Demographic, clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services

Purpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services

Cohort profile : demographic and clinical characteristics of the MILESTONE longitudinal cohort of young people approaching the upper age limit of their child mental health care service in Europe

Purpose: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports. Participants: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at. Findings to date: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be ‘markedly ill’, ‘severely ill’ or ‘among the most extremely ill’ by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year. Future plans: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared. Trial registration number: NCT03013595

Famotidine Prevent Deep Histologic Lesion Induced by 0.6N HCl in Rat Gastric Mucosa : Role of Parietal Cells

The assessment of the protective actions of H-2-receptor antagonists against gastric mucosal Lesions by necrotizing agents relies on the gross observation of the gastric mucosa only. We examined the activity of famotidine against 0.6 N HCl-induced damage and the role of parietal cells by light and transmission electron microscopy. Rats received famotidine 0.3-10 mg/kg intragastrically. Sixty minutes later 0.6 N HCl (1 ml/rat) was given and after an additional 30 min the stomachs were removed. Macroscopically visible lesions were measured. Histologic lesions were scored on the basis of the depth. The ultrastructure of parietal cells in the isthmus-neck region was examined. Pretreatment with famotidine resulted in a slight increase of macroscopically visible gastric lesions in response to HCl. While the extent of total histologic damage was not modified, the antisecretory dose significantly reduced only lesions deep within the mucosa. Famotidine alone determined the dose-dependent occurrence of a distinct parietal cell morphological state, suggestive of inhibition of the secretory system. A causal link between the protective effect on the region where parietal cells are located, the percentage of cells shifting to the inhibited morphological state, and the inhibitory effect on acid secretion is proposed

Histamine H3 receptors and the gastric mucosa: a link between protection and epithelial proliferation?

The role of histamine H3 receptors in the control of gastric functions is considered. The selective agonist of histamine H3 receptors, (R)-α-methylhistamine, reduces gastric damage exerted by mechanistically distinct noxious stimuli in the rat. Its effect is reversed by H3-receptor selective antagonists, ciproxifan and clobenpropit, while prevention of damage is similarly achieved with FUB 407, a reference compound for a novel class of histamine H3-receptor agonists structurally not related to histamine. It is concluded that H3 receptors are involved in the maintenance of gastric muscosal integrity. H3 receptors appear to have a minor role in the control of acid secretion, while they effectively enhance synthesis and secretion of mucus as well as increase the number of both surface mucous cells and mucous neck cells. H3 receptors ligands promptly increase the rate of proliferation in the gastric mucosa, their target being stem cells located in the isthmal region. They also influence the process of differentiation, by promoting the expansion of the lineage of surface mucous cells. Prevention of acute damage and regulation of cell cycle of gastric epithelial cells can be viewed as functionally linked effects, influenced by histamine H3 receptors

Ligands for histamine H(3) receptors modulate cell proliferation and migration in rat oxyntic mucosa

1. (R)-α-methylhistamine, a selective agonist of histamine H(3) receptors, promotes mucus secretion and increases the number and volume of mucus-secreting cells. The hypothesis that the increased number of mucous cells could reside in an alteration of homeostasis in the gastric epithelium was investigated. 2. (R)-α-methylhistamine was administered to rats 1 h (10–100 mg kg(−1) by intragastric and by intraperitoneal route) and 24 h (100 mg kg(−1) by intragastric route) prior to killing. The (S)-isomer of α-methylhistamine (55.4 mg kg(−1)), 100 times less potent than the (R)-isomer at H(3) receptors, and the H(3)-receptor agonist FUB 407 (9.14–91.35 mg kg(−1)) were intragrastically administered 1 h prior to killing. The H(1)-receptor antagonist mepyramine (30 mg kg(−1)), the H(2)-receptor antagonist famotidine (3 mg kg(−1)), and the H(3)-receptor antagonists ciproxifan (3 mg kg(−1)) and clobenpropit (30 mg kg(−1)) were intragastrically administered 30 min before (R)-α-methylhistamine. Gastric tissue was processed for histology and immunohistochemistry. 3. Within 1 h, (R)-α-methylhistamine and FUB 407 dose-dependently increased the number of BrdU-positive cells and of apoptotic cells. (S)-α-methylhistamine failed to modify proliferation and apoptosis. The increase in proliferation by (R)-α-methylhistamine was reversed by ciproxifan and clobenpropit, but not by mepyramine and famotidine. 4. (R)-α-methylhistamine accelerated the differentiation towards pit cells and their outward migration 24 h after its administration. These effects were counteracted by ciproxifan. The apoptosis rate was unaffected at 24 h. 5. These findings reveal a primary role of histamine H(3)-receptor ligands in modulating cell proliferation and migration in rat fundic mucosa