The Massachusetts Child Psychiatry Access Project: Supporting Mental Health Treatment in Primary Care

Outlines the implementation and success of a program that provides primary care providers treating children with telephonic psychiatric and clinical guidance and, in turn, in-person assessment, transitional therapy, and/or linkage to community services

State Case Studies of Infant and Early Childhood Mental Health Systems: Strategies for Change

Profiles efforts to develop mental health identification and intervention systems for children up to age 5 in Colorado, Indiana, Massachusetts, and Rhode Island. Examines hurdles, reform potentials, and lessons learned, including the role of partnerships

The Utility of Trouble: Maximizing the Value of Our Human Services Dollars

Outlines recommendations to standardize service delivery areas and consolidate area offices of the state's seven largest human services agencies, as well as to close antiquated institutions. Projects benefits such as improved accessibility and savings

Problem Management Plus: An Evidence-Based Approach to Expanding Access to Community-Based Mental Health Supports

Problem Management Plus (PM+) is a proven, scalable, and cost-effective low-intensity mental health intervention that can be delivered by trained non-clinical workers for people who are experiencing common mental health conditions, such as anxiety or depression, or stressful life problems. PM+ fills a gap in the behavioral health services system by providing early intervention and potential prevention of more acute behavioral health service needs. As a model that relies on building the capacity and diversity of the behavioral health workforce, it holds promise for enhancing access to community-based mental health supports. This issue brief is designed to define and describe the PM+ intervention and its origins and identify preliminary considerations for implementing it in the United States

Tracking of vitamin D status from childhood to early adulthood and its association with peak bone mass

Background: To our knowledge, there are few longitudinal studies of vitamin D status from childhood to early adulthood, and it is uncertain whether vitamin D predicts peak bone mass in young adults. Objectives: The purpose of this longitudinal study was to evaluate the long-term stability of vitamin D status from ages 6 to 20 y in healthy individuals and to study associations between serum 25-hydroxyvitamin D [25(OH)D] at different developmental stages and bone mass measured at age 20 y. Design: Participants were offspring of the Western Australian Pregnancy Cohort (Raine) study. Serum 25(OH)D was assessed at ages 6, 14, 17, and 20 y, and whole-body bone mineral content (BMC) and bone mineral density (BMD) were measured at age 20 y through the use of dual-energy X-ray absorptiometry (DXA). Our analysis included 821 participants (385 females) who had ≥3 serum 25(OH)D measures and DXA data. We used latent class growth analysis and identified 4 vitamin D status trajectories: consistently lower (n = 259), decreasing (n = 125), increasing (n = 138), and consistently higher (n = 299). Results: There were significant correlations between serum 25(OH)D concentrations at different time points in both sexes (r = 0.346–0.560, P \u3c 0.001), with stronger correlations at adjacent time points. In males, but not in females, serum 25(OH)D at ages 6, 17, and 20 y was positively associated with total-body BMC and BMD at age 20 y [covariate-adjusted increments of 40.7–53.9 g and 14.7–18.6 mg/cm2, respectively, per 25 nmol/L 25(OH)D]; when 25(OH)D at all 4 ages was included in the same model, the concentration at age 6 y remained significant. Males in the “consistently higher” trajectory had 3.2–3.4% higher total body BMC and BMD than those who were in the “consistently lower” trajectory, accounting for age and anthropometric and lifestyle factors. Conclusions: Within both sexes, there are moderate associations between vitamin D status measured in prepuberty, adolescence, and early adulthood. Vitamin D status in childhood is a significant predictor of peak bone mass in male but not female subjects

Serum 25-hydroxyvitamin D concentrations and cardiometabolic risk factors in adolescents and young adults

Evidence associating serum 25-hydroxyvitamin D (25(OH)D) concentrations and cardiometabolic risk factors is inconsistent and studies have largely been conducted in adult populations. We examined the prospective associations between serum 25(OH)D concentrations and cardiometabolic risk factors from adolescence to young adulthood in the West Australian Pregnancy Cohort (Raine) Study. Serum 25(OH)D concentrations, BMI, homoeostasis model assessment for insulin resistance (HOMA-IR), TAG, HDL-cholesterol and systolic blood pressure (SBP) were measured at the 17-year (n 1015) and 20-year (n 1117) follow-ups. Hierarchical linear mixed models with maximum likelihood estimation were used to investigate associations between serum 25(OH)D concentrations and cardiometabolic risk factors, accounting for potential confounders. In males and females, respectively, mean serum 25(OH)D concentrations were 73·6 (sd 28·2) and 75·4 (sd 25·9) nmol/l at 17 years and 70·0 (sd 24·2) and 74·3 (sd 26·2) nmol/l at 20 years. Deseasonalised serum 25(OH)D3 concentrations were inversely associated with BMI (coefficient -0·01; 95 % CI -0·03, -0·003; P=0·014). No change over time was detected in the association for males; for females, the inverse association was stronger at 20 years compared with 17 years. Serum 25(OH)D concentrations were inversely associated with log-HOMA-IR (coefficient -0·002; 95 % CI -0·003, -0·001; P<0·001) and positively associated with log-TAG in females (coefficient 0·002; 95 % CI 0·0008, 0·004; P=0·003). These associations did not vary over time. There were no significant associations between serum 25(OH)D concentrations and HDL-cholesterol or SBP. Clinical trials in those with insufficient vitamin D status may be warranted to determine any beneficial effect of vitamin D supplementation on insulin resistance, while monitoring for any deleterious effect on TAG

Serum 25-hydroxyvitamin D concentrations and cardiometabolic risk factors in adolescents and young adults

Evidence associating serum 25-hydroxyvitamin D (25(OH)D) concentrations and cardiometabolic risk factors is inconsistent and studies have largely been conducted in adult populations. We examined the prospective associations between serum 25(OH)D concentrations and cardiometabolic risk factors from adolescence to young adulthood in the West Australian Pregnancy Cohort (Raine) Study. Serum 25(OH)D concentrations, BMI, homoeostasis model assessment for insulin resistance (HOMA-IR), TAG, HDL-cholesterol and systolic blood pressure (SBP) were measured at the 17-year (n 1015) and 20-year (n 1117) follow-ups. Hierarchical linear mixed models with maximum likelihood estimation were used to investigate associations between serum 25(OH)D concentrations and cardiometabolic risk factors, accounting for potential confounders. In males and females, respectively, mean serum 25(OH)D concentrations were 73·6 (sd 28·2) and 75·4 (sd 25·9) nmol/l at 17 years and 70·0 (sd 24·2) and 74·3 (sd 26·2) nmol/l at 20 years. Deseasonalised serum 25(OH)D3 concentrations were inversely associated with BMI (coefficient -0·01; 95 % CI -0·03, -0·003; P=0·014). No change over time was detected in the association for males; for females, the inverse association was stronger at 20 years compared with 17 years. Serum 25(OH)D concentrations were inversely associated with log-HOMA-IR (coefficient -0·002; 95 % CI -0·003, -0·001; P<0·001) and positively associated with log-TAG in females (coefficient 0·002; 95 % CI 0·0008, 0·004; P=0·003). These associations did not vary over time. There were no significant associations between serum 25(OH)D concentrations and HDL-cholesterol or SBP. Clinical trials in those with insufficient vitamin D status may be warranted to determine any beneficial effect of vitamin D supplementation on insulin resistance, while monitoring for any deleterious effect on TAG

Associations between endogenous sex hormone levels and mammographic and bone densities in premenopausal women

PURPOSE: Mammographic breast and bone mineral densities (BMD) have been associated with luteal phase hormone concentrations in premenopausal women. We assessed the associations of breast and bone densities with follicular phase hormones and sex hormone binding globulin (SHBG) in premenopausal women given that follicular phase hormones have been shown to be positively associated with premenopausal breast cancer risk. METHODS: One hundred and ninety two 40-45 year old women provided a spot urine and/or blood sample during the follicular phase. Hormone and SHBG concentrations and bone density were measured and routine mammograms were accessed and digitized to obtain breast density measures. Regression models were fit to assess the associations between hormones and SHBG and breast and bone densities. RESULTS: Positive associations were observed between percent breast density and SHBG (p trend = 0.02), as well as estradiol (p trend = 0.08), after controlling for body mass index (BMI), number of pregnancies, and breast feeding history. In addition, a statistically significant inverse association was observed between total testosterone and head BMD (p trend = 0.01), after controlling for BMI. CONCLUSIONS: Associations were observed between breast and bone densities and serum hormone concentrations during the follicular phase of the menstrual cycle