Mental Health, Adolescents and Children: a Comparative Analysis of the Practice/Policy Interface

Mental health services for children and adolescents in Ireland exist in a state of ambiguity. Services operate within a context of resource constraints and increasing demand. The result is that practitioners have to prioritise the client groups according to policy dictates. In Ireland the policy priority is children at risk of physical and sexual abuse. Utilising current literature in the field, this paper discusses the potential consequences of such a focus for clients, practitioners and policy through a comparative analysis with the United Kingdom. It is argued that a lack of legislative clarity, combined with a focus on abuse has led to the neglect of older adolescents with psychological problems non-consequent of abuse. The implications of such neglect are indicated and discusse

Critical realism: a philosophical framework for the study of gender and mental health

This paper explores gender and mental health with particular reference to the emerging philosophical field of critical realism. This philosophy suggests a shared ontology and epistemology for the natural and social sciences. Until recently, most of the debate surrounding gender and mental health has been guided either implicitly or explicitly within a positivist or constructivist philosophy. With this in mind, key areas of critical realism are explored in relation to gender and mental health, and contrasted with the positions of positivism and constructivism. It is argued that critical realism offers an alternative philosophical framework for the exploration of gender issues within mental health care

Priorities, ‘street level bureaucracy’ and the community mental health team

In the United Kingdom a combination of high profile incidents and reports personally critical of mental health policy in general and individual practitioners’ actions in particular (Sheppard 1995) highlight the pressures which operate on mental health professionals in the community (Mechanic 1995a). These pressures are exacerbated by policy contradictions and resource limitations. Consequently community mental health practitioners (e.g. psychiatrists, community psychiatric nurses and social workers) can be sensitive to political and managerial agendas which may have a negative impact on their implementation of individual care programs (Marks ef al. 1994). Using the concept of ’street level bureaucracy’ (Lipsky 1980), this paper examines recent literature. It is argued that practitioners’ reception and implementation of policy is influenced by the need to balance the tension between four elements: the political and policy imperatives, the agenda of local management, the professional and peer cultures in which practitioners operate and the balance of perceived personal advantage. It is further postulated that managers and policy makers may have a vested interest in not scrutinizing practitioners’ implementation of policy too vigorously as a way of deflecting responsibility for its consequences. The ’Care Programme Approach and recent legislative changes regarding community supervision (Department of Health 1995a) highlight the important and sometimes negative consequences for the service user that may result

Salud es Vida: Development of a Cervical Cancer Education Curriculum for Promotora Outreach With Latina Farmworkers in Rural Southern Georgia

Methods: A systematic review was conducted to synthesize evidence from all prospective controlled studies on effectiveness of CHW programs in improving screening mammography rates. Studies reported in English and conducted in the United States were included if they: (i) evaluated a CHW intervention designed to increase screening mammography rates in women 40 years of age or older without a history of breast cancer; (ii) were a randomized controlled trial (RCT), case-controlled study, or quasi-experimental study; and (iii) evaluated a CHW intervention outside of a hospital setting. Results: Participation in a CHW intervention was associated with a statistically significant increase in receipt of screening mammography [risk ratio (RR): 1.06 (favoring intervention); 95% CI: 1.02-1.11, P = 0.003]. The effect remained when pooled data from only RCTs were included in meta-analysis (RR: 1.07; 95% CI: 1.03-1.12, P = 0.0005) but was not present using pooled data from only quasi-experimental studies (RR: 1.03; 95% CI: 0.89-1.18, P = 0.71). In RCTs, participants recruited from medical settings (RR: 1.41; 95% CI: 1.09-1.82, P = 0.008), programs conducted in urban settings (RR: 1.23; 95% CI: 1.09, 1.39, P = 0.001), and programs where CHWs were matched to intervention participants on race or ethnicity (RR: 1.58, 95% CI: 1.29-1.93, P = 0.0001) showed stronger effects on increasing mammography screening rates. Conclusions: CHW interventions are effective for increasing screening mammography in certain settings and populations. Impact: CHW interventions are especially associated with improvements in rate of screening mammography in medical settings, urban settings, and in participants who are racially or ethnically concordant with the CHW

A numerical study of multi-soliton configurations in a doped antiferromagnetic Mott insulator

We evaluate from first principles the self-consistent Hartree-Fock energies for multi-soliton configurations in a doped, spin-1/2, antiferromagnetic Mott insulator on a two-dimensional square lattice. We find that nearest-neighbor Coulomb repulsion stabilizes a regime of charged meron-antimeron vortex soliton pairs over a region of doping from 0.05 to 0.4 holes per site for intermediate coupling 3 < U/t <8. This stabilization is mediated through the generation of ``spin-flux'' in the mean-field antiferromagnetic (AFM) background. Holes cloaked by a meron-vortex in the spin-flux AFM background are charged bosons. Our static Hartree-Fock calculations provide an upper bound on the energy of a finite density of charged vortices. This upper bound is lower than the energy of the corresponding charged stripe configurations. A finite density of charge carrying vortices is shown to produce a large number of unoccupied electronic levels in the Mott-Hubbard charge transfer gap. These levels lead to significant band tailing and a broad mid-infrared band in the optical absorption spectrum as observed experimentally. At very low doping (below 0.05) the doping charges create extremely tightly bound meron-antimeron pairs or even isolated conventional spin-polarons, whereas for very high doping (above 0.4) the spin background itself becomes unstable to formation of a conventional Fermi liquid and the spin-flux mean-field is energetically unfavorable. Our results point to the predominance of a quantum liquid of charged, bosonic, vortex solitons at intermediate coupling and intermediate doping concentrations.Comment: 12 pages, 25 figures; added references, modified/eliminated some figure

Algae as nutritional and functional food sources: revisiting our understanding.

Global demand for macroalgal and microalgal foods is growing, and algae are increasingly being consumed for functional benefits beyond the traditional considerations of nutrition and health. There is substantial evidence for the health benefits of algal-derived food products, but there remain considerable challenges in quantifying these benefits, as well as possible adverse effects. First, there is a limited understanding of nutritional composition across algal species, geographical regions, and seasons, all of which can substantially affect their dietary value. The second issue is quantifying which fractions of algal foods are bioavailable to humans, and which factors influence how food constituents are released, ranging from food preparation through genetic differentiation in the gut microbiome. Third is understanding how algal nutritional and functional constituents interact in human metabolism. Superimposed considerations are the effects of harvesting, storage, and food processing techniques that can dramatically influence the potential nutritive value of algal-derived foods. We highlight this rapidly advancing area of algal science with a particular focus on the key research required to assess better the health benefits of an alga or algal product. There are rich opportunities for phycologists in this emerging field, requiring exciting new experimental and collaborative approaches.AGS & KEH thank the Biotechnology and Biological Sciences Research Council (BBSRC BB/1013164/1) of the UK for funding. The University of Dundee is a registered Scottish charity, No. SC015096. PP is supported by IDEALG in the frame of the stimuli program entitled “Investissements d’avenir, Biotechnologies-Bioressources” (ANR-10-BTBR-04-02). The open access fee was supported by NSF-OCE-1435021 (MLW), DIC project 1823-06 (MEC), Maine Sea Grant (NOAA) 5405971 (SHB), NSF #11A-1355457 to Maine EPSCoR at the University of Maine (SHB), and the listed funding to AGS and PP

Leptophobic U(1)'s and the R_b - R_c Crisis

In this paper, we investigate the possibility of explaining both the R_b excess and the R_c deficit reported by the LEP experiments through Z-Z' mixing effects. We have constructed a set of models consistent with a restrictive set of principles: unification of the Standard Model (SM) gauge couplings, vector- like additional matter, and couplings which are both generation-independent and leptophobic. These models are anomaly-free, perturbative up to the GUT scale, and contain realistic mass spectra. Out of this class of models, we find three explicit realizations which fit the LEP data to a far better extent than the unmodified SM or MSSM and satisfy all other phenomenological constraints which we have investigated. One realization, the \eta-model coming from E_6, is particularly attractive, arising naturally from geometrical compactifications of heterotic string theory. This conclusion depends crucially on the inclusion of a U(1) kinetic mixing term, whose value is correctly predicted by renormalization group running in the E_6 model given one discrete choice of spectra.Comment: LaTeX, 26 pages, 5 embedded EPSF figures. Version to be published in Phys. Rev.

An exploratory analysis of the impact of family functioning on treatment for depression in adolescents.

This article explores aspects of family environment and parent-child conflict that may predict or moderate response to acute treatments among depressed adolescents (N = 439) randomly assigned to fluoxetine, cognitive behavioral therapy, their combination, or placebo. Outcomes were Week 12 scores on measures of depression and global impairment. Of 20 candidate variables, one predictor emerged: Across treatments, adolescents with mothers who reported less parent-child conflict were more likely to benefit than their counterparts. When family functioning moderated outcome, adolescents who endorsed more negative environments were more likely to benefit from fluoxetine. Similarly, when moderating effects were seen on cognitive behavioral therapy conditions, they were in the direction of being less effective among teens reporting poorer family environments

Characterisation of the pathogenic effects of the in vivo expression of an ALS-linked mutation in D-amino acid oxidase: Phenotype and loss of spinal cord motor neurons

Amyotrophic lateral sclerosis (ALS) is the most common adult-onset neuromuscular disorder characterised by selective loss of motor neurons leading to fatal paralysis. Current therapeutic approaches are limited in their effectiveness. Substantial advances in understanding ALS disease mechanisms has come from the identification of pathogenic mutations in dominantly inherited familial ALS (FALS). We previously reported a coding mutation in D-amino acid oxidase (DAOR199W) associated with FALS. DAO metabolises D-serine, an essential co-agonist at the N-Methyl-D-aspartic acid glutamate receptor subtype (NMDAR). Using primary motor neuron cultures or motor neuron cell lines we demonstrated that expression of DAOR199W, promoted the formation of ubiquitinated protein aggregates, activated autophagy and increased apoptosis. The aim of this study was to characterise the effects of DAOR199W in vivo, using transgenic mice overexpressing DAOR199W. Marked abnormal motor features, e.g. kyphosis, were evident in mice expressing DAOR199W, which were associated with a significant loss (19%) of lumbar spinal cord motor neurons, analysed at 14 months. When separated by gender, this effect was greater in females (26%; p< 0.0132). In addition, we crossed the DAOR199W transgenic mouse line with the SOD1G93A mouse model of ALS to determine whether the effects of SOD1G93A were potentiated in the double transgenic line (DAOR199W/SOD1G93A). Although overall survival was not affected, onset of neurological signs was significantly earlier in female double transgenic animals than their female SOD1G93A littermates (125 days vs 131 days, P = 0.0239). In summary, some significant in vivo effects of DAOR199W on motor neuron function (i.e. kyphosis and loss of motor neurons) were detected which were most marked in females and could contribute to the earlier onset of neurological signs in double transgenic females compared to SOD1G93A littermates, highlighting the importance of recognizing gender effects present in animal models of ALS