Cyberbullying and internet safety: a survey of child and adolescent mental health practitioners.

OBJECTIVES: Cyberbullying is increasingly recognised as a threat for young people's mental health. Young people and their families may not know how to stay safe online or how to respond following unsafe internet experiences. This study aimed to examine Child and Adolescent Mental Health Service (CAMHS) staff perceived knowledge, practice and attitudes towards cyberbullying (CB) and internet safety (IS), and their training needs. METHODS: A descriptive, survey design was used. 59 CAMHS clinicians completed a study specific online survey examining their knowledge, practice, attitudes and training needs regarding CB and IS. Frequency and descriptive statistics were conducted on participant responses. RESULTS: Clinicians reported that risky internet behaviour and CB were frequent experiences reported by youth attending their clinical practice. Professionals were aware of potential adverse effects on the young person, including social withdrawal, low self-esteem, anxiety, self-injurious behaviour and suicidal thoughts. Training for young people on online behaviour and good digital citizenship skills was a highly endorsed preference. The majority of respondents felt CAMHS staff have a role in supporting families and managing IS and identified training and resource materials as strategies to assist them in this regard. CONCLUSIONS: Findings support a need for clinicians to regularly inquire about internet use, safety and adverse online experiences. The ongoing development of resources and training in CB and IS for CAMHS clinicians, children and caregivers is necessary. Further research is warranted due to the small sample size and the subjective nature of the current study.

General practitioners' training and their attitudes towards young people who self-harm: A cross-sectional survey.

AIM: Self-harm is common among adolescents and young adults and carries increased risk of suicide and other negative outcomes, yet only a small proportion will seek professional help. General practitioners (GPs) are a potentially valuable source of help as most young people visit their GP regularly for other reasons. The primary aim of this research was to explore GPs' empathy and attitudes towards young people who self-harm and how these are related to GP specialist training. METHOD: GPs completed questionnaires regarding their training, levels of empathy, perceived knowledge and attitudes towards young people who self-harm. The cross-sectional design included a random sample of 178 GPs and 47 GPs-in-training in the Republic of Ireland. Bootstrapped mediation analysis using structural equation modelling (SEM) was applied to explore the pattern of relationships among GP-training, empathy, perceived knowledge of self-harm and attitudes towards youth who self-harm. RESULTS: The SEM results revealed that the model had a very good fit to the data. Empathy was the strongest predictor of attitudes towards self-harm even if GPs had received youth mental health training and fully mediated the effect of youth mental health training on perceived knowledge of self-harm. Specialized training in self-harm was a stronger predictor of perceived knowledge than empathy but had no association with negative attitudes. CONCLUSIONS: The findings emphasize positive outcomes associated with GP training and highlight potential differences in the effects associated with specific vs general training in youth mental health. These differences may be used to inform the design and implementation of continuing professional development.

A longitudinal investigation into cognition and disease progression in spinocerebellar ataxia types 1, 2, 3, 6, and 7.

BACKGROUND: The natural history of clinical symptoms in the spinocerebellar ataxias (SCA)s has been well characterised. However there is little longitudinal data comparing cognitive changes in the most common SCA subtypes over time. The present study provides a preliminary longitudinal characterisation of the clinical and cognitive profiles in patients with SCA1, SCA2, SCA3, SCA6 and SCA7, with the aim of elucidating the role of the cerebellum in cognition. METHODS: 13 patients with different SCAs all caused by CAG repeat expansion (SCA1, n = 2; SCA2, n = 2; SCA3, n = 2; SCA6, n = 4; and SCA7, n = 3) completed a comprehensive battery of cognitive and mood assessments at two time points, a mean of 7.35 years apart. All patients were evaluated clinically using the Scale for the Rating and Assessment of Ataxia (SARA) and the Inventory of Non-Ataxia Signs (INAS). Patients underwent structural MRI imaging at follow-up. RESULTS: Clinical scale scores increased in all patients over time, most prominently in the SCA1 (SARA) and SCA3 (INAS) groups. New impairments on neuropsychological tests were most commonly observed with executive functions, speed, attention, visual memory and Theory of Mind. Results suggest possible differences in cognitive decline in SCA subtypes, with the most rapid cognitive decline observed in the SCA1 patients, and the least in the SCA6 patients, congruent with observed patterns of motor deterioration. Minimal changes in mood were observed, and MRI measures of atrophy did not correlate with cognitive decline. CONCLUSION: As well as increasing physical impairment, cognitive decline over time appears to be a distinct aspect of the SCA phenotype, in keeping with the cerebellar cognitive-affective syndrome. Our data suggest a trend of cognitive decline that is different for each SCA subtype, and for the majority is related to the severity of cerebellar motor impairment.

A qualitative description of falls in a neuro-rehabilitation unit: the use of a standardised fall report including the International Classification of Functioning (ICF) to describe activities and environmental factors.

PURPOSE: Falls are a recognised problem for people with long-term neurological conditions but less is known about fall risk in young adults. This study describes fallers' and falls' characteristics in adults less than 60 years old, in a neuro-rehabilitation unit. METHODS: This single-centre, longitudinal, observational study included 114 consecutive admissions to a UK neuro-rehabilitation unit over 20 months. The demographic and clinical characteristics of eligible patients included age, sex, diagnosis, hospital length of stay and the Functional Independence Measure (FIM). Falls were recorded prospectively in a fall report, using the activities and environmental domains of the International Classification of Functioning (ICF). RESULTS: A total of 34 (30%) patients reported a fall, with 50% experiencing more than one fall. The majority of falls (60%) occurred during the first 2 weeks, during day-time (90%) and during mobile activities (70%). Overall, falls rate (95% confidence interval) was 1.33 (1.04 to 1.67) per 100 d of patient hospital stay. Factors associated with increased falls included becoming a walker during admission or being cognitively impaired. There were no serious fall-related injuries. CONCLUSION: The first 2 weeks of admission is a high risk time for fallers, in particular those who become walkers or are cognitively impaired. Prevention policies should be put in place based on fall characteristics. Implications for Rehabilitation The ICF is a valuable instrument for describing subject and environmental factors during a fall-event. Falls are frequent events but do not usually cause serious injuries during inpatient rehabilitation. There is an increased fall risk for subjects with cognitive impairments or those relearning how to walk.

The risk of falling in young adults with neurological conditions: a systematic review.

PURPOSE: To review systematically the literature on fall risk factors for young patients affected by neurological disorders. METHOD: A systematic search of all primary research-based literature on risk factors for falls or fall characteristics in young adults (mean age <55 years) published prior to July 2012 was conducted using 11 databases. Studies that focused on fall risk screening tools, fear of falling or interventions for fall prevention were excluded. Two reviewers independently agreed on eligibility and methodological quality and extracted data. RESULTS: Twenty-three final studies were selected, including 21 observational studies; one randomised controlled trial and one qualitative study. An average of 50.2% of the 2776 total participants experienced at least one fall. Among the multiple risk factors studied, a reduced performance in balance and gait was consistently associated with falls, while the contribution of single physical and cognitive impairments was variable in different populations. Walking aids, wheelchair characteristics and environmental hazards are significant environmental risk factors. The heterogeneity of the assessment tools used to measure risk factors limited comparison across studies. CONCLUSION: Falling is a common problem among young patients affected by neurological disorders, although the risk of falling for a specific individual is difficult to predict and the risk of a severe fall-related injury has not yet been established. IMPLICATIONS FOR REHABILITATION: Young patients with impaired gait and balance or medium to severe motor disability appear to be at increased risk of falling. Patients who are relatively independent and still participating in challenging activities have an increased exposure to fall-risk. Walking aids, wheelchair characteristics and environmental hazards are significant environmental risk factors. These risk factors should be monitored closely in the young neurological population to help prevent falls.