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Abstract Background This case study describes research, which is located in Turkey, where more than 750,000 Syrian refugees reside autonomously in Istanbul. The research developed and pilot tested a novel model for helping urban refugee families with limited to no access to evidence-based mental health services, by delivering a transdiagnostic family intervention for common mental disorders in health and non-health sector settings using a task-sharing approach. This case study addresses the following question: What challenges were encountered in developing and piloting a low intensity trans-diagnostic family support intervention in a humanitarian emergency setting? Discussion The rapidly growing scale of humanitarian crises requires new response capabilities geared towards addressing populations with prolonged high vulnerability to mental health consequences and limited to no access to mental health, health, and social resources. The research team faced multiple challenges in conducting this research in a humanitarian emergency setting including: 1) Non-existent or weak partnerships geared towards mental health research in a humanitarian emergency; 2) Lack of familiarity with task-sharing; 3). Insufficient language and cultural competency; 3) Fit with families’ values and demands; 4) Hardships of urban refugees. Through the research process, the research team learned lessons concerning: 1) building a coalition of academic and humanitarian organization partners; 2) investing in the research capacity building of local researchers and partners; 3) working in a community-collaborative and multi-disciplinary approach. Conclusion Conducting research in humanitarian emergency settings calls for innovative collaborative and multidisciplinary approaches to understanding and addressing many sociocultural, contextual, practical and scientific challenge.
Abstract Aim: Research investigating association between attention deficit/hyperactivity disorder (ADHD) and oxidative stress have reported conflicting and inconsistent findings. We aimed to investigate a novel oxidative stress marker, thiol/disulphide homeostasis, in patients with ADHD and compare the results with the healthy control group. Materials and Methods: A total of 47 medication naive children and adolescents (35 boys and 12 girls) aged 6–17 years with a diagnosis of ADHD were investigated for oxidative stress parameters and results were compared with that of 41 subjects (28 boys and 13 girls) matched for age and gender. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (KSADS-PL) was conducted to support ADHD diagnosis and to exclude comorbid psychiatric disorders. Thiols, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI) levels were measured in serum samples in addition to myeloperoxidase (MPO) and dynamic thiol/disulphide homeostasis. Results: TOS, OSI and MPO levels were significantly lower in ADHD group (p=0.001, p=0.022, p=0.007, respectively). Predominantly inattentive type ADHD had significantly higher levels of TAS (p=0.014) and TOS (p=0.01) than those with combined ADHD subtype. Oxidative stress index (OSI) levels decreased with increasing age in both ADHD and control groups as well in the whole sample when control and patient groups were tested together (r=-0.376, p=0.009; r=-0.479, p= 0.002; and r=-0.367, p<0.001, respectively). TAS scores significantly increased with age in ADHD group (r= 0.523, p<0.001). Thiol/disulphide homeostasis showed no difference. Discussion and Conclusion: The current study reveals no association between pediatric-age ADHD and thiol/disulphide homeostasis. The nature of relationship between oxidative stress and ADHD needs to be clarified with methodologically robust studies. Keywords: oxidative stress; thiol/disulphide homeostasis; attention deficit hyperactivity disorder; children and adolescents Ozet Amac: Bilimsel calismalar dikkat eksikligi hiperaktivite bozuklugu (DEHB) ve oksidatif stres arasindaki iliski ile ilgili farkli ve tutarsiz veriler sunmaktadir. Bu calismada DEHB hastalarinda tiyol/ disulfit homeostazi gibi yeni bir oksidatif stres markirini incelemek ve sonuclari saglikli kontrol grubu ile karsilastirmak amaclanmistir. Gerec ve Yontemler: Calismaya psikotrop ilac kullanim oykusu olmayan 6–17 yas araliginda ve DEHB tanili 47 cocuk (35 erkek ve 12 kiz) ve yas ve cinsiyet olarak benzer 41 saglikli cocuk (28 erkek, 13 kiz) dâhil edilmistir. Total antioksidan seviyesi (TAS), total oksidan seviyesi (TOS), oksidatif stres indeksi (OSI), miyeloperoksidaz (MPO) ve dinamik tiyol/disulfit homeostazi gibi oksidatif stres parametreleri bu iki grup arasinda karsilastirilmistir. Es tani durumu Okul Cagi Cocuklari icin Duygulanim Bozukluklari ve Sizofreni Gorusme Cizelgesi-Simdi ve Yasam Boyu Sekli-Turkce Uyarlamasi (CDSG-SY-T) kullanilarak degerlendirilmistir. Bulgular: TOS, OSI ve MPO degerleri DEHB grubunda anlamli olarak dusuk bulunmustur (sirasiyla p=0,001; p=0,022; p=0,007). Dikkat-eksikligi-baskin-tip DEHB grubunda TAS (p=0.014) ve TOS (p=0.01) degerleri kombine alt tipe oranla anlamli olarak daha dusuk cikmistir. Oksidatif stres indeksi (OSI), hem hasta ve kontrol gruplarinda hem de iki grup birlikte degerlendirildiginde artan yas ile birlikte istatistiksel olarak anlamli bir azalma gostermistir (sirasiyla r= - 0.376, p=0.009; r= - 0.479, p= 0.002 ve r= - 0.367, p<0.001). TAS degerleri kontrol grubunda, TOS degerleri ise hasta grubunda yas ile anlamli bir iliski gostermistir. Tiyol/disulfit dengesi iki grup arasinda anlamli bir fark gostermemistir. Tartisma ve Sonuc: Mevcut calismada, dinamik tiyol/disulfit dengesi ve cocukluk cagi DEHB’si arasinda anlamli bir iliski bulunamamistir. Diger calismalarda bildirilen ve bizim calismamizda da kismen desteklenen olasi iliski alanlarin aciga kavusturulmasi ve olasi sebep-sonuc iliskisinin aydinlatilmasi icin metodolojik olarak daha guclu calismalara ihtiyac vardir. Anahtar Sozcukler: oksidatif stres; tiyol/disulfit dengesi; dikkat eksikligi hiperaktivite bozuklugu; cocuk ve ergen
Abstract Background: The study is located in Istanbul, Turkey, where more than 750,000 Syrian refugees reside, largely in urban settings. It develops and pilot tests a novel model for helping urban refugee families in settings with limited to no access to evidence-based mental health services for refugees, by delivering a transdiagnostic family intervention for common mental disorders in health and non-health sector settings using a task-sharing approach. This case study addresses the following question: How can we address the common mental disorders of both children and parents, and support protective family resilience processes, through a low intensity trans-diagnostic family support intervention? Discussion: The rapidly growing scale of humanitarian crises requires new response capabilities geared towards addressing populations with prolonged high vulnerability to mental health consequences and limited to no access to mental health, health, and social resources. We faced multiple challenges in conducting this research including: 1) identifying local academic partners with research capacity, including in implementation science; 2) lack of culture of partnership between academics and humanitarian organizations; 3) getting local clinicians to embrace on a task-sharing model; 4) cultural competency of local and U.S. partners for refugee population; 5) getting local academics to focus on humanitarian emergency; 6) planning for a family intervention that would work with families with rigid gender role perspectives; 7) multiple social and economic problems that could not be solved, such as children working; 8) engagement challenges due to high demands on families. Through the research process, the research team learned lessons concerning: 1) building a coalition of academic and humanitarian organization partners; 2) investing in research capacity building of local partners; 3) working in a community-collaborative and multi-disciplinary approach to best understand and address socio-cultural, contextual, practical and scientific challenges needed to develop and implement the new family support model. Conclusion: Conducting research in humanitarian emergency settings calls for significant attention to building a coalition of academic and humanitarian organization partners, investing in research capacity building of local partners, and working in a community-collaborative and multi-disciplinary approach.
This study aims to investigate possible risk factors associated with specific phobias in children and comorbid mental disorders. Patients between 6-18 years of age who had presented to the child psychiatry outpatient clinic at Bezmialem Vakif University between October 2017 and February 2018 were assessed with The Kiddie Schedule for Affective Disorders and Schizophrenia- Present version (KSADS-P) for specific phobias and comorbid diagnoses. Risk factors of specific phobia were further evaluated with a data collection tool, developed by the authors of the present study. The most common specific phobia subtype was animal phobia (n=48; 48%), which was followed by natural environment (n=27; 27%), blood-injection (n=25; 25%), situational (n=17; 17%) and other phobia (n=2; 2%). The majority of the subjects (n=59; 63.4%) reported that specific phobias began between 3-7 years of age. While %32 percent of subjects reported a sudden onset, for 40% the onset was slow and gradual. Majority of the participants (67.7%) were not able to identify a possible trigger, whilst 25.3% reported that it started after a certain event. Only 10% of the participants had reportedly sought treatment for phobia in the past. Subjects with animal phobia or situational phobia had lower, blood/injection type phobia or natural environment type phobias had higher rates of comorbidity with an externalizing disorder as compared to the rest of the sample(Χ2=9.54, p=0.002 and Χ2=11.51, p=0.001, Χ2=6.00, p=0.014 and Χ2=8.45, p=0.004; respectively). In conclusion children and adolescents do not appear to seek help for specific phobias and such cases can be easily missed if not specifically enquired by clinicians.
Sluggish Cognitive Tempo (SCT) has been proposed as a serious problem of attention, however there no validated psychometric measures for its evaluation in Turkish in a community sample. The present study aimed to examine the psychometric characteristics of the first SCT scale in Turkish in children and adolescents. A total of 418 children and adolescents between the ages of 6-18 years (9.83±2.8) were recruited. The data was obtained from parents using Sluggish Cognitive Tempo Scale and Strengths and Difficulties Questionnaire. The SCT scale-Turkish form demonstrated very good internal homogeneity (Cronbach's α = .90), good test-retest reliability (r = .98), good concurrent validity (r range = .35- .65) and good construct validity. Goodness of fit indices were found to be acceptable and statistically significant associations were found between SDQ and SCT scales. The SCT scale is a valid and reliable instrument in Turkish children and adolescents.