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Our objective was to assess the relationship between hyperbilirubinemia with and without kernicterus and metabolic profile at newborn screening. Included were 1,693,658 infants divided into a training or testing subset in a ratio of 3:1. Forty-two metabolites were analyzed using logistic regression (odds ratios (ORs), area under the receiver operating characteristic curve (AUC), 95% confidence intervals (CIs)). Several metabolite patterns remained consistent across gestational age groups for hyperbilirubinemia without kernicterus. Thyroid stimulating hormone (TSH) and C-18:2 were decreased, whereas tyrosine and C-3 were increased in infants across groupings. Increased C-3 was also observed for kernicterus (OR: 3.17; 95% CI: 1.18-8.53). Thirty-one metabolites were associated with hyperbilirubinemia without kernicterus in the training set. Phenylalanine (OR: 1.91; 95% CI: 1.85-1.97), ornithine (OR: 0.76; 95% 0.74-0.77), and isoleucine + leucine (OR: 0.63; 95% CI: 0.61-0.65) were the most strongly associated. This study showed that newborn metabolic function is associated with hyperbilirubinemia with and without kernicterus.

Background: Suicide is the leading cause of death of children and young people under 35 in the UK, and suicide rates are rising in this age group. Schools are considered an appropriate and logical setting for youth suicide prevention activities, with universal, selective, and indicated approaches all demonstrating efficacy. Given that international best practice recommends suicide prevention programmes combine these approaches, and that to date this has not been done in school settings in the UK, this study aims to evaluate the feasibility of delivering a suicide prevention programme incorporating universal, selective, and indicated components in UK schools. Methods: This study is a feasibility cluster-randomised controlled trial (RCT) of an adapted version of the Multimodal Approach to Preventing Suicide in Schools (MAPSS) programme. The programme, initially developed in Australia, involves delivering universal psychoeducation to all pupils, screening them for suicide risk, and delivering Internet-based Cognitive Behavioural Therapy (Reframe IT-UK) to those students identified as being at high-risk for suicide. The programme will be trialled in six secondary schools in Northwest England and will target Year 10 students (14- and 15-year-olds). The primary aims are to assess: 1) the acceptability and safety of delivering MAPSS in a school setting in the UK; 2) the social validity of the MAPSS programme; and 3) the feasibility of delivering a large-scale, appropriately powered, cluster-RCT and economic evaluation of this intervention in the future. Secondary aims are to assess changes over time in mental health and wellbeing outcomes. Discussion: This study is the first to evaluate a suicide prevention programme comprising universal, selective, and indicated components in UK schools. If the programme is found to be feasible, it could be more widely tested in schools and may ultimately lead to reduced rates of suicide and suicidal behaviour in young people. [ABSTRACT FROM AUTHOR]

Background: Outcome monitoring of depression treatment is recommended but there is a lack of evidence on patient benefit in primary care. Aim: To test monitoring depression using the Patient Health Questionnaire (PHQ-9) with patient feedback. Design and setting: An open cluster-randomised controlled trial was undertaken in 141 group practices. Method: Adults with new depressive episodes were recruited through record searches and opportunistically. The exclusion criteria were as follows: dementia; psychosis; substance misuse; and suicide risk. The PHQ-9 was administered soon after diagnosis, and 10–35 days later. The primary outcome was the Beck Depression Inventory (BDI-II) score at 12 weeks. The secondary outcomes were as follows: BDI-II at 26 weeks; Work and Social Adjustment Scale (WSAS) and EuroQol EQ-5D-5L quality of life at 12 and 26 weeks; antidepressant treatment; mental health and social service contacts; adverse events, and Medical Interview Satisfaction Scale (MISS) over 26 weeks. Results: In total, 302 patients were recruited to the intervention arm and 227 to the controls. At 12 weeks, 254 (84.1%) and 199 (87.7%) were followed-up, respectively. Only 40.9% of patients in the intervention had a GP follow-up PHQ-9 recorded. There was no significant difference in BDI-II score at 12 weeks (mean difference −0.46; 95% confidence interval [CI] = −2.16 to 1.26; adjusted for baseline depression, baseline anxiety, sociodemographic factors, and clustering by practice). EQ-5D-5L quality-of-life scores were higher in the intervention arm at 26 weeks (adjusted mean difference 0.053; 95% CI = 0.013 to 0.093. A clinically significant difference in depression at 26 weeks could not be ruled out. No significant differences were found in social functioning, adverse events, or satisfaction. In a per-protocol analysis, antidepressant use and mental health contacts were significantly greater in patients in the intervention arm with a recorded follow-up PHQ-9 (P = 0.025 and P = 0.010, respectively). Conclusion: No evidence was found of improved depression outcome at 12 weeks from monitoring. The findings of possible benefits over 26 weeks warrant replication, investigating possible mechanisms, preferably with automated delivery of monitoring and more instructive feedback. [ABSTRACT FROM AUTHOR]

The effectiveness of universal social emotional learning (SEL) programs are dependent on the incorporation of best practice principles, including an evaluative component. In the present study, the effects of a best practice, teacher-led SEL program was examined with 854 children aged 8-12 years. KooLKIDS uses an interactive multimedia format and animated character to help children develop their emotion regulation capacities, social and friendship skills, empathy and compassion for others, and self-esteem. A quasi-experimental waitlist-control design was used to examine the impact of KooLKIDS on social and emotional competence, behavioral and emotional problems, academic achievement and effort. Hierarchical linear modeling demonstrated significant increases in social and emotional competence, and reductions in internalizing and externalizing problems in children post KooLKIDS program in the intervention group. The findings suggest that KooLKIDS has strong potential as a teacher-led, classroom-based, structured program for enhancing children's social and emotional learning.

School-based social and emotional learning (SEL) programmes represent a practical method of improving social and emotional well-being in students. To date, however, what is less well understood is why a theoretically sound, appropriately administered, engaging universal SEL programme may be more effective for some children over others. In the present study, an established SEL programme, KooLKIDS Whole of Class, was delivered to 524, 8 to 12-year-old Australian primary school students. Classroom teachers completed pre- and post-measures regarding children's social-emotional competence and emotional and behavioural difficulties. Hierarchical linear modelling was used to examine which characteristics predicted differential improvement from the programme. Findings revealed that the pre-programme total score on emotional and behavioural difficulties was the strongest predictor of improvements in SEL, independent of age, sex or socioeconomic status. This implies that while universal SEL programmes represent an effective and relatively low-cost method of improving social competence for all children, they may be particularly effective for improving social and emotional competence in those with greater emotional and behavioural difficulties.

OBJECTIVE:Earlier pregnancy discovery is important in the context of prenatal and abortion care. We evaluated characteristics associated with later pregnancy discovery among women seeking abortion care. STUDY DESIGN:Data come from a survey of women seeking abortion care at four family planning facilities in Utah. The participants completed a survey during the state-mandated abortion information visit they are required to complete prior to having an abortion. The outcome in this study was pregnancy discovery before versus after 6 weeks since respondents' last menstrual period (LMP). We used logistic regression to estimate the relationship between sociodemographic and health-related independent variables of interest and pregnancy discovery before versus after 6 weeks. RESULTS:Among the 458 women in the sample, 28% discovered their pregnancy later than 6 weeks since LMP. Most (n=366, 80%) knew the exact date of their LMP and a significant minority estimated it (n=92, 20%). Those who estimated the date of their LMP had higher odds of later pregnancy discovery than those who knew the exact date (adjusted odds ratio (aOR)=1.81[1.07-3.07]). Those who used illicit drugs weekly, daily, or almost daily had higher odds of later pregnancy discovery (aOR=6.33[2.44, 16.40]). CONCLUSION:Women who did not track their menstrual periods and those who frequently used drugs had higher odds of discovering their pregnancies later. IMPLICATIONS:Women who estimated the date of their LMP and who frequently used drugs may benefit from strategies to help them recognize their pregnancies earlier and link them to care when they discover their pregnancies later.

Accessible Summary: What is known on the subject?: Emergency departments (ED) are key settings to support and manage suicidal crisis; thus, ED staff are often the first point of contact for people in suicidal crisis. Despite this, some ED staff receive little training and/or education on how to best support such patients. What the paper adds to existing knowledge: Previous research focuses on one staffing role (e.g. triage nurses) whereas this paper includes staff working across the ED pathway. Administrative staff have often been excluded from research, despite representing a key part of the clinical pathway and being a person's initial contact with the ED.Overall findings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. Staff also perceive there to be a negative ED culture, which often leads to poor attitudes towards suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention.Findings build upon previous research to highlight key challenges different staff face along the clinical pathway and the implications this can have on a patient's journey and follow‐up care provided. What are the implications for practice?: Findings are of particular importance and relevance to ED managers, and more broadly NHS England. Negative ED culture, poor staff attitudes and confidence can have a detrimental impact on both staff health and wellbeing, as well as a patient's journey throughout the ED, resulting in repeat presentations and absconding as appropriate support is not received.Policymakers need to consider staff burnout and lack of resources in mental health care strategies, and training programmes should be developed to improve culture and confidence among ED staff and managers to improve care for people attending EDs in suicidal crisis. Introduction: Emergency departments (EDs) are often the first point of contact for people in suicidal crisis. Yet, previous work has tended to focus on only one type of staffing role, failing to account for different staff perspectives along the clinical pathway. Aims: To explore and synthesise the perspectives of ED administrative (i.e. receptionists), medical (triage nurses) and mental health staff (liaison psychiatrists) working with people presenting in suicidal crisis. Method: Qualitative study guided by thematic analysis of semi‐structured interviews with 23 ED staff across six EDs in Cheshire and Merseyside, England. Results: Findings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention. Discussion: Staff felt unequipped to deal with suicide‐related presentations. Organisational support is perceived to be lacking, with increased staffing pressures and poor service availability. This lack of support was linked to job dissatisfaction. Implications for Practice: Findings are of particular relevance to individual EDs and NHS England. Addressing the challenges staff are reporting can have positive implications for staff wellbeing, as well as a patient's experience and journey throughout the ED. [ABSTRACT FROM AUTHOR]

Concerns about excessive use of force by U.S. police have led to calls for agencies to move from 'warrior' to 'guardian' policing. 'Warrior' policing embodies an aggressive or coercive approach to law enforcement, while 'guardian' policing prioritises communication, procedural justice and citizen safety. Associations between guardian and warrior policing orientations and use of force attitudes in the U.S. have been found, however the influence of these orientations on police use of force in Australia has not been examined. This study examined the association of guardian and warrior policing orientations with use of force attitudes, threat perceptions and tactical decision-making among Australian officers, through a survey of 183 police officers in Queensland. Regression analyses indicated that warrior policing was associated with greater support for use of force and greater perceived threat in an ambiguous threat scenario, while guardian policing was associated with more restraint in tactical decision-making among Australian police officers. [ABSTRACT FROM AUTHOR]

This article seeks to test the police 'empowerment hypothesis' to better understand public support for police powers during the COVID-19 pandemic. To do so, we draw on Australian survey data to compare the efficacy of the instrumental and normative models of police empowerment to enforce social distancing regulations. We find that instrumental concerns about risk dominate participants' willingness to empower the police during the COVID-19 pandemic. However, when it comes to what police can do to encourage police empowerment, procedural justice appears to be more important than police effectiveness, supporting the normative model. Our article adds to the limited but growing body of research that examines the correlates of police empowerment and the conditions under which members of the public are willing to grant police expanded powers. [ABSTRACT FROM AUTHOR]

Emergency department (ED) staff are often the first point of contact for individuals in suicidal crisis. Despite this, there is no published research systematically examining the factors influencing decision-making for this patient group. MedLine, CINAHL, PsycINFO, Web of Science and Cochrane Library databases were searched for three key concepts: (1) suicide, (2) accident and emergency department and (3) decision-making. Three reviewers screened titles, abstracts and full papers independently against the eligibility criteria. Data synthesis was achieved by extracting and analyzing study characteristics and findings. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of included studies. Seventeen studies met the eligibility criteria and were included in this systematic review. Studies were published from 2004 to 2020 and were of good methodological quality. A number of patient (method of self-harm, age, gender), contextual (availability of services and staff) and staff-related factors (attitudes, training, knowledge) were reported to influence decision-making for patients in suicidal crisis presenting to EDs. Decision-making in the ED is complex and is influenced by patient, contextual and staff-related factors. These decisions can have an impact on the future care and clinical pathways of patients in suicidal crisis. Additional training is needed for ED staff specifically related to suicide prevention. [ABSTRACT FROM AUTHOR]

Objective: Crisis lines are the first mental health service contact point for many people, making them a vital community and public health intervention. Given the current and potential utility of crisis lines, better understanding the characteristics, socioeconomic factors and subsequent referral pathways of callers is critical to identifying targeted ways to improve such services. Study Design: The dataset captured calls to the Cheshire & Wirral Partnership NHS Foundation Trust (CWP) crisis line between August 2020 and August 2021. Calls were examined if self-harm, risk to self, or overdose were reported by the caller. Descriptive analyses were conducted to produce a clinical and demographic profile of the callers using the crisis line. Results: Call handlers were significantly more likely to call 999, hand over to a practitioner and less likely to provide advice and guidance if self-harm, risk to self or overdose was reported. Social issues were found to be significantly associated with all 3 outcomes: self-harm, risk to self and overdose. Conclusion: The current study provides the first exploratory analysis of the socioeconomic factors and resultant care pathways for those contacting a UK crisis line service. The findings have important implications for community early intervention efforts to reduce self-harm and suicidal behaviours. [ABSTRACT FROM AUTHOR]

Police have been criticized for their biased treatment of minorities. While many officers do not hold prejudicial attitudes toward minorities, discrimination continues. Stereotype threat research offers one possible explanation for why this is so. Paradoxically, studies reveal that officers who feel more threatened by the 'racist cop' stereotype rely more on coercive force in interactions with minorities. This perpetuates the view that police are racist. This study examines whether officers can overcome the negative consequences of experiencing stereotype threat. It focuses on the link between stereotype threat and officers' support for procedural justice policing, and examines how social identity moderates this relationship. Using survey data from 307 police officers (22.5% females, 11.1% non-Australian ancestry, and 69.4% general duties officers), we find that stereotype threat is associated with reduced support for procedural justice, but is moderated by how officers self-identify. Officers who identify more strongly as 'guardians' (i.e. they emphasize policing as a service) are more likely to display stereotype resistance; that is, they are better able to resist the negative consequences of the 'racist cop' stereotype. Those who identify less strongly as 'guardian' officers, in contrast, fall victim to stereotype threat and display stereotype conformity. Implications are discussed. [ABSTRACT FROM AUTHOR]