Physical activity, bodyweight, health and fear of negative evaluation in primary school children.

Fear of negative evaluation (FNE) is regarded as being the core feature of social anxiety. The present study examined how FNE is associated with physical activity (PA), body mass index (BMI) and perceived physical health (PPH) in children. Data were collected in a sample of 502 primary school children in first and fifth grades taking part in a randomized-controlled trial ("Kinder-Sportstudie KISS") aimed at increasing PA and health. PA was assessed by accelerometry over 7 days, PPH by the Child Health Questionnaire and FNE by the Social Anxiety Scale for Children--Revised. BMI z-scores were calculated based on Swiss norms. Cross-sectional analyses indicated that children high in FNE exercised less, reported lower levels of PPH and had higher BMI z-scores (P<0.01). Using mixed linear models, the school-based PA intervention did not manage to reduce FNE scores. Overweight children demonstrated a greater increase in FNE (P<0.05) indicating that enhanced weight may be a risk factor for FNE. In conclusion, the associations among high FNE, low PA and increased BMI should be considered when promoting an active lifestyle in children.

Distinct neuronal circuits underlying the bahavioral and physiological components of the fear response

Abstract : Expression of fear involves changes in a number of behavioral and physiological parameters that are triggered by the central amygdala (CeA). The fear circuit also includes a series of brain stem nuclei that are the final effectors of the changes induced by the fear reaction. The CeA expresses many different neuropeptide receptors that can modulate fear responses. Today, the precise organization and the modulation of projections from the amygdala to the brain stem are still poorly understood. The aim of this project was to better understand the organization and the modulation of the fear circuit. To investigate this we first determined whether the CeA is composed of separate neuronal populations, where each one projects to specific brain stem nuclei, or whether single CeA neurons project to several nuclei. For this purpose, we first selected two brain stem nuclei implicated in the modulation of different components of the fear reactions, the periaqueductal gray (implicated in freezing) and the nucleus of solitary tract (implicated in heart rate modulation). We then performed double injections of two different retrograde tracers in these two nuclei and we quantified the subsequent presence of co-labelling in the CeA. We found that neurons projecting to the PAG and to the NTS are organized in separate populations. Subsequent electrophysiological recordings of the two populations revealed that PAG and NTS projecting neurons also have different electrophysiological characteristics. We then verified in vitro whether the neurons projecting to different brain stem nuclei express specific combinations of neuropeptide receptors, and whether a neuropeptide acting pre-synaptically (oxytocin) specifically modulates one of these two projections. We did not find differences at the level of expression of neurópeptide receptors, but we observed that oxytocin, a neuropeptide with anxiolytic properties, modulates PAG projecting neurons without affecting NTS projecting neurons. As oxytocin appeared to specifically modulate projections to the PAG, involved in the modulation of the freezing reaction, but did not affect the projections to the NTS, implicated in the modulation of cardiovascular parameters, we verified how this modulation translates in living animals. We investigated the effects of infra-amygdala injection of oxytocin on cardiovascular and behavioral changes induced by contextual fear conditioning. We found that oxytocin decreased the freezing response without affecting the cardiovascular system. Finally, as neuropeptides are considered potential future anxiolytics, we investigated whether diazepam and oxytocin, acting on the same circuit, had additive effects. This question was addressed exclusively with an in vitro electrophysiological approach. We obtained that oxytocin and diazepam, when co-applied, had an additive effect on both synaptic transmission and neuronal activity. These results open new perspectives for the possible clinical applications of oxytocin. Résumé : L'expression de la peur est accompagnée par de nombreux changements physiologiques et comportementaux qui sont déclenchés par l'amygdale centrale (CeA). Le circuit inclue aussi une série de noyaux du tronc cérébrale qui sont les effecteurs des différentes composantes de la réaction de peur. On sait que CeA envoie des projections aux noyaux du tronc cérébral et que ces neurones expriment une grande variété de récepteurs aux neuropeptides. Par contre, l'organisation des projections, ainsi que la modulation de ces projections par les neuropeptides reste encore peu connue. Avec ce projet, on premièrement voulu déterminer si CeA est composée de populations neuronales séparées qui projettent vers un noyau spécifique, ou bien si chaque neurones envoie des projections vers plusieurs noyaux. A ce propos, on a effectué des doubles injections de deux traceurs rétrogrades différentes dans deux noyaux du tronc cérébral impliqués dans des différentes composantes des réactions de peur. On a injecté la substance grise périaqueducale (PAG), qui est impliquée dans la réponse d'immobilisation, ainsi que le noyau du tractus solitaire (NTS) qui est responsable des changements cardiovasculaires. On a ensuite quantifié la présence de neurones contenant les deux traceurs dans CeA. On a trouvé que la plupart des neurones de l'amygdale centrale projettent vers un noyau spécifique, et on peut donc dire que l'amygdale semble être composée de populations neuronales séparées. On a ensuite mesuré les caractéristiques électrophysiologiques de ces deux projections et on a trouvé des différences substantielles concernant la résistance membranaire, la capacitance, le potentiel membranaire de repos ainsi que la fréquence des potentiels d'action spontanés. Puis, comme beaucoup de neuropéptides dans l'amygdale exercent un effet modulatoire sûr les réactions de peur et sur l'anxiété, on a étudié les effets directs et indirects d'une série de neuropeptides sur les différentes projections pour évaluer s'il y a des neuropeptides qui agissent spécifiquement sur une. On n'a pas trouvé de différences entre neurones qui projettent vers le PAG et neurones qui projettent vers le NTS concernant les effets de neuropeptides qui agissent directement sur ces cellules. Par contre, on a trouvé que l'ocytocine, un neuropeptide qui se lie à des récepteurs dans la partie latérale de l'amygdale centrale et inhibe de façon indirecte les neurones de l'amygdala centrale médiale, module les projections vers le PAG sans affecter celles qui vont vers le NTS. Comme le PAG est impliqué dans la réponse d'immobilisation, alors que le NTS est impliqué dans la modulation cardiovasculaire, on a ensuite étudié les effets de l'ocytocine injectée dans l'amygdale de rat vivants sur les réactions de peur conditionnées. On a trouvé que l'ocytocine diminue la réponse d'immobilisation sans par contre affecter la réponse cardiovasculaire. Pour terminer, on a vérifié si l'ocytocine potentialise les effets d'un médicament anxiolytique, le diazeparn. Avec une étude in vitro on a trouvé qu'une co-application d'ocytocine et diazeparn résulte en un effet additionnel à la fois sur la transmission synaptique ainsi que sur l'activité neuronale des neurones de l'amygdale centrale médiale. Ces résultats ouvrent des nouvelles perspectives pour une potentielle utilisation clinique de l'ocytocine.

What is the relationship between fear of falling and gait in well-functioning older persons aged 65 to 70 years?

OBJECTIVE: To investigate the association between fear of falling and gait performance in well-functioning older persons. DESIGN: Survey. SETTING: Community. PARTICIPANTS: Subjects (N=860, aged 65-70y) were a subsample of participants enrolled in a cohort study who underwent gait measurements. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Fear of falling and its severity were assessed by 2 questions about fear and related activity restriction. Gait performance, including gait variability, was measured using body-fixed sensors. RESULTS: Overall, 29.6% (210/860) of the participants reported fear of falling, with 5.2% (45/860) reporting activity restriction. Fear of falling was associated with reduced gait performance, including increased gait variability. A gradient in gait performance was observed from participants without fear to those reporting fear without activity restriction and those reporting both fear and activity restriction. For instance, stride velocity decreased from 1.15+/-.15 to 1.11+/-.17 to 1.00+/-.19 m/s (P<.001) in participants without fear, with fear but no activity restriction and with fear and activity restriction, respectively. In multivariate analysis, fear of falling with activity restriction remained associated with reduced gait performance, independent of sex, comorbidity, functional status, falls history, and depressive symptoms. CONCLUSIONS: In these well-functioning older people, those reporting fear of falling with activity restriction had reduced gait performance and increased gait variability, independent of health and functional status. These relationships suggest that early interventions targeting fear of falling might potentially help to prevent its adverse consequences on mobility and function in similar populations.

Quand la peur des dépenses incite au gaspillage humain et financier [When the fear of spending incites a human and financial waste!]

Dans les années 80, la crainte de la pléthore médicale imposait des mesures radicales. En 2002, c'est l'angoisse de l'envahisseur européen qui a justifié un moratoire sur l'ouverture de nouveaux cabinets. Aujourd'hui, alors que la Suisse recrute de plus en plus de médecins étrangers pour ses besoins, le Conseiller fédéral Couchepin brandit la menace d'une augmentation des coûts de la santé de 300 millions par an pour justifier une troisième prolongation du moratoire. Ces mesures ont été dictées par la peur d'une explosion des coûts au point de faire perdre de vue la globalité de la situation. Aujourd'hui pourtant, une gestion rationnelle des ressources impose de tout faire pour qu'un maximum de médecins puissent travailler, car la population en a besoin et a déjà beaucoup investi dans leur formation ! Pour y parvenir, la création de postes d'assistanat à temps partiel, l'adaptation urgente des structures d'accueil en garderie et le respect de conditions de travail raisonnables sont des éléments incontournables mais trop souvent négligés par les politiques et les médecins eux-mêmes !

Oxytocin selectively gates fear responses through distinct outputs from the central amygdala.

Central amygdala (CeA) projections to hypothalamic and brain stem nuclei regulate the behavioral and physiological expression of fear, but it is unknown whether these different aspects of the fear response can be separately regulated by the CeA. We combined fluorescent retrograde tracing of CeA projections to nuclei that modulate fear-related freezing or cardiovascular responses with in vitro electrophysiological recordings and with in vivo monitoring of related behavioral and physiological parameters. CeA projections emerged from separate neuronal populations with different electrophysiological characteristics and different response properties to oxytocin. In vivo, oxytocin decreased freezing responses in fear-conditioned rats without affecting the cardiovascular response. Thus, neuropeptidergic signaling can modulate the CeA outputs through separate neuronal circuits and thereby individually steer the various aspects of the fear response.

The relationship between fear of falling and foot clearance in older people

Introduction : Fear of falling (FOF) is associated with falls and modifications in gait parameters. Foot clearance during walking is directly linked to tripping and falling. The relationship between FOF and foot Downloaded from http://gerontologist.oxfordjournals.org/ at Université & EPFL Lausanne on January 23, 2013 436 The Gerontological Society of America clearance has never been evaluated. Methods : Participants (N=568, aged 66 to 71 years, 57.2% women) underwent gait parameters measurements using footworn sensors. Specific foot clearance parameters evaluated included maximal and minimal heel and toe clearances and their variability. FOF was assessed using a single question. Results : Overall, 27.4% of the participants reported FOF. Compared to the others, participants with FOF had decreased maximal heel (28.9 vs 30.4 cm, p<.001) and toe clearance (12.5 vs 13.8 cm, p<.001), and decreased minimal toe clearance variability (SD 3.7 vs 4.0 cm, p<.001). Conclusion : These preliminary results suggest a relationship between FOF and foot clearance parameters. Multivariate analyses are underway.

Fear and anxiety at the basis of adolescent externalizing and internalizing behaviors: a case study.

Juvenile delinquency is rarely associated with success in psychotherapeutic treatment. Up until now, few data have been recorded regarding possible overlaps or common features of conduct disorders with anxiety disorders. This case report of a delinquent adolescent's presenting an obsessive-compulsive disorder discusses possible underlying common features of externalizing and internalizing disorders, mainly in terms of fear and anxiety regulation. The successful psychotherapy is discussed with regard to efficient psychological assessment and treatment of delinquent adolescents, and it underlies the importance of detailed analysis of psychopathology in cases of juvenile delinquency.

Do we fear tax competition among new and old European countries ?

The purpose of this paper is to study both theoretically and empirically tax competition in the enlarged EU and to provide some insights on ongoing reforms concerning business taxation. We support the idea that even if one can observe cuts in "new" members statutory business tax rates, this should not result in fiercer tax competition between the "core" and "the "periphery" since infrastructure endowments and the existence of agglomeration rents in the core of the EU may prevent (at least partially) activities to relocate to the "new" members.

Evaluating fear of falling among community-dwelling older people: A qualitative pattern model based on the experience of falls

This research was conducted in the context of the project IRIS 8A Health and Society (2002-2008) and financially supported by the University of Lausanne. It was aomed at developping a model based on the elder people's experience and allowed us to develop a "Portrait evaluation" of fear of falling using their examples and words. It is a very simple evaluation, which can be used by professionals, but by the elder people themselves. The "Portrait evaluation" and the user's guide are on free access, but we would very much approciate to know whether other people or scientists have used it and collect their comments. (contact: Chantal.Piot-Ziegler@unil.ch)The purpose of this study is to create a model grounded in the elderly people's experience allowing the development of an original instrument to evaluate FOF.In a previous study, 58 semi-structured interviews were conducted with community-dwelling elderly people. The qualitative thematic analysis showed that fear of falling was defined through the functional, social and psychological long-term consequences of falls (Piot-Ziegler et al., 2007).In order to reveal patterns in the expression of fear of falling, an original qualitative thematic pattern analysis (QUAlitative Pattern Analysis - QUAPA) is developed and applied on these interviews.The results of this analysis show an internal coherence across the three dimensions (functional, social and psychological). Four different patterns are found, corresponding to four degrees of fear of falling. They are formalized in a fear of falling intensity model.This model leads to a portrait-evaluation for fallers and non-fallers. The evaluation must be confronted to large samples of elderly people, living in different environments. It presents an original alternative to the concept of self-efficacy to evaluate fear of falling in older people.The model of FOF presented in this article is grounded on elderly people's experience. It gives an experiential description of the three dimensions constitutive of FOF and of their evolution as fear increases, and defines an evaluation tool using situations and wordings based on the elderly people's discourse.

Fear of Falling Appearing after Post-Acute Rehabilitation is Associated with Reduced Functional Status

Objective: To investigate the association between fear of falling appearing within one month after discharge from post-acute rehabilitation and functional status in elderly patients. Methods: Participants (N=180, mean age 81.37.1 years, 75.6% women) were patients consecutively admitted to rehabilitation over a 6-month period. Demographics, functional, cognitive and affective status were assessed upon admission; functional status was assessed at discharge; history of falls since discharge, functional and affective status were assessed by phone one month after discharge. Fear of falling was assessed using the question: "Are you afraid of falling?". Results: Among patients without fear of falling at discharge (N=95), 20.0% (N=19) reported new fear of falling one month after discharge. Living alone (adjOR=4.9, 95%CI 1.04-23.16, P=.045), functional status at discharge (adjOR=0.5, 95%CI 0.32-0.88, P=.014), and depressive symptoms (adjOR=5.4, 95%CI 1.20-24.32, P=.028) independently predicted fear of falling at one month. There was weak evidence that history of falls since discharge (adjOR=4.1, 95%CI 0.81-21.31, P=.088) was associated with new fear of falling. Developing fear of falling was also associated with reduced functional status at one month (mean basic ADL score: fearful 5.20.8; confident: 5.80.4,P<.001). This association remained after controlling for demographics, functional status at discharge, depressive symptoms, and history of falls since discharge (coef =-0.4, 95%CI -0.73 to -0.16, P=.003). Conclusion: Fear of falling appearing within one month after discharge from post-acute rehabilitation was associated with reduced functional status in elderly patients. Further studies should determine whether early interventions targeting specifically fear of falling in these patients would improve their functional status.

Neurophysiological effects of vasopressin and oxytocin in the central amygdala of the rat : a potential mechanism for the opposite modulation of anxiety and fear behavior

Abstract The amygdala is a group of nuclei in the temporal lobe of the brain that plays a crucial role in anxiety and fear behavior. Sensory information converges in the basolateral and lateral nuclei of the amygdala, which have been the first regions in the brain where the acquisition of new (fear) memories has been associated with long term changes in synaptic transmission. These nuclei, in turn, project to the central nucleus of the amygdala. The central amygdala, through its extensive projections to numerous nuclei in the midbrain and brainstem, plays a pivotal role in the orchestration of the rapid autonomic and endocrine fear responses. In the central amygdala a large number of neuropeptides and receptors is expressed, among which high levels of vasopressin and oxytocin receptors. Local injections of these peptides into the amygdala modulate several aspects of the autonomic fear reaction. Interestingly, their effects are opposing: vasopressin tends to enhance the fear reactions, whereas oxytocin has anxiolytic effects. In order to investigate the neurophysiological mechanisms that could underlie this opposing modulation of the fear behavior, we studied the effects of vasopressin and oxytocin on the neuronal activity in an acute brain slice preparation of the rat central amygdala. We first assessed the effects of vasopressin and oxytocin on the spontaneous activity of central amygdala neurons. Extracellular single unit recordings revealed two major populations of neurons: a majority of neurons was excited by vasopressin and inhibited by oxytocin, whereas other neurons were only excited by oxytocin receptor activation. The inhibitory effect of oxytocin could be reduced by the block of GABAergic transmission, whereas the excitatory effects of vasopressin and oxytocin were not affected. In a second step we identified the cellular mechanisms for the excitatory effects of both peptides as well as the morphological and biochemical mechanisms underlying the opposing effects, by using sharp electrode recordings together with intracellular labelings. We revealed that oxytocin-excited neurons are localized in the lateral part (CeL) whereas vasopressin excited cells are found in the medial part of the central amygdala (CeM). The tracing of the neuronal morphology showed that the axon collaterals of the oxytocin-excited neurons project from the CeL, far into the CeM. Combined immunohistochemical stainings indicated that these projections are GABAergic. In the third set of experiments we investigated the synaptic interactions between the two identified cell populations. Whole-cell patch-clamp recordings in the CeM revealed that the inhibitory effect of oxytocin was caused by the massive increase of inhibitory GABAergic currents, which was induced by the activation of CeL neurons. Finally, the effects of vasopressin and oxytocin on evoked activity were investigated. We found on the one hand, that the probability of evoking action potentials in the CeM by stimulating the basolateral amygdala afferents was enhanced under vasopressin, whereas it decreased under oxytocin. On the other hand, the impact of cortical afferents stimulation on the CeL neurons was enhanced by oxytocin application. Taken together, these findings have allowed us to develop a model, in which the opposing behavioral effects of vasopressin and oxytocin are caused by a selective activation of two distinct populations of neurons in the GABAergic network of the central amygdala. Our model could help to develop new anxiolytic treatments, which modulate simultaneously both receptor systems. By acting on a GABAergic network, such treatments can further be tuned by combinations with classical benzodiazepines. Résumé: L'amygdale est un groupe de noyaux cérébraux localisés dans le lobe temporal. Elle joue un rôle essentiel dans les comportements liés à la peur et l'anxiété. L'information issue des aires sensorielles converge vers les noyaux amygdaliens latéraux et basolatéraux, qui sont les projections vers différents noyaux du tronc cérébral et de l'hypothalamus, joue un rôle clef premières régions dans lesquelles il a été démontré que l'acquisition d'une nouvelle mémoire (de peur) était associée à des changements à long terme de la transmission synaptique. Ces noyaux envoient leurs projections sur l'amygdale centrale, qui à travers ses propres dans l'orchestration des réponses autonomes et endocrines de peur. Le contrôle de l'activité neuronale dans l'amygdale centrale module fortement la réaction de peur. Ainsi, un grand nombre de neuropeptides sont spécifiquement exprimés dans l'amygdale centrale et un bon nombre d'entre eux interfère dans la réaction de peur et d'anxiété. Chez les rats, une forte concentration de récepteurs à l'ocytocine et à la vasopressine est exprimée dans le noyau central, et l'injection de ces peptides dans l'amygdale influence différents aspects de la réaction viscérale associée à la peur. Il est intéressant de constater que ces peptides exercent des effets opposés. Ainsi, la vasopressine augmente la réaction de peur alors que l'ocytocine a un effet anxiolytique. Afin d'investiguer les mécanismes neurophysiologiques responsables de ces effets opposés, nous avons étudié l'effet de la vasopressine et de l'ocytocine sur l'activité neuronale de préparations de tranches de cerveau de rats contenant entre autres de l'amygdale centrale. Tout d'abord, notre intérêt s'est porté sur les effets de ces deux neuropeptides sur l'activité spontanée dans l'amygdale centrale. Des enregistrements extracellulaires ont révélé différentes populations de neurones ; une majorité était excitée par la vasopressine et inhibée par l'ocytocine ; d'autres étaient seulement excités par l'activation du récepteur à l'ocytocine. L'effet inhibiteur de l'ocytocine a pu être réduit par l'inhibition de la transmission GABAergique, alors que ses effets excitateurs n'étaient pas affectés. Dans un deuxième temps, nous avons identifié les mécanismes cellulaires responsables de l'effet excitateur de ces deux peptides et analysé les caractéristiques morphologiques et biochimiques des neurones affectés. Des enregistrements intracellulaires ont permis de localiser les neurones excités par l'ocytocine dans la partie latérale de l'amygdale centrale (CeL), et ceux excités par la vasopressine dans sa partie médiale (CeM). Le traçage morphologique des neurones a révélé que les collatérales axonales des cellules excitées par l'ocytocine projetaient du CeL loin dans le CeM. De plus, des colorations immuno-histochimiques ont révélé que ces projections étaient GABAergiques. Dans un troisième temps, nous avons étudié les interactions synaptiques entre ces deux populations de cellules. Les enregistrements en whole-cell patch-clamp dans le CeM ont démontré que les effets inhibiteurs de l'ocytocine résultaient de l'augmentation massive des courants GABAergique résultant de l'activation des neurones dans le CeL. Finalement, les effets de l'ocytocine et de la vasopressine sur l'activité évoquée ont été étudiés. Nous avons pu montrer que la probabilité d'évoquer un potentiel d'action dans le CeM, par stimulation de l'amygdale basolatérale, était augmentée sous l'effet de la vasopressine et diminuée sous l'action de l'ocytocine. Par contre, l'impact de la stimulation des afférences corticales sur les neurones du CeL était augmenté par l'application de l'ocytocine. L'ensemble de ces résultats nous a permis de développer un modèle dans lequel les effets comportementaux opposés de la vasopressine et de l'ocytocine sont causés par une activation sélective des deux différentes populations de neurones dans un réseau GABAergique. Un tel modèle pourrait mener au développement de nouveaux traitements anxiolytiques en modulant l'activité des deux récepteurs simultanément. En agissant sur un réseau GABAergique, les effets d'un tel traitement pourraient être rendus encore plus sélectifs en association avec des benzodiazépines classiques.

Extreme self-monitoring, fear of hypoglycemia and obsessive-compulsive disorder in type 1 diabetes mellitus: when less is better

Background: Pre-existing psychological factors can strongly influence coping with type 1 diabetes mellitus and interfere with self-monitoring. Psychiatric disorders seem to be positively associated with poor metabolic control. We present a case of extreme compulsive blood testing due to obsessive fear of hypoglycemia in an adolescent with type 1 diabetes mellitus. Case report: Type 1 diabetes mellitus (anti GAD-antibodies 2624 U/l, norm < 9.5) was diagnosed in a boy aged 14.3 years [170 cm (+ 0.93 SDS), weight 50.5 kg (+ 0.05 SDS)]. Laboratory work-up showed no evidence for other autoimmune disease. Family and past medical history were unremarkable. Growth and developmental milestones were normal. Insulin-analog based basal-bolus regime was initiated, associated to standard diabetic education. Routine psychological evaluation performed at the onset of diabetes revealed intermittent anxiety and obsessivecompulsive traits. Accordingly, a close psychiatric follow-up was initiated for the patient and his family. An adequate metabolic control (HbA1c drop from >14 to 8%) was achieved within 3 months, attributed to residual -cell function. In the following 6 months, HbA1c rose unexpectedly despite seemingly adequate adaptations of insulin doses. Obsessive fear of hypoglycemia leading to a severe compulsive behavior developed progressively with as many as 68 glycemia measurements per day (mean over 1 week). The patient reported that he could not bear leaving home with glycemia < 15 mmol/l, ending up with school eviction and severe intra-familial conflict. Despite intensive psychiatric outpatient support, HbA1c rose rapidly to >14% with glycemia-testing reaching peaks of 120 tests/day. The situation could only be discontinued through psychiatric hospitalization with intensive behavioral training. As a result, adequate metabolic balance was restored (HbA1c value: 7.1 %) with acceptable 10-15 daily glycemia measurements. Discussion: The association of overt psychiatric disorders to type 1 diabetes mellitus is very rare in the pediatric age group. It can lead to a pathological behavior with uncontrolled diabetes. Such exceptional situations require long-term admissions with specialized psychiatric care. Slow acceptation of a "less is better" principle in glycemia testing and amelioration of metabolic control are difficult to achieve.