Purpose There is a dearth of research on what constitutes effective transfer of care from children’s and young people services to adult services for patients with eating disorders (EDs) in the UK. Transition has implications for continuity of care and particularly for early intervention which has the best prognosis. The purpose of this paper is to understand the experience of transition and identify facilitators and barriers to this. Design/methodology/approach Qualitative methodology was used. Focus groups (n = 4) were held with clinicians (n = 22) working in Child and Adolescent Mental Health Services or adult ED services. Individual interviews were conducted with patients (n = 5) who had commenced/completed transition to adult services and with parents/carers (n = 6) of patients invited for interview. Findings A number of factors may facilitate or impede transition and can be grouped into the broad themes of communication, managing the differences between services and timing of transition. Improvements in communication, clear explanation of service differences and flexibility around the timing of transitions may enhance the experience for patients and parents/carers. Research limitations/implications The service evaluation was limited to transition between two specialist ED services in one geographical location. The findings provide the basis for a wider research study to examine which factors are most important when planning transition from the perspectives of patients, parents/carers and clinicians. Originality/value This is the first study examining ED transitions in the UK. It provides valuable insight of the experience of service users and carers and highlights potential improvements when planning transitions for this patient group.
Introduction: Little is known how problems in alerting functions or response inhibition affect objective infrared activity measurements during a continuous performance test (QbTest) despite an increasing use of these tests for the clinical assessment of ADHD. Difficulties in alerting functions and response inhibition are both associated with the presence of behavioural features in all three core domains of ADHD, i.e. inattention, impulsivity and hyperactivity. We hypothesized that objective infrared activity measurements during CPT and behavioural ratings for hyperactivity from a commonly used questionnaire for ADHD (Conners rating scale) would be raised for both alerting functions and response inhibition. Method: 951 sequential referrals completed a QbTest and parent and teacher Conners rating scales followed by a clinical assessment with a CAMHS clinician. Two groups, one with exclusive difficulties in alerting functions (inattention) and the other with exclusive difficulties in response inhibition (impulsive) resulting from the QbTest performance were extracted from the pool and activity measurements, rating scales and diagnostic outcome were compared. Results: Contrary to our hypothesis, only the group with difficulties in alerting functions (inattentive) showed significantly raised activity measurements during CPT. However, both groups had raised scores for hyperactivity in the behavioural rating scales. A higher number of cases with difficulties in alerting functions (79.6%) were assigned a diagnosis of ADHD compared to the group with exclusively difficulties in response inhibition (61.8%). Discussion: A cautious evaluation of activity measurements during the QbTest with full consideration of the interplay between naturalistic and laboratory environmental effects on motor activity is recommended
Background: Viewing self-harm and suicide-related images online can precede these behaviours. We reviewed studies of potential impacts and mechanisms associated with viewing self-harm-related images on the internet and social media. Method: CINAHL, Cochrane Library, EMBASE, HMIC, MEDLINE, PsycArticles, PsycINFO, PubMed, Scopus, Sociological Abstracts and Web of Science Core Collection databases were searched for relevant studies from inception to 22 January 2022. Inclusion criteria were English language, peer-reviewed, empirical studies with data related to impacts of viewing self-harm images or videos on the internet or social media. Quality and risk of bias were assessed using Critical Appraisal Skills Programme tools. A narrative synthesis approach was used. Results: Of the 15 identified studies, all found harmful effects of viewing self-harm-related images online. These included escalation of self-harm, reinforcement of engagement behaviours (e.g. commenting and sharing images), encouragement of social comparison (comparing own self-harm with others), development of a self-harm identity, social connection perpetuating or escalating self-harm, and emotional, cognitive, and physiological impacts triggering self-harm urges and acts. Nine studies found protective effects, including self-harm mitigation or reduction, promotion of self-harm recovery, encouraging social connection and help-giving, and emotional, cognitive and physiological impacts mitigating or reducing self-harm urges and acts. Causality of impact was not determined in any study. Most of the studies did not explicitly evaluate or discuss potential mechanisms. Conclusions: Viewing self-harm images online may have both harmful and protective effects, but harmful effects predominated in the studies. Clinically, it is important to assess individual's access to images relating to self-harm and suicide, and the associated impacts, alongside pre-existing vulnerabilities and contextual factors. Higher quality longitudinal research with less reliance on retrospective self-report is needed, as well as studies that test potential mechanisms. We have developed a conceptual model of the impact of viewing self-harm images online to inform future research.
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