Faculty Bibliography

In the published version of the above mentioned article, the author name "Katherine A Siminovitch" was not included. The authorship and affiliation given above is updated with all the author names and their respective affiliations for this article.

Background A 2015 National Eczema Association study concluded that topical steroid withdrawal is an effect of prolonged, frequent use of topical steroids occurring mostly in adult women. It is unclear whether children develop topical steroid withdrawal. Objective The aim of this study was to assess current evidence regarding topical steroid withdrawal in children. Methods This study is a systematic review of medical literature as well as online social media sites and blogs regarding topical steroid withdrawal in children. Results Literature search yielded zero studies on/or reporting classic topical steroid withdrawal in children; however, periorificial dermatitis, which is generally a steroid-induced disorder in children, was reported in >320 cases. Of 142 social media blogs on topical steroid withdrawal, 26 were blogs discussing children. Twenty-seven cases were included in this review. Length of topical steroid use ranged from 2 months to 12 years. Conclusions Topical steroid withdrawal occurs in children and can result from discontinuing topical steroids used for as little as 2 months. Resultant signs/symptoms can last >12 months, even with short duration of use. Clinicians and caregivers should be aware of this possible adverse effect of topical steroids and monitor the effects of topical steroids on infants/children, but more data are needed on this condition.

Background/Purpose: Sjogren's syndrome and systemic lupus erythematosus (SLE) are chronic, autoimmune diseases that are related by clinical and serological manifestations as well as genetic risks. Both diseases are much more commonly found in women compared to men at a ratio of about 10 to 1. We have previously shown that relatively common X chromosome aneuploidies, 47XXY (Klinefelter's syndrome, 1 in 500 live male births) and 47XXX (1 in 1000 live female births), are enriched among men and women, respectively, with Sjogren's or SLE. We undertook this study to describe rare X chromosome aneuploidies among large cohorts of patients with these diseases. Methods: We examined large cohorts of Sjogren's syndrome or SLE patients with intensity plots of X chromosome single nucleotide polymorphism (SNP) alleles. In addition, we also carried out karyotype of peripheral blood mononuclear cells from Sjogren's syndrome and SLE subjects. Results: Among 2,426 women with SLE we found three patients with a triple mosaic consisting of 45X/46XX/47XXX, a statistically significant increase compared to controls and the known birth rate by binomial confidence intervals. Among 2138 women with Sjogren's syndrome, one patient had 45X/46XX/47XXX with a triplication of the distal p arm of the X chromosome in the 47XXX cells. Neither the triple mosaic nor a partial triplication were found among controls. In fact, the triple mosaic occurs in approximately 1 in 25,000 to 50,000 live female births, while a partial triplication such as the one found is even rarer. In another cohort of Sjogren's patients, we found a mother-daughter pair in which the mother had an inversion of the proximal region of Xq and the daughter had a Xp isochrome with partial triplication of distal Xp. Conclusion: Very rare X chromosome abnormalities are present among patients with either Sjogren's or SLE. These rare variants may be informative as to location of a gene or genes on the X chromosome that mediate a gene dose effect as well as critical cell types in which a gene dose effect is operative

Developing mental health care capacity in postearthquake Haiti is hampered by the lack of assessments that include culturally bound idioms Haitians use when discussing emotional distress. The current paper describes a novel emic-etic approach to developing a depression screening for Partners in Health/Zanmi Lasante. In Study 1 Haitian key informants were asked to classify symptoms and describe categories within a pool of symptoms of common mental disorders. Study 2 tested the symptom set that best approximated depression in a sample of depressed and not depressed Haitians in order to select items for the screening tool. The resulting 13-item instrument produced scores with high internal reliability that were sensitive to culturally informed diagnoses, and interpretations with construct and concurrent validity (vis-a-vis functional impairment). Discussion focuses on the appropriate use of this tool and integrating emic perspectives into developing psychological assessments globally. The screening tool is provided as an Appendix.

Conflict-affected populations are exposed to stressful events during and after war, and it is well established that both take a substantial toll on individuals' mental health. Exactly how exposure to events during and after war affect mental health is a topic of considerable debate. Various hypotheses have been put forward on the relation between stressful war exposure (SWE), daily stressors (DS) and the development of post-traumatic stress disorder (PTSD). This paper seeks to contribute to this debate by critically reflecting upon conventional modeling approaches and by advancing an alternative model to studying interrelationships between SWE, DS, and PTSD variables. The network model is proposed as an innovative and comprehensive modeling approach in the field of mental health in the context of war. It involves a conceptualization and representation of variables and relationships that better approach reality, hence improving methodological rigor. It also promises utility in programming and delivering mental health support for war-affected populations.

Mental health professionals from North America and Europe have become common participants in postconflict and disaster relief efforts outside of North America and Europe. Consistent with their training, these practitioners focus primarily on posttraumatic stress disorder (PTSD) as their primary diagnostic concern. Most research that has accompanied humanitarian aid efforts has likewise originated in North America and Europe, has focused on PTSD, and in turn has reinforced practitioners' assumptions about the universality of the diagnosis. In contrast, studies that have attempted to identify how local populations conceptualize posttrauma reactions portray a wide range of psychological states. We review this emic literature in order to examine differences and commonalities across local posttraumatic cultural concepts of distress (CCDs). We focus on symptoms to describe these constructs - i.e., using the dominant neo-Kraepelinian approach used in North American and European psychiatry - as opposed to focusing on explanatory models in order to examine whether positive comparisons of PTSD to CCDs meet criteria for face validity. Hierarchical clustering (Ward's method) of symptoms within CCDs provides a portrait of the emic literature characterized by traumatic multifinality with several common themes. Global variety within the literature suggests that few disaster-affected populations have mental health nosologies that include PTSD-like syndromes. One reason for this seems to be the almost complete absence of avoidance as pathology. Many nosologies contain depression-like disorders. Relief efforts would benefit from mental health practitioners getting specific training in culture-bound posttrauma constructs when entering settings beyond the boundaries of the culture of their training and practice.

OBJECTIVE:: To examine the prevalence of self-reported head injury among treatment-seeking refugee survivors of torture, a population at high risk for such injuries. PARTICIPANTS:: A total of 488 survivors of torture accepted at a torture treatment clinic between January 1, 2008, and December 31, 2011. MAIN MEASURES:: Harvard Trauma Questionnaire, incidence of head injury and resulting loss of consciousness (LOC), chief physical complaints, general health scale, indicators of torture severity (length of detention, sexual assault, and number of different persecution types). RESULTS:: Of the 488 cases reviewed, 335 (69%) patients reported sustaining a blow to the head. Of the 335 with head injury, 185 (55%) reported LOC following the injury. Those who reported sustaining a head injury were significantly more likely to be men, to have a greater number of types of torture experiences, and report sleep disturbances and headaches as their primary medical complaints. CONCLUSIONS:: The high rates of head injury and head injury followed by LOC among treatment-seeking survivors of torture indicates the need for torture treatment centers to assess for possible brain injury. Our findings suggest that patients with possible traumatic brain injury (TBI) may be at a higher risk of negative physical outcomes than those without possible TBI.

This study examined the predictors of posttraumatic stress disorder (PTSD) in a clinical sample of 875 immigrant survivors of political violence resettled in the United States, with a specific aim of comparing the relative predictive power of pre-migration and post-migration experiences. Results from a hierarchical OLS regression indicated that pre-migration experiences such as rape/sexual assault were significantly associated with worse PTSD outcomes, as were post-migration factors such as measures of financial and legal insecurity. Post-migration variables, which included immigration status in the US, explained significantly more variance in PTSD outcomes than premigration variables alone. Discussion focused on the importance of looking at postmigration living conditions when treating trauma in this population.

The current study employs a grounded theory approach to examine West African immigrants' resolution of parent-child conflict and intimate partner conflict. Data from 59 participants present an interactive social ecological framework, where a lack of resolution at one level results in attempts to resolve problems at higher levels. Four levels are identified within West African immigrants' problem solving ecology, each with specific actors in positions of authority: individual/dyadic (parents and spouses), extended family (which includes distant relatives and relatives living in home countries), community leadership (non-family elders and religious leaders), and state authorities. From participants' descriptions of family challenges emerged a picture of a social ecology in flux, with traditional, socially conservative modes of resolving family conflict transposed across migration into the more liberal and state-oriented familial context of the United States. This transposition results in a loss spiral for the traditional social ecology, differentially affecting individual actors within families. Implications for helping professionals working with new immigrant communities include identifying variability in openness to adapting structures that are not working well (e.g., patriarchal protection of abusive husbands) and supporting structures known to be associated with well being (e.g., collective monitoring of youth).