Where’s the need? the use of specialist mental health services in adolescence and young adulthood

Childhood and adolescence are vulnerable phases in life during which there is a high risk of developing a mental disorder. The negative consequences of such disorders are often visible well into adulthood. Effective mental health care is important, but it remains to be seen whether youths actually receive such care. The overall aim in this PhD thesis was therefore to investigate the extent to which youths receive care for their mental disorders, and which factors play a decisive role in this process. Psychiatric disorders are common in Dutch youths. Many youths are not in mental health care for their disorders, however, or wait long, often many years, before entering into care. Youths often only enter into care if a new disorder develops, in addition to the existing disorder. Mental health care use does increase in young adulthood, but even then only a minority of the young adults with psychological problems receives care. Help-seeking is impeded because youths are dependent on their environment, such as their parents and teachers, and because symptoms often disappear by themselves after a while. The research in this PhD thesis shows that it is difficult to detect mental disorders in childhood or adolescence in an early stage. Youths often only seek help once their problems deteriorate, and they are severely impaired in their daily functioning. It is therefore of the upmost importance to prevent the development of mental disorders from childhood onwards as much as possible, and to provide timely and effective health care to youths who develop a mental disorder

Mental Disorder During Adolescence:Evidence of Arrested Personality Development

The experience of a mental disorder may affect the development of personality in multiple ways, but empirical evidence regarding psychopathology effects on personality development that persist after remission of the disorder is limited and inconsistent. In the longitudinal cohort TRacking Adolescents' Individual Lives Survey (TRAILS), mental disorders during adolescence were assessed using the Composite International Diagnostic Interview and parent-reported effortful control, fearfulness, and frustration at age 11 and age 19 through the Early Adolescent Temperament Questionnaire. We found that adolescent mental disorders had small effects on personality change. Internalizing disorders predicted increases of fearfulness and frustration but hardly affected effortful control; externalizing disorders were unrelated to frustration and fearfulness but predicted a decrease of effortful control. Whereas fearfulness and frustration partially caught up after disorder remission, virtually all delay in effortful control was still present 2.9 years later, suggesting scarring effects

The association of developmental trajectories of adolescent mental health with early-adult functioning

BACKGROUND: Mental health problems during adolescence may create a problematic start into adulthood for affected individuals. Usually, categorical indicators of adolescent mental health issues (yes/no psychiatric disorder) are used in studies into long-term functional outcomes. This however does not take into account the full spectrum of mental health, nor does it consider the trajectory of mental health problem development over time. The aim of this study was twofold: (1) to identify distinct developmental trajectories of (co-occurring) internalizing and externalizing mental health symptoms over the course of adolescence (ages 11-19), and (2) to document the associations between these adolescent trajectories and economic, social, and health outcomes in young adulthood (age 22), unadjusted and adjusted for childhood functioning, putative confounders and current mental health. METHODS: Data were used from the Dutch TRAILS cohort study (subsample n = 1524, 47.3% males). Self-reported INT and EXT symptoms using the Youth/Adult Self Report were assessed four times (ages 11y, 13y, 16y, 19y). Adolescent mental health trajectories were estimated using Parallel-Processes Latent Class Growth Analyses. Self-reported economic, social, and health outcomes and parent-reported current mental health (using Adult Behaviour Checklist) were assessed at age 22. Multiple logistic regression analyses were performed to test associations between trajectories and outcomes. RESULTS: Four distinct trajectory classes were identified: (1) a normative class with decreasing-low INT+EXT symptoms (n = 460), (2) continuous moderately-high INT+EXT (n = 298), (3) continuous moderate, INT>EXT (n = 414), and (4) decreasing moderate, EXT>INT (n = 352). Compared to the normative class, the other three trajectories generally predicted less optimal early-adult outcomes, with the strongest effects observed for individuals with continuous moderate-high levels of both INT and EXT symptoms throughout adolescence. The associations largely remained after adjustment for pre-adolescent functioning, selected confounders and current mental health. CONCLUSIONS: Both adolescent trajectories and current mental health had substantial independent effects on early-adult functioning

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BACKGROUND: With psychopathology rising during adolescence and evidence suggesting that adult mental health burden is often due to disorders beginning in youth, it is important to investigate the epidemiology of adolescent mental disorders. METHOD: We analysed data gathered at ages 11 (baseline) and 19 years from the population-based Dutch TRacking Adolescents' Individual Lives Survey (TRAILS) study. At baseline we administered the Achenbach measures (Child Behavior Checklist, Youth Self-Report) and at age 19 years the World Health Organization's Composite International Diagnostic Interview version 3.0 (CIDI 3.0) to 1584 youths. RESULTS: Lifetime, 12-month and 30-day prevalences of any CIDI-DSM-IV disorder were 45, 31 and 15%, respectively. Half were severe. Anxiety disorders were the most common but the least severe whereas mood and behaviour disorders were less prevalent but more severe. Disorders persisted, mostly by recurrence in mood disorders and chronicity in anxiety disorders. Median onset age varied substantially across disorders. Having one disorder increased subjects' risk of developing another disorder. We found substantial homotypic and heterotypic continuity. Baseline problems predicted the development of diagnosable disorders in adolescence. Non-intact families and low maternal education predicted externalizing disorders. Most morbidity concentrated in 5-10% of the sample, experiencing 34-55% of all severe lifetime disorders. CONCLUSIONS: At late adolescence, 22% of youths have experienced a severe episode and 23% only mild episodes. This psychopathology is rather persistent, mostly due to recurrence, showing both monotypic and heterotypic continuity, with family context affecting particularly externalizing disorders. High problem levels at age 11 years are modest precursors of incident adolescent disorders. The burden of mental illness concentrates in 5-10% of the adolescent population

Arrangement for interfacing a telephone device with a personal computer

An arrangement provides an interface between a telephone device and a personal computer in such a manner that enhanced capability for both the telephone device and the computer in processing information in an analog telephone environment is provided. The telephone device attaches to an analog telephone line and advantageously operates either as a stand-alone device when the computer is powered-off or in tandem with the computer when the computer is powered-on. A user is able to access any of the available telephony features from the telephone device at all times and from the computer when it is powered-on. Such available telephony features include, by way of example, Caller ID for decoding available information presented on the analog telephone line and an integrated telephone answering system, which provides for reception, transmission, and storage of voice, facsimile, and electronic mail messages.Published versio

Morphological and molecular characterizationof a new species of black coral from Elvers Bank, north-western Gulf of Mexico (Cnidaria:Anthozoa: Hexacorallia: Antipatharia:Aphanipathidae: Distichopathes)

The continental shelf edge of the NW Gulf of Mexico supports dozens of reefs and banks, including the West and East Flower Garden Banks (FGB) and Stetson Bank that comprise the Flower Garden Banks National Marine Sanctuary (FGBNMS). Discovered by fishermen in the early 1900s, the FGBs are named after the colourful corals, sponges and algae that dominate the region. The reefs and banks are the surface expression of underlying salt domes and provide important habitat for mesophotic coral ecosystems (MCE) and deep coral communities to 300 m depth. Since 2001, FGBNMS research teams have utilized remotely operated vehicles (e.g. ‘Phantom S2’, ‘Mohawk’, ‘Yogi’) to survey and characterize benthic habitats of this region. In 2016, a Draft Environmental Impact Statement proposed the expansion of the current sanctuary boundaries to incorporate an additional 15 reefs and banks, including Elvers Bank. Antipatharians (black corals) were collected within the proposed expansion sites and analysed using morphological and molecular methods. A new species, Distichopathes hickersonae, collected at 172 m depth on Elvers Bank, is described within the family Aphanipathidae. This brings the total number of black coral species in and around the sanctuary to 14

Unique cellular organization in the oldest root meristem

Roots and shoots of plant bodies develop from meristems—cell populations that self-renew and produce cells that undergo differentiation—located at the apices of axes [1].The oldest preserved root apices in which cellular anatomy can be imaged are found in nodules of permineralized fossil soils called coal balls [2], which formed in the Carboniferous coal swamp forests over 300 million years ago [3, 4, 5, 6, 7, 8 and 9]. However, no fossil root apices described to date were actively growing at the time of preservation [3, 4, 5, 6, 7, 8, 9 and 10]. Because the cellular organization of meristems changes when root growth stops, it has been impossible to compare cellular dynamics as stem cells transition to differentiated cells in extinct and extant taxa [11]. We predicted that meristems of actively growing roots would be preserved in coal balls. Here we report the discovery of the first fossilized remains of an actively growing root meristem from permineralized Carboniferous soil with detail of the stem cells and differentiating cells preserved. The cellular organization of the meristem is unique. The position of the Körper-Kappe boundary, discrete root cap, and presence of many anticlinal cell divisions within a broad promeristem distinguish it from all other known root meristems. This discovery is important because it demonstrates that the same general cellular dynamics are conserved between the oldest extinct and extant root meristems. However, its unique cellular organization demonstrates that extant root meristem organization and development represents only a subset of the diversity that has existed since roots first evolved.</p

What evidence is there to support skill mix changes between GPs, pharmacists and practice nurses in the care of elderly people living in the community?

Background: Workforce shortages in Australia are occurring across a range of health disciplines but are most acute in general practice. Skill mix change such as task substitution is one solution to workforce shortages. The aim of this systematic review was to explore the evidence for the effectiveness of task substitution between GPs and pharmacists and GPs and nurses for the care of older people with chronic disease. Published, peer reviewed (black) and non-peer reviewed (grey) literature were included in the review if they met the inclusion criteria. Results: Forty-six articles were included in the review. Task substitution between pharmacists and GPs and nurses and GPs resulted in an improved process of care and patient outcomes, such as improved disease control. The interventions were either health promotion or disease management according to guidelines or use of protocols, or a mixture of both. The results of this review indicate that pharmacists and nurses can effectively provide disease management and/or health promotion for older people with chronic disease in primary care. While there were improvements in patient outcomes no reduction in health service use was evident. Conclusion: When implementing skill mix changes such as task substitution it is important that the health professionals' roles are complementary otherwise they may simply duplicate the task performed by other health professionals. This has implications for the way in which multidisciplinary teams are organised in initiatives such as the GP Super Clinics

Revisiting the Strange Stories: Revealing Mentalizing Impairments in Autism

A test of advanced theory of mind (ToM), first introduced by F. Happé (1994), was adapted for children (mental, human, animal, and nature stories plus unlinked sentences). These materials were closely matched for difficulty and were presented to forty-five 7- to 12-year-olds with autism and 27 control children. Children with autism who showed ToM impairment on independent tests performed significantly more poorly than controls solely on the mental, human, and animal stories with greatest impairment on the former and least on the latter. Thus, a mentalizing deficit may affect understanding of biologic agents even when this does not explicitly require understanding others' mental states

Impoverished Rural Districts of Pakistan: An Independent Evaluation of Impact on Educational and Cognitive Outcomes in Sindh Province, Pakistan

This article presents findings of cognitive and performance assessment among recipient and non?recipient school girls in the catchment schools of the Tawana Pakistan Project using standardised matrices. This is the first such evaluation of the relationship of a school feeding programme with developmental outcomes in rural Pakistan. There was evidence of benefits of the school feeding programme on a range of outcomes with significant improvement in the literacy and numeracy scores. The paired analysis showed a significant improvement (p&lt;0.001) in Raven's Coloured Progressive Matrices and Draw?a?Person test while no association was established in grade performance assessment (GPA). The correlation analyses in terms of the effects of intervention on child cognitive development confirmed the positive correlation in all aspects. DID estimates also revealed an improvement in cognitive outcomes due to the programme. Findings support such potential programmes for improving educational and cognitive outcomes of primary school girls in impoverished districts of Pakistan