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In Italy, the only prevalence study carried out with rigorous methodology in a sample of children and adolescents found that about 8% met criteria for any mental disorders. However, there is no systematic information available about the sociodemographic, clinical and treatment-related characteristics of young patients in contact with Child and Adolescent Mental Health Services (CAMHS).
To assess the characteristics of children and adolescents in contact with CAMHS and to analyse the pathways through which they referred to services.
All public outpatient CAMHS operating in a Region of 633,725 inhabitants aged 6–17 years participated to the study. A total of 710 consecutive patients were enrolled and were evaluated with a detailed Sociodemografic Form, and standardized assessment instruments, including the CBCL, the HoNOSCA, the C-GAS, the CGI.
The mean age of the users was 10(± 3) years, about 60% was male, and they were comparable to general population in terms of nationality, living situation and socioeconomic status. A large proportion (76%) of patients were diagnosed within the broad groups of emotional and specific developmental disorders. Most parents had been referred by general practitioners (48,2%), and/or by school teacher (31,9%); About 60% had never received any treatment before the first contact with CAMHS.
Overall, patients do not come from families with disadvantaged social and economic backgrounds; adolescent with behavioural disorders seems to require more intensive levels of care. the recognition of the patient's problems by parents and general practitioners play a central role in the referral pathway to CAMHS.
Although service data are crucial for estimating the resources required by Child and Adolescent Mental Health Services (CAMHS) and to improve their quality, no studies have yet been conducted in Italy to this aim, and even in other countries health services research in this area has been extremely limited in scope and magnitude.
To collect data on the physical characteristics, staffing arrangements, and activities of CAMHS in Emilia-Romagna, a densely populated Italian region with 633,725 inhabitants aged 0–17 years.
Unit Chiefs of all the CAMHS filled in a structured ‘Facility Form’, with activity data referring to 2008 (for inpatient facilities we referred to 2009).
Eleven CAMHS were operative, including 110 outpatient units, with a ratio of approximately 20 child psychiatrists and 23 psychologists per 100,000 inhabitants aged 0–17 years. All outpatient units were well equipped and all granted free service access. in 2008, approximately 6% of the target population was in contact with CAMHS; first-ever contacts accounted for 30% of annual visits. Hospital bed availability was 5 per 100,000 inhabitants aged 0–17 years.
The overall number of child psychiatrists per 100,000 inhabitants is one of the highest in Europe and is comparable with the most well equipped areas in the US. This comparison should be interpreted with caution, however, because in Italy, child psychiatrists also treat neurological disorders. Critical areas requiring improvement are: the uneven utilisation of standardised assessment procedures and the limited availability of dedicated emergency services during non-office hours.
Studies in the general population report that unusual subjective experiences are relatively common. Such experiences have been conceptualized either as extreme personality traits or as vulnerability markers for psychosis, and often grouped under the expression “schizotypal experiences”. This study investigates the heterogeneity of schizotypal traits using factor and latent class analysis.
One thousand and thirty-two adolescents were recruited for this study. Schizotypal experiences were assessed with the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE); psychological distress was assessed with the General Health Questionnaire (GHQ). Confirmatory Factorial Analysis (CFA) and Latent Class Analysis (LCA) were performed on the O-LIFE and on the association with the GHQ and demographic variables.
CFA replicated the original 4-factor structure of the O-LIFE. Three latent classes (LC) of schizotypal features were identified: participants in LC1 (26% of the total sample) showed minimal level of item endorsement; LC2 accounted for 52% of the sample and showed overall higher item endorsement compared to LC1, especially for disorganization and positive signs of schizotypy, but not for negative affective items. LC3 (22%) showed an overall higher level of item endorsement across schizotypal dimensions, and positive association with psychological distress and family history of psychosis.
Different latent class of schizotypal features can be empirically defined in adolescent community samples. The most extreme class is defined not only by a profile of higher positive replies to the items, but also by anhedonia, high psychological distress, and family history of psychosis. These findings can inform prevention research in schizophrenia.
The moral status of the human embryo is particularly controversial in the United States, where one debate has centered on embryos created in excess at in vitro fertilization (IVF) clinics. Little has been known about the disposal of these embryos.
We mailed anonymous, self-administered questionnaires to directors of 341 American IVF clinics.
217 of 341 clinics (64 percent) responded. Nearly all (97 percent) were willing to create and cryopreserve extra embryos. Fewer, but still a majority (59 percent), were explicitly willing to avoid creating extras. When embryos did remain in excess, clinics offered various options: continual cryopreservation for a charge (96 percent) or for no charge (4 percent), donation for reproductive use by other couples (76 percent), disposal prior to (60 percent) or following (54 percent) cryopreservation, and donation for research (60 percent) or embryologist training (19 percent). Qualifications varied widely among those personnel responsible for securing couples' consent for disposal and for conducting disposal itself. Some clinics performed a religious or quasi-religious disposal ceremony. Some clinics required a couple's participation in disposal; some allowed but did not require it; some others discouraged or disallowed it.
The disposal of human embryos created in excess at American IVF clinics varies in ways suggesting both moral sensitivity and ethical divergence.
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