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Background Overcontrol is a transdiagnostic cluster of traits associated with excessive psychological, behavioural and social inhibitory control. It is associated with psychiatric diagnoses of depression, restrictive eating disorders and/or obsessive-compulsive personality disorder. Radically Open Dialectical Behaviour Therapy is a transdiagnostic treatment for maladaptive overcontrol. This case series evaluates an adolescent adaption (RO-A) for a transdiagnostic group of adolescents identified as overcontrolled. Methods Twenty-eight adolescents were consecutively referred for RO-A from two different National and Specialist Child and Adolescent Mental Health Services between June 2017 and February 2020. Baseline self-report measures assessed overcontrol characteristics, relationship and attachment quality and mental health symptoms of depression and eating disorders, which were repeated at discharge. Results Adolescents in this case series reported high rates of depression (78.6%), self-harm (64.3%) and eating disorders (78.6%). Most (85.7%) had two or more mental health diagnoses and all had previous mental health treatments before starting RO-A. The mean number of RO-A sessions attended was 18 group-based skills classes and 21 individual sessions over a mean period of 34 weeks. Significant improvements with medium and large effect sizes were reported in cognitive flexibility (d = 1.63), risk aversion (d = 1.17), increased reward processing (d = .79) and reduced suppression of emotional expression (d = .72). Adolescents also reported feeling less socially withdrawn (d = .97), more connected to others (d = 1.03), as well as more confident (d = 1.10) and comfortable (d = .85) in attachment relationships. Symptoms of depression (d = .71), eating disorders (d = 1.06) and rates of self-harm (V = .39) also significantly improved. Exploratory correlation analyses suggest improvements in overcontrol are moderately to strongly correlated with improvements in symptoms of depression and eating disorders. Conclusions This case series provides preliminary data that RO-A may be an effective new treatment for adolescents with overcontrol and moderate to severe mental health disorders like depression and eating disorders. RO-A led to improved management of overcontrol, improved relationship quality and reduced mental health symptoms. Further evaluation is indicated by this case series, particularly for underweight young people with eating disorders. More rigorous testing of the model is required as conclusions are only tentative due to the small sample size and methodological limitations.

Although 70% of autistic children and young people meet criteria for co-occurring psychiatric conditions, there are few screening measures specifically for autistic individuals. We describe the development and validation of the Assessment of Concerning Behavior (ACB), an instrument co-developed with the autistic community to assess mental health and problematic/risky behaviors. Items include descriptions to facilitate symptom recognition by autistic people, and carers/professionals. The ACB was completed by 255 parents, 149 autistic children and young people and 30 teachers. Internal consistency, stability and validity was assessed. The ACB parent-version fit a two-factor model (internalizing and externalizing problems) and showed adequate test–retest reliability, internal consistency and construct validity. The ACB is a promising new measure for research and clinical use in autism. Electronic supplementary material The online version of this article (10.1007/s10803-020-04748-1) contains supplementary material, which is available to authorized users.

Brief, evidence-based interventions for adolescent depression are urgently required, particularly for school-settings. Cognitive mechanisms research suggests dysfunctional mental imagery and overgeneral memory could be promising targets to improve mood. This feasibility randomised controlled trial with parallel symptomatic groups (n = 56) compared a novel imagery-based cognitive behavioural intervention (ICBI) to non-directive supportive therapy (NDST) in school settings. Blind assessments (of clinical symptoms and cognitive mechanisms) took place pre-intervention, post-intervention and follow-up three months later. The trial aimed to evaluate the feasibility and acceptability of the methodology and interventions, and estimate the likely range of effects of the intervention on self-reported depression. The pre-defined criteria for proceeding to a definitive RCT were met: full recruitment occurred within eleven months; retention was 89%; ICBI acceptability was above satisfactory; and no harm was indicated. Intention-to-treat analysis found large effects in favour of ICBI (relative to NDST) at post-intervention in reducing depressive symptoms (d = −1.34, 95% CI [-1.87, −0.80]) and improving memory specificity (d = 0.79 [0.35, 1.23]), a key cognitive target. The findings suggest that ICBI may not only improve mood but also strengthen abilities associated with imagining and planning the future, critical skills at this life stage. A fully powered evaluation of ICBI is warranted. Trial Registration: https://www.isrctn.com/ ; ISRCTN85369879.

Background:Tendencies to attend to threatening cues in the environment and to interpret ambiguous situations with negative/hostile intent maintain and may even precipitate internalizing and externalizing problems in young people with a history of maltreatment. Challenging maladaptive information-processing styles using cognitive bias modification (CBM) training may reduce symptoms.Aims:To investigate the acceptability of CBM training in nine young people attending alternate education provision units in the UK, and 10 young people living in out-of-home care institutions in Nepal with a history of maltreatment.Method:CBM training consisted of five sessions of training over a 2-week period; each training session consisted of one module targeting attention biases and one module targeting interpretation biases for threat. A feedback form administered after training measured acceptability. Pre- and post-intervention measures of internalizing and externalizing symptoms were also taken.Results:Most young people (89%) found the training helpful and 84% found the training materials realistic. There were reductions in many symptom domains, but with individual variation. Although limited by the lack of a control condition, we established generalizability of acceptability across participants from two cultural settings.Conclusions:Replication of these findings in larger feasibility randomized controlled trials with measures of attention and interpretation bias before and after intervention, are needed to assess the potential of CBM in reducing anxiety symptoms and its capacity to engage targeted mechanisms.

Introduction Suboptimal male engagement in HIV programmes is a persistent challenge, leading to lower coverage of HIV testing, prevention and treatment services, and to worse outcomes for men. Differentiated service delivery models, such as peer‐led community antiretroviral refill groups (CARGs), offer the opportunity to enhance patient satisfaction, retention and treatment outcomes. We conducted an exploratory qualitative study to identify facilitators and barriers to CARG participation by HIV‐positive men, with inputs from recipients of HIV care, community members, healthcare workers (HCWs), donors and policymakers. Methods Between July and October 2017, we conducted 20 focus group discussions (FGDs) with 147 adults living with HIV, including men and women enrolled in CARGs and men not enrolled in CARGs, and 46 key informant interviews (KIIs) with policymakers, donors, HCWs and community members. FGDs and KIIs were recorded, transcribed and translated. A constant comparison approach was used to triangulate findings and identify themes related to male engagement in CARGs in rural Zimbabwe. Results CARG participants, policymakers, donors, HCWs, and community members noted many advantages to CARG participation, including convenience, efficiency, solidarity and mutual psychosocial support. Although those familiar with CARGs reported that these groups decreased HIV‐related stigma, concerns about stigma and privacy were perceived to be the primary reason for men’s non‐participation. Other important barriers to male enrolment included lack of awareness of CARGs, misunderstanding of how CARGs operate, few perceived benefits and lack of flexibility in CARG implementation. Conclusions More effective educational and awareness campaigns, community‐based anti‐stigma campaigns, more flexible CARG designs, and provision of financial and/or in‐kind support to CARG members could mitigate many of the barriers to male enrolment in CARGs. Men may also prefer alternative differentiated service delivery models that are facility‐based and/or do not require group participation.

Belize trained psychiatric nurse practitioners (PNPs) in the early 1990s to provide mental health services throughout the country. Despite overwhelming success, the program is limited by lack of monitoring, evaluation, and surveillance. To promote quality assurance, we developed a chart audit tool to monitor mental healthcare delivery compliance for initial psychiatric assessment notes completed by PNPs. After reviewing the Belize Health Information System electronic medical record system, we developed a clinical audit tool to capture 20 essential components for initial assessment clinical notes. The audit tool was then piloted for initial assessment notes completed during July through September of 2013. One hundred and thirty-four initial psychiatric interviews were audited. The average chart score among all PNPs was 9.57, ranging from 3 to 15. Twenty-three charts—or 17.2 %—had a score of 14 or higher and met a 70 % compliance benchmark goal. Among indicators most frequently omitted included labs ordered and named (15.7 %) and psychiatric diagnosis (21.6 %). Explicit statement of medications initiated with dose and frequency occurred in 47.0 % of charts. Our findings provide direction for training and improvement, such as emphasizing the importance of naming labs ordered, medications and doses prescribed, and psychiatric diagnoses in initial assessment clinical notes. We hope this initial assessment helps enhance mental health delivery compliance by prompting creation of BHIS templates, development of audits tools for revisit follow-up visits, and establishment of corrective actions for low-scoring practitioners. These efforts may serve as a model for implementing quality assurance programming in other low resource settings.

In a somatic society which promotes visible, idealized forms of embodiment, men are increasingly being interpellated as image-conscious body-subjects. Some research suggests that men negotiate appearance issues in complex and varied ways, partly because image concerns are conventionally feminized. However, little research has considered how overweight men construct body projects in the context of weight loss, or how men talk to each other about weight management efforts. Since sources of information and support for overweight men are now provided online, including dedicated weight loss discussion forums, our analysis focuses on one such forum, linked to a popular male-targeted magazine. We conducted a thematic analysis of selected extracts from seven threads on the forum. Our analysis suggests a widespread focus on appearance, as well as the use of emotion categories when describing difficult bodily experiences. Invariably, however, such talk was carefully constructed and constrained by hegemonic masculinities founded on discipline, work-orientation, pragmatism and self-reliance. The findings are discussed in relation to magazine masculinities and aesthetics, as well as literature on male embodiment.

Measurements of 10Be concentrations in quartz‐rich boulders exposed by the uplift of anticlinal ranges in Central Otago, New Zealand, are used to investigate the fault propagation styles and rates for the underlying blind reverse faults. 10Be ages along Little Rough Ridge reveal the propagation rate for this fault to be between zero (i.e., not propagating at all, if the ages reflect emergence of a fault of fixed length through a sloping surface) and a maximum of 8.1 mm/yr, if the ages reflect true lateral growth. Regardless of the propagation rate, Little Rough Ridge has established its length rapidly compared with the rate at which it has accumulated displacement. On Raggedy Range, the 10Be ages, together with structural data, imply that the ridge reached its current length by the merging of several small fault segments. This study emphasises the importance of combining 10Be measurements with geomorphic observations. Without understanding the geomorphological context, 10Be exposure ages are diff...

Purpose – The purpose of this paper is to ascertain which employees choose to access occupational health checks (OHCs), their perceptions of the usefulness of information received and whether they choose to act on tailored advice provided. Design/methodology/approach – In total, 253 hospital employees attended workplace OHC then completed online questionnaire survey. Findings – Participants included new cases (80 per cent) and those who had accessed the service previously (20 per cent), all age categories (23-69 years) and all occupational groups, although the vast majority were in office-based sedentary job roles, nursing or allied health professions (AHP) (78.3 per cent). Almost half were overweight or obese (46.7 per cent); many reported existing health problems or family history of chronic disease. Participants perceived OHC s to be convenient, informative and useful for raising their awareness of health issues, reassurance and monitoring, early identification of potential health problems and signposting to appropriate services. Participants reported post-check dietary changes (41 per cent) and increases in physical activity (30 per cent); smokers reported quitting or cutting down (44 per cent) and those exceeding alcohol limits reported cutting frequency or units of consumption (48 per cent). More than half those advised to visit their GP complied (53 per cent). Research limitations/implications – Future studies should investigate the efficacy of OHCs and whether reported lifestyle changes are sustained in the long-term. Originality/value – General health checks can be feasibly delivered in a multi-site hospital workplace setting with diverse appeal. Provision of tailored health information can help to raise health awareness and motivate health behaviour change or maintenance amongst hospital employees, including those reporting risk factors for chronic disease. Employees value the investment of healthcare organisations in the health and wellbeing of their workforce.

[1] In situ cosmogenic 10Be and 26Al measurements on sedimentary quartzites, together with analysis of abandoned river terraces, can be used to show how drainage responded to the lateral propagation of a late Quaternary anticline forming above a blind reverse fault in Central Otago, New Zealand. A close link between the progression of cosmogenic ages and the tectonic geomorphology allows us to confirm that uplift and propagation rates on the anticline are in the ranges 0.08–0.12 mm yr−1 and 0.8–1.5 mm yr−1, respectively, over the last 550,000 years. The agreement between the isotopic and geomorphological evidence in turn requires that minimum 10Be exposure ages as great as 660 ka are not in steady state with respect to erosion. This is a geochemical result of significance, as it opens the possibility of a more regional analysis of landscape evolution in this region, using the same rocks. On an adjacent anticline, thought to be even older on geomorphological arguments, 10Be concentrations give minimum exposure ages in the range 750–1400 ka. These extremely old minimum ages are rare worldwide, as they are usually limited to smaller values by erosion. They are attributable to the very resistant nature of the quartz-rich boulders in which the measurements were made, which in places are shown to have erosion rates lower than 0.5 mm kyr−1.

$^{10}Be$ concentrations measured in silica-cemented Tertiary sandstones in Central Otago have yielded minimum exposure ages of up to 1400 ka, some of the oldest ever recorded outside the dry valleys of Antarctica and some arid deserts. The silica-cemented sandstones outcrop as boulders in a region where their exposure is caused by the growth of anticlinal ridges above blind reverse faults. Initial studies using a combination of in situ cosmogenic isotope measurements and geomorphological observations on one range have demonstrated the potential of this technique to investigate Late Cenozoic fault growth and erosion rates. The best-exposed and preserved occurrence of the quartz-rich boulders is at German Hill on North Rough Ridge, where their stratigraphic context and their sedimentary and diagenetic origin, together with their method of emplacement and preservation on the modern land surface, can be studied in detail. These are all features that affect their suitability for cosmogenic isotope studies of landscape development and are discussed in this article. $^{10}Be$ concentrations in the German Hill rocks yield minimum exposure ages of 600–1300 ka, and it is possible that these concentrations are not in saturated steady state with respect to erosion. These ages imply that the uplift of North Rough Ridge by its underlying fault is a Quaternary phenomenon. This conclusion has implications for the likely earthquake recurrence on the fault, which with an estimated average long-term slip rate of 0.5 mm yr$^{-1}$, is expected to be infrequent.

We use in situ cosmogenic 10 Be measurements in quartzites to examine the growth and propagation rates of a Late Quaternary anticline forming above a blind reverse fault in Central Otago, New Zealand. We obtain average uplift and propagation rates of 0.10–0.15 mm yr −1 and 1.0–2.0 mm yr −1 respectively over the last 450 000 yr, though it is probable that growth occurred episodically, with more rapid development in the periods 600–400 kyr and 200–100 kyr and relative quiescence between about 400 and 200 kyr ago. These results quantify and confirm a qualitative analysis of the fault evolution based on geomorphology and drainage patterns. We obtain minimum 10 Be exposure ages of up to 750 000 yr for the quartzites, some of the oldest ages obtained by this method outside Antarctica, which are made possible by the extremely low erosion rates of less than 0.6 mm kyr −1 in the resistant quartzites. These rocks consequently provide an opportunity to study geomorphic and tectonic processes in this region over unusually long time periods.