Comparison between the dynamics of lipid/gramicidin A systems in the lamellar and hexagonal phases: a solid-state 13C NMR study

Adolescence is a developmental period marked by multiple challenges and demands which create a heightened vulnerability to the development of emotional disorders. Primary care physicians are in an ideal position to intervene in the early stages and prevent the tragic consequences which can occur with an untreated mental health disorder. This article reviews the assessment and treatment of adolescent mental health in the primary care medical setting. Knowledge of these disorders and their manifestations in the primary care environment will enable clinicians to provide higher quality medical care and will reduce the potential for continual life disruptions into the adult years.     

Pathways to mental health care among South African adolescents: analysis of referrals to an adolescent psychiatric unit

Assessment forms of 670 adolescents referred over four years to an adolescent psychiatric unit were analyzed to establish how they entered mental health care. The first part of the study examined referral sources; the second established the appropriateness of referral. Adolescents were referred via a number of pathways, of which school sources, psychiatric services, and social agencies were prominent. Interestingly, 60.7% of the referrals were from persons not trained in mental health care. No significant difference in appropriateness of referral was found between trained and nontrained sources. Thus, the unique referral base of adolescents in need of mental health care must be recognized. Although the majority in this study were not mental health care workers, the findings show that their referrals were clinically appropriate. This suggests that by improving the mental health skills of this sector, the provision of psychiatric care to adolescents could be enhanced.     

Health counseling in adolescent preventive visits: effectiveness, current practices, and quality measurement

Most morbidity and mortality among adolescents results from their participation in health-compromising behaviors. Recent guidelines for clinical adolescent preventive services recommend that primary care clinicians routinely screen for and counsel adolescents about these behaviors, identify and address related social, psychological, and biologic factors. Office-based counseling can influence adult health behaviors, but little is known about the effectiveness of office-based counseling for adolescents. In this review we: (a) evaluate available information about the effectiveness of office-based health counseling to improve outcomes; (b) report what is known about the health counseling adolescents receive from primary care clinicians; and (c) critically review different approaches that have been, or might be, used to measure the content and quality of health counseling provided during adolescent medical visits. With the emphasis on accountability in the current health care environment, evidence supporting the effectiveness of counseling is needed to justify investment in this aspect of clinical adolescent preventive services. Challenges to studying the effectiveness of health counseling include the lack of well-defined theory-based models for adolescent office-based counseling, the complexity of measuring counseling quality, and the many factors that influence adolescent outcomes. Reliable and valid measures of counseling quality are needed both to study and to ensure the quality of counseling received by adolescents. No single measure can be expected to fully capture counseling quality, although patient self-report deserves further development.     

Adolescent pregnancy prevention in managed care

Efforts by the US government, employers, and insurance industry to address women's health issues have neglected the problem of adolescent pregnancy. 30 million of the 37.4 million US adolescents have health insurance coverage and 20-40% of them are enrolled in managed care plans, either through private insurance or Medicaid. Each year, managed care insurance plans pay for 150,000-300,000 adolescent pregnancies, half of which end in a live birth. There are many gaps in current approaches to adolescent health care that can be filled by physicians and managed care organizations. Prevention of adolescent pregnancy would have immediate, cost-effective results. Managed care insurance, with its organizational structure, has the potential to address the traditional obstacles to adolescent reproductive health of lack of confidentiality and difficulties with access. An adolescent health care coordinator could be hired to track teen care within the insurance plan, educate staff, and arrange and enforce protocols. It would be instructive to see whether such case management could achieve reductions in repeat adolescent pregnancies by targeting follow-up activities to this risk group. Finally, managed care organizations should analyze teen pregnancy prevention programs in their own setting and select the most effective interventions on the basis of cost and medical outcome rather than political expediency.     

Asian blepharoplasty with a short-pulsed contact Nd-Yag laser: limited-incision resectable laser double fold with internal medial and lateral functional epicanthoplasty

PURPOSE: To determine how often primary care physicians screen adolescents for important risk factors and to determine how rates of screening vary by physicians' specialty and practice setting, patients' age, and type of risk factor. METHODS: A stratified random sample of 343 California physicians who are Board certified in pediatrics, family practice, or internal medicine, and physicians in these specialties who specialized in adolescent medicine were surveyed about their screening practices using a mailed questionnaire. Subjects were asked the percentage of routine comprehensive physical examination during which they personally queried or screened each age group of adolescents (11-14 years old and 15-18 years old) for each of the following risk factors: high blood pressure, alcohol use, cigarette use, sexual activity, and drug use. RESULTS: The frequency with which primary care physicians reported actually screening younger and older adolescents for the various risks were approximately: 93% and 96% for high blood pressure, 70% and 84% for alcohol use, 74% and 82% for drug use, 67% and 83% for sexual activity, and 76% and 86% for smoking, respectively. For all risk factors, providers screened older adolescents more frequently than younger adolescents (p < 0.01). Finally, screening rates varied by specialty (p < 0.01) but not by practice setting. CONCLUSIONS: This study found that California physicians frequently screen adolescents for a variety of risk factors. However, the reported rates may not be consistent with published guidelines. Interventions may need to be developed which focus on improving primary care physicians' adolescent-specific screening practices.     

Adolescent health care: A public policy perspective.

Focuses on the importance of psychosocial and behavioral components of health care in the area of adolescent health care. The authors contend that it will ultimately be as a direct result of psychology's tangible (and visual) successes in areas such as adolescent health that will lead to psychological services becoming fully accepted within the overall health care system. The underlying policy notion is that if psychology addresses society's perceived needs, society (i.e., the nation's public policy/political leadership) will strive to meet the mental health profession's needs. The majority of problems adolescents face, regardless of apparent physical symptomatology, are essentially behavioral (psychosocial) in nature. The symptom distress model provides for a school-based integration of psychological knowledge with clinical and educational expertise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rural and urban adolescents' perceptions of mental health

This study investigated rural and urban adolescents' perceptions of mental health. A questionnaire containing nine vignettes (involving child abuse and adult and adolescent mental health issues) was devised based on a tool developed by Flaskerud (1980). Analysis of responses to the questionnaire indicated that there was general agreement among the students about unhealthy behaviors. However, there were some significant differences related to rural/urban setting, gender, and ethnic background. The findings provide insight into rural and urban students' perceptions of problematic behaviors, who should intervene, and how. It is recommended that health care providers assist adolescents in expanding their range of coping behaviors, especially in regard to alcohol abuse and violence.     

Issues in mental health services for children and adolescents

Existing system of psychiatric care for children and adolescents is in need of basic reorganization. The authors propose: 1) reestablishment of the speciality of children's and adolescent psychiatrist, a specialist in children's and adolescent narcology, a psychiatrist of early child's age and a pediatric medical psychologist; 2) carrying out the reform of child mental care equal in rights with general psychiatry; 3) preservation and widening of both specialized inpatient and outpatient clinics in general system of child's mental care; 4) legislative and public rehabilitation of children's psychiatry, which suffered considerably from antipsychiatric campaign; 5) professionally organized systematic elevation of psychohygienic, psychiatric and psychotherapeutic knowledges of allied medical and other specialists as well as of parents and of all population too; 6) integration and interaction of govermental services concerning mental health of children and adolescent; 7) organization of regional psychoprophylaxic interdisciplinary centers for children and adolescent.     

Use of the Mental Health Inventory with adolescents: A secondary analysis of the Rand Health Insurance Study.

Few instruments exist for the assessment of adolescent mental health. In order to examine the appropriateness of the Mental Health Inventory (MHI) for use with adolescents, secondary analyses were conducted of the large subsample (n?=?953) of adolescents who participated in the community-based Rand Health Insurance Study. The reliability and readability of the MHI were confirmed. Subscales reflecting Psychological Well-Being and Psychological Distress were derived. The MHI, with its adolescent norms, is recommended for the assessment of adolescent mental health, particularly in studies in which comparison to a nonpsychiatric, normative adolescent population is indicated. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Apolipoprotein E (ApoE) peptide regulates tau phosphorylation via two different signaling pathways

OBJECTIVE: The aim of this study was to compare levels of emotional and behavioural problems and competencies among immigrant and non-immigrant adolescents, and to determine factors that may contribute to any differences reported. METHOD: Subjects were selected randomly from students aged 12-16 years attending a high school with a high proportion of immigrants in Perth, Western Australia. Parents completed the Child Behaviour Checklist (CBCL), and students completed the Youth Self-Report (YSR) and a Personal History Questionnaire. RESULTS: On univariate analyses, non-immigrant adolescents had significantly higher CBCL and YSR scores than immigrant adolescents. Multivariate analyses suggested that CBCL scores were predicted by a number of variables other than immigration, including family intactness, socioeconomic status (SES) and gender. Higher YSR scores were predicted by non-intact families, school setting and non-immigrant status, and higher competencies scores were predicted by higher SES and parents not being immigrants. CONCLUSIONS: In assessing the effects of immigration on adolescent mental health, it is important to control for factors associated with adolescent behavioural and emotional problems and to use multiple informants. Overall, immigrant adolescents report fewer total and externalizing problems and fewer competencies than native-born adolescents. This finding may reflect strict immigration policies or cultural differences in definitions of psychopathology and the social expectations for adolescents' behaviour.     

Monitoring challenges: A closer look at parental monitoring, maternal psychopathology, and adolescent sexual risk.

The present study sought to examine associations between maternal psychopathology, parental monitoring, and adolescent sexual activity among adolescents in mental health treatment. Seven hundred ninety mother-adolescent dyads recruited from adolescent mental health treatment settings completed audio computer-assisted structured interview assessments examining parent psychiatric symptoms, parental monitoring, and adolescent sexual risk behavior. Path analysis was used to examine the associations between variables of interest. Maternal caregivers who reported more mental health symptoms were more likely to have adolescents who reported recent sex and this relationship was mediated by less parental monitoring. These findings suggest that maternal caregivers with mental health symptoms may need specific interventions that provide assistance and support in monitoring their teens in order to reduce sexual risk taking among adolescents in mental health treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings.

Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome Questionnaire (Y-OQ) were retrieved for children and adolescents (4–17 years old) served in a community mental health system (n = 936, mean age = 12 years, 40% girls or young women, 28% from families of color) and a managed care organization (n = 3,075, mean age = 13 years, 45% girls or young women, race and ethnicity not reported). The authors analyzed Y-OQ data using multilevel modeling and partial proportional odds modeling to test for differences in change trajectories and final outcomes across the 2 service settings. Results: Although initial symptom level was comparable across the 2 settings, the rate of change was significantly steeper for cases in the managed care setting. In addition, 24% of cases in the community mental health setting demonstrated a significant increase in symptoms over the course of treatment, compared with 14% of cases in the managed care setting. Conclusions: These results emphasize the need for increased attention to negative outcomes in routine mental health services and provide a stronger foundation for identifying youth cases at risk for treatment failure. In addition, given the overall differences observed across treatment settings for average rate of change and deterioration rates, results suggest that setting-specific model heuristics should be used for identifying cases at risk for negative outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Redefining the targets for mental illness

This article reviews the initiatives which have been developed in mental health services in an attempt to meet the targets set out in the government's Health of the Nation White Paper (1). The author argues that the targets for mental health were crudely defined and more funding is needed to address primary care problems which are currently badly neglected.     

Angiocardiographic digital still images compressed via irreversible methods: concepts and experiments

OBJECTIVE: Primary care occupies a strategic positive in the evaluation, treatment, and prevention of the mental disturbances of later life. This article highlights four themes that are crucial to understanding mental disturbances among older adults: 1) subsyndromal depression, 2) coexisting depression and anxiety, 3) comorbidity of depression and chronic medical conditions, and 4) risk factors for cognitive impairment. METHOD: The literature was selectively reviewed for each theme to ask the central question, "What can primary care physicians learn about mental disturbances of their older patients from epidemiologic and community studies?" RESULTS: The primary care setting itself is an important venue for an examination of aging issues and mental health. Workers in the "middle ground of psychiatric epidemiology"--primary health care--have not yet reached a full appreciation for the value of research in the primary care setting for enhancing our understanding of the mental disturbances of late life, and how these intersect with other salient factors. CONCLUSIONS: Primary care physicians and others who work in primary care should advocate for further mental health integration and research in primary care. Research is needed that will lead to new ways of maximizing the health and quality of life of older adults and their families.     

Child temperament moderates the impact of parental separation on adolescent mental health: The trails study.

The potential effect of parental separation during early adolescence on adolescent externalizing and internalizing problems was investigated in a longitudinal sample of adolescents (n = 1274; mean age = 16.27; 52.3% girls). Pre-separation mental health problems were controlled for. Building on a large number of studies that overall showed a small effect of parental separation, it was argued that separation may only or especially have an effect under certain conditions. It was examined whether child temperament (effortful control and fearfulness) moderates the impact of parental separation on specific mental health domains. Hypotheses were derived from a goal-framing theory, with a focus on goals related to satisfying the need for autonomy and the need to belong. Controlling for the overlap between the outcome domains, we found that parental separation led to an increase in externalizing problems but not internalizing problems when interactions with child temperament were ignored. Moreover, child temperament moderated the impact of parental separation, in that it was only related to increased externalizing problems for children low on effortful control, whereas it was only related to increased internalizing problems for children high on fearfulness. The results indicate that person-environment interactions are important for understanding the development of mental health problems and that these interactions can be domain-specific. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Managing sexually transmitted diseases in adolescents

Control of sexually transmitted diseases (STDs) in adolescents is a primary responsibility of health care providers. Using the tools of history and physical examination, and drawing on the awareness of different stages of adolescent development, health care providers can define at-risk for STDs. This article discusses screening practices, disease control through reporting and preventive counseling, and treatment guidelines for common STD syndromes.     

Associating supplemental case management activities with ethnic minority children’s reduced use of psychiatric emergency services.

Studying children and adolescents receiving publicly financed outpatient treatment, the authors investigated whether receipt of supplemental case management was associated with reduced odds of ethnic minority children’s and adolescent’s receipt of crisis care, and whether the minority’s reduction was greater than the reduction for Whites. The data were 97,618 Medicaid records of mental health services provided to children and adolescents ages 0–18 years in California’s public mental health system. The study’s quasi-experimental research capitalized on a large, multisystem, and multiyear data set to address key challenges to internal and external validity. Results indicated that receiving case management along with outpatient treatment was associated with significantly reduced odds of crisis service use for Blacks, Asian Americans, and Latinos especially. The results provide preliminary evidence that supplementing outpatient care with case management helps to close a troubling disparity in mental health treatment access. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental disorders and access to medical care in the United States

OBJECTIVE: The authors examined the barriers to receipt of medical services among people reporting mental disorders in a representative sample of U.S. adults. METHOD: The sample was drawn from adults who responded to the 1994 National Health Interview Survey (N=77,183). The authors studied the association between report of a mental disorder and 1) access to health insurance and a primary provider, and 2) actual receipt of medical care. Multivariate techniques were used to model problems with access as a function of mental disorders, controlling for demographic, insurance, and health variables. RESULTS: While people who reported mental disorders showed no difference from those without mental disorders in likelihood of being uninsured or of having a primary care provider, they were twice as likely to report having been denied insurance because of a preexisting condition or having stayed in their job for fear of losing their health benefits. Among respondents with insurance, those who reported mental illness were no less likely to have a primary care provider but were about two times more likely to report having delayed seeking needed medical care because of cost or having been unable to obtain needed medical care. CONCLUSIONS: People who reported mental disorders experienced significant barriers to receipt of medical care. Efforts to measure and improve access to health care for this population may need to go beyond simply providing insurance benefits or access to general medical providers.     

Phonological codes are early sources of constraint in visual semantic categorization

Current statistics show a marked increase in suicides among adolescents 15 to 19 years of age. The literature suggests an increase in the use of lethal methods such as firearms by young suicide attempters. Studies show that most adolescent suicide completers have never received mental health treatment, although the majority had exhibited psychiatric symptoms previous to their deaths. This review of the literature identifies the characteristics and precipitants of suicidal behavior among adolescents. The literature clearly indicates a need for suicide awareness and prevention programs and for the early identification of teenagers at risk for suicidal behaviors. The most logical location for suicide prevention programs and activities is in the schools where the greatest number of adolescents can be reached. The master's-prepared psychiatric mental health nurse in a consultive and collaborative role can be instrumental in the successful formation and execution of these programs. In a joint effort, school personnel and the psychiatric mental health nurse specialist may be able to decrease significantly the number of suicidal behaviors among adolescents.