The health impacts of local traffic pollution on primary school age children

There is a large body of medical research on the health impacts of local traffic air pollution. Vehicle emissions, road dust and tyre fragmentation together cause an increase in atmospheric levels of carbon monoxide, sulphur dioxide, nitrates and particulate matter in both solid and liquid forms. For those exposed to such pollution, there is a documented increase in mortality and morbidity from both respiratory and cardiac diseases. There is also evidence that the effects are greater on children. Despite these findings, there has been comparatively little work done in estimating the effect on student health of school location, with most studies focusing instead on residential location. By combining a random sample of primary schools in Sydney with detailed traffic volume data, we estimate the impact of traffic pollution on the health of primary school children in Sydney

The design and relevance of a computerised therapy program for indigenous Māori adolescents.

Background: Depression is a major health issue among Māori indigenous adolescents, yet there has been little investigation into the relevance or effectiveness of psychological treatments for them. Further, consumer views are critical for engagement and adherence to therapy. However, there is little research regarding indigenous communities’ opinions about psychological interventions for depression. Objective: The objective of this study was to conduct semistructured interviews with Māori (indigenous New Zealand) young people (taitamariki) and their families to find out their opinions of a prototype computerized cognitive behavioral therapy (cCBT) program called Smart, Positive, Active, Realistic, X-factor thoughts (SPARX), a free online computer game intended to help young persons with mild to moderate depression, feeling down, stress or anxiety. The program will teach them how to resolve their issues on their own using Cognitive Behavioural Therapy as psychotherapeutic approach. Methods: There were seven focus groups on the subject of the design and cultural relevance of SPARX that were held, with a total of 26 participants (19 taitamarki, 7 parents/caregivers, all Māori). There were five of the groups that were with whānau (family groups) (n=14), one group was with Māori teenage mothers (n=4), and one group was with taitamariki (n=8). The general inductive approach was used to analyze focus group data. Results: SPARX computerized therapy has good face validity and is seen as potentially effective and appealing for Māori people. Cultural relevance was viewed as being important for the engagement of Māori young people with SPARX. Whānau are important for young peoples’ well-being. Participants generated ideas for improving SPARX for Māori and for the inclusion of whānau in its delivery. Conclusions: SPARX computerized therapy had good face validity for indigenous young people and families. In general, Māori participants were positive about the SPARX prototype and considered it both appealing and applicable to them. The results of this study were used to refine SPARX prior to it being delivered to taitamariki and non-Māori young people

Experiences of engaging with mental health services in 16- to 18-year-olds: an interpretative phenomenological analysis

Despite older adolescence being a risk period for the development of mental health concerns, mental health service engagement is low among 16- to 18-year-olds. As therapeutic attendance is linked to clinical outcome, it is important to understand engagement in this population. There is a paucity of research looking specifically at the older adolescent engagement phenomenon. Previous qualitative research into adolescent experiences has provided rich and detailed results. Interpretative phenomenological analysis was chosen as the methodological approach. Ten 16- to 18-year-olds were recruited from two London-based child and adolescent mental health services. Each young person was interviewed to understand his or her personal experience of engaging in mental health services, and associated engagement barriers and facilitators. Interviews were transcribed and underwent analysis. Analysis revealed ten subthemes subsumed within four superordinate themes: engagement begins at help seeking, strength of inner resolve, evolution of the self and in the clinic room. Themes are discussed in detail. Conclusions are drawn in relation to previous theory and research. When considering 16- to 18-year understandings of the engagement phenomena, key elements include clinician and service developmental appropriateness, negotiation of developmental tasks in relation to engagement, experience of the physical building environment, and awareness of service policy. Suggestions for clinical practice in relation to engagement facilitators and threat are made, and recommendations for future research proposed

Using integrated urban models to respond to climate change in cities

This paper presents a single, integrated urban model that focuses on the key areas of transport, domestic energy-use, and domestic water use and how these relate to urban planning and other policies. The model structure is spatial ï½ requiring a sub-division of the urban region into disjoint sub-regions. Such a sub-division is necessary, not only because spatial information is essential to any transport model, but also because climatic and demographic factors are common to all resource models, and are spatially heterogeneous. The model is intended for use by local, regional, and state authorities, government departments, energy, and utility service companies as a modelling and decision support tool for analysing the impact on cities of a range of energy, water, transport, and land use related policies. In particular, it seeks to understand the impact - reductions possible at household and city scales. Growing awareness of the threats from climate change has focused attention on greenhouse gas (GHG) emissions and the need to reduce them. Using a sample analysis of Sydney, our on-going research collaboration seeks to examine the working relationships between multiple infrastructure sectors through a single analysis platform. The need to integrate policy for multiple infrastructures is critical given the multiple fronts on which the sustainability of urban systems are now jeopardised

Utilization of health services in relation to mental health problems in adolescents: A population based survey

BACKGROUND: Only a minority of adolescents reporting symptoms above case-levels on screenings for mental health seeks and receives help from specialist health services. The objective of this study was to a) examine help-seeking for symptoms of anxiety and depression in relation to symptom load dimensionally, b) identify the level of specialization in mental health among service-providers, and c) identify associations between mental health problems and contact with different types of health services. METHODS: This cross-sectional school-based study (response-rate 88%, n = 11154) is based on Norwegian health surveys among 15 and 16 year olds. RESULTS: We found a dose-response association between symptom-load and help seeking. Only 34% of individuals with mental symptom-load above 99(th )percentile reported help-seeking in the last 12 months. Forty percent of help seekers were in contact with specialists (psychiatrists or psychologists), the remaining were mainly in contact with GPs. Mental health problems increased help seeking to all twelve service providers examined. CONCLUSION: It might not be reasonable to argue that all adolescents with case-level mental health problems are in need of treatment. However, concerning the 99(th )percentile, claiming treatment need is less controversial. Even in the Norwegian context where mental health services are relatively available and free of charge, help-seeking in individuals with the highest symptom-loads is still low. Most help seekers achieved contact with health care providers, half of them at a non specialized level. Our results suggest that adolescents' recognition of mental health problems or intention to seek help for these are the major "filters" restricting treatment

Heterogeneity of quality of life in young people attending primary mental health services

AIMS: The utility of quality of life (QoL) as an outcome measure in youth-specific primary mental health care settings has yet to be determined. We aimed to determine: (i) whether heterogeneity on individual items of a QoL measure could be used to identify distinct groups of help-seeking young people; and (ii) the validity of these groups based on having clinically meaningful differences in demographic and clinical characteristics. METHODS: Young people, at their first presentation to one of five primary mental health services, completed a range of questionnaires, including the Assessment of Quality of Life–6 dimensions adolescent version (AQoL-6D). Latent class analysis (LCA) and multivariate multinomial logistic regression were used to define classes based on AQoL-6D and determine demographic and clinical characteristics associated with class membership. RESULTS: 1107 young people (12–25 years) participated. Four groups were identified: (i) no-to-mild impairment in QoL; (ii) moderate impairment across dimensions but especially mental health and coping; (iii) moderate impairment across dimensions but especially on the pain dimension; and (iv) poor QoL across all dimensions along with a greater likelihood of complex and severe clinical presentations. Differences between groups were observed with respect to demographic and clinical features. CONCLUSIONS: Adding multi-attribute utility instruments such as the AQoL-6D to routine data collection in mental health services might generate insights into the care needs of young people beyond reducing psychological distress and promoting symptom recovery. In young people with impairments across all QoL dimensions, the need for a holistic and personalised approach to treatment and recovery is heightened

Young men’s experiences of accessing and receiving help from child and adolescent mental health services following self-harm

Given the high rates of completed suicide and poor help-seeking among young men, this research explored how young men, who had successfully sought help from a Child and Adolescent Mental Health Service (CAMHS), experienced help-seeking. The study focused on the factors that facilitated initial access and on-going engagement in services. Eight young men between the ages of 16-18, who had entered CAMHS following self-harm or suicidal ideation, and who were engaged in on-going therapy, were recruited. Each young man was interviewed to elicit his personal experiences of help-seeking and help-receiving. Interviews were transcribed and subjected to Interpretative Phenomenological Analysis. Four superordinate themes, that overarched participant’s individual experiences, emerged from the data: Role of external adult in recognising, normalising and initiating help seeking; Challenging and renegotiating perception of need for help and meaning behind this need; Maintaining an independent self; and Mechanisms of engagement. Help-seeking was described as a journey of two stages: 1) initial access and 2) on-going engagement, during which the presence and timing of external influences (parents, teachers) and internal influences (personal beliefs and attitudes) were crucial. A model of help seeking in young men who self-harmed was developed, which considered both access and engagement to help, and combined a consideration of internal and external influences on their ability to access help