Very preterm (VPT) birth is associated with altered cortical development and long-term neurodevelopmental sequelae. We used voxel-based morphometry to investigate white (WM) and grey matter (GM) distribution in VPT adolescents and controls, and the association with gestational age and neonatal ultrasound findings in the VPT individuals. GM and WM volumes were additionally investigated in relation to adolescent neurodevelopmental outcome. Structural MRI data were acquired with a 1.5 Tesla machine in 218 VPT adolescents (<33 weeks, gestation) and 128 controls aged 14-15 years, and analysed using SPM2 software. VPT individuals compared to controls showed reduced GM in temporal, frontal, occipital cortices and cerebellum, including putamen, insula, cuneus, fusiform gyrus, thalamus and caudate nucleus, and increased GM predominantly in temporal and frontal lobes, including cingulate and fusiform gyri and cerebellum. WM loss was concentrated in the brainstem, internal capsule, temporal and frontal regions and the major fasciculi. WM excesses were observed in temporal, parietal and frontal regions. Investigation of the inter-relationships between brain regions and changes revealed that all selected areas where between-group increased and decreased WM and GM volumes differences were observed, were structurally associated, highlighting the influence that abnormalities in one brain area may exert over others. VPT individuals with evidence of periventricular haemorrhage and ventricular dilatation on neonatal ultrasound exhibited the greatest WM and GM alterations. VPT adolescents obtained lower scores than controls on measures of language and executive function and were more likely to show cognitive impairment compared to controls (27% versus 14%, respectively). Several areas where VPT individuals demonstrated decreased GM and WM volume were linearly associated with gestational age and mediated cognitive impairment. To summarize, our data demonstrates that VPT birth is associated with altered brain structure in adolescence. GM and WM alterations are associated with length of gestation and mediate adolescent neurodevelopmental impairment. Thus, anatomical brain changes may contribute to specific cognitive deficits associated with VPT birth and could be used in the identification of those individuals who may be at increased risk for cognitive impairment.

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Consumer satisfaction with health care is one of the goals of health care delivery. Information on what affects satisfaction helps health care providers to deliver patient-centred care. The aim of this study was to explore the relationship between young persons' symptoms and satisfaction with Child and Adolescent Mental Health Services (CAMHS). It also examined differences in satisfaction of the parent/carer and their child. Self-report questionnaires were used to gather information from respondents. High levels of satisfaction were reported, although children and adolescents were less satisfied than parents/carers. Young people with self-reported conduct problems were least satisfied with CAMHS, as were those who rated their problems as having a significant impact on their lives. There was no relationship between carer-reported 'caseness' and carer satisfaction with services. Further exploration of the needs and expectations of young people who have behavioural difficulties is necessary so that their needs are better understood and expectations met.

Background Countries worldwide are experiencing a third wave of the coronavirus disease 2019 (COVID-19) pandemic. Government-imposed restrictive measures continue with undetermined effects on physical and mental health. Aims To compare child and adolescent mental health services (CAMHS) referrals over 11 months (January–November) in 2020, 2019 and 2018 and examine any impact the different phases of the COVID-19 restrictions might have on referral rates. Method Monthly CAMHS Health Service Executive data were examined, covering a catchment population of 260 560 or 12.7% of all youth (age group 0–18 years) in Ireland. The total number of urgent and routine referrals, appointments offered, rates of non-attendances and discharge outcome are presented. Results There was a significant drop in referrals in 2020, compared with prior years (χ2 = 10.3, d.f. = 2, P = 0.006). Referrals in 2020 dropped from March to May by 11% and from June to August by 10.3%. From September, both routine and urgent referrals increased by 50% compared with previous years (2018/2019), with the highest increase in November 2020 (180%). Clinic activity also increased from September, with double the number of out-patient appointments offered, compared with previous years (χ2 = 5171.72, d.f. = 3, P < 0.001) and lower (6.6%) rates of non-attendance (χ2 = 868.35, d.f. = 3, P < 0.001). Conclusions In 2020, following an initial decline, referrals to CAMHS increased consistently from September. Such unprecedented increase in referrals places further strain on services that are already underresourced and underfunded, with the likelihood of increased waiting lists post COVID-19. It is envisaged that once the pandemic is over, resources will be even more constrained, and CAMHS will be urgently in need of additional ring-fenced funding.