Access to and perceived unmet need for mental health services and support in a community sample of UK adolescents with and without experience of childhood adversity

AIMS

Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students.

METHODS

We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children's Anxiety and Depression Scale (RCADS).

RESULTS

Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR) = 1.36; 95% confidence interval (CI): 1.29-1.43) and perceived unmet need for mental health services (OR = 1.47; 95% CI: 1.37-1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR) = 1.25; 95% CI: 1.17-1.34 with a significant interaction between RCADS and ACE scores, aOR = 0.88; 95% CI: 0.84-0.93) as well as perceived unmet need (aOR = 1.32; 95% CI: 1.21-1.43 with a significant interaction between RCADS and ACE scores, aOR = 0.85; 95% CI: 0.78-0.91).

CONCLUSIONS

Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.

COmbination of Targeted temperature management and Thrombectomy after acute Ischemic Stroke (COTTIS): a pilot study

BACKGROUND

To evaluate the feasibility and safety of a fast initiation of cooling to a target temperature of 35°C by means of transnasal cooling in patients with anterior circulation large vessel occlusion (LVO) undergoing endovascular thrombectomy (EVT).

METHODS

Patients with an LVO onset of <24 hour who had an indication for EVT were included in the study. Transnasal cooling (RhinoChill) was initiated immediately after the patient was intubated for EVT and continued until an oesophageal target temperature of 35°C was reached. Hypothermia was maintained with surface cooling for 6-hour postrecanalisation, followed by active rewarming (+0.2°C/hour). The primary outcome was defined as the time required to reach 35°C, while secondary outcomes comprised clinical, radiological and safety parameters.

RESULTS

Twenty-two patients (median age, 77 years) were included in the study (14 received additional thrombolysis, 4 additional stenting of the proximal internal carotid artery). The median time intervals were 309 min for last-seen-normal-to-groin, 58 min for door-to-cooling-initiation, 65 min for door-to-groin and 123 min for door-to-recanalisation. The target temperature of 35°C was reached within 30 min (range 13-78 min), corresponding to a cooling rate of 2.6 °C/hour. On recanalisation, 86% of the patients had a body temperature of ≤35°C. The median National Institutes of Health Stroke Scale at admission was 15 and improved to 2 by day 7, and 68% of patients had a good outcome (modified Rankin Scale 0-2) at 3 months. Postprocedure complications included asymptomatic bradycardia (32%), pneumonia (18%) and asymptomatic haemorrhagic transformation (18%).

CONCLUSION

The combined application of hypothermia and thrombectomy was found to be feasible in sedated and ventilated patents. Adverse events were comparable to those previously described for EVT in the absence of hypothermia. The effect of this procedure will next be evaluated in the randomised COmbination of Targeted temperature management and Thrombectomy after acute Ischemic Stroke-2 trial.

Limited Cutaneous Leishmaniasis as Ulcerated Verrucous Plaque on Leg, Tucson, Arizona, USA1

We report a 34-year-old man who had a nonhealing, verrucous plaque with central ulceration on the lower leg. This case-patient is a rare example of endemic limited cutaneous leishmaniasis in Tucson, Arizona, USA. Clinicians should be aware of this disease because its manifestations can vary for individual patients.

260 Comparison of Patient Satisfaction and Outcomes of Day Case Mastectomy Versus Inpatient Model, Using a Validated Questionnaire

Introduction

Many women undergoing simple mastectomy have an overnight hospital stay. Offering a day case procedure for simple mastectomy has the potential to improve outcomes in terms of patient safety, feasibility, and reduction in associated costs. We aimed to study the proportion of day case mastectomies over a 2-year period and assessed relative readmission and complication rates alongside patient reported outcome measures (PROMs). Following this, we wanted to analyse whether a day case procedure should be routinely offered.

Method

A retrospective audit was conducted on all patients undergoing a simple mastectomy. Data were collected from patient and pathology records. PROMs were obtained via telephone conversation using the validated BREAST-Q survey. Patient demographics, reason for mastectomy and readmission for complications were all assessed.

Results

Out of the 202 patients analysed, over 75% had an overnight stay. The most common complications for both groups of patients were readmission due to infection and haematoma evacuation, with similar rates across the two (p = 0.26, p = 0.69). Data from PROMs also suggested that patients had similar outcome and satisfaction levels (p = 0.27).

Conclusions

The result from this study shows that it is safe as well as acceptable to patients to offer simple mastectomies as a day case procedure. This has become more important since COVID-19 reduced inpatient theatre capacity, and it is anticipated that these outcomes will allow a routine day case mastectomy pathway to be established even when normal operations recommence as encouraged by the association of day case surgery.

Is there still a role for talimogene laherparepvec (T-VEC) in advanced melanoma? An indirect efficacy comparison of T-VEC plus ipilimumab combination therapy versus T-VEC alone as salvage therapy in unresectable metastatic melanoma

BACKGROUND

Talimogene laherparepvec (T-VEC) improves overall survival (OS) in unresectable stage IIIB/C-IV melanoma T-VEC may have synergistic effects with CTLA-4 inhibitors In the absence of a trial comparing T-VEC and ipilimumab (T-VEC + IPI) to T-VEC, we applied a novel indirect comparison method using extrapolated OS curves to estimate OS outcomes in a simulated trial comparing both regimens in stage IIIB/C-IV unresectable melanoma.

RESEARCH DESIGN AND METHODS

Two trials with extractable OS curves for a T-VEC versus T-VEC + IPI comparison were identified. Outcomes were adjusted for heterogeneity in prognostic factors using a calculated adjustment factor. T-VEC and adjusted/unadjusted T-VEC+IPI curves were plotted with 95% CIs.

RESULTS

Unadjusted indirect OS comparison of T-VEC versus T-VEC + IPI revealed no significant difference up to 15 months. Extrapolation beyond 15 months showed significant survival benefits for T-VEC + IPI over T-VEC, confirmed in adjusted analyses. The expected OS percentage at 48 months is 32.0% (95% CI = 26.6-37.3) for T-VEC, 60.0% (95% CI = 46.2-69.1) for unadjusted, and 81.1% (95% CI = 72.3-85.9) for adjusted T-VEC + IPI.

CONCLUSIONS

Our novel indirect comparison suggests that T-VEC + IPI may demonstrate a significantly improved OS versus T-VEC alone. Findings may portend a possible role for the addition of T-VEC to advanced melanoma treatment regimens in select patients as salvage therapy.

Suicidal ideation in the perinatal period: findings from the Thailand-Myanmar border

BACKGROUND

Suicide is a leading cause of maternal death globally. Migrant and refugee populations may experience higher risk of suicide. We report data on suicidal ideation from migrant and refugee women living on the Thailand-Myanmar border.

METHODS

Women were recruited in their first trimester of pregnancy. Depression status was assessed by diagnostic interview in the first, second and third trimesters and at 1 month post-partum. We calculated prevalence of suicidal ideation and used logistic regression to identify associated socio-demographic factors.

RESULTS

During the perinatal period, 5.3% (30/568) women experienced suicidal ideation. Refugee women were more likely to experience suicidal ideation than migrant women (8.0 versus 3.1%; P = 0.01). Most women with suicidal ideation did not have severe depression. Previous trauma (OR 2.32; 95% CI: 1.70-3.15) and unplanned pregnancy (OR 2.74; 95% CI: 1.10-6.86) were significantly associated with suicidal ideation after controlling for all other variables.

CONCLUSIONS

Suicidal ideation represents an important symptom among migrant and refugee women on the Thailand-Myanmar border. Screening only those with severe depression may be insufficient to identify women at risk of suicide. Community-level interventions addressing social and gender inequalities and prioritization of family planning programmes are needed alongside targeted suicide prevention initiatives to help lower the rates of people dying by suicide.

The Effect of Microencapsulation of Phenolic Compounds from Lemon Waste by Persian and Basil Seed Gums on the Chemical and Microbiological Properties of Mayonnaise

Natural preservatives with high level of phenolic compounds, antioxidants and antimicrobial activities are used in mayonnaise to improve quality and safety due to their potential health benefits. Application of these compounds in production processes highlights many difficulties due to instability of their physical and chemical properties. Microencapsulation is used to address these restrictions. In this study, phenolic compounds from lemon waste were encapsulated with Persian gum (PG) and basil seed gum (BSG) as coating materials at different ratios (0:1, 1:0, and 1:1) at 15% (w/w) total biopolymer. We confirmed microencapsulation by scanning electron microscopy, and evaluate phenolic content, antioxidant activity, encapsulation efficiency, morphology, water solubility indexes, and water absorption indexes. Sample mayonnaise was prepared using microencapsulated polyphenols from lemon waste and extract (1,000 ppm of concentration), and control samples without extracts or microcapsules. All samples were subjected to chemical (measuring the peroxide, thiobarbituric acid, acidity, and color) and microbial (total count of microorganisms and Escherichia coli) analysis during 30 days of storage. BSG samples exhibited the highest antioxidant activity (61.19%) and encapsulation efficiency (70.72%), and PG/BSG microcapsules had the highest capability to prevent oxidative deterioration during storage. Addition of microcapsules led to increases in parameter b^* and decreases in parameters a^* and L^*. In general, PG/BSG microcapsules were considered optimal samples for production of mayonnaise, since they prevented mayonnaise deterioration and exhibited antioxidant and antimicrobial properties.

Microstructure and Corrosion Characterization of a MgO/Hydroxyapatite Bilayer Coating by Plasma Electrolytic Oxidation Coupled with Flame Spraying on a Mg Alloy

Thermally sprayed hydroxyapatite coatings are one of the main strategies to improve the bioactivation of metal implants. However, the naturally low corrosion resistance of these coatings is the main challenge for their use. In this study, plasma electrolytic oxidation (PEO) was used to create an intermediate layer. The anodization process was used for comparison. According to the polarization curves, the PEO layer was more effective than the anodized layer in reducing the corrosion current density (I _corr of 0.05 × 10^-9 A/cm² vs I _corr of 0.05 A/cm²). The results of electrochemical impedance spectroscopy showed higher resistance of the sample with a PEO interlayer than that of the sample with an anodized interlayer. The results of the hydrogen evolution test revealed that the PEO layer as a middle layer served as the main barrier for reducing the magnesium corrosion rate, especially during the initial immersion time.

A co-curricular diabetes-specific elective with interprofessional students and faculty

BACKGROUND AND PURPOSE

Develop and assess the effectiveness of an interprofessional co-curricular elective in improving pharmacy students' confidence in providing diabetes self-management education and support (DSMES) to patients.

EDUCATIONAL ACTIVITY AND SETTING

As part of an interprofessional collaboration, a student organized diabetes-specific enrichment elective, was offered originally to medical students and then extended to include pharmacy students. The interprofessional elective included an overview of diabetes and its prevention, medications, insulin therapy/administration, blood glucose monitoring, insulin pumps, nutrition and fitness. This elective served as a co-curricular activity, in that it was not offered for course credits, rather provided an opportunity to learn in an interprofessional environment with small group, unstructured interactions. The impact of the elective on pharmacy student confidence was evaluated using a retrospective pre-post survey.

FINDINGS

A total of 16 pharmacy students participated (response rate of 63%). A Wilcoxon signed-rank test revealed an increase in students' confidence in most of the areas assessed. Eighty percent of respondents found the elective valuable.

SUMMARY

An interprofessional co-curricular diabetes-specific elective significantly improved pharmacy students' confidence in providing DMSES to patients in the majority of assessed areas. Pharmacy and medical students were given the opportunity to learn alongside one another and learn from an interprofessional team of instructors in a setting that modeled such communication and collaboration. Developing such enrichment electives may be beneficial to equip students with the skills needed to provide education/support to patients with chronic diseases and interact with other health professionals effectively.

Improvement of Corrosion and Tribocorrosion Behavior of Pure Titanium by Subzero Anodic Spark Oxidation

The present investigation reports corrosion and tribocorrosion behavior of anodic spark oxidation (ASO) coatings formed at 20 and -10 °C. Despite the numerous open pores on the layers formed at 20 °C , the plasma discharged channels were blocked on the surfaces of the subzero ASO coatings. According to polarization curves, the samples treated at -10 °C showed a significant increase in the corrosion resistance ( j_corr of 0.75 nA cm^-2). Electrochemical impedance spectroscopy experiments illustrated lower capacitance and higher resistance of both inner and porous layers formed at low temperature. Subzero ASO coatings also demonstrated the lowest overall open circuit potential drop in tribocorrosion studies.

Impact of supplemental training programs on improving medical students' confidence in providing diabetes self-management education and support

BACKGROUND/PURPOSE

The purpose of this study was to evaluate the effectiveness of supplemental diabetes-related training modalities and volunteer activities in increasing first-year medical students' knowledge/comfort in providing diabetes self-management education and support (DSMES) to patients.

METHODS

A group of medical students developed supplemental diabetes-related training/volunteer programs. The training modalities included an optional 7-session interprofessionally taught Diabetes Enrichment Elective and a 3-hour endocrinologist-led training session intended to prepare students for involvement in an inpatient DSMES volunteer program. The volunteer program provided the students with the opportunity to provide DSMES to patients with diabetes admitted to an academic medical center. Those participating in any of the stated programs were compared to those with no such training regarding confidence in providing DSMES using an optional online survey. The results were analyzed by using Mann-Whitney U test and descriptive analyses.

RESULTS

A total of 18 first-year medical students responded to the optional survey with a response rate of ~30% (10 of 33) among participants in any training/volunteer program. First-year medical students who attended any of the offered optional programs had statistically significant higher comfort level in 4 of the 6 areas assessed regarding providing DSMES compared with those with no such training (p<0.05), with medium to large effect size (r=0.48-0.59).

CONCLUSION

This study suggests that the supplemental preclerkship diabetes-specific training modalities/volunteer programs can provide benefit in providing medical students with practical knowledge while improving their confidence in providing DSMES to patients with diabetes.

A Topical Zinc Ionophore Blocks Tumorigenic Progression in UV-exposed SKH-1 High-risk Mouse Skin

Nonmelanoma skin cancer (NMSC) is the most common malignancy in the United States representing a considerable public health burden. Pharmacological suppression of skin photocarcinogenesis has shown promise in preclinical and clinical studies, but more efficacious photochemopreventive agents are needed. Here, we tested feasibility of harnessing pharmacological disruption of intracellular zinc homeostasis for photochemoprevention in vitro and in vivo. Employing the zinc ionophore and FDA-approved microbicidal agent zinc pyrithione (ZnPT), used worldwide in over-the-counter (OTC) topical consumer products, we first demonstrated feasibility of achieving ZnPT-based intracellular Zn²⁺ overload in cultured malignant keratinocytes (HaCaT-ras II-4; SCC-25) employing membrane-permeable fluorescent probes. Zinc overload was accompanied by induction of intracellular oxidative stress, associated with mitochondrial superoxide release as substantiated by MitoSOX Red™ fluorescence microscopy. ZnPT-induced cell death observable in malignant keratinocytes was preceded by induction of metal (MT2A), proteotoxic (HSPA6, HSPA1A, DDIT3, HMOX1) and genotoxic stress response (GADD45A, XRCC2) gene expression at the mRNA and protein levels. Comet analysis revealed introduction of formamidopyrimidine-DNA glycosylase (Fpg)-sensitive oxidative DNA lesions. In a photocarcinogenesis model (UV-exposed SKH-1 high-risk mouse skin), topical ZnPT administration post-UV caused epidermal zinc overload and stress response gene expression with pronounced blockade of tumorigenesis. Taken together, these data suggest feasibility of repurposing a topical OTC drug for zinc-directed photochemoprevention of solar UV-induced NMSC.

Migration and perinatal mental health in women from low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Migrant women are at risk of perinatal mental disorders due to stressors experienced before, during and after migration.

OBJECTIVES

This systematic review and meta-analysis summarises the prevalence, associated factors and interventions for perinatal mental disorders in migrant women from low- and middle-income countries (LMIC).

SEARCH STRATEGY

We systematically searched nine electronic databases and the grey literature using a predefined search strategy.

SELECTION CRITERIA

Studies were included if they assessed pregnant or postpartum migrants from LMIC, used a structured tool and a case-control, cross-sectional, cohort or intervention study design.

DATA COLLECTION AND ANALYSIS

Data was double-extracted. We calculated pooled prevalence of depression and weighted mean anxiety and depression scores. We calculated crude odds ratios from risk factor studies and summarised intervention studies descriptively.

MAIN RESULTS

Forty studies were identified from 10 123 references. Pooled prevalence was 31% [95% condidence interval (CI) 23%-40%] for any depressive disorder and 17% (95% CI 12-23%) for major depressive disorder. Previous depression and lower social support were associated with perinatal depression. There were insufficient data to assess the burden of anxiety, post-traumatic stress disorder or psychosis in this population.

CONCLUSIONS

One in three migrant women from LMIC experiences symptoms of perinatal depression. Social support is an important protective factor. Evidence on LMIC women relocating to other LMIC is lacking. Given the adverse consequences of perinatal mental illness on women and their children, further research in low-resource settings is a priority.

TWEETABLE ABSTRACT

One in three migrant women from low- and middle-income countries has symptoms of perinatal depression.

A student-implemented elective to improve medical student confidence in providing diabetes self-management support

BACKGROUND

The purpose of this study was to develop a preclerkship elective and assess its effectiveness in supplementing medical students' education.

METHODS

A group of medical students under the guidance of two faculty advisors developed an elective consisting of six sessions covering a variety of practical aspects of diabetes care/education taught by an interprofessional team. Following the course completion, a survey was emailed to the enrollees who attended at least one session. The results were analyzed using Wilcoxon signed-rank and descriptive analyses.

RESULTS

A total of 14 medical students were enrolled (nine first year and five second year). An average of 4.4 sessions/student was attended. Thirteen students attended at least one session and were surveyed. The survey response rate was ~62% (8/13). All eight students indicated that the course was valuable and would recommend it to their colleagues. A Wilcoxon signed-rank test revealed a statistically significant increase in students' confidence in all five areas assessed following participation in the course, P<0.05 with a large effect (r>0.5).

CONCLUSION

This study suggests the feasibility of developing disease state-specific preclerkship elective courses and that such courses can be beneficial in supplementing medical student education with practical knowledge.

The Effects of ISM1 Medium on Embryo Quality and Outcomes of IVF/ICSI Cycles

BACKGROUND

The aim of this study is to investigate the effect of ISM1 culture medium on embryo development, quality and outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. This study compares culture medium commonly used in the laboratory setting for oocyte recovery and embryo development with a medium from MediCult. We have assessed the effects of these media on embryo development and newborn characteristics.

MATERIALS AND METHODS

In this prospective randomized study, fertilized oocytes from patients were randomly assigned to culture in ISM1 (MediCult, cycles: n=293) or routine lab culture medium (G-1TM v5; Vitrolife, cycles: n=290) according to the daily media schedule for oocyte retrieval. IVF or ICSI and embryo transfer were performed with either MediCult media or routine lab media. Embryo quality on days 2/3, cleavage, pregnancy and implantation rates, baby take home rate (BTHR), in addition to the weight and length of newborns were compared between groups.

RESULTS

There were similar cleavage rates for ISM1 (86%) vs. G-1TM v5 (88%). We observed a significantly higher percentage of excellent embryos in ISM1 (42.7%) compared to G-1TM v5 (39%, p<0.05). Babies born after culture in ISM1 had both higher birth weight (3.03 kg) and length (48.8 cm) compared to G-1TM v5 babies that had a birth weight of 2.66 kg and a length of 46.0 cm (p<0.001 for both).

CONCLUSION

This study suggests that ISM1 is a more effective culture medium in generating higher quality embryos, which may be reflected in the characteristics of babies at birth.

Comparison of tea and sesame seed oils as two natural antioxidants in a fish oil model system by radical scavenging activity

Tea and sesame seed oils, two natural antioxidants at 5% and 10% levels, were added to carp (Cyprinus caprio) and common kilka (Clupeonella cultiventris caspia) oils, and the peroxide value and thiobarbituric acid were evaluated after 13 days at 60 degrees C (oven test). The results showed that the antioxidant effects of tea and sesame seed oils in the two aforementioned fish oils were statistically similar. In addition, the radical scavenging activity (RSA) of tea and sesame seed oils (extracted with two solvents:n-hexane and benzene) and their methanolic extract (methanol-soluble phase), ethanolic extract (ethanol-soluble phase) and lipid fraction (non-soluble in methanol or ethanol) were evaluated by the 2,2-diphenyl-1-picrylhydrazyl radical method. The results revealed that the RSA of sesame seed oil was higher than that of tea seed oil (IC(50) = 52 mg and 45 mg, respectively). In addition, among ethanolic and methanolic extracts, the RSA of the ethanolic extract of sesame seed oil (IC(50) = 65 ml and 68 ml in n-hexane and benzene solvents, respectively) and of the ethanolic extract of tea seed oil in benzene solvent (IC(50) = 73 ml) were the highest. Also, the RSA in the lipid fraction, non-soluble phase of sesame seed oil was the highest (IC(50) = 74 mg and 81 mg in n-hexane and benzene solvents, respectively). Furthermore, after 6 days at 60 degrees C the RSA values of tea and sesame seed oils were the same.

Overnight Intensive Recovery: Elective Open Aortic Surgery Without a Routine ICU Bed

OBJECTIVES

Most patients are managed on the intensive care unit (ICU) after elective open aortic surgery. We preoperatively identify patients suitable for extubation in theatre with overnight management in theatre recovery before discharge back to the ward (overnight intensive recovery (OIR)). The safety of this was investigated.

DESIGN

Retrospective case note analysis of all patients who underwent EOAS from 1998 to 2002, recording in-hospital morbidity and mortality. Physiological and operative severity score for the enUmeration of mortality and morbidity (POSSUM) data were collected prospectively.

METHODS

Patients were divided into those selected for OIR and those booked for elective ICU admission. Observed morbidity and mortality data were compared with predicted outcomes generated by Portsmouth-POSSUM and POSSUM equations.

RESULTS

Hundred and fifty-two out of 178 patients used OIR; 155 patients had abdominal aortic aneurysm (AAA) repair. The elective ICU group had significantly higher anaesthetic risk scores (ASA grade), larger AAA, greater intraoperative blood loss and longer operations. In the OIR group, ten patients (7%) needed ICU admission within 48h postoperatively. Complications occurred in 85/152, with two deaths. There was no excess morbidity or mortality in the OIR group (predicted 95% CI 83-105 and 5-17, respectively).

CONCLUSION

Most patients having elective open aortic surgery can be managed safely using OIR.

The mental health of refugee children

The UK is facing a major increase in the number of people seeking asylum each year, of whom approximately a quarter are children. The stressors to which refugees are exposed are described in three stages: (1) while in their country of origin; (2) during their flight to safety; and (3) when having to settle in a country of refuge. The evidence concerning the impact of displacement on children's mental health is reviewed and a framework for conceptualising the risk factors is proposed. The available literature shows consistently increased levels of psychological morbidity among refugee children, especially post-traumatic stress disorder, depression, and anxiety disorders. The principles underlying the delivery of mental health care for these children are also considered. It is argued that much primary prevention can be undertaken in the school context. Some key aspects of British immigration law are examined and the tension between the law and the best interests of the child principle is discussed. There is particular concern for the plight of unaccompanied children. Attention to the mental health needs of this vulnerable group is urgently required.

Perceived life quality of older and younger tibetans

Tibetans have enjoyed a reputation for contentment and a jovial disposition. This study examines the extent to which this positive outlook on life persists despite their 25-year stay as refugees in India, and the transferability of this positive outlook to first-generation, Indian-born Tibetans. With this in mind, older Tibetan refugees (N = 45) and younger Tibetan refugees (N = 45) residing in Himachal Pradesh in India were administered the Life Quality Scale (Q.O.L.). As expected, younger Tibetan refugees shared significant characteristics on the Q.O.L. scale with older Tibetans. Similarities and differences in the outlook of the two age groups are examined.