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Background: Adolescence is characterized by marked psychosocial, behavioural and biological changes and represents a critical life transition through which adult health and well-being are established. Substantial research confirms the role of psycho-social and environmental influences on this transition, but objective research examining the role of puberty hormones, testosterone in males and oestradiol in females (as biomarkers of puberty) on adolescent events is lacking. Neither has the tempo of puberty, the time from onset to completion of puberty within an individual been studied, nor the interaction between age of onset and tempo. This study has been designed to provide evidence on the relationship between reproductive hormones and the tempo of their rise to adult levels, and adolescent behaviour, health and wellbeing. Methods/Design: The ARCHER study is a multidisciplinary, prospective, longitudinal cohort study in 400 adolescents to be conducted in two centres in regional Australia in the State of New South Wales. The overall aim is to determine how changes over time in puberty hormones independently affect the study endpoints which describe universal and risk behaviours, mental health and physical status in adolescents. Recruitment will commence in school grades 5, 6 and 7 (10-12 years of age). Data collection includes participant and parent questionnaires, anthropometry, blood and urine collection and geocoding. Data analysis will include testing the reliability and validity of the chosen measures of puberty for subsequent statistical modeling to assess the impact over time of tempo and onset of puberty (and their interaction) and mean-level repeated measures analyses to explore for significant upward and downward shifts on target outcomes as a function of main effects. Discussion: The strengths of this study include enrollment starting in the earliest stages of puberty, the use of frequent urine samples in addition to annual blood samples to measure puberty hormones, and the simultaneous use of parental questionnaires. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to show the particular difference Independent Mental Capacity Advocates (IMCA) can make towards specific decisions which some acquired brain injury clients, who are eligible for the IMCA service, experience.Design/methodology/approach - A case study is highlighted in which the role of the IMCA is described against the background of a selective literature review on the history of advocacy in relation to its emergence as a profession. This analysis references issues of spirituality and culture.Findings - Themes raised in the case are discussed with reference to ongoing research and these are related to the best interests of clients, and to reflexivity as a basis for the professionalisation of advocacy.Research limitations/implications - IMCA practitioners are instructed in well-defined "best interests" situations, where an individual has no capacity, support or representation, or requires safeguarding measures in relation to certain decisions. In these cases, social, cultural, emotional, religious or spiritual factors can contribute to the decisions which need to be made.Practical implications - The emerging role of the IMCA in the "best interests" process is outlined, including how health and social care professionals, or decision-makers, may relate to, benefit from, or respond to challenges by the IMCA in supporting clients in decisions made on their behalf.Originality/value - Healthcare professionals and those advocating, including IMCA, could more intentionally weigh up the values and beliefs of clients using, for example, the "best interests checklist" or by referring to "spiritual assessment", as used increasingly by mental health ward staff and chaplains. [ABSTRACT FROM AUTHOR]

The Mental Capacity Act (2005) and the amendments to the Mental Health Act (1983) in 2007-which came into effect in 2007 and 2009, respectively, in England and Wales-made it a statutory duty for the NHS and local authorities to refer to advocacy services. This is part of a growth in advocacy which coincides with an increase in literature on mental health and spirituality. Independent advocates and spiritual care coordinators (or chaplains) provide expressions of advocacy. For Independent Mental Capacity Advocates, social, cultural and spiritual factors are influential. Research involved a literature review on the history of advocacy and interviews with over 30 advocates, chaplains and service users and subsequent grounded theory analysis. The attested “rediscovery of the spiritual dimension in health and social care” was supported by overlaps in the practices of advocates and chaplains. This highlighted shortcomings around the professionalisation of advocacy in relation to culture and spirituality. [ABSTRACT FROM AUTHOR]