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The reported lifetime prevalence of depression in adolescents has increased drastically in recent decades. Depression in this population can be particularly damaging and can frequently have a long-lasting adverse impact. The common treatment approach includes psychological therapy and/or anti-depressant medication. However, the efficacy of these approaches, both singularly and combined, is far from conclusive. Recently, there have been an increased number of studies investigating the effect of exercise and physical activity on adolescent depression, however, despite this increased attention, there are no recent reviews and meta-analyses synthesising such studies.
The review examines the treatment effect of exercise on depression symptoms for adolescents aged 13–17 years of age.
A systematic search of seven electronic databases identified relevant randomised controlled trials. Screening, data extraction and trial methodological quality were undertaken by two independent researchers. Standardized mean differences were used for pooling post-intervention depressive symptom scores.
Eleven trials met the inclusion criteria, eight of which provided the necessary data for calculation of standardized effect size. Exercise showed a statistically significant moderate overall effect on depressive symptom reduction. Sensitivity analyses were also conducted and will be presented.
Exercise and physical activity appear to improve depression symptoms in adolescents, especially in clinical samples, suggesting that exercise may be a useful treatment strategy for adolescents with depression.
Despite the positive findings, large clinical trials that adequately minimise bias are required for firmer conclusions on the effectiveness of exercise as an antidepressant treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Epilepsy is a common neurological condition that shows a marked genetic predisposition. The advent of next-generation sequencing (NGS) has transformed clinical genetic testing by allowing the rapid screen for causative variants in multiple genes. There are currently no NGS-based multigene panel diagnostic tests available for epilepsy as a licensed clinical diagnostic test in Ontario, Canada. Eligible patient samples are sent out of country for testing by commercial laboratories, which incurs significant cost to the public healthcare system.
An expert Working Group of medical geneticists, pediatric neurologists/epileptologists, biochemical geneticists, and clinical molecular geneticists from Ontario was formed by the Laboratories and Genetics Branch of the Ontario Ministry of Health and Long-Term Care to develop a programmatic approach to implementing epilepsy panel testing as a provincial service.
The Working Group made several recommendations for testing to support the clinical delivery of care in Ontario. First, an extension of community healthcare outcomes-based program should be incorporated to inform and educate ordering providers when requesting and interpreting a genetic panel test. Second, any gene panel testing must be “evidence-based” and takes into account varied clinical indications to reduce the chance of uncertain and secondary results. Finally, an ongoing evaluative process was recommended to ensure continued test improvement for the future.
This epilepsy panel testing implementation plan will be a model for genetic care directed toward a specific set of conditions in the province and serve as a prototype for genetic testing for other genetically heterogeneous diseases.
In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
Multiple genes/variants have been implicated in various epileptic conditions. However, there is little general guidance available on the circumstances in which genetic testing is indicated and test selection in order to guide optimal test appropriateness and benefit. This is an account of the development of guidelines for genetic testing in epilepsy, which have been developed in Ontario, Canada. The Genetic Testing Advisory Committee was established in Ontario to review the clinical utility and validity of genetic tests and the provision of genetic testing in Ontario. As part of their mandate, the committee also developed recommendations and guidelines for genetic testing in epilepsy. The recommendations include mandatory prerequisites for an epileptology/geneticist/clinical biochemical geneticist consultation, prerequisite diagnostic procedures, circumstances in which genetic testing is indicated and not indicated and guidance for selection of genetic tests, including their general limitations and considerations. These guidelines represent a step toward the development of evidence-based gene panels for epilepsy in Ontario, the repatriation of genetic testing for epilepsy into Ontario molecular genetic laboratories and public funding of genetic tests for epilepsy in Ontario.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
To achieve their conservation goals individuals, communities and organizations need to acquire a diversity of skills, knowledge and information (i.e. capacity). Despite current efforts to build and maintain appropriate levels of conservation capacity, it has been recognized that there will need to be a significant scaling-up of these activities in sub-Saharan Africa. This is because of the rapid increase in the number and extent of environmental problems in the region. We present a range of socio-economic contexts relevant to four key areas of African conservation capacity building: protected area management, community engagement, effective leadership, and professional e-learning. Under these core themes, 39 specific recommendations are presented. These were derived from multi-stakeholder workshop discussions at an international conference held in Nairobi, Kenya, in 2015. At the meeting 185 delegates (practitioners, scientists, community groups and government agencies) represented 105 organizations from 24 African nations and eight non-African nations. The 39 recommendations constituted six broad types of suggested action: (1) the development of new methods, (2) the provision of capacity building resources (e.g. information or data), (3) the communication of ideas or examples of successful initiatives, (4) the implementation of new research or gap analyses, (5) the establishment of new structures within and between organizations, and (6) the development of new partnerships. A number of cross-cutting issues also emerged from the discussions: the need for a greater sense of urgency in developing capacity building activities; the need to develop novel capacity building methodologies; and the need to move away from one-size-fits-all approaches.
The Parkes 64 m telescope has been used to survey a complete sample of nearby red giants (i.e. not members of close binaries or showing strong emission lines of CaII). The sample consisted of all 82 stars in the Bright Star Catalogue within 30 pc having spectral types G, K, M and luminosity classes I, II, III south of the celestial equator.
The role of fludeoxyglucose F 18 positron emission tomography (PET) in the presurgical evaluation of patients with medically intractable epilepsy continues to be refined. The purpose of this study was to systematically review the literature to assess the diagnostic accuracy and utility of PET in this setting. Thirty-nine studies were identified through MEDLINE and EMBASE databases that met the inclusion criteria. In adult patients, PET hypometabolism showed a 56 to 90% agreement with seizure onset localized by intracranial electroencephalogram (pediatric: 21 to 86%). In temporal lobe epilepsy patients with good surgical outcome, PET displayed moderate to high sensitivity in localizing the seizure focus (range: 71 to 89%). The sensitivity increased by 8 to 23% when PET results were combined with magnetic resonance imaging or electroencephalogram. PET has been shown to affect patient management by improving the guidance of intracranial electrodes placement, altering the decision to perform surgery, or excluding patients from further evaluation.
This paper presents the results of a multiwavelength observational study of the active young F-type star HR 1817. The star was monitored at 4.80 and 8.64 GHz over 2 × 12 h allocations with the Australia Telescope Compact Array on 8 and 9 December, 2000. The Anglo-Australian Telescope was used for simultaneous optical spectropolarimetry during a 2 h period on 9 December.
The low levels of observed radio emission have characteristics that are similar to those seen in other active stars, and a gyrosynchrotron mechanism is proposed to explain them; this is supported by the relatively low fractions of circular polarisation measured in HR 1817.
Comparison of the emissions from 4.80 and 8.64 GHz shows a very strong cross-correlation peak, indicative of a common origin, although the shift of this peak indicates that 8.64 GHz variations tend to precede those at 4.80 GHz by, typically, ˜20 min.
The optical spectropolarimetry reveals polarisation signals characteristic of surface magnetic fields, with profile changes indicating a complex dynamo-type magnetic topology is present on the star. This result makes HR 1817 the star with the earliest spectral type on which dynamo magnetic fields have been detected directly up to now.
Radio and optical observations from December 2001 and January 2002 of the active RS CVn-like binary CC Eri are presented. The star was monitored at 4.80 and 8.64 GHz over 3 × 12 h allocations with the Australia Telescope Compact Array on 28 to 30 December 2001. The Anglo-Australian Telescope was used for simultaneous optical spectropolarimetry during a 0.5 h period on 30 December. Data from four nights of broadband photometry gathered around the same period are also included in this present multiwavelength study.
The low levels of radio emission were circularly polarised at ∼20% with slightly positive spectral indices of ∼0.26. Two flare-like increases were observed on successive nights with steep positive spectral indices and no detectable polarisation. Cross-correlation analysis of the 4.80 and 8.64 GHz intensities over the stronger flare showed that the higher frequency emission preceded that at the lower frequency by ∼5 min, a result consistent with the propagation of a hydromagnetic disturbance outwards through the corona. On the same night, a significant cross-correlation in the ‘quiescent’ emission indicates the presence of micro-flaring, although its low intensity does not permit the evaluation of a time delay. The emission parameters on the three nights are compatible with a gyrosyncrotron mechanism, in which the radio source becomes optically thick during strong flaring. We develop a simple model, which is based on assuming that the number of radiating electrons is a given function of the magnetic field in the source region, and derive feasible values for the field, source radius, and number of emitting electrons, which are not strongly dependent on the field modelling function or the aspect ratio of the source. Spectropolarimetry demonstrates the presence of a strong surface magnetic field. Optical photometry, covering a sufficient amount of the orbit, indicates a maculation region of significant size (∼14° radius).
The results help develop a three-dimensional picture of a large stellar magnetically active region and encourage more detailed follow-up multiwavelength studies of this and similar stars.
A 10 min education programme was developed which, if effective in changing the behaviour of pregnant women, would eliminate or greatly reduce the risk of congenital toxoplasmosis. It was taught in 26 randomly selected (case) prenatal classes offered to women early in their pregnancy. The remaining 26 (control) classes received routine class material which did not mention toxoplasmosis. A questionnaire was administered to all women prior to this early class (pre-test) and again after the last prenatal class, held just prior to delivery (post-test). Changes in pet, food and personal hygiene behaviour between the pre- and post-test were determined and a score calculated by adding points for change towards those behaviours recommended in the programme and subtracting points for change in the opposite direction. Cat owners in case classes had a significantly higher score in pet hygiene behaviour than those in control classes (P < 0·05). No significant difference was found between the food or personal hygiene scores of women in case and control classes, possibly because of low power. However, although behaviours did not differ on the pre-test, women in case classes had significantly better cooking methods for roast beef and hamburger on the post-test (P < 0·05 and P < 0·01 respectively). It is concluded that this programme is effective and should be offered to all women in order to reduce congenital toxoplasmosis incidence.
Extensive grazing experiments were conducted over four summer breeding seasons in north-west Queensland between 1984 and 1989. Ewes in the last third of pregnancy were grazed on Mitchell grass (Astrebla spp.) pastures of varying forb (herbaceous plant other than a grass) content. Pastures of low forb content (F-) were attained by stocking paddocks heavily with wethers prior to the experiment, or by selecting paddocks which already contained pastures of low forb content. Pastures of high forb content (F+) were kept without animals prior to the experimental period. Pastures comprised a range of forb biomass (29–828 kg DM/ha) and percentage forbs in total biomass (3–49%). Lamb marking percentage was found to be dependent on the biomass of forbs and proportion of forbs in the pasture, in two experiments. Ewes which grazed F+ pastures had lower lamb marking percentages than those grazing F- pastures.
Twenty pasture species collected during the experiments were analysed for the ratio of 13C: 12C and photosynthetic pathway was determined. Five forb and all three grass species had C4-dicarboxylic acid pathways, ten forbs had Calvin-C3 pathways and two forbs had crassulacean acid metabolism pathways.
Estimates of the proportion of C3 and C4 species in the diet were determined by analysing the ratio of 13C:12C in faeces. The apparent high proportion of Calvin-C3 pathway forbs in the diet of ewes compared to the proportion in the total pasture biomass indicated that ewes preferentially select C3 forbs in the diet, although there was no dependence of lambing percentage on the estimated proportion of C3 forbs in the diet. Management strategies that may improve lambing percentage in the Mitchell grass areas of north-west Queensland are discussed.
Anencephaly and spina bifida cystica, malformations of the central nervous system, are due to failure of closure of the neural tube. These malformations are a major cause of stillbirth, infant death and (in the case of spina bifida) of childhood morbidity in Britain today.
Their aetiology is not known in detail. There are, however, indications from family studies and from the striking racial variation in their incidence (which is in part at least maintained after migration) that genetic factors are important in their causation. There is also evidence from maternal age and birth order effects, secular and seasonal variation, and social class effects that environmental factors also are important in their aetiology.