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Many mental health problems begin in adolescence and occur on a spectrum of severity: early recognition and intervention is important. This study is a quantitative feasibility study of the Mental Health Foundation’s Peer Education Project (PEP). Attrition, psychometric properties of questionnaires, indications of improvement on a range of outcomes, and sample size required for a powered trial of effectiveness were assessed. 203 students completed the survey both pre and post-intervention. It was found that existing previously-validated measures had good psychometric properties, with two new questionnaires demonstrating reasonable reliability (self-help confidence alpha = 0.78, mental health knowledge alpha = 0.59). There were indications of improvement in help-seeking intentions, the number of sources likely to seek help from, and mental health knowledge from pre- to post-intervention. A future trial of PEP with a sample of approximately 36 schools, researcher-led data collections, and help-seeking intentions or sources as a primary outcome appears to be feasible.

A user often needs training and guidance while performing several daily life procedures, e.g., cooking, setting up a new appliance, or doing a COVID test. Watch-based human activity recognition (HAR) can track users' actions during these procedures. However, out of the box, state-of-the-art HAR struggles from noisy data and less-expressive actions that are often part of daily life tasks. This paper proposes PrISM-Tracker, a procedure-tracking framework that augments existing HAR models with (1) graph-based procedure representation and (2) a user-interaction module to handle model uncertainty. Specifically, PrISM-Tracker extends a Viterbi algorithm to update state probabilities based on time-series HAR outputs by leveraging the graph representation that embeds time information as prior. Moreover, the model identifies moments or classes of uncertainty and asks the user for guidance to improve tracking accuracy. We tested PrISM-Tracker in two procedures: latte-making in an engineering lab study and wound care for skin cancer patients at a clinic. The results showed the effectiveness of the proposed algorithm utilizing transition graphs in tracking steps and the efficacy of using simulated human input to enhance performance. This work is the first step toward human-in-the-loop intelligent systems for guiding users while performing new and complicated procedural tasks.

Sequestration of aromatic volatile organic compounds (VOCs) via metal-organic frameworks (MOFs) as sorbents is a viable means of environmental preservation. In this investigation, we shed light on the key features associated with MOFs that govern the selective uptake of a subclass of VOCs containing benzene, toluene, ethylbenzene, and xylenes (BTEX). We investigate, through a multistep computational framework including

Background: Participant motion in magnetic resonance imaging (MRI) is associated with processing problems including potentially non-useable data. This has implications for representativeness in research. Few large studies have investigated predictors of increased motion in the first instance.Method: We tested for association between multiple psychological and physical health traits with concurrent motion during T1 structural, diffusion, average resting-state and task functional magnetic resonance imaging (rfMRI; tfMRI) in N=52,951 UK Biobank imaging sub-sample participants. These traits included history of cardiometabolic, inflammatory, neurological and psychiatric conditions, as well as concurrent cognitive test scores and anthropometric traits. We tested for stability in motion in participants with longitudinal imaging data (n=5,305, average 2.64 years later).Results: All functional and T1 structural motion variables were significantly inter-correlated (Pearson r range 0.3 to 0.8, all P

The COVID lockdowns were characterised by new forms of governmentality as lives were disrupted and controlled through the vertical transmission of biopolitics by the state. The paper considers how this was experienced by academics in 11 different countries through analysis of diaries written during the first lockdown. The paper asks if communities can offer an alternative to governmentality by looking at three levels: the national, the neighbourhood and the personal. Whilst at a national level the idea of community was instrumentalised to encourage compliance to extraordinary measures, at the local level community compassion through helping neighbours encouraged horizontal connections that could offer a “space” within the dominant logic of governmentality. At the level of personal communities, the digitalisation of social relationships helped to create supportive networks over widely dispersed areas but these were narrowly rather than widely focused, avoiding critical discussion.

BACKGROUND: The high volume and pace of research has posed challenges to researchers, policymakers and practitioners wanting to understand the overall impact of the pandemic on children and young people's mental health. We aimed to search for and review the evidence from epidemiological studies to answer the question: how has mental health changed in the general population of children and young people? METHODS: Four databases (Medline, CINAHL, EMBASE and PsychINFO) were searched in October 2021, with searches updated in February 2022. We aimed to identify studies of children or adolescents with a mean age of 18 years or younger at baseline, that reported change on a validated mental health measure from prepandemic to during the pandemic. Abstracts and full texts were double-screened against inclusion criteria and quality assessed using a risk of bias tool. Studies were narratively synthesised, and meta-analyses were performed where studies were sufficiently similar. RESULTS: 6917 records were identified, and 51 studies included in the review. Only four studies had a rating of high quality. Studies were highly diverse in terms of design, setting, timing in relation to the pandemic, population, length of follow-up and choice of measure. Methodological heterogeneity limited the potential to conduct meta-analyses across studies. Whilst the evidence suggested a slight deterioration on some measures, overall, the findings were mixed, with no clear pattern emerging. CONCLUSIONS: Our findings highlight the need for a more harmonised approach to research in this field. Despite the sometimes-inconsistent results of our included studies, the evidence supports existing concerns about the impact of Covid-19 on children's mental health and on services for this group, given that even small changes can have a significant impact on provision at population level. Children and young people must be prioritised in pandemic recovery, and explicitly considered in planning for any future pandemic response.

Peer reviewed: True, INTRODUCTION: Attention deficit/hyperactivity disorder (ADHD) is a prevalent and impairing cluster of traits affecting 2%-5% of children. These children are at risk of negative health, social and educational outcomes and often experience severe difficulties at school, so effective psychosocial interventions are needed. There is mixed evidence for existing school-based interventions for ADHD, which are complex and resource-intensive, contradicting teachers' preferences for short, flexible strategies that suit a range of ADHD-related classroom-based problems. They are also poorly evaluated. In this study, a prototype intervention comprising a digital 'toolkit' of behavioural strategies will be tested and refined. We aim to refine the prototype so that its use is feasible and acceptable within school settings, and to establish whether a future definitive, appropriately powered, trial of effectiveness is feasible. This novel iterative study aims to pre-emptively address implementation and evaluation challenges that have hampered previous randomised controlled trials of non-pharmacological interventions. METHODS AND ANALYSIS: A randomised iterative mixed-methods case-series design will be used. Schools will be randomised to the time (school term) they implement the toolkit. Eight primary schools and 16-32 children with impairing traits of ADHD will participate, along with school staff and parents. The toolkit will be refined after each term, or more frequently if needed. Small, theory-based and data driven changes hypothesised as relevant across school contexts will be made, as well as reactive changes addressing implementation barriers. Feasibility and acceptability will be assessed through quantitative and qualitative data collection and analyses in relation to study continuation criteria, and ADHD symptoms and classroom functioning will be tracked and visually evaluated to assess whether there are early indications of toolkit utility. ETHICS AND DISSEMINATION: Ethical approval has been obtained. Results will be presented in journal articles, conferences and through varied forms of media to reach policymakers, stakeholders and the public.

Once considered an urban phenomenon, rural enterprise hubs (REH) and rural coworking spaces (RCWS) are now increasing in popularity to support entrepreneurial rural communities. Whilst previous research has examined economic and community benefits, a focus on well-being benefits has been overlooked. Framed by self-determination theory, this empirical research investigates whether rural coworking is reported to enhance user’s well-being by fulfilling key psychological needs for autonomy, competence and relatedness. By applying a well-being focus, we found that potential key drivers of rural coworking uptake and durability could be elucidated, in terms of these three needs. In addition, we identified another category of well-being that was fulfilled through engagement with RCWS and REH – namely – ‘communion with nature’. We suggest that considerations of well-being are important to understand how rural coworking can attract and sustain local workers and suggest a future research agenda to further conceptualise well-being effects.

The effective capture of common water contaminants using metal-organic frameworks (MOFs) presents a remedy for current environmental concerns arising from the pollution of water sources. The crystalline porous nature of MOFs, their high internal surface area, and exceptional tunability make them suitable candidates for sequestration and removal of pollutants. However, the efficiency of capture depends largely on the nature of the interactions between the anions and the MOF. In this work, to elucidate the host-guest interactions involved in the capture of such pollutants, we explore three characteristically different MOFs: ZIF-8, iMOF-2c, and MOF-74. We demonstrate by ab initio electronic structure calculations the importance of exploiting qualitatively different binding modes for strong host-guest interactions available in the selected MOFs. Our simulations reveal the relative performance of neutral and cationic adsorbents while underscoring the importance of employing MOFs containing open metal sites for the efficient uptake of anions.

Background Digital decision aids are becoming increasingly common in many areas of healthcare. These aids are designed to involve patients in medical decision making, with the aim of improving patient outcomes while decreasing healthcare burden. Previously developed contraceptive-based decision aids have been found to be effective at increasing women’s knowledge about reproductive health and contraception. Here, we sought to evaluate the effectiveness of a novel contraceptive-based decision aid at increasing women’s self-efficacy and knowledge about their reproductive health and contraceptive options, as well as their perceptions of their learning. This study was registered as a clinic trial at ClinicalTrials.gov (Contraception Decision Aid Use and Patient Outcomes, ID# NCT05177783) on 01-05-2022. Methods The Tuune→ contraceptive decision aid’s effectiveness was evaluated by conducting an experiment in which 324 women were assigned to use the TuuneⓇ decision aid or a control decision aid. Primary outcomes included reproductive health self-efficacy, reproductive health and contraceptive knowledge, and perceptions of learning. Secondary analyses examined whether prior experience using hormonal contraceptives moderated the relationship between decision aid and each outcome measure. Results Women assigned to use the Tuune→ decision aid exhibited greater reproductive health self-efficacy, greater knowledge about reproductive health and contraception, and perceived having learned more than women assigned to use the control decision aid. This pattern was also observed in women with previous contraceptive use experience, where women using TuuneⓇ reported better outcomes than women using the control aid, regardless of their history of hormonal contraceptive use experience. Conclusions Use of the Tuune→ contraceptive-based decision aid improved each of the predicted outcomes relative to a control decision aid. This suggests that use of the TuuneⓇ contraceptive-based decision aid is well poised to increase women’s confidence and knowledge about contraceptive use and may also reduce burden on healthcare systems.

We present a Work-habit Intervention Model (WhIM) to explain and predict how to change work-habits to be more effective. Habit change has primarily been researched within the health domain. The WhIM contributes a unique theoretical perspective by: (i) suggesting that work-habit change requires a two-stage process of exposure to regular rationalized plans and a stated intention to use these plans; and, (ii) defining effective work-habit change in terms of improvements to both goal attainment and well-being over time. Self-regulatory resources are included as potential moderators of habit change. This approach implies that work-habits (unlike health-habits) are seldom constitutionally ‘good’ or ‘bad’, which means that change requires a clear rationale in terms of improving goal attainment and well-being. The WhIM was evaluated in a 12-month wait-list intervention study designed to improve work-email habits for workers in a UK organization (N = 127 T1; N = 58 T3; N = 46 all data). Findings were that the two-stage process changed work-email habits for those with higher levels of self-efficacy, which predicted well-being in terms of reduced negative affect (via perceived goal attainment). We outline theoretical and practical implications and encourage future research to refine the WhIM across a range of other work contexts. Practitioner points: Workers need to regularly engage with rationalized plans of action and state their intention to use these, in order to change work-email habits. Organizations should consider training workers to enhance their self-efficacy prior to implementing a work-email habit change intervention. Providing regular feedback about the impact of work-email habit change on well-being and goal attainment is likely to make the change sustainable in the long-term.

Introduction Peer education, whereby peers (‘peer educators’) teach their other peers (‘peer learners’) about aspects of health is an approach growing in popularity across school contexts, possibly due to adolescents preferring to seek help for health-related concerns from their peers rather than adults or professionals. Peer education interventions cover a wide range of health areas but their overall effectiveness remains unclear. This review aims to summarise the effectiveness of existing peer-led health interventions implemented in schools worldwide. Methods Five electronic databases were searched for eligible studies in October 2020. To be included, studies must have evaluated a school-based peer education intervention designed to address the health of students aged 11–18-years-old and include quantitative outcome data to examine effectiveness. The number of interventions were summarised and the impact on improved health knowledge and reductions in health problems or risk-taking behaviours were investigated for each health area separately, the Mixed Methods Appraisal Tool was used to assess quality. Results A total of 2125 studies were identified after the initial search and 73 articles were included in the review. The majority of papers evaluated interventions focused on sex education/HIV prevention (n = 23), promoting healthy lifestyles (n = 17) and alcohol, smoking and substance use (n = 16). Papers mainly reported peer learner outcomes (67/73, 91.8%), with only six papers (8.2%) focussing solely on peer educator outcomes and five papers (6.8%) examining both peer learner and peer educator outcomes. Of the 67 papers reporting peer learner outcomes, 35/67 (52.2%) showed evidence of effectiveness, 8/67 (11.9%) showed mixed findings and 24/67 (35.8%) found limited or no evidence of effectiveness. Of the 11 papers reporting peer educator outcomes, 4/11 (36.4%) showed evidence of effectiveness, 2/11 (18.2%) showed mixed findings and 5/11 (45.5%) showed limited or no evidence of effectiveness. Study quality varied greatly with many studies rated as poor quality, mainly due to unrepresentative samples and incomplete data. Discussion School-based peer education interventions are implemented worldwide and span a wide range of health areas. A number of interventions appear to demonstrate evidence for effectiveness, suggesting peer education may be a promising strategy for health improvement in schools. Improvement in health-related knowledge was most common with less evidence for positive health behaviour change. In order to quantitatively synthesise the evidence and make more confident conclusions, there is a need for more robust, high-quality evaluations of peer-led interventions using standardised health knowledge and behaviour measures.

Bone invasion has long been recognized as a poor prognostic indicator for cutaneous squamous cell carcinoma (SCC). Survival analyses of factors associated with SCC with bone invasion have not been published.To analyze all published demographic, clinical, and treatment data for SCC with bone invasion and assess the impact of prognostic variables on disease progression, disease-specific death, and overall mortality.A systematic review and pooled-survival analysis was performed using individual patient data from case reports. Progression-free survival (PFS), disease-specific survival (DSS), and overall survival (OS) were estimated by Kaplan-Meier analysis.The study included 76 cases of SCC with bone invasion from 49 publications. Recurrent tumors and nonsurgical treatment modality were predictors of disease progression in univariable analysis and tumors of the trunk, head, and neck were predictors of disease progression in multivariable analysis. At 5 years from bone invasion diagnosis, patients had a PFS, DSS, and OS rate of 66.7%, 71.7%, and 66.2%, respectively.Cases of SCC with bone invasion had poor DFS, DSS, and OS rates, with worse outcomes imparted to tumors of the trunk, head, and neck.

Background: Traumatic brain injury (TBI) is a recognized risk factor for neurodegenerative disease (NDD). Nevertheless, currently we have no means to identify patients most at risk of NDD following TBI and, as a result, no means to target risk mitigation interventions. To address this, we tested for associations between TBI, cognitive performance and imaging measures of white matter integrity in UK Biobank (UKB) participants. Method: From the UKB imaging sub-study (n=47,920), participants were identified with either self-reported (n=177) or ICD-10 coded broad- (head injury codes; n=822) or narrow-band (TBI specific codes; n=239) TBI, or as controls with no relevant history of injury (n=47,098). Cognitive scores and magnetic resonance imaging (MRI) measures of white matter integrity were then compared between TBI and non-TBI participants, with results corrected for age at assessment, sex, deprivation, and cardiometabolic/exogenous hormone medications. Results: Whether based on self-reported history or ICD-10 coding, participants with TBI demonstrated poorer cognitive scores and multiple MRI measures of disturbance in corpus callosum integrity compared to participants with no TBI history. The strongest deleterious associations were for narrow-band TBI, with standardized betas around 0.2-0.3 difference (all P

Many studies have investigated the effectiveness of school-based ADHD interventions at modifying different social, emotional and behavioural target outcomes. However, there is a lack of evidence about which targets stakeholders perceive to be most important. This study sought to obtain consensus on which outcomes are perceived to be most important. A total of 114 people with ADHD, educational professionals, parents of children with ADHD, clinicians and researchers participated in a Delphi survey with 3 rounds. The importance of 52 intervention targets was rated on a scale from 0 to 8 (8 being extremely important). Consensus was reached if >70% of a stakeholder group rated a target as between 6–8 and Complexity of ADHD, Relationships, School Context, and What ADHD means to me. School-based ADHD interventions should target outcomes identified as most important to those who stand to benefit from such interventions. Some outcomes prioritised by our participants have not yet been targeted in school-based ADHD interventions. Implications of our findings for intervention and research design are discussed.

Office-based work today involves dealing with email, despite being denigrated and lauded in almost equal measures. Using the Conservation of Resources theory we examine whether Extraversion (expressed through two facets) acts as a resource to explain the differential impact that work-email has on people’s energy resources (relating to fatigue and boredom). An experience-sampling study was undertaken, whereby 54 knowledge-workers completed records of their response (n = 589) to new work-email over the course of a typical working day. Results were analysed using hierarchical linear modelling (HLM). Participants who felt tired prior to dealing with email, reported that they felt more energized afterwards (but only if they were higher on Agentic extraversion). Work-email did not re-energize extraverts when they had been bored beforehand. By examining changes in energy resources, and by measuring different facets of Extraversion, we offer theoretical and methodological contributions to advancing understanding about the role of resources in dealing with work-email. Specifically, our results suggest that Extraversion may not constitutionally be a key resource within COR, because its value and contribution to resource building is contingent on context. Implications for practitioners concerned with how best to manage digital communications at work, are discussed.

ObjectivesTo assess if a nurse-led application of a paediatric head injury clinical decision tool would be safe compared with current practice.MethodsAll paediatric (ResultsOf the 1739 patients screened, 61 had CTs performed due to head injury (six abnormal) with a CT rate of 3.5% and 2% re-presentations. Of the entire cohort, 1052 screened negative. 1 CT occurred in this group showing no abnormalities. Of those screened negative, 349 (33%)/1052 had ‘no other injuries’ and 543 (52%)/1052 had ‘abrasions or lacerations’. HIDATq's negative predictive value for CT was 99.9% (95% CI 99.4% to 99.9%) and 100% (95% CI 99.0% to 100%) for intracranial injury. The positive predictive value of the tool was low. Five patients screened negative and re-presented within 72 hours but did not require CT imaging.ConclusionA negative HIDATq appears safe in our ED. Potentially 20% (349/1739) of all patients with head injuries presenting to our department could be discharged by nurses at triage with adequate safety netting advice. This increases to 50% (543/1739), if patients with lacerations or abrasions were given advice and discharged at triage. A large multicentre study is required to validate the tool.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition. As such most schools, Further Education colleges, vocational training and Higher Education settings will need to support affected children and young people. When young people who require ongoing treatment for ADHD are around 18 years of age, they must transition from child to adult mental health services. However, only a small proportion successfully transition. As significant educational transitions are often happening at the same time, there is a need to consider how education and health service transitions may impact on one another. This paper presents findings from a large UK qualitative study involving 144 semi-structured interviews with young people who had ADHD, parents and health professionals. Two themes were identified which support the notion that education transition can impact health transition. Firstly, transition to adult health services typically requires continued prescription of ADHD medication, yet many young people stop taking their medication due to a belief that it is only needed for education-based learning. Secondly, if a young person is continuing education post-18, a lack of joined-up planning between education and health (outside of special schools) or consistent support in Higher/Further Education can leave young people with ADHD in limbo between health services and struggling within education. Given these findings, we recommend regarding multi-agency service statutory health care transition, educational staff training and ongoing oversight of child to adult health service and adult to adult health service transition effectiveness.

Funder: Joint United Nations Programme on HIV/AIDS; Id: http://dx.doi.org/10.13039/501100018734, Introduction: HIV planning requires granular estimates for the number of people living with HIV (PLHIV), antiretroviral treatment (ART) coverage and unmet need, and new HIV infections by district, or equivalent subnational administrative level. We developed a Bayesian small‐area estimation model, called Naomi, to estimate these quantities stratified by subnational administrative units, sex, and five‐year age groups. Methods: Small‐area regressions for HIV prevalence, ART coverage and HIV incidence were jointly calibrated using subnational household survey data on all three indicators, routine antenatal service delivery data on HIV prevalence and ART coverage among pregnant women, and service delivery data on the number of PLHIV receiving ART. Incidence was modelled by district‐level HIV prevalence and ART coverage. Model outputs of counts and rates for each indicator were aggregated to multiple geographic and demographic stratifications of interest. The model was estimated in an empirical Bayes framework, furnishing probabilistic uncertainty ranges for all output indicators. Example results were presented using data from Malawi during 2016–2018. Results: Adult HIV prevalence in September 2018 ranged from 3.2% to 17.1% across Malawi's districts and was higher in southern districts and in metropolitan areas. ART coverage was more homogenous, ranging from 75% to 82%. The largest number of PLHIV was among ages 35 to 39 for both women and men, while the most untreated PLHIV were among ages 25 to 29 for women and 30 to 34 for men. Relative uncertainty was larger for the untreated PLHIV than the number on ART or total PLHIV. Among clients receiving ART at facilities in Lilongwe city, an estimated 71% (95% CI, 61% to 79%) resided in Lilongwe city, 20% (14% to 27%) in Lilongwe district outside the metropolis, and 9% (6% to 12%) in neighbouring Dowa district. Thirty‐eight percent (26% to 50%) of Lilongwe rural residents and 39% (27% to 50%) of Dowa residents received treatment at facilities in Lilongwe city. Conclusions: The Naomi model synthesizes multiple subnational data sources to furnish estimates of key indicators for HIV programme planning, resource allocation, and target setting. Further model development to meet evolving HIV policy priorities and programme need should be accompanied by continued strengthening and understanding of routine health system data.

No abstract available.

Computer-mediated communication (CMC) interruptions are a common feature of people’s work activity. In studying interruptions, researchers can understand how people manage and co-ordinate their work when faced with multiple, often competing, demands. However, CMC interruptions are characteristically different from each other and impact people’s work performance in different ways. In this theoretical paper we define and differentiate between computer-mediated communication (CMC) interruptions, according to the level of control people are able to exert over an interruption at different points in the delivery timeline. Informed by the extant interruptions literature and Action Regulation Theory, a classification framework is provided, to help researchers and work designers distinguish which types of real-world CMC interruption are more or less disruptive, based on levels of control. Using the developed framework, two key research propositions are made, which we encourage future research to attend to. Unique contributions and implications of this paper are discussed.

Chitinozoans were recovered from the Naranco, Huergas and Gustalapiedra formations of northern Spain, which yielded a diverse assemblage including 29 taxa in 9 named genera. The deposits are of early Givetian age, a time when Iberia was isolated from large continents as part of the Armorican Terrane Assemblage. The formations studied here consist of a large clastic unit interrupting carbonate deposition, with large limestone formations positioned above and below the formations analyzed here. This clastic unit includes the Kacak Event, an important global extinction event associated with anoxia in the marine realm. In this paper, the relatively well-preserved chitinozoan assemblage is described and considered from a biogeographical and stratigraphical perspective. The chitinozoan community was deposited in a short space of time and includes various taxa not previously known from the Middle Devonian, though the assemblage as a whole is attributable to the period. Only moderate similarity is seen with assemblages reported from Laurussia and Gondwana, with a slight bias towards the latter. This report adds to our knowledge of chitinozoan paleobiogeography and to other recent studies of Middle Devonian palynology in northern Iberia.

There is little research exploring educational practitioners' experiences of working with children with attention deficit/hyperactivity disorder (ADHD). The current study aimed to understand educational practitioners' beliefs concerning the home lives of children with ADHD, and how they perceive that home lives affect children's behaviour in school. Forty‐two practitioners from primary, secondary and pupil referral schools participated in focus groups or interviews. Thematic analysis was used to identify themes arising from the data. Three themes emerged as relevant to beliefs about the home lives of children with ADHD: inconsistency, psychosocial adversity and isolation. Educational practitioners relate their experiences of working with children to what they believe occurs at home. On the basis of these findings, we make recommendations for strategies that school practitioners can use when working with children with ADHD. [ABSTRACT FROM AUTHOR]

BackgroundThe occurrence of early childhood adversity is strongly linked to later self-harm, but there is poor understanding of how this distal risk factor might influence later behaviours. One possible mechanism is through an earlier onset of puberty in children exposed to adversity, since early puberty is associated with an increased risk of adolescent self-harm. We investigated whether early pubertal timing mediates the association between childhood adversity and later self-harm.MethodsParticipants were 6698 young people from a UK population-based birth cohort (ALSPAC). We measured exposure to nine types of adversity from 0 to 9 years old, and self-harm when participants were aged 16 and 21 years. Pubertal timing measures were age at peak height velocity (aPHV – males and females) and age at menarche (AAM). We used generalised structural equation modelling for analyses.ResultsFor every additional type of adversity; participants had an average 12–14% increased risk of self-harm by 16. Relative risk (RR) estimates were stronger for direct effects when outcomes were self-harm with suicidal intent. There was no evidence that earlier pubertal timing mediated the association between adversity and self-harm [indirect effect RR 1.00, 95% confidence interval (CI) 1.00–1.00 for aPHV and RR 1.00, 95% CI 1.00–1.01 for AAM].ConclusionsA cumulative measure of exposure to multiple types of adversity does not confer an increased risk of self-harm via early pubertal timing, however both childhood adversity and early puberty are risk factors for later self-harm. Research identifying mechanisms underlying the link between childhood adversity and later self-harm is needed to inform interventions.

BACKGROUND: Among children aged 6-16, there is a clear association between attention-deficit/hyperactivity disorder (ADHD) symptoms and academic attainment. We wanted to know whether this association was replicated in younger children.AIMS: To explore the relationship between children aged 4-8 with probable ADHD and their academic attainment and school attendance. Secondly, the study aimed to explore their behaviour within school and their reported attitudes towards school.SAMPLE: A total of 1,152 children who were taking part in the Supporting Teachers and Children in Schools (STARS) cluster randomized controlled trial.METHODS: ADHD status was established by using the Strengths and Difficulties Questionnaire predictive algorithm to identify children with probable ADHD. Using baseline data, random-effects regression models on ADHD status were fitted to attainment, attendance, special educational needs (SEN) provision, and attitudes towards school and classroom behaviour; models that were also fitted to attainment were evaluated again at 9, 18, and 30 months after baseline.RESULTS: Children with probable ADHD (n = 47) were more likely than controls (n = 1,105) to have below-expected attainment in literacy (odds ratio (OR) 16.7, 95% CI 6.93-to-40.1), numeracy (OR 11.3, 95% CI 5.34-to-24.1) and to be identified as having SEN (OR-55.2, 95%-CI 22.1-to-137). Their attendance was poorer with more unauthorized absences (rate ratio (RR)-1.91, 95%-CI-1.57-to-2.31). They had more teacher-reported behavioural problems (mean difference (MD) 5.0, 95%-CI 4.6-to-5.4) and less positive attitudes towards school (MD -1.1, 95% CI -0.56 to -1.85). Poorer attainment in literacy and numeracy persisted at all follow-ups.CONCLUSIONS: Children aged as young as 4 whose behaviour indicates probable ADHD struggle to cope at school in terms of academic attainment, attendance, classroom behaviour, and attitude towards school when compared to other children. Early identification and intervention to help these children manage in school are needed.

Objectives Receiving a diagnosis of dementia is life-changing for the individual and their companion. The aim of the study was to explore the feasibility of collecting salivary cortisol from patients who are informed if they have dementia and their companions. Patients and companions collected nine saliva samples in three batches: 1–2 weeks before, immediately before, and immediately after the diagnostic meeting. Each batch consisted of three samples taken in the evening, after awaking and 30 mins post-waking. Results 22.7% (N = 10) of 44 invited patients and nine companions agreed, with 18.2% patients (N = 8) and 15.9% companions (N = 7) providing samples. Participants found that saliva collection was demanding and disrupted routines. On a purely descriptive level, some indications of an increased cortisol stress response in patients diagnosed with dementia were found in this very small sample. Researchers should expect low recruitment rates in this elderly population. Simpler collection procedures, e.g. pre-labelled packages with date/time, possible omission of morning samples and objective rather than self-report assessment of waking and saliva collection times—using actigraphy wrist-watches bleeps to prompt people at the timepoints and electronic track caps—might improve adherence and improve the accuracy of timepoints when swabs were actually collected.

BackgroundRecent research suggests that between 20% and 50% of paediatric head injuries attending our emergency department (ED) could be safely discharged soon after triage, without the need for medical review, using a ‘Head Injury Discharge At Triage’ tool (HIDAT). We sought to implement this into clinical practice.MethodsPaediatric ED triage staff underwent competency-based assessments for HIDAT with all head injury presentations 1 May to 31 October 2020 included in analysis. We determined which patients were discharged using the tool, which underwent CT of the brain and whether there was a clinically important traumatic brain injury or representation to the ED.ResultsOf the 1429 patients screened; 610 (43%) screened negative with 250 (18%) discharged by nursing staff. Of the entire cohort, 32 CTs were performed for head injury concerns (6 abnormal) with 1 CT performed in the HIDAT negative group (normal). Of those discharged using HIDAT, four reattended, two with vomiting (no imaging or admission) and two with minor scalp wound infections. Two patients who screened negative declined discharge under the policy with later medical discharge (no imaging or admission). Paediatric ED attendances were 29% lower than in 2018.ConclusionWe have successfully implemented HIDAT into local clinical practice. The number discharged (18%) is lower than originally described; this is likely multifactorial. The relationship between COVID-19 and paediatric ED attendances is unclear but decreased attendances suggest those for whom the tool was originally designed are not attending ED and may be accessing other medical/non-medical resources