Associations between family and clinician ratings of child mental health: a study of UK CAMHS assessments and outcomes

Background: The rated severity of child mental health problems depends on who is doing the rating, whether child, carer or clinician. It is important to know how these ratings relate to each other. Aims: To investigate to what extent clinicians’ views are associated with carers’ and young people’s views in routine care in the United Kingdom. Method: Ratings of clinician and parent/child viewpoints from a large Child and Adolescent Mental Health Services (CAMHS) sample (ns 1773–47,299), as measured by the Children’s Global Assessment Scale (CGAS) and Strengths and Difficulties Questionnaire (SDQ) respectively, were analysed. The parent SDQ added value score (AVS), which adjusts for regression to the mean and other non-treatment change, was also included in the analyses. Results: Small-to-medium correlations were found between family and clinician ratings; however, ratings diverged for the lowest-function CGAS bands. Regression analyses showed that pro-social ratings from both child and parent contributed to clinician ratings. Knowing child-reported emotional problem severity made parent ratings of emotions irrelevant to clinician judgements. There was a positive association between SDQ AVS and CGAS; as hypothesised, CGAS showed more change than the SDQ AVS, suggesting that clinicians over-estimate change. Conclusion: This study shows the importance of multi-informant data gathering and the integration of multiple views by clinicians when monitoring outcomes

Why do so many white working class boys underachieve? An exploration of underpinning factors and beliefs

The media and current literature portray white working class boys as educational failures with restricted life chances. To date, no mixed methods research has been conducted to explore these commonly held views. This study serves as a starting point, taking what we know about achievement and exploring this from the perspective of WWCBs. A two-phase sequential mixed methods exploratory design was used with purposive sampling. All participants were in key stage 3, recorded as white British, in receipt of free school meals and attending a comprehensive secondary school. Participants were categorised as low or high/average attaining, based on their current attainment levels. In phase 1, the School Attitude Assessment Survey-Revised (McCoach, 2002) was used to measure participants’ attitudes on five factors known to be associated with achievement. This data was then analysed using an independent samples T-test. Phase 2 included low attaining pupils only and, using semi-structured interviews, explored the boy’s views and beliefs about schooling. In phase 1, the low and high/average groups did not significantly differ in their academic self-perceptions, attitudes towards school, attitudes towards teachers, goal valuation or self-regulation and motivation. Phase 2 used thematic analysis to explore the interview data of six year 9 boys and identified four over-arching themes: feeling valued in the learning relationship, academic self-perceptions, choosing one’s own path and misalignment. The quantitative phase results indicated that the academic attainment of the participating white working class boys (WWCBs) was not significantly mediated by factors measured by the SAAS-R, and commonly believed to affect achievement. The findings from the qualitative phase supported these findings and generated alternative factors that highlighted the importance of considering the reciprocal nature of education and the effect of relationships on learning. The data suggests a unilateral within child view may not be sufficient in understanding why working class boys underachieve

Hair ageing in Black women (age>59): impact on personal and social identity and subjective wellbeing

This interdisciplinary study explores the evolution of hair management practices of Black women from age-related biological, personal and social perspectives. It seeks to clarify if and how any changes impact the subjective wellbeing of women. The study focuses on Black women living in the UK who are 59 years old and over as biological changes to hair become more prominent after menopause. The study contributes to raising the visibility of this group of women who appear underrepresented in the research fields of hair science, well-being and ageing as well as in the media

Serotonin, β‐amyloid, and cognition in Parkinson disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144631/1/ana25236_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144631/2/ana25236.pd

Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease: Results from the CREDENCE trial and meta-analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-Analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-Analysis. RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: Total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]). CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Propuesta para la Implementaciòn de un Servicio turìstico culinario en la ciudad de Guayaquil

Ecuador ha realizado durante los ùltimos años un trabajo importante en la atracciòn de turistas, teniendo como objetivo que los ingresos de la industria turìstica se conviertan en el princìpal contribuyente del PIB en el paìs, por otra parte la empresa Pùblica Municipal de Turismo en Guayaquil se ha propuesto convertir a la ciudad en el principal destino turistico del paìs. Tourifood Guayaquil surge con el objetivo de contribuir como una alternativa de entretenimiento con una oferta de valor que ofrecerà un servicio de turismo gastronòmico que permita explorar los sitios màs representativos de comida tìpica, y relalizar recorridos por lugres emblematicos de la ciudad.GuayaquilMagìster Ejecutiva en Administraciòn de Empresa

Needs assessment for direct ophthalmoscopy training in neurology residency.

BACKGROUND: Assessment of the ocular fundus, traditionally by direct ophthalmoscopy (DO), is essential to evaluate many neurologic diseases. However, the status of DO training in neurology residencies is unknown. We conducted a needs assessment to determine current attitudes, curricula, and gaps in DO training. METHODS: A survey was developed and administered to residents and program directors (PDs) at ACGME accredited neurology residencies in the United States. The survey assessed factors such as current DO curricula, perceived importance of DO, confidence of skills, and need for improvement. Data analysis was performed using the Mann Whitney U test and Fisher Exact Test. RESULTS: Nineteen PDs (11.6%) and 74 (41.1%) residents responded to the survey. 97.1% of residents and 100.0% of PDs believe DO is an important skill to learn. 29.4% of PDs expected graduating residents to have completed &gt; 10 supervised DO exams, while 0.0% of graduating fourth year residents reported doing so (p = 0.03). 35.7% of graduating residents had never correctly identified an abnormal finding on DO. The number of times residents practiced DO unsupervised correlated with increasing confidence in all components of the DO exam (p &lt; 0.05). Residents who felt their program emphasized DO were more likely to perform DO at least once a week compared to residents who did not perceive program emphasis (61.9% vs. 35.0%, p = 0.02) and were more confident in DO (p &lt; 0.05). 66.7% of residents and 42.1% of PDs were not satisfied with current levels of DO training. 96.7% of residents and 78.9% of PDs felt it was important to improve curriculum for DO training. Supervised practice and practice skills sessions were identified as the most helpful interventions to improve DO training. CONCLUSIONS: The vast majority of neurology PDs and residents believe DO is an important skill to learn, are unsatisfied with the current level of DO training, and advocate for improvement in DO curricula. Current DO curricula have limited formal didactic training and supervised practice. The bulk of DO learning occurs through unsupervised practice, which is influenced by motivational factors such as perceived residency emphasis on DO learning