Sociodemographic, psychological, and clinical characteristics associated with health service (non-)use for mental disorders in adolescents and young adults from the general population.

Most adolescents and young adults who experience psychological distress do not seek professional help. This study aims to enhance the understanding of sociodemographic, psychological, and clinical characteristics associated with the underuse of health services by adolescents and young adults with mental disorders. Data from a cross-sectional, epidemiological study with a population-based sample (N = 1180 participants, 14-21 years old) were used. Participants completed a fully standardized, computer-assisted diagnostic interview (DIA-X-5/D-CIDI) administered by trained clinical interviewers to assess lifetime mental disorders according to DSM-5 as well as lifetime health service use for mental health problems, and completed self-report questionnaires to assess various psychological variables (e.g., stigma). Predictors of health service use were examined using univariate and multiple logistic regression analyses, data were weighted for age and sex to improve representativeness Of n = 597 participants with any lifetime mental disorder, 32.4% [95% CI 28.4; 36.7] had ever used any health services because of a mental health, psychosomatic, or substance use problem. Even less had received psychotherapeutic or pharmacological treatment (Cognitive Behavioral Therapy: 12.1% [9.5; 15.2]; other psychotherapy: 10.7% [8.4; 13.7]; medication: 5.4% [3.7; 7.8]). High education was associated with less health service use (low/ middle/ other vs. high education: 53.8% vs. 26.9%; OR = 0.26, p < .001). In the multiple regression model, stigma toward mental disorders was the single psychological variable associated with a reduced likelihood of using health services (OR = 0.69 [0.52; 0.90], p < .01). These findings draw attention to the treatment gap for mental disorders during adolescence and highlight related factors to be addressed in public health contexts.

5-HTT genotype and inertia of negative affect in adolescents and young adults from the general population.

The study aims to replicate the previous found association of 5-HTTLPR and inertia of negative affect in daily life of adolescents and young adults. Data of 877 adolescents (aged 14-21 years) of the Behavior and Mind Health (BeMIND) study (epidemiological cohort study, Dresden, Germany) were genotyped for 5-HTTLPR/rs25531, grouped into SS/SLG/SLA/LGLA/LGLG vs. LALA, and provided ratings on negative affect items, depression and anxiety (Patient-Reported Outcomes Measurement Information System) eight times a day over 4 days. Multilevel regression models did not reveal an association of 5-HTTLPR genotype and inertia of negative affect, nor associations with inertia of anxiety or depression. Inertia of negative affect seems not to be a psychological mechanism through which 5-HTTLPR acts on psychopathology.

Food in the cold: exploring food security and sovereignty in Whitehorse, Yukon.

Harsh weather patterns that are unpredictable owing to climate change, remoteness, dependence on food imports and limited local food production place Arctic and Subarctic food systems under serious pressure. The model of food sovereignty provides a surprisingly interesting contribution to address the food insecurity in these regions; it promotes long-term stable provision of healthy foods (sustainable) that are accessible to all (equity) and fosters local food production-consumption patterns (localisation). This study aims to deepen the understanding of food insecurity in the Subarctic regions and explores the possibilities for a food sovereignty approach at both individual and regional level. The study focuses on Whitehorse, capital of Yukon, Canada, and uses a cross-sectional online survey among residents of Whitehorse and semi-structured in-depth interviews with food-systems experts in Yukon. The findings indicated a need for affordable year-round local food production. Application of food sovereignty has provided the opportunities for local food procurement, innovation hubs, and several types of greenhouses including hydroponics and vertical farming, to work towards a more localised food system, thereby improving food security and sovereignty in Yukon. The findings constitute the scientific knowledge base for the formulation of prospective scenarios in the spirit of the food sovereignty theory.

Non-suicidal self-injury and its co-occurrence with suicidal behavior: An epidemiological-study among adolescents and young adults.

OBJECTIVE: Non-suicidal self-injury (NSSI) comprising thoughts and behaviors is common and often co-occurring with suicidal behavior like ideation, plan, and attempt. As limited data are available for adolescents and young adults, this study aims to present prevalence estimates for lifetime NSSI, its co-occurrence with suicidal behavior, conditional probabilities and their association with socio-demographic characteristics, severity characteristics of suicidal behavior, and health service utilization. METHOD: The epidemiological Behavior and Mind Health (BeMIND) study assessed in 2015/16 a random-community sample of N = 1180 aged 14-21 years from Dresden, Germany, regarding lifetime NSSI via self-administered questionnaire and suicidal behaviors via standardized interview. RESULTS: Any lifetime NSSI was reported by 19.3% (thoughts: 18.0%, behaviors: 13.6%) of the sample with higher prevalence in females (OR = 2.7, 95% CI 1.9-3.8, P < 0.001). Lifetime prevalence of co-occurring NSSI and suicidal behavior was 7.7%. Females had a 3.3- to 8.8-fold odds of co-occurrence than males. Among those with any NSSI, 39.6% endorsed suicidal behavior, and 66.3% of those with any suicidal behavior reported NSSI. 42.3% of those with any NSSI reported to have used mental healthcare services at any time during their life with higher rates in those with co-occurring suicidal behavior (62.3%). CONCLUSION: Non-suicidal self-injury and co-occurring suicidal behavior is common in adolescents and young adults-especially females. The limited utilization of mental healthcare services underpins the need for improving recognition of NSSI and suicidal behavior as well as the accessibility of mental healthcare services during adolescence and emerging adulthood.

Does parental support influence children's active school travel?

Today's 'backseat generation' of children is more often driven to school. Active school travel (AST) can contribute up to 30% of recommended daily physical activity. Although governed by a complex set of factors, parents are considered 'gatekeepers' of children's travel mode decisions. Therefore, we investigate the relationship between parental support and children's AST. Data were from Active Streets, Active People-Junior (British Columbia, Canada). Children self-reported travel mode to/from school for 1 week (10 trips). We assessed parental perceived neighborhood traffic and crime safety (Neighborhood Environmental Walkability Scale-Youth) and frequency of parental support for AST (0-5 ×/week). We investigated the association between daily AST behaviour and parental support using logistic regression (controlling for age, sex, distance to school and perceived neighborhood safety). In our sample (n = 179, 11.0 ± 1.0 years, 59% girls), 57% reported daily AST and 63% of parents provided daily support. Bivariate analyses showed AST behaviour was significantly associated with parental support frequency and parents' perceived safety. In adjusted analysis, daily parental support remained significantly associated with daily AST (OR 9.0, 95% CI 4.2, 19.7). The relationship between parental support and AST was independent of noted correlates of AST. Thus, interventions that focus solely on changes to the built environment may not be enough to encourage AST. Therefore, interventions that aim to increase AST should involve parents and children in the planning process.

Six-year changes in body mass index and cardiorespiratory fitness of English schoolchildren from an affluent area.

We compared values of body mass index (BMI) and cardiorespiratory fitness (20 m shuttle-run test) of n=157 boys and n=150 girls aged 10-11 measured in 2014 with measures from 2008 and 1998. Boys' fitness was lower (d=0.68) in 2014 than 2008, despite a small (d=0.37) decline in BMI. Girl's BMI changed trivially (d=0.08) but cardiorespiratory fitness was lower (d=0.47) in 2014 than 2008. This study suggests fitness is declining at 0.95% per year, which exceeds the 0.8% rate of decline we reported between 1998 and 2008 and is double the global average of 0.43%. Declines in fitness were independent of changes in BMI suggesting continued reductions in English children's habitual physical activity levels.

The impact of attachment and depression symptoms on multiple risk behaviors in post-war adolescents in northern Uganda.

BACKGROUND: We have previously shown that depression symptoms are associated with multiple risk behaviors and that parental attachments are protective against depression symptoms in post-war adolescents. Accumulating literature indicates that low levels of attachment may sensitize individuals to increased multiple risk behaviors when depression symptoms exist. This investigation examined the interactive effects of attachment and depression symptoms on multiple risk behavior. METHODS: We conducted hierarchical logistic regression analyses to examine the impact of attachment and depression symptoms on multiple risk behavior in our post-war sample of 551 adolescents in Gulu district. RESULTS: Analyses revealed interactive effects for only maternal attachment-by-depression interaction. Interestingly, high levels of maternal attachment exacerbated the relationship between depression symptoms and multiple risk behaviors while low levels of maternal attachment attenuated this relationship. LIMITATIONS: It is possible that this analysis could be biased by a common underlying factor that influences self-reporting and therefore is correlated with each of self-reported attachment security, depressive symptoms, and multiple risk behaviors. CONCLUSIONS: These findings suggest that maternal attachment serves as a protective factor at low levels while serving as an additional risk factor at high levels. Findings support and expand current knowledge about the roles that attachment and depression symptoms play in the development of multiple risk behaviors and suggest a more complex etiology for post-war adolescents.

Systemic lupus erythematosus is not a risk factor for poor outcomes after total hip and total knee arthroplasty.

OBJECTIVES: Historically, arthroplasty in systemic lupus erythematosus (SLE) patients has been less successful than for patients with osteoarthritis (OA). It is not known if SLE remains an independent risk factor for poor arthroplasty outcomes or if other factors, such as avascular necrosis (AVN), continue to play a role. METHODS: A case-control study using data from a single-institution arthroplasty registry compared SLE total hip arthroplasty (THA) and total knee arthroplasty (TKA) with OA controls matched by age, gender and presence of AVN. Baseline, two-year administrative and self-report data, and diagnosis leading to arthroplasty were evaluated. RESULTS: A total of 54 primary SLE THA and 45 primary SLE TKA were identified from May 2007 through June 2011. AVN was present in 32% of SLE THA and no TKA. SLE THA had worse preoperative WOMAC pain (42.5 vs. 52.7; p = 0.01) and function (38.8 vs. 48.0; p = 0.05) compared with OA. However, at two years there was no difference in WOMAC pain (91.1 vs. 92.1; p = 0.77) or WOMAC function (86.4 vs. 90.8; p = 0.28). SLE TKA were similar to OA in both preoperative pain (42.6 vs. 48.4; p = 0.14) and function (42.1 vs. 46.8; p = 0.30) and two-year pain (85.7 vs. 88.6; p = 0.50) and function (83.7 vs. 85.1; p = 0.23). Compared to OA, SLE THA and TKA patients had more renal failure (14% vs. 1%; p = 0.007) and hypertension (52% vs. 29%; p = 0.009). In a multivariate linear regression, SLE was not predictive of either poor pain or poor function. CONCLUSIONS: While SLE patients have more comorbidities than OA, and SLE THA have worse preoperative pain and function compared with OA controls, SLE was not an independent risk factor for poor short-term pain or function after either hip or knee arthroplasty.

Cardiovascular control, autonomic function, and elite endurance performance in spinal cord injury.

We aimed to determine the relationship between level of injury, completeness of injury, resting as well as exercise hemodynamics, and endurance performance in athletes with spinal cord injury (SCI). Twenty-three elite male paracycling athletes (C3-T8) were assessed for neurological level/completeness of injury, autonomic completeness of injury, resting cardiovascular function, and time to complete a 17.3-km World Championship time-trial test. A subset were also fitted with heart rate (HR) monitors and their cycles were fitted with a global positioning systems device (n = 15). Thoracic SCI exhibited higher seated systolic blood pressure along with superior time-trial performance compared with cervical SCI (all P < 0.01). When further stratified by autonomic completeness of injury, the four athletes with cervical autonomic incomplete SCI exhibited a faster time-trial time and a higher average speed compared with cervical autonomic complete SCI (all P < 0.042). Maximum and average HR also tended to be higher in cervical autonomic incomplete vs autonomic complete. There were no differences in time-trial time, HR, or speed between thoracic autonomic complete vs incomplete SCI. In conclusion, autonomic completeness of injury and the consequent ability of the cardiovascular system to respond to exercise appear to be a critical determinant of endurance performance in elite athletes with cervical SCI.

The good, the bad and the ugly of catheterization practices among elite athletes with spinal cord injury: a global perspective.

STUDY DESIGN: Despite significant progress in bladder management, urinary tract infections (UTIs) are still common among individuals with spinal cord injury (SCI), and could negatively impact their health and quality of life. However, there are no data available on bladder management and frequency of UTIs among elite athletes with SCI. METHODS: Athletes were assessed during the London 2012 Paralympic Games and 2013 Paracycling World Championships. Athletes completed the standard form of the International Standards to Document remaining Autonomic Functions after SCI, along with the standardized Autonomic Function Questionnaire. RESULTS: A total of 61 (age=35.5±7.7 years (mean±s.d.); time since injury=16.0±7.6 years) elite athletes from 15 countries with traumatic SCI and who used clean intermittent catheterization were included in this study. The majority (75%) were from developed nations. Athletes catheterized on average 6±2 times per day. We found that individuals who reused catheters experienced more frequent UTIs (P<0.001). We also demonstrated that 83% of individuals from developed nations never reused a single-use catheter, whereas only 27% of individuals from developing nations used a new catheter each time (P<0.001). We also noted a twofold increase in the frequency of UTIs in individuals from developing nations (P=0.027). CONCLUSIONS: This study demonstrates that catheter reuse is intimately linked to UTI frequency and provides novel insight on bladder function and management in elite athletes with SCI. Reasons for catheter reuse may be due to a lack of health education and/or a lack of bladder-management resources. (Support: Craig Neilsen Foundation, ICORD, IPC).

Influence of ketamine-xylazine anaesthesia on cubic and quadratic high-frequency distortion-product otoacoustic emissions.

Ketamine is a dissociative anaesthetic, analgesic drug as well as an N-methyl-D-aspartate receptor antagonist and has been reported to influence otoacoustic emission amplitudes. In the present study, we assess the effect of ketamine-xylazine on high-frequency distortion-product otoacoustic emissions (DPOAE) in the bat species Carollia perspicillata, which serves as model for sensitive high-frequency hearing. Cubic DPOAE provide information about the nonlinear gain of the cochlear amplifier, whereas quadratic DPOAE are used to assess the symmetry of cochlear amplification and potential efferent influence on the operating state of the cochlear amplifier. During anaesthesia, maximum cubic DPOAE levels can increase by up to 35 dB within a medium stimulus level range from 35 to 60 dB SPL. Close to the -10 dB SPL threshold, at stimulus levels below about 20-30 dB SPL, anaesthesia reduces cubic DPOAE amplitudes and raises cubic DPOAE thresholds. This makes DPOAE growth functions steeper. Additionally, ketamine increases the optimum stimulus frequency ratio which is indicative of a reduction of cochlear tuning sharpness. The effect of ketamine on cubic DPOAE thresholds becomes stronger at higher stimulus frequencies and is highly significant for f2 frequencies above 40 kHz. Quadratic DPOAE levels are increased by up to 25 dB by ketamine at medium stimulus levels. In contrast to cubic DPOAEs, quadratic DPOAE threshold changes are variable and there is no significant loss of sensitivity during anaesthesia. We discuss that ketamine effects could be caused by modulation of middle ear function or a release from ipsilateral efferent modulation that mainly affects the gain of cochlear amplification.

Athletic performance and birth month: is the relative age effect more than just selection bias?

The aim of this study was to determine if month of birth affects performance in 3 tests of physical function in children and adolescents. We measured cardiorespiratory fitness, handgrip strength and lower-body power expressed them relative to (whole year) age then compared scores between calendar year birth-months. We also expressed test performance as the likelihood of achieving criterion-referenced fitness standards. There were significant main effects of birth-month for cardiorespiratory fitness (F=4.54, p<0.001), strength (F=6.81, p<0.001) and power (F=3.67, p<0.001). Children born in November were fitter and more powerful than those born at other times, particularly the summer months (April, May and June). October-born children were stronger than those born in all months except September and November. This relationship was evident despite controlling for decimal age and despite no significant inter-month differences in anthropometric characteristics.There is a clear physical advantage for those born in the autumn and this may explain some of the bias in sports selection attributed to the relative age effect, particularly when the British school-year (September) cut-off is used.

Neural maps for target range in the auditory cortex of echolocating bats.

Computational brain maps as opposed to maps of receptor surfaces strongly reflect functional neuronal design principles. In echolocating bats, computational maps are established that topographically represent the distance of objects. These target range maps are derived from the temporal delay between emitted call and returning echo and constitute a regular representation of time (chronotopy). Basic features of these maps are innate, and in different bat species the map size and precision varies. An inherent advantage of target range maps is the implementation of mechanisms for lateral inhibition and excitatory feedback. Both can help to focus target ranging depending on the actual echolocation situation. However, these maps are not absolutely necessary for bat echolocation since there are bat species without cortical target-distance maps, which use alternative ensemble computation mechanisms.

Temporal relationships between screen-time and physical activity with cardiorespiratory fitness in English schoolchildren: a 2-year longitudinal study.

OBJECTIVE: To determine the temporal relationships screen-time and physical activity have with cardiorespiratory fitness. METHOD: Measures were made over two years (2008-2010) in 1500 participants aged 11.5 (SD 0.5) years at baseline. RESULTS: Tracking coefficients were low-to-moderate for all measures. At follow-up, 25% of participants moved from having low (<2h) to high (≥ 2 h) daily screen-time and 6% became unfit according to FITNESSGRAM standards. Baseline screen-time was the strongest univariate predictor of becoming unfit. Multivariate analysis controlling for decimal age, BMI and deprivation confirmed baseline screen-time as the strongest independent predictor of becoming unfit over the 2-year study period (OR 2.4; 95%CI:1.4-4.0). Current (OR 2.3; 95%CI:1.3-4.0) and previous (OR 1.7; 95%CI:1.0-2.9) physical activity levels also independently predicted becoming unfit. CONCLUSION: There is currently no guidance for limiting screen-time in UK children. These longitudinal data add to the cross-sectional evidence of lower physical activity and fitness in children reporting ≥ 2 h daily screen-time. More importantly, these data demonstrate that high screen-time during childhood is an independent predictor of lower cardiorespiratory fitness in adolescence.

Achilles tendon shape and echogenicity on ultrasound among active badminton players.

The relationship between Achilles tendon ultrasound abnormalities, including a spindle shape and heterogeneous echogenicity, is unclear. This study investigated the relationship between these abnormalities, tendon thickness, Doppler flow and pain. Sixty-one badminton players (122 tendons, 36 men, and 25 women) were recruited. Achilles tendon thickness, shape (spindle, parallel), echogenicity (heterogeneous, homogeneous) and Doppler flow (present or absent) were measured bilaterally with ultrasound. Achilles tendon pain (during or after activity over the last week) and pain and function [Victorian Institute of Sport Achilles Assessment (VISA-A)] were measured. Sixty-eight (56%) tendons were parallel with homogeneous echogenicity (normal), 22 (18%) were spindle shaped with homogeneous echogenicity, 16 (13%) were parallel with heterogeneous echogenicity and 16 (13%) were spindle shaped with heterogeneous echogenicity. Spindle shape was associated with self-reported pain (P<0.05). Heterogeneous echogenicity was associated with lower VISA-A scores than normal tendon (P<0.05). There was an ordinal relationship between normal tendon, parallel and heterogeneous and spindle shaped and heterogeneous tendons with regard to increasing thickness and likelihood of Doppler flow. Heterogeneous echogenicity with a parallel shape may be a physiological phase and may develop into heterogeneous echogenicity with a spindle shape that is more likely to be pathological.

Prevalence of high screen time in English youth: association with deprivation and physical activity.

BACKGROUND: Physical activity (PA) and deprivation are major determinants of health. We estimated the prevalence of high screen time (ST) among English youth and examined whether deprivation mediated the relationship between ST and PA. METHODS: It is a cross-sectional study of 6240 participants (53% boys, aged 10-15 years) enrolled in the East of England Healthy Hearts study. The participants were categorized into three groups based on daily ST: <2, 2-4 or >4 h. Participants were classified as 'active' or 'inactive' based on PA z-scores. RESULTS: Prevalence of >2 h ST was 36%. Participants reporting <2 h daily ST were more likely to be active than those reporting 2-4 h (adjusted OR: 1.51, 95% CI: 1.26-1.82, P< 0.001) or >4 h (adjusted OR: 2.26, 95% CI: 1.91-2.67, P< 0.001). Analysis of covariance demonstrated a significant main effect for ST on PA (F = 85.7, P< 0.001) with lower PA in each ascending ST group (P< 0.001). Deprivation was not significantly associated with PA and did not mediate the relationship between ST and PA. CONCLUSIONS: There is high prevalence of >2 h ST in English schoolchildren. PA is lower in children reporting 2-4 versus <2 h daily ST and lower still in those classified as heavy users (>4 h) independent of deprivation.

Contrasting physical activity patterns in children and adolescents living in differing environments in the U.K.

AIMS: There is evidence for lower physical activity (PA) in rural adults; it is important to evaluate how the environment influences the PA of children and adolescents. METHODS: We compared the PA of 6485 English 10-15.9 year olds according to two systems for classifying the immediate environment. System one compared urban and rural areas. System two compared urban, town and fringe, and rural areas. Analyses were carried out separately for children (<13 years) and adolescents (>13 years). RESULTS: Rural children were more active than those from urban areas (OR 1.38, 95% CI 1.15-1.66) as were adolescents (OR 1.30, 95% CI 1.11-1.51). Using trilateral division, children were more active if they lived in town and fringe (OR 1.32, 95% CI 1.03-1.67) or rural (OR 1.45, 95% CI 1.14-1.84) areas compared with urban areas. Adolescents from town and fringe areas were more active than urban dwellers (OR 1.50, 95% CI 1.24-1.81). Rural adolescents' PA did not differ from urban dwellers'. CONCLUSIONS: Rural environments support PA in children but not that of adolescents. Town and fringe areas with mixed elements of rural and urban land use appear to facilitate and sustain PA in both children and adolescents.