The Effectiveness of Preventative Interventions to Reduce Mental Health Problems in at-risk Children and Young People: A Systematic Review of Reviews.

Mental health problems are the leading cause of childhood disability worldwide, resulting in poor outcomes for children and young people that persist into adulthood. It is essential that those young people most at risk of developing mental health problems receive effective preventative interventions. Whilst there have been a number of systematic reviews which have examined the effectiveness of secondary prevention interventions for specific groups of children and young people, or to address identified mental health concerns, no review has engaged with the breadth of this literature. We conducted a systematic review of systematic reviews to map this complex field of secondary preventative interventions and identify effective interventions to prevent mental health problems in children and adolescents aged 3-17 years. The review protocol was registered on PROSPERO. We searched five electronic databases from inception to February 2023. The certainty of the evidence was appraised using the AMSTAR 2. We included 49 unique systematic reviews each including between 2 and 249 (mean 34) unique studies; the majority of which were reviews which included only or mostly randomised controlled trials (70%). The reviews examined selective interventions (defined as interventions which are delivered to sub-group populations of young people at increased risk of mental health problems) (n = 22), indicated interventions (defined as interventions which target young people who are found to have pre-clinical symptoms) (n = 15) or a synthesis of both (n = 12). The certainty of the evidence in the reviews was rated as high, (n = 12) moderate (n = 5), low (n = 9) and critically low (n = 23). We found evidence to support both selective and indicated interventions in a range of populations and settings, with most of this evidence available for children and young people in their mid-years (6-10 years) and early adolescence (11-13 years). There was a large body of evidence suggesting that resilience enhancing, cognitive behaviour therapy-based and psychoeducational interventions for children who experience adversity, or those with subclinical externalising problems may offer promise. Early selective interventions for a subpopulation of children and young people who have experienced adversity which combines risk reduction and resilience enhancing approaches directed at children and their families may be effective at reducing mental health problems.

A realist approach to understanding alliancing within Local Government public health and social care service provision.

BACKGROUND: Within the current context of continued austerity and post-pandemic recovery, it remains important that Local Government services address the increasing needs of residents as cost-effectively as possible. Alliancing, whereby services work collaboratively focusing on the 'whole-system', has gained popularity as a tool with the potential to support collaborative whole systems approaches. This synthesis aims to identify how alliancing can be successfully operationalised in the commissioning of public health, wider National Health Service (NHS) and social care-related services. METHODS: A realist literature synthesis was undertaken in order to identify underlying generative mechanisms associated with alliancing, the contextual conditions surrounding the implementation and operationalisation of the alliancing approach mechanisms, and the outcomes produced as a result. An iterative approach was taken, using a recent systematic review of the effectiveness of Alliancing, online database searches, and grey literature searches. RESULTS: Three mechanistic components were identified within the data as being core to the successful implementation of alliances in public health and social care-related services within Local Government: (i) Achieving a system-level approach; (ii) placing local populations at the heart of the system; and (iii) creating a cultural shift. Programme theories were postulated within these components. CONCLUSIONS: The alliancing approach offers an opportunity to achieve system-level change with the potential to benefit local populations. The realist synthesis approach taken within this study has provided insights into the necessary contextual and mechanistic factors of the Alliancing approach, above and beyond effectiveness outcomes typically collected through more conventional evaluation methodologies.

Dietary experience modifies horses' feeding behavior and selection patterns of three macronutrient rich diets.

Choice feeding is often used to investigate an animal's nutritional requirements and dietary preferences. A problem with this approach is that animals with long gut transit times, such as the horse, may find it difficult to associate a chosen food with its nutritional consequence when alternative foods are presented simultaneously. One solution is to present foods singly for a period of time before a simultaneous choice session to allow the development of learned associations. This method was used to determine if horse's voluntary intake and feeding behavior was influenced by the macronutrient composition of the diet. Seven stabled horses, maintained on a low intensity exercise regimen, were allowed, on an ad libitum basis, haylage and 3 isocaloric forage based diets that were rich in 1 of 3 macronutrients (protein, lipid, and hydrolyzable carbohydrate). Initially, diets were presented as a 3-way choice for 5 d (self-selection a [SSa]), then singly (monadic phase) with exposure to each diet for 2 separate periods of 3 d each, and finally again as a choice for 5 d (self-selection b [SSb]). The total amount of trial diet offered differed with trial phase, with 2 to 2.5% of BW during SSa and the monadic phase, increasing to ad libitum access during SSb. To control differences in the total amount of trial diet offered, 2 measurements of voluntary intake were taken at 4 and 22 h postpresentation. Daily macronutrient and energy intakes were estimated from proximate analysis of the trial diets and batches of haylage fed. Feeding behavior was observed over a single 4-h period during both self-selection phases. Horses showed no initial preference after 4 h for any 1 diet during SSa. Following the monadic phase, horses demonstrated a preference for the protein and hydrolyzable carbohydrate rich diets over the lipid rich diet (P < 0.001). Dietary experience modified foraging behavior as the total number of visits to the diets decreased during SSb (P < 0.005). Analysis of 24 -h macronutrient consumption showed that protein and hydrolyzable carbohydrate intake increased during SSb, whereas lipid intake remained constant over both self-selection phases (P < 0.001). These data indicate for perhaps the first time that horses can respond to dietary macronutrient content and that single presentations during choice studies facilitates expression of dietary preferences.

Evaluation of the effects of cage height and stocking density on the behaviour of laying hens in furnished cages.

1. Limited information is available on how changes in horizontal and vertical space within enriched or furnished layer cages (as defined by Directive 1999/74/EC) influence hen behaviour. This study evaluated the effects of varying minimum cage heights and space allowances on the behaviour of laying hens housed in furnished cages. It was conducted on two flocks of medium brown hybrid hens housed in furnished cages with access to perches and nest boxes on a semi-commercial scale at ADAS Gleadthorpe. 2. Flock 1 consisted of two layer strains (ISA Brown and Babcock 380), housed at two minimum cage heights (38 and 45 cm) and 5 stocking densities between 609 and 870 cm2/bird, with 12 replicates of each of the 20 strain/cage height/stocking density treatment combinations. Stocking density was varied by varying the number of birds per cage from 10 to 7 in standard full-width cages or housing 7 hens in a narrower cage. As a consequence stocking density, group size and trough width per bird co-varied for 4 out of 5 stocking density treatments. 3. Behaviour of flock 1 was sampled at 33 to 36, 46 and 68 weeks of age. At each age one top-tier, one middle-tier and one bottom-tier cage was sampled for each treatment. 4. Few behavioural differences due to cage treatments were detected. Hens at 870 cm2 had shorter feeding bouts than hens at 609 and 762 cm2. Yawning was more common in the cages with greater cage height. 5. Video recordings of flock 1 examined cage height effects on hens' use of vertical space and provided additional data on stretching and self-maintenance activities. No differences in behaviour between 38 and 45 cm cages were found except that scratching head was more common in cages with greater cage height. 6. Flock 2 consisted of two layer strains (Shaver Brown and Hy-Line Brown), housed at 38 and 45 cm and 609, 762 and 1016 cm2/bird, with 18 replicates of each of the 12 strain/cage height/stocking density treatment combinations. Stocking density was varied by housing 10, 8 or 6 hens in standard full-width cages. Behaviour of flock 2 was sampled at 30, 48, 60 and 67 weeks from video recordings. Three cages per treatment from middle-tiers only were sampled at each age. 7. Hens housed at 609 cm2/hen had the longest mean feeding bout, greater than for hens at 762 cm2/hen but not hens at 1016 cm2/hen. More unsuccessful attempts to reach the feeder and sideways and backwards displacements from the feeder occurred at 762 and 609 cm2/hen than at 1016 cm2/hen. A maximum of 8 hens were observed feeding synchronously. 8. These results suggest that changes in horizontal and vertical space over the ranges we studied had little effect on behaviour other than feeding behaviour. Specifying a minimum useable trough space per hen, rather than calculating feeder space from total length of feeder per cage, irrespective of accessibility, might help avoid crowding at the feeder and associated disturbance of feeding bouts.

Intra-cerebral ventricular infusion of 5-iodo-2-deoxyuridine (IUDR) as a radiosensitizer in the treatment of a rat glioma.

The efficacy of 5-iodo-2-deoxyuridine (IUDR) as a radiosensitizer when administered by continuous infusion into the cerebral spinal fluid (CSF) of the lateral cerebral ventricle was evaluated in a 9L gliosarcoma rat brain tumor model. Stereotactic implantation of a 5 x 10(4) tumor cell suspension into the left caudate nucleus was carried out in four groups of 10 rats each. Control animals had a median survival of 16.9 days (range 16-21 days). IUDR, 8.4 mg over 7 days administered by continuous infusion into the left lateral ventricle produced a slight survival advantage (median survival 21.5 days, range 12-56). Irradiation of the entire brain, 8 Gy on days 4, 6 and 7 after tumor cell implantation also produced a slight improvement in survival (median 19.5 days, range 17-34). The combination of radiation and IUDR infusion into the CSF produced a marked survival advantage (median 30.5, range 22-54) compared to the control and single modality treatment groups. This is the first demonstration of the effectiveness of IUDR as a radiosensitizer when administered into the lateral cerebral ventricle in the treatment of an intraparenchymal brain tumor.