Ketamine treatment for refractory anxiety: A systematic review.

There is a growing interest in the psychiatric properties of the dissociative anaesthetic ketamine, as single doses have been shown to have fast-acting mood-enhancing and anxiolytic effects, which persist for up to a week after the main psychoactive symptoms have diminished. Therefore, ketamine poses potential beneficial effects in patients with refractory anxiety disorders, where other conventional anxiolytics have been ineffective. Ketamine is a noncompetitive antagonist of the N-methyl-d-aspartate (NMDA) glutamate receptor, which underlies its induction of pain relief and anaesthesia. However, the role of NMDA receptors in anxiety reduction is still relatively unknown. To fill this paucity in the literature, this systematic review assesses the evidence that ketamine significantly reduces refractory anxiety and discusses to what extent this may be mediated by NMDA receptor antagonism and other receptors. We highlight the temporary nature of the anxiolytic effects and discuss the high discrepancy among the study designs regarding many fundamental factors such as administration routes, complementary treatments and other treatments.

Development of a School Health Policy Implementation Survey: A Delphi Study.

Data on school health policy implementation are limited due to the absence of a validated measurement tool. The purpose of this study was to create and pilot a school health policy implementation survey. A modified, four-round Delphi process was used to achieve consensus on content and format of the survey. The final 76-item survey was piloted in 655 schools with a return rate of 57.1% (n = 378). Seven schools participated in environmental audits. Based on the audits, survey responses represented an accurate description of school practices for 84.2% (n = 64) of questions. The remaining 15.8% (n = 12) of survey items were eliminated or revised. This measurement tool begins to fill the research gap between the evaluation of written school health policy and implementation. Further, this tool may be used by school nurses in alignment with the Framework for 21st Century School Nursing Practice.

School Health Policy Implementation: Facilitators and Challenges.

Schools are uniquely positioned to impact student health and academic outcomes through health and wellness policies. The purpose of this study was to describe factors influencing implementation of school health and wellness policies, specifically those focused on physical activity and nutrition. In-depth, stakeholder interviews were conducted with key informants at eight Chicago Public Schools (K-eighth grade). Data were analyzed using summative content analysis. Two themes were identified, facilitators and challenges to policy implementation. Facilitators included district support and motivation (internal and external). Challenges included limited school nurse availability, breaking tradition and budget. The external community and wellness team composition fell within both themes. Specific strategies are suggested to build upon policy implementation facilitators and overcome challenges. While school nurses play an integral role in student health and wellness, further research is needed to understand school nurse impact on student health and academic outcomes through school health policy.

The rising use of cognitive enhancement drugs and predictors of use during COVID-19: findings from a cross-sectional survey of students and university staff in the UK.

Background: The use of psychoactive substances to increase cognitive performance while studying has been termed 'pharmacological cognitive enhancement' (PCE). In previous years, several large-scale national surveys have focused on their use by students at university, including drug types, prevalence rates, and predictive factors. The recent coronavirus pandemic brought about widespread structural changes for UK universities, as students were forced to adapt to home-based learning and in many cases reduced academic support. No study has yet focused primarily on the impact of pandemic social restrictions on PCE in students and academic staff, and whether personality and demographic factors reveal user profiles that predict use during the pandemic period. Method: A convenience sample of 736 UK students and staff aged 18-54 (M = 22.2, SD = 5.2) completed a cross-sectional survey assessing PCE prevalence rates, polydrug use, perceived effects, academic self-efficacy and personality during the first year of social restrictions (March 2020 - February 2021) compared with the previous year (March 2019 - February 2020). Results: There was a significant self-reported rise in the use of all drug types (all ps < 0.001) during social restrictions, particularly with Modafinil (+42%), nutraceuticals (+30.2%) and microdose LSD (+22.2%). Respondents also indicated stronger PCE effects for all substances, except alcohol, in comparison to the previous year. Polydrug use with modafinil and other prescription stimulants increased the most during social restrictions. Personality factors and gender identity reliably predicted PCE use and lower agreeableness was often the strongest predictor, followed by identifying as male and lower conscientiousness. Academic self-efficacy and student/academic staff status were not consistent predictors. Conclusion: This is the first survey of UK students to investigate PCE during coronavirus social restrictions and to assess predictive factors. Findings reveal a rise in PCE use and polydrug use which we suggest is because of increased pressures on students created by the lockdown and reduced access to university resources.

Title IX Experiences of Pregnant and Parenting Youth in Chicago: A Qualitative Study.

BACKGROUND: Under Title IX, pregnant and/or parenting students (PPY) are protected from discrimination and are required to receive equal access to education. This study examines the implementation of Title IX, investigating whether Title IX rights are upheld for pregnant and/or parenting students attending Chicago Public Schools (CPS) using qualitative research methods. METHODS: Stakeholder interviews with pregnant and/or parenting students and staff members at CPS were conducted. Qualitative data were transcribed, and a codebook was developed of common key themes. RESULTS: Results indicated Title IX is not implemented to its fullest extent or consistently throughout CPS. Pregnant and parenting students experienced a range of academic environments from supportive to hostile. Some students lacked accommodations and academic planning. CONCLUSION: Study findings can inform policymakers in improving Title IX policy and guide schools on compliance with Title IX. Schools must aim to act beyond policy to meet the needs of pregnant and parenting students and ensure their future success.

Caregiver Perceptions of Children's Psychological Well-being During the COVID-19 Pandemic.

Importance: Understanding youth well-being during the COVID-19 pandemic can help appropriately allocate resources and inform policies to support youth. Objective: To examine caregiver-reported changes in the psychological well-being of their children 3 to 4 months after the start of COVID-19 stay-at-home orders, and to examine the association of caregiver-reported COVID-19 exposure and family stressors with caregiver perceptions of child psychological well-being. Design, Setting, and Participants: This survey study used an anonymous survey distributed via email from June 24 to July 15, 2020, to 350 000 families of students attending public schools in Chicago, Illinois. The a priori hypotheses were that caregivers would report worsening in child psychological well-being during the closure period compared with preclosure and that exposure to COVID-19-related stressors would be associated with a higher probability of worsening child psychological well-being. Data were analyzed from September 10, 2020, to March 15, 2021. Main Outcomes and Measures: Outcomes were 7 mental health concerns and 5 positive adjustment characteristics reported by caregivers using a retrospective pre-post design. COVID-19 exposure and family stressors were also reported by caregivers. Results: Among 350 000 families invited to participate, 32 217 caregivers (10 827 [39.3%] White, 8320 [30.2%] Latinx, 6168 [22.4%] Black; 2223 [8.1%] with multiple or other races/ethnicities) completed the survey on behalf of 49 397 children in prekindergarten through 12th grade. Child-specific outcomes were reported for 40 723 to 40 852 children depending on the specific question. The frequency of caregiver endorsement of youth mental health concerns ranged from 0.1 percentage point (suicidal ideation or self-harm, reported by 191 caregivers [0.5%] preclosure vs 246 caregivers [0.6%] during closure; P < .001) to 28.3 percentage points (loneliness, reported by 1452 caregivers [3.6%] preclosure vs 13 019 caregivers [31.9%] during closure; P < .001) higher after the end of in-person instruction compared with preclosure. Frequency of caregiver endorsement of youth positive adjustment characteristics ranged from -13.4 percentage points (plans for the future, reported by 18 114 caregivers [44.3%] preclosure vs 12 601 caregivers [30.9%] during closure; P < .001) to -30.9 percentage points (positive peer relationships, reported by 24 666 caregivers [60.4%] preclosure vs 19 130 caregivers [46.8%] during closure; P < .001) lower after the end of in-person instruction. Significant differences in COVID-19 exposure were observed across racial/ethnic (F3,27 534 = 614.8; P < .001) and household income strata (F5,27 506 = 842.0; P < .001). After accounting for covariates, all mental health concerns increased in probability (eg, angry: odds ratio, 1.55 [95% CI, 1.48-1.62]; P < .001) and all the positive adjustment characteristics decreased in probability (eg, hopeful or positive: odds ratio, 0.88 [95% CI, 0.84-0.92]; P < .001) as COVID-19 exposure and family stressors increased. Conclusions and Relevance: In this survey study of caregivers during the COVID-19 pandemic, COVID-19 and resulting exposure to stress were associated with worse youth psychological well-being, demonstrating the need for a comprehensive public health approach that prioritizes children's well-being and draws broad public attention to the mental health needs of youth.

Addressing Food Insecurity: An Evaluation of Factors Associated with Reach of a School-Based Summer Meals Program.

BACKGROUND: One in six US households with children experiences food insecurity, with higher rates in the summer. Approximately 3 million children receive free meals each summer weekday through the US Department of Agriculture's Summer Nutrition Programs. However, participation in these programs has been declining in recent years and is lower than participation in programs that serve free or reduced-price meals during the school year. OBJECTIVE: To identify school and site characteristics associated with greater reach by school-based free summer meals program sites. DESIGN: This observational study combined program data, public school data, and Google Maps data to determine factors associated with site reach. PARTICIPANTS/SETTING: LunchStop Summer Meals Program sites (N=100) and schools at which they were based during summer 2018 in Chicago, IL. MAIN OUTCOME MEASURES: Reach of sites was measured by the mean daily meals served at each site throughout summer 2018. STATISTICAL ANALYSES PERFORMED: Associations between site reach and each independent variable were evaluated using Mann-Whitney tests and simple linear regressions. Variables significantly associated with site reach in bivariate analyses (P<0.05) were included in a multivariate linear regression. RESULTS: In bivariate analyses, sites with greater reach were significantly more likely to be based at schools with higher attendance percentages, higher percentages of Hispanic/Latino students, larger student populations, and locations in a network of southwest Chicago schools. Those with greater reach were also significantly more likely to have continuity in program staff and more years of site operation (all P values ≤0.01). The last four factors remained significant in multivariate analysis. CONCLUSIONS: School-based summer meals programs may be able to reach more vulnerable children by taking into account continuity among sites and staff. Further research is needed to clarify whether the relationships between these variables and increased reach is causal.

Review of the Neural Processes of Working Memory Training: Controlling the Impulse to Throw the Baby Out With the Bathwater.

BACKGROUND: Smartphone technology has enabled the creation of many working memory training (WMT) Apps, with those peer-reviewed described in a recent review. WMT claims to improve working memory, attention deficits, hyperactivity and fluid intelligence, in line with plasticity brain changes. Critics argue that WMT is unable to achieve "far-transfer"-the attainment of benefits to cognition from one taught context to another dissimilar context-associated with improved quality of life. However, brain changes after a course of WMT in frontoparietal and striatal circuits-that often occur prior to behavioral changes-may be a better indicator of far-transfer efficacy, especially to improve impulse control commonly dysregulated in those with addictive disorders, yet not commonly examined in WMT studies. METHOD: In contrast to previous reviews, the aim here is to focus on the findings of brain imaging WMT training studies across various imaging modalities that use various paradigms, published via PubMed, Scopus, Medline, and Google Scholar. RESULTS: 35 brain imaging studies utilized fMRI, structural imaging (MRI, DTI), functional connectivity, EEG, transcranial direct current stimulation (tDCS), cerebral perfusion, and neurogenetic analyses with tasks based on visuospatial and auditory working memory, dual and standard n-back. DISCUSSION: Evidence suggests that repeated WMT reduces brain activation in frontoparietal and striatal networks reflective of increased neural circuitry efficiency via myelination and functional connectivity changes. Neural effects of WMT may persist months after training has ended, lead to non-trained task transfer, be strengthened by auxiliary methods such as tDCS and be related to COMT polymorphisms. WMT could be utilized as an effective, non-invasive intervention for working memory deficits to treat impulse and affective control problems in people with addictive disorders.