scholarly journals Do you mind if I take your blood pressure? Physical health monitoring of children and young people on ADHD medication amidst a pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S183-S184
Author(s):  
Emma Davies ◽  
Maham Khan ◽  
Claire Jones
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Young People ◽  
Physical Health ◽  
Health Monitoring ◽  
Neurodevelopmental Disorder ◽  
Adhd Medication ◽  
Children And Young People ◽  
Nice Guidance ◽  
The Impact

AimsTo establish whether physical health monitoring for CYP on ADHD medication is according to NICE guidance (2018).To determine the impact of COVID-19 pandemic restrictions on physical health monitoring for CYP on ADHD medication.Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity, directly impacting on academic, occupational, or social functioning. It affects between 1-5% of children and young people (CYP) most often presenting in early-mid childhood.Pharmacological treatment can be considered in CYP if certain criteria are met, where licensed medications include methylphenidate, dexamfetamine, lisdexamfetamine, atomoxetine and guanfacine. Stimulant and non-stimulant medications require frequent physical health monitoring due to their side effects including an increase in blood pressure and/or heart rate, loss of appetite, growth restriction and tics.MethodStandards and criteria were derived from the NICE guidance (2018), whilst local trust policies were reviewed, demonstrating discrepancies. Standards were expected to be met for 100% of patients.Electronic patient records were reviewed retrospectively from a representative cohort of CYP reviewed by clinicians in a community CAMHS service during March-November 2020. Data were entered manually into a spreadsheet for evaluation.ResultA total of 27 CYP records were reviewed, average age 13yo, on a range of stimulant/non-stimulant preparations.5 (19%) had height checked every 6 months, with 4 delayed to 7-8 months.For those >10yo, only 5 (19%) had weight checked every 6 months.Only 2 (7%) had their height and weight plotted on a growth chart and reviewed by the healthcare professional responsible for treatment.Just 4 (15%) had heart rate and blood pressure recorded before and after each dose change, whilst similarly only 4 (not the same) had these parameters recorded every 6 months.17 patients were reviewed by telephone/video call, where 5 patients provided physical health parameters (measured at home).ConclusionAcross all parameters, standards are not being met for the required physical health monitoring for CYP on ADHD medication.The COVID-19 pandemic has significantly changed the working conditions for community teams, impacting face to face reviews, creating challenges for physical health monitoring.Our ongoing implementations for change include the use of a proforma for physical health measurements, improving psychoeducation for families, exploring potential barriers with senior colleagues and collaborating with pharmacy colleagues to update local guidelines in accordance with the latest NICE recommendations. We aim to re-audit in June 2021.

scholarly journals School Closures and Returning to School: Views of Parents of Children With Disabilities in England During the Covid-19 Pandemic

2021 ◽  
Vol 6 ◽  
Author(s):  
Susana Castro-Kemp ◽  
Arif Mahmud
Keyword(s):  
Young People ◽  
Physical Health ◽  
Future Research ◽  
School Closures ◽  
Children And Young People ◽  
Parental Perspectives ◽  
Returning To School ◽  
The Impact ◽  
Mental And Physical Health

Children and young people with special educational needs and disabilities and their families are likely to be significantly affected by the Covid-19 pandemic at various levels, particularly given the implementation of school closures during national lockdowns. This study employed a survey design to assess parental perspectives on the impact of school closures and of returning to school in England, as a result of the Covid-19 pandemic. Eighty-three parents of children and young people with various types of need responded to the survey between September and December 2020. The survey included multiple choice questions and open-ended questions for further in-depth examination of parental perspectives. Results show that: the majority of parents reported that school closures had a detrimental effect on their children’s mental health (particularly those from the most deprived neighbourhoods) and on their own mental and physical health (particularly for ethnically diverse parents and for those whose children attend specialized settings); returning to school was considered to have a positive impact on children’s mental and physical health for the vast majority of parents, despite fearing exposure to the virus; many parents have reported that their children were calmer and happier at home during school closures and became more anxious and stressed upon returning to school. The role of cumulative risk in these children and families, as well as the role of schools as key support agents for the most vulnerable are discussed with implications for future research and policy.

The impact of algorithmic decision-making processes on young people’s well-being (Preprint)

2019 ◽  
Author(s):  
Elvira Perez Vallejos ◽  
Liz Dowthwaite ◽  
Helen Creswich ◽  
Virginia Portillo ◽  
Ansgar Koene ◽  
...  
Keyword(s):  
Young People ◽  
Significant Proportion ◽  
Well Being ◽  
Early Years ◽  
Negative Experiences ◽  
Children And Young People ◽  
Online Platforms ◽  
Internet Users ◽  
Decision Making Processes ◽  
The Impact

BACKGROUND Algorithms rule the online environments and are essential for performing data processing, filtering, personalisation and other tasks. Research has shown that children and young people make up a significant proportion of Internet users, however little attention has been given to their experiences of algorithmically-mediated online platforms, or the impact of them on their mental health and well-being. The algorithms that govern online platforms are often obfuscated by a lack of transparency in their online Terms and Conditions and user agreements. This lack of transparency speaks to the need for protecting the most vulnerable users from potential online harms. OBJECTIVE To capture young people's experiences when being online and perceived impact on their well-being. METHODS In this paper, we draw on qualitative and quantitative data from a total of 260 children and young people who took part in a ‘Youth Jury’ to bring their opinions to the forefront, elicit discussion of their experiences of using online platforms, and perceived psychosocial impact on users. RESULTS The results of the study revealed the young people’s positive as well as negative experiences of using online platforms. Benefits such as being convenient and providing entertainment and personalised search results were identified. However, the data also reveals participants’ concerns for their privacy, safety and trust when online, which can have a significant impact on their well-being. CONCLUSIONS We conclude by making recommendations that online platforms acknowledge and enact on their responsibility to protect the privacy of their young users, recognising the significant developmental milestones that this group experience during these early years, and the impact that technology may have on them. We argue that governments need to incorporate policies that require technologists and others to embed the safeguarding of users’ well-being within the core of the design of Internet products and services to improve the user experiences and psychological well-being of all, but especially those of children and young people. CLINICALTRIAL N/A

scholarly journals Impact of lockdown and school closure on children in special schools: a single-centre survey

2021 ◽  
Vol 5 (1) ◽  
pp. e000981
Author(s):  
Tapomay Banerjee ◽  
Amjad Khan ◽  
Piriyanga Kesavan
Keyword(s):  
Young People ◽  
Significant Role ◽  
Well Being ◽  
School Closure ◽  
Special Educational Needs ◽  
Single Centre ◽  
Special Schools ◽  
Daily Lives ◽  
Children And Young People ◽  
The Impact

Special schools play a significant role in the daily lives of children and young people with special educational needs and disabilities. We explored the impact of the COVID-19-related first lockdown and resulting school closure by surveying parents whose children attended three special schools in Bedford, UK. We asked about anxiety and impact on emotional well-being and education. We received 53 responses from parents: 31 felt their child was more anxious during the lockdown period/school closure compared with beforehand and 42 felt their child’s emotional well-being had been affected. Children and young people attending special schools may have struggled both academically and emotionally during the COVID-19 pandemic.

Modifying effects of the R389G β1-adrenoceptor polymorphism on resting heart rate and blood pressure in patients with obstructive sleep apnoea

2005 ◽  
Vol 110 (1) ◽  
pp. 117-123 ◽  
Author(s):  
Jan Börgel ◽  
Tino Schulz ◽  
Nina K. Bartels ◽  
Jörg T. Epplen ◽  
Nikolaus Büchner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Obstructive Sleep Apnoea ◽  
Nervous Activity ◽  
Sleep Apnoea ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

OSA (obstructive sleep apnoea) stimulates sympathetic nervous activity and elevates resting HR (heart rate) and BP (blood pressure). In the present study in a cohort of 309 untreated OSA patients, the resting HR and BP during the daytime were correlated with AHI (apnoea/hypopnea index) and compared with patients with R389R (n=162), R389G (n=125) and G389G (n=22) genotypes of the β1-adrenoreceptor R389G polymorphism. We analysed the impact of the genotype on the decline of HR and BP in a subgroup of 148 patients (R389R, n=86; R389G, n=54; G389G, n=8) during a 6-month follow-up period under CPAP (continuous positive airway pressure) therapy during which cardiovascular medication remained unchanged. In untreated OSA patients, we found an independent relationship between AHI and resting HR (β=0.096, P<0.001), systolic BP (β=0.09, P=0.021) and diastolic BP (β=0.059, P=0.016). The resting HR/BP, however, did not differ among carriers with the R389R, R389G and G389G genotypes. CPAP therapy significantly reduced HR [−2.5 (−1.1 to −4.0) beats/min; values are mean difference (95% confidence intervals)] and diastolic BP [−3.2 (−1.5 to −5.0) mmHg]. The decline in HR was more significantly pronounced in the R389R group compared with the Gly389 carriers [−4.1 (−2.3 to −5.9) beats/min (P<0.001) compared with −0.2 (2.1 to −2.6) beats/min (P=0.854) respectively; Student's t test between groups, P=0.008]. Diastolic BP was decreased significantly (P<0.001) only in Gly389 carriers (R389G or G389G) compared with R389R carriers [−5.0 (−2.3 to −7.6) mmHg compared with −2.0 (0.4 to −4.3) mmHg respectively]. ANOVA revealed a significant difference (P=0.023) in HR reduction between the three genotypes [−4.1 (±8.4) beats/min for R389R, −0.5 (±9.3) beats/min for R389G and +1.9 (±7.2) beats/min for G389G]. In conclusion, although the R389G polymorphism of the β1-adrenoceptor gene did not influence resting HR or BP in untreated OSA patients, it may modify the beneficial effects of CPAP therapy on these parameters.

The impact of child maltreatment on the mental and physical health of child victims: a review of the evidence

2021 ◽  
pp. 1-11
Author(s):  
Eileen Vizard ◽  
Jenny Gray ◽  
Arnon Bentovim
Keyword(s):  
Child Maltreatment ◽  
Physical Health ◽  
Child Victims ◽  
Physical And Mental Health ◽  
Children And Young People ◽  
Genital Mutilation ◽  
Health And Development ◽  
The Impact ◽  
Mental And Physical Health ◽  
Female Genital

SUMMARY This article gives a general overview of the current situation in relation to a range of widely recognised and also newly identified types of child maltreatment. The academic and clinical evidence relating to the impact of child maltreatment on the mental and physical health of child victims is substantial and steadily increasing in volume. New types of abuse are being identified, and changing environmental circumstances, which exacerbate the possibility of widely recognised types of child maltreatment occurring, are also being described. These include multi-type maltreatment, female genital mutilation and online child maltreatment. Serious questions may arise regarding neglect of the moral and social development of children and young people who become addicted to online gaming and pornography. Multiple national and local definitions of each of these existing and new forms of maltreatment have been created, some of which are covered here. The impact of these abuses on the physical and mental health and development of child victims in families or settings where abuse or neglect has occurred is discussed.

scholarly journals Audit of physical health monitoring during initiation and ongoing treatment with antipsychotic medication in a tier 3 outpatient CAMHS service, Belfast

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S323-S324
Author(s):  
Pam Hamlyn ◽  
Aaron McMenamin ◽  
Hilary Boyd ◽  
Lara Patton
Keyword(s):  
Young People ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Health Monitoring ◽  
Care Pathway ◽  
Electronic System ◽  
Clinical Notes ◽  
Medication Monitoring ◽  
Tier 3 ◽  
Health Parameters

AimsTo evidence that physical health monitoring during antipsychotic initiation and continued treatment within the Child and Family Clinic is current, as per the agreed Antipsychotic Medication Monitoring Schedule for Belfast Trust CAMHS (2015), supporting Quality Network for Community CAMHS(QNCC) accreditation.BackgroundThe Antipsychotic Medication Monitoring Schedule CAMHS(2015) was agreed by a working group of consultant psychiatrists and pharmacists, based on evidence from The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMSEA), NICE Guidelines CG 185(2014), CG155(2013) and Maudsley Guidelines, and was to be located on the electronic system (PARIS).MethodIn January 2019, a list of all children/young people on antipsychotic medication was collated (n = 12). Presence of the monitoring schedule in the clinical notes or PARIS was recorded. The Electronic Care Record was reviewed for blood results and PARIS letters for documentation of physical health parameters (heart rate, blood pressure, height, weight, BMI, extrapyramidal side effects, ECG) and to identify documentation of risk/benefit review where monitoring was declined. Re-audit January 2020 (n = 9). Criteria:All patients commenced on antipsychotic medication will have baseline blood investigations and other physical health parameters documented as per the monitoring schedule. If monitoring was declined, the reason for this and indications for prescribing must be documented as a risk/benefit analysis.All patients on antipsychotic medication will be current with their physical health Monitoring Schedule.All patients will have their Monitoring Schedule completed in clinical notes or on PARIS.ResultFirst cycle results (n = 12):Baseline bloods (or documented declined) = 92%, Baseline ECG (or documented declined) = 75%Complete monitoring bloods = 33%, Physical health monitoring parameters complete = 42%Monitoring schedule present in the notes and current = 42% (0% on PARIS).Initial Recommendations: Standardised recording of monitoring using PARIS clinic letters and the schedule in front of clinical notes; Baseline ECG mandatorySecond cycle results (n = 9):Baseline bloods (or declined) = 89%, Baseline ECG (or declined) = 67%Complete monitoring bloods = 44%, Physical health monitoring parameters complete = 56%Monitoring schedule present in notes and current = 38%, Present, not current = 50% (0% on PARIS).ConclusionLower numbers at re-audit limit interpretation.Further recommendations: Antipsychotic initiation checklist; Central bloods diary for clinicians; Antipsychotic care-pathway booklet, co-produced with young people, incorporating the monitoring schedule.

scholarly journals Audit of ADHD medication prescription and monitoring in intellectual disability services, Greater Glasgow & Clyde

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S66-S66
Author(s):  
Neha Bansal ◽  
Muzammil Hayat
Keyword(s):  
Intellectual Disability ◽  
Side Effects ◽  
Physical Health ◽  
Health Monitoring ◽  
Symptom Severity ◽  
Adhd Medication ◽  
Audit Tool ◽  
Medication Prescription ◽  
Ongoing Treatment ◽  
Medication Dosage

AimsStudies have shown that people with intellectual disability (ID) show a greater severity of attention deficit hyperactivity disorder (ADHD) symptoms and atypical presentation, as well as having a greater risk of developing comorbidities, such as challenging behaviour, anxiety, tic disorders and sleep problems. It is estimated that 1.5% of patients with ID will have a clinical diagnosis of ADHD.The aim of this audit was to find whether individuals with ID and ADHD, who are prescribed medication for ADHD are adequately monitored and reviewed in accordance with the ADHD medication prescription guidance by NICE and the Royal College of Psychiatrists (RCPsych).MethodThis audit looked at ADHD medication prescription for the ID population within Greater Glasgow & Clyde NHS. This is the 6th audit cycle where electronic records (EMIS) were analysed between 28/9/19 to 09/10/20. (The 5th cycle data collection period ended on 28/9/19). We collected data on all patients aged over 18 years.An audit tool was developed to find whether the following were documented; patient demographics, physical health monitoring, symptom severity, medication dosage, side effects, need for ongoing treatment and frequency of review. 100% of patients should have all components on the ADHD audit tool documented, as per NICE/ RCPsych prescription guidance.Result32 patients were identified as being diagnosed with ADHD prescribed medication. One patient was impacted by the COVID-19 pandemic which meant that the required monitoring was not fully carried out. The age ranged from 18 to 56 years. 75% had mild intellectual disability, 19% had moderate and 6% had severe, with no cases of profound intellectual disability. Blood Pressure/pulse was recorded in 84% of patients. Height/weight/ BMI was recorded in 81% of patients. 97% of patients had ADHD symptom severity, medication dosage, side effects, need for ongoing treatment and frequency of review recorded.ConclusionThere is further scope for improvement in the monitoring and documentation of physical health observations, however there was a significant improvement compared to the previous cycle of the audit. Other aspects of monitoring and documentation appear to be recorded in almost 100% of patients. This finding emphasises the challenges of physical health monitoring and compliance in psychiatry as a whole. We need to continue to encourage awareness and education around the physical health risks to our patients, not only due to their comorbidities but also as a result of the psychotropic medications we prescribe them.

scholarly journals The role of television in the constitution of contemporary readers

Comunicar ◽  
2005 ◽  
Vol 13 (25) ◽  
Author(s):  
Maria-Luiza Oswald
Keyword(s):  
Young People ◽  
Cultural Studies ◽  
Latin American ◽  
Children And Young People ◽  
The World ◽  
Nestor Garcia Canclini ◽  
Latin American Cultural Studies ◽  
The Impact ◽  
Estudios Culturales

This paper intends to show, based on the contributions of Latin American Cultural Studies, that the difficulty children and young people have with the organization of written texts, such as that found in books, is determined by the impact that the technology of images exercises over the ways in which they learn to read the world. An analysis of the first interviews with young people, conducted as part of an institutional project in progress, point to the role played by the language of television cartoons in their development as readers. El presente trabajo trae el análisis de las primeras entrevistas realizadas en el ámbito de una investigación institucional en curso interesada en investigar los sentidos/lecturas que niños y jóvenes realizan acerca de los productos de la cultura pop japonesa –mangás (historias en cuadritos), animes (dibujos animados) e videojuegos– basada en la orientación de los Estudios Culturales latinoamericanos (Jesús Martín-Barbero, Néstor García Canclini, Guillermo Orozco Gomes, entre otros autores). Ellos proponen que la recepción de los productos mediáticos sea analizada a partir de un desplazamiento teórico-metodológico que, reorientando el foco de los medios/mensaje para las mediaciones, permite identificar los receptores no como «dóciles audiencias», sino como productores activos de sentidos. Se pretende, con eso, intentar contribuir para la superación de la tensión entre la escuela y las culturas infantil y juvenil, tensión que tiene como uno de sus pilares el conflicto entre la cultura letrada y la cultura de la imagen. El estudio, que supone la opción por un abordaje cualitativo de carácter etnográfico, viene siendo realizado a través de entrevistas semi-estructuradas individuales con consumidores del trípode de la poderosa industria de entretenimiento nipónica, que se viene constituyendo como fenómeno mundial de comunicación de masa. Los discursos de los primeros entrevistados –cuatro jóvenes fanáticos de animes y mangas, cuya edad oscila entre 17 y 22 años– destacaron la influencia que el lenguaje de la TV ejerce sobre el extrañamiento que mantiene con el texto impreso tal como él se organiza en el libro. No obstante, la presencia en lo cotidiano de esos sujetos de un cúmulo de estímulos sonoros y visuales, no es raro depararnos con la existencia de una crisis de lectura que afecta niños y jóvenes, influenciando su desempeño en la escuela. Delante de los relatos, el grupo de investigación se formula algunas cuestiones: ¿la alusión a la crisis no sería, en el fondo, una incapacidad de las generaciones que fueron educadas y escolarizadas en los moldes de la cultura letrada?; entender que «el pretencioso gesto universal del libro» (W. Benjamin) ya no resuena entre las nuevas generaciones que ya nacieron bajo el impacto que la tecnología del sonido y de la imagen ejercen sobre la escritura? No sería, entonces, posible suponer que, si hay una crisis de la lectura, ¿es por las generaciones pasadas que está sendo vivenciada? Frente a esto, ¿no sería más adecuado, en vez de quedarnos repitiendo que existe una crisis de lectura que afecta la escolarización de niños y jóvenes y de permanecer buscando soluciones milagrosas para ese conflicto, asumir que estamos delante no de una crisis, sino de un contexto histórico del cual precisamos aproximarnos para no perder el tren de la historia? Esas fueron algunas de las preguntas que el examen de las cuatro primeras entrevistas con los jóvenes permitió sacar a luz de los fundamentos de los Estudios Culturales latinoamericanos, y es sobre ellas que ese texto se vuelca, no con la intención de responderlas, sino con el objetivo de constituirlas como un mapa que puede revelarnos caminos «para pasar de las respuestas que fracasaron a las preguntas que renuevan las ciencias sociales y las políticas libertadoras» (Néstor Canclini).

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