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JOURNALS INDEX
EXTRACTS FROM THE “OTHER” JOURNALS
RELATING TO CHILDREN, YOUTH AND FAMILIES —
IN THE FIELDS OF HEALTH,
SUBSTANCE ABUSE, EDUCATION, PSYCHOLOGY, SCIENCE ...
January 2007
Glaxo distorted Paxil drug test data: BBC
GlaxoSmithKline Plc was accused on Monday of distorting clinical trial results of its antidepressant Seroxat, or Paxil, and covering up a link with suicide in teenagers. The BBC plans to air a Panorama program later saying the drug company attempted to show that Seroxat worked for depressed children despite failed clinical trials and that Glaxo-employed ghostwriters influenced "independent" academics.
A summary of the program was published on the BBC Web site (http://news.bbc.co.uk/2/hi/programmes/panorama/6291773.stm)
"We utterly reject the allegations that are being made in their program," a Glaxo spokeswoman said. She denied the company had improperly withheld any trial information and said results from pediatric studies were documented and submitted to regulators in accordance with requirements, as well as being presented publicly and published.
Regulators in 2003 recommended against using Seroxat in people under 18 due to an increase in the rate of self-harm and potentially suicidal behaviors in this age group when the drug was prescribed. But Glaxo said the increase in suicidal thinking was only revealed when results of separate clinical studies were pooled at the end of its research program, at which point the company brought the findings to the attention of regulatory authorities.
29 January 2007
http://www.sciam.com/article.cfm?chanID=sa003&articleID=97CBC42BF29A147E4A2C287664032734
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EUROPE
Children's drug treatment boost
The law will aid research into children's cancer treatment Children will have access to improved treatment following changes to European laws, campaigners say. From this week, any new medicine licensed in Europe must be examined for its potential use for children. The changes will apply to all kinds of drugs, but cancer experts say they will be of particular benefit to children with the disease.
Cancer Research UK says the law will allow more knowledge about how anti-cancer drugs work in children. This new law presents a massive boost to drug discovery programmes across Europe
Dr Sally Burtles, Cancer Research UK
'The extra months meant a lot'
The charity says such research is currently affected by drug company concerns over the challenges of developing medicines for children. Around 2,000 people under the age of 19 are diagnosed with cancer in the UK each year.
Children with a wide range of conditions are currently given scaled-down doses of medication designed for adults which may not have gone through full clinical trials. This means doctors often have to estimate the dose which a child will need, increasing the risk of dangerous side-effects or ineffective treatment.
The Association of the British Pharmaceutical Industry (ABPI) estimates 90% of children in neonatal intensive care units are given unlicensed medicines, as are 45% of medicines used on general children's wards and up to 20% of drugs prescribed to children by GPs.
Drug company benefits
Under the new legislation, there will have to be a paediatric
investigation plan which sets out which age groups will need to be
studied before a drug can be made available to patients. The law makes
distinctions between the different needs of newborns (nought to
one-month-old), infants (one to 23 months), young children (two to 12
years) and adolescents (aged 12-18).
Applications could be made for medicines which would clearly not be used on children, such as hormone replacement therapy, to be exempt from the law. The changes apply to both new and existing medicines. Pharmaceutical companies will be rewarded for putting extra efforts into researching children's medicines with a six-month patent extension on new medicines and exclusivity on data on medicines which are out of patents for 10 years.
Dr Sally Burtles, director of Cancer Research UK's drug development office, said: "Childhood cancers are very different from adult tumours. "This new law presents a massive boost to drug discovery programmes across Europe and will encourage further collaboration between pharmaceutical companies and childhood cancer experts."
Dr Richard Tiner, medical director of the ABPI, said: "This new legislation represents a huge opportunity for European research into children's medicines and the UK is probably the most prepared country in the EU to take this forward. "Clinical trials obviously raise questions of ethics, plus each stage of a child's development from infant to teenager requires different formulations. As a result, patient numbers per drug may be small - especially for rare conditions. In the past this made it difficult for drug companies to recoup the massive costs of research."
27 January 2007
http://news.bbc.co.uk/2/hi/health/6298717.stm
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Time out better than spanking for naughty kids: experts
Time out, extra chores and taking away privileges are more useful forms of disciplining naughty children than spanking or hitting, according to a study on Wednesday.
An estimated 94 percent of parents use some form of corporal punishment to teach their toddlers right from wrong, according to research studies. But psychologists say it could lead to later emotional and behavioral problems. Even children who were only smacked occasionally are more likely to show signs of depression or lower self-esteem.
"The key is consistency. Using something like corporal punishment that seems severe at best doesn't help and can put a child at risk for problems," said Dr Paul Frick, of the University of New Orleans in Louisiana. "It is better to use other types of discipline and focus on the consistency," he added.
The use of physical punishment to discipline children has long been controversial. In countries such as Austria, Finland, Germany and Sweden it is illegal to use corporal punishment at home or in schools.
Frick and his team, who studied the impact of corporal punishment on 98 children, said they couldn't find any positive effects. Some children learned more from the hitting aspect than what the parent was trying to teach them. "The key is to have a lot of different forms of punishment depending on the age of the child," said Frick, who reported his findings in the Journal of Applied Developmental Psychology. He recommended time out for younger children and taking away television and electronic toys for older youngsters. Giving extra chores can also get the message across.
Other disciplinary measures are at least as effective as corporal punishment and have less harmful potential consequences.
The researchers screened children whom they thought were at risk of later conduct problems and an equal number of other children who acted as a control group, to study what disciplinary measures would be most helpful. They questioned the parents and the children about positive and negative parenting behavior including the use of corporal punishment.
"We got it from both perspectives," said Frick. He added that children on the receiving end of a slap can learn that when they are upset and angry they hit, rather than understanding their behavior was wrong and that they need to do better.
Patricia Reaney
24January 2007
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10-minute test helps tell if your child is dyslexic
Syntax samples: children will be asked to read
sentences, including
"Which dog did the cat push?" and "The cat is washing herself."
Cartoon pictures of a grey mongrel cat washing herself and a small blue alien are at the heart of a new test to help parents to establish whether their children have dyslexia. The ten-minute test, developed by speech therapists and psychologists, screens young children for language disorders from the age of 3. By testing simple grammatical and pre-reading skills, parents, teachers or assistants can check whether a child is “school-ready” or may need more help.
The test comes after Ruth Kelly, the former Education Secretary, sent her nine-year-old son, who is believed to have dyslexia, to a private boarding school which specialises in teaching children with the condition.
The grammar and phonology screening test (Gaps) has been developed over 16 years by Professor Heather van der Lely, the director of the Centre for Developmental Language Disorders and Cognitive Neuroscience at University College London. “What motivated me was seeing first-hand how failing to diagnose these problems was blighting young lives. In most cases, once diagnosed, these language disorders can be helped or overcome with the right treatments and professional help.”
Professor van der Lely, who is dyslexic, added: “My team and I used existing knowledge of specific language impairment to devise a test for 3½ to 6½-year-olds which would evaluate their basic grammatical ability — something that is crucial if they are to understand teachers’ instructions and learn to write sentences.” Designed to be easy to use and accurate for parents and professionals, Ms van der Lely employs Bik, a small blue alien, to examine whether children can create sentences and add sounds to make words.
For £50, parents receive an illustrated booklet and five tests, from which they read sentences out to their child. In the first part of the test, the child repeats back the sentence to Bik, the alien cut-out who, they are told, only understands children. In the second part, parents say specially made-up words to their children and ask them to say them back.
Sentences such as “the cat is washing herself” are designed to test the syntax — or rules of a sentence — as well as the morphology of words — how words are made bigger. A child with language difficulties will not be able to repeat the entire sentence and might say, “The cat is washing her”.
The made-up words test the phonology or sound system of a sentence. If a children score less than 10-15 per cent, Professor van der Lely recommends that parents seek professional help. If scores are borderline, she suggests that children are retested later on.
The test has been welcomed by the British Dyslexia Association, which receives numerous calls from parents who cannot persuade schools to test their children for dyslexia.
Although the special educational needs code of practice states that every school and authority has a duty to “identify, assess and make provision for children with special educational needs”, Jennifer Owen Adams, the association’s director of education, said that not all are proactive. Parents could now test their child and use the results not as a stick to chastise schools but to begin a constructive dialogue, she said.
“What’s good about this test, is that it gives parents the power to test their child — but not to use it as a stick with which to beat schools, just one to use in constructive dialogue,” she said.
The test packs, which were tried on 668 children, are available at www.dldcn.com
Problems with words
More than half a million children suffer from a language problem and
about ten per cent of the population is believed to have dsylexia. About
375,000 children in Britain are severely dyslexic Dyslexia makes
learning to read, write, spell and do mathematics difficult. An
inability to concentrate and a lack of short-term memory are also
symptoms Famous dyslexics include Albert Einstein, Winston Churchill,
Tom Cruise, Jamie Oliver and Felicity Kendal
Alexandra Blair
23 January 2007
http://www.timesonline.co.uk/article/0,,2-2561005,00.html
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Two flu shots needed to protect young children
Infants and toddlers given two doses of the influenza vaccine are less likely to contract flu, pneumonia and influenza-like illnesses, but one dose does not appear to have any effect, according to findings published in the Journal of Pediatrics.
Dr. Mandy A. Allison, of the University of Utah, Salt Lake City, and colleagues examined the effectiveness of the currently recommended two-dose influenza vaccine for young children, as well as the effect of one dose of the vaccine, in preventing visits to the doctor for influenza-like illness. They analyzed data for 5193 healthy children between the ages of 6 and 21 months who were seen at five Denver pediatric practices during the 2003-2004 flu season. The average age of the children was 15.5 months. The kids were defined as being partially vaccinated if they had one shot more than 14 days before the first influenza-like illness visit, and fully vaccinated if they had the full two shots more than 14 days before the first visit.
Overall, 28 percent of the children were seen for influenza-like illness and 5 percent had a visit for pneumonia/influenza.
Full vaccination was 69 percent effective in preventing office visits for influenza-like illness and 87 percent effective in preventing office visits for pneumonia/influenza. This is comparable to the effectiveness of the vaccine in adults. However, the partially vaccinated children were just as likely to be seen for influenza-like illness or pneumonia/influenza as were unvaccinated children.
The results confirm the effectiveness of two doses of flu vaccine and "lend support to the recommendation for universal immunization against influenza in 6- to 23-month-old children," Allison's team concludes.
SOURCE: Journal of Pediatrics, December 2006.
23 January 2007
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Parents reflect, schools mobilize to curb suicide
Less than an hour before she found her son's suicide note, Camilla Barry was laughing with him over lunch.
It was a rare Monday afternoon when Clive Barry, 16, had the day off from Tamalpais High School in Mill Valley, and his mother was home from work to eat and take a nap. Clive talked about how much he respected his father. They made plans to hang out later in the afternoon. But when Camilla Barry woke up, her son was gone. The note he'd left said he was going to kill himself. An hour later, authorities found his bike at the Golden Gate Bridge. Clive's body still hasn't been found, but authorities presume he jumped to his death Jan. 8.
"I've come to realize I didn't know Clive as well as I thought," Camilla Barry said. "His death was a shock to me. There were so many things he didn't tell me. Not necessarily bad things, just things. He's a teenager, so we thought he was still in our realm. But I don't think we knew Clive."
After a teen suicide, family and friends often are left wondering if there were signs they missed, whether they should have seen it coming. Indeed, there are signs, but they can be subtle and difficult to spot -- especially for parents and friends who don't know what to look for, or who don't want to admit that a child is depressed.
Clinical psychologist and author Madeline Levine, who has been in practice in Marin County for 25 years, said she increasingly sees teens who are stressed, depressed and still flying under the radar because they look good on the outside. "There is a kind of kid now with this relentless kind of perfection," said Levine, who recently wrote "The Price of Privilege: How Parental Pressure and Material Advantage Are Creating a Generation of Disconnected and Unhappy Kids."
Some teenagers do exhibit classic signs. They start falling behind at school, grow uninterested in activities they used to love, have trouble sleeping, turn to alcohol and drugs. But those signs don't always manifest themselves in time.
"I believe some of the typical signs of depression -- the checklist from the pediatrician -- are not always evident in a child," said Anne Magill, whose daughter Grace, a student at St. Ignatius College Preparatory in San Francisco, took her life in 2005. Magill said her daughter was gorgeous and spirited and never missed a day of school but started cutting herself in September 2005. A friend recognized her cry for help, and her school and family quickly got mental health professionals involved. Even so, she died a suicide months later.
And many teenagers make a concerted effort to hide their pain.
Camilla Barry found a book in her son's room with a chapter on how to hide feelings and keep secrets. "I'm mad he didn't let us know what was going on," she said. "But he planned it that way." In fact, he'd tried to kill himself at age 14 by swallowing rat poison. Afterward, he went to a counselor but hated it -- his mother didn't like the therapist either -- and he stopped going.
Clive's was the third suicide in four years involving current or former students at Tamalpais High. That's not an unusual number for one community. In fact, suicide is the third-leading cause of death among people ages 15 to 24, according to the federal Centers for Disease Control and Prevention. Nationwide, the suicide rate among teenagers has fallen since 1990, from 11.1 per 100,000 15- to 19-year-olds to 7.3 per 100,000 in 2003, the most recent year for which consistent national data are available. There were 1,486 teen suicides in 2003.
Teenage boys are more likely than girls to kill themselves, with a rate of 11.6 deaths per 100,000 in 2003, compared with 2.7 for girls, federal statistics show. The suicide rate for people of all ages was 10.8 in 2003. Among people ages 15-24, which is how statistics are broken down by ethnicity, those most likely to take their own lives in 2003 were Native American males, at 27.2 per 100,000. White, non-Hispanic males in that age group had the next-highest rate, 18.2 per 100,000, though white males in all the older age groups had higher rates. Women of all ages and ethnicities had lower rates than men, and their overall rate was 4.2 per 100,000. The lowest rate for males was 8.3 per 100,000, for black men ages 65-74.
Occasionally, a cluster of suicides will rattle a community. In fall 2004, Clayton Valley High School in central Contra Costa County was rocked by two suicides and one attempted suicide of students or former students -- all in a three-week period. When a fourth student at nearby College Park High School killed herself, less than a month after the first suicide, rumors and parent paranoia about suicide pacts sent the community reeling.
Retired Clayton Valley High Principal John Neary said schools have to face the problem of suicide head-on, without glorifying it. "Just the facts," he said. "What kids eat up is the drama of it all." He also urged parents to "be parents." "Parents these days don't hear the cries for attention, for support, for direction," Neary said. "They are too busy today, making a living, doing other things. There are so many divorces."
Schools are seeking new ways to deal directly with the threat of suicide. Three private schools in San Francisco, including St. Ignatius, are trying a program called TeenScreen developed at Columbia University to identify students in trouble. The program includes a questionnaire for ninth-graders about whether they have been depressed, have a problem with alcohol and drugs or have tried to kill themselves.
Teens who score high are interviewed by counselors. If they are at risk, TeenScreen contacts their parents and makes referrals for further counseling. The 20-minute test is voluntary and requires parental consent. "We've been amazed by how open kids are about what's going on with their lives. They are more likely to be forthcoming on pen and paper or with a computer questionnaire than face to face," said Dr. Susan Smiga, director of the Children's Center at Langley Porter at UCSF, which runs TeenScreen in San Francisco.
TeenScreen is being used at more than 400 sites in 43 states, said Executive Director Laurie Flynn in New York. About 30 percent of San Francisco private school teens tested so far were found to be at risk, Smiga said, and about half of those were referred for treatment. Local public schools have resisted TeenScreen. San Francisco Unified School District, for example, passed on TeenScreen because it can generate false positives and drain counseling resources, said spokeswoman Gentle Blythe. Other critics worry TeenScreen could send kids unnecessarily into treatment and land too many on psychiatric drugs. And some critics say parents should be in charge of those lessons for their children.
Some communities are addressing suicide prevention with more traditional methods. Youth pastors with Celebration Christian Center in Livermore, where Livermore High has lost two students to suicide in two years, formed the nonprofit Youth United to tackle the problem. Last week, Youth United arranged for motivational speaker Michael Miller to talk to the student body, and next week counselors will visit classrooms to start conversations about how to identify if a friend needs help and how to ask for help. Youth United also hopes to open a crisis hot line in the near future, said Pastor Aaron Chidester. The school, which also lost a student each year from 1998 to 2000, has introduced several other programs over the years to head off suicide, said Chandra Whetzel, a school secretary whose son Ryan, a graduate, killed himself in the family garage when he was 19 in 1998.
Whetzel, like many parents, was taken by surprise. She knew he had been caught in an insurance scam and was worried, but she didn't know he was desperate. "Kids today only tell the parents what they want to hear. I think my son felt that he let us down," she said. After Ryan died, she and her husband introduced a program at Livermore High in which the school's 2,000 students each receive cards bearing hot line numbers and yellow ribbons at the beginning of the school year.
Magill is working through the Edgewood Center in San Francisco -- which provides child counseling and other services -- to educate students, eliminate the stigma of adolescent mental illness and help peers recognize the signs that a friend might need help.
And Camilla Barry is talking.
Clive wasn't, she said, a troubled kid. He didn't seem to display any of the obvious signs of distress. He had a wide group of friends and a girlfriend. He wasn't a stellar student, but he was active at school. He was cheerful at home and liked to spend lots of time with his family. He seemed fine after he quit seeing the therapist two years ago, she said. But in hindsight, she wonders if he ever got over what was troubling him. He had been going through a tough time at school -- something she says now was probably worse than she knew. "I'm sort of horrified that we did not take that (first suicide attempt) more seriously," Camilla Barry said. "He told us it was nothing, and I just believed him. Clive had this way of seeming very grown-up. And when he told me, 'Mom, it's done, it's over,' I just believed him. I shouldn't have believed him. But he was so young when he did it," she said. "And he seemed happy. There really weren't any other signs. It's only in retrospect, little comments he'd make. He was probably thinking about this for two years."
| Some warning signs
There aren't always clear signs a teen is in trouble, but these behaviors could indicate a person is deeply depressed and may be considering taking his or her own life:
Source: American Academy of Child & Adolescent Psychiatry |
Ilene Lelchuk, Erin Allday
22 January 2007
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/01/22/MNGDANML2R1.DTL
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FUNCTIONAL FAMILY THERAPY
New justice program aims to work with at-risk teenagers
Several representatives of agencies that work with at-risk adolescents spent last Tuesday learning about a program soon to be offered in northwest Kansas for teens and their families.
High Plains Mental Health was awarded a Juvenile Justice Parental Modeling Program Grant to provide Functional Family Therapy to adolescents who are being supervised on a diversion through JJA, have had more than one contact with law enforcement officials or who are at risk of going into the custody of the state.
“The FFT services will be available in all of our branch offices, the Hays office and at Westside Alternative School,” said Audrey Schoenberger, youth crisis and stabilization program manager for HPMH.
Helen Midouhas, an FFT trainer from Pennsylvania, spoke to probation officers and judges about the program. “When we're talking about an FFT program, what we're saying is, we can guarantee a good outcome because this is backed by years of research,” Midouhas told them.
The FFT therapy approach was developed in 1969 and has received high marks from numerous studies, Midouhas told them. Among the agencies that have rated the FFT approach well is the Boulder, Colo.-based Center for the Study for Prevention of Violence, which compared many widely-offered programs that focus on risk and protective factors and ranked FFT as a “blueprint program” — effective for helping communities reduce violence and keep at-risk adolescents in their homes.
Midouhas noted the D.A.R.E program did not currently meet the Study for Prevention of Violence's criteria for an effective program. Big Brothers Big Sisters, on the other hand, was rated a blueprint program. FFT targets youth ages 11 to 18, Midouhas said. It is a short-term, family-based program that can address a range of adolescent problems including violence, drug abuse, conduct disorder and family conflict.
For moderate cases, eight to 13 sessions are held. For more serious cases, 26 to 30 sessions are held. The sessions are spread over three to six months.
The approach doesn't seek to change who is who in the family or change their positions in the family but focuses instead on working within the family's established dynamics. It is respectful of individual differences and focuses on strengths and resources of the family, aiming for obtainable change.
Under the JJA grant, services for families where a child meets the criteria will be paid for by the grant. FFT will be available for a fee to families who don't meet the grant criteria of having had more than one negative encounter with law enforcement.
Phyllis Zorn
17 January 2007
http://online.hdnews.net/content/news/teens011707.shtml
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Youthful drinkers rely on alcohol later
People who start drinking alcohol at a young age are more likely to drink a lot when they get older -- and to get into trouble with it. That's been known for a while and is not much of a surprise.
A new study, however, sheds important light on one reason that early drinkers often become heavy -- or dependent -- older drinkers. It's because they are more likely to use alcohol as a "stress reducer" than do people who began drinking at an older age. Alcohol, it seems, becomes an overused tool for weathering the trials of adulthood if a person first uses it as a young teenager.
Deborah A. Dawson, of the federal government's National Institute on Alcohol Abuse and Alcoholism, analyzed the responses of nearly 27,000 people in a nationally representative survey of Americans and their drinking habits. The respondents, average age 43, were asked when they started drinking, how much they drank now and whether they had experienced any of 12 stressful events in the previous year. The events include such things as death of a family member, financial crises, marital disruption and loss of a job.
Regardless of when people started drinking, alcohol use increased with the number of stressful events a person experienced. People who started drinking at 14 or younger and reported six or more "stressors" in the previous year consumed an average of six drinks a day -- five times the amount of similarly stressed people who started drinking at 18 or older.
The early drinkers increased their alcohol intake 19 percent with each additional stressful event they suffered, compared with only 3 percent by the later-starting drinkers. The trend of youthful drinkers growing into adults who rely on alcohol to cope was evident even when the scientists considered only events that heavy drinking was not likely to have caused -- things such as the death or illness of a family member, a new living situation or a change in work hours.
Source: This month's Alcoholism: Clinical and Experimental Research.
David Brown
21 January 2007
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As a teacher, Charlotte Morbey had always been
sceptical about school phobia
until her son threatened to jump from the window sill
When school is too scary
Six months ago I de-registered my 13-year-old son from school. As a former teacher and head of year, home education had seemed a foolhardy thing to undertake. But as a parent, I had reached the end of the road with mainstream schooling.
I thought I knew about school phobia. In common with colleagues, I used the terms “school phobia” and “school refusal” interchangeably. I was sympathetic but sceptical. I felt it was probably exaggerated and pandered to by parents who colluded with difficult children for a quiet life.
Working closely with the education social worker for my year group, I knew attendance issues could cause intractable problems. We would call meetings and put plans in place, knowing even as we walked away from the room that it wouldn’t work and the child would drift away again within days. I would make phone calls, attempt to cajole and persuade the child to come in, negotiate through car windows in some cases if they wouldn’t get out. It was time-consuming, frustrating and unrewarding. We wanted these children in school, their parents said they did – so why didn’t it happen?
Then my own son developed school phobia. It started with headaches and stomach pains every day. My first thought was that he was making them up, but they seemed genuine. We talked about school – was he being bullied; was the work too hard; did he have friends? Everything was fine, he said. He just felt ill.
With this came the nightmares and I’d hear him shouting in his sleep. He would appear at breakfast looking grey and exhausted. I would jolly him along and tell him to go to school, then go off to work assuming all would be well once he got there. However, I started getting phone calls to say he hadn’t arrived. My colleagues were heroic, covering for me at short notice . But I still felt awful rushing out at 10am. Once home, I’d spend the day trying to get him to school – I’d drive him in and escort him into the reception area where he’d simply turn and flee. I’d drive home, pick him up and we’d start again. One day I did this six times.
By now, lots of people were getting involved. His head of year tried one strategy after another, the Educational Social Work (ESW) service was calling meetings and the GP referred us to the Adolescent Mental Health service. Everyone asked him, “Why won’t you come to school?” Every time he answered: “I don’t know.”
The tension and sadness leached into every aspect of our family life and he barely left his room. He stopped washing and brushing his hair and fought all attempts to get him into clean clothes, insisting on wearing old tracksuit trousers and a huge dressing gown. We worried that his friends were drifting away.
On the advice of the child psychologist, we had a system of rewards and sanctions. No school meant no pocket money, DVDs, computer games or internet. He accepted this without question – one of the ironies was that we knew we could trust him not to breach these conditions. He’d lie on his bed all day reading or, if he felt particularly bad, staring at the ceiling. By this time, I was on sick leave from work. We battled our way through every morning, sometimes getting as far as the front door before the fear overtook him and he raced upstairs to barricade himself in his room. We talked through his door or, when I could get in, with him sitting on his window sill threatening to jump.
I followed advice given by the child psychologist and told him that I didn’t want him to harm himself but that he had to go to school. He sat weeping and shaking on the window sill until I retreated and he could rebuild his barriers. Only when school was off the agenda would he come downstairs and put his arms around me, sadly repeating, “I don’t know why, I just don’t.”
| Do's and don'ts of dealing with phobias | |
Do
|
Don’t
|
Charlotte Morbey and Adi Bloom
19 January 2007
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UNICEF says more than 1,000 children under 15 infected with HIV each day
Despite progress in preventing HIV transmission from pregnant mothers to their babies, more than 1,000 children around the world were infected with the disease each day in 2006, according to a U.N. report. Some sub-Saharan African countries – such as Namibia, Swaziland, South Africa and Rwanda – greatly increased access to treatment for vulnerable mothers between 2004 and 2005, said the report issued Tuesday by the New York-based U.N. children's fund.
But worldwide, 410,000 to 660,000 children under the age of 15 were infected with the disease last year – mostly during or immediately after birth – the report said. Half of them will die of AIDS-related diseases within two years if they do not receive appropriate medical treatment. Only seven countries are on track to meet the target of providing access to treatment for 80 percent of women in need by 2010, UNICEF spokesman Patrick McCormick said. These countries are Argentina, Brazil, Botswana, Jamaica, Russia, Thailand and Ukraine.
Overall, only 9 percent of HIV-infected pregnant women in middle- to low-income countries were receiving anti-retroviral drugs to reduce the risk of mother-to-child transmission, the report said. UNICEF said early diagnosis and treatment with cost-effective drugs were crucial to achieving a turnaround in the AIDS epidemic, which claims about 2.9 million lives worldwide each year, including some 380,000 children.
17 January 2007
http://www.signonsandiego.com/news/health/20070117-0628-un-children-aids.html
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Irish youth face health threat from 'driven and materialistic' society
The health of Ireland’s youth will be one of the major health issues facing this country in the future, given the “increasingly driven and materialistic society in which we live”, according to the Medical Director of Ireland’s largest health insurer Vhi. Despite the increased wealth and prosperity of modern Ireland, Dr Bernadette Carr said in relation to the health of Irish children that: “Survival of the fittest means what it says.”
Dr Carr believes the challenges for the Irish heath system in the future are many and varied, “not least the cost implications associated with an ageing population, the development of effective but expensive new drugs, accelerated technology innovation and increasing affluence”. The most immediate challenge facing private health insurers in Ireland is the unprecedented increase in private bed capacity, which has been encouraged by the generous tax relief available for such investment. The cost of financing the new capacity will place huge pressure on the provision of quality health insurance at affordable prices,” she said.
“The biggest health issues facing Irish society in the coming years are the health effects on our young people of the increasingly driven and materialistic society in which we live. The increasing incidence of liver failure and cirrhosis in young women in their thirties is no surprise to anyone who has collected teenagers from outside any of our teen discos or worked in an A&E department. When you add to this the epidemic of eating disorders (both obesity and anorexia) in young women and the levels of suicide in young men it seems that it is truly hard times for the young of Ireland,” Dr Carr said.
Irish youth face health threat from 'driven and materialistic' society Glenn Taylor The health of Ireland’s youth will be one of the major health issues facing this country in the future, given the “increasingly driven and materialistic society in which we live”, according to the Medical Director of Ireland’s largest health insurer Vhi.
The health of Ireland’s youth will be one of the major health issues facing this country in the future, given the “increasingly driven and materialistic society in which we live”, according to the Medical Director of Ireland’s largest health insurer Vhi. Despite the increased wealth and prosperity of modern Ireland, Dr Bernadette Carr said in relation to the health of Irish children that: “Survival of the fittest means what it says.”
Dr Carr believes the challenges for the Irish heath system in the future are many and varied, “not least the cost implications associated with an ageing population, the development of effective but expensive new drugs, accelerated technology innovation and increasing affluence. The most immediate challenge facing private health insurers in Ireland is the unprecedented increase in private bed capacity, which has been encouraged by the generous tax relief available for such investment. The cost of financing the new capacity will place huge pressure on the provision of quality health insurance at affordable prices,” she said.
“The biggest health issues facing Irish society in the coming years are the health effects on our young people of the increasingly driven and materialistic society in which we live. The increasing incidence of liver failure and cirrhosis in young women in their thirties is no surprise to anyone who has collected teenagers from outside any of our teen discos or worked in an A&E department. When you add to this the epidemic of eating disorders (both obesity and anorexia) in young women and the levels of suicide in young men it seems that it is truly hard times for the young of Ireland,” Dr Carr said.
Irish youth face health threat from 'driven and materialistic' society Glenn Taylor The health of Ireland’s youth will be one of the major health issues facing this country in the future, given the “increasingly driven and materialistic society in which we live”, according to the Medical Director of Ireland’s largest health insurer Vhi.
The health of Ireland’s youth will be one of the major health issues facing this country in the future, given the “increasingly driven and materialistic society in which we live”, according to the Medical Director of Ireland’s largest health insurer Vhi. Despite the increased wealth and prosperity of modern Ireland, Dr Bernadette Carr said in relation to the health of Irish children that: “Survival of the fittest means what it says.”
Dr Carr believes the challenges for the Irish heath system in the future are many and varied, “not least the cost implications associated with an ageing population, the development of effective but expensive new drugs, accelerated technology innovation and increasing affluence. The most immediate challenge facing private health insurers in Ireland is the unprecedented increase in private bed capacity, which has been encouraged by the generous tax relief available for such investment. The cost of financing the new capacity will place huge pressure on the provision of quality health insurance at affordable prices,” she said.
“The biggest health issues facing Irish society in the coming years are the health effects on our young people of the increasingly driven and materialistic society in which we live. The increasing incidence of liver failure and cirrhosis in young women in their thirties is no surprise to anyone who has collected teenagers from outside any of our teen discos or worked in an A&E department. When you add to this the epidemic of eating disorders (both obesity and anorexia) in young women and the levels of suicide in young men it seems that it is truly hard times for the young of Ireland,” Dr Carr said.
Source: Irish Medical Times
Glenn Taylor
19 Januray 2007
http://www.imt.ie/displayarticle.asp?AID=12354&NS=1&SID=1
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UK
Nicotine patches did help children
A controversial scheme that saw North children as young as 12 given nicotine patches has been hailed a success after persuading some of them to give up smoking. The project in County Durham hit the national headlines in 2005 after health workers revealed that some children were starting smoking at the age of eight or nine and were becoming hooked by 12.
At the time, nicotine replacement patches were not licensed for use with children, and health workers from the County Durham Primary Care Trust had to work carefully with GPs to ensure that they were comfortable about prescribing them. But, after 18 months of the project, the number of children asking for help in giving up smoking has doubled and 28 of the 103 children taking part have managed to kick the habit.
Iain Miller, smoking cessation co-ordinator for County Durham Primary Care Trust, said: “The scheme initiated from pupil interest in accessing support in stopping smoking. We felt that if adults could access evidence-based treatment, there would be some young pupil who would benefit from it too. We got agreement from the primary care trust to do that, but it caused a bit of a storm so we developed a protocol to give GPs the confidence that they were following robust guidelines. The numbers of young people accessing the service rose from 33 in 2004-5 to 70 the following year so we certainly see that as a success. The quit rate stayed about the same, but that’s twice as many young people who’ve stopped which is pleasing too. There are still groups meeting in a few of the schools and even when it doesn’t work with some young people, it’s planted the seed in them and increases the likelihood that they will stop some time in the future.”
The project began after a roadshow warning of the dangers of drink and drug addiction led to young pupils asking for help. Many were smoking as many as 20 cigarettes a day, despite being only in their early teens. Greencroft School in Stanley piloted the scheme, and it was then taken up by four other schools in Derwentside, followed by another four around Chester-le-Street and Durham City.
School nurses are not obliged to tell children’s parents that they are receiving treatment, though they are encouraged to be open with their families to get support. Children who do not want to tell parents they smoke have to do a test to show they are capable of making the decision to have nicotine patches.
Although the scheme received some criticism when it first started, it has since been copied in a number of areas around the country. Health workers insist that only children who are committed to stopping smoking are given patches, with a group at one school being refused when they didn’t do enough to convince project staff that they were genuine. “We’re not giving these things out like sweets,” said Mr Miller.
Graeme Whitfield
16 January 2007
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Study questions "gateway" theory of drug abuse
A new study suggests that a tendency toward delinquency or living in a neighborhood where drugs are readily available are just as important in determining whether a young person will abuse marijuana as whether or not he tries cigarettes or alcohol first. The findings call into question the "gateway" hypothesis - that is, that youths at risk of drug abuse progress from using alcohol and cigarettes to illegal "soft" drugs like marijuana to "hard" drugs like cocaine and heroin, Dr. Ralph E. Tarter of the University of Pittsburgh School of Pharmacy and colleagues write in the American Journal of Psychiatry.
Instead, Tarter and his team say their findings support the common liability model, which proposes that factors such as behavioral deviancy and "genetic risk" can predispose a person to abusing any type of drug, illegal or otherwise. Based on this model, they note, the best way to protect kids from becoming drug abusers is to cope with conduct problems early, before the vulnerable adolescent years.
Tarter and associates followed 224 boys from about age 10 to 12 until they reached the age of 22. Ninety-nine of the boys only smoked cigarettes or drank alcohol, 97 used these "legal drugs" before trying marijuana, and 28 tried pot before taking up drinking and smoking. The boys who had followed the traditional "gateway" path were no more likely to develop alcohol or marijuana abuse problems than those who went in the reverse direction, the researchers found.
Living in a poor-quality neighborhood was the single factor that predisposed youths to marijuana use. For youths who did conform to the gateway path, delinquency was more important than previous legal drug use in determining whether they would wind up using marijuana. Based on this and other research, Tarter and his colleagues write, "in effect, the greater the deviancy, the more likely an individual is to use an illegal drug. These findings underscore the need to prevent conduct problems in early childhood to diminish the risk of later illicit drug use."
SOURCE: American Journal of Psychiatry, December 2006.
15 January 2007
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Parents hail 'enormous' benefits of rugby training for autistic children
Children with autism should be encouraged to take part in sport, experts said yesterday after a study showed big improvements in youngsters with the condition who played rugby.
A project in Glasgow enrolled 27 children between the ages of seven and 16 to take part in six rugby training sessions. The researchers found that more than half the youngsters saw improvements in their relationships and social skills. They now hope more sports clubs will develop projects to help autistic children, who have problems communicating and are often described as living in their own world.
The training sessions were run by coaches at Glasgow's Cartha Queen's Park RFC. Project leader Duncan Clark, director of NHS Lanarkshire Child and Adolescent Mental Health Service, said several of the children who took part in the study were now playing in mainstream youth teams alongside others without autism. "When we started the training we realised that the kids loved the competitive element, they loved playing the games and they seemed to have a lot of fun. As we went on we saw that their understanding of the game increased significantly. To start with some of the children were just going off and doing their own thing. But then they started to join in and take more of an interest in playing as part of a team."
The researchers found that interacting with other children in a training environment soon led to improvements off the pitch. Assessments found that after the training course, 53 per cent of the children saw significant improvement in relationships with their peers. The same percentage saw improvements in social behaviour and ability to communicate.
The parents of the children also said they saw the benefits the training had, with youngsters becoming more sociable and comfortable in their surroundings.
Mr Clark said: "The vast majority of children showed some improvement in their communication skills. It is by no means a cure, but there was a distinct improvement from the children most severely affected by autism to those further down the scale. Although this was a small group, the research is reliable enough to show that participation in team sport does benefit these children." Mr Clark said they had already received interest from other clubs wanting to set up their own training programme.
A new project in Glasgow is set to start in March.
John McDonald, chief executive at the Scottish Society for Autism, welcomed the study. "This is a way of getting autistic children interested in everyday life. Other children could benefit if this was tried out with other sports and in other clubs."
Charmaine Jolliffe, from Baillieston, took her son Andrew, 15, along to take part in the rugby training and said she was impressed by the scheme. Andrew was diagnosed as autistic at the age of nine, after his parents became concerned about his inability to make eye contact with people. "We have seen an improvement outside of the club. Anything that gets these children interested and interacting with people is important," she said.
Yvonne Daly's son Drew has seen his confidence boosted by his participation in the scheme. The 15-year-old now plays for the club's youth side. "I want to carry on with the rugby as far as I can take it," he said.
Mrs Daly, from Mount Vernon, said the project had helped the youngsters enormously. "These children need things like this. They don't have friends, usually because their schools are far away from where they live, and need to be able to interact. In the past Drew would shy away from mainstream children but now he is getting to know everyone and mixing well."
Lyndsay Moss
16 January 2007
http://news.scotsman.com/health.cfm?id=78242007
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Former inmates often untreated for mental illness
Findings from a small study suggest that prison inmates seldom seek
help for a diagnosed or a perceived mental health problem upon release
from prison. A lack of trust in the healthcare system was the main
reason cited for not seeking help.
Previous reports have identified high rates of mental illness and
suicide among ex-convicts, according to the report in the British
Medical Journal. Moreover, ex-convicts are known to underutilize mental
health services.
To shed light on the factors that influence an ex-convict's help-seeking
behavior, Dr. John Campbell, from Peninsula Medical School in Exeter,
UK, and colleagues conducted face-to-face interviews with 35 male
offenders between 18 and 52 years of age, including 19 who were
interviewed again after release from prison. Approximately one quarter
of the subjects were identified as being at risk for self-harm.
Several of the inmates reported receiving a formal psychiatric diagnosis
and many others believed they had some sort of mental health problem,
the report indicates.
Twenty-one of the men said they would not consider seeking help from a
general practitioner for mental health problems. None of the 19 men who
were interviewed after their release reported contacting a healthcare
profession for mental health problems.
In addition to a lack of trust in the healthcare system, a chaotic
upbringing and a fear of mental health diagnosis were key predictors of
not seeking help for a mental health problem.
"Distrust is a major barrier to accessing healthcare among offenders,"
the authors conclude. "By ensuring that a positive precedent is set,
particularly for skeptical groups such as ex-prisoners, general
practitioners and prison doctors may be able to encourage future help
seeking."
SOURCE: British Medical Journal
12 January 2007
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Death risk high after release from prison
Former prison inmates have a high risk of dying after being released from prison, a study shows. The risk of death is greatest in the first 14 days after release, suggesting that the reentry process is especially difficult for many ex-inmates.
"The US population of former prison inmates is large and growing, notes the study team in The New England Journal of Medicine this week. The period immediately after release may be challenging for former inmates and may involve substantial health risks." Among the 30,237 inmates released from the Washington State Department of Corrections from July 1999 through December 2003, records showed that 443 died during an average follow up of 1.9 years.
According to Dr. Ingrid A. Binswanger from the University of Colorado Health Sciences Center, Denver and colleagues, the risk of death, factoring in the effect of age, gender and race, among former prison inmates was 3.5 times higher than that of other state residents. During the first 2 weeks after release, the risk of death among former prison inmates was 12.7 times that of other state residents. By far, drug overdose was the leading cause of death in newly released prisoners, followed by heart disease, homicide and suicide.
Interventions aimed at decreasing the risk of death among ex-inmates are needed, Binswanger and colleagues conclude. These could include "planning for the transition from prison to the community, including use of halfway houses, work-release programs, drug-treatment programs, education about susceptibility to overdose after relative abstinence during incarceration, and preventive care to modify cardiac risk factors."
SOURCE: The New England Journal of Medicine
11 January 2007
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NEW YORK
Children who eat with the family 'stay slim'
Spending more time around the family dinner table - and less time in front of the TV - can help prevent children from getting fat, a new study shows.
Among 8 000 children followed from kindergarten to third grade, those who watched the most TV were at the greatest risk of being or becoming overweight, Dr Sara Gable of the University of Missouri, Columbia and her colleagues found. And the fewer meals children ate each week with their families, the more likely they were to put on excess pounds. "Families need to work together to help children maintain a healthy weight, Gable told Reuters Health in an email message. Even the simple things, like how often families eat together and the amount of time that children spend watching television, play a role in children's weight status."
To identify factors associated with being or becoming overweight, Gable and her team divided the 8 000 children who were participating in a national, long-term study into three groups: those who had never been overweight; those who began the study at a normal weight, but then became overweight; or those who were overweight throughout the study.
The risk of being persistently overweight increased by three percent for every additional hour a child spent watching TV each week, the researchers found, while each family meal missed per week increased the risk of persistent overweight by eight percent. Living in a neighbourhood perceived as unsafe for outside exercise also substantially increased the risk of being overweight.
Children who stayed at a normal weight throughout the study watched 14.12 hours of TV a week, compared with 15.63 hours for those who became overweight and 16.09 hours for those who were overweight for the entire study period. Children who did not become overweight ate 10.26 meals a week with their families, compared with 9.54 for children who became overweight and 9.57 for persistently overweight children.
While the actual percentages for increased risk were small, the investigators note that "even a small effect matters when the base rate of the phenomenon in question is as high as the prevalence of overweight in a general population." They add that 17 percent of the children in the current study were overweight by third grade. "Children rely on parents to initiate such things as family mealtimes and to set limits on children's TV time, Gable told Reuters Health. Teaching children about healthy habits requires the whole family's involvement; children are not going to learn these things on their own."
Anne Harding
10 January 2007
http://www.iol.co.za/index.php?set_id=1&click_id=117&art_id=qw1168461902161B243
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Don't hate the smoker
If smokers are marginalised in our society there is a danger that they will begin to see their habit as a badge of honour.
In the British Medical Journal today it's argued that smokers should be denied operations unless they quit. And recently there have been cases of people being refused jobs or are being sacked just for being smokers even though they promise not to smoke at work. This is not what Action on Smoking and Health is fighting for - we are anti-smoking, yes, but not anti-smoker and in today's climate we think that there is a very real danger that smokers are being marginalised in our society.
When the smoking ban comes into force in England in July smokers will be exiled to the outdoors. Ash campaigned for the new law because we now know that second-hand smoke is a killer and it is only right that smokers should not harm those around them. Smokers should be allowed to carry on smoking if they want to, as long as the health of others is not put at risk, and the only way to do that is not to allow people to smoke in enclosed places. But we don't want to see smokers marginalised, because there's a danger that they'll begin to see their habit as a badge of honour, a sign of individuality, something to be proud of.
While it's important to accept the rights of smokers to carry on smoking, it also needs to be recognised that being a smoker is not a matter of free choice; they're gripped by an addiction fuelled by the tobacco industry and they need support to give up.
A new advertising campaign currently being aired on TV illustrates the truth - that smokers are literally "hooked" on tobacco. The sickening images of smokers being dragged along by giant fish hooks illustrates the strength of nicotine addiction which can be as difficult to break as heroin or crack cocaine. These advertisements and others telling you about the many poisonous substances in cigarettes, such as benzene, arsenic and formaldehyde or how fags make you impotent, smell bad and look old are all designed to shock people into giving up.
The evidence is that these advertisements work. Research in Britain, the US and Australia all showed that young people in particular responded most to advertisements with graphic, visceral, negative or strong testimonial elements. Young people think they're invincible and they need strong messages for them to take on board the information. And it's important to reach smokers when they're young, 80% of smokers start smoking before they leave their teens and if you start smoking when you're fifteen you're three times more likely to die of lung cancer than if you start in your late twenties.
Most smokers wish they could quit their habit but once started it is very difficult to stop. Over the last 25 years only one half of smokers gave up before they reached 60. For those who don't give up the odds are terrible - half of all lifelong smokers die early from their habit, often losing many years of life, and for every one that dies another twenty suffer serious smoking-related diseases. What's more shocking than that?
Deborah Arnott
8 January 2007
http://commentisfree.guardian.co.uk/deborah_arnott/2007/01/post_877.html
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UK
Teachers say they cannot cope with needs of dyslexic children
The majority of state school teachers lack confidence in educating dyslexic pupils, a survey for Britain's biggest teaching union shows.
Fewer than one in 14 say they would be "very confident" in identifying a child with dyslexia while only 9 per cent say they would be "very confident" in teaching such a pupil. The survey, by the National Union of Teachers (NUT), reveals the vast majority believe they do not have enough training to deal with special needs children.
The finding follows the revelation on Monday that the former education secretary Ruth Kelly pulled her son out of a state school and sent him to a £15,000-a-year private prep school. She said she did not believe state schools near her home in Tower Hamlets, east London, had the expertise to deal with his needs.
The NUT's survey argues that it is the Government's fault - through failing to provide the resources for adequate training - that teachers feel they lack the confidence to cope with special needs children. "An overwhelm-ing number of teachers in mainstream schools feel that they lack support and professional development in teaching children with special educational needs," it concludes.
One hundred teachers from a wide range of local authorities took part in the survey and several warned of increasing disruption in schools brought about by the Government's policy of "inclusion". This means all parents should have the right to choose a mainstream school for their children. One teacher said: "I support the ideal of inclusion in schools. However, without appropriate training and support in the classroom, teachers cannot do the job effectively. In my experience, if it happens, it's ad hoc and in corridors or a few rushed exchanges after lessons."
Nearly three-quarters felt they did not have enough additional trained support in the classroom. On dyslexia, 77 per cent said they would like extra training to cope.
John Bangs, head of education at the NUT, said: "The vast majority of teachers don't feel properly qualified with the skills and expertise they need."
Richard Garner
10 January 2007
http://education.independent.co.uk/news/article2140269.ece
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Abused children face depression risk as adults
Children who are abused and neglected are at increased risk of becoming depressed adults, new research suggests. The study, which appears in the January issue of the Archives of General Psychiatry, examined the relationship between abuse and neglect during childhood and depression in adulthood.
Researchers from the New Jersey Medical School tested their theory that abused and neglected children are at increased risk of depression as adults. The study included 676 children who had been physically and sexually abused and neglected before age 11, and 520 children who had not been abused or neglected. The researchers followed the children into young adulthood. "The current results show that childhood physical abuse was associated with increased risk for lifetime major depressive disorder, the authors wrote. We also provide new evidence that neglected children are at increased risk for depression as well."
Children who were abused and neglected were 51 percent more likely to be depressed in young adulthood. Those who were physically abused and those who experienced multiple types of abuse had a 59 percent and 75 percent increased risk of being depressed during their lifetime, respectively, compared with children who were not abused or neglected.
Childhood sexual abuse was not associated with an elevated risk of depression. But, as the authors pointed out, the study participants who had been sexually abused reported significantly more symptoms of depression than the children who had not been abused or neglected.
The onset of depression started in childhood for many of the participants. "Our age-at-onset findings reinforce the need to intervene early in the lives of these abused and neglected children, before depression symptoms cascade into other spheres of functioning," the authors wrote.
Source: Archives of General Psychiatry
9 January 2007
http://www.healthfinder.gov/news/newsstory.asp?docid=600735
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Dyslexia and dyspraxia: Children can fall behind
Children with dyslexia appear bright, intelligent and articulate but some will fall behind with their schoolwork or even be wrongly labelled as careless or inattentive because of the difficulties they have in turning words on a page into language sounds. Dyslexia is largely considered a reading disorder because that is how it usually manifests itself. For no obvious reason, some children fail to progress with reading skills.
In the past it was wrongly assumed that they see a jumble of letters on the page, or words written back to front. More recent theories suppose that it is not visual problems that are to blame, but phonological processes in the brain - the business of translating letters into sounds and vice versa.
Many dyslexic people learn to read, even though it may be hard, but they may continue to have problems with spelling, writing, memory and organisation. Those affected can also have problems with maths. Some people are affected more than others and many learn to compensate through skilled teaching, particularly in their early years.
According to the charity Dyslexia Action, the condition need not be a barrier to achievement and success if it is properly recognised within society, and steps are taken to provide suitable teaching and training along with strategies and resources to help children compensate for the condition.
Children with dyslexia can be affected by dyspraxia as well. Dyspraxia used to be known as clumsy child syndrome. It is thought to be caused by an immaturity in the way the brain processes information which results in messages not being fully transmitted. It affects movement, but also language, perception and thought. The early signs of dyspraxia may appear in babyhood and include being late to meet developmental milestones, such as rolling over, sitting up, walking and speaking.
Later the child may not be able to do all the physical things other children their age enjoy, such as kicking a ball, running and jumping, which may lead to a lack of friends. They may be slow and hesitant in their movements and fall over a lot. In their early school life, they may have difficulty holding a pencil, be unable to do jigsaws and their art work may be immature.
Later they may have trouble with maths and with writing, according to the Dyspraxia Foundation. They write laboriously and have trouble copying from the blackboard, although the condition affects spelling more than reading. Their attention span is short and they do badly in class, although they do significantly better if taught on a one-to-one basis.
Dyspraxia is not curable but the Foundation says that children with the condition may improve as they get older. Symptoms in children and adults can be reduced if they are given appropriate treatment and advice on practical ways to minimise the day-to-day difficulties that their dyspraxia can cause.
Sarah Boseley
9 January 2007
http://politics.guardian.co.uk/publicservices/story/0,,1985955,00.html
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Earlier youth discharges in mental health treatment
In the most comprehensive study of its kind, researchers have found that the inpatient length of stay for youth with mental illness fell more than sixty percent between 1990 and 2000, despite concurrent increases in illness severity and self-harm, and declining transfers to intermediate and inpatient care within the same population.
Lead author, Brady Case, MD, with the Bradley Hasbro Children's Research Center, the Brown Medical School Division of Child and Psychiatry Fellowship Program, and the New York University School of Medicine, analyzed data from one thousand community hospitals nationwide and found that in the course of a decade, the average length of inpatient hospitalization for youth undergoing mental health treatment declined from 12.2 days to 4.5 days.
"These trends prompt serious questions about diagnostic practices and quality of care for children and adolescents with mental disorders," says Case.
The study appears in the January 2007 issue of the Archives of General Psychiatry.
The authors found that children and adolescents treated for mental illness were discharged from community hospitals far more quickly in 2000 than ten years earlier. However, in the same year, more youth were diagnosed with psychotic, depressive, and bipolar disorders, and more were found to have intentionally harmed themselves. The total number and population rate of discharges did not change, but the total number of inpatient days and the average cost per visit each fell by approximately one half. They also report that transfers to short-term, nursing, and other inpatient facilities declined.
"During a decade which saw the emergence of managed mental health care and increased use of psychotropic medications by young people, our findings raise concerns about diagnostic practices and quality of inpatient care for mentally ill youth," says Case.
While these findings reflect changes in diagnostic patterns for children and adolescents, the authors do not know if this trend is because youth treated in hospitals are increasingly ill, or because the understanding of pediatric mental illness has evolved, or because mental health providers must indicate more severe diagnoses to obtain payment.
"Most troubling is the possibility that, driven by financial and other pressures, mental health providers are discharging severely ill youth too early in treatment. However, it may be that mental health providers are using hospital resources more efficiently and that children are increasingly being treated safely in day programs, clinics, and private offices," says Case.
Inpatient stays at Bradley Hospital, the nation's first psychiatric hospital for children and adolescents, seem to concur with this study.
"While the average length of stay at Bradley Hospital is a bit longer than what's found in the study, we've seen the trend toward shorter lengths of stay occur over the last decade. It's been necessary to develop rapid and systematic assessments of our child and adolescent patients and to develop comprehensive treatment plans faster than ever before because of the pressure from health insurance companies to discharge patients quickly. In spite of this pressure, we have to consistently try to do what is best for the child and adolescent and their families," says Jeffrey Hunt, MD, director of Bradley's Adolescent Program.
Over the years, Hunt's team has created new programs to augment existing inpatient treatment in order to manage adolescents with serious mood disorders and impulse control problems (such as is seen with early onset bipolar disorder). In addition, he says that the expansion of day hospital programs and therapeutic school programs have been critical to the safe outcomes for patients.
"We are able to maintain more prolonged contact with patients and their families by utilizing these newer services. However, even with the existence of these programs it is unlikely that we can shrink the length of an inpatient stay more than it already is," says Hunt.
Inpatient mental health professionals now routinely evaluate, treat, and discharge depressed children and adolescents in four days, well before the onset of response to antidepressants or the emergence of side effects. To do so safely requires access to extensive clinical resources, including specialized inpatient mental health services and intensive outpatient follow-up, the authors report.
"It remains unclear whether the changes we found represent a more efficient use of hospital resources, a withdrawal of necessary services, or some combination of both. Further research can clarify the extent to which community hospitals are meeting the mounting clinical demands of increasingly rapid diagnosis and treatment of mentally ill youth," says Case.
Source: Archives of General Psychiatry
8 January 2007
http://www.medicalnewstoday.com/medicalnews.php?newsid=60257
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Boosting intelligence among poor is child's play
Giving pre-school children toys to play with boosts their mental development even if they suffer from malnutrition, a report said on Friday. The report, published in the Lancet medical journal, said several studies had found a clear link between intelligence and child's play.
"We have done play programs in Bangladesh where the children are severely malnourished and we have produced up to a nine-point improvement in the IQ of these kids -- just with play, said author Sally McGregor of the Institute of Child Health at University College London. Malnutrition on its own is a problem. Malnutrition without mental stimulation is an even bigger problem," she said in an interview.
The report found that more than 200 million of the world's poorest children were underfed and under-stimulated. It said 89 million of the most neglected children lived in south Asia, while 145 million were divided among India, Nigeria, China, Bangladesh, Ethiopia, Indonesia, Pakistan, the Democratic Republic of Congo, Uganda and Tanzania.
Simple intervention at the lowest level by governments and aid agencies to change attitudes and encourage pre-school play at home, as well as basic nutrition, could have a major effect, researchers concluded. "People are focused on reducing mortality. But they haven't realized that so many children are not reaching their potential, said McGregor. But by the time they reach five or six and go to school their chances are almost blown."
McGregor said that, in studies in Jamaica, villagers with no secondary education themselves were sent into homes with home-made toys to teach mothers how play with their children. "We followed the children up to 18 years of age and their IQ is better, their reading is better, they are less likely to drop out of school and their mental health is better -- they are less depressed, less anxious and have better self-esteem, she said. There is a lot of ignorance about what a child needs -- they think that play is not for adults and they don't understand that they can improve the child's development," she added.
Source: The Lancet
7 January 2007
http://www.tehrantimes.com/Description.asp?Da=1/7/2007&Cat=7&Num=10
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