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1.
BMJ Open ; 11(12): e053373, 2021 12 16.
Article in English | MEDLINE | ID: mdl-34916319

ABSTRACT

PURPOSE: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports. PARTICIPANTS: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at. FINDINGS TO DATE: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be 'markedly ill', 'severely ill' or 'among the most extremely ill' by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year. FUTURE PLANS: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared. TRIAL REGISTRATION NUMBER: NCT03013595.


Subject(s)
Adolescent Health Services , Mental Health Services , Adolescent , Cohort Studies , Demography , Europe , Humans , Mental Health , Prospective Studies , Retrospective Studies
2.
J Autism Dev Disord ; 51(8): 2812-2828, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33051784

ABSTRACT

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.


Subject(s)
Autism Spectrum Disorder/psychology , Mental Health/trends , Parents/psychology , Problem Behavior/psychology , Psychometrics/methods , Surveys and Questionnaires , Adolescent , Adult , Autism Spectrum Disorder/diagnosis , Behavior Rating Scale , Caregivers/psychology , Child , Female , Humans , Male , Reproducibility of Results , Young Adult
3.
BMJ Open ; 10(6): e033324, 2020 06 23.
Article in English | MEDLINE | ID: mdl-32580979

ABSTRACT

OBJECTIVE: Young people moving from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) are faced with significant challenges. To improve this state of affairs, there needs to be a recognition of the problem and initiatives and an urgent requirement for appropriate tools for measuring readiness and outcomes at the transfer boundary (16-18 years of age in Europe). The objective of this study was to develop and validate the Transition Readiness and Appropriateness Measure (TRAM) for assessing a young person's readiness for transition, and their outcomes at the transfer boundary. DESIGN: MILESTONE prospective study. SETTING: Eight European Union (EU) countries participating in the EU-funded MILESTONE study. PARTICIPANTS: The first phase (MILESTONE validation study) involved 100 adolescents (pre-transition), young adults (post-transition), parents/carers and both CAMHS and AMHS clinicians. The second phase (MILESTONE cohort study and nested cluster randomised trial) involved over 1000 young people. RESULTS: The development of the TRAM began with a literature review on transitioning and a review of important items regarding transition by a panel of 34 mental health experts. A list of 64 items of potential importance were identified, which together comprised the TRAM. The psychometric properties of the different versions of the TRAM were evaluated and showed that the TRAM had good reliability for all versions and low-to-moderate correlations when compared with other established instruments and a well-defined factor structure. The main results of the cohort study with the nested cluster randomised trial are not reported. CONCLUSION: The TRAM is a reliable instrument for assessing transition readiness and appropriateness. It highlighted the barriers to a successful transition and informed clinicians, identifying areas which clinicians on both sides of the transfer boundary can work on to ease the transition for the young person. TRIAL REGISTRATION NUMBER: ISRCTN83240263 (Registered 23 July 2015), NCT03013595 (Registered 6 January 2017); Pre-results.


Subject(s)
Mental Health Services , Transition to Adult Care , Adolescent , Adult , Child , Europe , Female , Health Services Research , Humans , Male , Prospective Studies
4.
Sci Total Environ ; 724: 138223, 2020 Jul 01.
Article in English | MEDLINE | ID: mdl-32247126

ABSTRACT

Microcosm and field investigation were conducted to examine the effects of heavy metals on the decomposition and accumulation of organic carbon in contaminated Mersey estuarine floodplain, northwest England. The results show that inhibition of microbially mediated decomposition of organic matter occurred in the water-inundated soils. However, individual heavy metals had differential effects on the inhibition of soil organic matter decomposition with arsenic and copper being much stronger, as compared to other investigated heavy metals. The weak inhibitory effects of chromium on organic matter decomposition was due to the conversion of highly toxic Cr(VI) to less toxic Cr(III) under reducing conditions. Lead also had a weaker capacity to inhibit organic matter decomposition due to its low solubility. It was surprising that the same phenomenon was not clearly observed during the field examination. The inhibitory effects of heavy metals on soil organic matter decomposition could be curtained under field conditions. pH, Eh and EC played more important roles, as compared to soil-borne heavy metals, in affecting the soil carbon dynamics in the contaminated Mersey estuarine floodplain.

5.
Chemosphere ; 240: 124872, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31550589

ABSTRACT

Batch experiments were conducted using two biochar materials produced from different feedstocks to examine the behavior of solution-borne nitrate in the presence and absence of three model low-molecular weight organic acids (LMWOAs). The results showed that the biochar materials alone were not able to remove the solution-borne nitrate. LMWOAs caused protonation of the biochar surfaces and consequently enabled the biochar materials to adsorb nitrate from the solution. Different types of LMWOA had different capacities to immobilize solution-borne nitrate. Over 80% of the solution-borne nitrate could be removed within 72 h in the presence of citric acid or malic acid. By comparison, removal rate of nitrate was lower in the presence of oxalic acid, possibly due to competition of oxalate ion with nitrate for the available adsorption sites on the biochar surfaces. Nitrate adsorption onto the MSP700 biochar in the presence of all three-LMWOAs followed first order and second order kinetics, suggesting that the immobilization of nitrate involved complex interplay of physisorption and chemisorption. Nitrate adsorption onto RH700 biochar in citric and malic acid treatment systems followed second order kinetics. In the presence of oxalic acid for both biochar materials, nitrate adsorption showed perfect correlation R2 = 1 for both models.


Subject(s)
Charcoal/chemistry , Nitrates/chemistry , Organic Chemicals/chemistry , Molecular Weight
6.
Ecotoxicol Environ Saf ; 166: 383-389, 2018 Dec 30.
Article in English | MEDLINE | ID: mdl-30278401

ABSTRACT

The effects of softwood-derived biochar materials on the chemical behaviour of environmental contaminants in soils were examined in two microcosm scenarios. Addition of the biochar materials into an alkaline sandy soil significantly reduced NH3 volatilization and made it available for conversion into NO3- via nitrification. This process could be enhanced by an increased application rate of biochar produced at a higher pyrolysis temperature. Under the alkaline conditions encountered in the experiment, the biochar surfaces tended to be negatively charged which disfavours the adsorption of NO3-. Therefore, in a fully open system, the addition of biochar materials was likely to contribute to nitrate leaching from the fertilized alkaline sandy soil. The effects of the biochar materials on the immobilization of Fe2+ generated via anaerobic iron reduction in the inundated contaminated soil were not observed, except for the treatment with a higher dose of biochar material produced under pyrolysis temperature at 700 °C after the 240th h of incubation. Arsenic showed similar behaviour to Fe. Zn tended to have a higher affinity to the biochar, as compared to Mn. Immobilization of Pb occurred regardless of whether or not the biochar is present.


Subject(s)
Charcoal/metabolism , Environmental Pollution/prevention & control , Environmental Restoration and Remediation/methods , Nitrogen/metabolism , Soil Pollutants/analysis , Soil/chemistry , Adsorption , Nitrogen/toxicity , Soil Pollutants/toxicity , Trace Elements/analysis
7.
Ecotoxicol Environ Saf ; 165: 219-223, 2018 Dec 15.
Article in English | MEDLINE | ID: mdl-30199792

ABSTRACT

Biochar materials originated from sewage sludge may contain elevated levels of potentially toxic elements. There was a lack of information on the mobility of biochar-borne elements, as driven by low-molecular-weight organic acids (LMWOAs) contained in plant root exudates. A batch experiment was conducted to examine the effects of three common LMWOAs on the release of major elements and trace elements with a focus on various potentially toxic trace elements. The results showed that substantial amounts of Al, Mn, Fe, K, Na and Mg were extracted from two sewage sludge-derived biochar materials by the LMWOAs. A much higher release rate of potentially toxic trace elements was observed in the presence of LMWOAs, as compared to reported data using extractants not encountered in root exudates. The LMWOA-driven releasibility of various potentially toxic trace elements was in the following decreasing order: Zn > Ni > Pb > Cu > Cr >Co = Cd. Other trace elements that are subject to mobilization in the presence of LMWOAs included B, Ba, In, Li and Sr except Ba under oxalic acid extraction. Among the three LMWOAs, oxalic acid showed a generally stronger capacity to mobilize these metals. The findings obtained from this study provides new information that can be used for better evaluating the phyto-availability of trace elements bound to sewage sludge-originated biochar materials.


Subject(s)
Acids/chemistry , Charcoal/chemistry , Metals, Heavy/chemistry , Oxalic Acid/chemistry , Sewage , Water Pollutants, Chemical/chemistry , Cations , Hydrogen-Ion Concentration , Spectroscopy, Fourier Transform Infrared , Trace Elements/chemistry
8.
Sci Total Environ ; 630: 1188-1194, 2018 Jul 15.
Article in English | MEDLINE | ID: mdl-29554740

ABSTRACT

A batch experiment was conducted to examine the effects of biochar on the behaviour of soil-borne arsenic and metals that were mobilized by three low-molecular-weight organic acids. In the presence of citric acid, oxalic acid and malic acid at a molar concentration of 0.01M, the surface of biochar was protonated, which disfavours adsorption of the cationic metals released from the soil by organic acid-driven mobilization. In contrast, the oxyanionic As species were re-immobilized by the protonated biochar effectively. Biochar could also immobilize oxyanionic Cr species but not cationic Cr species. The addition of biochar increased the level of metals in the solution due to the release of the biochar-borne metals under attack by LMWOAs via cation exchange. Biochar could also have the potential to enhance reductive dissolution of iron and manganese oxides in the soil, leading to enhanced release of trace elements bound to these oxides. The findings obtained from this study have implications for evaluating the role of biochar in immobilizing trace elements in rhizosphere. Adsorption of cationic heavy metals on biochar in the presence of LMWOAs is unlikely to be a mechanism responsible for the impeded uptake of heavy metals by plants growing in heavy metal-contaminated soils.

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