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Cross-sectional evidence suggests females in late adolescence exhibit higher rates of post-traumatic stress symptoms (PTSS) than males and younger age groups. However, longitudinal evidence is limited, and underlying factors are not well understood. We investigated the emergence of sex differences in PTSS from childhood to adolescence in a large, longitudinal UK cohort, and tested whether these could be explained by overlap between PTSS and depressive symptoms, or onset of puberty.
Trauma exposure and PTSS were assessed at ages 8, 10, 13 (parent-report) and 15 (self-report) years in a sub-sample of 9966 children and adolescents from the ALSPAC cohort-study. Analyses of PTSS focused on those who reported potential trauma-exposure at each time-point (ranged from n = 654 at 15 years to n = 1231 at 10 years). Age at peak-height velocity (APHV) was used as an indicator of pubertal timing.
There was no evidence of sex differences in PTSS at ages 8 and 10, but females were more likely to show PTSS at ages 13 (OR 1.54, p = 0.002) and 15 (OR 2.04, p = .001), even once symptoms related to depression were excluded. We found little evidence that the emergence of sex differences was related to pubertal timing (as indexed by APHV).
Results indicate that females show higher levels of PTSS in adolescence but not during childhood. The emergence of this sex difference does not seem to be explained by overlap with depressive symptoms, while the influence of pubertal status requires further investigation.
To better understand and improve the rehabilitation process of older adults with sensory losses in both hearing and vision or dual sensory impairment (DSI), this study explored the perspectives of health care professionals who work with this population. Thirteen individuals, with varied professional backgrounds, were interviewed about their experiences in working with older adults with DSI. We transcribed and coded the interviews, then conducted content analysis. Regardless of their professional backgrounds, the participants reported additional roles that they perceived they fulfilled: (a) counsellor, (b) navigator, and (c) trainer and re-trainer. These roles involved helping individuals with DSI, and their family, with depression, acceptance, repeat consultations, and way-finding through the health system. From the professionals’ perspective, these additional roles increase workload and place them in situations they were not trained for. They suggest education for all professionals and for family members working with people with DSI; moreover, they suggest a multidisciplinary team rehabilitation approach.
Psychological therapy groups for people in adult mental health services can relieve waiting list pressures and potentially reduce stigma and social isolation. Compassion-focused therapy (CFT) focuses on shame and self-criticism. The aim of this study was to evaluate a transdiagnostic CFT group.
Quantitative and qualitative data were obtained from 13 people who completed the group.
Participants completed a range of pre- and post-group self-report outcome measures that assess self-criticism and self-compassion.
Statistically significant improvements were found on all measures used, suggesting that attending the CFT group did result in meaningful changes. People who completed the group also provided positive feedback about the experience.
The results suggest that running CFT groups is feasible and acceptable to clients with a range of psychiatric diagnoses as part of their care from community mental health teams. People who completed the group demonstrated significant improvements. A proportion of people did not complete the group, and more research is required about the reasons for this. Limitations of this study are considered together with future directions for research into CFT.
Contaminated hands of healthcare workers (HCWs) are an important source of transmission of healthcare-associated infections. Alcohol-based hand sanitizers, while effective, do not provide sustained antimicrobial activity. The objective of this study was to compare the immediate and persistent activity of 2 hand hygiene products (ethanol [61% w/v] plus chlorhexidine gluconate [CHG; 1.0% solution] and ethanol only [70% v/v]) when used in an intensive care unit (ICU).
Prospective, randomized, double-blinded, crossover study
Three ICUs at a large teaching hospital
In total, 51 HCWs involved in direct patient care were enrolled in and completed the study.
All HCWs were randomized 1:1 to either product. Hand prints were obtained immediately after the product was applied and again after spending 4–7 minutes in the ICU common areas prior to entering a patient room or leaving the area. The numbers of aerobic colony-forming units (CFU) were compared for the 2 groups after log transformation. Each participant tested the alternative product after a 3-day washout period.
On bare hands, use of ethanol plus CHG was associated with significantly lower recovery of aerobic CFU, both immediately after use (0.27 ± 0.05 and 0.88 ± 0.08 log10 CFU; P = .035) and after spending time in ICU common areas (1.81 ± 0.07 and 2.17 ± 0.05 log10 CFU; P<.0001). Both the antiseptics were well tolerated by HCWs.
In comparison to the ethanol-only product, the ethanol plus CHG sanitizer was associated with significantly lower aerobic bacterial counts on hands of HCWs, both immediately after use and after spending time in ICU common areas.
There is limited evidence on the prevalence and identification of antenatal mental disorders.
To investigate the prevalence of mental disorders in early pregnancy and the diagnostic accuracy of depression-screening (Whooley) questions compared with the Edinburgh Postnatal Depression Scale (EPDS), against the Structured Clinical Interview DSM-IV-TR.
Cross-sectional survey of women responding to Whooley questions asked at their first antenatal appointment. Women responding positively and a random sample of women responding negatively were invited to participate.
Population prevalence was 27% (95% CI 22–32): 11% (95% CI 8–14) depression; 15% (95% CI 11–19) anxiety disorders; 2% (95% CI 1–4) obsessive–compulsive disorder; 0.8% (95% CI 0–1) post-traumatic stress disorder; 2% (95% CI 0.4–3) eating disorders; 0.3% (95% CI 0.1–1) bipolar disorder I, 0.3% (95% CI 0.1–1%) bipolar disorder II; 0.7% (95% CI 0–1) borderline personality disorder. For identification of depression, likelihood ratios were 8.2 (Whooley) and 9.8 (EPDS). Diagnostic accuracy was similar in identifying any disorder (likelihood ratios 5.8 and 6).
Endorsement of Whooley questions in pregnancy indicates the need for a clinical assessment of diagnosis and could be implemented when maternity professionals have been appropriately trained on how to ask the questions sensitively, in settings where a clear referral and care pathway is available.
Declaration of interest
L.M.H. chaired the National Institute for Health and Care Excellence CG192 guidelines development group on antenatal and postnatal mental health in 2012–2014.
This chapter will provide you with the fundamental skills for working with children, young people and their families to promote mental health. Adolescent mental health and wellbeing are covered in more detail elsewhere in this text, but it is important to acknowledge that good mental health is an important goal from birth (and even before birth), throughout childhood and into adolescence. Some adolescent mental health disorders are adolescent limited – that is, they begin and end in the period of adolescence – but mostly mental health and mental health disorders are experienced along a continuum. Indeed, as you will learn from this chapter, temporal assessment of children's behaviours is paramount in any assessment of mental health. As children mature, their behaviours change accordingly. Behaviours that can be expected among young children should disappear as they mature, such as the inability to regulate emotions, or to experience empathy for others. It is therefore imperative that mental health and behavioural assessments are not completed in one encounter. Paediatric mental health clinicians view the child or young person as a representative of a family system. This means that the family is necessarily incorporated into every facet of care, including assessment, planning, treatment and evaluation of care. Children and young people, their parents and guardians, families, school and broader communities are all considered in the planning for optimal mental healthcare service delivery.
Children and young people are actually at high risk of mental health disorders, and in Australia 8.3 per cent of children and young people live with mild, moderate or severe mental disorders (Lawrence et al., 2016). Since the first Australian survey of children's mental health was reported in 2000, the prevalence of children's mental health disorders has been stable. The National Youth Mental Health Initiative launched by the Australian Government in 2005 (Headspace) has focused on increasing prevention and treatment services for children and young people. It seems that for children identified as having mental health disorders, the uptake of services is high. But there continues to be a need for improving the prevention and early intervention strategies and services, especially for those children and young people already experiencing mental health problems.
Adélie penguins (Pygoscelis adeliae) are responding to ocean–climate variability throughout the marine ecosystem of the western Antarctic Peninsula (WAP) where some breeding colonies have declined by 80%. Nuclear and mitochondrial DNA (mtDNA) markers were used to understand historical population genetic structure and gene flow given relatively recent and continuing reductions in sea ice habitats and changes in numbers of breeding adults at colonies throughout the WAP. Genetic diversity, spatial genetic structure, genetic signatures of fluctuations in population demography and gene flow were assessed in four regional Adélie penguin colonies. The analyses indicated little genetic structure overall based on bi-parentally inherited microsatellite markers (FST =-0.006–0.004). No significant variance was observed in overall haplotype frequency (mtDNA ΦST =0.017; P=0.112). Some comparisons with Charcot Island were significant, suggestive of female-biased philopatry. Estimates of gene flow based on a two-population coalescent model were asymmetrical from the species’ regional core to its northern range. Breeding Adélie penguins of the WAP are a panmictic population and hold adequate genetic diversity and dispersal capacity to be resilient to environmental change.
CASE C-157/15 Achbita v G4S Secure Solutions NV ECLI:EU:C:2017:203 and Case C-188/15, Bougnaoui v Micropole SA ECLI:EU:C:2017:204 concerned Muslim women who wanted to wear a headscarf at work. In both cases the women were ultimately dismissed from their employment. In Achbita the employer, G4S, initially had an unwritten rule, which was converted into a written rule, prohibiting the wearing of visible signs of political, philosophical and religious beliefs. Ms Achbita refused to comply and was dismissed. In Bougnaoui it was not wholly clear whether the employer, Micropole, had a general rule requiring visually neutral clothing. Nevertheless Ms Bougnaoui was asked not to wear her headscarf while working at a customer's site and was dismissed for misconduct when she refused.
This paper presents the first major data release and survey description for the ANU WiFeS SuperNovA Programme. ANU WiFeS SuperNovA Programme is an ongoing supernova spectroscopy campaign utilising the Wide Field Spectrograph on the Australian National University 2.3-m telescope. The first and primary data release of this programme (AWSNAP-DR1) releases 357 spectra of 175 unique objects collected over 82 equivalent full nights of observing from 2012 July to 2015 August. These spectra have been made publicly available via the WISEREP supernova spectroscopy repository.
We analyse the ANU WiFeS SuperNovA Programme sample of Type Ia supernova spectra, including measurements of narrow sodium absorption features afforded by the high spectral resolution of the Wide Field Spectrograph instrument. In some cases, we were able to use the integral-field nature of the Wide Field Spectrograph instrument to measure the rotation velocity of the SN host galaxy near the SN location in order to obtain precision sodium absorption velocities. We also present an extensive time series of SN 2012dn, including a near-nebular spectrum which both confirms its ‘super-Chandrasekhar’ status and enables measurement of the sub-solar host metallicity at the SN site.
In this chapter, we explore the challenges that Earth system researchers face in addressing human-induced global environmental changes and the societal consequences of global change within their research toolkit. We focus on areas of research that have particular resonance with today’s social and political demands.
The Earth system and the ‘problematic human’
The state of play and our position
The great scientific challenge faced by today’s global change scientists is to understand the Earth system. Part of this is knowing that we ourselves, as human beings, are an influential component of that system and that the understanding we develop shapes our responses to the environmental changes we see around us. In scientific terms, most of the fundamental workings of our planet, including the processes that change climate and landscapes on short and long timescales, were already well understood by the end of the twentieth century. Earth system science is the field of study that has brought these areas of knowledge together. It has not just provided insight into the phenomena of global environmental change, but also explained the ‘hows’ and ‘whys’ behind them, bringing insights into the future prospects for our planet. The enormity of the challenge lies in the realization that we are seeking to understand and predict the properties of a complex adaptive system of which we are a part, recognizing that our choices and our agency as human beings are important controls on its workings. More than that, our ability to deploy our knowledge and make choices about our actions is an important facet, perhaps even a characterizing trait, of our existence.
The ability to predict conversion to multiple sclerosis (MS) accurately when assessing a patient with a clinically isolated syndrome (CIS) is of paramount importance.Magnetic resonance imaging (MRI) is the best paraclinical tool currently available; however the significance of a history of an event suggestive of demyelination prior to CIS presentation has not been evaluated.
Aretrospective chart review of all optic neuritis cases presenting as CIS to a single neuro-ophthalmologist in London, Ontario between 1990 to 1998 was performed. Data were collected regarding demographics, past medical history, history of present illness, and family history. Conversion to MS was determined by the McDonald criteria after ten years of follow-up. Bayesian statistics and logistic regression were used to determine the best predictors of conversion to MS from CIS.
One hundred and sixteen optic neuritis subjects were included in the analysis. After ten years, 42.2% had converted to MS. The best predictor of future conversion remained at least one brain lesion, disseminated in space, on MRI (sensitivity 0.90, specificity 0.75). However, if the subject additionally had a history suggestive of a demyelinating event in the past that had not been confirmed clinically, the specificity increased to 0.96. These two traits taken together had an odds ratio of 27.8 for conversion to MS in the next ten years (p<0.001).
A history of an event suggestive of demyelination prior to presenting with optic neuritis as CIS increases the ability of the clinician to predict conversion to MS in the next ten years.
This article reports four case studies illustrating the implementation of the Choose Health Program, a cognitive behavioural lifestyle intervention for overweight and obese adolescents. Participants were an overweight (12 years) and obese (15 years) female, and an overweight (14 years) and obese (12 years) male. The program was delivered by provisional psychologists with program specific training and supervision. All participants demonstrated improvements in body composition, and maintained or improved dietary quality and psychosocial wellbeing. The program had variable effects on physical activity and minimal effect on cardiovascular fitness for three of the four participants. While parents and adolescents required considerable assistance to develop and monitor long term program goals, these goals were a useful clinical tool to support the adolescent and parent to recognise the improvements they had made. Identification and monitoring of specific, measurable, and realistic behaviour change strategies was particularly important in assisting adolescents and their parents to translate session information into improved health behaviours. Results indicate that an adolescent overweight and obesity treatment program that promotes adolescent responsibility and autonomy, and emphasises the importance of parent support and family change is both effective and highly acceptable to both adolescents and parents.
The aim of the study was to examine the effect of the introduction of a new food-support benefit ‘Healthy Start’ (HS) on dietary intakes and eating patterns of low-income, Caucasian, pregnant and postpartum women living in Sheffield (UK). A before-and-after study comparing nutritional behaviour of participants, who were beneficiaries or eligible for the Welfare Food Scheme (WFS) (phase 1) or HS (phase 2), was conducted. Dietary intakes and eating patterns were assessed using a validated semi-quantified FFQ. In phase 1, 176 WFS subjects (ninety pregnant and eighty-six postpartum) were recruited and in phase 2, there were 160 HS subjects (ninety-six pregnant and sixty-four postpartum). The results suggested that pregnant and postpartum HS women significantly increased their daily intakes of energy, Fe, Ca, folate and vitamin C compared with the WFS women. Observed differences remained significant after controlling for potential confounding effects of known factors, i.e. education and age. HS women were more likely to meet the recommended nutrient intakes for Fe, folate, Ca and vitamin C. HS women ate significantly more mean portions of fruit and vegetables per d (P = 0·004 and P = 0·023) respectively. None of the HS recipients was receiving HS vitamin supplements. The present study showed that pregnant and postpartum HS women increased their food consumption, and a higher proportion of them than the earlier WFS scheme met the recommended intakes for Ca, folate, Fe and vitamin C.