Examining the psychometric properties of the headspace Youth (mental health) Service Satisfaction Scale in a mental health service in Ireland.

INTRODUCTION: Evaluating service quality and satisfaction is central to the provision of accessible and developmentally appropriate youth mental health services. However, there are limited suitable measures and a lack of published evidence on the psychometric properties of measures to assess young people's satisfaction with youth mental health services. The headspace Youth (Mental Health) Service Satisfaction Scale (YSSS) was designed and implemented to assess young people's satisfaction with headspace mental health services in Australia. This study examined the reliability and factor structure of the YSSS in a youth mental health service in Ireland. METHODS: The sample comprised 1449 young people (66.2% female) aged 12-25 years (M = 16.48, SD = 2.97). Participants completed the YSSS after their final brief intervention session through Jigsaw-The National Centre for Youth Mental Health. Confirmatory factor analysis (CFA) was performed on one- and four-factor models to test findings from previous studies. Reliability was also examined. RESULTS: CFA supported a single-factor structure of the YSSS, and all items were suitable for inclusion. The internal consistency of the measure was deemed acceptable (α = 0.89). CONCLUSIONS: Findings suggest that the YSSS is a reliable measure for monitoring satisfaction with youth mental health services in an Irish context. The measure demonstrated a unidimensional construct of satisfaction. These findings support the broader application of the YSSS and add to existing knowledge on measuring satisfaction within youth mental health services.

School-based health promotion to improve mental health literacy: a comparative study of peer- versus adult-led delivery.

BACKGROUND: School-based youth mental health promotion is increasingly recognised as a useful tool to improve mental health knowledge and help-seeking among adolescents. Peer-led initiatives are emerging as a potentially viable mode of delivering this material. Yet, there is limited evidence on the effectiveness of these initiatives compared to more traditional, adult-led, forms of mental health promotion. AIMS: This study aimed to compare improvements in students' mental health knowledge and help-seeking after attending either a peer- or adult-led youth mental health promotion workshop. It also sought to examine differential effects by gender. METHOD: A within- and between-group comparative design was used to examine secondary school students' (N = 536) mental health knowledge and help-seeking intentions before and after attending a school-based mental health promotion workshop. RESULTS: Students' mental health knowledge and help-seeking intentions significantly improved in both peer- and adult-led groups. Outcomes did not differ across modes of delivery, although the impact of adult-led workshops on mental health knowledge was moderated by gender. CONCLUSIONS: Peer-led youth mental health promotion appears to be as effective as traditional adult-led delivery, and seems to be particularly beneficial for male students who respond more favourably to content communicated through their peers.

DKA Prevention and Insulin Pumps: Lessons Learned From a Large Pediatric Pump Practice.

PURPOSE: This purpose of the study was to describe recent diabetic ketoacidosis (DKA) incidence data in youth with type 1 diabetes using insulin pumps and the impact of continuous glucose monitors (CGMs) on DKA rates. METHODS: DKA data were obtained through a retrospective chart review of insulin pump users (ages <26 years) between December 2019 and June 2021 in an academic pediatric endocrinology practice where 68% of patients were pump users. RESULTS: Among 591 pump patients, 28 events occurred (3.16 events per 100 patient-years). Mean age was 13.6±3.4 years; 85.7% ranged from 12 to 19 years. Mean A1C was 10.2±2.3%, diabetes duration was 6.1±4.0 years, and 57.1% used CGM. Admission pH levels ranged between 7.0 and 7.31, with 28.6% of events classified as "moderate" and 46.4% "severe." There was no significant difference in the DKA severity between those who wore a CGM and those who did not (ie, pH, serum bicarbonate, mentation alteration, length of stay, intensive care unit admission, and hospital admission). DKA events were attributed to concurrent illness (10.7%), insulin omission (14.3%), pump site failure (57.1%), or other pump malfunctions (14.3%). CONCLUSION: DKA events in pump-treated patients were relatively uncommon; most episodes occurred in adolescents with higher A1C levels, and notably, most events could have been avoided if users followed standard troubleshooting guidelines. Thus, DKA prevention education should be reinforced at each encounter, particularly for teens with higher A1C levels. Moreover, more than 50% of those with DKA episodes wore a CGM, suggesting that pump users using CGM require frequent reinforcement of this education and that the development of such educational materials is critical.

A year in perspective: The impact of the COVID-19 pandemic on engagement with Jigsaw youth mental health services.

AIM: The COVID-19 pandemic has presented significant challenges for young people and youth mental health services. To address a gap in knowledge about the impact of the pandemic and associated restrictions on youth mental health services, this paper examined the nature of young people's engagement with Jigsaw's brief intervention service during the pandemic. METHOD: Data gathered from young people engaging with Jigsaw's brief intervention service in the 12 months after the official declaration of the COVID-19 pandemic (n = 6161), and 12 months prior (n = 8665) were examined. RESULTS: There were less referrals to Jigsaw during the pandemic, especially during lockdown periods, but this rebounded when public health restrictions were eased. A higher proportion of females (p < .001) and 12-17 year olds (p < .001) were referred during the pandemic period. There was an increase in the proportion of young people who presented with anxiety (p < .001) and sleep changes (p < .001). Although 12-16 year olds reported significantly higher levels of distress during the pandemic (p < .05), the effect size was small. Young people reported high levels of satisfaction with the new phone/video modes of support offered by Jigsaw, and the overall attendance rate improved during the pandemic period. CONCLUSIONS: The impact of COVID-19 on young people's mental health needs to be considered as a priority. This paper is helpful for services considering the long-term mental health needs of young people, and the best way of meeting those needs.

Discovery of Novel, Orally Bioavailable Pyrimidine Ether-Based Inhibitors of ELOVL1.

In our efforts to identify novel small molecule inhibitors for the treatment of adrenoleukodystrophy (ALD), we conducted a high-throughput radiometric screen for inhibitors of elongation of very long chain fatty acid 1 (ELOVL1) enzyme. We developed a series of highly potent, central nervous system (CNS)-penetrant pyrimidine ether-based compounds with favorable pharmacokinetics culminating in compound 22. Compound 22 is a selective inhibitor of ELOVL1, reducing C26:0 VLCFA synthesis in ALD patient fibroblasts and lymphocytes in vitro. Compound 22 reduced C26:0 lysophosphatidyl choline (LPC), a subtype of VLCFA, in the blood of ATP binding cassette transporter D1 (ABCD1) KO mice, a murine model of ALD to near wild-type levels. Compound 22 is a low-molecular-weight, potent ELOVL1 inhibitor that may serve as a useful tool for exploring therapeutic approaches to the treatment of ALD.

Cognitive Impairment and Length of Stay in Acute Care Hospitals: A Scoping Review of the Literature.

Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.

Primary Ovarian Insufficiency in the Prepubertal Adolescent: A Case Report.

Although there are many etiologies for delayed puberty in adolescent-aged girls, the pediatric provider should consider primary ovarian insufficiency if estradiol remains undetectable despite elevated levels of gonadotropins. Adolescent girls with this diagnosis will need holistic care from their primary care provider, focusing on both their medical and psychosocial needs. The following case study describes a 14-year-old girl who was referred to pediatric endocrinology for delayed puberty, in the setting of increased gonadotropins and undetectable estradiol. The differential diagnosis, evaluation, and management of primary ovarian insufficiency are reviewed as well as potential long-term health considerations.

A Comment on Test Validation: The Importance of the Clinical Perspective.

Purpose The misuse of standardized assessments has been a long-standing concern in speech-language pathology and traditionally viewed as an issue of clinician competency and training. The purpose of this article is to consider the contribution of communication breakdowns between test developers and the end users to this issue. Method We considered the misuse of standardized assessments through the lens of the 2-communities theory, in which standardized tests are viewed as a product developed in 1 community (researchers/test developers) to be used by another community (frontline clinicians). Under this view, optimal test development involves a conversation to which both parties bring unique expertise and perspectives. Results Consideration of the interpretations that standardized tests are typically validated to support revealed a mismatch between these and the interpretations and decisions that speech-language pathologists typically need to make. Test development using classical test theory, which underpins many of the tests in our field, contributes to this mismatch. Application of item response theory could better equip clinicians with the psychometric evidence to support the interpretations they desire but is not commonly found in the standardized tests used by speech-language pathologists. Conclusions Advocacy and insistence on the consideration of clinical perspectives and decision making in the test validation process is a necessary part of our role. In improving the nature of the statistical evidence reported in standardized assessments, we can ensure these tools are appropriate to fulfill our professional obligations in a clinically feasible way.

Challenges in the Treatment of Iron Deficiency Anemia in a Child With Autism Spectrum Disorder: A Case Study.

Children with autism spectrum disorder (ASD) face many challenges, including feeding problems due to behavioral issues and food aversions. Therefore, pediatric nurse practitioners need to assess for different mineral deficiencies, including iron deficiency anemia (IDA). The following case study describes a 4-year-old with ASD with persistent IDA despite typical recommendation of oral iron supplementation. Other potential etiologies of IDA are reviewed. Finally, different management approaches for managing IDA in children with ASD are described.

The Evaluation and Treatment of Tall Stature in Preadolescent Girls: A Case Report.

Families may approach primary care providers for advice and treatment for tall stature (height more than two standard deviations above the mean height for a given age) in pre-pubertal children. The following case report describes an 11-year-old girl who was referred to an endocrinology specialist for familial tall stature. Potential pathological causes for tall stature are reviewed. The assessment, management, and risks and benefits of treatment for this condition are described. Finally, the role of the pediatric nurse practitioner in caring for youth with this chief complaint is discussed.

Patient engagement in research related to dementia: A scoping review.

Patient 'engagement' or 'involvement' in health research broadly refers to including people with lived experience (i.e. individuals with personal experience of a health issue and their friends, family and caregivers or carers) in the research process. Although previous reviews have systematically summarized approaches to patient engagement in research, it is unclear whether and how engagement activities have been implemented or adapted for research related to dementia. We conducted a scoping review to describe the extent and nature of patient engagement approaches that have been used to involve persons with dementia and their care partners in research. We then summarized the reported barriers, enablers, and impacts of this engagement. Fifty-four research articles were included in the review and almost all were published after 2010. Persons with dementia and their care partners have been engaged in diverse phases of the research process. The majority of engagement involved both persons with dementia and care partners. Barriers and enablers to engagement included those identified for general patient engagement in research, but some more specific to engaging persons with dementia and their care partners were also reported. Very few studies assessed the impact of patient engagement. While the arguments for patient engagement in research are compelling, research to demonstrate the impact - on the research process and outcomes as well as on persons with dementia, care partners, researchers, research institutions and society - is still needed.

Using the Delphi Technique to Explore Complex Concepts in Speech-Language Pathology: An Illustrative Example From Children's Social Communication.

PURPOSE: In recent years, there has been an increasing interest in expanding the research approaches that speech-language pathologists utilize, particularly for addressing complex questions. Consensus-building techniques can be useful for addressing such questions. The Delphi technique is a consensus-building process involving structured communication among members of an expert panel via independent responses to iterative rounds of questionnaires. The purpose of this research note is to describe and demonstrate the Delphi technique using an application to a complex problem in speech-language pathology, that is, the bases of social communication and pragmatics. METHOD: The Delphi technique was described and illustrated via the following study: 10 expert speech-language pathologists participated in a 3-round Delphi study. Participants were asked to list the key features of social communication and pragmatics in Round 1. Questions for Rounds 2 and 3 were developed on the basis of the participants' responses to previous rounds. RESULTS: The Delphi technique was useful in bringing participants to consensus on the key features of social communication and pragmatics and offered a starting point for the continued exploration of this complex problem. CONCLUSION: A discussion of the benefits and limitations of the technique is included, highlighting the utility of the technique to the field of speech-language pathology.

An Intracardiac Soft Robotic Device for Augmentation of Blood Ejection from the Failing Right Ventricle.

We introduce an implantable intracardiac soft robotic right ventricular ejection device (RVED) for dynamic approximation of the right ventricular (RV) free wall and the interventricular septum (IVS) in synchrony with the cardiac cycle to augment blood ejection in right heart failure (RHF). The RVED is designed for safe and effective intracardiac operation and consists of an anchoring system deployed across the IVS, an RV free wall anchor, and a pneumatic artificial muscle linear actuator that spans the RV chamber between the two anchors. Using a ventricular simulator and a custom controller, we characterized ventricular volume ejection, linear approximation against different loads and the effect of varying device actuation periods on volume ejection. The RVED was then tested in vivo in adult pigs (n = 5). First, we successfully deployed the device into the beating heart under 3D echocardiography guidance (n = 4). Next, we performed a feasibility study to evaluate the device's ability to augment RV ejection in an experimental model of RHF (n = 1). RVED actuation augmented RV ejection during RHF; while further chronic animal studies will provide details about the efficacy of this support device. These results demonstrate successful design and implementation of the RVED and its deployment into the beating heart. This soft robotic ejection device has potential to serve as a rapidly deployable system for mechanical circulatory assistance in RHF.

Systematic review and meta-analyses of foodservice interventions and their effect on nutritional outcomes and satisfaction of adult oncology patients.

AIM: An understanding of effective foodservice interventions on nutrition outcomes in adult patients with cancer is required to support clinical decision making. This systematic review aimed to determine the effect of foodservice interventions across a range of nutritional outcomes and satisfaction of hospitalised and ambulatory adult oncology patients. METHODS: The review protocol was registered with PROSPERO (CRD42016045772). Six databases were searched using search terms associated with the intervention and population. No date or language restrictions were applied. Authors applied the inclusion criteria to titles and abstracts and then full-text papers. The final library was assessed for risk of bias. Outcome data were combined narratively and, where possible, by meta-analysis. RESULTS: From the title and abstract review of 4414 studies, 12 studies testing the effect of foodservice interventions were included in this review. Meta-analyses demonstrated significantly greater energy (mean difference 1.54 MJ/day; 95% CI 0.85-2.23 MJ/day) and protein (mean difference 18.98 g/day; 95% CI 11.58-26.39 g/day) intake through the addition of oral nutrition supplements. Other positive effects on anthropometric outcomes were also recorded. Patient satisfaction was enhanced through other foodservice interventions. CONCLUSIONS: Limited original research was found exploring the effect of foodservice interventions in oncology patients. Significant findings were found in favour of the intervention across a range of nutritional outcomes, suggesting that foodservice interventions may improve clinical outcomes and satisfaction in this population. Effective foodservice interventions for oncology patients remain under-researched, so we encourage dietitians and foodservice staff to implement rigorous study designs to evaluate and publish interventions in this clinical group.

Disordered Eating Behaviors in Emerging Adults With Type 1 Diabetes: A Common Problem for Both Men and Women.

INTRODUCTION: Emerging adults (EA) with disordered eating behaviors (DEBs) and Type 1 diabetes (T1D) are at increased risk for severe complications of T1D, and these behaviors have been reported in EA women with T1D. Few studies, though, have included men. This study assessed the prevalence of DEB in both EA men and women with T1D. METHODS: DEB was measured with the diabetes-specific Diabetes Eating Problem Survey-Revised (DEPS-R); scores of 20 or greater indicate need for further evaluation for DEB. RESULTS: A total of 27 women and 33 men (age range = 21 ± 2.5 years) completed the DEPS-R; 27% of women and 18% of men had scores of 20 or greater (p = .23). Hemoglobin A1c level was significantly higher in subjects with elevated DEPS-R scores (10.4 ± 2.1% vs. 7.8 ± 1.3%; p < .001), and DEPS-R scores correlated with increased body mass index values (r = 0.27, p < .05). DISCUSSION: Clinicians should assess for DEB in both male and female emerging adults with T1D, especially overweight patients with poor glycemic control.

UTILITY OF PSYCHOLOGICAL SCREENING OF YOUNG ADULTS WITH TYPE 1 DIABETES TRANSITIONING TO ADULT PROVIDERS.

OBJECTIVE: Screening for depression, diabetes distress, and disordered eating in youth with type 1 diabetes (T1D) is recommended, as these comorbidities contribute to poor glycemic control. No consensus exists on which measures are optimal, and most previous studies have used nondisease-specific measures. We examined the utility of screening for these disorders using two disease-specific and one general measure at the time of transition from pediatric to adult care. METHODS: Forty-three young adults from a T1D transition clinic completed the Patient Health Questionnaire, the Diabetes Distress Scale, and the Diabetes Eating Problem Survey-Revised. Chart review determined if clinicians noted similar symptoms during the year prior to transition. Metabolic data were also recorded. RESULTS: Chart review identified 5 patients with depressive symptoms and 8 patients with diabetes distress. Screening identified 2 additional patients with depressive symptoms and 1 additional patient with diabetes distress. Of those noted to have symptomatic depression or diabetes distress on chart review, several subsequently screened negative on transition. Disordered eating was not detected by chart review, but 23.5% screened positive on transition. While depression, diabetes distress, and disordered eating positively correlated with glycated hemoglobin (HbA1c) (r = 0.31, P = .05; r = 0.40, P = .009; r = 0.63, P<.001, respectively), disordered eating accounted for the majority of observed variance (df = 1; F = 18.6; P<.001). Even though HbA1c was higher in patients with versus without disordered eating (P<.001), body mass index did not differ between the 2 groups (P = .51). CONCLUSION: In young adults with T1D, formal screening provides an opportunity to detect psychological problems, which, when treated, may help optimize metabolic control during the transition process. ABBREVIATIONS: T1D = type 1 diabetes HbA1C = hemoglobin A1c YCDP = Yale Children's Diabetes Program PHQ-8 = Patient Health Questionnaire-8 DDS = Diabetes Distress Scale DEPS-R = Diabetes Eating Problem Survey-Revised.

Autoimune Conditions Associated With Type 1 Diabetes.

Type 1 diabetes is the most commonly seen endocrinopathy in pediatrics. This is an autoimmune condition. Children with type 1 diabetes are at much greater risk for other autoimmune conditions, particularly autoimmune thyroiditis, most commonly Hashimoto's thyroiditis, and celiac disease. It is important for the primary care practitioner to be aware of subtle symptoms of these conditions and how to screen for them because early treatment of both conditions can lead to better diabetes control and improved health in general.