Emotion processing in preschoolers with autism spectrum disorders

Children spend most of their days interacting with their social environment. Emotions form a large part of these interactions and vice versa social emotions become meaningful when interacting with others. Understanding the emotion processes that underlie successful social functioning is important, especially in children that experience difficulties in social-emotional functioning such as children with Autism Spectrum Disorders (ASD). These studies used a unique approach towards understanding the complex mechanisms that are involved in emotion processing, incorporating how emotions are perceived, experienced, regulated, and expressed. Sensitive and direct measures of emotion processing such as eyetracking and physiology revealed for the first time on a neurobiological level that children with ASD have difficulties emotionally resonating with others, use less efficient strategies to regulate their emotions, and provided evidence for a possible discordance between the expression and experience of emotions. The preschool years also presented with a possible window of opportunity; children with ASD do feel emotions when it comes to their own experiences and the development of social attention towards others might be prone to improvements during the preschool years. These findings are important to parents and professional and enhance the understanding of emotion processing during these very early years of life. Development Psychopathology in context: clinical setting

Klimaatdijk een verkenning

IntroductionClimate change, land subsidence and the increasing economic value of property and activities in flood-prone areas justify the question of how we can maintain flood protection in the Netherlands at its current level, or even improve it. The changing social, scientific and technical developments and insights of our day mean that the time is ripe to consider alternatives for flood protection, other than the customary call to raise the dikes yet higher, time and again.The Climate DikeThe Climate Dike is a logical addition to the current practice of raising and reinforcing dikes. A Climate Dike is defined here as ¿a collective term for design components that result in flood defences so robust that they are virtually impossible to breach, and thus offer lasting protection, even in the face of ongoing climate change The Climate Dike concerns a type of dike that allows some wave overflow and even a limited amount of flooding, but which prevents the uncontrolled catastrophic dike breaks associated with devastating flooding of the hinterland. The number of potential victims and the resulting damage are therefore in no way comparable to those incurred when a traditional dike breaks. The risk, calculated as a product of the probability of occurrence and the resulting damage, is therefore drastically reduced.Another feature of the Climate Dike is its integrated multi-functional character. On it, a wider range of socio-economic interests can be built than on traditional dikes. This means that greater opportunities for financing also become available.Before the Climate Dike can be approached as a serious alternative, clarity is needed on the relevant information, experience, policy and knowledge that exists (and does not yet exist). The current inventory was conducted with that requirement in mind.The authors looked at, among others, projects that presented problems and challenges similar to those expected in development of a Climate Dike. These relate, among others, to technical,economic, social and spatial issues.A long time horizonBecause of its more multidisciplinary character, development of a Climate Dike requires a longer time horizon than a traditional dike. The current system of 5-yearly testing, in which dikes that fail to meet current safety standards are immediately subjected to an urgent upgrade trajectory, provides an inadequate framework for developing the Climate Dike.In the current system, evolving scientific insights, environmental conditions and safety requirements could mean that even immediately after a dike has been strengthened, the next reinforcement is just around the corner. Such a situation is clearly undesired for a multifunctional Climate Dike with, for example, buildings on it. Also, after its construction, a Climate Dike has to be able to guarantee safety for many more decades than a traditional dike, and to do so in a way that other interests can build on, literally and figuratively. A longer planning horizon and new means of anticipating on future developments are therefore essential.ChallengingThe Climate Dike has no set dimensions or form, though it does tend to be wider and less steep than traditional dikes and include a protection zone parallel to existing flood defences. It goes without saying that not every aspect of the Climate Dike concept, which is often broad in both functional and physical terms, will be applicable at every location.One of the many challenges arising in applying the Climate Dike concept is the question of how to effectively look ahead over an extremely long stretch of time (for example, a century), since we cannot predict with any certainty how society will look after such a long period. How can ideas and procedures be tailored to as yet unknown future developments? How can we best ensure the ability to adapt to new situations and insights?One of the complexities involved in developing a Climate Dike is the use of space. How can the required space be secured without having to demolish large numbers of buildings and infrastructure and without excluding large zones of land from any possible socio-economic activity, perhaps for many decades?Costs and benefitsA Climate Dike is costly, if one limits the field of vision to the safety aspect and the traditional time horizon of 50 years. Broaden the view to bring in multiple interests that over a longer time period can, literally and figuratively, build on the presence of the Climate Dike, then this form of flood protection becomes much more financially attractive. Certainly when considering other options for flood protection, such as compartmentalisation dikes or the raising of immense tracts of land.Law and legislationTo give designers and managers of flood defences more opportunity to develop the Climate Dike, modifications are required in current design guidelines and technical prerequisites. Also, it must be made clear whether and how a Climate Dike is to be subjected to the 5-yearly testing cycle. Is such testing needed if the dike is considered to be virtually impossible to breach? How do we deal with the probability of flooding versus the risk of a dike break? Current law and legislation are geared fairly specifically to the traditional dike. Alternative concepts such as the Climate Dike call for modified policies, laws and legislation, as well as newly formulated design requirements and prerequisites. Or it will have to be made clearer how these should be interpreted for such innovative concepts

Physiological Arousal and Emotion Regulation Strategies in Young Children with Autism Spectrum Disorders

Development Psychopathology in context: clinical setting

A simplified low volume colorimetric assay for rapid comparison of cyanogenic glycoside production between barley genotypes

Ethyl carbamate (EC), a genotoxic and carcinogenic compound, is an undesirable trace component in spirits and whisky. The precursor of EC produced from barley (Hordeum vulgare L.) malt is primarily a cyanogenic glycosidic nitrile (GN) known as epiheterodendrin (EPH). EPH production is genetically controlled in barley, low or non-GN varieties exist and EPH production can be controlled by using low or non-GN barley varieties for malt production. Here, we report on a rapid and inexpensive colorimetric assay modified from Cook and Oliver (in: European Brewery Convention (eds) Proceedings of the 23rd Congress, Lisbon. European Brewery Convention, Zoeterwoude, Netherlands, 1991). The new low-volume, high-throughput, semi-quantitative test method can be used for the selection of low or non-GN breeding lines through samples of acrospires. This method is based on the detection of cyanide by the reaction with chloramine-T followed by the addition of the reagent (pyridine-barbituric acid) to form a soluble violet-blue product measured at 590 nm. Absorbance measurements and the visual color are used to estimate the presence of EPH production in acrospires. In this report, the level of EPH production was compared among some commercial European non-GN lines, Canadian malt varieties and advanced barley breeding lines

When health services are powerless to prevent suicide: results from a linkage study of suicide among men with no service contact in the year prior to death

Aims: To investigate cases of suicide in which there was no healthcare contact, by looking at history of help-seeking and evidence of previous mental health vulnerability. To identify any life events associated with suicide for which individuals did not seek help. Background: Previous research has suggested that non-consultation is the main barrier to suicide prevention among men. Estimates suggest approximately 22% of men who die by suicide have not consulted their GP in the year before their death. Little is known about the lifetime pattern of engagement with services among these individuals and whether or not this may influence their help-seeking behaviour before death. Methods: Coroner records of suicide deaths in Northern Ireland over 2 years were linked to general practice (GP) records. This identified 63 individuals who had not attended health services in the 12 months before death. Coroner’s data were used to categorise life events associated with the male deaths. Lifetime mental health help-seeking at the GP was assessed. Findings: The vast majority of individuals who did not seek help were males (n=60, 15% of all suicide deaths). Lack of consultation in the year before suicide was consistent with behaviour over the lifespan; over two-thirds had no previous consultations for mental health. In Coroner’s records, suicides with no prior consultation were primarily linked to relationship breakdown and job loss. These findings highlight the limitations of primary care in suicide prevention as most had never attended GP for mental health issues and there was a high rate of supported consultation among those who had previously sought help. Public health campaigns that promote service use among vulnerable groups at times of crisis might usefully be targeted at those likely to be experiencing financial and relationship issues

Does the attention General Practitioners pay to their patients' mental health problems add to their workload? A cross sectional national survey

BACKGROUND: The extra workload induced by patients with mental health problems may sometimes cause GPs to be reluctant to become involved in mental health care. It is known that dealing with patients' mental health problems is more time consuming in specific situations such as in consultations. But it is unclear if GPs who are more often involved in patients' mental health problems, have a higher workload than other GPs. Therefore we investigated the following: Is the attention GPs pay to their patients' mental health problems related to their subjective and objective workload? METHODS: Secondary analyses were made using data from the Second Dutch National Survey of General Practice, a cross sectional study conducted in the Netherlands in 2000–2002. A nationally representative selection of 195 GPs from 104 general practices participated in this National Survey. Data from: 1) a GP questionnaire; 2) a detailed log of the GP's time use during a week and; 3) an electronic medical registration system, including all patients' contacts during a year, were used. Multiple regression analyses were conducted with the GP's workload as an outcome measure, and the GP's attention for mental health problems as a predictor. GP, patient, and practice characteristics were included in analyses as potential confounders. RESULTS: Results show that GPs with a broader perception of their role towards mental health care do not have more working hours or patient contacts than GPs with a more limited perception of their role. Neither are they more exhausted or dissatisfied with the available time. Also the number of patient contacts in which a psychological or social diagnosis is made is not related to the GP's objective or subjective workload. CONCLUSION: The GP's attention for a patient's mental health problems is not related to their workload. The GP's extra workload when dealing in a consultation with patients' mental health problems, as is demonstrated in earlier research, is not automatically translated into a higher overall workload. This study does not confirm GPs' complaints that mental health care is one of the components of their job that consumes a lot of their time and energy. Several explanations for these results are discussed

Do list size and remuneration affect GPs' decisions about how they provide consultations?

Background: Doctors' professional behaviour is influenced by the way they are paid. When GPs are paid per item, i.e., on a fee-for-service basis (FFS), there is a clear relationship between workload and income: more work means more money. In the case of capitation based payment, workload is not directly linked to income since the fees per patient are fixed. In this study list size was considered as an indicator for workload and we investigated how list size and remuneration affect GP decisions about how they provide consultations. The main objectives of this study were to investigate a) how list size is related to consultation length, waiting time to get an appointment, and the likelihood that GPs conduct home visits and b) to what extent the relationships between list size and these three variables are affected by remuneration. Methods: List size was used because this is an important determinant of objective workload. List size was corrected for number of older patients and patients who lived in deprived areas. We focussed on three dependent variables that we expected to be related to remuneration and list size: consultation length; waiting time to get an appointment; and home visits. Data were derived from the second Dutch National Survey of General Practice (DNSGP-2), carried out between 2000 and 2002. The data were collected using electronic medical records, videotaped consultations and postal surveys. Multilevel regression analyses were performed to assess the hypothesized relationships. Results: Our results indicate that list size is negatively related to consultation length, especially among GPs with relatively large lists. A correlation between list size and waiting time to get an appointment, and a correlation between list size and the likelihood of a home visit were only found for GPs with small practices. These correlations are modified by the proportion of patients for whom GPs receive capitation fees. Waiting times to get an appointment tend to become shorter with increasing patient lists when there is a larger capitation percentage. The likelihood that GPs will conduct home visit rises with increasing patient lists when the capitation percentage is small. Conclusion: Remuneration appears to affect GPs' decisions about how they provide consultations, especially among GPs with relatively small patient lists. This role is, however, small compared to other factors such as patient characteristics.

To support and not to cure: general practitioner management of loneliness

Loneliness is associated with numerous detrimental effects on physical health, mental health, cognition and lifestyle. Older adults are one of the groups at highest risk of loneliness, and indeed about 46% of older adults in England feel lonely. Those experiencing loneliness visit their general practitioner (GP) more frequently than those who are not, which has the capacity to put a strain on GPs and primary care waiting lists and costs. This study's aim was to explore GPs' views and experiences of loneliness within their older adult patients, and to understand GPs' awareness and feelings of agency within this. Nineteen UK GPs were recruited using purposive sampling and snowballing techniques. Individual semi‐structured interviews were conducted either in person or over the telephone. Data were analysed using thematic analysis. Four overarching themes were identified from the data: Whose responsibility is it anyway?, Pandora's box of shame; Keeping distance; and Community responsibility. Themes emphasise that GPs tend to hold a medicalised and individualistic view of loneliness. This intensifies stigma which in turn creates barriers to raising the topic. GPs felt powerless in their ability to fix the ‘problem’ and tended to believe that the solution had to lie in the community, the individual or in social care rather than in primary care. The findings are discussed in the context of literature on GP management of other social problems which give rise to similar issues concerning the restrictions of the medical model and the need for joined‐up approaches in which the GP is one part of a wider social support structure. It is suggested that it might be useful for training and support for GPs to address management of social problems jointly rather than training specific to loneliness which GPs tend to see as peripheral to their core remit