Considering Harm and Safety in Youth Mental Health: A Call for Attention and Action

The possibility of harm from mental health provision, and in particular harm from youth mental health provision, has been largely overlooked. We contend that if we continue to assume youth mental health services can do no harm, and all that is needed is more services, we continue to risk the possibility that the safety of children and young people is unintentionally compromised. We propose a three level framework for considering harm from youth mental health provision (1. ineffective engagement, 2. ineffective practice and 3. adverse events) and suggest how this framework could be used to support quality improvement in services

The clinical utility and cost effectiveness of routine thyroid screening in adult psychiatric patients presenting at Stikland Hospital, Cape Town, South Africa

Objective: The use of thyroid tests to assess psychiatric patients remains debatable. Therefore, this study was conducted to examine the utility and cost effectiveness of the current protocol used in thyroid testing in adult psychiatric patients presenting at Stikland Hospital, Cape Town, South Africa. Method: This was a retrospective chart review conducted at Stikland Hospital between 1 January 2000 and 31 December 2005. The following data was recorded: demographic variables, clinical diagnoses at admission and discharge, number of days from admission to a thyroid test request, the reason for thyroid screening, number of thyroid tests, their yield and costs involved, as well as the action taken following an abnormal thyroid test result. Results: The mean age of patients (n = 1080: n = 364 male, n = 716 female) was 42.8 years (SD ±16.6). Pre-existing thyroid disease was documented in 70 (6%) of patients. Normal Thyroid Stimulating Hormone (TSH) test results significantly (p = 0.0001) increased, whilst abnormal TSH test results significantly (p = 0.0001) decreased from baseline to follow-up. Except for gender, the outcome of TSH screening was independent of demographic and clinical diagnoses. Only 16% of TSH tests yielded clinically significant results. Conclusion: The findings of this study do not support the early, routine screening for thyroid dysfunction in psychiatric patients at this facility. It is possible that thyroid screening may present with transient abnormalities of no particular clinical significance, and would therefore not be a cost effective practice.Keywords: Psychiatry; Screening; Thyroid abnormality; Thyroid stimulating hormon

The Intertwined Successional Development of the Lamb Gut Microbiota And Immune System (Poster)

Gastrointestinal tract (GIT) microbes play critical roles in host nutrition, health and immunological development. For adult ruminants, GIT-dwelling microbes provide ~70% of daily energy requirements. The GIT also houses 70 % of the animal’s immune system in the form of the Gut-associated Lymphatic Tissue (GALT), which houses 80% of all plasma cells and depends on microbial stimulation for maturation. Because nutrition and disease are two major factors in the economic sustainability of livestock production, our group set out to characterize the successional development of GIT microbiota and immune activity. Blood and GIT samples were collected from lambs immediately at birth through one-year of age, and from the dam’s vagina, mouth, and rectum at parturition. Blood samples were profiled for serum titers of IgM, IgA and IgG, while microbiota were profiled in GIT samples by 16S rRNA gene sequencing. Lamb GIT microbiota initially resembled the dam’s vaginal microbiota but following exposure to the dam, became rapidly more similar to the dam’s teat. GIT samples eventually formed stable climax communities similar to the dams around 180 days of age. This corresponded to the peak serum titers for each immunoglobin, which, aside from a peak in IgG at birth (likely colostral transfer), had gradually increased prior to this time. Immunoglobins peaked and then return to a sub peak level between 180 and 365 days. These results indicate dam vaginal microbiota have a short-lived impact on the neonatal microbiota, with the GIT microbiota going through a dynamic successional development to 180 d when immune function appears to peak