Early intervention in bipolar disorders : clinical, biochemical and neuroimaging imperatives

In the absence of clear targets for primary prevention of many psychiatric illnesses, secondary prevention becomes the most feasible therapeutic target, and is best encompassed by the concept of early intervention. This construct encompasses the goals of minimising diagnostic delay and the prompt initiation of clinically appropriate therapy. This paper develops the rationale for early intervention in bipolar disorder. Three interrelated themes are discussed; the clinical data supporting the value of prompt diagnosis and treatment in bipolar disorder, the putative biochemical mechanisms underlying the pathophysiological processes, and the parallel concept of neuroprotection, and the developing neuroimaging data that supports early intervention. Early initiation of appropriate therapy may potentially facilitate improved clinical outcomes, and further might allow the secondary prevention of the sequelae of untreated illness, which include the deleterious impact on family relationships, psychosexual and vocational development, identity and self-concept and self-stigma.

Early intervention with erythropoietin does not affect the outcome of acute kidney injury (the EARLYARF trial)

We performed a double-blind placebo-controlled trial to study whether early treatment with erythropoietin could prevent the development of acute kidney injury in patients in two general intensive care units. As a guide for choosing the patients for treatment we measured urinary levels of two biomarkers, the proximal tubular brush border enzymes γ-glutamyl transpeptidase and alkaline phosphatase. Randomization to either placebo or two doses of erythropoietin was triggered by an increase in the biomarker concentration product to levels above 46.3, with a primary outcome of relative average plasma creatinine increase from baseline over 4 to 7 days. Of 529 patients, 162 were randomized within an average of 3.5 h of a positive sample. There was no difference in the incidence of erythropoietin-specific adverse events or in the primary outcome between the placebo and treatment groups. The triggering biomarker concentration product selected patients with more severe illness and at greater risk of acute kidney injury, dialysis, or death; however, the marker elevations were transient. Early intervention with high-dose erythropoietin was safe but did not alter the outcome. Although these two urine biomarkers facilitated our early intervention, their transient increase compromised effective triaging. Further, our study showed that a composite of these two biomarkers was insufficient for risk stratification in a patient population with a heterogeneous onset of injury.

Psychological needs of adolescents in the early phase of bipolar disorder : implications for early intervention

Aim: This paper will describe the rationale for, and importance of, psychological interventions for young people early in the course of bipolar disorder.
Methods: Emerging literature in this field will be discussed in addition to describing specific clinical challenges and opportunities with this population.
Results: In order to be more developmentally appropriate for young people with bipolar disorder, eight aspects of clinical work which may require modification were identified.
Conclusions: The evidence base for the effectiveness of psychological interventions for people diagnosed with bipolar disorder is growing. However, some aspects relating to working with adults with bipolar disorder require modification to be effective in working with young people early in the course of the disorder.

TOBY : Early intervention in autism through technology

We describe TOBY Playpad, an early intervention program for children with Autism Spectrum Disorder (ASD). TOBY teaches the teacher - the parent - during the crucial period following diagnosis, which often coincides with no access to formal therapy. We reflect on TOBY's evolution from tabletop aid for flashcards to an iPad app covering a syllabus of 326 activities across 51 skills known to be deficient for ASD children, such imitation, joint attention and language. The design challenges unique to TOBY are the need to adapt to marked differences in each child's skills and rate of development (a trait of ASD) and teach parents unfamiliar concepts core to behavioural therapy, such as reinforcement, prompting, and fading. We report on three trials that successively decrease oversight and increase parental autonomy, and demonstrate clear evidence of learning. TOBY's uniquely intertwined Natural Environment Tasks are found to be effective for children and popular with parents. Copyright 2013 ACM.

Longitudinal evaluation of ICT intervention programs for girls

Intervention programs creating awareness among girls about the wide range of career opportunities in the Information and Communications Technology (ICT) field are conducted in many countries to tackle the problem of female under-representation in ICT. The long-term effects of these programs, however, are rarely evaluated which hinders the understanding of how they could be improved, their value and success factors. The goal of this study is, therefore, to investigate the longitudinal influence of one such program held biennially in Australia since 2006, by analysing survey data both quantitatively and qualitatively (n = 153). The results show that continuous study of an ICT subject at school by girls positively influences both their intention to choose a career in ICT and the actual choice of ICT as a university major. Moreover, the attitude towards the intervention program has a weak, but significant positive effect on the decision to study ICT at school.

The impact of IT intervention programs for girls

The goal of our study is to investigate the longitudinal effects of one intervention program for schoolgirls in the Information Technology (IT) field. This bi-annual event has been conducted regularly since 2006 with the aim of confronting a decline in the interest among girls to study IT and promoting study and work opportunities in the field. Each event has been evaluated with pre- and post-event surveys. Longitudinally, both students and teachers have also been surveyed three to four years after the event in which they participated. Results from the 2006 cohort surveyed in 2009-2010 are reported on in this paper. The main conclusion is that, unfortunately, any increase in the uptake of IT in schools that occurred as a result of attending the event was transitory. Therefore, it is crucial that inspiring, engaging, and empowering computing classes are being offered continuously at all secondary schools.

Examining potential barriers to early intervention access in Australian hearing impaired children

Early intervention for children with hearing loss involves assistance in oral speech development, optimal use of hearing devices and fostering a holistic partnership between allied health and the children's families. Adequate access to early intervention has been shown to be vital in the positive development of long term language and social outcomes. However, there has been limited research to identify the factors which may influence access. This study aimed to explore whether access to early intervention by children with hearing loss is affected by: geographical location, socio-economic status and ethnic-minority family status.