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Adolescent mental health difficulties are increasing over time. However, it is not known whether their adulthood health and socio-economic sequelae are changing over time.
Participants (N = 31 349) are from two prospective national birth cohort studies: 1958 National Child Development Study (n = 16 091) and the 1970 British Cohort Study (n = 15 258). Adolescent mental health was operationalised both as traditional internalising and externalising factors and a hierarchical bi-factor. Associations between adolescent psychopathology and age 42 health and wellbeing (mental health, general health, life satisfaction), social (cohabitation, voting behaviour) and economic (education and employment) outcomes are estimated using linear and logistic multivariable regressions across cohorts, controlling for a wide range of early life potential confounding factors.
The prevalence of adolescent mental health difficulties increased and their associations with midlife health, wellbeing, social and economic outcomes became more severe or remained similar between those born in 1958 and 1970. For instance, a stronger association with adolescent mental health difficulties was found for those born in 1970 for midlife psychological distress [odds ratio (OR) 1970 = 1.82 (1.65–1.99), OR 1958 = 1.60 (1.43–1.79)], cohabitation [OR 1970 = 0.64 (0.59–0.70), OR 1958 = 0.79 (0.72–0.87)], and professional occupations [OR 1970 = 0.75 (0.67–0.84), OR 1958 = 1.05 (0.88–1.24)]. The associations of externalising symptoms with later outcomes were mainly explained by their shared variance with internalising symptoms.
The widening of mental health-based inequalities in midlife outcomes further supports the need to recognise that secular increases in adolescent mental health symptoms is a public health challenge with measurable negative consequences through the life-course. Increased public health efforts to minimise adverse outcomes are needed.
The COVID-19 pandemic has impacted community mental health, but the effect on psychiatric admissions is unknown. We investigated factors contributing to acute psychiatric admissions, and whether this changed during the first UK lockdown.
A retrospective case-note review study with an exploratory mixed-methods design was used to examine factors in psychiatric admissions following the first UK 2020 lockdown compared to the same time periods in 2019 and 2018.
Themes of psychopathology, risk, social stressors, community treatment issues, and physical health concerns were generated. The mean number of codes per case was 6⋅19 (s.d. = 2⋅43), with a mean number of categories per case of 3⋅73, (s.d. = 0⋅98). Changes in routines and isolation were common factors in the study year; accommodation and substance abuse were more prominent in the control year. Relationship stressors featured strongly in both groups. There were significantly more women (χ2(1, N = 98) = 20⋅80, p < 0⋅00001) and older adults (χ2(1, N = 98) = 8⋅61, p = 0⋅0033) in the study group than the control. Single people, compared to those in a relationship (χ2(1, N = 45) = 4.46, p = 0⋅035), and people with affective disorders compared to psychotic disorders ((χ2(1, N = 28) = 5.19, p = 0⋅023), were more likely to have a COVID-19 related admission factor.
The COVID-19 pandemic amplified pre-existing psychosocial vulnerabilities with a disproportionate psychiatric admissions impact on the mental health of women, the elderly and those with affective disorders.
The workhouse remains a totemic institution for social historians, yet we still know very little about the day-to-day experiences of the indoor poor. Nowhere is this clearer than in discussions about workhouse clothing, which remain overwhelmingly negative in the literature and consistent with the predominant view of the workhouse as a place of suffering and humiliation. Yet more often than not, this view is based on relatively shallow empirical foundations and tends to rely on anecdotal evidence or on the uncritical use of subjective sources such as photographs, newspaper editorials and other cultural products. This article takes a different approach by looking again at the whole range of meanings that workhouse clothing held for paupers and those who oversaw its allocation, and at the practical and symbolic usages to which it was put by them. On the basis of this evidence the authors argue that, contrary to the orthodox view, workhouse clothing was rarely intended to be degrading or stigmatising; that it would have held very different meanings for different classes of paupers; and that, far from being a source of unbridled misery, paupers often found it to be a source of great strategic and practical value.
Children born very preterm (VP) display altered growth in corticolimbic structures compared with full-term peers. Given the association between the cortiocolimbic system and anxiety, this study aimed to compare developmental trajectories of corticolimbic regions in VP children with and without anxiety diagnosis at 13 years.
MRI data from 124 VP children were used to calculate whole brain and corticolimbic region volumes at term-equivalent age (TEA), 7 and 13 years. The presence of an anxiety disorder was assessed at 13 years using a structured clinical interview.
VP children who met criteria for an anxiety disorder at 13 years (n = 16) displayed altered trajectories for intracranial volume (ICV, p < 0.0001), total brain volume (TBV, p = 0.029), the right amygdala (p = 0.0009) and left hippocampus (p = 0.029) compared with VP children without anxiety (n = 108), with trends in the right hippocampus (p = 0.062) and left medial orbitofrontal cortex (p = 0.079). Altered trajectories predominantly reflected slower growth in early childhood (0–7 years) for ICV (β = −0.461, p = 0.020), TBV (β = −0.503, p = 0.021), left (β = −0.518, p = 0.020) and right hippocampi (β = −0.469, p = 0.020) and left medial orbitofrontal cortex (β = −0.761, p = 0.020) and did not persist after adjusting for TBV and social risk.
Region- and time-specific alterations in the development of the corticolimbic system in children born VP may help to explain an increase in anxiety disorders observed in this population.
In April of 1915, the German-Jewish chemist Fritz Haber supervised the first deployment of industrialized chemical weapons against French colonial troops. The uncertain nature of the attack, both in its execution and outcome, led many German military men to question the controllability of poison gas. Over the next three decades, Germans would continue this line of inquiry, as aero-chemical attacks appeared increasingly imminent. This article narrates the German search for control over chemical weapons between the world wars, revealing the ways in which interwar techno-nationalists tied the mastery of poison gas to ethno-racial definitions of Germanness. Under the Nazis, leaders in civilian aero-chemical defense picked up this interwar thread and promoted a dangerous embrace of gas that would supposedly cull the technically superior Germans from other lesser races. Although this vision of a chemically saturated world did not suffuse German society, such logic did play out in the gas chambers of the Holocaust.
Women with underlying cardiac conditions have an increased risk of adverse pregnancy outcomes. Counselling reproductive age women with heart disease is important to assist them in deciding whether to pursue pregnancy, to ensure their best cardiovascular status prior to pregnancy, and that they understand the risks of pregnancy for them and baby. This also provides an opportunity to explore management strategies to reduce risks. For this growing cohort of women, there is a great need for pre-conceptual counselling.
This retrospective comparative audit assessed new referrals and pre-conceptual counselling of women attending a joint obstetric–cardiology clinic at a tertiary maternity centre in a 12-month period of 2015–2016 compared with 2018–2019. This reflected the timing of the introduction of a multidisciplinary meeting prior to clinics and assessed the impact on referrals with the introduction of the European Society of Cardiology guidelines.
Data were reviewed from 56 and 67 patients in respective audit periods. Patient’s risk was stratified using modified World Health Organization classification.
Less than 50% of women with pre-existing cardiac conditions had received pre-conceptual counselling, although half of them had risks clearly documented. The majority of patients had a recent electrocardiograph and echocardiogram performed prior to counselling, and there was a modest improvement in the number of appropriate functional tests performed between time points. One-third of patients in both cohorts were taking cardiac medications during pregnancy.
There was a significant increase in the number of pregnant women with cardiac disease and in complexity according to modified World Health Organization risk classification. While there have been improvements, it is clear that further work to improve availability and documentation of pre-pregnancy counselling is needed.
To identify attention profiles at 7 and 13 years, and transitions in attention profiles over time in children born very preterm (VP; <30 weeks’ gestation) and full term (FT), and examine predictors of attention profiles and transitions.
Participants were 167 VP and 60 FT children, evaluated on profiles across five attention domains (selective, shifting and divided attention, processing speed, and behavioral attention) at 7 and 13 years using latent profile analyses. Transitions in profiles were assessed with contingency tables. For VP children, biological and social risk factors were tested as predictors with a multinomial logistic regression.
At 7 and 13 years, three distinct profiles of attentional functioning were identified. VP children were 2–3 times more likely to show poorer attention profiles compared with FT children. Transition patterns between 7 and 13 years were stable average, stable low, improving, and declining attention. VP children were two times less likely to have a stable average attention pattern and three times more likely to have stable low or improving attention patterns compared with FT children. Groups did not differ in declining attention patterns. For VP children, brain abnormalities on neonatal MRI and greater social risk at 7 years predicted stable low or changing attention patterns over time.
VP children show greater variability in attention profiles and transition patterns than FT children, with almost half of the VP children showing adverse attention patterns over time. Early brain pathology and social environment are markers for attentional functioning.
The coronavirus disease 2019 (COVID-19) pandemic is likely to lead to a significant increase in mental health disorders among healthcare workers (HCW).
We evaluated the rates of anxiety, depressive and post-traumatic stress disorder (PTSD) symptoms in a population of HCW in the UK.
An electronic survey was conducted between the 5 June 2020 and 31 July 2020 of all hospital HCW in the West Midlands, UK using clinically validated questionnaires: the 4-item Patient Health Questionnaire(PHQ-4) and the Impact of Event Scale-Revised (IES-R). Univariate analyses and adjusted logistic regression analyses were performed to estimate the strengths in associations between 24 independent variables and anxiety, depressive or PTSD symptoms.
There were 2638 eligible participants who completed the survey (female: 79.5%, median age: 42 years, interquartile range: 32–51). The rates of clinically significant symptoms of anxiety, depression and PTSD were 34.3%, 31.2% and 24.5%, respectively. In adjusted analysis a history of mental health conditions was associated with clinically significant symptoms of anxiety (odds ratio (OR) = 2.3, 95% CI 1.9–2.7, P < 0.001), depression (OR = 2.5, 95% CI 2.1–3.0, P < 0.001) and PTSD (OR = 2.1, 95% CI 1.7–2.5, P < 0.001). The availability of adequate personal protective equipment (PPE), well-being support and lower exposure to moral dilemmas at work demonstrated significant negative associations with these symptoms (P ≤ 0.001).
We report higher rates of clinically significant mental health symptoms among hospital HCW following the initial COVID-19 pandemic peak in the UK. Those with a history of mental health conditions were most at risk. Adequate PPE availability, access to well-being support and reduced exposure to moral dilemmas may protect hospital HCW from mental health symptoms.
Potential yield losses in grain sorghum due to weed interference based on quantitative data from the major grain sorghum-growing areas of the United States are reported by the WSSA Weed Loss Committee. Weed scientists and extension specialists who researched weed control in grain sorghum provided data on grain sorghum yield loss due to weed interference in their region. Data were requested from up to 10 individual experiments per calendar year over 10 yr between 2007 and 2016. Based on the summarized information, farmers in Arkansas, Kansas, Missouri, Nebraska, South Dakota, and Texas would potentially lose an average of 37%, 38%, 30%, 56%, 61%, and 60% of their grain sorghum yield with no weed control, and have a corresponding annual monetary loss of US $19 million, 302 million, 7 million, 32 million, 25 million, and 314 million, respectively. The overall average yield loss due to weed interference was estimated to be 47% for this grain sorghum-growing region. Thus, US farmers would lose approximately 5,700 million kg of grain sorghum valued at approximately US $953 million annually if weeds are not controlled. With each dollar invested in weed management (based on estimated weed control cost of US $100 ha−1), there would be a return of US $3.80, highlighting the return on investment in weed management and the importance of continued weed science research for sustaining high grain sorghum yield and profitability in the United States.
Cybermentoring refers to virtual peer support in which young people themselves are trained as cybermentors and interact with those needing help and advice (cybermentees) online. This article describes the training in, and implementation of, a cross-national cybermentoring scheme, Beatbullying Europe, developed in the United Kingdom. It involved train-the-trainer workshops for partners and life mentors in six European countries (Italy, Spain, Portugal, Romania, Poland and the Czech Republic) in 2013–2014, followed by training sessions for pupil cybermentors aged 11–16 years. Although BeatBullying went into liquidation in November 2014, the project was largely completed. We (1) report an evaluation of the training of the life mentors and mentors, via questionnaire survey; and (2) discuss findings about the implementation of the scheme and its potential at a cross-national level, via partner interviews during and at the end of the project. The training was found to be highly rated in all respects, and in all six countries involved. The overall consensus from the data available is that there was a positive impact for the schools and professionals involved; some challenges encountered are discussed. The BeatBullying Europe project, despite being unfinished, was promising, and a similar approach deserves further support and evaluation in the future.
Although school-based programmes for the identification of children and young people (CYP) with mental health difficulties (MHD) have the potential to improve short- and long-term outcomes across a range of mental disorders, the evidence-base on the effectiveness of these programmes is underdeveloped. In this systematic review, we sought to identify and synthesise evidence on the effectiveness and cost-effectiveness of school-based methods to identify students experiencing MHD, as measured by accurate identification, referral rates, and service uptake.
Electronic bibliographic databases: MEDLINE, Embase, PsycINFO, ERIC, British Education Index and ASSIA were searched. Comparative studies were included if they assessed the effectiveness or cost-effectiveness of strategies to identify students in formal education aged 3–18 years with MHD, presenting symptoms of mental ill health, or exposed to psychosocial risks that increase the likelihood of developing a MHD.
We identified 27 studies describing 44 unique identification programmes. Only one study was a randomised controlled trial. Most studies evaluated the utility of universal screening programmes; where comparison of identification rates was made, the comparator test varied across studies. The heterogeneity of studies, the absence of randomised studies and poor outcome reporting make for a weak evidence-base that only generate tentative conclusions about the effectiveness of school-based identification programmes.
Well-designed pragmatic trials that include the evaluation of cost-effectiveness and detailed process evaluations are necessary to establish the accuracy of different identification models, as well as their effectiveness in connecting students to appropriate support in real-world settings.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Background: Self-report instruments are commonly used to assess for childhood depressive symptoms. Historically, clinicians have relied heavily on parent-reports due to concerns about childrens’ cognitive abilities to understand diagnostic questions. However, parents may also be unreliable reporters due to a lack of understanding of their child's symptomatology, overshadowing by their own problems, and tendencies to promote themselves more favourably in order to achieve desired assessment goals. One such variable that can lead to unreliable reporting is impression management, which is a goal-directed response in which an individual (e.g. mother or father) attempts to represent themselves, or their child, in a socially desirable way to the observer. Aims: This study examined the relationship between mothers who engage in impression management, as measured by the Parenting Stress Index-Short Form defensive responding subscale, and parent-/child-self-reports of depressive symptomatology in 106 mother–child dyads. Methods: 106 clinic-referred children (mean child age = 10.06 years, range 7–16 years) were administered the Child Depression Inventory, and mothers (mean mother age = 40.80 years, range 27–57 years) were administered the Child-Behavior Checklist, Parenting Stress Index-Short Form, and Symptom Checklist-90-Revised. Results: As predicted, mothers who engaged in impression management under-reported their child's symptomatology on the anxious/depressed and withdrawn subscales of the Child Behavior Checklist. Moreover, the relationship between maternal-reported child depressive symptoms and child-reported depressive symptoms was moderated by impression management. Conclusions: These results suggest that children may be more reliable reporters of their own depressive symptomatology when mothers are highly defensive or stressed.
The Neolithic in north-east Asia is defined by the presence of ceramic containers, rather than agriculture, among hunter-gatherer communities. The role of pottery in such groups has, however, hitherto been unclear. This article presents the results of organic residue analysis of Neolithic pottery from Sakhalin Island in the Russian Far East. Results indicate that early pottery on Sakhalin was used for the processing of aquatic species, and that its adoption formed part of a wider Neolithic transition involving the reorientation of local lifeways towards the exploitation of marine resources.
Objectives: Preterm children demonstrate deficits in executive functions including inhibition, working memory, and cognitive flexibility; however, their goal setting abilities (planning, organization, strategic reasoning) remain unclear. This study compared goal setting abilities between very preterm (VP: <30 weeks/<1250 grams) and term born controls during late childhood. Additionally, early risk factors (neonatal brain abnormalities, medical complications, and sex) were examined in relationship to goal setting outcomes within the VP group. Methods: Participants included 177 VP and 61 full-term born control children aged 13 years. Goal setting was assessed using several measures of planning, organization, and strategic reasoning. Parents also completed the Behavior Rating Inventory of Executive Function. Regression models were performed to compare groups, with secondary analyses adjusting for potential confounders (sex and social risk), and excluding children with major neurosensory impairment and/or IQ<70. Within the VP group, regression models were performed to examine the relationship between brain abnormalities, medical complications, and sex, on goal setting scores. Results: The VP group demonstrated a clear pattern of impairment and inefficiency across goal setting measures, consistent with parental report, compared with their full-term born peers. Within the VP group, moderate/severe brain abnormalities on neonatal MRI predicted adverse goal setting outcomes at 13. Conclusions: Goal setting difficulties are a significant area of concern in VP children during late childhood. These difficulties are associated with neonatal brain abnormalities, and are likely to have functional consequences academically, socially and vocationally. (JINS, 2018, 24, 372–381)
Arterial wall thickening, stimulated by low-grade systemic inflammation, underlies many cardiovascular events. As diet is a significant moderator of systemic inflammation, the dietary inflammatory index (DIITM) has recently been devised to assess the overall inflammatory potential of an individual’s diet. The primary objective of this study was to assess the association of the DII with common carotid artery–intima-media thickness (CCA–IMT) and carotid plaques. To substantiate the clinical importance of these findings we assessed the relationship of DII score with atherosclerotic vascular disease (ASVD)-related mortality, ischaemic cerebrovascular disease (CVA)-related mortality and ischaemic heart disease (IHD)-related mortality more. The study was conducted in Western Australian women aged over 70 years (n 1304). Dietary data derived from a validated FFQ (completed at baseline) were used to calculate a DII score for each individual. In multivariable-adjusted models, DII scores were associated with sub-clinical atherosclerosis: a 1 sd (2·13 units) higher DII score was associated with a 0·013-mm higher mean CCA–IMT (P=0·016) and a 0·016-mm higher maximum CCA–IMT (P=0·008), measured at 36 months. No relationship was seen between DII score and carotid plaque severity. There were 269 deaths during follow-up. High DII scores were positively associated with ASVD-related death (per sd, hazard ratio (HR): 1·36; 95 % CI 1·15, 1·60), CVA-related death (per sd, HR: 1·30; 95 % CI 1·00, 1·69) and IHD-related death (per sd, HR: 1·40; 95 % CI 1·13, 1·75). These results support the hypothesis that a pro-inflammatory diet increases systemic inflammation leading to development and progression of atherosclerosis and eventual ASVD-related death.