Exeley Inc.

Lane, Geraldine

Matthews, Brian

Ellison, Caroline

Palmer, Carolyn

There&rsquo;s more to a dog guide than meets the eye: A preliminary exploration of potential health benefits of dog guide use

Cheah, Vincent

Australasian Journal of Neuroscience Volume 27 ● Number 1 ● May 2017 
7
Background: 
Lubag syndrome is an extremely rare 
adult onset neurodegenerative movement 
disorder first described in Filipino males from 
the Panay Islands in 1975 (Lee, Maranon, 
Demaisip, Peralta, Borres-Icasiano, Arancillo 
& Reyes,  2002). The term ‘Lubag’ is a broad, 
meaning ‘twisted’ in the local Filipino dialect 
of Ilongo and also used to describe the tor-
sion seen in children with cerebral palsy. Lub-
ag syndrome is known as X-linked dystonia 
Parkinsonism (XDP) or DYT3 after the gene 
which produces the mutation causing XDP. 
XDP presents a higher male incidence as 
recessive mutation affects the X chromo-
some.  
 
 
 
Males, having only the one X chro-
mosome, are more likely to express the muta-
tion where women, having two chances to 
obtain a normal dominant X chromosome, are 
less likely to display the mutation (Dobyns, et 
al. 2004). Females can be carriers of the de-
fective gene however it is rare for symptoms 
to be displayed and if present, they appear 
comparatively mild to male counterparts (Lee, 
et al. 2002).  
Statistics reported in the Philippines 
state that prevalence amongst the general 
Filipino population is estimated at 
0.34/100,000 with the highest rates being 
seen in the province of Capiz where approxi-
mately one in every 4000 males are affected 
by XDP (Lee, et al. 2002). The mutation of 
the gene DYT3 and its effects can be traced 
back over 2000 years in the Ilongo ethnic 
group of the Panay islands (Lee, et al. 2002). 
Filipinos have migrated across the globe and 
cases identified outside the Philippines show 
that maternal ancestry traces back to this eth-
nic group on Panay Islands (Evidente, et al. 
2002).  
Abstract: 
Sex-linked dystonia parkinsonism (XDP) also known as Lubag Syndrome is a rare sex-
linked genetic progressive movement disorder affecting almost exclusively males from the prov-
ince of Capiz in the Philippines and their descendants. At the Mater Centre for Neurosciences 
we have recently treated two patients with XDP utilising Deep Brain Stimulation (DBS) implants. 
Mr G. Infante was the second patient to be treated, the first being his uncle. Mr G. Infante’s case 
was brought to the attention of the Mater Centre for Neurosciences at South Brisbane after the 
success of his uncle’s treatment two years prior.  
In the three years from when Mr G. Infante’s dystonia symptoms were first noticed, his 
condition progressively worsened until he was wheelchair bound. With severe chronic pain, una-
ble to walk, difficulties talking and swallowing, Mr G’s quality of life was severely impacted by 
XDP. 
XDP is a movement disorder considered a variation to Parkinson’s Disease. The differ-
ence being that the XDP starts with a long period of dystonia that eventually evolves into the 
tremor and associated symptoms typical of Parkinson’s Disease. Due to the similarity of the con-
ditions the patient’s needs and treatment methods, both medical and surgical, are almost identi-
cal.  Deep brain stimulation surgery involves implantation of electrodes into specific regions of 
the brain. The electrodes are then used to deliver finely tuned electrical currents in order to re-
duce the signs and symptoms of both neuropsychiatric and movement disorders such as Parkin-
son’s and XDP. The high frequency electrical charges sent to deep structures in the brain stimu-
late or shut down nerve cells around the electrode. The areas of the brain that the electrodes 
target are thought to participate in the circuitry involved and effectively disrupts these processes 
and reduces the symptoms of the disease.  
This paper presents the journey of Mr G. Infante’s XDP and DBS and provides an expla-
nation of how DBS works to improve the quality of life for patients who suffer from XDP. 
Key Words: lubag syndrome, x-linked dystonia parkinsonism, deep brain stimulation. 
Questions or comments about this article should be   
directed to Vincent Cheah Registered Nurse Mater Pri-
vate Hospital, South Brisbane Queensland 
 vincecheah852@gmail.com 
Copyright © 2017ANNA 
Lubag Syndrome (X-linked Dystonia Parkinsonism) 
Case Study of Mr G. Infante 
Vincent Cheah 
Australasian Journal of Neuroscience Volume 27 ● Number 1 ● May 2017 
 8 
Mr G Infante’s symptoms appeared at 
age thirty-nine, typical of the disease which 
begins to effect the individual from age thirty 
to forty (Lehn, Airey, Olson, O’Sullivan & 
Boyle, 2014). In a typical case of XDP, as 
seen with Mr G Infante, the symptoms that 
lead to a diagnosis include continous muscle 
cramping and spasms, postural instability, 
blepharospasms, difficulties with speaking, 
swallowing, coordination and walking (Lee, et 
al. 2002). The sufferer will also develop focal 
dystonic movement which spreads and gen-
eralizes to the whole body within five years of 
onset (Evidente, et al. 2002).  After several 
years the dystonic movements become less 
prominent and stiffening of the limbs and 
trunk occurs (Lehn et al., 2014). This is 
known as the dystonia/parkinsonism phase. 
As XDP is a neurodegenerative disease, as 
the basal ganglia degenerates over time, the 
symptoms of parkinsonism begin to become 
more prominent. 
Currently XDP has no cure, treat-
ment is aimed at alleviating the symptoms to 
improve quality of life for sufferers. Unfortu-
nately the treatment options, particularly in 
the Phillipines, are both limited and expen-
sive. It is often the case that sufferers are 
isolated and unable to access treatment or 
support due to the financial burdens of both 
living with the disease and the treatments 
themselves. In early stages of the disease 
options include the use of benzodiazepines 
and anti-cholinergic agents, and Botox injec-
tions to relieve focal dystonia. Allied health 
services including speech, physiotherapy and 
occupational provide benefits to assist the 
individual to improve and maintain symptoms 
and function in daily life. Dependent on the 
availability of finances, the symptoms and 
age it is possible for patients to undergo le-
sioning surgery or deep brain stimulation 
(DBS).  
While the underlying mechanisms of 
DBS are not yet fully understood, it allows 
changes in brain activity to be made in a con-
trolled manner (Herrington, Cheng & Eskan-
dar 2016). Prior to DBS surgical lesioning 
was the primary surgical intervention for 
Parkinson’s Disease (PD) and dystonic con-
ditions. This involves the insertion of a heat-
ed electrode into structures within the basal 
ganglia, destroying cells within a very small 
area and disrupting electrical brain signals to 
reduce symptoms. The disadvantage of this 
procedure is XDP and PD are degenerative 
diseases that progressively worsen over time 
and while destroying small parts of the basal 
ganglia can relieve symptoms, damaging too 
much can lead to a significant further loss of 
function. DBS aims to provide the same re-
sults as lesioning without permanently de-
stroying brain cells (Okun, Zellman, 2017). 
DBS consists of 3 elements: electrodes, ex-
tension cables and an impulse generator.  
The cost of DBS surgery can range 
from $35,000 to upwards of $70,000 for bilat-
eral procedures (Okun, Zellman, 2017). The 
electrodes are placed in targets within the 
basal ganglia, the location depending on 
symptoms. As both PD and XDP affect simi-
lar regions the DBS brain targets include the 
globus pallidus internus, sub-thalamic nucle-
us (Okun, Zellman, 2017). These structures 
are targets as they relay the sensory and mo-
tor signals to the cerebral cortex. The im-
pulse generator creates a small charge at a 
high frequency >100 Hz (Beuter, Anne, & 
Modolo, 2009). This high frequency disrupts 
electrical activity in the target area creating a 
‘temporary lesion’.  
By interrupting these unwanted sig-
nals to the key brain areas DBS is able to 
alleviate symptoms. Due to the dystonia that 
is present with XDP after successful implan-
tation and stimulation there is a latency effect 
or lag that does not occur in those patients 
with PD. This lag is due to the brain re-
organising itself through neuro-modulation, 
synaptic plasticity and then finally anatomical 
reorganization (Beuter, Anne, & Modolo, 
2009). Another benefit of DBS for XDP is that 
as symptom progression occurs, frequencies 
of the impulse generator can be adjusted. 
Current technological advancements have 
seen wireless technology incorporated into 
DBS devices so that medical professionals 
are able to remotely assess and treat pa-
tients.  
Australasian Journal of Neuroscience Volume 27 ● Number 1 ● May 2017 
 9 
Case Study: Mr G. Infante 
Mr G. Infante is a forty-nine year old 
Filipino male diagnosed with XDP at forty-six 
years of age. Mr Infante has a notable family 
history of XDP with one blood and three half 
brothers to the same mother, a carrier of the 
XDP mutation. Mr Infante’s father is of Ger-
man decent and does not carry the XDP mu-
tation. Mr Infante’s three half-brothers all suf-
fer from XDP however his biological brother 
is yet to show any signs. Mr Infante had a 
normal birth and unremarkable developmen-
tal milestones during childhood and early 
adulthood. At thirty-nine years of age he de-
veloped subtle shuffling and slowing of gait. 
Mr Infante ignored these symptoms at the 
time, considering them as fatigue related to 
work.  
At age forty-one Mr Infante’s symp-
toms worsened and he developed a resting 
tremor, dystonic posturing of his upper left 
limb, as well as torticollis; typical of the pro-
gression of the disease process. By the age 
of forty-six, a continued deterioration of 
symptoms led to constant tongue protrusion 
causing dysarthria and dysphagia. During 
this period Mr Infante also suffered worsen-
ing chronic back pain, decline in gait with fre-
quent falls, dysphagia that progressed to the 
point of significant dietary modification and 
weight loss from 85.7 kilograms to 68 kilo-
grams in three months. When Mr Infante 
came to Australia for treatment he was 
wheelchair bound and required maximum 
assistance for his everyday needs.  
The story of how Mr Infante came to 
the Mater Centre of Neurosciences is quite 
remarkable. Following successful DBS im-
plantation for XDP, Mr Infante’s uncle dis-
cussed his case with neurologist Dr Alexan-
der Lehn and neurosurgeon Dr Sarah Olsen 
to see if they could help to treat his nephew. 
In a generous humanitarian gesture, the Ma-
ter Executive Board approved funding for Mr 
Infante and his wife to travel from the Philip-
pines to the Mater Private Hospital in South 
Brisbane for assessment at the Movement 
Disorder Clinic headed by Dr Lehn. After ini-
tial assessments of Mr Infante both Dr Lehn 
and Dr Olsen wanted to help but were faced 
with challenges regarding the costs of DBS 
equipment, theatre time and rehabilitation as 
Mr Infante was not an Australian citizen.  In 
an incredible stroke of luck, on the day Mr 
Infante was assessed at the clinic a repre-
sentative of St Jude Medical, the manufactur-
ers of DBS equipment, was visiting the hospi-
tal.  Upon hearing of Mr Infante and the 
struggles that he and his wife had faced while 
dealing with this debilitating condition, the 
representative was moved. Phone calls were 
made and remarkably the DBS equipment, 
worth upward of $30 000, was donated to Mr 
Infante’s cause. Dr Olsen and Dr Lehn had 
agreed without hesitation to perform the im-
plantation surgery and the Mater Private Hos-
pital Brisbane organised the donation of the 
theatre time and services of Mater Centre for 
Neuroscience and associated teams to im-
prove the quality of life for Mr Infante.   
Mr Infante was successfully implant-
ed bilaterally into the globus pallidus internus. 
Following surgery Mr Infante spent a few 
days in the intensive care unit before return-
ing to the neurosurgical ward. CT scans 
showed no bleeding and electrode placement 
was accurate. The first stimulation was 
around two weeks post-surgery with positive 
results showing two to three weeks later. Dai-
ly physiotherapy, speech therapy and occu-
pational therapy helped Mr Infante make the 
slow and steady journey towards independ-
ence. Through time in the rehabilitation unit 
Mr Infante slowly regained his ability to walk 
with minimal assistance, together with im-
proved fine motor skills and speech.  
The improvement seen in Mr Infante 
was remarkable and highlights the signifi-
cance of DBS therapy in those individuals 
who suffer from XDP. Mr Infante came to the 
Mater in a wheelchair and left walking with 
only minor aid. He is very grateful to the Ma-
ter Private Hospital South Brisbane for the 
DBS treatment that significantly improved his 
quality of life for himself and his wife. Mr In-
fante is currently residing at home in the Phil-
ippines with regular contact with neurologist 
Dr Lehn. 
Australasian Journal of Neuroscience Volume 27 ● Number 1 ● May 2017 
 10 
References: 
Lee, LV, Maranon, E, Demaisip, C, Peralta, O, 
Borres-Icasiano, R, Arancillo, J, , Rivera C, 
Munoz E, Tan K, Reyes MT  (2002) ‘The natu-
ral history of sex-linked recessive dystonia 
parkinsonism of Panay, Philippines 
(XDP)’, Parkinsonism & Related Disor-
ders, vol. 9, no. 1: pp. 29-38. 
Evidente, VGH, Advincula, J, Esteban, R, Pasco, P, 
Alfon, JA, Natividad, FF, Cuanang J, Luis AS, 
Gwinn-Hardy K, Hardy J, Hernandez D (2002), 
‘Phenomenology of “Lubag” or X-linked dysto-
nia–parkinsonism’, Movement Disorders, vol. 
17, no. 6: pp.1271-1277. 
Dobyns, WB, Filauro, A, Tomson, BN, Chan, AS, 
Ho, AW, Ting, NT, Oosterwijk JC, Ober C 
(2004), ‘Inheritance of most X linked traits is 
not dominant or recessive, just X linked’, 
American Journal of Medical Genetics Part 
A, vol. 129, no. 2; pp. 136-143. 
Lehn, A. Airey, C, Olson, S, O’Sullivan, JD, and 
Boyle, R (2014), ‘Deep Brain Stimulation for 
DYT3 Dystonia’,  Movement Disorders Clinical 
Practice,  vol. 1, no. 1; pp. 73-75. 
Okun, M and Zellman. P (2017), ‘Parkinson’s Dis-
ease: Guide to Deep Brain Stimulation Thera-
py’, National Parkinson Foundation Patient 
and Family Education, pp. 1-56. 
Herrington, TM, Cheng, JJ, and Eskandar, EN 
(2016), ‘Mechanisms of deep brain stimula-
tion.’, Journal of Neurophysiology, vol. 115, 
no. 1: pp. 19-38. 
Beuter, A, and Modolo, J (2009), ‘Delayed and 
lasting effects of deep brain stimulation on 
locomotion in Parkinson’s disease’, Chaos: An 
interdisciplinary Journal of Nonlinear Science, 
vol. 19, no. 2; pp. 1-11. 
Acknowledgements 
The author wishes to thank: 
Mr G. Infante and his wife Leah Infante for giving permis-
sion to present his case at the ANNA 2016 conference. 
He wishes his name to remain unchanged in hopes more 
work can be done to help sufferers of Lubag Syndrome. 
Neurologist Dr Alexander Lehn for his expertise, profes-
sionalism and mentorship. 
Joan Crystal Nurse Unit Manager at the Mater Centre for 
Neurosciences providing the opportunities to present this 
case at ANNA 2016. 


Lubag Syndrome (X-linked Dystonia Parkinsonism) Case Study of Mr G. Infante

Tandon, Mini

Grant, Julia D.

Madden, Pamela A.F.

Bucholz, Kathleen K.

Heath, Andrew C.

52 
Scandinavian Journal of Child and Adolescent Psychiatry and Psychology 
Vol. 5(2):52-54 (2017) 10.21307/sjcapp-2017-006 
 
Brief Research Article Open Access 
 
 
 
 
Smoking as an early risk factor for problematic parenting practices 
 
Mini Tandon*, Julia D. Grant, Pamela A.F. Madden, Kathleen K. Bucholz, Andrew C. Heath 
 
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA 
 
 
*Corresponding author: tandonm@psychiatry.wustl.edu 
 
Abstract 
 
Parenting among those who use non-illicit and more common drugs such as cigarettes remains an understudied area for 
investigation. Secondary data analyses were performed in 2015 on a prospective study with parent and twin data available on 
n=3,009 individual members of female twin pairs born between July 1975 and June 1985 identified from Missouri-state birth 
records. Maternal smoking when the twins were 3+ years of age remained a significant predictor of offspring report of 
childhood sexual abuse (OR, 1.40; 95% CI, 1.02-1.92) after controlling for key covariates. Given limited public health 
resources, mothers who smoke during child’s preschool years may be targeted for tailored parenting intervention . 
 
Keywords: Early childhood; parenting; maltreatment; smoking; maternal 
 
 
 
 
Introduction 
A number of studies have reviewed parenting of 
young children by mothers with alcohol and illicit 
substance dependence (1). However, parenting 
among those who use non-illicit and more common 
drugs such as cigarettes is less well investigated (2,3). 
A key challenge in studying parenting practices 
among substance-abusing parents is that their 
families are often also at risk for a host of additional 
psychosocial risks including poverty, single 
parenting, low maternal education, and parent and 
child psychopathology, which also contribute to 
parenting risks (4). Nonetheless, after controlling for 
such variables, the need to explicate what, if any, 
parenting risks are predicted by mothers who smoke 
is critical for the development of early childhood and 
family interventions. As such, smoking in mothers 
could then be utilized as a risk factor for at-risk 
parenting and targeted intervention needs, given 
limited public health resources. If smoking in 
mothers with young children predicts parenting 
problems, these families could be referred for 
targeted, early preventive interventions that focus on 
parenting practices – in addition to the obvious needs 
for smoking cessation. In the present study, the 
authors utilized a sample of female twins and 
hypothesized that smoking in mothers during their 
child’s preschool years would predict harsh, 
ineffective parenting practices such as increased risk 
for corporal punishment. 
 
Methods 
Secondary data analyses were performed in 2015 on 
a prospective study with parent and twin data 
available on n=3009 individual members of female 
twin pairs (n=1418 complete pairs and n=164 with 
only one member of the twin pair) born between July 
1975 and June 1985, identified from Missouri-state 
birth records (from the Missouri Adolescent Female 
Twin Study) from 1995 to 1997, and included in the 
present analysis (Table 1) (5). At the time of the 
original study, females were understudied and 
therefore the focus. A cohort-sequential sampling 
design was used, with initial cohorts of 13-, 15-, 17-, 
and 19-year-old twins and their families recruited 
during the first two years of data collection and 
continued recruitment of 13-year-olds in years 3 and 
4. In addition to baseline telephone interviews 
conducted with parents, all twin pairs were targeted 
for three waves of telephone interviews (waves 1, 4, 
and 5). The Semi-Structured Assessment for the 
Genetics of Alcoholism, a reliable, valid, and highly 
structured comprehensive interview for drug use and 
psychiatric assessment was used (6). Data from wave 
1 [mean age=15.4 (2.3) years for twins and 41.5 (5.2) 
years for mothers] and wave 4 [mean age=21.7 (2.7) 
Smoking and parenting practices 
 
 
53 
 
years for twins] were included in the present analyses. 
For each wave, participants gave verbal consent (or 
assent, if minors) following procedures approved by 
the Institutional Review Board at Washington 
University School of Medicine. Logistic regression 
analysis was used to examine study questions 
hypothesizing whether maternal retrospective report 
of maternal smoking history, extrapolated for the 
period during the twin’s preschool years (child age 
≥3 years), would predict parenting variables 
including hitting, arguing, closeness, reduced interest 
in the twin, and/or child physical or sexual abuse.  
 
Results 
More than 80% of mothers who smoked during 
child’s preschool years were also pregnancy smokers. 
Maternal smoking when the twins were 3+ years of 
age remained a significant predictor of offspring 
report of childhood sexual abuse [odds ratio (OR), 
1.40; 95% confidence interval (CI), 1.02–1.92], after 
controlling for ethnicity, parental marital status, 
family income, maternal education, maternal report 
of her own inattention and hyperactivity symptoms, 
maternal depression, more than three alcohol-use 
disorder symptoms, maternal report of paternal 
history of alcohol problems, and maternal reports of 
the twin’s DSM-IV inattention and hyperactivity and 
Oppositional Defiant Disorder diagnosis. 
After controlling for covariates, maternal smoking 
during child’s early years also predicted reduced 
maternal-reported closeness with the child (OR, 0.62; 
95% CI, 0.43–0.89); however, it did not predict child-
reported physical abuse or maternal-reported hitting, 
strictness, interest, or maternal report of coparent’s 
hitting of the child (OR range, 0.68–1.36; all p >.05).  
 
Discussion 
In this analysis, hypotheses for maternal smoking as 
a risk factor for problematic parenting were 
supported insofar as maternal closeness and risk for 
sexual abuse, but not other domains of harshness or 
abuse, examined. Findings in this study were limited 
by a sample of only females and must be understood 
in this context. It is of interest that a majority of 
smokers who smoked during child’s preschool years, 
also smoked during pregnancy. As such, these 
findings are in line with prior studies suggesting a risk 
profile of maternal smoking during pregnancy 
increased prediction of maltreatment by the age of 1 
by a relative risk of 2.8 (7). However, findings of this 
study were limited to later sexual and not physical 
abuse. Given limited public health resources, 
mothers who smoke during pregnancy and child’s 
preschool years may be targeted for early preventive 
interventions that focus on parenting practices such 
as decreasing conflict, increased closeness/warmth, 
and increased parental monitoring along with 
smoking cessation efforts. Estimates suggest only 
50% of parents of young children are queried and 
educated by physicians on the risks of smoking, 
despite established health risks (8). 
 
Financial Disclosures  
Dr. Tandon has a copyright on a children’s book and 
receives royalties. No other conflicts were disclosed by the 
authors. This project was supported by funding from the 
following grants from the National Institutes of Health 
(NIH): K12DA000357 to Dr. Tandon; AA011998, 
AA009022, AA017915, AA017688, AA021492 to Dr. 
Heath. 
 
Acknowledgments 
The research in this paper is that of the authors and does 
not reflect the official policy of the NIH. Dr. Tandon was 
responsible for the design of the study and its writing, Dr. 
Grant performed statistical analyses, and Drs. Madden, 
Bucholz and Heath were integral to the data collection and 
editing of the content. This project was supported by 
funding from the following grants from the National 
Institutes of Health (NIH): K12DA000357 to Dr. 
Tandon; AA011998, AA009022, AA017915, AA017688, 
AA021492 to Dr. Heath. 
This manuscript has not been published in another 
journal. 
 
Conflicts of interest 
No conflicts of interest were reported by the authors of 
this paper. 
 
 
References  
 
1. Bauman PS, Dougherty FE. Drug-addicted mothers’ parenting and 
their children’s development. Int J Addict 1983;18(3):291-302. 
 
2. Chassin L, Presson CC, Rose J, Sherman SJ, Dvais MJ, Gonzalez JL. 
Parenting style and smoking-specific parenting practices as 
predictors of adolescent smoking onset. J Pediatr Psychol 
2005;30(4):333-44.  
 
3. Tandon M, Si X, Belden A, Spitznagel E, Wakschlag LS, Luby J. 
Parenting practices in pregnancy smokers compared to nonsmokers. 
J Clin Med Res 2013;5(2): 84-91. 
 
4. Kettinger LA, Nair P, Schuler ME. Exposure to environmental risk 
factors and parenting attitudes among substance-abusing women. 
Am J Drug Alcohol Abuse 2000;26(1):1-11. 
 
5. Heath AC, Madden PAF, Bucholz KK. Ascertainment of a twin 
sample by computerized record matching, with assessment of 
possible sampling biases. Behav Genet 1999;29(4):209-19.  
 
6. Hesselbrock M, Easton C, Bucholz KK, Schuckit M, Hesselbrock 
V. A validity study of the SSAGA – a comparison with the SCAN. 
Addiction 1999;94(9):1361-70. 
 
7. Wu SS, Ma CX, Carter RL, et al. Risk factors for infant maltreatment: 
a population-based study. Child Abuse Negl 2004;28(12):1253-64. 
 
8. Winickoff JP, McMillen RC, Carroll BC, et al. Addressing parental 
smoking in pediatrics and family practice: a national survey of 
parents. Pediatrics 2003;112(5):1146-51. 
Smoking and parenting practices 
 
 
54 
 
TABLE 1. Maternal- and twin-reported characteristics1 
 Mothers who did not 
smoke when twins 
were 3+ years 
(n=922) (%) 
Mothers who 
smoked when twins 
were 3+ years 
(n=661) (%) 
Demographic characteristics (maternal report) 
African American  10.4 14.1* 
Mother married to biological father at interview 70.1 48.0*** 
Mother’s education    
 Less than high school degree   4.4 15.8*** 
 High school degree, no college 35.4 45.2*** 
 Some college 29.6 29.6 
 College degree or higher 30.7 9.6*** 
Household income <$50,000 49.3 71.7*** 
Maternal smoking history 
Lifetime   
 Never 35.5 --- 
 <100 lifetime 49.0 --- 
 100+ but quit before twins were born 11.0 --- 
 100+ but quit when twins were <3 years 4.6 --- 
 100+ and smoked when twins were 3+ years2 – 100 
Smoking during pregnancy (of 100+ lifetime smokers; n=127 who did not smoke and n=637 
who smoked when the twins were 3+ years) 
  
 None 71.7 18.5*** 
 Smoked during part of pregnancy (1 week to 8 months) 22.8 34.2* 
 Smoked for >8 months of pregnancy 5.5 47.3*** 
Maternal report of psychopathology 
 Mother self-reported childhood inattention  4.9 9.7*** 
 Mother self-reported childhood hyperactivity 2.8 4.7* 
 Mother self-reported lifetime depression  26.8 40.0*** 
 Mother self-reported 3+ alcohol-dependence symptoms lifetime 3.0 7.6*** 
 Mother reported biological father was a problem drinker (lifetime) 23.2 41.5*** 
 Mother reported twin DSM-IV inattention (in 3000 twins)3 4.5 6.6 
 Mother reported twin DSM-IV hyperactivity (in 2998 twins)4 1.0 4.0*** 
 Mother reported twin DSM-IV ODD (in 2988 twins)5 8.5 16.8*** 
Maternal report of parenting (when twins were 6 to 13 years old) 
 Mother reported hitting twin with a “belt or stick or something like that”, “sometimes” 
or “often” 
5.2 7.6 
 Mother reported being more strict than most parents  51.0 49.0 
 Mother reported “often” being interested in the twins’ friends and activities 94.3 87.0*** 
 Mother reported being “very close” to the twins  92.6 84.7*** 
 Mother reported arguing “often” with the twins  7.4 12.9*** 
 Mother reported the coparent hitting twin with a “belt or stick or something like that”, 
“sometimes” or “often”6 
3.0 4.5 
Twin report of childhood physical and sexual abuse Twins whose mother 
did not smoke when 
they were 3+ years 
of age (n=1762) 
Twins whose 
mother smoked 
when they were 3+ 
years of age 
(n=1239) 
 Twin-reported childhood physical abuse  16.1 23.6*** 
 Twin-reported childhood sexual abuse  7.7 14.7*** 
 
Note. DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th edition; ODD, Oppositional Defiant Disorder. 
1N=1583 biological interviewed mothers had data on smoking during the twins’ childhood; there was minimal missing data on individual 
measures; all mother-reported measures had >1580 mother responses, except for household income (N=1538), her smoking during pregnancy 
(N=1542), her own childhood inattention and hyperactivity (N=1542), her own alcohol-dependence history (N=1572), her report of biological 
father’s alcohol history (N=1563), her own history hitting the twins (N=1551), and her own strictness (N=1549). 
2Includes N=49 mothers who quit when twins were 3–6 years, N=86 who quit when twins were 7+ years, and N=526 who never quit. 
3A total of 1418 mothers reporting on complete pairs and 164 reporting on only one member of a twin pair; 6+ of 9 DSM-IV inattention 
symptoms, for 6+ months, before the age of 7, with impairment (causing problems at home or school, or consulted a health professional 
about problems). 
4A total of 1417 mothers reporting on pairs and 164 reporting on only one member of a twin pair; 6+ of 9 DSM-IV hyperactive symptoms, for 
6+ months, before age 7, with impairment (causing problems at home or school, or consulted a health professional about problems). 
5As reported by 1580 mothers, with 1408 mothers reporting on pairs and 172 reporting on only one member of a twin pair); 4+ of 8 DSM-IV 
ODD, for 6+ months, at any age, with impairment (causing problems at home or school, or consulted a health professional about problems). 
6N=1264 mothers with a coparent. 
*Significant at p < .05 
**Significant at p < .01 
***Significant at p < .001 
 


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Australasian Journal of Neuroscience Volume 27 ● Number 1 ● May 2017 
 4 
Linda Nichols 
Editor 
This edition begins  a new journey for me 
and as I approach my second decade of 
nursing, I am honoured to be taking over 
the helm as Editor of the AJoN. 
Thank you Vicki for your guest editorial. 
Change is certainly continuous and  this is 
also true in terms of journals and publish-
ing.  
Those of you who remember the early vol-
umes will have seen many changes over 
the years. In my lifetime, I have seen tech-
nology develop and I often reflect on how 
we managed prior to smart phones and the 
internet.  
With this in mind I honour the early journal 
editors, when articles were typed and  sent 
back and forwards via post  with hand writ-
ten comments that needed to be ad-
dressed.  
The internet and email has changed many 
things we do and whilst it is not always  for 
the better it has certainly made this job of 
editor and my substantive role as an aca-
demic easier. 
Now we can share articles electronically 
using email and platforms such as Re-
search Gate. However , not so long ago 
this task was completed via posted request 
for reprints. Academics would have calling 
cards printed that they would send to au-
thors requesting a copy of manuscripts 
and waiting patiently for the copy to be 
posted them. Now our poor library staff are 
pressured to find and deliver archived and 
obscure articles in hours, not the weeks or 
even months that this task once took.  
We take the ability to serach the internet  
for granted at times and often forget that 
this is a relatively new technology.  Access 
to literature is now often  overwhelming 
and perhaps it was easier in the old days 
when you could not be criticised for not 
knowing what you didn’t have access to. 
However, like many of you  I will take an 
electronic search engine any day over the 
hours I remember scanning microfiche  
cards. 
Vicki Evans 
We’ve come a long way…. 
As I approach a milestone third decade of 
being a Registered Nurse, everywhere around 
me tells me that we are surrounded by 
‘change’ and that if you don’t go with the flow, 
you’ll be swept aside.  Nursing and medicine 
are in continuous motion, constantly chang-
ing, formulating ways for improvement and 
best practice. 
Some of you may remember the days of spi-
nal surgery and the use of ‘pillow packs’ and 
log rolls for several days. Nowadays no one 
lies in bed. The hospital in which I work re-
ported on the world-first vertebral artery stent. 
Now, stenting is hardly uncommon.  
Today, the news is reporting that an Australi-
an neurosurgeon has completed a world-first 
surgery removing a vertebral chordoma and 
successfully replacing the vertebra with a 3D-
printed body part. Constant change. 
So what have I learned in the seven years in 
the editor’s role? I have learned to check and 
recheck, that submissions don’t just come in 
automatically, that there are many people 
around to assist and that neuro nurses do 
great things!  
In keeping with the state of constant move-
ment, it is time to hand the editorial responsi-
bilities over to Linda Nichols. Linda is a neuro 
nurse and academic from the University of 
Tasmania.  
She was a regular provider of manuscripts for 
the AJoN over the years and I encourage you 
as members/readers to send in your manu-
scripts for publication. What you are doing out 
there makes a difference – why not tell peo-
ple?  
To assist Linda in her new role, I asked the 
question:- 
What is an Editor? The Collins Dictionary 
describes the editor as a person who 
is in charge of, determines selection 
and revises the final content of mate-
rial for publication in a newspaper, 
magazine, or book. 
The editor’s role encompasses many 
points including– 
Australasian Journal of Neuroscience Volume 27 ● Number 1 ● May 2017 
 5 
To find an article we now  head to the in-
ternet and simply serach. The internet has 
become an invaluable resource, it has 
opened up endless opportunities for our 
own research, be that to publish or just to 
find information. 
This is a  huge change from 20 years ago 
when an academic would refer to ‘Current 
Contents’, a weekly publication that would 
be 100s of printed pages that was organ-
ised by field (life sciences, physical scienc-
es or humanities).  
‘Current Contents’ was a paper data base/
index, a compilation of the Tables of Con-
tents of all the journals in the fields. From 
here  researchers would spend hours 
reading and scanning for key words, refer-
ence numbers and citations. Then if you 
were really organised, these details were 
hand written on a card system. When I get 
frustrated with End Note I always try to 
take a deep breath and think of the alter-
natives. 
With all these changes and the anticipated 
changes ahead I read and take on board 
Vicki’s advise. For me this is another re-
warding challenge in my neuroscience 
journey and I look forward to this next 
stage. 
Cheers and thank you for all your support 
and guidance Vicki. 
Linda 
Publicising the AJoN and encouraging 
submissions. 
Screening manuscripts and sending to the 
Review Team for peer comment. 
Final decisions: Once peer review has 
been completed, the editor decides 
on final acceptance or rejection.   
Communication: the editor is required to 
communicate to the ANNA Executive 
formally & informally as well as the 
Review Team and prospective au-
thors.  
Ethical dilemmas: Occasionally, the editor 
is asked to make decisions concern-
ing ethical issues such as possible 
plagiarism or multiple submissions of 
the same material to other journals. 
Administrative & Technical duties: The 
editor participates in numerous proce-
dures essential to publication of the 
AJoN including the makeup and lay-
out of each issue. Manuscripts are 
converted by the Editor from a Word 
document to a Publisher file and for-
matted before being sent to the print-
ers as a PDF. Factors that must be 
considered include the quality and 
size of figures/tables and proofread-
ing of the final version before the print
-run.
All the best Linda! 
Vicki 


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