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The clinical high-risk (CHR) for psychosis paradigm is changing psychiatric practice. However, a widespread confounder, i.e. baseline exposure to antipsychotics (AP) in CHR samples, is systematically overlooked. Such exposure might mitigate the initial clinical presentation, increase the heterogeneity within CHR populations, and confound the evaluation of transition to psychosis at follow-up. This is the first meta-analysis examining the prevalence and the prognostic impact on transition to psychosis of ongoing AP treatment at baseline in CHR cohorts.
Major databases were searched for articles published until 20 April 2020. The variance-stabilizing Freeman-Tukey double arcsine transformation was used to estimate prevalence. The binary outcome of transition to psychosis by group was estimated with risk ratio (RR) and the inverse variance method was used for pooling.
Fourteen studies were eligible for qualitative synthesis, including 1588 CHR individuals. Out of the pooled CHR sample, 370 individuals (i.e. 23.3%) were already exposed to AP at the time of CHR status ascription. Transition toward full-blown psychosis at follow-up intervened in 112 (29%; 95% CI 24–34%) of the AP-exposed CHR as compared to 235 (16%; 14–19%) of the AP-naïve CHR participants. AP-exposed CHR had higher RR of transition to psychosis (RR = 1.47; 95% CI 1.18–1.83; z = 3.48; p = 0.0005), without influence by age, gender ratio, overall sample size, duration of the follow-up, or quality of the studies.
Baseline AP exposure in CHR samples is substantial and is associated with a higher imminent risk of transition to psychosis. Therefore, such exposure should be regarded as a non-negligible red flag for clinical risk management.
By way of context to the detailed analysis of investor–State arbitration conducted in Part III of the textbook, Chapter 10 examines in turn the types of investment-related disputes that can arise and the various dispute settlement mechanisms that can be availed of to settle such disputes. For the types of investment-related disputes, it distinguishes between the different types of State–State disputes and investor–State disputes. For the purpose of examining dispute settlement mechanisms, a distinction is made between the mechanisms made available in international investment agreements (IIAs) to settle investment-related disputes and those that have been used prior to or in parallel to the development of IIA practice to settle ‘single’ disputes or ‘sets’ of disputes. Specific attention is paid to the mechanisms that have been established or contemplated in the 2010s to replace investor–State arbitration in the settlement of investor–State disputes as a reaction to the criticism formulated across civil society against the latter.
Patient suicide is one of the most frequent incidents in healthcare facilities to be reported to the National Observatory of Sentinel Events in Italy. Despite national initiatives, in Tuscany potentially preventable patient suicides still occur in both acute and community care settings. We describe here an aggregated qualitative analysis of 14 patient suicides that took place in public health services between 2017 and 2018. We outline the methodology and results of an improvement action we enacted in the healthcare system that involved reviewing and reinforcing relevant managerial strategies and clinical activities, with the aim of reducing potentially preventable patient suicides.
In the face of technology failures in preventing oil from reaching beaches and coasts after catastrophic oil spills in the 1960s and early 1970s, the oil industry and governmental officials needed to quickly reconsider their idea of prevention. Initially, prevention meant stopping spilled oil from coating beaches and coasts. Exploring the presentations at three oil-spill conferences in 1969, 1971 and 1973, this idea of prevention changed as the technological optimism of finding effective methods met the realities of oil-spill cleanup. By 1973, prevention meant stopping oil spills before they happened. This rapid policy transformation came about because the oil industry could not hide the visual evidence of the source of their technology failures. In this century, as policymakers confront invisible pollutants such as pesticides and greenhouse gases, considering ways to visually show the source of the pollution along with the effects could quicken policy decisions.
Prevention is a central pillar of the ‘Women, Peace and Security’ agenda, a policy architecture governing gender and conflict that is anchored in a suite of United Nations Security Council resolutions adopted under the title of ‘Women and Peace and Security’. In this article, I argue that prevention is currently constituted within the WPS agenda in multiple ways, all of which are organised in accordance with different logics: a logic of peace; a logic of militarism; and a logic of security. This presents prevention as a paradox, because in operation it collapses back into a logic of security, even as it is constructed and positioned as security's temporal and conceptual other. I provide a close reading of the WPS resolutions and show how the articulations of prevention across the agenda, and in certain resolutions, operate according to logics of security and militarism. The significance of such an argument is twofold: it lies both in the possibility of reconstruction of prevention in the WPS agenda according to different logics, and in the potential of undoing security – as the manifestation of prevention in practice – in queer, feminist, decolonial, and posthuman ways of knowing and encountering the world.
International liability and international criminal law are presented as alternatives to the law of state responsibility. Both regimes have developed out of real-life incidents to which state responsibility has not offered a sufficient enough solution. With their respective focus on adequate compensation and the desire to penalize perpetrators for the most serious violations of international law, they represent qualitatively different approaches to state responsibility. A more limited test of functionality is conducted in order to analyze whether the practical utility of these two regimes is higher than concerning the law of state responsibility. Three criteria that are crucial to a well-functioning and practical responsibility regime are explored: social control, collectivity, and signalling effect. The thematic evaluation of the two responsibility regimes shows that in some respects these particularized regimes fare better than state responsibility while also suffering from problems internal to their particular regimes. The core of the matter is that both regimes have their own rationale from which they do not purport to slide.
There has been increased interest in executive function (EF), not only in relation to specific clinical disorders, but also in relation to development and school performance in children and youth who may not have a clinical disorder. EF is associated with self-regulation, effortful control, inhibition, and social-emotional status; deficits in EF may result in maladjustment. Not only predictive of behavioral outcomes, EF is associated with academic performance in both math and reading. With this increased recognition of the importance of EF, approaches to foster development of EF and address EF deficits within a multitiered system of support (MTSS) have been developed. While further research is needed, preliminary results indicate improvements in social-emotional function, behavior, and academic skills, as well as targeted EF skills. The theoretical basis and available research are reviewed, and implications for future research provided.
In this chapter, we examine the theoretical underpinnings of bullying behavior and link bullying to related but distinct forms of aggression. Bullying prevention and intervention strategies are reviewed and the connection between school climate and bullying is reinforced. Prevention and intervention programs that address improving the school climate are necessary but insufficient to effectively reduce bullying. Given that bullying and targeted violence are typically seen as distinct behaviors, the authors suggest that promoting a holistic violence prevention model should replace the individual and often independent approaches for dealing with various forms of aggression and violence. Instead, a comprehensive and coordinated system of assessment, prevention, and intervention will lead to reductions in bullying and other forms of targeted violence. This will require students, teachers, parents, and community stakeholders (i.e., law enforcement, community leaders, politicians) to work together for the holistic health of schools and communities.
Given the individual and societal consequences of teen drug use, prevention efforts have increased in order to help avoid years of the debilitating effects that substance use has on the health and lifespan development of adolescents. Prevention programming focuses on changing adolescents’ existing habits that precede occurrence or worsening of the substance use behavior, whereas cessation intervention efforts focus on disrupting behavior patterns and offering proper treatment. Providing high-quality substance use prevention programs to adolescents requires sound, evidence-based material, implementation fidelity, interactive practitioner involvement, and use of appropriate delivery channels. When implementing these programs, practitioners need to consider the neurobiological, cognitive, social, and environmental aspects of substance use among youth to effectively address crucial time-points and processes during an adolescent’s life, such as puberty. Practitioners should also be aware of emerging threats to adolescents, such as use of marijuana, e-cigarettes, and opioids, and co-occurring substance use and mental disorders.
The constructs now subsumed under the label “internalizing disorders” had garnered the attention of researchers and practitioners long before the recent terminology was coined in the 1980s. Spanning decades of research, intervention, and practice, this chapter describes childhood internalizing disorders by their traits and prevalence, and then highlights the important contribution of factor analysis in marking their scientific evolution. We learn how exposure of the underlying dimensionality of internalizing disorders, along with critical refinements to terminology, precipitated the identification of early (subsyndromal) symptoms of depression and anxiety, and paved the way for the development of assessment scales that would ultimately expand our ability to intervene with precision, refine research, develop methods for prevention, identify moderator variables, and discover the potential of universal screening. The chapter concludes by providing a brief sampler of tools currently in use by practitioners and schools for the treatment, reduction of symptoms, and prevention of internalizing disorders.
Chronic pediatric illnesses are common and they are often educationally consequential. Many chronically ill children experience severe educational impairments. Empirical research on the pediatric illness–schooling interface notwithstanding, theoretical endeavors on the topic are largely missing. This chapter presents a theoretical model comprising four interrelated dimensions. These are the nature and severity of the pediatric illness itself (e.g., asthma, epilepsy), educational challenges common to each illness (e.g., direct neurocognitive effects, uninformed teachers), students’ personal strengths (e.g., emotional resilience), and environmental supports (e.g., social supports at school). These three dimensions are hypothesized to mutually determine the nature and severity of any adverse educational impacts (e.g., academic or attendance problems). The model is abbreviated as P-CSI, to denote Pediatric, Challenges, Strengths/Supports, and Impacts. It is argued that the P-CSI model helps contextualize existing information on prevention and intervention. It may also reveal gaps to be addressed by future research concerning pediatric illnesses at school.
The value of services for those with the ‘At Risk Mental State for Psychosis’ (ARMS) continues to be disputed. ARMS services have provided a valuable stimulus to academic research into the transition into psychosis. Furthermore, there is currently a welcome trend to transform such clinics into youth mental health services catering for the broader clientele of young people suffering from anxiety and depression, who already constitute the bulk of those seen at ARMS clinics. However, such services are never likely to make major inroads into preventing psychosis because they only reach a small proportion of those at risk. Evidence from medicine shows that avoiding exposure to factors which increase the risk of disease (e.g. poor nutrition, transmission of infection, tobacco smoking), produces greater public benefit than focussing efforts on individuals with, or about to develop, disease. We consider that the most productive approach for psychosis prevention is avoiding exposure to risk-increasing factors. The best-established risk factors for psychosis are obstetric events, childhood abuse, migration, city living, adverse life events and cannabis use. Some as city living, are likely proxies for an unknown causal factor(s) while preventing others such as childhood abuse is currently beyond our powers. The risk factor for psychosis which is most readily open to this approach is the use of cannabis. Therefore, as an initial step towards a strategy for universal primary prevention, we advocate public health campaigns to educate young people about the harms of regular use of high potency cannabis.
Sentinel surveillance system plays a key role in screening and monitoring emerging and acute infectious diseases in order to identify the suspected cases in time. During SARS period in 2003, fever clinics emerged in many cities in mainland China with the purpose to screen the suspected SARS patients and to transfer the confirmed cases to designated hospitals for professional management. Shanghai city has reserved the fever clinics and the designated hospitals since then. Hence, clinicians in the front line are able to respond quickly to the emerging COVID-19 outbreak with their accumulated knowledge and experiences from the past. One hundred seventeen fever clinics distributed in various district areas in Shanghai have played a vital ‘sentinel’ role to fight against the COVID-19 epidemic. Most of suspected patients were identified in fever clinics and thereafter among these suspected patients the COVID-19 cases were confirmed and were isolated quickly to avoid the spread. We would like to share the sentinel roadmap for screening and diagnosis of COVID-19 to medical healthcare workers around the world, especially countries who are facing great challenges to cope with COVID-19 and meanwhile with limited medical resources. These sentinel surveillance strategies will certainly provide insight into the early detection and timely isolation of suspected cases from the others.
One in six adolescents suffers from mental health problems. Despite the presence of general information on Italian adolescents' mental health, researches conducted with standardized assessment tools are scarce in the literature. We evaluated the prevalence of self-reported behavioral and emotional problems in a group of Italian adolescents and examined their relation to socio-demographical variables.
This population-based sampling survey was conducted on high school students aged 14–18 from urban areas of Rome and Latina. Participants completed Youth Self-Report (YSR) and a socio-demographic schedule to collect information on age, gender, type of school attended, socio-economic status, urbanicity.
Final sample consisted of 1400 adolescents (38.61% male, mean age 16 years, s.d. 1.42). Prevalence of Internalizing Problems, Externalizing Problems and Total Problems was 29.55%, 18.34% and 24.13%. In our multivariable model, Internalizing Symptoms were not explained by sociodemographic variables while Externalizing Symptoms were explained by Male Gender [OR = 1.53 (1.14–2.06)], older age [OR = 2.06 (1.52–2.79)] and attending a Technical and Professional Institute [OR = 2.15 (1.53–3.02)], with an adjusted R2 = 4.32%. Total Problems were explained by School Type [Technical and Professional Institutes and Art and Humanities v. Grammar and Science School; OR respectively 1.93 (1.40–2.67) and 1.64 (1.08–2.47)], adjusted R2 = 1.94.
The study provides, for the first time, evidence of a great prevalence of self-reported behavioral and emotional problems in a large sample of Italian adolescents, highlighting the role of different socio-demographic variables as risk factors for externalizing behaviors. Our results emphasize the urgent need for implementing prevention programs on mental health in adolescence.
In the past two decades, the emergence of Novel Psychoactive Substances (NPS) has changed the face of drug markets. Synthetic cathinones, synthetic cannabinoid receptor agonists, novel synthetic opioids, tryptamines, and piperazines became popular alternatives to illicit drugs, primarily because of their easy availability, low price, and intense effects. Analogous NPS are also often misold as traditional drugs due to the often broader profit margins and lower criminal risk profile associated with them. This chapter aims to provide an overview of the epidemiology, user and consumption characteristics, toxicity, and pharmacokinetics of the most proliferate NPS, alongside an introduction to effective prevention and treatment methods for both adolescent and adult populations of NPS users.
To collect and summarise all current data from observational studies, generating evidence of the association between health literacy (HL) and the dietary intake of sugar, salt and fat, to analyse intervention studies on the promotion of an appropriate dietary intake of the above-mentioned nutrients and to ascertain whether HL moderates the efficacy of such intervention.
A systematic literature search of analytical observational studies on the association between HL and dietary intake of sugar, salt and fat was performed in Medline and Scopus databases. Intervention studies on the promotion of healthy nutrition that concerned the intake of sugar, salt and fat were also assessed.
Of the eight observational studies included in this review, five investigated dietary intake of sugar, one focused on salt, one assessed sugar and salt and one analysed the fat intake. The results of the five studies assessing sugar were mixed: three found an association between low levels of HL and a high sugar intake, one found this association only for boys and two found no evidence of any association. The two studies assessing salt and the one assessing fat found no evidence of any association with HL. One intervention study on the sugar intake concluded that HL was not a significant moderator of the intervention’s effectiveness.
No evidence of any association between HL and salt and fat intake emerged, while for sugar, the results are mixed. More work is needed to better understand the moderating effects of HL on the outcomes of health promotion interventions.
What are the philosophical arguments justifying limited strikes? This essay, as part of the roundtable “The Ethics of Limited Strikes,” adopts a French perspective both because France is, along with the United States and the United Kingdom, one of the states that launched such limited strikes in recent years, and because it developed a limited warfare ethos. There is something specific about such an ethos that makes it particularly receptive to the jus ad vim framework and, therefore, to the issue of limited strikes. This essay also builds on the case of the use (or threat) of limited force in Syria as a response to the country's use of chemical weapons between 2013 and 2018. Presented as a way to “punish” the Syrian regime as much as to “deter” it from using chemical weapons again, these limited strikes are a good illustration of the traditional retributive/preventive dichotomy of penal philosophy. I argue that the moral justification of those strikes should be guided by a consequentialist ethic, preventive rather than retributive. From a consequentialist perspective, limited strikes are justified when they “work”—that is, when they have a deterrent/compellent effect. For that to happen, they need to be credible and imply the potential of an escalation; the challenge being to keep the escalation under control. Carrying the risk of inefficacy at one end of the spectrum and of escalation at the other, limited strikes are indeed a matter of balance.
Alcohol and other substance use problems are common, and the efficacy of current prevention and intervention programs is limited. Genetics may contribute to differential effectiveness of psychosocial prevention and intervention programs. This paper reviews gene-by-intervention (G×I) studies of alcohol and other substance use, and implications for integrating genetics into prevention science. Systematic review yielded 17 studies for inclusion. Most studies focused on youth substance prevention, alcohol was the most common outcome, and measures of genotype were heterogeneous. All studies reported at least one significant G×I interaction. We discuss these findings in the context of the history and current state of genetics, and provide recommendations for future G×I research. These include the integration of genome-wide polygenic scores into prevention studies, broad outcome measurement, recruitment of underrepresented populations, testing mediators of G×I effects, and addressing ethical implications. Integrating genetic research into prevention science, and training researchers to work fluidly across these fields, will enhance our ability to determine the best intervention for each individual across development. With growing public interest in obtaining personalized genetic information, we anticipate that the integration of genetics and prevention science will become increasingly important as we move into the era of precision medicine.
Alcohol use disorder (AUD) is common and associated with increased risk of suicide.
To examine healthcare utilisation prior to suicide in persons with AUD in a large population-based cohort, which may reveal opportunities for prevention.
A national cohort study was conducted of 6 947 191 adults in Sweden in 2002, including 256 647 (3.7%) with AUD, with follow-up for suicide through 2015. A nested case–control design examined healthcare utilisation among people with AUD who died by suicide and 10:1 age- and gender-matched controls.
In 86.7 million person-years of follow-up, 15 662 (0.2%) persons died by suicide, including 2601 (1.0%) with AUD. Unadjusted and adjusted relative risks for suicide associated with AUD were 8.15 (95% CI 7.86–8.46) and 2.22 (95% CI 2.11–2.34). Of the people with AUD who died by suicide, 39.7% and 75.6% had a healthcare encounter <2 weeks or <3 months before the index date respectively, compared with 6.3% and 25.4% of controls (adjusted prevalence ratio (PR) and difference (PD), <2 weeks: PR = 3.86, 95% CI 3.50–4.25, PD = 26.4, 95% CI 24.2–28.6; <3 months: PR = 2.03, 95% CI 1.94–2.12, PD = 34.9, 95% CI 32.6–37.1). AUD accounted for more healthcare encounters within 2 weeks of suicide among men than women (P = 0.01). Of last encounters, 48.1% were in primary care and 28.9% were in specialty out-patient clinics, mostly for non-psychiatric diagnoses.
Suicide among persons with AUD is often shortly preceded by healthcare encounters in primary care or specialty out-patient clinics. Encounters in these settings are important opportunities to identify active suicidality and intervene accordingly in patients with AUD.
The burden of disease attributable to alcohol and other drug (AOD) use in young people is considerable. Prevention can be effective, yet few programs have demonstrated replicable effects. This study aimed to replicate research behind Climate Schools: Alcohol and Cannabis course among a large cohort of adolescents.
Seventy-one secondary schools across three States participated in a cluster-randomised controlled trial. Year 8 students received either the web-based Climate Schools: Alcohol and Cannabis course (Climate, n = 3236), or health education as usual (Control, n = 3150). Outcomes were measured via self-report and reported here for baseline, 6- and 12-months for alcohol and cannabis knowledge, alcohol, cannabis use and alcohol-related harms.
Compared to Controls, students in the Climate group showed greater increases in alcohol- [standardised mean difference (SMD) 0.51, p < 0.001] and cannabis-related knowledge (SMD 0.49, p < 0.001), less increases in the odds of drinking a full standard drink[(odds ratio (OR) 0.62, p = 0.014], and heavy episodic drinking (OR 0.49, p = 0.022). There was no evidence for differences in change over time in the odds of cannabis use (OR 0.57, p = 0.22) or alcohol harms (OR 0.73, p = 0.17).
The current study provides support for the effectiveness of the web-based Climate Schools: Alcohol and Cannabis course in increasing knowledge and reducing the uptake of alcohol. It represents one of the first trials of a web-based AOD prevention program to replicate alcohol effects in a large and diverse sample of students. Future research and/or adaptation of the program may be warranted with respect to prevention of cannabis use and alcohol harms.