Ethnic Differences in Pathways in Care for Young Children with Problem Behaviour: road work in progress

The study described in this thesis explores ethnic differences in the process of help-seeking for emotional and behavioural problems in 5-6-year-old children in a Dutch preventive care setting. Research has shown that early detection of emotional and behavioural problems in childhood is possible and can be beneficial to a child’s development, well-being and health [1-3]. Preventive child health care services, like we know in the Netherlands, can be regarded as an ideal setting for early identification and early management of emotional and behavioural problems through its routine health examinations of the entire population of children. However, identification of problems in itself is not a guarantee for an adequate solution of these problems. To justify screening for emotional and behavioural problems, insight into pathways in care following identification is necessary. Such insight can show which children with emotional and behavioural problems need care and whether these children receive the care they need. Until now, little is known about these pathways in care, especially pathways in care of young children from ethnic minority groups. It is important to investigate if such pathways apply in the same manner to ethnic minority children as to ethnic majority children. Ethnic differences in mental health problems are frequently cited as justification for the need to intervene in particular populations. However, understanding the reasons behind these disparities is often challenging and critical for the effectiveness of such interventions. Until now, this understanding is still largely lacking. Therefore, the first aim of this thesis is to describe ethnic differences in pathways in care after detection of emotional and behavioural problems in young children. The second aim of this thesis is to explore ethnic differences in determinants of care use through quantitative research methods as well as through qualitative research methods

Gene therapy for insulin dependent diabetes mellitus using IL-12p40- producing islet grafts

本研究では, インスリン依存型糖尿病 (IDDM) のモデル動物である NOD (nonobese diabetic) マウスに, 抑制性サイトカイン遺伝子をアデノウイルスベクターを用いて導入した膵ラ島移植を行ない自己免疫機序による拒絶反応の阻止を試みた。糖尿病発症NODマウスに, IL-12p40およびIL-10遺伝子をアデノウイルスベクターを用いて導入したNODマウス膵ラ島を移植した。IL-12p40産生膵ラ島移植では4週間以上の移植片の生着を認めたが, IL-10産生膵ラ島移植では移植片の長期の生着は得られなかった。組織学的検討では, IL-12p40産生膵ラ島移植では移植7日および60日後で正常膵ラ島構造を維持し軽度の単核球浸潤のみ認めたが, IL-10産生膵ラ島移植では移植7日後ですでに著明な単核球浸潤を伴い膵ラ島構造も破壊されていた。また, RT-PCR法での移植片局所のサイトカインの解析より, 移植片の長期生着のメカニズムとして, IL-12p40産生膵ラ島移植ではIFN-γ産生細胞の減少とTGF-β産生細胞の誘導により免疫寛容が成立した可能性が示唆された。以上より, IL-12p40産生膵ラ島移植では移植片の長期生着が可能であり, 今後のIDDM発症後の治療法として膵ラ島移植を用いた遺伝子療法の確立への第一歩と考えられた。 / Insulin dependent diabetes mellitus (IDDM) is considered to be a T cell-mediated autoimmune disease. It has been demonstrated that T helper (Th) 1 cells would play an important role in destruction of pancreatic β cells. It has recently been reported that systemic administration of IL-12 accelerates diabetes onset and that IL-12p40, an antagonist of IL-12, prevents diabetes development. From these results, we considered to establish gene therapy for IDDM with the islet grafts producing immunosuppressive cytokine such as IL-12p40. The syngeneic islet transplantation into diabetic nonobese diabetic (NOD) mice was performed using the recombinant adenoviral vector with inserted mlL-12p40 (Ad. IL-12p40) or mlL-10 (Ad. IL-10). Ad. IL-12p40-transfected islet grafts could significantly prevent autoimmune diabetes recurrence for over 4wk after transplantation (Tx). In contrast, Ad.IL-10 could not prolong syngeneic islet graft survival. Histological study revealed that IL-12p40-producing islet grafts remained normal in configulation with a small amount of lymphoid infiltration on day 60 after Tx, in contrast to IL-10-producing islet grafts with massive infiltration on day 7 after Tx. Reverse transcription (RT)-PCR analysis demonstrated that IL-12p40 gene transfer into islet grafts led to the significant decrease of IFN- 7 and the augmentation of TGF-β. These results suggest that IL-12 plays a key role in the autoimmune diabetes and that locally-produced IL-12p40 protects syngeneic islet grafts from recurrent autoimmune destruction of β cells by reducing IFN- γ and increasing TGF-β. This novel gene therapy would be clinically applicable to human IDDM

The predictive value of neurobiological measures for recidivism in delinquent male young adults

Background: Neurobiological measures have been associated with delinquent behaviour, but little is known about the predictive power of these measures for criminal recidivism and whether they have incremental value over and above demographic and behavioural measures. This study examined whether selected measures of autonomic functioning, functional neuroimaging and electroencephalography predict overall and serious recidivism in a sample of 127 delinquent young adults. Methods: We assessed demographics; education and intelligence; previous delinquency and drug use; behavioural traits, including aggression and psychopathy; and neurobiological measures, including heart rate, heart rate variability, functional brain activity during an inhibition task and 2 electroencephalographic measures of error-processing. We tested longitudinal associations with recidivism using Cox proportional hazard models and predictive power using C-indexes. Results: Past offences, long-term cannabis use and reactive aggression were strongly associated with recidivism, as were resting heart rate and error-processing. In the predictive model, demographics, past delinquency, drug use and behavioural traits had moderate predictive power for overall and for serious recidivism (C-index over 30 months [fraction of pairs in the data, where the higher observed survival time was correctly predicted]: C30 = 0.68 and 0.75, respectively). Neurobiological measures significantly improved predictive power (C30 = 0.72 for overall recidivism and C30 = 0.80 for serious recidivism). Limitations: Findings cannot be generalized to females, and follow-up was limited to 4 years. Conclusion: Demographic and behavioural characteristics longitudinally predicted recidivism in delinquent male young adults, and neurobiological measures improved the models. This led to good predictive function, particularly for serious recidivism. Importantly, the most feasible measures (autonomic functioning and electroencephalography) proved to be useful neurobiological predictors.</p

The role of adverse childhood experiences and mental health care use in psychological dysfunction of male multi-problem young adults

Adverse childhood experiences (ACEs) are associated with severe problems later in life. This study examines how eleven types of ACEs and mental health care use history are related to current psychological dysfunction among multi-problem young adults. A sample of 643 multi-problem young adult men (age 18-27) gave informed consent for us to collect retrospective regional psychiatric case register data and filled out questionnaires. ACEs were highly prevalent (mean 3.6, SD 2.0). Logistic regression analysis showed that compared with participants who experienced other ACEs, participants who experienced psychological problems in their family and grew up in a single-parent family were more likely to have used mental health care, and physically abused participants were less likely to have used mental health care. Linear regression analyses showed a dose-response relationship between ACEs and internalizing and externalizing problems. Linear regression analyses on the single ACE items showed that emotional abuse and emotional neglect were positively related to internalizing problems. Emotional and physical abuse and police contact of family members were positively related to externalizing problems. While multi-problem young adults experienced many ACEs, only a few ACEs were related to mental health care use in childhood and adolescence. Long-term negative effects of ACEs on psychological functioning were demonstrated; specifically, emotional abuse and emotional neglect showed detrimental consequences. Since emotional abuse and emotional neglect are not easily identified and often chronic, child health professionals should be sensitive to such problems

Criminal History and Adverse Childhood Experiences in Relation to Recidivism and Social Functioning in Multi-problem Young Adults

This study examines the relationship between criminal history and adverse childhood experiences (ACEs) and how they collectively predict (a) recidivism and (b) positive social functioning among multi-problem young adults. Criminal records and self-report data regarding ACEs and adult education/employment and quality of life (QoL) were collected for 692 multiproblem young adults (18–27 years). Results indicated that an extensive criminal history was related to non-violent and violent recidivism and lack of involvement in education/employment in young adulthood. On the contrary, a higher number of ACEs was related to lower QoL later in life, while this was not associated with recidivism or education/employment. These findings highlight again that past criminal behavior is a strong predictor of future criminality, particularly within this group of young adults with multiple problems. Furthermore, experiencing negative events in childhood shows to have long-term negative effects on QoL even for these individuals who already experience multiple life problems. Implications are discussed

Validity and Reliability of the Strengths and Difficulties Questionnaire in 5–6 Year Olds: Differences by Gender or by Parental Education?

Introduction: The Strengths and Difficulties Questionnaire (SDQ) is a relatively short instrument developed to detect psychosocial problems in children aged 3-16 years. It addresses four dimensions: emotional problems, conduct problems, hyperactivity/inattention problems, peer problems that count up to the total difficulties score, and a fifth dimension; prosocial behaviour. The validity and reliability of the SDQ has not been fully investigated in younger age groups. Therefore, this study assesses the validity and reliability of the parent and teacher versions of the SDQ in children aged 5-6 years in the total sample, and in subgroups according to child gender and parental education level. Methods: The SDQ was administered as part of the Dutch regularly provided preventive health check for children aged 5-6 years. Parents provided information on 4750 children and teachers on 4516 children. Results: Factor analyses of the parent and teacher SDQ confirmed that the original five scales were present (parent RMSEA = 0.05; teacher RMSEA = 0.07). Interrater correlations between parents and teachers were small (ICCs of 0.21-0.44) but comparable to what is generally found for psychosocial problem assessments in children. These correlations were larger for males than for females. Cronbach's alphas for the total difficulties score were 0.77 for the parent SDQ and 0.81 for the teacher SDQ. Four of the subscales on the parent SDQ and two of the subscales on the teacher SDQ had an alpha <0.70. Alphas were generally higher for male children and for low parental education level. Discussion: The validity and reliability of the total difficulties score of the parent and teacher SDQ are satisfactory in all groups by informant, child gender, and parental education level. Our results support the use of the SDQ in younger age groups. However, some subscales are less reliable and we recommend only to use the total difficulties score for screening purposes

地域空間における「景観利益」 : 国立市マンション事件東京地裁判決をめぐって(2002.12.18)(<特集>地方自治と司法判断)

textabstractBackground: The Strengths and Difficulties Questionnaire (SDQ) is a valuable screening tool for identifying psy- chosocial problems. Its performance in a multi-ethnic society, common to many paediatric health care workers, has not been investigated. Because it is important that screening instruments are valid and reliable for all ethnic groups within one society, we examined differences in the SDQ’s psychometric properties in a multi-ethnic society. Methods: The SDQ parent (n = 8114) and teacher form (n = 9355) were completed as part of a preventive health check for children aged 5–6 years of Dutch and non-Dutch ethnic backgrounds. The Child Behaviour Checklist (CBCL)/Teacher Report Form (TRF) was administered to a subsample. Results: Factor analysis of the parent-rated SDQ showed different rating patterns for two of the five subscales for non-Dutch children as compared with Dutch children. Cronbach’s alpha for the total difficulties score varied by ethnic group (0.73–0.78 parent-rated SDQ, 0.80–0.83 teacher-rated SDQ), and coefficients were generally smaller for non-Dutch than for Dutch children (P<0.05). Alpha coefficients for subscales varied between 0.31–0.85 for ethnic groups. Inter-rater correlations between parents and teachers for the total difficulties score varied between 0.20–0.41 between ethnic groups and were larger for Dutch than for non-Dutch children (P<0.05). Concurrent validity was acceptable for most scales and most ethnic groups. Conclusion: The total difficulties score of the parent- and teacher-rated SDQ is valid and reliable for different ethnic groups within Dutch society. However, there are differences in reliability and validity of the subscales, which makes interpretation of the subscales difficult for certain ethnic groups

Validation of the SDQ in a multi-ethnic population of young children

Background: The Strengths and Difficulties Questionnaire (SDQ) is a valuable screening tool for identifying psychosocial problems. Its performance in a multi-ethnic society, common to many paediatric health care workers, has not been investigated. Because it is important that screening instruments are valid and reliable for all ethnic groups within one society, we examined differences in the SDQ's psychometric properties in a multi-ethnic society. Methods: The SDQ parent (n = 8114) and teacher form (n = 9355) were completed as part of a preventive health check for children aged 5-6 years of Dutch and non-Dutch ethnic backgrounds. The Child Behaviour Checklist (CBCL)/Teacher Report Form (TRF) was administered to a subsample. Results: Factor analysis of the parent-rated SDQ showed different rating patterns for two of the five subscales for non-Dutch children as compared with Dutch children. Cronbach's alpha for the total difficulties score varied by ethnic group (0.73-0.78 parent-rated SDQ, 0.80-0.83 teacher-rated SDQ), and coefficients were generally smaller for non-Dutch than for Dutch children (P < 0.05). Alpha coefficients for subscales varied between 0.31-0.85 for ethnic groups. Inter-rater correlations between parents and teachers for the total difficulties score varied between 0.20-0.41 between ethnic groups and were larger for Dutch than for non-Dutch children (P < 0.05). Concurrent validity was acceptable for most scales and most ethnic groups. Conclusion: The total difficulties score of the parent- and teacher-rated SDQ is valid and reliable for different ethnic groups within Dutch society. However, there are differences in reliability and validity of the subscales, which makes interpretation of the subscales difficult for certain ethnic groups

Ethnic differences in problem perception and perceived need for care for young children with problem behaviour

Background: Problem perception and perceived need for professional care are important determinants that can contribute to ethnic differences in the use of mental health care. Therefore, we studied ethnic differences in problem perception and perceived need for professional care in the parents and teachers of 5- to 6-year-old children from the general population who were selected for having emotional and behavioural problems. Methods: A cross-sectional study with data of 10,951 children from grade two of the elementary schools in the Rotterdam-Rijnmond area, the Netherlands. Parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ) as well as questions on problem perception and perceived need for care. The SDQ was used to identify children with emotional and behavioural problems. We included Dutch, Surinamese, Antillean, Moroccan and Turkish children in our sample with high (>P90) SDQ scores (N = 1,215), who were not currently receiving professional care for their problems. Results: Amongst children with high SDQ scores, problem perception was lower in non-Dutch parents than in Dutch parents (49% vs. 81%, p < 0.01). These lower rates of problem perception could not be explained by differences in socioeconomic position or severity of the problems. No ethnic differences were found in parental perceived need and in problem perception and perceived need reported by teachers. Higher levels of problem perception and perceived need were reported by teachers than by parents in all ethnic groups (PP: 87% vs. 63% and PN: 48% vs. 23%). Conclusions: Child health professionals should be aware of ethnic variations in problem perception as low problem perception in parents of non-Dutch children may lead to miscommunication and unmet need for professional care for the child