The characteristics and activities of child and adolescent mental health services in Italy: a regional survey

<p>Abstract</p> <p>Background</p> <p>To date, no studies have assessed in detail the characteristics, organisation, and functioning of Child and Adolescent Mental Health Services (CAMHS). This information gap represents a major limitation for researchers and clinicians because most mental disorders have their onset in childhood or adolescence, and effective interventions can therefore represent a major factor in avoiding chronicity. Interventions and mental health care are delivered by and through services, and not by individual, private clinicians, and drawbacks or limitations of services generally translate in inappropriateness and ineffectiveness of treatments and interventions: therefore information about services is essential to improve the quality of care and ultimately the course and outcome of mental disorders in childhood and adolescence.</p> <p>The present paper reports the results of the first study aimed at providing detailed, updated and comprehensive data on CAMHS of a densely populated Italian region (over 4 million inhabitants) with a target population of 633,725 subjects aged 0-17 years.</p> <p>Methods</p> <p>Unit Chiefs of all the CAMHS filled in a structured 'Facility Form', with activity data referring to 2008 (data for inpatient facilities referred to 2009), which were then analysed in detail.</p> <p>Results</p> <p>Eleven CAMHS were operative, including 110 outpatient units, with a ratio of approximately 20 child psychiatrists and 23 psychologists per 100,000 inhabitants aged 0-17 years. All outpatient units were well equipped and organized and all granted free service access. In 2008, approximately 6% of the target population was in contact with outpatient CAMHS, showing substantial homogeneity across the eleven areas thereby. Most patients in contact in 2008 received a language disorder- or learning disability diagnosis (41%). First-ever contacts accounted for 30% of annual visits across all units. Hospital bed availability was 5 per 100,000 inhabitants aged 0-17 years.</p> <p>Conclusion</p> <p>The percentage of young people in contact with CAMHS for mental disorders is in line with those observed in previous epidemiological studies. The overall number of child psychiatrists per 100,000 inhabitants is one of the highest in Europe and it is comparable with the most well equipped areas in the US. This comparison should be interpreted with caution, however, because in Italy, child psychiatrists also treat neurological disorders. Critical areas requiring improvement are: the uneven utilisation of standardised assessment procedures and the limited availability of dedicated emergency services during non-office hours (e.g., nights and holidays).</p

Rationale for BepiColombo Studies of Mercury's Surface and Composition

BepiColombo has a larger and in many ways more capable suite of instruments relevant for determination of the topographic, physical, chemical and mineralogical properties of Mercury's surface than the suite carried by NASA's MESSENGER spacecraft. Moreover, BepiColombo's data rate is substantially higher. This equips it to confirm, elaborate upon, and go beyond many of MESSENGER's remarkable achievements. Furthermore, the geometry of BepiColombo's orbital science campaign, beginning in 2026, will enable it to make uniformly resolved observations of both northern and southern hemispheres. This will offer more detailed and complete imaging and topographic mapping, element mapping with better sensitivity and improved spatial resolution, and totally new mineralogical mapping. We discuss MESSENGER data in the context of preparing for BepiColombo, and describe the contributions that we expect BepiColombo to make towards increased knowledge and understanding of Mercury's surface and its composition. Much current work, including analysis of analogue materials, is directed towards better preparing ourselves to understand what BepiColombo might reveal. Some of MESSENGER's more remarkable observations were obtained under unique or extreme conditions. BepiColombo should be able to confirm the validity of these observations and reveal the extent to which they are representative of the planet as a whole. It will also make new observations to clarify geological processes governing and reflecting crustal origin and evolution. We anticipate that the insights gained into Mercury's geological history and its current space weathering environment will enable us to better understand the relationships of surface chemistry, morphologies and structures with the composition of crustal types, including the nature and mobility of volatile species. This will enable estimation of the composition of the mantle from which the crust was derived, and lead to tighter constraints on models for Mercury's origin including the nature and original heliocentric distance of the material from which it formed.Peer reviewe

Geodetic, geological and geophysical evidence of active tectonics in south-western Sicily and offshore

tIntegrated geological, geodetic and marine geophysical data provide evidence of active deformation insouth-western Sicily, in an area spatially coincident with the macroseismic zone of the destructive 1968Belice earthquake sequence. Even though the sequence represents the strongest seismic event recordedin Western Sicily in historical times, focal solutions provided by different authors are inconclusive onpossible faulting mechanism, which ranges from thrusting to transpression, and the seismogenic sourceis still undefined. Interferometric (DInSAR) observations reveal a differential ground motion on a SW–NEalignment between Campobello di Mazara and Castelvetrano (CCA), located just west of the maximummacroseismic sector. In addition, new GPS campaign-mode data acquired across the CCA alignment doc-uments NW–SE contractional strain accumulation. Morphostructural analysis allowed to associate thealignment detected through geodetic measurements with a topographic offset of Pleistocene marine sed-iments. The on-land data were complemented by new high-resolution marine geophysical surveys, whichindicate recent contraction on the offshore extension of the CCA alignment. The discovery of archaeo-logical remains displaced by a thrust fault associated with the alignment provided the first likely surfaceevidence of coseismic and/or aseismic deformation related to a seismogenic source in the area. Resultsof the integrated study supports the contention that oblique thrusting and folding in response to NW–SEoriented contraction is still active. Although we are not able to associate the CCA alignment to the 1968seismic sequence or to the historical earthquakes that destroyed the ancient Greek city of Selinunte,located on the nearby coastline, our result must be incorporated in the seismic hazard evaluation of thisdensely populated area of Sicil

Geodetic, geological and geophysical evidence of active tectonics in south-western Sicily and offshore

tIntegrated geological, geodetic and marine geophysical data provide evidence of active deformation insouth-western Sicily, in an area spatially coincident with the macroseismic zone of the destructive 1968Belice earthquake sequence. Even though the sequence represents the strongest seismic event recordedin Western Sicily in historical times, focal solutions provided by different authors are inconclusive onpossible faulting mechanism, which ranges from thrusting to transpression, and the seismogenic sourceis still undefined. Interferometric (DInSAR) observations reveal a differential ground motion on a SW–NEalignment between Campobello di Mazara and Castelvetrano (CCA), located just west of the maximummacroseismic sector. In addition, new GPS campaign-mode data acquired across the CCA alignment doc-uments NW–SE contractional strain accumulation. Morphostructural analysis allowed to associate thealignment detected through geodetic measurements with a topographic offset of Pleistocene marine sed-iments. The on-land data were complemented by new high-resolution marine geophysical surveys, whichindicate recent contraction on the offshore extension of the CCA alignment. The discovery of archaeo-logical remains displaced by a thrust fault associated with the alignment provided the first likely surfaceevidence of coseismic and/or aseismic deformation related to a seismogenic source in the area. Resultsof the integrated study supports the contention that oblique thrusting and folding in response to NW–SEoriented contraction is still active. Although we are not able to associate the CCA alignment to the 1968seismic sequence or to the historical earthquakes that destroyed the ancient Greek city of Selinunte,located on the nearby coastline, our result must be incorporated in the seismic hazard evaluation of thisdensely populated area of Sicil

Australian Cerebral Palsy Child Study: protocol of a prospective population based study of motor and brain development of preschool aged children with cerebral palsy

Background: Cerebral palsy (CP) results from a static brain lesion during pregnancy or early life and remains the most common cause of physical disability in children (1 in 500). While the brain lesion is static, the physical manifestations and medical issues may progress resulting in altered motor patterns. To date, there are no prospective longitudinal studies of CP that follow a birth cohort to track early gross and fine motor development and use Magnetic Resonance Imaging (MRI) to determine the anatomical pattern and likely timing of the brain lesion. Existing studies do not consider treatment costs and outcomes. This study aims to determine the pathway(s) to motor outcome from diagnosis at 18 months corrected age (c.a.) to outcome at 5 years in relation to the nature of the brain lesion (using structural MRI).Methods: This prospective cohort study aims to recruit a total of 240 children diagnosed with CP born in Victoria (birth years 2004 and 2005) and Queensland (birth years 2006-2009). Children can enter the study at any time between 18 months to 5 years of age and will be assessed at 18, 24, 30, 36, 48 and 60 months c.a. Outcomes include gross motor function (GMFM-66 & GMFM-88), Gross Motor Function Classification System (GMFCS); musculoskeletal development (hip displacement, spasticity, muscle contracture), upper limb function (Manual Ability Classification System), communication difficulties using Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS-DP), participation using the Paediatric Evaluation of Disability Inventory (PEDI), parent reported quality of life and classification of medical and allied health resource use and determination of the aetiology of CP using clinical evaluation combined with MRI. The relationship between the pathways to motor outcome and the nature of the brain lesion will be analysed using multiple methods including non-linear modelling, multilevel mixed-effects models and generalised estimating equations.Discussion: This protocol describes a large population-based study of early motor development and brain structure in a representative sample of preschool aged children with CP, using direct clinical assessment. The results of this study will be published in peer reviewed journals and presented at relevant international conferences.Trial registration: Australia and New Zealand Clinical Trials Register (ACTRN1261200169820)