The Demand Side: Uses of Research in Child and Adolescent Mental Health Services

This special issue on child and adolescent mental health contains a thoughtful set of papers that address many of the challenges in bridging research and practice. These articles, however, focus predominantly on the supply side of producing research for use by a range of audiences, including practitioners, administrators and policy makers. This commentary emphasizes the importance of attending to, and better understanding, the demand side with regard to how research evidence is evaluated, understood, and utilized. Drawing from work underway at the William T. Grant Foundation, the authors argue for the need to understand three broad topics: user settings and perspectives, political, economic and social contexts, and the various uses of research. Furthermore, understanding the use of research evidence, or the demand side, is itself a topic for empirical investigation. The authors conclude that, when it comes to supplying evidence, don’t forget the demand side

Listeria pathogenesis and molecular virulence determinants

The gram-positive bacterium Listeria monocytogenes is the causative agent of listeriosis, a highly fatal opportunistic foodborne infection. Pregnant women, neonates, the elderly, and debilitated or immunocompromised patients in general are predominantly affected, although the disease can also develop in normal individuals. Clinical manifestations of invasive listeriosis are usually severe and include abortion, sepsis, and meningoencephalitis. Listeriosis can also manifest as a febrile gastroenteritis syndrome. In addition to humans, L. monocytogenes affects many vertebrate species, including birds. Listeria ivanovii, a second pathogenic species of the genus, is specific for ruminants. Our current view of the pathophysiology of listeriosis derives largely from studies with the mouse infection model. Pathogenic listeriae enter the host primarily through the intestine. The liver is thought to be their first target organ after intestinal translocation. In the liver, listeriae actively multiply until the infection is controlled by a cell-mediated immune response. This initial, subclinical step of listeriosis is thought to be common due to the frequent presence of pathogenic L. monocytogenes in food. In normal indivuals, the continual exposure to listerial antigens probably contributes to the maintenance of anti-Listeria memory T cells. However, in debilitated and immunocompromised patients, the unrestricted proliferation of listeriae in the liver may result in prolonged low-level bacteremia, leading to invasion of the preferred secondary target organs (the brain and the gravid uterus) and to overt clinical disease. L. monocytogenes and L. ivanovii are facultative intracellular parasites able to survive in macrophages and to invade a variety of normally nonphagocytic cells, such as epithelial cells, hepatocytes, and endothelial cells. In all these cell types, pathogenic listeriae go through an intracellular life cycle involving early escape from the phagocytic vacuole, rapid intracytoplasmic multiplication, bacterially induced actin-based motility, and direct spread to neighboring cells, in which they reinitiate the cycle. In this way, listeriae disseminate in host tissues sheltered from the humoral arm of the immune system. Over the last 15 years, a number of virulence factors involved in key steps of this intracellular life cycle have been identified. This review describes in detail the molecular determinants of Listeria virulence and their mechanism of action and summarizes the current knowledge on the pathophysiology of listeriosis and the cell biology and host cell responses to Listeria infection. This article provides an updated perspective of the development of our understanding of Listeria pathogenesis from the first molecular genetic analyses of virulence mechanisms reported in 1985 until the start of the genomic era of Listeria research

The reactions of depressives to depressives: The interpersonal consequences of depression.

Two studies were conducted to examine the interpersonal world of the depressive. It was hypothesized that depressed subjects would not like nondepressed targets as much as would nondepressed subjects. In addition, it was hypothesized that depressed subjects would feel worse after speaking with nondepressed targets. Finally it was hypothesized that perceived similarity would mediate these effects by covarying with mood and liking measures. To assess these hypotheses, study one had depressed and nondepressed college students speak with one another in either depressed-depressed, nondepressed-depressed, or nondepressed-nondepressed pairs. Measures of liking for the person with whom they conversed, of perceived similarity toward the person with whom they conversed, and of the subject's mood were then taken. Although the results were mixed, it was found that depressed subjects felt worse after speaking to depressed targets, though there were no differences in liking or perceived similarity between the groups. Perceived similarity did covary with most of the liking measures for the depressed and nondepressed subjects. Study two examined whether depressives had best friends who were themselves more depressed than best friends who were nondepressives. It was hypothesized that the best friends of depressives would be more depressed. Furthermore, it was expected that the best friends would also be perceived as more depressed by the subjects. These hypotheses were confirmed when depressives brought their best friends in for a study and the level of depression for these best friends was measured. In addition, the depressed subjects reported feeling worse after speaking with their friends when compared to how the nondepressed subjects reported feeling after speaking with their best friends

If it walks like a duck and quacks like a duck then must it be a rabbit? Programs, systems and a cumulative science of children's mental health services

The system of care approach as a strategy for serving children and adolescents with serious emotional disturbance (SED) is by any measure a success with one exception: there is controversy regarding the scientific evidence documenting that the services provided through systems of care improve the symptomatic and functional outcomes of the youth and their families served when compared to the services provided through more traditional service systems. This paper traces this essential problem to challenges in the definitions of systems of care, particularly the level at which systems of care are conceived to exist and the impact of these challenges on the collection of relevant and meaningful data that could otherwise create a cumulative science regarding systemic interventions for youth with SED. In many regards, systems of care are often viewed in the context of programs of care that are predominantly evaluated within program evaluation rather than system evaluation perspectives. This article elucidates the problems created by the varying definitions of systems of care for the development of a cumulative practice and policy relevant research base pertaining to children and adolescents with serious emotional disturbance. Alternative strategies for future research are discussed in the context of alternative definitions of the system of care concept.Children and adolescents Mental health Outcomes System of care Program evaluation System evaluation