A randomized, controlled cross-over trial of dermally-applied lavender (lavandula angustifolia) oil as a treatment of agitated behaviour in dementia

Background: Lavender essential oil shows evidence of sedative properties in neurophysiological and animal studies but clinical trials of its effectiveness as a treatment of agitation in people with dementia have shown mixed results. Study methods have varied widely, however, making comparisons hazardous. To help remedy previous methodological shortcomings, we delivered high grade lavender oil in specified amounts to nursing home residents whose agitated behaviours were recorded objectively. Methods: 64 nursing home residents with frequent physically agitated behaviours were entered into a randomized, single-blind cross-over trial of dermally-applied, neurophysiologically active, high purity 30% lavender oil versus an inactive control oil. A blinded observer counted the presence or absence of target behaviours and rated participants’ predominant affect during each minute for 30 minutes prior to exposure and for 60 minutes afterwards. Results: Lavender oil did not prove superior to the control oil in reducing the frequency of physically agitated behaviours or in improving participants’ affect. Conclusions: Studies of essential oils are constrained by their variable formulations and uncertain pharmacokinetics and so optimal dosing and delivery regimens remain speculative. Notwithstanding this, topically delivered, high strength, pure lavender oil had no discernible effect on affect and behaviour in a well-defined clinical sample. Trial registration: Australian and New Zealand Clinical Trials Registry (ACTRN 12609000569202

The value of follicle-stimulating hormone concentration and clinical findings as markers of the late menopausal transition

CONTEXT: The Stages of Reproductive Aging Workshop proposed bleeding and hormonal criteria for the menopausal transition, but operational definitions of hormone parameters were not specified. OBJECTIVE: This paper investigates the longitudinal relationship of annual serum FSH levels with four proposed bleeding criteria for the late menopausal transition in two cohort studies. The goal is to provide empirically based guidance regarding application of hormonal criteria that may be optimal for widespread application in clinical and research settings for assessing menopausal stage. DESIGN/SETTING: Prospective menstrual calendar and annual serum FSH data were collected from two population-based cohort studies: the Melbourne Women\u27s Midlife Health Project and the Study of Women\u27s Health Across the Nation. PARTICIPANTS: Participants in the study were 193 Melbourne Women\u27s Midlife Health Project and 2223 Study of Women\u27s Health Across the Nation women aged 42-57 yr at baseline who contributed 10 or more menstrual cycles and at least one annual serum FSH value. MAIN OUTCOME MEASURE(S): Association between bleeding criteria for the late menopausal transition and FSH was a main outcome measure. Associations of bleeding criteria, FSH, and hot flashes with the final menstrual period were also measured. RESULTS: A single FSH measure is an independent marker of the late menopausal transition, but FSH concentrations are less predictive of menopausal stage than any of four proposed bleeding criteria. Criterion FSH values for the late transition are similar across both studies. Experience of hot flashes adds no information in the presence of hormonal and bleeding criteria. CONCLUSIONS: An annual serum FSH concentration of 40 IU/liter could be incorporated, in conjunction with bleeding markers, into the Stages of Reproductive Aging Workshop paradigm for markers of the late menopausal transition

Emotion recognition of static and dynamic faces in autism spectrum disorder

There is substantial evidence for facial emotion recognition (FER) deficits in autism spectrum disorder (ASD). The extent of this impairment, however, remains unclear, and there is some suggestion that clinical groups might benefit from the use of dynamic rather than static images. High-functioning individuals with ASD (n = 36) and typically developing controls (n = 36) completed a computerised FER task involving static and dynamic expressions of the six basic emotions. The ASD group showed poorer overall performance in identifying anger and disgust and were disadvantaged by dynamic (relative to static) stimuli when presented with sad expressions. Among both groups, however, dynamic stimuli appeared to improve recognition of anger. This research provides further evidence of specific impairment in the recognition of negative emotions in ASD, but argues against any broad advantages associated with the use of dynamic displays

The Association Between Parent Engagement and Child Outcomes in Social Skills Training Programs: Discovering the Secret Agent Society in Partnership

Previous research in clinical, community, and school settings has demonstrated positive outcomes for the Secret Agent Society (SAS) social skills training program. This is designed to help children on the autism spectrum become more aware of emotions in themselves and others and to ‘problem-solve’ complex social scenarios. Parents play a key role in the implementation of the SAS program, attending information and support sessions with other parents and providing supervision, rewards, and feedback as their children complete weekly ‘home mission’ assignments. Drawing on data from a school-based evaluation of the SAS program, this study examined whether parents’ engagement with these elements of the intervention was linked to the quality of their children’s participation and performance. Sixty-eight 8-14 year olds (mean age 10.7) with a diagnosis of autism participated in the program. The findings indicated that ratings of parental engagement were positively correlated with children’s competence in completing home missions and with the quality of their contribution during group teaching sessions. However, there was a less consistent relationship between parental engagement and measures of children’s social and emotional skill gains over the course of the program

Psychopathology in Young People With Intellectual Disability

Context Comorbid severe mental health problems complicating intellectual disability are a common and costly public health problem. Although these problems are known to begin in early childhood, little is known of how they evolve over time or whether they continue into adulthood. Objective To study the course of psychopathology in a representative population of children and adolescents with intellectual disability. Design, Setting, and Participants The participants of the Australian Child to Adult Development Study, an epidemiological cohort of 578 children and adolescents recruited in 1991 from health, education, and family agencies that provided services to children with intellectual disability aged 5 to 19.5 years in 6 rural and urban census regions in Australia, were followed up for 14 years with 4 time waves of data collection. Data were obtained from 507 participants, with 84% of wave 1 (1991-1992) participants being followed up at wave 4 (2002-2003). Main Outcome Measures The Developmental Behaviour Checklist (DBC), a validated measure of psychopathology in young people with intellectual disability, completed by parents or other caregivers. Changes over time in the Total Behaviour Problem Score and 5 subscale scores of the DBC scores were modeled using growth curve analysis. Results High initial levels of behavioral and emotional disturbance decreased only slowly over time, remaining high into young adulthood, declining by 1.05 per year on the DBC Total Behaviour Problem Score. Overall severity of psychopathology was similar across mild to severe ranges of intellectual disability (with mean Total Behavior Problem Scores of approximately 44). Psychopathology decreased more in boys than girls over time (boys starting with scores 2.61 points higher at baseline and ending with scores 2.57 points lower at wave 4), and more so in participants with mild intellectual disability compared with those with severe or profound intellectual disability who diverged from having scores 0.53 points lower at study commencement increasing to a difference of 6.98 points below severely affected children by wave 4. This trend was observed in each of the subscales, except the social-relating disturbance subscale, which increased over time. Prevalence of participants meeting criteria for major psychopathology or definite psychiatric disorder decreased from 41% at wave 1 to 31% at wave 4. Few of the participants (10%) with psychopathology received mental health interventions during the study period. Conclusion These results provide evidence that the problem of psychopathology comorbid with intellectual disability is both substantial and persistent and suggest the need for effective mental health interventions

Implementation, Evalution and Maintenance of a Social-Emotional Skills Training Program for Children with an Autism Spectrum Disorder in a Specialist School Setting

Socialization difficulties in children with an Autism Spectrum Disorder (ASD) are often associated with peer rejection and impaired academic achievement. Schools might appear to offer an ideal setting for social-emotional skills (SES) instruction. However, common challenges to successful implementation of school-based programs include inadequate staffing and resourcing, and a lack of ASD-specific staff training. This paper describes how barriers to program implementation were overcome in a project evaluating the Secret Agent Society (SAS) SES training intervention within Autism Spectrum Australia (Aspect) specialist classes. Questionnaire data was collected from school staff over a one-year period. Findings supported the effectiveness of the adoption process used, and suggest that SAS was feasible and acceptable to school staff

The Melbourne Study of Psychoanalytic Psychotherapy low‐cost clinic I: Implementation, mental health and life functioning gains

The Melbourne Study of Psychoanalytic Psychother-apy examined the implementation, lived experience, and perceived therapeutic gains of psychoanalytic psychother-apy in a low-cost, private-sector community clinic. A first in Australia, this 8-year demonstration project allowed natural-istic study of the impact and process of intensive, long-term, time-limited psychoanalytic psychotherapy delivered to self-referred adults by clinicians with a common theoretical frame of practice. Presented in three papers, the research employed the RE-AIM planning and evaluation framework, using complementary quantitative and qualitative methods, to study the psychotherapy service in terms of Reach, Effec-tiveness, Adoption, Implementation and Maintenance. This first paper reports the Reach of the program to be 67% for those presenting for assessment for psychoanalytic psycho-therapy, with Adoption of the full 2-year treatment program being 60%. Improvements in mental health and life function-ing provided quantitative evidence of Effectiveness for those completing the 2-year treatment program, with Maintenanceat 8-month follow-up. Patient age, gender and personality

Reconstructing the queen’s household, 1485-1547: a study in royal service

This thesis examines the queen’s household in England and the careers of its servants from 1485 to 1547. Reconstructing the offices they held in the queen’s Chamber and Privy Chamber, and their relationships with the queen, their mistress, the king, their sovereign, and the wider court and kingdom, it reassesses and redefines our understanding of the nature of royal service. This thesis builds upon the wider historiography on queenship, politics and women in this period. It demonstrates that the study of monarchy must constitute the sovereign and their consort, and reiterates the importance of studying servants, and women, reinstating them as central to the reigns of Henry VII and Henry VIII. In order to conceptualise fully the political, religious, and cultural significance of the court, not strictly the king’s servants, but the queen’s servants too, must be studied. Six women served as queens consort during Henry VIII’s reign, and their households were situated at the centre of their rise and fall. This thesis investigates the impact of Henry VIII’s marital instability, which saw the queen’s household discharged, its servants disbanded, and many of their careers cut short on no less than five occasions between 1527 and 1547. Requiring new and extensive archival research to reconstruct the households of Henry VIII’s queens, this thesis constructs a database of servants for prosopographical study, and integrates them into the master narrative of court studies. Rethinking and reflecting upon royal service more broadly as a career, this thesis provides a framework through which to interpret the evidence of service more sensitively, and accurately. It recommends ongoing and in-depth research into their individual careers, with a more nuanced understanding of the nature of royal service, and of the Tudor court from 1485 to 1603