Functioning Of Young People Research Articles

Cochrane Review: Psychological and educational interventions for preventing depression in children and adolescents

AbstractBackgroundDepression is common in young people, has a marked negative impact and is associated with self‐harm and suicide. Preventing its onset would be an important advance in public health.ObjectivesTo determine whether psychological or educational interventions, or both, are effective in preventing the onset of depressive disorder in children and adolescents.Search methodsThe Cochrane Depression, Anxiety and Neurosis Review Group's trials registers (CCDANCTR) were searched at the editorial base in July 2010. Update searches of MEDLINE, EMBASE, PsycINFO and ERIC were conducted by the authors in September 2009. Conference abstracts, reference lists of included studies and reviews were searched and experts in the field contacted.Selection criteriaRandomised controlled trials of psychological or educational prevention programmes, or both, compared with placebo, any comparison intervention, or no intervention for young people aged 5 to 19 years‐old, who did not currently meet diagnostic criteria for depression or who were below the clinical range on standardised, validated, and reliable rating scales of depression, or both, were included.Data collection and analysisTwo authors independently assessed studies for inclusion and rated their quality. Sample sizes were adjusted to take account of cluster designs and multiple comparisons. We contacted study authors for additional information where needed. Main resultsFifty‐three studies including 14,406 participants were included in the analysis. There were only six studies with clear allocation concealment, participants and assessors were mostly not blind to the intervention or blinding was unclear so that the overall risk of bias was moderately high. Sixteen studies including 3240 participants reported outcomes on depressive diagnosis. The risk of having a depressive disorder post‐intervention was reduced immediately compared with no intervention (15 studies; 3115 participants risk difference (RD) ‐0.09; 95% confidence interval (CI) ‐0.14 to ‐0.05; P<0.0003), at three to nine months (14 studies; 1842 participants; RD ‐0.11; 95% CI ‐0.16 to ‐0.06) and at 12 months (10 studies; 1750 participants; RD ‐0.06; 95% CI ‐0.11 to ‐0.01). There was no evidence for continued efficacy at 24 months (eight studies; 2084 participant; RD ‐0.01; 95% CI ‐0.04 to 0.03) but limited evidence of efficacy at 36 months (two studies; 464 participants; RD ‐0.10; 95% CI ‐0.19 to ‐0.02). There was significant heterogeneity in all these findings. There was no evidence of efficacy in the few studies that compared intervention with placebo or attention controls.Authors' conclusionsThere is some evidence from this review that targeted and universal depression prevention programmes may prevent the onset of depressive disorders compared with no intervention. However, allocation concealment is unclear in most studies, and there is heterogeneity in the findings. The persistence of findings suggests that this is real and not a placebo effect. Plain Language SummaryPsychological and educational interventions for preventing depression in children and adolescentsDepressive disorder is common and has a major impact on the functioning of young people. The aim of this review was to assess the effectiveness of programmes designed to prevent its onset.We found that, compared with no intervention, psychological depression prevention programmes were effective in preventing depression with a number of studies showing a decrease in episodes of depressive illness over a year. There were some problems with the way the studies were done but despite this the results are encouraging. We found data to support both targeted and universal programmes, which is important as universal programmes are likely to be easier to implement. We recommend that further research be undertaken to identify the most effective programmes and to test these in the real world.

Long-Term Follow-Up of Adolescents With Resistant Depression Treated With Repetitive Transcranial Magnetic Stimulation

There is a paucity of information about repetitive transcranial magnetic stimulation (rTMS) as a treatment for adolescent depression, and there are no data about its long-term effectiveness and safety in this age group. The aim of this study was to evaluate symptoms of depression and cognitive functioning in young people who had been treated 3 years previously with rTMS for resistant depression. Eight of 9 subjects who had participated in an open-label rTMS study were reassessed using the Child and Adolescent Depression Rating Scale-Revised and the Beck Depression Inventory II. Six of the subjects were also cognitively reassessed using the Cambridge Neuropsychological Test Automated Battery. The follow-up assessments were compared with the earlier pretreatment, inter-treatment and posttreatment assessments. At 3-year follow-up, there was no evidence of deterioration in symptoms of depression or cognitive functioning compared to the last assessment after rTMS. Preliminary evidence suggests that rTMS treatment of resistant depression in adolescents is not associated with long-term cognitive deterioration and that posttherapy clinical improvement can be maintained. It seems that some subjects may derive long-term benefit from the rTMS course.

Self Report of Negative Parenting Styles, Psychological Functioning and Risk of Negative Parenting by One Parent being Replicated by the Other in a Sample of Adolescents aged 13–15

AbstractThis study, which used a community sample of 13–15 year old adolescents (N = 391), sought to establish the extent to which negative parenting styles are linked to increased likelihood of abnormal psychological functioning in young people, and the likelihood of negative parenting by one parent being replicated by the other. Findings suggest that negative parenting styles are significantly correlated with raised scoring on the Strengths and Difficulties Questionnaire, and that particular negative parenting styles in one parent are likely to be found in the other. The high percentages of young people reporting parents being often angry, sometimes frightening and lacking in warmth and affection give rise to concern about the facilitation of parenting in the UK. Copyright © 2009 John Wiley & Sons, Ltd.

Effect of local and remote ischemic preconditioning on endothelial function in young people and healthy or hypertensive elderly people

To verify whether age affects remote preconditioning, we compared healthy young people (mean age=28.0 years, SD: 7.2), healthy elderly people (age=69.2 years, SD: 5.0), and hypertensive elderly people (group 3, age=72.8 years, SD: 3.9). Each group included 10 participants. The flow-mediated-dilation (FMD) was measured after local (same arm) and remote (leg) ischemic preconditioning.Healthy elderly people had the greatest increase of FMD after ischemic preconditioning compared to baseline (173% after local and 181% after remote preconditioning) and young participants the smallest increase (77% after local and 69% after remote preconditioning) while hypertensive elderly had an intermediate increase (P for comparison across groups: 0.347 for local and 0.064 for remote preconditioning). However, absolute values of FMD after preconditioning were much lower in elderly hypertensive than in healthy young adults.Remote preconditioning increases endothelial reactivity in healthy and hypertensive elderly. The potential clinical relevance of this finding deserves consideration.

How does social functioning in the early stages of psychosis relate to depression and social anxiety?

The study aims to compare social functioning in young people considered to be at risk of psychosis with those meeting criteria for first episode psychosis (FEP) and controls, and to determine the association between social functioning and positive and negative symptoms, depressive symptoms, and social anxiety. This study examined social functioning in 20 individuals at risk of psychosis, 20 FEP patients and 20 healthy controls. Social functioning was measured using the Social Functioning Scale and World Health Organization Disability Assessment Scale. Psychiatric variables were also measured using the Comprehensive Assessment of At-Risk Mental States, the Brief Psychiatric Rating Scale, the Brief Social Phobia Scale, and the Depression Anxiety and Stress Scale. At-risk individuals had comparable social deficits to the FEP group, and both patient groups had significantly poorer social functioning than controls. Importantly, social functioning was most strongly associated with depressive and social anxiety symptoms and to a lesser extent with positive symptoms. However, negative symptoms did not appear to relate to social functioning. Social functioning impairments precede the onset of full-threshold psychosis and may therefore be a significant marker for the illness. Additionally, associated psychiatric symptoms such as depression and social anxiety may provide an avenue for early interventions of social functioning deficits in psychosis.

Microvascular and macrovascular complications associated with diabetes in children and adolescents

Department of Pediatrics, Ulleval University˚Hospital, and Faculty of Medicine, University of Oslo, NorwayCorresponding author:Assoc. Prof. Kim DonaghueThe Children’s Hospital at Westmead, Locked Bag 4001,Westmead, NSW 2145, Australia.Tel: C61 2 9845 3172;fax: C61 2 9845 3170;e-mail: kimd@chw.edu.auAcknowledgments: Esko Wiltshire, Gisela Dahlquist, KennethLee Jones, Edna Roche, Amina Balafrej and Riccardo Bonfanti.Conflicts of interest: The authors have declared no conflictsof interest.Editors of the ISPAD Clinical Practice Consensus Guide-lines 2009 Compendium: Ragnar Hanas, Kim Donaghue,Georgeanna Klingensmith, and Peter Swift.This article is a chapter in the

Relationships between measures of fitness, physical activity, body composition and vascular function in children

Background The prevalence of obesity and physical inactivity in Western countries has increased rapidly. Both are modifiable risk factors for cardiovascular disease. Atherosclerosis begins in childhood and endothelial dysfunction is its earliest detectable manifestation. Methods We assessed flow-mediated dilation (FMD) in 129 children (75 female; 10.3 + 0.3 yrs; 54 male; 10.4; 0.3 yrs). FMD was normalised for differences in the eliciting shear rate stimulus between subjects (SR AUC). Fitness was assessed as peak oxygen uptake during an incremental treadmill exercise test ( V ˙ O 2peak). Body composition was measured using a dual-energy X-ray absorptiometry (DEXA) scan. Physical activity (PA) was assessed using Actigraph accelerometers. The cohort was split into tertiles according to FMD% and also FMD% corrected for SR AUC to gain insight into the determinants of vascular function. Results Across the cohort, significant correlations were observed between FMD%/SR AUC and DEXA percentage fat ( r = −0.23, p = 0.009) and percentage lean mass ( r = 0.21, p = 0.008), and also with PA performed at moderate-to-high intensity ( r = 0.363, p = 0.001). For children in the lowest FMD%/SR AUC tertile, a stronger relationship with all PA measures was observed, particularly with high intensity PA ( r = 0.572, P = 0.003). Regression analysis revealed that high intensity PA was the only predictor of impaired FMD%/SR AUC. Conclusions These data suggest that traditional risk factors for CHD in adult populations impact upon vascular function in young people. Furthermore, it appears that individuals with impaired FMD may benefit from performing high intensity PA, whereas no relationships exist between FMD and lower intensities of PA or between PA and FMD in those subjects who possess preserved vascular function a priori.

Minimizing impairment-related youth traffic deaths: the need for comprehensive provincial action.

Despite the progress made between the early 1980s and the mid-1990s, traffic crashes remain the single largest cause of death among 15-24 year-old Canadians. In recent years, approximately 45% of these deaths have been alcohol-related and, no doubt, additional youth crash deaths are drug-related. While young people are significantly overrepresented in impairment-related deaths as drivers, their overrepresentation is even greater as passengers, pedestrians, bicyclists, and users of recreational vehicles. These crashes are not simply a function of young people's immaturity and lack of driving experience; they also reflect young people's hazardous patterns of alcohol and drug use. Under the Canadian constitution, the provinces have extensive legislative authority over driver and vehicle licensing, traffic enforcement, liquor licensing, and off-premise alcohol sales. Moreover, research in Canada and abroad has identified legislative initiatives that can significantly reduce impairment-related youth traffic deaths. Consequently, the provinces are well positioned to protect Canadian youth from such preventable harm. The provinces need to adopt a broad approach, including a comprehensive graduated licensing program, a zero blood-alcohol restriction on drivers under 21, enhanced police powers, and more rigorous enforcement of the existing licensing legislation.

Social functioning in young people at risk for schizophrenia

Deficits in social functioning are potential risk factors for schizophrenia. Social functioning was assessed in 55 individuals “at risk” for schizophrenia, 16 first episode patients with schizophrenia and 45 normal comparison subjects. The Social Adjustment Inventory for Children and Adolescents (SAICA) was administered to adolescents < 18 and the Social Adjustment Scale (SAS-SR) to young adults > 17. The at risk and first episode groups significantly differed from the normal subjects on measures of social functioning in the domains of peer, family, work and school relationships. Individuals at risk for schizophrenia have significant functional deficits which may be potential indicators of increased vulnerability for psychosis.

YOUNG PEOPLE WITH VISUAL IMPAIRMENTS IN DIFFICULT SITUATIONS

The problem of puberty and the functioning of young people in society is the object of constant psychological studies. This question also pertains to teenagers with visual impairments for whom disability in itself is a difficult situation. My investigations using the Emotional Factors Inventory (EFI) of Bauman (1960), the Adjective Check List (ACL; Gough &amp; Heilbrun, 1971) and an Unfinished Sentences Test of my own invention, permitted me to study the reactions of teenagers with visual disability in comparison to their nonimpaired peers. The age of the participants in the study ranged from 14 – 15 years and 18 – 19 years. The results do not imply a direct relationship between disability and behavior in difficult situations; reactions depend on other factors.

Stress and HPA-axis functioning in young people at ultra high risk for psychosis

It is thought that hypothalamic-pituitary-adrenal (HPA) axis functioning mediates between the experience of stress and development of psychotic symptoms. This study aimed to evaluate this model in a cohort of young people at ultra high risk (UHR) of psychosis. Information about the experience of psychological symptoms and recent stressful experiences was obtained from 23 young people who met UHR criteria. Plasma samples were taken to assess cortisol and glucocorticoid receptor numbers, and an MRI scan was also performed. Plasma cortisol levels were significantly and positively correlated with the experience of ‘hassles’ but not with the experience of stressful life events. Significant positive associations were also found between plasma cortisol levels and level of depression and anxiety. No significant relationships were found between plasma cortisol level and global psychopathology, psychotic symptomatology, functioning or pituitary and hippocampal volumes. These results suggest that the number of hassles experienced by young people at UHR of psychosis could be an important factor in raising their cortisol levels, which might, in turn, affect the severity of depressive and anxiety symptoms. No other relationships were found between plasma cortisol levels and the experience of psychotic symptoms, functioning or hippocampal and pituitary volumes. These results indicate possible impairment in HPA-axis functioning in the early stages of psychotic illness, but further investigation of the relationships between these parameters is required.

Cognitive functioning in young people with first episode psychosis: relationship to diagnosis and clinical characteristics.

To examine the extent and nature of neuropsychological deficits in adolescents and young people with first episode psychosis (FEP), and to determine whether the pattern and extent of neuropsychological deficits varied according to diagnosis. A total of 83 FEP subjects aged 13-25 years, and 31 healthy controls completed a comprehensive battery of neuropsychological tests, grouped into 10 cognitive domains. First episode psychosis subjects were stratified into three diagnostic groups (schizophrenia, affective disorders, substance-induced psychosis) and differences in cognitive profiles were examined. The contribution of demographic and clinical characteristics to cognitive performance was also explored. The schizophrenia group demonstrated significantly worse performance on tasks of verbal learning and memory than the affective disorders group. Compared to healthy controls, the schizophrenia group also demonstrated global impairment across the majority of cognitive domains. The substance-induced group's performance lay between that of the schizophrenia and affective disorders groups. Analyses of differential deficits revealed that verbal learning, verbal memory and current intellectual functioning were selectively impaired in the schizophrenia group, whereas the affective disorders group demonstrated a selective deficit in speeded processing. Premorbid intellectual functioning, negative symptomatology and medication levels were the strongest predictors of cognitive performance in FEP subjects. Verbal memory deficits differentiate individuals with schizophrenia from those with psychotic affective disorders. Although significant cognitive deficits are evident across all diagnostic FEP groups, individuals with schizophrenia appear to have more generalized impairment across a broad array of cognitive functions than other psychotic diagnoses. Lower premorbid intellectual functioning does not appear to contribute to greater cognitive deterioration following onset of psychosis, but severity of illness may be a more important factor than levels of mood disturbance.

Cognitive functioning in young people with first episode psychosis: relationship to diagnosis and clinical characteristics

Cognitive functioning in young people with first episode psychosis: relationship to diagnosis and clinical characteristics

Neuropsychological correlates of symptom profiles in first episode schizophrenia

This paper aimed to examine the relationship between the trichotomous symptom structure of psychopathology and neuropsychological functioning in young people with first episode schizophrenia (FES), most of whom were receiving atypical antipsychotic medication. This was with a view to providing insight into the underlying pathophysiology of the clinical symptoms of schizophrenia. Fifty-three young people (aged 13–25 years) with FES participated in the study. Subjects completed a comprehensive clinical and neuropsychological examination. Cognitive domain scores were correlated with composite scores relating to Disorganisation, Psychomotor Poverty and Reality Distortion. A significant association was identified between Disorganisation and Verbal Acquisition, Verbal Recall and Cognitive Flexibility. There were no significant associations between cognitive domains and either Reality Distortion or Psychomotor Poverty, nor with measures of depressive symptomatology. The present study provides preliminary evidence that symptoms associated with the Disorganisation factor are significantly associated with cognitive deficits suggesting impaired frontal–temporal functioning. Differences between the current findings and those of similar research may reflect the effects of different medication regimes, as well as the absence of illness chronicity.

Nasal airway ion transport and lung function in young people with cystic fibrosis.

There is strong evidence that abnormal airway ion transport is the primary defect that initiates the pathophysiology of lung disease in cystic fibrosis (CF). To examine the relationship between airway ion transport abnormality and severity of lung disease, we measured nasal potential difference in 51 young people with CF using a validated modified technique. There was no correlation between any component of the ion transport measurement and clinical condition (respiratory function, chest radiograph score, or Shwachman clinical score). Thirty subjects, homozygous for the DeltaF508 mutation, were divided into those above and those below average respiratory function for their age. There was no significant difference in any of the ion transport parameters between those with above and below average pulmonary function. Of the 51 subjects, 10 had significant hyperpolarization after perfusion with a zero Cl- solution (> 5 mV). This Cl- secretory capacity did not correlate with above average lung function. These data do not support the assertion that the extent of lung disease in CF reflects the degree of ion transport abnormality. We suggest that although an ion transport abnormality initiates lung disease, other factors (e.g., environmental and genetic modifiers) are more influential in determining disease severity.

Neuropsychological functioning in young people at high-risk for psychosis

Neuropsychological functioning in young people at high-risk for psychosis

MALE GONADAL FUNCTION IN SURVIVORS OF CHILDHOOD HODGKIN AND NON-HODGKIN LYMPHOMA

The aim of this study was to investigate the impact of therapy on long-term gonadal function of young people cured of childhood lymphomas and to assess whether a prepubertal state during the treatment protects the gonads from chemotherapy and/or radiotherapy late effects. Clinical evaluation, semen analysis, and endocrine status were studied in 20 survivors of childhood lymphomas. Five patients received Inverted Y radiotherapy, 2320 cGy (1550-4000); all 20 received chemotherapy as follows: MOPP/ABVD protocol, 9 patients; COMP protocol, 5 patients; MOPP protocol, 3 patients; other protocols, 3 patients. Semen analysis results were as follows: normal values, 4/20 patients; oligospermia, 8/20 patients; azoospermia, 8/20 patients; FSH above normal level, 10/20 patients; 4/5 who received Inverted Y irradiation were azoospermic and 1 was severely oligospermic. Treatment damage to the testis involves tubular germinal elements. Radiotherapy and chemotherapy combinations that included nitrogen mustard or cyclophosphamide were associated with high rates of oligospermia and azoospermia. MOPP/ABVD combination did not have a significant better outcome of sperm counts compared to MOPP alone. Age at chemotherapy did not correlate with the sperm count; hence a prepubertal state did not protect the gonad from the late effects of treatment.

Progress in social-independent functioning of young people with Down's syndrome.

The progress over a 5-year period in the social-independent functioning of 96 older children and teenagers with Down's syndrome was examined. A significant increase in scores on the Self-Sufficiency Index was found, with considerable individual variability. Path analysis was used to trace the factors associated with current levels of self-sufficiency and the degree of change over time. Earlier level of cognitive development was the strongest predictor of progress in self-sufficiency, but family factors were also important, particularly mothers' strategies for coping with child problems and mothers' levels of social support. For a small number of children with the lowest developmental level, family factors were less important as their self-sufficiency was more strongly limited by their severe disability. The results suggest that interventions aimed at changing maternal coping strategies and supplementing social support may benefit the development of social-independent functioning in young people with Down's syndrome.

Cardiovascular Characteristics of the Young With Borderline Hypertension

Borderline hypertension generally describes blood pressure levels at the margins of an established disease state. Prior to adulthood, this definition becomes less clear. Juveniles with blood pressure levels at the extremes of the normal distribution may be borderline hypertensive, hypertensive, or normal. Aberrant mechanisms that progress to essential hypertension have their onset in the young. Evidence is emerging that demonstrates variation in neurogenic function in young people. Other functional and structural variations have also been described prior to adulthood. These observations are beginning to characterize young people having borderline hypertension and also those with a greater risk for progressing to essential hypertension.

Adrenocortical function after stimulation with synthetic ACTH

In order to assess the effect of ACTH on the adrenal cortex when used as a therapeutic or diagnostic agent, adrenocortical function was tested before and 2 hours after 0.5 mg tetracosactrin given intramuscularly in 31 healthy children, divided into 4 groups according to age and sex. Mean plasma cortisol levels were shown to be 184% higher than baseline values after administration of the drug, and there were no significant differences related to age or sex. It is suggested that this simple test can be of practical value in the diagnosis of adrenocortical function in young people.