starting at 10-12 years of age. However, children with LMNA variants are underrepresented in research publications and data are lacking on both the onset of a cardiac phenotype and the prevalence of cardiac events in this population. Purpose The study aimed to investigate the prevalence of cardiac events in LMNA genotype positive children and penetrance of LMNA cardiac phenotype in genotype positive paediatric relatives. Methods We conducted a longitudinal cohort study including consecutive genotype-positive LMNA patients and genotype positive relatives, all ≤18 years of age, followed between 2009 and 2022. The patients were examined by electrocardiography, Holter monitoring, and echocardiography. A cardiac phenotype was defined as the presence of either atrioventricular (AV) block, prolonged sinus arrest, atrial fibrillation/ flutter (AF), ventricular tachycardia (VT), or echocardiographic DCM. Cardiac events were defined as AF, VT, cardiac syncope, sudden cardiac arrest (SCA) or heart transplantation (Htx). Childhood-onset disease was defined as the presence of a cardiac phenotype ≤12 years of age. Results Among 44 LMNA genotype-positive children (age 10.4 [IQR 6.5-12.9] years, 34 relatives), 12 (27 %) became phenotype-positive at a median age of 12.8 [IQR 7.9-14.1] years, of which 7 (58 %) had childhood-onset disease (Figure 1). Nine (18 %) of the children experienced a cardiac event and 44 % of these were ≤12 years of age (Figure 2). Three children had AF, 5 had VT, and one had cardiac syncope. Htx was performed in two unrelated children, at 6 and 8 years of age, respectively. Among the 34 genotype-positive paediatric relatives, 21 % (n=7) became phenotype-positive at a median age of 10.9 [IQR 7.5-15.1] years, of which 57 % (n=4) had childhood-onset disease. Conclusions In a cohort of LMNA genotype children, there was a high prevalence of cardiac events and 44 % of these occurred in children ≤12 years of age. The penetrance of LMNA cardiac phenotype in genotype positive paediatric relatives was 21 %, highlighting the importance of early family screening and cardiological follow-up.

Abstract 12124: GlycA is Associated With Both Coronary Artery Calcium Incidence and Progression: ELSA-Brasil Cohort Analysis

Introduction: GlycA is an emerging systemic inflammatory marker and quantifies N-acetyl glucosamine within the glycan region of acute phase proteins. Elevated levels of GlycA, are associated with a higher risk for coronary artery disease (CAD). There is conflicting evidence on whether GlycA levels can predict subclinical CAD progression in healthy adults. Hypothesis: High GlycA levels can predict subclinical CAD progression in healthy patients. Methods: We included 2,690 participants from the ELSA-Brasil cohort without cardiovascular/chronic inflammatory disease not receiving statin therapy who had GlycA level measured and two interval coronary artery calcium score (CAC) assessments between 2010 through 2018. Multivariable regression models adjusted for demographics, lifestyle, comorbidities, and laboratory parameters were used to assess the consistency of GlycA levels and CAC incidence and progression (Berry definition). CAC incidence required that the first CAC = 0. CAC progression required that the first CAC > 0. Therefore, the presence of CAC incidence and progression were mutually exclusive. Results: The mean age of participants was 48.6 ± 7.7 years, 56.7% were female, 54.6% and 16.1% (429/2690) were White and Black, respectively. The mean CAC interscan period was 5.1 ± 0.9 years, the mean GlycA level was 414.7 ± 65 μmol/L, and the incidence of CAC was 13.1%. GlycA level odds ratio (OR) for CAC incidence was 1.002 (95% CI 1.0005-1.005, p = .016) adjusted for demographics, lifestyle, early (≤60 years) CAD family history, lipid panel, and comorbidities. The GlycA (≤p25 vs >p75) OR for CAC progression (Berry definition) was 1.77 (95% CI 1.07-2.96, p = .03) in a similar multivariable adjustment model. Conclusions: Higher GlycA levels were associated with CAC incidence and progression even after adjusting for multivariable risk factors in a healthy Brazilian cohort. GlycA may have potential to further stratify CAD risk in healthy patients.

Childhood abuse as a mediator of the relationship between early family socio-economic status and geriatric depression: A population-based study in China

Previous studies have suggested that childhood socioeconomic status (SES) is linked to geriatric depressive symptoms in many developed countries. However, the potential pathways of the relationship between childhood SES and geriatric depressive symptoms need to be further explored. This study aimed to assess the mediating effect of being abused during childhood on the association between childhood SES and geriatric depressive symptoms, using evidence from a longitudinal study in China. The study cohort included 8137 individuals. Childhood abuse was defined as experiences related to parental violence, sibling abuse, school violence, community violence, and parental quarrel. Results indicated poor childhood SES was associated significantly with geriatric depressive symptoms. The indirect effect of poor childhood SES to high geriatric depressive risk through community violence, sibling abuse, school violence, and parental quarrel were 0.02, 0.01, 0.02, and 0.01, respectively. Our findings shed new light on the literature regarding the impact of childhood SES on elderly depressive symptoms. Furthermore, childhood SES demonstrated a significant correlation with geriatric depressive symptoms through bullying behaviors. The findings highlight the need to promote both childhood social welfare and psychological well-being within the elderly population.

Mindfulness, coping, and disruptions as predictors of college student distress at the beginning of the COVID-19 pandemic

Objective: This research examined how stressors experienced by college students within the first month of the COVID-19 pandemic were associated with their reports of psychological distress, mindfulness, and coping strategies. Participants: Students attending 11 universities in the U.S. (N = 464, M age = 20.72, SD = 3.90, 91% female, 61% White, and 77% non-Hispanic) in early childhood education, child development, and family science classes participated. Methods: Students completed an online survey about pandemic-related disruptions, depressive symptoms, mindfulness, coping, and demographics. Results: Students whose families had more financial difficulties reported more disruptions. Depression and avoidant coping were positively correlated with distress, while mindfulness was inversely correlated with distress and depression. Disruptions, family financial status, depressive symptoms, mindfulness, and avoidant coping significantly predicted distress, controlling for university site and student sex, age, race, and ethnicity in multiple regression analyses. Avoidant coping significantly moderated (amplified) the effect of disruptions on distress. Conclusions: College student well-being can be supported through Campus programming that includes mindfulness practices and alternatives to avoidant strategies for coping with stress.

The Impact of Early Family Environment on Childrens Creativity

With the rise of artificial intelligence and the increase in social demand, creativity has increasingly become a competitive factor for individuals. Therefore, the impact of early family environments on childrens creativity development, especially the psychological one, is further emphasized. However, there is still a research gap in the impact of different parenting styles and different language environments on childrens creativity. This article uses literature analysis to study the impact of bilingual family environment and ancestral dominated family environment on childrens creativity. Among them, intergenerational education usually has a negative influence on childrens creativity due to the educational limitations of the grandparent, while bilingual education can cultivate childrens unique ways of thinking, thus playing a positive role in developing childrens creativity. Parents and grandparents should pay attention to choosing positive strategies when creating an early family environment for their children, in order to strengthen the generation of positive effects and reduce the impact of negative effects.

Guidelines for virtual early childhood and family learning: An equity, diversity, inclusion, and decolonization-informed systematic review of the literature

This article presents an equity-informed systematic review of research pertinent to the offering of virtual early childhood education programming to young children and their families. Findings are presented as guidelines which may shape the delivery of future programming within virtual contexts. These findings are organized within three major areas that were identified through the methodology: Building Connections and Fostering Online Relationships; Interactive Virtual Programming, Digital Tools, and Responsiveness; and Digital Technologies, Considerations for Access, Use, Professional Learning, and Safety. Findings highlight that developing inclusive, meaningful, and collaborative programs within virtual spaces is necessary for maximizing the learning opportunities and engagement of all children and families. Developing such services requires the careful negotiation and consideration of a range of worldviews, knowledges, priorities, and interests within unique families and contexts. Practice implications are drawn from the research, opportunities for pedagogical change are identified, and future research needs are provided.

Young Children's Development and Behavior: Associations with Timing of Household Food Insecurity in a Racially and Ethnically Diverse Early Head Start Sample.

The objective of this study was to assess the impact of household food insecurity (HFI) over time on behavioral and developmental health in early childhood while considering the impact of timing/persistence of HFI and potential differences among racially or ethnically minoritized children. Families from the Early Head Start Family and Child Experiences Study (N = 760) were followed longitudinally until age 3 years. Caregiver interview data were collected on HFI, problem behaviors (PBs), delays in development (DD), and sociodemographic information. Analysis of Covariances examined differences between persistent vs transient HFI. Multiple regressions examined the impact of HFI on PB and DD and whether this relation was stronger in racially or ethnically minoritized children. The timing of HFI differentially affected PB, such that those with persistent HFI demonstrated greater PB than those with only early or only late HFI. A different pattern was identified for DD, in which those with late HFI had more DD than those with persistent HFI. Over and above other sociodemographics, including maternal risk factors and an income-to-needs ratio, HFI was associated with greater PB for children of all races and ethnicities. HFI was associated with more DD in non-Latino/a/e/x White families compared with non-Latino/a/e/x Black and Latino/a/e/x families. Meaningful differences were found in how the persistence/timing of HFI is differentially associated with PB and DD. In addition, while controlling for socioeconomic risk, a cumulative risk effect was not observed in how HFI affected racially or ethnically minoritized children.

Lived Experiences of Women Who are Long-Term Breast Cancer Survivors in Lagos State, Nigeria

Introduction: Breast cancer (BrCa) survivors have increased globally with the continued improvement in cancer management. Despite this, there are significant issues experienced by these women during BrCa treatment. It is therefore important to explore the unique experiences of women who are long-term BrCa survivors.
 Objective: This study aimed to explore the lived experiences of 22 women who are long-term BrCa survivors in Lagos State, Nigeria.
 Methodology: A phenomenological approach was used to carry out one-on-one unstructured interviews with the participants, who were selected purposively using a snowball sampling technique. The interviews were analysed using Nvivo 14 to identify themes and subthemes.
 Result: The participants were 5 years or more, post-treatment for BrCa, with an average age of 43 years at the time of diagnosis. Four themes emerged: (i) In the very beginning, (ii) Going through difficult times, (iii) Becoming a survivor, and (iv) Living as a survivor. Sixteen subthemes were also identified. The participants had a self-identification pattern as survivors, and an interpretation of their experiences which were influenced by a cascade of factors including spirituality, family support, financial burden, counselling and emotional support which differs from one participant to the other.
 Conclusion: The study highlights the unique experiences of long-term BrCa survivors and the challenges they face on their journey to survivorship. Early diagnosis, inner strength, family support, faith, and quality treatment were identified as important factors in fighting cancer and reaching survivorship. The findings have implications for nurses and other healthcare providers, who should acknowledge the distinct experiences of these women to provide appropriate support and care.

Influence of Early Family Nurturing Environment on Children's Psychological and Emotional Social Development.

A good family environment and rearing mode play important roles in children's physical and psychological growth. This study aims to clarify the specific influence of early family nurturing environment on children's emotional and social development through longitudinal observation to provide theoretical reference for promoting the healthy development of children's bodies and minds. Overall, 1320 parents of children aged 2 to 6 yr old in Xinyang City, Henan Province in 2021, were selected by stratified sampling. The children's physical and mental development, family rearing environment and emotional and social development were investigated by questionnaire. 58.03% family rearing environment is good, 27.95% normal, and 14.02% bad. There were significant differences in positive rates of adaptive ability, social behavior, language, developmental quotient score and emotional sociality among children in different families (all P<0.05). Language/cognition was significantly positively correlated with adaptive ability, social behavior, language and developmental quotient (all P<0.05), and social adjustment/self-care was significantly positively correlated with adaptive ability, social behavior, language and developmental quotient (all P<0.05). Emotional warmth/environmental atmosphere was negatively correlated with implicit behavior and disorder and positively correlated with ability (all P<0.05). Language/cognition was positively correlated with explicit behavior and ability (all P<0.05). Social adjustment/self-care was negatively correlated with explicit behavior and positively correlated with ability (all P<0.05); Neglect/punishment was significantly negatively correlated with explicit behavior, implicit behavior and disorder and significantly positively correlated with ability (all P<0.05). The early family environment affects children's physical, mental, emotional and social development.

Practicing Family Medicine in a Pandemic World: Lessons for Telemedicine, Health Care Delivery, and Mental Health Care.

In this issue of the Journal, several articles evaluate the strengths and weaknesses of telemedicine. Evidence demonstrates that telemedicine is not equally effective for all clinical situations. Another set of articles report research on the delivery of health care: electronic reminders for physicians, standing orders, guideline use, and screening for social determinants of health. Two studies report on the effects of the pandemic on the mental health of subpopulations. The impact of changing insurance status on chronic disease diagnoses, the implications of eliminating the X-waiver, and trends in early career family physician salaries are also studied.

Comparing Practice Intentions and Patterns of Family Physicians in Canada.

In Canada, competency-based medical education prepares family medicine (FM) graduates to provide a broad scope of practice (SoP). We compared the practice intentions of FM residents at the end of training with actual practice patterns of early career family physicians (FPs) for SoP activities reflective of comprehensive family medicine. We collected self-reported data from cross-sectional family medicine longitudinal surveys for exiting FM residents in 2015 and 2016 and from a separate cohort of FPs who were 3 years into practice in 2018 and 2019 from 15 programs. We measured outcomes from exiting FM residents intending to participate in SoP activities and FPs participating in 15 SoP domains of family medicine. A total of 1,409 exiting FM residents (58.2% response rate) and 523 early career FPs (21% response rate) responded to the surveys. A high correlation existed between the percentage of exiting residents who intended to participate in each SoP activity and the percentage of FPs who participated in those activities (r2=0.95). However, we found statistically significant declines in the percentage of FPs reporting involvement in the SoP activities compared to their reported practice intentions for 14 of the 15 domains. We saw the greatest declines in providing care in long-term care facilities, rural communities, emergency departments, intrapartum care, and care for Indigenous populations (P&lt;.001). While SoP patterns are highly correlated with practice intentions, early-career FPs are less likely to provide care as intended for all SoP activities. Further research is needed on the factors influencing practice patterns in specific areas to determine how FP graduates can be supported to provide comprehensive care.

Understanding the health decline of Americans in boomers to millennials

Morbidity and mortality are on the rise among Americans from Boomers to Millennials. We investigate early-life diseases and the socioeconomic, psychosocial, and bio-behavioral factors behind this worsening health trend. Using data from the Panel Study of Income Dynamics Family and Individual Files 1968–2013, we find that the chronic disease index and poor subjective health have continuously increased for Baby Boomers and later cohorts. Early-life diseases, obesity, and shortening job tenure account for about half the health decline across cohorts. Weakening union protection, decreasing marriage, and declining religion only make minor contributions. All other factors, including early life nutrition and family background, adulthood socioeconomic status, physical activity, and smoking behaviors, make negative or non-significant contributions. These findings highlight that even though recent cohorts have better childhood nutrition, family socioeconomic environment,and higher levels of education and income, these advantages have been offset by elevated early-life disease exposure, obesity, and a precarious labor market. We discuss the findings in the context of Case and Deaton's “cumulative deprivation” thesis.

Early childhood predictors of early school‐age academic skills and resilience among children living in poverty

AbstractThis longitudinal study of low‐income families tested neighborhood‐, family‐, and child‐centered promotive factors in early childhood, responses to an early family intervention, and their interactions as predictors of school‐entry levels of and early school‐age gains in academic skills. Using a racially‐diverse, low‐income sample (n = 527) from a randomized controlled trial of the Family Check‐Up (FCU) intervention and Bayesian multilevel regression modeling, we tested whether neighborhood cohesion, positive mother–child engagement, and child self‐regulation in early childhood (ages 2–5 years) and their interactions with FCU group assignment predicted the intercept and slope of academic skills across child age 5, 7.5, and 8.5 years. Higher positive mother–child engagement and child self‐regulation predicted higher academic skills at school entry. An interaction between the FCU intervention and positive mother–child engagement predicted gains in academic skills compared to national norms. The findings suggest the FCU intervention leveraged positive mother–child engagement in early childhood to promote academic skills, offering a potential avenue from which to prevent income achievement gaps before school entry.

The Interplay Between Table Tennis Skill Development and Sports Performance: A Comprehensive Review

This study presents a comprehensive literature review on skill development in table tennis, focusing on various factors that influence expertise in the sport. The research synthesizes findings from multiple studies to understand the effectiveness of mental training programs, the relationship between cognitive functions and table tennis skills, differences between elite and sub-elite players, the impact of visual attention on performance, the effects of plyometric training on serve performance, and the comparison of practice schedules for skill learning and retention. Additionally, the paper explores the stages of tennis forehand attacking technique development, encompassing generalization, differentiation, consolidation, and automation stages, while discussing individual and environmental factors influencing skill development, highlighting the importance of early learning experiences, motivation, intelligence, and family support. Furthermore, the research delves into the history of table tennis performance evaluation methods, including video observation, expert interviews, and the four-stage index evaluation, establishing the reciprocal relationship between skill development and sports performance, emphasizing how enhanced athletic performance fosters skill mastery and vice versa. The findings underscore the significance of mental preparation, cognitive functions, technical proficiency, visual attention, and practice structuring in the pursuit of expertise in table tennis, indicating that incorporating mental training, cognitive training, specialized practice, and plyometric exercises can be beneficial for skill development and performance improvement in the sport.

Early mobility and family partnerships in the intensive care unit: A scoping review of reviews.

Critical illness significantly impacts the well-being of patients and families. Previous studies show that family members are willing to participate in patient care. Involving families in early mobility interventions may contribute to improved recovery and positive outcomes for patients and families. In this scoping review, we investigated early mobility interventions for critically ill patients evaluated in randomized controlled trials and the extent to which family engagement in those interventions are reported in the literature. In this scoping review of reviews, EMBASE, CINAHL, PubMed and Cochrane Central databases were searched in October 2019 and updated in February 2022. Systematic reviews were included and assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) 2. Data were synthesized using a narrative approach. PRISMA-ScR guidelines were adhered to for reporting. Thirty-three reviews were included which described a range of early mobility interventions for critically ill patients; none explicitly mentioned family engagement. Almost half of the reviews were of low or critically low quality. Insufficient detail of early mobility interventions prompted information to be extracted from the primary studies. There are a range of early mobility interventions for critically ill patients but few involve families. Given the positive outcomes of family participation, and family willingness to participate in care, there is a need to explore the feasibility and acceptability of family participation in early mobility interventions. Family engagement in early mobility interventions for critically ill patients should be encouraged and supported. How to best support family members and clinicians in enacting family involvement in early mobility requires further investigation.

Early Growth Response 1 Contributes to Renal IR Injury by Inducing Proximal Tubular Cell Apoptosis.

Renal ischemia-reperfusion (IR) causes acute kidney injury due to oxidative stress, tubular inflammation, and apoptosis. Early growth response 1 (Egr-1) is a transcription factor belonging to the immediate early gene family and is known to regulate cell proliferation, differentiation, and survival. Egr-1 expression is induced during renal IR; however, its pathogenic role and underlying mechanisms remain elusive. Here, we investigated the function of Egr-1 during renal IR using C57BL/6 mice and cultured renal proximal tubular HK-2 cells. Egr-1 expression increased immediately, 1-4 h after IR, whereas plasma creatinine and oxidative stress increased progressively over 24 h after IR. Egr-1 overexpression showed greater increases in plasma creatinine, renal tubular injury, and apoptosis than in the control after IR. Egr-1 overexpression also showed significant neutrophil infiltration and increased pro-inflammatory cytokines (TNF-α, MIP-2, and IL-6) after IR. Consistently, proximal tubular HK-2 cells showed immediate induction of Egr-1 at 1 h after hypoxia and reoxygenation, where its downstream target, p53, was also increased. Interestingly, Egr-1 overexpression enhanced p53 levels and tubular apoptosis, while the knockdown of Egr-1 reduced p53 levels and tubular apoptosis after H2O2 treatment. Egr-1 was recruited to the p53 promoter, which activates p53 transcription, and Egr-1 induction occurred through Erk/JNK signaling kinases, as the specific inhibitors blocked its expression. Taken together, these results show that Egr-1 is upregulated in proximal tubular cells and contributes to renal IR injury by inducing tubular apoptosis, mediated by p53 transcriptional activation. Thus, Egr-1 could be a potential therapeutic target for renal IR injury.

Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood.

In light of the youth mental health crisis, as 1 in 5 children have a mental disorder diagnosis by age 3, identification of transdiagnostic behavioral vulnerability prior to impairing psychopathology must occur at an earlier phase of the clinical sequence. Here, we lay the groundwork for a pragmatic irritability measure to identify at-risk infant-toddlers. Data comprised N=350 diverse infant-toddlers and their mothers assessed at ∼14months old for irritability (Multidimensional Assessment Profiles- Temper Loss-Infant/Toddler (MAPS-TL-IT) and impairment (Early Childhood Irritability-Related Impairment Interview, E-CRI; and Family Life Impairment Scale (FLIS). Bimonthly follow-up surveys assessed impairment (FLIS) over the following year. Stepwise logistic regression indicated that 5 MAPS-TL-IT items were most informative for differentiating concurrent impairment on the FLIS: "frustrated about small things"; "hit, bite, or kick during tantrums"; "trouble cheering up when grumpy"; "grumpy during fun activities" and "tantrums in public". With this summed score, Receiver Operating Characteristics analysis differentiating concurrent impairment on the E-CRI indicated good classification accuracy for (Area under the curve=0.755, p<0.05), with a cutoff of 5 maximizing sensitivity (71.4%) and specificity (70.6%). Elevated irritability on this MAPS-TL-IT clinically optimized screener increased likelihood of persistently elevated FLIS impairment trajectories over the following year more than fourfold (OR=4.37; Confidence intervals=2.40-7.97, p<0.001). Our findings represent the first step toward a pragmatic tool for screening for transdiagnostic mental health risk in toddlers, optimized for feasibility in clinical care. This has potential to strengthen resilience pathways via earlier identification of mental health risk and corollary prevention in toddlers.

Atypical findings: Atypical parkinsonian syndromes or Atypical parkinsonian syndromes look-alikes

ObjectiveIn parkinsonian syndromes, presentations other than current diagnostic criteria are considered atypical findings. Our goal was to identify and describe the frequency and features of uncommon manifestations of atypical parkinsonian syndromes within our group. MethodsWe retrospectively retrieved the medical records of all patients admitted to our clinic with parkinsonism between January 2011 and January 2022. We only included patients with atypical parkinsonian syndromes, in which the diagnosis was based on current clinical criteria. We retrospectively analyzed neurological, psychiatric, radiological, and electrophysiological characteristics. Typical and atypical features were classified according to the current clinical criteria and previous reports. ResultsWe determined 51 patients with atypical parkinsonian syndromes; 46 were included, whereas five were excluded due to insufficient follow-up. The probable diagnoses were multiple system atrophy (MSA, n = 19), dementia with Lewy bodies (DLB, n = 10), frontotemporal dementia (FTD, n = 10), corticobasal syndrome (CBS, n = 3), progressive supranuclear palsy (PSP, n = 4). The prevalence of atypical findings was similar among different types of atypical parkinsonian syndromes (p = 0.847). Atypical findings were eyelid myoclonus, double vision in MSA; ataxia, myoclonus, and a typical hummingbird sign on MRI in DLB; pyramidal findings and family history in FTD; early onset, family history, and onset with psychiatric findings in PSP-like phenotype. Genetic causes were identified in the FTD-like phenotype with pyramidal findings, whereas symptom onset was early with myoclonus in the PSP-like phenotype. ConclusionAtypical findings such as abnormal saccades, myoclonus, and ataxia may be a part of degenerative syndromes. However, family history, onset at an earlier age, and specific neurological findings suggest genetic syndromes.