General Practitioner referrals to Child and Adolescent Mental Health Services: Did they differ during Covid-19?

OBJECTIVES: The COVID pandemic has been associated with poorer mental health in youth. This study aimed to evaluate any change in General Practitioner (GP) referral pattern to Child and Adolescent Mental Health (CAMH) services during the first 10 months of Covid-19 and compare with a similar time frame in 2019. METHODS: All accepted referrals to a CAMH Service in Dublin during the study time frame were reviewed. Referral letters were batch anonymised and clinical data extracted using a study specific proforma for analysis. RESULTS: Referral numbers between the two time periods did not statistically differ. Proportionally more females were referred during the pandemic, increasing to 56.9%, n = 99, compared to 43.1%, n = 75 in 2019 (p = 0.01). Referrals were more often designated by the clinician as urgent during the pandemic (61.3%, n = 98) than before (39%, n = 62, p < 0.001). Referrals outlining self-harm or suicidal ideation increased significantly, from 42.1% (n = 67) to 55.9% (n = 90) (p = 0.014). Referrals for externalising problems fell from 2019 rates; ADHD (21.4%, n = 34 vs 11.1%, n = 18; p = 0.013), ASD (26.4%, n = 42 vs 16.1%, n = 26; p = 0.038) and conduct problems (23.3%, n = 37 vs 7.4%, n = 12; p < 0.001). Although numbers for psychosis in 2019 were low (10.7%, n = 17), these also fell significantly in 2020 (2.5%, n = 4; p < 0.001). DISCUSSION: The finding of reduced referrals for ADHD and ASD has not previously been reported. With concerns regarding educational loss linked to online learning, it is crucial that these youth are not doubly disadvantaged by delayed referral and education decline.

Should all community mental health teams be sectorised?

OBJECTIVES: Sectorised catchment areas have characterised Irish mental health service delivery since the devolution of institutional care. Unlike other catchment areas, the Cluain Mhuire Community Mental Health Service (CMCMHS) never sectorised. With the development of Community Health Networks (CHNs) and Primary Care Centres, the CMCMHS has come under renewed pressure for structural change. We aimed to consider the implications of these proposed changes on staff and service users. METHOD: We obtained demographic information comparing the CHNs with respect to attendee numbers, new referrals and admissions over a 1- year period. Secondly, we conducted an anonymous survey seeking opinions on the proposals to switch to a sector-based model and/or specialist inpatient care. RESULTS: Referral and admission rates differed across CHNs, broadly consistent with populations. About 36% of staff and 33% of service users supported changing to a sector-based system. In the event of a sector-based system of care being implemented, 66% of service users felt that existing service users should remain under the care of their current team. There was little support among any group for the development of specialist inpatient teams. CONCLUSIONS: We discuss the benefits and drawbacks of sectorisation of mental health service provision. Most patients did not want to change teams either as current service users or as re-referrals (indicating it will take a significant time to transition to a sector-based system). Without clear pathways towards integration with primary care teams, the advantages of sectorisation may not outweigh the challenges associated with its implementation.

[Verification of the laboratories based on the program of the control of reliability of toxicological analyses of biological materials 1985-1989]. / Weryfikacja laboratoriów na podstawie przeprowadzonych akcji kontroli wiarygodnosci analiz toksykologicznych materialu biologicznego w latach 1985-1989.

The evaluation of work of laboratories over the period between 1985 and 1989 is presented made by the Institute of Occupational Medicine in Lódz within the programme of reliability control of toxicological analyses. The analysis made it possible to select all properly working laboratories, as a result of a strict verification. The examination of collected material indicates a need to introduce serious organizational changes in preparing toxicological analyses of biological material. The changes should result in reducing the number of laboratories which perform toxicological analyses and founding several central laboratories active in particular regions of the country. The newly founded centres should participate in the control programmes organized by the Institute of Occupational Medicine in Lódz which would enable the laboratories to get attestation to perform toxicological analyses of biological material.

[Analysis of the effects of physico-chemical factors on the stability of lead and mercury levels in biological specimens. I. Biological specimens with the addition of Pb and Hg standards]. / Analiza wplywu czynników fizykochemiczych na stalosc stezenia olowiu i rteci w materiale biologicznym. Czesc I. Material biologiczny z dodatkiem wzorców Pb I Hg.

For the analysis of the process of precipitation and adsorption in the walls of polyethylene and glass vessels in which biological specimens containing mercury and lead were stored, the techniques of scanning electrone microscopy and X-ray microanalysis were applied. It was observed that the losses of: --lead in stored urine specimens were mainly due to precipitation, --mercury in stored urine specimens occur, among others, through adsorption on vessels' walls. X-ray microanalysis may also facilitate determination of the chemical composition of micro-structural fragments deposited on the surface of vessels.

[Evaluation of the stability of biological specimens used for monitoring of occupational exposure. Studies of the stability of phenol and trichloroacetic acid in urine]. / Ocena stabilnosci materialu biologicznego przeznaczonego do monitorowania ekspozycji przemyslowej.

The paper presents results of studies on phenol and trichloroacetic acid concentration in urine samples stored for 30 days at + 5 degrees C and + 20 degrees C. It has been checked whether the addition of sulphuric acid as a conservant to urine can affect changes in phenol concentration in the samples stored. The results obtained did not indicate any significant changes in concentrations of phenol or trichloroacetic acid in the urine samples. It has been recommended that due to bacterial processes the material studied should be kept in refrigerator (+ 5 degrees C).

[Results of the control of the reliability of toxicological analyses of biological specimens 1980-1984]. / Wyniki akcji kontroli wiarygodnosci analiz toksykologicznych materialu biologicznego za okres 1980-1984.

Within the programme of the National Specialist Group relating to Industrial Medicine the Department of Laboratory Diagnostics, Institute of Occupational Medicine in Lódz, carries on biological material reliability control. This paper has been aimed at an evaluation of the work carried on by laboratories basing on the results of determinations of control samples of lead, mercury, phenol, trichloroacetic acid and deltaminolevulinic acid.

[Selection of a statistical model for the evaluation of the reliability of the results of toxicological analyses. II. Selection of our statistical model for the evaluation]. / Dobór modelu statystycznego dla oceny wiarygodnosci wyników analiz toksykologicznych.

Part II presents a statistical model devised by the authors for evaluating toxicological analyses results. The model includes: 1. Establishment of a reference value, basing on our own measurements taken by two independent analytical methods. 2. Selection of laboratories -- basing on the deviation of the obtained values from reference ones. 3. On consideration of variance analysis, t-student's test and differences test, subsequent quality controls and particular laboratories have been evaluated.

[Selection of a statistical model for evaluation of the reliability of the results of toxicological analyses. I. Discussion on selected statistical models for evaluation of the systems of control of the results of toxicological analyses]. / Dobór modelu statystycznego dla oceny wiarygodnosci wyników analiz toksykologicznych. Czesc I. Omówienie wybranych modeli statystycznych sluzacych dla oceny systemów kontroli wyników analiz toksykologicznych.

2 statistical models for evaluation of toxicological studies results have been presented. Model I. after R. Hoschek and H. J. Schittke (2) involves: 1. Elimination of the values deviating from most results-by Grubbs' method (2). 2. Analysis of the differences between the results obtained by the participants of the action and tentatively assumed value. 3. Evaluation of significant differences between the reference value and average value for a given series of measurements. 4. Thorough evaluation of laboratories based on evaluation coefficient fx. Model II after Keppler et al. As a criterion for evaluating the results the authors assumed the median. Individual evaluation of laboratories was performed on the basis of: 1. Adjusted test "t" 2. Linear regression test.

[Kinetices of urinary excretion of various metals after administration of a single massive dose]. / Przyczynek do kinetyki wydalania niektórych metali z moczem po wprowadzeniu do ustroju jednorazowej masywnej dawki.

The rate of excreting chromium, mercury, thallium and arsenic, in cases when they induced acute poisoning, was observed. Only in a few cases of intoxication, Cr, Hg, Tl and As excretion was diphase. In 40% of subjects, the excretion was irregular and not diphase. What seems interesting is that in some cases some dependence between the rate of Cr, Hg and As excretion and the magnitude of diuresis was observed.