Inter-parental conflict and children's externalising problems during the transition from primary to secondary school

Background: The prevalence rates of aggressive and antisocial behaviour among children and adolescents are a cause for concern among parents, teachers and policy makers. The aetiology of these dimensions of child psychopathology remains high on the research agenda. Attention has been directed at specific family relations, including inter-parental and parent-child relationships, and school-based factors, such as student-teacher relationships and school transitions, as aspects of children's social environment that may contribute to externalising problems. This thesis explores the role of home-school interplay by examining the pathways through which pre- and post-transition inter-parental conflict is associated with children and adolescents' externalising problems in secondary school. Method The thesis employs a mixed methods design. Multivariate analysis using both cross-sectional and prospective, longitudinal research designs are used to assess relationships between inter-parental conflict and children's externalising problems during the transition from primary to secondary school. This is supplemented by a thematic analysis of qualitative responses identifying the school-based factors that children, their parents and teachers have identified as helpful and unhelpful to foster adaptation to school transition. Results Findings emphasise the importance of family relations for children's school- based adjustment. Inter-parental conflict preceding and co-occurring with the school transition consistently predicted externalising problems in secondary school via children's responsibility attributions for the conflict. The results also underscore the value of considering the interface between home and school for understanding variation in children's psychological adjustment by showing that inter-parental conflict increases children's transition-related anxiety, which predicts poor adjustment to secondary school. Supportive teacher behaviour appears to be a significant factor that helps children prepare for the transition. It appears to be particularly important for children experiencing heightened levels of discord and hostility within the home, who may be among those at greater risk of manifesting externalising problems. Conclusions It is important to consider aspects of the home and school environment to understand variation in children's externalising problems in school during periods of transition. Results are discussed and recommendations made for policy and practice aimed at reducing aggression and antisocial behaviour during this critical period of normative life stress

Therapist guided, parent-led cognitive behavioural therapy (CBT) for pre-adolescent children with obsessive compulsive disorder (OCD) : a non-concurrent multiple baseline case series

BACKGROUND: Cognitive behavioural therapy (CBT) including exposure and response prevention (ERP) is an effective treatment for preadolescent children with obsessive compulsive disorder (OCD); however, there is a need to increase access to this treatment for affected children. AIMS: This study is a preliminary evaluation of the efficacy and acceptability of a brief therapist-guided, parent-led CBT intervention for pre-adolescent children (5-12 years old) with OCD using a non-concurrent multiple baseline approach. METHOD: Parents of 10 children with OCD were randomly allocated to no-treatment baselines of 3, 4 or 5 weeks before receiving six to eight individual treatment sessions with a Psychological Wellbeing Practitioner. Diagnostic measures were completed prior to the baseline, 1-week post-treatment, and at a 1-month follow-up, and parents completed weekly measures of children's OCD symptoms/impairment. RESULTS: Seventy percent of children were 'responders' and/or 'remitters' on diagnostic measures at post-treatment, and 60% at the 1-month follow-up. At least 50% of children showed reliable improvements on parent-reported OCD symptoms/impairment from pre- to post-treatment, and from pre-treatment to 1-month follow-up. Crucially, the intervention was acceptable to parents. CONCLUSIONS: Brief therapist-guided, parent-led CBT has the potential to be an effective, acceptable and accessible first-line treatment for pre-adolescent children with OCD, subject to the findings of further evaluations.Peer reviewe

Synergistic Effects of Salinity and Temperature on the Survival of Two Nonnative Bivalve Molluscs, Perna viridis

This study examined the combined salinity and temperature tolerance of two marine bivalve molluscs, Perna viridis and Mytella charruana, which have recently invaded the southeastern United States. It is essential to understand the role that these abiotic variables play in invasions and establishment of nonnative species. We simultaneously explored survival at three salinity ranges (5–9, 20–22.5, and 35–40 ppt) in both cold and warm water for juveniles and adults of both species. We determined that Perna viridis can survive at a wide range of temperatures (9–35°C) when the salinity is 35–37 ppt; however, as salinity decreased, the thermal survival range for P. viridis became narrower. With M. charruana, our data suggest that juvenile and adult individuals can survive at a wide range of salinities (5–40 ppt) at 20°C, but the salinity tolerance range narrowed as the temperature decreased or increased. Additionally, we observed that temperature rapidly impacted survival of P. viridis and M. charruana (within hours), while salinity impacts were more gradual (days to weeks). These data can be used to help predict successful introductions and future expansions of P. viridis and M. charruana in introduced habitats

Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p <0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.Peer reviewe

Anxiety disorders in children and young people

Anxiety disorders are the most common psychiatric disorders among children and young people, affecting an estimated 6.5% of children and young people worldwide. Childhood anxiety disorders often persist into adulthood if left untreated and are associated with a significant emotional and financial cost to individuals, their families, and wider society. Models of the development and maintenance of childhood anxiety disorders have underpinned prevention and treatment approaches, and cognitive behavioural treatments have good evidence for their efficacy. Ongoing challenges for the field include the need to improve outcomes for those that do not benefit from current prevention and treatment, and to increase access to those who could benefit

Children's appraisals of relationships in stepfamilies and first families

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