Age Of First Contact Research Articles

Access to early diagnosis for attention-deficit/hyperactivity disorder among children and adolescents in Mexico City at specialized mental health services

BackgroundIn Mexico, this pioneering research was undertaken to assess the accessibility of timely diagnosis of Dyads [Children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and their primary caregivers] at specialized mental health services. The study was conducted in two phases. The first phase involved designing an “Access Pathway” aimed to identify barriers and facilitators for ADHD diagnosis; several barriers, with only the teacher being identified as a facilitator. In the second phase, the study aimed to determine the time taken for dyads, to obtain a timely diagnosis at each stage of the Access Pathway. As well as identify any disparities based on gender and socioeconomic factors that might affect the age at which children can access a timely diagnosis.MethodIn a retrospective cohort study, 177 dyads participated. To collect data, the Acceda Survey was used, based on the robust Conceptual Model Levesque, 2013. The survey consisted of 48 questions that were both dichotomous and polytomous allowing the creation of an Access Pathway that included five stages: the age of perception, the age of search, the age of first contact with a mental health professional, the age of arrival at the host hospital, and the age of diagnosis. The data was meticulously analyzed using a comprehensive descriptive approach and a nonparametric multivariate approach by sex, followed by post-hoc Mann-Whitney’s U tests. Demographic factors were evaluated using univariable and multivariable Cox regression analyses.Results71% of dyads experienced a late, significantly late, or highly late diagnosis of ADHD. Girls were detected one year later than boys. Both boys and girls took a year to seek specialized mental health care and an additional year to receive a formal specialized diagnosis. Children with more siblings had longer delays in diagnosis, while caregivers with formal employment were found to help obtain timely diagnoses.ConclusionsOur findings suggest starting the Access Pathway where signs and symptoms of ADHD are detected, particularly at school, to prevent children from suffering consequences. Mental health school-based service models have been successfully tested in other latitudes, making them a viable option to shorten the time to obtain a timely diagnosis.

Mastering English Multiple Adjectives Ordering among Early versus Late Second Language Speakers: Evidence from Arabic-English Bilinguals

Recent research has shown that learners demonstrate huge variability in second language (L2) end-state attainment. While some L2 learners attain native-like command, others only attain an undeveloped command and some stuck in between. It is also assumed that early learners often surpass owing to Lenneberg’s Critical Period Hypothesis (1967) that proposes that early onset often advance L2 development. This study investigates the extent to which, age is associated with mastering the target language among late versus early Arabic-English bilinguals. Specifically, this study concerns itself with the issue of how Arabic-English bilinguals typically perceive the right ordering of multiple consecutive adjectives (e.g., the small yellow bird). A considerable amount of literature has established that L2 learners encounter challenges in mastering the right sequence of adjectives, particularly when there are several adjectives modifying a single noun. To determine how Arabic-learners of English perceive English descriptive adjective orderings, this study observes whether an earlier age of first contact with English enhances the learners’ accuracy and the reaction time. To test this assumption, the intuitions of two groups of early (n=8) vs. late (n=8) Arabic-English bilinguals in the United Kingdom (i.e. Leeds) were compared for English descriptive adjective ordering preferences through a Speeded Acceptability Judgment Task (SAJT). The participants were requested to show their ordering preferences for a couple of multi-adjective strings (n=16). The findings suggested that early Arabic-English bilinguals significantly outperformed late Arabic-English bilinguals in terms of exhibiting native-like ordering preferences. The study concludes that early exposure is more likely to facilitate mastering the target system and that it generally accelerates L2 development. This study also concludes that accuracy and response time may reflect the L2 development. The study suggests a number of pedogeological implications for teaching and learning an L2.

Self-harm and suicidal ideation among young people is more often recorded by child protection than health services in an Australian population cohort.

We investigated patterns of service contact for self-harm and suicidal ideation recorded by a range of human service agencies - including health, police and child protection - with specific focus on overlap and sequences of contacts, age of first contact and demographic and intergenerational characteristics associated with different service responses to self-harm. Participants were 91,597 adolescents for whom multi-agency linked data were available in a longitudinal study of a population cohort in New South Wales, Australia. Self-harm and suicide-related incidents from birth to 18 years of age were derived from emergency department, inpatient hospital admission, mental health ambulatory, child protection and police administrative records. Descriptive statistics and binomial logistic regression were used to examine patterns of service contacts. Child protection services recorded the largest proportion of youth with reported self-harm and suicidal ideation, in which the age of first contact for self-harm was younger relative to other incidents of self-harm recorded by other agencies. Nearly 40% of youth with a health service contact for self-harm also had contact with child protection and/or police services for self-harm. Girls were more likely to access health services for self-harm than boys, but not child protection or police services. Suicide prevention is not solely the responsibility of health services; police and child protection services also respond to a significant proportion of self-harm and suicide-related incidents. High rates of overlap among different services responding to self-harm suggest the need for cross-agency strategies to prevent suicide in young people.

Does early drug use-related police contact predict premature mortality and morbidity: A population register-based study.

IntroductionThe aim was to analyse whether age at first drug offense predicts premature mortality and morbidity due to substance use and violence among adolescents and young adults.MethodsA prospective longitudinal register‐linkage study based on a total population sample from Finland including individuals born between 1987 and 1992 and aged 15–25 years during follow‐up in 2002–2017 (n = 386 435). Age‐specific rates of deaths and health‐care admissions (morbidity) during a 5‐year follow‐up were calculated from the first drug offense. Cox regression models were used to estimate differences in mortality and morbidity at ages 21–25.ResultsOf all 15‐ to 20‐year‐olds, 1.4% (n = 5540) have had a police contact. The 5‐year mortality rates (per 1000 person‐years) among those with first drug offense at ages 15–16 was 2.92 [95% confidence interval (CI) 1.56–6.18], and 5.26 (CI 4.00–7.07) and 5.05 (CI 4.06–6.38) at ages 17–18, and 19–20, respectively. The rates of morbidity varied between 61.20 (CI 52.43–71.76) and 87.51 (CI 82.11–93.33). Both mortality and morbidity rates were over 10 times higher than among the general population. In models adjusted for family background, first police contact at an early age (15–16) did not increase the risk of mortality at ages 21–25 compared with first police contact at ages 17–18 (hazard ratio 1.55, CI 0.77–3.09) or 19–20 (hazard ratio 1.52, CI 0.78–2.98). The results were similar for morbidity.Discussion and ConclusionsAdolescents with drug‐related police contacts have high risk of mortality and morbidity due to substance use and violence regardless of age of first contact.

Educational and health outcomes of schoolchildren in local authority care in Scotland: A retrospective record linkage study.

BackgroundLooked after children are defined as children who are in the care of their local authority. Previous studies have reported that looked after children have poorer mental and physical health, increased behavioural problems, and increased self-harm and mortality compared to peers. They also experience poorer educational outcomes, yet population-wide research into the latter is lacking, particularly in the United Kingdom. Education and health share a bidirectional relationship; therefore, it is important to dually investigate both outcomes. Our study aimed to compare educational and health outcomes for looked after children with peers, adjusting for sociodemographic, maternity, and comorbidity confounders.Methods and findingsLinkage of 9 Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions, unemployment, and looked after children provided retrospective data on 715,111 children attending Scottish schools between 2009 and 2012 (13,898 [1.9%] looked after). Compared to peers, 13,898 (1.9%) looked after children were more likely to be absent (adjusted incidence rate ratio [AIRR] 1.27, 95% confidence interval [CI] 1.24 to 1.30) and excluded (AIRR 4.09, 95% CI 3.86 to 4.33) from school, have special educational need (SEN; adjusted odds ratio [AOR] 3.48, 95% CI 3.35 to 3.62) and neurodevelopmental multimorbidity (AOR 2.45, 95% CI 2.34 to 2.57), achieve the lowest level of academic attainment (AOR 5.92, 95% CI 5.17 to 6.78), and be unemployed after leaving school (AOR 2.12, 95% CI 1.96 to 2.29). They were more likely to require treatment for epilepsy (AOR 1.50, 95% CI 1.27 to 1.78), attention deficit hyperactivity disorder (ADHD; AOR 3.01, 95% CI 2.76 to 3.27), and depression (AOR 1.90, 95% CI 1.62 to 2.22), be hospitalised overall (adjusted hazard ratio [AHR] 1.23, 95% CI 1.19 to 1.28) for injury (AHR 1.80, 95% CI 1.69 to 1.91) and self-harm (AHR 5.19, 95% CI 4.66 to 5.78), and die prematurely (AHR 3.21, 95% CI 2.16 to 4.77). Compared to children looked after at home, children looked after away from home had less absenteeism (AIRR 0.35, 95% CI 0.33 to 0.36), less exclusion (AIRR 0.63, 95% CI 0.56 to 0.71), less unemployment (AOR 0.53, 95% CI 0.46 to 0.62), and better attainment (AIRR 0.31, 95% CI 0.23 to 0.40). Therefore, among those in care, being cared for away from home appeared to be a protective factor resulting in better educational outcomes. The main limitations of this study were lack of data on local authority care preschool or before 2009, total time spent in care, and age of first contact with social care.ConclusionsLooked after children had poorer health and educational outcomes than peers independent of increased neurodevelopmental conditions and SEN. Further work is required to understand whether poorer outcomes relate to reasons for entering care, including maltreatment and adverse childhood events, neurodevelopmental vulnerabilities, or characteristics of the care system.

Applying Offending Trajectory Analyses to Men Adjudicated for Child Sexual Exploitation Material Offenses

We applied offending trajectory analyses to 387 men adjudicated for child sexual exploitation material (CSEM) offenses. After an average of 20 years, we found two trajectories of sexual offending and violent offending: one that peaked in late adolescence and was associated with higher rates of crimes, and one that peaked in the 30s and was associated with a lower rate of crime. We found four trajectories when modeling any crime. The findings highlight the heterogeneity of men with CSEM offenses. Although lifelong patterns of numerous sexual crimes were uncommon, men with more sexual crimes had greater indicators of sexual interest in children and a younger age of first contact with police. CSEM offenses were rarely the first offense in their criminal trajectories. As such, early intervention targeting youth before they are further advanced in their criminal careers may also reduce future CSEM offending.

Consequences of alcohol use, and its association with psychological distress, sensitivity to emotional contagion and age of onset of alcohol use, in Uruguayan youth with or without college degree.

Psychological distress can promote alcohol consumption during emerging adulthood. Still unknown is, however, how predisposition to emotional contagion alters psychological distress, and how these phenomena are affected by level of education. The present study analyzed the effect of psychological distress, age of first contact with alcohol (early, late), and predisposition to emotional contagion on alcohol-induced negative consequences and on the volume of alcohol consumed during the last year. We also described alcohol-use behaviors as a function of sex, maximum level of education and age of first contact with alcohol, in 1505 youth from Uruguay (18-30 years). A survey measured alcohol use (Alcohol Use Disorders Identification Test and ad-hoc questionnaire), negative consequences of alcohol use [young adult alcohol consequences questionnaire (YAACQ)], psychological distress (Kessler scale) and proclivity to emotional contagion (Doherty Emotional contagion scale). The patterns of alcohol use were greater in men vs. women and in those featuring an early age of first alcohol use, yet similar in college and non-college graduates. Early drinkers had greater levels of psychological distress than late-onset drinkers. There was a significant bivariate and multiple correlation between psychological distress and the number of negative consequences of alcohol experienced during the last year, which remained significant even after controlling for total volume of alcohol consumed. Significant associations emerged between YAACQ scores and frequency of heavy episodic or binge drinking, and between psychological distress and emotional contagion, but not between emotional contagion and any of the remaining variables. Psychological distress was not significantly correlated with heavy episodic or binge drinking. The study indicates that, during adolescence and youth, psychological distress is associated with experiencing negative consequences of alcohol consumption. The study also suggested that greater levels of psychological distress may underlie the facilitating effect of an early age of drinking onset upon alcohol drinking patterns.

Treatment of alcohol dependence. Alcohol and the young: social point of view.

Adolescents are the most vulnerable group for alcohol-related diseases, as starting to drink at a young age is associated with an increased risk of alcohol dependence in adulthood. Young people tend to drink large amounts of alcohol to seek out strong emotions and for reaching fun at all costs through the psychotropic properties of alcohol. The behavioural motivations of this kind of drinking (binge drinking) depend on the lack of awareness of the harmful effects of alcohol, in the rite of social conviviality (a condition for which alcohol is attributed to the function of facilitating the aggregation among young people), in the absence of personal interests, lack of controls and family habits. Actions to be taken to limit or stop harmful alcohol consumption in young people should be based on interventions aimed at delaying the age of first contact with alcoholic beverages through the implementation of educational campaigns aimed at young people, their families and the whole society.

Trauma exposure and undetected posttraumatic stress disorder among adults with a mental disorder.

Trauma exposure and posttraumatic stress disorder (PTSD) are common among individuals with a mental disorder, but symptoms often go undetected and untreated. The aim of this study was to determine the prevalence of PTSD among a large sample of adults with psychiatric diagnoses and to establish factors associated with symptoms going undetected. Participants were 1,946 adults recruited by the National Centre for Mental Health. Structured interviews and validated self-report questionnaires were used to ascertain clinical and demographic information for analysis. The prevalence of participants screening positive for PTSD that had not been detected by clinical services was 13.9% [12.4-15.5%, 95% confidence interval]). Factors associated with undetected PTSD were female gender, younger age of first contact with psychiatric services, and lower household income. Especially, poor rates of detection were observed after traumatic events, such as child abuse and sexual assault. Our findings demonstrate the need for routine assessment of trauma histories and symptoms of PTSD among individuals with anymental disorder.

Internet Use and Access, Behavior, Cyberbullying, and Grooming: Results of an Investigative Whole City Survey of Adolescents.

BackgroundAccording to the Digital Agenda for Europe, the way children use the Internet and mobile technologies has changed dramatically in the past years.ObjectiveThe aims of this study were to: (1) breakdown the modalities of access and use of the Internet by teenagers to assess risks and risky behaviors; and (2) provide scientific data to evaluate and counsel safe use of the Internet and new technologies by teenagers.MethodsThe study was conducted under the program “Strategies for a Better Internet for Children” started in May 2012 by the European Commission. It represents the main result of the project launched by Telecom Italia, “Anche io ho qualcosa da dire” (I too have something to say), thanks to which many contributions were collected and used to develop a survey. The questionnaire was structured in 45 questions, covering three macro areas of interest. It was approved by the Department Board at University of Magna Graecia’s School of Medicine. After authorization from the regional high school authority, it was administered to all 1534 students (aged 13-19 years) in the city of Catanzaro, Italy.ResultsThe data was broken down into three main groups: (1) describing education and access to the Internet; (2) methods of use and social networking; and (3) perception and evaluation of risk and risky behaviors. Among noteworthy results in the first group, we can mention that the average age of first contact with information technologies was around 9 years. Moreover, 78.87% (1210/1534) of the interviewed students reported having access to a smartphone or a tablet. Among the results of the second group, we found that the most used social networks were Facebook (85.78%, 1316/1534), YouTube (61.14%, 938/1534), and Google+ (51.56%, 791/1534). About 71.31% (1094/1534) of the interviewed teenagers use their name and surname on social networks, and 40.09% (615/1534) of them knew all their Facebook contacts personally. Among the results of the third group, we found that 7.69% (118/1534) of the interviewed teenagers have uploaded pictures or movies of which they felt ashamed; 27.05% (415/1534) have received invitations from people they met on the Internet to meet in real life; and 8.67% (133/1534) have accepted such invitations.ConclusionsThe results offer a breakdown of the teenagers’ use of the Internet, focusing on how teenagers learn to use and access it while taking into account factors such as parental coaching, schooling, or self-education. It describes how they approach and interact with social networks and how they perceive risks and risky behaviors on the Internet. Information technology must be seen as an instrument and not as a hindrance. For this to happen, parental guidance, schooling, and medical counseling are needed for a sound development of the child in this critical stage.

The Inventory of Callous–Unemotional Traits: Psychometric properties among referred and non-referred Portuguese female juveniles

The presence of callous–unemotional (CU) traits delineates a subgroup of male youth with severe conduct disorder and antisocial behavior, but little research has been done among female youth. Drawing on 377 female adolescents (103 selected from forensic settings and 274 selected from school settings) from Portugal, the current study is the first to simultaneously examine the psychometric properties of the Inventory of Callous–Unemotional Traits (ICU) in incarcerated female youth and community youth. The results support the use of the ICU in terms of its factor structure, and internal consistency despite the fact an item had to be removed from the Callousness dimension. Statistically significant positive associations were found with measures of psychopathic traits and aggression, as well as non-significant associations with empathy and social anxiety. Significant associations were also found with several indicators of delinquent careers including age of criminal onset, age of first contact with the law, Conduct Disorder symptoms and diagnosis, crime seriousness, previous violent offending, number of criminal charges, alcohol use, and drug use. Findings are discussed in terms of the use of the ICU among female juvenile offenders and community youths.

Two distinct patterns of treatment resistance: clinical predictors of treatment resistance in first-episode schizophrenia spectrum psychoses.

Clozapine remains the only evidence-based antipsychotic for treatment-resistant schizophrenia (TRS). The ability to predict which patients with their first onset of schizophrenia would subsequently meet criteria for treatment resistance (TR) could help to diminish the severe functional disability which may ensue if TR is not recognized and correctly treated. This is a 5-year longitudinal assessment of clinical outcomes in a cohort of 246 first-episode schizophrenia spectrum patients recruited as part of the NIHR Genetics and Psychosis (GAP) study conducted in South London from 2005 to 2010. We examined the relationship between baseline demographic and clinical measures and the emergence of TR. TR status was determined from a review of electronic case records. We assessed for associations with early-, and late-onset TR, and non-TR, and differences between those TR patients treated with clozapine and those who were not. Seventy per cent (n = 56) of TR patients, and 23% of the total study population (n = 246) were treatment resistant from illness onset. Those who met criteria for TR during the first 5 years of illness were more likely to have an early age of first contact for psychosis (<20 years) [odds ratio (OR) 2.49, 95% confidence interval (CI) 1.25-4.94] compared to those with non-TR. The relationship between an early age of first contact (<20 years) and TR was significant in patients of Black ethnicity (OR 3.71, 95% CI 1.44-9.56); and patients of male gender (OR 3.13 95% CI 1.35-7.23). For the majority of the TR group, antipsychotic TR is present from illness onset, necessitating increased consideration for the earlier use of clozapine.

Childhood body mass index and risk of schizophrenia in relation to childhood age, sex and age of first contact with schizophrenia

Childhood leanness is associated with an increased risk of schizophrenia, but the effects of gender, age at anthropometric measurements and age at first diagnosis on this relationship are unclear. The present study aimed at elucidating these associations. MethodsPopulation-based cohort study with childhood anthropometric measures obtained annually from the age of 7 to 13 years in 253,353 Danes born 1930–1976 and followed to 31 December 2010. During this period, 4936 were registered with schizophrenia. The associations of childhood BMI with risk of schizophrenia were estimated with Cox regression models. ResultsChildhood BMI was significantly inversely associated with risk of schizophrenia, however with different patterns among boys and girls. In boys, childhood BMI had an inverse non-linear association with schizophrenia risk dependent on age at diagnosis; in particular, a surprisingly strong association was found between leanness and later onset of schizophrenia. In girls, the risk of schizophrenia decreased linearly with increasing BMI z-score (HR: 0.93; 95% CI: 0.88–0.98). In both boys and girls, birth weight was inversely associated with later risk. In girls, but not in boys, birth weight appeared to significantly modify the associations; there was a somewhat stronger inverse association in the lowest birth weight category. ConclusionBirth weight as well as childhood BMI at ages 7 through 13 years is associated with risk of schizophrenia in both genders, but with a particular high risk of late-onset in lean boys irrespective of birth weight, and in lean girls with low birth weight. If replicated, these observations may inform preventive efforts build on schizophrenia trajectories rooted in early life.

Dairy heifers benefit from the presence of an experienced companion when learning how to graze

Pasture remains important on many dairy farms, but the age of first contact with pasture varies depending on the month of birth, weaning age, and farm management. Regardless of age, naïve dairy heifers must learn to graze when first introduced to pasture. This study investigated whether being grouped with experienced dairy cows would affect the development of grazing behaviors. Sixty-three Holstein heifers (mean ± SD 14.2±1.3 mo; 546±60.7kg) and 21 dry Holstein cows (2.6±0.8 lactations; 751±53.9kg) were assigned into 7 groups of 12 animals (3 dry cows and 9 naïve heifers), and each was divided and assigned to an experienced (3 cows and 3 heifers) and nonexperienced (6 heifers) sub-group. Sub-groups were introduced to pasture in different paddocks without visual contact with any other cattle. No difference was found in the time after introduction to the paddock for heifers to first attempt to nibble grass [experienced: 0:23 (0:17–0:43) vs. nonexperienced 0:40 (0:35–0:46); median (quartile 1 − quartile 3), h:mm]. However, heifers grouped with experienced cows showed a shorter latency to begin grazing [experienced: 0:47 (0:28–00:52) vs. nonexperienced 2:13 (1:25–2:30)]. During the first hour after introduction to pasture, heifers in the experienced treatment showed fewer stomping events [experienced: 2.5 (1.25–4) vs. nonexperienced: 6.5 (4–8)] and vocalized less often [experienced: 3.5 (1.25–5.75) vs. nonexperienced: 7 (5–8.75)]. After this initial period, animals in both subgroups began to graze normally; treatments did not differ in grazing behaviors over the 3-d observation period. These results indicate that grouping heifers with pasture-experienced cows improves grazing behavior of dairy heifers in the first hours following introduction to pasture.

Initial predictors of outcome in an early intervention in psychosis service

The aims of this study were to determine medium-term outcomes of a cohort of early intervention service users after discharge from the service. Additionally, to establish whether characteristics can be easily identified in the early stages of treatment to predict outcome, aid discharge planning and focus interventions. One hundred fifty-five early intervention service users were followed-up for a mean of 4.6 years from the start of early intervention treatment. Patients were divided into good and poor outcome groups and these groups were compared on gender, duration of untreated psychosis, age at first presentation to mental health services, hospital admissions in the first year and time spent on the waiting list. A third of the patients had a good outcome, with a discharge to primary care and no subsequent return to mental health services. Good outcome was associated with a later age of first contact with mental health services and fewer hospital admissions in the first year of treatment. We would suggest that clinicians working in this and similar services could use these two factors as early as one year into treatment to begin to consider discharge planning, or conversely to focus resources most appropriately on those likely to benefit most or those who have the greatest predicted need. This study supports an optimist view of prognosis for a significant proportion of first-episode psychosis patients.

Hábitos alcoólicos e protecção cardiovascular no Centro de Saúde de Barão do Corvo

Objectivos: Caracterizar habitos de consumo de bebidas alcoolicas dos utentes utilizadores do Centro de Saude Barao do Corvo (CSBC) e verificar se existe associacao entre habitos alcoolicos moderados e o risco global cardiovascular (RGC), calculado pelas tabelas SCORE. Tipo de estudo: Estudo observacional, transversal e analitico. Local: Ambulatorio de medicina geral e familiar. Populacao do estudo: utentes utilizadores do CSBC com idade ³ a 18 anos. Metodos: Colheita de dados atraves de entrevista pessoal, em Maio e Junho de 2007, no CSBC,Vila Nova de Gaia. Amostra de conveniencia (n=502). Usado o teste c2. Nivel de significância: 0,05. Resultados: 51,8% dos inquiridos consumiram alcool alguma vez na vida, e 46% no ultimo ano. O consumo e maior entre o sexo masculino, individuos mais idosos, reformados, viuvos e com escolaridade inferior ao 3o ciclo. 63,7% dos inquiridos iniciaram o consumo antes dos 20 anos. 39,6% eram consumidores moderados, e 6,8% consumidores pesados. A proporcao de inquiridos com RGC superior a 5% aumenta com o consumo de alcool. Conclusao:Comparando com a populacao portuguesa, verifica-se menor consumo de alcool alguma vez na vida (51,8% vs 76%) e no ultimo ano (46% vs 59%). Como na populacao portuguesa, a idade do primeiro contacto situa-se maioritariamente entre os 15 e os 19 anos.A duracao media do consumo e superior a da populacao portuguesa. Os resultados apoiam a hipotese da curva dose-resposta para o consumo de bebidas alcoolicos ser em J e nao em U.Assim, parece mais prudente nao aconselhar o consumo de alcool pelos seus beneficios cardiovasculares e recomendar a diminuicao deste consumo aos consumidores habituais.

Factors associated with multiple re-admission to a psychiatric hospital

Background: Previous studies have attempted to identify various demographic and associated factors which place psychiatric service users at risk of re-admission to a psychiatric hospital following discharge.Aims: To conduct a 2-year follow-up of a group of patients who had been admitted to a psychiatric ward and to investigate possible variables that could determine readmission to hospital.Method: A cross sectional and a two year longitudinal design were used.Results: “Revolving-door” service users were more likely to be taking medication, were younger at age of first contact with services, and had been using services for longer. They were also more likely to be living in council housing, which is, housing provided by and subsidised by local government, and have a diagnosis of affective disorder. There were no differences between the previous cohort and the current sample in terms of demographics, and history of contact with services. A larger proportion of service users met the “revolving-door” criteria during the present study as compared to our previous study. There were some differences between the current and previous study in terms of accommodation at discharge, diagnosis, and social living status.Conclusions: Several variables were shown to predict membership in the “revolving-door” group and findings replicate Langdon et al. (), although there were differences. “Revolving-door” patients may have more enduring and chronic mental illnesses, but were similar to their “non-revolving door” counterparts on some variables. Research of this nature is difficult given the cross-sectional nature of studies, and a lack of a clear consensus within the literature as to which factors are associated with “revolving-door” service users remains.Declaration of interest: None.

Success of ectoparasites: how important is timing of host contact?

Hosts often differ in their degree of parasitism and their expression of resistance. Yet very little is known about how the availability (and allocation) of resources to parasites at pre-infective stages influences their success in initiating parasitism, or in inducing and succumbing to resistance from hosts. We studied a damselfly-mite association to address how experimental variation in the age of first contact with hosts (timing) influenced subsequent parasite fitness. We demonstrate that timing influenced the ability of larval mites to make the transition to parasitism, but was not associated with measures of physiological resistance by hosts. Timing presumably relates to the availability of resources remaining for individuals to exploit their hosts. More research is needed on the importance of such factors, from variation in host resistance and parasite success and, ultimately, to the numbers and distributions of parasites on hosts.

Tabaquismo escolar en el medio rural de Castilla-León. Actitudes de la población escolar

Tobacco smoking is the most important health problem among school-age children and educational programs aiming at prevention must be taken up by all members of the school community (parents, teachers and students) as well as by health providers. We designed an anti-smoking campaign lasting three years directed towards sixth, seventh and eight-grade elementary school students and secondary school pupils attending classes in the area of Vitigudino (Salamanca). We report the results of student attitude surveys done at the beginning of the program. Sixty-eight percent of boys and 50.7% of girls have smoked at some time. The average age of first contact with tobacco was 12.1 +/- 2.4 years, with boys starting to smoke at a significantly younger age (p < 0.001) than girls. At present, 13.7% of school children smoke. The main reasons given for starting to smoke were that friends smoked (56.9%) and curiosity (55.4%). Tobacco smoking in the family was mentioned by only 29.5% of the students surveyed. Knowledge of medical problems related to smoking was limited. Intention to smoke upon leaving school was reported by 9%, while 46.7% did not know if they would smoke. The fact that only 44.1% of school children believe they will not smoke upon leaving school highlights the need to provide support information that will help students abstain. Programs aimed at school children have been shown to help reduce tobacco smoking in this population. An adolescent who learns to avoid tobacco is unlikely to be a smoker in adulthood.(ABSTRACT TRUNCATED AT 250 WORDS)

Services to schizophrenic patients: epidemiological and cost-effectiveness issues

AbstractObjective: This study is designed to evaluate a hospital based integrated service for the comprehensive delivery of care and treatment to patients with schizophrenia, on epidemeological, cost effectiveness, and quality of life parameters. Methods: All patients with an ICD9 diagnosis of schizophrenia who received services from the St. Lomans Catchment area during a 2 year period were evaluated for service utilization during a subsequent 2 year period. Data was collected on basic demographics for the epidemiological aspects of the study, and for all aspects of services utilized, eg. day hospital attendance, inpatient bed useage, time spent with psychiatrist, community nurse visit or clinic visit. Costs for all services were calculated using disaggregate cost data. Quality of life of the patients was assessed through the Lehman quality of life questionnaire administered to every third identified patient. Results: 572 schizophrenic patients were identified from the case register and case records search. An analysis of the data indicated no difference in age of first contact with services on rural/urban or male/female comparisons contrasting with previously reported findings. Males tend to utilize proportionately more services in both rural and urban settings. Inpatient hospitalizations contributed the most to per patient costs and a small group of patients, comprising less than 5% of the total population, consumed 10% of the total costs consumed by all diagnostic groups and 30% of the costs of all schizophrenics. Non-hospitalized patients experienced the highest quality of life ratings. Conclusions: Hospital based community services to schizophrenics can be run cost-effectively. There remains a small subgroup of schizophrenic patients who are hard to place or treat in the community and they consume a disporportionate amount of the hospital's costs. Services that attempt to establish patients in the community can do so cost effectively provided there are hospital inpatient beds available as a back up. The benefits of this type of comprehensive service delivery to the schizophrenic population served are demonstrated.