Background The stepped-care approach, where people with early symptoms of depression are stepped up from low-intensity interventions to higher-level interventions as needed, has the potential to assist many people with mild depressive symptoms. Self-monitoring techniques assist people to understand their mental health symptoms by increasing their emotional self-awareness (ESA) and can be easily distributed on mobile phones at low cost. Increasing ESA is an important first step in psychotherapy and has the potential to intervene before mild depressive symptoms progress to major depressive disorder. In this secondary analysis we examined a mobile phone self-monitoring tool used by young people experiencing mild or more depressive symptoms to investigate the relationships between self-monitoring, ESA, and depression. Objectives We tested two main hypotheses: (1) people who monitored their mood, stress, and coping strategies would have increased ESA from pretest to 6-week follow-up compared with an attention comparison group, and (2) an increase in ESA would predict a decrease in depressive symptoms. Methods We recruited patients aged 14 to 24 years from rural and metropolitan general practices. Eligible participants were identified as having mild or more mental health concerns by their general practitioner. Participants were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored), and both groups self-monitored for 2 to 4 weeks. Randomization was carried out electronically via random seed generation, by an in-house computer programmer; therefore, general practitioners, participants, and researchers were blinded to group allocation at randomization. Participants completed pretest, posttest, and 6-week follow-up measures of the Depression Anxiety Stress Scale and the ESA Scale. We estimated a parallel process latent growth curve model (LGCM) using Mplus to test the indirect effect of the intervention on depressive symptoms via the mediator ESA, and calculated 95% bias-corrected bootstrapping confidence intervals (CIs). Results Of the 163 participants assessed for eligibility, 118 were randomly assigned and 114 were included in analyses (68 in the intervention group and 46 in the comparison group). A parallel process LGCM estimated the indirect effect of the intervention on depressive symptoms via ESA and was shown to be statistically significant based on the 95% bias-corrected bootstrapping CIs not containing zero (–6.366 to –0.029). The proportion of the maximum possible indirect effect estimated was κ 2 =.54 (95% CI .426–.640). Conclusions This study supported the hypothesis that self-monitoring increases ESA, which in turn decreases depressive symptoms for young people with mild or more depressive symptoms. Mobile phone self-mon...

Hip displacement is common in children with cerebral palsy, with an overall incidence of 35% found in this study. The risk of hip displacement is directly related to gross motor function as graded with the Gross Motor Function Classification System. This information may be important when assessing the risk of hip displacement for an individual child who has cerebral palsy, for counseling parents, and in the design of screening programs and resource allocation.

BackgroundOver 75% of mental health problems begin in adolescence and primary care has been identified as the target setting for mental health intervention by the World Health Organisation. The mobiletype program is a mental health assessment and management mobile phone application which monitors mood, stress, coping strategies, activities, eating, sleeping, exercise patterns, and alcohol and cannabis use at least daily, and transmits this information to general practitioners (GPs) via a secure website in summary format for medical review.MethodsWe conducted a randomised controlled trial in primary care to examine the mental health benefits of the mobiletype program. Patients aged 14 to 24 years were recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants, and researchers were blind to group allocation at randomisation. Participants completed pre-, post-, and 6-week post-test measures of the Depression, Anxiety, Stress Scale and an Emotional Self Awareness (ESA) Scale.ResultsOf the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention group n = 68, comparison group n = 46). Mixed model analyses revealed a significant group by time interaction on ESA with a medium size of effect suggesting that the mobiletype program significantly increases ESA compared to an attention comparison. There was no significant group by time interaction for depression, anxiety, or stress, but a medium to large significant main effect for time for each of these mental health measures. Post-hoc analyses suggested that participation in the RCT lead to enhanced GP mental health care at pre-test and improved mental health outcomes.ConclusionsMonitoring mental health symptoms appears to increase ESA and implementing a mental health program in primary care and providing frequent reminders, clinical resources, and support to GPs substantially improved mental health outcomes for the sample as a whole.Trial RegistrationClinicalTrials.gov NCT00794222.

This letter is commented on by Reid et al. on page 867-868 of this issue SIR-Reid et al. 1 reported on the long-term survival of persons with cerebral palsy in the Australian state of Victoria. They found that rates, predictors, and causes of mortality were in line with reports from other countries. They also found that 'contrary to expectation, no improvement in survival was seen over the 40 years of the study.' We wish to raise two issues, possibly related, regarding this last point.The first issue is methodological. The authors' approach was to identify four cohorts according to the decade of birth, the first being the 1970s and the fourth being the 2000s. The authors found no difference in the survival of these cohorts. There are several potential difficulties with this approach. By working with mortality of cohorts followed over several decades rather than with observed mortality in a specific calendar year, it does not answer the question of real interest: is mortality lower in later years -the year 2000, say -than it was in 1975? The children in the 1970s cohort, for example, may contribute data to all four decades. A better approach is to work directly with person-years, as in the California studies cited by the authors. 2,3A further methodological difficulty with the authors' approach is that it does not take into account the severity of disabilities, a factor known to be of critical importance to survival. Conceivably, for example, because of advances in neonatal medicine, more of the children with the most extreme disabilities survive infancy in the later decades than in the earlier decades. If that were the case then the comparison of birth cohorts would be biased, as the later cohorts would have a greater proportion of very fragile children. Once again, this problem could have been avoided with the use of the personyear approach.This brings us to the second issue, the use of gastrostomy feeding. The authors write: 'We did not present data on feeding, as tube feeding is an indicator that an individual has severe problems and a poor prognosis for survival, but it is also performed to improve survival and quality of life. ' We agree with the assertions in the second half of this sentence, but they scarcely constitute a reason to ignore the data on tube feeding. As is well known, the need for tube feeding is a powerful predictor of mortality and the use of gastrostomy feeding has become far more common in recent decades.2,3 It would therefore be important to take gastrostomy dependence into account, along with a measure of motor function, etc. when examining the mortality data for a possible trend over time.Had the authors taken a person-year approach that properly took account of motor function, gastrostomy dependence, etc. in addition to calendar year, they may have found improved survival over the decades. At the least, if they still did not observe such a trend it would represent much better evidence that it had not occurred.

The VCPR is ideal for population-based studies of gross motor function in children with CP. Gross motor function is similar in populations of children with CP in developed countries but the comparison of motor types and topographical distribution is difficult because of lack of consensus with classification systems. Use of the GMFCS provides a valid and reproducible method for clinicians to describe gross motor function in children with CP using a universal language.

AIM This study used data collected prospectively since 1986 from a population-based cerebral palsy registry to explore the rates, predictors, trends, and causes of mortality for individuals born in Victoria, Australia, between 1970 and 2004. METHOD Data were extracted for 3507 individuals (1972 males; 1535 females). The probability of survival before 31 May 2010 was determined using the Kaplan-Meier method; age-specific mortality rates were calculated per 1000 person-years and related to population rates. Using Cox proportional hazards regression, relative risks of mortality were estimated for different categories of chosen demographic and clinical variables. Causes were tabulated according to the direct cause of death.RESULTS There were 418 deaths. Crude mortality was 20% at the age of 40 years. Relative to the population, mortality was highest in children aged under 15 years and decreased to twice the population rate at the age of 35 years. The strongest independent predictor of mortality was no independent ambulation (adjusted hazard ratio 6.2 [95% confidence interval 3.3-11.8]); additional predictors were severe intellectual impairment Cerebral palsy (CP) is a diagnostic label that embraces a range of disorders of movement and posture. Substantial variation exists with regard to the type, topographical pattern, and severity of the movement disorder, the presence of associated conditions and impairments, and how these combine to impact on function, participation, and quality of life. Since the label 'CP' accommodates such a wide variety of possible clinical manifestations, information about survival with CP based on different combinations of clinical features is needed to counsel families about a child's prognosis, to plan for the provision of medical, educational, and social services, to inform public policy, and for medicolegal services relating to litigation. The aim of this study was to describe the rates, trends, predictors, and causes of mortality in individuals with nonpostneonatally acquired CP who were born in the Australian state of Victoria between 1970 and 2004. A number of groups have previously studied life expectancy in CP samples but many studies have had shortcomings. Recent studies of all CP cases from long-standing registers in Western Australia, 1 the UK, 2 and Denmark 3 have provided useful information on the long-term prognosis of all newly diagnosed children. The UK study noted regional differences in survival, but it was unclear whether these reflected regional variation in survival patterns, risk factor profiles, levels of care, or differences in definition, classification, or ascertainment.2 Severity of disability is the key factor influencing survival in CP. Immobility or severe motor impairment of all four limbs, 1-9 intellectual impairment, 1,2,4-7,10 epilepsy, 3,4,10 severe visual and hearing impairments, 2,7,11 hydrocephalus, 4 and an increasing number of impairments 1,2,5-7 have been associated with poorer survival. Although different severity profiles have been used by ea...

Background Both alcohol and cannabis use carry health risks. Both are commonly initiated in adolescence. To date little research has described trajectories of adolescent cannabis or alcohol use or compared their respective consequences in young adulthood. Methods The design was a 10-year eight-wave cohort study of a state-wide community sample of 1943 Victorians initially aged 14-15 years. Moderate-and high-risk alcohol use was defined according to total weekly alcohol consumption. Moderate-and high-risk cannabis use were defined as weekly and daily use, respectively. Results Around 90% of young adults used either alcohol or cannabis. Although an association existed between alcohol and cannabis use, there was a tendency for heavy users to use one substance predominantly at any one time. Weekly or more frequent cannabis use in the absence of moderate-risk alcohol use in teenagers predicted a sevenfold higher rate of daily cannabis use in young adults but only a twofold increase in high-risk alcohol use. Conversely, moderate-risk adolescent alcohol use in the absence of weekly cannabis predicted an approximately threefold increased rate of both high-risk drinking and daily cannabis use in young adulthood. Selective heavy cannabis use in both adolescence and young adulthood was associated with greater illicit substance use and poorer social outcomes in young adulthood than selective alcohol use. Conclusions Heavier teenage cannabis users tend to continue selectively with cannabis use. Considering their poor young adult outcomes, regular adolescent cannabis users appear to be on a problematic trajectory.

The mobiletype program captured a range of detailed and interesting qualitative and quantitative data about young people's everyday mood, stresses, responses, and general functioning.