John Knight

Attachment characteristics and behavioural problems in rural and urban juvenile delinquents

Self-reported attachment characteristics, substance use and behavioural problems were assessed in 68 male juvenile delinquents from rural and urban areas. As was predicted, insecure attachment characteristics were related to behavioural problems, substance use, and poor family functioning. Urban delinquents reported more substance use and more interpersonal problems with peers and family members than their rural counterparts. Contextual influences on adolescent attachment relationships and adjustment problems may have implications for the administration and delivery of psychological treatments in youth correctional settings.

Behavioural and substance use problems in rural and urban delinquent youths.

Objective: To examine rates of behavioural and substance use problems in incarcerated young offenders and to explore rural and urban differences in the expression and severity of these problems. Method: We assessed a sample of 68 confined male young offenders (63.3% rural and 35.3% urban), using the Drug Use Screening Inventory (DUSI) and the Youth Self-Report (YSR). Results: Based on clinical cut-offs, data showed high rates of externalizing behavioural problems (75.4%) and substance use problems (95.7%). Urban delinquent youths showed higher rates of attention problems, delinquent behaviours, and externalizing behaviours than those in rural communities. Conclusions: Incarcerated young offenders show elevated rates of psychological problems that require treatment. Rural and urban differences in the rates of these problems may reflect differences in community service availability in these areas or in environmental influences on the development of child behavioural problems.

The relationship among body mass index, subjective reporting of chronic disease, and the use of health care services in Newfoundland and Labrador, Canada.

The purpose of the study was to examine the association of body mass index (BMI) with the prevalence of chronic disease and health services use in adults living in Newfoundland and Labrador (NL). A cross-sectional analysis of 2345 adult respondents to the 2001 Canadian Community Health Survey was performed. Outcome measures included the prevalence of chronic disease and health services use. The sample comprised normal (37%), overweight (39%), obese (17%), and morbidly obese (6%) individuals. Obese and morbidly obese individuals were more likely to report the presence of a chronic disease. Adjusting for age and sex, increasing BMI category was significantly associated with a greater likelihood of cardiovascular, endocrine, and pulmonary diseases (excluding asthma). The majority of survey respondents in each category reported having a regular doctor (>75%), and there were no significant differences across categories. Compared to those with a normal BMI, obese and morbidly obese individuals reported a significantly higher number of visits to a family physician. There were no differences across BMI categories and the use of specialist or hospital services. Almost a quarter of the study sample in NL was classified as morbidly obese or obese. These individuals reported more chronic conditions and more visits to a family physician than the normal-weight group. The greater morbidity and the increased frequency of visits to family physicians suggests greater consideration should be given to channeling financial and human resources to the primary health care of this high-risk population.

Idazoxan increases perforant path-evoked EPSP slope paired pulse inhibition and reduces perforant path-evoked population spike paired pulse facilitation in rat dentate gyrus

Norepinephrine, acting via beta-adrenoceptors, enhances the perforant path-evoked potential in dentate gyrus. Using systemic idazoxan to increase norepinephrine, and paired perforant path pulses to probe early inhibition, previous investigators reported that idazoxan increased initial spike amplitude and increased somatic feedback inhibition. Here, feedback inhibition was re-examined in idazoxan-treated (5 mg/kg) rats under urethane anesthesia. To control for initial increased spike amplitude after idazoxan, evoked potentials were matched, pre- and post-idazoxan, on initial population spike. Input-output current profiles were also compared pre- and post-idazoxan. Saline- and timolol-filled micropipettes permitted evaluation of a contribution of local beta-adrenoceptors. As previously observed, initial spike amplitude was potentiated by idazoxan. Comparable spike potentiation was not seen on the timolol micropipette. Paired pulse inhibition of spike amplitude apparently increased, but input-output curve comparisons revealed a loss of feedback facilitation rather than an increase in feedback inhibition. Initial EPSP slopes were depressed after idazoxan in input-output curve data. EPSP slope feedback ratios were significantly reduced following idazoxan. These data suggest idazoxan has multiple effects on perforant path input to the dentate gyrus. Spike potentiation following idazoxan has previously been shown to depend on intact norepinephrine input. Here, the reduction in spike potentiation on the timolol pipette is consistent with other evidence that norepinephrine-mediated potentiation of the perforant path-evoked potential is dependent on local beta-adrenoceptor activation. The input-output data suggest a decrease in feedback facilitation after idazoxan is likely to account for the apparent increase in feedback inhibition previously reported. Decreased EPSP slope ratios with similar paired pulse intervals have been reported in novel environments. Since exposure to novel environments activates locus coeruleus neurons, norepinephrine may mediate the change in EPSP slope inhibition reported in awake rats. In summary, these results are consistent with the hypothesis that idazoxan potentiates granule cell responses to perforant path input in the dentate gyrus via increases in norepinephrine that lead to beta-adrenoceptor activation, and, further, that idazoxan reduces paired pulse feedback spike facilitation and enhances EPSP slope, but not spike, feedback inhibition.

Relation between family physician retention and avoidable hospital admission in Newfoundland and Labrador: a population-based cross-sectional study

BACKGROUNDnPhysician turnover, involving physicians leaving clinical practice in a specific area, may disrupt continuity of care, leading to poorer health outcomes and greater use of health care services. The purpose of this study was to investigate the relation between family physician retention and avoidable hospital admission for ambulatory-care-sensitive conditions.nnnMETHODSnWe conducted a population-based cross-sectional study using provincial health administrative data for residents of Newfoundland and Labrador who held a provincial health card between 2001 and 2009. Five-year family physician retention was calculated by regional economic zone, and residents within economic zones were grouped into tertiles based on physician retention level. We compared hospital admission for ambulatory-care-sensitive conditions among tertiles while adjusting for covariates.nnnRESULTSnFor 475u202f691 residents of the province, there was a negative relation between physician retention and hospital admission for ambulatory-care-sensitive conditions: residents of areas with moderate or low physician retention had admission rates that were 16.5% (95% confidence interval [CI) 12.6%-20.4%) and 19.9% (95% CI 15.2%-24.7%) higher, respectively, compared to areas with high retention. No relation was found when analysis was limited to those aged 65 years or more.nnnINTERPRETATIONnThe findings suggest that high physician retention is associated with lower rates of hospital admission for ambulatory-care-sensitive conditions even after control for other factors. This is consistent with our hypothesis that physician turnover acts to disrupt continuity of care, resulting in higher admission rates.