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The article focuses on the results of various studies that analyzed the efficacy of evidence based treatments in the treatment of young people with psychological problems or maladaptive behavior. The studies examined delinquency and substance abuse, or both; conduct problems; and internalising problems. The results showed that EBTs were more effective than usual care for youths with psychological problems and maladaptive behavior.

Research comparing cultural and ethnic groups on child psychopathology has relied heavily on parent reports. But don't parents' own cultural backgrounds bias their reports, undermining valid assessment of actual child behavior? The question is hard to address because parent and child culture tend to be confounded. To solve this problem, we assembled an unusual but heuristically valuable sample: 50 bicultural families, each with an ethnic Thai parent reared in Thailand and a Caucasian parent reared in the U.S. Parents in each pair independently completed standardized problem checklists on the same child in their family. Across all 10 empirically derived problem syndromes, no parental culture effect was either significant or larger than "small," by Cohen's (1988) standards; across all 140 specific problems, the mean percent of variance accounted for by parent culture was less than 1%. Results do not point to a biasing effect of parental culture. [ABSTRACT FROM AUTHOR]

Objective: To review the empirical, methodological, and conceptual limitations of psychotherapy and pharmacotherapy for childhood and adolescent depression and to present descriptive data on key characteristics of a depressed sample to illustrate gaps in treatment.Method: Interview-based assessment of psychiatric features and psychosocial functioning, family psychopathology and marital adjustment, and child and parent stressful life events was performed in a sample of 43 depressed youngsters seeking outpatient treatment.Results: The empirical and conceptual review indicated that treatments based on downward extensions of adult procedures are limited in number and success. Also, the treatments generally neglect the following characteristics revealed in the descriptive data: depressed youngsters have high rates of recurrent depression and comorbid conditions, impaired academic and social functioning, exposure to high rates of parental psychopathology, parental assortative mating, severe marital dysfunction, and high rates of severe stressors.Conclusions: Treatments need to be informed by and address the actual characteristics of depressed youngsters and their environments, which are highly dysfunctional. [ABSTRACT FROM AUTHOR]

Background: A randomized controlled trial was conducted to examine the effectiveness of the Modular Approach to Therapy for Youths with Anxiety, Depression, Trauma, and Conduct Problems (MATCH) for Norwegian youths referred to seven Child and Adolescent Psychiatric Outpatient Clinics. MATCH addresses comorbid problems that are common in children and youth, and its transdiagnostic design may therefore be more effective compared to standard treatments that often address single problems. MATCH has, however, never been evaluated in a Nordic context, and the present study aimed to fill this gap., Methods: A sample of 121 Norwegian youths (M age = 9.83, 58.7% boys) was randomly assigned to MATCH (n = 73) or treatment as usual (TAU, n = 48). Primary treatment outcomes were youths' externalizing and internalizing problems as reported by parents, using the Child Behavior Checklist, the Behavior and Feelings Survey. In addition, the study included assessments of parent-reported Top Problems., Results: Overall, youths showed significant improvements in both externalizing and internalizing problems from intake to post-test. Results did not provide evidence that MATCH reduces symptoms of these problems compared to TAU., Conclusions: The findings were inconclusive regarding whether MATCH was more effective than TAU in reducing youth internalizing and externalizing problems., Trial Registration Identifier: ISRCTN24029895. Registration date: 8/8/2016., (© 2024. The Author(s).)

The COVID-19 pandemic has impacted parents' and children's well-being. This study aimed to evaluate the impact of the COVID-19 pandemic and its preventive measures on children's well-being and their parents' anxiety level. Parents/caregivers were invited to respond to a self-administered survey. The primary outcome was to assess the rate and severity of parental anxiety during the pandemic/lockdown. Four hundred and thirty parents completed the survey. Ninety-two (21%) and 10 (2%) parents reported that their children gained or lost weight during the pandemic, respectively. Eighty-one (19%) parents reported a regression in their children's developmental milestones, particularly in toileting, speech, and social interaction. The GAD-7 mean scores increased by 2.9 points (95% CI [2.5, 3.25]; P < .001) in comparison with prepandemic scores. Adjusted multivariable analysis showed that having children with psychological conditions and a maternal education level less than a university degree were significantly associated with higher parental anxiety.

Background: The preoperative nutritional state has prognostic postoperative value. Tomographic density and area of psoas muscle are validated tools for assessing nutritional status. There are few reports assessing the utility of staging tomography in gastric cancer patients in this field., Aims: This study aimed to determine the influence of sarcopenia, measured by a preoperative staging computed tomography scan, on postoperative morbimortality and long-term survival in patients operated on for gastric cancer with curative intent., Methods: This retrospective study was conducted from 2007 to 2013. The definition of radiological sarcopenia was by measurement of cross-sectional area and density of psoas muscle at the L3 (third lumbar vertebra) level in an axial cut of an abdominopelvic computed tomography scan (in the selection without intravascular contrast media). The software used was OsirixX version 10.0.2, with the tool "propagate segmentation", and all muscle seen in the image was manually adjusted., Results: We included 70 patients, 77% men, with a mean cross-sectional in L3 of 16.6 cm2 (standard deviation+6.1) and mean density of psoas muscle in L3 of 36.1 mean muscle density (standard deviation+7.1). Advanced cancers were 86, 28.6% had signet-ring cells, 78.6% required a total gastrectomy, postoperative surgical morbidity and mortality were 22.8 and 2.8%, respectively, and overall 5-year long-term survival was 57.1%. In the multivariate analysis, cross-sectional area failed to predict surgical morbidity (p=0.4) and 5-year long-term survival (p=0.34), while density of psoas muscle was able to predict anastomotic fistulas (p=0.009; OR 0.86; 95%CI 0.76-0.96) and 5-year long-term survival (p=0.04; OR 2.9; 95%CI 1.04-8.15)., Conclusions: Tomographic diagnosis of sarcopenia from density of psoas muscle can predict anastomotic fistulas and long-term survival in gastric cancer patients treated with curative intent.

Objective: To evaluate the effectiveness of a multimodal child poverty curriculum for pediatric residents., Methods: The Trainee Education in Advocacy and Community Health (TEACH) curriculum trains residents to recognize and address the effects of child poverty, utilizing learning objectives modified from the US Child Poverty Curriculum, new interactive web-based modules, experiential learning, and reflection. This mixed-methods evaluation of the first component, "Epidemiology of Child Poverty," includes nearly 2 years of resident participation. Pre/post knowledge and attitudes regarding child poverty were assessed. Behavior change was evaluated in a subset of participants using an Objective Structured Clinical Examination (OSCE), comparing intervention and control groups of residents. Residents' experience with the curriculum was assessed using qualitative analysis of debrief sessions with faculty., Results: Fifty-two residents completed the curriculum between June 2018 and March 2020. Residents increased in knowledge (P < .001) and confidence (P < .0001) in recognizing and addressing poverty. They also self-reported greater preparedness (P < .001) and effectiveness (P < .001) in addressing social determinants of health. Early data from the OSCE have not shown a statistically significant change in skills compared with a control group. Qualitative themes included an increase in empathy for, understanding of, and responsibility to address the effects of poverty in caring for patients., Conclusions: The multimodal "Epidemiology of Child Poverty" portion of the TEACH curriculum increased resident knowledge, confidence, and empathy. Given the ubiquitous nature of poverty and the generalizability of the online modules, the TEACH curriculum can be a resource for other residency programs., (Copyright © 2022 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background: Surfactant protein-A (SP-A) plays a critical role in lung innate immunity by regulating alveolar macrophages (AM), expression of inflammatory mediators, and other host defense proteins. The toponome imaging system (TIS), a serial immunostainer, was used to study the AM toponome because it characterizes the localization of multiple markers and identifies marker combinations in each pixel as combinatorial molecular phenotypes (CMPs). We used TIS to study the AM toponome from wild type (WT) and SP-A knockout (KO) mice and changes following Klebsiella pneumoniae exposure., Methods: WT or KO mice received intratracheal K. pneumoniae or vehicle and AM were obtained by bronchoalveolar lavage after one hour. AM were attached to slides and underwent TIS analysis. Images were analyzed to characterize all pixels. AM CMPs from WT vehicle (n=3) and infected (n=3) mice were compared to each other and to AM from KO (n=3 vehicle; n=3 infected). Histograms provided us with a tool to summarize the representation of each marker in a set of CMPs., Results: Using the histograms and other tools we identified markers of interest and observed that: 1) Both comparisons had conserved (present in all group members) CMPs, only in vehicle AM and only in infected AM, or common to both vehicle and infected AM, (i.e., unaffected by the condition). 2) the CMP number decreased with infection in WT and KO versus vehicle controls. 3) More infection-specific CMPs in WT vs KO AM. 4) When AM from WT and KO vehicle or infected were compared, there were more unique CMPs exclusive to the KO AM. 5) All comparisons showed CMPs shared by both groups., Conclusions: The decrease of CMPs exclusive to infected AM in KO mice may underlie the observed susceptibility of KO mice to infection. However, both KO groups had more exclusive CMPs than the corresponding WT groups, perhaps indicating a vigorous effort by KO to overcome deficits in certain proteins and CMPs that are dysregulated by the absence of SP-A. Moreover, the presence of shared CMPs in the compared groups indicates that regulation of these CMPs is not dependent on either infection or the presence or absence of SP-A., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Phelps, Chinchilli, Zhang, Shearer, Weisz and Floros.)

Objective: Many women are affected by vulvodynia, but medical therapies to date have proven ineffective. We performed a pilot study using gel-based proteomics to develop a map of proteins present in vaginal/vestibular secretions and identify proteins that could be considered for future evaluation as potential therapeutic targets., Materials and Methods: We collected vestibular fluid from 4 controls and 4 patients with vulvodynia by placing a cotton swab in the vestibule and extracting the absorbed proteins. The proteins underwent 2-dimensional difference gel electrophoresis and mass spectrometry to develop a protein map. Immunohistochemistry was used to validate proteomic findings., Results: A map was constructed of 32 of the more abundant proteins in vestibular fluid and their levels compared in control subjects and vulvodynia patients. Among these were annexin A1, interleukin 1 receptor antagonist, protein S100 A9, and a number of antiproteases and proteases. Many of these proteins differed by at least 50% between groups, but only annexin A1, one of the protease inhibitors, and immunoglobulin G κ chain were significantly different. The results with annexin A1 were validated by similar findings with immunohistochemistry., Conclusions: The findings of this pilot study demonstrate a set of vestibule mucosa proteins that differ significantly-either increasing or decreasing-in vulvodynia patients compared with controls, and several others that exhibited greater than 1.5-fold change but did not reach statistical significance. This study constitutes a proof-of-principle that an open, unbiased proteomic approach can identify molecular participants in vulvodynia, some of which had not been identified to date by hypothesis-driven studies., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASCCP.)

Using the Toponome Imaging System (TIS), a serial immunostainer, we studied the patterns of expression of multiple markers in alveolar macrophages (AM) from female mice lacking surfactant protein A (SP-A knockouts; KO) after "rescue" with exogenous SP-A1. We also used a 7-marker subset to compare with AM from males. AM were harvested 18 h after intrapharyngeal SP-A1 or vehicle, attached to slides, and subjected to serial immunostaining for 12 markers. Expression of the markers in each pixel of the image was analyzed both in the whole image and in individual selected cells. The marker combination in each pixel is referred to as a combinatorial molecular phenotype (CMP). A subset of antibodies was used to compare AM from male mice to the females. We found: (a) extensive AM heterogeneity in females by CMP analysis and by clustering analysis of CMPs in single cells; (b) AM from female KO mice respond to exogenous SP-A1 by increasing CMP phenotypic diversity and perhaps enhancing their potential innate immune capabilities; and (c) comparison of male and female AM responses to SP-A1 revealed that males respond more vigorously than females and clustering analysis was more effective in distinguishing males from females rather than treated from control., (© 2022. The Author(s).)

Literature on the effectiveness of child poverty education in undergraduate medical education is scant. This study adds quantitative and qualitative support for incorporation of a multimodal curriculum to improve student knowledge, confidence, and attitudes toward child poverty., (Copyright © 2021 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Alveolar macrophages (AMs) are differentially regulated by human surfactant protein-A1 (SP-A1) or SP-A2. However, AMs are very heterogeneous and differences are difficult to characterize in intact cells. Using the Toponome Imaging System (TIS), an imaging technique that uses sequential immunostaining to identify patterns of biomarker expression or combinatorial molecular phenotypes (CMPs), we studied individual single cells and identified subgroups of AMs (n = 168) from SP-A-KO mice and mice expressing either SP-A1 or SP-A2. The effects, as shown by CMPs, of SP-A1 and SP-A2 on AMs were significant and differed. SP-A1 AMs were the most diverse and shared the fewest CMPs with KO and SP-A2. Clustering analysis of each group showed 3 clusters where the CMP-based phenotype was distinct in each cluster. Moreover, a clustering analysis of all 168 AMs revealed 10 clusters, many dominated by 1 group. Some CMP overlap among groups was observed with SP-A2 AMs sharing the most CMPs and SP-A1 AMs the fewest. The CMP-based patterns identified here provide a basis for understanding not only AMs' diversity, but also most importantly, the molecular basis for the diversity of functional differences in mouse models where the impact of genetics of innate immune molecules on AMs has been studied.

Annexins and S100 proteins form two large families of Ca 2+ -binding proteins. They are quite different both structurally and functionally, with S100 proteins being small (10-12 kDa) acidic regulatory proteins from the EF-hand superfamily of Ca 2+ -binding proteins, and with annexins being at least three-fold larger (329 ± 12 versus 98 ± 7 residues) and using non-EF-hand-based mechanism for calcium binding. Members of both families have multiple biological roles, being able to bind to a large cohort of partners and possessing a multitude of functions. Furthermore, annexins and S100 proteins can interact with each other in either a Ca 2+ -dependent or Ca 2+ -independent manner, forming functional annexin-S100 complexes. Such functional polymorphism and binding indiscrimination are rather unexpected, since structural information is available for many annexins and S100 proteins, which therefore are considered as ordered proteins that should follow the classical "one protein-one structure-one function" model. On the other hand, the ability to be engaged in a wide range of interactions with multiple, often unrelated, binding partners and possess multiple functions represent characteristic features of intrinsically disordered proteins (IDPs) and intrinsically disordered protein regions (IDPRs); i.e., functional proteins or protein regions lacking unique tertiary structures. The aim of this paper is to provide an overview of the functional roles of human annexins and S100 proteins, and to use the protein intrinsic disorder perspective to explain their exceptional multifunctionality and binding promiscuity.

Patients with eating disorders (EDs) often feel ambivalent about recovery, and motivation-enhancement interventions are ineffective for many patients. Identifying new targets for motivational interventions may be particularly valuable. We interviewed 13 recovered ED patients to identify factors that motivated recovery, applying thematic analysis to identify central themes. Here we discuss exploratory findings about one theme from these interviews: the role of feminist ideas in ED recovery. Forty-six percent ( n = 6) of our participants reported that feminist themes helped them recover. Participants described understanding harmful cultural forces (e.g., weight-related stigma), developing strategies to fight these forces (e.g., challenging stigmatizing language), engaging with feminist texts, hearing about feminist ideas from clinicians, and forming relationships with female role models. Interestingly, participants did not all refer to their experiences as "feminist," and one rejected the label. Our exploratory findings indicate that feminist ideas can motivate ED recovery, suggesting directions for future research.

Background: We used the Toponome Imaging System (TIS) to identify "patterns of marker expression", referred to here as combinatorial molecular phenotypes (CMPs) in alveolar macrophages (AM) in response to the innate immune molecule, SP-A1., Methods: We compared 114 AM from male SP-A deficient mice. One group ( n  = 3) was treated with exogenous human surfactant protein A1 (hSP-A1) and the other with vehicle ( n  = 3). AM obtained by bronchoalveolar lavage were plated onto slides and analyzed using TIS to study the AM toponome, the spatial network of proteins within intact cells. With TIS, each slide is sequentially immunostained with multiple FITC-conjugated antibodies. Images are analyzed pixel-by-pixel identifying all of the proteins within each pixel, which are then designated as CMPs. CMPs represent organized protein clusters postulated to contribute to specific functions., Results: 1) We compared identical CMPs in KO and SP-A1 cells and found them to differ significantly ( p  = 0.0007). Similarities between pairs of markers in the two populations also differed significantly ( p  < 0.0001). 2) Focusing on the 20 most abundant CMPs for each cell, we developed a method to generate CMP "signatures" that characterized various groups of cells. Phenotypes were defined as cells exhibiting similar signatures of CMPs. i) AM were extremely diverse and each group contained cells with multiple phenotypes. ii) Among the 114 AM analyzed, no two cells were identical. iii) However, CMP signatures could distinguish among cell subpopulations within and between groups. iv) Some cell populations were enriched with SP-A1 treatment, some were more common without SP-A1, and some seemed not to be influenced by the presence of SP-A1. v) We also found that AM were more diverse in mice treated with SP-A1 compared to those treated with vehicle., Conclusions: AM diversity is far more extensive than originally thought. The increased diversity of SP-A1-treated mice points to the possibility that SP-A1 enhances or activates several pathways in the AM to better prepare it for its innate immune functions and other functions shown previously to be affected by SP-A treatment. Future studies may identify key protein(s) responsible for CMP integrity and consequently for a given function, and target it for therapeutic purposes., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2020.)

A personalized approach to treatment with patients being matched to the best-fit treatment has been proposed as one possible solution to the currently modest treatment response rates for adolescent depression. Personalized treatment involves identifying and characterizing subgroups likely to respond differently to different treatments. We investigated the feasibility of this approach, by focusing on two key risk factors that are the purported treatment targets of cognitive behavioral therapy (CBT) and interpersonal psychotherapy for depressed adolescents (IPT-A): negative unrealistic cognitions and interpersonal relationship difficulties, respectively. We sought to learn whether subgroups high and low on the two risk factors, respectively, might be identified in a large sample of depressed, treatment-seeking adolescents. Latent class analysis (LCA) was conducted on measures of the two risk factors among 431 adolescents (age 12-17) in the Treatment for Adolescents with Depression Study. LCA identified three classes: (1) adolescents with high levels of problems in both family relationships and cognitions (21.6% of sample), (2) adolescents with moderate levels of problems in both domains (52.4%), and (3) adolescents with low levels of problems in both domains (26.0%). These subgroups did not predict treatment outcome with CBT or CBT + fluoxetine (COMB). The results challenge a current assumption about how treatments could be personalized, and they support a multi-causal model of depression rather than a risk-factor-specific model. Strategies other than risk factor-based personalizing for case assignment to CBT vs. IPT-A are discussed.

Patients with eating disorders (EDs) often lack motivation to recover, and interventions designed to increase recovery motivation have not demonstrated to be effective. In fact, few studies have identified factors that increase recovery motivation in patients with EDs. We performed interviews with 13 women who recovered from EDs to identify factors that influenced their motivation to recover. Here, we present exploratory findings about a central theme from these interviews: the importance of hearing from others who had recovered from EDs (i.e., recovery self-disclosures [RSDs]). Of our 13 participants, 11 spontaneously reported that RSDs increased their motivation to recover. RSDs from therapists helped participants realize that recovery was possible, visualize the benefits of recovery, understand the recovery process, and develop stronger relationships with their therapists. RSDs from nontherapists produced similar benefits. Some of our participants who had become ED therapists after recovery reflected on the process of self-disclosing ED history to patients. They described when they choose to self-disclose (e.g., to boost patient motivation to change), what type of information they choose to self-disclose (e.g., information related to the patient's stage of recovery), and risks of recovery self-disclosures (e.g., stimulating patient competitiveness). Overall, our findings suggest that recovery self-disclosures may increase recovery motivation in patients with EDs. Limitations include discovering the theme of self-disclosure post hoc and exclusively interviewing participants who self-identified as recovered. Future research should identify if RSDs can be used in interventions to boost motivation for change and increase prorecovery behaviors, especially for patients with EDs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Marine sponges harbour diverse communities of microbes. Mechanisms used to establish microbial symbioses in sponges are poorly understood, and the relative contributions of horizontal and vertical transmission are unknown for most species. We examined microbial communities in adults and larvae of carotenoid-rich Clathria prolifera and Halichondria bowerbanki from the mid-Atlantic region of the eastern United States. We sequenced microbiomes from larvae and their mothers and seawater (16S rRNA gene sequencing), and compared microbial community characteristics between species and ambient seawater. The microbial communities in sponges were significantly different than those found in seawater, and each species harboured a distinctive microbiome. Larval microbiomes exhibited significantly lower richness compared with adults, with both sponges appearing to transfer to larvae a particular subset of the adult microbiome. We also surveyed culturable bacteria isolated from larvae of both species. Due to conspicuous coloration of adults and larvae, we focused on pigmented heterotrophic bacteria. We found that the densities of bacteria, in terms of colony-forming units and pigmented heterotrophic bacteria, were higher in larvae than in seawater. We identified a common mode of transmission (vertical and horizontal) of microbes in both sponges that might differ between species., (© 2019 The Authors. Environmental Microbiology Reports published by Society for Applied Microbiology and John Wiley & Sons Ltd.)

Background: Norwegian health, care, and welfare services are experiencing increased demands to deliver services that are safe, effective, of high quality, and that ensure user involvement. Yet, evidence-based treatment for common disorders such as depression, anxiety, trauma, and behavioral problems in children are not regularly used in clinical practice in Norway. Possible explanations for this are that many standard, evidence-based treatments may have difficulty addressing the complexity and comorbidity of referred children and the fact that children's treatment needs often shift during treatment. The Modular Approach to Therapy for children with Anxiety, Depression, Trauma and Conduct problems (MATCH-ADTC) was designed to address these challenges and reduce some of the barriers to therapists' use of evidence-based treatment in their practice., Methods/design: Participants will include 280 children (aged 6-14.5 years at intake) who receive treatment in child and adolescent mental health outpatient clinics in Norway, and their families. Families are randomly assigned to either the experimental group receiving treatment from therapists trained in MATCH, or to the comparison group receiving treatment from therapists delivering treatment as usual (TAU). Data on children's symptomology, child and family functioning, demographics, background information, and mental health outcomes are collected as well as frequent feedback on treatment response, plus video-recordings of treatment sessions and implementation quality scores from each participating clinic. Questionnaires are administered in six waves., Discussion: MATCH has been tested in the US with promising results, but we do not know whether this treatment approach will produce similar results in Norway. The implications of this study are 1. Possibly better treatment outcomes and/or more efficient improvements for children and families treated in mental health outpatient clinics in Norway 2. Clinicians learning to use more evidence-based practices in their treatment 3. Implementation of standard procedures for obtaining feedback from children and families and sharing the feedback with clinicians 4. Increased understanding, at the end of the trial, of whether introducing MATCH improves outcomes for children and families treated in mental health outpatient clinics TRIAL REGISTRATION: ISRCTN, registration number: ISRCTN24029895 . Registered on 8 August 2016.

Background: Single-session interventions (SSIs) show promise in the prevention and treatment of youth psychopathology, carrying potential to improve the scalability and accessibility of youth psychological services. However, existing SSIs have conferred greater benefits for youths with anxiety, compared to depression or comorbid problems, and their effects have generally waned over time - particularly for follow-ups exceeding 3 months., Method: To help address these discrepancies, we tested whether a novel SSI teaching growth mindset of personality (the belief that personality is malleable) could reduce depression and anxiety and strengthen perceived control in high-risk adolescents (N = 96, ages 12-15). At baseline, youths were randomized to receive a 30-min, computer-guided growth mindset intervention or a supportive-therapy control. Youths and parents reported youth anxiety and depressive symptoms, and youths reported their levels of perceived control, at baseline and across a 9-month follow-up period., Results: Compared to the control program, the mindset intervention led to significantly greater improvements in parent-reported youth depression (d = .60) and anxiety (d = .28), youth-reported youth depression (d = .32), and youth-reported perceived behavioral control (d = .29) by 9-month follow-up. Intervention effects were nonsignificant for youth-reported anxiety, although 9-month effect sizes reached the small-to-medium range (d = .33). Intervention group youths also experienced more rapid improvements in parent-reported depression, youth-reported depression, and perceived behavioral control across the follow-up period, compared to control group youths., Conclusions: Findings suggest a promising, scalable SSI for reducing internalizing distress in high-risk adolescents., Clinical Trial Registration Number: NCT03132298., (© 2017 Association for Child and Adolescent Mental Health.)

To address implementation challenges faced by some evidence-based youth psychotherapies, we developed an efficient transdiagnostic approach-a potential "first course" in evidence-based treatment (EBP)-guided by five empirically supported principles of therapeutic change. An open trial of the resulting FIRST protocol was conducted in community clinics. Following a 2-day training, staff practitioners treated 24 clinically referred youths ages 7-15, 50% male, 87% White and 13% Latino, all with the Schedule for Affective Disorders and Schizophrenia for School-Age Children Diagnostic and Statistical Manual of Mental Disorders (4th ed.) anxiety, depressive, or conduct-related disorders, and averaging 2.21 disorders. We evaluated the protocol's (a) feasibility for use in everyday clinical practice (examining therapy process, client engagement, and therapist adherence and competence in using the protocol), (b) acceptability (examining therapeutic alliance and treatment satisfaction by youths, caregivers, and therapists), and (c) potential for clinical benefit (examining treatment outcomes across multiple measures and time points). FIRST scored well on measures of feasibility, acceptability to clients and clinicians, and clinical outcomes, matching or exceeding the corresponding scores in most benchmarking comparisons. Observational coding of sessions showed high levels of protocol adherence (86.6%) and good therapist competence in the evidence-based skills. Weekly assessments throughout treatment showed effect sizes for clinical improvement ranging from .41 to 2.66 on weekly total problems and problems deemed "most important" by caregivers and youths. The FIRST protocol showed evidence of feasibility, acceptability, and clinical benefit when used by practitioners with referred youths treated in community clinics. The findings suggest sufficient potential to justify a full randomized controlled trial of FIRST.

Listening to the stories of people belonging to different generations in motion-both in our consulting rooms and our personal lives-served as introductory lectures into the fundamental aspects of changing context. Through these rich and diverse stories, one enters a territory which is not only multilingual but multidimensional: defined and shaped by historical, political, economic and socio-cultural transformations. Giving voice to these silent stories proved helpful for us when going behind walls that traditional analysis could not always penetrate, partly because, in many cases, analysts and analysands have been struggling with the same untouchable issues. It is our professional task to find creative ways to make sense of past and recent experiences of emigration, new prejudices, discriminative forms and attitudes-in order to achieve a better psychoanalytical understanding of the external and internal confusion that has been brought about by the immense changes during the past centuries and the present one.

Background: Crohn's disease (CD) is associated with depression. It is unclear if psychosocial interventions offer benefit for depressive symptoms during active CD. In this secondary analysis of a larger study of treating depression in pediatric inflammatory bowel disease, we assessed whether cognitive behavioral therapy (CBT) would differentiate from supportive nondirective therapy in treating depression and disease activity in youth with CD. We also explored whether somatic depressive symptoms showed a different pattern of response in the overall sample and the subset with active inflammatory bowel disease., Methods: Youth with depression and CD (n = 161) were randomized to 3 months of CBT (teaching coping skills) or supportive nondirective therapy (supportive listening). Depressive severity was measured using the Children's Depression Rating Scale-Revised (CDRS-R) with the somatic depressive subtype consisting of those CDRS-R items, which significantly correlated with CD activity. Disease activity was measured by the Pediatric Crohn's disease Activity Index. Given the potential confound of higher dose steroids, subanalyses excluded subjects on >20 mg/d prednisone equivalent (n = 34)., Results: Total CDRS-R scores in the overall sample significantly decreased over time after both treatments (P < 0.0001). Treatment with CBT was associated with a significantly greater improvement in the Pediatric Crohn's disease Activity Index (P = 0.05) and somatic depressive subtype (P = 0.03) in those with active inflammatory bowel disease (n = 95) compared with supportive nondirective therapy. After excluding those on steroids (n = 34), there was a significant improvement in total CDRS-R (P = 0.03) and in Pediatric Crohn's disease Activity Index (P = 0.03) after CBT., Conclusions: Psychotherapy may be a useful adjunct to treat depression in the context of CD-related inflammation in youth who are not concurrently on higher dose steroids.

Environmental contributions to cancer development are widely accepted, but only a fraction of all pertinent exposures have probably been identified. Traditional toxicological approaches to the problem have largely focused on the effects of individual agents at singular endpoints. As such, they have incompletely addressed both the pro-carcinogenic contributions of environmentally relevant low-dose chemical mixtures and the fact that exposures can influence multiple cancer-associated endpoints over varying timescales. Of these endpoints, dysregulated metabolism is one of the most common and recognizable features of cancer, but its specific roles in exposure-associated cancer development remain poorly understood. Most studies have focused on discrete aspects of cancer metabolism and have incompletely considered both its dynamic integrated nature and the complex controlling influences of substrate availability, external trophic signals and environmental conditions. Emerging high throughput approaches to environmental risk assessment also do not directly address the metabolic causes or consequences of changes in gene expression. As such, there is a compelling need to establish common or complementary frameworks for further exploration that experimentally and conceptually consider the gestalt of cancer metabolism and its causal relationships to both carcinogenesis and the development of other cancer hallmarks. A literature review to identify environmentally relevant exposures unambiguously linked to both cancer development and dysregulated metabolism suggests major gaps in our understanding of exposure-associated carcinogenesis and metabolic reprogramming. Although limited evidence exists to support primary causal roles for metabolism in carcinogenesis, the universality of altered cancer metabolism underscores its fundamental biological importance, and multiple pleiomorphic, even dichotomous, roles for metabolism in promoting, antagonizing or otherwise enabling the development and selection of cancer are suggested., (Published by Oxford University Press 2015.)

Purpose: Mental disorders are among the largest contributors to the global burden of disease. Since the cessation of the Sierra Leonean civil war in 2002, there have been few mental health resources available for war-affected youth. Co-occurring psychological problems are commonly reported by youth in the post-conflict setting, suggesting a need for evidence-based interventions that cater to comorbid psychological difficulties. This feasibility study outlines the implementation and evaluation of a mixed-methods approach for developing and piloting a culturally grounded group mental health treatment-the Youth Readiness Intervention (YRI)-for war-affected Sierra Leonean youth., Methods: Participating youth (N = 32; 50% female; ages, 15-24 years) were allocated to one of four gender- and age-stratified groups, facilitated by gender-matched Sierra Leonean interventionists. The intervention comprised adapted cognitive behavioral therapy techniques to address issues pertinent to war-affected youth. Analyses comprised assessments of reliable symptom change, mental health, functional adaptation, and interventionist fidelity outcomes., Results: The YRI was found to be acceptable, feasible and associated with reliable changes in internalizing and externalizing symptoms and improvements in functional impairments and emotion regulation (mean effect size, d = .64)., Conclusions: Youth struggling with the mental health consequences of past trauma due to war merit special attention. The YRI presents a feasible and acceptable intervention for use in this low resource setting. A randomized controlled trial is planned to further test intervention effectiveness and scalability., (Copyright © 2015. Published by Elsevier Inc.)