Extracurricular activity participation moderates impact of family and school factors on adolescents’ disruptive behavioural problems

BackgroundThe prevalence of problem behaviours among British adolescents has increased in the past decades. Following Erikson’s psychosocial developmental theory and Bronfenbrenner’s developmental ecological model, it was hypothesized that youth problem behaviour is shaped in part by social environment. The aim of this project was to explore potential protective factors within the social environment of British youth’s for the presentation of disruptive behavioural problems.MethodThis study used secondary data from the Longitudinal Study of Young People in England, a cohort study of secondary school students. These data were analysed with generalized estimation equations to take the correlation between the longitudinal observations into account. Three models were built. The first model determined the effect of family, school, and extracurricular setting on presentation of disruptive behavioural problems. The second model expanded the first model by assuming extracurricular activities as protective factors that moderated the interaction between family and school factors with disruptive behavioural problems. The third model described the effect of prior disruptive behaviour on current disruptive behaviour.ResultsAssociations were found between school factors, family factors, involvement in extracurricular activities and presence of disruptive behavioural problems. Results from the second generalized estimating equation (GEE) logistic regression models indicated that extracurricular activities buffered the impact of school and family factors on the presence of disruptive behavioural problems. For instance, participation in sports activities decreased the effect of bullying on psychological distress. Results from the third model indicated that prior acts of disruptive behaviour reinforced current disruptive behaviour.ConclusionThis study supports Erikson’s psychosocial developmental theory and Bronfenbrenner’s developmental ecological model; social environment did influence the presence of disruptive behavioural problems for British adolescents. The potential of extracurricular activities to intervention strategies addressing disruptive behavioural problems of adolescents is discussed

Mental health service users' perceptions of data sharing and data protection: a qualitative report.

BACKGROUND: To improve health services, social, economic and health data should be shared and linked to create a full narrative of lived experience. Mental health data sharing is often considered a particularly sensitive area. OBJECTIVE: To assess mental health service users' perceptions regarding the current practice of administrative data-driven research. METHOD: We conducted a focus group using case study scenarios. Themes and subthemes were analysed using qualitative methods. RESULTS: Participants were generally happy for data owners to share their health, social and economic data if the purpose was transparent and if the information would inform and improve health policy and practice. Participants were less keen on sharing data through digital applications. CONCLUSION: This case study informs a data linkage study protocol. Research teams and database owners should strive to educate service users on data protection and create dissent opportunities

The Palestinian primary ciliary dyskinesia (PCD) cohort: clinical, diagnostic and genetic spectrum

Background: Diagnostic testing for PCD started in 2013 in Palestine. We aimed to describe the clinical, diagnostic and genetic spectrum of the Palestinian PCD cohort. Methods: 390 individuals with symptoms suggestive of PCD and 74 family members underwent nasal nitric oxide (nNO); and/or transmission electron microscopy (TEM); and/or PCD genetic panel or whole exome testing. Clinical characteristics were collected close to diagnosis including FEV1 GLI z-scores and BMI z-scores. Results: 82 had a definite positive PCD diagnosis (TEM and/or genetics) and 103 were highly likely (Kartagener’s and/or low nNO). Positive cases (n=82) had median age of 13.5 years (range 0-43), were highly consanguineous (95%) and 100% Arabic descent. Clinical features included persistent wet cough (95%), neonatal respiratory distress (79%), clubbing (21%) and situs inversus (41%). Lung function at diagnosis was already impaired FEV1 z-score mean -1.49 (sd=1.79) and BMI z-score mean -0.30 SD=1.4. 69 families were genotyped. 59 individuals from 42 families (60%) had mutations in 14 PCD-genes; CCDC39 (26% of families), DNAH11 (17%) and LRRC6 (12%) were the most common. 16% had mutations in candidate genes, 24% had no variants identified. 100% of variants were homozygous. TEM defects and genotype associations were as expected. Conclusions: Despite limited local resources, collaborations during the last 7-years have facilitated detailed geno- and phenotyping of one of the largest PCD cohorts globally. nNO identifies likely cases and targeted genetic testing, conducted locally, can now identify specific mutations in known families

The Palestinian primary ciliary dyskinesia population: first results of the diagnostic, and genetic spectrum

BACKGROUND: Diagnostic testing for primary ciliary dyskinesia (PCD) started in 2013 in Palestine. We aimed to describe the diagnostic, genetic and clinical spectrum of the Palestinian PCD population. METHODS: Individuals with symptoms suggestive of PCD were opportunistically considered for diagnostic testing: nasal nitric oxide (nNO) measurement, transmission electron microscopy (TEM) and/or PCD genetic panel or whole-exome testing. Clinical characteristics of those with a positive diagnosis were collected close to testing including forced expiratory volume in 1 s (FEV1) Global Lung Index z-scores and body mass index z-scores. RESULTS: 68 individuals had a definite positive PCD diagnosis, 31 confirmed by genetic and TEM results, 23 by TEM results alone, and 14 by genetic variants alone. 45 individuals from 40 families had 17 clinically actionable variants and four had variants of unknown significance in 14 PCD genes. CCDC39, DNAH11 and DNAAF11 were the most commonly mutated genes. 100% of variants were homozygous. Patients had a median age of 10.0 years at diagnosis, were highly consanguineous (93%) and 100% were of Arabic descent. Clinical features included persistent wet cough (99%), neonatal respiratory distress (84%) and situs inversus (43%). Lung function at diagnosis was already impaired (FEV1 z-score median −1.90 (−5.0–1.32)) and growth was mostly within the normal range (z-score mean −0.36 (−3.03–2.57). 19% individuals had finger clubbing. CONCLUSIONS: Despite limited local resources in Palestine, detailed geno- and phenotyping forms the basis of one of the largest national PCD populations globally. There was notable familial homozygosity within the context of significant population heterogeneity

The Impact on Parents of Diagnosing PCD in Young Children

Primary ciliary dyskinesia (PCD) is an incurable, rare, inherited, chronic condition. Treatment includes the regular clearing of airway mucus, aggressive treatment of infections and management of hearing loss. Caregiver burden has not been explored, hence we interviewed 18 mothers and 6 fathers of children under 6 years to understand the impact of diagnostic testing and implications of a positive diagnosis. Interviews were transcribed and thematically analysed and five key themes were identified. These included the parents’ experiences following child’s diagnosis, impact of child’s treatment regimen on parent, impact of child’s health status on parent, parent’s coping strategies, and parental concerns for the future. Parents described their diagnostic journey, with the findings revealing how a lack of awareness among clinicians of the PCD symptom pattern can lead to a delayed diagnosis. Parents discussed the emotional and practical impact of a PCD diagnosis and the coping strategies employed to deal with challenges arising following a diagnosis. Parents use a variety of different lifestyle changes to accommodate their child’s treatment regimen and to cope with disruptive life events such as the COVID-19 pandemic. This study provides valuable insights into parental adjustment and adaptation to a PCD diagnosis and management regimen. Going forward, this research highlights the need for integrated social care for PCD patients and their families

The impact of psychosis on vocational functioning

In order to further the field of psychiatric vocational rehabilitation, an innovative research model has been used to study the neurobiological, developmental, and psychosocial pathways through which psychotic affective disorders might affect vocational functioning among 226 participants enrolled in the Suffolk County Mental Health Project. This model was based on the social selection hypothesis, which theorizes that disruption of a career path or educational attainment can cause a decline in socio-economic status. It is also based on the results of empirical studies which have found that vocational decline within the psychiatric population is associated with past vocational functioning, social functioning deficits, and hospitalization history. Vocational profiles that assess functioning retrospectively before the first hospitalization and prospectively after the first hospitalization reveal that most vocational active participants experienced a descending career path. For students educational stagnation is dominantly present at the college level. Neuro-cognitive deficits in the form of lack of concentration and a short-term memory dysfunction, were associated with a downward vocational drift. From a social learning perspective, the adverse events of an interrupted educational path, during the development of a vocational personality was associated with a downward vocational drift. According to the open linked systems model, social impairments, stressors in the living situation, mood, limitations of medical treatment, and illness factors were found to be related to poor performance in the vocational domain. The participants enrolled in this study indicated that the vocational rehabilitative system on Long Island was unable to meet their needs. There was a specific demand for more effective vocational training, help locating resources to facilitate vocational functioning, help to maintain their vocational role, job development and placement services, and supported education programs. Policy reforms should therefore focus on promoting community-based psychosocial rehabilitation programs that have vocational services included in their package. Access to these services should be more readily available to all individuals with psychiatric disabilities. In addition, the participants included in this study mentioned that current legislation regarding vocational role protection was lacking. <br/

The impact of psychosis on vocational functioning

In order to further the field of psychiatric vocational rehabilitation, an innovative research model has been used to study the neurobiological, developmental, and psychosocial pathways through which psychotic affective disorders might affect vocational functioning among 226 participants enrolled in the Suffolk County Mental Health Project. This model was based on the social selection hypothesis, which theorizes that disruption of a career path or educational attainment can cause a decline in socio-economic status. It is also based on the results of empirical studies which have found that vocational decline within the psychiatric population is associated with past vocational functioning, social functioning deficits, and hospitalization history. Vocational profiles that assess functioning retrospectively before the first hospitalization and prospectively after the first hospitalization reveal that most vocational active participants experienced a descending career path. For students educational stagnation is dominantly present at the college level. Neuro-cognitive deficits in the form of lack of concentration and a short-term memory dysfunction, were associated with a downward vocational drift. From a social learning perspective, the adverse events of an interrupted educational path, during the development of a vocational personality was associated with a downward vocational drift. According to the open linked systems model, social impairments, stressors in the living situation, mood, limitations of medical treatment, and illness factors were found to be related to poor performance in the vocational domain. The participants enrolled in this study indicated that the vocational rehabilitative system on Long Island was unable to meet their needs. There was a specific demand for more effective vocational training, help locating resources to facilitate vocational functioning, help to maintain their vocational role, job development and placement services, and supported education programs. Policy reforms should therefore focus on promoting community-based psychosocial rehabilitation programs that have vocational services included in their package. Access to these services should be more readily available to all individuals with psychiatric disabilities. In addition, the participants included in this study mentioned that current legislation regarding vocational role protection was lacking

Silymarin (milk thistle) treatment of adults with gambling disorder: a double-blind, placebo-controlled trial

Objective: data on the pharmacological treatment of gambling disorder are limited. Silymarin (derived from milk thistle) has antioxidant properties. The goal of the current study was to determine the efficacy and tolerability of silymarin in adults with gambling disorder. Methods: forty-three individuals (18 [41.9%] women; mean age=49.61 [±13.1] years) with gambling disorder entered an 8-week, double-blind, placebo-controlled study. Dosing of silymarin ranged from 150 to 300 mg twice a day. The primary outcome measure was the Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS). Secondary outcome measures comprised the Gambling Symptom Assessment Scale and measures of depression and anxiety. Outcomes were examined using mixed-effect models. Results: silymarin did not statistically differentiate from the placebo on any of the outcome measures of interest, in terms of treatment group time interactions. There was a robust response in the placebo group (57% reduction on the PG-YBOCS), and on average there was a 56% reduction in YBOCS score for the milk thistle. Conclusions: the findings of this study do not support the use of silymarin/milk thistle in the treatment of gambling disorder but highlight the large placebo response seen in gambling disorder. Treatment interventions for gambling disorder need to better understand and address the placebo response.</p

Health and social care diversity among individuals with longstanding physical and psychological health problems: Pooled repeated cross sectional analyses

This paper examines differences in health-and-social care utilisation for individuals with physical and/or mental health problems. Logistic regression models are used to determine disparity in the percentage of General Household/Lifestyle Survey participants with physical compared to mental health problems receiving disability benefits or health care services between 2000 and 2011. Our findings of a relative underutilisation of secondary health care combined with a relative overutilization of out-of-work benefits by individuals with mental health problems is novel to the field of rehabilitative health care. These results provide evidence for the previously suspected disparity in health care utilisation of individuals with mental health problems and indicate problems in labour force integration. The findings support the political call for a 'parity of esteem', which, in Britain, was enshrined in the Health and Social Care Act of 2012.</p