Influence of Neighborhood Environment on Physical Activity Participation among Children with Autism Spectrum Disorder.

Despite the positive influence of environmental factors on physical activity (PA) levels of children, further investigation is necessary when considering the unique characteristics of children with autism spectrum disorder (ASD). The purpose of this study was to examine the relationship between neighborhood environment factors and PA among children with ASD by examining the extent to which (a) the built environment, (b) neighborhood safety, and (c) neighborhood support contributes to PA. A secondary data analysis using the 2016 and 2017 combined dataset of the National Survey of Children's Health was used. The total sample included 14,944 children between the ages of 6-17 years; of this, a sample of 494 children had a parent-reported diagnosis of ASD. Multivariate logistic regressions were conducted to explore the unique influences of the above three neighborhood environment factors on PA engagement. Among children with and without ASD, an association was found between feeling safe and engaging in PA, that is, the odds of engaging in PA are greater among children who were safe in their neighborhoods than children who were not in safe neighborhoods. Surprisingly, other neighborhood factors do not have a significant relationship with PA participation among children with ASD at this time. Future studies should consider how to incorporate the support of others and feeling of safety into the neighborhood along with how to improve accessibility of the built environment in order to increase PA for children with ASD. LAY SUMMARY: The results of this study showed that neighborhood factors influence physical activity (PA) among children with ASD differently compared to their peers without ASD. Children with ASD who live in safe neighborhoods are more likely to engage in PA, while other neighborhood factors, such as playgrounds and support, are not associated with an increased likelihood of engaging in PA at this time. Efforts should be made to improve neighborhood accessibility and design in order to increase PA among children with ASD.

Mental Illness Discrimination in Mental Health Treatment Programs: Intersections of Race, Ethnicity, and Sexual Orientation.

People with mental illnesses (PWMI) who are of color and/or lesbian, gay, or bisexual (LGB) experience mental health disparities, including within mental health treatment programs (MHTPs). Informed by a critical framework with attention to intersectionality and microaggressions, this qualitative study asked 20 PWMI and family members who also are of color and/or LGB whether they had experienced mental illness discrimination in MHTPs, a possible factor in disparities. We also asked participants about aspects of MHTPs that supported recovery. Participants reported that they were ignored/not listened to, not viewed as complex individuals, experienced condescension/lack of respect and violations of privacy or other rights, and were presumed to lack intelligence. In addition, identifying mental illness discrimination was complex due to intersections of identities. Despite these perceptions of discrimination, participants described supportive aspects of MHTPs. Implications for practice and research are offered.

Mental health issues in recently returning women veterans: implications for practice.

Increasing numbers of women are found in the military, and they are now performing roles very similar to those of male service members. More returning servicewomen and veterans have been exposed to stressful and traumatic experiences, such as combat and difficult living circumstances, and military sexual trauma is common. These experiences have been found to be associated with adverse mental health outcomes, posttraumatic stress disorder, depression, and substance abuse in particular. Comorbidity rates are also high. In addition, more veterans are returning with injuries, including traumatic brain injuries. Although more women veterans of Operation Enduring Freedom and Operation Iraqi Freedom are seeking health services at Veterans Administration facilities, many are not. Thus, community-based social workers need to be familiar with the needs of this growing population to serve them effectively. Use of empirically supported assessment instruments and screening for military sexual trauma are recommended. Recommended interventions include the use of evidence-supported practices, such as cognitive-behavioral treatment, and offering assistance to enhance social support among women veterans.

Peer employees' and clinicians' perceptions of public mental illness stigma and discrimination.

OBJECTIVE: Stigma and discrimination against people with mental illnesses are serious problems that can lead to many negative effects. This study examined providers' awareness of consumers' daily lived experience of discrimination. METHOD: We surveyed 51 peer employees and 52 licensed clinicians to learn how they viewed the extent of public stigma and discrimination. RESULTS: Clinicians, women, and those who had observed a friend with a mental illness treated unfairly perceived significantly higher levels of public discrimination than did their counterparts (adjusted R² = .399, p < .001). Men's perceptions of public discrimination were more strongly affected by personal contact. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Mental health providers are uniquely situated to help consumers deal with the effects of discrimination and should incorporate this issue into their clinical practice. Further research should examine the reasons for differences in perception and how these differences relate to provider behavior and consumer outcomes.

Stigma in the mental health workplace: perceptions of peer employees and clinicians.

Informed by a structural theory of workplace discrimination, mental health system employees' perceptions of mental health workplace stigma and discrimination against service recipients and peer employees were investigated. Fifty-one peer employees and 52 licensed behavioral health clinicians participated in an online survey. Independent variables were employee status (peer or clinician), gender, ethnicity, years of mental health employment, age, and workplace social inclusion of peer employees. Analysis of covariance on workplace discrimination against service recipients revealed that peer employees perceived more discrimination than clinicians and whites perceived more discrimination than employees of color (corrected model F = 9.743 [16, 87], P = .000, partial ŋ (2) = .644). Analysis of covariance on workplace discrimination against peer employees revealed that peer employees perceived more discrimination than clinicians (F = 4.593, [6, 97], P = .000, partial ŋ (2) = .223).

Conation: a missing link in the strengths perspective.

Conation is action derived from instinct, purposeful mode of striving, volition. It is a conscious effort to carry out self-determined acts and, as such, may result in the same goal being approached by different individuals through the use of different actions. It is a critical, yet neglected aspect of the "tripartite" human mind, which is composed of cognitive, affective, and conative elements. Because most social workers are not familiar with the concept, client behavior that represents action toward a goal might not be understood or might be misunderstood. A true strengths-based approach to social work requires this understanding. The authors use case studies to describe conation and to demonstrate its applicability. They present examples of how clients' and social workers' conative ability are important to the assessment and intervention process and describe implications for research.

Parents with co-occurring mental health and substance abuse conditions involved in Child Protection Services: clinical profile and treatment needs.

This article reports findings of an exploratory study of 71 parents with substance abuse conditions involved in a child dependency court. Over half (59%) of the parents had a co-occurring mental health condition. Parents with co-occurring conditions (PWCC) differed in several important ways from those with only substance abuse conditions. PWCC were also more likely than their case managers were to report a need for mental health treatment. Implications for child welfare practice and research are offered.

Digitized hand-wrist radiographs: comparison of subjective and software-derived image quality at various compression ratios.

INTRODUCTION: The objectives of this study were to compare the effect of JPEG 2000 compression of hand-wrist radiographs on observer image quality qualitative assessment and to compare with a software-derived quantitative image quality index. METHODS: Fifteen hand-wrist radiographs were digitized and saved as TIFF and JPEG 2000 images at 4 levels of compression (20:1, 40:1, 60:1, and 80:1). The images, including rereads, were viewed by 13 orthodontic residents who determined the image quality rating on a scale of 1 to 5. A quantitative analysis was also performed by using a readily available software based on the human visual system (Image Quality Measure Computer Program, version 6.2, Mitre, Bedford, Mass). ANOVA was used to determine the optimal compression level (P < or =.05). RESULTS: When we compared subjective indexes, JPEG compression greater than 60:1 significantly reduced image quality. When we used quantitative indexes, the JPEG 2000 images had lower quality at all compression ratios compared with the original TIFF images. There was excellent correlation (R2 >0.92) between qualitative and quantitative indexes. CONCLUSIONS: Image Quality Measure indexes are more sensitive than subjective image quality assessments in quantifying image degradation with compression. There is potential for this software-based quantitative method in determining the optimal compression ratio for any image without the use of subjective raters.

Promoting reduced and discontinued substance use among adolescent substance users: effectiveness of a universal prevention program.

Efforts to address youth substance use have focused on prevention among non-users and treatment among severe users with less attention given to youth occupying the middle ground who have used substances but not yet progressed to serious abuse or addiction. Using a sample from 35 middle schools of 1,364 youth who reported using substances, this study examined the effectiveness of a universal youth substance use prevention program, the SAMHSA Model Program keepin' it REAL, in promoting reduced or recently discontinued alcohol, cigarette, and marijuana use. Discrete-time event history methods modeled the rates of reduced and recently discontinued use across four waves of data. Each substance (alcohol, cigarettes, and marijuana) was modeled separately. Beginning at the second wave, participants who reported use at wave 1 were considered at risk of reducing or discontinuing use. Since the data sampled students in schools, multi-level models accounted for the nesting of data at the school level. Results indicated that prevention program participation influenced the rates of reduced and recently discontinued use only for alcohol, controlling for baseline use severity, age, grades, socioeconomic status, ethnicity and gender. Among youth who reported use of alcohol in wave 1 (N=1,028), the rate of reducing use for program participants was 72% higher than the rate for control students. The rate of discontinuing use was 66% higher than the rate for control students. Among youth who reported use of one or more of the three substances in wave 1 (N=1,364), the rate of discontinuing all use was 61% higher for program participants than for control students. Limitations and implications of these findings and plans for further research are discussed.

Psychiatric rehabilitation: an empowerment-based approach to mental health services.

Psychiatric rehabilitation is a framework for providing services to people with mental illness that encourages adaptive community functioning in all life domains. Despite its well-established inclusion in community mental health treatment programs, psychiatric rehabilitation has received little attention in the discipline-specific social work literature. The philosophical base of psychiatric rehabilitation is built around the principles of empowerment, competence, and recovery. Its goal of promoting adaptive community functioning is consistent with social work values and contemporary social work practice models. This article provides an overview of the history, philosophy, and services components of psychiatric rehabilitation and analyzes its compatibility with social work. Further integration of psychiatric rehabilitation and social work services is suggested.

Is social work's door open to people recovering from psychiatric disabilities?

Social workers are the major providers of mental health services in the United States, yet the profession has been reluctant to include recovering consumers in its ranks. This article contrasts social work's historic focus on the deficits believed to be inherent in colleagues' history of psychiatric disorder with an empowerment perspective. The article describes perceived risks and benefits to clients when the social worker has a history of a psychiatric disorder. It reviews recovering consumers' successful roles as paraprofessionals in mental health services delivery as a demonstration of the strengths consumers bring to the mental health field. Finally, it identifies barriers to social work employment faced by the social worker who has a history of a psychiatric disability.

The evolution of A beta peptide burden in the APP23 transgenic mice: implications for A beta deposition in Alzheimer disease.

BACKGROUND: High levels of A beta in the cerebral cortex distinguish demented Alzheimer's disease (AD) from nondemented elderly individuals, suggesting that decreased amyloid-beta (A beta) peptide clearance from the brain is a key precipitating factor in AD. MATERIALS AND METHODS: The levels of A beta in brain and plasma as well as apolipoprotein E (ApoE) in brain were investigated by enzyme-linked immunosorbent assay (ELISA) and Western blotting at various times during the life span of the APP23 transgenic (Tg) and control mice. Histochemistry and immunocytochemistry were used to assess the morphologic characteristics of the brain parenchymal and cerebrovascular amyloid deposits and the intracellular amyloid precursor protein (APP) deposits in the APP23 Tg mice. RESULTS: No significant differences were found in the plasma levels of A beta between the APP23 Tg and control mice from 2-20 months of age. In contrast, soluble A beta levels in the brain were continually elevated, increasing 4-fold at 2 months and 33-fold in the APP23 Tg mice at 20 months of age when compared to the control mice. Soluble A beta42 was about 60% higher than A beta40. In the APP23 Tg mice, insoluble A beta40 remained at basal levels in the brain until 9 months and then rose to 680 microg/g cortex by 20 months. Insoluble A beta40 was negligible in non-Tg mice at all ages. Insoluble A beta42 in APP23 Tg mice rose to 60 microg/g cortex at 20 months, representing 24 times the control A beta42 levels. Elevated levels of ApoE in the brain were observed in the APP23 Tg mice at 2 months of age, becoming substantially higher by 20 months. ApoE colocalized with A beta in the plaques. Beta-amyloid precursor protein (betaAPP) deposits were detected within the neuronal cytoplasm from 4 months of age onward. Amyloid angiopathy in the APP23 Tg mice increased markedly with age, being by far more severe than in the Tg2576 mice. CONCLUSIONS: We suggest that the APP23 Tg mouse may develop an earlier blockage in A beta clearance than the Tg2576 mice, resulting in a more severe accumulation of A beta in the perivascular drainage pathways and in the brain. Both Tg mice reflect decreased A beta elimination and as models for the amyloid cascade they are useful to study AD pathophysiology and therapy.

Cholinergic deafferentation of the rabbit cortex: a new animal model of Abeta deposition.

Brain deposition of the amyloid beta-peptide (Abeta) is a critical step in the pathogenesis of Alzheimer's disease (AD) and human cerebral amyloid angiopathy (CAA). A small fraction of AD and CAA cases are caused by gene mutations leading to increased production and deposition of Abeta, but for the majority, there is no known direct genetic cause. We have hypothesized that Abeta deposition in these sporadic cases occurs as a result of cortical cholinergic deafferentation. Here we show that cortical cholinergic deafferentation, induced in rabbits by a selective immunotoxin, leads to Abeta deposition in cerebral blood vessels and perivascular neuropil. Biochemical measurements confirmed that lesioned animals had 2.5- and 8-fold elevations of cortical Abeta40 and Abeta42, respectively. Cholinergic deafferentation may be one factor that can contribute to Abeta deposition.

Omega-3 fatty acid intake results in a relationship between the fatty acid composition of LDL cholesterol ester and LDL cholesterol content in humans.

The relationship between the fatty acid composition of the low density lipoprotein (LDL) cholesterol ester and LDL cholesterol content was assessed in 26 free-living, normal subjects. Dietary intakes of 14:0, 16:0, 18:0, 18:1, 18:2omega6, 18:3omega3, 20:4omega6, 20:5omega3, 22:6omega3 were calculated from seven-day food records kept by each subject at baseline and after three months of supplementation with olive, flaxseed or fish oil, respectively. A randomized cross-over design was used. The fatty acid content of specific foods was calculated. Fasting blood samples, taken at the beginning and end of each supplementation period, were analyzed for the fatty acid content present in individual lipoproteins. There was a significant correlation between 20:5omega3 and 22:6omega3 intake and the content of these fatty acids in the LDL cholesterol ester fraction. During the fish oil treatment period the 16:0 and 18:0 content of the LDL cholesterol ester was highly predictive of LDL cholesterol content. This relationship was not observed during the baseline or placebo (olive oil) supplement period.

Normal subjects consuming physiological levels of 18:3(n-3) and 20:5(n-3) from flaxseed or fish oils have characteristic differences in plasma lipid and lipoprotein fatty acid levels.

The study assessed the effect of low doses of fatty acids from fish or flaxseed oil on plasma lipid concentrations in normal humans consuming diets with either high (0.87, n = 11) or low (0.48, n = 15) dietary polyunsaturated/saturated fatty acid (P/S) ratios. The dose of (n-3) fatty acids reflected an (n-3) intake that could easily be attained by selection of foods in a normal diet. The individuals were initially supplemented with olive oil [35 mg 18:1/(kg body weight.d)], and then were randomly assigned to either flaxseed or fish oil [35 mg 18:3(n-3) or 35 mg 20:5(n-3) + 22:6(n-3)/(kg body weight.d), respectively] treatments. Participants consumed each oil supplement for 3 mo. Blood samples were drawn for analysis at the end of each 3-mo period. Plasma triacylglycerol, total, LDL and HDL cholesterol concentrations, and lipoprotein fatty acid concentrations are shown. Fish oil reduced plasma triacylglycerol and increased lipoprotein levels of 20:5(n-3) and 22:6(n-3). The flaxseed oil did not alter plasma triacylglycerol level and produced small changes in 20:5(n-3) and 22:6(n-3) concentrations. Total, LDL and HDL cholesterol levels were not affected by either (n-3) fatty acid. Significant differences in plasma triacylglycerol concentrations and total and LDL cholesterol levels were found between the two dietary P/S groups after all oil treatment periods. Levels of 18:3(n-3), 20:4(n-6), 20:5(n-3), and 22:6(n-3) in LDL were also different in high vs. low dietary P/S groups for all oil treatments and in the VLDL for the olive oil and fish oil supplementation. This study indicates that low intake of purified fish oil induces changes in plasma triacylglycerol, 20:5(n-3) levels in VLDL, LDL, and HDL, and 22:6(n-3) levels in LDL and HDL that are apparent after 3 mo and which might influence atherogenicity of lipoprotein particles in normal free-living individuals.

Occurrence of melanin in pheochromocytoma.

Melanin or a melanin-like pigment was observed in six of 19 pheochromocytomas. The intracellular pigment was Fontana-positive, bleach-labile dark brown to black material and distinct from coincidental hemosiderin and lipochrome. Ultrastructural components of the pigmented tumors include melanosomes and premelanosomes. Two patients with pigmented tumors had associated von Hippel-Lindau syndrome, and one had neurofibromatosis. The occurrence of melanin and melanosomes in pheochromocytoma has not been previously reported in the English literature. It is probably a reflection of the neural crest origin of this neoplasm.

Feeding strategies for the dysphagic patient: a nursing perspective.

The goal of treatment for the dysphagic patient is to maintain safe oral feeding. Achieving this goal requires an individualized care plan using selected feeding strategies. This care plan will need to be altered as changes in the patient's condition occur.

Using the Fleming index of dysphagia to establish prevalence.

The Fleming index of dysphagia was used to determine the prevalence of dysphagia in patients in a long-term, neuropsychiatric medical center. Prevalence varied by section, with the ventilator-dependent patients having the highest rate and the chemical-dependent patients having the lowest. The Fleming index appears to be a quick and useful instrument to identify patients who are at risk of dysphagic complications, but further reliability and validity studies are needed to demonstrate its utility.