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

Agonist Regulation of Adrenergic Receptors in the Rabbit

Acute elevations of the circulating catecholamines, adrenaline and noradrenaline are observed in physiological situations such as exercise, posture change and stress. Pathological settings such as phaeochromocytoma, heart failure and cirrhosis may be associated with chronic increases in plasma catecholamines. These high catecholamine levels have been associated with decreases in adrenergic receptor responsiveness or desensitisation. A reduction in adrenergic receptor density or down regulation has also been detected under these conditions. However, although the in vitro effects of raised concentrations of plasma catecholamines have been widely studied, similar investigations in vivo are not so well characterised. In addition, some in vivo experimental models (e.g. rat phaeochromocytoma) have produced plasma catecholamine levels vastly exceeding those found in many pathological settings. Therefore, the current investigations principally aimed to evaluate the effects of moderate increases in circulating catecholamines in vivo on adrenergic receptor function and number in a rabbit model. The first series of experiments were designed to validate the methods used and characterise the receptor populations under investigation. To begin with, experiments were carried out to determine if the pro-aggregatory response to adrenaline in rabbit platelets was mediated (like human platelets) by alpha2 adrenoceptors. The ability of the alpha adrenoceptor antagonists, idazoxan, yohimbine and prazosin to inhibit the platelet pro-aggregatory responses to adrenaline was recorded and IC50 values concentration of antagonist required to produce fifty percent inhibition of response) were calculated. The alpha2 adrenoceptor antagonists, idazoxan and yohimbine were found to be more potent than the alpha1 adrenoceptor antagonist, prazosin at inhibiting the platelet pro-aggregatory response to adrenaline. Therefore, these results demonstrated that alpha2 adrenoceptors primarily mediate the platelet pro-aggregatory response to adrenaline in the rabbit. The specificity of [3H] yohimbine binding to alpha2 adrenoceptors in rabbit platelets and kidney was also determined. Displacement assays were performed and the ability of various unlabelled alpha adrenoceptor antagonists to compete for [3H] yohimbine binding sites was examined and expressed as KI (a measure of affinity) values. Yohimbine was found to have a considerably higher potency than prazosin for displacing [3H] yohimbine binding sites on rabbit platelets. Similarly, in rabbit kidney; prazosin and phentolamine were both less potent than yohimbine at displacing [3H] yohimbine binding. These results were consistent with [3H] yohimbine binding to alpha2 receptors in rabbit platelets and kidney. Subpopulations of beta adrenoceptors were characterised in the platelets, lymphocytes, heart and lung of the rabbit. The ability of the beta1 (atenolol or metoprolol) and beta2 (ICI 118551 ) adrenoceptor selective antagonists to displace the beta adrenoceptor selective [125I](-) Iodocyanopindolol (ICYP) from its binding sites in platelets and was assessed. ICI 118551 was found to be more potent than atenolol in displacing [125I](-) ICYP specific binding in both tissues. These findings were in agreement with previous studies showing that the beta adrenoceptors in rabbit platelets and lymphocytes (like humans) were largely beta2 in type. In a separate study, the beta1 adrenoceptor selective antagonist, metoprolol had a higher affinity than the beta2 selective ICI 118551 at inhibiting [125I](-) ICYP specific binding in rabbit heart and lung. These results confirmed that both the heart and the lung of the rabbit harbour a higher proportion of beta1 adrenergic receptors in the rabbit. Interestingly, the proportion of beta1 and beta2 adrenoceptors in rabbit lung were shown to be quite the inverse of most other mammalian species. (Abstract shortened by ProQuest.)

Gastrointestinal tract size, total-tract digestibility, and rumen microflora in different dairy cow genotypes

peer-reviewedThe superior milk production efficiency of Jersey (JE) and Jersey × Holstein-Friesian (JE × HF) cows compared with Holstein-Friesian (HF) has been widely published. The biological differences among dairy cow genotypes, which could contribute to the milk production efficiency differences, have not been as widely studied however. A series of component studies were conducted using cows sourced from a longer-term genotype comparison study (JE, JE × HF, and HF). The objectives were to (1) determine if differences exist among genotypes regarding gastrointestinal tract (GIT) weight, (2) assess and quantify whether the genotypes tested differ in their ability to digest perennial ryegrass, and (3) examine the relative abundance of specific rumen microbial populations potentially relating to feed digestibility. Over 3 yr, the GIT weight was obtained from 33 HF, 35 JE, and 27 JE × HF nonlactating cows postslaughter. During the dry period the cows were offered a perennial ryegrass silage diet at maintenance level. The unadjusted GIT weight was heavier for the HF than for JE and JE × HF. When expressed as a proportion of body weight (BW), JE and JE × HF had a heavier GIT weight than HF. In vivo digestibility was evaluated on 16 each of JE, JE × HF, and HF lactating dairy cows. Cows were individually stalled, allowing for the total collection of feces and were offered freshly cut grass twice daily. During this time, daily milk yield, BW, and dry matter intake (DMI) were greater for HF and JE × HF than for JE; milk fat and protein concentration ranked oppositely. Daily milk solids yield did not differ among the 3 genotypes. Intake capacity, expressed as DMI per BW, tended to be different among treatments, with JE having the greatest DMI per BW, HF the lowest, and JE × HF being intermediate. Production efficiency, expressed as milk solids per DMI, was higher for JE than HF and JE × HF. Digestive efficiency, expressed as digestibility of dry matter, organic matter, N, neutral detergent fiber, and acid detergent fiber, was higher for JE than HF. In grazing cows (n = 15 per genotype) samples of rumen fluid, collected using a transesophageal sampling device, were analyzed to determine the relative abundance of rumen microbial populations of cellulolytic bacteria, protozoa, and fungi. These are critically important for fermentation of feed into short-chain fatty acids. A decrease was observed in the relative abundance of Ruminococcus flavefaciens in the JE rumen compared with HF and JE × HF. We can deduce from this study that the JE genotype has greater digestibility and a different rumen microbial population than HF. Jersey and JE × HF cows had a proportionally greater GIT weight than HF. These differences are likely to contribute to the production efficiency differences among genotypes previously reported

An mHealth Intervention (ReZone) to Help Young People Self-Manage Overwhelming Feelings: Cluster-Randomized Controlled Trial

BACKGROUND: Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs. OBJECTIVE: The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people. METHODS: The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up. RESULTS: There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone. CONCLUSIONS: It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.7019

THE IMPACT OF ESSENTIAL AMINO ACID SUPPLEMENTS ENRICHED WITH L-LEUCINE ON APPETITE AND ENERGY INTAKE IN ELDERLY WOMEN

Rationale: Inadequate protein intake (PI), the main source of essential amino acids (EAAs), and reduced appetite are contributing factors to age-related sarcopenia. The satiating effects of dietary protein may negatively affect energy intake (EI), thus there is a need to explore alternative strategies to facilitate PI without compromising appetite and subsequent EI. Methods: Elderly women completed two experiments (EXP1&2) where they consumed either a Bar (B, 135 kcal) or a Gel (G, 114 kcal), rich in EAAs (7.5 g, 40% L-Leucine), or nothing [control (C)]. In EXP1, subjects (n=10, 68±5 years, mean±SD) consumed B, G or C with appetite sensations and appetite-related hormonal responses monitored for 1h, followed by consumption of an ad libitum breakfast (ALB). In EXP2, subjects (n=11, 69±5 years) ingested B, G or C alongside an ALB. Results: In EXP1, EI at ALB was not different (P=0.674) between conditions (282±135, 299±122, 288±131 kcal for C, B and G respectively). However, total EI was significantly higher in B and G compared to C after accounting for the energy content of the supplements (P<0.0005). Analysis revealed significantly higher appetite Area under the Curve (AUC) (P<0.007), a tendency for higher acylated ghrelin AUC (P=0.087), and significantly lower pancreatic polypeptide AUC (P=0.02) in C compared with B and G. In EXP2, EI at ALB was significantly higher (P=0.028) in C (306±122 kcal) compared to B (245±135 kcal) and G (254±118 kcal). However, total EI was significantly higher in B and G after accounting for the energy content of the supplements (P<0.007). Conclusion: Supplementation with either the bar or gel increased total energy intake whether consumed 1h before or during breakfast. This may represent an effective nutritional means for addressing protein and total energy deficiencies in elderly women

The Child Outcome Rating Scale: validating a four-item measure of psychosocial functioning in community and clinic samples of children aged 10-15

Psychosocial functioning is considered an important and valued outcome in relation to young people’s mental health as a construct distinct from psychiatric symptomology, especially in the light of an increasing focus on transdiagnostic approaches. Yet, the level of psychosocial functioning is rarely directly asked of young people themselves, despite the widespread recognition that the young person’s perspective is valuable and is often at odds with those of other reporters, such as parents or professionals. One possible reason for this is that the field lacks a clear agreed tool to capture this information in a non-burdensome way. To begin to address this gap, this paper describes psychometric analysis of the Child Outcome Rating Scale (CORS), a brief and highly accessible self-report measure of young people’s psychosocial functioning already used extensively by mental health professionals around the world but with only limited data on psychometric robustness. Using large community (n = 7822) and clinic (n = 2604) samples, we explore the factor structure, construct validity, internal consistency, differential item functioning, and sensitivity of the CORS. We found that the CORS stands up to psychometric scrutiny, having found satisfactory levels of reliability, validity, and sensitivity in this sample. We also found that the CORS is suitable for use with young people as old as 15 years old. That the CORS has been found to be psychometrically robust while being highly feasible (brief, simple, easy to administer) for use in busy clinical settings, combined with the fact that the CORS has already been widely adopted by clinicians and young people, suggests CORS may be an important tool for international use

A Decision Aid Intervention to Improve Decisions about Weight Management Referral in Primary Care: Development and Feasibility Study

Patient non-attendance after referral to weight management support is a problem in routine health care. The decision making process prior to referral is a useful focus for research. The present study aimed to develop a patient decision aid intervention and to investigate patient and clinician perspectives on its acceptability and implementation in primary care. The content of a decision aid booklet was developed following in-depth interviews with 52 adults (mean age 56 years; 26 women, 26 men). The content was refined within a study of patients (n=21, 15 women) and clinicians (n=45) comprising doctors (n=12), nurses (n=15) and allied professions (n=18). An exploratory study of implementation was undertaken in primary care with feedback obtained from 18 patients (mean age 52 years; 12 women) and 5 nurses in relation to weight review consultations. Study findings show the weight management decision process is potentially complex and challenging to patients for both cognitive and social reasons. A decision aid developed to address patient needs was liked by patients and, to a lesser extent, by clinicians. The intervention was viewed as acceptable and feasible for implementation into routine practice. Active ingredients within a complex intervention appeared to be improvements in cognitive processing for patients but also improvements in rapport between patient and clinician. Further research should now evaluate outcomes including consultation rapport and patient attendance

Systematic review of approaches to using patient experience data for quality improvement in healthcare settings

Objectives: Explore how patient-reported experience measures (PREMs) are collected, communicated and used to inform quality improvement (QI) across healthcare settings. Design: Systematic review. Setting: Various primary and secondary care settings, including general practice, and acute and chronic care hospitals. Participants: A full range of patient populations from (children through to the elderly) and staff (from healthcare practitioners to senior managers). Methods: Scientific databases were searched (CINAHL, PsycINFO, MEDLINE and Cochrane Libraries) as was grey literature. Qualitative and quantitative studies describing collection of PREM data and subsequent QI actions in any healthcare setting were included. Risk of bias was assessed using established criteria. Of 5312 initial hits, 32 full texts were screened, and 11 were included. Results: Patient experience data were most commonly collected through surveys and used to identify small areas of incremental change to services that do not require a change to clinician behaviour (eg, changes to admission processes and producing educational materials). While staff in most studies reported having made effective improvements, authors struggled to identify what those changes were or the impact they had. Conclusions: Findings suggest there is no single best way to collect or use PREM data for QI, but they do suggest some key points to consider when planning such an approach. For instance, formal training is recommended, as a lack of expertise in QI and confidence in interpreting patient experience data effectively may continue to be a barrier to a successful shift towards a more patient-centred healthcare service. In the context of QI, more attention is required on how patient experience data will be used to inform changes to practice and, in turn, measure any impact these changes may have on patient experience

The association between ethnicity and care pathway for children with emotional problems in routinely collected child and adolescent mental health services data

Adults from black and minority ethnic (BAME) backgrounds are less likely to access mental health services through voluntary care pathways and are more likely to access through compulsory ones. The aim of the present research was to explore the association between ethnicity and care pathway through child and adolescent mental health services (CAMHS), in terms of reason for referral and case closure, in children presenting with emotional problems. A sample of N = 11,592 children from 26 CAMHS was taken from a national routinely collected dataset (56 % female; 7 % aged 0–5 years, 40 % 6–12 years, 53 % 13–18 years, and <1 % 19–25 years). Multinomial logistic regressions showed that BAME children were consistently more likely to be referred to CAMHS through education, social, and other services than primary care, compared to White British children (odds ratio (OR) = 1.52–9.96, p < .001) and they were less likely to end treatment due to child and family non-attendance (OR = 0.59–0.79, p < .05). Similar to adults, children from BAME groups may be more likely to access CAMHS through compulsory than voluntary care pathways

An update on UK rheumatology consultant workforce provision: the BSR/ARC Workforce Register 2005–07: assessing the impact of recent changes in NHS provision

Objectives. To describe changes in the provision of rheumatology services, monitor the pattern of inequalities in UK rheumatology service provision since 2005, and to summarize the 3-yr impact of the new National Health Service (NHS) consultant contract and the Musculoskeletal Services Framework in England and Wales