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There is substantial variation in patient symptoms following psychological therapy for depression and anxiety. However, reliance on endpoint outcomes ignores additional interindividual variation during therapy. Knowing a patient's likely symptom trajectories could guide clinical decisions. We aimed to identify latent classes of patients with similar symptom trajectories over the course of psychological therapy and explore associations between baseline variables and trajectory class.
Patients received high-intensity psychological treatment for common mental health problems at National Health Service Improving Access to Psychological Therapies services in South London (N = 16 258). To identify trajectories, we performed growth mixture modelling of depression and anxiety symptoms over 11 sessions. We then ran multinomial regressions to identify baseline variables associated with trajectory class membership.
Trajectories of depression and anxiety symptoms were highly similar and best modelled by four classes. Three classes started with moderate-severe symptoms and showed (1) no change, (2) gradual improvement, and (3) fast improvement. A final class (4) showed initially mild symptoms and minimal improvement. Within the moderate-severe baseline symptom classes, patients in the two showing improvement as opposed to no change tended not to be prescribed psychotropic medication or report a disability and were in employment. Patients showing fast improvement additionally reported lower baseline functional impairment on average.
Multiple trajectory classes of depression and anxiety symptoms were associated with baseline characteristics. Identifying the most likely trajectory for a patient at the start of treatment could inform decisions about the suitability and continuation of therapy, ultimately improving patient outcomes.
Anxiety and depressive disorders can be chronic and disabling. Although there are effective treatments, only a fraction of those impaired receive treatment. Predictors of treatment-seeking and treatment receipt could be informative for initiatives aiming to tackle the burden of untreated anxiety and depression.
To investigate sociodemographic characteristics associated with treatment-seeking and treatment receipt.
Two binary retrospective reports of lifetime treatment-seeking (n = 44 810) and treatment receipt (n = 37 346) were regressed on sociodemographic factors (age, gender, UK ethnic minority background, educational attainment, household income, neighbourhood deprivation and social isolation) and alternative coping strategies (self-medication with alcohol/drugs and self-help) in UK Biobank participants with lifetime generalised anxiety or major depressive disorder. Analyses were also stratified by gender.
Treatment access was more likely in those who reported use of self-help strategies, with university-level education and those from less economically advantaged circumstances (household income <£30 000 and greater neighbourhood deprivation). Treatment access was less likely in those who were male, from a UK ethnic minority background and with high household incomes (>£100 000). Men who self-medicated and/or had a vocational qualification were also less likely to seek treatment.
This work on retrospective reports of treatment-seeking and treatment receipt at any time of life replicates known associations with treatment-seeking and treatment receipt during time of treatment need. More work is required to understand whether improving rates of treatment-seeking improves prognostic outcomes for individuals with anxiety or depression.
Flexible learning programs (FLPs) provide a place for students who have disengaged and disconnected from mainstream schools. Despite the legislative framework in Australia supporting the participation of students with disability in their local mainstream schools wherever possible, very little research focusing on whether students with disability are being excluded from, or dropping out of, mainstream schools into these FLPs has been conducted. In this paper, we report on the findings of an online cross-sectional survey of FLP leaders about their student populations, with a focus on the 10 most prevalent disabilities among Australian children. Data from the 22 participants who completed all items of the survey were analysed. The participants’ (n = 22) schools represented a total enrolment of 2,383 students in FLPs across Australia: Tasmania (n = 3), Victoria (n = 5), New South Wales (n = 5), Queensland (n = 4), Western Australia (n = 3), and South Australia (n = 2). We found that while there was an apparent overrepresentation of students with certain types of disabilities in FLPs, others were not overrepresented at all. The findings of this preliminary study are discussed, with an exploration of issues relating to why students with some disabilities may be more likely to disengage, or be excluded, from mainstream schooling while others are not, as well as recommendations for future research.
The unique traits and behaviours of students with autism spectrum disorder (ASD) often present a range of barriers to their educational experiences and development. The present study investigated collaborative partnerships between 3 stakeholders that often support students with ASD: teachers, parents, and allied health professionals (AHPs). With current literature on collaboration between teachers, parents, and AHPs involved in the education of students with ASD predominantly relating to specific skill or knowledge acquisition, there was an insufficient understanding of ‘collaborative processes’ and the factors that benefit or limit effective practice. In the present study, the researchers explored the experiences, processes, and opinions of parents, teachers, and AHPs supporting students with ASD in mainstream Australian primary schools. A total of 129 responses were recorded (41 teachers, 44 parents, and 44 AHPs) through an online survey, and thematic data analysis was used to qualitatively interpret the open-ended questions. The findings highlight the current opportunities and challenges faced by key stakeholders in this important process.
Individuals with the pervasive developmental disorder Asperger's syndrome (AS) are generally of average or above average intelligence and attend mainstream schools. Despite their intelligence, some of the characteristics and challenges associated with AS can impact upon the quality of life they experience at school. Although both males and females are diagnosed with AS, females have been underrepresented and unrepresented in much of the AS research. Consequently, much of what is known about the school experiences of students with AS is based on studies consisting predominately of male perspectives. This article discusses what adult females with AS and parents of females with AS currently attending school wish teachers understood about AS in females. Many of the experiences described by participants indicate there is a lack of understanding about AS, both generally and specifically, in relation to females. Implications of these findings and recommendations for educators and schools are provided, and directions for future research are outlined.
This article reports on a study into university preservice teachers’ perceptions of online video-recorded interviews as an alternative to the traditional lecture format in a course on inclusive education. With the aim of assisting preservice teachers to link theory and practice, the series of video-recorded interviews focused on key concepts around educating students with diverse needs and abilities. The interviews were conducted between the course coordinator and a number of professionals with relevant field experience in special education and inclusion, and were then made available to preservice teachers online. Survey data indicated that this type of delivery model was perceived as effective in promoting engagement and learning, and in facilitating an understanding of the connection between theory and practice. Implications for teacher education are discussed.
In healthy older subjects, the glycaemic response to carbohydrate-containing meals is dependent on gastric emptying and intestinal absorption; when the latter is slowed, the magnitude of the rise in glucose is attenuated. The oligosaccharide α-cyclodextrin has been reported to diminish the glycaemic response to starch in young adults; this effect has been attributed to the inhibition of pancreatic amylase. We examined the effects of α-cyclodextrin on gastric emptying of, and the glycaemic and insulinaemic responses to, oral sucrose in healthy older subjects; as sucrose is hydrolysed by intestinal disaccharides, any effect(s) of α-cyclodextrin would not be attributable to amylase inhibition. A total of ten subjects (seven males and three females, age 68–76 years) were studied on 2 d. Gastric emptying, blood glucose and serum insulin were measured after ingestion of a 300 ml drink containing 100 g sucrose, labelled with 99mTc-sulphur colloid, with or without 10 g α-cyclodextrin. Gastric emptying was slowed slightly by α-cyclodextrin; this effect was evident between 135 and 195 min and was associated with a slight increase (P < 0·05) in distal stomach retention. After α-cyclodextrin, blood glucose was slightly less (P < 0·05) at 60 min, and serum insulin was less (P < 0·0005) at 90 and 120 min. There was no difference in the incremental areas under the curve (iAUC) for blood glucose, but there was a trend for the iAUC for serum insulin to be lower (P = 0·09) after α-cyclodextrin. We conclude that in a dose of 10 g, α-cyclodextrin has modest effects to slow gastric emptying of, and modify the glycaemic and insulinaemic responses to, oral sucrose, probably due to delayed intestinal carbohydrate absorption.
Postprandial hypotension is an important disorder for which current management is suboptimal. In healthy older subjects, oral and small-intestinal glucose administration decreases blood pressure (BP), and the magnitude of the reduction is dependent on the rate of glucose entry into the small intestine and, possibly, the release of glucagon-like peptide-1 (GLP-1). There is little information about the effects of other carbohydrates, particularly those poorly absorbed, on BP. The aim of the present study was to compare the effects of drinks containing xylose, glucose or water alone on BP, gastric emptying (GE), incretin hormone secretion, glycaemia and insulinaemia in healthy older subjects. A total of eight healthy older subjects (aged 65–75 years) had simultaneous measurements of BP (DINAMAP), GE (three-dimensional ultrasound), blood glucose, serum insulin, GLP-1 and glucose-dependent insulinotropic peptide (GIP), on three separate occasions, in a double-blind, randomised order. On each day, subjects consumed a 300 ml drink of water, glucose (50 g) or d-xylose (50 g). Glucose (P = 0·02), but not xylose (P = 0·63), was associated with a fall in BP. There was no difference in the GE of glucose and xylose (P = 0·47); both emptied slower than water (P < 0·001). Xylose had minimal effects on blood glucose, serum insulin or serum GIP, but was more potent than glucose in stimulating GLP-1 (P = 0·002). In conclusion, in healthy older subjects, xylose empties from the stomach at the same rate as glucose, but has no effect on BP, possibly because it is a potent stimulus for GLP-1 release. Xylose may be considered as an alternative sweetener to glucose in the management of postprandial hypotension.
It has been reported that the artificial sweetener, sucralose, stimulates glucose absorption in rodents by enhancing apical availability of the transporter GLUT2. We evaluated whether exposure of the proximal small intestine to sucralose affects glucose absorption and/or the glycaemic response to an intraduodenal (ID) glucose infusion in healthy human subjects. Ten healthy subjects were studied on two separate occasions in a single-blind, randomised order. Each subject received an ID infusion of sucralose (4 mm in 0·9 % saline) or control (0·9 % saline) at 4 ml/min for 150 min (T = − 30 to 120 min). After 30 min (T = 0), glucose (25 %) and its non-metabolised analogue, 3-O-methylglucose (3-OMG; 2·5 %), were co-infused intraduodenally (T = 0–120 min; 4·2 kJ/min (1 kcal/min)). Blood was sampled at frequent intervals. Blood glucose, plasma glucagon-like peptide-1 (GLP-1) and serum 3-OMG concentrations increased during ID glucose/3-OMG infusion (P < 0·005 for each). However, there were no differences in blood glucose, plasma GLP-1 or serum 3-OMG concentrations between sucralose and control infusions. In conclusion, sucralose does not appear to modify the rate of glucose absorption or the glycaemic or incretin response to ID glucose infusion when given acutely in healthy human subjects.
The rate of alcohol absorption is dependent on gastric emptying (GE). As the slowing of GE by fat is dependent on lipolysis, orlistat may increase the rise in blood alcohol when alcohol is consumed with, or after, fat. The aim of the study was to evaluate the effects of orlistat on GE and blood alcohol after an alcohol-containing drink following a fat ‘preload’, in healthy subjects. Ten healthy males consumed 120 ml cream with or without 120 mg orlistat, 30 min before an alcohol-containing drink labelled with 20 MBq [99 mTc]sulfur colloid on 2 d. GE, plasma alcohol and blood glucose were measured. GE was slightly faster with orlistat (P<0·05) compared with control. Plasma alcohol at 15 min was slightly higher with orlistat (0·034 (sem 0·006) g/100 ml) v. control (0·029 (sem 0·005) g/100 ml) (P<0·05), but there was no effect on the area under the curve 0–240 min. The increase in blood glucose was greater with orlistat, for example, at 15 min (1·07 (sem 0·2) mmol/l) v. control (0·75 (sem 0·2) mmol/l) (P=0·05). The rise in blood glucose and plasma alcohol were related (for example, at 15 min r 0·49; P=0·03). In conclusion, lipase inhibition accelerates GE of an alcohol-containing drink following a fat ‘preload’ with a minor increase in the initial rise in plasma alcohol.
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