The mental health profiles of pediatric organ transplant recipients.

BACKGROUND: Solid organ transplantation is the indicated treatment for children with end-stage organ failure. Little is known about the impact of organ transplantation on pediatric transplant recipients' mental health. Symptoms of medical procedure and generalized anxiety, post-traumatic stress, and depression may emerge, despite the successful restoration of organ function. METHODS: We examined symptoms of anxiety, depression, trauma, and medical procedure anxiety-specifically, fear and avoidance of needles-in youth who had received a kidney, liver, or heart transplant. Parent-report on child mental health symptoms was also collected. RESULTS: Data were obtained for 56 youth. Most children did not endorse clinically significant symptoms of depression. In contrast, 20% of parents reported symptoms of depression in their child that exceeded clinical cutoffs. Parents also reported higher levels of anxiety in their children than did the children themselves. Indeed, on average, children reported lower levels of depression and anxiety than would be expected in a general population. On a trauma measure, 22.6% of youths' scores were above clinical cutoffs, with girls scoring higher than boys. Finally, 10.9% of children stated that they attempted to avoid needles because of fear. Once again, girls reported higher needle fear scores than boys and younger patients reported experiencing higher levels of needle fear. CONCLUSIONS: Anxiety, depression, post-traumatic stress, and needle fear are important psychological parameters that should be considered in the evaluation of pediatric patients with solid organ transplant, as part of their routine post-transplant care.

Evidence for Protein-Protein Interaction between Dopamine Receptors and the G Protein-Coupled Receptor 143.

Protein-protein interactions between G protein-coupled receptors (GPCRs) can augment their functionality and increase the repertoire of signaling pathways they regulate. New therapeutics designed to modulate such interactions may allow for targeting of a specific GPCR activity, thus reducing potential for side effects. Dopamine receptor (DR) heteromers are promising candidates for targeted therapy of neurological conditions such as Parkinson's disease since current treatments can have severe side effects. To facilitate development of such therapies, it is necessary to identify the various DR binding partners. We report here a new interaction partner for DRD2 and DRD3, the orphan receptor G protein-coupled receptor 143 (GPR143), an atypical GPCR that plays multiple roles in pigment cells and is expressed in several regions of the brain. We previously demonstrated that the DRD2/ DRD3 antagonist pimozide also modulates GPR143 activity. Using confocal microscopy and two FRET methods, we observed that the DRs and GPR143 colocalize and interact at intracellular membranes. Furthermore, co-expression of wildtype GPR143 resulted in a 57% and 67% decrease in DRD2 and DRD3 activity, respectively, as determined by ß-Arrestin recruitment assay. GPR143-DR dimerization may negatively modulate DR activity by changing affinity for dopamine or delaying delivery of the DRs to the plasma membrane.

Questioning fairness: the relationship of mental health and psychopathic characteristics with young offenders' perceptions of procedural justice and legitimacy.

BACKGROUND: Theories of procedural justice suggest that individuals who experience the criminal justice system as fair are more likely to perceive it as legitimate and, in turn, are less likely to reoffend. However, when individuals come into contact with the legal system, they are not blank slates - they have beliefs and personality characteristics that may systematically influence such perceptions. AIMS: Our aim was to establish the extent to which demographic characteristics, legal history and clinical features, including personality characteristics, systematically influenced the degree to which young people experience the justice system as fair and legitimate. METHOD: Self-report, file and interview data were collected from ninety-two 12 to 17-year-olds on probation in Western Canada. RESULTS: Substance use and traumatic experiences were inversely correlated with perceptions of procedural justice and legal legitimacy. Young people with higher scores on interpersonal, lifestyle and antisocial facets of the psychopathy checklist: youth version believed less strongly in the legitimacy of the law, but regression analyses confirmed that only history of trauma was independently associated with perceived procedural justice and legitimacy. Those in the youngest age group were more likely to have positive perceptions of justice than older youths, but demographics and legal history otherwise did not relate to outcomes. CONCLUSIONS: Our findings suggest that examining the relationship between procedural justice, legitimacy and offending without taking intra-individual variables into account may neglect important influences on those relationships. Other research has begun to show that young people who do not accept the law as legitimate or the criminal justice system as fair are more likely to offend. Copyright © 2016 John Wiley & Sons, Ltd.

Procedural justice versus risk factors for offending: predicting recidivism in youth.

Theories of procedural justice suggest that individuals who experience respectful and fair legal decision-making procedures are more likely to believe in the legitimacy of the law and, in turn, are less likely to reoffend. However, few studies have examined these relationships in youth. To begin to fill this gap in the literature, in the current study, the authors studied 92 youth (67 male, 25 female) on probation regarding their perceptions of procedural justice and legitimacy, and then monitored their offending over the subsequent 6 months. Results indicated that perceptions of procedural justice predicted self-reported offending at 3 months but not at 6 months, and that youths' beliefs about the legitimacy of the law did not mediate this relationship. Furthermore, procedural justice continued to account for unique variance in self-reported offending over and above the predictive power of well-established risk factors for offending (i.e., peer delinquency, substance abuse, psychopathy, and age at first contact with the law). Theoretically, the current study provides evidence that models of procedural justice developed for adults are only partially replicated in a sample of youth; practically, this research suggests that by treating adolescents in a fair and just manner, justice professionals may be able to reduce the likelihood that adolescents will reoffend, at least in the short term.

Disclosure of new health problems and intervention planning using a geriatric assessment in a primary care setting.

AIM: To determine the prevalence of health problems uncovered by a Standardized Assessment for Elderly Patients in a Primary Care Setting (STEP), to explore how often STEP uncovered conditions new to general practitioners (GP) and ascertain how often STEP results led GPs to plan further interventions. METHODS: This descriptive, interim analysis was based on the data of 189 elderly patients (median age, 78 years; interquartile range [IQ], 74-81) and their 20 GPs collected in Hannover region, Germany, between June 2008 and April 2009. Study nurses in the practice setting applied the 44-item STEP instrument, based mainly on self-reporting, as well as a standardized patient interview. Subsequently, GPs indicated whether the problems were new to them, and whether they planned further action or health interventions on the basis of the problems identified by STEP. RESULTS: A median of 11 health problems (IQ, 8-14) were uncovered per patient, of which a median of 2 (IQ, 1-4) were new to the GP and interventions were planned for a median of 2 problems (IQ, 0-4). Many of the identified health problems are typical of old age. The following health problems uncovered by STEP were often new to the GPs (percentages differ to numbers due to missing GP ratings): cognitive impairment (33 of 64 affected by this problem, 73%), missing or unknown immunization status (84 of 160, 55%), and recent chest pain (19 of 37, 53%). Alcohol misuse was new in all 4 affected patients (100%) and recent falls were new in 5 of 7 patients (83%). Interventions for affected patients were frequently planned for problems of immunization (for 83 patients of 160 reporting the problem, 57%), current anxiety (4 of 9, 50%), and chest pain (14 of 37, 44%). Moreover, further management was frequently planned for depression (10 of 29, 39%) and cognitive impairment (16 of 64, 38%). CONCLUSION: Using a geriatric assessment in primary care discloses relevant heath problems and treatment needs that GPs may otherwise overlook.

Defense attorneys' concerns about the competence of adolescent defendants.

Research indicates that a sizable proportion of adolescent defendants have difficulty understanding and participating in legal proceedings against them, and may be incompetent to stand trial. To examine attorneys' experience in defending adolescents with competence-related difficulties, 214 juvenile attorneys were surveyed. Findings indicated that attorneys have doubts about the competence of approximately 10% of adolescent defendants, and that they find these cases particularly challenging to defend. Most attorneys appear to recognize that developmental factors may contribute to adolescents' competence-related difficulties, and believe that the law should accept developmental immaturity as a basis for incompetence findings. In approximately half of the cases in which attorneys had doubts about competence, attorneys did not request a competence evaluation but instead made other efforts to address competence issues, such as by teaching adolescents about legal proceedings and further involving their parents. The implications of these findings are discussed.

Machine learning approaches for phenotype-genotype mapping: predicting heterozygous mutations in the CYP21B gene from steroid profiles.

OBJECTIVE: Non-linear relations between multiple biochemical parameters are the basis for the diagnosis of many diseases. Traditional linear analytical methods are not reliable predictors. Novel nonlinear techniques are increasingly used to improve the diagnostic accuracy of automated data interpretation. This has been exemplified in particular for the classification and diagnostic prediction of cancers based on expression profiling data. Our objective was to predict the genotype from complex biochemical data by comparing the performance of experienced clinicians to traditional linear analysis, and to novel non-linear analytical methods. DESIGN AND METHODS: As a model, we used a well-defined set of interconnected data consisting of unstimulated serum levels of steroid intermediates assessed in 54 subjects heterozygous for a mutation of the 21-hydroxylase gene (CYP21B) and in 43 healthy controls. RESULTS: The genetic alteration was predicted from the pattern of steroid levels with an accuracy of 39% by clinicians and of 64% by linear analysis. In contrast, non-linear analysis, such as self-organizing artificial neural networks, support vector machines, and nearest neighbour classifiers, allowed for higher accuracy up to 83%. CONCLUSIONS: The successful application of these non-linear adaptive methods to capture specific biochemical problems may have generalized implications for biochemical testing in many areas. Nonlinear analytical techniques such as neural networks, support vector machines, and nearest neighbour classifiers may serve as an important adjunct to the decision process of a human investigator not 'trained' in a specific complex clinical or laboratory setting and may aid them to classify the problem more directly.