Descriptive Analysis of Clinical Encounters by Emergency Medical Services Physicians Using the RE-AIM Framework.

CONTEXT: Emergency medical services (EMS) medicine continues to expand and mature as a recognized subspeciality within emergency medicine. In the United States, EMS physicians historically supported training, protocol development, and EMS clinician credentialing. In the past, only limited programs existed in which prehospital physicians were engaged in the direct and routine care of prehospital patients; however, a growing number of EMS programs are recognizing the value and impact of direct EMS physician involvement in prehospital patient care. PROGRAM: A large suburban, volunteer-based EMS agency implemented a volunteer prehospital physician program where providers routinely responded to emergency calls for service. IMPLEMENTATION: Beginning in November 2019, a cadre of board-certified physicians completed a field preceptorship and local protocol orientation. Once complete, the physicians were released to function and respond independently to high acuity emergency calls or any call at their discretion. Prehospital physicians were authorized to utilize their full scope of practice and expected to provide field mentorship to traditional prehospital clinicians. EVALUATION: This study systematically evaluated a prehospital physician program for public health relevance, sustainability, and population health impact using the RE-AIM framework. A retrospective descriptive analysis was performed on the role and responses by a cohort of prehospital physicians using dispatch data and electronic medical records. DISCUSSION: Over the 17-month study period, 9 prehospital physicians responded to 482 calls, predominately cardiac arrests, traumatic injuries, and cardiac/chest pain. The physicians performed 99 procedures and administered 113 medications. Ultimately, the program added physician-level care to the prehospital setting in an ongoing and sustainable way. The routine placement of physicians in the prehospital environment can help benefit patients by enhancing access to advanced clinical knowledge and skills, while also benefiting EMS clinicians through opportunities for enhanced patient-side training, education, and medical control.

Effects of dietary interventions on depressive symptom profiles: results from the MooDFOOD depression prevention study.

BACKGROUND: Dietary interventions did not prevent depression onset nor reduced depressive symptoms in a large multi-center randomized controlled depression prevention study (MooDFOOD) involving overweight adults with subsyndromal depressive symptoms. We conducted follow-up analyses to investigate whether dietary interventions differ in their effects on depressive symptom profiles (mood/cognition; somatic; atypical, energy-related). METHODS: Baseline, 3-, 6-, and 12-month follow-up data from MooDFOOD were used (n = 933). Participants received (1) placebo supplements, (2) food-related behavioral activation (F-BA) therapy with placebo supplements, (3) multi-nutrient supplements (omega-3 fatty acids and a multi-vitamin), or (4) F-BA therapy with multi-nutrient supplements. Depressive symptom profiles were based on the Inventory of Depressive Symptomatology. RESULTS: F-BA therapy was significantly associated with decreased severity of the somatic (B = -0.03, p = 0.014, d = -0.10) and energy-related (B = -0.08, p = 0.001, d = -0.13), but not with the mood/cognition symptom profile, whereas multi-nutrient supplementation was significantly associated with increased severity of the mood/cognition (B = 0.05, p = 0.022, d = 0.09) and the energy-related (B = 0.07, p = 0.002, d = 0.12) but not with the somatic symptom profile. CONCLUSIONS: Differentiating depressive symptom profiles indicated that food-related behavioral interventions are most beneficial to alleviate somatic symptoms and symptoms of the atypical, energy-related profile linked to an immuno-metabolic form of depression, although effect sizes were small. Multi-nutrient supplements are not indicated to reduce depressive symptom profiles. These findings show that attention to clinical heterogeneity in depression is of importance when studying dietary interventions.

Effect of food-related behavioral activation therapy on food intake and the environmental impact of the diet: results from the MooDFOOD prevention trial.

PURPOSE: Food-based dietary guidelines are proposed to not only improve diet quality, but to also reduce the environmental impact of diets. The aim of our study was to investigate whether food-related behavioral activation therapy (F-BA) applying Mediterranean-style dietary guidelines altered food intake and the environmental impact of the diet in overweight adults with subsyndromal symptoms of depression. METHODS: In total 744 adults who either received the F-BA intervention (F-BA group) or no intervention (control group) for 12 months were included in this analysis. Food intake data were collected through a food frequency questionnaire at baseline and after 6 and 12 months. Greenhouse gas emissions (GHGE), land use (LU), and fossil energy use (FEU) estimates from life-cycle assessments and a weighted score of the three (pReCiPe score) were used to estimate the environmental impact of each individual diet at each timepoint. RESULTS: The F-BA group reported increased intakes of vegetables (19.7 g/day; 95% CI 7.8-31.6), fruit (23.0 g/day; 9.4-36.6), fish (7.6 g/day; 4.6-10.6), pulses/legumes (4.0 g/day; 1.6-6.5) and whole grains (12.7 g/day; 8.0-17.5), and decreased intake of sweets/extras (- 6.8 g/day; - 10.9 to - 2.8) relative to control group. This effect on food intake resulted in no change in GHGE, LU, and pReCiPe score, but a relative increase in FEU by 1.6 MJ/day (0.8, 2.4). CONCLUSIONS: A shift towards a healthier Mediterranean-style diet does not necessarily result in a diet with reduced environmental impact in a real-life setting. TRIAL REGISTRATION: ClinicalTrials.gov. Number of identification: NCT02529423. August 2015.

Effect of Multinutrient Supplementation and Food-Related Behavioral Activation Therapy on Prevention of Major Depressive Disorder Among Overweight or Obese Adults With Subsyndromal Depressive Symptoms: The MooDFOOD Randomized Clinical Trial.

Importance: Effects of nutritional interventions on the prevention of major depressive disorder (MDD) in overweight adults are unknown. Objective: To examine the effect of 2 nutritional strategies (multinutrient supplementation, food-related behavioral activation therapy) and their combination for prevention of a new MDD episode in overweight adults with subsyndromal depressive symptoms. Design, Setting, and Participants: This multicenter 2 × 2 factorial randomized clinical trial included overweight adults (body mass index, 25-40) with elevated depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores ≥5) and no MDD episode in the past 6 months from 4 European countries. A total of 1025 adults were randomized (July 30, 2015-October 12, 2016) and followed up for 1 year (October 13, 2017). Interventions: Daily multinutrient supplements (1412-mg omega-3 fatty acids, 30-µg selenium, 400-µg folic acid, and 20-µg vitamin D3 plus 100-mg calcium) vs placebo and 21 individual or group therapy sessions vs none (blinded to researchers) for 1 year. Participants were allocated to placebo without therapy (n = 257), placebo with therapy (n = 256), supplements without therapy (n = 256), and supplements with therapy (n = 256). Main Outcome and Measures: Cumulative 1-year onset of MDD via the Mini International Neuropsychiatric Interview at 3, 6, and 12 months. Logistic regression using effect-coded variables (-1 indicating control, 1 indicating intervention) evaluated intervention effects both individually and in combination (interaction) on MDD onset. Results: Among 1025 participants (mean age, 46.5 years; 772 women [75%]; mean BMI, 31.4), 779 (76%) completed the trial. During the 12-month follow-up, 105 (10%) developed MDD: 25 (9.7%) patients in the placebo without therapy, 26 (10.2%) in the placebo with therapy, 32 (12.5%) in the supplement without therapy, and 22 (8.6%) in the supplement with therapy group. None of the treatment strategies affected MDD onset. The odds ratio (OR) for supplements was 1.06 (95% CI, 0.87-1.29); for therapy, 0.93 (95% CI, 0.76-1.13); and for their combination, 0.93 (95% CI, 0.76-1.14; P for interaction, .48). One person in the supplementation with therapy group, died. Twenty-four patients in each of the placebo groups and 24 patients in the supplementation with therapy group were hospitalized, and 26 patients in the supplementation-only group were hospitalized. Conclusions and Relevance: Among overweight or obese adults with subsyndromal depressive symptoms, multinutrient supplementation compared with placebo and food-related behavioral activation therapy compared with no therapy did not reduce episodes of major depressive disorder during 1 year. These findings do not support the use of these interventions for prevention of major depressive disorder. Trial registration: ClinicalTrials.gov Identifier: NCT02529423.

High-intensity interval training, but not continuous training, reverses right ventricular hypertrophy and dysfunction in a rat model of pulmonary hypertension.

Exercise is beneficial in pulmonary arterial hypertension (PAH), although studies to date indicate little effect on the elevated pulmonary pressures or maladaptive right ventricle (RV) hypertrophy associated with the disease. For chronic left ventricle failure, high-intensity interval training (HIIT) promotes greater endothelial stimulation and superior benefit than customary continuous exercise training (CExT); however, HIIT has not been tested for PAH. Therefore, here we investigated acute and chronic responses to HIIT vs. CExT in a rat model of monocrotaline (MCT)-induced mild PAH. Six weeks of treadmill training (5 times/wk) were performed, as either 30 min HIIT or 60 min low-intensity CExT. To characterize acute hemodynamic responses to the two approaches, novel recordings of simultaneous pulmonary and systemic pressures during running were obtained at pre- and 2, 4, 6, and 8 wk post-MCT using long-term implantable telemetry. MCT-induced decrement in maximal aerobic capacity was ameliorated by both HIIT and CExT, with less pronounced pulmonary vascular remodeling and no increase in RV inflammation or apoptosis observed. Most importantly, only HIIT lowered RV systolic pressure, RV hypertrophy, and total pulmonary resistance, and prompted higher cardiac index that was complemented by a RV increase in the positive inotrope apelin and reduced fibrosis. HIIT prompted a markedly pulsatile pulmonary pressure during running and was associated with greater lung endothelial nitric oxide synthase after 6 wk. We conclude that HIIT may be superior to CExT for improving hemodynamics and maladaptive RV hypertrophy in PAH. HIIT's superior outcomes may be explained by more favorable pulmonary vascular endothelial adaptation to the pulsatile HIIT stimulus.

Elevated morning cortisol is a stratified population-level biomarker for major depression in boys only with high depressive symptoms.

Major depressive disorder (MD) is a debilitating public mental health problem with severe societal and personal costs attached. Around one in six people will suffer from this complex disorder at some point in their lives, which has shown considerable etiological and clinical heterogeneity. Overall there remain no validated biomarkers in the youth population at large that can aid the detection of at-risk groups for depression in general and for boys and young men in particular. Using repeated measurements of two well-known correlates of MD (self-reported current depressive symptoms and early-morning cortisol), we undertook a population-based investigation to ascertain subtypes of adolescents that represent separate longitudinal phenotypes. Subsequently, we tested for differential risks for MD and other mental illnesses and cognitive differences between subtypes. Through the use of latent class analysis, we revealed a high-risk subtype (17% of the sample) demarcated by both high depressive symptoms and elevated cortisol levels. Membership of this class of individuals was associated with increased levels of impaired autobiographical memory recall in both sexes and the greatest likelihood of experiencing MD in boys only. These previously unidentified findings demonstrate at the population level a class of adolescents with a common physiological biomarker specifically for MD in boys and for a mnemonic vulnerability in both sexes. We suggest that the biobehavioral combination of high depressive symptoms and elevated morning cortisol is particularly hazardous for adolescent boys.

Prevention of depression through nutritional strategies in high-risk persons: rationale and design of the MooDFOOD prevention trial.

BACKGROUND: Obesity and depression are two prevalent conditions that are costly to individuals and society. The bidirectional association of obesity with depression, in which unhealthy dietary patterns may play an important role, has been well established. Few experimental studies have been conducted to investigate whether supplementing specific nutrients or improving diet and food-related behaviors can prevent depression in overweight persons. METHOD/DESIGN: The MooDFOOD prevention trial examines the feasibility and effectiveness of two different nutritional strategies [multi-nutrient supplementation and food-related behavioral change therapy (FBC)] to prevent depression in individuals who are overweight and have elevated depressive symptoms but who are not currently or in the last 6 months meeting criteria for an episode of major depressive disorder (MDD). The randomized controlled prevention trial has a two-by-two factorial design: participants are randomized to daily multi-nutrient supplement (omega-3 fatty acids, calcium, selenium, B-11 vitamin and D-3 vitamin) versus placebo, and/or FBC therapy sessions versus usual care. Interventions last 12 months. In total 1000 participants aged 18-75 years with body mass index between 25-40 kg/m(2) and with a Patient Health Questionnaire-9 score ≥ 5 will be recruited at four study sites in four European countries. Baseline and follow-up assessments take place at 0, 3, 6, and 12 months. Primary endpoint is the onset of an episode of MDD, assessed according to DSM-IV based criteria using the MINI 5.0 interview. Depressive symptoms, anxiety, food and eating behavior, physical activity and health related quality of life are secondary outcomes. During the intervention, compliance, adverse events and potentially mediating variables are carefully monitored. DISCUSSION: The trial aims to provide a better understanding of the causal role of specific nutrients, overall diet, and food-related behavior change with respect to the incidence of MDD episodes. This knowledge will be used to develop and disseminate innovative evidence-based, feasible, and effective nutritional public health strategies for the prevention of clinical depression. TRIAL REGISTRATION: ClinicalTrials.gov. Number of identification: NCT02529423 . August 2015.

Revising on the run or studying on the sofa: prospective associations between physical activity, sedentary behaviour, and exam results in British adolescents.

BACKGROUND: We investigated prospective associations between physical activity/sedentary behaviour (PA/SED) and General Certificate of Secondary Education (GCSE) results in British adolescents. METHODS: Exposures were objective PA/SED and self-reported sedentary behaviours (screen (TV, Internet, Computer Games)/non-screen (homework, reading)) measured in 845 adolescents (14·5y ± 0·5y; 43·6 % male). GCSE results at 16y were obtained from national records. Associations between exposures and academic performance (total exam points) were assessed using multilevel mixed-effects linear regression adjusted for mood, BMI z-score, deprivation, sex, season and school; potential interactions were investigated. RESULTS: PA was not associated with academic performance. One-hour more accelerometer-assessed SED was associated with (ß(95 % CI)) 6·9(1·5,12·4) more GCSE points. An extra hour of screen time was associated with 9.3(-14·3,-4·3) fewer points whereas an extra hour of non-screen time (reading/homework) was associated with 23·1(14·6,31·6) more points. Screen time was still associated with poorer scores after adjusting for objective PA/SED and reading/homework. CONCLUSIONS: An extra hour/day of screen time at 14·5y is approximately equivalent to two fewer GCSE grades (e.g., from B to D) at 16y. Strategies to achieve the right balance between screen and non-screen time may be important for improving academic performance. Concerns that encouraging more physical activity may result in decreased academic performance seem unfounded.

The longitudinal psychometric properties of the EAS temperament survey in adolescence.

Studies on the psychometric properties of the EAS Temperament Survey (EAS) have produced equivocal results. In particular the psychometrics of the EAS are largely unknown in adolescence. Confirmatory factor analysis was used to explore the EAS structure in adolescents. Structural equation modeling was also used to assess measurement invariance and factor stability. A modified 4-factor model provided the best fit to the data and demonstrated reasonable longitudinal invariance and stability. Furthermore, the standardized factor scores correlated at near unity with the sum of observed scores, suggesting factor interpretations remained unchanged. However, the modifications suggest that further work is necessary.

The effect of brief exposure to virtual nature on mental wellbeing in adolescents.

Adolescence is a time of multiple transitions and a vulnerability period for mental health difficulties. There are many barriers to the treatment of mental health conditions which is one reason for developing alternatives to help improve efficacy in treatment and prevention. One approach is to use nature-based interventions (NBIs) to improve mental wellbeing. In this experimental proof-of-principle intervention study, we randomly allocated a sample of adolescents to brief exposure (6 min) to either a virtual woodland nature video or a busy train journey and tested the effect on mental wellbeing. Results showed beneficial effects in the nature condition on several self-reported outcomes including stress, relaxation, affect, mood, attention, nature connection and nature spirituality. The intervention was mainly acceptable and feasible to do suggesting that overall brief virtual nature interventions may have utility in a range of mental health contexts for adolescents including as self-help universal or targeted prevention strategies, adjunct to psychological therapy and as preparation for more intensive NBIs. Additionally, brief virtual nature interventions support accessibility for those who may be limited on time, unable to access real-life nature or who may be more biophobic.

5-HTTLPR-environment interplay and its effects on neural reactivity in adolescents.

It is not known how 5-HTTLPR genotype x childhood adversity (CA) interactions that are associated with an increased risk for affective disorders in population studies operate at the neural systems level. We hypothesized that healthy adolescents at increased genetic and environmental risk for developing mood disorders (depression and anxiety) would demonstrate increased amygdala reactivity to emotional stimuli compared to those with only one such risk factor or those with none. Participants (n=67) were classified into one of 4 groups dependent on being homozygous for the long or short alleles within the serotonin-transporter-linked polymorphic region (5-HTTLPR) of the SLC6A4 gene and exposure to CA in the first 11 years of life (present or absent). A functional magnetic resonance imaging investigation was undertaken which involved viewing emotionally-salient face stimuli. In addition, we assessed the role of other variables hypothesized to influence amygdala reactivity, namely recent negative life-events (RNLE) assessed at ages 14 and 17, current anxiety symptoms and psychiatric history. We replicated prior findings demonstrating moderation by gene variants in 5-HTTLPR, but found no support for an effect of CA on amygdala reactivity. We also found a significant effect of RNLE aged 17 with amygdala reactivity demonstrating additive, but not interactive effects with 5-HTTLPR. A whole-brain analysis found a 5-HTTLPR×CA interaction in the lingual gyrus whereby CA appears to differentially modify neural reactivity depending on genotype. These results demonstrate that two different forms of environmental adversities interplay with 5-HTTLPR and thereby differentially impact amygdala and cortical reactivity.

Item response theory and validity of the NEO-FFI in adolescents.

The present study applied item response theory (IRT) to the NEO five factor inventory (NEO-FFI) completed by a community based sample of adolescents. The results revealed that many of these personality items may not be discriminating well, with some traits demonstrating greater reliability than others. Furthermore, the threshold values highlighted that the majority of the items had skewed responses, suggesting a limited utility of some response categories. Generally, removing poorly discriminating items does not harm external validity, suggesting IRT reduces measurement error and increases reliability without compromising validity.

Does CBT facilitate emotional processing?

BACKGROUND: Cognitive Behavioural Therapy (CBT) is not primarily conceptualized as operating via affective processes. However, there is growing recognition that emotional processing plays an important role during the course of therapy. AIMS: The Emotional Processing Scale was developed as a clinical and research tool to measure emotional processing deficits and the process of emotional change during therapy. METHOD: Fifty-five patients receiving CBT were given measures of emotional functioning (Toronto Alexithymia Scale [TAS-20]; Emotional Processing Scale [EPS-38]) and psychological symptoms (Brief Symptom Inventory [BSI]) pre- and post-therapy. In addition, the EPS-38 was administered to a sample of 173 healthy individuals. RESULTS: Initially, the patient group exhibited elevated emotional processing scores compared to the healthy group, but after therapy, these scores decreased and approached those of the healthy group. CONCLUSIONS: This suggests that therapy ostensibly designed to reduce psychiatric symptoms via cognitive processes may also facilitate emotional processing. The Emotional Processing Scale demonstrated sensitivity to changes in alexithymia and psychiatric symptom severity, and may provide a valid and reliable means of assessing change during therapy.

The Potential for Outdoor Nature-Based Interventions in the Treatment and Prevention of Depression.

There is growing interest in nature-based interventions (NBI) to improve human health and wellbeing. An important nascent area is exploring the potential of outdoor therapies to treat and prevent common mental health problems like depression. In this conceptual analysis on the nature-depression nexus, we distil some of the main issues for consideration when NBIs for depression are being developed. We argue that understanding the mechanisms, or 'active ingredients' in NBIs is crucial to understand what works and for whom. Successfully identifying modifiable mediating intervention targets will pave the way for interventions with increased efficacy. We highlight a non-exhaustive list of five clinically relevant putative, candidate mechanisms which may underly the beneficial effects of NBIs on depression: stress, rumination, mindfulness, sleep and exercise. We also make the case that when developing NBIs it is important to not neglect young people, explore personalised approaches and focus on both treatment and prevention approaches. To achieve these aims methodologically rigorous programmes of clinical research are needed that include well-powered and controlled experimental designs including randomised controlled trials, qualitative research, longitudinal studies and large prospective cohorts.

A Systematic Review of Mechanisms Underpinning Psychological Change Following Nature Exposure in an Adolescent Population.

This systematic review aimed to identify mechanisms of psychological change following exposure to nature within an adolescent population. Keyword searches within Scopus, PsychINFO and Web of Science were carried out to include articles published by 14 September 2021. Records were reviewed in line with inclusion criteria: samples with an average age of 24 and under, exposure to nature vs. control using an experimental or quasi-experimental design and outcomes of mental health and psychological status. The review resulted in 27 papers that were assessed for methodological quality and manually searched for mediation analyses. A range of psychological outcomes were identified and grouped into 10 categories: Mood and Affect, Mental Health, Wellbeing, Perceived Restoration, Stress, Energy, Cognitive Functioning, Resilience, Self-Concept and Pro-Social Behaviour. Only one formal mediation analysis was reported, highlighting a mediating role of belonging in increases in resilience. Limitations include the majority use of university student samples and over half of the papers being of low methodological quality. No firm conclusions on key mechanisms in an adolescent population were made due to insufficient evidence of mediating variables. The development of methodologically rigorous experimental studies with the inclusion of statistical pathway modelling is needed to test and specify plausible mechanisms.

Nature-Based Meditation, Rumination and Mental Wellbeing.

Novel approaches for children and young people (CYP) in the prevention and intervention of mental illness are needed and nature-based interventions (NBI) may be clinically useful. This proof-of-principle study tested the effects of a novel brief nature-based meditation on rumination, depressive symptoms and wellbeing in young people. Sixty-eight university students were randomised to one of three conditions: active control (n = 23), indoor meditation (n = 22) or nature-based meditation (n = 23). Participants completed self-report measures on state and trait rumination post intervention and depression and wellbeing at a 2-week follow-up. Depressive rumination significantly decreased post intervention in the nature condition and depressive symptoms improved for both intervention groups. Wellbeing only significantly improved at follow-up in the nature condition. Nature condition participants demonstrated one minimal clinically important difference (MCID) for wellbeing at follow-up. Depressive symptoms for this condition were below the clinically significant threshold for depression. The number needed to treat (NNT) analysis suggested that two to five young people would need to complete the intervention. Preliminary evidence suggests NBIs, such as the one in the present study, can reduce depressive rumination and symptoms and improve wellbeing. Replication with larger clinical samples is required to substantiate findings.

Mental Health and Wellbeing in Young People in the UK during Lockdown (COVID-19).

This study aimed to assess the levels of mental wellbeing and potential for clinical need in a sample of UK university students aged 18-25 during the COVID-19 pandemic. We also tested the dose-response relationship between the severity of lockdown restrictions and mental wellbeing. We carried out a prospective shortitudinal study (one month between baseline and follow up) during the pandemic to do this and included 389 young people. We measured a range of facets of mental wellbeing, including depression, depressogenic cognition (rumination), wellbeing, stress and sleep disturbance. Our primary outcome was 'probable depression' as indexed by a score of ≥10 on the patient health questionnaire (PHQ-8). The prevalence of probable depression was significantly higher than pre-pandemic levels (55%) and did not decrease significantly over time (52%). Higher levels of lockdown severity were prospectively associated with higher levels of depressive symptoms. Nearly all students had at least one mental wellbeing concern at either time point (97%). The evidence suggests that lockdown has caused a wellbeing crisis in young people. The associated long-term mental, social, educational, personal and societal costs are as yet unknown but should be tracked using further longitudinal studies.

Near-Infrared-Emitting Hemicyanines and Their Photodynamic Killing of Cancer Cells.

A series of hemicyanine dyes was synthesized starting from the vinyl chloride-based cyanine dye IR-780. The dyes absorbed and emitted in the near-infrared region, while heavy atom (bromo and iodo) substitution promoted the generation of both singlet oxygen (1O2) as well as a range of other reactive oxygen-based species (ROS) upon irradiation at wavelengths greater than 610 nm. One hemicyanine dye displayed an outstanding singlet oxygen quantum efficiency (ΦΔ = 0.8) and was successfully applied in in vitro studies to mimic photodynamic therapy application.

Combinatorial ECM Arrays Identify Cooperative Roles for Matricellular Proteins in Enhancing the Generation of TH+ Neurons From Human Pluripotent Cells.

The development of efficient cell culture strategies for the generation of dopaminergic neurons is an important goal for transplantation-based approaches to treat Parkinson's disease. To identify extracellular matrix molecules that enhance differentiation and might be used in these cell cultures we have used micro-contact printed arrays on glass slides presenting 190 combinations of 19 extracellular matrix molecules selected on the basis of their expression during embryonic development of the ventral midbrain. Using long-term neuroepithelial stem cells (Lt-NES), this approach identified a number of matricellular proteins that enhanced differentiation, with the combination of Sparc, Sparc-like (Sparc-l1) and Nell2 increasing the number of tyrosine hydroxylase+ neurons derived from Lt-NES cells and, critically for further translation, human pluripotent stem cells.

Parents' postnatal depressive symptoms and their children's academic attainment at 16 years: Pathways of risk transmission.

The aim of the study was to examine whether parents' increased postnatal depressive symptoms predicted children's academic attainment over time and whether the parent-child relationship, children's prior academic attainment, and mental health mediated this association. We conducted secondary analyses on the Avon Longitudinal Study of Parents and Children data (12,607 mothers, 9,456 fathers). Each parent completed the Edinburgh-Postnatal Depression Scale at 8 weeks after the child's birth (predictor) and a questionnaire about the mother-child and father-child relationship at 7 years and 1 month (mediator). The children's mental health problems were assessed with the teacher version of the Strengths and Difficulties Questionnaire at 10-11 years (mediator). We used data on the children's academic attainment on UK Key Stage 1 (5-7 years; mediator) and Key Stage 4 (General Certificate of Secondary Education 16 years) (outcome). We adjusted for the parents' education, and child gender and cognitive ability. The results revealed that parents' depressive symptoms at 8 weeks predicted lower academic performance in children at 16 years. Mothers' postnatal depressive symptoms had an indirect effect through children's mental health problems on academic outcomes at 16 years via negative mother-child relationship, and prior academic attainment. There was a significant negative indirect effect of fathers' postnatal depressive symptoms on academic attainment at 16 years via negative father-child relationship on child mental health. The findings suggest that the family environment (parental mental health and parent-child relationship) and children's mental health should be potential targets for support programmes for children of depressed parents.