Objective:The majority of children who initially engage in mental health treatment in the United States drop out prematurely, a problem further exacerbated among children living in poverty. This ...study examined the relationships between sociodemographic characteristics, barriers to treatment use, and session attendance.Methods:Data were obtained from participants (N=225) in the 4R2S field trial. Barriers were measured using the Kazdin Barriers to Treatment Participation Scale.Results:Barriers endorsed by families attending less treatment primarily aligned with practical rather than perceptual obstacles. Critical events linked to lower attendance included moving too far away from the clinic, a job change, and a child’s moving out of the home.Conclusions:Child mental health programs serving low-income families may consider structural modifications to allow for greater family support as well as flexibility in treatment delivery by leveraging technology. Future research is needed to evaluate barriers to treatment and alternate modalities in relation to service utilization.
Plants enter their reproductive phase when the environmental conditions are favourable for the successful production of progeny. The transition from vegetative to reproductive phase is influenced by ...several environmental factors including ambient temperature. In the model plant Arabidopsis thaliana, SHORT VEGETATIVE PHASE (SVP) is critical for this pathway; svp mutants cannot modify their flowering time in response to ambient temperature. SVP encodes a MADS-box transcription factor that directly represses genes that promote flowering. SVP binds DNA in complexes with other MADS-box transcription factors, including FLOWERING LOCUS M (FLM), which acts with SVP to repress the floral transition at low temperatures. Small temperature changes post-transcriptionally regulate FLM through temperature-dependent alternative splicing (TD-AS). As ambient temperature increases, the predominant FLM splice isoform shifts to encode a protein incapable of exerting a repressive effect on flowering. Here we characterize a closely related MADS-box transcription factor, MADS AFFECTING FLOWERING2 (MAF2), which has independently evolved TD-AS. At low temperatures the most abundant MAF2 splice variant encodes a protein that interacts with SVP to repress flowering. At increased temperature the relative abundance of splice isoforms shifts in favour of an intron-retaining variant that introduces a premature termination codon. We show that this isoform encodes a protein that cannot interact with SVP or repress flowering. At lower temperatures MAF2 and SVP repress flowering in parallel with FLM and SVP, providing an additional input to sense ambient temperature for the control of flowering.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Gaucher disease is caused by mutations in GBA1, which encodes the lysosomal enzyme glucocerebrosidase (GCase). GBA1 mutations drive extensive accumulation of glucosylceramide (GC) in multiple innate ...and adaptive immune cells in the spleen, liver, lung and bone marrow, often leading to chronic inflammation. The mechanisms that connect excess GC to tissue inflammation remain unknown. Here we show that activation of complement C5a and C5a receptor 1 (C5aR1) controls GC accumulation and the inflammatory response in experimental and clinical Gaucher disease. Marked local and systemic complement activation occurred in GCase-deficient mice or after pharmacological inhibition of GCase and was associated with GC storage, tissue inflammation and proinflammatory cytokine production. Whereas all GCase-inhibited mice died within 4-5 weeks, mice deficient in both GCase and C5aR1, and wild-type mice in which GCase and C5aR were pharmacologically inhibited, were protected from these adverse effects and consequently survived. In mice and humans, GCase deficiency was associated with strong formation of complement-activating GC-specific IgG autoantibodies, leading to complement activation and C5a generation. Subsequent C5aR1 activation controlled UDP-glucose ceramide glucosyltransferase production, thereby tipping the balance between GC formation and degradation. Thus, extensive GC storage induces complement-activating IgG autoantibodies that drive a pathway of C5a generation and C5aR1 activation that fuels a cycle of cellular GC accumulation, innate and adaptive immune cell recruitment and activation in Gaucher disease. As enzyme replacement and substrate reduction therapies are expensive and still associated with inflammation, increased risk of cancer and Parkinson disease, targeting C5aR1 may serve as a treatment option for patients with Gaucher disease and, possibly, other lysosomal storage diseases.
Abstract The goal of this study was to examine the impact of supplementing Trauma-focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2006 ) with evidence-based engagement strategies on ...foster parent and foster youth engagement in treatment, given challenges engaging foster parents in treatment. A randomized controlled trial of TF-CBT standard delivery compared to TF-CBT plus evidence-based engagement strategies was conducted with 47 children and adolescents in foster care and one of their foster parents. Attendance, engagement, and clinical outcomes were assessed 1 month into treatment, end of treatment, and 3 months post-treatment. Youth and foster parents who received TF-CBT plus evidence-based engagement strategies were more likely to be retained in treatment through four sessions and were less likely to drop out of treatment prematurely. The engagement strategies did not appear to have an effect on the number of canceled or no-show sessions or on treatment satisfaction. Clinical outcomes did not differ by study condition, but exploratory analyses suggest that youth had significant improvements with treatment. Strategies that specifically target engagement may hold promise for increasing access to evidence-based treatments and for increasing likelihood of treatment completion.
Research use in policymaking is multi-faceted and has been the focus of extensive study. However, virtually no quantitative studies have examined whether the determinants of research use vary ...according to the type of research use or phase of policy process. Understanding such variation is important for selecting the targets of implementation strategies that aim to increase the frequency of research use in policymaking.
A web-based survey of US state agency officials involved with children's mental health policymaking was conducted between December 2019 and February 2020 (n = 224, response rate = 33.7%, 49 states responding (98%), median respondents per state = 4). The dependent variables were composite scores of the frequency of using children's mental health research in general, specific types of research use (i.e., conceptual, instrumental, tactical, imposed), and during different phases of the policy process (i.e., agenda setting, policy development, policy implementation). The independent variables were four composite scores of determinants of research use: agency leadership for research use, agency barriers to research use, research use skills, and dissemination barriers (e.g., lack of actionable messages/recommendations in research summaries, lack of interaction/collaboration with researchers). Separate multiple linear regression models estimated associations between determinant and frequency of research use scores.
Determinants of research use varied significantly by type of research use and phase of policy process. For example, agency leadership for research use was the only determinant significantly associated with imposed research use (β = 0.31, p < 0.001). Skills for research use were the only determinant associated with tactical research use (β = 0.17, p = 0.03) and were only associated with research use in the agenda-setting phase (β = 0.16, p = 0.04). Dissemination barriers were the most universal determinants of research use, as they were significantly and inversely associated with frequency of conceptual (β = -0.21, p = 0.01) and instrumental (β = -0.22, p = 0.01) research use and during all three phases of policy process.
Decisions about the determinants to target with policy-focused implementation strategies-and the strategies that are selected to affect these targets-should reflect the specific types of research use that these strategies aim to influence.
•Community and policy engagement take intensive time and effort.•Collaboration with stakeholders and policy makers require engagement in science that meets a felt need as well as relationship ...building and opportunities for interaction over time.•Implementation scientists needs to be willing to participate in a full range of collaborative activities.•Scientifically based recommendations have to be organized quickly and made accessible to policy makers.•The process of engagement and collaboration needs to be guided by frameworks.
Approximately 450 million people, many of whom live in poverty and are from low and middle-income countries (LMICs), experience serious mental health challenges. Children in sub-Saharan Africa comprise half of the total regional population, yet existing mental health services are severely under-equipped to meet their needs and evidence-based practices (EBPs) are scarce. In Uganda, one in five children present mental health challenges, including disruptive behavior disorders. Guided by the Practical, Robust Implementation and Sustainability (PRISM) framework, this paper describes the strategies by which we have engaged community and government partners to invest in a collaborative, longitudinal study in Uganda aimed at improving youth behavioral health outcomes by testing a collaboratively adapted EBP. We emphasize that implementation scientists should be prepared and willing to invest time and effort engaging key stakeholders and sustain relationships through a full range of collaborative activities; ensure that their science meets a felt need among the stakeholders; and translate their research findings rapidly into accessible and actionable policy recommendations. Finally, we highlight that collaboration with global communities and governments plays a critical role in the adaptation, uptake, scalability, and sustainability of EBPs, and that the process of engagement and collaboration can be guided by conceptual frameworks.
Disruptive behavioral disorders (DBDs) are common among children/adolescents in sub-Saharan Africa. A 16-week manualized multiple family group (MFG) intervention called Amaka Amasanyufu designed to ...reduce DBDs among school-going children/adolescents in low-resource communities in Uganda was efficacious in reducing symptoms of poor mental health relative to usual care in the short-term (4 months post-intervention-initiation). We examined whether intervention effects are sustained 6 months postintervention.
We used longitudinal data from 636 children positive for DBDs: (1) Control condition, 10 schools, n = 243; (2) MFG delivered via parent peers (MFG-PP), eight schools, n = 194 and; (3) MFG delivered via community healthcare workers (MFG-CHW), eight schools, n = 199 from the SMART Africa-Uganda study (2016–2022). All participants were blinded. We estimated three-level linear mixed-effects models and pairwise comparisons at 6 months postintervention and time-within-group effects to evaluate the impact on Oppositional Defiant Disorder (ODD), impaired functioning, depressive symptoms, and self-concept.
At 6 months postintervention, children in MFG-PP and MFG-CHW groups had significantly lower means for ODD (mean difference MD = −1.08 and −1.35) impaired functioning (MD = −1.19 and −1.16), and depressive symptoms (MD = −1.06 and −0.83), than controls and higher means for self-concept (MD = 3.81 and 5.14). Most outcomes improved at 6 months compared to baseline. There were no differences between the two intervention groups.
The Amaka Amasanyufu intervention had sustained effects in reducing ODD, impaired functioning, and depressive symptoms and improving self-concept relative to usual care at 6 months postintervention. Our findings strengthen the evidence that the intervention effectively reduces DBDs and impaired functioning among young people in resource-limited settings and was sustained over time.
This study aims to examine the short-term impact of a combined intervention consisting of evidence-based family economic empowerment (FEE) and multiple family group (MFG) interventions on depressive ...symptoms among school-going adolescent girls in southwestern Uganda.
We analyzed longitudinal data from a cluster randomized trial. The sample consisted of 1,260 adolescent girls (aged 14–17 years at enrollment) recruited from senior one and senior two classes across 47 secondary schools in the southwestern region of Uganda. Participants were randomized at the school level to either the control condition receiving bolstered standard of care or one of the two treatment conditions—the treatment one condition receiving the FEE intervention or the treatment two conditions receiving both the FEE plus MFG interventions. Descriptive statistics and a three-level mixed-effects model were conducted to examine the effect of a combination intervention on depressive symptoms.
At baseline, there were no significant differences between the control condition and both treatment conditions. While all three groups experienced a substantial reduction in depressive symptoms from baseline to 12 months, the reductions were stronger for the two intervention groups. However, FEE + MFG was not significantly different from FEE at 12 months.
Results imply that the FEE intervention may be a promising tool in addressing depressive symptoms among adolescent girls. Therefore, to reduce the long-term implications of adverse psychosocial health during adolescence, policymakers and program implementers should explore scaling up economic empowerment interventions in similar settings to bridge the mental health treatment gap for adolescent girls.
Objective
The key objective of this paper is to provide a phenomenological account of the mental health challenges and experiences of adolescent new mothers. We explore the role of social support and ...the absence of empathy plays in depression among pregnant adolescents. The project also collected data on the adolescents’ caregiving environment which includes the adolescents’ mothers, their partners, the community, and health care workers, as well as feedback from staff nurses at the maternal and child health centers. The caregivers provide additional insight into some of the barriers to access of mental health services and pregnancy care, and the etiology of adolescents’ distress.
Methods
The interviews were conducted in two health facilities of Kariobangi and Kangemi’s maternal and child health (MCH) centers that cover a huge low-income and low-middle-income formal and informal settlements of Nairobi. A grounded theory approach provided a unique methodology to facilitate discussion around adolescent pregnancy and depression among the adolescents and their caregivers. Our interviews were cut across four samples with 36 participants in total. The sample 1 comprised of eight pregnant adolescents who screened positive for depression in Kariobangi, sample 2 were six caregivers from both sites, and sample 3 were 22 new adolescent mothers from both sites. After individual interviews, we carried out one focused group discussion (FDG) in order to understand the cross-cutting issues and to gather some consensus on key issues, and the sample 4 were 20 community health workers, health workers, and nurses from both sites. We had one FGD with all health facility-based workers to understand the cross-cutting issues. The interviews in sample 1 and 2 were individual interviews with pregnant and parenting adolescents, and their caregivers. All our adolescent participants interviewed in sample 1 were screened for depression. Individual interviews followed the FGD.
Findings
Pregnant and parenting adolescents faced several adversities such as social stigma, lack of emotional support, poor healthcare access, and stresses around new life adjustments. We highlighted a few useful coping mechanisms and strategies that these adolescents were thinking to reduce their stress. Primary social support for pregnant and parenting teens comes from the adolescent’s mother. The external family and male partners provide negligible support in the rearing of the child. While the mother’s reactions to the daughters’ pregnancy were empathetic sometimes, absence of food and resources made the mother distant and constraint in lending support. For those adolescents who were living with partners, in their new mother role, they had to negotiate additional challenges such as solutions to everyday childcare responsibilities and other family duties. The health care workers and community health workers confirmed that adolescent mothers have multiple needs, but there is a lack of holistic approach of service, and that their own training and capacities were very limited.
Conclusions
Our paper highlights several individual stakeholder-related and system-level barriers in the MCH primary care setting that affect delivery of psychosocial support for pregnant adolescent. We have identified these knowledge, practice, and institutional gaps that need addressing through careful community and health service staff engagement using implementation strategies that are effective in low-resource settings. Pregnant adolescents are highly vulnerable group and mental health services needs to be understood better.
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