Serious safety concerns have been raised recently about the use of second generation antipsychotics (SGAs), in young patients. In this population based study, utilization of antipsychotics use in the youth population of Manitoba between 1996 and 2011 was determined. Rates of adverse events (diabetes, hypertension, EPS) were compared among the users of SGAs. School enrolment and high school completion rates were evaluated for young users. Databases from the Population Health Research Data Repository, housed at the Manitoba Centre of Health Policy were accessed. Increased utilization (prevalence: 2.3 to 9 per 1,000 persons; incidence: 1.2 to 2.7 per 1,000 between 2001 and 2011) of SGAs was observed in the youth population of MB. The most common diagnosis recorded were Attention Deficit Hyperactivity Disorder (56.8%), Conduct Disorders (38%) and Mood Disorders (22.7%). Olanzapine therapy seemed to be associated with a higher risk of hypertension compared to risperidone users (HR: 2.52, 95% CI: 1.20 – 5.29). Risperidone users seemed to be at higher risk of EPS than quetiapine users (HR: 0.46, 95% CI: 0.26 – 0.82). School enrolment of SGAs users appeared to be comparable to those reported for the general population. High school completion rates may be lower than those of the general population.

The purpose of the current study was to examine a model explaining a pathway from anxiety to depression in youth. Additionally, a second model was considered examining specifically the worry component of anxiety and its role in the development of depression. Path analyses were used to examine the relationships between general anxiety and worry and academic competence and functioning, social competence and functioning, attributional style, hopelessness, and depression. In addition, the impact of sex and cognitive ability on these relationships was examined. Results revealed that anxious and depressive symptomatology were significantly correlated. Further, some support was found to suggest that the significant relationship between self-reported anxiety and depression was partially mediated through social and/or academic variables as well as attributional style and hopelessness. While sex was not found to significantly impact these relationships, cognitive ability did moderate the relationship between worry and academic functioning even when other variables were considered simultaneously. The implications of these findings for treatment and research are discussed. / Ph. D.

Hypnotherapy has been utilised with children and adolescents for more than 200 years. Despite this fact, there has been no documented research on the use of hypnotherapy for children and adolescents in South Africa. This research focused on the perspectives of qualified South African psychologists on the use of hypnosis as a therapeutic technique for children and adolescents. The aim of the research was to expand on current knowledge and understandings of hypnosis and hypnotherapy, to explore how the technique has been adapted to a South African context and to identify drawbacks found in the use of this technique. The research sample comprised eight qualified psychologists who utilise hypnotherapy with children and adolescents. The research design for this study adopted a qualitative approach in which semi-structured interviews were utilised. Although the technique largely relies on foreign practises that have not been adapted to the South African context, it still proved highly valuable. While the psychologists opinions differed on the ages and conditions for which hypnotherapy could be applied, this seemed to be based on their personal experiences and success rates rather than on inherent limitations of the technique. The educational psychologists who specialised in treating children and adolescents found that there were no limitations on the use of the technique and they were confident in its application for all ages. There was also a prevailing belief, on the part of the psychologists, that black individuals appear to be more responsive to hypnotherapy than other races. The overall findings of this research study suggest that hypnotherapy is a beneficial therapeutic technique for children and adolescents in a South African context. The research aimed to further educational psychologists’ knowledge on the applicability of this technique to children and adolescents. With an awareness of its benefits, training by these professionals may be undertaken or the opinions of specialists trained in this area may be sought.

Bakgrund: Uppkomsten till migrän är inte klarlagd och därav har barriärer uppkommit som försvårar behandling och omvårdnad. Barn och ungdomar är en utsatt grupp då deras utveckling kan påverkas både fysiskt, emotionellt, socialt och i skolan. Syfte: Att beskriva hur livskvalitet hos barn och ungdomar påverkas av migrän. Metod: I denna allmänna litteraturstudie har tio empiriska studier granskats med avseende på kvalitet och innehåll gällande domänerna i livskvalitet. Litteratursökning har genomförts i  EBSCO Discovery Service och CINAHL Complete. Resultat: Migrän påverkar barn och ungdomars livskvalitet negativt både fysiskt, emotionellt, socialt och i skolan. Smärtan har en inverkan på deras dagliga aktiviteter samt ger dem en känsla av oro, nedstämdhet och ångest. Även deras sömn påverkas. Migränen gör det svårt att komma överens och hålla jämna steg med familj och vänner, både i skolan och på fritiden. Slutsats: Studien bidrar med kunskap om hur barn och ungdomars livskvalitet påverkas av migrän. Kunskap hos allmänheten överensstämmer inte med hur barn och ungdomar upplever migrän. Vidare forskning behövs därav beträffande bemötande/behandling av barn och ungdomar med migrän. / Background: The origin of migraine is unclear and therefore barriers which complicate treatment and nursing have arisen. Children and adolescents is a vulnerable group because their development may be affected physically, emotionally, socially and in school. Aim: To describe how the quality of life in children and adolescents is affected by migraine. Method: In this general literature study have ten empirical studies been examined in terms of quality and content of existing domains of quality of life. The literature search has been made in EBSCO Discovery Service and CINAHL Complete. Results: Migraine affects children’s and adolescents’ quality of life negatively both physically, emotionally, socially and in school. The pain has an impact on their daily activities as well as giving them a sense of worry, depression and anxiety. Even sleep is affected. Migraine makes it difficult to get along and keep up with family and friends, both at school and in leisure. Conclusion: This study contributes to knowledge about how children’s and adolescents’ quality of life is affected by migraine. Knowledge in general does not conform with children’s and adolescents’ experience of migraine. Further research is needed regarding the attitudes/treatment towards migraine.

Introdução: Nas últimas décadas os óbitos por DCNT aumentaram três vezes nos estados brasileiros. Assim, o objetivo do estudo foi identificar a prevalência da obesidade e da hipertensão arterial na população de crianças e adolescentes estudantes da rede estadual de ensino de Ribeirão Preto/SP. Métodos: Foi conduzido um estudo transversal com 505 crianças/adolescentes, da faixa etária de 10 a 16 anos, que frequentavam as escolas estaduais de Ribeirão Preto. A coleta de dados, foi realizada através de pesquisa de campo com visitas às escolas e entrevista dos alunos selecionados ao longo dos anos de 2013 e 2014. Medidas antropométricas (peso, altura, cintura, quadril), e os níveis de pressão arterial foram aferidos em todos os participantes. Resultados: Aproximadamente 53% (n=265) dos estudantes eram do gênero masculino e 47% (n=240) do gênero feminino, com média de idade de 12,74 anos. Verificou-se alteração do peso corporal em 30,9% da população estudada, sendo 18,22% com sobrepeso e 12,67% com obesidade, sem diferença estatística entre os gêneros. Quanto aos níveis de pressão arterial, verificou-se alteração em 8,71% da população total, sendo mais frequente no grupo feminino (4,95%). As crianças com níveis de PA normal admitem passar menos tempo livre sem gasto energético quando comparadas com as de PA alterada [RP 0,92 (IC95% 0,88 0,97)]. Encontrou-se associação significativa [RP 2,02 (IC95% 1,28;3,2)] para o IMC alterado e menarca antes dos 10 anos de idade. A análise de regressão linear simples mostrou associação positiva entre IMC e níveis de PA tanto sistólica (R² = 0,2244; y= 61,1770 + 1,8228x; p<0,001) quanto diastólica (R² = 0,3450; y = 35,2008 + 1,0726 x; p <0,0001). Para as demais variáveis comportamentais e de hábitos alimentares, não foram encontradas associações entre obesidade ou níveis de PA. Conclusão: Observou-se alta prevalência de obesidade e hipertensão arterial na população estudada. Foi encontrada associação positiva entre IMC e HAS. Para as variáveis comportamentais e alimentares poucas foram as associações. Houve associação para a ocorrência da menarca antes dos 10 anos e o IMC alterado. Houve associação também para o aumento dos níveis pressóricos e o tempo livre sem gasto energético. Não foram encontradas associações significativas entre consumo elevado de doces, refrigerantes e a prática de atividade física foi menor que a recomendação feita pela OMS. Ressalta-se a importância do desenvolvimento de estratégias de intervenção com a participação de equipe multiprofissional e familiares para prevenção e controle da obesidade e da hipertensão arterial nas crianças e adolescentes. / Introduction: In recent decades, deaths from CDNT increased three times in the Brazilian county. The objective of the study was to identify the prevalence of obesity and high blood pressure in the population of children and adolescents students of the county school of Ribeirão Preto/SP. Methods: A cross-sectional study was conducted with 505 children / adolescents, the age group 10-16 years who attended state schools in Ribeirão Preto/SP. Data collection was conducted through field research with visits to schools and interviews of selected students over the years 2013 and 2014. Anthropometric measurements (weight, height, waist, and hip) and blood pressure levels were measured for all participants. Results: Approximately 53% (n=265) of the students were male and 47 % (n 240) were female, with a mean age of 12.74 years. There was change in body weight in 30.9 % of the study population, and 18.22 % were overweight and 12.67 % were obese, with no statistical difference between genders. As for blood pressure levels, there was change to 8.71 % of the total population, being more frequent in the female group (4.95%). Children with normal BP levels admit spend less time off without energy expenditure compared with the amended BP [RP 0.92 (95% CI from 0.88 to 0.97)]. Found a significant association [RP 2.02(95% CI 1.28, 3.2)] BMI changed and menarche before 10 years of age. Simple linear regression analysis showed a positive association between BMI and both systolic BP levels (R² = 0.2244, y = 61.1770 + 1,8228x; p < 0.001) and diastolic (R² = 0.3450, y = 35 2008 x + 1.0726; p <0.0001). For the other behavioral and eating habits variables, there were no associations between obesity and BP levels. Conclusion: There was a high prevalence of obesity and hypertension in this population. There was a positive association between BMI and SAH. For behavioral and dietary variables were few associations. There was an association for the occurrence of menarche before age 10 and the changed BMI. Was associated also to increased blood pressure and the free time without energy expenditure. Significant associations between high consumption of sweets, soft drinks and physical activity lower than recommended were found. It emphasizes the importance of developing intervention strategies with the participation of multidisciplinary team, including schools and family for the prevention and control of obesity and high blood pressure in children and adolescents.

Mental health problems in pregnancy and the postnatal period can have long-term negative effects on women and their children. A key barrier to helping women in this period is the low level of identification of mental health problems. Depression has commonly been screened for using the Whooley Questions or Edinburgh Postnatal Depression Scale (EPDS) but women may experience a broad range of symptoms of distress not captured by these measures. The research reported in this dissertation was designed to address several aims. The first strand aimed to explore women's experiences of postnatal mental health problems and how they conceptualise their symptoms. The focus of the first qualitative study was the lived experience of 17 women who had experienced psychological distress in the first postnatal year, and used interpretative phenomenological analysis. The second qualitative study used thematic analysis with the same sample to explore different symptoms of distress and women's experiences of being assessed for these. The second strand reviewed and evaluated currently existing measures of commonly reported affective symptoms with a view to informing future assessment. A systematic review found a lack of measures of anxiety designed for or validated sufficiently with perinatal women. Factor analyses of the EPDS then explored the structure of depression and anxiety symptoms in the perinatal period in the Avon Longitudinal Study of Parents and Children (N = 11,195 – 12,166). Results suggested symptom clusters of anhedonia, depression and anxiety. Finally, validity of the CORE-10, a short measure of psychological distress was evaluated in a sample of 366 pregnant women. The CORE-10 showed promising psychometric properties. Anxiety was the most reported symptom. Overall findings suggest that perinatal women need to be assessed for a variety of mental health problems and that further work is needed to identify the most effective assessment tool and process.

Introdução: Nas últimas décadas os óbitos por DCNT aumentaram três vezes nos estados brasileiros. Assim, o objetivo do estudo foi identificar a prevalência da obesidade e da hipertensão arterial na população de crianças e adolescentes estudantes da rede estadual de ensino de Ribeirão Preto/SP. Métodos: Foi conduzido um estudo transversal com 505 crianças/adolescentes, da faixa etária de 10 a 16 anos, que frequentavam as escolas estaduais de Ribeirão Preto. A coleta de dados, foi realizada através de pesquisa de campo com visitas às escolas e entrevista dos alunos selecionados ao longo dos anos de 2013 e 2014. Medidas antropométricas (peso, altura, cintura, quadril), e os níveis de pressão arterial foram aferidos em todos os participantes. Resultados: Aproximadamente 53% (n=265) dos estudantes eram do gênero masculino e 47% (n=240) do gênero feminino, com média de idade de 12,74 anos. Verificou-se alteração do peso corporal em 30,9% da população estudada, sendo 18,22% com sobrepeso e 12,67% com obesidade, sem diferença estatística entre os gêneros. Quanto aos níveis de pressão arterial, verificou-se alteração em 8,71% da população total, sendo mais frequente no grupo feminino (4,95%). As crianças com níveis de PA normal admitem passar menos tempo livre sem gasto energético quando comparadas com as de PA alterada [RP 0,92 (IC95% 0,88 0,97)]. Encontrou-se associação significativa [RP 2,02 (IC95% 1,28;3,2)] para o IMC alterado e menarca antes dos 10 anos de idade. A análise de regressão linear simples mostrou associação positiva entre IMC e níveis de PA tanto sistólica (R² = 0,2244; y= 61,1770 + 1,8228x; p<0,001) quanto diastólica (R² = 0,3450; y = 35,2008 + 1,0726 x; p <0,0001). Para as demais variáveis comportamentais e de hábitos alimentares, não foram encontradas associações entre obesidade ou níveis de PA. Conclusão: Observou-se alta prevalência de obesidade e hipertensão arterial na população estudada. Foi encontrada associação positiva entre IMC e HAS. Para as variáveis comportamentais e alimentares poucas foram as associações. Houve associação para a ocorrência da menarca antes dos 10 anos e o IMC alterado. Houve associação também para o aumento dos níveis pressóricos e o tempo livre sem gasto energético. Não foram encontradas associações significativas entre consumo elevado de doces, refrigerantes e a prática de atividade física foi menor que a recomendação feita pela OMS. Ressalta-se a importância do desenvolvimento de estratégias de intervenção com a participação de equipe multiprofissional e familiares para prevenção e controle da obesidade e da hipertensão arterial nas crianças e adolescentes. / Introduction: In recent decades, deaths from CDNT increased three times in the Brazilian county. The objective of the study was to identify the prevalence of obesity and high blood pressure in the population of children and adolescents students of the county school of Ribeirão Preto/SP. Methods: A cross-sectional study was conducted with 505 children / adolescents, the age group 10-16 years who attended state schools in Ribeirão Preto/SP. Data collection was conducted through field research with visits to schools and interviews of selected students over the years 2013 and 2014. Anthropometric measurements (weight, height, waist, and hip) and blood pressure levels were measured for all participants. Results: Approximately 53% (n=265) of the students were male and 47 % (n 240) were female, with a mean age of 12.74 years. There was change in body weight in 30.9 % of the study population, and 18.22 % were overweight and 12.67 % were obese, with no statistical difference between genders. As for blood pressure levels, there was change to 8.71 % of the total population, being more frequent in the female group (4.95%). Children with normal BP levels admit spend less time off without energy expenditure compared with the amended BP [RP 0.92 (95% CI from 0.88 to 0.97)]. Found a significant association [RP 2.02(95% CI 1.28, 3.2)] BMI changed and menarche before 10 years of age. Simple linear regression analysis showed a positive association between BMI and both systolic BP levels (R² = 0.2244, y = 61.1770 + 1,8228x; p < 0.001) and diastolic (R² = 0.3450, y = 35 2008 x + 1.0726; p <0.0001). For the other behavioral and eating habits variables, there were no associations between obesity and BP levels. Conclusion: There was a high prevalence of obesity and hypertension in this population. There was a positive association between BMI and SAH. For behavioral and dietary variables were few associations. There was an association for the occurrence of menarche before age 10 and the changed BMI. Was associated also to increased blood pressure and the free time without energy expenditure. Significant associations between high consumption of sweets, soft drinks and physical activity lower than recommended were found. It emphasizes the importance of developing intervention strategies with the participation of multidisciplinary team, including schools and family for the prevention and control of obesity and high blood pressure in children and adolescents.

Researchers have suggested there is a wide range of neuropsychological deficits individuals with anorexia nervosa (AN) possess, including impairments in nonverbal reasoning, attention and processing speed, memory, and executive functioning. While growing, examination of the neuropsychological functioning of children and adolescents with AN is quite sparse compared to the abundance of research on adults with AN, and the many conflicting findings have been attributed to inconsistent methodologies across studies. This study examined the neuropsychological functioning of children and adolescents with AN by conducting a quantitative study loosely based on Bayless et al. (2002) and Remberk, Namysłowska, Krempa-Kowalewska, Gadaś, and Skalska (2011). Results indicated verbal intellectual functioning was significantly higher than other intellectual domains, and verbal memory was almost significantly higher than nonverbal memory (p = .051). Negative correlations were found between individual subtests and clinical data (e.g., age of onset of AN and duration of AN) as well as the EDI-3 Personal Alienation scale and the BMI-for-age percentile. Clinical implications include providing treatment improving cognitive functioning and implementing a biopsychosocial model.

Syfte Syftet med studien var att beskriva hur barn- och ungdomsledare resonerar kring att inkludera barn och ungdomar med funktionsnedsättning inom föreningsidrottens aktiviteter. Metod En kvalitativ intervjustudie valdes som design där 12 barn- och ungdomsledare deltog i studien. Deltagarna var mellan 30-45 år gamla (medelålder 36,6 år) och aktiva inom föreningsidrotten sedan minst 1 år tillbaka (medelvärde 7,9 år). Studien innefattade idrotterna innebandy, fotboll, handboll, simning, gymnastik och friidrott och samtliga deltagare hade erhållit minst en ledarutbildning. Urvalet av deltagare skedde genom ett snöbollsurval med utgångspunkt i två skilda geografiska områden i Sverige. Vid dataanalysen användes en kvalitativ innehållsanalys med induktiv ansats och resultatet presenterades i tre kategorier med tillhörande underkategorier tillsammans med citat från deltagarna. Resultat I kategorierna Individens förutsättningar och hur föräldrar och ledare påverkar möjligheten tillinkludering, Idrottens utformning och föreningars arbete kring inkludering samt Hur bemötande från omgivningen och samhällets utformning påverkar inkludering presenterades ett flertal olika förutsättningar som kan skapa möjligheter för en framgångsrik inkludering av barn- och ungdomar med funktionsnedsättning inom föreningsidrotten. I resultatet framkom bland annat att utbildning, ledares kompetens och föräldrars engagemang var viktiga förutsättningar för en lyckad inkludering. Konklusion Studien har bidragit till en inblick kring vilka förutsättningar som främjar barn och ungdomar med funktionsnedsättningars möjligheter att delta inom föreningsidrotten. Resultatet gav indikationer på att arbetsterapeutens kompetens kan användas för att främja en möjlig inkludering för barn och ungdomar med funktionsnedsättning.

The investigations described in this thesis were conducted in order to increase the understanding of the relationships between physical activity, aerobic fitness, body composition, asthma, and asthma severity in children and adolescents. This was largely achieved by examining the aforementioned factors in a sizeable population of Melbourne school children and adolescents. However, during the course of the school-based testing, it became apparent that the severe asthmatic category was under-represented, typical of the current literature. Thus, effort was also directed at addressing this knowledge gap by examining a severely asthmatic cohort in a laboratory-based setting. The outcomes generated by these investigations can be summarised as follows: 1) In ‘school-tested’ youth aged 10 to 14 years, prevalence rates of overweight and obesity were 19.1% and 4.0%, respectively. Approximately 16% of participants also suffered from asthma. These rates appear to be representative of similarly aged children and adolescents within Australia. The latter observation also adds weight to the view that asthma prevalence has attenuated in recent years. In addition, overweight and obesity were more prevalent in asthmatics than non-asthmatics, supporting the proposed notion of an asthma-obesity association. 2) Asthmatic and non-asthmatic young people had comparable aerobic fitness and daily physical activity levels and the severity of disease did not influence aerobic fitness nor involvement in physical activity. Males possessed greater aerobic fitness and physical activity levels and had a lower percentage body fat compared to age-matched females, independent of asthma status (i.e. asthmatic or non-asthmatic). 3) There was a significant inverse relationship between aerobic fitness and markers of increased body fat among non-asthmatic children and adolescents, even after corrections to aerobic fitness were made for fat free mass. Differences in daily physical activity could only partially explain this association. In fact, the current findings suggest that decreased levels of daily physical activity are not the cause of the increased overweight/obesity prevalence among this sample, and that physical activity lacks a strong link to paediatric overweight/obesity in this population. These findings were also present in asthmatic youth. 4) Severely asthmatic youth, premedicated with bronchodilator, had aerobic fitness levels comparable to their non-asthmatic and less severe asthmatic peers. This finding indicates that severely asthmatic youngsters should be able to train at work intensities sufficient to bring about improvements in cardio-respiratory fitness without any added functional limitation due to their condition. In addition, a state of well-controlled asthma (as were the severe asthmatics in this study) afforded the participants the ability to engage in similar levels of physical activity as their non-asthmatic or less severe asthmatic peers. In agreement with data from the ‘school-tested’ asthmatics, a significantly greater proportion of severely asthmatic participants were overweight or obese in comparison to their non-asthmatic peers. These findings (i) highlight the association between aerobic fitness and overweight/obesity; (ii) suggested that decreased levels of daily physical activity were not associated with the increased overweight/obesity prevalence in a youth sample within Australia; (iii) emphasize that well-controlled asthmatic young people can undertake levels of physical activity and achieve cardio-respiratory fitness similar to that of their non-asthmatic peers, independent of asthma severity, and; (iv) indicated that asthma is either a risk factor for overweight and obesity or that overweight and obesity may precede asthma.