41 results
Impact of sedentary behavior and emotional support on prenatal psychological distress and birth outcomes during the COVID-19 pandemic
- Alison E. Hipwell, Irene Tung, Phillip Sherlock, Xiaodan Tang, Kim McKee, Monica McGrath, Akram Alshawabkeh, Tracy Bastain, Carrie V. Breton, Whitney Cowell, Dana Dabelea, Cristiane S. Duarte, Anne L. Dunlop, Assiamira Ferrera, Julie B. Herbstman, Christine W. Hockett, Margaret R. Karagas, Kate Keenan, Robert T. Krafty, Catherine Monk, Sara S. Nozadi, Thomas G. O'Connor, Emily Oken, Sarah S. Osmundson, Susan Schantz, Rosalind Wright, Sarah S. Comstock
-
- Journal:
- Psychological Medicine / Volume 53 / Issue 14 / October 2023
- Published online by Cambridge University Press:
- 08 March 2023, pp. 6792-6805
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background
Studies have reported mixed findings regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women and birth outcomes. This study used a quasi-experimental design to account for potential confounding by sociodemographic characteristics.
MethodsData were drawn from 16 prenatal cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) program. Women exposed to the pandemic (delivered between 12 March 2020 and 30 May 2021) (n = 501) were propensity-score matched on maternal age, race and ethnicity, and child assigned sex at birth with 501 women who delivered before 11 March 2020. Participants reported on perceived stress, depressive symptoms, sedentary behavior, and emotional support during pregnancy. Infant gestational age (GA) at birth and birthweight were gathered from medical record abstraction or maternal report.
ResultsAfter adjusting for propensity matching and covariates (maternal education, public assistance, employment status, prepregnancy body mass index), results showed a small effect of pandemic exposure on shorter GA at birth, but no effect on birthweight adjusted for GA. Women who were pregnant during the pandemic reported higher levels of prenatal stress and depressive symptoms, but neither mediated the association between pandemic exposure and GA. Sedentary behavior and emotional support were each associated with prenatal stress and depressive symptoms in opposite directions, but no moderation effects were revealed.
ConclusionsThere was no strong evidence for an association between pandemic exposure and adverse birth outcomes. Furthermore, results highlight the importance of reducing maternal sedentary behavior and encouraging emotional support for optimizing maternal health regardless of pandemic conditions.
A distributed geospatial approach to describe community characteristics for multisite studies
- Patrick H. Ryan, Cole Brokamp, Jeff Blossom, Nathan Lothrop, Rachel L. Miller, Paloma I. Beamer, Cynthia M. Visness, Antonella Zanobetti, Howard Andrews, Leonard B. Bacharier, Tina Hartert, Christine C. Johnson, Dennis Ownby, Robert F. Lemanske, Heike Gibson, Weeberb Requia, Brent Coull, Edward M. Zoratti, Anne L. Wright, Fernando D. Martinez, Christine M. Seroogy, James E. Gern, Diane R. Gold
-
- Journal:
- Journal of Clinical and Translational Science / Volume 5 / Issue 1 / 2021
- Published online by Cambridge University Press:
- 05 February 2021, e86
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.
Subfossil lemur discoveries from the Beanka Protected Area in western Madagascar
- David A. Burney, Haingoson Andriamialison, Radosoa A. Andrianaivoarivelo, Steven Bourne, Brooke E. Crowley, Erik J. de Boer, Laurie R. Godfrey, Steven M. Goodman, Christine Griffiths, Owen Griffiths, Julian P. Hume, Walter G. Joyce, William L. Jungers, Stephanie Marciniak, Gregory J. Middleton, Kathleen M. Muldoon, Eliette Noromalala, Ventura R. Pérez, George H. Perry, Roger Randalana, Henry T. Wright
-
- Journal:
- Quaternary Research / Volume 93 / January 2020
- Published online by Cambridge University Press:
- 02 October 2019, pp. 187-203
-
- Article
- Export citation
-
A new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
Yellow-naped Amazon Amazona auropalliata populations are markedly low and rapidly declining in Costa Rica and Nicaragua
- TIMOTHY F. WRIGHT, THOMAS C. LEWIS, MARTÍN LEZAMA-LÓPEZ, GRACE SMITH-VIDAURRE, CHRISTINE R. DAHLIN
-
- Journal:
- Bird Conservation International / Volume 29 / Issue 2 / June 2019
- Published online by Cambridge University Press:
- 09 July 2018, pp. 291-307
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Accurate assessments of population sizes and trends are fundamental for effective species conservation, particularly for social and long-lived species in which low reproductive rates, aging demographic structure and Allee effects could interact to drive rapid population declines. In the parrots (Order Psittaciformes) these life history characteristics have combined with habitat loss and capture for the pet trade to lead to widespread endangerment, with over 40% of species classified under some level of threat. Here we report the results of a population survey of one such species, the Yellow-naped Amazon, Amazona auropalliata, that is classified as ‘Endangered’ on the IUCN Red List. We conducted a comprehensive survey in June and July of 2016 of 44 night roosts of the populations in contiguous Pacific lowlands of northern Costa Rica and southern Nicaragua and compared numbers in Costa Rica to those found in a similar survey conducted in June 2005. In 2016 we counted 990 birds across 25 sites surveyed in Costa Rica and 692 birds across 19 sites surveyed in Nicaragua for a total population estimate of only 1,682 birds. Comparisons of 13 sites surveyed in both 2005 and 2016 in Costa Rica showed a strong and statistically significant decline in population numbers over the 11-year period. Assessment of group sizes approaching or leaving roosts indicated that less than 25% of groups consisted of three or more birds; there was a significantly higher proportion of these putative family groups observed in Nicaragua than Costa Rica. Taken together, these results are cause for substantial concern for the health of this species in a region that has previously been considered its stronghold, and suggest that stronger conservation action should be undertaken to protect remaining populations from capture for the pet trade and loss of key habitat.
20 - Attentional problems services
-
- By Sarah Bryan, Christine Williams, North Yorkshire & York Primary Care Trust, Barry Wright, North Yorkshire & York Primary Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 191-199
-
- Chapter
- Export citation
-
Summary
‘No fine work can be done without concentration, and self-sacrifice and toil and doubt.’
Max BeerbohmIntroduction
In the UK, ADHD has been shown to be the most common reason for follow-up appointments to be offered by CAMHS (Meltzer et al, 2000). Child and adolescent mental health services are regularly called upon to assess children who have problems with attention, concentration, distractibility, impulsivity, overactivity, regulatory difficulties, or a combination of these. These difficulties may be part of ADHD or may be symptoms of other disorders that mimic the clinical features of ADHD (Hill & Cameron, 1999). Attention-deficit hyperactivity disorder is a condition where the symptom profile and aetiology are regularly being redefined. Comprehensive guidelines from NICE (National Institute for Health and Clinical Excellence, 2006; National Collaborating Centre for Mental Health, 2008) and a large US study, with its recently published follow-up study (MTA Cooperative Group, 1999; Jensen et al, 2007) have also informed good practice. As additional resources have not often generally been forthcoming to support such good practice, existing services may restructure aspects of their functioning in order to form Tier 3 teams.
One way of rationalising resources effectively is to establish interagency links so that multidisciplinary working is not limited by professional boundaries. Some centres have done just this to meet the needs of children with complex problems, including ADHD complicated by comorbid difficulties (Williams et al, 1999). Where there is no coordinated approach to assessment and intervention for children who present with these difficulties, confusion may arise and contradictory advice may be given by different agencies. Parents and carers need to feel confident that professionals are working with them and with other agencies to provide a comprehensive assessment and treatment package for their children. A Tier 3 team within a CAMHS has the advantage of multidisciplinary working, and this facilitates the development of shared learning and understanding, and the evolution of clear protocols (Voeller, 1991). A specific attentional problems clinic can provide assessment, diagnosis, monitoring and a range of ongoing interventions.
The attentional problems team should ideally include a child psychiatrist, a clinical psychologist and a community psychiatric nurse.
16 - Paediatric liaison
-
- By Barry Wright, North Yorkshire & York Primary Care Trust, Sebastian Kraemer, Whittington Hospital, London, Kate Wurr, West Leeds CAMHS, NHS Leeds, Christine Williams, North Yorkshire & York Primary Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 151-161
-
- Chapter
- Export citation
-
Summary
‘What is the matter with Mary Jane?
She's perfectly well and she hasn't a pain,
And it's lovely rice pudding for dinner again!
What is the matter with Mary Jane?’
A. A. MilneIntroduction
The first of the five outcomes in Every Child Matters (Department for Children, Schools and Families, 2003), a government aspirational document, is ‘Be healthy’ and clearly refers to ‘enjoying good physical and mental health’. These go hand in hand and services should be integrated to achieve these aspirations.
Children with mental health problems and psychiatric disorders or psychological morbidity frequently present in paediatric clinics and wards. Those with medical disorders have a higher incidence of mental disorders (Green et al, 2004; Hysing et al, 2007). These are sometimes not identified in paediatric services (Slowik & Noronha, 2004) and where they are, paediatricians rarely have the time or training to deal adequately with them (Garralda & Bailey, 1989). Without mental health provision and training, these children's needs will not be addressed. There are initiatives to address training by provision of mental health training specifically for paediatricians (www.rcpch.ac.uk/Education/Education-Courses-and- Programmes/Child-In-Mind) and this should also improve collaboration with paediatric colleagues. The opportunity for early intervention is crucial to prevent longer-term problems or unnecessary paediatric intervention and hospitalisations.
Despite evidence of need and effectiveness, most paediatric departments are still without any meaningful CAMHS input (Woodgate & Garralda, 2006), yet the most pressing need for CAMHS in general (Potter et al, 2005) is for precisely the cases that are found in hospital paediatric and child development departments: children with medical ill health, intellectual disabilities, developmental disorders, autism-spectrum disorders, selfharm, child abuse and comorbid cases. Between a quarter and a half of children in paediatric out-patient clinics have conditions in which psychological factors play a major role (Lask, 1994). Only a quarter of such children are likely to have received any CAMHS help (Glazebrook et al, 2003). The children's NSF recommended paediatric liaison (Department of Health, 2004), and the report on the implementation of Standard 9 of that NSF (Department of Health, 2006) outlines the need for CAMHS paediatric liaison as ‘an essential service for the ill child, siblings, parents and carers in cases where the presenting illness has a psychological component, or where psychological distress is caused as a result of the illness’.
18 - Learning disability services
-
- By Christine Williams, North Yorkshire & York Primary Care Trust, Barry Wright, North Yorkshire & York Primary Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 169-181
-
- Chapter
- Export citation
-
Summary
‘For the world's more full of weeping than we can understand.’
William Butler Yeats (1865–1939)Introduction
Approximately 2–3% of the general population has some form of intellectual disability (Department of Health, 2001). The prevalence of severe intellectual disability (IQ <50) is 3–4 per 1000, and that of moderate intellectual disability (IQ 50–70) is 30–40 per 1000 (Felce et al, 1994).
There is abundant evidence that children with intellectual disabilities are at significantly increased risk of developing mental health problems (Dykens, 2000; Stromme & Diseth, 2000; Tonge & Einfield, 2000; Emerson, 2003; Whitaker & Read, 2006) and that this affects between 40 and 75% (Corbett, 1985; Gillberg et al, 1986; Wallace et al, 1995). Emerson & Hatton (2007) estimate that children with intellectual disabilities are six times more likely to have a diagnosable psychiatric condition than other children in Britain. They are also at increased risk of having specific disorders such as autism-spectrum disorders (Fombonne, 1998; Emerson & Hatton, 2007) and ADHD (Dykens, 2000). Mental health services for children and young people with an intellectual disability and their families should therefore be readily available and of a high quality. In the UK, the government (Department of Health, 1992) and the Royal College of Psychiatrists (1992) have long recognised this. Despite this and the fact that Standard 8 of the NSF for children states that Local Authorities, primary care trusts and CAMHS must work together to ‘ensure that disabled children have equal access to CAMHS’ (Department for Education and Skills & Department of Health, 2004), only 60% of primary care trusts had commissioned CAMHS for young people with intellectual disabilities in June 2006 (Department for Education and Skills & Department of Health, 2006). This chapter may therefore have a practical role to play as commissioners and services seek to address this gap in service provision.
Organisation of services
It is first necessary to decide where mental health services for children and young people with intellectual disabilities will sit organisationally. Historical models often placed such services within all age services for people with intellectual disabilities. It was argued that this gave rise to good continuity of care. In recent times, dedicated children's services have become accepted as more appropriate.
19 - Services for autism-spectrum disorders
-
- By Christine Williams, North Yorkshire & York Primary Care Trust, Barry Wright, North Yorkshire & York Primary Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 182-190
-
- Chapter
- Export citation
Contributors
-
- By Arthur S. Abramson, Norhaida Aman, Virginie Attina, Sapna Bhat, B. Bhuvaneshwari, Denis Burnham, Brian Byrne, Hsin-Chin Chen, Shyamala K. Chengappa, Chris Davis, Jackson T. Gandour, Winston D. Goh, Thom Huebner, Lixian Jin, Jing Zhou, R. Malatesha Joshi, Benjawan Kasisopa, Jeesun Kim, Christine Kitamura, Ananthanarayan Krishnan, Lay Wah Lee, Elena Lieven, Sudaporn Luksaneeyanawin, Ramesh Mishra, Sonali Nag, Vishnu K. K. Nair, Loraine K. Obler, Tomasina Oh, Richard K. Olson, Prakash Padakannaya, Aparna Pandey, Avanthi Niranjan Paplikar, Shalmalee Pitale, Chaitra Rao, Theeraporn Ratitamkul, Nan Xu Rattanasone, Sunil Kumar Ravi, Rogayah A. Razak, Ronan Reilly, Susan Rickard Liow, Khazriyati Salehuddin, Stefan Samuelsson, Vaijayanthi M. Sarma, Yasuhiro Shirai, Shruti Sircar, John Song, Sabine Stoll, Lidia Suárez, Jennie Tran, Jie-Li Tsai, Kimiko Tsukada, Jyotsna Vaid, Heather Winskel, Janet Wright, Kelly Yeo
- Edited by Heather Winskel, Southern Cross University, Australia, Prakash Padakannaya, University of Mysore, India
-
- Book:
- South and Southeast Asian Psycholinguistics
- Published online:
- 05 December 2013
- Print publication:
- 28 November 2013, pp xvii-xx
-
- Chapter
- Export citation
Effects of a multi-micronutrient-fortified beverage, with and without sugar, on growth and cognition in South African schoolchildren: a randomised, double-blind, controlled intervention
- Christine Taljaard, Namukolo M. Covic, Averalda E. van Graan, Herculina S. Kruger, Cornelius M. Smuts, Jeannine Baumgartner, Jane D. Kvalsvig, Hattie H. Wright, Martha E. van Stuijvenberg, Johann C. Jerling
-
- Journal:
- British Journal of Nutrition / Volume 110 / Issue 12 / 28 December 2013
- Published online by Cambridge University Press:
- 04 July 2013, pp. 2271-2284
- Print publication:
- 28 December 2013
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Little is known about the effects of combined micronutrient and sugar consumption on growth and cognition. In the present study, we investigated the effects of micronutrients and sugar, alone and in combination, in a beverage on growth and cognition in schoolchildren. In a 2 × 2 factorial design, children (n 414, 6–11 years) were randomly allocated to consume beverages containing (1) micronutrients with sugar, (2) micronutrients with a non-nutritive sweetener, (3) no micronutrients with sugar or (4) no micronutrients with a non-nutritive sweetener for 8·5 months. Growth was assessed and cognition was tested using the Kaufman Assessment Battery for Children version II (KABC-II) subtests and the Hopkins Verbal Learning Test (HVLT). Micronutrients decreased the OR for Fe deficiency at the endpoint (OR 0·19; 95 % CI 0·07, 0·53). Micronutrients increased KABC Atlantis (intervention effect: 0·76; 95 % CI 0·10, 1·42) and HVLT Discrimination Index (1·00; 95 % CI 0·01, 2·00) scores. Sugar increased KABC Atlantis (0·71; 95 % CI 0·05, 1·37) and Rover (0·72; 95 % CI 0·08, 1·35) scores and HVLT Recall 3 (0·94; 95 % CI 0·15, 1·72). Significant micronutrient × sugar interaction effects on the Atlantis, Number recall, Rover and Discrimination Index scores indicated that micronutrients and sugar in combination attenuated the beneficial effects of micronutrients or sugar alone. Micronutrients or sugar alone had a lowering effect on weight-for-age z-scores relative to controls (micronutrients − 0·08; 95 % CI − 0·15, − 0·01; sugar − 0·07; 95 % CI − 0·14, − 0·002), but in combination, this effect was attenuated. The beverages with micronutrients or added sugar alone had a beneficial effect on cognition, which was attenuated when provided in combination.
Notes on Contributors
-
- By David Amigoni, Mark Asquith, Jane Bownas, Adelene Buckland, Carolyn Burdett, Pamela Dalziel, Christine DeVine, Tim Dolin, Roger Ebbatson, Trish Ferguson, Shanyn Fiske, Simon Gatrell, Sophie Gilmartin, William Greenslade, Ann Heilmann, Michael Herbert, John Hughes, Rena Jackson, Elizabeth Langland, Sarah E. Maier, Phillip Mallett, Francesco Marroni, Jane Mattisson, Andrew Nash, K. M. Newton, Francis O’Gorman, John Osborne, Patrick Parrinder, Andrew Radford, Fred Reid, Angelique Richardson, Mary Rimmer, Peter Robinson, Dennis Taylor, Jenny Bourne, Jane Thomas, Herbert F. Tucker, Norman Vance, Roger Webster, Rebecca Welshman, Glen Wickens, Melanie Williams, Keith Wilson, T. R. Wright
- Edited by Phillip Mallett, University of St Andrews, Scotland
-
- Book:
- Thomas Hardy in Context
- Published online:
- 05 February 2013
- Print publication:
- 18 March 2013, pp ix-xvi
-
- Chapter
- Export citation
Coupling In-Situ Techniques to Analyze Zinc Deposition and Dissolution for Energy Storage Applications
- Jayme Keist, Christine Orme, Frances Ross, Dan Steingart, Paul Wright, James Evans
-
- Journal:
- MRS Online Proceedings Library Archive / Volume 1491 / 2013
- Published online by Cambridge University Press:
- 25 January 2013, mrsf12-1491-c03-04
- Print publication:
- 2013
-
- Article
- Export citation
-
This investigation describes preliminary results of in-situ analysis of zinc deposition within an ionic liquid electrolyte utilizing electrochemical atomic force microscopy (EC AFM). From the AFM analysis, the morphology of the zinc deposition was analyzed by quantifying the surface roughness using height-height correlation functions. These results will be used to analyze the scattering data obtained from zinc deposition analysis utilizing an electrochemical ultra-small angle x-ray scattering (EC USAXS). The goal of this research is to link the early nucleation and growth behavior to the formation of detrimental morphologies.
Transferring information to an out-of-hours primary care service for patients with palliative care needs: an action research study to improve the use of handover forms
- Anthea Asprey, Suzanne H. Richards, Christine Wright, Clare Seamark, David Seamark, Jane Moxon
-
- Journal:
- Primary Health Care Research & Development / Volume 14 / Issue 1 / January 2013
- Published online by Cambridge University Press:
- 07 February 2012, pp. 7-20
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Aim
To work with service users and providers to optimise the design and implementation of handover forms to support the transfer of information between daytime and out-of-hours primary care services for patients with palliative care needs.
BackgroundThere is a need for improved informational continuity between daytime and out-of-hours primary care services for patients with palliative care needs. Research suggests that while handover forms are vital to ensure continuity of care, they remain underused for such patients. Audit work in an out-of-hours primary care service in South West England identified that their current system of handover forms was underused.
MethodsAn action research study consisting of two phases was undertaken. In phase one, the views of general practitioners and nurses working in the out-of-hours and daytime primary care services (29 health professionals) in Devon (population c.1.4 million) and patients with palliative care needs and their carers (8 participants) were investigated using qualitative interviews and focus group methods. Participants’ views on the content and use of handover forms, and of the systems supporting their generation were sought. In phase two, additional feedback from the health professional stakeholder groups was collected and collaborative work undertaken with the out-of-hours service to implement recommendations emerging from the qualitative research.
FindingsRespondents identified variable use of handover forms and inconsistent practice in terms of: who was responsible for generating and updating forms; when and where they were discussed in primary care; the criteria used to define which patient needed a form; and the information forms should contain. There was uncertainty about how handover forms were used by the out-of-hours service and concerns about incomplete access to forms for certain groups of staff. An action plan to improve the existing system was developed. This included distribution of educational materials (desktop guide, newsletter) to key stakeholders, and the modification of information systems to facilitate the updating of messages and the accessibility of electronic records for previously under-served staff.
Acute effects of elevated NEFA on vascular function: a comparison of SFA and MUFA
- Katie J. Newens, Abby K. Thompson, Kim G. Jackson, John Wright, Christine M. Williams
-
- Journal:
- British Journal of Nutrition / Volume 105 / Issue 9 / 14 May 2011
- Published online by Cambridge University Press:
- 16 December 2010, pp. 1343-1351
- Print publication:
- 14 May 2011
-
- Article
-
- You have access Access
- HTML
- Export citation
-
There is emerging evidence to show that high levels of NEFA contribute to endothelial dysfunction and impaired insulin sensitivity. However, the impact of NEFA composition remains unclear. A total of ten healthy men consumed test drinks containing 50 g of palm stearin (rich in SFA) or high-oleic sunflower oil (rich in MUFA) on separate occasions; a third day included no fat as a control. The fats were emulsified into chocolate drinks and given as a bolus (approximately 10 g fat) at baseline followed by smaller amounts (approximately 3 g fat) every 30 min throughout the 6 h study day. An intravenous heparin infusion was initiated 2 h after the bolus, which resulted in a three- to fourfold increase in circulating NEFA level from baseline. Mean arterial stiffness as measured by digital volume pulse was higher during the consumption of SFA (P < 0·001) but not MUFA (P = 0·089) compared with the control. Overall insulin and gastric inhibitory peptide response was greater during the consumption of both fats compared with the control (P < 0·001); there was a second insulin peak in response to MUFA unlike SFA. Consumption of SFA resulted in higher levels of soluble intercellular adhesion molecule-1 (sI-CAM) at 330 min than that of MUFA or control (P ≤ 0·048). There was no effect of the test drinks on glucose, total nitrite, plasminogen activator inhibitor-1 or endothelin-1 concentrations. The present study indicates a potential negative impact of elevated NEFA derived from the consumption of SFA on arterial stiffness and sI-CAM levels. More studies are needed to fully investigate the impact of NEFA composition on risk factors for CVD.
Contributors
-
- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
-
- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
-
- Chapter
- Export citation
16 - Paediatric liaison
-
- By Barry Wright, Consultant Child and Adolescent Psychiatrist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust, Sebastian Kraemer, MBBS, FRCPsych, Consultant Child and Adolescent Psychiatrist, Whittington Hospital, London, Kate Wurr, MBChB, MRCPsych, Consultant and Honorary Senior Lecturer in Child and Adolescent Psychiatry, Cringlebar, West Leeds CAMHS, NHS Leeds, Christine Williams, Consultant Child Clinical Psychologist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published online:
- 02 January 2018
- Print publication:
- 01 February 2010, pp 151-161
-
- Chapter
- Export citation
-
Summary
‘What is the matter with Mary Jane?
She's perfectly well and she hasn't a pain,
And it's lovely rice pudding for dinner again!
What is the matter with Mary Jane?’
A. A. MilneIntroduction
The first of the five outcomes in Every Child Matters(Department for Children, Schools and Families, 2003), a government aspirational document, is ‘Be healthy’ and clearly refers to ‘enjoying good physical and mental health’. These go hand in hand and services should be integrated to achieve these aspirations.
Children with mental health problems and psychiatric disorders or psychological morbidity frequently present in paediatric clinics and wards. Those with medical disorders have a higher incidence of mental disorders (Green et al, 2004; Hysing et al, 2007). These are sometimes not identified in paediatric services (Slowik & Noronha, 2004) and where they are, paediatricians rarely have the time or training to deal adequately with them (Garralda & Bailey, 1989). Without mental health provision and training, these children's needs will not be addressed. There are initiatives to address training by provision of mental health training specifically for paediatricians (www.rcpch.ac.uk/Education/Education-Courses-and- Programmes/Child-In-Mind) and this should also improve collaboration with paediatric colleagues. The opportunity for early intervention is crucial to prevent longer-term problems or unnecessary paediatric intervention and hospitalisations.
Despite evidence of need and effectiveness, most paediatric departments are still without any meaningful CAMHS input (Woodgate & Garralda, 2006), yet the most pressing need for CAMHS in general (Potter et al, 2005) is for precisely the cases that are found in hospital paediatric and child development departments: children with medical ill health, intellectual disabilities, developmental disorders, autism-spectrum disorders, selfharm, child abuse and comorbid cases. Between a quarter and a half of children in paediatric out-patient clinics have conditions in which psychological factors play a major role (Lask, 1994). Only a quarter of such children are likely to have received any CAMHS help (Glazebrook et al, 2003). The children's NSF recommended paediatric liaison (Department of Health, 2004), and the report on the implementation of Standard 9 of that NSF (Department of Health, 2006) outlines the need for CAMHS paediatric liaison as ‘an essential service for the ill child, siblings, parents and carers in cases where the presenting illness has a psychological component, or where psychological distress is caused as a result of the illness’.
20 - Attentional problems services
-
- By Sarah Bryan, BHSc (Hons) OT, Senior Occupational Therapist, York, Barry Wright, Consultant Child and Adolescent Psychiatrist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust, Christine Williams, Consultant Child Clinical Psychologist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published online:
- 02 January 2018
- Print publication:
- 01 February 2010, pp 191-199
-
- Chapter
- Export citation
-
Summary
‘No fine work can be done without concentration, and self-sacrifice and toil and doubt.’
Max BeerbohmIntroduction
In the UK, ADHD has been shown to be the most common reason for follow-up appointments to be offered by CAMHS (Meltzer et al, 2000). Child and adolescent mental health services are regularly called upon to assess children who have problems with attention, concentration, distractibility, impulsivity, overactivity, regulatory difficulties, or a combination of these. These difficulties may be part of ADHD or may be symptoms of other disorders that mimic the clinical features of ADHD (Hill & Cameron, 1999). Attention-deficit hyperactivity disorder is a condition where the symptom profile and aetiology are regularly being redefined. Comprehensive guidelines from NICE (National Institute for Health and Clinical Excellence, 2006; National Collaborating Centre for Mental Health, 2008) and a large US study, with its recently published follow-up study (MTA Cooperative Group, 1999; Jensen et al, 2007) have also informed good practice. As additional resources have not often generally been forthcoming to support such good practice, existing services may restructure aspects of their functioning in order to form Tier 3 teams.
One way of rationalising resources effectively is to establish interagency links so that multidisciplinary working is not limited by professional boundaries. Some centres have done just this to meet the needs of children with complex problems, including ADHD complicated by comorbid difficulties (Williams et al, 1999). Where there is no coordinated approach to assessment and intervention for children who present with these difficulties, confusion may arise and contradictory advice may be given by different agencies. Parents and carers need to feel confident that professionals are working with them and with other agencies to provide a comprehensive assessment and treatment package for their children. A Tier 3 team within a CAMHS has the advantage of multidisciplinary working, and this facilitates the development of shared learning and understanding, and the evolution of clear protocols (Voeller, 1991). A specific attentional problems clinic can provide assessment, diagnosis, monitoring and a range of ongoing interventions.
18 - Learning disability services
-
- By Christine Williams, Consultant Child Clinical Psychologist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust, Barry Wright, Consultant Child and Adolescent Psychiatrist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published online:
- 02 January 2018
- Print publication:
- 01 February 2010, pp 169-181
-
- Chapter
- Export citation
-
Summary
‘For the world's more full of weeping than we can understand.’
William Butler Yeats (1865–1939)Introduction
Approximately 2–3% of the general population has some form of intellectual disability (Department of Health, 2001). The prevalence of severe intellectual disability (IQ < 50) is 3–4 per 1000, and that of moderate intellectual disability (IQ 50–70) is 30–40 per 1000 (Felce et al, 1994).
There is abundant evidence that children with intellectual disabilities are at significantly increased risk of developing mental health problems (Dykens, 2000; Stromme & Diseth, 2000; Tonge & Einfield, 2000; Emerson, 2003; Whitaker & Read, 2006) and that this affects between 40 and 75% (Corbett, 1985; Gillberg et al, 1986; Wallace et al, 1995). Emerson & Hatton (2007) estimate that children with intellectual disabilities are six times more likely to have a diagnosable psychiatric condition than other children in Britain. They are also at increased risk of having specific disorders such as autism-spectrum disorders (Fombonne, 1998; Emerson & Hatton, 2007) and ADHD (Dykens, 2000). Mental health services for children and young people with an intellectual disability and their families should therefore be readily available and of a high quality. In the UK, the government (Department of Health, 1992) and the Royal College of Psychiatrists (1992) have long recognised this. Despite this and the fact that Standard 8 of the NSF for children states that Local Authorities, primary care trusts and CAMHS must work together to ‘ensure that disabled children have equal access to CAMHS’ (Department for Education and Skills & Department of Health, 2004), only 60% of primary care trusts had commissioned CAMHS for young people with intellectual disabilities in June 2006 (Department for Education and Skills & Department of Health, 2006). This chapter may therefore have a practical role to play as commissioners and services seek to address this gap in service provision.
Organisation of services
It is first necessary to decide where mental health services for children and young people with intellectual disabilities will sit organisationally. Historical models often placed such services within all age services for people with intellectual disabilities. It was argued that this gave rise to good continuity of care. In recent times, dedicated children's services have become accepted as more appropriate.
19 - Services for autism-spectrum disorders
-
- By Christine Williams, Consultant Child Clinical Psychologist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust, Barry Wright, Consultant Child and Adolescent Psychiatrist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published online:
- 02 January 2018
- Print publication:
- 01 February 2010, pp 182-190
-
- Chapter
- Export citation
-
Summary
‘I can't stress enough the importance of early diagnosis because without a diagnosis, without explanation of the way the child is behaving there is nothing you can do, there's no way you can move on … Once a diagnosis has been given, an explanation of why this child is frustrated and behaving this way, then we can begin to put in appropriate strategies for the family and for the child. It makes one huge amount of difference to their lives.’
Dr Judith GouldIntroduction
Autism-spectrum disorders are thought to affect many more people than is generally recognised. It is very difficult to give precise figures about the prevalence of these disorders because of difficulties with diagnosis, use of diagnostic terms and prevalence study methodology. Reviews indicate approximately 60 per 10 000 children under the age of 8 years (Medical Research Council, 2001), but other estimates are around 1 in a 100 children in the UK (Green et al, 2005; Baird et al, 2006).
Children and adolescents with autism show abnormalities in:
• communication and language development
• reciprocal social interaction
• symbolic play
• patterns of interests (the range of interests is restricted, and they centre on repetitive or stereotyped activities).
A number of different disorders appear to overlap, each overlapping area having different characteristics (Fig. 19.1).
Difficulties in each of these areas vary considerably with the age of the child, severity of symptoms and individual differences in the child. The autism spectrum includes the syndromes described by Kanner (1943) and by Asperger (1944), but is wider than these two subgroups (Wing & Gould, 1979). Child and adolescent mental health services are frequently asked to assess children who may have autism; such assessment is complex, as described in Box 19.1.
Box 19.1 Difficulties in assessment
Children and young people with autism-spectrum disorders may present in very different ways at different times.
• The range of intellectual ability extends from severely intellectually disabled to those who are of average or above average intelligence. Similarly, language skills range from those with no language to those who display complex, grammatically correct speech.
• Changes occur with age, especially in those with higher levels of ability; different aspects of the behaviour patterns are more obvious at some ages than at others.
Development of an early intervention to prevent long-term incapacity for work: using an online RAND/UCLA appropriateness method to obtain the views of general practitioners
- Christine Wright, Alice Moseley, Rupatharshini Chilvers, Laura Stabb, John L. Campbell, Suzanne H. Richards
-
- Journal:
- Primary Health Care Research & Development / Volume 10 / Issue 1 / January 2009
- Published online by Cambridge University Press:
- 01 January 2009, pp. 65-78
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Aim
To explore the acceptability amongst general practitioners (GPs) of an early intervention to prevent long-term sickness absence from work and to identify the appropriate broad characteristics of such a service.
BackgroundThe effect of long-term sickness absence from work on individuals and society has been the subject of recent policy debate. In the United Kingdom, a number of return-to-work interventions have been piloted and plans to reform the incapacity benefit system are underway. Since GPs play a key role in the sickness certification process, their views on the appropriateness of an early return-to-work intervention were sought to help inform the development of a primary care-based model.
MethodsA panel of nine GPs from eight practices in a mixed rural/urban area of the South West of England participated in a modified RAND/UCLA appropriateness method (RAM) study. Panellists completed two rounds of an online survey in which they were asked to read a summary of relevant research evidence and then rate the level of appropriateness of providing a return-to-work intervention in a series of clinical scenarios.
FindingsThere was general support for a return-to-work intervention. Panellists considered the intervention would be more appropriate for patients with mild-moderate rather than severe symptoms and for those with longer symptom duration. There was support for early intervention after approximately seven weeks of absence from work, but not before four weeks of absence. The return-to-work intervention was considered most appropriate for patients with repeat or recurrent patterns of sickness absence, rather than those on their first sickness absence period, and for those not already receiving specialist health input for their condition. Panellists considered that a multidisciplinary team providing a combination of biopsychosocial and vocational support would be the most appropriate model, with the service possibly being located outside of a general practice setting.