E-mental health care among young adults and help-seeking behaviors: a transversal study in a community sample

Background

The Internet is widely used by young people and could serve to improve insufficient access to mental health care. Previous information on this topic comes from selected samples (students or self-selected individuals) and is incomplete.

Objective

In a community sample of young adults, we aimed to describe frequency of e-mental health care study-associated factors and to determine if e-mental health care was associated with the use of conventional services for mental health care.

Methods

Using data from the 2011 wave of the TEMPO cohort study of French young adults (N=1214, aged 18-37 years), we examined e-mental health care and associated factors following Andersen’s behavioral model: predisposing factors (age, sex, educational attainment, professional activity, living with a partner, children, childhood negative events, chronic somatic disease, parental history of depression), enabling factors (social support, financial difficulties, parents’ income), and needs-related factors (lifetime major depression or anxiety disorders, suicidal ideation, ADHD, cannabis use). We compared traditional service use (seeking help from a general practitioner, a psychiatrist, a psychologist; antidepressant or anxiolytics/hypnotics use) between participants who used e-mental health care versus those who did not.

Results

Overall, 8.65% (105/1214) of participants reported seeking e-mental health care in case of psychological difficulties in the preceding 12 months and 15.7% (104/664) reported psychological difficulties. Controlling for all covariates, the likelihood of e-mental health care was positively associated with 2 needs-related factors, lifetime major depression or anxiety disorder (OR 2.36, 95% CI 1.36-4.09) and lifetime suicidal ideation (OR 1.91, 95% CI 1.40-2.60), and negatively associated with a predisposing factor: childhood life events (OR 0.60, 95% CI 0.38-0.93). E-mental health care did not hinder traditional care, but was associated with face-to-face psychotherapy (66.2%, 51/77 vs 52.4%, 186/355, P=.03).

Conclusions

E-mental health care represents an important form of help-seeking behavior for young adults. Professionals and policy makers should take note of this and aim to improve the quality of online information on mental health care and to use this fact in clinical care.

Hall effect in the accumulation layers on the surface of organic semiconductors

We have observed the Hall effect in the field-induced accumulation layer on the surface of single-crystal samples of a small-molecule organic semiconductor rubrene. The Hall mobility muH increases with decreasing temperature in both the intrinsic (high-temperature) and trap-dominated (low-temperature) conduction regimes. In the intrinsic regime, the density of mobile field-induced charge carriers extracted from the Hall measurements, nH, coincides with the density n calculated using the gate-channel capacitance and becomes smaller than n in the trap-dominated regime. The Hall data are consistent with the diffusive bandlike motion of field-induced charge carriers between trapping events.

Intrinsic charge transport on the surface of organic semiconductors

The air-gap field-effect technique enabled realization of the intrinsic (not limited by static disorder) polaronic transport on the surface of rubrene (C42H28) crystals over a wide temperature range. The signatures of this intrinsic transport are the anisotropy of the carrier mobility, mu, and the growth of mu with cooling. Anisotropy of mu vanishes in the activation regime at low temperatures, where the transport is dominated by shallow traps. The deep traps, introduced by x-ray radiation, increase the field-effect threshold without affecting mu, an indication that the filled traps do not scatter polarons.

Clinical and MRI long term evolution of intracavernous and carotid ophtalmic artery aneurysms, treated by common carotid ligation

In four large, 15-25 mm, internal carotid artery aneurysms (3 intracavernous and 1 carotid ophthalmic), treatment by common carotid ligation was preferred. Pre- and postoperative MRI were obtained, at a delay between 5 to 9 years. Recovery of the ocular and visual symptomatology was a function of the role played by mechanical and/or ischaemic factors. No early or late consequences, ascribable to the common carotid ligation, were observed. Aneurysmal thrombosis occurred in the first postoperative week, but retraction of the thrombosed aneurysms was only obvious and maximal after several months. For this reason, rapid clinical recovery could be due, in the first instance, to the loss of aneurysmal pulsatility. Complete disappearance of the aneurysm was observed in two cases. In the other two, a small remnant of the initial lesion, without any unfavourable consequences, was revealed, respectively 6 and 9 years after the intervention, by current, modern-days, MRA.

The association of tranexamic acid and nimodipine in the pre-operative treatment of ruptured intracranial aneurysms

In the scope of a late intervention policy on ruptured intracranial aneurysms, on D.+12 on an average, we first used tranexamic acid, at moderate doses: 3 g orally or 1.5 g intravenously per day. We, subsequently, added nimodipine, usually 240 mg orally per day or 2 mg intravenously per hour. The medical treatment consisted of amply sufficient hydration, and in systematic and regular administration of analgesics and sedatives. Hypotension was absolutely avoided; if necessary, an antihypertensive treatment was prescribed very cautiously. Phenytoin was regularly given. In the present study, we try to answer the following questions: (1) Can we confirm that the preventive action of tranexamic acid remains as effective, when doses, markedly lower than usually recommended, are used? (2) Does nimodipine prevent the increase of pre-operative ischaemic complications, which should be expected when tranexamic acid is administered? Amongst 101 patients with SAH of proven aneurysmal origin, 84 were treated with tranexamic acid and nimodipine. In 25 patients, an aneurysm was not visualised; 21 received this treatment. For several reasons, only a retrospective study was possible, to evaluate the results of our antifibrinolytic and calcium-blocking therapies, on rebleeding and pre-operative delayed ischaemia. We compared, therefore, similar cases from the literature, with our own cases, taking into consideration the clinical grades, the days of admission and of intervention, the moment of rebleeding and of delayed pre-operative ischaemia, etc. The following impressions emerge: (1) same effectiveness of moderate doses of tranexamic acid; (2) no increase of pre-operative delayed ischaemic complications, in comparison with patients not receiving antifibrinolytics but nimodipine; (3) important role of a devastating initial bleed and of operative complications; (4) difficulty of avoiding rebleeding at D.0, whatever the therapeutic measures, medical and/or surgical.

The changing face of children's health: a positive state perspective

In the midst of health care cutbacks, imposed or increasing copays, and managed care crises, the face of children's health care is undergoing significant changes. These, quite fortunately for the children of Texas, are positive changes, including the establishment of the Texas Healthy Kids Corporation and utilization of the newly implemented Children's Health Insurance Plan.

The influence of desmopressin on blood loss during spinal fusion surgery in neuromuscular patients

STUDY DESIGN

A double-blind study comparing the effects of desmopressin and a placebo (normal saline) on blood loss during spinal instrumentation for neuromuscular scoliosis.

OBJECTIVE

To determine the effectiveness of desmopressin acetate (DDAVP) in reducing operative blood loss in hemostatically normal patients undergoing spinal fusion surgery for neuromuscular scoliosis.

SUMMARY OF BACKGROUND DATA

Desmopressin acetate has been shown to improve bleeding times and to provide surgical hemostasis in patients with platelet disorders. Its effect in reducing bleeding times in normal patients has been the subject of debate in several surgical specialties. Recent observations that DDAVP seems to reduce bleeding times and blood loss in patients undergoing spinal surgery for neuromuscular scoliosis warranted a more focused analysis on its role in this surgical procedure.

METHODS

Patients undergoing surgery for neuromuscular scoliosis were randomly assigned to receive DDAVP or placebo. Bleeding times and plasma clotting factors were measured before the administration of the DDAVP or placebo and 60 minutes after. Operative blood loss was carefully measured.

RESULTS

Although the administration of DDAVP decreased overall blood loss by an average of 19% compared with blood loss in the placebo group and blood loss per vertebra fused by an average of 15%, these results were not statistically significant.

CONCLUSIONS

Bleeding time and blood loss seem to respond better to DDAVP in some patients, in whom significant decreases were observed, than they do in others. The problem is in identifying those patients in whom a decrease in bleeding time will be elicited after administration of DDAVP. Preoperative administration of DDAVP to such patients should significantly decrease operative blood loss.

Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage

The radiological aspect, pathology, treatment and results of 132 subdural haematomas observed in 100 patients, are discussed. The majority of these cases were characterized by a nonhomogenous CT scan picture, resulting from repeated bleeding in a previous subdural haematoma evolving to chronicity, or in a pre-existent subdural hygroma. Taking aspirin may have constituted a predisposing factor in 16% of our patients, whilst coagulation disturbances, including anticoagulant treatment, were observed in another 6%; ethylism was present in 11%. A traumatic origin was ascertained in 80% of the patients. The treatment consisted of burr hole evacuation and drainage in 91.5% of the haematomas, corresponding to 92% of the patients; it was eventually repeated once or twice in some cases. In 6% of the patients, a subduro-peritoneal drainage had to be placed ultimately and in 2%, a membranectomy had to be performed because the haematoma had become nearly completely fibrous. The necessity for repeated evacuation and eventual subduro-peritoneal drainage seems to depend mainly on a slow brain re-expansion in some elderly people, who are actually more frequently referred. Two patients died; one was deeply comatose and another in poor general condition. Morbidity in the 96 remaining patients, 2 being lost to follow-up, was 11%: 5% related to the haematoma or to the causal trauma, and 6% from other concomitant neurological disease. The functional result was satisfactory in 85%.